Instrumental and Pavlovian Mechanisms in Alcohol Use Disorder
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ALCOHOL (A HEINZ & N ROMANCZUK-SEIFERTH, SECTION EDITORS)
Instrumental and Pavlovian Mechanisms in Alcohol Use Disorder Nuria Doñamayor 1 & Claudia Ebrahimi 1 & Maria Garbusow 1 & Friederike Wedemeyer 1 & Florian Schlagenhauf 1 & Andreas Heinz 1 Accepted: 16 September 2020 # The Author(s) 2020
Abstract Purpose of Review Current theories of alcohol use disorders (AUD) highlight the importance of Pavlovian and instrumental learning processes mainly based on preclinical animal studies. Here, we summarize available evidence for alterations of those processes in human participants with AUD with a focus on habitual versus goal-directed instrumental learning, Pavlovian conditioning, and Pavlovian-to-instrumental transfer (PIT) paradigms. Recent Findings The balance between habitual and goal-directed control in AUD participants has been studied using outcome devaluation or sequential decision-making procedures, which have found some evidence of reduced goal-directed/model-based control, but little evidence for stronger habitual responding. The employed Pavlovian learning and PIT paradigms have shown considerable differences regarding experimental procedures, e.g., alcohol-related or conventional reinforcers or stimuli. Summary While studies of basic learning processes in human participants with AUD support a role of Pavlovian and instrumental learning mechanisms in the development and maintenance of drug addiction, current studies are characterized by large variability regarding methodology, sample characteristics, and results, and translation from animal paradigms to human research remains challenging. Longitudinal approaches with reliable and ecologically valid paradigms of Pavlovian and instrumental processes, including alcohol-related cues and outcomes, are warranted and should be combined with state-of-the-art imaging techniques, computational approaches, and ecological momentary assessment methods. Keywords Alcohol use disorder . Habits . Goal-directed control . Pavlovian conditioning . Pavlovian-to-instrumental transfer . Humans
Introduction Drug addiction has been characterized in terms of the brain’s learning and memory systems. This view posits a gradual shift from initial voluntary drug use to an increasing loss of control over drug intake, which becomes habitual or even compulsive drug addiction [1–4]. Drug use starts out as a goal-directed behavior, mediated by the reinforcing and hedonic effects of the drug, but habitual processes eventually take over, hampering attempts to stop drug intake, in spite of severely aversive This article is part of the Topical Collection on Alcohol Addiction * Nuria Doñamayor [email protected] 1
Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, Berlin 10117, Germany
consequences and conscious decisions to reduce consumption or to remain abstinent. This transition is considered to depend up
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