Clinical Usefulness of the Iowa Gambling Task in Severe Alcohol Use Disorders: Link with Relapse and Cognitive‐Physiological Deficits. (7th September 2018)

• Record Type: Journal Article
• Authors: Maurage, Pierre; Lannoy, Séverine; Dormal, Valérie; Blanco, Marine; Trabut, Jean‐Baptiste
• Is Part Of: Alcoholism. Volume 42:Number 11(2018)
• Page Start: 2266
• Page End: 2273
• Publication Date: 2018-09-07
• Subjects: Alcohol Dependence -- Decision Making -- Executive Functions -- Liver Dysfunction -- Cognitive Impairments; Alcoholism -- Periodicals; Alcoholism -- Periodicals; Alcoolisme; Electronic journals; Périodique électronique (Descripteur de forme); Ressource Internet (Descripteur de forme); 616.861005
• DOI: 10.1111/acer.13873
• Languages: English
• ISSNs: 0145-6008

Abstract

Abstract : Background: Decision‐making impairments have been repeatedly evaluated in severe alcohol use disorders (SAUD) using the Iowa Gambling Task (IGT). The IGT, capitalizing on strong theoretical background and ecological significance, allowed identifying large‐scale deficits in this population and is now a standard decision‐making assessment in therapeutic settings. However, the clinical usefulness of the IGT, particularly regarding its ability to predict relapse and its link with key cognitive‐physiological deficits, remains to be clarified. Methods: Thirty‐eight recently detoxified patients with SAUD and 38 matched healthy controls performed the IGT, a neuropsychological task using monetary rewards to assess decision making under uncertainty and under risk. Disease characteristics (e.g., duration and intensity), cognitive abilities, psychopathological comorbidities, and physiological damage were also measured, as well as relapse rates 6 months later. Results: Compared to controls, patients with SAUD presented a dissociation between preserved decision making under uncertainty and impaired decision making under risk. In the SAUD group, while relapsers (55% of the sample) presented lower global cognitive functioning and stronger liver damage than nonrelapsers at detoxification time, no difference was found between these subgroups for the IGT. IGT results were not related to alcohol‐consumption characteristics or cognitive‐physiological deficits. Conclusions: SAUD is not related to a global IGT deficit, as suggested earlier, but rather to a specific impairment for decision making under risk. This deficit is not associated with other disease‐related variables and has no relapse prediction power. These results question the clinical usefulness of the IGT as a tool identifying key treatment levers and guiding (neuro)psychological rehabilitation. Abstract : The Iowa Gambling Task (IGT) has been suggested as a promising relapse predictor in severe alcohol‐use disorders (SAUD). While confirming impaired IGT performance in SAUD, we show that: (1) No global IGT impairment is observed in SAUD, but rather a dissociation between impaired decision under risk and preserved decision under uncertainty; (2) IGT results are not related to other cognitive/physiological impairments; (3) IGT results have no predictive power on relapse. These results question the clinical usefulness of IGT.