A preliminary study of the neural correlates of the intensities of self-reported gambling urges and emotions in men with pathological gambling

Neural fingerprints of gambling disorder using diffusion tensor imaging

Gambling disorder (GD) is a behavioral addiction associated with personal, social and occupational consequences. Thus, examining GD's clinical relationship with its neural substrates is critical. We compared neural fingerprints using diffusion tensor imaging (DTI) in GD subjects undergoing treatment relative to healthy volunteers (HV). Fifty-three (25 GD, 28 age-matched HV) males were scanned with structural magnetic resonance imaging (MRI) and DTI. We applied probabilistic tractography based on DTI scanning data, preprocessed and analyzed using permutation testing of individual connectivity weights between regions for group comparison. Permutation-based comparisons between group-averaged connectomes highlighted significant structural differences. The GD group demonstrated increased connectivity, and striatal network reorganisation, contrasted by reduced connectivity within and to frontal lobe nodes. Modularity analysis revealed that the GD group had fewer hubs integrating information across the brain. We highlight GD neural changes involved in controlling risk-seeking behaviors. The observed striatal restructuring converges with previous research, and the increased connectivity affects subnetworks highly active in gambling situations, although these findings are not significant when correcting for multiple comparisons. Modularity analysis underlines that, despite connectivity increases, the GD connectome loses hubs, impeding its neuronal network coherence. Together, these results demonstrate the feasibility of using whole-brain computational modeling in assessing GD.

Internet gaming disorder impacts gray matter structural covariance organization in the default mode network

INTRODUCTION

Although previous studies have revealed that dysfunctional brain organization is associated with internet gamingdisorder (IGD), the neuroanatomical basis that underlies IGD remains elusive. In this work, we aimed to investigate gray matter (GM) volume alterations and structural covariance patterns in relation to IGD severity.

METHODS

Structural magnetic resonance imaging data were acquired from two hundred and thirty young adults encompassing a wide range of IGD severity. Voxel-based morphometry (VBM) analysis was applied to examine GM volume changes associated with IGD severity. Furthermore, the organization of whole-brain structural covariance network (SCN) was analyzed using the regions identified as seeds from VBM analysis.

RESULTS

Individuals with greater IGD severity had increased GM volumes in the midline components of the default mode network (DMN), namely, the right medial prefrontal cortex (mPFC) and precuneus. More importantly, the SCN results revealed impaired patterns of structural covariance between the DMN-related regions and areas associated with visuospatial attention and reward craving processing as the addiction severity of IGD worsened.

LIMITATIONS

Only young Chinese adults were enrolled in our study andthe extent to which findings generalize to samples in other age groups and diverse cultures is unclear.

CONCLUSIONS

These results showed volume expansion of the DMN components and its weakened structural association with visuospatial attention and motivational craving regions with increasing IGD severity. This study deepens our understanding of the underlying neuroanatomical correlates of IGD, which may help to explain why some individuals are more vulnerable to compulsive gaming usage than others.

Substance Use Initiation, Particularly Alcohol, in Drug-Naive Adolescents: Possible Predictors and Consequences From a Large Cohort Naturalistic Study

OBJECTIVE

It is unclear whether deviations in brain and behavioral development, which may underpin elevated substance use during adolescence, are predispositions for or consequences of substance use initiation. Here, we examine behavioral and neuroimaging indices at early and mid-adolescence in drug-naive youths to identify possible predisposing factors for substance use initiation and its possible consequences.

METHOD

Among 304 drug-naive adolescents at baseline (age 14 years) from the IMAGEN dataset, 83 stayed drug-naive, 133 used alcohol on 1 to 9 occasions, 42 on 10 to 19 occasions, 27 on 20 to 39 occasions, and 19 on >40 occasions at follow-up (age 16 years). Baseline measures included brain activation during the Monetary Incentive Delay task. Data at both baseline and follow-up included measures of trait impulsivity and delay discounting.

RESULTS

From baseline to follow-up, impulsivity decreased in the 0 and 1- to 9-occasions groups (p < .004), did not change in the 10- to 19-occasions and 20- to 29-occasions groups (p > .294), and uncharacteristically increased in the >40-occasions group (p = .046). Furthermore, blunted medial orbitofrontal cortex activation during reward outcome at baseline significantly predicted higher alcohol use frequency at follow-up, above and beyond behavioral and clinical variables (p = .008).

CONCLUSION

These results suggest that the transition from no use to frequent drinking in early to mid-adolescence may disrupt normative developmental changes in behavioral control. In addition, blunted activity of the medial orbitofrontal cortex during reward outcome may underscore a predisposition toward the development of more severe alcohol use in adolescents. This distinction is clinically important, as it informs early intervention efforts in preventing the onset of substance use disorder in adolescents.

The neural basis of gambling disorder: An activation likelihood estimation meta-analysis

Previous imaging studies suggested that impairments of prefrontal-striatal and limbic circuits are correlated to excessive gambling. However, the neural underpinnings of gambling disorder (GD) continue to be the topic of debate. The present study aimed to identify structural changes in GD and differentiate the specific brain activity patterns associated with decision-making and reward-processing. We performed a systematic review complemented by Activation likelihood estimation (ALE) meta-analyses on morphometric and functional studies on neural correlates of GD. The ALE meta-analysis on structural studies revealed that patients with GD showed significant cortical grey-matter thinning in the right ventrolateral and ventromedial prefrontal cortex compared to healthy subjects. The ALE meta-analyses on functional studies revealed that patients with GD showed a significant hyperactivation in the medial prefrontal cortex and in the right ventral striatum during decision-making and gain processing compared to healthy subjects. These findings suggest that GD is related to an alteration of brain mechanisms underlying top-down control and appraisal of gambling-related stimuli and provided indications to develop new interventions in clinical practice.

Psychometric Properties of the Italian Versions of the Gambling Urge Scale (GUS) and the Gambling Refusal Self-Efficacy Questionnaire (GRSEQ)

Gambling urges and gambling refusal self-efficacy beliefs play a major role in the development and maintenance of problem gambling. This study aimed to translate the Gambling Urge Scale (GUS) and the Gambling Refusal Self-Efficacy Questionnaire (GRSEQ) from English to Italian (GUS-I, GRSEQ-I) and to test their factor structure, internal consistency, construct validity, concurrent validity, and gender differences in 513 individuals from the Italian community. Factor structure and construct validity were tested through Confirmatory Factor Analysis, internal consistency through Cronbach’s alpha, concurrent validity through correlations with gambling-related cognitions (GRCS-I), probable pathological gambling (SOGS-I), and gambling functioning (GFA-R-I). Results confirmed that the 6 items of the GUS-I load highly on one dimension of Gambling Urge, and each of the 26 items of the GRSEQ-I load highly on their relevant sub-dimension, among the following: situations/thoughts, drugs, positive emotions, negative emotions. Both scales are internally consistent and show concurrent validity with gambling-related cognitions, probable pathological gambling, and gambling functioning. Males score higher than females at the GUS-I; females score higher than males at the GRSEQ-I. The findings from the present study suggest that the GUS-I and the GRSEQ-I are internally consistent and valid scales for the assessment of gambling urges and gambling refusal self-efficacy in Italian individuals from the community, with significant repercussions in terms of assessment, prevention, and intervention.

Examining neural reactivity to gambling cues in the age of online betting

Purpose of Review

The goal of this review is to provide new insights as to how and why functional magnetic resonance imaging (fMRI) research on gambling cue reactivity can contribute to significant progress towards the understanding of gambling disorder. After having offered a detailed description of experimental paradigms and a comprehensive summary of findings related to gambling cue reactivity, the present review suggests methodological avenues for future research.

Recent Findings

The fMRI literature on problem gambling has identified the main neural pathways associated with reactivity to gambling cues. Yet, the current knowledge on the key factors underlying cue reactivity in gambling is still very incomplete. Here, we suggest that the recent expansion of online sports betting calls for a new line of research offering a fine-grained and up-to-date approach of neural cue reactivity in gambling disorder.

Summary

Experimental designs that investigate individual-specific and study-specific factors related to sports betting have the potential to foster progress towards efficient treatment and prevention of gambling disorder.

Exploring Patterns of Change Processes Over Distinct In-Treatment Phases of Cognitive and Exposure Therapies for Electronic Gaming Machine Problem Gamblers

Little is known about the change processes in gambling disorder-specific cognitive therapy (CT) and exposure therapy (ET). These therapies are underpinned by the cognitive approach (i.e., restructuring gambling cognitions) and the psychobiological approach (i.e., elimination of gambling urges) to treating problem gambling. Here, piecewise-linear modelling is used in a secondary analysis of randomised trial data for a CT group (n = 44) versus an ET group (n = 43) with the aim to open a discourse on how individuals respond to CT and ET relative to theory. Measures were administered between therapy sessions (average = 6.2 per individual) across 18 weeks for gambling urge (GUS) and gambling cognitions (GRCS). Results indicated the ET group had a stronger reduction in GUS (p < .01) in the first 4 weeks of treatment. Between 4–12 weeks, improvement in GUS (p < .01) and GRCS (p = .02) was more rapid in the CT group. Both groups experienced comparable improvements from 12–18 weeks. These findings have implications for further treatment development, including a combined cognitive and exposure approach that is flexibly adapted to the patient. A larger trial is needed to formally establish change processes and identify differences in problem gambler subgroups. This would provide therapists capacity to offer each patient a clear direction and an expedited pathway to their preferred outcome.

Cue-reactivity in behavioral addictions: A meta-analysis and methodological considerations

Background and aims Recent research has applied cue-reactivity paradigms to behavioral addictions. The aim of the current meta-analysis is to systematically analyze the effects of learning-based cue-reactivity in behavioral addictions. Methods The current meta-analysis includes 18 studies (29 data sets, 510 participants) that have used a cue-reactivity paradigm in persons with gambling (eight studies), gaming (nine studies), or buying (one study) disorders. We compared subjective, peripheral physiological, electroencephal, and neural responses toward addiction-relevant cues in patients versus control participants and toward addiction-relevant cues versus control cues in patients. Results Persons with behavioral addictions showed higher cue-reactivity toward addiction-relevant cues compared with control participants: subjective cue-reactivity (d = 0.84, p = .01) and peripheral physiological and electroencephal measures of cue-reactivity (d = 0.61, p < .01). Increased neural activation was found in the caudate nucleus, inferior frontal gyrus, median cingulate cortex, subgenual cingulate, and precentral gyrus. Persons with gambling, gaming, or buying disorders also showed higher cue-reactivity toward addiction-relevant cues compared with control cues: subjective cue-reactivity (d = 0.39, p = .11) and peripheral physiological and electroencephal measures of cue-reactivity (d = 0.47, p = .05). Increased neural activation was found in the caudate nucleus, inferior frontal gyrus, angular gyrus, inferior network, and precuneus. Discussion and conclusions Cue-reactivity not only exists in substance-use disorders but also in gambling, gaming, and buying disorders. Future research should differentiate between cue-reactivity in addictive behaviors and cue-reactivity in functional excessive behaviors such as passions, hobbies, or professions.

Gender differences in temporal relationships between gambling urge and cognitions in treatment-seeking adults

Many gambling-specific CBT programs seek to target either gambling-related urge or cognitions or both. However, little is known of the influence of one symptom type on another across time and whether these differ for men and women help-seeking problem gamblers. The aim of this study was threefold: to determine presence of measurement invariance for urge and cognition measures over time; to investigate the effect of baseline urge on end-of-treatment gambling-related cognitions - and the reciprocal relationship; and, identify whether these pathways differ across gender. Self-reported gambling urge (GUS), and gambling-related cognitions (GRCS) data from treatment-seeking problem gamblers prior to and post treatment (N = 223; 62% men) were analyzed with cross-lagged panel models, moderated by gender. Conceptualization of urge and cognitions were found to be temporally stable. There was no significant association between baseline GUS scores and post-treatment GRCS scores, nor the reverse relationship. Putatively, this infers that coexisting urge and gambling-related cognition components of problem gambling operate independently over time. Analyses revealed gambling urge had a significantly stronger tracking correlation across time for men than women when adjusting for cognition paths. This investigation provides early evidence for tailoring CBT in response to sub-population gambling-related characteristics, demonstrated across men and women.

A Preliminary Study of DBH (Encoding Dopamine Beta-Hydroxylase) Genetic Variation and Neural Correlates of Emotional and Motivational Processing in Individuals With and Without Pathological Gambling

Background and aims Corticostriatal-limbic neurocircuitry, emotional and motivational processing, dopaminergic and noradrenergic systems and genetic factors have all been implicated in pathological gambling (PG). However, allelic variants of genes influencing dopaminergic and noradrenergic neurotransmitters have not been investigated with respect to the neural correlates of emotional and motivational states in PG. Dopamine beta-hydroxylase (DBH) converts dopamine to norepinephrine; the T allele of a functional single-nucleotide polymorphism rs1611115 (C-1021T) in the DBH gene is associated with less DBH activity and has been linked to emotional processes and addiction. Here, we investigate the influence of rs1611115 on the neural correlates of emotional and motivational processing in PG and healthy comparison (HC) participants. Methods While undergoing functional magnetic resonance imaging, 18 PG and 25 HC participants, all European Americans, viewed gambling-, sad-, and cocaine-related videotapes. Analyses focused on brain activation differences related to DBH genotype (CC/T-carrier [i.e., CT and TT]) and condition (sad/gambling/cocaine). Results CC participants demonstrated greater recruitment of corticostriatal-limbic regions, relative to T-carriers. DBH variants were also associated with altered corticostriatal-limbic activations across the different videotape conditions, and this association appeared to be driven by greater activation in CC participants relative to T-carriers during the sad condition. CC relative to T-carrier subjects also reported greater subjective sadness to the sad videotapes. Conclusions Individual differences in genetic composition linked to aminergic function contribute significantly to emotional regulation across diagnostic groups and warrant further investigation in PG.

Brain Activity During Cocaine Craving and Gambling Urges: An fMRI Study

Although craving states are important to both cocaine dependence (CD) and pathological gambling (PG), few studies have directly investigated neurobiological similarities and differences in craving between these disorders. We used functional magnetic resonance imaging (fMRI) to assess brain activity in 103 participants (30 CD, 28 PG, and 45 controls) while they watched videos depicting cocaine, gambling, and sad scenarios to investigate the neural correlates of craving. We observed a three-way urge type × video type × diagnostic group interaction in self-reported craving, with CD participants reporting strong cocaine cravings to cocaine videos, and PG participants reporting strong gambling urges to gambling videos. Neuroimaging data revealed a diagnostic group × video interaction in anterior cingulate cortex/ventromedial prefrontal cortex (mPFC), activating predominantly to cocaine videos in CD participants, and a more dorsal mPFC region that was most strongly activated for cocaine videos in CD participants, gambling videos in PG participants, and sad videos in control participants. Gender × diagnosis × video interactions identified dorsal mPFC and a region in posterior insula/caudate in which female but not male PG participants showed increased responses to gambling videos. Findings illustrate both similarities and differences in the neural correlates of drug cravings and gambling urges in CD and PG. Future studies should investigate diagnostic- and gender-specific therapies targeting the neural systems implicated in craving/urge states in addictions.

Experiences and Perceptions of Problem Gamblers on Cognitive and Exposure Therapies When Taking Part in a Randomised Controlled Trial: A Qualitative Study

In South Australia (SA) problem gambling is mainly a result of the widespread availability of electronic gaming machines. A key treatment provider in SA offers free cognitive and behavioural therapy (CBT) to help-seeking problem gamblers. The CBT program focuses on the treatment of clients' urge to gamble using exposure therapy (ET) and cognitive therapy (CT) to restructure erroneous gambling beliefs. The aim of this study was to explore treatment specific and non-specific effects for CT alone and ET alone using qualitative interviews. Interviewees were a sub-sample of participants from a randomised trial that investigated the relative efficacy of CT versus ET. Findings revealed that all interviewees gained benefit from their respective therapies and their comments did not appear to favour one therapy over another. Both treatment specific and treatment non-specific effects were well supported as playing a therapeutic role to recovery. Participants' comments in both therapy groups suggested that symptom reduction was experienced on a gambling related urge-cognition continuum. In addition to symptom improvement from therapy-specific mechanisms, ET participants described a general acquisition of "rational thought" from their program of therapy and CT participants had "taken-over" their gambling urges. The findings also highlighted areas for further improvement including therapy drop-out.

Does gender moderate the subjective measurement and structural paths in behavioural and cognitive aspects of gambling disorder in treatment-seeking adults?

INTRODUCTION

Gender differences have been observed in the pathogenesis of gambling disorder and gambling related urge and cognitions are predictive of relapse to problem gambling. A better understanding of these mechanisms concurrently may help in the development of more directed therapies.

METHODS

We evaluated gender effects on behavioural and cognitive paths to gambling disorder from self-report data. Participants (N=454) were treatment-seeking problem gamblers on first presentation to a gambling therapy service between January 2012 and December 2014. We firstly investigated if aspects of gambling related urge, cognitions (interpretive bias and gambling expectancies) and gambling severity were more central to men than women. Subsequently, a full structural equation model tested if gender moderated behavioural and cognitive paths to gambling severity.

RESULTS

Men (n=280, mean age=37.4years, SD=11.4) were significantly younger than women (n=174, mean age=48.7years, SD=12.9) (p<0.001). There was no gender difference in conceptualising latent constructs of problem gambling severity, gambling related urge, interpretive bias and gambling expectancies. The paths for urge to gambling severity and interpretive bias to gambling severity were stronger for men than women and statistically significant (p<0.001 and p=0.004, respectively) whilst insignificant for women (p=0.164 and p=0.149, respectively). Structural paths for gambling expectancies to gambling severity were insignificant for both men and women.

CONCLUSION

This study detected an important signal in terms of theoretical mechanisms to explaining gambling disorder and gender differences. It has implications for treatment development including relapse prevention.

The neural bases of cognitive processes in gambling disorder

Functional imaging is offering powerful new tools to investigate the neurobiology of cognitive functioning in people with and without psychiatric conditions like gambling disorder. Based on similarities between gambling and substance-use disorders in neurocognitive and other domains, gambling disorder has recently been classified in the Diagnostic and Statistical Manual of Mental Disorders (5th edn) (DSM-5) as a behavioral addiction. Despite the advances in understanding, there exist multiple unanswered questions about the pathophysiology underlying gambling disorder and the promise for translating the neurobiological understanding into treatment advances remains largely unrealized. Here we review the neurocognitive underpinnings of gambling disorder with a view to improving prevention, treatment, and policy efforts.

Perceived problems with computer gaming and internet use among adolescents: measurement tool for non-clinical survey studies

Background

Existing instruments for measuring problematic computer and console gaming and internet use are often lengthy and often based on a pathological perspective. The objective was to develop and present a new and short non-clinical measurement tool for perceived problems related to computer use and gaming among adolescents and to study the association between screen time and perceived problems.

Methods

Cross-sectional school-survey of 11-, 13-, and 15-year old students in thirteen schools in the City of Aarhus, Denmark, participation rate 89%, n = 2100. The main exposure was time spend on weekdays on computer- and console-gaming and internet use for communication and surfing. The outcome measures were three indexes on perceived problems related to computer and console gaming and internet use.

Results

The three new indexes showed high face validity and acceptable internal consistency. Most schoolchildren with high screen time did not experience problems related to computer use. Still, there was a strong and graded association between time use and perceived problems related to computer gaming, console gaming (only boys) and internet use, odds ratios ranging from 6.90 to 10.23.

Conclusion

The three new measures of perceived problems related to computer and console gaming and internet use among adolescents are appropriate, reliable and valid for use in non-clinical surveys about young people’s everyday life and behaviour. These new measures do not assess Internet Gaming Disorder as it is listed in the DSM and therefore has no parity with DSM criteria. We found an increasing risk of perceived problems with increasing time spent with gaming and internet use. Nevertheless, most schoolchildren who spent much time with gaming and internet use did not experience problems.

Neurobiology of gambling behaviors

For many, gambling is a recreational activity that is performed periodically without ill effects, but for some, gambling may interfere with life functioning. A diagnostic entity, pathological gambling (PG), is currently used to define a condition marked by excessive and problematic gambling. In this review, the current status of understanding of the neurobiologies of gambling and PG is described. Multiple neurotransmitter systems (norepinephrine, serotonin, dopamine, opioid and glutamate) and brain regions (ventral striatum, ventromedial prefrontal cortex, insula, among others) have been implicated in gambling and PG. Considerations for future directions in gambling research, with a view towards translating neurobiological advances into more effective prevention and treatment strategies, are discussed.

Abnormal brain network organization in body dysmorphic disorder

Body dysmorphic disorder (BDD) is characterized by preoccupation with misperceived defects of appearance, causing significant distress and disability. Previous studies suggest abnormalities in information processing characterized by greater local relative to global processing. The purpose of this study was to probe whole-brain and regional white matter network organization in BDD, and to relate this to specific metrics of symptomatology. We acquired diffusion-weighted 34-direction MR images from 14 unmedicated participants with DSM-IV BDD and 16 healthy controls, from which we conducted whole-brain deterministic diffusion tensor imaging tractography. We then constructed white matter structural connectivity matrices to derive whole-brain and regional graph theory metrics, which we compared between groups. Within the BDD group, we additionally correlated these metrics with scores on psychometric measures of BDD symptom severity as well as poor insight/delusionality. The BDD group showed higher whole-brain mean clustering coefficient than controls. Global efficiency negatively correlated with BDD symptom severity. The BDD group demonstrated greater edge betweenness centrality for connections between the anterior temporal lobe and the occipital cortex, and between bilateral occipital poles. This represents the first brain network analysis in BDD. Results suggest disturbances in whole brain structural topological organization in BDD, in addition to correlations between clinical symptoms and network organization. There is also evidence of abnormal connectivity between regions involved in lower-order visual processing and higher-order visual and emotional processing, as well as interhemispheric visual information transfer. These findings may relate to disturbances in information processing found in previous studies.

Biological contributions to addictions in adolescents and adults: prevention, treatment, and policy implications

PURPOSE

Despite significant advances in our understanding of the biological bases of addictions, these disorders continue to represent a huge public health burden that is associated with substantial personal suffering. Efforts to target addictions require consideration of how the improved biological understanding of addictions may lead to improved prevention, treatment, and policy initiatives.

METHOD

In this article, we provide a narrative review of current biological models for addictions with a goal of placing existing data and theories within a translational and developmental framework targeting the advancement of prevention, treatment, and policy strategies.

RESULTS

Data regarding individual differences, intermediary phenotypes, and main and interactive influences of genetic and environmental contributions in the setting of developmental trajectories that may be influenced by addictive drugs or behavior indicate complex underpinnings of addictions.

CONCLUSIONS

Consideration and further elucidation of the biological etiologies of addictions hold significant potential for making important gains and reducing the public health impact of addictions.