Cue-induced effects on decision-making distinguish subjects with gambling disorder from healthy controls.

Alexander Genauck,Caroline Matthis,Andreas Heinz,Milan Andrejevic,Nina Romanczuk‐Seiferth,Katharina Brehm,Norbert Kathmann,André Weinreich

doi:10.1111/adb.12841

Abstract

While an increased impact of cues on decision-making has been associated with substance dependence, it is yet unclear whether this is also a phenotype of non-substance-related addictive disorders, such as gambling disorder (GD). To better understand the basic mechanisms of impaired decision-making in addiction, we investigated whether cue-induced changes in decision-making could distinguish GD from healthy control (HC) subjects. We expected that cue-induced changes in gamble acceptance and specifically in loss aversion would distinguish GD from HC subjects. Thirty GD subjects and 30 matched HC subjects completed a mixed gambles task where gambling and other emotional cues were shown in the background. We used machine learning to carve out the importance of cue dependency of decision-making and of loss aversion for distinguishing GD from HC subjects. Cross-validated classification yielded an area under the receiver operating curve (AUC-ROC) of 68.9% (p = .002). Applying the classifier to an independent sample yielded an AUC-ROC of 65.0% (p = .047). As expected, the classifier used cue-induced changes in gamble acceptance to distinguish GD from HC. Especially, increased gambling during the presentation of gambling cues characterized GD subjects. However, cue-induced changes in loss aversion were irrelevant for distinguishing GD from HC subjects. To our knowledge, this is the first study to investigate the classificatory power of addiction-relevant behavioral task parameters when distinguishing GD from HC subjects. The results indicate that cue-induced changes in decision-making are a characteristic feature of addictive disorders, independent of a substance of abuse.

Highlights

Gambling disorder (GD) is characterized by continued gambling for money despite severe negative consequences.[1]
To better understand the basic mechanisms of impaired decision‐making in addiction, we investigated whether cue‐induced changes in decision‐making could distinguish GD from healthy control (HC) subjects
The results indicate that cue‐induced changes in decision‐making are a characteristic feature of addictive disorders, independent of a substance of abuse decision‐making, gambling disorder, loss aversion, Pavlovian‐to‐instrumental transfer

Summary

Introduction

Gambling disorder (GD) is characterized by continued gambling for money despite severe negative consequences.[1]. Cue reactivity has been a crucial concept in understanding addictive disorders including GD.[5,6] Through Pavlovian conditioning, any neutral stimulus can become a conditioned stimulus (i.e. a cue) if it has been paired with the effects of the addictive behavior.[7] In addictive disorders, including GD, cues may induce attentional bias, arousal, and craving for the addictive behavior in periods of abstinence.[8,9] Treatment of addictive disorders may focus on identifying and coping with individual cues that induce craving for addictive behavior.[10] If we understood better how cues exert control over instrumental behavior and decision‐ making, we would be able to improve treatment tools and even public health policy for GD and perhaps other addictive disorders. In the present study we were interested in broadening our understanding of the basic mechanisms of impaired decision making in addictions, especially with respect to cue‐induced effects on value‐ based decision making

Methods

Findings

Discussion

Conclusion