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Addiction and ChoiceRethinking the relationship$
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Nick Heather and Gabriel Segal

Print publication date: 2016

Print ISBN-13: 9780198727224

Published to Oxford Scholarship Online: November 2016

DOI: 10.1093/acprof:oso/9780198727224.001.0001

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PRINTED FROM OXFORD SCHOLARSHIP ONLINE (oxford.universitypressscholarship.com). (c) Copyright Oxford University Press, 2021. All Rights Reserved. An individual user may print out a PDF of a single chapter of a monograph in OSO for personal use. date: 18 October 2021

Choice in addiction

Choice in addiction

A neural tug of war between impulse and insight

(p.171) Chapter 10 Choice in addiction
Addiction and Choice

Marc D. Lewis

Oxford University Press

The neuroscience of addiction does not frame addiction as a disease. In fact, an examination of brain processes helps clarify the role of choice in addiction, by explaining how habitual perceptions and time-based biases influence decision-making for addicts and non-addicts alike. The impact of addictive cues is enhanced by dopamine signals to the striatum and orbitofrontal cortex, due to repeated experiences of pleasure or relief. Moreover, dopamine-based craving peaks when addictive rewards become available, in the moment. Finally, the consolidation of synaptic networks modifies brain structures to maximize the appeal of addictive activities over competing rewards. Given these neural realities, the choice to engage in an addictive activity is biased in favor of momentary fulfillment, but it’s still a choice. Choice is always pulled between momentary and long-term rewards. Thus choice is never “rational”—it is a spontaneous resolution to unbalanced goals. Addiction merely epitomizes this inescapable human conundrum.

Keywords:   neuroscience of addiction, dopamine, striatum, choice, decision-making, craving

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