Electrophysiological and electrodermal correlates of risk-taking in substance use disorder during a virtual reality balloon analogue risk task

Introduction People with substance use disorder (SUD) continue to use despite mounting losses, which suggests that negative outcomes fail to shape later choices. Behavioral, cortical and autonomic indices of this failure are rarely measured together. Methods Forty-two adults with DSM-5 SUD and 42 matched healthy controls completed an immersive virtual reality Balloon Analogue Risk Task with hypothetical monetary rewards while 20-channel mobile electroencephalography and skin conductance were recorded simultaneously, alongside validated psychometric scales. The primary outcome was adjusted pumps. Secondary outcomes were pump latency, adjustment after balloon bursts, burst-locked feedback-related negativity (FRN), P3 and midfrontal theta, and anticipatory and burst-evoked skin conductance responses. Results The SUD group made more adjusted pumps than controls ( d = 0.51) and reduced its pumping less after a burst, whereas response latency did not differ significantly. After bursts, the FRN difference wave was smaller in the SUD group ( η 2 p = 0.08); the P3 did not differ, and a small theta reduction did not survive correction for multiple comparisons. Anticipatory skin conductance rose before high-risk decisions in controls but much less in the SUD group, while responses to the bursts themselves were comparable. Only anticipatory skin conductance was independently associated with risk-taking, with modest explained variance. Discussion The findings are consistent with selective differences in early feedback-related processing and anticipation of risk; larger studies are needed to test whether later outcome processing is preserved. Combining validated virtual reality, EEG and electrodermal tools in one paced task is feasible in clinical samples.