RP7: Implicit associations and altered cue-associated impulse control in gaming disorder, gambling disorder, and alcohol-use disorder

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Dual-process theories of addiction differentiate between explicit and implicit cognitions involved in addictive behaviors. They also distinguish between a controlled (reflective) and an automatic (impulsive) system and argue that controlled processing is associated with explicit cognitions, while automatic processing is linked to implicit cognitions. Explicit cognitions are frequently associated with executive functions, which may act as top-down processes linked to prefrontal cortex integrity, potentially controlling implicit cognitions and affective processes like craving and incentive salience. Deficits in executive functions have been considered both as vulnerability factors for the development of addictive behaviors and as potential consequences of substance-use disorders. Furthermore, it is argued that decision making, which may be characterized as the result of the interaction between affective processes (e.g., craving) and explicit cognitions (e.g., inhibitory control) is impaired in substance use disorders and addictive behaviors in terms of a preference for short-term rewarding options which may be linked to negative consequences in the long term. This project aims at investigating the relationships between implicit cognitions, stimulus-specific inhibitory control, stimulus-specific monitoring functions, and decision making upon confrontation with addiction-related stimuli in gaming disorder, gambling disorder, and alcohol-use disorder. These three disorders have been classified in the ICD-11 within the category of disorders due to substance use or addictive behaviors. There is reliable evidence, including results from meta-analyses, of altered implicit and explicit cognitions in individuals with gaming disorder, gambling disorder and substance-use disorders (e.g., alcohol-use disorder). Most previous studies focused on single aspects of either implicit or explicit cognitive functions and did not consider interactions among implicit and explicit cognitions when addiction-related cues are involved. These interactions will be investigated and compared between all three mentioned disorders. Four groups of participants will be included in the study: patients with 1) gaming disorder, 2) gambling disorder, 3) alcohol-use disorder, and 4) healthy controls. Besides the surveys and structured interviews for the diagnostics and the experimental and neuropsychological tasks of the core battery, an Implicit Association Test, the Balanced Switching Task, the Iowa Gambling Task with additional assessment of skin conductance response, each task using addiction-related stimuli, will be administered. The research project is strongly linked to RP4 assessing decision making under ambiguity in gaming disorder and pornography-use disorder, RP5 assessing implicit cognitions in buying-shopping disorder and social-networks-use disorder, and RP8 assessing implicit cognitions in social-networks-use disorder and tobacco-use disorder.