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

Internet and gaming addiction: a systematic literature review of neuroimaging studies

In the past decade, research has accumulated suggesting that excessive Internet use can lead to the development of a behavioral addiction. Internet addiction has been considered as a serious threat to mental health and the excessive use of the Internet has been linked to a variety of negative psychosocial consequences. The aim of this review is to identify all empirical studies to date that used neuroimaging techniques to shed light upon the emerging mental health problem of Internet and gaming addiction from a neuroscientific perspective. Neuroimaging studies offer an advantage over traditional survey and behavioral research because with this method, it is possible to distinguish particular brain areas that are involved in the development and maintenance of addiction. A systematic literature search was conducted, identifying 18 studies. These studies provide compelling evidence for the similarities between different types of addictions, notably substance-related addictions and Internet and gaming addiction, on a variety of levels. On the molecular level, Internet addiction is characterized by an overall reward deficiency that entails decreased dopaminergic activity. On the level of neural circuitry, Internet and gaming addiction led to neuroadaptation and structural changes that occur as a consequence of prolonged increased activity in brain areas associated with addiction. On a behavioral level, Internet and gaming addicts appear to be constricted with regards to their cognitive functioning in various domains. The paper shows that understanding the neuronal correlates associated with the development of Internet and gaming addiction will promote future research and will pave the way for the development of addiction treatment approaches.

Deutsche Übersetzung und Validierung der Yale Food Addiction Scale

Zusammenfassung. Exzessives Essen wird häufig mit süchtigem Verhalten in Verbindung gebracht. Bisher mangelte es im deutschen Sprachraum jedoch an einem Messinstrument, das spezifisch das Konstrukt Nahrungsmittelabhängigkeit erfasst. Um diesen Mangel zu beheben, stellt die vorliegende Arbeit die deutsche Version der Yale Food Addiction Scale (YFAS) von Gearhardt, Corbin & Brownell (2009) vor. Diese Skala ermöglicht es, Menschen mit ausgeprägten Symptomen einer Abhängigkeit von bestimmten Nahrungsmitteln zu identifizieren. Die psychometrischen Kennwerte dieses Fragebogens wurden an einer Stichprobe von überwiegend Studierenden (N = 752) getestet. Die einfaktorielle Struktur der YFAS konnte bestätigt werden, bei einer zufriedenstellenden internen Konsistenz. Konvergente Validität zeigte sich in mittleren bis hohen Korrelationen mit anderen Maßen problematischen Essverhaltens, während sich geringe Zusammenhänge mit anderen, aber dennoch verwandten Konstrukten, wie Alkoholabhängigkeit und Impulsivität, ergaben. Weiterhin zeigte sich die YFAS als signifikanter Prädiktor für die Häufigkeit von Essanfällen. Die YFAS scheint somit ein brauchbares Instrument für die Erfassung essensbezogener, suchtähnlicher Verhaltensweisen darzustellen.

The case for compulsive shopping as an addiction

Addictive drugs like cocaine, opiates and nicotine, through direct or indirect means, hyperstimulate the dopamine (DA) reward system. Some behaviors, for some people, can have similar effects on the same DA reward circuitry resulting in very similar addictive behavior patterns and consequences. Although the term "addictive" has been used loosely with many behaviors, it may be an appropriate term to describe compulsive shopping. Increased accessibility, hyperstimulating marketing techniques, a loss of the protective delay between impulse and purchase, and overvaluing of the shopping process and objects purchased may all contribute to the potentially addictive nature of shopping.

Associations between pathological gambling and psychiatric comorbidity among help-seeking populations in Hong Kong

Problem gambling is complex and often comorbid with other mental health problems. Unfortunately, gambling studies on comorbid psychiatric disorders among Chinese communities are extremely limited. The objectives of this study were to (a) determine the prevalence of comorbid psychiatric disorders among treatment-seeking pathological gamblers; (b) compare the demographic profiles and clinical features of pathological gamblers with and without comorbid psychiatric disorders; (c) explore the associations between pathological gambling and psychiatric disorders and their temporal relationship. Participants (N = 201) who sought gambling counseling were examined by making Axis-I diagnoses including mood disorders, schizophrenia spectrum disorders, substance use disorders, anxiety disorders, and adjustment disorder. Results showed that 63.7% of participants had lifetime comorbid psychiatric disorder. The most common comorbid psychiatric mental disorders were mood disorders, adjustment disorder, and substance use disorders. Pathological gamblers with psychiatric comorbidities were significantly more severe in psychopathology, psychosocial functioning impairment, and gambling problems than those without the disorders.

Exercise addiction: symptoms, diagnosis, epidemiology, and etiology

Regular physical activity plays a crucial role in health maintenance and disease prevention. However, excessive exercise has the potential to have adverse effects on both physical and mental health. The scholastic and empirical discussion of excessive physical activity focuses on obsessive and compulsive exercising, and uses several labels. However, in this review, we argue that the most appropriate term for this phenomenon is exercise addiction, emphasizing that excessive physical exercise fits the typical and most common characteristics of behavioral addictions. The aim of this review is to synthesize the current knowledge on symptomology, diagnosis, epidemiology, and etiology of exercise addiction.

Concurrent and predictive relationships between compulsive internet use and substance use: findings from vocational high school students in China and the USA

PURPOSE

Compulsive Internet Use (CIU) has increasingly become an area of research among process addictions. Largely based on data from cross-sectional studies, a positive association between CIU and substance use has previously been reported. This study presents gender and country-specific longitudinal findings on the relationships between CIU and substance use.

METHODS

Data were drawn from youth attending non-conventional high schools, recruited into two similarly implemented trials conducted in China and the USA. The Chinese sample included 1,761 students (49% male); the US sample included 1,182 students (57% male) with over half (65%) of the US youth being of Hispanic ethnicity. Path analyses were applied to detect the concurrent and predictive relationships between baseline and one-year follow-up measures of CIU level, 30-day cigarette smoking, and 30-day binge drinking.

RESULTS

(1) CIU was not positively related with substance use at baseline. (2) There was a positive predictive relationship between baseline CIU and change in substance use among female, but not male students. (3) Relationships between concurrent changes in CIU and substance use were also found among female, but not male students. (4) Baseline substance use did not predict an increase in CIU from baseline to 1-year follow-up.

CONCLUSIONS

While CIU was found to be related to substance use, the relationship was not consistently positive. More longitudinal studies with better measures for Internet Addiction are needed to ascertain the detailed relationship between Internet addiction and substance use.

Could a continuous measure of individual transmissible risk be useful in clinical assessment of substance use disorder? Findings from the National Epidemiological Survey on Alcohol and Related Conditions

OBJECTIVE

Toward meeting the need for a measure of individual differences in substance use disorder (SUD) liability that is grounded in the multifactorial model of SUD transmission, this investigation tested to what degree transmissible SUD risk is better measured using the continuous Transmissible Liability Index (TLI) (young adult version) compared to alternative contemporary clinical methods.

METHOD

Data from 9535 18- to 30-year-olds in the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions, a U.S. representative sample, were used to compute TLI scores and test hypotheses. Other variables were SUDs of each DSM-IV drug class, clinical predictors of SUD treatment outcomes, treatment seeking and usage, age of onset of SUDs and substance use (SU), and eligibility for SUD clinical trials.

RESULTS

TLI scores account for variation in SUD risk over and above parental lifetime SUD, conduct and antisocial personality disorder criteria and frequency of SU. SUD risk increases two- to four-fold per standard deviation increment in TLI scores. The TLI is associated with SUD treatment seeking and usage, younger age of onset of SU and SUD, and exclusion from traditional clinical trials of SUD treatment.

CONCLUSIONS

The TLI can identify persons with high versus low transmissible SUD risk, worse prognosis of SUD recovery and to whom extant SUD clinical trials results may not generalize. Recreating TLI scores in extant datasets facilitates etiology and applied research on the full range of transmissible SUD risk in development, treatment and recovery without obtaining new samples.

To use or not to use: Expanding the view on non-addictive psychoactive drug consumption and its implications

Proposing a change to the view on psychoactive drug use in non-addicts touches a sensitive issue because of its potential implications to addiction prevention, therapeutic practice, and drug policy. Commentators raised nine questions that ranged from clarifications, suggested extensions of the model to supporting data previously not regarded, to assumptions on the implications of the model. Here, we take up the suggestions of the commentators to expand the model to behavioral addictions, discuss additional instrumentalization goals, and review the evidence from laboratory animal studies on drug instrumentalization. We consider further the role of sociocultural factors and individual development in the establishment in drug instrumentalization and addiction. Finally, we clarify which implications we think this model may have. We conclude that drug instrumentalization theory can be further applied to other behaviors but will require a sensitive debate when used for drug and addiction policy that directly affects prevention and treatment.

The behavioral economics and neuroeconomics of reinforcer pathologies: implications for etiology and treatment of addiction

The current paper presents a novel approach to understanding and treating addiction. Drawing from work in behavioral economics and developments in the new field of neuroeconomics, we describe addiction as pathological patterns of responding resulting from the persistently high valuation of a reinforcer and/or an excessive preference for the immediate consumption of that reinforcer. We further suggest that, as indicated by the competing neurobehavioral decision systems theory, these patterns of pathological choice and consumption result from an imbalance between two distinct neurobehavioral systems. Specifically, pathological patterns of responding result from hyperactivity in the evolutionarily older impulsive system (which values immediate and low-cost reinforcers) and/or hypoactivity in the more recently evolved executive system (which is involved in the valuation of delayed reinforcers). This approach is then used to explain five phenomena that we believe any adequate theory of addiction must address.

Drinking patterns of pathological gamblers before, during, and after gambling treatment

Despite the high co-occurrence of alcohol consumption and gambling, few studies have investigated alcohol use changes during gambling treatment. Using latent growth modeling, we examined weekly alcohol use trajectories of treatment-seeking pathological gamblers across 36 weeks, allowing rates of change to differ across the 12-week pretreatment, during-treatment and posttreatment periods. For these secondary data analyses, we retained drinking gamblers (N = 163) from a combined sample of two randomized clinical trials for the treatment of pathological gambling. Results indicated a decrease in alcohol use corresponding with treatment entry and maintenance of less drinking during treatment and posttreatment. Despite these decreases in alcohol use overall, 31% (50 of 163) of participants exhibited risky drinking during the treatment or posttreatment periods. Gender, age, at-risk drinking (at any point in the 36-week interval), baseline gambling severity, treatment condition, and gambling during treatment predicted latent alcohol use growth factors. Although entry into gambling treatment was temporally associated with reductions in alcohol use in this retrospective analysis, a substantial portion of the sample exhibited at-risk drinking after treatment entry, suggesting that interventions targeting reductions in alcohol use may be useful for this population.

Online social networking and addiction--a review of the psychological literature

Social Networking Sites (SNSs) are virtual communities where users can create individual public profiles, interact with real-life friends, and meet other people based on shared interests. They are seen as a 'global consumer phenomenon' with an exponential rise in usage within the last few years. Anecdotal case study evidence suggests that 'addiction' to social networks on the Internet may be a potential mental health problem for some users. However, the contemporary scientific literature addressing the addictive qualities of social networks on the Internet is scarce. Therefore, this literature review is intended to provide empirical and conceptual insight into the emerging phenomenon of addiction to SNSs by: (1) outlining SNS usage patterns, (2) examining motivations for SNS usage, (3) examining personalities of SNS users, (4) examining negative consequences of SNS usage, (5) exploring potential SNS addiction, and (6) exploring SNS addiction specificity and comorbidity. The findings indicate that SNSs are predominantly used for social purposes, mostly related to the maintenance of established offline networks. Moreover, extraverts appear to use social networking sites for social enhancement, whereas introverts use it for social compensation, each of which appears to be related to greater usage, as does low conscientiousness and high narcissism. Negative correlates of SNS usage include the decrease in real life social community participation and academic achievement, as well as relationship problems, each of which may be indicative of potential addiction.

Massively multiplayer online role-playing games: comparing characteristics of addict vs non-addict online recruited gamers in a French adult population

BACKGROUND

Massively Multiplayer Online Role-Playing Games (MMORPGs) are a very popular and enjoyable leisure activity, and there is a lack of international validated instruments to assess excessive gaming. With the growing number of gamers worldwide, adverse effects (isolation, hospitalizations, excessive use, etc.) are observed in a minority of gamers, which is a concern for society and for the scientific community. In the present study, we focused on screening gamers at potential risk of MMORPG addiction.

METHODS

In this exploratory study, we focused on characteristics, online habits and problematic overuse in adult MMORPG gamers. In addition to socio-demographical data and gamer behavioral patterns, 3 different instruments for screening addiction were used in French MMORPG gamers recruited online over 10 consecutive months: the substance dependence criteria for the Diagnostic and Statistical Manual of Mental Disorder, fourth revised edition (DSM-IV-TR) that has been adapted for MMORPG (DAS), the qualitative Goldberg Internet Addiction Disorder scale (GIAD) and the quantitative Orman Internet Stress Scale (ISS). For all scales, a score above a specific threshold defined positivity.

RESULTS

The 448 participating adult gamers were mainly young adult university graduates living alone in urban areas. Participants showed high rates of both Internet addiction (44.2% for GIAD, 32.6% for ISS) and DAS positivity (27.5%). Compared to the DAS negative group, DAS positive gamers reported significantly higher rates of tolerance phenomenon (increased amount of time in online gaming to obtain the desired effect) and declared significantly more social, financial (OR: 4.85), marital (OR: 4.61), family (OR: 4.69) and/or professional difficulties (OR: 4.42) since they started online gaming. Furthermore, these gamers self-reported significantly higher rates (3 times more) of irritability, daytime sleepiness, sleep deprivation due to play, low mood and emotional changes since online gaming onset.

CONCLUSIONS

The DAS appeared to be a good first-line instrument to screen MMORPG addiction in online gamers. This study found high MMORPG addiction rates, and self-reported adverse symptoms in important aspects of life, including mood and sleep. This confirms the need to set up relevant prevention programs against online game overuse.

A framework for the specificity of addictions

Research over the last two decades suggests that a wide range of substance and behavioral addictions may serve similar functions. Yet, co-occurrence of addictions has only been reported among a minority of addicts. "Addiction specificity" pertains to a phenomenon in which one pattern of addictive behaviors may be acquired whereas another is not. This paper presents the PACE model as a framework which might help explain addiction specificity. Pragmatics, attraction, communication, and expectation (PACE) variables are described, which may help give some direction to future research needs in this arena.

Disordered gambling: etiology, trajectory, and clinical considerations

Gambling-related research has advanced rapidly during the past 20 years. As a result of expanding interest in pathological gambling (PG), stakeholders (e.g., clinicians, regulators, and policy makers) have a better understanding of excessive gambling, including its etiology (e.g., neurobiological/neurogenetic, psychological, and sociological factors) and trajectory (e.g., initiation, course, and adaptation to gambling exposure). In this article, we examine these advances in PG-related research and then consider some of the clinical implications of these advances. We consider criteria changes for PG recently proposed by the DSM-V Impulse Control Work Group for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V). We also review how clinicians can more accurately and efficiently diagnose clients seeking help for gambling-related problems by utilizing brief screens. Finally, we consider the importance of future research that can identify behavioral markers for PG. We suggest that identifying these markers will allow clinicians to make earlier diagnoses, recommend targeted treatments, and advance secondary prevention efforts.

Gambling accessibility: a scale to measure gambler preferences

Geographic closeness of gambling venues is not the only aspect of accessibility likely to affect gambling frequency. Perceived accessibility of gambling venues may include other features such as convenience (e.g., opening hours) or "atmosphere". The aim of the current study was to develop a multidimensional measure of gamblers' perceptions of accessibility, and present evidence for its reliability and validity. We surveyed 303 gamblers with 43 items developed to measure different dimensions of accessibility. Factor analysis of the items produced a two factor solution. The first, Social Accessibility related to the level at which gambling venues were enjoyed because they were social places, provided varying entertainment options and had a pleasant atmosphere. The second factor, Accessible Retreat related to the degree to which venues were enjoyed because they were geographically and temporally available and provided a familiar and anonymous retreat with few interruptions or distractions. Both factors, developed as reliable subscales of the new Gambling Access Scale, demonstrated construct validity through their correlations with other gambling-related measures. Social Accessibility was moderately related to gambling frequency and amount spent, but not to problem gambling, while, as hypothesised, Accessible Retreat was associated with stronger urges to gamble and gambling problems.

Psychometrische Evaluation der deutschen Barratt Impulsiveness Scale – Kurzversion (BIS-15)

Zusammenfassung. Impulsivität ist ein Persönlichkeitsmerkmal, das mit schnellen, unüberlegten Handlungen ohne Beachtung möglicher negativer Konsequenzen einhergeht. Eines der am weitesten verbreiteten Verfahren zur Erfassung von Impulsivität ist die Barratt Impulsiveness Scale (BIS-11; Patton, Stanford & Barratt, 1995 ). Es wurde gezeigt, dass die drei Faktoren nicht-planende, motorische und aufmerksamkeitsbasierte Impulsivität auch ausreichend gut mit einer verkürzten Form der BIS-11 erfasst werden können (BIS-15; Spinella, 2007 ). Die vorliegende Arbeit stellt diese Kurzversion der BIS-11 in einer deutschen Übersetzung vor. Reliabilität und Faktorstruktur des Fragebogens wurden in einer Stichprobe (N = 752) von überwiegend Studierenden getestet. Die dreifaktorielle Struktur von Spinella (2007) konnte bestätigt werden. Die interne Konsistenz war gut (Cronbachs α = .81). In einer zweiten Studie (N = 51) zeigte sich konvergente Validität durch Zusammenhänge mit einem anderen Impulsivitätsmaß (UPPS). Die BIS-15 empfiehlt sich durch ihre guten psychometrischen Kennwerte und ihre ökonomische Durchführbarkeit für die Erfassung von Impulsivität im deutschen Sprachraum.

Individual vulnerability to addiction

The process of addiction is often studied in the neurosciences as a function of the quantity or type of substance consumed, with the ultimate goal of counteracting these effects by other pharmacological means. However, epidemiology and clinical research have extensively demonstrated that most individuals who use drugs do not develop dependence. Numerous factors may explain an individual's propensity to addiction. This review discusses these paradigms and summarizes research on individual differences that encompass cultural and sociodemographic factors, psychiatric or psychological vulnerability, and biological or genetic propensity to addiction. Although these different factors often interact in the expression of vulnerable phenotypes, it is possible to alter or control specific sources of vulnerability. For these reasons, integrating individual vulnerability to addiction across different research disciplines is likely to provide the greatest advances for intervention and prevention efforts.

Pathological video game use among youths: a two-year longitudinal study

OBJECTIVES

We aimed to measure the prevalence and length of the problem of pathological video gaming or Internet use, to identify risk and protective factors, to determine whether pathological gaming is a primary or secondary problem, and to identify outcomes for individuals who become or stop being pathological gamers.

METHODS

A 2-year, longitudinal, panel study was performed with a general elementary and secondary school population in Singapore, including 3034 children in grades 3 (N = 743), 4 (N = 711), 7 (N = 916), and 8 (N = 664). Several hypothesized risk and protective factors for developing or overcoming pathological gaming were measured, including weekly amount of game play, impulsivity, social competence, depression, social phobia, anxiety, and school performance.

RESULTS

The prevalence of pathological gaming was similar to that in other countries (∼9%). Greater amounts of gaming, lower social competence, and greater impulsivity seemed to act as risk factors for becoming pathological gamers, whereas depression, anxiety, social phobias, and lower school performance seemed to act as outcomes of pathological gaming.

CONCLUSION

This study adds important information to the discussion about whether video game "addiction" is similar to other addictive behaviors, demonstrating that it can last for years and is not solely a symptom of comorbid disorders.

How can we begin to measure recovery?

BACKGROUND

There is a lack of consensus in the addiction treatment literature regarding the definition of substance abuse "recovery".

METHODS

This study utilized a review of the literature together with a participatory research design to construct a conceptual model of recovery from the perspectives of addiction treatment professionals, those recovering from addictions, and researchers.

RESULTS

A multidimensional, comprehensive hypothetical model consisting of seven conceptual domains (physical, biomarker, psychological, psychiatric, chemical dependency, family/social, and spiritual) is presented. Each domain is operationally defined by identifying reliable and valid instruments that may be used to measure the domain. It is proposed that the conceptual model be tested using confirmatory factor analysis.

CONCLUSIONS

If empirically supported, this conceptual model would validate the hypothesized multidimensional nature of recovery and provide a potential means for assessing recovery in future treatment outcome studies.

Commonalities in the psychological factors associated with problem gambling and Internet dependence

The most commonly applied conceptual approach for excessive Internet use has been as a behavioral addiction, similar to pathological or problem gambling. In order to contribute to the understanding of Internet dependence as a disorder resembling problem gambling, the current study aimed to examine the relationship between problem gambling and Internet dependence and the degree to which psychological factors associated with problem gambling are relevant to the study of Internet dependence. The factors of depression, anxiety, student stressors, loneliness, and social support were examined in a sample of university students from several Australian universities. The findings revealed that there is no overlap between the populations reporting problem gambling and Internet dependence, but that individuals with these disorders report similar psychological profiles. Although requiring replication with larger community samples and longitudinal designs, these preliminary findings suggest that problem gambling and Internet dependence may be separate disorders with common underlying etiologies or consequences. The implications of the findings in relation to the conceptualization and management of these disorders are briefly discussed.

Pathological Video-Gaming among Singaporean Youth

Introduction: Increase in internet use and video-gaming contributes to public concern on pathological or obsessive play of video games among children and adolescents worldwide. Nevertheless, little is known about the prevalence of pathological symptoms in video-gaming among Singaporean youth and the psychometric properties of instruments measuring pathological symptoms in video-gaming. Materials and Methods: A total of 2998 children and adolescents from 6 primary and 6 secondary schools in Singapore responded to a comprehensive survey questionnaire on sociodemographic characteristics, video-gaming habits, school performance, somatic symptoms, various psychological traits, social functioning and pathological symptoms of video-gaming. After weighting, the survey data were analysed to determine the prevalence of pathological video-gaming among Singaporean youth and gender differences in the prevalence. The construct validity of instrument used to measure pathological symptoms of video-gaming was tested. Results: Of all the study participants, 8.7% were classified as pathological players with more boys reporting more pathological symptoms than girls. All variables, including impulse control problem, social competence, hostility, academic performance, and damages to social functioning, tested for construct validity, were significantly associated with pathological status, providing good evidence for the construct validity of the instrument used. Conclusion: The prevalence rate of pathological video-gaming among Singaporean youth is comparable with that from other countries studied thus far, and gender differences are also consistent with the findings of prior research. The positive evidence of construct validity supports the potential use of the instrument for future research and clinical screening on Singapore children and adolescents’ pathological video-gaming. Key words: Construct validity, Prevalence of video-gaming, Singapore children and adolescents

Pathological gambling and compulsive buying: do they fall within an obsessive-compulsive spectrum?

Both compulsive buying (CB) and pathological gambling (PG) have been proposed as members of a spectrum of disorders related to obsessive-compulsive disorder (OCD). The spectrum hypothesis originated in the early 1990s and has gained considerable support, despite the lack of empirical evidence. Interest in this hypothesis has become critical because some investigators have recommended the creation of a new category that includes these disorders in DSM-5, now under development. In this article, the authors describe the origin of the obsessive-compulsive (OC) spectrum and its theoretical underpinnings, review both CB and PG, and discuss the data both in support of and against an OC spectrum. Both disorders are described in terms of their history, definition, classification, phenomenology family history, pathophysiology, and clinical management. The authors conclude that: (i) CB and PG are probably not related to OCD, and there is insufficient evidence to place them within an OC spectrum in DSM-V; (ii) PG should stay with the impulse-control disorders (ICDs); and (iii) a new diagnosis of CB should be created and be classified as an ICD.

Recent research on impulsivity in individuals with drug use and mental health disorders: implications for alcoholism

Alcohol misuse and dependence, and many of its accompanying psychological problems, are associated with heightened levels of impulsivity that both accelerate the development of clinically significant illness and complicate clinical outcome. This article reviews recent developments in our understanding of impulsivity as they relate to brain circuitry that might underlie these comorbid factors, focusing upon the clinical features of substance use (and dependence), bipolar disorder, and pathological gambling. Individuals who are affected by these disorders exhibit problems in several domains of impulsive behavior including deficient response or "motor" control, and the tolerance of prolonged delays prior to larger rewards at the expense of smaller rewards ("delay-discounting"). These populations, like alcoholic dependents, also exhibit impairments in risky decision-making that may reflect dysfunction of monoamine and catecholamine pathways. However, several areas of uncertainty exist including the specificity of impairments across disorders and the relationship between impulse control problems and altered evaluation of reward outcomes underlying observed impairments in action selection.

Optimizing DSM-IV-TR classification accuracy: a brief biosocial screen for detecting current gambling disorders among gamblers in the general household population

OBJECTIVE

To develop a pathological gambling (PG) screen for efficient application to the household population and for clinicians to use with treatment seekers.

METHOD

We applied a series of multivariate discriminant functions to past-12-month Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR)-based, gambling-related problems; the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) measured and collected this data. The NESARC conducted computer-assisted personal interviews with 43 093 households and identified the largest sample of pathological gamblers drawn from the general household population.

RESULTS

We created a 3-item, brief biosocial gambling screen (BBGS) with high sensitivity (Sensitivity = 0.96; 76 of 79 pathological gamblers correctly identified) and high specificity (Specificity = 0.99; 10 892 of 11 027 nonpathological gamblers correctly identified).

CONCLUSIONS

Major US studies reveal extensive comorbidity of PG with other mental illnesses. The BBGS features psychometric advantages for health care providers that should encourage clinicians and epidemiologists to consider current PG along with other problems. The BBGS is practical for clinical application because it uses only 3 items and they are easy to ask, answer, and include in all modes of interviewing, including self-administered surveys. The BBGS has a strong theoretical foundation because it includes 1 item from each of the addiction syndrome 3 domains: neuroadaptation (for example, withdrawal); psychosocial characteristics (for example, lying); and adverse social consequences of gambling (for example, obtaining money from others).

How do gamblers start gambling: identifying behavioural markers for high-risk internet gambling

BACKGROUND

The goal of this study is to identify betting patterns displayed during the first month of actual Internet gambling on a betting site that can serve as behavioural markers to predict the development of gambling-related problems.

METHODS

Using longitudinal data, k-means clustering analysis identified a small subgroup of high-risk gamblers.

RESULTS

Seventy-three percent of the members of this subgroup eventually closed their account due to gambling-related problems. The characteristics of this high-risk subgroup were as follows: (i) frequent and (ii) intensive betting combined with (iii) high variability across wager amount and (iv) an increasing wager size during the first month of betting.

CONCLUSION

This analysis provides important information that can help to identify potentially problematic gamblers during the early stages of gambling-related problems. Public health workers can use these results to develop early interventions that target high-risk Internet gamblers for prevention efforts. However, one study limitation is that the results distinguish only a small proportion of the total sample; therefore, additional research will be necessary to identify markers that can classify larger segments of high-risk gamblers.

Obesity and its relationship to addictions: is overeating a form of addictive behavior?

Obesity is a major public health problem and notoriously difficult to treat. There are many parallels between obesity/overeating and addictions to alcohol and drugs. This paper discusses similarities between obesity and addictive disorders, including common personality characteristics, disruptive behavior syndromes, and brain mechanisms. Although there are important differences between overeating and other addictive behaviors, an addiction model of overeating may effectively inform prevention and treatment of obesity.

The impact of prior risk experiences on subsequent risky decision-making: the role of the insula

Risky decision-making is significantly affected by homeostatic states associated with different prior risk experiences, yet the neural mechanisms have not been well understood. Using functional MRI, we examined how gambling decisions and their underlying neural responses were modulated by prior risk experiences, with a focus on the insular cortex since it has been implicated in interoception, emotion and risky decision-making. Fourteen healthy young participants were scanned while performing a gambling task that was designed to simulate daily-life risk taking. Prior risk experience was manipulated by presenting participants with gambles that they were very likely to accept or gambles that they were unlikely to accept. A probe gamble, which was sensitive to individual's risk preference, was presented to examine the effect of prior risk experiences (Risk vs. Norisk) on subsequent risky decisions. Compared to passing on a gamble (Norisk), taking a gamble, especially winning a gamble (Riskwin), was associated with significantly stronger activation in the insular and dorsal medial prefrontal cortices. Decision making after Norisk was more risky and more likely to recruit activation of the insular and anterior cingulate cortices. This insular activity during decision making predicted the extent of risky decisions both within- and across-subjects, and was also correlated with an individual's personality trait of urgency. These findings suggest that the insula plays an important role in activating representations of homeostatic states associated with the experience of risk, which in turn exerts an influence on subsequent decisions.

Severity of gambling is associated with severity of depressive symptoms in pathological gamblers

The objective of this study was to investigate the relationship between gambling severity and depressive symptoms in pathological gamblers addicted to slot machines, with the hypothesis that comorbid depressive symptoms are associated with exacerbated gambling symptoms and behavior. Twenty controls and 20 pathological gamblers with different levels of depressive symptoms were studied during slot machine gambling. We found exacerbated gambling behavior in gamblers with high compared to low levels of depressive symptoms in terms of self-reported gambling urge (P < 0.01) and excitement from gambling (P < 0.05), number of games played (P < 0.01), and duration of gambling (P < 0.05). A correlation between depressive and gambling symptoms was found (r = 0.602, P < 0.01), thereby questioning which symptoms contribute to the exacerbated gambling behavior. Regression analyses showed that the symptoms influenced gambling behavior albeit in different ways. Although gambling symptoms predicted the rate of games played (P < 0.001), depressive symptoms predicted gambling urge (P < 0.01) and duration of gambling (P < 0.05). We discuss whether gambling symptoms only co-occur with other disorders; the need to look beyond the classification of pathological gambling as an impulse control disorder; and the potential role of anhedonia in depressed gamblers.

Disordered gambling, type of gambling and gambling involvement in the British Gambling Prevalence Survey 2007

BACKGROUND

The purpose of this study was to examine the relationships between types of gambling and disordered gambling, with and without controlling for gambling involvement (i.e. the number of types of games with which respondents were involved during the past 12 months).

METHODS

We completed a secondary data analysis of the 2007 British Gambling Prevalence Survey (BGPS), which collected data in England, Scotland and Wales between September 2006 and March 2007. The sample included 9003 residents, aged 16 or older, recruited from 10 144 randomly selected addresses. 5832 households contributed at least one participant. Post-facto weighting to produce a nationally representative sample yielded 8968 observations. The BGPS included four primary types of measures: participation in gambling (during the past 12 months and during the past 7 days), disordered gambling assessments, attitudes toward gambling and descriptive information.

RESULTS

Statistically controlling for gambling involvement substantially reduced or eliminated all statistically significant relationships between types of gambling and disordered gambling.

CONCLUSIONS

Gambling involvement is an important predictor of disordered gambling status. Our analysis indicates that greater gambling involvement better characterizes disordered gambling than does any specific type of gambling.

CBT for adolescent pathological gambling - lessons from adult research

OBJECTIVES

Features of gambling, particularly among young people have changed over the past decade and, while there are no data from Ireland, there are suggestions from those working in the field that pathological gambling is increasing among adolescents. Relatively little is known about the effective treatment of pathological gambling in adolescents. This paper aims to review research in cognitive behavioural treatments with a view to their application in adolescents. Research among adolescence is given prominence when this is available.

METHODS

The methodology comprised a literature search of Medline, Psycinfo, and EMBASE databases, using the search terms: 'cognitive behavioural therapy'; 'gambling; 'psychology'; 'epidemiology'; 'adolescent'; 'motivation'; 'effectiveness'; 'outcome'; 'relapse'; and 'internet'. In addition, a hand search of Clinical Psychological Reviews, Journal of Gambling Studies, Addiction, Psychology of Addictive Behaviors, and International Gambling Studies (1997-2007) was performed.

RESULTS

A total of 23 studies comprising various cognitive and behavioural approaches were identified, all but three of them confined to adult subjects. Study methodology and quality varied greatly, with many case studies or small case series, and only three randomised control trials. None used an intention-to-treat analysis, and there was little long-term follow-up. Almost ail indicated, with more or less evidence, that cognitive behavioural strategies might be beneficial.

CONCLUSIONS

Many varieties and modifications of cognitive behavioural therapy have been applied to pathological gambling, though there are few studies of any psychological treatments for adolescent gamblers. Methodological problems surround much of the research. Notwithstanding these reservations cognitive behavioural approaches seem to offer promise in managing this serious problem.

Pathological video-game use among youth ages 8 to 18: a national study

Researchers have studied whether some youth are "addicted" to video games, but previous studies have been based on regional convenience samples. Using a national sample, this study gathered information about video-gaming habits and parental involvement in gaming, to determine the percentage of youth who meet clinical-style criteria for pathological gaming. A Harris poll surveyed a randomly selected sample of 1,178 American youth ages 8 to 18. About 8% of video-game players in this sample exhibited pathological patterns of play. Several indicators documented convergent and divergent validity of the results: Pathological gamers spent twice as much time playing as nonpathological gamers and received poorer grades in school; pathological gaming also showed comorbidity with attention problems. Pathological status significantly predicted poorer school performance even after controlling for sex, age, and weekly amount of video-game play. These results confirm that pathological gaming can be measured reliably, that the construct demonstrates validity, and that it is not simply isomorphic with a high amount of play.

Longitudinal patterns of gambling activities and associated risk factors in college students

AIMS

To investigate which clusters of gambling activities exist within a longitudinal study of college health, how membership in gambling clusters change over time and whether particular clusters of gambling are associated with unhealthy risk behaviour.

DESIGN

Four-year longitudinal study (2002-2006).

SETTING

Large, public university.

PARTICIPANTS

Undergraduate college students.

MEASUREMENTS

Ten common gambling activities were measured during 4 consecutive college years (years 1-4). Clusters of gambling activities were examined using latent class analyses. Relations between gambling clusters and gender, Greek membership, alcohol use, drug use, personality indicators of behavioural undercontrol and psychological distress were examined.

FINDINGS

Four latent gambling classes were identified: (1) a low-gambling class, (2) a card gambling class, (3) a casino/slots gambling class and (4) an extensive gambling class. Over the first college years a high probability of transitioning from the low-gambling class and the card gambling class into the casino/slots gambling class was present. Membership in the card, casino/slots and extensive gambling classes were associated with higher scores on alcohol/drug use, novelty seeking and self-identified gambling problems compared to the low-gambling class. The extensive gambling class scored higher than the other gambling classes on risk factors.

CONCLUSIONS

Extensive gamblers and card gamblers are at higher risk for problem gambling and other risky health behaviours. Prospective examinations of class membership suggested that being in the extensive and the low gambling classes was highly stable across the 4 years of college.