Department of Psychology, Macquarie University, Sydney, New South Wales, Australia.
Discipline of Addiction Medicine, Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
Neuropsychobiology. 2023;82(2):117-129. doi: 10.1159/000529156. Epub 2023 Feb 22.
Individuals with alcohol use disorder (AUD) have difficulties regulating alcohol consumption, despite adverse drinking-related consequences. This may be due to incapacity incorporating previous negative feedback from drinking, resulting in impaired decision-making.
We assessed whether decision-making is impaired in participants with AUD related to severity of AUD, indexed by severe negative drinking consequences using the Drinkers Inventory of Consequences (DrInC) and reward and punishment sensitivity with the Behavioural Inhibition System Behavioural Activation System (BIS BAS) scales. 36 treatment-seeking alcohol-dependent participants completed the Iowa gambling task (IGT) with skin conductance responses (SCRs) measured continuously as an index of somatic autonomic arousal to evaluate impaired expectancy of negative outcomes.
Two-thirds of the sample showed behavioural impairment during the IGT, with greater AUD severity related to worse performance. BIS moderated IGT performance according to severity of AUD, with increased anticipatory SCRs for those with fewer reported DrInC severe consequences. Participants with more DrInC severe consequences showed IGT deficits and reduced SCRs regardless of BIS scores. BAS-Reward was associated with increased anticipatory SCRs to disadvantageous deck choices among those with lower AUD severity, while SCRs did not differ related to AUD severity for reward outcomes.
Effective decision-making in the IGT and adaptive somatic responses were moderated by punishment sensitivity contingent on severity of AUD in these drinkers, with impairments in expectancy to negative outcomes from risky choices, including reduced somatic responses, resulting in poor decision-making processes that may help explain impaired drinking and worse drinking-related consequences.
患有酒精使用障碍（AUD）的个体在饮酒相关后果不利的情况下难以控制饮酒量。这可能是由于无法整合以前与饮酒相关的负面反馈，从而导致决策受损。
我们评估了与 AUD 严重程度相关的 AUD 患者的决策是否受损，该严重程度通过使用 DrInC 评估严重的负性饮酒后果以及通过 BIS/BAS 量表评估奖励和惩罚敏感性来确定。36 名接受治疗的酒精依赖参与者完成了赌博任务（IGT），同时连续测量皮肤电反应（SCR）作为评估对负面结果的期望受损的躯体自主唤醒的指标。
三分之二的样本在 IGT 中表现出行为障碍，AUD 严重程度与较差的表现相关。BIS 根据 AUD 的严重程度调节 IGT 表现，对于 DrInC 报告的严重后果较少的个体，预测性 SCR 增加。无论 BIS 得分如何，具有更多 DrInC 严重后果的参与者均表现出 IGT 缺陷和减少的 SCR。对于 AUD 严重程度较低的参与者，BAS-Reward 与对不利的牌组选择的预测性 SCR 增加有关，而与 AUD 严重程度相关的奖励结果的 SCR 则没有差异。
在这些饮酒者中，基于 AUD 的严重程度，惩罚敏感性可调节 IGT 中的有效决策和适应性躯体反应，对风险选择的负面结果的期望受损，包括减少躯体反应，导致较差的决策过程，这可能有助于解释饮酒受损和更差的饮酒相关后果。
