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Dysfunctional approach behavior triggered by alcohol-unrelated Pavlovian cues predicts long-term relapse in alcohol dependence.

Abstract：

:We demonstrated that alcohol-dependent patients who relapsed within 1 year after detoxification showed stronger PIT effects compared with abstainers and controls. Relapsers particularly failed to correctly perform in trials where an instrumental stimulus required inhibition while a Pavlovian background cue indicated a monetary gain. Under that condition, relapsers approached the instrumental stimulus, independent of the expected punishment. The failure of inhibiting an aversive stimulus in favor of approaching an appetitive context cue reflects dysfunctional altered learning mechanisms in relapsers. :Pavlovian conditioned cues (CSs) can drive instrumental behavior in alcohol-dependent patients. However, it remains unclear if the influence of Pavlovian CSs might also promote maladaptive decisions that can increase the risk of relapse. We studied 109 abstinent alcohol-dependent patients and 93 controls who completed a Pavlovian-to-instrumental transfer (PIT) paradigm, and assessed patients' subsequent relapse status during a 1-year follow-up. In our PIT task, participants had to collect “good shells” (instrumental approach) or leave “bad shells” (instrumental inhibition) during the presence of money-related Pavlovian CSs or drink-related pictures in the background. Pavlovian CSs indicated either a monetary gain (ie, 1€, 2€), a monetary loss (ie, -1€, −2€) or a neutral stimulus (0€). Drink-related background pictures were either pictures of participants' favorite alcoholic drink or pictures of water. We found that the influence of money-related Pavlovian CSs on instrumental behavior (ie, the PIT effect) was more pronounced in future relapsers compared with abstainers and controls. Relapsers particularly failed to correctly perform in trials where the instrumental stimulus required inhibition while a Pavlovian background CS indicated a monetary gain. Under that condition, relapsers approached the instrumental stimulus, independent of the expected punishment. In contrast, we found no difference in PIT between relapsers and abstainers when drink-related background pictures were presented. The failure of inhibiting an aversive stimulus in favor of approaching an appetitive non-alcohol-related context cue might reflect dysfunctional altered learning mechanisms in relapsers. A possible relation to maladaptive decision making that can lead to high-risk situations for relapse is discussed.

journal_name

Addict Biol

journal_title

Addiction biology

authors

Sommer C,Birkenstock J,Garbusow M,Obst E,Schad DJ,Bernhardt N,Huys QM,Wurst FM,Weinmann W,Heinz A,Smolka MN,Zimmermann US

doi

10.1111/adb.12703

subject

Has Abstract

pub_date

2020-01-01 00:00:00

pages

e12703

issue

eissn

1355-6215

issn

1369-1600

journal_volume

pub_type

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Dysfunctional approach behavior triggered by alcohol-unrelated Pavlovian cues predicts long-term relapse in alcohol dependence.