Stages of dysfunctional decision-making in addiction

Pharmacol Biochem Behav. 2018 Jan;164:99-105. doi: 10.1016/j.pbb.2017.02.003. Epub 2017 Feb 16.


Drug use is a choice with immediate positive outcomes, but long-term negative consequences. Thus, the repeated use of drugs in the face of negative consequences suggests dysfunction in the cognitive mechanisms underpinning decision-making. This cognitive dysfunction can be mapped into three stages: the formation of preferences involving valuation of decision options; choice implementation including motivation, self-regulation and inhibitory processes; and feedback processing implicating reinforcement learning. This article reviews behavioral studies that have examined alterations in these three stages of decision-making in people with substance use disorders. Relative to healthy individuals, those with alcohol, cannabis, stimulant and opioid use disorders value risky options more highly during the formation of preferences; have a greater appetite for superficially attractive rewards during choice implementation; and are both more efficient in learning from rewards and less efficient in learning from losses during feedback processing. These observed decision-making deficits are most likely due to both premorbid factors and drug-induced effects. Because decision-making deficits have been prospectively associated with a greater risk of drug relapse, we advocate for greater research on modulating the component stages that give rise to dysfunctional decision-making in disorders of addiction.

Publication types

  • Review

MeSH terms

  • Cognition Disorders / complications
  • Cognition Disorders / psychology
  • Decision Making*
  • Humans
  • Reinforcement, Psychology
  • Reward
  • Substance-Related Disorders / complications
  • Substance-Related Disorders / psychology*
  • Substance-Related Disorders / therapy