Risky Decision-Making but Not Delay Discounting Improves during Inpatient Treatment of Polysubstance Dependent Alcoholics

Abstract

Background: High levels of impulsivity, characteristics of addicted patients, are known to be important predictors of relapse. However, so far, little is known about the stability or variability of two main components of impulsivity (delay discounting and decision-making). The present study examined the changes in impulsivity during the first week of an abstinence based, behavioral orientated inpatient treatment program.Method: Thirty-seven polysubstance dependent alcoholics completed the Delay Discounting Task (DDT), and the Iowa Gambling Task (IGT) using the original version with decks A′B′C′D′, and an alternative version with decks K′L′M′N′, for measuring decision-making, after 2 and 6 weeks of active treatment.Results: It was found that performances on the IGT changed during treatment while performances on the DDT did not (test-retest period: 4 weeks).Conclusion: The results provide preliminary evidence that improvements in decision-making might be related to treatment effects. All patients followed a highly structured cognitive-behavioral treatment program, which might have enhanced their executive functioning (coping skills training).

A preliminary study of longitudinal neuroadaptation associated with recovery from addiction

“…For example, brain signals associated with aberrant cue and reward processing (Beck et al, 2012; Grusser et al, 2004; Jia et al, 2011; Marhe et al, 2013a; Stewart et al, 2014a,b), diminished control-related signaling (Brewer et al, 2008; Kober et al, 2014; Luo et al, 2013; Marhe et al, 2013b) and impaired decision-making (Gowin et al, 2014; Paulus et al, 2005; Stewart et al, 2014a,b) have been implicated in subsequent relapse risk. However, there is also accumulating evidence that cognitive functioning is partially restored across multiple domains during early recovery (Bates et al, 2013; Mann et al, 1999; Stavro et al, 2013) including improved cognitive control (Connolly et al, 2012) and reduced risky decision-making (De Wilde et al, 2013). The current findings suggest that reduced reward-seeking during early recovery (which may reflect improved cognitive control) may represent a protective factor against relapse.…”

Brain perfusion in polysubstance users: Relationship to substance and tobacco use, cognition, and self-regulation

“…These reductions in regional blood flow and glucose metabolism are of functional importance as they are associated with relapse to drinking within the first year after treatment (Durazzo et al, 2010a) and poorer neurocognition in cocaine dependence (Browndyke et al, 2004; Goldstein et al, 2004, 2001; review by Hanlon et al, 2013) and in alcohol dependence (Adams et al, 1993; Dao-Castellana et al, 1998; Goldstein et al, 2004; Melgaard et al, 1990; Nicolas et al, 1993; Wang et al, 1993), although with some contradictions (Demir et al, 2002; Gazdzinski et al, 2006; Mon et al, 2009). Furthermore, research has been conducted on measures of self-regulation/inhibitory control (e.g., impulsivity, risk taking, decision making) in alcohol dependence (Fein et al, 2004; Gonzalez et al, 2007; Noel et al, 2007; Tomassini et al, 2012), cocaine dependence (LoBue et al, 2014; Moeller et al, 2001), and in polysubstance dependent alcoholics (De Wilde et al 2013a,b). However, the relationships of these measures, highly relevant to sustained abstinence and relapse, with regional cerebral perfusion have generally not been studied in substance users.…”

“…Both showed lower frontal and parietal perfusion in PSU abstinent from substances for a few days compared to the cocaine only group, with frontal perfusion deficits recovering after 21 days of abstinence (Gottschalk and Kosten, 2002; Kosten et al, 1998). However, these studies did not report on measures of neurocognition or self-regulation known to be impacted in PSU (De Wilde et al, 2013a,b). …”

Efecto del tratamiento sobre el descuento temporal y probabilístico en participantes con trastorno por uso de crack

“…Se observó que las tasas de descuento no se modifican con una intervención psicológica, aun en modalidades cognitivo-conductuales aplicadas al autocontrol, ya que el factor tipo de participante no resultó con interacción en los cambios después del tratamiento; este hallazgo apoya la literatura previa sobre la estabilidad de las tasas de descuento (Dennhardt et al, 2015;De Wilde et al, 2013;Jones, 2013;Landes et al, 2012;López, 2014;Secades-Villa et al, 2014;Weidel, 2013). Sin embargo, el presente estudio demostró la estabilidad en ambos procedimientos, temporales y probabilísticos, al considerar cuatro de las cinco tareas, ya que la de actividad de tiempo libre cambió en ambos procedimientos, sin interacción con el tipo de tratamiento.…”

“…Este hallazgo podría suponer que aquellos usuarios de drogas que acuden a recibir algún tipo de intervención psicológica modificarán su descuento, en contraste con los que no reciban la intervención. Se ha demostrado que las tasas de descuento temporal en ganancias de dinero son estables después del tratamiento cognitivo-conductual, el entrenamiento en atención plena y el manejo de contingencias (MC) en usuarios de alcohol (Dennhardt, Yurasek, & Murphy, 2015;De Wilde, Bechara, Sabbe, Hulstijn, & Dom, 2013;Jones, 2013), tabaco (López, 2014;López-Torrecillas, Perales, Nieto-Ruiz, & Verdejo-García, 2014;Secades-Villa, Weidberg, García-Rodríguez, Fernández-Hermida, & Yoon, 2014; y otras drogas ilegales (Weidel, 2013). En contraste con estos estudios, Landes y colaboradores (2012) encontraron en usuarios con dependencia de opioides que 48% de la muestra no cambiaba sus tasas de descuento, 39% mostró un decremento de su tasa y 12% la incrementó, sin interacción con el tipo de tratamiento recibido.…”