title: Stages of dysfunctional decision-making in addiction.
abstract: 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.
authors.affiliation: Monash Institute of Cognitive & Clinical Neuroscience (MICCN), Monash University, Australia; School of Psychological Sciences, Monash University, Australia. Electronic address: antonio.verdejo@monash.edu.
authors.forename: Antonio
authors.initials: A
authors.lastname: Verdejo-Garcia
authors.affiliation: Monash Institute of Cognitive & Clinical Neuroscience (MICCN), Monash University, Australia; School of Psychological Sciences, Monash University, Australia.
authors.forename: Trevor T-J
authors.initials: TT
authors.lastname: Chong
authors.affiliation: Monash Institute of Cognitive & Clinical Neuroscience (MICCN), Monash University, Australia; School of Psychological Sciences, Monash University, Australia.
authors.forename: Julie C
authors.initials: JC
authors.lastname: Stout
authors.affiliation: Monash Institute of Cognitive & Clinical Neuroscience (MICCN), Monash University, Australia; School of Psychological Sciences, Monash University, Australia.
authors.forename: Murat
authors.initials: M
authors.lastname: Yücel
authors.affiliation: Semel Institute of Neuroscience, University of California Los Angeles, United States.
authors.forename: Edythe D
authors.initials: ED
authors.lastname: London
mesh_terms: D003072:Cognition Disorders / Q000150:complications / Q000523:psychology; D003657:Decision Making; D006801:Humans; D012054:Reinforcement, Psychology; D012201:Reward; D019966:Substance-Related Disorders / Q000150:complications / Q000523:psychology* / Q000628:therapy