Contrasting the Effects of Alcohol and Alcohol Expectancies on Gambling Behavior

The influence of alcohol on risk-taking may be through both pharmacological action and individual expectancies. A recent meta-analysis highlighted the need for evidence about the precise role of alcohol expectations on individuals' gambling behavior while under the influence of alcohol and a need to understand what specific gambling behaviors are influenced. This laboratory study investigated the effects of alcohol consumption and alcohol expectancies on gambling behavior in a sample of young adult men. Thirty-nine participants were randomly assigned to one of three experimental conditions in which they consumed alcohol, alcohol-placebo, or no-alcohol beverages and then played a computerized roulette game. The roulette game provided each participant with the same pattern of wins and losses and recorded gambling behavior including wagers made, number of spins, and final dollar amount remaining. Significant main effects were found between conditions on total number of spins with the alcohol and alcohol-placebo groups gambling significantly more than the no-alcohol group. The alcohol and alcohol-placebo groups were not statistically different. These findings support that individuals' expectations play an important role in understanding the effects of alcohol consumption on gambling; this effect may be primarily associated with persistence in wagering.

Cognitive-behavioral treatment for gambling harm: Umbrella review and meta-analysis

The aim of the current umbrella review and meta-analysis was to evaluate the methodological rigor of existing meta-analyses on cognitive-behavioral treatment (CBT) for gambling harm. The Cochrane Database of Systematic Reviews, PsycINFO, and PubMed were searched for meta-analyses of CBT for gambling harm among individuals aged 18 years and older. The search yielded five meta-analyses that met inclusion criteria, representing 56 unique studies and 5389 participants. The methodological rigor for one meta-analyses was rated high, two were moderate, and two were critically low. Including only moderate- to high-quality meta-analyses, a robust variance estimation meta-analysis indicated that CBT significantly reduced gambling disorder severity (g = -0.91), gambling frequency (g = -0.52), and gambling intensity (g = -0.32) relative to minimal and no treatment control at posttreatment, suggesting 65%-82% of participants receiving CBT will show greater reductions in these outcomes than minimal or no treatment controls. Overall, there is strong evidence for CBT in reducing gambling harm and gambling behavior, and this evidence provides individuals, clinicians, managed care companies, and policymakers with clear recommendations about treatment selection.

The Influence of Alcohol Consumption on Gambling: Do the Laboratory Study Findings Generalize to Natural Environments?

A recent meta-analysis of laboratory studies on the effects of acute alcohol consumption on risk-taking did not support that acute alcohol consumption increased risk-taking. Questions about whether this finding generalizes to those gambling in naturalistic settings remain. Therefore, we examined the gambling behavior of frequent gamblers who did and did not consume alcohol while gambling. Participants were 769 weekly gamblers (66% male) who were U.S. residents and at least 18 years old. Participants recruited via MTurk completed measures through the Qualtrics survey platform. Significant predictors of gambling under the influence of alcohol were drinking days per month and PGSI score. A linear regression model predicting percentage of time spent gambling under the influence of alcohol revealed that gambling days per week, gambling hours per day, PGSI score, and drinking days per month were significant predictors. Finally, significant predictors of spending at least 50% of gambling time gambling under the influence of alcohol included: gambling hours per day, PGSI score, and drinking days per month. These findings were consistent with the recent meta-analysis of laboratory studies. However, finding that gambling disorder symptoms and overall rates of alcohol consumption were related to gambling under the influence of alcohol replicated the frequently found relation of alcohol problems among those who also exhibit gambling problems.

Does acute alcohol consumption increase risk-taking while gambling? A systematic review and meta-analysis

AIMS

To estimate the effect of acute alcohol consumption on risk-taking while gambling, examine blood alcohol concentration as a moderator and explore possible moderators of this effect.

DESIGN, SETTING AND PARTICIPANTS

A systematic review and meta-analysis was completed. A Boolean search strategy was used to identify studies that included (a) alcohol consumption as an independent variable; (b) a gambling or risk-taking task; (c) a control or placebo comparison; (d) human participants; and (e) English publications. Descriptive information, sample characteristics and experimental data were extracted from each study. Searched databases included: PsycINFO, Web of Science, Medline, Cochrane Library and ProQuest Dissertations and Theses. Included as participants were experiments that compared the effects of alcohol and non-alcoholic or placebo beverages on risk-taking while gambling.

MEASUREMENT

Comprehensive Meta-Analysis version 3.3.070 was used. Standardized mean differences of risk-taking while gambling between the experimental and control conditions were calculated when studies did not report effect sizes. Random-effects models were used for overall effect and meta-regressions while mixed-effects models were used for subgroup analyses.

FINDINGS

Twenty articles containing 47 alcohol versus control comparisons met inclusion criteria. The overall Hedges'g for the difference between groups consuming alcohol and groups consuming a placebo or non-alcoholic drink control was 0.03, 95% confidence interval (CI) = -0.07, 0.12, p = 0.60, indicating no significant difference. Larger effect sizes were found for studies using non-alcoholic control drinks (Hedges' g = 0.30, 95% CI = 0.01, 0.58) compared to placebo beverages (Hedges' g = -0.03, 95% CI = -0.13, 0.06), Cochran's Q = 4.67, p = 0.03.

CONCLUSIONS

Finding that acute alcohol consumption had no reliable effect on risk-taking while gambling was consistent with existing animal research. No support was found for the relation between alcohol dose and risk-taking. The significantly larger effect size for experiments using non-alcoholic versus placebo beverages suggests the potential role of expectancy effects.

Frequent Gamblers' Reasons for and Against Completing a Problem Gambling Screener

Problem gambling screeners are easily accessible and potentially reduce harm for those individuals who engage in risky levels of gambling behavior. However, a recent study found that when frequent gamblers were offered the chance to complete a screener and receive feedback, most chose not to do so. In this paper, secondary analysis was completed on frequent gamblers' open-ended responses to questions regarding reasons for and against completing a problem gambling screener. Participants (N = 262) were individuals who gambled at least once per week and were not currently being treated for gambling problems. A qualitative open-coding procedure independently completed by multiple researchers revealed that the most common reasons for completing the screener were individuals having a desire to check in on their behavior, because they were curious about the screener, because they were experiencing gambling-related harm, or that they were already considering making changes to their gambling. The most common reasons against completing the screener were that they were either avoidant of the experience because they thought it might cause psychological distress, or because they believed that they did not have a problem. This study provides insight into why many individuals who engage in risky levels of gambling behavior do not seek out helping resources. In addition to creating practically accessible helping resources, researchers should focus on techniques that can make help-seeking a less distressing and more acceptable experience.

Oncogenicity evaluation of resveratrol in p53(+/-) (p53 knockout) mice

A six-month study was conducted in p53(+/-) mice to evaluate the possible oncogenicity of resveratrol (3,5,4'-trihydroxy-trans-stilbene), a cancer chemopreventive agent present in grapes and other foods. p53(+/-) mice (25/sex/group) received daily gavage exposure to vehicle only (negative control), resveratrol doses of 1000, 2000, or 4000 mg/kg/day, or p-cresidine (400 mg/kg/day; positive control). No mortality was seen in mice receiving the low dose of resveratrol. However, the mid and high doses induced mortality associated with impaction of the test article in the gastrointestinal tract. Resveratrol had no effect on body weight, food consumption, or clinical signs in surviving mice in any dose group, but induced dose-related increases in liver weight and serum cholesterol in both sexes. Mild anemia was seen in male mice at the high dose only; hematologic effects were not seen in females. Histopathology identified the kidney (hydronephrosis) and urinary bladder (epithelial hyperplasia) as target tissues for resveratrol toxicity. The incidences of both benign and malignant tumors in mice exposed to resveratrol were comparable to those in vehicle controls. By contrast, the positive control article, p-cresidine, induced urinary bladder cancer in both sexes. When administered to p53(+/-) mice at its maximum tolerated dose, resveratrol demonstrates no evidence of oncogenicity.

Altered hepatic mRNA expression of apoptotic genes during dimethylnitrosamine exposure

The role of TNFalpha in regulating apoptotic signaling was investigated during subacute, low-dose (5.0 mg/kg) dimethylnitrosamine (DMN)-induced hepatotoxicity. In TNFalpha receptor (TNFR) intact (wild-type, WT) mice following 4 and 7 DMN exposures, hepatic transcripts for TNFalpha and TNFR-1 were elevated as compared to vehicle controls. DMN hepatotoxicity in WT and TNFR-1/TNFR-2 double knockout (DKO) mice were then compared over a 7-d exposure period. Liver RNA was isolated to measure hepatic expression of TNFalpha/Fas-related genes and the Bcl-2 family of genes that impact apoptosis. Hepatic mRNA levels for Fas, the apoptosis-promoting gene Bax, and the anti-apoptotic gene, Bcl-X(L), were up regulated following 4 and 7 DMN exposures in both WT and TNFR DKO mice as compared to vehicle controls. Notably, hepatic transcript levels for Bax were higher in TNFR DKO mice treated with DMN compared to identically treated WT mice. However, we detected approximately equal DMN-induced apoptotic degradation of liver DNA following 1, 4, and 7 exposures in WT and TNFR DKO mice. Taken together, these data show DMN-induced hepatic TNFalpha expression and suggest that TNFR-1 signaling may be up regulated following 4 and 7 daily DMN exposures. However, TNFalpha is not required for apoptotic signaling at the mRNA transcript level within the liver and instead may actually decrease Bax production.

Acute hepatotoxicant exposure induces TNFR-mediated hepatic injury and cytokine/apoptotic gene expression

Tumor necrosis factor receptor knockout (TNFR KO) mice were used to examine the role of tumor necrosis factor-alpha (TNFalpha) signaling during acute hepatotoxicant exposure. Mice were exposed intraperitoneally (ip) to either vehicle, phosphate-buffered saline (PBS), or dimethylnitrosamine (DMN, 100 mg/kg) for 24 h. Histological evaluation showed that DMN-treated TNFR-2 KO mice had increased liver damage compared to wild type (WT), TNFR-1 KO, or TNFR double KO (DKO) mice. Also, 3 of 8 TNFR-2 KO mice died following DMN treatment, suggesting that hepatic TNFR-2 signaling produces protective responses that counteract TNFR-1-mediated damage. DMN-induced cellular infiltration was absent in TNFR-1-deficient mice, indicating that infiltrating cells do not exacerbate acute hepatotoxic events. In separate experiments, mice were exposed ip to either DMN (5.0 or 100 mg/kg), carbon tetrachloride (CCl4, 0.3 or 1.0 ml/kg), or corresponding PBS/corn oil controls for 6 or 24 h to compare the hepatic mRNA expression of cytokine- and apoptotic-associated genes. Following 24 h of DMN (100 mg/kg) or 6-24 h of CCl4 treatment, hepatic transcripts for TNFalpha, interferon (IFN)-gamma, IL (interleukin)-1RI, and transforming growth factor (TGF)-betaRII were induced. Hepatotoxicant-treated WT and TNFR DKO mice induced liver transcripts for the pro- and anti-apoptotic genes, Bax and Bcl-X(L), respectively, indicating TNF-independent gene activation. The anti-apoptotic gene, Bfl-1, was highly expressed in CCl4-treated, TNFR-positive strains, but minimally expressed in TNFR DKO mice, suggesting that hepatic Bfl-1 is TNF-regulated. Taken together, these data show that acute hepatotoxicant exposure is followed by upregulation of liver cytokine, cytokine receptor, and apoptotic transcripts, and that TNFalpha regulates various aspects of liver inflammation and injury in a TNFR-specific fashion.

Evaluation of depression in a general hospital: utility and limitations of the dexamethasone suppression test

Use of the DST was studied in medically hospitalized, depressed patients. Although complicating medical factors necessarily excluded nearly 60% of referrals, post-dexamethasone plasma cortisol values were significantly higher in 14 major depressives appropriate for the DST as compared to 12 patients with milder, subsyndromal depressive conditions. Using a plasma cortisol criterion of greater than 7 micrograms/dl, the DST identified major depression with 57% sensitivity and 92% specificity in this subsample (p less than 0.005). While limited by a high exclusion rate, the DST may be useful for confirmation of major depression in carefully screened general hospital patients. Implications for research and practice are discussed.

Patterns of utilization of a neuropsychiatric assessment unit

During a one-year period an inpatient psychiatric ward specializing in the evaluation of neuropsychiatric disorders admitted 306 patients for neurodiagnostic services and 119 general psychiatric patients for brief treatment. About half the neurodiagnostic patients were referred by sources not affiliated with the unit, and about a quarter came from outside the immediate area, indicating that a variety of community agencies relied on the unit as a referral facility. In nearly 60 per cent of the cases evaluated, suspected medical or neurologic abnormality was confirmed and the probable etiology determined, while in only a small percentage was a previously unsuspected abnormality detected; this combination of outcomes suggests that most referrals were appropriate and that the unit's main function was to clarify etiologic relationship and design treatment plans.

Psychotic pica, nicotinism, and complicated myocardial infarction

The authors report a case of a schizophrenic patient who repeatedly consumed a wide variety of inedible materials, including significant quantities of tobacco. The phenomenology of this behavior, as well as its psychiatric and medical complications are discussed. It is probable that chronic nicotinism contributed to this patient's refractoriness to psychiatric treatment and to his eventual cardiovascular crisis. The occurrence of pica as a manifestation of severe psychopathology was vividly described by the early pioneers of neuropsychiatry, but has received little attention in recent psychiatric literature. This is in marked contrast to the syndrome of psychogenic water intoxication which continues to be reported frequently. The majority of descriptions of pica have dealt with its occurrence in children, in pregnant women, and as a societal practice in certain cultures studied from a medico-anthropologic point of view. The toxic organic brain syndrome caused by chronic ingestion of nicotine-containing products has also been neglected in psychiatric publications. Descriptions of the neuropsychiatric complications of subacute and chronic nicotinism have been restricted to textbooks of toxicology, where greater emphasis has been given to the acute effects of large quantities of nicotine, often in forms other than tobacco. The following case illustrates the near-fatal practice of tobacco pica in a psychotic patient and dramatically demonstrates the systemic and central nervous system effects of nicotinism.