Competitive Bias in Severe Alcohol Use Disorder: An Exploration Through the Prisoner's Dilemma Paradigm.

BACKGROUND: Biased social decision-making might play a critical role in interpersonal difficulties and relapse among individuals with severe alcohol use disorder (SAUD), but its exploration remains scarce. We measured social decision-making in SAUD through an ecological iterated prisoner's dilemma paradigm, measuring cooperative versus competitive tendencies during social interactions. METHODS: Forty detoxified patients with SAUD (16 females, mean age = 50.40 years, SD = 9.82) and 40 matched control participants (17 females, mean age = 44.48 years, SD = 12.87) played six iterated prisoner's dilemma games in a laboratory setting, varying according to the type of opponent (computer/human being) and the strategy followed by this opponent (competitive/cooperative/random). We measured the competition rates of participants in each condition as well as their social cognition performance (hostile attribution bias/empathy) and psychological measures [depression/(social) anxiety/impulsivity/interpersonal difficulties]. We assessed relapse at 6-month follow-up. RESULTS: Patients displayed a competitive bias during prisoner's dilemma games (resulting in higher outcomes) and a less efficient adaptation to their opponent's strategy. Both patients and controls were more competitive toward a computer than a human. We observed no link between the competitive bias of patients with SAUD and their social cognition difficulties. We observed that patients' competitive bias was associated with relapse rates at 6 months. CONCLUSIONS: SAUD is characterized by a competitive bias during social decision-making. Such bias, despite leading to more advantageous decisions at the economic level, suggests difficulties in understanding others' intentions and behaving accordingly in social situations, which could favor social difficulties and relapse.