Decision-making impairment appears greater in alcoholics with coexisting personality disorders

People make decisions all the time: they form preferences, take action, and evaluate outcomes, whether rewarding or aversive. Impaired decision making is regarded as one of the neurobehavioral hallmarks of addiction. New research has found that alcoholics with certain coexisting personality disorders (PDs) have decision-making abilities that are particularly impaired.

Results are published in the October issue of Alcoholism: Clinical & Experimental Research.

"Normally, we make choices by weighing immediate benefits of different options relative to possible negative consequences in the longer term," said Geert Dom, head of treatment at the Alexian Brothers Psychiatric Centre in Boechout, Belgium. "When these abilities are impaired, people are less able to cognitively evaluate the longer-term consequences of their choices. This is reflected in real life by choices that are socially inadequate and/or related to overtly negative outcomes. Substance or polydrug use/abuse is one example."

On a neuronal level, added Dom, decision making is believed to involve multiple brain structures in the limbic region. "These brain regions are very important in the processing of emotions, motivational processes and the processing of rewards and punishments," he said. "Earlier studies have indicated that individuals with lesions in these regions lose the ability to make advantageous decisions, reflected by severe social behavioral problems and impaired performance on decision-making tasks such as the Iowa Gambling Task, which was originally designed to study decision-making in neurological patients with brain lesions."

For this study, researchers also utilized the Iowa Gambling Task among two groups: "controls" with no substance-abuse issues (n=53); and abstinent alcoholics divided into three subgroups, those without any PD (n=38), those with a cluster A or C PD (n=19), and those with certain cluster B Antisocial and Borderline


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