Competitive Bias in Severe Alcohol Use Disorder: Exploration through the Prisoner’s Dilemma

Aims: 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 explored social decision-making in SAUD through an ecological iterated prisoner’s dilemma paradigm, specifically measuring cooperative versus competitive tendencies during social interactions. Method: Forty recently detoxified patients with SAUD (16 females, mean age = 50.40) and 40 matched control participants (17 females, mean age = 44.48) played six iterated prisoner’s dilemma games in a laboratory setting, varying according to the type of opponent (computer vs. human being) and the strategy followed by this opponent (competitive vs. cooperative vs. random). We measured the competition rates of participants in each condition of the prisoner’s dilemma games and their performance on social cognition (hostile attribution bias and empathy) and psychological measures [depression, (social) anxiety, impulsivity, interpersonal difficulties]. We assessed their relapse 6-months post detoxification.Results: Patients with SAUD displayed a competitive bias during the games (resulting in higher outcomes) and a less efficient adaptation to their opponent’s strategy. Patient and control groups were equally sensitive to the type of opponent (computer vs. human beings). We observed no link between the competitive bias of patients with SAUD and their social cognition difficulties. Critically, we observed that patients’ competitive bias was positively linked with relapse rates at six months follow-up. Conclusions: SAUD is characterized by a competitive bias during social decision-making.