Relationship of Interoceptive Accuracy With Risky Decision-Making and Treatment Outcomes in Male Patients With Alcohol Use Disorder

Abstract

Abstract. Lower levels of interoceptive awareness (IA) may be present in individuals with substance use disorder (SUD), and damage to related brain regions caused by substance use may disrupt IA. Disturbance in the bodily feedback system may fail to engage in effective decision-making. This study focused on the premise that interoceptive accuracy (IAc), as the primary construct of IA, is implicated in SUD and that poor IAc is linked to risky decision-making and adversely affects treatment outcomes. Eighty-five patients with alcohol use disorder (AUD) (current severity: moderate or severe) and 87 healthy control subjects were enrolled in the present study. All participants performed the heart rate tracking task and a computerized version of the Iowa gambling task (IGT). Characteristics of patients’ addiction profiles were assessed with the Addiction Profile Index (API) Clinical Form. IAc and IGT scores of patients with AUD were lower than healthy controls. IGT scores of patients with low IAc were lower than those of patients with high IAc and decreased IAc is predictive of decreased IGT scores. No significant differences were determined in treatment outcomes at 3, 6, and 12 months after hospitalization between the low-IAc and high-IAc patient groups. Our results suggest that IAc is implicated in AUD and that poor IAc is predictive of increased risky decision-making. Risky decision-making that results in substance use may be partly related to a deficit in the interoceptive ability to guide behavior. Focus on IAc without reference to complex clinical case presentations in AUD makes it difficult to draw any definitive conclusions about the role of IAc in clinical outcomes.

Risky Decision-Making in Adults with Alcohol Use Disorder—A Systematic and Meta-Analytic Review

“…In contrast, Brevers et al (2014) [70] found no significant association between IGT, CGT, or CT performance and the number of cigarettes consumed per day in a combined group of AUD and control participants. Similarly, two studies found no significant correlation between IGT performance and the smoking amount or history of the AUD group [76,99] or the CG [76]. In line with these findings, Loeber et al ( 2009) [52] did not observe a significant correlation between the severity of nicotine dependence and IGT performance, and in the study by Brière et al (2019) [78], no significant correlation was found between IGT performance and the presence of co-addictions.…”

“…In the AUD groups, a higher age was found to correlate significantly with a worse (i.e., riskier) performance on the CGT [83], and with a better (i.e., less risky) performance on the RTT [67] and the EGT [58]. Contrastingly, three studies found no significant correlation between age and IGT performance in the AUD group [76,94,99] or the CG [76]. In combined samples of AUD and control participants, two studies further found no significant correlations between age and IGT [70,82], CFT/LA(G)T [70], and CT performance [70].…”

“…Regarding the association between the performance on risky decision-making tasks and education level, three studies found that a higher level of education correlated significantly with a better performance on the IGT [82,89] or the RTT [67]. However, seven studies did not find significant correlations between performance on the IGT [70,76,86,94,99,101], CFT/LA(G)T [70], CT [70], or EGT [58] and the level of education of the AUD and/or control participants.…”

“…In total, 25 studies indicated that the AUD group showed an aberrant performance (i.e., performed in a riskier fashion) as compared to the CG on one or more of the outcome measures used (25/30 = 83%). Specifically, 20 out of 28 studies (71%) reporting on the total net scores, total financial outcome, or total number of advantageous/disadvantageous choices indicated the overall task performance to be significantly worse (i.e., riskier) in the AUD group as compared to the CG [54,55,64,70,73,76,78,79,82,84,89,90,[92][93][94][95]97,[99][100][101]103]. This increased risk taking corresponds to the medium pooled effect size of 0.56 (95% CI = 0.45-0.68, p < 0.001) that was found in the subgroup meta-analysis for the IGT, which included 27 studies.…”

“…None of the studies that looked into the association between symptoms of depression or anxiety and risky decision-making found significant correlations between the depression and/or anxiety ratings and performance on the IGT [52,70,73,94,99], CFT/LA(G)T [70], CT [70], or CPT [73]. Likewise, in the regression model introduced by Körner et al (2015) [90], scores on the depression rating did not explain a significant proportion of the variance in IGT performance in the AUD group or CG.…”