Decision‐ and feedback‐related brain potentials reveal risk processing mechanisms in patients with alcohol use disorder

Abstract

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.

Feedback-Related Brain Potentials Indicate the Influence of Craving on Decision-Making in Patients with Alcohol Use Disorder: An Experimental Study

“…The BART is sensitive to risky behaviors like smoking, illegal drug use, and gambling [28]. While these results are in line with the other reports reviewed in Sehrig et al [26], we are not aware of evidence on SPN abnormality in AUD patients.…”

“…This attentional bias toward reward feedback, if associated with effortful processing, may have distracted from concise, adjusted decision performance. As reported in Sehrig et al [26] AUD exhibited larger positive ERP than healthy controls in the decision phase (including the decision-related P3 and P2a in response to successful pump decisions, thus, reward feedback) under neutral conditions. The present results verified accentuation of the feedback-related P2a in those AUD patients, who experienced craving in the craving condition.…”

“…Moreover, accentuated N2 was reported for a NoGo task in subjects reporting intense craving in an alcohol-related context [31]. Extending the study on ERP correlates of decision-making [26] by adding a within comparison condition from a 2nd lab session (neutral condition vs. craving condition), the present study examined the impact of craving on ERPs sensitive to the feedback (P2a and FRN) and reward anticipation (SPN) with the following hypotheses: 1. After craving induction, AUD patients show less adjustment of their choice behavior in the BART after reward or loss feedback and more variable decisions than in neutral condition; this effect is particularly pronounced in those AUD patients who experience high craving upon cue exposure.…”

“…Thereafter, craving intensity was rated again (VAS3) before the session ended with debriefing and remuneration. b Schematic illustration of the BART variant (from Sehrig et al [26], with permission). Top: Each run starts with an 800 ms fixation cross, followed by a limp balloon presented for 1,000-1,300 ms (jittered across trials).…”

“…The modified version of the BART was presented on a computer screen via Presentation software (Neurobehavioral Systems Inc., Albany, CA, USA). As detailed in Sehrig et al [26] (Fig. 1b), each of 100 runs started with an 800-ms fixation cross followed by the picture of a limp (minimal size) balloon.…”