Neuroeconomic Perspectives on the Potent but Inconsistent Motivations Characteristic of Addiction

Abstract

Clinical definitions of addiction are complex, generally involving cut‐offs based on whether some minimal number of symptoms are present (APA, 2000; WHO, 2004). One implication of this is that individuals with very different symptom profiles can receive the same diagnosis. However, many medical conditions that were once diagnosed on the basis of a complex and heterogeneous symptom presentation came later to be diagnosed on the basis of a singular underlying pathology. Diagnosis (and sometimes misdiagnosis; see Ochola, Vounatsou, Smith, Mabaso, & Newton, 2006) of malaria based on symptom profile was eventually replaced by diagnosis based on the presence of a particular parasite. Could the analog come to pass for addiction neuroscience? Is there something in the brain that marks the transition – a metaphorical flipping switch – between normal motivation and addiction (Leshner, 1997)? We think the answer to the above question is “no.” Even those who meet clinical definitions for addiction remain responsive to other contingencies (Heyman, 2009). In a therapeutic context, a few dollars each day for bio‐assay‐confirmed drug abstinence is an effective intervention for many who meet criteria for addiction Neuroeconomic Perspectives on the Potent but Inconsistent Motivations Characteristic of Addiction A. James Melrose, Eustace Hsu, and John Monterosso 19

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