Individuals with methamphetamine use disorder show reduced directed exploration and learning rates independent of an...

Methamphetamine use disorder (MUD) is associated with substantially reduced quality of life. Yet, decisions to use persist, due in part to avoidance of anticipated withdrawal states. However, the specific cognitive mechanisms underlying this decision process, and possible modulatory effects of aversive states, remain unclear. Here, 56 individuals with MUD and 58 healthy comparisons (HCs) performed a decision task, both with and without an aversive interoceptive state induction. Computational modeling measured the tendency to test beliefs about uncertain outcomes (directed exploration) and the ability to update beliefs in response to outcomes (learning rates). Compared to HCs, the MUD group exhibited less directed exploration and slower learning rates, but these differences were not affected by the aversive state induction. Follow-up analyses further suggested that reduced exploration in those with MUD was best explained by greater avoidance of uncertainty on the task, and that trait differences in cognitive reflectiveness might account for these differences in task behavior. These results suggest state-independent computational mechanisms whereby individuals with MUD may have difficulties in testing beliefs about the tolerability of abstinence and in adjusting behavior in response to consequences of continued use.