Research on pathogenesis and treatment has long been concentrated on the problems involving abnormalities in the reward and motivational system. However, current research also looks at decision making, including both error detection and behavioral inhibition. It is assumed that compulsive use and relapse in patients with a substance use disorder or with pathological gambling are the result not only of excessive salience of drug related stimuli but also of impaired error detection and behavioral disinhibition.

In this presentation an overview will be given of the research on decision making in alcoholics, drug addicts and pathological gamblers. The data show that patients with both chemical and non-chemical addictions have serious problems with error detection and behavioral inhibition independent of the presence of antisocial or borderline personality disorders. Recent data also show that ex-addicts have fewer problems with behavioral inhibition, indicating either pre-existing normality or improvement after abstinence. The fact that patients with low levels of behavioral inhibition relapse more frequently supports the first explanation. It, therefore, seems important to improve decision making in patients with addictive behaviors, using pharmacological interventions (cognitive enhancers), neurophysiological techniques (biofeedback)or psychotherapeutic treatments(training).