Of the neuropsychological impairments that might be shared between pathological gambling and substance users, problems with decision-making appear to be one of the most salient (Bechara and Damasio, 2002; Bechara et al., 2002; Ersche et al., 2005; Goudriaan et al., 2005; Lawrence et al., 2009a). In a clinical context, heightened impulsivity often appears as a significant contributor to the maladaptive choices that clinical patients sometime make and which, for example, appear to increase the prospects of relapse in alcohol (Bechara et al., 2001) and substance misuse (Adinoff et al., 2007). While some forms of impulsive behavior seem to involve predominantly problems in behavioral control as either action restraint or cancellation (Bjork et al., 2004; Robbins, 2002; Schachar et al., 2001), others involve variability in the capacity to select between actions that vary in their evaluated outcomes (Rushworth et al., 2007; Schweighofer et al., 2007); in this way, increased delay-discounting is as much a manifestation of altered decision-making as faulty impulse control.
