Pathological gambling: relationship to obesity, self-reported chronic medical conditions, poor lifestyle choices, and impaired quality of life

Somatic and psychiatric comorbidity in people with diagnosed gambling disorder: A Finnish nation-wide register study

BACKGROUND AND AIMS

This is the first nation-wide register study based on a total population sample measuring the gender-specific incidences of chronic diseases and conditions among adults diagnosed with gambling disorder (GD).

DESIGN, SETTING AND PARTICIPANTS

The study used aggregated data for 2011-22 retrieved from the Register of Primary Health Care visits, Care Register for Health Care and Care Register for Social Welfare, including specialized outpatient and inpatient health care, inpatient social care and institutional care and housing services with 24-hour or part-time assistance, set in mainland Finland. Participants comprised people aged 18-90+ years with GD diagnosis [corresponding to pathological gambling, International Classification of Diseases 10th revision (ICD-10) code F63.0, n = 3605; men n = 2574, women n = 1031] and the general population (n = 4 374 192).

MEASUREMENTS

Incidences of somatic diseases and psychiatric disorders were calculated for the people with diagnosed GD and for the general population, separately for women and men.

FINDINGS

After standardizing for age, the incidence of each diagnostic group was systematically higher for people with GD compared with the general population, except for cancer. The highest standardized incidence ratio (SIR) values were for psychiatric disorders [SIR = 234.2; 95% confidence interval (CI) = 226.1-242.4], memory disorders (SIR = 172.1; 95% CI = 119.1-234.8), nervous system diseases (SIR = 162.8; 95% CI = 152.8-173.1), chronic respiratory diseases (SIR = 150.6; 95% CI = 137.6-164.2), diabetes (SIR = 141.4; 95% CI = 127.9-155.5) and digestive diseases (SIR = 134.5; 95% CI = 127.1-142.2).

CONCLUSIONS

In Finland, the incidence of chronic diseases and conditions among people with gambling disorder is higher compared with the general population, apart from cancer.

Loss, gain and choice difficulty in gambling patients: Neural and behavioural processes

Impaired decision-making is often displayed by individuals suffering from gambling disorder (GD). Since there are a variety of different phenomena influencing decision-making, we focused in this study on the effects of GD on neural and behavioural processes related to loss aversion and choice difficulty. Behavioural responses as well as brain images of 23 patients with GD and 20 controls were recorded while they completed a mixed gambles task, where they had to decide to either accept or reject gambles with different amounts of potential gain and loss. We found no behavioural loss aversion in either group and no group differences regarding loss and gain-related choice behaviour, but there was a weaker relation between choice difficulty and decision time in patients with GD. Similarly, we observed no group differences in processing of losses or gains, but choice difficulty was weaker associated with brain activity in the right anterior insula and anterior cingulate cortex in patients with GD. Our results showed for the first time the effects of GD on neural processes related to choice difficulty. In addition, our findings on choice difficulty give new insights on the psychopathology of GD and on neural processes related to impaired decision-making in GD.

Changes in some health and lifestyle behaviours are significantly associated with changes in gambling behaviours: Findings from a longitudinal New Zealand population study

Although a large number of studies have investigated associations between risky gambling behaviours and health, lifestyle and social factors, research has not focused on changes in these factors and associations with changes in gambling risk level. This study utilised existing data from the four waves of the longitudinal New Zealand National Gambling Study to examine associations between changes in substance use, mental and physical health, and quality of life and deprivation with changes in gambling risk level over time. A Markov chain transition model was used to perform these analyses using data from participants who had completed all four waves (11,080 data transitions). Although changes in various covariates were associated with changes in all gambling risk levels, the highest number of significant factors was for transitioning into risky gambling from non-problematic gambling, including development, or continuation, of several negative health and lifestyle factors that may possibly be alleviated by transitioning out of risky gambling. These findings highlight the importance of screening for gambling behaviours when assisting people with substance use, health issues, or social situations or conditions in order to provide appropriate and effective social, health and treatment supports for people whose gambling behaviour increases over time.

A nationwide case-control study on cardiovascular and respiratory-related disorders in patients with gambling disorder in Sweden

OBJECTIVES

We aimed to examine potential relationships and gender differences between cardiovascular disease (CVD), diabetes, obesity, respiratory-related disorders, and gambling disorder (GD). We hypothesized that (1) GD patients would be more likely than controls to have CVD, diabetes, obesity, and respiratory-related diseases; and (2) females with GD would be more likely than men with GD to have CVD, diabetes, obesity, and respiratory-related diseases.

STUDY DESIGN

National retrospective case-control study.

METHODS

We used data from the Swedish National Board of Health and Welfare between 2005 and 2019. A total of 10,766 patients were included, and 3592 of them had GD. Every GD patient was matched with two age- and gender-matched controls. Patient data, including the history of medical diagnoses, were extracted. Descriptive statistics, Chi-squared and Fisher's exact tests were used to compare GD patients and controls.

RESULTS

GD patients had a higher prevalence of CVD and respiratory-related disorders than controls. Diabetes rates were 5% for GD patients and 2% for controls; CVD (18% vs 12%); respiratory-related disease (7% vs 4%); and obesity (7% vs 3%). Women with a diagnosis of GD have a higher prevalence of obesity and somatic comorbidities other than diabetes compared to men.

CONCLUSIONS

This is the largest case-control study conducted to date showing GD patients have a higher prevalence of CVD, diabetes, obesity, and respiratory-related disorders than controls. Women with GD appear to be more susceptible than men to CVD, obesity, and respiratory-related disorders; however, this may be partially explained by differences in help-seeking behavior. Thus, our findings highlight the importance of early identification of GD patients who may also have somatic conditions requiring treatment. This can be accomplished by implementing a screening program for GD, CVD, diabetes, obesity, and respiratory-related disorders, and by including healthy lifestyle management strategies.

Gambling, tobacco use, and health among individuals in substance use disorder treatment

BACKGROUND AND OBJECTIVES

Gambling is highly comorbid with disordered use of tobacco and other drugs, and may increase relapse risk among substance use disorder (SUD) patients. We investigated associations between gambling and tobacco use behaviors among SUD patients to inform clinical care.

METHODS

Patients (N = 651, 170 female) from 25 residential SUD treatment programs in California completed surveys about tobacco use, health, and gambling. Using multivariate regression, we examined associations between gambling, tobacco use behaviors, and mental and physical health.

RESULTS

Past-year gamblers were more likely than non-gamblers to be current smokers (adjusted odds ratio [AOR] = 1.44, 95% confidence interval [CI] = 1.03, 2.01). Smokers who gambled had higher mean Heaviness of Smoking Index (HSI) scores (mean difference = +0.32, 95% CI = 0.04, 0.60), and more often reported smokeless tobacco use (AOR = 1.73, 95% CI = 1.16, 2.58), compared to non-gambling smokers. Past-year problem gamblers were more likely than all others (non-gamblers and non-problem gamblers) to be current smokers (AOR = 1.44, 95% CI = 1.08, 1.90) and to report high psychosocial stress (AOR = 1.87, 95% CI = 1.34, 2.61). Smokers with problem gambling also had higher HSI scores (mean difference = +0.54, 95% CI = 0.14, 0.95) compared to smokers without problem gambling.

DISCUSSION AND CONCLUSIONS

Gambling and problem gambling were associated with tobacco use and heavier smoking. SUD patients with gambling comorbidity may be heavier smokers and may need concurrent treatment for tobacco use and problem gambling.

SCIENTIFIC SIGNIFICANCE

This study provides novel data regarding gambling and tobacco use behaviors among SUD patients.

Drug-Induced Gambling Disorder: Epidemiology, Neurobiology, and Management

Problematic gambling has been suggested to be a possible consequence of dopaminergic medications used mainly in neurological conditions, i.e. pramipexole and ropinirole, and possibly by one antipsychotic compound, aripiprazole. Patients with Parkinson's disease, restless legs syndrome and other conditions potentially treated with dopamine agonists, as well as patients treated for psychotic disorders, are vulnerable patient groups with theoretically increased risk of developing gambling disorder (GD), for example due to higher rates of mental ill-health in these groups. The aim of the present paper is to review the epidemiological, clinical, and neurobiological evidence of the association between dopaminergic medications and GD, and to describe risk groups and treatment options. The neurobiology of GD involves the reward and reinforcement system, based mainly on mesocorticolimbic dopamine projections, with the nucleus accumbens being a crucial area for developing addictions to substances and behaviors. The addictive properties of gambling can perhaps be explained by the reward uncertainty that activates dopamine signaling in a pathological manner. Since reward-related learning is mediated by dopamine, it can be altered by dopaminergic medications, possibly leading to increased gambling behavior and a decreased impulse control. A causal relationship between the medications and GD seems likely, but the molecular mechanisms behind this association have not been fully described yet. More research is needed in order to fully outline the clinical picture of GD developing in patient groups with dopaminergic medications, and data are needed on the differentiation of risk in different compounds. In addition, very few interventional studies are available on the management of GD induced by dopaminergic medications. While GD overall can be treated, there is need for treatment studies testing the effectiveness of tapering of the medication or other gambling-specific treatment modalities in these patient groups.

Efficacy of cognitive-behavioral therapy in improving the quality of life of people with compulsive gambling, a systematic review

FUNDAMENTALS

Cognitive-behavioral therapy can reduce gambling behavior and other symptoms of pathological gambling.

AIM

To synthesize and analyze the evidence on the efficacy of cognitive-behavioral interventions to improve the quality of life of people with pathological gambling.

METHODOLOGY

Systematic review with a narrative synthesis of clinical trials published in English and Spanish in Medline, Scopus, Web of Science, CINAHL, The Cochrane Library Plus, PsycoInfo, and ProQuest of articles until January 2020 that will analyze this phenomenon. The PRISMA Declaration was followed and the quality of the articles was analyzed with the Jadad scale.

RESULTS

1233 articles were found, including nine in the review. Two studies confirmed the efficacy of cognitive behavioral therapy-based interventions for improving the quality of life in people with pathological gambling. In addition, these interventions improved depression, anxiety, the amount of money played, and reduced alcohol consumption and the gambling diagnosis score, which had an impact on improving the quality of life. Cognitive behavioral interventions were more effective when it was supported by a manual or when were combined with Mindfulness or Player Anonymous sessions. Having better long-term results in these cases.

CONCLUSIONS

Cognitive behavioral-based interventions can improve the quality of life of people with pathological gambling and other psychological variables without being its immediate effect. Future research should analyze whether they are more efficacy online or in person, individually, or in groups, and the number of sessions required for their effects to last over time.

A Systematic Review on Common and Distinct Neural Correlates of Risk-taking in Substance-related and Non-substance Related Addictions

Both substance-related as well as non-substance-related addictions may include recurrent engagement in risky actions despite adverse outcomes. We here apply a unified approach and review task-based neuroimaging studies on substance-related (SRAs) and non-substance related addictions (NSRAs) to examine commonalities and differences in neural correlates of risk-taking in these two addiction types. To this end, we conducted a systematic review adhering to the PRISMA guidelines. Two databases were searched with predefined search terms to identify neuroimaging studies on risk-taking tasks in individuals with addiction disorders. In total, 19 studies on SRAs (comprising a total of 648 individuals with SRAs) and 10 studies on NSRAs (comprising a total of 187 individuals with NSRAs) were included. Risk-related brain activation in SRAs and NSRAs was summarized individually and subsequently compared to each other. Results suggest convergent altered risk-related neural processes, including hyperactivity in the OFC and the striatum. As characteristic for both addiction types, these brain regions may represent an underlying mechanism of suboptimal decision-making. In contrast, decreased DLPFC activity may be specific to SRAs and decreased IFG activity could only be identified for NSRAs. The precuneus and posterior cingulate show elevated activity in SRAs, while findings regarding these areas were mixed in NSRAs. Additional scarce evidence suggests decreased ventral ACC activity and increased dorsal ACC activity in both addiction types. Associations between identified activation patterns with drug use severity underpin the clinical relevance of these findings. However, this exploratory evidence should be interpreted with caution and should be regarded as preliminary. Future research is needed to evaluate the findings gathered by this review.

Prevalence and Trends in Problem Gambling in Denmark with Special Focus on Country of Origin: Results from the Danish Health and Morbidity Surveys

Belonging to an ethnic minority has been described as a possible risk factor for problem gambling, but the literature is inconclusive whether this association is true or just a proxy for other underlying risk factors. Hence, the aims were to investigate: (1) past year prevalence of problem gambling in the adult Danish population and trends since 2005, (2) past year prevalence of problem gambling in 2017 and trends since 2010 by country of origin, and (3) whether a marginalisation by country of origin or problem gambling, respectively, is seen in various health-related indicators. Data were derived from the Danish Health and Morbidity Surveys in 2005, 2010, 2013, and 2017. The Lie/Bet Questionnaire was used to define problem gamblers. The overall prevalence of past year problem gambling has increased slightly from 2005 (1.0%) to 2017 (1.5%), but a more alarming increase was observed among men with non-western origin (3.1% in 2010 and 7.0% in 2017). A lower prevalence of good self-rated health and a higher prevalence of poor mental health was observed among individuals with a non-western origin compared to those with a Danish origin, although the differences became smaller between 2010 and 2017. The findings indicate a slightly increase in the prevalence of past year problem gambling and that particular attention should be paid to individuals with a non-western origin. The study also highlights the need for better differentiation of risk factors that may variously predispose different ethnic groups to develop gambling problems.

LIPOSA pharmacopuncture, a new herbal formula, affects localized adiposity by regulating lipid metabolism in vivo

Localized adiposity is a serious aesthetic problem and a well-known health risk factor. There is a growing interest in minimally invasive treatment options for excessive fat accumulation, such as pharmacopuncture. LIPOSA is a newly developed pharmacopuncture formula from three natural herbs: The tuber of Pinellia ternata (Thunb.) Breitenb., the whole plant of Taraxacum platycarpum Dahlst. and the root of Astragalus membranaceus Bunge. The present study investigated the effects of pharmacopuncture treatment with LIPOSA on localized adiposity. Male C57BL/6J mice were fed high fat diet for 8 weeks to induce obesity. Then, 100 µl LIPOSA was injected into the left-side inguinal fat pad at various concentrations, including 13.35, 26.7 and 53.4 mg/ml. Normal saline was injected into the right-side inguinal fat pad of each mouse as a control. The treatment was performed three times per week for 2 weeks. The weight and histological changes were analyzed in the inguinal fat pad of the obese mice. The expression levels of adipose triglyceride lipase (ATGL), hormone-sensitive lipase (HSL), autophagy-related gene (ATG)5, ATG7 and LC3-II, as lipophagy-related factors, were evaluated to confirm the lipid-catabolic effects of LIPOSA. LIPOSA pharmacopuncture markedly decreased the weight of the fat tissue and the size of the adipocytes in the inguinal region of the mouse models of obesity in a dose-dependent manner. The expression levels of ATGL, HSL, ATG5, ATG7 and LC3-II were significantly increased by the LIPOSA treatments. In addition, LIPOSA pharmacopuncture was found to decrease the expression levels of ACC, PPAR-γ and PEPCK. The results indicated that subcutaneous injection of LIPOSA can degrade local fat and induce lipophagic and lipase activation effects. In addition, lipid metabolism related to fat accumulation was regulated by the LIPOSA treatment. The present study suggests that LIPOSA pharmacopuncture can be a non-surgical alternative in the treatment of localized adiposity.

Neural networks during delay discounting as trans-disease marker: A meta-analytical review

Delay discounting reflects a devaluation of delayed long-term benefits but pursuing immediate rewards. Higher discounting rates (h-DR) are found ubiquitous in many diseases and unhealthy conditions, particularly in addiction disorder (AD), attention-deficit/hyperactivity disorder (ADHD), and obesity. Thus, h-DR was considered to be a common benchmark across many diseases facilitating to understand one disease to relevant others, which was called trans-disease process. However, the common and specific neural biomarkers associated with this process has not yet been studied well. We performed a voxel-wise task-related neuroimaging meta-analysis to clarify the neural pattern of trans-disease process across AD, ADHD and obesity. We recruited 19 eligible papers, including 9 AD papers (154 patients), 6 ADHD papers (106 patients) and 4 obesity studies (94 patients). Neuroimaging meta-analysis demonstrated the presence of neural biomarkers of trans-disease process: these patients showed inadequate brain response in caudate, ventromedial and dorsolateral prefrontal cortex (dlPFC) than do of healthy controls (HCs). Disease-specific neural patterns were also found, with prominent hypoactivation in parahippocampal-striatum network for AD, hyperactivation in dopamine-projection striatum network for ADHD and decreased activity in dorsal anterior cingulate cortex and dlPFC for obesity. This study provided robust evidence to reveal the neural substrates of trans-disease process, as well further promoted the triple brain network model in favor of the theoretical developments of these neuropsychiatric disorders.

Risky Gambling Behaviors: Associations with Mental Health and a History of Adverse Childhood Experiences (ACEs)

Problem gambling and adverse childhood experiences (ACEs) are highly co-morbid and lead to numerous adverse health outcomes. Research demonstrates that greater levels of well-being protect individuals from experiencing ACE-related harms after a history of childhood adversity; however, this relationship has not been examined in the gambling literature. We hypothesized that individuals who experienced ACEs would engage in more problem gambling behaviors. We also hypothesized that individuals who experienced ACEs and reported flourishing mental health would have lower rates of problem gambling than individuals who experienced ACEs but did not report flourishing mental health. We conducted a secondary data analysis of the adult sample in the Well-Being and Experiences (WE) Study. Examining a parent population, parents and caregivers (N = 1000; M_age = 45.2 years; 86.5% female) of adolescents were interviewed on a variety of measures, including their history of ACEs, their gambling behaviors within the past year, and their mental health and well-being. We used multinomial logistic regression analysis to examine the relationship between 15 ACEs and gambling type (i.e., non-gambler, non-problem gambler, at-risk/problem gambler). We used interaction terms between each ACE and mental health to examine the moderating role of flourishing mental health and well-being. ACEs were associated with at-risk/problem gambling supporting hypothesis 1. Contrary to hypothesis 2, overall, flourishing mental health did not moderate the relationship between ACEs and gambling severity except for one ACE. In this study, we were able to gain a better understanding of how different ACEs each contribute to varying levels of gambling severity.

The Role of Betting on Digital Credit Repayment, Coping Mechanisms and Welfare Outcomes: Evidence from Kenya

Digital financial services and more importantly, mobile money, have become an important financial innovation to advance financial inclusion in developing and emerging economies. While digital financial services have improved the lives of many Kenyans, to the growing betting segment of the Kenyan population, these innovations have also brought great convenience to betting. The innovations have allowed easy access to digital credit which can be used for betting. Despite betting or gambling being a widely studied area, particularly in developed countries, little is known about its interaction with financial innovations such as digital financial services in developing and emerging economies. Using data from a 2017 digital credit survey in Kenya, this study investigates if bettors are more likely than non-bettors to be financially distressed or engage in welfare-undermining coping strategies and potentially experience inferior welfare outcomes. The study uses a representative sample of 1040 digital borrowers, of which 304 were digital bettors. Using multivariate logistic regressions, the study found that, after controlling for socio-economic and demographic factors, bettors are significantly more likely than non-bettors to be financially distressed, engage in welfare undermining coping strategies, and have inferior welfare outcomes.

Gambling Disorder and Childhood Trauma: A Complex Association

Gambling disorder (GD) is classified as a behavioural addiction and has some phenotypic similarities with substance use disorders (SUDs). Childhood adversity and life stressors are associated with increased risk for SUDs in adulthood. However, there is limited research investigating the association between childhood trauma, stressors and behavioural addictions such as GD. In this case-control cross-sectional study, 31 adult patients with GD were compared to 31 matched healthy controls (HCs) in terms of exposure to early adversity using the Childhood Trauma Questionnaire (CTQ-SF). In addition, past 12-month stressful life event exposure was assessed using the Life Event Stress Scale (LESS) and investigated as a possible moderator of the relationship between childhood trauma and GD by means of a two-way analysis of variance (ANOVA). Logistic regression analyses were used to test if childhood trauma (CTQ-SF) and its subtypes were significant predictors of a diagnosis of GD. Severity of childhood trauma in general, and on all five subtypes, was significantly higher in GD patients compared to HCs. Childhood trauma was a significant predictor of a diagnosis of GD, with physical neglect being the single trauma subtype to significantly increase odds of GD in adulthood. Stressful life events moderated the relationship between childhood trauma and GD, i.e. childhood trauma was significantly higher in GD patients compared to HCs when LESS was low. The findings support a link between childhood trauma and GD, with current stress as a moderating variable, and may be useful for future individualized therapeutic strategies.

Problem gambling, associations with comorbid health conditions, substance use, and behavioural addictions: Opportunities for pathways to treatment

Background

Problem gambling is a public health issue and its comorbidity with other health conditions may provide an opportunity for screening in healthcare settings; however, a high level of uncertainty and a lack of research in the field remains. The objective of this study is to investigate potential associations between problem gambling and numerous other health conditions, including substance use, mental health problems, and behavioural addictions.

Methods

A cross-sectional web-survey was distributed by a market research company to an online panel of respondents in Sweden, which aimed to be representative of the general population. Chi-squared and Mann-Whitney U tests, followed by logistic regression analysis, were performed to determine associations between screening positive for lifetime problem gambling and potential comorbid conditions and behaviours.

Results

Among 2038 participants, 5.7 percent screened positive for lifetime problem gambling. Significant associations were found between problem gambling and male gender, education level, daily tobacco use, moderate psychological distress, problematic shopping, and problem gaming.

Conclusion

The association between screening for problem gambling and other health conditions, including psychological distress and behavioural addictions such as shopping and gaming, demonstrates the need to screen for problem gambling in the context of other health hazards, such as in different healthcare settings. Further research is required to identify the temporal relationship between these conditions and to investigate underlying etiological mechanisms.

Abnormalities of striatal morphology in gambling disorder and at-risk gambling

OBJECTIVE

The clinical phenotype of gambling disorder (GD) is suggestive of changes in brain regions involved in reward and impulse suppression, notably the striatum. Studies have yet to characterize striatal morphology (shape) in GD and whether this may be a vulnerability marker.

AIMS

To characterize the morphology of the striatum in those with disordered gambling (at-risk gambling and GD) versus controls.

METHOD

Individuals aged 18-29 years were classified a priori into those with some degree of GD symptoms (at-risk gambling and GD) or controls. Exclusion criteria were a current mental disorder (apart from GD), history of brain injury, or taking psychoactive medication within 6 weeks of enrollment. History of any substance use disorder was exclusionary. Participants completed an impulsivity questionnaire and structural brain scan. Group differences in volumes and morphology were characterized in subcortical regions of interest, focusing on the striatum.

RESULTS

Thirty-two people with GD symptoms (14 at-risk and 18 GD participants) and 22 controls completed the study. GD symptoms were significantly associated with higher impulsivity and morphological alterations in the bilateral pallidum and left putamen. Localized contraction in the right pallidum strongly correlated with trait impulsivity in those with GD symptoms.

CONCLUSIONS

Morphologic abnormalities of the striatum appear to exist early in the disease trajectory from subsyndromal gambling to GD and thus constitute candidate biological vulnerability markers, which may reflect differences in brain development associated with trait impulsivity. Striatal morphology and associated impulsivity might predispose to a range of problematic repetitive behaviors.

Public health effects of gambling - debate on a conceptual model

BACKGROUND

Gambling for money is a popular leisure time activity in most countries, which has major social and economic impacts not only affecting the gambler, but his/her significant others, and the society. Gambling impact studies can help researchers and policymakers compare the health and social costs and benefits of different gambling policies and can be used when considering which gambling policies will reduce or increase costs or benefits the most. In a public health approach, the impacts of gambling, negative and positive, are assessed across the entire severity spectrum of the activity. Although some studies have created basic principles for conducting impact studies, a theoretical model is currently lacking. The aim of this debate is to review complementing and contrasting views on the effects of gambling to create a conceptual model, where a public health perspective is applied.

MAIN TEXT

The effects of gambling can be structuralized using a conceptual model, where impacts are divided into negative and positive; costs and benefits. Costs and benefits are categorized into three classes: financial, labor and health, and well-being. These classes manifest in personal, interpersonal, and societal levels. Individual impacts cause effects on a personal level to gamblers themselves. External impacts influence the interpersonal and society/community levels and concern other people. The temporal level refers to the development, severity and scope of the gambling impact. These include general impacts, impacts of problem gambling and long-term impacts of gambling.

CONCLUSIONS

The conceptual model offers a base on which to start building common methodology for assessing the impact of gambling on the society. While measuring monetary impacts is not always straightforward, the main issue is how to measure the social impacts, which are typically ignored in calculations, as are personal and interpersonal impacts. The reviewed empirical work largely concentrated on the costs of gambling, especially costs on the community level. The Model can be used to identify areas where research is scarce. Filling the gaps in knowledge is essential in forming a balanced evidence base on the impacts of gambling. Ideally, this evidence could be the starting point in formulating public policies on gambling.

Gambling disorder

Gambling disorder is characterized by a persistent, recurrent pattern of gambling that is associated with substantial distress or impairment. The prevalence of gambling disorder has been estimated at 0.5% of the adult population in the United States, with comparable or slightly higher estimates in other countries. The aetiology of gambling disorder is complex, with implicated genetic and environmental factors. Neurobiological studies have implicated cortico-striato-limbic structures and circuits in the pathophysiology of this disorder. Individuals with gambling disorder often go unrecognized and untreated, including within clinical settings. Gambling disorder frequently co-occurs with other conditions, particularly other psychiatric disorders. Behavioural interventions, particularly cognitive-behavioural therapy but also motivational interviewing and Gamblers Anonymous, are supported in the treatment of gambling disorder. No pharmacological therapy has a formal indication for the treatment of gambling disorder, although placebo-controlled trials suggest that some medications, such as opioid-receptor antagonists, may be helpful. Given the associations with poor quality of life and suicide, improved identification, prevention, policy and treatment efforts are needed to help people with gambling disorder.

Quality of life instruments used in problem gambling studies: A systematic review and a meta-analysis

The purpose of this systematic review was to identify the instruments used in original articles to measure quality of life (QOL) or health-related QOL (HRQOL) in gambling-disorder patients and to assess their suitability. The systematic literature search to identify QOL/HRQOL instruments used among gambling-disorder patients was performed in PubMed, Embase and PsycINFO databases up to November 2018. A meta-analysis was performed to study the effect size of the QOL/HRQOL instruments and gambling outcomes after an intervention. Thirty-five studies were included. Seven types of instruments aiming at measuring QOL/HRQOL were identified. These instruments explored twenty-six domains. The instruments used were not properly validated in the studies. Most of the clinical trials reported a significant difference in QOL/HRQOL between pre- and post-intervention. These results were concordant with gambling outcomes but had a smaller effect size than gambling outcomes. The currently used general instruments are efficient to measure a significant change after an intervention but might not evaluate specific areas of health related QOL impacted by gambling disorders.

Trends and patterns in UK treatment seeking gamblers: 2000-2015

BACKGROUND AND AIMS

Gambling is an activity that for some can become disordered, with severe negative consequences. Existing literature does little to inform us regarding changing gambling habits of treatment seeking gamblers; the current study sought to measure trends and patterns in UK treatment seeking gambler behaviour and demographics over a 15-year period.

METHODS

Case files for 768 gamblers seeking residential treatment with the Gordon Moody Association (GMA) were analysed, collected between 2000 and 2015. Case files comprised initial assessment questionnaires, demographic data, current gambling behaviour, mental and physical health status, and a risk assessment. Chi-squared analyses were used to measure change in categorical distribution.

RESULTS

Prevalence of different forms of gambling identified as problematic have changed over time: Fixed Odds Betting Terminals (FOBTs), sports betting, and poker have become more common; horse and dog racing, and the National Lottery have become less common. Online gambling has also increased over time. In more recent years, gamblers are also more likely to have attempted suicide, to report a co-occurring mental health disorder, and to start treatment having already been prescribed medication.

DISCUSSION AND CONCLUSIONS

This is the first study to demonstrate that UK treatment seeking gambler behaviour has changed over time; major changes relate to the forms of gambling engaged in problematically, and the mental health of disordered gamblers. Whilst much media focus is directed towards one form of gambling, this should not detract focus from other forms and associated disorders, and the impact of the legislative environment.

Gambling disorder, increased mortality, suicidality, and associated comorbidity: A longitudinal nationwide register study

BACKGROUND AND AIMS

Gambling disorder (GD) appears to be an independent risk factor for suicide, and all-cause mortality has been sparsely studied in patients with GD. This study aims to explore mortality and suicide rates in individuals with GD compared to the general population as well as explore risk factors associated with all-cause mortality and suicide mortality.

METHODS

This is a nationwide register study on 2,099 individuals with a GD diagnosis in the Swedish inpatient and/or outpatient specialist health care system between the years of 2005-2016. Comorbid diagnoses from treatment episodes included in national registers were categorized into diagnostic groups according to the 10th revision of International Classification of Diseases, and prevalence rates (any occurrence during 2005-2016) were calculated for each diagnostic group. Multivariate Cox regression analyses on risk factors for death and suicide were performed, controlling for age, gender, and major categories of comorbidity. Standardized mortality ratios (SMRs) were calculated for men and women with regard to overall mortality and suicide compared to the general Swedish population.

RESULTS

The population consisted of 1,625 men and 474 women ranging from 18 to 83 years of age at first GD diagnosis (mean: 36.5 years). Sixty-seven individuals passed away, among whom 21 deaths were due to suicide. SMR calculations showed a 1.8-fold increase in mortality for individuals 20-74 years old with GD compared to the general population, and a 15-fold increase in suicide mortality. All-cause mortality was predicted by higher age and any treatment episode for cardiovascular disease, whereas suicide death was predicted by depression.

DISCUSSION AND CONCLUSIONS

Mortality and suicide rates are significantly elevated among individuals with GD. Although common mental health comorbidities did not predict overall mortality, depression predicted suicide death. Findings call for attention to long-term risk of death in GD patients and interventions against comorbid health problems.

Do 'environmental bads' such as alcohol, fast food, tobacco, and gambling outlets cluster and co-locate in more deprived areas in Glasgow City, Scotland?

This study utilised an innovative application of spatial cluster analysis to examine the socio-spatial patterning of outlets selling potentially health-damaging goods/services, such as alcohol, fast food, tobacco and gambling, within Glasgow City, Scotland. For all categories of outlets combined, numbers of clusters increased linearly from the least to the most income deprived areas (i.e. one cluster within the least deprived quintile to ten within the most deprived quintile). Co-location of individual types of outlets (alcohol, fast food, tobacco and gambling) within similar geographical areas was also evident. This type of research could influence interventions to tackle the co-occurrence of unhealthy behaviours and contribute to policies tackling higher numbers of 'environmental bads' within deprived areas.

Dietary influences on cognition

Obesity is a world-wide crisis with profound healthcare and socio-economic implications and it is now clear that the central nervous system (CNS) is a target for the complications of metabolic disorders like obesity. In addition to decreases in physical activity and sedentary lifestyles, diet is proposed to be an important contributor to the etiology and progression of obesity. Unfortunately, there are gaps in our knowledge base related to how dietary choices impact the structural and functional integrity of the CNS. For example, while chronic consumption of hypercaloric diets (increased sugars and fat) contribute to increases in body weight and adiposity characteristic of metabolic disorders, the mechanistic basis for neurocognitive deficits in obesity remains to be determined. In addition, studies indicate that acute consumption of hypercaloric diets impairs performance in a wide variety of cognitive domains, even in normal non-obese control subjects. These results from the clinical and basic science literature indicate that diet can have rapid, as well as long lasting effects on cognitive function. This review summarizes our symposium at the 2017 Society for the Study of Ingestive Behavior (SSIB) meeting that discussed these effects of diet on cognition. Collectively, this review highlights the need for integrated and comprehensive approaches to more fully determine how diet impacts behavior and cognition under physiological conditions and in metabolic disorders like type 2 diabetes mellitus (T2DM) and obesity.

Caffeine's influence on gambling behavior and other types of impulsivity

BACKGROUND

Young adulthood is a developmental period frequently associated with occurrence of impulsive behaviors including gambling. It is estimated that 73% of children and 87% of adults in the United States regularly use caffeine. Questions remain, however, concerning the role of caffeine in the development and maintenance of impulsive behaviors such as gambling.

METHODS

Sixty-one young adults with at least some degree of disordered gambling were recruited from two Mid-Western university communities in the United States using media advertisements. Caffeine intake over the preceding month was quantified using the Caffeine Use Questionnaire. Clinician rating scales, questionnaires, and cognitive tests germane to impulsivity were completed. Relationships between caffeine intake and demographic, gambling symptom, and neurocognitive measures were evaluated using the statistical technique of partial least squares (PLS).

RESULTS

Average weekly caffeine intake in the gamblers was 1218.5mg (a figure higher than previously reported in the general population). PLS yielded an optimal model with one latent factor, which explained 14.8% of variation in demographic/clinical/cognitive measures and 32.3% of variation in caffeine intake. In this model, higher caffeine intake was significantly associated with earlier age at first gambling, higher personality-related impulsiveness, more nicotine consumption, older age, and more impulsive decision-making.

CONCLUSIONS

These data suggest a particularly strong relationship between caffeine intake, earlier age of first gambling, and certain types of impulsivity in gamblers. Providing education about healthy caffeine use may be especially valuable in gamblers. Future work should explore whether the relationship between caffeine use and gambling is due to a common predisposing factor (impulsive tendencies) or, rather, constitutes a form of self-medication in gamblers (or a means of sustaining gambling habits for longer).

Gambling Type, Substance Abuse, Health and Psychosocial Correlates of Male and Female Problem Gamblers in a Nationally Representative French Sample

Many studies carried out on treatment-seeking problem gamblers (PG) have reported high levels of comorbid substance use disorders, and mental and physical health problems. Nevertheless, general population studies are still sparse, most of them have been carried out in the United States or Canada, and gender differences have not always been considered. Thus, the aim of this study was to describe the type of games, and psychological and physical correlates in male and female PG in a nationally representative French sample. The total sample studied involved 25,647 subjects aged 15-85 years, including 333 PG and 25,314 non-problem gamblers (NPG). Data were extracted from a large survey of a representative sample of the French general population. They were evaluated for sociodemographic variables, gambling behavior, type of gambling activity, substance use, psychological distress, body mass index, chronic disease, and lack of sleep. Overall, there were significant differences between PG and NPG in gender, age, education, employment and marital status, substance use disorders (alcohol, tobacco, cannabis, cocaine and heroin), psychological distress, obesity, lack of sleep and type of gambling activity. Although male and female PG had different profiles, the gambling type, especially strategic games, appeared as an important variable in the relationship between gender and problem gambling. This research underlines the importance of considering gender differences and gambling type in the study of gambling disorders. Identifying specific factors in the relationship between gender, gambling type and gambling problems may help improve clinical interventions and health promotion strategies.

At-Risk and Problem Gambling among Finnish Youth: The Examination of Risky Alcohol Consumption, Tobacco Smoking, Mental Health and Loneliness as Gender-Specific Correlates

Aims

The aims were to compare past-year at-risk and problem gambling (ARPG) and other at-risk behaviours (computer gaming, risky alcohol consumption, tobacco smoking) by age and gender, and to explore how ARPG is associated with risky alcohol consumption, tobacco smoking, poor mental health and loneliness in males and females.

Design

Data from respondents aged 15–28 (n = 822) were derived from a cross-sectional random sample of population-based data (n = 4484). The data were collected in 2011–2012 by telephone interviews. The Problem Gambling Severity Index (PGSI, score≥2) was used to evaluate ARPG. Prevalence rates for risk behaviours were compared for within gender-specific age groups. Regression models were gender-specific.

Results

The proportion of at-risk and problem gamblers was higher among males than females in all age groups except among 18–21-year-olds, while frequent computer gaming was higher among males in all age groups. The odds ratio (95% CI) of being a male ARPGer was 2.57 (1.40–4.74) for risky alcohol consumption; 1.95 (1.07–3.56) for tobacco smoking; 2.63 (0.96–7.26) for poor mental health; and 4.41 (1.20–16.23) for feeling lonely. Likewise, the odds ratio (95% CI) of being a female ARPGer was 1.19 (0.45–3.12) for risky alcohol consumption; 4.01 (1.43–11.24) for tobacco smoking; 0.99 (0.18–5.39) for poor mental health; and 6.46 (1.42–29.34) for feeling lonely. All 95% CIs of ARPG correlates overlapped among males and females.

Conclusions

Overall, past-year at-risk and problem gambling and computer gaming seem to be more common among males than females; however, for risky alcohol consumption similar gender differences were evident only for the older half of the sample. No clear gender differences were seen in correlates associated with ARPG.

Factors predicting desired autonomy in medical decisions: Risk-taking and gambling behaviors

This study investigated factors that influence patients’ desired level of autonomy in medical decisions. Analyses included previously supported demographic variables in addition to risk-taking and gambling behaviors, which exhibit a strong relationship with overall health and decision-making, but have not been investigated in conjunction with medical autonomy. Participants (N = 203) completed measures on Amazon’s Mechanical Turk, including two measures of autonomy. Two hierarchical regressions revealed that the predictors explained a significant amount of variance for both measures, but the contribution of predictor variables was incongruent between models. Possible causes for this incongruence and implications for patient–physician interactions are discussed.

The intersection of obesity and the longitudinal course of problem gambling

The purpose of this analysis was to assess the potential association between body mass index (BMI) and change in gambling symptom severity in a sample of non-treatment-seeking problem gamblers over a one year period. One-hundred sixty problem gamblers age 18-29 were recruited from the surrounding community and completed assessments of gambling behavior and related variables at baseline and one-year visits. Hierarchical multiple regression was used to examine the association between BMI and symptom change, while accounting for nicotine use, gender, age, and baseline gambling severity. The sample included 102 normal weight, 35 overweight, and 23 obese gamblers. Groups differed in sex, age, gambling risk level, and current nicotine use. There was a significant obesity x baseline gambling risk level interaction for the model predicting changes in GD-YBOCS scores over the 1-year follow-up. Obese participants with gambling disorder showed significantly smaller improvements in symptoms over one year than normal weight participants. Results suggest that obesity predicts smaller improvements in gambling symptoms over time in those meeting criteria for gambling disorder. Future research should clarify the possible influence of impulsivity on this association, and assess the clinical utility of weight management programs in treatments for gambling disorder.

Burden of Iron Deficiency Anemia in a Bariatric Surgery Population in the United States

BACKGROUND

Obesity is a serious condition affecting more than 35% of adults in the United States. In obese individuals for whom other weight control methods have been ineffective, bariatric surgery is a safe and effective method of weight control. An estimated 150,000 to 160,000 bariatric surgeries are performed in the United States yearly. Iron deficiency anemia is common in patients after bariatric surgery, with incidence rates up to 49%, and may be due to malabsorption of nutrients. 

OBJECTIVES

To (a) compare the medical resource utilization (MRU)- both medical care and treatment resources-and associated costs in a sample of commercially insured adult bariatric surgery patients with and without iron deficiency anemia (IDA), and (b) describe anti-anemia treatment patterns in those bariatric surgery patients diagnosed with IDA.

METHODS

Using Truven Health MarketScan claims data, bariatric surgery patients were identified by the ICD-9-CM and CPT procedure codes for bariatric surgery and classified by surgery and IDA diagnosis within 2 years of initial surgery. Intravenous (IV) iron treatment was determined by HCPCS codes, prescription oral iron by NDC numbers, and blood transfusions by CPT and ICD-9-CM codes. Clinical, MRU, and economic outcomes for all-cause health services were compared between IDA and non-IDA patients. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using logistic regression, controlling for demographic and clinical characteristics on outcomes of complications and hospitalization.

RESULTS

Of the 24,344 bariatric surgery patients analyzed, 11.6% received an IDA diagnosis 2 years after surgery (average days to diagnosis = 279). Most IDA patients (78.5%) received a test for iron in the post-index period; only 9.1% received IV iron treatment, with iron dextran (3.8%) and iron sucrose (3.4%) being the most common (average days to IV iron treatment = 403 days). Prescription oral iron was found in 4.9% of all IDA patients (average days to oral iron treatment = 476.7). Approximately 9% of IDA patients received a blood transfusion (average days to transfusion = 304.8). For the total sample, the average age was 46 years with a higher percentage of females (83.9% IDA; 78.7% non-IDA). Most clinical characteristics were similar among patients with and without IDA, except heart disease (1.3% IDA vs. 0.8% non-IDA; P = 0.005) and gallbladder disease (0.0% IDA vs. 0.2% non-IDA; P = 0.037). More IDA patients had complications after surgery (40.4% vs. 27.7%; P  less than  0.001), such as nonabsorption (22.4% vs. 16.5%; P  less than  0.001); digestive (15.6% vs. 10.2%; P  less than  0.001); and gastrojejunal ulcer (7.6% vs. 2.0%; P  less than  0.001). Multivariate results showed that IDA patients were more likely to have a bariatric surgery complication over non-IDA patients (OR = 1.367, 95% CI = 1.257-1.487; P  less than  0.05). Adjusted results showed IDA patients more than twice as likely to be hospitalized (OR = 2.567, 95% CI = 2.363-2.790; P  less than  0.05). Total costs were twice as much in the IDA group compared with the non-IDA group ($37,882 vs. $19,253; P  less than  0.001). 

CONCLUSIONS

Bariatric surgery patients who develop IDA may be subject to higher complication rates, MRU, and direct medical costs. Although most bariatric surgery patients who develop IDA are tested for iron, most are not treated with IV iron or oral iron and do not receive blood transfusions. Further research is needed to determine if IDA is a result of bariatric surgery complications or a predictor of increased MRU and costs.

White matter tract integrity in treatment-resistant gambling disorder

BACKGROUND

Gambling disorder is a relatively common psychiatric disorder recently re-classified within the DSM-5 under the category of 'substance-related and addictive disorders'.

AIMS

To compare white matter integrity in patients with gambling disorder with healthy controls; to explore relationships between white matter integrity and disease severity in gambling disorder.

METHOD

In total, 16 participants with treatment-resistant gambling disorder and 15 healthy controls underwent magnetic resonance imaging (MRI). White matter integrity was analysed using tract-based spatial statistics.

RESULTS

Gambling disorder was associated with reduced fractional anisotropy in the corpus callosum and superior longitudinal fasciculus. Fractional anisotropy in distributed white matter tracts elsewhere correlated positively with disease severity.

CONCLUSIONS

Reduced corpus callosum fractional anisotropy is suggestive of disorganised/damaged tracts in patients with gambling disorder, and this may represent a trait/vulnerability marker for the disorder. Future research should explore these measures in a larger sample, ideally incorporating a range of imaging markers (for example functional MRI) and enrolling unaffected first-degree relatives of patients.

Protocol for a systematic review of evaluation research for adults who have participated in the 'SMART recovery' mutual support programme

INTRODUCTION

Self-Management and Recovery Training (SMART Recovery) offers an alternative to predominant 12-step approaches to mutual aid (eg, alcoholics anonymous). Although the principles (eg, self-efficacy) and therapeutic approaches (eg, motivational interviewing and cognitive behavioural therapy) of SMART Recovery are evidence based, further clarity regarding the direct evidence of its effectiveness as a mutual aid package is needed. Relative to methodologically rigorous reviews supporting the efficacy of 12-step approaches, to date, reviews of SMART Recovery have been descriptive. We aim to address this gap by providing a comprehensive overview of the evidence for SMART Recovery in adults with problematic alcohol, substance and/or behavioural addiction, including a commentary on outcomes assessed, potential mediators, feasibility (including economic outcomes) and a critical evaluation of the methods used.

METHODS AND ANALYSIS

Methods are informed by the Cochrane Guidelines for Systematic Reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. 6 electronic peer-reviewed and 4 grey literature databases have been identified. Preliminary searches have been conducted for SMART Recovery literature (liberal inclusion criteria, not restricted to randomised controlled trials (RCTs), qualitative-only designs excluded). Eligible 'evaluation' articles will be assessed against standardised criteria and checked by an independent assessor. The searches will be re-run just before final analyses and further studies retrieved for inclusion. A narrative synthesis of the findings will be reported, structured around intervention type and content, population characteristics, and outcomes. Where possible, 'summary of findings' tables will be generated for each comparison. When data are available, we will calculate a risk ratio and its 95% CI (dichotomous outcomes) and/or effect size according to Cohen's formula (continuous outcomes) for the primary outcome of each trial.

ETHICS AND DISSEMINATION

No ethical issues are foreseen. Findings will be disseminated widely to clinicians and researchers via journal publication and conference presentation(s).

PROSPERO REGISTRATION NUMBER

CRD42015025574.

Gambling participation and policies in Malaysia

Regulatory policies for responsible gambling practices in Asia are constantly evolving as the gambling industry and technological landscape change over time. Malaysia makes an interesting case study for a commentary on gambling participation and policies, as this country has a unique dual justice system with religious and ethnic diversity that may impact on the way in which gambling activities are regulated. This regulatory ecosystem has important consequences on behaviour change, treatment approaches and recovery processes involved in gambling disorder. This commentary will discuss evidence for Malaysian gambling antecedents, public policy and socioeconomic impacts of gambling, possible costs and benefits of gambling legalization, and issues pertinent to regulating gambling activities in Malaysia.

Reduced cortical thickness in gambling disorder: a morphometric MRI study

Gambling disorder has recently been recognized as a prototype 'behavioral addiction' by virtue of its inclusion in the DSM-5 category of 'Substance-Related and Addictive Disorders.' Despite its newly acquired status and prevalence rate of 1-3 % globally, relatively little is known regarding the neurobiology of this disorder. The aim of this study was to explore cortical morphometry in untreated gambling disorder, for the first time. Subjects with gambling disorder (N = 16) free from current psychotropic medication or psychiatric comorbidities, and healthy controls (N = 17), were entered into the study and undertook magnetic resonance imaging (3T MRI). Cortical thickness was quantified using automated segmentation techniques (FreeSurfer), and group differences were identified using permutation cluster analysis, with stringent correction for multiple comparisons. Gambling disorder was associated with significant reductions (average 15.8-19.9 %) in cortical thickness, versus controls, predominantly in right frontal cortical regions. Pronounced right frontal morphometric brain abnormalities occur in gambling disorder, supporting neurobiological overlap with substance disorders and its recent reclassification as a behavioral addiction. Future work should explore the trait versus state nature of the findings and whether similarities exist with other not-yet-reclassified putative behavioral addictions.

Obesity and dissociable forms of impulsivity in young adults

OBJECTIVE

Obesity is one of the leading causes of preventable morbidity and mortality, and young people are increasingly affected. The aim of this study was to examine relationships between obesity and dissociable forms of impulsivity in young adults.

METHODS

A group of young adults (511) was recruited from city areas in the United States using media advertisements. These young adults were administered careful and extensive clinical and neurocognitive assessment in order to quantify different aspects of impulsivity (behavioral/phenomenological-, cognitive-, and personality-related measures). Associations between obesity and impulsivity were explored using multivariate analysis of variance and discriminant function analysis.

RESULTS

10.8% of the sample was obese, and 21.5% was overweight. Compared to controls, subjects with obesity showed significantly elevated rates of maladaptive gambling behaviors, monetary amounts lost to gambling, nicotine consumption, impulsive action (prolonged stop-signal reaction times in the Stop-Signal Test), and impulsive decision-making (reduced modulation of behavior as a function of risk in the Cambridge Gamble Test). Even accounting for potential confounding variables, obesity was significantly predicted by female gender, older age, more maladaptive gambling behaviors, and worse inhibitory control (stop-signal reaction times).

CONCLUSION

Obesity is associated with several dissociable forms of impulsivity in young people, especially gambling and impulse dyscontrol. Family doctors should screen for gambling problems in obese young adults. Successful treatment of nicotine dependence in young obese people is likely to require intensive weight management support. Neuropsychological deficits relating to impulsivity occur in obese people in early adulthood, and may represent vulnerability markers rather than being due to chronic untoward metabolic effects on brain function.

Health behaviour and body mass index among problem gamblers: results from a nationwide survey

Problem gambling is a serious public health issue. The objective of this study was to investigate whether past year problem gamblers differed from non-problem gamblers with regard to health behaviour and body mass index (BMI) among Danes aged 16 years or older. Data were derived from the Danish Health and Morbidity Surveys in 2005 and 2010. Past year problem gambling was defined using the lie/bet questionnaire. Logistic regression analyses were used to examine the association between past year problem gambling and health behaviour and BMI. Problem gambling was associated with unhealthy behaviour and obesity. The odds of smoking was significantly higher among problem gamblers than among non-problem gamblers. Further, the odds of high-risk alcohol drinking and illicit drug use were significantly higher among problem gamblers. The prevalence of sedentary leisure activity, unhealthy diet pattern and obesity was higher among problem gamblers than among non-problem gamblers. The associations found in this study remained significant after adjustment for sex, age, educational and cohabiting status as well as other risk factors. Our findings highlight the presence of a potential, public health challenge and elucidate the need for health promotion initiatives targeted at problem gamblers. Furthermore, more research is needed in order to understand the underlying social mechanism of the association between problem gamblers and unhealthy behaviour.

An Examination of the Prevalence, Consumer Profiles, and Patterns of Energy Drink Use, With and Without Alcohol, in Australia

BACKGROUND

There has been a significant growth in the energy drink (ED) market in Australia and around the world; however, most research investigating the popularity of ED and alcohol and energy drink (AED) use has focused on specific subpopulations such as university students. The aim of this study was to estimate the prevalence, consumption patterns, and sociodemographic correlates of ED and combined AED use among a representative Australian population sample.

METHODS

A computer-assisted telephone interview survey (n = 2,000) was undertaken in March-April 2013 of persons aged 18 years and over. Half of the interviews were obtained through randomly generated landline telephone numbers and half through mobile phones. Approximately half of the sample was female (55.5%; n = 1,110) and the mean age of participants was 45.9 (range 18 to 95, SD 20.0).

RESULTS

Less than 1 in 6 Australians reported ED use (13.4%, n = 268) and 4.6% (n = 91) reported AED use in the past 3 months. Majority of ED and AED users consumed these beverages monthly or less. ED and AED users are more likely to be aged 18 to 24 years, live in a metropolitan area, and be moderate risk or problem gamblers. AED consumers are more likely to report moderate levels of psychological distress.

CONCLUSIONS

Our findings in relation to problem gambling and psychological distress are novel and require further targeted investigation. Health promotion strategies directed toward reducing ED and AED use should focus on young people living in metropolitan areas and potentially be disseminated through locations where gambling takes place.

A critical review of chronic traumatic encephalopathy

Chronic traumatic encephalopathy (CTE) has been described in the literature as a neurodegenerative disease with: (i) localized neuronal and glial accumulations of phosphorylated tau (p-tau) involving perivascular areas of the cerebral cortex, sulcal depths, and with a preference for neurons within superficial cortical laminae; (ii) multifocal axonal varicosities and axonal loss involving deep cortex and subcortical white matter; (iii) relative absence of beta-amyloid deposits; (iv) TDP-43 immunoreactive inclusions and neurites; and (v) broad and diverse clinical features. Some of the pathological findings reported in the literature may be encountered with age and other neurodegenerative diseases. However, the focality of the p-tau cortical findings in particular, and the regional distribution, are believed to be unique to CTE. The described clinical features in recent cases are very similar to how depression manifests in middle-aged men and with frontotemporal dementia as the disease progresses. It has not been established that the described tau pathology, especially in small amounts, can cause complex changes in behavior such as depression, substance abuse, suicidality, personality changes, or cognitive impairment. Future studies will help determine the extent to which the neuropathology is causally related to the diverse clinical features.

Gambling behaviors and attitudes in adolescent high-school students: Relationships with problem-gambling severity and smoking status

BACKGROUND AND AIMS

Smoking is associated with more severe/extensive gambling in adults. The purpose of this study was to examine relationships between smoking and gambling in adolescents.

METHODS

Analyses utilized survey data from 1591 Connecticut high-school students. Adolescents were classified by gambling (Low-Risk Gambling [LRG], At Risk/Problem Gambling [ARPG]) and smoking (current smoker, non-smoker). The main effects of smoking and the smoking-by-gambling interactions were examined for gambling behaviors (e.g., type, location), and gambling attitudes. Data were analyzed using chi-square and logistic regression; the latter controlled for gender, race/ethnicity, grade, and family structure.

RESULTS

For APRG adolescents, smoking was associated with greater online, school, and casino gambling; gambling due to anxiety and pressure; greater time spent gambling; early gambling onset; perceived parental approval of gambling; and decreased importance of measures to prevent teen gambling. For LRG adolescents, smoking was associated with non-strategic gambling (e.g., lottery gambling); school gambling; gambling in response to anxiety; gambling for financial reasons; greater time spent gambling; and decreased importance of measures to prevent teen gambling. Stronger relationships were found between smoking and casino gambling, gambling due to pressure, earlier onset of gambling, and parental perceptions of gambling for ARPG versus LRG adolescents.

DISCUSSION

Smoking is associated with more extensive gambling for both low- and high-risk adolescent gamblers.

CONCLUSION

Smoking may be a marker of more severe gambling behaviors in adolescents and important to consider in gambling prevention and intervention efforts with youth.

Obesity and gambling: neurocognitive and clinical associations

OBJECTIVE

Research on health correlates in gamblers has found an association between gambling and obesity. The neurocognitive underpinnings of impulsivity may be useful targets for understanding and ultimately treating individuals with both gambling and obesity problems.

METHOD

207 non-treatment seeking young adults (18-29 years) with subsyndromal gambling disorder were recruited from the community. Subjects were grouped according to weight ('normal weight' BMI<25, 'overweight' BMI≥25; or 'obese' BMI≥30). Measures relating to gambling behaviour and objective computerized neurocognitive measures were collected.

RESULTS

Of the 207 subjects, 22 (10.6%) were obese and 49 (23.7%) were overweight. The obese gamblers consumed more nicotine (packs per day equivalent) and reported losing more money per week to gambling. Obese gamblers exhibited significant impairments in terms of reaction times for go trials on the stop-signal test (SST), quality of decision making and risk adjustment on the Cambridge Gamble Test (CGT), and sustained attention on the rapid visual information processing task (RVP).

CONCLUSION

Obesity was associated with decision making and sustained attention impairments in gamblers, along with greater monetary loss due to gambling. Future work should use longitudinal designs to examine the temporal relationship between these deficits, weight, other impulsive behaviour, and functional impairment.

Prevalence and correlates of problem gambling in people with psychotic disorders

OBJECTIVE

There are few published studies on the comorbidity of psychosis and problem gambling. This paper provides estimates of the prevalence and clinical correlates of problem gambling in a representative sample of people with psychotic disorders.

METHOD

The second Australian national survey of psychosis was undertaken in 2010 and included adults (18-64 years) attending mental health services. Problem gambling was measured using the Canadian Problem Gambling Index (CPGI) at two sites of this study, with 442 participants providing data suitable for analysis.

RESULTS

There were 151 participants who screened positive to past-year gambling. 4.1% of the total sample was classified as low risk gamblers, 6.4% were moderate risk gamblers and 5.8% were problem gamblers. Moderate risk/problem gamblers were more likely to be male, have left school with no qualifications and have sought financial assistance in the last year. There was a significant association with substance use, including alcohol use disorders and use of cannabis and 'other' drugs (excluding cannabis).

CONCLUSIONS

People with psychosis are four times more likely to have a gambling problem than the general population. The association of gambling with substance use disorders is consistent with community studies, while the increased need for financial assistance suggests that problem gambling increases the likelihood of financial harm for this population. Clinicians should screen for comorbid gambling problems in people with psychosis, while there is also a need for additional research into this area.