Impaired Decision-making, Impulsivity, and Compulsivity: Addictions' Effect on the Cerebral Cortex
A. Tom Horvath, Ph.D., ABPP, Kaushik Misra, Ph.D., Amy K. Epner, Ph.D., and Galen Morgan Cooper, Ph.D. , edited by C. E. Zupanick, Psy.D.The cerebral cortex is the outer most layer of the brain. The cerebral cortex is further divided into four areas. These four areas are: the frontal lobe (or frontal cortex), parietal lobes (left and right), temporal lobes (left and right), and occipital lobes (left and right). Each area is associated with certain brain functions: One area of the frontal cortex is called the prefrontal cortex. It has a vital role in higher-order functions. These functions include language, spatial learning, conscious thought, judgment, and decision-making. The process of addiction can negatively affect this area and alter its functioning.
The prefrontal cortex enables us to make rational, sound decisions. It also helps us to override impulsive urges. If acted upon, these impulses urges can cause us to act without thinking. This is usually not in our best interest. For instance, suppose I've had a bad day at work. I may have an impulsive urge to tell my boss exactly what I think of her. To act on this impulse is not in my best interest. Fortunately, my prefrontal cortex is functioning quite well. I still have my job!
Obviously, this ability to inhibit impulses is very helpful. It enables us to function well in society. It protects us from harm by allowing us to consider the consequences of our actions. However, when the pre-frontal cortex is not functioning correctly, the opposite occurs. Addiction causes changes to the prefrontal cortex. These changes account for two characteristics of addiction: impulsivity and compulsivity.
Impulsivity is the inclination to act upon sudden urges or desires without considering potential consequences. Sometimes people describe impulsivity as living in the present moment without regard to the future. Compulsivity is a behavior that an individual feels driven to perform to relieve anxiety. Once a person performs the compulsive behavior, the anxiety goes away and restores comfort. Thus, the presence of these behavioral characteristics in addicted persons indicates that changes to the prefrontal cortex have occurred. Unfortunately, these changes also make the discontinuation of drug use more difficult.
Addiction is a process that coordinates the transition from impulsive to compulsive behavior. Impulsivity occurs during the early stages of addiction. During this phase, people impulsively act on powerful urges to experience the pleasure of their addiction. Anxiety is not associated with the urges during these early stages. Instead, addiction reflects acting on impulsive desire to receive immediate pleasure from the drug or activity. People are not considering the future consequences.
As addiction progresses a shift begins to occur. At this point, the compulsive aspect of addiction takes hold. When this shift occurs, people are no longer pursuing their addiction solely for pleasure. The compulsions compel them to participate in their addiction to relieve anxious, uncomfortable feelings. These may arise at the mere thought of stopping the addiction for any reason (supply shortages, lack of opportunity, etc.). At this later compulsive stage, "pleasure" comes in the form of relief from these anxious, uncomfortable feelings. Thus, despite the negative consequences of addiction, the addictive behavior continues in a compulsive manner.
Another way to describe the pre-frontal cortex is to think of it as a braking system. The pre-frontal cortex acts as the brain's brakes. It sends out signals to inhibit particular behaviors or actions. When addiction damages this brain area, it limits the brain's ability to control other behavioral systems as well. Imagine how difficult it would be to operate a car without brakes. At this point, we might say the brain is "high-jacked" by the addiction. The prefrontal cortex also projects to other brain regions associated with addictive problems. These include the reward system; memory and emotion; and stress regulation centers of the brain. Therefore, damage to the prefrontal cortex may further interfere with the functioning of these other brain regions as well.
Although addiction damages the brain's brakes (pre-frontal cortex) this is not to say there is a complete loss of control. We are not slaves to our biology. We have a tremendous amount of control over our actions. This is true even when impulsive and compulsive forces are operating. This recognition is vitally important if someone wishes to recover from addiction. When a person consciously decides the costs of addiction outweigh its benefits, they become motivated and able stop. This allows them to actively counter the effects of addiction on the frontal cortex and other brain regions.
Unfortunately, people's addictions limit their ability to use rationale thought. This is due in part to the damage to the prefrontal cortex. They may incorrectly tally the costs and benefits of their addiction; over-estimating the benefits, while minimizing the costs. The addict is often told, "You're in denial." This is incorrect. When people use this phrase, they are applying it improperly. Denial refers to a psychological defense, or justification for a negative behavior. This is quite different than a loss of rational brain functioning that occurs with addiction. This is where addiction treatment professionals can be very helpful. They can guide addicted persons to make an accurate assessment of the costs and benefits. This more accurate assessment often leads to the motivation to change. Once someone decides it is time to change, they have taken the first step toward recovery.
The addiction process relies on learning and memory to drive the addiction cycle forward. Addiction chemically alters the system. However, people can learn how counteract these changes. There are specific techniques that people can learn to oppose powerful urges. As people become more skillful, the wonderfully adaptive brain makes adjustments and corrections. This in turn leads to lasting recovery from addiction. We discuss these techniques and strategies in The Psychology of Addiction and Recovery. In some cases, pharmacological intervention may also be beneficial.
Resources
-
Articles
-
What is Addiction?
- Introduction to What is An Addiction
- Definition of Addiction
- Definiton of Addiction Continued
- The Addiction Definition Compared to Other Addiction Terms
- How Do I Know if I Have An Addiction?
- Why Don't They Just Stop? Addiction and the Loss of Control
- Is Alcoholism a Disease?
- Addiction Statistics: How Big of a Problem Is It?
- A Brief History of Alcoholism
-
What Causes Addiction?
- Introduction to Causes of Addiction
- The Many Causes of Addiction and Bio-Psych-Social-Spiritual Model
- Biological Causes of Addiction
- Disease Model of Addiction and Recovery Implications
- Evolutionary Model of Addiction and Recovery Implications
- Psychological Causes of Addiction
- Learning Theory of Addiction and Recovery Implications:
- Social Learning Theory of Addiction and Recovery Implications
- Cognitive (Expectancy) Theory of Addiction and Recovery Implications
- Educational Model of Addiction and Recovery Implications
- Developmental Model of Addiction and Recovery Implications
- Sociological Causes of Addiction and the Temperance Model
- General Systems Theory of Addiction and Recovery Implications
- Sociocultural Model of Addiction and Recovery Implications
- Public Health Model of Addiction and Recovery Implications
- Moral and Spiritual Causes of Addiction
- Addiction and Personal Responsibility: A Fundamental Conflict
- Personal Responsibility and Locus of Control
- Controversies in the Addiction Field: Change Versus Acceptance
- Conflict between 12-Step Anonymous Groups and Science: A Historical Perspective
- Conflict between 12-Step Anonymous Groups and Science Continued
-
How Do You Get Addicted?
- Introduction to How Do You Get Addicted?
- The Biology of Addiction and Recovery
- How Does Addiction Affect the Brain?
- Addiction Changes the Brain's Chemistry
- Addiction Changes the Brain's Communication Pathways
- Addiction Changes Brain Structures and Their Functioning
- Impaired Decision-making, Impulsivity, and Compulsivity: Addictions' Effect on the Cerebral Cortex
- Drug Seeking and Cravings: Addictions' Effect on the Brain's Reward System
- Habit Formation, Craving, Withdrawal, and Relapse Triggers: Addictions' Effect on the Amygdala
- Stress Regulation and Withdrawal: Addictions' Effect on the Hypothalamus
- The Good News: The Brain Also Helps to Reverse Addiction
- The Psychology of Addiction and Recovery
- Learning Theory and Addiction
- Classical Conditioning and Addiction
- Operant Conditioning and Addiction
- Social Learning Theory and Addiction
- Cognitive Theory and Addiction (Thoughts, Beliefs, Expectations)
- Cognitive Theory and Addiction Continued
- Cognitive-Behavioral Therapy: Improving Coping Skills
- Addiction and Other Psychological Disorders
- Developmental Theory and Addiction
- Recovery from Addiction: The Psychology of Motivation and Change
- Addiction: Social and Cultural Influences
- Addiction and Sociological Influences: Culture and Ethnicity
- Recovery from Addiction: Becoming Aware of Cultural Influences
- Recovery from Addiction: The Powerful Influence of Families
- Recovery from Addiction: Social Support
- The Spirituality of Addiction & Recovery
- The Spirituality of Addiction & Recovery Continued
- Incorporating Spirituality into Recovery from Addiction
-
Signs and Symptoms of Addiction
- How Do You Know If You Have An Addiction?
- The Diagnostic Criteria for Substance Use Disorders (Addiction)
- The Diagnostic Criteria of Substance-Induced Disorders
- Alcohol-Related Disorders
- Caffeine-Use Disorders
- Cannabis-Related Disorders (Marijuana)
- Hallucinogen-Related Disorders
- Inhalant-Related Disorders
- Opioid-Related Disorders (Heroin, Oxycontin®, Vicodin® and other pain medications)
- Sedative-, Hypnotic-, Or Anxiolytic-Related Disorders
- Stimulant Use Disorder: Amphetamine Type (e.g., methamphetamine)
- Tobacco-Related Disorders
- Other Substance-Related Diagnosis and Unspecified Other Substance-Related Disorder
- Activity Addictions (Behavioral Addictions)
- Gambling Disorder (Addiction)
- Sexual Addiction and Pornography Addiction
- Other Activity (or Behavioral) Addictions: Internet Gaming Disorder (Addiction)
- Other Activity (or Behavioral) Addictions: Food Addiction
- Addiction and Other Psychological Disorders
- Addiction and Eating Disorders
- Addiction and Personality Disorders
- Addiction with Depression, Anxiety, and Compulsive Disorders
- Summary of the Diagnostic Process
-
Treatment for Addiction
- Treatment for Addiction
- Natural Recovery: Recovery from Addiction Without Treatment
- Natural Recovery Continued
- Choosing An Effective Treatment Approach: Evidenced-Based Practices
- What Makes An Addictions Treatment Effective?
- Biological Approaches to Addiction Treatment: Medications
- The Role of Medication in Addictions Treatment
- Pharmacologic Medications for Addictions Treatment
- Pharmacologic Medications for Addictions Treatment: Part II
- Psychological Approaches to Addiction Treatment
- Motivation for Change: The Stages of Change Model
- Motivation for Change Continued
- Types of Evidenced-Based (Effective) Treatments for Addiction: Motivational Interviewing
- Relapse Prevention Therapy
- Contingency Management
- Cognitive-Behavioral Therapy
- Dialectical Behavioral Therapy
- Acceptance and Commitment Therapy
- What The Pros Know: The Practical Recovery Model
- Social Approaches Addictions Recovery
- A Cultural Approach to Addictions Treatment: Harm Reduction
- Family Approaches to Addictions Treatment: CRAFT, Intervention And Al-Anon
- The Social Support Approach to Addictions Recovery: Recovery Support Groups
- Self-Empowering Support Groups for Addiction Recovery: Smart Recovery
- Moderation Management
- Women for Sobriety
- LifeRing Secular Recovery
- Summary of Self-Empowering Support Groups
- Spiritual Approaches to Addiction Recovery
- 12-Step Support Groups: Groups That End With "Anonymous"
- 12-Step Support Groups: Part II
- 12-Step Support Groups: Part III
- Expanding Addiction Treatment Choices in the United States
- Developing a Personal Action Plan for Addiction Recovery: Part I
- Developing a Personal Action Plan for Addiction Recovery: Part II
- References
- Resources
- Frequentlly Asked Questions about Addiction
-
What is Addiction?
-
Questions and Answers
-
Tests
-
Book & Media Reviews
-
Self-Help Groups
-
Links
-
Videos
- Technology Addiction
- Why People Can Become Addicted to Opioids
- The Swiss Cheese Model of Drug Addiction
- The 7 Skills for Addiction-Free Living: Alternatives to Substance Abuse
- Teen Drug Use: 2014 Monitoring The Future Survey Results
- Sex and Gender Differences of Importance to Addiction Science
- How to Tell if a Loved One is Abusing Opioids
- Why Addiction is a “Disease” and Why Is It Important
- NIDA Emerging Drugs-Methylone and Molly
- Designed to Drink? The Genetics of Alcoholism
-
39 more
- Women and Addiction: Why Gender Matters
- Designed to Drink? The Genetics of Alcoholism
- Gaming disorder: questions and answers
- ADHD & Risk of Adult Drug Use
- Energy Drink Sparking More ER Visits
- Why are Drugs So Hard To Quit
- Anyone Can Become Addicted to Drugs
- Substance Use: Addiction Theories New Treatments and the Role of Doctoring in Society
- The Impact of Changing Social Behaviors on Teen Drug Use
- Teen Substance Use
- Cannabis Effects on Driving Performance
- Epidemiology of Tobacco Use
- Addiction: Learning to Forget
- Addiction: What Can I Do About It?
- Addiction: Treat It Like a Disease
- Addiction: What Is It?
- One in 4 People Prescribed Opioids Progresses to Longer-Term Prescriptions
- NIDA’s Dr. Phil Skolnick discusses intranasal naloxone
- "Eyes On" Research in Drugged Driving
- How Will Anti-Drug Vaccines Be Used? An Interview With Dr. Thomas Kosten
- Opioid Use in Pregnancy: A Community’s Approach
- Naloxone Rescue Kits
- Living Without Fear
- What You Need to Know About Internet Addiction
- Hooked, Hacked, Hijacked: Reclaim Your Brain from Addictive Living
- The Neuroscience of Internet Addiction
- Internet Addiction: Signs You Need to Shut Down
- What the Internet is Doing to Our Brains
- Addressing Suicidal Thoughts and Behaviors in Substance Abuse Treatment
- The Reward Circuit: How the Brain Responds to Cocaine
- The Reward Circuit: How the Brain Responds to Methamphetamine
- The Reward Circuit: How the Brain Responds to Marijuana
- The Reward Circuit: How the Brain Responds to Natural Rewards and Drugs
- Mindfulness-Based Relapse Prevention (MBRP) for Addictions Video (vol. 1)
- Mindfulness-Based Relapse Prevention for Addictions (vol. 2)
- Prescription Opioid Misuse
- Substance Use Disorders/Addictions - Clinical Overview
- Addiction in the Elderly
- Teenagers, ADHD, and Substance Abuse
Topics
-
Related Topic Centers
-
Addictions
-
Aging & Elder Care
-
Assessments & Interventions
-
Career & Workplace
-
Emotional Well-Being
-
Life Issues
-
Parenting & Child Care
-
Abuse
-
ADHD: Attention Deficit Hyperactivity Disorder
-
Adoption
-
Autism
-
Child & Adolescent Development: Overview
-
Child & Adolescent Development: Puberty
-
Child Development & Parenting: Early (3-7)
-
Child Development & Parenting: Infants (0-2)
-
Child Development & Parenting: Middle (8-11)
-
Child Development & Parenting:Adolescence (12-24)
-
Child Development Theory: Adolescence (12-24)
-
Child Development Theory: Middle Childhood (8-11)
-
Childhood Mental Disorders and Illnesses
-
Childhood Special Education
-
Divorce
-
Family & Relationship Issues
-
Intellectual Disabilities
-
Learning Disorders
-
Oppositional Defiant Disorder
-
Parenting
-
Self Esteem
-
-
Psychological Disorders
-
Anxiety Disorders
-
Bipolar Disorder
-
Conversion Disorders
-
Depression: Depression & Related Conditions
-
Dissociative Disorders
-
Domestic Violence and Rape
-
Eating Disorders
-
Impulse Control Disorders
-
Intellectual Disabilities
-
Mental Disorders
-
Obsessive-Compulsive Spectrum Disorders
-
Personality Disorders
-
Post-Traumatic Stress Disorder
-
Schizophrenia
-
Sexual Disorders
-
Somatic Symptom and Related Disorders
-
Suicide
-
Tourettes and other Tic Disorders
-