Toward a syndrome model of addiction: multiple expressions, common etiology

Parental bonding in subjects with pathological gambling disorder compared with healthy controls

The new Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-V) includes pathological gambling disorder (PGD) in the subgroup of "Addiction and Related Disorders" due to the similarities between PGD and substance-based addictions in neurobiological, psychological, and social risk factors. Family factors as parental rearing attitudes play a crucial role in the development of substance use disorders and PGD. The aim of the present study was to assess the parental bonding during childhood perceived for adults with PGD compared with healthy controls. Twenty males with PGD and 20 control subjects answered the parental bonding instrument, which measures subjects' recollections of parenting on dimensions of care and protection. Subjects with PGD showed significantly lower maternal and paternal care (p = 0.016 and p = 0.031, respectively) than controls, and higher paternal protection (p = 0.003). The most common parental pattern for PGD subjects was the affectionless control (50% for the father and 60% for the mother). Preliminary results suggest that, as previously reported for substance use disorders, an affectionless control parenting style is associated with PGD.

Disordered gambling in residential substance use treatment centers: an unmet need

This study examined prevalence and potential impact of disordered gambling in a sample of individuals (N = 684) undergoing residential treatment for substance use disorders at 13 facilities. Lifetime disordered gambling prevalence was 20.2%, as identified by South Oaks Gambling Screen. Within individuals who screened positive for disordered gambling, few had sought help for gambling (15.9%) and only 14.3% reported having gambling addressed in their current substance use disorder treatment. Meanwhile, 30.4% identified gambling as a concern in their recovery efforts. The presence of a gambling problem, either historical or current, potentially affects residential treatment outcomes and warrants clinical attention within these programs.

Development and content validity of a screening instrument for gaming addiction in adolescents: the Gaming Addiction Identification Test (GAIT)

This study describes the development of a screening tool for gaming addiction in adolescents - the Gaming Addiction Identification Test (GAIT). Its development was based on the research literature on gaming and addiction. An expert panel comprising professional raters (n = 7), experiential adolescent raters (n = 10), and parent raters (n = 10) estimated the content validity of each item (I-CVI) as well as of the whole scale (S-CVI/Ave), and participated in a cognitive interview about the GAIT scale. The mean scores for both I-CVI and S-CVI/Ave ranged between 0.97 and 0.99 compared with the lowest recommended I-CVI value of 0.78 and the S-CVI/Ave value of 0.90. There were no sex differences and no differences between expert groups regarding ratings in content validity. No differences in the overall evaluation of the scale emerged in the cognitive interviews. Our conclusions were that GAIT showed good content validity in capturing gaming addiction. The GAIT needs further investigation into its psychometric properties of construct validity (convergent and divergent validity) and criterion-related validity, as well as its reliability in both clinical settings and in community settings with adolescents.

Translational Models of Gambling-Related Decision-Making

Gambling is a harmless, recreational pastime that is ubiquitous across cultures. However, for some, gambling becomes a maladaptive and compulsive, and this syndrome is conceptualized as a behavioural addiction. Laboratory models that capture the key cognitive processes involved in gambling behaviour, and that can be translated across species, have the potential to make an important contribution to both decision neuroscience and the study of addictive disorders. The Iowa gambling task has been widely used to assess human decision-making under uncertainty, and this paradigm can be successfully modelled in rodents. Similar neurobiological processes underpin choice behaviour in humans and rats, and thus, a preference for the disadvantageous "high-risk, high-reward" options may reflect meaningful vulnerability for mental health problems. However, the choice behaviour operationalized by these tasks does not necessarily approximate the vulnerability to gambling disorder (GD) per se. We consider a number of psychological challenges that apply to modelling gambling in a translational way, and evaluate the success of the existing models. Heterogeneity in the structure of gambling games, as well as in the motivations of individuals with GD, is highlighted. The potential issues with extrapolating too directly from established animal models of drug dependency are discussed, as are the inherent difficulties in validating animal models of GD in the absence of any approved treatments for GD. Further advances in modelling the cognitive biases endemic in human decision-making, which appear to be exacerbated in GD, may be a promising line of research.

Exploring risk and protective factors with a community sample of American Indian adolescents who attempted suicide

American Indian adolescents are at disproportionate risk for suicide, and community-based studies of this population, which allow a deeper understanding of risks and resilience to inform interventions, are rare. This is a cross-sectional study of N = 71 Apache adolescents. Strengths include the role of the community and American Indian paraprofessionals in the design, implementation, and interpretation of findings. Participants were M = 16.0 years old, 65% female, and 69% multiple attempters. Risks included suicidal behavior among peers and family (68%), caregivers with substance problems (62%), and participant substance use history, namely alcohol (91%) and marijuana (88%). Areas of resiliency included lower depression scores (M = 23.1) and cultural activity participation. A multi-tiered intervention at individual, family, and community levels is needed.

Problematic Internet use and problematic alcohol use from the cognitive-behavioral model: a longitudinal study among adolescents

Problematic Internet use (PIU) and problematic alcohol use are two pervasive problems during adolescence that share similar characteristics and predictors. The first objective of this study was to analyze the temporal and reciprocal relationships among the main components of PIU from the cognitive-behavioral model (preference for online social interaction, mood regulation through the Internet, deficient self-regulation, and negative consequences). The second objective was to examine the temporal and reciprocal relationships between PIU components and problematic alcohol use. We also examined whether these relationships differ between males and females. The sample comprised 801 Spanish adolescents (mean age=14.92, SD=1.01) who completed the measures both at Time 1 (T1) and Time 2 (T2) six months apart. We used structural equation modeling to analyze the relationship among the variables. Results showed that deficient self-regulation at T1 predicted an increase in preference for online interactions, mood regulation, and negative consequences of the Internet at T2. In turn, the emergence of negative consequences of PIU at T1 predicted a rise in problematic alcohol use at T2. Longitudinal relationships between different components of PIU and between the components of PIU and problematic alcohol use were invariant across genders. Deficient self-regulation, consisting of diminished self-control over cognition and behaviors related to the Internet, plays a central role in the maintenance of PIU, increasing the preference for online interactions, mood regulation, and negative consequences from Internet use over time. In turn, adolescents who present negative consequences of PIU are vulnerable targets for problematic alcohol use.

Gambling disorder and other behavioral addictions: recognition and treatment

Addiction professionals and the public are recognizing that certain nonsubstance behaviors--such as gambling, Internet use, video-game playing, sex, eating, and shopping--bear resemblance to alcohol and drug dependence. Growing evidence suggests that these behaviors warrant consideration as nonsubstance or "behavioral" addictions and has led to the newly introduced diagnostic category "Substance-Related and Addictive Disorders" in DSM-5. At present, only gambling disorder has been placed in this category, with insufficient data for other proposed behavioral addictions to justify their inclusion. This review summarizes recent advances in our understanding of behavioral addictions, describes treatment considerations, and addresses future directions. Current evidence points to overlaps between behavioral and substance-related addictions in phenomenology, epidemiology, comorbidity, neurobiological mechanisms, genetic contributions, responses to treatments, and prevention efforts. Differences also exist. Recognizing behavioral addictions and developing appropriate diagnostic criteria are important in order to increase awareness of these disorders and to further prevention and treatment strategies.

Exploring Addiction-as-Occupation

Introduction

Despite advances in addiction research and practice, addiction remains a significant public health problem with strikingly high relapse rates and low treatment retention rates. This study explored whether the concept of addiction-as-occupation aligned with the experiences of ten persons with addiction(s), and suggests that further development of a model based on this concept may help to elucidate and address some barriers to addiction recovery services.

Methods

Semi-structured interviews were performed to gain descriptions of the occupational lives and first-hand experiences of ten persons with addiction(s). Transcripts were analysed using a qualitative thematic analysis methodology.

Results

Seven themes were identified in the data: connection, locus of control, penetration, habituation, identity, motivation, and coping/escape. Participants in this study described their addictions using occupational terms, and addressed both the gains and harms of performing their addictions.

Conclusion

Further investigation of experiences of addiction-as-occupation could be useful for informing occupational therapy interventions for substance-related and addictive disorders. Potential implications and contributions of a conceptual model based on the notion of addiction-as-occupation, as well as areas for future research, are discussed.

Dimensions and disorder specificity of impulsivity in pathological gambling

Impulsivity is a core characteristic of pathological gambling (PG), even though the underlying structure and disorder specificity is unclear. This study aimed to explore different dimensions of impulsivity in a clinical sample including PG. Furthermore, we aimed to test which alterations of the impulsivity-related dimensions are disorder specific for PG. Participants were individuals diagnosed with PG (n=51) and two groups also characterized by various impulsive behaviors: an alcohol dependence (AD; n=45) and a Gilles de la Tourette syndrome (GTS; n=49) group. A healthy control (HC; n=53) group was recruited as comparison group. A comprehensive assessment was used including impulsivity-related and antipodal parameters of the Stop Signal Task, Stroop Task, Tower of London Task, Card Playing Task, Iowa Gambling Task and the Barratt Impulsiveness Scale-11. Principal axis factor analysis revealed four impulsivity-related dimensions that were labeled 'self-reported impulsivity', 'prepotent response impulsivity', 'choice impulsivity' and 'motor impulsivity'. The PG group scored significantly higher on all four dimensions compared to the HC group. In contrast, the PG group did not differ on any of the dimensions from the AD or the GTS group, except for 'choice impulsivity' where the PG group exhibited higher factor scores compared to the GTS group. Altogether, PG is associated with generally heightened impulsivity profiles compared to a HC group, which may be further used for intervention strategies. However, heightened scores in the impulsivity dimensions are not disorder specific for PG. Further research on shared or different underlying mechanisms of these overlapping impulsivity impairments is necessary.

Insula and striatum activity in effort-related monetary reward processing in gambling disorder: the role of depressive symptomatology

The neurobiological underpinnings of effort-related monetary reward processing of gambling disorder have not been previously studied. To date neuroimaging studies lack in large sample sizes and as a consequence less attention has been given to brain reward processing that could potentially be attributed to comorbid conditions such as depressive mood state. We assessed monetary reward processing using an effort-dependent task during 3 tesla functional magnetic resonance imaging. We investigated a large sample of male, right-handed, slot-machine-playing disordered gamblers (DGs; N = 80) as well as age- and smoking-matched male healthy controls (HCs; N = 89). Depressive symptoms were assessed using the Beck Depression Inventory (BDI). DGs and HCs were divided into subgroups ("high" and "low") based on their BDI scores. Effort-related monetary reward processing did not differ between the complete groups of HCs and DGs. Brain activation during receipt of monetary reward though revealed a significant Group × BDI interaction: DGs with higher BDI scores compared to DGs with lower BDI scores showed greater brain activity in the right insula cortex and dorsal striatum while no differences were observed for HCs with higher versus lower BDI scores. Our results suggest that effort-related aspects of monetary motivation, i.e. when monetary output is tied to performance, are not altered in DG. Additionally, our findings strengthen the need for subgroup comparisons in future investigations of the disorder as part of a personalized medicine approach.

The (co-)occurrence of problematic video gaming, substance use, and psychosocial problems in adolescents

AIMS

The current study explored the nature of problematic (addictive) video gaming (PVG) and the association with game type, psychosocial health, and substance use.

METHODS

Data were collected using a paper and pencil survey in the classroom setting. Three samples were aggregated to achieve a total sample of 8478 unique adolescents. Scales included measures of game use, game type, the Video game Addiction Test (VAT), depressive mood, negative self-esteem, loneliness, social anxiety, education performance, and use of cannabis, alcohol and nicotine (smoking).

RESULTS

Findings confirmed problematic gaming is most common amongst adolescent gamers who play multiplayer online games. Boys (60%) were more likely to play online games than girls (14%) and problematic gamers were more likely to be boys (5%) than girls (1%). High problematic gamers showed higher scores on depressive mood, loneliness, social anxiety, negative self-esteem, and self-reported lower school performance. Nicotine, alcohol, and cannabis using boys were almost twice more likely to report high PVG than non-users.

CONCLUSIONS

It appears that online gaming in general is not necessarily associated with problems. However, problematic gamers do seem to play online games more often, and a small subgroup of gamers - specifically boys - showed lower psychosocial functioning and lower grades. Moreover, associations with alcohol, nicotine, and cannabis use are found. It would appear that problematic gaming is an undesirable problem for a small subgroup of gamers. The findings encourage further exploration of the role of psychoactive substance use in problematic gaming.

Correlates of food addiction in obese individuals seeking bariatric surgery

Recent evidence suggests that palatable, high-calorie foods may have an addictive potential. Accordingly, obesity and overconsumption of such foods have been associated with addiction-like eating behaviour. The present study investigated whether individuals with obesity can be classified as food-addicted and which factors would differentiate between food-addicted and non-addicted individuals. We administered the German version of the Yale Food Addiction Scale and other questionnaires to obese individuals seeking bariatric surgery (N = 96). Results showed that 40% of the sample could be diagnosed as food-addicted. Food-addicted individuals reported more frequent food cravings, higher eating disorder psychopathology and more depressive symptoms than the non-addicted group. Age, body mass and gender distribution did not differ between groups. The food addiction group had higher attentional but similar motor and non-planning impulsivity, and had lower scores on the Alcohol Use Disorders Identification Test (AUDIT) compared with the non-addicted group. Scores on the AUDIT were associated with impulsivity in the non-addicted group only. We conclude that the prevalence of food addiction is higher in candidates for bariatric surgery compared with the general population and obese individuals not seeking bariatric surgery. A diagnosis of food addiction is associated with higher eating pathology and depression. Moreover, only attentional impulsivity, but not other dimensions of impulsivity, is associated with addictive eating. Finally, food addiction and impulsivity interactively predicted alcohol use, suggesting a crucial role of psychological variables and eating style in determining alcohol consumption in pre-bariatric patients, independent of body mass.

Disordered gambling and co-morbidity of psychiatric disorders among college students: an examination of problem drinking, anxiety and depression

We assessed the occurrence of co-morbid psychiatric disorders (i.e., problem drinking, anxiety, and depression) among college students who met the threshold for disordered gambling. The participants included a large sample of undergraduate students (n = 1,430) who were enrolled in an introductory health course at a large, southeastern university in Spring 2011 and completed an online assessment that included scales to assess disordered gambling, problem drinking, anxiety, and depression. We calculated screening scores, computed prevalence rates for each disorder, and calculated Pearson correlations and Chi square tests to examine correlations and co-morbid relationships between the four disorders. Analyses indicated that all disorders were significantly associated (p < .01) except for disordered gambling and anxiety. Because college students who experience disordered gambling (and other psychiatric disorders) are at increased risk of experiencing co-occurring disorders, it might be useful for college health professionals to concurrently screen and intervene for co-occurring disorders.

Alcohol, marijuana, and tobacco use trajectories from age 12 to 24 years: demographic correlates and young adult substance use problems

Substance use trajectories were examined from early adolescence to young adulthood among a diverse sample of 998 youths. Analysis of longitudinal data from ages 12 to 24 identified distinct trajectories for alcohol, marijuana, and tobacco use. Modeling revealed 8 alcohol, 7 marijuana, and 6 tobacco use trajectories. Analyses assessed risk for substance use problems in early adulthood within each trajectory, as well as overlap among alcohol, marijuana, and tobacco use trajectories. Findings confirmed that adolescents with early- and rapid-onset trajectories are particularly vulnerable to the development of problematic substance use in early adulthood. However, analyses also identified an escalating high school onset trajectory for alcohol and for marijuana use that was equally prognostic of problem use in adulthood. Moreover, tobacco use in early adolescence was associated with developing high-risk marijuana and alcohol use patterns. Random assignment to the Family Check-Up intervention was found to reduce risk for membership in the high-risk marijuana use trajectories, suggesting that family-based approaches delivered during adolescence can prevent escalations to problematic substance use. These findings suggest the importance of developmental heterogeneity and equifinality in considering prevention for alcohol and drug use.

A prospective study of adolescent risk and protective factors for problem gambling among young adults

There is a paucity of research examining prospective predictors of problem gambling. The current study utilised a large longitudinal data set (N = 2328) to examine a large range of adolescent risk and protective factors for problem gambling in young adulthood. These risk and protective factors covered the domains of the community, family, school, peer group and individual. Numerous predictors associated with the family, school and peer-individual were statistically significant in analyses adjusted for gender and age. However, in the fully adjusted multivariate analyses, only two predictors were statistically significant. Within this model, gender (female) was associated with a reduced risk of young adult problem gambling, while family rewards for prosocial involvement moderated the risk relationship between adolescent alcohol use and young adult problem gambling. These findings highlight the importance of adolescent alcohol use and family environment as potentially modifiable predictors of young adult problem gambling.

Relationships between problematic internet use and problem-gambling severity: findings from a high-school survey

With the popularity of Internet use among adolescents, there is concern that some youth may display problematic or addictive patterns of Internet use. Although excessive patterns of Internet use was considered for inclusion in the DSM-5 with pathological gambling and substance-use disorders in a category of addictive disorders, it was determined that more research was needed on Internet-use behaviors before such actions be further considered and possibly undertaken. The present study is the first to investigate whether at-risk/problematic Internet use (ARPIU) may moderate the strength of association between problem-gambling severity and gambling-related characteristics and health and well-being measures in adolescents. Survey data from 1884 Connecticut high-school student stratified by Internet use (ARPIU vs. non-ARPIU) were examined in bivariate analyses and logistic regression models. Gambling-related characteristics and health and well-being measures were mostly positively associated with problem-gambling severity in both Internet use groups. Interaction odds ratio revealed that the strength of the associations between problem-gambling severity and marijuana, alcohol and caffeine use were stronger amongst the non-ARPIU compared to the ARPIU group, suggesting that the relationships between these substance use behaviors and problem gambling may be partially accounted for by ARPIU. Future studies should examine the extent to which preventative interventions targeting both problematic Internet use and problem gambling may synergistically benefit measures of health and reduce risk-taking behaviors in adolescence.

Proportionality Review in EU Gambling Law

This chapter starts with a thorough introduction to gambling addiction according to the current state of research. It explains the nature and mechanisms of this mental disorder. These findings lay the ground to analyse the proportionality review: judicial views are contrasted with empirical findings. It is shown that the Court of Justice's – legally relevant(!) – assumptions on gambling addiction are (only) partly supported by empirical evidence.

The chapter also establishes that different standards of review have applied to different aspects of gambling regulation, with the most lenient review being applied to national choices of licensing models and the strictest to penalties and procedural requirements in licensing tenders. In a next step, the Court’s review practice is compared to judgments in other areas that involved similar consumer protection concerns (alcohol addiction and youth drinking; internet threats). Again, a diverging standard of review is noted.

The chapter inquires the causes for the Court’s peculiar approach to gambling issues. It analyses in particular the political context of the early case law and it identifies passages in the jurisprudence that illustrate a subjective-moral rather than objective-scientific perspective on gambling-related risks.

Finally, the chapter addresses the consequences of the Court’s diverging approach. Dealing with gambling as a ‘peculiar issue’ and a topos of public morality led to a lack of a science-informed assessment of gambling-related risks. The chapter notes a ‘judicial vacuum’ in the review practice; the numerous cases referred to the Court of Justice are an expression of this problem as predicted by the late Advocate General Colomer.

Examining the efficacy of a personalized normative feedback intervention to reduce college student gambling

OBJECTIVE

To evaluate the efficacy of a stand-alone personalized normative feedback (PNF) intervention targeting misperceptions of gambling among college students.

PARTICIPANTS

Undergraduates (N = 136; 55% male) who reported gambling in the past 30 days were recruited between September 2011 and March 2012.

METHODS

Using a randomized clinical trial design, participants were assigned to receive either PNF or an attention control task. In addition to self-report, this study used 2 computer-based risk tasks framed as "gambling opportunities" to assess cognitive and behavioral change at 1 week post intervention.

RESULTS

After 1 week, participants receiving PNF showed a marked decrease in perception of other students' gambling, and evinced lower risk-taking performance on 2 analog measures of gambling.

CONCLUSIONS

Changes in both self-reported perceived norms and analog gambling behavior suggest that a single, stand-alone PNF intervention may modify gambling among college students. Whether it can impact gambling outside of the laboratory remains untested.

Effectively addressing addiction requires changing the language of addiction

Public knowledge and attitudes about addiction are largely inconsistent with scientific evidence. The gap between the facts and public and professional perceptions is due in part to the language used to describe the disease and those who have it. A key step in modifying public attitudes and improving how health professionals and policymakers address addiction is to better align the language of addiction with the scientific evidence. Unless we clarify the language, those with the disease will continue to experience the stigma associated with it and attempts to deliver comprehensive and effective evidence-based prevention, treatment, and disease management will be profoundly compromised.

Comorbid internet addiction in male clients of inpatient addiction rehabilitation centers: psychiatric symptoms and mental comorbidity

Addictive Internet use has recently been proposed to be included in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Still, little is known about its nosological features, including comorbidity with other mental disorders and disorder-specific psychopathological symptoms. To investigate whether Internet addiction (IA) is an issue in patients in addiction treatment, 1826 clients were surveyed in 15 inpatient rehabilitation centers. Male patients meeting criteria for comorbid IA (n = 71) were compared with a matched control group of male patients treated for alcohol addiction without addictive Internet use (n = 58). The SCL-90-R, the Patient Health Questionnaire, and the seven-item Generalized Anxiety Disorder were used to assess associated psychiatric symptoms and further comorbid disorders. Comorbid IA was associated with higher levels of psychosocial symptoms, especially depression, obsessive-compulsive symptoms, and interpersonal sensitivity. Moreover, the patients with IA more frequently met criteria for additional mental disorders. They display higher rates of psychiatric symptoms, especially depression, and might be in need of additional therapeutic treatment. In rehabilitation centers, a regular screening for IA is recommended to identify patients with this (non-substance-related) addiction and supply them with additional disorder-specific treatment.

Games and gambling involvement among casino patrons

A growing literature is addressing the nature of the relationships among gambling activity, gambling involvement, and gambling-related problems. This research suggests that among the general population, compared to playing any specific game, gambling involvement is a better predictor of gambling-related problems. To date, researchers have not examined these relationships among casino patrons, a population that differs from the general population in a variety of important ways. A survey of 1160 casino patrons at two Las Vegas resort casinos allowed us to determine relationships between the games that patrons played during the 12 months before their casino visit, the games that patrons played during their casino visit, and patrons' self-perceived history of gambling-related problems. Results indicate that playing specific gambling games onsite predicted (i.e., statistically significant odds ratios ranging from .5 to 4.51) self-perceived gambling-related problems. However, after controlling for involvement, operationally defined as the number of games played during the current casino visit and self-reported gambling frequency during the past 12 months, the relationships between games and gambling-related problems disappeared or were attenuated (i.e., odds ratios no longer statistically significant). These results extend the burgeoning literature related to gambling involvement and its relationship to gambling-related problems.

Pathological and problem gambling in substance use treatment: a systematic review and meta-analysis

Pathological and problem gambling refer to a class of disorders, including those meeting criteria for a psychiatric diagnosis (i.e., pathological gambling), and others comprising a spectrum of severity defined by significant personal and social harm (i.e., problem gambling), that may be common in substance use treatment but are frequently unrecognized. This paper presents a systematic review and meta-analysis of available evidence indicating the prevalence of such gambling disorders in substance use treatment. It provides weighted mean estimates from across studies of clinical samples of substance users, and suggests around 14% of patients that demonstrate comorbid pathological gambling. Around 23% suffer conditions along the broader spectrum of problem gambling. The review also highlights important limitations of existing evidence, including scant data on current versus lifetime comorbidity, as well as reliance on convenience samples and self-administered measures of gambling problems. Notwithstanding a concomitant need for caution when applying these results, the findings suggest a strong need to identify and manage gambling comorbidity in substance use treatment. Strategies for identification of gambling disorders, and therapies that may provide useful adjunctive interventions in substance use treatment are discussed.

Individual differences in motives, preferences, and pathology in video games: the gaming attitudes, motives, and experiences scales (GAMES)

A new measure of individual habits and preferences in video game use is developed in order to better study the risk factors of pathological game use (i.e., excessively frequent or prolonged use, sometimes called “game addiction”). This measure was distributed to internet message boards for game enthusiasts and to college undergraduates. An exploratory factor analysis identified 9 factors: Story, Violent Catharsis, Violent Reward, Social Interaction, Escapism, Loss-Sensitivity, Customization, Grinding, and Autonomy. These factors demonstrated excellent fit in a subsequent confirmatory factor analysis, and, importantly, were found to reliably discriminate between inter-individual game preferences (e.g., Super Mario Brothers as compared to Call of Duty). Moreover, three factors were significantly related to pathological game use: the use of games to escape daily life, the use of games as a social outlet, and positive attitudes toward the steady accumulation of in-game rewards. The current research identifies individual preferences and motives relevant to understanding video game players' evaluations of different games and risk factors for pathological video game use.

Drop-out from addiction treatment: a systematic review of risk factors

Completion of addiction treatment is one of the most consistent factors associated with a favorable treatment outcome. Unfortunately, it is more common for a patient to drop-out of addiction treatment than to complete the treatment. To prevent drop-out, risk factors must be identified. This box-score review focuses on studies investigating the risk factors associated with drop-out from addiction treatment published in peer-reviewed journals from 1992 to 2013. A total of 122 studies involving 199,331 participants met the inclusion criteria. Contrary to recommendations from previous reviews, 91% of the included studies focused primarily on enduring patient factors, mainly demographics. The most consistent risk factors across the different study designs, samples, and measurement methods were cognitive deficits, low treatment alliance, personality disorder, and younger age. With the exception of younger age, none of the demographic factors emerged as consistent risk factors. Further research on the relationship between simple demographic factors and drop-out risk is of limited value. However, little is known about the potential risk factors related to treatment programs and to the treatment processes. Based on the review, clinical recommendations include assessing cognitive functioning and personality disorders at baseline and continuous monitoring of treatment alliance.

The exclusion of nicotine: closing the gap in addiction policy and practice

Addiction is a complex brain disease with frequently overlapping expressions involving nicotine, alcohol, and other drugs. Yet current health care practices, public policies, and national treatment data too often exclude nicotine or address its use as completely separate from other forms of substance use and addiction, compromising patients' health and incurring unnecessary health care costs. Effective prevention and treatment requires the inclusion of nicotine in a comprehensive approach addressing all manifestations of addiction within health care policy and practice.

Khat dependence syndrome: a cross sectional preliminary evaluation amongst UK-resident Yemeni khat chewers

ETHNOPHARMACOLOGICAL RELEVANCE

Khat is a natural psychostimulant that has pharmacological effects similar to that of amphetamine. The behaviour of khat chewing is embedded within a cultural context. Meanwhile khat chewing is associated with psychological and physiologically burden, as a 'dependence producing' substance.

AIMS OF THE STUDY

To assess the applicability of the construct of substance dependence syndrome (DSM-IV, 1994) to khat chewing and to examine psychosocial and behavioural correlates of this syndrome including tobacco use.

MATERIALS AND METHODS

A sample of 204 khat chewers was recruited during random visits to khat sale outlets. A face to face interview that assessed socio-demographic, psychosocial dependence, substance dependence syndrome and behavioural characteristics was conducted. Descriptive, exploratory psychometric and multivariate analyses were employed.

RESULTS

Approximately a third (31%) of khat chewers reported symptoms consistent with dependence syndrome including increased khat chewing (13%) and cessation attempts (19%) while 17% reported withdrawal symptoms including depression (61%), increase in appetite (74%) and interrupted sleep (58%). Thirty-eight percent reported continued khat chewing despite impacts on their health. Psychometric assessment of the DSM-IV criteria for khat chewing dependence identified two factors; factor 1 consisted of bio-behavioural items and factor 2 withdrawal items, accounting for 67% of the variance and Cronbach's alpha coefficient at 0.78. In multivariate logistic regression modelling, there was an association between intensity of psychological khat dependence (SDS-Khat) and nicotine dependence with the likelihood of exhibiting khat chewing dependence syndrome (p=0.0005, OR=1.51, 95%CI=1.33-1.71; p=0.043, OR=2.87, 95%CI=1.03-7.98, respectively).

CONCLUSIONS

The substance dependence syndrome criteria are applicable to khat chewing and associated with increased intensity of nicotine and psychological khat dependence. The applicability of khat dependence syndrome and exploration of its dimensions and associated factors should be extended in future research. Concurrent validation of these findings using specific objective measures for self-report khat chewing is also recommended.

Dirty habits? Online pornography use, personality, obsessionality, and compulsivity

Internet pornography use can be compulsive, but evaluation of pathology underlying this is difficult to assess. The present study aimed to distinguish individual differences in personality and psychopathology that predict pornography consumption in an individual, and whether this reflected more general compulsive processes, assessing 226 male participants. Neuroticism, agreeableness, conscientiousness, and obsessional checking all significantly correlated with a latent measure of compulsive behavior upon which use of Internet pornography use also loaded. The authors suggest the greater use of pornography on the Internet may reflect a general vulnerability to compulsive problems related to basic disposition, and that problems associated with this behavior can be managed with generic clinical approaches to obsessional and compulsive disorders.

Subtypes of disordered gamblers: results from the National Epidemiologic Survey on Alcohol and Related Conditions

AIMS

To derive empirical subtypes of problem gamblers based on etiological and clinical characteristics described in the Pathways Model, using data from a nationally representative survey of US adults. DESIGN & MEASUREMENT: Data were collected from structured diagnostic face-to-face interviews using the Alcohol Use Disorder and Associated Disabilities Interview Schedule DSM-IV version IV (AUDADIS-IV).

SETTING

The study utilized data from US National Epidemiologic Survey on Alcohol and Related Conditions (NESARC).

PARTICIPANTS

All disordered gambling participants (n = 581) from a nationally representative cross-sectional sample of civilian non-institutionalized adults aged 18 years or older.

FINDINGS

Latent class analyses indicated that the best-fitting model was a three-class solution. Those in the largest class (class 1: 50.76%, n = 295) reported the lowest overall levels of psychopathology including gambling problem severity and mood disorders. In contrast, respondents in class 2 (20.06%, n = 117) had a high probability of endorsing past-year substance use disorders, moderate probabilities of having parents with alcohol/drug problems and of having a personality disorder, and the highest probability for past-year mood disorders. Respondents in class 3 (29.18%, n = 169) had the highest probabilities of personality and prior-to-past year mood disorders, substance use disorders, separation/divorce, drinking-related physical fights and parents with alcohol/drug problems and/or a history of antisocial personality disorder (ASPD).

CONCLUSIONS

Three subtypes of disordered gamblers can be identified, roughly corresponding to the subtypes of the Pathways Model, ranging from a subgroup with low levels of gambling severity and psychopathology to one with high levels of gambling problem severity and comorbid psychiatric disorders.

Codependence with hypersexual and gambling disorder

Background The risks of behavioral addictions are well documented. There are biological, medical, social, spiritual, psychological, and safety risks to the individual as well as risks, like ripple effects, to the family and friends with whom the individual with behavioral addictions lives. The phenomenon of collateral damage from addictions, especially alcoholism and substance dependence, is well documented. Aims and methods A selected review of the literature reveals little regarding the risks of collateral damage, in particular codependence, from behavioral addictions on non-addicted family and friends. Results This article theoretically posits the existence of codependence to those with two well documented and researched behavioral addictions, hypersexual and gambling disorder, using the biopsychosocial lens. Conclusions Addictions professionals are encouraged to revisit the literature on codependence and consider its influence on family and friends of those with behavioral addictions when providing services.

Komorbide Substanzstörungen in der erwachsenen Allgemeinbevölkerung

Ziel: Ziel ist die Untersuchung der homotypischen Komorbidität von Störungen im Zusammenhang mit dem Konsum von legalen und illegalen Substanzen sowie Medikamenten in der erwachsenen Bevölkerung. Methodik: Die Auswertungen basieren auf Daten des Epidemiologischen Suchtsurveys 2012. In einem zweistufigen Zufallsverfahren wurde eine Stichprobe von n = 9084 Personen realisiert (Ausschöpfung 53.6 %). Substanzbezogene Störungen nach DSM-IV wurden mithilfe des Münchener Composite International Diagnostic Interview für Alkohol, Tabak, Cannabis, Kokain, Amphetamine sowie Schmerz-, Schlaf- und Beruhigungsmittel erfasst. Ergebnisse: Multiple Diagnosen (Missbrauch und/oder Abhängigkeit) lagen bei insgesamt 6.6 % der Stichprobe vor. Der Anteil komorbider Substanzstörungen war bei Störungen durch Cannabis-, Schlafmittel- und Kokainkonsum am höchsten. Als Risikofaktoren für das Auftreten mindestens einer bzw. mehr als einer Diagnose erwiesen sich männliches Geschlecht, jüngeres Alter, niedrigere Schulbildung, lediger/geschiedener Familienstand und nicht-deutsche Staatsbürgerschaft. Schlussfolgerungen: Ein nicht unerheblicher Anteil der deutschen Bevölkerung ist von multiplen Substanzstörungen betroffen. Weitere epidemiologische Studien zur Beschreibung dieser Hochrisikogruppe sind nötig.

Motivation and Self-Regulation in Addiction: A Call for Convergence

Addiction models have frequently invoked motivational mechanisms to explain the initiation and maintenance of addictive behaviors. However, in doing so, these models have emphasized the unique characteristics of addictive behaviors and overlooked the commonalities that they share with motivated behaviors in general. As a consequence, addiction research has failed to connect with and take advantage of promising and highly relevant advances in motivation and self-regulation research. The present article is a call for a convergence of the previous approaches to addictive behavior and the new advances in basic motivation and self-regulation. The authors emphasize the commonalities that addictive behaviors may share with motivated behavior in general. In addition, it is suggested that the same psychological principles underlying motivated action in general may apply to understand challenging aspects of the etiology and maintenance of addictive behaviors.

Problematic Internet Use, Mental Health and Impulse Control in an Online Survey of Adults

BACKGROUND AND AIMS

Internet use has become a popular entertainment source and has become highly integrated into daily life. However, some people display problematic or addictive usage of the Internet. The present study attempts to fill current knowledge gaps regarding at-risk/problematic Internet use (ARPIU) and its relation to various health and functioning measures.

METHODS

Online survey data from 755 adults in the United States were analyzed using chi-square and ANOVAs.

RESULTS

The ARPIU group did not differ from the non-ARPIU group with respect to substance use. Individuals with ARPIU were, however, more likely to report at-risk/problematic engagement in video-game playing and gambling. Compared to the non-ARPIU group, the ARPIU group reported poorer self-control and higher levels of impulsivity and depression.

CONCLUSIONS

ARPIU appears associated with other risk behaviors, particularly those that might be performed on the Internet. Future studies should examine the extent to which the Internet may promote engagement in these risk behaviors and the extent to which preventative interventions targeting better self-control or negative mood states might help a range of non-substance-related addictive behaviors.

Perceptions of relationship satisfaction and addictive behavior: Comparing pornography and marijuana use

Background and aims Research indicates that excessive pornography use can negatively impact romantic relationships. However, it is unclear whether these negative outcomes are different than negative outcomes produced by other compulsive or addictive behaviors, such as drug use. This study compared perceptions of relationship outcomes from either a romantic partner's excessive marijuana or pornography use. Furthermore, this study experimentally manipulated four factors potentially related to perceptions of relationship satisfaction and addictive behavior. Methods A total of 186 college-aged women read 16 scenarios describing heterosexual romantic relationships in which one partner used either pornography or marijuana. Each scenario varied on four variables: relationship commitment, secrecy of partner's behavior, frequency of partner's behavior, and context of partner's behavior. Results Results suggest that partner pornography and marijuana use are perceived to impact romantic relationships similarly and are influenced by similar factors, such as greater frequency, higher secrecy, and partner's availability for interaction. Conclusions Such findings are consistent with recommendations by professionals that compulsive pornography use be considered worthy of treatment intervention.

Women with elevated food addiction symptoms show accelerated reactions, but no impaired inhibitory control, in response to pictures of high-calorie food-cues

Addictive behaviors are accompanied by a lack of inhibitory control, specifically when individuals are confronted with substance-related cues. Thus, we expected women with symptoms of food addiction to be impaired in inhibitory control, when confronted with palatable, high-calorie food-cues. Female college students (N=50) were divided in low and high food addiction groups based on the symptom count of the Yale Food Addiction Scale. Participants performed a Go/No-go-task with high-calorie food-cues or neutral pictures presented behind the targets. Self-reported impulsivity was also assessed. The high food addiction group had faster reaction times in response to food-cues as compared to neutral cues and reported higher attentional impulsivity than the low food addiction group. Commission and omission errors did not differ between groups or picture types. Hence, women with food addiction symptoms reported higher attentional impulsivity and reacted faster in response to food-cues, although neither increased self-reported motor impulsivity nor impaired behavioral inhibition was found. Food addiction symptoms seem to be related to attentional aspects of impulsivity but not other facets of impulsivity.

The detrimental effects of emotional process dysregulation on decision-making in substance dependence

Substance dependence is complex and multifactorial, with many distinct pathways involved in both the development and subsequent maintenance of addictive behaviors. Various cognitive mechanisms have been implicated, including impulsivity, compulsivity, and impaired decision-making. These mechanisms are modulated by emotional processes, resulting in increased likelihood of initial drug use, sustained substance dependence, and increased relapse during periods of abstinence. Emotional traits, such as sensation-seeking, are risk factors for substance use, and chronic drug use can result in further emotional dysregulation via effects on reward, motivation, and stress systems. We will explore theories of hyper and hypo sensitivity of the brain reward systems that may underpin motivational abnormalities and anhedonia. Disturbances in these systems contribute to the biasing of emotional processing toward cues related to drug use at the expense of natural rewards, which serves to maintain addictive behavior, via enhanced drug craving. We will additionally focus on the sensitization of the brain stress systems that result in negative affect states that continue into protracted abstinence that is may lead to compulsive drug-taking. We will explore how these emotional dysregulations impact upon decision-making controlled by goal-directed and habitual action selections systems, and, in combination with a failure of prefrontal inhibitory control, mediate maladaptive decision-making observed in substance dependent individuals such that they continue drug use in spite of negative consequences. An understanding of the emotional impacts on cognition in substance dependent individuals may guide the development of more effective therapeutic interventions.

Disordered gambling among higher-frequency gamblers: who is at risk?

BACKGROUND

When gambling opportunities are made available to the public in a given jurisdiction, some individuals participate occasionally and others more frequently. Among frequent gamblers, some individuals develop problematic involvement and some do not. This study addresses the association among demographic and social risk factors, frequency of gambling and gambling disorders.

METHOD

Data from an adult community sample (n=1372) were used to identify risk factors for higher-frequency gambling and disordered gambling involvement.

RESULTS

Individuals with higher intelligence, older individuals and more religious individuals were less frequent gamblers. Males, single individuals and those exposed to gambling environments (friends and family who gamble) and those who started to gamble at a younger age were more frequent gamblers. Excitement-seeking personality traits were also higher among more frequent gamblers. A different set of risk factors was associated with the likelihood of gambling disorder among these higher-frequency gamblers. These variables included mental health indicators, childhood maltreatment and parental gambling involvement. Among higher-frequency gamblers, individuals who smoke cigarettes, those with a diagnosis of alcohol or drug dependence or obsessive-compulsive disorder, those with higher anxiety or depression and those with higher impulsivity and antisocial personality traits were more likely to report gambling-related problems. These individuals were also more likely to report gambling on electronic gambling machines (e.g. slot machines).

CONCLUSIONS

These data suggest a model in which higher-frequency gambling, particularly with electronic gambling machines, when combined with any type of emotional vulnerability increased the likelihood of gambling disorder.