A Systematic Review of the Balloon Analogue Risk Task (BART) in Alcohol Research

Abstract

Risk-taking propensity has been crucial to the investigation of alcohol use and consequences. One measure, the balloon analogue risk task (BART), has been used consistently over the past two decades. However, it is unclear how this measure is related to alcohol outcomes. This paper systematically reviews the literature on the BART and alcohol outcomes. First, direct associations between the BART and alcohol use are reviewed including correlations, group comparisons, the BART’s prediction of alcohol outcomes and BART performance after consuming alcohol. Then, potential moderators that explain when and for whom the BART is related to alcohol outcomes are reviewed. Finally, potential mechanisms that explain how the BART and alcohol outcomes are related are reviewed. This review reveals patterns in the BART suggesting risk-taking propensity may be related to changes in alcohol use over time; however, there is little evidence to suggest BART scores increase after consuming alcohol. Yet, additional research suggests adjusted average pump scores may be too simplistic for the amount of information the BART captures and understanding individual’s patterns of responses on the BART is important for investigating its relation to alcohol outcomes. Finally, this review opens up several future directions for research to understand how risk-taking propensity is related to alcohol outcomes.

Decision-Making Under Risk and Uncertainty by Substance Abusers and Healthy Controls

“…The data analysis did not reveal any statistically significant differences, and small effect sizes among groups from the decision-making tasks. In consideration of the evidence demonstrated by the literature on each type of task (2,6,8,15), these results were not expected; however, we are aware that we had a small sample size with insufficient power to detect such a difference (see Table 2).…”

“…For example, one of the most affected cognitive abilities is decisionmaking (1,2). Recent studies have demonstrated that substance abusers who are in treatment (alcohol, cocaine, heroin, tobacco, and methamphetamine) exhibit extreme values of choosing small immediate rewards over large delay rewards (i.e., steeply delay discounting) (3)(4)(5), and risk-taking behaviors (6)(7)(8). Nevertheless, it remains unclear whether risk-taking behaviors are associated with impulsivity (i.e., steeply delay discounting).…”

“…Another important task to measure risk-taking is the Balloon Analog Risk Task (BART) (select pumps with different probabilities). This task has similarly reported that substance abusers are prone to select more pumps in contrast to healthy control participants (6,8). However, upon evaluating risk-taking behavior and impulsivity in substance abusers, the correlation among several behavioral tasks remains unclear.…”

Appropriately Tuning Stochastic-Psychometric Properties of the Balloon Analogue Response Task (BART)

“…By implementing suboptimal designs in previous studies, the approximation of individual risk-taking behavior may have been biased or noisy (see also Kılıç et al, 2020;Yakobi and Danckert, 2021). Comprehensive studies tend to indicate discrepancies across patterns of results involving the BART (Bishara et al, 2009;Purcell et al, 2017;De Groot and Thurik, 2018;Canning et al, 2022). For example, Maner and colleagues (2007) reported effects of anxiety on risk-taking, while a later study did not find such association (Buelow and Barnhart, 2017).…”

“…Although the underlying paradigm is reasonably practical and straightforward, the BART in its standard design entails unsolved criticalities that may hinder the usefulness of the collected data. Previous works discussed putative issues of the BART, including the censoring of information, the confusion of risk with the expected value, a poor distinguishing between uncertainty and risk, and the ambiguity in the definition of adaptive versus maladaptive behavior (Schonberg et al, 2011;De Groot and Thurik, 2018;De Groot, 2020;Canning et al, 2022). While these concerns are relevant, a significant source of inaccuracies in the BART is the unsafe interaction between two stochastic processes.…”