Research

Computational Psychiatry & Decision-making

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Abstracts

  • When habits are dangerous: alcohol expectancies and habitual decision-making in alcohol dependence
  • Sebold M, Nebe S, Garbusow M, Schad DJ, Beck A, Kuitunen-Paul S, Sommer C, Neu P, Zimmermann US, Rapp MA, Smolka MN, Huys QJM, Schlagenhauf F, Heinz A
  • Biological Psychiatry (2017) In Press
  • Addiction is supposed to be characterized by a shift from goal-directed to habitual decision-making, thus facilitating automatic drug intake. The two-step task allows distinguishing between these mechanisms by computationally modelling goal-directed and habitual behavior as model-based and model-free control. In addicted patients, decision-making may also strongly depend upon drug-associated expectations. Therefore, we investigated model-based vs. model-free decision-making and its neural correlates as well as alcohol expectancies in alcohol-dependent patients and healthy controls and assessed treatment outcome in patients. Ninety detoxified, medication-free alcohol-dependent patients and 96 age- and gender-matched control underwent functional magnetic resonance imaging during the two-step task. Alcohol expectancies were measured with the Alcohol Expectancy Questionnaire.. Over a follow-up period of 48 weeks, 37 patients remained abstinent whereas 53 patients. Patients who relapsed displayed reduced medial prefrontal cortex (mPFC) activation during model-based decision-making. Furthermore high alcohol expectancies were associated with low model-based control in relapsers, while the opposite was observed in abstainers and healthy controls. However, reduced model-based control per se was not associated with subsequent relapse. These findings suggest that poor treatment outcome in addicted patients does not simply result from reduced model-based control but is rather dependent on the interaction between high drug expectancies and low model-based decision-making. Reduced model-based mPFC signatures in prospective relapsers point to a neural correlate of relapse risk. These observations suggest that therapeutic interventions should target subjective alcohol expectancies.