volitional dysfunction in self-control failures and addictive behaviors

Conditions: Addictive Behavior; Alcohol Use Disorder (AUD); Tobacco Use Disorder; Self-Control; Executive Dysfunction

Summary: the aim of this project is to elucidate whether impairments of cognitive control, performance-monitoring, and value-based decision-making and dysfunctional interactions between underlying brain systems are mediating mechanisms and vulnerability factors for daily self-control failures and addictive disorders.

failures of self-control during conflicts between long-term goals and immediate desires are a key characteristic of many harmful behaviors, including unhealthy eating habits, lack of exercise and problematic substance use, which often have adverse personal consequences and incur great societal costs. the project aims to elucidate neurocognitive mechanisms mediating deficient self-control, both in daily self-control failures and in substance use disorders and behavioral addictions, which are characterized by a loss of control despite awareness of adverse consequences. a prospective cohort study was launched using a multi-level approach that combines (i) a comprehensive clinical assessment, (ii) behavioral task batteries assessing cognitive control and decision-making functions, (iii) task-related and resting state fmri, and (iv) smartphone-based ecological momentary assessment of daily self-control failures. from a representative community sample, three groups of participants were recruited (each n = 100; age 20 - 26) with (a) symptoms of non-substance related and (b) substance-related addictive disorders and (c) syndrome-free controls. participants are invited to yearly clinical follow-up assessments and further multi-level assessments 3 and 6 years after initial recruitment. results obtained so far (until 06/2020) provide converging evidence that task performance as well as brain activity in monitoring, control, and valuation networks is reliably associated with the propensity to commit real-life self-control failures. results support a process model, according to which deficient performance-monitoring leads to an insufficient recruitment of control networks, which attenuates the impact of long-term goals on neural value signals and increases the likelihood of self-control failures. in the final funding period (until 06/2024), the clinical follow-up period will be extended to 7 years. in addition, stress markers will be assessed as possible moderators of self-control. with the cross-lagged panel design it is expected to make a substantial contribution to the central unresolved question whether dysfunctions of cognitive control are causally involved in the development and trajectories of self-control failures and addictive behaviors, as well as to the disputed question of communalities and differences between different addictive disorders. thereby, the project will to contribute to mechanism-based models of self-control impairments as a foundation for improved prevention and therapy.

Eligibility criteria:
inclusion criteria (at baseline): 1. age 19-27 2. fulfill the criteria for one of three groups (sud, nd, controls) 3. written informed consent exclusion criteria (at baseline): 1. no written informed consent or limited ability to understand the questionnaires and tasks 2. disorders that might influence cognition or motor performance (e.g. craniocerebral injury) 3. magnetic resonance contraindications 4. current treatment for mental disorders 5. current use of psychotropic medication or substances 6. lifetime psychotic symptoms, bipolar disorder, or other sud or nd not under study 7. major depression, somatoform, anxiety, obsessive compulsive, or eating disorders within the last 4 weeks

Keywords: cognitive control decision-making impulsivity risk-seeking