Gambling disorder seeking treatment patients and tobacco use in relation to clinical profiles

OBJECTIVES

Tobacco smoking and gambling disorder (GD) often co-occur. However, few studies have assessed the extent to which cigarette smoking may serve to classify and/or better define GD behaviour profiles.

METHODS

Among a large sample of n = 3,652 consecutive treatment-seeking patients with GD (91% men). Smokers were compared to non-smokers across different sociodemographic, clinical, psychopathological and personality variables. The effect sizes for the means and the proportion differences between the groups were estimated. An evaluation of the smoking changes over the last 15 years was also performed.

RESULTS

From the total sample, 62.4% of gamblers reported tobacco use. A decreasing linear trend in tobacco use was observed within the studied period, women having a more irregular pattern. The use of tobacco was linked to the use of alcohol and other illegal drugs. Gamblers who smoke, as compared to those who don't, presented lower education levels, lower social position indexes and active employment. They were younger, with an earlier age of onset, shorter duration of the gambling behavior, higher GD severity, more psychological symptoms, higher scores in novelty seeking and lower scores in reward dependence, self-directedness and self-transcendence.

CONCLUSIONS

Gamblers seeking treatment who smoke display particular social, clinical, psychological, temperamental and character features different from non-smoking gamblers, suggesting that the presence or absence of comorbid smoking condition in GD should always be considered when developing an optimal treatment, as gamblers who smoke might need treatment strategies different from non-smoking gamblers.

Response trajectories of gambling severity after cognitive behavioral therapy in young-adult pathological gamblers

BACKGROUND AND AIMS

The significant increase in the prevalence of gambling disorder (GD) among young adults in recent years has attracted interest in determining therapeutic efficiency in this sector of the population. The aim of this work was to estimate the response trajectories of gambling severity during the six-month follow-up after a cognitive behavioral therapy (CBT) program in young adult patients and to identify the main variables associated with each trajectory.

METHODS

The sample included n = 192 patients, aged 19-35 years old, seeking treatment for GD. Response trajectories were identified through latent class growth analysis.

RESULTS

Three trajectories emerged: T1 (n = 118, 61.5%), composed of patients with severe GD at pre-treatment and good evolution to recovery; T2 (n = 62, 32.3%), with patients with moderate-high GD affectation at baseline and good evolution to recovery; and T3 (n = 12, 6.3%), with participants with severe baseline GD severity and poor evolution after CBT (Abbott, 2019). The highest risk of poor therapeutic outcomes was related to lower social index positions, high emotional distress, high scores in harm avoidance and low scores in self-directedness.

DISCUSSION AND CONCLUSIONS

Differences in the response trajectories at short-term follow-up after CBT reveal heterogeneity in the samples including young and young-adult GD patients. Patients' phenotype at baseline should be considered when developing efficient, person-centered intervention programs, which should comprise strategies aimed at increasing emotional regulation capacities, self-esteem and self-efficacy, with the aim of avoiding relapses in the medium-long term after therapy.

Modulation of the Endocannabinoids N-Arachidonoylethanolamine (AEA) and 2-Arachidonoylglycerol (2-AG) on Executive Functions in Humans

Animal studies point to an implication of the endocannabinoid system on executive functions. In humans, several studies have suggested an association between acute or chronic use of exogenous cannabinoids (Δ9-tetrahydrocannabinol) and executive impairments. However, to date, no published reports establish the relationship between endocannabinoids, as biomarkers of the cannabinoid neurotransmission system, and executive functioning in humans. The aim of the present study was to explore the association between circulating levels of plasma endocannabinoids N-arachidonoylethanolamine (AEA) and 2-Arachidonoylglycerol (2-AG) and executive functions (decision making, response inhibition and cognitive flexibility) in healthy subjects. One hundred and fifty seven subjects were included and assessed with the Wisconsin Card Sorting Test; Stroop Color and Word Test; and Iowa Gambling Task. All participants were female, aged between 18 and 60 years and spoke Spanish as their first language. Results showed a negative correlation between 2-AG and cognitive flexibility performance (r = −.37; p<.05). A positive correlation was found between AEA concentrations and both cognitive flexibility (r = .59; p<.05) and decision making performance (r = .23; P<.05). There was no significant correlation between either 2-AG (r = −.17) or AEA (r = −.08) concentrations and inhibition response. These results show, in humans, a relevant modulation of the endocannabinoid system on prefrontal-dependent cognitive functioning. The present study might have significant implications for the underlying executive alterations described in some psychiatric disorders currently associated with endocannabinoids deregulation (namely drug abuse/dependence, depression, obesity and eating disorders). Understanding the neurobiology of their dysexecutive profile might certainly contribute to the development of new treatments and pharmacological approaches.