Emotion, decision-making and substance dependence: A somatic-marker model of addiction

A. Verdejo-García, M. Pérez-García, A. Bechara

Research output: Contribution to journalReview ArticleResearchpeer-review

85 Citations (Scopus)

Abstract

Similar to patients with orbitofrontal cortex lesions, substance dependent individuals (SDI) show signs of impairments in decision-making, characterised by a tendency to choose the immediate reward at the expense of severe negative future consequences. The somatic-marker hypothesis proposes that decision-making depends in many important ways on neural substrates that regulate homeostasis, emotion and feeling. According to this model, there should be a link between abnormalities in experiencing emotions in SDI, and their severe impairments in decision-making in real-life. Growing evidence from neuroscientific studies suggests that core aspects of substance addiction may be explained in terms of abnormal emotional guidance of decision-making. Behavioural studies have revealed emotional processing and decision-making deficits in SDI. Combined neuropsychological and physiological assessment has demonstrated that the poorer decision-making of SDI is associated with altered reactions to reward and punishing events. Imaging studies have shown that impaired decision-making in addiction is associated with abnormal functioning of a distributed neural network critical for the processing of emotional information, including the ventromedial cortex, the amygdala, the striatum, the anterior cingulate cortex, and the insular/somato-sensory cortices, as well as non-specific neurotransmitter systems that modulate activities of neural processes involved in decision-making. The aim of this paper is to review this growing evidence, and to examine the extent of which these studies support a somatic-marker model of addiction.

Original languageEnglish
Pages (from-to)17-31
Number of pages15
JournalCurrent Neuropharmacology
Volume4
Issue number1
DOIs
Publication statusPublished - Jan 2006
Externally publishedYes

Keywords

  • Addiction
  • Amygdala
  • Craving
  • Decision-making
  • Dopamine
  • Serotonin
  • Somatic states
  • Ventromedial prefrontal cortex

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