Impulsivity and Decision-making Style Among Tramadol Drug Addicts and its Relation to Frontal Lobe Volume

Objectives: Drug addiction has its effects on different behavioral and personality traits including impulsivity and pattern of decision-making. The frontal lobe was the focus of many of these studies regarding its important role in decision-making and other higher cognitive processes. We aimed to detect the pattern of decision-making styles and impulsivity among people with tramadol addiction, and also to find out if tramadol addiction has effects on the volume of different regions of the frontal lobe. Materials and Methods: Two groups were included: group A included 12 patients with tramadol addiction and group B included 23 healthy cross-matching controls. Both groups were subjected to urine drug screening, Iowa gambling task (IGT), UPPS scales (negative urgency, lack of perseverance, lack of premeditation, and sensation seeking), and structural magnetic resonance imaging brain study. Results: The patients’ group has shown a significantly lower volume of the brain white matter, gray matter, and cortical thickness (P<0.001). This group has also shown a significantly higher scores of IGT-A and IGT-B (P<0.001 and P=0.02, respectively) and has shown a higher score of all subscales of UPPS. Conclusions: Tramadol addiction is associated with a reduced volume of the brain white matter, gray matter, and cortical thickness. All regions of the frontal lobe have shown significant volume reduction in the tramadol group. Tramadol addiction and its duration are associated with risky decision-making style and with higher impulsivity than nonaddicts.