Supplementary Material for: Impaired Decision-Making and Skin Conductance Responses Are Associated with Reward and Punishment Sensitivity in Individuals with Severe Alcohol Use Disorder

<b><i>Introduction:</i></b> Individuals with alcohol use disorder (AUD) have difficulties regulating alcohol consumption, despite adverse drinking-related consequences. This may be due to incapacity incorporating previous negative feedback from drinking, resulting in impaired decision-making. <b><i>Methods:</i></b> We assessed whether decision-making is impaired in participants with AUD related to severity of AUD, indexed by severe negative drinking consequences using the Drinkers Inventory of Consequences (DrInC) and reward and punishment sensitivity with the Behavioural Inhibition System Behavioural Activation System (BIS BAS) scales. 36 treatment-seeking alcohol-dependent participants completed the Iowa gambling task (IGT) with skin conductance responses (SCRs) measured continuously as an index of somatic autonomic arousal to evaluate impaired expectancy of negative outcomes. <b><i>Results:</i></b> Two-thirds of the sample showed behavioural impairment during the IGT, with greater AUD severity related to worse performance. BIS moderated IGT performance according to severity of AUD, with increased anticipatory SCRs for those with fewer reported DrInC severe consequences. Participants with more DrInC severe consequences showed IGT deficits and reduced SCRs regardless of BIS scores. BAS-Reward was associated with increased anticipatory SCRs to disadvantageous deck choices among those with lower AUD severity, while SCRs did not differ related to AUD severity for reward outcomes. <b><i>Discussion:</i></b> Effective decision-making in the IGT and adaptive somatic responses were moderated by punishment sensitivity contingent on severity of AUD in these drinkers, with impairments in expectancy to negative outcomes from risky choices, including reduced somatic responses, resulting in poor decision-making processes that may help explain impaired drinking and worse drinking-related consequences.

<b><i>引言：</i></b> 酒精使用障碍（Alcohol Use Disorder, AUD）患者难以调节饮酒行为，即便饮酒已引发诸多与之相关的不良后果。这一现象可能源于患者无法整合过往饮酒带来的负面反馈，进而导致决策功能受损。<b><i>方法：</i></b> 本研究采用饮酒后果量表（Drinkers Inventory of Consequences, DrInC）以严重饮酒相关负面后果为指标量化AUD的严重程度，并借助行为抑制系统-行为激活系统（Behavioural Inhibition System- Behavioural Activation System, BIS-BAS）量表评估个体的奖赏与惩罚敏感性，以此探究AUD患者的决策功能损害是否与其疾病严重程度存在关联。36名寻求临床治疗的酒精依赖参与者完成了爱荷华赌博任务（Iowa Gambling Task, IGT），实验期间持续记录皮肤电反应（Skin Conductance Responses, SCRs）作为躯体自主唤醒的指标，以评估个体对负面结果的预期能力受损情况。<b><i>结果：</i></b> 本研究样本中有三分之二的参与者在IGT中表现出行为损害，且AUD疾病严重程度越高，任务表现越差。BIS对IGT任务表现的调节作用依赖于AUD的严重程度：在DrInC量表中报告严重饮酒负面后果较少的参与者，其预期性SCRs水平更高。而报告更多严重饮酒负面后果的参与者，无论BIS得分如何，均表现出IGT任务缺陷与SCRs水平降低。在AUD严重程度较低的参与者中，BAS奖赏敏感性分量表（BAS-Reward）得分与不利牌组选择时的预期性SCRs升高存在关联；而对于奖赏结果，SCRs水平与AUD严重程度无显著相关性。<b><i>讨论：</i></b> 本研究结果表明，此类饮酒者的IGT有效决策能力与适应性躯体反应，受惩罚敏感性的调节且依赖于AUD的严重程度；风险选择所引发的负面结果预期能力受损（包括躯体反应降低），会导致决策过程出现缺陷，这或可解释为何患者出现饮酒行为失控且饮酒相关不良后果更为严重的情况。