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The Mind of an Addict

Preference reversal as a hallmark of addiction.

Imagine you set your alarm clock at midnight to wake up at 6 a.m. the next morning to exercise (or work on an assignment). But when the alarm goes off the next morning, the choice that you made last night now seems absurd. The warmth and comfort of the bed makes you change your mind. What was chosen the night before is now rejected. On the day before, your preference was to get up at 6 a.m., while when the time comes to get out of bed your preference is to stay in bed longer. This problem must have happened pervasively in most students’ life. There is a gap between what they prefer to do and what they actually do.

This tendency is often referred to as preference reversal (or time-inconsistent behavior). Preference reversal means that an individual’s preference at time1 differs from her preference at time 2. At time 1, the person chooses to overeat; at time 2, this person wishes that he had consumed a small portion. And unless the person somehow commits himself to his previous preferences, he succumbs. The most basic consequence of preference reversal is that we are strangers to ourselves. When you are making a promise to yourself, but you fail to keep the promise, then you can’t rely on yourself. The result is unhappiness.

The preference reversal is also reflected in addictive behavior. For example, problem drinkers may wake up every morning with a desire to abstain to attain future positive health, education, or better family outcomes. However, they may change their minds when faced with the immediate opportunity to drink (when a colleague mentions that there will be a happy hour right after work). The value of drinking, now immediately available, exceeds the delayed value of abstinence, resulting in a preference reversal and decision to drink.

These self-control failures that are seemingly at odds with “true preferences” or values are a key feature of relapse and addiction. On any occasion, using drugs, or overeating produces limited harm. The damage occurs after repeated indulgences. For example, someone who has a second helping of dessert every night ends up twenty pounds heavier than he or she had planned. Health behavior choices that create an undesirable way of life are made one day at a time. They are not made at the level of a lifestyle.

Thus, consistency (rationality) is not costless. It requires effort and investment. The costs vary among individuals by the amount of limited willpower. What can a person (or an addict) do to overcome the decision bias? One approach is to use self-control strategies that influence the value of options in the choice situation by attaching penalties to temptation and rewards to long-term goal pursuit. For example, some former alcoholics try to stay dry by taking disulfiram (Antabuse), a drug that has the effect of making the user violently ill if one takes a drink. Within a few minutes of ingesting alcohol, the user will experience severe nausea and vomiting. Similarly, the over-the-counter Alli (Orlistat) is a popular weight-loss drug (Orlistat is available with a prescription) that partially blocks the body’s ability to absorb fat. Like the Antabuse, the users who eat too much fat immediately experience the unpleasant side effects, such as gas, diarrhea, and abdominal pain.

More from Shahram Heshmat Ph.D.
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