Drug and Alcohol Dependence 86 (2007) 287–289 Short communication Impaired decision-making in psychopathic heroin addicts Jasmin Vassileva a,* , Pavlina Petkova b , Stefan Georgiev b , Eileen M. Martin a , Ruslan Tersiyski b , Margarita Raycheva c , Vladimir Velinov b , Peter Marinov b a Department of Psychiatry (MC 912), University of Illinois at Chicago, 1601 West Taylor Street, Chicago, IL 60612, United States b Department of Psychiatry, St-Naum State University Hospital of Neurology and Psychiatry, Sofia, Bulgaria c Department of Neurology, Alexandrovska University Hospital, Sofia, Bulgaria Received 25 April 2006; received in revised form 22 June 2006; accepted 28 June 2006 Abstract Substance-dependent individuals (SDIs) often show neurocognitive deficits in decision-making, such that their choices are biased toward the greatest immediate reward rather than the optimal future outcome. However, studies of SDIs are often hampered by two significant methodolog- ical challenges: polysubstance dependence and comorbid conditions, which are independently associated with neurocognitive impairments. We addressed these methodological challenges by testing heroin addicts in Bulgaria, where heroin addiction is highly prevalent but polysubstance dependence is rare. The goal of the current study was to evaluate the potential contribution of psychopathy to decision-making processes among this group of Bulgarian heroin addicts. We tested 78 male currently abstaining heroin addicts, classified as psychopathic or non-psychopathic using the Hare Psychopathy Checklist, Revised (PCL-R). Psychopathic heroin addicts showed notable deficits in decision-making in that they made significantly more disadvantageous decisions relative to non-psychopathic heroin addicts. Results indicate that the presence of psychopathy may exacerbate decision-making deficits in heroin addicts. © 2006 Elsevier Ireland Ltd. All rights reserved. Keywords: Substance dependence; Heroin addiction; Decision-making; Psychopathy 1. Introduction Substance-dependent individuals (SDIs) frequently show decision-making deficits such that their behavioral choices are dictated by the greatest immediate reward rather than the maxi- mally optimal future outcome (Bechara et al., 2001; Grant et al., 2000). The Iowa Gambling Task (IGT) (Bechara et al., 1994), which simulates real-life decision-making in the way it factors uncertainty, rewards, and punishments, is the most widely used task to measure decision-making. However, recent studies (Bechara and Damasio, 2002; Bechara and Martin, 2004) have shown that not all SDIs manifest impairments on the IGT, which suggests that some additional risk factors may influence one’s vulnerability to decision-making deficits. Addressing this problem is hindered by two methodological problems common in any study of neurocognition and drug addiction, namely the high prevalence of polysubstance depen- dence among SDIs and the presence of comorbid conditions * Corresponding author. Tel.: +1 312 413 0149; fax: +1 312 413 8147. E-mail address: jvassileva@psych.uic.edu (J. Vassileva). characterized by similar decision-making deficits as those exhib- ited by SDIs. In order to overcome these methodological difficulties, we conducted the current study in Bulgaria, a country with signifi- cantly high prevalence of heroin addiction. Importantly, patterns of heroin addiction in Bulgaria are unique in that polysubstance dependence is uncommon. Therefore, the subjects in the current study represent a rare study population in that they are relatively “pure” heroin addicts, not concurrently dependent on other sub- stances. The goal of the current study was to evaluate the potential con- tribution of psychopathy to decision-making processes among this group of Bulgarian heroin addicts. Psychopathy is a disor- der characterized by a constellation of affective, interpersonal, and behavioral characteristics such as egocentricity, impulsivity, shallow affect, lack of empathy, pathological lying, manipula- tiveness, and persistent violation of social norms (Hare, 1991). Research indicates that psychopathy is closely related to sub- stance use disorders and that it is more strongly associated with illicit drug use than with alcohol use (Taylor and Lang, 2006). Research also reveals that up to one-quarter of drug dependent populations show elevated levels of psychopathy and that among 0376-8716/$ – see front matter © 2006 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.drugalcdep.2006.06.015