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When Habits Are Dangerous: Alcohol Expectancies and Habitual Decision Making Predict Relapse in Alcohol Dependence

  • BACKGROUND: Addiction is supposedly characterized by a shift from goal-directed to habitual decision making, thus facilitating automatic drug intake. The two-step task allows distinguishing between these mechanisms by computationally modeling goal-directed and habitual behavior as model-based and model-free control. In addicted patients, decision making may also strongly depend upon drug-associated expectations. Therefore, we investigated model-based versus model-free decision making and its neural correlates as well as alcohol expectancies in alcohol-dependent patients and healthy controls and assessed treatment outcome in patients. METHODS: Ninety detoxified, medication-free, alcohol-dependent patients and 96 age-and gender-matched control subjects underwent functional magnetic resonance imaging during the two-step task. Alcohol expectancies were measured with the Alcohol Expectancy Questionnaire. Over a follow-up period of 48 weeks, 37 patients remained abstinent and 53 patients relapsed as indicated by the Alcohol TimelineBACKGROUND: Addiction is supposedly characterized by a shift from goal-directed to habitual decision making, thus facilitating automatic drug intake. The two-step task allows distinguishing between these mechanisms by computationally modeling goal-directed and habitual behavior as model-based and model-free control. In addicted patients, decision making may also strongly depend upon drug-associated expectations. Therefore, we investigated model-based versus model-free decision making and its neural correlates as well as alcohol expectancies in alcohol-dependent patients and healthy controls and assessed treatment outcome in patients. METHODS: Ninety detoxified, medication-free, alcohol-dependent patients and 96 age-and gender-matched control subjects underwent functional magnetic resonance imaging during the two-step task. Alcohol expectancies were measured with the Alcohol Expectancy Questionnaire. Over a follow-up period of 48 weeks, 37 patients remained abstinent and 53 patients relapsed as indicated by the Alcohol Timeline Followback method. RESULTS: Patients who relapsed displayed reduced medial prefrontal cortex activation during model-based decision making. Furthermore, high alcohol expectancies were associated with low model-based control in relapsers, while the opposite was observed in abstainers and healthy control subjects. However, reduced model-based control per se was not associated with subsequent relapse. CONCLUSIONS: These findings suggest that poor treatment outcome in alcohol dependence does not simply result from a shift from model-based to model-free control but is instead dependent on the interaction between high drug expectancies and low model-based decision making. Reduced model-based medial prefrontal cortex signatures in those who relapse point to a neural correlate of relapse risk. These observations suggest that therapeutic interventions should target subjective alcohol expectancies.show moreshow less

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Author:Miriam Sebold, Stephan NebeORCiD, Maria Garbusow, Matthias Guggenmos, Daniel J. Schad, Anne Beck, Soeren Kuitunen-Paul, Christian Sommer, Robin Frank, Peter Neu, Ulrich S. Zimmermann, Michael A. Rapp, Michael N. Smolka, Quentin J. M. Huys, Florian Schlagenhauf, Andreas Heinz
DOI:https://doi.org/10.1016/j.biopsych.2017.04.019
ISSN:0006-3223
ISSN:1873-2402
Pubmed Id:http://www.ncbi.nlm.nih.gov/pubmed?term=28673442
Parent Title (English):Biological psychiatry : a journal of psychiatric neuroscience and therapeutics ; a publication of the Society of Biological Psychiatry
Publisher:Elsevier
Place of publication:New York
Document Type:Article
Language:English
Year of first Publication:2017
Year of Completion:2017
Release Date:2020/04/20
Tag:Alcohol dependence; Alcohol expectancy; Goal-directed control; Medial prefrontal cortex; Reinforcement learning; Treatment outcome
Volume:82
Pagenumber:10
First Page:847
Last Page:856
Funder:German Research Foundation (Deutsche Forschungsgemeinschaft Forschergruppe) [HE2597/14-1, HE2597/14-2, RA1047/2-1, RA1047/2-2, SM 80/7-1, SM 80/7-2, ZI1119/3-1, ZI1119/3-2, 1617]
Organizational units:Humanwissenschaftliche Fakultät / Institut für Sportmedizin und Prävention
Peer Review:Referiert