Aims: Two main therapeutic programs were offered to patients suffering from alcohol use disorders (AUDs): avoid the alcohol by abstinence or controlling their consumption. After information and motivational sessions, the patient chooses his own therapeutic plan. However, patients with AUD exhibit poor decision-making. The purpose of this study was to investigate the decision-making in AUD by comparing patients who chose to reduce and control their consumption to those who chose abstinence program. Methods: Sixty-seven subjects with alcohol use disorder were included (AUD group) for treatment, choosing either a relapse prevention program (RPP) or a harm reduction program (HRP). Patients were compared to a healthy control group (n = 31). Cognitive skills were assessed through the Montreal Cognitive Assessment test, the National Adult Reading Test, the Trail Making Test and the Iowa Gambling Task (IGT). Results: Thirty-seven patients with AUD chose the RPP while 30 followed a HRP. The AUD group performed worse than controls on the IGT. The RPP group had significantly lower performance than both HRP and control groups (these later groups being not statistically different). No correlation was observed between the available clinical, cognitive and intellectual measures. Conclusion: This study confirms that the decision-making process of patients with an alcohol use disorder is impaired. However, the 2 groups differ on the IGT scores, despite comparable clinical and cognitive profiles. The patients’ decision-making abilities could be a useful guide when developing therapeutic programs.

Keywords:
Decision-making skills, Iowa Gambling Task, Harm reduction
1.
Bechara A, Damasio AR. The somatic marker hypothesis: A neural theory of economic decision.
Games Econ Behav
. 2005;52(2):336–72.
2.
Ekhtiari H, Victor TA, Paulus MP. Aberrant decision-making and drug addiction : how strong is the evidence?
Curr Opin Behav Sci
. 2017;13:25–33.
3.
Bowden-Jones H, McPhillips M, Rogers R, Hutton S, Joyce E. Risk-taking on tests -sensitive to ventromedial prefrontal cortex dysfunction predicts early relapse in -alcohol dependency: a pilot study.
J Neuropsychiatry Clin Neurosci
. 2005;17(3):417–20.
4.
De Wilde B, Verdejo-García A, Sabbe B, Hulstijn W, Dom G. Affective decision-making is predictive of three-month relapse in polysubstance-dependent alcoholics.
Eur Addict Res
. 2013;19(1):21–8.
5.
Domínguez-Salas S, Díaz-Batanero C, Lozano-Rojas OM, Verdejo-García A. Impact of general cognition and executive function deficits on addiction treatment outcomes: systematic review and discussion of neurocognitive pathways.
Neurosci Biobehav Rev
. 2016 Dec;71:772–801.
6.
Verdejo-Garcia A, Chong TT, Stout JC, Yücel M, London ED. Stages of dysfunctional decision-making in addiction.
Pharmacol Biochem Behav
. 2018 Jan;164:99–105.
7.
Ernst M, Paulus MP. Neurobiology of -decision making: a selective review from a neurocognitive and clinical perspective. 
Bio l Psychiatry
. 2005 Oct;58(8):597–604.
8.
Chong TT, Apps M, Giehl K, Sillence A, Grima LL, Husain M. Neurocomputational mechanisms underlying subjective valuation of effort costs.
PLoS Biol
. 2017 Feb;15(2):e1002598.
9.
Brevers D, Bechara A, Cleeremans A, Kornreich C, Verbanck P, Noël X. Impaired decision-making under risk in individuals with alcohol dependence. -
Alcohol Clin Exp Res
. 2014 Jul;38(7):1924–31.
10.
Le Berre AP, Rauchs G, La Joie R, Mézenge F, Boudehent C, Vabret F, et al. Impaired decision-making and brain shrinkage in alcoholism.
Eur Psychiatry
. 2014 Mar;29(3):125–33.
11.
Houston RJ, Derrick JL, Leonard KE, Testa M, Quigley BM, Kubiak A. Effects of heavy drinking on executive cognitive functioning in a community sample.
Addict Behav
. 2014 Jan;39(1):345–9.
12.
Bechara A, Damasio AR, Damasio H, Anderson SW. Insensitivity to future consequences following damage to human prefrontal cortex.
Cognition
. 1994 Apr-Jun;50(1-3):7–15.
13.
Bottesi G, Ghisi M, Ouimet AJ, Tira MD, Sanavio E. Compulsivity and Impulsivity in Pathological Gambling: Does a Dimensional-Transdiagnostic Approach Add Clinical Utility to DSM-5 Classification?
J Gambl Stud
. 2015 Sep;31(3):825–47.
14.
Bechara A, Damasio H. Decision-making and addiction (part I): impaired activation of somatic states in substance dependent individuals when pondering decisions with negative future consequences.
Neuropsychologia
. 2002;40(10):1675–89.
15.
Verdejo-Garcia A, Benbrook A, Funderburk F, David P, Cadet JL, Bolla KI. The differential relationship between cocaine use and marijuana use on decision-making performance over repeat testing with the Iowa Gambling Task.
Drug Alcohol Depend
. 2007 Sep;90(1):2–11.
16.
O’Brien JW, Lichenstein SD, Hill SY. Maladaptive decision making and substance use outcomes in high-risk individuals: preliminary evidence for the role of 5-HTTLPR variation.
J Stud Alcohol Drugs
. 2014 Jul;75(4):643–52.
17.
Malone SM, Luciana M, Wilson S, Sparks JC, Hunt RH, Thomas KM, et al. Adolescent drinking and motivated decision-making: a cotwin-control investigation with monozygotic twins.
Behav Genet
. 2014 Jul;44(4):407–18.
18.
Barry D, Petry NM. Predictors of decision-making on the Iowa Gambling Task: independent effects of lifetime history of substance use disorders and performance on the Trail Making Test.
Brain Cogn
. 2008b Apr;66(3):243–52.
19.
Andó B, Must A, Kurgyis E, Szkaliczki A, Drótos G, Rózsa S, et al. Personality traits and coping compensate for disadvantageous decision-making in long-term alcohol abstinence.
Alcohol Alcohol
. 2012 Jan-Feb;47(1):18–24.
20.
Körner N, Schmidt P, Soyka M. Decision making and impulsiveness in abstinent alcohol-dependent people and healthy individuals: a neuropsychological examination.
Subst Abuse Treat Prev Policy
. 2015 Jun;10(1):24.
21.
Noël X, Bechara A, Dan B, Hanak C, Verbanck P. Response inhibition deficit is involved in poor decision making under risk in nonamnesic individuals with alcoholism.
Neuropsychology
. 2007 Nov;21(6):778–86.
22.
Friedrichs A, Silkens A, Reimer J, Kraus L, Scherbaum N, Piontek D, et al. Role preferences of patients with alcohol use disorders.
Addict Behav
. 2018 Sep;84:248–54.
23.
American Psychiatric Association. DSM-5 – Manuel diagnostique et statistique des troubles mentaux. In Elsevier Masson, 2015.
24.
Société-Française-d’Alcoologie. Recommandation de bonne pratique -Mésusages de l’alcool : dépistage, diagnostic et traitement.
Alcool Addictol
. 2015;37(1):5–84.
25.
Nasreddine ZS, Phillips NA, Bédirian V, Charbonneau S, Whitehead V, Collin I, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment.
J Am Geriatr Soc
. 2005 Apr;53(4):695–9.
26.
War departement: Manual of directions and scoring, Test Individual Army. Washington: Adjutant General's office; 1944.
27.
Mackinnon A, Mulligan R. Estimation de l’intelligence prémorbide chez les francophones.
Encephale
. 2005 Jan-Feb;31(1 Pt 1):31–43.
28.
Damasio AR, Blanc M.
L’erreur de Descartes la raison des émotions
. Paris: O. Jacob; 2009.
29.
Cordovil De Sousa Uva M, Luminet O, Cortesi M, Constant E, Derely M, De Timary P. Distinct effects of protracted withdrawal on affect, craving, selective attention and executive functions among alcohol-dependent patients.
Alcohol Alcohol
. 2010 May-Jun;45(3):241–6.
30.
Loeber S, Duka T, Welzel H, Nakovics H, Heinz A, Flor H, et al. Impairment of cognitive abilities and decision making after chronic use of alcohol: the impact of multiple detoxifications.
Alcohol Alcohol
. 2009 Jul-Aug;44(4):372–81.
31.
Bechara A, Dolan S, Denburg N, Hindes A, Anderson SW, Nathan PE. Decision-making deficits, linked to a dysfunctional ventromedial prefrontal cortex, revealed in alcohol and stimulant abusers.
Neuropsychologia
. 2001;39(4):376–89.
32.
Gonzalez R, Bechara A, Martin EM. Executive functions among individuals with methamphetamine or alcohol as drugs of choice: preliminary observations.
J Clin Exp Neuropsychol
. 2007 Feb;29(2):155–9.
33.
Bechara A, Martin EM. Impaired decision making related to working memory deficits in individuals with substance addictions.
Neuropsychology
. 2004 Jan;18(1):152–62.
34.
Bechara A, Dolan S, Hindes A. Decision-making and addiction (part II): myopia for the future or hypersensitivity to reward?
Neuropsychologia
. 2002;40(10):1690–705.
35.
Goudriaan AE, Oosterlaan J, de Beurs E, van den Brink W. Psychophysiological determinants and concomitants of deficient decision making in pathological gamblers.
Drug Alcohol Depend
. 2006 Oct;84(3):231–9.
36.
Acheson A, Robinson JL, Glahn DC, Lovallo WR, Fox PT. Differential activation of the anterior cingulate cortex and caudate nucleus during a gambling simulation in persons with a family history of alcoholism: studies from the Oklahoma Family Health Patterns Project.
Drug Alcohol Depend
. 2009 Feb;100(1-2):17–23.
37.
Lejoyeux M: Addictologie. in: Elsevier Health Sciences; 2013.
38.
Ihara H, Berrios GE, London M. Group and case study of the dysexecutive syndrome in alcoholism without amnesia.
J Neurol Neurosurg Psychiatry
. 2000 Jun;68(6):731–7.
© 2019 S. Karger AG, Basel
2019
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.