10 Apr Brain Dysfunction Can Trigger Substance Abuse
Decision-making is part of a higher-level mental capacity called executive function. In a study review published in 2013 in the journal Drug and Alcohol Dependence, researchers from two U.S. institutions looked at the impact that unusually poor decision-making has on the chances that a person will develop a substance use disorder. The researchers concluded that people with substance use disorders clearly have problems with their ability to make decisions and that these problems may appear before any substance-related issues arise.
Executive Function and Decision-Making
As we grow older, humans gradually develop the ability to put past experiences in context and to use this context to decide what to do now and in the future. Doctors and researchers refer to this ability as executive function. In addition to the capacity to make short- and long-term decisions, executive function is responsible for the capacity to do such things as hold conversations on simple or complex topics, consider the relative merits of different ideas, interpret the spoken and unspoken rules of social interactions, correct or amend previous decisions and incorporate new experiences and new knowledge over time. Humans also rely on executive function and the decision-making process to restrain or channel short-term urges or impulses that could potentially produce harm or other types of negative consequences. The skills needed to use executive function are distributed in multiple areas throughout the brain.
As a rule, teenagers don’t have the same fully developed capacity for executive function as adults. This means that teens are relatively susceptible to poor decision-making, involvement in impulsive or risky behaviors and poor comprehension of social interactions. Compared to adults, teens also tend to think about their actions or reconsider their previous choices significantly less often. However, not all adults have the same ability to make sound decisions or otherwise rely on executive function. Some adults never completely develop their executive function-related capabilities; others experience a decline in these capabilities at some point after their development.
Impact on Substance Use Disorder
Substance use disorder is the collective term currently in use to describe any form of diagnosable substance abuse or diagnosable substance addiction. The American Psychiatric Association adopted this term in May 2013 as part of a larger revision of the terms commonly used to define and diagnose mental health problems in the U.S. In the study review published in Drug and Alcohol Dependence, researchers from the Veterans Affairs San Diego Healthcare System and the University of California San Diego analyzed the results of previous studies that used modern-day brain imaging technology to examine the decision-making processes in the brains of people affected by substance use disorder. They conducted this analysis in order to update the level of understanding regarding the connection between brain dysfunction and the inappropriate intake of alcohol or drugs.
Upon completing their review of the various brain-imaging projects, the researchers concluded that, compared to people who don’t have problems with drugs or alcohol, people affected by substance use disorder clearly experience unusual, dysfunctional changes in six brain regions associated with executive function, decision-making and the ability to avoid participating in high-risk behaviors. They also concluded that two other brain areas associated with these skills might go through dysfunctional alterations in people with serious drug or alcohol problems.
Significance and Considerations
While the authors of the study published in Drug and Alcohol Dependence concluded that the decision-making process is likely damaged in people affected by substance use disorder, they did not definitively determine if decision-making problems set the stage for substance-related problems or, conversely, if substance-related problems lead to a decline in decision-making. In truth, both of these explanations may be partially correct. The study’s authors note a need for further research to clarify several important issues regarding the interaction between decision-making problems and substance use disorder. These issues include the specific executive function-related brain processes altered in substance abusers and substance addicts, the impact that the use of specific drugs has on the ability to make appropriate decisions and the likelihood that any given substance abuser or addict will recover his or her decision-making abilities if and when drug or alcohol use comes to an end.
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