Abnormal cue reactivity is a central characteristic of addiction, associated with increased activ... more Abnormal cue reactivity is a central characteristic of addiction, associated with increased activity in motivation, attention and memory related brain circuits. In this neuroimaging study, cue reactivity in problem gamblers (PRG) was compared with cue reactivity in heavy smokers (HSM) and healthy controls (HC). A functional magnetic resonance imaging event-related cue reactivity paradigm, consisting of gambling, smoking-related and neutral pictures,
Little is known about the incremental effects of medically assisted detoxification on outpatient ... more Little is known about the incremental effects of medically assisted detoxification on outpatient treatment for alcohol use disorders. The objective of this study was to compare drinking outcomes in a psychosocial treatment program between two groups of heavy drinking patients who had an alcohol use disorder: (a) one group with initial medically assisted detoxification and (b) a second group without initial medically assisted detoxification. Analyses were conducted on 262 patients with a more severe alcohol use disorder who completed both an intake assessment and a 9-month follow-up assessment. The effect of medically assisted detoxification was determined using logistic regression analysis with a propensity score to control for possible baseline differences between the two groups. Of the 262 patients, 82 (31.3%) received medically assisted detoxification. These patients were more likely to abstain from alcohol than those without medically assisted detoxification. Abstinence rates in...
Impulsivity is a core characteristic of pathological gambling (PG), even though the underlying st... more Impulsivity is a core characteristic of pathological gambling (PG), even though the underlying structure and disorder specificity is unclear. This study aimed to explore different dimensions of impulsivity in a clinical sample including PG. Furthermore, we aimed to test which alterations of the impulsivity-related dimensions are disorder specific for PG. Participants were individuals diagnosed with PG (n=51) and two groups also characterized by various impulsive behaviors: an alcohol dependence (AD; n=45) and a Gilles de la Tourette syndrome (GTS; n=49) group. A healthy control (HC; n=53) group was recruited as comparison group. A comprehensive assessment was used including impulsivity-related and antipodal parameters of the Stop Signal Task, Stroop Task, Tower of London Task, Card Playing Task, Iowa Gambling Task and the Barratt Impulsiveness Scale-11. Principal axis factor analysis revealed four impulsivity-related dimensions that were labeled 'self-reported impulsivity', ...
Individuals with alcohol dependence are known to make disadvantageous decisions, possibly caused ... more Individuals with alcohol dependence are known to make disadvantageous decisions, possibly caused by alterations in either reward or punishment sensitivity, which lead to persistent alcohol use despite its adverse consequences. Previous studies in alcohol dependence have mainly focused on reward anticipation processing and results from these studies are mixed. To clarify the nature of the motivational deficit that underlies disadvantageous choice in alcohol dependence, the current study sought to characterize the neural representation of expected value in individuals with alcohol dependence, separating expectancy-related processing of gains and losses, as a function of outcome magnitude and outcome probability. Functional MRI was used to examine brain responses during the expectation of gains and losses in patients with alcohol dependence (n=19) and healthy controls (n=19). The task manipulated outcome magnitude (€1 and €5) and outcome probability (30% and 70%). Compared to healthy controls, patients with alcohol dependence were more responsive to the expectancy of large wins, in the caudate and putamen. This effect was driven by a higher caudate activity in the contrast comparing €5 vs. €1 trials in patients with alcohol dependence. There were no group differences in the responses to the expectancy for loss. The patient group reported lower expectancies of winning in the trial-by-trial ratings. Patients with alcohol dependence showed caudate hyperactivity when expecting wins. The result contrasts with past work using the monetary incentive delay task, showing caudate hypoactivity; the passive nature of our task contrasts with an active response requirement in the MIDT studies.
This article reviews the neuroimaging research on pathological gambling (PG). Because of the simi... more This article reviews the neuroimaging research on pathological gambling (PG). Because of the similarities between substance dependence and PG, PG research has used paradigms similar to those used in substance use disorder research, focusing on reward and punishment sensitivity, cue reactivity, impulsivity, and decision making. This review shows that PG is consistently associated with blunted mesolimbic-prefrontal cortex activation to nonspecific rewards, whereas these areas show increased activation when exposed to gambling-related stimuli in cue exposure paradigms. Very little is known, and hence more research is needed regarding the neural underpinnings of impulsivity and decision making in PG. This review concludes with a discussion regarding the challenges and new developments in the field of neurobiological gambling research and comments on their implications for the treatment of PG.
Decision making deficits play an important role in the definition of pathological gambling (PG). ... more Decision making deficits play an important role in the definition of pathological gambling (PG). However, only few empirical studies are available regarding decision making processes in PG. This study therefore compares decision making processes in PG and normal controls in detail using three decision making tasks examining general performance levels on these tasks as well as feedback processing using reaction time analyses. To investigate the specificity of decision making deficits in PG, a substance dependence group (alcohol dependence; AD) and an impulse control disordered group (Tourette syndrome; TS) were included. The PG group (n = 48), AD group (n = 46), TS group (n = 47), and a normal control (NC) group (n = 49) were administered (1) the Iowa Gambling Task (IGT), an ecologically valid gambling task; (2) the Card Playing Task, a task measuring perseveration for reward; and (3) a Go/No-Go discrimination task, a task measuring reward and response cost sensitivity. The PG group ...
Recent theories hypothesize that the impulsivity observed in addictive behaviors is a two-factor ... more Recent theories hypothesize that the impulsivity observed in addictive behaviors is a two-factor construct, consisting of Rash Impulsiveness and Reward Sensitivity. There is some evidence for this distinction, but it is unknown what the clinical relevance of this distinction is. The present study examines the predictive value of the two-factor model regarding drop-out from treatment and relapse into substance use in a clinical population of male substance dependent patients. Both behavioral and self-report measures of Rash Impulsiveness and Reward Sensitivity were measured during treatment while substance use relapse was measured after 90days. Results indicate that treatment drop-out could be predicted by a behavioral index of Reward Sensitivity (Card Playing Task); self-reported Rash Impulsiveness only approached significance as predictor drop-out. In contrast, relapse could not be predicted in the present study. These findings might have implications for the early identification a...
One hallmark of gambling disorder (GD) is the observation that gamblers have problems stopping th... more One hallmark of gambling disorder (GD) is the observation that gamblers have problems stopping their gambling behavior once it is initiated. On a neuropsychological level, it has been hypothesized that this is the result of a cognitive inflexibility. The present study investigated cognitive inflexibility in patients with GD using a task involving cognitive inflexibility with a reward element (i.e., reversal learning) and a task measuring general cognitive inflexibility without such a component (i.e., response perseveration). For this purpose, scores of a reward-based reversal learning task (probabilistic reversal learning task) and the Wisconsin card sorting task were compared between a group of treatment seeking patients with GD and a gender and age matched control group. The results show that pathological gamblers have impaired performance on the neurocognitive task measuring reward-based cognitive inflexibility. However, no difference between the groups is observed regarding non-...
Recent studies consistently indicate high rates of delay discounting in drug users, which refers ... more Recent studies consistently indicate high rates of delay discounting in drug users, which refers to a strong tendency to devaluate delayed rewards. Many addiction treatment programs however, place high demands on the ability to postpone immediate gratification. Therefore, these programs may be particularly challenging for drug users who are disproportionally oriented towards the present, potentially leading to a drop in their treatment involvement. Still, few studies to date have looked at whether delay discounting in drug users is associated with poorer treatment motivation or shorter treatment retention (i.e., the length of stay in treatment). In the current study, we examined whether delay discounting, as measured shortly following treatment entry, was predictive of poor treatment retention among 84 substance-dependent individuals (SDI) attending an inpatient detoxification program. In addition, we examined whether motivation for treatment would act as a mediator of this relationship. Delay discounting was predictive of shorter treatment retention and higher odds of dropping out of treatment prematurely. The effects of delay discounting on treatment retention were partially mediated by a subcomponent of treatment motivation, i.e., treatment readiness. The propensity to more steeply discount delayed rewards in drug users has the potential to become a clinically relevant behavioral marker, alerting clinicians that these clients may exhibit lower treatment readiness and are more likely to drop out of treatment prematurely. Targeting delay discounting or increasing treatment readiness in drug users with a low tolerance for delay-of-gratification may help to improve treatment retention among these individuals.
Journal of psychopharmacology (Oxford, England), Jan 13, 2015
The opioid receptor antagonist naltrexone is successfully used in the treatment of opioid and alc... more The opioid receptor antagonist naltrexone is successfully used in the treatment of opioid and alcohol dependence. However, questions have been raised about possible anhedonic side effects, because the opioid system is directly involved in hedonic responses to natural rewarding activities, possibly due to its indirect effects on the striatal dopamine transporter (DAT). In order to test this hypothesis, 30 rats were randomized to either a 10-day treatment with 3 mg/kg short-acting naltrexone or vehicle. No significant differences between the groups were found in striatal DAT availability, cumulative food intake (for 48 or 72 h), body weight gain and abdominal fatpad weight. Thus, the results of this study suggest that (sub)chronic treatment with short-acting naltrexone does not induce possible anhedonic effects. However, it cannot be ruled out the anhedonic effect of naltrexone is only short-lived and thus not detected in the current study. Therefore, future studies are needed to stud...
Most studies investigating the role of personality as a risk factor for the development of opioid... more Most studies investigating the role of personality as a risk factor for the development of opioid dependence compare dependent opioid users with healthy controls who never used heroin. In order to understand the potential protective role of personality, it is crucial to compare illicit opioid users who never became dependent with dependent opioid users. This study aims to examine the role of personality as a risk factor for opioid use and as a protective factor for the development of opioid dependence. Comparing personality factors between three groups: (1) 161 never-dependent illicit opioid users who have been using illicit opioids but never became opioid dependent; (2) 402 dependent opioid users in methadone maintenance treatment or heroin-assisted treatment; and (3) 135 healthy controls who never used heroin. Personality was assessed with a short version of Cloninger's Temperament and Character Inventory. Never-dependent opioid users reported more Novelty Seeking and Harm Avoidance and less Self-Directedness and Cooperativeness than healthy controls and more Reward Dependence and Self-Directedness, and less Harm Avoidance than dependent opioid users. Furthermore, never-dependent opioid users reported more Self-Transcendence than both dependent opioid users and healthy controls. Never-dependent opioid users may have started to use opioids partly due to their tendency to seek novel and/or spiritual experiences (high Novelty Seeking, high Self-Transcendence) and their tendency to avoid aversive stimuli (high Harm Avoidance), whereas they may have been protected against the development of dependence by their need for social approval (high Reward Dependence) and their self-efficacy (high Self-Directedness).
Human studies on the relation between testosterone levels and risk-taking behaviour are scarce. R... more Human studies on the relation between testosterone levels and risk-taking behaviour are scarce. Related functions, like aggression, have been related to higher testosterone levels more consistently, especially in the animal literature. Estradiol affects several neurotransmitter systems that play a role in behaviour regulation. Existing human studies on neurocognitive functions and testosterone levels have largely ignored the interrelatedness of testosterone levels and estradiol levels. Therefore, in this study, the effects of a 1-week combined testosterone and estradiol intervention on risk-taking behaviours were investigated. Twenty-one healthy men, with a normal body mass index, were treated for 7 days with an aromatase inhibitor (letrozole 2.5 mg), resulting in high-normal levels of testosterone and low-normal levels of estradiol, or with a combination of an aromatase inhibitor and estradiol (75 μg/24 h), resulting in low-normal levels of testosterone and high-normal levels of estradiol. A randomized experimenter and participant-blind controlled design was applied. Neurocognitive measures of risk-taking and reward and punishment sensitivity were assessed before starting with the medication and after 7 days of drug administration: Balloon Analogue Risk Task (BART), Game of Dice Task (GDT), and Iowa Gambling Task (IGT). A group by time effect was present for the BART, indicating that the high-normal testosterone group showed an increase in risk-taking on the BART, from the first drug-naive BART performance, to the second BART performance (aromatase inhibitor), whereas such an increase was not present in the low-normal testosterone/high estradiol group. No group by time interactions were present in GDT or IGT performance. These results implicate that testosterone levels in healthy men are associated with increased risk-taking under conditions of unknown probabilities, but not in conditions of known probabilities (GDT) or of strategic decision making (IGT).
Abnormal cue reactivity is a central characteristic of addiction, associated with increased activ... more Abnormal cue reactivity is a central characteristic of addiction, associated with increased activity in motivation, attention and memory related brain circuits. In this neuroimaging study, cue reactivity in problem gamblers (PRG) was compared with cue reactivity in heavy smokers (HSM) and healthy controls (HC). A functional magnetic resonance imaging event-related cue reactivity paradigm, consisting of gambling, smoking-related and neutral pictures,
Little is known about the incremental effects of medically assisted detoxification on outpatient ... more Little is known about the incremental effects of medically assisted detoxification on outpatient treatment for alcohol use disorders. The objective of this study was to compare drinking outcomes in a psychosocial treatment program between two groups of heavy drinking patients who had an alcohol use disorder: (a) one group with initial medically assisted detoxification and (b) a second group without initial medically assisted detoxification. Analyses were conducted on 262 patients with a more severe alcohol use disorder who completed both an intake assessment and a 9-month follow-up assessment. The effect of medically assisted detoxification was determined using logistic regression analysis with a propensity score to control for possible baseline differences between the two groups. Of the 262 patients, 82 (31.3%) received medically assisted detoxification. These patients were more likely to abstain from alcohol than those without medically assisted detoxification. Abstinence rates in...
Impulsivity is a core characteristic of pathological gambling (PG), even though the underlying st... more Impulsivity is a core characteristic of pathological gambling (PG), even though the underlying structure and disorder specificity is unclear. This study aimed to explore different dimensions of impulsivity in a clinical sample including PG. Furthermore, we aimed to test which alterations of the impulsivity-related dimensions are disorder specific for PG. Participants were individuals diagnosed with PG (n=51) and two groups also characterized by various impulsive behaviors: an alcohol dependence (AD; n=45) and a Gilles de la Tourette syndrome (GTS; n=49) group. A healthy control (HC; n=53) group was recruited as comparison group. A comprehensive assessment was used including impulsivity-related and antipodal parameters of the Stop Signal Task, Stroop Task, Tower of London Task, Card Playing Task, Iowa Gambling Task and the Barratt Impulsiveness Scale-11. Principal axis factor analysis revealed four impulsivity-related dimensions that were labeled 'self-reported impulsivity', ...
Individuals with alcohol dependence are known to make disadvantageous decisions, possibly caused ... more Individuals with alcohol dependence are known to make disadvantageous decisions, possibly caused by alterations in either reward or punishment sensitivity, which lead to persistent alcohol use despite its adverse consequences. Previous studies in alcohol dependence have mainly focused on reward anticipation processing and results from these studies are mixed. To clarify the nature of the motivational deficit that underlies disadvantageous choice in alcohol dependence, the current study sought to characterize the neural representation of expected value in individuals with alcohol dependence, separating expectancy-related processing of gains and losses, as a function of outcome magnitude and outcome probability. Functional MRI was used to examine brain responses during the expectation of gains and losses in patients with alcohol dependence (n=19) and healthy controls (n=19). The task manipulated outcome magnitude (€1 and €5) and outcome probability (30% and 70%). Compared to healthy controls, patients with alcohol dependence were more responsive to the expectancy of large wins, in the caudate and putamen. This effect was driven by a higher caudate activity in the contrast comparing €5 vs. €1 trials in patients with alcohol dependence. There were no group differences in the responses to the expectancy for loss. The patient group reported lower expectancies of winning in the trial-by-trial ratings. Patients with alcohol dependence showed caudate hyperactivity when expecting wins. The result contrasts with past work using the monetary incentive delay task, showing caudate hypoactivity; the passive nature of our task contrasts with an active response requirement in the MIDT studies.
This article reviews the neuroimaging research on pathological gambling (PG). Because of the simi... more This article reviews the neuroimaging research on pathological gambling (PG). Because of the similarities between substance dependence and PG, PG research has used paradigms similar to those used in substance use disorder research, focusing on reward and punishment sensitivity, cue reactivity, impulsivity, and decision making. This review shows that PG is consistently associated with blunted mesolimbic-prefrontal cortex activation to nonspecific rewards, whereas these areas show increased activation when exposed to gambling-related stimuli in cue exposure paradigms. Very little is known, and hence more research is needed regarding the neural underpinnings of impulsivity and decision making in PG. This review concludes with a discussion regarding the challenges and new developments in the field of neurobiological gambling research and comments on their implications for the treatment of PG.
Decision making deficits play an important role in the definition of pathological gambling (PG). ... more Decision making deficits play an important role in the definition of pathological gambling (PG). However, only few empirical studies are available regarding decision making processes in PG. This study therefore compares decision making processes in PG and normal controls in detail using three decision making tasks examining general performance levels on these tasks as well as feedback processing using reaction time analyses. To investigate the specificity of decision making deficits in PG, a substance dependence group (alcohol dependence; AD) and an impulse control disordered group (Tourette syndrome; TS) were included. The PG group (n = 48), AD group (n = 46), TS group (n = 47), and a normal control (NC) group (n = 49) were administered (1) the Iowa Gambling Task (IGT), an ecologically valid gambling task; (2) the Card Playing Task, a task measuring perseveration for reward; and (3) a Go/No-Go discrimination task, a task measuring reward and response cost sensitivity. The PG group ...
Recent theories hypothesize that the impulsivity observed in addictive behaviors is a two-factor ... more Recent theories hypothesize that the impulsivity observed in addictive behaviors is a two-factor construct, consisting of Rash Impulsiveness and Reward Sensitivity. There is some evidence for this distinction, but it is unknown what the clinical relevance of this distinction is. The present study examines the predictive value of the two-factor model regarding drop-out from treatment and relapse into substance use in a clinical population of male substance dependent patients. Both behavioral and self-report measures of Rash Impulsiveness and Reward Sensitivity were measured during treatment while substance use relapse was measured after 90days. Results indicate that treatment drop-out could be predicted by a behavioral index of Reward Sensitivity (Card Playing Task); self-reported Rash Impulsiveness only approached significance as predictor drop-out. In contrast, relapse could not be predicted in the present study. These findings might have implications for the early identification a...
One hallmark of gambling disorder (GD) is the observation that gamblers have problems stopping th... more One hallmark of gambling disorder (GD) is the observation that gamblers have problems stopping their gambling behavior once it is initiated. On a neuropsychological level, it has been hypothesized that this is the result of a cognitive inflexibility. The present study investigated cognitive inflexibility in patients with GD using a task involving cognitive inflexibility with a reward element (i.e., reversal learning) and a task measuring general cognitive inflexibility without such a component (i.e., response perseveration). For this purpose, scores of a reward-based reversal learning task (probabilistic reversal learning task) and the Wisconsin card sorting task were compared between a group of treatment seeking patients with GD and a gender and age matched control group. The results show that pathological gamblers have impaired performance on the neurocognitive task measuring reward-based cognitive inflexibility. However, no difference between the groups is observed regarding non-...
Recent studies consistently indicate high rates of delay discounting in drug users, which refers ... more Recent studies consistently indicate high rates of delay discounting in drug users, which refers to a strong tendency to devaluate delayed rewards. Many addiction treatment programs however, place high demands on the ability to postpone immediate gratification. Therefore, these programs may be particularly challenging for drug users who are disproportionally oriented towards the present, potentially leading to a drop in their treatment involvement. Still, few studies to date have looked at whether delay discounting in drug users is associated with poorer treatment motivation or shorter treatment retention (i.e., the length of stay in treatment). In the current study, we examined whether delay discounting, as measured shortly following treatment entry, was predictive of poor treatment retention among 84 substance-dependent individuals (SDI) attending an inpatient detoxification program. In addition, we examined whether motivation for treatment would act as a mediator of this relationship. Delay discounting was predictive of shorter treatment retention and higher odds of dropping out of treatment prematurely. The effects of delay discounting on treatment retention were partially mediated by a subcomponent of treatment motivation, i.e., treatment readiness. The propensity to more steeply discount delayed rewards in drug users has the potential to become a clinically relevant behavioral marker, alerting clinicians that these clients may exhibit lower treatment readiness and are more likely to drop out of treatment prematurely. Targeting delay discounting or increasing treatment readiness in drug users with a low tolerance for delay-of-gratification may help to improve treatment retention among these individuals.
Journal of psychopharmacology (Oxford, England), Jan 13, 2015
The opioid receptor antagonist naltrexone is successfully used in the treatment of opioid and alc... more The opioid receptor antagonist naltrexone is successfully used in the treatment of opioid and alcohol dependence. However, questions have been raised about possible anhedonic side effects, because the opioid system is directly involved in hedonic responses to natural rewarding activities, possibly due to its indirect effects on the striatal dopamine transporter (DAT). In order to test this hypothesis, 30 rats were randomized to either a 10-day treatment with 3 mg/kg short-acting naltrexone or vehicle. No significant differences between the groups were found in striatal DAT availability, cumulative food intake (for 48 or 72 h), body weight gain and abdominal fatpad weight. Thus, the results of this study suggest that (sub)chronic treatment with short-acting naltrexone does not induce possible anhedonic effects. However, it cannot be ruled out the anhedonic effect of naltrexone is only short-lived and thus not detected in the current study. Therefore, future studies are needed to stud...
Most studies investigating the role of personality as a risk factor for the development of opioid... more Most studies investigating the role of personality as a risk factor for the development of opioid dependence compare dependent opioid users with healthy controls who never used heroin. In order to understand the potential protective role of personality, it is crucial to compare illicit opioid users who never became dependent with dependent opioid users. This study aims to examine the role of personality as a risk factor for opioid use and as a protective factor for the development of opioid dependence. Comparing personality factors between three groups: (1) 161 never-dependent illicit opioid users who have been using illicit opioids but never became opioid dependent; (2) 402 dependent opioid users in methadone maintenance treatment or heroin-assisted treatment; and (3) 135 healthy controls who never used heroin. Personality was assessed with a short version of Cloninger's Temperament and Character Inventory. Never-dependent opioid users reported more Novelty Seeking and Harm Avoidance and less Self-Directedness and Cooperativeness than healthy controls and more Reward Dependence and Self-Directedness, and less Harm Avoidance than dependent opioid users. Furthermore, never-dependent opioid users reported more Self-Transcendence than both dependent opioid users and healthy controls. Never-dependent opioid users may have started to use opioids partly due to their tendency to seek novel and/or spiritual experiences (high Novelty Seeking, high Self-Transcendence) and their tendency to avoid aversive stimuli (high Harm Avoidance), whereas they may have been protected against the development of dependence by their need for social approval (high Reward Dependence) and their self-efficacy (high Self-Directedness).
Human studies on the relation between testosterone levels and risk-taking behaviour are scarce. R... more Human studies on the relation between testosterone levels and risk-taking behaviour are scarce. Related functions, like aggression, have been related to higher testosterone levels more consistently, especially in the animal literature. Estradiol affects several neurotransmitter systems that play a role in behaviour regulation. Existing human studies on neurocognitive functions and testosterone levels have largely ignored the interrelatedness of testosterone levels and estradiol levels. Therefore, in this study, the effects of a 1-week combined testosterone and estradiol intervention on risk-taking behaviours were investigated. Twenty-one healthy men, with a normal body mass index, were treated for 7 days with an aromatase inhibitor (letrozole 2.5 mg), resulting in high-normal levels of testosterone and low-normal levels of estradiol, or with a combination of an aromatase inhibitor and estradiol (75 μg/24 h), resulting in low-normal levels of testosterone and high-normal levels of estradiol. A randomized experimenter and participant-blind controlled design was applied. Neurocognitive measures of risk-taking and reward and punishment sensitivity were assessed before starting with the medication and after 7 days of drug administration: Balloon Analogue Risk Task (BART), Game of Dice Task (GDT), and Iowa Gambling Task (IGT). A group by time effect was present for the BART, indicating that the high-normal testosterone group showed an increase in risk-taking on the BART, from the first drug-naive BART performance, to the second BART performance (aromatase inhibitor), whereas such an increase was not present in the low-normal testosterone/high estradiol group. No group by time interactions were present in GDT or IGT performance. These results implicate that testosterone levels in healthy men are associated with increased risk-taking under conditions of unknown probabilities, but not in conditions of known probabilities (GDT) or of strategic decision making (IGT).
Uploads
Papers by Anna Goudriaan