Neurobiological Models of Risky Decision-Making and Adolescent Substance Use

Abstract

This article provides an overview of evidence-based neurobiological models of risky decision-making, noting their implications for adolescent substance use. Drawing on brain and behavioral research, neural imbalance and fuzzy-trace theory are reviewed to explain developmental differences in preferences for risk (tolerating the possibility of bad outcomes to achieve larger rewards), time (waiting for larger but delayed rewards), and ambiguity (willingness to explore the unknown to achieve rewards). Consistent with these theories and evidence, and also with major theories of addiction, developmental differences in reward sensitivity, cognitive control to inhibit impulses, and their neural substrates partially explain adolescents’ greater willingness to use substances. However, meta-analyses show that preferences depend on a shift in cognitive representations from risk-reward tradeoffs to simple gist, as predicted by fuzzy-trace theory. Gist representations also facilitate adolescents’ ability to connect social norms and values to decisions. Implications for periods of vulnerability, individual differences, and treatments for addiction are discussed, including opioid addiction. Addiction can begin when multiple vulnerabilities coincide at neurological, psychological, and sociocultural levels, but theory identifies potential strategies for prevention and treatment.