Abstract
Methamphetamine use disorder (MUD) is increasing worldwide and commonly associated with learning deficits. Little is known the about underlying trajectories, i.e., how the affected higher-order cognitive functions develop over time and with respect to abstinence and relapse. A probabilistic reversal learning (PRL) paradigm was implemented to uncover the microstructure of impulsive choice and maladaptive learning strategies in 23 patients with MUD in comparison with 24 controls. Baseline data revealed fewer optimal choices and a pattern of altered learning behavior from negative and positive feedback in patients suggesting impairments in flexibly-adapting behavior to changes of reward contingencies. Integrating longitudinal data from a follow-up assessment after 3 months of specific treatment revealed a group-by-time interaction indicating a normalization of these cognitive impairments in patients with MUD. In summary, our study demonstrates behavioral correlates of maladaptive decision-making processes in patients with MUD, which may recover after 3 months of MUD-specific therapy paving the way for further learning-based interventions. Limited by a small sample size, the results of this pilot study warrant replication in larger populations.
Highlights
Methamphetamine use disorder (MUD) has been a growing worldwide problem, and in the last decade, the incidence in Western Europe has increased rapidly [1]
Behavioral approaches have been the mainstay of treatment, and some behavioral interventions have increased retention rates [2], little is known about predictors that influence treatment responses and the trajectories of cognitive functioning in MUD
Impulsive choice is influenced by the dynamic interaction of biases in delay and reward magnitude [23], it is unclear whether temporal discounting in MUD reflects deficits in processing and integrating reward contingencies and consequences
Summary
Methamphetamine use disorder (MUD) has been a growing worldwide problem, and in the last decade, the incidence in Western Europe has increased rapidly [1]. Reversal Learning Deficits in Methamphetamine Dependence deficits [1, 4], including persistent gliosis and apoptosis in dopaminergic and serotonergic neurons [5] and abnormalities in morphology and function of fronto-striatal and limbic regions [6,7,8,9] These changes have been linked to a broad range of cognitive impairments [10, 11], including multiple domains such as attention control, working memory and executive functions especially decision making [12,13,14,15,16,17]. Adaptive decision making requires cognitive flexibility to maximize outcomes, whether to obtain reward or avoid punishment, and as learned drug-taking habits prevail despite devastating psychosocial consequences [24], it is critically important to identify the extent to which impulsive choice is related to deficits in processing and integrating outcomes/consequences
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