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Dysfunctional approach behavior triggered by alcohol-unrelated Pavlovian cues predicts long-term relapse in alcohol dependence.

  • Sommer, Christian1
  • Birkenstock, Julian1
  • Garbusow, Maria2
  • Obst, Elisabeth1
  • Schad, Daniel J3
  • Bernhardt, Nadine1
  • Huys, Quentin M4, 5
  • Wurst, Friedrich M6, 7
  • Weinmann, Wolfgang8
  • Heinz, Andreas2
  • Smolka, Michael N1
  • Zimmermann, Ulrich S1, 9
  • 1 Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Germany. , (Germany)
  • 2 Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Campus Mitte, Germany. , (Germany)
  • 3 Department of Cognitive Science, University of Potsdam, Germany. , (Germany)
  • 4 Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry, University of Zürich, Switzerland. , (Switzerland)
  • 5 Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zürich and ETH Zürich, Switzerland. , (Switzerland)
  • 6 Psychiatry Department, Psychiatric University Hospital Basel, Switzerland. , (Switzerland)
  • 7 Center for Interdisciplinary Addiction Research, University of Hamburg, Germany. , (Germany)
  • 8 Institute of Forensic Medicine, Forensic Toxicology and Chemistry, University of Bern, Switzerland. , (Switzerland)
  • 9 Department of Addiction Medicine and Psychotherapy, kbo Isar-Amper-Klinikum, Munich, Germany. , (Germany)
Published Article
Addiction Biology
Wiley (Blackwell Publishing)
Publication Date
Jan 01, 2020
DOI: 10.1111/adb.12703
PMID: 30561790


Pavlovian conditioned cues (CSs) can drive instrumental behavior in alcohol-dependent patients. However, it remains unclear if the influence of Pavlovian CSs might also promote maladaptive decisions that can increase the risk of relapse. We studied 109 abstinent alcohol-dependent patients and 93 controls who completed a Pavlovian-to-instrumental transfer (PIT) paradigm, and assessed patients' subsequent relapse status during a 1-year follow-up. In our PIT task, participants had to collect “good shells” (instrumental approach) or leave “bad shells” (instrumental inhibition) during the presence of money-related Pavlovian CSs or drink-related pictures in the background. Pavlovian CSs indicated either a monetary gain (ie, 1€, 2€), a monetary loss (ie, -1€, −2€) or a neutral stimulus (0€). Drink-related background pictures were either pictures of participants' favorite alcoholic drink or pictures of water. We found that the influence of money-related Pavlovian CSs on instrumental behavior (ie, the PIT effect) was more pronounced in future relapsers compared with abstainers and controls. Relapsers particularly failed to correctly perform in trials where the instrumental stimulus required inhibition while a Pavlovian background CS indicated a monetary gain. Under that condition, relapsers approached the instrumental stimulus, independent of the expected punishment. In contrast, we found no difference in PIT between relapsers and abstainers when drink-related background pictures were presented. The failure of inhibiting an aversive stimulus in favor of approaching an appetitive non-alcohol-related context cue might reflect dysfunctional altered learning mechanisms in relapsers. A possible relation to maladaptive decision making that can lead to high-risk situations for relapse is discussed.

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