Kumar Rajesh, Kumar Keshav J, Benegal Vivek, Roopesh Bangalore N, Ravi Girikematha S
Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.
Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.
Indian J Psychiatry. 2020 Jul-Aug;62(4):384-391. doi: 10.4103/psychiatry.IndianJPsychiatry_103_20. Epub 2020 Jul 27.
Impulsivity and aberrant reward processing are the core features of substance use disorders, including alcoholism. The present study examined the effects of an Integrated Intervention Program for Alcoholism (IIPA) on impulsiveness and disadvantageous reward processing/risk-taking in persons with alcoholism.
The study adopted age- and education-matched (±1 year) randomized control design with the pre-post comparison. The sample comprised 50 persons with alcoholism. They were allotted randomly into two groups, the intervention (IIPA) group and treatment as usual (TAU) group ( = 25 in each). Participants were assessed at pre-intervention on impulsivity (Barratt's Impulsiveness Scale) and decision-making task, which reflects reward processing deficits (modified Iowa gambling task [mIGT]). The TAU group received usual treatment for alcoholism (i.e., pharmacotherapy; three sessions in a week group therapy on relapse prevention and six sessions in week yoga) for 18 days. The intervention group received IIPA along with usual treatment (except yoga). Outcome assessment was repeated after 18 days of intervention.
Both groups were comparable at pre-intervention (baseline). However, the intervention (IIPA) group showed a significant reduction in impulsivity and selection from disadvantageous decks on mIGT at post-intervention, while the TAU group had no significant change.
The findings suggest that IIPA could improve impulsivity and disadvantageous reward processing/risk-taking in persons with alcoholism. These are core features of substance use disorders and could pose a high chance for relapse after treatment. Further studies may examine improving these characteristics with IIPA and its impact on treatment outcomes such as relapse rate and maintaining sobriety.
冲动性和异常的奖赏处理是物质使用障碍(包括酒精成瘾)的核心特征。本研究考察了酒精成瘾综合干预项目(IIPA)对酒精成瘾者冲动性及不利奖赏处理/冒险行为的影响。
本研究采用年龄和教育程度匹配(±1岁)的随机对照设计,并进行前后比较。样本包括50名酒精成瘾者。他们被随机分为两组,即干预(IIPA)组和常规治疗(TAU)组(每组25人)。在干预前,对参与者进行冲动性(巴拉特冲动性量表)和决策任务评估,该任务反映奖赏处理缺陷(改良爱荷华赌博任务[mIGT])。TAU组接受酒精成瘾的常规治疗(即药物治疗;每周三次预防复发的团体治疗和每周六次瑜伽治疗),为期18天。干预组在接受常规治疗(瑜伽除外)的同时接受IIPA。干预18天后重复进行结果评估。
两组在干预前(基线)具有可比性。然而,干预(IIPA)组在干预后冲动性显著降低,在mIGT上从不利牌组的选择减少,而TAU组无显著变化。
研究结果表明,IIPA可以改善酒精成瘾者的冲动性及不利奖赏处理/冒险行为。这些是物质使用障碍的核心特征,治疗后可能有很高的复发几率。进一步的研究可以考察通过IIPA改善这些特征及其对治疗结果(如复发率和保持清醒)的影响。