Recovering alcoholics can remain sober for years

Recovering alcoholics can remain sober for years despite poor decision-making abilities, a new study says.

The study used a test that gauged participants' abilities to make sound choices between short-term rewards and the long-term negative consequences of their decisions. Subjects included abstaining alcoholics who had not drunk alcohol for an average of 6.6 years and a control group of non-alcoholics.

Compared to non-abusing control subjects, lower scores on the test did not lead the abstaining alcoholics to such a lack of self-control that they started drinking again, says George Fein, Ph.D., of Neurobehavioral Research Inc. in Corte Madera, Calif.

"Although these abstinent alcoholics remain susceptible to making poor decisions," Fein says, "they somehow manage to compensate for their deficits by recruiting other mechanisms of behavioral control that enable them to resist drinking."

The study appears in the journal Alcoholism: Clinical and Experimental Research.

The decision-making deficits may result from the effects of long-term alcoholism on the brain or may reflect some pre-existing factor that led to alcoholism and continues even with abstinence, Fein says.

Fein and two colleagues used the Simulated Gambling Task, a test originally designed to measure socially deviant behavior in patients with damage to a part of the brain called the ventromedial prefrontal cortex. Such patients can't see negative long-term consequences of short-term rewards.

In the test, subjects playing for fake money must choose between decks of cards that offer either small immediate rewards and small negative consequences or large rewards but even larger long-term losses. Over the long run, choosing from the "good" decks of cards leads to modest gains, while picking from the "bad" decks leads to big losses. The abstinent alcoholics did worse than the controls on the test and men did worse than women.

This reflects difficulties with real-life choices that drug and alcohol abusers make, Fein says. "Users persist in behaviors that have short-term benefits - like intoxication - despite long-term major negative consequences."

The degree of impairment was associated with the number of years spent drinking heavily, but not with the time elapsed since they had stopped drinking. However, it was not clear if the test results were due to difficulties in thinking or in motivation. The abstaining alcoholics also had worse scores on tests of social deviance.

Fein's team is now examining brain scans of his subjects to see if they had any abnormalities in their ventromedial prefrontal cortexes. They also speculate that alcoholics who cannot remain abstinent may have even more impaired decision making on the Simulated Gambling Task and even more abnormal psychological profiles.