Drug use, decision-making and the blunders of Rob Ford

Toronto mayor Rob Ford has had a rough couple of months. He has recently confessed to using crack cocaine "in a drunken stupor", been caught on video making drunken death threats, and commented to reporters about his cunnilingus skills. He has also previously beencharged with drink-driving, and admitted on separate occasions tobuying illegal drugs and "smoking a lot of marijuana". Other allegationsfrom former staff members include physical assault, making racist and sexist remarks, and sexual harassment.

Needless to say, the man has made some questionable choices recently. While Mayor Ford has vehemently denied all accusations of drug or alcohol dependence, this pattern of poor decision-making is reflective of impairments in self-control and impulsivity that are often seen in problem drug and alcohol users.

Impaired adolescent decision-making

I am pleased to announce that my first first-author publication has recently been released online by the journal Developmental Psychology. The article, on decision-making in children and adolescents, looks at the developmental trajectory of affective decision-making abilities using the Iowa Gambling Task (IGT) in children between the ages of 8 and 17. It compares this type of "hot" executive function with more typical "colder" cognitive abilities, such as impulse control and working memory. Contrary to the accepted belief that children improve universally on cognitive tasks as they age, we discovered that early adolescents (ages 11-13) are actually more impaired on this task than some of the younger participants, making riskier decisions and failing to learn from their mistakes.

The IGT requires participants to choose between four decks of cards that give out varying amounts of wins and losses. Two of the decks issue low wins but also low losses, resulting in an overall net gain, whereas the other two decks are riskier options, giving high payoffs but also higher losses, making them ultimately disadvantageous. A net score is calculated by subtracting the total number of disadvantageous choices from the total advantageous decisions. Early adolescents had significantly lower mean net scores on the task than older participants, but did not differ from the younger children in their ability. However, the total trajectory of mean scores across all ages resulted in a significant J-shaped curve, signifying a dip in ability in early adolescence.

We speculate that this curvilinear trajectory is due to the varying developmental schedules of different regions of the brain, particularly the striatum (involved in reward processing) and the prefrontal cortex, which is responsible for more inhibitory control. Structures in the basal ganglia typically develop earlier in adolescence,  whereas the prefrontal cortex is not fully matured until the early 20s. This earlier development of the striatum could lead adolescents to place undue emphasis on the initially high reward, but ultimately disadvantageous options in the IGT. Coupled with the delayed development of the prefrontal cortex, this group could also lack the necessary inhibitory control to offset this reward-driven urge. Supporting this theory, other imaging studies investigating developing cognitive ability have shown adolescents to disproportionately recruit from subcortical regions, particularly the basal ganglia, on tasks involving monetary rewards.

Conversely, younger children performed neither overtly advantageously nor disadvantageously on the task, choosing between the decks more randomly. This could be due to an earlier neurodevelopmental stage, before the striatum and other limbic regions had fully developed, making them less sensitive to the risky high reward options. Also supporting this J-shape trajectory theory, older adolescents performed the most advantageously on the task, improving their performance and successfully inhibiting the urge to make impulsive choices. This improvement presumably correlates with the continued maturation of their prefrontal cortices, as these inhibitory abilities come on-line.

Notably, all other cognitive tasks administered during the course of testing improved linearly across age, demonstrating that affective decision-making is a unique process that taps into the limbic regions, rather than just relying on the cortical cognitive network.

Importantly, these results are not implying that all adolescents are impulsive risk-seekers doomed to make lasting poor decisions. We all go through these stages of neurodevelopment and the vast majority of us emerge from adolescence relatively unscathed. Also, as this was not an imaging study the neural correlates of the abnormal decision-making development is speculative. However, this study does provide an interesting glimpse into how we develop in our affective decision-making tendencies and how they change as we mature.

External (and internal) influences on decisions

We like to think that we are in control of our decisions. Yet evidence from various neuroeconomics and marketing studies have shown that many of the decisions we make in our day-to-day lives have less to do with our own personal choices than we would like to think, and that we are instead easily influenced by internal visceral states and external suggestions and primes. According to Martin Lindstrom, author of Brandwashed, many of the decisions we make, particularly in supermarkets and shopping situations, are often determined by manipulations made by marketing executives. Whole Foods and other supermarkets prime us to shop by arranging their stores, displays and prices in a certain way to make us perceive their products in a particular manner. They fill their stores with flowers, particularly right at the entrances, connoting freshness and evoking thoughts of newly picked produce right from the fields, when in fact much of these products have been sitting in warehouses for weeks. They also display items packed unnecessarily in ice or sprayed with water, again ensuring us of their freshness and vitality. These manipulations do little for the products themselves, but affect our perception of them and therefore our willingness to pay.

Bodily states can also alter our decision-making processes and preferences. Previous studies investigating the effect of visceral states on external decisions have shown that when in a condition of hunger, people have a greater desire not only for food but also for money. Fasted individuals also make riskier bets on a financial decision-making task involving lottery choices, opting for the riskier option significantly more often when fasted, and choosing the safer bet when full. This finding is supported by the animal literature, in which animals are more risk-averse when sated but risk-seeking when hungry. This is presumably an evolutionarily selected trait prompting exploration and risk-seeking when in states of hunger, which could potentially lead to the acquisition of new food sources.

A similar "state of urgency" might be expected to be seen in situations where people have to use the restroom, choosing an immediate satisfaction over long-term outcomes. However, in a clever study published last year in Psychological Science (and that recently won an Ig Noble award), individuals with a full bladder actually chose the delayed reward more often than instant gratification.

Led by Mirjam Tuk, researchers in the Netherlands had participants consume either 700 or 50 ml of water and then complete a delay discounting task. The discounting task involved binary decisions between two set options, one a small reward that participants could receive immediately and the other a reward of greater magnitude they would receive after a certain period of time. Participants also had to indicate how badly they needed to urinate, ranging from "very urgently" to "not urgently at all". Individuals who had consumed the larger amounts of water (and who reported a greater urgency to urinate) chose the delayed option more often than those who had received the smaller serving of water.

Researchers hypothesized that this was because bladder control involves deliberate inhibitory measures on the individual's part, which then promote inhibition and self-control in other aspects of life. The authors call this idea "inhibitory spill over", where conscious cognition in one aspect, influenced by a visceral state, leaks over into other domains. This contradicts other theories of self-control, which believe restraint to be a limited personal resource that can be depleted through instances of restriction in one area, thereby allowing lapses of control at other instances.

These studies provide evidence that we should be aware of our surroundings and current physical and mental states when making important decisions, particularly concerning money. Clearly we do not live or function in a vacuum, nor make our decisions in one, but being mindful of the subconscious influences that are upon us, both internally and externally, can help us to make better decisions with a clearer mind and less biased approach.