At the heart of most of our behaviors is the moment of deciding: the go/no-go, do/do-not-do, yes/no, proceed/stop. This most primary, and at the same time ultimate, moment in our behaviors is THE MOMENT—the decision-making moment. This THE MOMENT is actually a chain of moments, as any one decision is actually a chain of decisions, many of which are so subtle we are not conscious of them. Most behaviors, when broken into small steps, increments, actually involve long chains of conscious, subconscious and uncon-scious decision-making processes.
GO AND NO-GO
One analysis of the process of selecting responses is called the go/
no-go model. In go/no-go testing, different types of cues that indicate to the subject whether to respond or to refrain from responding to the cue are presented. Many drug addicted individuals have difficulty avoiding responses to pictures or stimuli related to their addictions.
In laboratory go/no-go studies, addicted persons demonstrate greater inability to refrain from responding—greater inhibitory impairment
—when presented with drug-related cues.
A decision-making task commonly used to study addicted person’s thinking is the so-called delay discounting task. This type of task requires subjects to decide between a reward (such as a sum of money) being available sooner and a larger reward (such as a larger sum of money) being available at a later time. Addicted persons tend to
choose the smaller, more immediate addiction-related rewards more often, despite their relatively small size and thereby diminished reward amount: The delay which is part of the delayed but larger reward diminishes the perceived value of the delayed but larger reward in the now. This is called delay discounting and it has been reported for a variety of addictive disorders, including addiction to nicotine, alcohol, amphetamines, cocaine, opiates, gambling, and shopping. While this tendency for problem pattern addicts to more steeply or more frequently discount delayed monetary rewards is quite consistent, it also appears that delayed rewards consisting of the drug of choice are discounted even more severely by drug addicts. For example, heroin-addicted persons who are participating in risky needle-sharing behaviors show greater delay discounting of both heroin and monetary rewards. The drug of choice with a cleaner nee-dle later does not register as as valuable as the drug of choice now with no insurance of clean needle. And, it is also seen that money later is not as valuable as money, albeit less money, now to buy the drug now.
Whether or not addicted to heroin, or any substance, it is becoming increasingly clear that we all carry within us mechanisms for overvaluing immediate rewards (what may only seem to be rewards) over delayed perceived or actual rewards. This very mechanism primes us to con-tinue problem addicted behavior in the now in the face of its negative consequences later. (We tend to think of this tendency as belonging to an adolescent state of mind, that the young are so very focused on to-day that planning for tomorrow can be too low a priority. Refer again to Chapter 7 on why good judgment falls by the wayside.) Hence when we say that addiction is the continued use or behavior in the face of adverse consequences, we are frequently saying that addiction NOW is the continued use or behavior NOW in the face of CON-CEIVABLE adverse consequences LATER, whether that LATER be a moment, an hour, a day, a week, a month, a year, or several years later. The reality of later recedes as the problem pattern dominates one’s reality.
ACTION SELECTING AND INHIBITING
The brain plays a major role, in fact virtually the only role, in both selecting and inhibiting our actions. The brain makes our decisions about our actions for us. Our biocomputer brain is always working, always serving either us—or our positive and negative pattern
addictions. In that our brain is responsible for the programming that addicts us, (for example that addicts us to drugs and to nondrug activ-ities), we have to wonder at what point the brain becomes invested in our selecting fueling behavior over addiction-inhibiting behavior. (In my years of working with problem addicted persons, I have come to recognize the matter of investment in addic-tion as central.)
A great deal of evidence regarding the role of the brain’s frontal areas in action selection and in complex decision making comes to us from neuroimaging data. Among the findings is the understanding that the brain’s right hemisphere’s frontal lobe is involved in our efforts to prevent or deter what of our behaviors we may want (or may think we want) to prevent or deter. Another area of the brain, the fronto-median cortex, plays a role in voluntary response inhibi-tion. Other studies point to the importance of dopamine in regulating discounting behavior. How amazing it is that the brain employs bio-logical, biochemical mechanisms to make the right (and wrong) deci-sions about problem addiction in the face of present and future adverse consequences. We have to wonder, how much is the failure of our response inhibition function actually voluntary and conscious, and how much of this is subconscious and out of our conscious con-trol? What can we do to convince our mental main frames, our brains, to bring these decisions back into conscious control? Who is in charge here, our troubled patterns or our SELVES?
Who should be in charge here, the pattern addiction or the SELF?
The answer may be obvious—the SELF—unless you speak for the problem pattern which has taken control of the SELF.