Physicians generally recommend that patients resuscitated with naloxone after opioid overdose stay in the emergency department for a period of observation in order to prevent harm from delayed sequelae of opioid toxicity. Patients frequently refuse this period of observation despiteenefit to risk. Healthcare providers are thus confronted with the challenge of how best to protect the patient’s interests while also respecting autonomy, including assessing whether the patient is making an autonomous choice to refuse care. Previous studies have shown that physicians (...) have widely divergent approaches to navigating these conflicts. This paper reviews what is known about the effects of opioid use disorder on decision-making, and argues that some subset of these refusals are non-autonomous choices, even when patients appear to have decision making capacity. This conclusion has several implications for how physicians assess and respond to patients refusing medical recommendations after naloxone resuscitation. (shrink)

Previous research on linguistic relativity and economic decisions hypothesized that speakers of languages with obligatory tense marking of future time reference (FTR) should value future rewards less than speakers of languages which permit present tense FTR. This was hypothesized on the basis of obligatory linguistic marking (e.g., will) causing speakers to construe future events as more temporally distal and thereby to exhibit increased “temporal discounting”: the subjective devaluation of outcomes as the delay until they will occur increases. However, several aspects (...) of this hypothesis are incomplete. First, it overlooks the role of “modal” FTR structures which encode notions about the likelihood of future outcomes (e.g., might). This may influence “probability discounting”: the subjective devaluation of outcomes as the probability of their occurrence decreases. Second, the extent to which linguistic structures are subjectively related to temporal or probability discounting differences is currently unknown. To address these, we elicited FTR language and subjective ratings of temporal distance and probability from speakers of English, which exhibits strongly grammaticized FTR, and Dutch, which does not. Several findings went against the predictions of the previous hypothesis: Framing an FTR statement in the present (“Ellie arrives later on”) versus the future tense (“…will arrive…”) did not affect ratings of temporal distance; English speakers rated future statements as relatively more temporally proximal than Dutch speakers; and English and Dutch speakers rated future tenses as encoding high certainty, which suggests that obligatory future tense marking might result in less discounting. Additionally, compared with Dutch speakers, English speakers used more low-certainty terms in general (e.g., may) and as a function of various experimental factors. We conclude that the prior cross-linguistic observations of the link between FTR and psychological discounting may be caused by the connection between low-certainty modal structures and probability discounting, rather than future tense and temporality. (shrink)

The broad spectrum revolution brought greater dependence on skill and knowledge, and more demanding, often social, choices. We adopt Sterelny's account of how cooperative foraging paid the costs associated with longer dependency, and transformed the problem of skill learning. Scaffolded learning can facilitate cognitive control including suppression, whereas scaffolded exchange and trade, including inter-temporal exchange, can help develop resolve.

Ainslie identifies two possible motivational sources for resolve: “thinking categorically” and “intertemporal bargaining.” Ainslie opts for intertemporal bargaining, adding that thinking categorically has no motivational power. The most researched instance of willpower is remission from addiction. This literature shows that aspirations for a more desirable identity and comfortable lifestyle motivate remission. In other words, “thinking categorically” drives willpower.

Redish et al. present a compelling, interdisciplinary, unified framework of addiction. The effort to integrate pathological gambling is especially important, but only the vulnerability of misclassifying situations is described in detail as being linked directly to this disorder. This commentary focuses on further developing the comprehensiveness of this framework for pathological gambling using over-fast discounting as an illustrative example.

Intertemporal choice requires one to decide between smaller sooner and larger later payoffs and is captured by discount rates. Across two preregistered experiments testing three language pairs (Polish vs. English, Spanish, and German; Experiment 1) and with incentivized participants (Experiment 2), we found no evidence that using a foreign language decreased the strength or increased the consistency of intertemporal choices. On the contrary, there was some evidence of stronger discounting when a foreign language was used. We confirmed prior findings that (...) more reflective individuals discount less strongly but observed that they were just as (un)affected by using foreign language as less reflective individuals. Thus, we provide preliminary evidence that the foreign language effect is robust to individual differences in cognitive reflection. (shrink)

Humans discount rewards as a function of the delay to their receipt. This tendency is referred to as delay discounting and has been extensively researched in the last decades. The magnitude effect and the trait effect are two phenomena which have been consistently observed for a variety of reward types. Here, we wanted to investigate if these effects also occur in the context of the novel but widespread reward types of Instagram followers and likes and if delay discounting of these (...) outcomes is related to self-control and Instagram screen time. In a within-subject online experiment, 214 Instagram users chose between smaller, immediate and larger, delayed amounts of hypothetical money, Instagram followers and likes. First, we found that the magnitude effect also applies to Instagram followers and likes. Second, delay discounting of all three reward types was correlated, providing further evidence for a trait influence of delay discounting. Third, no relationships were found between delay discounting and self-control as well as Instagram screen time, respectively. However, a user’s average like count was related to delay discounting of Instagram likes. (shrink)

In this review, I discuss recent advances in philosophical and psychological approaches to self-control. The review is divided in 4 parts, in which I discuss: a) different conceptions of self-control; b) standard methods for studying it; c) some models of how self-control is exercised; and d) the connections between self-control and other relevant psychological constructs. The review was originally commissioned by the John Templeton Foundation to provide an informative overview that would knit together different strands of current debates in the (...) field. It is meant to be useful to well-informed audiences, as well as new-comers to the discussion. (shrink)

We examine the relation between worker substance abuse and workplace fraud in a sample of medical doctors. Relative to their peers, we observe that doctors engaging in substance abuse are between 50 and 100 times more likely to commit fraud in a given year. This result is consistent with research suggesting that substance abuse both creates financial pressures and impairs the functioning of cognitive self-regulatory mechanisms. Our results are robust in within-subject tests and between-subject tests, as well as in tests (...) using instrumental variables that exploit exogenous variation in the state-level availability of opioids, a commonly abused substance. (shrink)

The model proposed by Redish et al. considers vulnerabilities within decision systems based on expectancy-value assumptions. Further understanding of processes leading to addiction can be gained by considering other inputs to decision-making, particularly affective associations with behaviors. This consideration suggests additional decision-making vulnerabilities that might explain addictive behaviors.

This paper proposes a novel account of why intertemporal decisions tend to display impatience: People pay more attention to the opportunity costs of choosing larger, later rewards than to the opportunity costs of choosing smaller, sooner ones. Eight studies show that when the opportunity costs of choosing smaller, sooner rewards are subtly highlighted, people become more patient, whereas highlighting the opportunity costs of choosing larger, later rewards has no effect. This pattern is robust to variations in the choice task, to (...) the participant population, and is observed for both incentivized and hypothetical choices. We argue that people are naturally aware of the opportunity costs associated with delayed rewards, but pay less attention to those associated with taking smaller, sooner ones. We conclude by discussing implications for theory and policy. (shrink)

ABSTRACT Choice theorists such as George Ainslie and Gene Heyman argue that the drug-seeking behaviour of addicts is best understood in the same terms that explain everyday choices. Everyday choices, they claim, aim to maximise the reward from available incentives. Continuing drug-use is, therefore, what addicts most want given the incentives they are aware of but they will change their behaviour if and when better incentives become available. This model might explain many typical cases of addiction, but there are hard (...) cases that pose a problem. In these hard cases the addicted individual does not cease using drugs in the face of consequences that are so adverse it is implausible that they are unaware of more rewarding paths of action. These cases force the choice theorist into a dilemma: either these addicts? drug use does not count as action and so is best described by a neurobiological model, or reference to ?reward? in these cases means merely ?motivated? and so provides no explanatory power. We propose a different model of motivation that takes self-conception into account. We show how that can better explain the hard cases of addiction and also inform our understanding of recovery and self-control. (shrink)

Temporal discounting is the tendency to devalue temporally distant rewards. Past studies have examined the k-value, the indifference point, and the area under the curve as dependent measures on this task. The current study included these three measures and a fourth measure, called the interest rate total score. The interest rate total score was based on scoring only those items in which the delayed choice should be preferred given the expected return based on simple interest rates. In addition, associations with (...) several individual difference measures were examined including intelligence, executive functions (inhibition, working memory, and set-shifting), thinking dispositions (Need for Cognition and Consideration of Future Consequences) and engagement in substance use and gambling behavior. A staircase temporal discounting task was examined in a sample of 99 university students. Replicating previous studies, temporal discounting increased with longer delays to reward and decreased with higher reward magnitudes. A hyperbolic function accounted for variance in temporal discounting better than an exponential function. Reaction time at the indifference point was significantly longer than at the other choice points. The four dependent measures of temporal discounting were all significantly correlated and were also significantly associated with our individual difference measures. That is, the tendency to wait for a larger delayed reward on all of the temporal discounting measures was associated with higher intelligence, higher executive functions and more consideration of future consequences. Associations between our measures of temporal discounting and outcomes related to substance use and gambling behavior were modest in our university sample. (shrink)

Delay discounting is a common phenomenon in daily life, which refers to the subjective value of a future reward decreasing as a function of time. Previous studies have identified several cortical regions involved in delay discounting, but the neural network constructed by the cortical regions of delay discounting is less clear. In this study, we employed resting-state functional magnetic resonance imaging (RS-fMRI) to measure the spontaneous neural activity in a large sample of healthy young adults and used the Monetary Choice (...) Questionnaire to directly measure participants’ level of delay discounting. To identify the neural network of delay discounting at rest, we used an individual difference approach to explore brain regions whose spontaneous activities were related to delay discounting across the whole brain. Then, these brain regions served as seeds to identify the neural network of delay discounting. We found that the fractional amplitude of low-frequency fluctuations (fALFF) of the left insula were positively correlated to delay discounting. More importantly, its connectivity to the anterior cingulate cortex was read out for participants’ behavioral performance in the task of delay discounting. In short, our study provides empirical evidence that insula-anterior cingulate cortex connectivity may serve as a part of the neural network for delay discounting. (shrink)

The Discounting Inventory, originally developed in polish language, allows the measurement of individual differences in the delay, probabilistic, effort, and social discounting rates. The present study attempted to validate the DI’s psychometric properties using German university students and to compare the results to those from a sample of Polish university students. Over four hundred participants completed the DI and traditional discounting measures. A confirmatory factor analyses indicated that the original four-factor model of the DI provided an excellent fit for the (...) German data and internal consistency was high. These outcomes were similar, if not superior, to those from the Polish sample. DI scores strongly correlated with traditional discounting measures scores in both samples, replicating previous results. These findings indicate that the DI is a valid measure for use in a sample from another cultural setting, which is potentially useful to both researchers and practitioners. (shrink)

Models of intertemporal choice draw on three evaluation rules, which we compare in the restricted domain of choices between smaller sooner and larger later monetary outcomes. The hyperbolic discounting model proposes an alternative-based rule, in which options are evaluated separately. The interval discounting model proposes a hybrid rule, in which the outcomes are evaluated separately, but the delays to those outcomes are evaluated in comparison with one another. The tradeoff model proposes an attribute-based rule, in which both outcomes and delays (...) are evaluated in comparison with one another: People consider both the intervals between the outcomes and the compensations received or paid over those intervals. We compare highly general parametric functional forms of these models by means of a Bayesian analysis, a method of analysis not previously used in intertemporal choice. We find that the hyperbolic discounting model is outperformed by the interval discounting model, which, in turn, is outperformed by the tradeoff model. Our cognitive modeling is among the first to offer quantitative evidence against the conventional view that people make intertemporal choices by discounting the value of future outcomes, and in favor of the view that they directly compare options along the time and outcome attributes. (shrink)

The understanding of decision-making systems has come together in recent years to form a unified theory of decision-making in the mammalian brain as arising from multiple, interacting systems (a planning system, a habit system, and a situation-recognition system). This unified decision-making system has multiple potential access points through which it can be driven to make maladaptive choices, particularly choices that entail seeking of certain drugs or behaviors. We identify 10 key vulnerabilities in the system: (1) moving away from homeostasis, (2) (...) changing allostatic set points, (3) euphorigenic signals, (4) overvaluation in the planning system, (5) incorrect search of situation-action-outcome relationships, (6) misclassification of situations, (7) overvaluation in the habit system, (8) a mismatch in the balance of the two decision systems, (9) over-fast discounting processes, and (10) changed learning rates. These vulnerabilities provide a taxonomy of potential problems with decision-making systems. Although each vulnerability can drive an agent to return to the addictive choice, each vulnerability also implies a characteristic symptomology. Different drugs, different behaviors, and different individuals are likely to access different vulnerabilities. This has implications for an individual's susceptibility to addiction and the transition to addiction, for the potential for relapse, and for the potential for treatment. (shrink)

Socioeconomic differences in behaviour are pervasive and well documented, but their causes are not yet well understood. Here, we make the case that a cluster of behaviours is associated with lower socioeconomic status, which we call “the behavioural constellation of deprivation.” We propose that the relatively limited control associated with lower SES curtails the extent to which people can expect to realise deferred rewards, leading to more present-oriented behaviour in a range of domains. We illustrate this idea using the specific (...) factor of extrinsic mortality risk, an important factor in evolutionary theoretical models. We emphasise the idea that the present-oriented behaviours of the constellation are a contextually appropriate response to structural and ecological factors rather than a pathology or a failure of willpower. We highlight some principles from evolutionary theoretical models that can deepen our understanding of how socioeconomic inequalities can become amplified and embedded. These principles are that small initial disparities can lead to larger eventual inequalities, feedback loops can embed early-life circumstances, constraints can breed further constraints, and feedback loops can operate over generations. We discuss some of the mechanisms by which SES may influence behaviour. We then review how the contextually appropriate response perspective that we have outlined fits with other findings about control and temporal discounting. Finally, we discuss the implications of this interpretation for research and policy. (shrink)