Computational Psychiatry & Decision-making

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  • doi pdf Dysfunctional approach behavior triggered by alcohol-unrelated Pavlovian cues predicts long-term relapse in alcohol dependence
  • Sommer C, Birkenstock J, Garbusow M, Obst E, Schad DJ, Bernhardt N, Huys QJM, Wurst F, Weinmann W, Heinz A, Smolka M and Zimmermann US
  • Addiction Biology (2018)
  • Pavlovian conditioned cues (CSs) can drive instrumental behavior in alcohol-dependent patients. However, it remains unclear if the influence of Pavlovian CSs might also promote maladaptive decisions that can increase the risk of relapse. We studied 109 abstinent alcohol-dependent patients and 93 controls who completed a Pavlovian-to-instrumental transfer (PIT) paradigm, and assessed patients' subsequent relapse status during a 1-year follow-up. In our PIT task, participants had to collect "good shells" (instrumental approach) or leave "bad shells" (instrumental inhibition) during the presence of money-related Pavlovian CSs or drink-related pictures in the background. Pavlovian CSs indicated either a monetary gain (i.e. 1#, 2#), a monetary loss (i.e. -1#, -2#) or a neutral stimulus (0#). Drink-related background pictures were either pictures of participants' favorite alcoholic drink or pictures of water. We found that the influence of money-related Pavlovian CSs on instrumental behavior (i.e., the PIT effect) was more pronounced in future relapsers compared to abstainers and controls. Relapsers particularly failed to correctly perform in trials where the instrumental stimulus required inhibition while a Pavlovian CS in the background indicated a monetary gain. Under that condition, future relapsers falsely approached the instrumental stimulus, independent of the expected punishment. In contrast, we found no difference in PIT between future relapsers and abstainers when pictures of alcohol or water were presented in the background. The failure of inhibiting an aversive stimulus in favor of approaching an appetitive contextual cue might reflect a general susceptibility in relapsers to the influence of positive valued cues that are incongruent to previous learned behavior. A possible relation to maladaptive decision making that can lead to high-risk situations for relapse is discussed.