Aberrant decision-making and drug addiction - how strong is the evidence?

•Decision making dysfunction (DMD) is a core component of many aspects of drug addiction.•DMD is a multifaceted construct that can be measured across multiple domains and methods of analysis.•DMD is measured inconsistently among drug users in addiction studies.•Clinical, contextual, and methodological diversity contribute to inconsistencies in measuring DMD.•The application of DMD as a transdiagnostic construct in addiction medicine requires further investigation.

There are a growing number of studies with different substance use populations that show evidence for aberrant decision-making, which involves but is not limited to increased temporal discounting, increased risk-taking, and inability to mediate between immediate large gains and long-term larger losses. However, the current literature is inconsistent on how these dysfunctions manifest across different substance use disorders and whether they contribute to the initiation, progression and recovery from these disorders. Moreover, there is an incomplete understanding of the neurocognitive processes that underlie these deficits, the best methods to measure them, and ways to improve dysfunction. Here, recently published literature on aberrant decision-making is reviewed to address these questions using four domains: self-report measures, behavioral tasks, computational modeling, and functional neuroimaging. In conclusion, we provide suggestions to improve the consistency, validity and applicability of these measures to the reduction of decision-making dysfunction as a core component of prevention and recovery for the future of addiction medicine.

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