Impulsive decision-making predicts the course of substance-related and addictive disorders

Anja Kräplin,Gerhard Bühringer,Thomas Goschke,Michael Höfler,Michael N Smolka,Max Wolff,Shakoor Pooseh,Klaus-Martin Krönke

doi:10.1007/s00213-020-05567-z

Abstract

BackgroundThis study investigated whether patterns of impulsive decision-making (i) differ between individuals with DSM-5 substance use disorders (SUD) or non-substance-related addictive disorders (ND) and healthy controls, and (ii) predict the increase of SUD and ND severity after one year.MethodsIn a prospective-longitudinal community study, 338 individuals (19–27 years, 59% female) were included in one of three groups: SUD (n = 100), ND (n = 118), or healthy controls (n = 120). Group differences in four impulsive decision-making facets were analyzed with the Bayesian priors: delay discounting (mean = 0.37, variance = 0.02), probability discounting for gains and for losses (each − 0.16, 0.02), and loss aversion (− 0.44, 0.02). SUD and ND severity were assessed at baseline and after 1 year (n = 312, 92%). Predictive associations between decision-making and SUD/ND severity changes were analyzed with the Bayesian prior: mean = 0.25, variance = 0.016.ResultsCompared with controls, the SUD group displayed steeper delay discounting and lower probability discounting for losses; the ND group displayed lower probability discounting for losses (posterior probabilities > 98%). SUD symptom increase after 1 year was predicted by steeper delay discounting and lower loss aversion; ND symptom increase by lower probability discounting for losses and lower loss aversion (posterior probabilities > 98%). There was low evidence for predictive relations between decision-making and the quantity-frequency of addictive behaviours.DiscussionImpulsive decision-making characterizes SUD and ND and predicts the course of SUD and ND symptoms but not the engagement in addictive behaviours. Strength of evidence differed between different facets of impulsive decision-making and was mostly weaker than a priori expected.

Highlights

Addictive disorders (AD) are paradigmatic examples of impulsive choice behaviour
We hypothesized that AD is characterized by more impulsive decision-making within these facets compared with healthy controls, which would be indicated by lower probability discounting for gains, lower probability discounting for losses, and lower loss aversion
It was shown that patients with alcohol use disorder displayed a steeper delay discounting, lower probability discounting for gains, lower probability discounting for losses, and lower loss aversion compared with healthy controls (Bernhardt et al 2017)

Summary

Introduction

Addictive disorders (AD) are paradigmatic examples of impulsive choice behaviour. Individuals with AD prefer highly probable, immediate outcomes, such as hedonic experiences or to avoiding stress, each at the expense of possible long-term health, social, and financial benefits. Researchers found consistent evidence that individuals with SUD or ND are characterized by steeper delay discounting (for an overview, see Amlung et al 2017; Bickel et al 2014; Kluwe-Schiavon et al 2020) As another facet of impulsive decision-making, some studies used probability discounting tasks to assess the risk-taking propensity either for uncertain rewards (probability discounting for gains) or to avoid certain losses (probability discounting for losses). As a first step to address this research need, impulsive decisionmaking patterns were compared between individuals with SUD or ND and healthy controls This deepens our understanding of common and different underlying mechanisms (Petry et al 2014; Shaffer et al 2004) and facilitates the detection of further transdiagnostic processes related to maladaptive decision-making (Bickel et al 2019). Strength of evidence differed between different facets of impulsive decision-making and was mostly weaker than a priori expected

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