Addiction as a Learning Disorder
Is an addict capable of free choice?
Posted Jan 21, 2015
A key question of addiction is why addicts are so insensitive to the future consequences of their drug seeking behavior. Why do they persist? The consensus among scientists is that drug addiction is associated with altered learning systems that appears to overvalue pleasure, undervalue risk, and fail to learn from repeated mistakes. In other words, drugs distort an unconscious brain process into anticipating an exaggerated level of pleasure. An addict can try to overcome this effect by exercising cognitive control to no avail. Is an addict capable of free choice?
Anyone schooled in the basic principle of rational choice theory recognizes that decision making consists of three basic steps: 1) framing a problem, 2) assigning values to the available options, and 3) choosing. Rational person engages in some sort of maximization by choosing the best from the available options. This view of choice as a matter of computing maximal value is assumed in cost-benefit analysis, government policy-making and much of economic theory. One of the functions of the dopamine systems is to influence the valuation step. Basically dopamine converts experiences into a common currency of “reward” and that people make choices in order to maximize this reward.
Dopamine (pleasure chemical in the brain) responds to primary rewards (e.g., food, water, and sex) as well as abstract rewards (e.g., money). Expectations play a key role in the response of dopamine to stimuli. That is, dopamine is released in proportion to the difference between the “anticipated reward” and the “experienced reward” of a particular event. If one is told that they will get any prize for sure, and is then given that prize, there is no surprise and no dopamine release. Part of the appeal of live sporting events is their inherent unpredictability. Watching a surprise win in a game, thousands of spectators simultaneously experience a huge surge of dopamine. People keep coming back, as if addicted to the joy of experiencing unexpected rewards. In short, under normal conditions, dopamine is only involved in the process of pursuing a reward, not in the enjoyment of it.
In healthy people the dopamine signal is used to update the value attached to different actions, which in turn acts as an input into choice and learning. Learning takes place only when something unexpected happens. Nothing focuses the mind like surprise. When the learned rule is violated, the dopamine neuron responds. The reward system gets the message that old rules don’t apply anymore and it may be time to learn a new association. In general, how much we learn in life depends on how big the difference is between what we expected and what actually happened. We only learn by making mistakes!
But this learning process can be distorted by the use of drugs such as heroin, cocaine, and amphetamine. Addiction involves the overvaluation of the cues surrounding the drug-taking experience. With repeated drug use, dopamine systems assign excessive value to the cues and the contexts associated with drug taking. When dopamine continues to be released beyond the normal period, the brain is thrown into a perpetual state of “wanting,” which is the essence of addiction. That is, addictive substances, by artificially boosting dopamine levels in the brain, can lead to a desire for the substance that is way out of proportion with the pleasure it brings. In short, thanks to the distortions in the valuing system of addicted individuals, addiction seems to increase desire or want without increasing the enjoyment of the drugs.
People with a genetic mutation that reduces the number of dopamine receptors involved in the detection of errors, are less likely to learn from their mistakes. These people are significantly more likely to become addicted to drugs and alcohol. Because they have difficulty learning from their mistakes, they make the same mistakes over and over. They can’t adjust their behavior when it proves self-destructive.
Thus, addiction might be best viewed as a chronic disease (e.g., diabetes), so that most addicts will require long-term treatment and relapse can be expected to occur sometimes during the treatment. That is, in the later stages the addict may seemto lack all power of choice and free will.What are the treatment implications? One approach is that because the addicts’ brains are so compromised, it is necessary for others (families, friends, and professionals) to fill in as relentless supports for the inability to make decisions.
Viewing addicts with limited free will can produce a better understanding of addictive behaviors and can encourage a rehabilitative rather than retributive justice system. Nevertheless, some argue that addicts should still be held responsible for their actions. The illusion that they are responsible may be what gets them to change their behavior. Evidence shows that people function better and are more able to deal with stress when they feel that they are in control. Believing that things are beyond your control and they probably will be. We are wired for personal responsibility, even if it’s a bit fictional. Viewing ourselves as free and responsible agents is the groundwork for self-discipline and self-initiatives (Heyman, 2009). Believing that one can influence one’s fate provides the motivation to seek opportunities to escape from despair.