Investigation of impulsivity in a sample of treatment-seeking pathological gamblers: a multidimensional perspective

Impulsivity traits and addiction-related behaviors in youth

Background and aims Impulsivity is a risk factor for addictive behaviors. The UPPS-P impulsivity model has been associated with substance addiction and gambling disorder, but its role in other non-substance addiction-related behaviors is less understood. We sought to examine associations between UPPS-P impulsivity traits and indicators of multiple substance and non-substance addiction-related behaviors in youth with varying involvement in these behaviors. Methods Participants (N = 109, aged 16-26 years, 69% males) were selected from a national survey based on their level of externalizing problems to achieve a broad distribution of involvement in addiction-related behaviors. Participants completed the UPPS-P Questionnaire and standardized questionnaires assessing problematic use of substances (alcohol, cannabis, and other drugs) and non-substances (Internet gaming, pornography, and food). Regression analyses were used to assess associations between impulsivity traits and indicators of addiction-related behaviors. Results The UPPS-P model was positively associated with indicators of all addiction-related behaviors except problematic Internet gaming. In the fully adjusted models, sensation seeking and lack of perseverance were associated with problematic use of alcohol, urgency was associated with problematic use of cannabis, and lack of perseverance was associated with problematic use of other drugs than cannabis. Furthermore, urgency and lack of perseverance were associated with binge eating and lack of perseverance was associated with problematic use of pornography. Discussion and conclusions We emphasize the role of trait impulsivity across multiple addiction-related behaviors. Our findings in at-risk youth highlight urgency and lack of perseverance as potential predictors for the development of addictions and as potential preventative therapeutic targets.

Impulsivity profiles in pathological slot machine gamblers

INTRODUCTION

In gambling disorder (GD), impulsivity has been related with severity, treatment outcome and a greater dropout rate. The aim of the study is to obtain an empirical classification of GD patients based on their impulsivity and compare the resulting groups in terms of sociodemographic, clinical and gambling behavior variables.

METHODS

126 patients with slot machine GD attending the Pathological Gambling Unit between 2013 and 2016 were included. The UPPS-P Impulsive Behavior Scale was used to assess impulsivity, and the severity of past-year gambling behavior was established with the Screen for Gambling problems questionnaire (NODS). Depression and anxiety symptoms and executive function were also assessed. A two-step cluster analysis was carried out to determine impulsivity profiles.

RESULTS

According to the UPPS-P data, two clusters were generated. Cluster 1 showed the highest scores on all the UPPS-P subscales, whereas patients from cluster 2 exhibited only high scores on two UPPS-P subscales: Negative Urgency and Lack of premeditation. Additionally, patients on cluster 1 were younger and showed significantly higher scores on the Beck Depression Inventory and on the State-Trait Anxiety Inventory questionnaires, worse emotional regulation and executive functioning, and reported more psychiatric comorbidity compared to patients in cluster 2. With regard to gambling behavior, cluster 1 patients had significantly higher NODS scores and a higher percentage presented active gambling behavior at treatment start than in cluster 2.

CONCLUSIONS

We found two impulsivity subtypes of slot machine gamblers. Patients with high impulsivity showed more severe gambling behavior, more clinical psychopathology and worse emotional regulation and executive functioning than those with lower levels of impulsivity. These two different clinical profiles may require different therapeutic approaches.

Cannabis, a Significant Risk Factor for Violent Behavior in the Early Phase Psychosis. Two Patterns of Interaction of Factors Increase the Risk of Violent Behavior: Cannabis Use Disorder and Impulsivity; Cannabis Use Disorder, Lack of Insight and Treatment Adherence

Background: Previous literature suggests that prevalence of cannabis use in the early phase of psychosis is high, and that early psychosis patients are at high-risk for violent behavior. However, the link between cannabis use and violent behavior in early psychosis patients is unclear. We carried out a study on a sample of early psychosis patients, in order to explore the impact of cannabis use on the risk of violent behavior (VB), while taking into account (1) potential confounding factors and, (2) interactions with other dynamic risk factors of VB. Method: In a sample of 265 early psychosis patients, treated at the Treatment and Early Intervention in Psychosis Program (TIPP) in Lausanne, we used logistic regression models to explore the link between various dynamic risk factors of VB [positive symptoms, substance use disorder (drugs including cannabis, alcohol and others drugs), insight, impulsivity, affective instability, and treatment adherence], and VB occurring during treatment. In order to understand hierarchical effects attributable to the combinations of risk factors on VB we conducted a Classification and Regression Tree (CART). Results: Our results show that cannabis use disorder is a risk factor for VB. The associations among risk factors suggest the presence of two patient profiles with an increased rate of VB: the first is composed of patients with cannabis use disorder and impulsivity, and the second of patients combining cannabis use disorder, absence of insight and non-adherence to treatment. The results also show the moderating role of insight and adherence to treatment on the rate of VB in patients with cannabis use disorder. Conclusion: This study suggests that cannabis use disorder is a significant risk factor for VB amongst early psychosis patients, particularly when combined with either impulsivity, lack of insight and non-adherence to treatment. These results suggest that preventive strategies could be developed on the basis of such patient profiles.

No evidence for common processes of cognitive control and self-control

Cognitive control and self-control are often used as interchangeable terms. Both terms refer to the ability to pursue long-term goals, but the types of controlled behavior that are typically associated with these terms differ, at least superficially. Cognitive control is observed in the control of attention and the overcoming of habitual responses, while self-control is observed in resistance to short-term impulses and temptations. Evidence from clinical studies and neuroimaging studies suggests that below these superficial differences, common control process (e.g., inhibition) might guide both types of controlled behavior. Here, we study this hypothesis in a behavioral experiment, which interlaced trials of a Simon task with trials of an intertemporal decision task. If cognitive control and self-control depend on a common control process, we expected conflict adaptation from Simon task trials to lead to increased self-control in the intertemporal decision trials. However, despite successful manipulations of conflict and conflict adaptation, we found no evidence for this hypothesis. We investigate a number of alternative explanations of this result and conclude that the differences between cognitive control and self-control are not superficial, but rather reflect differences at the process level.

Cognitive Remediation Interventions for Gambling Disorder: A Systematic Review

Various therapeutic approaches are available for the treatment of gambling disorder (GD), especially cognitive behavioral therapy (CBT; the most widely used treatment). However, CBT has high dropout and relapse rates as well as non-compliance issues, which may be partly due to resistance to changing core characteristics, such as executive functioning, attention, and emotional regulation abnormalities. Finding new therapeutic approaches to treat GD is thus a key challenge. Cognitive remediation (CR) interventions represent a promising approach to GD management, which has recently been demonstrated to have efficacy for treating other addictive disorders. The objective of this review is to describe the possible benefits of CR interventions for GD management. Two systematic searches in MEDLINE and ScienceDirect databases were conducted up until January 2017. Potential neurocognitive targets of CR interventions for GD were reviewed, as is the use and efficacy of such interventions for GD. While there is evidence of several neurocognitive deficits in individuals with GD in terms of impulsive, reflective, and interoceptive processes, the literature on CR interventions is virtually absent. No clinical studies were found in the literature, apart from a trial of a very specific program using Playmancer, a serious videogame, which was tested in cases of bulimia nervosa and GD. However, neurocognitive impairments in individuals with addictive disorders are highly significant, not only affecting quality of life, but also making abstinence and recovery more difficult. Given that CR interventions represent a relatively novel therapeutic approach to addiction and that there is currently a scarcity of studies on clinical populations suffering from GD, further research is needed to examine the potential targets of such interventions and the effectiveness of different training approaches. So far, no consensus has been reached on the optimal parameters of CR interventions (duration, intensity, frequency, group vs. individual, pencil-and-paper vs. computerized delivery, etc.). Although no firm conclusions can be drawn, CR interventions represent a promising adjunct treatment for GD. Such a novel therapy could be associated with common interventions, such as CBT and educational and motivational interventions, in order to make therapies more effective and longer-lasting and to decrease the risk of relapse.

Established risk factors for addiction fail to discriminate between healthy gamers and gamers endorsing DSM-5 Internet gaming disorder

Background and aims The DSM-5 includes criteria for diagnosing Internet gaming disorder (IGD) that are adapted from substance abuse and widely used in research and clinical contexts, although evidence supporting their validity remains scarce. This study compared online gamers who do or do not endorse IGD criteria regarding self-control-related abilities (impulsivity, inhibitory control, and decision-making), considered the hallmarks of addictive behaviors. Method A double approach was adopted to distinguish pathological from recreational gamers: The first is the classic DSM-5 approach (≥5 criteria required to endorse the IGD diagnosis), and the second consists in using latent class analysis (LCA) for IGD criteria to distinguish gamers' subgroups. We computed comparisons separately for each approach. Ninety-seven volunteer gamers from the community were recruited. Self-reported questionnaires were used to measure demographic- and game-related characteristics, problematic online gaming (with the Problematic Online Gaming Questionnaire), impulsivity (with the UPPS-P Impulsive Behavior Scale), and depression (with the Beck Depression Inventory-II). Experimental tasks were used to measure inhibitory control (Hybrid-Stop Task) and decision-making abilities (Game of Dice Task). Results Thirty-two participants met IGD criteria (33% of the sample), whereas LCA identified two groups of gamers [pathological (35%) and recreational]. Comparisons that used both approaches (DSM-5 and LCA) failed to identify significant differences regarding all constructs except for variables related to actual or problematic gaming behaviors. Discussion The validity of IGD criteria is questioned, mostly with respect to their relevance in distinguishing high engagement from pathological involvement in video games.

Differential spontaneous recovery across cognitive abilities during detoxification period in alcohol-dependence

OBJECTIVE

There is a lack of consensus regarding the extent to which cognitive dysfunctions may recover upon cessation of alcohol intake by alcohol-dependents (AD), and the divergent findings are most likely due to methodological differences between the various studies. The present study was aimed at conducting a very strict longitudinal study of cognitive recovery in terms of assessment points, the duration of abstinence, control of age and duration of the addiction, and by use of individual analyses in addition to mean group comparisons. Our study further focused on the 2-3 week phase of alcohol detoxification that is already known to positively affect many biological, emotional, motivational, as well as neural variables, followed by longer-term therapies for which good cognitive functioning is needed.

METHODS

41 AD inpatients undergoing a detoxification program, and 41 matched controls, were evaluated twice in terms of five cognitive functions (i.e., short-term memory, working memory, inhibition, cognitive flexibility, and verbal fluency) within a three-week interval [on the first day (T1) and the 18th day (T2) of abstinence for AD patients]. Emotional (positive and negative affectivity and depression) and motivational (craving) variables were also measured at both evaluation times.

RESULTS

Although verbal fluency, short-term memory, and cognitive flexibility did not appear to be affected, the patients exhibited impaired inhibition and working memory at T1. While no recovery of inhibition was found to occur, the average working memory performance of the patients was comparable to that of the controls at T2. Improvements in emotional and motivational dimensions were also observed, although they did not correlate with the ones in working memory. Individual analysis showed that not all participants were impaired or recover the same functions.

CONCLUSIONS

While inhibition deficits appear to persist after 18 days of detoxification, deficits in working memory, which is a central component of cognition, are greatly reduced after alcohol detoxification. Individual differences in the trajectory of recovery do arise however, and it might be worth implementing individual assessments of impaired functions at the end of the detoxification phase in order to maximize the chances of success in longer-term treatments and abstinence.

Response Inhibition and Internet Gaming Disorder: A Meta-analysis

Previous research has demonstrated that Internet Gaming Disorder (IGD) has multiple negative effects in psychological functioning and health. This makes the identification of its underpinnings, such as response inhibition, essential for the development of relevant interventions that target these core features of the disorder resulting in more effective treatment. Several empirical studies have evaluated the relationship between response inhibition deficits and IGD using neurocognitive tasks, but provided mixed results. In this study, we conducted a meta-analysis of studies using three neurocognitive tasks, the Go/No Go, the Stroop, and the Stop-Signal tasks, to integrate existing research and estimate the magnitude of this relationship. We found a medium overall effect size (d=0.56, 95% CI [0.32, 0.80]) indicating that compared with healthy individuals, individuals with IGD are more likely to exhibit impaired response inhibition. This finding is in alignment with literature on inhibition and addictive and impulsive behaviors, as well as with neuroimaging research. Theoretical implications regarding the conceptualization of IGD as a clinical disorder, shared commonalities with externalizing psychopathology, and clinical implications for treatment are discussed.

Delay discounting and impulsivity traits in young and older gambling disorder patients

BACKGROUND

Impulsivity is understood to be a multidimensional construct involving aspects such as impulsive choice and impulsive traits. Delay discounting, the tendency to place greater value in immediate rewards over larger, long-term rewards, has been associated with maladaptive choices in gambling disorder (GD). Delay discounting is known to evolve with age; though no study to date has evaluated the interactions between impulsivity, GD severity and age in treatment-seeking patients.

OBJECTIVES

We aimed to examine whether associations between delay discounting and impulsivity traits differed between younger and older-aged GD patients. Secondly, we sought to untangle the mediating role of impulsivity in determining gambling behavior in these two age groups.

METHODS

GD patients (N=335) were evaluated using the UPPS-P Impulsive Behavior Scale and a delay discounting task. Structural Equation Modeling (SEM) was used to explore associations between impulsivity measures and gambling severity in young (18-30years) and old (31-70) GD patients.

RESULTS

No differences in delay discounting were found between young and old GD patients. Significant correlations between delay discounting and urgency levels (the tendency to act rashly under emotional states) were identified only in the young GD group. Path analyses also revealed both positive and negative urgency to be a mediator of GD severity levels in young GD patients.

DISCUSSION AND CONCLUSIONS

Significant associations between impulsive choice and positive urgency are only present in young gamblers, suggesting that positive urgency influence choice behavior to a greater degree at younger ages. Implications for targeted interventions are discussed.

Assessing the role of impulsivity in smoking & non-smoking disordered gamblers

BACKGROUND

Co-morbidity with other addictive behaviors is common in disordered gambling (DG). In particular, tobacco dependence has been found to be among the most prevalent disorders co-morbid with DG. While the extant literature has firmly established the co-occurrence of DG and smoking, there is a paucity of research examining factors that differentiate DGs who smoke from those who do not.

OBJECTIVES

To address this empirical gap, the current study tested whether dimensions of trait impulsivity as measured by the UPPS-P Impulsive Behavior Scale (positive urgency, negative urgency, lack of premeditation, lack of perseverance, and sensation seeking), discriminated between non-DGs and DGs based on their present smoking status: non-smoker, occasional smoker, and daily smoker.

METHODS

To this end, 564 community gamblers were recruited through a crowdsourcing platform (Amazon's Mechanical Turk) and completed an online survey, assessing problem gambling severity, tobacco use, and trait impulsivity.

RESULTS

MANOVA analyses revealed significant main effects for both gambling severity and smoking status groups. Importantly, a significant gambling by smoking interaction was also found. Pairwise comparisons revealed that DGs who were daily smokers scored higher on negative urgency than those who smoked occasionally or not all. Furthermore, among non-DGs, smoking status failed to discriminate between mean scores on negative urgency. No other significant interaction effects were found for the remaining UPPS-P impulsivity facets.

CONCLUSIONS

Results suggest that individual components of trait impulsivity, and more specifically negative urgency, successfully differentiate DGs who do not smoke, or just smoke occasionally, from DGs who smoke daily. These findings suggest that the degree of trait impulsivity may potentially distinguish between DGs and DGs who are dually addicted to other substances such as tobacco.

Trait and neurobiological underpinnings of negative emotion regulation in gambling disorder

BACKGROUND AND AIMS

Gambling disorder is characterized by poor regulation of negative emotions and impulsive behaviours. This study aimed to (1) compare gambling disorder patients (GDPs) and healthy controls (HCs) in self-report and brain activation measures of emotion regulation; and (2) establish its relationship with negative emotion-driven impulsivity.

DESIGN

Two cross-sectional case-control studies including GDPs and HCs.

SETTING AND PARTICIPANTS

GDPs and HCs were recruited from specialized gambling clinics in Andalusia (Spain), where they were following out-patient treatment, and from the community, respectively. Study 1 included 41 GDPs and 45 HCs [All males; M_age  = 35.22, 33.22; standard deviation (SD) = 11.16, 8.18; respectively]. Study 2 included 17 GDPs and 21 HCs (16/20 males; M_age  = 32.94, 31.00; SD = 7.77, 4.60; respectively).

MEASUREMENTS

In study 1, we compared both groups on suppression and re-appraisal emotion regulation strategies [Emotion Regulation Questionnaire (ERQ)]. In study 2, we compared GDPs with HCs on brain activation associated with down-regulation of negative emotions in a cognitive re-appraisal task, measured with functional magnetic resonance imaging (fMRI). In both studies, we correlated the measures of emotion regulation with mood-related impulsivity indicated by negative urgency (UPPS-P impulsive behaviour scale).

FINDINGS

GDPs relative to HCs showed higher levels of emotional suppression [F = 4.525; P = 0.036; means difference M_HCs -M_GDPs  = -2.433, 95% confidence interval (CI) = -4.706, -0.159] and higher activation of the premotor cortex and middle frontal gyrus during negative emotion regulation in the fMRI task [P ≤ 0.005, cluster size (CS) > 50 voxels]. Negative urgency correlated positively with emotional suppression (r = 0.399, 95% CI = 0.104, 0.629, one-tailed P = 0.005) and middle frontal gyrus activation during negative emotion regulation (P ≤ 0.005, CS > 50) in GDPs.

CONCLUSIONS

Gambling disorder is associated with greater use of emotional suppression and stronger pre-motor cortex and middle frontal gyrus activation for regulating negative emotions, compared with healthy controls. Emotional suppression use and middle frontal gyrus activation during negative emotion regulation are linked with negative emotion-driven impulsivity in this disorder.

Understanding Within-Session Loss-Chasing: An Experimental Investigation of the Impact of Stake Size on Cognitive Control

Loss-chasing is a central feature of problematic gambling, yet it remains a poorly conceived and understood concept. Loss-chasing is believed to stem from an erosion of cognitive control when gambling. The opportunity to gamble at significantly disparate stake sizes on a gambling activity is considered to be a risk factor for loss-chasing. This study investigated the impact of gambling at disparate stake sizes on executive processes integral to maintaining cognitive control when gambling, namely response inhibition and reflection impulsivity. Frequent adult non-problem gamblers (n = 32) participated in a repeated measures experiment; and gambled at three disparate stake sizes (£20, £2 and no stake per bet) on a simulated gambling task. Participants' response inhibition performance and reflection impulsivity levels after gambling at various stake sizes were compared via a go/no-go task and information sampling task, respectively. Quality of decision-making i.e. the evaluation of available information to make probability judgements was impaired after gambling at higher stakes in comparison to lower stakes, indicating an increase in reflection impulsivity. No effect on response inhibition was observed. Although exploratory, this suggests that the opportunity for participants to substantially increase stake size on a gambling activity may be a risk factor for impaired cognitive performance when gambling, and perhaps create vulnerability for within-session loss-chasing in some players.

Is gambling disorder associated with impulsivity traits measured by the UPPS-P and is this association moderated by sex and age?

OBJECTIVES

Impulsivity is a construct that is strongly associated with Gambling Disorder (GD). The main objectives in the present study are: 1) to explore the role of sex and age on impulsivity levels in GD patients; 2) to identify the relationship of the different impulsivity facets with comorbid psychopathology and other personality traits in GD patients; and (3) to assess whether impulsivity is a predictor for the severity of GD.

METHOD

The final sample consisted of 406 consecutive participants. All of them were seeking treatment for GD (88.4% male and 11.6% female) and completed the South Oaks Gambling Screen (SOGS), the UPPS-P Impulsive Behavior Scale, the Symptom Checklist (SCL-90-R), the Temperament and Character Inventory-R (TCI-R) as well as other clinical and psychopathological measures.

RESULTS

Results show a negative linear trend between age and lower sensation seeking levels as well as lack of premeditation (the higher the age the lower the UPPS-P scores), and a positive linear trend between age and positive urgency (UR) (the higher the age the higher the UPPS-P score). However, no sex differences were found for the assessed impulsivity dimensions. Lack of perseverance was positively associated with obsessive-compulsive symptoms and harm avoidance trait, and negatively related to persistence and self-directedness traits. Positive UR and negative UR were positively correlated with general psychopathology and the total number of DSM-IV criteria, and negatively associated to the following personality traits: self-directedness and cooperativeness. Finally, only the sensation seeking and negative UR of the UPPS-P showed predictive capacity on the severity of the disorder (the higher the impulsivity scores the higher the illness severity).

CONCLUSIONS

These findings highlight the association between impulsivity traits (measured by the UPPS-P) and GD in a large and consecutively recruited clinical sample with GD, taking into account the variables sex and age.

Comparison of impulsivity in non-problem, at-risk and problem gamblers

As a non-substance addiction, gambling disorder represents the model for studying the neurobiology of addiction without toxic consequences of chronic drug use. From a neuropsychological perspective, impulsivity is deemed as a potential construct responsible in the onset and development of drug addiction. The objective of this study was to investigate the associations between impulsivity and gambling status in young adults with varying severity of gambling. A sample of 1120 college students, equally divided into non-problem, at-risk and problem gamblers, were administered multiple measures of impulsivity including the UPPSP Impulsive Behaviors Scale (UPPSP), the Barratt Impulsiveness Scale-11 (BIS-11), and the Delay-discounting Test (DDT). Compared with non-problem gamblers, both at-risk gamblers and problem gamblers displayed elevated scores on Negative Urgency, Positive Urgency, Motor Impulsiveness, and Attentional Impulsiveness. Problem gamblers showed higher scores than at-risk gamblers on Positive Urgency. Logistic regression models revealed that only Negative Urgency positively predicted both at-risk gambling and problem gambling compared to non-problem gambling. These results suggest that dimensions of impulsivity may be differentially linked to gambling behavior in young adults, with Negative Urgency putatively identified as an important impulsivity-related marker for the development of gambling disorder, which may provide a better understanding of the pathogenesis.

Winning and losing: Effects on impulsive action

In the present study, we examined the effect of wins and losses on impulsive action in gambling (Experiments 1-3) and nongambling tasks (Experiments 4-5). In each experiment, subjects performed a simple task in which they had to win points. On each trial, they had to choose between a gamble and a nongamble. The gamble was always associated with a higher amount but a lower probability of winning than the nongamble. After subjects indicated their choice (i.e., gamble or not), feedback was presented. They had to press a key to start the next trial. Experiments 1-3 showed that, compared to the nongambling baseline, subjects were faster to initiate the next trial after a gambled loss, indicating that losses can induce impulsive actions. In Experiments 4 and 5, subjects alternated between the gambling task and a neutral decision-making task in which they could not win or lose points. Subjects were faster in the neutral decision-making task if they had just lost in the gambling task, suggesting that losses have a general effect on action. Our results challenge the dominant idea that humans become more cautious after suboptimal outcomes. Instead, they indicate that losses in the context of potential rewards are emotional events that increase impulsivity. (PsycINFO Database Record

Compulsive Buying Behavior: Clinical Comparison with Other Behavioral Addictions

Compulsive buying behavior (CBB) has been recognized as a prevalent mental health disorder, yet its categorization into classification systems remains unsettled. The objective of this study was to assess the sociodemographic and clinic variables related to the CBB phenotype compared to other behavioral addictions. Three thousand three hundred and twenty four treatment-seeking patients were classified in five groups: CBB, sexual addiction, Internet gaming disorder, Internet addiction, and gambling disorder. CBB was characterized by a higher proportion of women, higher levels of psychopathology, and higher levels in the personality traits of novelty seeking, harm avoidance, reward dependence, persistence, and cooperativeness compared to other behavioral addictions. Results outline the heterogeneity in the clinical profiles of patients diagnosed with different behavioral addiction subtypes and shed new light on the primary mechanisms of CBB.

Gambling among European professional athletes. Prevalence and associated factors

In Europe, the prevalence of gambling disorders in the general population ranges from 0.15 to 6.6%. Professional athletes are known for having risk factors for addictive behaviors, such as young age or sensation seeking, though no study has yet tried to evaluate the prevalence of gambling and gambling disorders among this specific population. The goals of this study were to estimate the prevalence of gambling, problematic or not, among European professional athletes and to explore the factors that are associated with gambling practice and gambling problems in professional athletes. A self-completion questionnaire was specifically designed for this study. The questionnaires were distributed by European Union athletes to professional ice hockey, rugby, handball, basketball, football, indoor football, volleyball, and cricket teams in Spain, France, Greece, Ireland, Italy, Sweden, and the United Kingdom. Socio-demographic variables (age, sex, education, marital and parental status, sport, country of birth, and country of practice), variables linked to gambling (gambling habits, screening of gambling problems with the Lie/Bet questionnaire, and gambling related cognitions), and impulsive behavior data (urgency, premeditation, perseverance, and sensation seeking [UPPS]-Short Form questionnaire) were gathered. There were 1,236 questionnaires filled out. The percentage of professional athletes that had gambled at least once during the previous year was 56.6%. The prevalence of problem gambling, current or past, was 8.2%. A certain number of variables were associated with the gambling status. In particular, betting on one's own team (OR = 4.1, CI_95% [1.5-11.5]), betting online (OR = 2.9, CI_95% [1.6-5.4]), gambling regularly (OR = 4.0, CI_95% [2.1-7.6]), and having a high positive urgency score (OR = 1.5, CI_95% [1.3-1.7]) were associated with gambling problems, current or past, among professional athletes. Professional athletes are particularly exposed to both gambling and problem gambling.

Ability to use the wait-and-see strategy in pathological gamblers

Pathological gamblers (PGs) perform differently on neurocognitive tests than do healthy controls (HC). The aim of this study was to assess "waiting ability" - a major components of inhibition control-using a modified Stop Signal Task (SST) in a population of male PGs (N=55), and HCs (N=53). Results indicated no differences between PGs and HCs in reaction times, intra-individual response variability, or number of false alarms and misses. In conclusion, PGs were not impaired in their ability to manipulate their on-line response strategy during the experimental task and were instead able to change their strategy to decrease the number of false alarms. However, much more empirical and theoretical work needs to be carried out in order to understand the key neural basis of impulsivity among PGs.

Commentary on: Are we overpathologizing everyday life? A tenable blueprint for behavioral addiction research. On functional and compulsive aspects of reinforcement pathologies

BACKGROUND

This paper is a commentary to a debate article entitled: "Are we overpathologizing everyday life? A tenable blueprint for behavioral addiction research", by Billieux et al. (2015). METHODS AND AIM: This brief response focused on the necessity to better characterize psychological and related neurocognitive determinants of persistent deleterious actions associated or not with substance utilization.

RESULTS

A majority of addicted people could be driven by psychological functional reasons to keep using drugs, gambling or buying despite the growing number of related negative consequences. In addition, a non-negligible proportion of them would need assistance to restore profound disturbances in basic learning processes involved in compulsive actions.

CONCLUSIONS

The distinction between psychological functionality and compulsive aspects of addictive behaviors should represent a big step towards more efficient treatments.

Components of Impulsivity in Gambling Disorder

This study examined the structure of impulsivity within gambling disorder. A group of 51 men and 53 women with gambling disorder completed self-report and behavioral measures of impulsivity. Principal component analyses found two factors. The first was interpreted as measuring trait impulsivity. This factor correlated with problem gambling severity, presence of comorbid mental health and substance use disorders, history of brain injury, and was higher in Aboriginal participants. The second factor had high loadings on the self-reported sensation-seeking scales and the behavioural measures of response impulsivity. This factor correlated with overall gambling involvement but not with indicators of pathology. Higher scores were associated with younger age. These results are consistent with an evolving model of the etiology of disordered gambling that suggests that sensation-seeking is related to gambling involvement but that trait impulsivity and mental health struggles are associated with the development of gambling disorder.

A multidimensional approach of impulsivity in adult attention deficit hyperactivity disorder

We aimed to compare adult patients with attention deficit hyperactivity disorder (ADHD) and matched controls on four dimensions of impulsivity (urgency, lack of premeditation, lack of perseverance, and sensation seeking) and to examine the association between impulsivity and ADHD symptoms. The study was conducted on 219 participants: 72 adult ADHD patients and 147 aged and gender matched controls. All participants completed questionnaires measuring the various facets of impulsivity (UPPS Impulsive Behavior Scale), ADHD and depressive symptoms severity. Patients were also assessed for ADHD subtypes, mood disorders, and addictive behaviors. ADHD patients exhibited higher urgency, lower premeditation and lower perseverance in comparison to controls. Lack of perseverance showed the strongest association with ADHD (area under curve=0.95). Patients with combined inattentive and hyperactive/impulsive subtypes reported more frequently substance abuse problems and had higher scores on urgency and sensation seeking dimensions of impulsivity than those with predominantly inattentive subtype. We report for the first time a multidimensional evaluation of impulsivity in adult ADHD patients. The UPPS Impulsive Behavior Scale may constitute a useful screening tool for ADHD in adults and may help to further understanding the psychological mechanisms underlying the differences between the ADHD subgroups.

Myopic decisions under negative emotions correlate with altered time perception

Previous studies have obtained inconsistent findings about emotional influence on inter-temporal choice (IC). In the present study, we first examined the effect of temporary emotional priming induced by affective pictures in a trial-to-trial paradigm on IC. The results showed that negative priming resulted in much higher percentages of trials during which smaller-but-sooner reward (SS%) were chosen compared with positive and neutral priming. Next, we attempted to explore the possible mechanisms underlying such emotional effects. When participants performed a time reproduction task, mean reaction times in negative priming condition were significantly shorter than those in the other two emotional contexts, which indicated that negative emotional priming led to overestimation of time. Moreover, such overestimation was negatively correlated with performance in the IC task. In contrast, temporary changes of emotional contexts did not alter performances in a Go/NoGo task (including commission errors and omission errors). In sum, our present findings suggested that myopic decisions under negative emotions were associated with altered time perception but not response inhibition.

Increased impulsivity in pathological gambling: Considering nicotine dependence

INTRODUCTION

It has been highlighted that increased impulsivity is an important etiological factor in pathological gambling (PG). However, the role of the highly prevalent comorbid mental disorders in PG remains unclear. This is of special concern as the highest comorbidity was found between PG and nicotine dependence (ND), which, in turn, has also been associated with heightened impulsivity. This study aimed to find out whether increased impulsivity in PG is a specific characteristic related to comorbid mental disorders in general or especially to ND.

METHOD

A cross-sectional study was designed that included a healthy control group and three disorder groups with comorbid PG excluding ND, comorbid PG including ND, and ND alone according to the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition. Impulsivity was assessed according to the dimensions response and choice impulsivity applying behavioral and self-report measures.

RESULTS

We found (a) increased response impulsivity in the comorbid PG group when compared to the control group. Furthermore, increased choice impulsivity was found (b) in comorbid PG excluding ND and (c) in comorbid PG including ND when compared to ND alone. Other group differences did not reach significance.

CONCLUSIONS

Our findings highlight that comorbid PG shares deficits in inhibitory control with ND. In contrast, maladaptive choices are a specific disorder characteristic of comorbid PG when compared to ND. If replicated in further studies, intervention strategies strengthening cognitive control skills might be effective for comorbid PG as well as ND whereas strategies enhancing maladaptive valuation of rewards might be specifically effective in comorbid PG.

Guanfacine enhances inhibitory control and attentional shifting in early abstinent cocaine-dependent individuals

OBJECTIVES

Attenuation of adrenergic drive and cognitive enhancement, via stimulation of alpha2 pre- and post-synaptic receptors, may selectively enhance executive performance in early abstinent cocaine-dependent individuals. As these cognitive processes underpin important treatment-related behaviors, the alpha2 agonist, guanfacine HCl, may represent an effective pharmaco-therapeutic intervention.

METHODS

Twenty-five early abstinent cocaine-dependent individuals were administered a battery of neurocognitive tasks on entry into treatment (baseline) and again following 3 weeks of either placebo or guanfacine treatment (up to 3 mg). Tasks included: Stop Signal, Stroop, 3-Dimentional Intra-dimensional/Extra-dimensional (IDED) task, Spatial Working Memory (SWM), Paired Associates Learning (PAL), Verbal Fluency and the Rey Auditory Verbal Learning Test (RAVLT).

RESULTS

Compared with placebo, the guanfacine group demonstrated attenuated anxiety and negative affect as well as improved performance on selective executive tests. This included fewer directional errors on the stop signal task, fewer errors on the extra-dimensional shift component of the IDED task and better attentional switching during verbal fluency. Guanfacine did not improve strategic working memory or peripheral memory.

CONCLUSION

Guanfacine improves selective cognitive processes which may underlie salient treatment-related regulatory behaviors. Alpha2 agonists may therefore represent important agents for cocaine dependence.

Relationships between trait urgency, smoking reinforcement expectancies, and nicotine dependence

Urgency (i.e., the tendency to act rashly during negative/positive affect) may increase vulnerability to a variety of risky behaviors. This cross-sectional study of nontreatment-seeking smokers examined the relationship between urgency, level of nicotine dependence, and smoking reinforcement expectancies. Both positive and negative urgency were associated with nicotine dependence. Mediational analyses illustrated that smoking reinforcement expectancies significantly accounted for urgency-dependence relations, with negative reinforcement expectancies displaying incremental mediational effects. If replicated and extended, these findings may support the use of treatments that modify beliefs regarding smoking reinforcement outcomes as a means of buffering the risk of nicotine dependence carried by urgency.

Psychometric properties of the Barratt Impulsiveness Scale in patients with gambling disorders, hypersexuality, and methamphetamine dependence

Although the Barratt Impulsiveness Scale (BIS; Patton, Stanford, & Barratt, 1995) is a widely-used self-report measure of impulsivity, there have been numerous questions about the invariance of the factor structure across clinical populations (Haden & Shiva, 2008, 2009; Ireland & Archer, 2008). The goal of this article is to examine the factor structure of the BIS among a sample consisting of three populations exhibiting addictive behaviors and impulsivity: pathological gamblers, hypersexual patients, and individuals seeking treatment for methamphetamine dependence to determine if modification to the existing factors might improve the psychometric properties of the BIS. The current study found that the factor structure of the BIS does not replicate in this sample and instead produces a 12-item three-factor solution consisting of motor-impulsiveness (5 items), non-planning impulsiveness (3 items), and immediacy impulsiveness (4 items). The clinical utility of the BIS in this population is questionable. The authors suggest future studies to investigate comparisons with this modified version of the BIS and other impulsivity scales such as the UPPS-P Impulsive Behavior Scale in clinical populations when assessing disposition toward rash action.

A preliminary experimental examination of the effect of emotion dysregulation and impulsivity on risky behaviors among women with sexual assault-related posttraumatic stress disorder

Posttraumatic stress disorder (PTSD) is associated with a wide range of risky behaviors (e.g., substance use and risky sexual behaviors); however, few studies have examined mechanisms that may underlie risky behaviors in this population. The present study utilized a prospective experimental design to examine the effects of emotion dysregulation and impulsivity on risky behaviors across time. Thirty women with sexual assault-related PTSD were randomly assigned to receive emotion modulation (EM), impulsivity reduction (IR), or healthy living (HL; comparison condition) skills trainings. Participants completed measures of emotion dysregulation, impulsivity, and risky behaviors pre-manipulation and 1-month post-manipulation. Participants in the EM and IR conditions reported a significant reduction in risky behaviors from pre- to post-manipulation relative to the HL condition. Changes in emotion dysregulation from pre- to post-manipulation fully accounted for reductions in risky behaviors over time. Results provide preliminary experimental support for the role of emotion dysregulation in risky behaviors.

Impaired Decision Making is Associated with Poor Inhibition Control in Nonpathological Lottery Gamblers

Previous studies by questionnaires have demonstrated that lottery gamblers who have not meet the criteria of pathological gambler show greater gambling acceptability. However, few empirical evidence of whether such nonpathological lottery gamblers (NPLGs) display the same impairments of decision making with pathological gamblers has been found so far. In present study, NPLGs and matched controls (MCs) were asked to perform the Iowa Gambling Task (IGT) and inter-temporal choice task (ICT). We found that compared to MCs, NPLGs displayed much lower IGT scores, net gains and proportions of advantageous decks in the IGT task and much higher percentages of trials during which smaller-but-sooner rewards were chosen in the ICT. These findings indicate that NPLGs display much more risky and impulsive decision makings, just like pathological gamblers in the previous studies. Next, the Go/NoGo task was employed to explore the role of response inhibition in the impairment of decision making in NPLGs. We found that NPLGs did show much higher commission errors compared to MCs. Moreover, IGT scores, net gain and proportions of advantageous decks were significantly negatively correlated with commission errors, which indicates that poor response inhibition might be involved in the impairments of decision making in NPLGs. To our knowledge, we provided the first empirical evidence of impairment of decision making and its cognitive mechanisms in NPLGs.

Dysfunctional decision-making in pathological gambling: pattern specificity and the role of impulsivity

Dysfunctional decision-making in individuals with pathological gambling (PGs) may result from dominating reward-driven processes, indicated by higher impulsivity. In the current study we examined (1) if PGs show specific decision-making impairments related to dominating reward-driven processes rather than to strategic planning deficits and (2) whether these impairments are related to impulsivity. Nineteen PGs according to DSM-IV and 19 matched control subjects undertook the Cambridge Gambling Task (CGT) to assess decision-making. The delay discounting paradigm (DDP) as well as the UPPS Impulsive Behavior Scale (measuring urgency, premeditation, perseverance and sensation seeking) were administered as multidimensional measures of impulsivity. Results revealed that (1) PGs exhibited higher risk seeking and an immediate reward focus in the CGT and, in contrast, comparable strategic planning to the control group. (2) Decision-making impairments were related to more severe delay discounting and, specifically, to increased urgency and less premeditation. Our findings suggest (1) the necessity to disentangle decision-making components in order to improve etiological models of PGs, and (2) that urgency and premeditation are specifically related to disadvantageous decision-making and should be tackled in intervention strategies focusing on emotion tolerance and control strategies.

A triadic neurocognitive approach to addiction for clinical interventions

According to the triadic neurocognitive model of addiction to drugs (e.g., cocaine) and non-drugs (e.g., gambling), weakened "willpower" associated with these behaviors is the product of an abnormal functioning in one or more of three key neural and cognitive systems: (1) an amygdala-striatum dependent system mediating automatic, habitual, and salient behaviors; (2) a prefrontal cortex dependent system important for self-regulation and forecasting the future consequences of a behavior; and (3) an insula dependent system for the reception of interoceptive signals and their translation into feeling states (such as urge and craving), which in turn plays a strong influential role in decision-making and impulse control processes related to uncertainty, risk, and reward. The described three-systems account for poor decision-making (i.e., prioritizing short-term consequences of a decisional option) and stimulus-driven actions, thus leading to a more elevated risk for relapse. Finally, this article elaborates on the need for "personalized" clinical model-based interventions targeting interactions between implicit processes, interoceptive signaling, and supervisory function aimed at helping individuals become less governed by immediate situations and automatic pre-potent responses, and more influenced by systems involved in the pursuit of future valued goals.