Impaired causal reasoning in methamphetamine use disorder under dynamic uncertainty.

Abstract

Preventing repeated relapse remains a central challenge in drug prevention and rehabilitation. The abstinence violation effect (AVE) highlights the importance of attribution in relapse, suggesting that when individuals misinterpret a transient lapse triggered by external circumstances as a personal failure of self-control, they may become more vulnerable to further relapse. However, the behavioral signatures and computational mechanisms of attributional reasoning under uncertainty in addiction remain poorly understood. We recruited 26 individuals with Methamphetamine Use Disorder (MUD) and 40 demographically matched healthy controls to perform an environment reasoning task (ERT), in which motion coherence manipulated confidence in perceptual decisions, allowing us to test whether negative feedback was attributed to internal perceptual errors or external environmental changes. Following negative feedback, individuals with MUD were less likely to use confidence-related perceptual evidence and accumulated negative feedback to update beliefs about external environment changes. Computational modeling further revealed individuals with MUD exhibited deficits in tracking and maintaining evidence for dynamic environmental changes. Importantly, the ability to maintain such evidence was significantly associated with abstinence duration. These findings provide process-level evidence relevant to the attributional component of AVE. Atypical causal reasoning under uncertainty may constitute a key cognitive mechanism underlying relapse, offering a computational account of how individuals respond to abstinence violations. This work provides a theoretical foundation for developing targeted cognitive-behavioral interventions aimed at reducing relapse risk.