Decision-making measured by the Iowa Gambling Task in patients with alcohol use disorders choosing harm reduction versus relapse prevention program (2019)

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.