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      Different aspects of impulsivity in chronic alcohol use disorder with and without comorbid problem gambling

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          Abstract

          Background and aims

          Alcohol use disorder (AUD) and problem gambling are highly comorbid disorders. This study aims to explore the role of four aspects of impulsivity (trait concept of impulsivity, choice impulsivity, impulsive aggression and response inhibition/decision-making) in long-term chronic AUD patients with and without problem or pathological gambling symptoms.

          Methods

          Cognitively intact chronic AUD patients were enrolled with (n = 32) and without (n = 71) problem gambling symptoms in an inpatient clinic for chronic alcohol users. Multiple facets of impulsivity, cognitive ability, psychopathological symptoms, alcohol and gambling severity were measured.

          Results

          Chronic AUD patients with gambling disorder symptoms showed longer lifetime alcohol consumption, more severe alcohol use and higher psychopathological symptom severity than AUD patients without gambling symptoms. Gambling severity correlated with overall trait impulsivity, but not with choice impulsivity, impulsive aggression or cognitive impulsivity with controlling for lifetime alcohol consumption, lifetime alcohol use and psychopathological symptom severity. High trait impulsivity and non-planning was associated with comorbid gambling symptoms in AUD patients, which was independent of the level of intelligence, age and psychopathological symptoms.

          Conclusion

          Comorbid gambling disorder symptoms in chronic AUD was connected to more severe alcohol-related variables. Higher trait impulsivity was also linked with gambling disorder symptoms in patients with chronic AUD. This accents the need of special focus on comorbid GD symptoms in AUD, since prognosis and treatment for them may vary.

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          Most cited references85

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          Deciding advantageously before knowing the advantageous strategy.

          Deciding advantageously in a complex situation is thought to require overt reasoning on declarative knowledge, namely, on facts pertaining to premises, options for action, and outcomes of actions that embody the pertinent previous experience. An alternative possibility was investigated: that overt reasoning is preceded by a nonconscious biasing step that uses neural systems other than those that support declarative knowledge. Normal participants and patients with prefrontal damage and decision-making defects performed a gambling task in which behavioral, psychophysiological, and self-account measures were obtained in parallel. Normals began to choose advantageously before they realized which strategy worked best, whereas prefrontal patients continued to choose disadvantageously even after they knew the correct strategy. Moreover, normals began to generate anticipatory skin conductance responses (SCRs) whenever they pondered a choice that turned out to be risky, before they knew explicitly that it was a risky choice, whereas patients never developed anticipatory SCRs, although some eventually realized which choices were risky. The results suggest that, in normal individuals, nonconscious biases guide behavior before conscious knowledge does. Without the help of such biases, overt knowledge may be insufficient to ensure advantageous behavior.
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            Specious reward: a behavioral theory of impulsiveness and impulse control.

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              Psychiatric Aspects of Impulsivity

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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: SoftwareRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: InvestigationRole: MethodologyRole: SupervisionRole: Writing – review & editing
                Role: ConceptualizationRole: MethodologyRole: Project administrationRole: SupervisionRole: Writing – review & editing
                Role: ConceptualizationRole: Formal analysisRole: MethodologyRole: SupervisionRole: Writing – original draftRole: Writing – review & editing
                Role: Formal analysisRole: MethodologyRole: Project administrationRole: SupervisionRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Project administrationRole: SupervisionRole: Writing – original draftRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                30 January 2020
                2020
                : 15
                : 1
                : e0227645
                Affiliations
                [1 ] Department of Psychiatry, Faculty of Medicine, University of Szeged, Szeged, Hungary
                [2 ] Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
                [3 ] Institute für Psychologie, Humboldt-Universität zu Berlin, Berlin, Germany
                University of Auckland, NEW ZEALAND
                Author notes

                Competing Interests: NO authors have competing interests.

                Author information
                http://orcid.org/0000-0003-4215-8351
                Article
                PONE-D-19-23925
                10.1371/journal.pone.0227645
                6992191
                31999707
                74366a21-f938-4834-8b75-d7863a97650b
                © 2020 Kovács et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 24 August 2019
                : 23 December 2019
                Page count
                Figures: 2, Tables: 1, Pages: 17
                Funding
                The authors received no specific funding for this work.
                Categories
                Research Article
                Biology and Life Sciences
                Psychology
                Personality
                Personality Traits
                Impulsivity
                Social Sciences
                Psychology
                Personality
                Personality Traits
                Impulsivity
                Biology and Life Sciences
                Nutrition
                Diet
                Alcohol Consumption
                Medicine and Health Sciences
                Nutrition
                Diet
                Alcohol Consumption
                Biology and Life Sciences
                Neuroscience
                Cognitive Science
                Cognitive Psychology
                Decision Making
                Biology and Life Sciences
                Psychology
                Cognitive Psychology
                Decision Making
                Social Sciences
                Psychology
                Cognitive Psychology
                Decision Making
                Biology and Life Sciences
                Neuroscience
                Cognitive Science
                Cognition
                Decision Making
                Biology and Life Sciences
                Psychology
                Addiction
                Gambling Addiction
                Social Sciences
                Psychology
                Addiction
                Gambling Addiction
                Medicine and Health Sciences
                Mental Health and Psychiatry
                Gambling Addiction
                Biology and Life Sciences
                Psychology
                Behavior
                Aggression
                Social Sciences
                Psychology
                Behavior
                Aggression
                Biology and Life Sciences
                Psychology
                Addiction
                Alcoholism
                Social Sciences
                Psychology
                Addiction
                Alcoholism
                Medicine and Health Sciences
                Mental Health and Psychiatry
                Substance-Related Disorders
                Alcoholism
                Medicine and Health Sciences
                Public and Occupational Health
                Substance-Related Disorders
                Alcoholism
                Biology and Life Sciences
                Psychology
                Behavior
                Recreation
                Gambling
                Social Sciences
                Psychology
                Behavior
                Recreation
                Gambling
                Medicine and Health Sciences
                Health Care
                Patients
                Custom metadata
                The data underlying the results presented in the study are available from https://dx.doi.org/10.6084/m9.figshare.11473296

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