21st century neurobehavioral theories of decision making in addiction: Review and evaluation

Abstract

This review critically examines neurobehavioral theoretical developments in decision making in addiction in the 21st century. We specifically compare each theory reviewed to seven benchmarks of theoretical robustness, based on their ability to address: why some commodities are addictive; developmental trends in addiction; addiction-related anhedonia; self-defeating patterns of behavior in addiction; why addiction co-occurs with other unhealthy behaviors; and, finally, means for the repair of addiction. We have included only self-contained theories or hypotheses which have been developed or extended in the 21st century to address decision making in addiction. We thus review seven distinct theories of decision making in addiction: learning theories, incentive-sensitization theory, dopamine imbalance and systems models, opponent process theory, strength models of self-control failure, the competing neurobehavioral decision systems theory, and the triadic systems theory of addiction. Finally, we have directly compared the performance of each of these theories based on the aforementioned benchmarks, and highlighted key points at which several theories have coalesced.

A Reinforcer Pathology perspective on relapse

“…Bickel et al, 2018). To our knowledge, the temporal window has not been previously addressed in other theories of drug dependence (c.f.…”

“…To our knowledge, the temporal window has not been previously addressed in other theories of drug dependence (c.f. Bickel et al, 2018). In this context, identifying functional relations between the temporal window and relapse would begin by measuring changes in the temporal window over time and then relating those to changes in an individual's preference and valuation of available reinforcers (e.g., drugs vs. prosocial activities).…”

Sensitivity to gains during risky decision-making differentiates chronic cocaine users from stimulant-naïve controls

“…From a clinical perspective, the lack of gain sensitivity is not surprising, since one of the core criteria of all substance-related disorders is the withdrawal from social, occupational, and recreational activities with high value in order to use the substance [52]. This pattern of behaviour was also proposed to reflect a shift in the subjective value of ordinary life events to substance-related rewards [23].…”

“…The negative consequences of cocaine use include not only decreases in quality of life and social functioning [3], but also an increase in high-risk behaviours and drug usage [11,22]. From a clinical perspective, chronic cocaine use is usually accompanied by increased forgoing of occupational or recreational activities and by an increase of cocaine-seeking behaviours [23], which, from a decision-making viewpoint, suggest an alteration in the sensitivity of value-based decisions to the risks and returns of different courses of action.…”

“…Neurobehavioral research has sought to identify the neuroplastic adaptations underlying disadvantageous decision-making [23,24], suggesting that chronic cocaine users (CU) are less sensitive to gains (i.e., magnitude of positive outcomes) and losses (i.e., magnitude of negative outcomes) in everyday situations [25,26]. Particularly, CU have been proposed to suffer from a generalised impairment in value representation, reflected in blunted neural responses to nonsubstance-related (social and non-social) rewards, specifically in value-coding regions such as ventromedial prefrontal cortex [3,27,28].…”