Decision-making inflexibility in a reversal learning task is associated with severity of problem gambling symptoms but not with a diagnosis of substance use disorder

Abstract

Background Decisions made by individuals with disordered gambling are markedly inflexible. However, whether anomalies in learning from feedback are gambling-specific, or extend beyond gambling contexts, remains an open question. More generally, addictive disorders—including gambling disorder—have been proposed to be facilitated by individual differences in feedback-driven decision-making inflexibility, which has been studied in the lab with the Probabilistic Reversal Learning Task (PRLT). In this task, participants are first asked to learn which of two choice options is more advantageous, on the basis of trial-by-trial feedback, but, once preferences are established, reward contingencies are reversed, so that the advantageous option becomes disadvantageous and vice versa. Inflexibility is revealed by a less effective reacquisition of preferences after reversal, which can be distinguished from more generalized learning deficits. Methods In the present study, we compared PRLT performance across two groups of 25 treatment-seeking patients diagnosed with an addictive disorder and who reported gambling problems, and 25 matched controls [18 Males/7 Females in both groups, Mage(SDage) = 25.24 (8.42) and 24.96 (7.90), for patients and controls, respectively]. Beyond testing for differences in the shape of PRLT learning curves across groups, the specific effect of problematic gambling symptoms’ severity was also assessed independently of group assignment. In order to surpass previous methodological problems, full acquisition and reacquisition curves were fitted using generalized mixed-effect models. Results Results showed that (1) controls did not significantly differ from patients in global PRLT performance nor showed specific signs of decision-making inflexibility; and (2) regardless of whether group affiliation was controlled for or not, gambling severity was specifically associated with more inefficient learning in phases with reversed contingencies. Conclusion Decision-making inflexibility, as revealed by difficulty to reacquire decisional preferences based on feedback after contingency reversals, seems to be associated with gambling problems, but not necessarily with a substance-use disorder diagnosis. This result aligns with gambling disorder models in which domain-general compulsivity is linked to vulnerability to develop gambling-specific problems with exposure to gambling opportunities.

Computational analysis of probabilistic reversal learning deficits in male subjects with alcohol use disorder

“…Some studies using PRL tasks have reported higher perseverative responses after reversals supporting impaired cognitive flexibility in patients with SUD (3)(4)(5)(6)(7). However, available studies have not revealed robust and consistent findings as some studies have failed to evidence higher perseverative responses in patients with alcohol use disorder (AUDP) (8,9) as well as in amphetamine (3), cocaine (10), and methamphetamine (11) use disorder patients compared to controls. The reasons for the heterogeneity in these findings are unclear but may be partly due to differences in the clinical characteristics of the sample such as stage of addiction, psychiatric comorbidity, and medication.…”

Computational modeling of reinforcement learning and functional neuroimaging of probabilistic reversal dissociates compulsive behaviors in Gambling and Cocaine Use Disorders

“…Patients with GD, in comparison, show difficulties in learning novel stimulus-outcome associations following contingency changes during reversal learning (Jara-Rizzo et al 2020).…”

“…The copyright holder for this preprint this version posted March 8, 2023. ; https://doi.org/10.1101/2023.03.06.531272 doi: bioRxiv preprint Patients with GD, in comparison, show difficulties in learning novel stimulus-outcome associations following contingency changes during reversal learning (Jara-Rizzo et al 2020).…”

“…A further common feature of GD and SUD is behavioral inflexibility, defined as a deficit in adjusting behavior based on changes in environmental feedback (Jara-Rizzo et al 2020; Smith et al 2020; Perandrés-Gómez et al 2021). Individuals with SUDs to a range of specific substances exhibit an increase in perseverative responding following a contingency change during probabilistic reversal learning (PRL), a paradigm used to investigate cognitive flexibility (Ersche et al 2011).…”

“…Patients with GD, in comparison, show difficulties in learning novel stimulus-outcome associations following contingency changes during reversal learning (Jara-Rizzo et al 2020). Following repeated negative feedback, patients with GD tend to stay rather than switch their response, or switch prematurely after little or no negative feedback during PRL (Perandrés-Gómez et al 2021).…”