Impaired learning from regret and disappointment in alcohol use disorder

Caterina Galandra,Nicola Canessa,Gianpaolo Basso,Chiara Crespi

doi:10.1038/s41598-020-68942-y

Abstract

The development of alcohol habits is considered a form of maladaptive reinforced learning, with sustained alcohol use resulting in the strengthening of associative links between consumption and either rewarding, or the lack of aversive, experiences. Despite recent efforts in characterizing decision-making skills in alcohol-use-disorder (AUD), it is still unknown whether impaired behavioural learning in AUD patients reflects a defective processing and anticipation of choice-related, cognitively mediated, emotions such as regret or relief for what might have been under a different choice. We administered a Wheel-of-Fortune (WoF) task to 26 AUD patients and 19 healthy controls, to investigate possible alterations in adjusting choices to the magnitude of experienced regret/relief, and in other facets of decision-making performance such as choice latency. AUD patients displayed both longer deliberation time than healthy controls, and impaired adaptations to previous outcome-related negative emotions. Although further evidence is needed to unveil the cognitive mechanisms underlying AUD patients’ abnormal choice, the present results highlight important implications for the clinical practice, e.g. in terms of cognitive treatments aiming to shape faulty perceptions about negative emotions associated with excessive alcohol exposure.

Highlights

Neurobiological models of addiction suggest that decision-making impairments in AUD may reflect defective behavioural adaptations to changes in reward contingencies, i.e. to “reward prediction errors” coding the difference between expected and actual o utcomes[25]
We investigated possible alterations in adjusting choices to experienced disappointment, regret and near-miss outcomes in AUD patients compared with healthy controls
We used a Wheel of Fortune (WoF) task[31], that allows to assess the extent to which choice behaviour is influenced by these variables, in addition to expected value[8]

Summary

Introduction

Neurobiological models of addiction suggest that decision-making impairments in AUD may reflect defective behavioural adaptations to changes in reward contingencies, i.e. to “reward prediction errors” coding the difference between expected and actual o utcomes[25]. Only few studies have investigated regret processing and/or anticipation in pathological p opulations[28,29], including problem gambling[30] but not AUD On this basis, we investigated possible alterations in adjusting choices to experienced disappointment, regret and near-miss outcomes in AUD patients compared with healthy controls. We used a Wheel of Fortune (WoF) task[31], that allows to assess the extent to which choice behaviour is influenced by these variables, in addition to expected value[8] In this task, subjects are repeatedly asked to choose between two gambles, depicted as wheels of fortune associated with specific paired combinations of monetary outcomes and levels of probability. Based on previous evidence of altered WoF performance in pathological populations[6,29], we predicted that AUD patients’ choice behaviour would reflect a) decreased integration of anticipated regret, and b) increased influence of near-miss outcomes, compared with healthy controls. Based on our previous findings, we predicted slower choice latencies in AUD patients compared with controls

Methods

Results

Conclusion