Pathological Gambling Disorder Research Articles

Problemli Kumar Oynama Şiddet Endeksi Türkçe Versiyonunun Psikometrik Özellikleri

Amaç: Bu çalışmada Problemli Kumar Oynama Şiddet Endeksi’nin kumar oynama bozukluğu tanısı olan ve olmayan katılımcılardan oluşan bir çalışma grubunda psikometrik özelliklerinin incelenmesi amaçlanmaktadır. Yöntem: Altmışı kumar oynama bozukluğu tanısı olan 539 kişiden veri toplanmıştır. Verilerin toplanmasında Problemli Kumar Oynama Şiddet Endeksi, South Oaks Kumar Tarama Testi ve demografik bilgi formu kullanılmıştır. Endeksin dilsel eşdeğerlik, geçerlik, güvenirlik ve madde istatistikleri incelenmiştir. Bulgular: Geçerlik kestirimleri için yapı geçerliği ve ölçüt bağıntılı geçerlik analizi yapılmıştır. Yapı geçerliğini incelemek için yapılan doğrulayıcı faktör analizi sonucunda ölçeğin dokuz maddeden ve tek alt boyuttan oluşan yapısının Türk kültüründe geçerli olduğu görülmüştür. Ölçüt bağıntılı geçerliği tespit etmek için Kumar Oynama Şiddet Endeksi ile South Oaks Kumar Tarama Testi arasındaki ilişki incelenmiştir. Yapılan analizler iki ölçek arasında anlamlı bir ilişki olduğunu göstermiştir. Güvenirlik kestirimleri için endeksin iç tutarlık analizi ve test-tekrar test güvenirliği incelenmiştir. İç tutarlılık düzeyi Cronbach alfa katsayısı ile hesaplanmış ve iç tutarlılığının yüksek olduğu görülmüştür. Yapılan test-tekrar test analizlerinde ölçeğin iki farklı zamanda aynı gruptaki uygulamaları arasındaki ilişkinin yüksek olduğu görülmüştür. Sonuç: Araştırma bulguları, Problemli Kumar Oynama Şiddet Endeksi’nin Türkiye’de yürütülecek hem klinik araştırma ve uygulama çalışmalarında hem de genel nüfus üzerinden yürütülecek tarama çalışmalarında kullanılabilecek geçerli ve güvenilir bir ölçme aracı olduğunu ortaya koymuştur.

Criticalities of Executive Functions (EFs) research in Gambling Disorder: between the behavioural and neurophysiological markers

The need to use different and heterogeneous approaches and methodologies to investigate the phenomenon of pathological Gambling Disorder (GD) arises from a substantial difference in the literature results emerging in this area. Furthermore, investigating the executive functioning (EFs) of subjects with GD provides important information that can influence the treatment setting of these populations. In the present paper the involvement of EFs in the present disorder was investigated. The cognitive functioning of subjects with GD was deepened, both through the study of the cerebral correlates of executive functioning in GD and through empirical studies that investigate the behavioural deficits of GD. Furthermore, we considered the role of some specific behavioral tasks (such as the Iowa Gambling Task, IGT) for the assessment of EFs. Finally, the relationship between EFs and some other crucial factors, such as reward sensitivity, were focused. Indeed, the behavioural aspects of GD are multiple, and they include not only traditional functions such as inhibitory control and reduced levels of self-control, but also high sensitivity to reward.

Pathological gambling and impulsivity related to Huntington's disease

Patients with Huntington's disease are a risk group for developing problematic gambling, which is characterised by subjects’ inability to stop gambling despite financial, personal or professional problems. Predisposition to pathological gambling and other addictions involves disturbances in the same corticostriatal circuits that are affected in Huntington's disease, and displays similar disinhibition‐related symptoms. The authors present a case of long‐standing pathological gambling, impulsivity and organic mood disorder related to Huntington's disease.

The steroidogenic inhibitor finasteride reverses pramipexole-induced alterations in probability discounting

Pramipexole is a potent agonist of D3 and D2 dopamine receptors, currently approved for clinical use in Parkinson's disease (PD) and restless leg syndrome. Several studies have shown that pramipexole significantly increases the risk of pathological gambling and impulse-control disorders. While these iatrogenic complications can impose a severe social and financial burden, their treatment poses serious clinical challenges. Our group previously reported that the steroidogenic inhibitor finasteride reduced pathological gambling severity in PD patients who developed this complication following pramipexole treatment. To study the mechanisms underlying these effects, here we tested the impact of finasteride in a rat model of pramipexole-induced alterations of probability discounting. We previously showed that, in rats exposed to low doses of the monoamine-depleting agent reserpine (1 mg/kg/day, SC), pramipexole (0.3 mg/kg/day, SC) increased the propensity to engage in disadvantageous choices. This effect was paralleled by a marked D3 receptor upregulation in the nucleus accumbens. First, we tested how finasteride (25–50 mg/kg, IP) intrinsically affects probability discounting. While the highest dose of finasteride produced a marked lack of interest in lever pressing (manifested as a significant increase in omissions), the 25 mg/kg (IP) dose did not intrinsically modify probability discounting. However, this finasteride regimen significantly reduced the adverse effects of reserpine and pramipexole in probability discounting by diminishing rats' propensity to engage in highly disadvantageous probabilistic choices. The same regimen also reversed the upregulation of D3 receptors in the nucleus accumbens induced by reserpine and pramipexole. These findings confirm that finasteride opposes the impulsivity caused by pramipexole and suggest that this effect may be underpinned by a normalizing effect on D3 receptor expression in the nucleus accumbens.

“That’s No Country for ‘Young’ Men”: A Critical Perspective on Responsible Online Gambling Policies for Gambling Disorder Prevention in Spanish Minors

Recently, some governments and other stakeholders in countries where online gambling has been legalized have implemented responsible gambling policies. From the theoretical and empirical evidence in this study, we show that these responsible gambling policies are insufficient to prevent the emergence of pathological gambling disorder in society, especially among adolescents. Since online gambling was legalized in Spain in June 2012, online gambling companies have been required by law to implement responsible gambling policies. The implemented policies largely consist of informing customers of the dangers of gambling and how to minimize harm by engaging in behaviour that prevents addiction. However, online gambling addiction has increased exponentially; at present, it is the second most common form of pathological gambling in Spain and the most common form among young children and adolescents (Chóliz, 2016). In our study involving 6,053 underage adolescents, the results showed that more than half of them had gambled and that the prevalence rate of pathological gambling was triple that of the general population. Our main conclusions are that online gambling especially affects male minors, some of whom have developed gambling disorders since the legalization (and broad promotion) of online gambling in Spain. Responsible gambling policies implemented by the conservative government of Spain (2011–2018) and by gambling companies were insufficient to prevent such disorders from becoming an epidemic among Spanish adolescents.

Assessing the mediating role of impulsivity between methamphetamine-induced psychotic disorders and increased gambling severity in methamphetamine-dependent individuals.

Pathological gambling (PG) and methamphetamine-induced psychotic disorders (MIPD) both frequentlyoccursin methamphetamine-dependent individuals. The current study examined whether impulsivity mediated the relationship between MIPD and gambling severity. The sample consisted of 320 pathological gamblers with methamphetamine dependence (mean age 32.6years, ranging from 15 to 64years) voluntarily recruited from three rehabilitation centers in Hunan, China. The semistructured clinical interview of DSM-IV-TR Axis I Disorders Patient Edition was used to diagnosis the presence of MIPD and PG by registered psychiatrists. The severity of gambling symptoms was assessed using the global assessment of functioning scale, and the Barratt Impulsiveness Scale-11 provided a measure of impulsivity. Of the sample, 53.4% of participants (n = 171) met diagnostic criteria for MIPD. Individuals with a dual diagnosis of MIPD were associated with higher levels of impulsivity and greater gambling severity. Notably, support for our hypothesized mediation model was found such that impulsivity mediated the association between MIPD and gambling severity. Our findings imply that impulsivity appears to be a transdiagnostic process, which may be targeted in treatment among pathological gamblers with a dual diagnosis of MIPD to reduce gambling behaviors. Limits and future directions for research are discussed.

The dimensional structure of the Yale-Brown Obsessive-Compulsive Scale for Pathological Gambling: functional differences between true compulsions and compulsive behavior

ABSTRACT The present study examined the factorial structure of the Pathological Gambling Adaptation of the Yale-Brown Obsessive-Compulsive Scale (PG-YBOCS) to delineate similarities and differences between thoughts and behavior related to pathological gambling (PG) versus obsessive-compulsive disorder (OCD). The PG-YBOCS was administered in its self-report version in 265 individuals with gambling problems. A factor analysis revealed a two-dimensional structure. The first dimension represented gambling severity; the second dimension reflected resistance to thoughts/urges and behavior. The first but not the second dimension was strongly correlated with depression and the severity and functional relevance of gambling problems. When the standard factor structure (thoughts vs. behavior) was adopted, depression, which is correlated with obsessions but not compulsions in OCD, was correlated with both subscales. Length of illness, a correlate of compulsions in OCD, showed no association with gambling. The present study corroborates factor analyses on the Y-BOCS, demonstrating the existence of an independent resistance dimension. Unlike in OCD, no evidence for independent factors tapping thoughts versus behaviors was obtained, which likely reflects the addictive rather than compulsive nature of problem gambling. Specific correlates of thoughts and behavior in OCD were not confirmed in gambling, further speaking for functional differences between the two disorders.

Don't Say the ‘P’ Word: Problem Gambling Is More than Harm

An important consequence of adoption of public health approaches in the field of gambling studies has been the increasing emphasis afforded to gambling harm. Reducing or eliminating harm has now become the overt stated mission of many government foundations and funding bodies. A by-product of these developments has been the gradual reduction of references to terms capturing the nature of the primary disorder (problem or pathological gambling or gambling disorder) in preference for what are considered to be more neutral or less ‘stigmatising’ terms (e.g. ‘people with gambling harm’). In this paper, we argue that this conflation of gambling harm with the disorder is misguided. Not only does it fail to acknowledge the validity of the disorder but it is also unjustified by evidence and may have unintended negative consequences for both people affected by gambling and the field more generally. In particular, we focus on the clinical and legal advantages of adherence to an individual-centred, pathology model of gambling disorder.

Rethinking the Approach to Gambling Disorder: The Case of the Italian Healthcare Services

In a cultural context where ludopathy is a social phenomenon built through normative and medical definitions, how are healthcare services approaching the treatment of gambling disorder? The purpose of this study is to examine the Italian healthcare service approach to pathological gambling disorder (PGD), with the aim of formulating proposals for action. Italy is chosen as a crucial terrain of investigation to understand the challenges posed by the growth of the gambling market in Europe and its consequences on its healthcare systems. The empirical material underpinning the analysis includes the latest official statistical data regarding the socio-medical treatment of people with addictions in Italy as well as qualitative interviews conducted with social-sanitary structure managers responsible for therapeutic activities combating dependencies. Through a social construction perspective, gambling and PGD are understood as social phenomena whose meaning and definition comes as a result of a process of negotiation. Accordingly, principal findings are related to the respondents’ visions of PGD and how they perceive the activities of social and health services, the impact of changes in legislation on the organisation of services, and the ongoing changes regarding this process.

Effects of Gambling Diagnostic Criteria Changes from DSM-IV to DSM-5 on Mental Disorder Comorbidity Across Younger, Middle-Aged, and Older Adults in a Nationally Representative Sample.

Changes in Diagnostic and Statistical Manual (DSM) criteria for a gambling disorder from DSM-IV to DSM-5 included a drop in the minimum number of criteria required to qualify for a diagnosis. This threshold reduction resulted in a near doubling of prevalence in non-gambling focused populations. However, the impact of this change on psychiatric comorbidity with gambling is unknown. The current study aimed to: (a) examine whether the diagnostic change affected the severity of those diagnosed with a gambling disorder with respect to mental disorder comorbidity, and (b) determine whether this relationship differed across younger (18-34years old), middle-aged (35-54years old), and older (55years old and over) age groups. This study utilized data from the National Epidemiological Survey for Alcohol and Related Conditions. Results indicated that the prevalence of comorbid mental health/substance use disorders did not significantly change between the DSM-IV pathological gambling group and DSM-5 gambling disorder group in the overall sample. However, among older adults, the DSM-5 gambling disorder were more likely to exhibit any anxiety disorder as well as any comorbid mental health/substance-use disorder compared to the DSM-IV pathological gamblers. No other significant differences were observed in mental health or substance-use disorders within age-specific groupings. Findings suggest that the new, less restrictive DSM-5 criteria for gambling addiction capture older gamblers with more severe clinical presentations in terms of co-occurring mental disorders, contrary to our expectation that the lowered threshold for diagnosis would result in less severe clinical cases.

Plasma levels of leptin in patients with pathological gambling, internet gaming disorder and alcohol use disorder

Leptin has been suggested to be involved in the pathophysiology of addictive disorders via modulation of mesolimbic reward pathways. Previous studies in patients with substance use disorders (alcohol, tobacco, cocaine) found positive correlations of leptin blood levels with craving. Here, we investigated leptin blood levels in patients with non-substance related addictive disorders such as pathological gambling (PG) and internet gaming disorder (IGD) in comparison to patients with alcohol use disorder (AUD) and healthy controls. Plasma levels of leptin were measured in male patients with PG (n = 14), male patients with IGD (n = 11), male patients with AUD (n = 39) and male healthy controls (n = 12). Additionally, correlation analyses with blood levels of HPA axis hormones were performed. Leptin plasma levels of patients with PG, IGD or AUD and healthy controls did not differ significantly across groups. In patients with PG, leptin plasma levels were correlated with copeptin, a surrogate for arginine vasopressin. Our findings do not suggest an involvement of leptin in abstinent patients with AUD or in patients with active IGD. In patients with active PG, leptin blood levels were not related to craving for gambling, but leptin might be involved in PG via an interaction with the HPA axis.

A Systematic Review of Land-Based Self-Exclusion Programs: Demographics, Gambling Behavior, Gambling Problems, Mental Symptoms, and Mental Health.

Systematic and quantitative reviews on the effects of land-based self-exclusion are scarce. Therefore, the current review aimed to provide a comprehensive summary of (1) the demographic characteristics of land-based self-excluders and changes after exclusion, including (2) gambling behavior, (3) gambling problems, (4) mental symptoms, and (5) mental health. A systematic database and literature search was performed following PRISMA guidelines. Nineteen naturalistic studies met the eligibility criteria. The quality of all included records was rated via adaption of the Newcastle-Ottawa Scale. Results from higher-quality records were more heavily weighted. Self-excluders were predominantly men in their early or middle forties. Changes after exclusion revealed wide ranges in the rates of abstinence (13-81%), rates of gambling reduction (29-92%), and rates of exclusion breaches (8-59%). The records consistently demonstrated significant changes in pathological gambling from before exclusion (61-95%) to after exclusion (13-26%). Up to 73% of self-excluders exhibited symptoms of anxiety, depression, and substance use disorders at program enrollment. Several aspects of mental health improved after exclusion, e.g., quality of life. Problem and pathological gambling are most prevalent in young men, but self-exclusion was most prominent in middle-aged men. The magnitude of effects widely differed between studies despite overall benefits of self-exclusion, and many individuals continued gambling after exclusion. This shortcoming could be minimized using improved access controls and the extension of exclusion to other gambling segments. High rates of pathological gambling and other mental disorders in self-excluders highlight the need for improved early detection and treatment accessibility.

Problem and Pathological Gambling in Schizophrenia: Exploring Links with Substance Use and Impulsivity

High rates of both problem and pathological gambling (PPG) and substance-use disorders (SUDs) have been reported in schizophrenia, and yet PPG frequently goes undetected in clinical practice and unexamined in research. Here, we aimed to examine the relationship between PPG and SUDs in a large sample of patients across several factors related to both gambling and substance use, including poly-substance use. Additionally, delay discounting is a form of impulsivity known to positively associate with both PPG and SUDs and thought to underlie mechanisms of addiction in both contexts. We aimed to investigate the relationship between PPG and delay discounting in schizophrenia. 337 individuals with schizophrenia completed structured face-to-face interviews regarding gambling behaviors, substance use, and delay discounting. PPG in schizophrenia was associated with substance use, in particular with poly-substance use, and with delay discounting among males. Factors related to substance use were strongly linked with gambling in this sample, but not always with PPG more than recreational gambling. Our findings overall support the notions that multiple forms of gambling in schizophrenia are clinically relevant, that gambling may share common substrates with substance use, and that delay discounting represents a potential mechanism of this association in males.

Serotonin transporter density in binge eating disorder and pathological gambling: A PET study with [11C]MADAM

Behavioral addictions, such as pathological gambling (PG) and binge eating disorder (BED), appear to be associated with specific changes in brain dopamine and opioid function, but the role of other neurotransmitter systems is less clear. Given the crucial role of serotonin in a number of psychiatric disorders, we aimed to compare brain serotonergic function among individuals with BED, PG and healthy controls. Seven BED patients, 13 PG patients and 16 healthy controls were scanned with high-resolution positron emission tomography (PET) using the serotonin transporter (SERT) tracer [11C]MADAM. Both region-of-interest and voxel-wise whole brain analyses were performed. Patients with BED showed increased SERT binding in the parieto-occipital cortical regions compared to both PG and healthy controls, with parallel decreases in binding in the nucleus accumbens, inferior temporal gyrus and lateral orbitofrontal cortex. No differences between PG patients and controls were observed. None of the subjects were on SSRI medications at the time of imaging, and there were no differences in the level of depression between PG and BED patients. The results highlight differences in brain SERT binding between individuals with BED and PG and provide further evidence of different neurobiological underpinnings in behavioral addictions that are unrelated to the co-existing mood disorder. The results aid in the conceptualization of behavioral addictions by characterizing the underlying serotonin changes and provide a framework for additional studies to examine syndrome-specific pharmaceutical treatments.

Comorbid pathological gambling, mental health, and substance use disorders: Health-care services provision by clinician specialty.

Background and aimsPathological gambling (PG) is an impulse control disorder. This study assessed the burden of co-occurring behavioral addictions and mental health disorders in treatment-seeking patients and estimated the likelihood of receiving care for these disorders by clinician specialty.MethodsStudy data were derived from the Massachusetts All-Payer Claims Database, a representative database, for the period 2009–2013. The sample included commercially insured adult residents of Massachusetts. Univariate and multivariate logistic regressions were used to estimate the likelihood of provision of care by clinician specialty adjusting for patient’s demographic characteristics and level of care. Bonferroni correction was applied to adjust for multiple testing.ResultsThe study sample included 869 patients. Treatment-seeking patients who had a diagnosis of PG were mostly males (71%), aged 45–54 years (26.7%) and enrolled in a health maintenance organization (47%). The most prevalent co-occurring disorders among patients with PG as principal diagnosis were anxiety disorders (28%), mood disorders (26%), and substance use disorders (18%). PG was associated with a more than twofold likelihood of receiving care from social workers and psychologists (p < .05). Depressive disorders were associated with a three times greater likelihood of receiving care from primary care physicians (PCPs) (p < .05). Having three and four or more diagnosis was associated with a greater likelihood of receiving care from PCPs.Discussion and conclusionsPsychiatric and substance use disorders are prevalent among treatment-seeking pathological gamblers. The likelihood of receiving care from specialty clinicians significantly varies by clinical diagnosis and patient clinical complexity.

SOGS-RA gambling scores and substance use in adolescents.

Background and aimsThere is a well-established association between pathological gambling and substance use disorders in adolescents. The aim of this study was to shed light on the association between adolescents’ different levels of involvement in gambling activities and substance use (smoking tobacco and cannabis and drinking alcoholic beverages), based on a large sample.MethodsA survey was conducted in 2013 on 34,746 students attending 619 secondary schools, who formed a representative sample of the Italian 15- to 19-year-old population. The prevalence of different categories of gamblers was estimated by age group and gender. A multiple correspondence analysis (CA) was conducted to explain the multivariate associations between substance use and gambling.ResultsThe prevalence of problem gambling was 2.7% among the 15- to 17-year-olds, and rose to 3.6% among the 18- and 19-year-olds. Multiple CA revealed that, even when it does not reach risk-related or problem levels, gambling is associated with the use of alcohol and tobacco. In particular, the analysis showed that non-problem gambling levels were associated with alcohol and tobacco use at least once in the previous month, and that higher-risk gambling levels related to the use of cannabis and episodes of drunkenness at least once in the previous month.ConclusionThis study found that any gambling behavior, even below risk-related or problem levels, was associated with some degree of substance use by youths, and that adolescents’ levels of gambling lay along a continuum of the categories of substance use.

Impulse Control Disorders and Related Complications of Parkinson's Disease Therapy.

Impulsive and compulsive behaviors in Parkinson's disease (PD) patients are most often attributed to dopamine agonist therapy; dysregulation of the mesocorticolimbic system accounts for this behavioral phenotype. The clinical presentation is commonly termed impulse control disorder (ICD): Behaviors include hypersexuality, compulsive eating, shopping, pathological gambling, and compulsive hobby participation. However, not all PD individuals taking dopamine agonists develop these behavioral changes. In this review, the authors focus on the similarities between the phenotypic presentation of ICDs with that of other reward-based behavioral disorders, including binge eating disorder, pathological gambling, and substance use disorders. With this comparison, we emphasize that the transition from an impulsive to compulsive behavior likely follows a ventral to dorsal striatal pattern, where an altered dopaminergic reward system underlies the emergence of these problematic behaviors. The authors discuss the neurobiological similarities between these latter disorders and ICDs, emphasizing similar pathophysiological processes and discussing treatment options that have potential for translation to PD patients.

Neurobiological mechanisms of problem gambling and treatment

Background and aimsIn the past decade, neurobiological research on pathological gambling has flourished. Based on neurobiological similarities between pathological gambling and substance use disorders and similarities in genetics, diagnostic criteria, and effective treatments, pathological gambling was the first behavioral addiction to be included in the DSM-5 within the revised category Substance-related and addictive disorders.In this presentation novel findings from gambling research in our research group focusing on the role of impulsivity, anticipation towards monetary outcomes, and the interaction between stress and cue reactivity will be presented, with a focus on new functional MRI results. An overview will be given on the concepts of impulsivity and compulsivity in pathological gambling and relevant neurocognitive and neuroimaging findings. Implications of neurobiological research for novel intervention research, such as in neuromodulation studies and personalized medicine will be highlighted.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Time Is Money: The Decision Making of Smartphone High Users in Gain and Loss Intertemporal Choice.

Nowadays the smartphone plays an important role in our lives. While it brings us convenience and efficiency, its overuse can cause problems. Although a great number of studies have demonstrated that people affected by substance abuse, pathological gambling, and internet addiction disorder have lower self-control than average, scarcely any study has investigated the decision making of smartphone high users by using a behavioral paradigm. The present study employed an intertemporal task, the Smartphone Addiction Inventory (SPAI) and the Barratt Impulsiveness Scale 11th version (BIS-11) to explore the decision control of smartphone high users in a sample of 125 college students. Participants were divided into three groups according to their SPAI scores. The upper third (69 or higher), middle third (from 61 to 68) and lower third (60 or lower) of scores were defined as high smartphone users, medium users and low users, respectively. We compared the percentage of small immediate reward/penalty choices in different conditions between the three groups. Relative to the low users group, high users and medium users were more inclined to request an immediate monetary reward. Moreover, for the two dimensions of time and money in intertemporal choice, high users and medium users showed a bias in intertemporal choice task among most of the time points and value magnitude compared to low users. These findings demonstrated that smartphone overuse was associated with problematic decision-making, a pattern similar to that seen in persons affected by a variety of addictions.

Risk of Gambling Disorder and Impulse Control Disorder With Aripiprazole, Pramipexole, and Ropinirole: A Pharmacoepidemiologic Study.

Recently, the US Food and Drug Administration issued a warning regarding the potential risk of gambling disorder, but large epidemiologic studies are lacking. We used a large health claims database from the United States and conducted a nested case-control study. Cases were defined as subjects newly diagnosed with gambling disorder or impulse control disorder. For each case, 10 controls were selected and matched to cases by age and follow-up time and calendar time. Adjusted rate ratios were computed with conditional logistic regression. There are 355 cases of gambling disorder and 3550 controls along with 4341 cases of impulse control disorder and 43,410 corresponding controls. After adjusting for confounders, users of aripiprazole demonstrated an increased risk of pathologic gambling (rate ratio [RR], 5.23; 95% confidence interval [CI], 1.78-15.38) and impulse control disorder (RR, 7.71; 95% CI, 5.81-10.34). The risk was also elevated for pramipexole or ropinirole for both gambling disorder and impulse control disorder (RR, 7.61; 95% CI, 2.75-21.07; RR, 3.28; 95% CI, 2.31-4.66, respectively). Our study confirms an association between aripiprazole, pramipexole, or ropinirole and impulse control disorder and gambling disorder.