Why is it that some people exposed to substances considered highly addictive don’t get hooked to the point of dependency, while other people seem pre-programmed for addiction? It is not surprising that the answer is complex, but it is also worthy of investigation.

Fortunately, a team of researchers has done a great deal of work to assemble and review all the theories of decision-making in addiction from 2000-2017. Their findings are published in the journal, Pharmacology Biochemistry and Behavior. They evaluate the theories of dysfunctional decision-making by the following criteria:

1. Why are some commodities addictive when others are not? 
2. Why does addiction follow common developmental trends?
3. Why do some individuals, as their valuation of drugs increases, also exhibit a decrease in valuation of non-addictive commodities? 
4. Why do individuals with addiction engage in consistent self-defeating patterns of behavior?
5. Why are individuals with addiction also likely to engage in other unhealthy behaviors? 
6. What interventions have been or are derivable from the tenets of these theories?

One interesting pattern identified by the authors is shown in Figure 1: Problem Usage Declines With Age. The peak age for binge drinking and illicit drug usage is the late teens and early 20s. Problem usage declines steadily with age after the age of 25.

Figure 1: Problem Usage Declines With Age. From “21st century neurobehavioral theories of decision making in addiction: Review and evaluation.” Used under fair use: Commentary.

One of the characteristics the authors identify across the publications surveyed is the addicted person’s decline in pleasure in activities and situations that previously had been pleasurable. The authors write,

Why do some individuals as their valuation of drugs increase also exhibit a decrease in valuation of non-addictive commodities? Individuals in the most advanced and severe stages of addiction may demonstrate concurrent patterns of overvaluation of addictive commodities, and undervaluation of alternative reinforcers, such as social and family engagement.

It will take some time for us to unpack the findings of this mammoth survey and present them here on AddictionNews. The authors arrive at four major groups of theories for explaining decision-making in addiction:

• Dopamine-Related Theories
• Negative Reinforcement Theories
• Self-Control Failure Theories
• Dual Systems Theories

It is enlightening to see how each of these ways of framing addiction is interconnected. The dopamine hit comes from many different substances and behaviors. The withdrawal of the dopamine hit is the negative reinforcement that leads to self-control failures. 

Ultimately, the authors conclude that “the exclusive validity of any one of these theories cannot be determined.” If only there were a unified theory of addiction that could encompass all the other theories. We’ll keep looking.

Written by Steve O’Keefe. First published December 22, 2023.

Sources:

“21st century neurobehavioral theories of decision making in addiction: Review and evaluation,” Pharmacology Biochemistry and Behavior, January 2018.

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