On a triadic neurocognitive approach of decision-making to addiction

Paradoxical behaviours characterizing an addiction could be understood as the result of a combination between an attempt to cope with dominant painful feelings (e.g., anxiety with low self-esteem) and sub-optimal decision-making prioritizing short-term over long-term consequences. This article focused on decision-making and emphasized that addicts’ decisions are determined by immediate outcomes because of abnormal interactions between key neural and cognitive systems: (1) an automatic, habitual and salient information processing mediated by amygdala-striatum dependent system; (2) an intention self-regulatory system forecasting the future consequences of a choice; (3) a interoceptive signals processing system which generates feeling states and in turn plays a strong influential role in decision-making and impulse control processes related to uncertainty, risk, and reward. As a whole, sub-optimal interactions such as a too strong automatic stimulus-driven actions associated with poor intentional control and a state of stress or craving are thought to result in prioritizing short-term consequences at the detriment of the necessary forecast of delayed consequences