Addiction

10 Causes of Decision-Making Failures in Addiction

The addicted brain.

Posted Feb 24, 2019

Addictive behavioral patterns can be seen as symptoms of decision-making processes that fail to take into account the long-term consequences of actions (Verdejo-Garcia, et al., 2018). These thinking errors can hamper attempts to maintain abstinence. The following describes several components of decision-making that are compromised in the context of addiction.

1. Highly sensitive to reward. Reward sensitivity is a personality trait that increases a person’s vulnerability to addiction. Reward sensitivity is defined as a tendency to seek exciting, pleasurable, and novel experiences.  And like any personality trait are more than 50 percent determined by heredity. People who seek high-sensation experiences are more vulnerable to substance abuse (Shulman et al., 2016). For example, high sensation seekers tend to perceive more benefits and fewer risks in drinking than do low sensation seekers.

2. Addiction as a disorder of self-control. Self-control can be defined as choosing according to long-term goals rather than immediate ones. For the most part, impulsive behaviors are self-defeating in terms of the individuals’ important goals. Research shows that impulsivity is higher in people with substance use disorders relative to those without (Bickel, et al., 2014). Addicts fail to have a proper valuation of distant rewards, and they often end up acting against their own best interest. The addicts and overeaters want to discontinue their behaviors at some point, but not today. It always feels better to defer aversive efforts.

3. Loss of willpower. Willpower refers to effortful control that is exerted with the purpose of controlling our impulsive behavior (Baumeister & Stillman, 2007). When resources are depleted, people tend to make poor choices and are more likely to be influenced by desires, urges, and cravings, although they may regret later. A number of situational factors can temporally impair willpower and lead to impulsive reactions (e.g., making a series of choices that involve conflict, stress, lack of sleep, and alcohol).

4. Working Memory Capacity (WMC). Working memory is the ability to hold information in mind. Working memory and attention are closely related concepts. Attention is the ability to select and focus on relevant information in the environment, at the same time ignoring other information of lesser task-related importance (e.g., irrelevant emails or text messages). Individuals low in WMC show limited capacity to inhibit impulsive responses (Hofmann & Nordgren, 2015). Working memory can be temporarily impaired by anxiety or stress, craving, and alcohol intoxications. This means that the demands on the WMC exceed its limited resources. The impairment leaves the person less able to control impulses.

5. Situational cues. Temptations are triggered by situational cues (stimuli), by means of Pavlovian conditioning, that promise immediate satisfaction at the cost of important long-term rewards (Ainslie, 2001). For example, the sight and smell of vodka increase one’s desire for a drink. The presence of craving shifts the individual’s preference for the drink, reversing an earlier resolution to avoid the alcohol. There are also many circumstances, such as strong feelings (e.g., anger or anxiety), in which people experience a disconnection between what they desire at the moment and what is best for their long-term self-interest.

6. Stress and escape from self-focus. There is plenty of evidence that many addicts use drugs to cope with stressful or traumatic experiences (Khantzian, 2012). Drug use offers them a euphoric escape from reality. Emotional distress causes a behavioral shift toward immediate improvements in mood, and so people make poor decisions. Thus, the impulsive behavior is like a purchase of a short-term reduction in negative affect at the price of long-term maintenance of the negative effect.

7. All-or-nothing thinking. This is a case when minor lapses snowball into self-control collapse (Marlatt & Donovan, 2005). For example, an individual who has successfully abstained from alcohol, after having one beer, may engage in binge drinking, thinking that since he has “fallen off the wagon” he might as well drink an entire case of beer. The AA calls this line of biased thinking as “A drink equals a drunk.” The relapse often creates a feeling of self-blame and loss of perceived self-control.

8. Projection bias. The projection bias is a cognitive bias in which we falsely project our current preferences onto our future preferences (Loewenstein, 2005). When we are in a neutral mindset, we tend to underestimate the power of craving or hungry to shape our behavior. This bias predicts that people will have a tendency to feel greater confidence in their ability to cope with temptation when they are in a neutral state and overexpose themselves to tempting situations.

9.     Denial. Addicts are notoriously prone to denial.  Denial explains why drug use persists in the face of negative consequences (Pickard, 2016). Denial is basically a defense mechanism. That is, individuals with substance disorders use denial in order to prevent threatening emotions from entering our conscious thought. There is also evidence suggesting that addicts lack the knowledge about the negative consequences not out of denial, but because of impairment in insight and self-awareness (Naqvi et al., 2007). Chronic drug abuse has been recognized to be associated with impaired self-awareness (dysfunction of the insular cortex), which manifests as denial of the severity of addiction and the need for treatment  (Bechara & Damasio, 2005).

10.  Long-term effects of drug use. Decision-making impairments can also be the consequence of substance use disorders, creating an addiction trap. Repeated use of stimulants sensitizes certain aspects of the reward system so that a small amount of the drug or even an environmental cue previously associated with the drug can trigger drug use. The result is joyless addiction (Kringelbac & Berridge, 2010). This explains why addicts often express that they continue to use drugs even when they no longer derive any pleasure. For example, some cigarette smokers express a deep hatred of smoking, but they continue to smoke regularly. A breakdown of the balance between pleasure (liking) and desire (wanting) can lead to bad decisions (or choices that are not liked). 

The nature of addiction is frequently debated as either a choice or a disease. The accumulative evidence shows that while initial drug experimentation is largely a choice, continued drug use impairs decision-making capability. Evidence also suggests that poor decision-making is a predisposing factor that contributes to the transition from casual drug use to compulsive abuse.

References

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Bechara, A.; Damasio, A.R. (2005). The somatic marker hypothesis: A neural theory of economic decision. Games and Economic Behavior. 52, 336–372.

Bickel, W. K., Johnson, M. W., Koffarnus, M. N., MacKillop, J., & Murphy, J. G. (2014). The behavioral economics of substance use disorders: Reinforcement pathologies and their repair. Annual Review of Clinical Psychology, 10, 641-677.

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Naqvi, Nasir H., David Rudrauf, Hanna Damasio, and Antoine Bechara (2007). Damage to the Insula Disrupts Addiction to Cigarette Smoking. Science 315: 531-534. 

Shulman, E.P.,  A.R. Smith, K. Silva, G. Icenogle, N. Duell, J. Chein, L. Steinberg The dual systems model: review, reappraisal: and reaffirmation, Dev. Cogn. Neurosci., 17 (2015), pp. 103-177.

Pickard Hanna (2016). Denial in Addiction. Mind and Language, Vol 31 (3): 277-299.

Verdejo-Garcia, A., et al., 2018, Stages of dysfunctional decision-making in addiction.  Pharmacology Biochemistry & Behavior, Vol 164: 99-105.