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Has Addiction Damaged Your Decision Making? (And How to Repair It!)

June 18, 2021

By Christa Banister

It’s not hard to see just how many aspects of life are negatively affected by addiction. Beyond the litany of health problems and the long-range effects on friendships, family life, mental health, productivity at school, and even future prospects, studies published by the National Library of Medicine have shown that repeated drug or alcohol misuse also causes disruption in the area of the brain responsible for decision-making.

The brain’s orbitofrontal cortex (OFC) plays a variety of important roles in how we make decisions, including:

  • Decision-making guided by a reward system (the release of feel-good dopamine, for example)
  • Flexible assignment of value to environmental stimuli that motivates or inhibits our choices and actions
  • Integration of emotional and sensory imagery from lower limbic structures
  • The ability to self-monitor and socially respond, both of which are behaviors viewed favorably by others

When there’s damage to the OFC, however, the ability to control cognitive operations is impacted, which helps explain why someone struggling with addiction can relapse — return to drug use — even after a long period of abstinence. 

As part of relapse prevention, nonhabit-forming medication can help with the recalibration of normal brain function and help decrease cravings.

Research has shown a few outcomes from a damaged OFC that are particularly concerning. Among these are:

  • Self-regulation deficits
  • Impulsive and inappropriate responses
  • Loss of crucial behavioral guidance system
  • Inability to properly assign value to rewards
  • A tendency to choose a small, immediate reward over a larger but delayed reward

Meadows Senior Fellow Kevin McCauley, MD, explains, “In addiction, the brain’s ability to correctly calculate value and probability becomes severely biased. This means that people in early recovery have a hard time assessing likelihood of future harm or risk.” 

How to Repair the Damage - Claudia Black Center

How to Repair the Damage 

Along with the pharmacological component of addiction, learning there’s a significant behavioral component to the disease has provided helpful insight in how to better approach treatment.

Dr. McCauley says it comes down to asking the question, “How can I protect myself from relapse decision-making when my ability to assess relapse risk itself is impaired?”

To answer this, Dr. McCaulay applies a form of risk management called “recovery management” by integrating addiction treatment and recovery support services. In addition to increasing engagement before recovery and facilitating the initiation of recovery, this approach promotes long-term recovery maintenance. At the same time it also improves the quality of a patient’s personal and family life by addressing the behavioral component of addiction that occurs when the OFC has been damaged. 

In addiction, the brain’s ability to correctly calculate value and probability becomes severely biased. This means that people in early recovery have a hard time assessing likelihood of future harm or risk.

In some cases, as part of relapse prevention, nonhabit-forming medication can help with the recalibration of normal brain function and help decrease cravings, according to the National Institute on Drug Abuse. Behavioral therapies, which help modify attitudes and behaviors related to drug use and encourage healthy life skills, have proven to be helpful as well.

Most importantly, accepting that addiction isn’t something that can be “cured” overnight is key. When brain function has changed, triggers are something that commonly emerge after treatment. Learning to identify these and their accompanying coping mechanisms is essential so they can be managed as they arise. 

Hope is Here

Are you or a young person you know struggling with addiction? There is hope at the Claudia Black Young Adult Center. With treatment specifically tailored to the needs of adults ages 18 to 26, our proven Meadows Model equips people to address the issues in a journey toward healing. For more information, contact us today.