We demonstrated that alcohol-dependent patients who relapsed within 1 year after detoxification showed stronger PIT effects compared with abstainers and controls. Relapsers particularly failed to correctly perform in trials where an instrumental stimulus required inhibition while a Pavlovian background cue indicated a monetary gain. Under that condition, relapsers approached the instrumental stimulus, independent of the expected punishment. The failure of inhibiting an aversive stimulus in favor of approaching an appetitive context cue reflects dysfunctional altered learning mechanisms in relapsers.
Pavlovian conditioned cues (CSs) can drive instrumental behavior in alcohol-dependent patients. However, it remains unclear if the influence of Pavlovian CSs might also promote maladaptive decisions that can increase the risk of relapse. We studied 109 abstinent alcohol-dependent patients and 93 controls who completed a Pavlovian-to-instrumental transfer (PIT) paradigm, and assessed patients' subsequent relapse status during a 1-year follow-up. In our PIT task, participants had to collect “good shells” (instrumental approach) or leave “bad shells” (instrumental inhibition) during the presence of money-related Pavlovian CSs or drink-related pictures in the background. Pavlovian CSs indicated either a monetary gain (ie, 1€, 2€), a monetary loss (ie, -1€, −2€) or a neutral stimulus (0€). Drink-related background pictures were either pictures of participants' favorite alcoholic drink or pictures of water. We found that the influence of money-related Pavlovian CSs on instrumental behavior (ie, the PIT effect) was more pronounced in future relapsers compared with abstainers and controls. Relapsers particularly failed to correctly perform in trials where the instrumental stimulus required inhibition while a Pavlovian background CS indicated a monetary gain. Under that condition, relapsers approached the instrumental stimulus, independent of the expected punishment. In contrast, we found no difference in PIT between relapsers and abstainers when drink-related background pictures were presented. The failure of inhibiting an aversive stimulus in favor of approaching an appetitive non-alcohol-related context cue might reflect dysfunctional altered learning mechanisms in relapsers. A possible relation to maladaptive decision making that can lead to high-risk situations for relapse is discussed.
Keywords: alcohol dependence; human Pavlovian-to-instrumental transfer; relapse.
© 2018 Society for the Study of Addiction.