Chronic Opioid Use Is Associated With Increased Avoidance Learning From Negative Reinforcement

Background: Opioid addiction remains a major public health crisis, with high relapse rates and poor treatment adherence despite available therapies. Preclinical models suggest that repeated withdrawal and aversive states reinforce drug use through negative reinforcement, but this mechanism has not been well demonstrated in humans. Objective: To determine whether chronic opioid use, both with and without addiction, is associated with increased avoidance learning from negative outcomes and whether this relates to compulsive opioid use and real-world behavior. Design/Participants: Case–control study involving individuals with chronic opioid use. Methods: 88 participants were included, 24 with opioid addiction, 26 with chronic nonaddicted opioid use, and 38 healthy controls. Participants completed a probabilistic reinforcement learning task assessing learning from loss versus avoiding loss (negative reinforcement), along with computational modeling to derive learning parameters. Se more...