Between knowledge and desire: perceptions of decision-making in the addictive behaviors

Behavioral change in the addictions is often conceptualized in terms of decision-making. It is argued that there are various problems and ambiguities inherent in the experimental research approach. An exploratory study across a range of dependencies (smoking, excessive gambling, drinking, and eating) is reported. The main aim is to examine personal accounts and views of the decision-making process instead of looking at this indirectly. Qualitative and quantitative evidence from a clinical and general population sample supports the perceived importance of decision-making across the dependencies studied. Such a process is thought to facilitate action and commitment. Firmness of decision in the clinical sample is significantly related to confidence in maintaining change. However, choices or decisions often involve relatively unsystematic processing. Blocks to implementation include unpleasant affect. The importance of understanding the link between affect and decision is emphasized as this is thought to be one of the critical determinants of successful change, yet is rarely explicitly studied. The discussion elaborates on possible ways of integrating decision-making with current clinical practice.