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Decision Making, Impulse Control and Loss of Willpower to Resist Drugs: A Neurocognitive Perspective

Institute for the Neurological Study of Emotion and Creativity, Department of Psychology, University of Southern California, Los Angeles, California 90089-2520, USA.
Nature Neuroscience (Impact Factor: 14.98). 12/2005; 8(11):1458-63. DOI: 10.1038/nn1584
Source: PubMed

ABSTRACT Here I argue that addicted people become unable to make drug-use choices on the basis of long-term outcome, and I propose a neural framework that explains this myopia for future consequences. I suggest that addiction is the product of an imbalance between two separate, but interacting, neural systems that control decision making: an impulsive, amygdala system for signaling pain or pleasure of immediate prospects, and a reflective, prefrontal cortex system for signaling pain or pleasure of future prospects. After an individual learns social rules, the reflective system controls the impulsive system via several mechanisms. However, this control is not absolute; hyperactivity within the impulsive system can override the reflective system. I propose that drugs can trigger bottom-up, involuntary signals originating from the amygdala that modulate, bias or even hijack the goal-driven cognitive resources that are needed for the normal operation of the reflective system and for exercising the willpower to resist drugs.

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    • "Substantially weakened PFC function could, in turn, further disinhibit limbic-striatal responses especially under challenging situations, including stress and exposure to alcohol-related cues. In addition, given the crucial role of the PFC in inhibitory control and decisionmaking (Bechara 2005; Goldstein and Volkow 2011), altered PFC function could result in an inability to inhibit compulsive alcohol seeking and poor decisionmaking when confronted with the choice to return to drinking and continued alcohol use despite negative consequences, thereby aggravating the relapse cycle. "
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    • "Thus, in the present study, it was tested whether observing drug-related cues such as the preparation and actual use of the drug in alcohol advertisement may be particularly potent in eliciting cue reactivity among alcohol-dependent patients. The conditioned reward circuitry response to drug-related cues is accompanied by activity of the autonomous nervous system (Bechara 2005). Parasympathetic nervous system activity in response to external stimulation can be measured using the High-frequency (HF) heart rate variability (HRV) component (Thayer and Lane 2000). "
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    • "Dual-process models of addiction could help to understand this paradoxical state of affairs. According to such models, two systems of information processing contribute to substance-related evaluations and behavior: An impulsive system that operates rapidly, automatically, and mostly outside of conscious control, and a reflective system that works more slowly, deliberately, and on a conscious level (Bechara, 2005; Wiers, Gladwin, Hofmann, Salemink, & Ridderinkhof, 2013). Subtle biases in the former system such as learned automatic approach tendencies towards food cues may undermine conscious control and may thus contribute to excessive food intake (Berridge, 1996; Wiers et al., 2013). "
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