Decision-making inflexibility in a reversal learning task is associated with severity of problem gambling symptoms but not with a diagnosis of substance use disorder

Abstract

Background: Decisions made by disordered gamblers are markedly inflexible. However, whether anomalies in learning from feedback are gambling-specific, or extend beyond gambling contexts, remains an open question. More generally, addictive disorders –including gambling disorder– have been proposed to be facilitated by individual differences in learning-driven decision-making inflexibility. Individual differences in decision-making inflexibility have been studied in the lab with the Affective Probabilistic Reversal Learning Task (PRLT). In this task, participants are first asked to learn which of two choice options is more advantageous, on the basis of trial-by-trial feedback, but, once preferences are established, reward contingencies are reversed, so that the advantageous option becomes disadvantageous and vice versa. Inflexibility is revealed by a less effective reacquisition of preferences after reversal, which can be distinguished from more generalized acquisition deficits.Methods: In the present study, we compared PRLT performance across two groups of 25 treatment-seeking patients with an addictive disorder and reported gambling problems, and 25 matched controls [18 Males/7 Females in both groups, Mage(SDage) = 25.24 (8.42) and 24.96 (7.90), for patients and controls, respectively]. Beyond testing for differences in the shape of PRLT learning curves across groups, the specific effect of gambling symptoms’ severity was also assessed in the group of patients. In order to surpass previous methodological problems, full acquisition and reacquisition curves were fitted using generalized mixed-effect models. Results: Results showed that (1) controls learned more efficiently than patients in all phases of the task, and were more likely to make correct choices by the end of each task phase, regardless of contingency (and so there were no specific signs of decision-making inflexibility in the group of patients); (2) gambling severity in the group of patients was specifically associated with more inefficient learning in phases with reversed contingencies (i.e., decision-making inflexibility). Conclusion: Decision-making inflexibility, as revealed by difficulty to reacquire decisional preferences based on feedback after contingency reversals, seems to be specifically associated with gambling problems, but not necessarily with a substance-use disorder diagnosis. This result aligns with gambling disorder models in which domain-general compulsivity is linked to vulnerability to develop gambling-specific problems with exposure to gambling opportunities.