Alcohol Dependence Associated with Increased Utilitarian Moral Judgment: A Case Control Study

Abstract

Recent studies indicate that emotional processes, mediated by the ventromedial prefrontal cortex (VMPC), are of great importance for moral judgment. Neurological patients with VMPC dysfunction have been shown to generate increased utilitarian moral judgments, i.e. are more likely to endorse emotionally aversive actions in order to maximize aggregate welfare, when faced with emotionally salient personal moral dilemmas. Patients with alcohol dependence (AD) also exhibit impairments in functions mediated by the prefrontal cortex, but whether they exhibit increased utilitarian moral reasoning has not previously been investigated. The aim of this study was to investigate moral judgment in AD patients (n = 20) compared to healthy controls (n = 20) matched by sex, age and education years. Each subject responded to a battery of 50 hypothetical dilemmas categorized as non-moral, moral impersonal and moral personal. They also responded to a questionnaire evaluating explicit knowledge of social and moral norms. Results confirmed our hypothesis that AD patients generated increased utilitarian moral judgment compared to controls when faced with moral personal dilemmas. Crucially, there was no difference in their responses to non-moral or impersonal moral dilemmas, nor knowledge of explicit social and moral norms. One possible explanation is that damage to the VMPC, caused by long term repeated exposure to alcohol results in emotional dysfunction, predisposing to utilitarian moral judgment. This work elucidates a novel aspect of the neuropsychological profile of AD patients, namely a tendency to generate utilitarian moral judgment when faced with emotionally salient moral personal dilemmas.

Why do people behave immorally when drunk?

“…As this article was going to press, Duke and Bègue published a study (2015) showing the opposite -that blood alcohol content is positively correlated with increased utilitarianism in responses to trolley problems. This complements existing studies, which have shown that subjects with VMPFC damage due to long-term alcohol abuse tend to be more utilitarian in their judgments (Khemiri et al 2012).…”

Impaired Decoding of Fear and Disgust Predicts Utilitarian Moral Judgment in Alcohol-Dependent Individuals

“…Nevertheless, future work should use neuropsychological measures of impulse control or biological markers of affective disturbance such as salivary cortisol (Dallman, 2005). The current demonstration of utilitarian responding in alcohol-dependent individuals is consistent with prior work, including a previous study in a Swedish sample (Khemiri et al, 2012). The utilitarian bias observed in the current sample also appears to be broader than the pattern observed in our prior work in a polysubstance-dependent group (Carmona-Perera et al, 2012a,b), in which the bias emerged only high-conflict personal dilemmas.…”

“…Typically, participants are instructed to choose between a utilitarian option (i.e., harming one person to save a greater number of people) and a deontological option (i.e., refusing to harm someone and thus allowing a greater number of people to die). Alcoholdependent individuals have been shown to endorse utilitarian options in response to moral dilemmas (Khemiri et al, 2012). Furthermore, among polysubstance users, severity of alcohol use predicts the degree of utilitarian bias (CarmonaPerera et al, 2012a,b) 2 .…”

Valence of emotions and moral decision-making: increased pleasantness to pleasant images and decreased unpleasantness to unpleasant images are associated with utilitarian choices in healthy adults

“…Because we show that variations in emotional experience, but not in subjective perceptions of moral content, are associated with utilitarian biases, we reason that the interventions for individuals with moral judgment problems should focus on training and shaping emotional response, rather than working on the “rules” characterizing moral violations. These type of emotional interventions may be useful to restore social decision-making in patients with acquired brain injuries (Koenigs et al, 2007; Moretto et al, 2010), psychopathy (Blair, 2007; Young et al, 2012) or drug addictions (Carmona-Perera et al, 2012; Khemiri et al, 2012). Our results should be also interpreted in the context of its relevant limitations.…”