Impulsivity and cognitive distortions in pathological gamblers attending the UK National Problem Gambling Clinic: a preliminary report

Emotional and non-emotional pathways to impulsive behavior and addiction

Impulsivity is tightly linked to addiction. However, there are several pathways by means of which impulsive individuals are more prone to become addicts, or to suffer an addiction more intensely and for a longer period. One of those pathways involves an inadequate appraisal or regulation of positive and negative emotions, leading to lack of control over hazardous behaviors, and inappropriate decisions. In the present work, we assessed cocaine-dependent individuals (CDI; n = 20), pathological gamblers (PG; n = 21), and healthy controls (HC; n = 23) in trait impulsivity measures (UPPS-P model's dimensions), and decision-making tasks (Go/No-go; delay-discounting task). During the Go/No-go task, electroencephalographic (EEG) activity was recorded, and Go/No-go stimuli-evoked potentials (ERP) were extracted. Theory-driven ERP analyses focused on the No-go > Go difference in the N2 ERP. Our results show that negative urgency is one of the several psychological features that distinguish addicts from HC. Nevertheless, among the dimensions of trait impulsivity, negative urgency is unique at independently covarying with gambling over-pathologization in the PG sample. Cocaine-dependent individuals performed more poorly than gamblers in the Go/No-go task, and showed abnormal Go/No-go stimuli-evoked potentials. The difference between the No-go stimulus-evoked N2, and the Go one was attenuated by severity and intensity of chronic cocaine use. Emotional dimensions of impulsivity, however, did not influence Go/No-go performance.

Irrational choice under uncertainty correlates with lower striatal D(2/3) receptor binding in rats

Individual differences in dopamine (DA) signaling, including low striatal D(2/3) receptors, may increase vulnerability to substance abuse, although whether this phenotype confers susceptibility to nonchemical addictions is unclear. The degree to which people use "irrational" cognitive heuristics when choosing under uncertainty can determine whether they find gambling addictive. Given that dopaminergic projections to the striatum signal reward expectancy and modulate decision-making, individual differences in DA signaling could influence the extent of such biases. To test this hypothesis, we used a novel task to model biased, risk-averse decision-making in rats. Animals chose between a "safe" lever, which guaranteed delivery of the wager, or an "uncertain" lever, which delivered either double the wager or nothing with 50:50 odds. The bet size varied from one to three sugar pellets. Although the amount at stake did not alter the options' utility, a subgroup of "wager-sensitive" rats increased their preference for the safe lever as the bet size increased, akin to risk aversion. In contrast, wager-insensitive rats slightly preferred the uncertain option consistently. Amphetamine increased choice of the uncertain option in wager-sensitive, but not in wager-insensitive rats, whereas a D(2/3) receptor antagonist decreased uncertain lever choice in wager-insensitive rats alone. Micro-PET and autoradiography using [(11)C]raclopride confirmed a strong correlation between high wager sensitivity and low striatal D(2/3) receptor density. These data suggest that the propensity for biased decision-making under uncertainty is influenced by striatal D(2/3) receptor expression, and provide novel support for the hypothesis that susceptibility to chemical and behavioral addictions may share a common neurobiological basis.

Emotional and non-emotional pathways to impulsive behavior and addiction

Impulsivity is tightly linked to addiction. However, there are several pathways by means of which impulsive individuals are more prone to become addicts, or to suffer an addiction more intensely and for a longer period. One of those pathways involves an inadequate appraisal or regulation of positive and negative emotions, leading to lack of control over hazardous behaviors, and inappropriate decisions. In the present work, we assessed cocaine-dependent individuals (CDI; n = 20), pathological gamblers (PG; n = 21), and healthy controls (HC; n = 23) in trait impulsivity measures (UPPS-P model's dimensions), and decision-making tasks (Go/No-go; delay-discounting task). During the Go/No-go task, electroencephalographic (EEG) activity was recorded, and Go/No-go stimuli-evoked potentials (ERP) were extracted. Theory-driven ERP analyses focused on the No-go > Go difference in the N2 ERP. Our results show that negative urgency is one of the several psychological features that distinguish addicts from HC. Nevertheless, among the dimensions of trait impulsivity, negative urgency is unique at independently covarying with gambling over-pathologization in the PG sample. Cocaine-dependent individuals performed more poorly than gamblers in the Go/No-go task, and showed abnormal Go/No-go stimuli-evoked potentials. The difference between the No-go stimulus-evoked N2, and the Go one was attenuated by severity and intensity of chronic cocaine use. Emotional dimensions of impulsivity, however, did not influence Go/No-go performance.

Striatal dopamine D₂/D₃ receptor binding in pathological gambling is correlated with mood-related impulsivity

Pathological gambling (PG) is a behavioural addiction associated with elevated impulsivity and suspected dopamine dysregulation. Reduced striatal dopamine D(2)/D(3) receptor availability has been reported in drug addiction, and may constitute a premorbid vulnerability marker for addictive disorders. The aim of the present study was to assess striatal dopamine D(2)/D(3) receptor availability in PG, and its association with trait impulsivity. Males with PG (n=9) and male healthy controls (n=9) underwent [11C]-raclopride positron emission tomography imaging and completed the UPPS-P impulsivity scale. There was no significant difference between groups in striatal dopamine D(2)/D(3) receptor availability, in contrast to previous reports in drug addiction. However, mood-related impulsivity ('Urgency') was negatively correlated with [11C]-raclopride binding potentials in the PG group. The absence of a group difference in striatal dopamine binding implies a distinction between behavioural addictions and drug addictions. Nevertheless, our data indicate heterogeneity in dopamine receptor availability in disordered gambling, such that individuals with high mood-related impulsivity may show differential benefits from dopamine-based medications.

Decreased saliency processing as a neural measure of Barratt impulsivity in healthy adults

Cognitive control is necessary to navigating through an uncertain world. With the stop signal task (SST), we measure how cognitive control functions in a controlled environment. There has been conflicting evidence on whether trait impulsivity might reflect differences in cognitive control during the SST. While some studies find that trait impulsivity relates to measures of response inhibition, such as the stop signal reaction time (SSRT), other studies do not. Here, in 92 young adult participants (58 females; age 25 ± 4 years), we examined whether trait impulsivity, measured by the Barratt impulsivity scale (BIS-11), is associated with differences in performance and regional brain activations for the component processes of cognitive control during the SST. Across participants, trait impulsivity showed a trend-level correlation with SSRT (F(1.90)=3.18, p<.07; Pearson regression). In simple regressions, activation of the right anterior dorsal insula and middle frontal cortex (MFC) during stop as compared to go trials negatively correlated with motor and non-planning impulsivity score. Using the generalized form of psychophysiological interaction (gPPI), we showed that functional connectivity of the right insula and MFC with the left dorsolateral prefrontal cortex and bilateral visual areas were also negatively correlated with impulsivity. None of the other component processes of cognitive control, including response inhibition, error processing, post-error slowing, were significantly related to Barratt impulsivity. These results suggest that trait impulsivity as measured by BIS-11 may have distinct effects on saliency processing in adult individuals.

Decision making, impulsivity, and addictions: do Parkinson's disease patients jump to conclusions?

Links between impulsive-compulsive behaviors (ICBs) in treated Parkinson's disease (PD), behavioral addictions, and substance abuse have been postulated, but no direct comparisons have been carried out so far. We directly compared patients with PD with and without ICBs with illicit drug abusers, pathological gamblers, and age-matched healthy controls using the beads task, a test of reflection impulsivity, and a working memory task. We found that all patients with PD made more impulsive and irrational choices than the control group. PD patients who had an ICB showed similar behavior to illicit substance abusers, whereas patients without ICBs more closely resembled pathological gamblers. In contrast, we found no difference in working memory performance within the PD groups. However, PD patients without ICBs remembered distractors significantly less than all other patients during working memory tests. We were able to correctly classify 96% of the PD patients with respect to whether or not they had an ICB by analyzing three trials of the 80/20 loss condition of the beads task with a negative prediction value of 92.3%, and we propose that this task may prove to be a powerful screening tool to detect an ICB in PD. Our results also suggest that intact cortical processing and less distractibility in PD patients without ICBs may protect them from developing behavioral addictions.

Distorted expectancy coding in problem gambling: is the addictive in the anticipation?

BACKGROUND

Pathologic gamblers are known to have abnormal neural responses associated with experiencing monetary wins and losses. However, neural responsiveness during reward and loss expectations in pathologic gamblers has not yet been investigated.

METHODS

We used a functional magnetic resonance imaging paradigm that allowed us to investigate the dissociable reward- and loss-related expectancies with various probabilities of winning or losing different amounts of money in 15 patients with problem gambling (PRGs) and 16 healthy control subjects (HCs).

RESULTS

Compared with HCs, PRGs showed stronger activation in the bilateral ventral striatum to 5 euro than to 1 euro trials. PRGs also showed more activation of the bilateral ventral striatum and left orbitofrontal cortex associated with gain-related expected value than HCs. In addition, regression analyses indicated a highly significant negative correlation between gambling severity scores and right amygdala activation associated with gain-related expected value coding. There were no group differences in brain activation for loss-related expected value.

CONCLUSIONS

PRGs show higher activity in the reward system during reward expectation than HCs, whereas we observed no difference between PRGs and HC in the loss value system. Furthermore, the negative relation between gambling severity and amygdala activation in gain expected value coding suggests that more severe PRGs are less likely to be risk aversive during gambling. Our study provides evidence that PRGs are characterized by abnormally increased reward expectancy coding, which may render them overoptimistic with regard to gambling outcomes.

Trait gambling cognitions predict near-miss experiences and persistence in laboratory slot machine gambling

'Near-miss' outcomes (i.e., unsuccessful outcomes close to the jackpot) have been shown to promote gambling persistence. Although there have been recent advances in understanding the neurobiological responses to gambling near-misses, the psychological mechanisms involved in these events remain unclear. The goal of this study was to explore whether trait-related gambling cognitions (e.g., beliefs that certain skills or rituals may help to win in games of chance) influence behavioural and subjective responses during laboratory gambling. Eighty-four individuals, who gambled at least monthly, performed a simplified slot machine task that delivered win, near-miss, and full-miss outcomes across 30 mandatory trials followed by a persistence phase in extinction. Participants completed the Gambling-Related Cognitions Scale (GRCS; Raylu & Oei, 2004), as well as measures of disordered gambling (South Oaks Gambling Screen [SOGS]; Lesieur & Blume, 1987) and social desirability bias (DS-36; Tournois, Mesnil, & Kop, 2000). Skill-oriented gambling cognitions (illusion of control, fostered by internal factors such as reappraisal of losses, or perceived outcome sequences), but not ritual-oriented gambling cognitions (illusion of control fostered by external factors such as luck or superstitions), predicted higher subjective ratings of desire to play after near-miss outcomes. In contrast, perceived lack of self-control predicted persistence on the slot machine task. These data indicate that the motivational impact of near-miss outcomes is related to specific gambling cognitions pertaining to skill acquisition, supporting the idea that gambling near-misses foster the illusion of control.