Smart drugs - smart decisions?

A new book co-authored by Professor Barbara Sahakian explores ‘hot’ and ‘cold’ decision-making and the possible improvement of bad or risky decisions with cognitive enhancing drugs. The book, 'Bad Moves: How decision making goes wrong and the ethics of smart drugs', co-authored with Jamie Nicole LaBuzetta, also discusses the increasing lifestyle use of ‘smart drugs’ by healthy people.

Professor Sahakian says the role of emotions in decision-making is not fully understood, but that knowledge about it is increasing. For example, she says, we know that we have to exert cognitive control by our prefrontal cortex over emotional areas of the brain such as the amygdala in order to have good emotional regulation. We also know that there are two forms of decision making: ‘hot’ cognition, which includes emotional and risky decisions, and ‘cold’ cognition, which includes rational or non-emotional decisions.

She says: “Understanding the differences between these two forms of cognition can help us to further discover how emotions are involved in decision making.” In healthy students, an example of ‘hot’ decision-making could be opting to go out the night before an exam which could affect their exam grade. An example of a problem of ‘hot’ cognition could be highly risky behaviour such as when a patient who is in the manic phase of bipolar disorder maxes out their credit cards. In contrast, ‘cold’ cognition might include such decisions as how to organise your day in the most effective way or deciding on ingredients for a meal.

She will be speaking about her research for ‘Bad Moves’ as part of the Cambridge series of talks at this year's Hay Festival. Professor Sahakian directs a laboratory of psychopharmacology at the University of Cambridge which uses cognitive enhancing drugs (‘smart drugs’) and psychological treatments to improve cognition, including decision-making, in patients with psychiatric disorders including Alzheimer’s disease, frontotemporal dementia, attention deficit hyperactivity disorder (ADHD), mania and depression.

Her aim is to improve the ability of patients to function successfully in their daily living at school, university, work or home, and to have a better quality of life and wellbeing. Given that 16% of people in the UK have a common mental health problem, such as depression, she feels it is important that there is a better understanding of difficulties people face which hopefully may lead to reduced stigmatisation.

She also has a strong interest in the safety and ethical issues with regard to the increasing lifestyle use of ‘smart drugs’ by healthy people. In particular, she is concerned about safety as there are no long term studies of the use of ‘smart drugs’ in healthy people. Another concern is the accessing of these ‘smart drugs’ over the Internet. Furthermore, there are ethical issues involved in the use of these drugs by healthy people, such as coercion, ‘cheating’ in competitive situations such as exams and the impact this will have on our society. These issues need to be discussed by an informed public.

*“Bad moves. How decision making goes wrong and the ethics of smart drugs” by Barbara J Sahakian and Jamie Nicole LaBuzetta is published by Oxford University Press.