Gambling and substance use: Comorbidity and treatment implications

Cash outs during in-play sports betting: Who, why, and what it reveals

Cashing out is a popular feature of modern 'in-play' sports betting that allows sports bettors to withdraw a bet before the sporting event on which the bet was placed is finalized. Previous studies have shown that use of the cash out feature is positively related to problem gambling symptomatology. However, little is known about demographic and psychological characteristics of in-play sports bettors who use the cash out feature, or their motivations for use. To fill this knowledge gap, we recruited 224 adults (18 + years) from Ontario who engaged in in-play sports betting in the past three months. Participants completed self-report measures of psychological and gambling-related variables. Participants also provided qualitative responses for their motivations for using the cash out feature. Approximately half (51.8 %) of the participants reported using the cash out feature. No statistically significant demographic differences were found between participants who used and did not use the cash out feature. Participants who used the feature (compared to those who did not) reported higher problematic alcohol and cannabis use, feelings of depression, anxiety, and stress, and were motivated to gamble to make money. The primary reasons for cashing out were to access money immediately, to cut losses, and because cashing out felt like a less risky option. The current findings shed light on underlying psychological vulnerabilities associated with individuals who use the cash out feature, which can inform initiatives to reduce the harms associated with this popular feature of sports betting.

Correlates of Problematic Gambling in Emerging Adult University Students in Ireland

INTRODUCTION

Understanding the correlates of problematic gambling among emerging adult university students is crucial for developing effective approaches to minimise harm.

METHODS

This cross-sectional survey study reports on 397 18-25 year old emerging adults studying at Irish universities who completed an online survey about problematic gambling and a range of biopsychosocial variables. Chi-square and binary logistic regression analyses explored the relationships between problematic gambling and the biopsychosocial variables measured.

RESULTS

Chi-square analyses showed that being male, having an online gambling account, having a mobile gambling app, novelty seeking (impulsivity), harm avoidance (fear of uncertainty), and high alcohol volume consumption were significantly associated with problematic gambling. Regression analyses showed that individuals were more likely to report problematic gambling if they were male (OR = 9.57 times), had an online gambling account (OR = 17.05 times), had a mobile gambling app (OR = 20.37 times), scored high in impulsivity (OR = 7.79 times), and reported high alcohol volume consumption (OR = 4.66 times). Individuals were less likely to report problematic gambling if they scored high in fear of uncertainty (OR = 0.26 times).

CONCLUSIONS

A high rate of problematic gambling was observed among the current study sample. Participants were more likely to reported problematic gambling if they were male, had online gambling accounts, mobile gambling apps, scored high in impulsivity, scored low in fear of uncertainty, or consumed high volumes of alcohol in typical drinking sessions. These findings have implications for Irish legislation and policy-makers, Irish higher education institutions, and young adult Irish university students.

Severity of gambling behaviors: exploring associations with venues, legality, and substance use

INTRODUCTION

The COVID-19 pandemic has been linked to an increase in gambling behaviors, potentially leading to Gambling Disorder (GD) and adverse health and social consequences. Problematic gambling has received little research attention over the years in Israeli society and the issue of gambling is not high on the list of priorities of Israeli policymakers. The present study examined gambling behavior in Israel on a continuum of severity and its association with venues where the gambling occurs, legality, attitude toward the legalization of casinos and poker, and substance use.

METHODS

The study questionnaires were distributed to approximately 15,000 Jewish-Israeli adults via internet panel. From 3,088 Israeli adults who answered the questionnaire, 1,251 (40.5%) reported gambling in the last year and were included in the analyses.

RESULTS

Based on the Problem Gambling Severity Index, 60% of participants were classified as non-problem gamblers, 25% as at low-risk for a gambling problem, 11% as at moderate risk, and 4% as having a gambling problem. Most online gambling was practiced by non-problem gamblers (40%) and most illegal gambling was by low-risk gamblers (34%). The more severe the gambling behavior was on the continuum, the more it was associated with illegal substance use and positive attitudes toward legalized casinos in Israel. Logistic regression showed the odds of developing moderate and problem gambling were 3.8 times higher for online gamblers (OR = 3.8; CI 2.6-5.4; p < 0.000) and 3.3 times higher for illegal gamblers (OR = 3.3; CI 2.2-4.9; p < 0.000).

CONCLUSION

Though more research attention should be paid to gambling behaviors, harm reduction gambling interventions should be made available to all categories on the continuum of severity of gambling behaviors. The present study provides evidence-based information to promote health policies that aim to prevent and reduce harm for Israeli gamblers.

Pharmacological management of gambling disorder: an update of the literature

INTRODUCTION

Gambling disorder (GD) is a mental health condition characterized by persistent and problematic betting behavior. GD generates distress and impairment, and treatment options include psychological and pharmacological interventions.

AREAS COVERED

This narrative review explores existing pharmacological treatments for GD. The following classes of medications were considered: opioid-receptor antagonists (e.g. naltrexone and nalmefene), serotonin reuptake inhibitors (e.g. fluvoxamine, paroxetine, sertraline, escitalopram, and citalopram), glutamatergic agents (e.g. N-acetylcysteine (NAC), acamprosate, and memantine), mood stabilizers (e.g. topiramate, carbamazepine, lithium), and other medications (e.g. modafinil, nefazodone, olanzapine, haloperidol, tolcapone, and bupropion).

EXPERT OPINION

Due to the limitations of the studies reviewed, solid conclusions regarding the optimal choice of pharmacotherapy for individuals with GD are challenging to draw at this time. Despite some medications, such as naltrexone and nalmefene, showing promising results, efficacy has varied across studies. The review highlights current gaps/limitations, including small sample sizes, limited diversity in participant demographics, the need for exploring different gambling subtypes and treatment responses, high placebo response rates, lack of longer-term longitudinal information, limited investigation of neurobiological correlates and co-occurring disorders, and the importance of implementation research. Further research is needed to address these gaps and explore additional medications, as well as interventions like neuromodulation.

The Influence of Genetic Polymorphic Variability of the Catechol-O-methyltransferase Gene in a Group of Patients with a Diagnosis of Behavioural Addiction, including Personality Traits

Gambling Disorder (GD) is characterised by a harmful, enduring, and recurrent involvement in betting-related behaviours. Therefore, GD shares similar biological mechanisms and symptoms to substance use disorders (SUD). Therefore, in this study, we chose the behavioural addictions group. During the examination and recruitment to the study, it turned out that all the people undergoing treatment for gambling addiction were also addicted to amphetamines, which is consistent with the biological mechanism related to cerebral neurotransmission. The aim of the study was to investigate the association of the COMT gene polymorphism with behavioral addiction. The study group consisted of 307 participants: 107 men with gambling disorder and amphetamine dependency (mean age = 27.51, SD = 5.25) and 200 non-addicted, nor dependent, free from neuro-psychiatric disorders control group men (mean age = 20.20, SD = 4.51). Both groups were subjected to psychometric evaluation using the State-Trait Anxiety Inventory and the NEO Five-Factor Personality Inventory. Genomic DNA was extracted from venous blood following standard protocols. Determination of the rs4680 polymorphism in the COMT gene was performed using the real-time PCR technique. Statistically significant differences in the frequency of rs4680 genotypes were found in the tested sample of subjects compared with the control group (p = 0.03543). Subjects with gambling disorder and amphetamine use disorder compared to the control group obtained higher scores in the assessment of the STAI trait scale (p = 0.0019), state scale (p < 0.0000), and NEO-FFI Neuroticism scale (p < 0.0000). Significantly lower results were obtained for the NEO-FFI Agreeability scale (p < 0.0000). Additionally, a significant statistical impact of gambling disorder and amphetamine use disorder, and the COMT rs4680 genotype was demonstrated for the score of the STAI trait (p = 0.0351) and state (p = 0.0343) and the NEO-FFI Conscientiousness scale (p = 0.0018). We conclude that COMT and its polymorphic variant influence the development of addiction. Still, considering its multifactorial and polygenic nature, it should be combined with other factors such as personality.

Screening and Treatment for Co-occurring Gambling and Substance Use: A Scoping Review

There is a high prevalence of gambling harms co-occurring with substance use harms. Where harms are co-occurring, they may be experienced as more severe. However, there is little evidence that services are systematically screening for such co-occurring harms in treatment-seeking populations. Furthermore, treatment modalities remain relatively under-developed, with treatment usually addressing only one source of harm.This scoping review looks at the current literature on screening and therapeutic interventions for co-occurring gambling and substance use harms to understand how co-occurring harms may be managed in a treatment setting. It draws together available data on the intersections of substance use harms and gambling related harms, in a treatment context.This research identifies a range of potentially useful validated tools for clinicians in substance use treatment settings to screen for gambling harms. For workers in gambling treatment settings who are seeking validated tools to screen for co-occurring substance use harms, the literature provides less guidance.The validated toolbox of therapeutic interventions for those experiencing co-occurring substance use and gambling harms is relatively sparse. Psychosocial interventions appear to offer the best outcomes on gambling measures for those experiencing co-occurring substance use harms. Further research is needed to establish the benefits of different combinations of treatment and treatment types in achieving reductions across both substance use and gambling harms, when these harms are experienced concurrently.

Early maladaptive schemas and addictive behaviours: A systematic review and meta-analysis

BACKGROUND

Recently, early maladaptive schemas have been increasingly focused as the underlying factor of several psychopathologies. The primary objective is to systematically review and meta-analytically analyse the evidence on the relationship between early maladaptive schemas and types of addictive behaviours. Additionally, the secondary objective was to examine potential moderators of the effect sizes.

METHODS

The systematic search was conducted on three databases including 'Scopus', 'Web of Science' and 'PubMed'. They were searched for quantitative studies investigating the relationship between early maladaptive schemas and addictive behaviours. The studies that were non-English and had insufficient information to calculate effect sizes were excluded. The random-effect model was utilized to estimate the pool effect sizes, and the meta-regression was used for moderation analysis.

RESULTS

Thirty-three studies with 12,577 participants were included for analyses. Most of included studies were conducted in the United States (k = 12, 36.36%). The mean ages of participants varied from 13.32 to 46.09 years. The findings indicated that all of early maladaptive schemas and schema domains positively correlated with addictive behaviours. The disconnection and rejection, impaired limits and impaired autonomy were the domains with the highest association with substance addictions (pool r = 0.338, 3.26 and 3.16, respectively). Furthermore, disconnection and rejection and impaired autonomy were the schema domains with the highest association with behavioural addictions (0.310 and 0.304, respectively). The moderation analysis demonstrated that study design was the factor affecting the effect sizes between schema domain and addictive behaviours.

LIMITATION

All included studies were from peer-reviewed journals in English. Moreover, the number of research examining the relationship between early maladaptive schemas and behavioural addictions was limited.

CONCLUSION

The findings provide evidence supporting the idea that substance addictions and behavioural addictions have shared risk factors, supporting the validity of the schema model, which can be applied for targeting and preventing addictive behaviours.

Clinical Differences of mild, Moderate, and Severe Gambling Disorder in a Sample of Treatment Seeking Pathological Gamblers in Sweden

INTRODUCTION

Gambling disorder (GD) is classified among the addictive disorders in the DSM-5 and the severity of the diagnosis can be specified as mild, moderate and severe. It has been seen that individuals with more severe gambling problems have a higher rate of comorbid disorders and other health problems compared to individuals with a milder clinical picture.

AIMS

The aim of this study was to explore clinical psychiatric differences related to the severity of disorder in treatment-seeking patients with GD.

METHOD

A sample of 163 patients with GD seeking treatment at an outpatient clinic was diagnosed using the SCI-GD, screened for comorbid diagnoses using the MINI, and further completed a range of self-report questionnaires measuring alcohol-, and drug-problems, symptoms of depression and anxiety, emotion regulation, cognitive distortions, and quality of life.

RESULTS

Greater severity was associated to more problems with alcohol and illicit drugs. Severe gamblers were more likely to gamble to "escape", and had more symptoms of depression and anxiety. Participants with moderate and severe gambling disorder had more difficulties with emotion regulation. Cognitive distortions were the same between severities. All groups had Quality-of-Life problems at a clinical level.

DISCUSSION

There are some distinctive differences between GD of different severities. The features shown by patients with severe GD indicates a more emotionally vulnerable group with increased symptom severity. Further knowledge about the features of GD severity levels is important for treatment planning in the clinic.

Profiling of Gamblers and Problem Gamblers Among Casino Patrons in Macao SAR

The study is one of the first prevalence studies of gambling and problem gambling among casino patrons in Macao. It aims to identify the demographic profile of gamblers and evaluate the extent of problem gambling among casino patrons. Using a convenience sampling approach, over 6,000 people were intercepted in the proximity of casinos and were invited to answer a structured questionnaire anonymously and voluntarily. Among these people 1,352 respondents indicated that they gambled in casinos at least once in the past 12 months. Over 90% (1,228) of the respondents reported that they gambled in Macao's casinos and slot lounges. The three most popular forms of casino gambling were baccarat, Sic Bo, and slot machines. The monthly median expenditure on gambling was HKD 1,845 with a range from HKD 2 to HKD 375,175. The prevalence rates for problem gambling and pathological gambling were 15.1% and 7.1%, respectively. Implications of the study's findings are given.

Developmental Patterns of Gambling Participation and Substance use Throughout Adolescence in a Population Birth Cohort

This study investigated adolescents' single and co-occurring developmental patterns of gambling participation and substance use and their association with gambling and substance use-related issues at age 17, controlling for confounders. Multiple assessments from age 12 to 17 were conducted in a population-based cohort (N=1594, 51.2% boys). Latent growth modeling was used to analyze developmental patterns and Generalized linear models to examine their association with age-17 gambling and substance use-related problems, types and variety of activities, and substance abuse. Results revealed six developmental patterns, including Low- or Non-substance Users or Gamblers (24.2% sample), two trajectory-classes of Later-Onset Increasing (to a moderate level) substance users, either with or without gambling participation (7.8% and 45.5%, respectively), two trajectory-classes of Early-Onset Increasing (to a higher level) substance users, either with or without gambling participation (6.2% and 12.7%, respectively), and a smaller trajectory-class of Slow-Increasing Substance Users and Early-Onset Gamblers, declining to non-gambling after age 13 (3.6%). Gambling participation and substance use did not appear to influence each other with regard to their onset and course throughout adolescence, and to age-17 types and variety of gambling activities or substances used, problems related to gambling participation or substance use, or substance abuse. These findings are consistent with the addictive syndrome model and with both common and individualized approaches to prevention and treatment for adolescent gamblers or substance users.

Web-based Evidence on the Treatment of Behavioral Addictions in United States Model Treatment Centers

Behavioral addictions are highly comorbid with substance use disorders, presenting in as many as 54% of service users receiving substance use treatment. Few studies have examined whether treatment centers are attentive to such other addictions, which may undermine treatment. This study examined the mention and treatment of behavioral addictions on United States treatment center websites. The 2021 Newsweek America's Best Addiction Treatment Centers website was utilized to examine the mention and treatment of behavioral addictions in 300 leading treatment centers across 25 states in the United States. Of 289 active websites, only 61 (21.1%) treatment centers mentioned anything about behavioral addictions. The highest prevalence was for gambling (n = 38), sex (n = 22), food/eating (n = 21), and internet gaming (n = 12). A total of 49 treatment centers reported treating those addictions. The most prevalent treatments involved 12-step programming (n = 18), cognitive behavioral therapy (CBT; n = 16), individual counseling (n = 16), and group therapy (n = 15). Little formalized importance via websites was provided regarding the mention or treatment of behavioral addictions at treatment centers. A greater emphasis on concurrent and substitute behavioral addictions is needed to improve the quality of life and lower the possibility of relapse among those persons in addictions treatment.

Serotonergic and dopaminergic control of impulsivity in gambling disorder

Gambling disorder (GD) is major public health issue. The disorder is often characterized by elevated impulsivity with evidence from analogous substance use disorders underlining prominent roles of brain monoamines in addiction susceptibility and outcome. Critically, GD allows the study of addiction mechanisms without the confounder of the effects of chronic substances. Here, we assessed the roles of striatal dopamine transporter binding and extrastriatal serotonin transporter binding in GD as a function of impulsivity using [¹²³ I]FP-CIT SPECT imaging in 20 older adults with GD (DSM-5 criteria; mean age 64 years) and 40 non-GD age- and sex-matched controls. We focused on GD in older individuals because there are prominent age-related changes in neurotransmitter function and because there are no reported neuroimaging studies of GD in older adults. Volume-of-interest-based and voxelwise analyses were performed. GD patients scored clearly higher on impulsivity and had higher tracer binding in the ventromedial prefrontal cortex than controls (p < 0.001), likely reflecting serotonin transporter activity. The binding in the medial prefrontal cortex positively correlated with impulsivity over the whole sample (r = 0.62, p < 0.001) as well as separately in GD patients (r = 0.46, p = 0.04) and controls (r = 0.52, p < 0.001). Striatal tracer binding, reflecting dopamine transporter activity was also positively correlated with impulsivity but showed no group differences. These findings highlight the role of prefrontal serotonergic function in GD and impulsivity. They identify cerebral coordinates of a potential target for neuromodulation for both GD and high impulsivity, a core phenotypic dimensional cognitive marker in addictions.

Prevalence and Possible Predictors of Gambling Disorder in a Sample of Students in the Healthcare Professions

The Italian version of the South Oaks Gambling Screen questionnaire (SOGS) and a socio-demographic questionnaire were administered to a sample of 275 healthcare professions students aged 19 to 58 years (mean age = 22.17; females = 81.1%) to address the research objectives: to examine the prevalence and correlates of problem gambling in a population of university healthcare professions students in Italy. Among the sample, 8.7% (n = 24) of participants showed problem gambling and 1.5% (n = 4) pathologic gambling. Lottery and scratch cards were the most frequent type of gambling in the sample, followed by cards and bingo. Compared to females, males tend to be more involved in problem gambling and pathological gambling. Males tend to be more involved than females in different types of gambling (such as cards, sports bets, gambling at the casino). Pathological gambling is positively associated with gender, being students lagging behind the regular schedule of exams and parents' level of education. These findings have important implications in terms of prevention and intervention on gambling and pathological gambling. Universities should make available educational programs and counselling services to address this issue.

Network Analysis of the Structure of the Core Symptoms and Clinical Correlates in Comorbid Schizophrenia and Gambling Disorder

Few studies have analyzed the clinical profile of treatment-seeking patients with the comorbid presence of schizophrenia (SCZ) and gambling disorder (GD), which warrants new research to assess the network structure of this complex mental condition. The aim of this study was to explore the organization of the symptoms and other clinical correlates of SCZ with GD. Network analysis was applied to a sample of N = 179 SCZ patients (age range: 19-70 years, mean=39.5, SD=9.9) who met clinical criteria for gambling disorder-related problems. Variables included in the network were the core GD symptoms according to the DSM-5, psychotic and paranoid ideation levels, global psychological distress, GD severity measures (debts and illegal behavior related with gambling), substances (tobacco, alcohol, and illegal drugs), and personality profile. The nodes with the highest authority in the network (variables of highest relevance) were personality traits and psychological distress. Four empirical modules/clusters were identified, and linkage analysis identified the nodes with the highest closeness (bridge nodes) to be novelty seeking and reward dependence (these traits facilitate the transition between the modules). Identification of the variables with the highest centrality/linkage can be particularly useful for developing precise management plans to prevent and treat SCZ with GD.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11469-022-00983-y.

Problematic Gambling Behavior in a Sample with Substance Use Disorder: The Role of Attachment Style and Alexithymia

Gambling disorder is a high comorbid disorder in substance abusers which conjunct appearance is related to worse symptomatology and evolution. Nevertheless, the research on the risk factors that may explain this comorbidity is scarce. We build of the self-regulation theory of attachment and addiction to examine if insecure attachment is related to gambling comorbidity in substance abuse disorder and the mediating role of alexithymia in this process. A cross-sectional study was carried out with 369 clinical patients with substance use disorder of which 69 presented comorbid gambling disorder diagnosed with the DSM-5 criteria. Results showed that insecure attachment was more prevalent in the group with comorbid gambling. In this group, the alexithymia levels were also higher and mediated the relationship in between attachment and gambling disorder comorbidity even controlling for several sociodemographic variables. This research indicates that insecure attachment enhances the risk of gambling comorbidity on substance abusers due to the detrimental effect on the self-regulation of emotion. Thus, interventions directed to increase the identification, expression and awareness of emotions might help to reduce comorbidity of gambling of substance use disorders.

The intergenerational transmission of gambling and other addictive behaviors: Implications of the mediating effects of cross-addiction frequency and problems

INTRODUCTION

This study examined the degree to which perceptions of familial and household participation in gambling and other addictive behaviors in youth was associated with frequency and problem severity of gambling, alcohol and/or drug use in participants as adults.

METHOD

The study measured perceived frequency of gambling, alcohol use, drug use and other potentially addictive behaviors in family/household members and the frequency and problem severity of gambling, alcohol, and drugs in an epidemiological sample of adults 18 and older (N = 3,499; m = 48.26 %, f = 51.74 %).

RESULTS

About 23.45 % of participants reported their father gambled when they were a child or adolescent, followed by mother (13.56 %), grandfather (9.73 %), or grandmother (7.83 %). A pathway model demonstrated cross-addiction inter- and intra-generational influences. Gambling by a father, mother or brother; substance use by a sister; and/or engagement in other behaviors by a brother, sister, grandmother or other household member was related to higher frequency of participant gambling (ps < 0.05), and, in turn, to higher levels of gambling, alcohol, and drug use problem severity (ps < 0.05).

DISCUSSION

Findings demonstrate the complex contributions of specific family and household members in the transmission of addictive behaviors. Frequency of gambling, alcohol use, and drug use mediated the relationship of perceived family behavior with and across addictions. In addition, perceptions regarding use of alcohol and/or other drugs, or engagement in other behaviors by family or household members was related not only to participants' alcohol and drug use but also to problem gambling frequency and severity.

Latent Classes for the Treatment Outcomes in Women with Gambling Disorder and Buying/Shopping Disorder

BACKGROUND

The risk for behavioral addictions is rising among women within the general population and in clinical settings. However, few studies have assessed treatment effectiveness in females. The aim of this work was to explore latent empirical classes of women with gambling disorder (GD) and buying/shopping disorder (BSD) based on the treatment outcome, as well as to identify predictors of the different empirical groups considering the sociodemographic and clinical profiles at baseline.

METHOD

A clinical sample of n = 318 women seeking treatment for GD (n = 221) or BSD (n = 97) participated. Age was between 21 to 77 years.

RESULTS

The four latent-classes solution was the optimal classification in the study. Latent class 1 (LT1, good progression to recovery) grouped patients with the best CBT outcomes (lowest risk of dropout and relapses), and it was characterized by the healthiest psychological state at baseline, the lowest scores in harm avoidance and self-transcendence, and the highest scores in reward dependence, persistence, self-directedness and cooperativeness. Latent classes 3 (LT3, bad progression to drop-out) and 4 (LT4, bad progression to relapse) grouped women with the youngest mean age, earliest onset of the addictive behaviors, and worst psychological functioning.

CONCLUSIONS

GD and BSD are complex conditions with multiple interactive causes and impacts, which need wide and flexible treatment plans. Specific interventions should be designed according to the specific profiles of women for achieving early inclusion, retention and well-maintained long-term effects.

Individual strategies in the rat gambling task are related to voluntary alcohol intake, but not sexual behavior, and can be modulated by naltrexone

INTRODUCTION

Gambling disorder (GD) is the first non-substance or behavioral addiction to be included in substance-related and addictive disorders in DSM-5. Since GD is a younger phenomenon relative to alcohol and substance use disorders, little is known about potential unique features in GD and to what extent characteristics are shared with alcohol and substance use disorders. The rat gambling task (rGT) is used to study decision-making in rats. This study aimed to identify individual differences in rGT strategies and explore the stability of these strategies over time. Moreover, motor impulsivity, sexual behavior, and voluntary alcohol intake were examined in rats with different rGT strategies. Finally, the response to naltrexone on performance in rats with different rGT strategies was investigated.

METHODS

Male Lister hooded rats (n = 40) underwent repeated testing in the rGT, repeated copulatory behavioral tests, and 7 weeks of voluntary alcohol intake through a modified intermittent two-bottle free-choice paradigm. Finally, rats were treated with naltrexone prior to testing in the rGT.

RESULTS

The results revealed individual choice strategies in the rGT that were stable over time, even after multiple interruptions and other behavioral testing. The rats with a risky choice strategy displayed higher motor impulsivity and voluntary alcohol intake than the other groups. No difference in sexual behavior was found between the different rGT groups. Finally, in all rats irrespectively of rGT strategy, treatment with naltrexone decreased the number of completed trials and premature responses, and increased omissions, which indicates an overall lowered motivation.

DISCUSSION

In conclusion, rats with risky rGT strategies had higher voluntary alcohol intake but not elevated sexual behavior, indicating shared underlying mechanisms between rGT strategies and alcohol intake but not natural rewards in terms of sexual behavior. Finally, naltrexone treatment resulted in an overall lowered motivation in the rGT.

Factors related to the dual condition of gambling and gaming disorders: A path analysis model

BACKGROUND AND AIMS

Gaming disorder has experienced rapid growth in the last decade among youth and adult populations, in parallel to the expansion of the videogame industry. The objective of this study was to explore the underlying process to explain the dual diagnosis of gaming with gambling disorder.

METHODS

The sample included n = 117 patients who met clinical criteria for gaming disorder, recruited from a tertiary care unit specialized in the treatment of behavioral addictions. Path analysis (implemented through structural equation modeling) assessed the direct and mediational mechanisms between the dual condition of gaming + gambling disorder and sociodemographic variables and personality traits.

RESULTS

The comorbid gaming + gambling disorder was met for 14.5% of the participants (additionally, 6.0% of the sample also met criteria for problematic gambling). The dual diagnosis was directly related to an older age at onset of the addiction problems, a higher level of the novelty seeking trait and being in active work. Employment status also mediated the relationship between persistence levels and chronological age. Greater psychopathological distress was related to females, higher levels of harm avoidance and persistence and lower levels of self-directedness.

CONCLUSIONS

The results of this study provide empirical evidence for the specific factors that increase the likelihood of the dual gaming + gambling disorder. Clinical settings should consider these features to improve gaming diagnosis and treatment. Preventive programs should also be focused on the most vulnerable groups to prevent onset and progression of this comorbid condition.

The prevalence and features of schizophrenia among individuals with gambling disorder

BACKGROUND-OBJECTIVES

Few studies have analyzed the comorbid presence of gambling disorder (GD) with schizophrenia, its sociodemographic correlates and clinical implications. This study estimated the prevalence of the dual diagnosis (GD with schizophrenia) and the differences in the profiles of patients with and without the dual condition.

METHOD

The sample included n = 3,754 patients consecutively accepted for treatment for GD. Sociodemographics, gambling-related variables, psychopathological state and personality traits were assessed and compared between the groups.

RESULTS

The prevalence of schizophrenia within patients who met clinical criteria for GD was 4.4% (95% confidence interval: 3.8%-5.1%). Variables related to the dual presence of GD with schizophrenia were single marital status, lower education level, inactive working status, socioeconomic disadvantage, younger age, earlier onset of gambling problems, worse global psychopathological state and more dysfunctional personality profile (higher level in harm avoidance and lower level in cooperativeness, reward dependence, persistence and self-directedness).

CONCLUSION

The presence of schizophrenia among patients with GD was around 4 times higher than the prevalence rate estimated in the reference general population. The differences in the profiles of GD patients with and without schizophrenia suggest that individuals with the dual diagnosis condition require unique assessment considerations and tailored treatment interventions specifically designed for the clinical and functioning higher risk.

Using the Risk-Return Model to Explain Gambling Disorder Symptoms in Youth: An Empirical Investigation with Italian Adolescents

Historically, individual differences research has sought to explain problem-gambling severity in adolescence by means of unitary "risk-taking" traits, such as sensation seeking and impulsivity, implying that these personality traits account for risk-taking tendencies across different types of behaviors and situations. However, increasing empirical evidence suggests that risk taking seems to be better conceptualized as a domain-specific construct. In the current study, we adopted a psychological risk-return framework, which posits that perceptions of perceived risks and benefits predict gambling risk attitudes, which in turn, account for variance in Gambling Disorder (GD) symptoms in adolescents. The study involved 296 Italian adolescents (68% boys, M_age = 17.76, SD = 1.17). Participants completed the risk-taking, risk perception, and expected benefits scales from the Adolescent Domain Specific Risk Taking (DOSPERT) scale (Barkley-Levenson et al. in Dev Cognitive Neurosci 3: 72-83, 2013), as well as the Gambling Behavior Scale for Adolescents (GBS-A; as reported (Primi et al. in Gambling Behavior Scale for Adolescents in, Hogrefe, Florence, 2015) were administered. Consistent with predictions, risk-taking scores for the Gambling domain predicted adolescent gambling outcomes, relative to the other DOSPERT risk-domains (Ethical, Health/Safety, Recreational, Social). Additionally, we found that greater Gambling risk perceptions were associated with lower risk-taking scores, whereas greater perceived expected benefits were associated with higher risk-taking scores. Moreover, we found significant indirect effects between perceived risks and benefits and problem-gambling severity, mediated via Gambling risk-taking scores, though expected benefits demonstrated a stronger indirect effect. These results have important implications for practice as they emphasize that specific interventions aimed at preventing problem gambling in adolescents should address their perceptions about gambling benefits.

Family history of substance use disorders: Significance for mental health in young adults who gamble

BACKGROUND

Although family history of psychiatric disorders has often been considered potentially useful in understanding clinical presentations in patients, it is less clear what a positive family history means for people who gamble in the general community. We sought to understand the clinical and cognitive impact of having a first-degree relative with a substance use disorder (SUD) in a sample of non-treatment seeking young adults.

METHODS

576 participants (aged 18-29 years) who gambled at least five times in the preceding year undertook clinical and neurocognitive evaluations. Those with a first-degree relative with a SUD were compared to those without on a number of demographic, clinical and cognitive measures. We used Partial Least Squares (PLS) regression to identify which variables (if any) were significantly associated with family history of SUDs, controlling for the influence of other variables on each other.

RESULTS

180 (31.3%) participants had a first-degree family member with a SUD. In terms of clinical variables, family history of SUD was significantly associated with higher rates of substance use (alcohol, nicotine), higher rates of problem gambling, and higher occurrence of mental health disorders. Family history of SUD was also associated with more set-shifting problems (plus higher rates of obsessive-compulsive tendencies), lower quality of decision-making, and more spatial working memory errors.

CONCLUSIONS

These results indicate that gamblers with a first-degree family member with a SUD may have a unique clinical and cognition presentation. Understanding these differences may be relevant to developing more individualized treatment approaches for disordered gambling. Compulsivity may be important as a proxy of vulnerability towards addiction.

Maladaptive consequences of repeated intermittent exposure to uncertainty

Recently we reported that nucleus accumbens (NAcc) dopamine (DA) tracks uncertainty during operant responding for non-caloric saccharin. We also showed that repeated intermittent exposure to this uncertainty, like exposure to drugs of abuse, leads to sensitization of the locomotor and NAcc DA effects of amphetamine and promotes the subsequent self-administration of the drug. Here we review these findings together with others showing that NAcc glutamate signaling is similarly affected by uncertainty. Extracellular levels of glutamate in this site also track uncertainty in a task in which nose poking for saccharin on an escalating variable ratio schedule of reinforcement is associated with progressively increasing variance between performance of the operant and payout. Furthermore, sensitized behavioral responding to and for amphetamine following exposure to uncertainty is accompanied by increased levels of Ca2+/calmodulin-dependent protein kinase II (CaMKII) and protein kinase C (PKC) phosphorylation as well as altered protein levels of the transcription factor ∆FosB (increased) and glutamate transporter 1 (GLT1; decreased) in NAcc tissues. Notably, phosphorylation by CaMKII and PKC regulates AMPA receptor trafficking and function in this site, is elevated following psychostimulant exposure, and is necessary for the expression of enhanced drug taking. Increased ∆FosB and decreased GLT1 levels are observed following psychostimulant exposure, are associated with increased drug taking and seeking, and are known to modulate AMPA receptors and extracellular glutamate levels respectively. These adaptations in glutamate transmission as well as those observed with DA following repeated intermittent exposure to uncertainty are similar to those produced by exposure to abused drugs. Together, they point to the recruitment of both DA and glutamate signaling pathways in the NAcc in both drug and behavioral addictions. As uncertainty is central to games of chance, these findings have particular relevance for gambling disorders known to exhibit comorbidity with drug abuse.

Reducing Internet Gambling Harms Using Behavioral Science: A Stakeholder Framework

Internet gambling provides a unique environment with design mechanics and data-driven opportunities that can impact gambling-related harms. Some elements of Internet gambling including isolation, lack of interruption, and constant, easy access have been argued to pose specific risks. However, identifiable player accounts enable identification of behavioral risk markers and personalized private interfaces to push customized messages and interventions. The structural design of the Internet gambling environment (website or app) can have a strong influence on individual behavior. However, unlike land-based venues, Internet gambling has few specific policies outlining acceptable and unacceptable design practices. Harm minimization including responsible gambling frameworks typically include roles and responsibilities for multiple stakeholders including individual users, industry operators, government regulators, and community organizations. This paper presents a framework for how behavioral science principles can inform appropriate stakeholder actions to minimize Internet gambling-related harms. A customer journey through internet gambling demonstrates how a multidisciplinary nexus of collaborative effort may facilitate a reduction in harms associated with Internet gambling for consumers at all stages of risk. Collaborative efforts between stakeholders could result in the implementation of appropriate design strategies to assist individuals to make decisions and engage in healthy, sustainable behaviors.

Suicide Attempt in Patients With Gambling Disorder-Associations With Comorbidity Including Substance Use Disorders

Background: Gambling disorder is known to be associated with increased risk of suicidal behavior. However, relatively little is known about how the risk of suicide attempts in gambling disorder is influenced by comorbid alcohol or drug use disorders, as well as other psychiatric conditions. Methods: The present study is a nationwide, diagnostic register study assessing the risk of suicide attempts (including fatal ones) in gambling disorder in Sweden in 2005-2016. Results: In a total of 2,099 individuals (23 percent women) with gambling disorder, 417 individuals had a suicide attempt (including 10 fatal cases of suicide) during the study period. Suicidal behavior was more common in patients with substance use disorders at any time during the study period (50 percent if both alcohol and drug use disorders were present, and 10 percent if none of these were present). In logistic regression, suicidal behavior was significantly associated with female gender (OR 2.13 [1.63-2.78]), mood disorders (OR 2.65 [2.00-3.50]), anxiety disorders (OR 1.78 [1.34-2.35]), and with alcohol (OR 1.95 [1.51-2.51]) or drug use disorders (OR 3.60 [2.76-4.69]), respectively. Conclusions: Suicidal behavior in clinical gambling disorder patients is common, but markedly more common in the presence of substance use and other comorbid disorders.