Decision-making deficits in drug addiction

doi:10.1016/S1364-6613(02)01960-5

Trends in Cognitive Sciences

Volume 6, Issue 9, 1 September 2002, Pages 361-363

https://doi.org/10.1016/S1364-6613(02)01960-5 Get rights and content

Abstract

Core aspects of addictive behaviour can be explained in terms of abnormal decision-making. Using recording of autonomic function during performance of two gambling tasks, Bechara et al. have recently identified three distinct neuropsychological subtypes in individuals with substance dependence. These subtypes may reflect dissociable patterns of disruption in limbic brain circuitry.

Section snippets

Neuropsychology of decision-making

Two recent studies by Bechara and colleagues 2., 3. have investigated the decision-making profile in substance abuse, using a neuropsychological measure known as the Gambling Task (see Fig. 1). In this task, subjects are presented with four decks of cards and must make a long series of decisions, picking from any deck on each go without knowing that there are ‘safe’ and ‘risky’ decks. Over 100 choices, healthy subjects typically develop a preference for the ‘safe’ decks (C and D) over the

Decision-making heterogeneity in substance-dependent individuals

Grant et al. have previously tested a group of multiple-drug users recruited from the community on the Gambling Task, and reported increased selection from the risky decks relative to controls [7]. Bechara et al. [2] extended these findings in a larger and more clinically severe group by administering the task with physiological monitoring to a group of 46 individuals, who were undergoing drug rehabilitation at an inpatient centre and who met DSM-IV criteria for alcohol or substance dependence.

Methodological issues in addiction research

Abnormalities in ventromedial PFC and amygdala therefore appear to be associated with distinct manifestations of decision-making impairment. Functional neuroimaging potentially provides a further step for confirming these dissociable neuroanatomical substrates, and the clinical and rehabilitative significance of the heterogeneity is another target for research. However, the precise nature of neuropsychological dysfunction in addiction remains unclear. Chronic exposure to substances of abuse

Component processes in decision-making

The learning context of the Gambling Task complicates its use in functional neuroimaging, where a carefully-matched control task is needed for subtraction analysis. A recent PET study by Ernst et al. [17] contrasted Gambling Task performance with a control condition using a specified order of card selection (i.e. A, B, C, D – A, B, C, D, etc…). Both dorsal and ventral aspects of PFC were activated in this subtraction, associated with the volitional aspects of decision-making. However, both

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Citation Excerpt :
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Trends in Cognitive Sciences

Research updateDecision-making deficits in drug addiction

Abstract

Section snippets

Neuropsychology of decision-making

Decision-making heterogeneity in substance-dependent individuals

Methodological issues in addiction research

Component processes in decision-making

Trends Cogn. Sci.

Neuropsychologia

Neuropsychologia

Neuroscience

Neuropsychologia

Neuropsychopharmacology

Failure to respond autonomically to anticipated future outcomes following damage to prefrontal cortex

Cereb. Cortex

Differential contributions of human amygdala and ventromedial prefrontal cortex to decision-making

J. Neurosci.

A neuropsychological investigation of prefrontal cortex involvement in acute mania

Am. J. Psychiatry

Characterization of the decision-making impairment of patients with ventromedial prefrontal cortex lesions

Brain

Different types of fear-conditioned behaviour mediated by separate nuclei within amygdala

Nature

Differential amygdala responses to winning and losing: a functional magnetic resonance imaging study in humans

Eur. J. Neurosci.

Striatal dopamine nerve terminal markers in human, chronic methamphetamine users

Nat. Med.

Research update
Decision-making deficits in drug addiction