Risky Decision-Making but Not Delay Discounting Improves during Inpatient Treatment of Polysubstance Dependent Alcoholics

Abstract

Background: High levels of impulsivity, characteristics of addicted patients, are known to be important predictors of relapse. However, so far, little is known about the stability or variability of two main components of impulsivity (delay discounting and decision-making). The present study examined the changes in impulsivity during the first week of an abstinence based, behavioral orientated inpatient treatment program.

Method: Thirty-seven polysubstance dependent alcoholics completed the Delay Discounting Task (DDT), and the Iowa Gambling Task (IGT) using the original version with decks A'B'C'D', and an alternative version with decks K'L'M'N', for measuring decision-making, after 2 and 6 weeks of active treatment.

Results: It was found that performances on the IGT changed during treatment while performances on the DDT did not (test-retest period: 4 weeks).

Conclusion: The results provide preliminary evidence that improvements in decision-making might be related to treatment effects. All patients followed a highly structured cognitive-behavioral treatment program, which might have enhanced their executive functioning (coping skills training).

Keywords: Iowa gambling task; impulsivity; polysubstance dependence; risky decision-making; treatment effects.

Figure 1

Flow chart. Addict: substance use measures (European Addiction Severity Index) – Memory (Rey Auditory Verbal Learning Test) – Intellect (Raven Progressive Matrices) – Neurocogn: neurocognitive measures (Iowa Gambling Task – Delay Discounting Task) – Imp pers: impulsive personality (Barratt Impulsiveness Scale – Sensitivity to Punishment and Sensitivity to Reward Questionnaires). PSA, polysubstance dependent alcoholics.

Figure 2

Test and retest of the Iowa Gambling Task (PSA,n = 37).