Decision-making deficits in alcohol-dependent patients with and without comorbid personality disorder.
BACKGROUND
Impairments in decision making are a consistent finding in substance use disorder (SUD) populations. However, decision-making deficits are not specific for SUDs and are also reported in the context of other psychiatric disorders such as antisocial and borderline personality disorders (PDs). Given the frequent comorbidity between SUD and cluster B PD, it might be questioned whether the decision-making impairments typically reported in SUD populations reflect the addictive disorder, the cluster B PD, or a combination of the 2.


METHODS
In the current study, we compare the decision-making performance of non-substance-abusing controls (n=53) on the Iowa Gambling Task (IGT) with the decision-making performance of 3 abstinent alcohol-dependent samples, i.e., alcoholic patients without any PD (n=38), alcoholic patients with a cluster A or C PD (n=19), and alcoholic patients with a cluster B PD (n=23).


RESULTS
Overall, all 3 alcohol-dependent subsamples performed inferior compared with controls. Between alcoholic subsamples, the alcoholic patients with a cluster A or C PD had the highest IGT score, followed by the alcoholic patients without a PD, while the cluster B alcoholic patients were the most impaired.


CONCLUSIONS
These findings suggest that impairments in decision making underlie both alcohol dependence and cluster B PD, and alcoholic patients with a comorbid cluster B PD are particularly impaired in their decision making. These deficits may underlie the severe problems that characterize cluster B alcoholic patients specifically in inappropriate behaviors (e.g., poly substance abuse, legal, and professional dysfunction).
Dom
Geert
G
PC Alexian Brothers, Boechout, Belgium. geert.dom@fracarita.org
De Wilde
Bieke
B
Hulstijn
Wouter
W
van den Brink
Wim
W
Sabbe
Bernard
B
D000328:Adult; D020751:Alcohol-Induced Disorders / Q000503:physiopathology / Q000523:psychology*; D000437:Alcoholism / Q000503:physiopathology / Q000523:psychology; D016739:Behavior, Addictive / Q000503:physiopathology / Q000523:psychology; D002492:Central Nervous System Depressants / Q000494:pharmacology*; D003657:Decision Making / Q000187:drug effects* / Q000502:physiology*; D017831:Diagnosis, Dual (Psychiatry); D000431:Ethanol / Q000494:pharmacology*; D005260:Female; D005715:Gambling; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010554:Personality Disorders / Q000503:physiopathology / Q000523:psychology*
D002492:Central Nervous System Depressants; D000431:Ethanol