Impulsivity enhances the impact of context cues during Pavlovian-to-Instrumental Transfer

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Zimmermann US1, Sommer C1, Garbusow M2, Jünger E1, Bernhardt N1, Schad DJ2, Huys QM3,4, Pooseh S1, Jabs B5, Glöckler T5, Birkenstock J1, Heinz A2, Smolka MN1

1 Department of Psychiatry and Psychotherapy, University Hospital, Technische Universität Dresden, Germany
2 Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Campus Mitte, Berlin, Germany
3 Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zürich, Switzerland
4 Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Switzerland,
5 Department of Psychiatry and Psychotherapy, Städtisches Klinikum Dresden-Neustadt, Dresden, Germany

Substance-related cues can markedly affect behavior of addicted patients to promote relapse, which can be explained by the concept of incentive salience. In contrast, the overall potency of substance-unrelated contextual cues to modulate behavior in general has received less attention, but may also contribute to relapse in dependent patients. The laboratory paradigm of Pavlovian-to-instrumental transfer (PIT) can model how Pavlovian conditioned context cues influence animal or human instrumental behavior. In humans, this PIT effect might be related to some aspects of impulsivity, and appears to be more pronounced in alcohol-dependent patients compared to controls. We therefore investigated how modulation of newly-learnt instrumental behavior is related to impulsivity in the context of alcoholism.
116 early abstinent alcohol-dependent patients and 91 healthy controls matched for age and gender completed an adaptive Delay Discounting task (DD) and a PIT paradigm using abstract stimuli conditioned to monetary gains or losses. As a measure for choice impulsivity, we extracted the discount rate k from the DD task and included this into the analysis of the PIT paradigm. We observed significantly stronger PIT effects in alcohol-dependent patients compared to controls, which was mainly driven by highly impulsive patients. Further, when analyzing patients and controls separately, higher choice impulsivity was linked to stronger PIT effects only within the patient group but not within controls. We conclude that highly impulsive alcoholics might be particularly susceptible for the influence of environmental cues that are contrary to their behavioral intention and therefore specifically benefit from interventions weakening automatic responses to cues.