Risk, reward and loss in addictive behavior: a six-year cross-lagged panel study

Decision making in the context of addiction is characterized by altered values regarding risk and reward, but the long-term and reciprocal relationship between value-based decision-making and addictive behavior remains poorly understood. In this study, 338 individuals (19-27 years, 59% female) from a community sample participated in a baseline assessment, including clinical interviews on addictive behaviors (quantity of use, frequency of use, DSM-5 criteria) and a task battery to assess four facets of value-based decision-making (delay aversion, risk-seeking for gains and losses, and loss aversion). Follow-up assessments were conducted after 3 and 6 years, with 75% and 71% of participants retained, respectively. Using random-intercept cross-lagged panel models (RI-CLPM) controlled for age, gender, IQ, and the baseline addiction level, we examined the bidirectional relationships between value-based decision-making and addictive behavior. Our findings demonstrate temporal stability in both decision-making and addictive behavior, but provide limited evidence for predictive cross-lagged relationships. While prior research indicates that altered value-based decision-making is a predictor of addictive behavior, our findings suggest that its impact may be more limited or context-dependent, highlighting the importance of multifaceted approaches to understanding addiction.