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The Loss of Gut Feelings in Addiction

The somatic marker theory of addiction.

Michal Jarmoluk/Pixabay
Source: Michal Jarmoluk/Pixabay

The somatic marker theory explains how and why our emotions and bodily feelings guide our decision-making (Damasio, 1994). This influential theory shows that emotions are necessary for proper reasoning and decision-making. For instance, the sensing of physiological signals such as rapid heartbeat in response to anxiety or hunger motivates one to act.

The somatic marker perspective suggests that dysfunctional decision-making patterns contribute to addiction development. The emotional deficit represents as an influencing factor to addiction that contributed to the shift from casual drug use to compulsive and can be worsened by the substance abuse (Bechara & Damasio, 2005).

The sensation in our body tells us when a choice feels wrong or right. Our gut feelings simplify life decisions for us by guiding our attention toward what is important. If a person makes a costly mistake, the next time when they approach a similar experience, their hunches will be triggered, creating a bad feeling that, in effect, warns the person not to repeat the past mistake. As the saying goes, “Once bitten, twice shy.”

Our past emotional experiences leave affective residues in the body (gut feelings). These gut feelings or intuition are stored hunches originating from past experiences. They are potentially helpful for guiding decision making.

For example, when deciding to speed on a highway because you are late for a meeting, the “thought” of being stopped by police, or the “thought” of getting into an accident, will trigger some form of a fear alarm signal, a bodily sensation that is associated with the imagined scenario. These feelings are indeed beneficial because they consciously or unconsciously bias the decision in an advantageous manner.

Intuition allows us to get access to pre-existing knowledge. When we use intuition, we know what is right, even if we cannot explain why. People from various professional backgrounds (e.g., firefighters, doctors, and nurses) use their intuition in complex situations and under high stress and time pressure.

The somatic marker theory of addiction holds that addiction is a state where the reflective system is compromised. That is, the reflective systems are not generating emotional signals that help bias the response away from disadvantageous decisions. Thus, the impulsive system, operating without the restraints of the reflective system, may bias the addict to immediate pleasure (Verdejo-Garcia & Bechara, 2009).

Evidence suggests that emotional signals are absent in addicts (Olsen et al., 2015). For instance, individuals with methamphetamine dependence have a reduced emotional response to fearful or angry faces and less empathy for another’s pain (Ibrahim et al., 2019). Only a small fraction of heavy drinkers admit they have a drinking problem. This is a reason why some people keep drinking even as they realize that the habit is destroying their lives.

In summary, emotion plays a critical role in decision-making processes. The somatic marker perspective demonstrates that it is more than an intellectual understanding of the consequences that guides a person’s actual behavior in the real world.

For addicts, the absence of an emotional response is an example of a dysfunction in the decision-making control mechanisms. Decision failures might explain why addicts pursue and consume drugs even in the face of negative consequences or the knowledge of positive outcomes that might come from quitting the drugs.

Interventions may help to promote awareness of negative consequences and the value of alternative rewards. For example, they help addicts to see the bigger picture. By its nature, optimal decision-making is focused not only on the “here and now,” but also takes into consideration the future consequences of decisions.


Bechara, A. & Damasio, A. R. The somatic marker hypothesis: A neural theory of economic decision. Games Econ. Behav. 52, 336–372 (2005).

Damasio, A. R. Descartes’ error (Random House, 2006).

Ibrahim, C., et al (2019), The Insula: A Brain Stimulation Target for the Treatment of Addiction, Front. Pharmacol., 10:720.

Olsen VV, Lugo RG, Sütterlin S. (2015) The somatic marker theory in the context of addiction: contributions to understanding development and maintenance. Psychol Res Behav Manag; 8:187-200.

Paulus, M. P. & Stein, M. B. An insular view of anxiety. Biol. Psychiatry 60, 383–387 (2006).

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