A Cognitive Pathway to Persistent, Maladaptive Choice

Abstract

Background: Correctly recognising that alcohol or other substances are causing problems is a necessary condition for those problems to spur beneficial behaviour change. Yet such recognition is neither immediate nor straightforward. Recognition that one s alcohol or drug use is causing negative consequences often occurs gradually. Contemporary addiction neuroscience has yet to make progress in understanding and addressing these recognition barriers, despite evidence that a lack of problem recognition is a primary impediment to seeking treatment. Summary: Based on our recent empirical work, this article shows how recognition barriers can emerge from dual constraints on how we learn about the negative consequences of our actions. One constraint is imposed by the characteristics of negative consequences themselves. A second constraint is imposed by the characteristics of human cognition and information processing. In some people, the joint action of these constraints causes a lack of correct awareness of the consequences of their behaviour and reduced willingness to update that knowledge and behaviour when confronted with counterevidence. Key Messages: This 'cognitive pathway' can drive persistent, maladaptive choice.