Computational Theories of Alcohol Use Disorder: Mapping Learning and Choice Mechanisms on Symptoms

Abstract

Alcohol use disorder (AUD) is characterized by a combination of symptoms including excessive craving, loss of control, and progressive neglect of alternative pleasures. A mechanistic understanding of what drives these symptoms is needed to improve diagnostic stratification and to develop new treatment and prevention strategies for AUD. To date, there is no consensus regarding a unifying mechanistic framework that accounts for the different symptoms of AUD. Reinforcement learning (RL) and economic choice theories may be key to elucidating the underlying processes of symptom development and maintenance in AUD. These algorithms may account for the different behavioral and physiological phenomena and are suited to dissect mechanisms linked to different symptoms of AUD. We here review different RL and economic choice models and how they map onto three symptoms of AUD: (1) cue-induced craving, (2) neglect of alternative rewards, and (3) consumption despite adverse consequences. For each symptom and theory, we describe findings from animal and human studies. In humans, we focus on empirical studies that investigated RL models in the context of treatment outcome in AUD. The review indicates important gaps to be addressed in the future by highlighting the challenges in transferring findings from RL and economic choice studies to clinical application. We also critically evaluate the potential and pitfalls of a symptom-oriented approach and highlight the importance of elucidating the role of learning and decision-making processes across diagnostic boundaries.

Exploring the steps of learning: computational modeling of initiatory-actions among individuals with attention-deficit/hyperactivity disorder

“…Given the well-documented comorbidities between ADHD and SUD/AUD, perhaps attributable to their shared core symptoms of impulsivity [ 85 , 86 ], we should consider the potential influence of these impulsive disorders on action–value processing effects [ 87 , 88 ]. E.g., Sebold et al [ 89 ] demonstrated that AUD is associated with alterations in value-based decision-making. Furthermore, in the context of SUD, Groman et al [ 90 ] conducted a review and showed evidence suggesting that value updating following positive outcomes, but not negative outcomes, predicts escalation in SUD.…”

Reducing maladaptive behavior in neuropsychiatric disorders using network modification

“…We believe all of these are important factors in developing a more thorough model of alcohol use disorder, and we aim to include them in the future. Other researchers have included some of these features in models of alcohol use disorder [38][39][40], but these other models were not structured as neural networks making it difficult to understand how modifications to the models could translate to potential treatments. In this study, by ignoring these complicating factors, we were able to improve generalizability and simplicity, which we felt was paramount to our research program at this stage.…”

Value-based decision-making predicts alcohol use and related problems in young men

“…Drinking may thus escalate when decision-making processes in dopamine-innervated frontostriatal circuits are characterized by low executive control or high alcohol valuation (Camchong et al, 2014;Goschke, 2014;Sebold et al, 2022;Zucker, 2015). Chronic alcohol use reinforces this imbalance, thereby facilitating value-based impulsive and stimulus-driven habitual decisions that characterize dependent drinking (Camchong et al, 2014;Goschke, 2014;Sebold et al, 2022;Zucker, 2015).…”

“…Another study in healthy adults targeted frontal dopamine and found a circuit mechanism for dopamine effects since delay discounting varied with tolcapone-induced changes in the left ventral putamen and the frontostriatal connectivity (Kayser et al, 2012). Drinking may thus escalate when decision-making processes in dopamine-innervated frontostriatal circuits are characterized by low executive control or high alcohol valuation (Camchong et al, 2014;Goschke, 2014;Sebold et al, 2022;Zucker, 2015). Chronic alcohol use reinforces this imbalance, thereby facilitating value-based impulsive and stimulus-driven habitual decisions that characterize dependent drinking (Camchong et al, 2014;Goschke, 2014;Sebold et al, 2022;Zucker, 2015).…”