Toma de decisiones bajo riesgo y tipos de retroalimentación asociadas al consumo de cocaína

Abstract

El consumo de cocaína constituye un grave problema de salud a nivel global que genera importantes consecuencias en el funcionamiento cognitivo, social y emocional. Actualmente, existe acuerdo en considerar que su consumo afecta el proceso de toma de decisiones, aunque es un área de vacancia el análisis en profundidad de los tipos de retroalimentaciones utilizadas en dicho proceso. El presente trabajo tuvo como objetivo analizar los tipos de retroalimentaciones utilizadas por las personas con diagnóstico de trastorno por consumo de cocaína en la toma de decisiones bajo riesgo. Se utilizó un diseño de tipo descriptivo con una muestra no probabilística, conformada por 96 personas, divididas en dos grupos: clínico y control. Se administró la tarea informatizada Game of Dice Task que evalúa el proceso de toma de decisiones bajo riesgo. Los resultados encontrados señalan que el grupo clínico presentó una tendencia al riesgo, con puntuaciones significativamente superiores en las respuestas riesgosas (p = .047), así como puntuaciones significativamente inferiores en las respuestas seguras y ventajosas (p = .047 y p = .00, respectivamente). A su vez, se registraron mayores puntajes en la retroalimentación de tipo 1, riesgosa (p = .00) y menores puntajes en la retroalimentación 5, segura (p = .02). Estos resultados sugieren que las personas con diagnóstico de trastorno por consumo de cocaína presentan una búsqueda de recompensa inmediata, a pesar de las consecuencias negativas que pueda traer aparejadas y, a su vez, no logran utilizar la retroalimentación como una señal para monitorear sus elecciones y guiar su conducta hacia una tendencia más segura y saludable en el largo plazo.

Cocaine use is a serious global health problem that generates important consequences in cognitive, social and emotional functioning. Among the main cognitive processes affected is the decision-making process, which includes from the most trivial decisions to the most complex ones and is essential for functioning in daily life. This process can be defined as the selection of an alternative within a set of existing options, taking into account the possible results of the choices made and their consequences on both present and future behavior. Two types of decision-making have been identified: analysis under ambiguity and analysis under risk. Decision-making under risk, studied in the this work, refers to those decisions that people must make in contexts where they have explicit information about the characteristics of possible results and their occurrences, for which they are carried out based on the defined knowledge of the situation, associated with the consequences and the various options that are evaluated. People with problematic substance use tend to have deficits in this type of decision-making, associated with alterations in the functioning of reward circuits. They present greater difficulties in the joint analysis of the information presented, having a tendency to highlight those stimuli that produce an immediate reward despite the possible negative consequences in the long term, leading to a greater assumption of risks. Decision making under risk is influenced by both executive functioning and feedback processing. This refers to the processing of the consequences of decisions from previous trials and their influence on present and future choices. Although feedback is not necessary to understand choice contingencies since they are defined and stable, it is expected that the feedback information will enable the development of a more effective decision-making strategy, facilitate the monitoring of current decision-making behaviour and encourage the adoption of alternative strategies or the continuation of non-risky strategies if deemed more appropriate. It is important to note that the feedback mechanisms that guide behavior in people with substance dependence constitutes an area of vacancy. The aim of this paper was to analyze the types of feedback used by people diagnosed with cocaine use disorder in making decisions under risk. A descriptive type design was used, with a non-probabilistic sample, consisting of 96 individuals, who where paired into two groups, clinical and control. The computerized Game of Dice Task was administered, which evaluates the decision-making process under risk. The results obtained indicate a tendency of the clinical group towards risky choices, with significantly higher scores in the risky responses (p = .047), as well as significantly lower scores in the safe and advantageous responses (p = .047 and p = .00 respectively). In turn, higher scores were recorded in type 1 feedback, which consists of choosing a risky option and in case of winning, continuing with risky (p = .00), and lower scores in feedback 5, which consists of choosing a safe option and in case of winning, continuing with a safe option (p = .02). These results suggest that people with a diagnosis of cocaine use disorder present a search for immediate reward despite the negative consequences that may come with it, and in turn, fail to use feedback as a signal to monitor their choices and guide their behavior towards a safer and healthier trend in the long term. Knowing the functioning of the decision-making process, the feedback mechanisms and its specific deficits, can contribute to the design of more appropriate interventions to favor the success of the treatments and the maintenance of abstinence.