Authors' reply

The findings of Bowden-Jones et al (2005) add to the accumulating evidence that impairments on decision-making tasks are an important characteristic of people with substance use and possibly other addictive disorders. The finding that those alcohol-dependent people that performed poorly on behavioural tasks were at higher risk of relapse is a nice demonstration of the ‘myopia’ for the future that is reflected by poor task performance. This is in line with other recent studies, including that of Goudriaan et al (2006), which showed that relapse among gamblers was associated with behavioural (but not self-reported) measures of impulsivity. Furthermore, Paulus et al (2005) reported that methamphetamine-dependent people with low prefrontal activation during a decision-making task relapsed significantly more frequently than those with greater activation. Together with the results of Bowden-Jones et al (2005), these findings represent an important new line of investigation.

Identification of distinctive neurobehavioural characteristics may allow detection of those people with addictions that are more vulnerable to relapse. Neurobehavioural (endophenotypic) characteristics may prove to be better for the identification of high-risk patients than traditional clinical (phenotypical) variables.