Nothing to lose? Neural correlates of decision, anticipation, and feedback in the balloon analog risk task.

Understanding the subprocesses of risky decision making is a prerequisite for understanding (dys-)functional decisions. For the present fMRI study, we designed a novel variant of the balloon-analog-risk task (BART) that measures three phases: decision making, reward anticipation, and feedback processing. Twenty-nine healthy young adults completed the BART. We analyzed neural activity and functional connectivity. Parametric modulation allowed assessing changes in brain functioning depending on the riskiness of the decision. Our results confirm involvement of nucleus accumbens, insula, anterior cingulate cortex, and dorsolateral prefrontal cortex in all subprocesses of risky decision-making. In addition, subprocesses were differentiated by the strength of activation in these regions, as well as by changes in activity and nucleus accumbens-connectivity by the riskiness of the decision. The presented fMRI-BART variant allows distinguishing activity and connectivity during the subprocesses of risky decision making and shows how activation and connectivity patterns relate to the riskiness of the decision. Hence, it is a useful tool for unraveling impairments in subprocesses of risky decision making in people with high risk behavior.

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

INTRODUCTION: Alcohol craving is a key symptom of alcohol use disorder (AUD) and a significant cause of poor treatment outcome and frequent relapse. Craving is supposed to impair executive functions by modulating reward salience and decision-making. OBJECTIVE: The present study sought to clarify this modulation by scrutinizing reward feedback processing in an experimental decision-making task, which was accomplished by AUD patients in 2 conditions, in the context of induced alcohol craving and in neutral context. METHODS: AUD inpatients (N = 40) accomplished the Balloon Analog Risk Task, while their EEG was monitored; counterbalanced across conditions, the tasks were preceded either by craving induction by means of imagery and olfactory alcohol cues, or by neutral cues. Decision choice and variability, and event-related potentials (ERPs) prior to (stimulus-preceding negativity [SPN]) and following (P2a) reward feedback upon decisions, and the outcome-related feedback-related negativity (FRN) were compared between conditions and between patients, who experienced high craving upon alcohol cues (N = 18) and those who did not (N = 22). RESULTS: Upon craving induction (vs. neutral condition), high-craving AUD patients showed less adjustment of decision choice to preceding reward experience and more variable decisions than low-craving AUD patients, together with accentuated reward-associated ERP (SPN and P2a), while outcome-related FRN was not modified by craving. CONCLUSIONS: Results support orientation to reward in AUD patients, particularly amplified upon experienced craving, which may interfere with (feedback-guided) decision-making even in alcohol-unrelated context. Craving-accentuated ERP indices suggest neuroadaptive changes of cognitive-motivational states upon chronic alcohol abuse. Together with altered reward-related expectancies, this has to be considered in intervention and relapse prevention.

Therapeutic success in relapse prevention in alcohol use disorder: the role of treatment motivation and drinking-related treatment goals.

Background: Changing addictive behavior is a complex process with high demands on motivation. The Transtheoretical Model of Behavior Change provides a theoretical framework for explaining and predicting behavioral change, although its predictive value for addiction is somewhat inconsistent.Objective: The aim of the present study is to extend the Transtheoretical Model of Behavior Change by investigating not only treatment motivation but also the predictive value of the type of drinking-related treatment goal. Additional predictors, such as substance-related and sociodemographic variables, are also included in analyses seeking to predict return to drinking during relapse prevention treatment for alcohol use disorder.Methods: In this observational study, 99 inpatients from a treatment center for alcohol use disorder were recruited. Treatment motivation was assessed in accordance with the Transtheoretical Model of Behavior Change, drinking-related treatment goal through a self-report questionnaire, and substance-related and sociodemographic variables via the clinic information system. Associations between the potential predictors and covariates were explored using stepwise logistic regression.Results: During treatment, 42.6% of participants had at least one relapse. Scoring higher on the action dimension at admission (OR = 0.81, p = .04) and being employed (OR = 0.37, p = .02) were significant predictors of abstinence during treatment.Conclusions: This study confirms that treatment motivation contributes to the prediction of treatment outcome, even when controlling for other variables. In future research, the underlying mechanisms of treatment motivation should be further explored.

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

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.