Review
21st century neurobehavioral theories of decision making in addiction: Review and evaluation

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Highlights

  • The field of addiction science must understand the decisional processes that result in continued substance use.

  • We have reviewed seven theories developed or extended in the 21st century to understand decision making in addiction.

  • We have evaluated each theory on its ability to answer six key questions within the field of addiction.

  • No one theory provides complete and independent answers to all of these six key questions.

Abstract

This review critically examines neurobehavioral theoretical developments in decision making in addiction in the 21st century. We specifically compare each theory reviewed to seven benchmarks of theoretical robustness, based on their ability to address: why some commodities are addictive; developmental trends in addiction; addiction-related anhedonia; self-defeating patterns of behavior in addiction; why addiction co-occurs with other unhealthy behaviors; and, finally, means for the repair of addiction. We have included only self-contained theories or hypotheses which have been developed or extended in the 21st century to address decision making in addiction. We thus review seven distinct theories of decision making in addiction: learning theories, incentive-sensitization theory, dopamine imbalance and systems models, opponent process theory, strength models of self-control failure, the competing neurobehavioral decision systems theory, and the triadic systems theory of addiction. Finally, we have directly compared the performance of each of these theories based on the aforementioned benchmarks, and highlighted key points at which several theories have coalesced.

Introduction

Addiction is a serious public health problem leading to excess morbidity and mortality and considerable economic burden (National Institute on Drug Abuse, 2015). For example, the opioid epidemic has resulted in a greater number of deaths than` automobile accidents (Warner et al., 2011). Recognizing that addiction results from the choices made by those with that disorder, the field of addiction science, beginning in the 21st century, has increasingly focused its attention on decision making processes. Indeed, a hallmark of addiction is the fact that the individual suffering from it continues to use despite punishing and negative consequences. Thus, the response of this field has, as an important part of its agenda, the goal of understanding the decisional processes that result in the continued use of one or more substances.

Progress in identifying the neurobehavioral decision processes underlying disadvantageous decision making evident in addiction could facilitate the transition from a symptom-focused approach to a mechanism-focused approach, and this may further the development of treatments for these conditions. Indeed, this growing emphasis on decision making renders the field of addiction closer to the Research Domain Criteria effort (Insel et al., 2010). The Research Domain Criteria unit within the National Institutes on Mental Health seeks to identify constructs and domains of functioning which can be examined on multiple units of analysis, from genomics to self-report, to understand how basic dimensions of functioning undergird both normal and abnormal human behavior. Although basic science of decision making has made and continues to make advances, using these decisional processes to mechanistically understand disorders remains a significant scientific gap (Goschke, 2014). However, this has not prevented the formulation of theories to understand the dysfunctional decision making evident in addiction. Such theoretical undertakings are important and useful for the field because theories typically serve three roles; that is, theories (1) explain the extant data collected, (2) predict what will be observed in novel circumstances and (3) generate new ideas about the range of events to which the theory may apply. Many of these theories are derived inductively and are refined over time as new data are obtained. Interestingly for the addiction science field, several contemporary theories of decision making in addiction are competing for scientific attention. From a Kuhnian perspective (Kuhn, 1961), these diverse theories would be considered in a pre-paradigmatic stage. However, some evidence is suggestive of coalescing around common elements across several theories.

In this paper, we seek to briefly evaluate the extant theories of addiction that have been developed since the beginning of the 21st century. We limit our paper to this timeframe because, as we noted above, the decision making emphasis within the field has gained momentum since the early 2000s. Thus, we will only review theories from the last century to the extent they are actively used and/or updated. We will use the word addiction as opposed to other terms (such as alcohol or drug use disorder or dependence) because we recognize that addictive-like behaviors can occur with a variety of commodities and events in addition to alcohol and drugs. In this paper, we first review the phenomena that could be used as a benchmark by which to evaluate any comprehensive theory of addiction. These benchmarks are a further elaboration of earlier phenomena we have identified (Bickel et al., 2013). This will be followed by a brief introduction to extant theories and evaluation against these benchmarks. Finally, we will conclude with our views of the future direction of decision making theories of addiction and remaining questions emerging from these theoretical developments.

Section snippets

Benchmarks for a theory of decision making in addiction

A theory of decision making in addiction ideally should satisfy several functions. In order to (1) explain extant collected data, (2) predict observations from novel circumstances, and (3) generate new ideas about theoretical applications, a theory must address or account for multiple components of addiction. The task that follows is identification of the components of addiction (see also Bickel et al., 2013) that are meaningful to meeting these three criteria. Specific phenomena widely

An overview of theories of decision making in addiction

Addiction, as a disorder of excessive consumption, develops from many individual instances of choice to consume or not consume substances. Each of these choices is the product of a decision making process, in which an individual selects a course of action from among several possible alternatives. In the following sections, we will provide a brief overview of theories and hypotheses that speak to this decision making process in addiction, and evaluate these theories and hypotheses against the

Synthesis and conclusion

In the preceding sections, we reviewed 21st century theories of decision making in addiction and evaluated their performance in addressing the following 6 benchmarks of theoretical utility:

  • (1)

    why are some commodities addictive when others are not?

  • (2)

    why does addiction follow common developmental trends?

  • (3)

    why do some individuals, as their valuation of drugs increases, also exhibit a decrease in valuation of non-addictive commodities?

  • (4)

    why do individuals with addiction engage in consistent self-defeating

Funding acknowledgement

This work was supported by the National Institutes of Health [Grant numbers 5UH2DK109543, 5R01DA039456, 5R21DA040559, DP7OD018428, R01AA021529, R01DA034755, R01DA036017, U19CA157345, R01MD007054, 1P01CA200512, 1R01DA042535, 1R21AA023605, R01DA030241]. The funding sources were not involved in the development or preparation of this report.

Declaration of interest

The authors report no personal or financial relationships to influence this work.

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