Review21st century neurobehavioral theories of decision making in addiction: Review and evaluation
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.
References (283)
- et al.
Pathological gambling severity is associated with impulsivity in a delay discounting procedure
Behav. Process.
(2003) - et al.
Age, socioeconomic status and obesity growth
J. Health Econ.
(2009) - et al.
Strength model of self-regulation as limited resource: assessment, controversies, update
- et al.
Uses of self-regulation to facilitate and restrain addictive behavior
Addict. Behav.
(2015) - et al.
The somatic marker hypothesis: a neural theory of economic decision
Games Econ. Behav.
(2005) - et al.
Alcohol demand indices predict outcomes among heavy-drinking young adults receiving a brief intervention
Drug Alcohol Depend.
(2014) - et al.
Remember the future: working memory training decreases delay discounting among stimulant addicts
Biol. Psychiatry
(2011) - et al.
Excessive discounting of delayed reinforcers as a trans-disease process contributing to addiction and other disease-related vulnerabilities: emerging evidence
Pharmacol. Ther.
(2012) - et al.
The behavioral- and neuro-economic process of temporal discounting: a candidate behavioral marker of addiction
Neuropharmacology
(2014) - et al.
Competing neurobehavioral decision systems theory of cocaine addiction: from mechanisms to therapeutic opportunities
Prog. Brain Res.
(2016)
Context, ambiguity, and unlearning: sources of relapse after behavioral extinction
Biol. Psychiatry
Corticotropin-releasing factor mediates the dysphoria-like state associated with alcohol withdrawal in rats
Behav. Brain Res.
The influence of episodic foresight on delay discounting and demand for alcohol
Addict. Behav.
Habitual alcohol seeking: time course and the contribution of subregions of the dorsal striatum
Biol. Psychiatry
A map of the rat mesencephalon for electrical self-stimulation
Brain Res.
Resolution from alcohol problems with and without treatment: reasons for change
J. Subst. Abus.
Episodic future thinking reduces delay discounting and energy intake in children
Eat. Behav.
Motivational systems in adolescence: possible implications for age differences in substance abuse and other risk-taking behaviors
Brain Cogn.
Amphetamine-induced dopamine release in human ventral striatum correlates with euphoria
Biol. Psychiatry
Neurobiology of decision making: a selective review from a neurocognitive and clinical perspective
Biol. Psychiatry
The neuropsychological basis of addictive behaviour
Brain Res. Brain Res. Rev.
Difficulties in emotion regulation and impulse control during cocaine abstinence
Drug Alcohol Depend.
Difficulties in emotion regulation and impulse control in recently abstinent alcoholics compared with social drinkers
Addict. Behav.
Repeated high-frequency transcranial magnetic stimulation over the dorsolateral prefrontal cortex reduces cigarette craving and consumption
Addiction
Dopamine receptor pruning in prefrontal cortex during the periadolescent period in rats
Synapse
Guidelines and methodological reviews concerning drug abuse liability assessment
Drug Alcohol Depend.
Ego depletion and self-control failure: an energy model of the self's executive function
Self Identity
Self-regulation failure: an overview
Psychol. Inq.
Self-defeating behavior patterns among normal individuals: review and analysis of common self-destructive tendencies
Psychol. Bull.
Chapter 9: self-regulation and the executive function of the self
Losing Control: How and Why People Fail at Self-Regulation
Ego depletion: is the active self a limited resource?
J. Pers. Soc. Psychol.
The strength model of self-control
Curr. Dir. Psychol. Sci.
Decision making, impulse control and loss of willpower to resist drugs: a neurocognitive perspective
Nat. Neurosci.
A systematic review of allostatic load, health, and health disparities
Biol. Res. Nurs.
Imaging depletion: fMRI provides new insights into the processes underlying ego depletion*
Soc. Cogn. Affect. Neurosci.
An Introduction to the Study of Experimental Medicine
Liking, wanting, and the incentive-sensitization theory of addiction
Am. Psychol.
Temporal discounting as a measure of executive function: insights from the competing neuro-behavioral decision system hypothesis of addiction
Adv. Health Econ. Health Serv. Res.
Impulsivity and cigarette smoking: delay discounting in current, never, and ex-smokers
Psychopharmacology
Understanding addiction as a pathology of temporal horizon
Behav. Anal. Today.
Behavioral and neuroeconomics of drug addiction: competing neural systems and temporal discounting processes
Drug Alcohol Depend.
Congruence of BOLD response across intertemporal choice conditions: fictive and real money gains and losses
J. Neurosci.
The behavioral economics and neuroeconomics of reinforcer pathologies: implications for etiology and treatment of addiction
Current Psychiatry Reports
Single- and cross-commodity discounting among cocaine addicts: the commodity and its temporal location determine discounting rate
Psychopharmacology
Are executive function and impulsivity antipodes? A conceptual reconstruction with special reference to addiction
Psychopharmacology
What is addiction?
The behavioral economics of substance use disorders: reinforcement pathologies and their repair
Annu. Rev. Clin. Psychol.
Novel therapeutics for addiction: behavioral and neuroeconomic approaches
Curr. Treat. Options Psychiatry.
The behavioral economics of tobacco products: innovations in laboratory methods to inform regulatory science
Cited by (97)
Recent Opioid Use Impedes Range Adaptation in Reinforcement Learning in Human Addiction
2024, Biological PsychiatryA motivation model of sex addiction – Relevance to the controversy over the concept
2022, Neuroscience and Biobehavioral ReviewsResponse inhibition training as an intervention to modify liking and wanting for foods based on energy density: a proof of concept study
2024, Journal of Behavioral Medicine