Feedback-Related Brain Potentials Indicate the Influence of Craving on Decision-Making in Patients with Alcohol Use Disorder : An Experimental Study
2021, Sehrig, Sarah, Odenwald, Michael, Rockstroh, Brigitte
Introduction: Alcohol craving is a key symptom of alcohol use disorder (AUD) and a significant cause of poor treatment outcome and frequent relapse. Craving is supposed to impair executive functions by modulating reward salience and decision-making.
Objective: The present study sought to clarify this modulation by scrutinizing reward feedback processing in an experimental decision-making task, which was accomplished by AUD patients in 2 conditions, in the context of induced alcohol craving and in neutral context.
Methods: AUD inpatients (N = 40) accomplished the Balloon Analog Risk Task, while their EEG was monitored; counterbalanced across conditions, the tasks were preceded either by craving induction by means of imagery and olfactory alcohol cues, or by neutral cues. Decision choice and variability, and event-related potentials (ERPs) prior to (stimulus-preceding negativity [SPN]) and following (P2a) reward feedback upon decisions, and the outcome-related feedback-related negativity (FRN) were compared between conditions and between patients, who experienced high craving upon alcohol cues (N = 18) and those who did not (N = 22).
Results: Upon craving induction (vs. neutral condition), high-craving AUD patients showed less adjustment of decision choice to preceding reward experience and more variable decisions than low-craving AUD patients, together with accentuated reward-associated ERP (SPN and P2a), while outcome-related FRN was not modified by craving. Conclusions: Results support orientation to reward in AUD patients, particularly amplified upon experienced craving, which may interfere with (feedback-guided) decision-making even in alcohol-unrelated context. Craving-accentuated ERP indices suggest neuroadaptive changes of cognitive-motivational states upon chronic alcohol abuse. Together with altered reward-related expectancies, this has to be considered in intervention and relapse prevention.
Therapeutic success in relapse prevention in alcohol use disorder : the role of treatment motivation and drinking-related treatment goals
2021, Senn, Smeralda, Odenwald, Michael, Sehrig, Sarah, Haffke, Peter, Rockstroh, Brigitte, Pereyra-Kröll, Devi, Menning, Hans, Wieber, Frank, Volken, Thomas, Rösner, Susanne
Changing addictive behavior is a complex process with high demands on motivation. The Transtheoretical Model of Behavior Change provides a theoretical framework for explaining and predicting behavioral change, although its predictive value for addiction is somewhat inconsistent.
The aim of the present study is to extend the Transtheoretical Model of Behavior Change by investigating not only treatment motivation but also the predictive value of the type of drinking-related treatment goal. Additional predictors, such as substance-related and sociodemographic variables, are also included in analyses seeking to predict return to drinking during relapse prevention treatment for alcohol use disorder.
In this observational study, 99 inpatients from a treatment center for alcohol use disorder were recruited. Treatment motivation was assessed in accordance with the Transtheoretical Model of Behavior Change, drinking-related treatment goal through a self-report questionnaire, and substance-related and sociodemographic variables via the clinic information system. Associations between the potential predictors and covariates were explored using stepwise logistic regression.
During treatment, 42.6% of participants had at least one relapse. Scoring higher on the action dimension at admission (OR = 0.81, p = .04) and being employed (OR = 0.37, p = .02) were significant predictors of abstinence during treatment.
This study confirms that treatment motivation contributes to the prediction of treatment outcome, even when controlling for other variables. In future research, the underlying mechanisms of treatment motivation should be further explored.
Experience-Induced Change of Alcohol-Related Risk Perception in Patients with Alcohol Use Disorders
2017-11-13, Sehrig, Sarah, Odenwald, Michael, Rösner, Susanne, Senn, Smeralda, Menning, Hans, Pereyra-Kröll, Devi, Rockstroh, Brigitte
The role of alcohol-related risk perception for effective treatment of alcohol use disorders (AUD) is still unclear. The present study on 101 alcohol-dependent patients undergoing a 10-week AUD treatment protocol investigated the relationship between alcohol-related risk perception and alcohol use with the hypotheses that (1) risk perception changes across treatment, (2) changes vary with treatment-related experiences of abstinence/relapse indicating ‘risk reappraisal,’ and (3) adjustment of perceived own vulnerability according to ‘risk reappraisal hypothesis’ predicts abstinence during follow-up. Abstinence during treatment was related to a decrease, and relapse during treatment to a slight increase in perceived own risks. Abstinence during the 3-month follow-up varied with experience-induced risk reappraisal. The results show an impact of risk reappraisal on alcohol use and hence advocate a focus on risk reappraisal in AUD treatment.
Decision- and feedback-related brain potentials reveal risk processing mechanisms in patients with alcohol use disorder
2019, Sehrig, Sarah, Weiss, Andreas, Miller, Gregory A., Rockstroh, Brigitte
Individuals with alcohol use disorder (AUD) are aware of the risks of alcohol abuse yet continue risky drinking. Research indicates that dysfunctional decision processes and trait variables such as impulsivity contribute to this awareness‐behavior discrepancy. The present study focused on decision‐related versus feedback‐related processes as potential contributors to decision making in AUD by examining the relationship between decision choices and decision‐ and feedback‐related ERP phenomena in the balloon analogue risk task (BART). N = 39 AUD and n = 35 healthy comparison participants (HC) performed the BART modified for EEG assessment. In each of 100 runs, participants made a series of choices about whether to pump up a virtual balloon, which popped pseudorandomly, ending the run. Alternatively, participants ended the run by pressing a “cash‐out” button. Each pump not producing a pop provided .05 €; popping resulted in loss of the run’s accumulated gain. Groups made similar choices, though AUD responded more slowly. The decision P3 200‒400 ms after decision prompt (balloon) was larger in AUD than in HC, and decision P3 enhancement on high‐risk trials predicted choices to pump. Feedback‐related negativity (FRN) after loss (relative to cash out) feedback was smaller in AUD than in HC, suggesting indifference to negative feedback. In AUD, high impulsivity was associated with risk‐modulated decision P3 but not FRN. Results indicate atypical decision‐ and feedback‐related processes that could contribute to difficulties in engaging with daily challenges effectively.
Risikowahrnehmung und Alkoholabhängigkeit
2016-12, Sehrig, Sarah, Odenwald, Michael, Rockstroh, Brigitte
Zielsetzung: Alkoholabhängige Personen (AP) zeigen riskanten Alkoholkonsum trotz des Wissens um dessen objektive Risiken. Um die Bedeutung des Konstrukts Risikowahrnehmung für diese Diskrepanz zu überprüfen, wurde die „accuracy“ Hypothese und der „optimistic bias“ bei Alkoholabhängigkeit untersucht.
Methodik: Zur Hypothesenprüfung wurden vier Dimensionen alkoholbezogener Risikowahrnehmung bei 73 stationär behandelten AP und 75 Kontrollpersonen (KP) anhand eines neu entwickelten deutschsprachigen Fragebogens verglichen und mit Alkoholkonsum in Beziehung gesetzt.
Ergebnisse: AP schätzten im Vergleich zu KP eigene Risiken als höher ein und bewerteten diese als bedrohlicher. Trotz realistischer Wahrnehmung tendierten sie zu optimistischer Unterschätzung der eigenen Risiken. Wahrgenommene Vulnerabilität und Peer Vulnerabilität klärten neben der Diagnose Varianz im Konsum (AP: vor Behandlungsbeginn) auf. Der positive Zusammenhang zwischen Konsumverhalten und affektiver Bewertung von Risiken zeigte sich nur bei AP.
Schlussfolgerungen: Die „accuracy“ Hypothese wurde bestätigt und konnte die realistische Wahrnehmung der Alkoholrisiken bei AP erklären. Gleichzeitig zeigten AP einen „optimistic bias“, welcher zu fortdauernd riskantem Trinken beitragen könnte. Das Konstrukt Risikowahrnehmung bietet Hypothesen für längsschnittliche Therapiestudien an, durch die weiterer Erkenntnisgewinn zu erwarten ist.