H1 "Decision-making and cognitive control in addictive disorders: From dysfunctions to knowledge translation"

Dr. rer. nat. Anja Kräplin

Duration: 10/2014 - 06/2020

Background: Addictive disorders (ADs), comprising both substance use and behavioural addictions, are highly prevalent in Western societies. The detrimental health consequences and societal costs of ADs highlight the importance of understanding underlying risk factors. Dysfunctions of decision-making and cognitive control have been discussed as core mech- anisms of ADs. However, it remains unclear (i) whether dysfunctions of decision-making and cognitive control predict the course of ADs and (ii) what we can learn from knowledge of the characteristics and risk factors of ADs for practice. The two open research questions were each addressed in one of the two parts of this thesis.

Aims: The first part of this thesis focused on the putative risk factors of dysfunctional decision-making and impaired cognitive control and aimed to discuss and investigate the reliability, validity, and context-specificity of measurements of these neurocognitive impairments, as well as the predictive relationship between these impairments and the course of AD severity. The second part of this thesis aimed to translate research knowledge on the characteristics and risk factors of ADs into practice using the example of gambling disorder (GD).

Methods: The first part of the thesis included one position paper and six empirical studies, two with cross-sectional designs and four with prospective longitudinal designs. The sam- ples comprise persons with substance-related and/or non-substance-related ADs and healthy controls. ADs were operationalized by applying (adapted) DSM-5 diagnostic criteria. Decision-making and cognitive control were measured with behavioural tasks, such as the intertemporal choice task and the go/no-go task. The second part of the thesis comprised five (partly systematic) literature overviews and position papers for different target groups (e.g., psychotherapists). Current knowledge on characteristics and risk factors of GD was synthesized and integrated to propose possible prevention and intervention strategies as knowledge tools according to the knowledge-to-action framework and applied to scientifi- cally address public health issues and questions.

Main results: Diagnostic criteria for behavioural addictions need to include the aspect of impairment to improve its validity and not pathologize normal behaviour. Decision-making and cognitive control parameters must be carefully selected and, in the best case, opera- tionalized using a latent variable approach to achieve high reliability and validity of measures. It must be considered that the measurement of decision-making and cognitive control depends on whether the context is neutral or addiction-specific. Over time, more dysfunctional decision-making predicts the progression of AD severity and increases as a result of ADs. Impaired cognitive control is more important for the escalation of addictive behaviours than for the progression of AD symptoms.

The knowledge translation papers in the second part of the thesis summarized multiple risk factors involved in the onset and course of GD, including intraindividual factors (e.g., neurocognitive dysfunctions), gambling-related factors (e.g., near misses), and environmen- tal factors (e.g., gambling peers). The papers on knowledge synthesis and tools proposed that effective prevention and intervention also require a multifaceted array of strategies. Individual and environmental risk factors form an important basis for prevention strategies, such as which risky gambling behaviours or specific high-risk groups need to be targeted. For therapeutic interventions, several characteristics and risk factors of GD were highlighted as possible target processes, such as cognitive distortions, dysfunctional decision-making, impaired cognitive control, and cue reactivity. In the knowledge application papers, it was argued that standard consumer protection measures such as gambling in- formation and mere supply reduction may not be adequate for high-risk gamblers who have problems controlling their gambling behaviour due to risk factors such as impulsive decision-making.

Discussion: Evidence from this thesis contributes to the proposal that dysfunctional deci- sion-making is a suitable candidate for transdiagnostic processes. To achieve a causal in- terpretation, it is important to further investigate the effects of neurocognitive training or neuromodulation on decision-making in ADs. Concerning cognitive control, the evidence of this thesis showed that impaired cognitive control plays a more important role in the loss of control over addictive use than in the course of AD symptoms. For the course of AD symptoms, it is also important to further investigate the role of deficient conflict monitor- ing and thus the mobilization of cognitive control in ADs using neuroimaging methods.

The second part of the thesis emphasizes that further scientific knowledge is required be- fore best practice guidelines for the prevention and treatment of GD can be derived. In line with the knowledge-to-action framework, a better-tailored knowledge inquiry is needed for GD. Therefore, research must move away from diagnosis-based case-control studies to- wards transdiagnostic processes and behavioural markers. This could inform prevention measures to identify at-risk gamblers at an earlier stage and could contribute to novel pro- cess-based therapeutic paradigms that explicitly target core mechanisms of GD, such as dysfunctional decision-making. In AD research in general, there is still a strong need for better collaboration among scientists, practitioners, and stakeholders and for knowledge translation and application to be better considered and appreciated by the research com- munity, the journals, and funding agencies.

Publications

• Part 1: Decision-making and cognitive control as predictive factors in the course of addictive disorders
  • 1.1 How reliable and valid are our concepts of behavioural addictions, decision- making and cognitive control?

    • Publication 1: Kräplin, A. (2017). Conceptualizing behavioural addiction in children and adolescents. Addiction, 112(10), 1721-1723. doi:10.1111/add.13846

    • Publication 2: Kräplin, A., Scherbaum, S., Bühringer, G. & Goschke, T. (2016). Retest reliabilities of decision-making and cognitive control measures in addictive disorders. SUCHT, 62(4), 191–202. doi:10.1024/0939-5911/a000430

  • 1.2 Are dysfunctional decision-making and cognitive control impairments general- ized or context-specific?

    • Publication 3: Kräplin, A., Scherbaum, S., Bühringer, G. & Goschke, T. (2019). Decision-

      making and inhibitory control after smoking-related priming in nicotine dependent smokers and never-smokers. Addictive Behaviors, 88, 114-121. doi:10.1016/j.addbeh.2018.08.020

    • Publication 4: Kräplin, A., Scherbaum, S., Bühringer, G., Goschke, T. & Schmidt, A. (2018). Negative interpersonal scenes decrease inhibitory control in healthy individuals but not in gambling disorder patients. International Gambling Studies, 18(2), 178-194. doi:10.1080/14459795.2018.1448426

  • 1.3 Are dysfunctional decision-making and cognitive control impairments conse- quences or predictive factors in the course of addictive disorders?

    • Publication 5: Kräplin, A., Höfler, M., Pooseh, S., Wolff, M., Krönke, K.-M., Goschke, T., Bühringer, G. & Smolka, M. N. (2020). Impulsive decision-making predicts the course of substance-related and addictive disorders. Psychopharmacology. doi:10.1007/s00213- 020-05567-z
    • Publication 6: Kräplin, A., Joshanloo, M., Wolff, M., Krönke, K.-M., Bühringer, G., Gosch- ke, T. & Smolka, M. N. (under review). Latent executive functioning in substance-related and addictive disorders: Cross-sectional and longitudinal relations. Addiction. Publication
    • 7: Kräplin, A., Scherbaum, S., Kraft, E.-M., Rehbein, F., Bühringer, G., Goschke, T. & Mößle, T. (2021). The role of inhibitory control and decision-making in the course of Internet gaming disorder. Journal of Behavioral Addictions, 9(4), 990-1001. doi:10.1556/2006.2020.00076
• Part 2: Knowledge translation of research on gambling disorder
  • 2.1 Knowledge translation: synthesis and tools

    • Publication 8: Kräplin, A. & Bühringer, G. (2016). Störung durch Glücksspielen - Ein Überblick [Gambling Disorder - An overview]. Report Psychologie, 41(5), 204-214. Link zum Volltext

    • Publication 9: Kräplin, A. & Goudriaan, A. E. (2018). Characteristics and risk factors of gambling disorder as basis for responsible gambling strategies. SUCHT, 64(5-6), 247-256. doi:10.1024/0939-5911/a000559

    • Publication 10: Kräplin, A. & Bühringer, G. (2021). Störung durch Glücksspielen und andere abhängige Verhaltensweisen. In S. Knappe & J. Hoyer (Eds.), Klinische Psychologie und Psychotherapie (Bd. 3, S. 933-946). Heidelberg: Springer.http://dx.doi.org/10.1007/978-3-662-61814-1_43

  • 2.2 Knowledge translation: application

    • Publication 11: Bühringer, G., Kotter, R., Czernecka, R. & Kräplin, A. (2018). Beyond Re- no II: Who cares for vulnerable gamblers? SUCHT, 64(5-6), 325-334. doi:10.1024/0939- 5911/a000566

    • Publication 12: Zoglauer, M., Czernecka, R., Bühringer, G., Kotter, R. & Kräplin, A. (under review). The relationship between physical availability of gambling and gambling behaviour/disorder: A systematic review. Journal of Gambling Issues.