The somatic marker theory in the context of addiction: contributions to understanding development and maintenance

Abstract

Recent theoretical accounts of addiction have acknowledged that addiction to substances and behaviors share inherent similarities (eg, insensitivity to future consequences and self-regulatory deficits). This recognition is corroborated by inquiries into the neurobiological correlates of addiction, which has indicated that different manifestations of addictive pathology share common neural mechanisms. This review of the literature will explore the feasibility of the somatic marker hypothesis as a unifying explanatory framework of the decision-making deficits that are believed to be involved in addiction development and maintenance. The somatic marker hypothesis provides a neuroanatomical and cognitive framework of decision making, which posits that decisional processes are biased toward long-term prospects by emotional marker signals engendered by a neuronal architecture comprising both cortical and subcortical circuits. Addicts display markedly impulsive and compulsive behavioral patterns that might be understood as manifestations of decision-making processes that fail to take into account the long-term consequences of actions. Evidence demonstrates that substance dependence, pathological gambling, and Internet addiction are characterized by structural and functional abnormalities in neural regions, as outlined by the somatic marker hypothesis. Furthermore, both substance dependents and behavioral addicts show similar impairments on a measure of decision making that is sensitive to somatic marker functioning. The decision-making deficits that characterize addiction might exist a priori to addiction development; however, they may be worsened by ingestion of substances with neurotoxic properties. It is concluded that the somatic marker model of addiction contributes a plausible account of the underlying neurobiology of decision-making deficits in addictive disorders that is supported by the current neuroimaging and behavioral evidence. Implications for future research are outlined.

Bad Choices Make Good Stories: The Impaired Decision-Making Process and Skin Conductance Response in Subjects With Smartphone Addiction

“…These findings suggest that subjects with addictions present impairment in recognizing disadvantageous alternatives, hypersensitivity to rewards and hyposensitivity to punishments. These pattern of decision making process contribute to the onset and maintenance of addictive disorders (49, 50).…”

Conceptualizing gambling disorder with the process model of emotion regulation

“…As argued by Olsen et al. ( 2015 ), a difficulty to identify one’s own emotional states may lead to an impairment in decision-making. This issue is particularly relevant in relation to GD where the individual seems unable to use the information contained in an aversive emotional state related to a negative external feedback.…”

“…Noteworthy, diagnostic criteria include a reference to a modification of mood tone and emotional experience, suggesting that gambling serves as a regulator of dysphoric affects ( Rosenberg & Feder, 2014 ). Theoretically, most authors attempting to understand the psychological factors underlying GD have often indirectly suggested the centrality of failures in emotion regulation (ER; Blaszczynski & Nower, 2002 ; Jacobs, 1986 ; Lesieur, 2001 ; McCormick, 1988 ; McDougall, 2004 ; Olsen, Lugo, & Sutterlin, 2015 ; Sharpe, 2002 ). ER refers to a transdiagnostic construct that is relevant to a wide range of disorders and is defined as the ability to modulate valence, intensity, or time course of one’s emotional experience and expression coherently with one’s goals and desires ( Garofalo, Velotti, & Zavattini, 2013 ; Gross, 1998 ; Thompson, 1990 ; Velotti & Garofalo, 2015 ).…”

“…Some theories argued for an involvement of specific components of emotion dysregulation in definite impairments of pathological gamblers’ (PGs) psychological functioning. For instance, the somatic markers theory of addiction ( Olsen et al., 2015 ) stated that difficulties in emotion processing account for abnormal decision-making in GD.…”

Behavioral approach and orbitofrontal cortical activity during decision-making in substance dependence

“…Dorsolateral prefrontal and orbitofrontal cortex have been implicated in impaired decision-making in SUD (Li et al, 2010; Olsen et al, 2015). The OFC is important for salience attribution of a stimulus, and may be overly active in drug users especially in response to drug cues (Chase et al, 2011; Schoenbaum and Shaham, 2008).…”