# The Die Is Cast: Decision‐Making Under Risk and Under Ambiguity in Schizophrenia and Alcohol Use Disorder

## TL;DR

This study compares decision-making in schizophrenia and alcohol use disorder, finding distinct patterns and suggesting cognitive training could help both groups.

## Contribution

The study directly compares decision-making profiles in SZ and AUD, revealing differential cognitive impairments and potential intervention targets.

## Key findings

- Both SZ and AUD show deficits in reflective decision-making, but only AUD shows impulsive decision-making.
- Executive function training, especially for planning and cognitive flexibility, may benefit both SZ and AUD.
- Impulse control training is suggested as an additional intervention for AUD.

## Abstract

Patients with schizophrenia (SZ) tend towards riskier decision‐making (DM). Yet the specificity of these findings, as well as the impact of impairments in executive functions (EF), has not been sufficiently clarified. In a preregistered study (https://osf.io/n7z6y) 40 SZ, 50 patients with alcohol use disorder (AUD) and 36 healthy controls (HC) completed an n‐back task (as EF challenge), the Game of Dice Task (GDT; DM under risk) and the Iowa Gambling Task (IGT; DM under ambiguity). AUD and SZ performed worse than HC in the n‐back task and riskier in the GDT. In the IGT, only AUD performed riskier than HC and preferred disadvantageous Deck B compared to SZ. However, controlling for demographics and IQ abolished significance. Correlations of performance in the GDT and IGT with working memory differed between groups. Taken together, both patient groups show a deficit in the reflective system, whereas only AUD show impairments in the impulsive system. Thus, the direct comparison of DM in SZ and AUD reveals a differential DM profile of SZ and AUD. Our results suggest that both groups may benefit from EF training, especially in planning, categorization and cognitive flexibility, whereas AUD could additionally profit from impulse control and inhibition training. However, the findings need replication with well‐matched samples, and the link between EF and DM in SZ should be examined more carefully with experimental approaches.

Decision‐making impairments are present in both patients with schizophrenia (SZ) and patients with alcohol use disorder (AUD) but differ in nature, with SZ showing deficits primarily in reflective processing and AUD additionally displaying impulsive decision‐making patterns.Executive functions (EF), particularly working memory, play a key role in these decision‐making deficits, highlighting the importance of cognitive assessments in clinical evaluations.EF training may be beneficial for both SZ and AUD, especially targeting planning, categorization and cognitive flexibility; AUD may also require interventions focused on impulse control and inhibition.

Decision‐making impairments are present in both patients with schizophrenia (SZ) and patients with alcohol use disorder (AUD) but differ in nature, with SZ showing deficits primarily in reflective processing and AUD additionally displaying impulsive decision‐making patterns.

Executive functions (EF), particularly working memory, play a key role in these decision‐making deficits, highlighting the importance of cognitive assessments in clinical evaluations.

EF training may be beneficial for both SZ and AUD, especially targeting planning, categorization and cognitive flexibility; AUD may also require interventions focused on impulse control and inhibition.