Decision-making biases, antisocial personality, and early-onset alcoholism

Background: Disinhibited, antisocial traits increase the risk for early- onset alcoholism. Research also suggests that decision biases which favor immediate large rewards regardless of long-term consequences may be important mechanisms associated with the biological substrates of antisocial traits. This study tested the hypothesis that early-onset alcoholism with antisocial personality (ASP) would be associated with favoring immediate larger rewards despite their being associated with long-term losses. Methods: Twenty-seven early-onset alcoholics with and without a diagnosis of ASP, eight subjects with ASP but no alcohol dependence, and 32 controls were tested on a task that manipulated the magnitude of immediate rewards and the magnitude of long-term punishments. The sample was recruited from the community via advertisements. Results: Compared with subjects without ASP, subjects with ASP favored larger immediate rewards despite long-term losses regardless of alcohol dependence; however, they learned to shift their decisions in a more advantageous direction over time. A disadvantageous decision bias also was associated with drinking greater quantities of alcohol and having a lower IQ. Conclusions: This study suggests that ASP in a young adult noninstitutionalized sample was associated with a pattern of disadvantageous decision making similar to that observed in patients with antisocial behavioral characteristics associated with lesions in the ventromedial frontal cortex. The data also suggest that this pattern of disadvantageous decision making is associated with consuming larger quantities of alcohol but not consuming alcohol more frequently.