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  When habits are dangerous: Alcohol expectancies and habitual decision making predict relapse in alcohol dependence

Sebold, M., Nebe, S., Garbusow, M., Guggenmos, M., Schad, D. J., Beck, A., et al. (2017). When habits are dangerous: Alcohol expectancies and habitual decision making predict relapse in alcohol dependence. Biological Psychiatry, 82(11), 847-856. doi:10.1016/j.biopsych.2017.04.019.

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Sebold, Miriam1, 2, Author
Nebe, Stephan3, 4, Author
Garbusow, Maria1, Author
Guggenmos, Matthias1, Author
Schad, Daniel J.2, Author
Beck, Anne1, Author
Kuitunen-Paul, Soeren5, Author
Sommer, Christian3, Author
Frank, Robin1, Author
Neu, Peter6, Author
Zimmermann, Ulrich S.3, Author
Rapp, Michael A.2, Author
Smolka, Michael N.3, 4, Author
Huys, Quentin J. M.7, 8, Author
Schlagenhauf, Florian1, 9, Author           
Heinz, Andreas1, Author
1Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Germany, ou_persistent22              
2Department of Social and Preventive Medicine, University of Potsdam, Germany, ou_persistent22              
3Department of Psychiatry and Psychotherapy, TU Dresden, Germany, ou_persistent22              
4Neuroimaging Center, TU Dresden, Germany, ou_persistent22              
5Institute of Clinical Psychology and Psychotherapy, TU Dresden, Germany, ou_persistent22              
6Jüdisches Krankenhaus Berlin, Germany, ou_persistent22              
7Institute for Biomedical Engineering, University of Zurich, Switzerland, ou_persistent22              
8Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital Zurich, Switzerland, ou_persistent22              
9Department Neurology, MPI for Human Cognitive and Brain Sciences, Max Planck Society, ou_634549              


Free keywords: Alcohol dependence; Alcohol expectancy; Goal-directed control; Medial prefrontal cortex; Reinforcement learning; Treatment outcome
 Abstract: Background

Addiction is supposedly characterized by a shift from goal-directed to habitual decision making, thus facilitating automatic drug intake. The two-step task allows distinguishing between these mechanisms by computationally modeling goal-directed and habitual behavior as model-based and model-free control. In addicted patients, decision making may also strongly depend upon drug-associated expectations. Therefore, we investigated model-based versus model-free decision making and its neural correlates as well as alcohol expectancies in alcohol-dependent patients and healthy controls and assessed treatment outcome in patients.

Ninety detoxified, medication-free, alcohol-dependent patients and 96 age- and gender-matched control subjects underwent functional magnetic resonance imaging during the two-step task. Alcohol expectancies were measured with the Alcohol Expectancy Questionnaire. Over a follow-up period of 48 weeks, 37 patients remained abstinent and 53 patients relapsed as indicated by the Alcohol Timeline Followback method.

Patients who relapsed displayed reduced medial prefrontal cortex activation during model-based decision making. Furthermore, high alcohol expectancies were associated with low model-based control in relapsers, while the opposite was observed in abstainers and healthy control subjects. However, reduced model-based control per se was not associated with subsequent relapse.

These findings suggest that poor treatment outcome in alcohol dependence does not simply result from a shift from model-based to model-free control but is instead dependent on the interaction between high drug expectancies and low model-based decision making. Reduced model-based medial prefrontal cortex signatures in those who relapse point to a neural correlate of relapse risk. These observations suggest that therapeutic interventions should target subjective alcohol expectancies.


Language(s): eng - English
 Dates: 2017-04-212016-12-242017-04-292017-05-222017-12-01
 Publication Status: Published in print
 Pages: -
 Publishing info: -
 Table of Contents: -
 Rev. Type: Peer
 Identifiers: DOI: 10.1016/j.biopsych.2017.04.019
PMID: 28673442
Other: Epub 2017
 Degree: -



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Project information

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Project name : Lern- und Gewöhnungsprozesse als Prädiktoren für die Entwicklung und Aufrechterhaltung alkoholbezogener Störungen / FOR 1617
Grant ID : HE2597/14-1 ; HE2597/14-2 ; RA1047/2-1 ; RA1047/2-2 ; SM 80/7-1 ; SM 80/7-2 ; ZI1119/3-1 ; ZI1119/3-2
Funding program : -
Funding organization : German Research Foundation (DFG)

Source 1

Title: Biological Psychiatry
  Other : Biol. Psychiatry
Source Genre: Journal
Publ. Info: New York : Elsevier
Pages: - Volume / Issue: 82 (11) Sequence Number: - Start / End Page: 847 - 856 Identifier: ISSN: 0006-3223
CoNE: https://pure.mpg.de/cone/journals/resource/954925384111