The challenge of addiction is to understand how and why addicts are so insensitive to the future consequences of their drug use. When faced with a choice that brings immediate pleasure, even at the risk of experiencing future negative outcomes, addicts appear oblivious to the consequences of their actions. Even more challenging is the understanding of why this same choice is repeatedly made with the negative consequences. Understanding what motivates these decisions is a critical part of prevention and treatment of addiction.
One way of understanding poor how decision-making might happen is to consider the processes involved in the dual decision-making model (Kahneman, 2011). The dual decision framework suggests that choice reflects the interaction of two distinct decision systems in conflict with each other: a goal-directed flexible (deliberative system) and automatic (habit-based system). These two systems have also been referred to as controlled (System 2) and impulsive (System 1), or conscious (planning-based) and unconscious (habit-based).
The tradeoff between speed and accuracy is a universal aspect of individual decision-making. The deliberative system is conscious (analytical) and relatively slow. The impulsive system, in contrast, is relatively effortless and spontaneous. Choices favoring the immediate reward are associated with the habit or impulsive system. In contrast, choices favoring the long-term consequences are associated with the deliberative system.
To achieve rational decision-making, the two systems have to work well together to reliably contribute to the person’s goal achievement. And the reflective system exerts control over the impulsive system to suppress the urges. The typical analogy is that of a horse and rider: the horse has a mind of its own and sometimes goes its own way. The challenge is to recognize instances in which the two systems are at war, such as ‘I want to go to the gym more often, but I don’t.’
The dual decision model views addiction as a consequence of perturbed balance in favor of impulsive system (Volkow and Baler, 2013). Addiction arises when the impulsive system wins the competition against the deliberative system for behavioral control. The capacity to inhibit impulsive behavior is a major contributor to an individual’s vulnerability to addiction (Heyman, 2009). In other words, an addict lacks a “healthy mind.”
This imbalance can also be triggered by repeated consumption of a drug and becoming sensitive to rewarding stimuli (Rangel et al., 2008). For example, cannabis use, particularly in early adolescence, is associated with the development of psychosis (Chadwick, et al., 2013). The addict gets stuck in an impulsive mode of deciding; overvaluing the immediate value of drug-related stimuli and undervaluing the long-term consequences.
In those individuals for whom drug use develops into addiction, drug use become compulsive (a single-minded focus), indicating a bias in decision making. Compulsive behavior is strongly cue-dependent in the sense that it is regularly triggered by certain situations, places, or people associated with the type of behavior in question. Relapses are frequently triggered by environmental cues (e.g., watching others drinking alcohol). Proximity can increase the strength of desire for tempting goods, such as a piece of a cake for a dieter.
The compulsive use of the substance comes at the expense of other rewards such as spending time with friends or family. This desire is presumably so strong that no other motives can realistically compete. Thus, the challenge for addicts is to build a life around something more meaningful than endless self-indulgence.
In sum, addiction arises when the automatic system wins the competition against the deliberative system for behavioral control. Both systems are important to forming decisions, and good choices appear most likely to emerge when the two systems work in concert.
Thus, addiction recovery includes restoring the balance between impulse and self-control. Eventually, there must be a connection between these two systems to control the impulsive system to treat the addictive behavior. For example, treating alcoholism is more than just stopping drinking alcohol, it requires to address the forces that compel needs for alcohol. Alcohol numbs the pain and allows one to think that one is doing just fine. Similarly, overeating (food high in sugar and fat) is used to deal with fear, doubt, and insecurity.
For an addict to get well, it is necessary to bring those unconscious forces to conscious-awareness and to connect them to thinking mind to end the conflict between the two systems (i.e., hypocrisy). Without harmony between two systems, we cannot be whole and integrated. In fact, the goal of therapy is to bring memories from the nonverbal to the verbal areas of the brain, to connect and integrate them (Panksepp and Biven, 2012). By becoming more aware of our unconscious wishes, we experience ourselves as free rather as victims.
Chadwick B, Miller ML, Hurd YL. Cannabis use during adolescent development: susceptibility to psychiatric illness. Front Psychiatry. 2013;4:129.
Heyman G.M. Addiction: A disorder of choice. Cambridge, MA: Harvard University Press; 2009.
Kahneman Daniel (2011) Thinking, Fast and Slow, New York: Farrar, Straus and Giroux
Rangel, C. Camerer, and R. Montague, A framework for studying the neurobiology of value-based decision-making, Nature Reviews Neuroscience, 2008, 9, 545-556
Panksepp J, Biven L, 2012. The Archaeology of Mind: Neuroevolutionary Origins of Human Emotions. New York: W.W. Norton
Volkow, N.D., Baler, R.D. (2014), Addiction science: Uncovering neurobiological complexity, Neuropharmacology,76, 235-249