A Research Domain Criteria Approach to Gambling Disorder and Behavioral Addictions: Decision-Making, Response Inhibition, and the Role of Cannabidiol.

Stefano Pallanti,Anna Marras,Nikolaos Makris

doi:10.3389/fpsyt.2021.634418

Abstract

Gambling Disorder (GD) has been recently re-classified in the DSM-5 under the “substance-related and addictive disorders,” in light of its genetic, endophenotypic, and phenotypic resemblances to substance dependence. Diminished control is a core defining concept of psychoactive substance dependence or addiction and has given rise to the concept of “behavioral” addictions, which are syndromes analogous to substance addiction, but with a behavioral focus other than ingestion of a psychoactive substance. The main symptom clusters are represented by loss of control, craving/withdrawal, and neglect of other areas of life, whereas in a Research Domain Criteria (RDoC) perspective, GD patients exhibit deficits in the domain of “Positive valence systems,” particularly in the “Approach motivation” and “Reward learning” constructs, as well as in the “Cognitive systems,” primarily in the “Cognitive control” construct. In the Addictions Neuroclinical Assessment (ANA), three relevant domains for addictions emerge: “Incentive salience,” “Negative Emotionality,” and “Executive Function.” The endocannabinoid system (ECS) may largely modulate these circuits, presenting a promising pharmaceutical avenue for treating addictions. Up to now, research on cannabidiol has shown some efficacy in Attention Deficit/Hyperactivity Disorder (ADHD), whereas in behavioral addictions its role has not been fully elucidated, as well as its precise action on RDoC domains. Herein, we review available evidence on RDoC domains affected in GD and behavioral addictions and summarize insights on the use of cannabidiol in those disorders and its potential mechanisms of action on reward, decisional, and sensorimotor processes.

Highlights

Behavioral addictions refer to syndromes analogous to substance addiction, but with a behavioral focus other than ingestion of a psychoactive substance [1] and Gambling Disorder (GD) is often recognized as the prototypical behavioral addiction [2]
The inclusion of GD in the “substance related and addictive disorders” chapter of DSM-5 recognizes the disorder as a prototypical behavioral addiction, characterized by symptom clusters of loss of control, craving/withdrawal, and neglect of other areas of life
Recent research in GD is focusing on the identification of the neurobiological underpinnings of most employed behavioral tasks related to decision making and response inhibition (e.g., Iowa Gambling Task, Delayed Discounting Task, and Stop Signal Task), to identify the neural correlates of the disorder’s symptomatologic clusters and domains

Summary

INTRODUCTION

Behavioral addictions refer to syndromes analogous to substance addiction, but with a behavioral focus other than ingestion of a psychoactive substance [1] and Gambling Disorder (GD) is often recognized as the prototypical behavioral addiction [2]. In regard to Cognitive systems and declarative memory, stimulation of cannabinoid receptors in hippocampal circuits diminishes glutamate release to below-threshold levels, inhibiting long-term potentiation necessary for encoding and abundance of evidence demonstrates transient, dosedependent 9-tetrahydrocannabinol (THC)-induced memory impairments (with a tolerance effect in heavy users) and the contrasting absence of memory deficits following CBD administration. Another study investigated the differential effects of -9THC and CBD on regional brain activation during a set of four tasks that engaged cognitive processes known to be affected by cannabis use: verbal memory, response inhibition, sensory processing, and emotional processing [65]. Results showed that while response inhibition has been shown to be impaired in human volunteers after THC administration, neither disruption of endocannabinoid signaling nor administration of a CB1R agonist had clear observable behavioral effects on stop-signal task performance [66]. There are only clinical studies on substance use disorder, while the effects of cannabidiol in other types of addiction or disorders of motivation have not been studied in randomized clinical trials yet

CONCLUSIONS

Findings

DATA AVAILABILITY STATEMENT