Behavioral and Neural Signatures of Reduced Updating of Alternative Options in Alcohol-Dependent Patients during Flexible Decision-Making

Abstract

Addicted individuals continue substance use despite the knowledge of harmful consequences and often report having no choice but to consume. Computational psychiatry accounts have linked this clinical observation to difficulties in making flexible and goal-directed decisions in dynamic environments via consideration of potential alternative choices. To probe this in alcohol-dependent patients (n ϭ 43) versus healthy volunteers (n ϭ 35), human participants performed an anticorrelated decision-making task during functional neuroimaging. Via computational modeling, we investigated behavioral and neural signatures of inference regarding the alternative option. While healthy control subjects exploited the anticorrelated structure of the task to guide decision-making, alcohol-dependent patients were relatively better explained by a model-free strategy due to reduced inference on the alternative option after punishment. Whereas model-free prediction error signals were preserved, alcohol-dependent patients exhibited blunted medial prefrontal signatures of inference on the alternative option. This reduction was associated with patients' behavioral deficit in updating the alternative choice option and their obsessive-compulsive drinking habits. All results remained significant when adjusting for potential confounders (e.g., neuropsychological measures and gray matter density). A disturbed integration of alternative choice options implemented by the medial prefrontal cortex appears to be one important explanation for the puzzling question of why addicted individuals continue drug consumption despite negative consequences.

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

“…Two other studies have associated blunted mPFC activation with reduced goal-directed control and flexible decision-making in AD (10,61). The mPFC plays a key role in alcoholassociated behavior including cue-induced craving in animals (62, 63) and humans (64,65).…”

Intact goal‐directed control in treatment‐seeking drug users indexed by outcome‐devaluation and Pavlovian to instrumental transfer: critique of habit theory

“…Experiment 2 tested a more complex biconditional version of the outcome‐devaluation and PIT procedures, in which the response–outcome contingencies were randomly reversed on a trial‐by‐trial basis, signalled by two discriminative stimuli (Hardy et al ., ; see also Colwill & Rescorla, ; Declercq & De Houwer, ; Bradfield & Balleine, ; Trask & Bouton, ). Given that drug users have been shown to be slower to learn the reversal of response–outcome contingencies in previous studies (Ersche et al ., ; Fortier et al ., ; Reiter et al ., ), we hoped that the reversal of response–outcome contingencies in the biconditional outcome‐devaluation and PIT tasks would reveal impaired goal‐directed control in drug users.…”

Model-Based Control in Dimensional Psychiatry

“…Preliminary evidence suggests that the capacity to build an internal model of the environment might be impaired in addictive and other compulsive disorders: in rodents, cocaine self-administration abolishes the representation of inferred outcomes(44). In human studies, smokers do not guide their decisions by fictive prediction errors(45) and AD subjects do not update 'what might have happened' particularly after punishment(46). Medial prefrontal BOLD activation reflecting prediction errors incorporating the updating of alternative choice options was reduced in both AD and BED(46,47).Similarly, the use of counterfactual computations in decision-making was also diminished in OCD patients(48).…”

“…In human studies, smokers do not guide their decisions by fictive prediction errors(45) and AD subjects do not update 'what might have happened' particularly after punishment(46). Medial prefrontal BOLD activation reflecting prediction errors incorporating the updating of alternative choice options was reduced in both AD and BED(46,47).Similarly, the use of counterfactual computations in decision-making was also diminished in OCD patients(48). These building blocks of an internal findings suggest reduced goal-directed behavior may be a trans-diagnostic feature across compulsive disorders.…”