Neurodevelopment, impulsivity, and adolescent gambling

What does metaphoric language say about aggression? The relationships between metaphoric language, impulsivity, and aggression

Aggressive behavior among adolescents has been identified as a serious worldwide problem, especially when combined with trait impulsivity. This study investigates the impact of an overlooked aspect of language, namely, metaphor comprehension, on impulsivity and aggression in adolescents. A total of 204 adolescents completed self-reported questionnaires assessing impulsivity and aggression and underwent tests assessing familiar and less familiar metaphor comprehension. The findings reveal inverse relationships between metaphor comprehension and both impulsivity and aggression. Regarding aggression, notable distinctions were observed in the correlations between familiar and less familiar metaphors with specific aggression types. Additionally, impulsivity was found to mediate the relationship between the comprehension of familiar metaphors and aggression. These results are elucidated in the context of cognitive and executive functions, emphasizing the significance of considering metaphor comprehension as a cognitive process capable of modulating aggressive behavior.

Exploring the relationships between psychological variables and loot box engagement, part 1: pre-registered hypotheses

Loot boxes are purchasable randomized rewards in video games that share structural and psychological similarities with gambling. Systematic review evidence has established reproducible associations between loot box purchasing and both problem gambling and problem video gaming, perhaps driven by a range of overlapping psychological processes (e.g. impulsivity, gambling-related cognitions, etc.) It has also been argued that loot box engagement may have negative influences on player financial and psychological wellbeing. We conducted a pre-registered survey of 1495 loot box purchasing gamers (LB cohort) and 1223 gamers who purchase other, non-randomized game content (nLB cohort). Our survey confirms 15 of our 23 pre-registered hypotheses against our primary outcome (risky loot box engagement), establishing associations with problem gambling, problem gaming, impulsivity, gambling cognitions, experiences of game-related 'flow' and specific 'distraction and compulsion' motivations for purchase. Results with hypotheses concerning potential harms established that risky loot box engagement was negatively correlated with wellbeing and positively correlated with distress. Overall, results indicate that any risks from loot boxes are liable to disproportionately affect various 'at risk' cohorts (e.g. those experiencing problem gambling or video gaming), thereby reiterating calls for policy action on loot boxes.

Childhood Use of Coin Pusher and Crane Grab Machines, and Adult Gambling: Robustness to Subjective Confidence in a Young Adult USA Sample

Gambling as a youth is a risk factor for experiencing gambling-related harm as an adult. Most youth gambling research focuses on illegal engagement with age-restricted products, but youth can also gamble legally, by for example betting with friends, or via coin pusher and crane grab machines. Research has associated recollected rates of usage of these machines as a child with adult gambling participation and problems, but only in the UK and Australia, and has not tested for robustness to subjective confidence. The present study conceptually replicated these prior studies by investigating the association between recollected childhood use of coin push and crane grab machines, and adult gambling behavior, in a young adult USA sample. Participants rated their subjective confidence to test if individual differences in recollection biases provided a better account for any observed associations. Results found high recollected engagement rates for both coin pusher (87.2%) and crane grab machines (97.0%), and 5 of the 6 tested associations between youth machine usage and adult gambling engagement and problems were significant and in the hypothesized direction. Rates of subjective confidence were on average high (83.3 and 89.2 on a 0 to 100 scale), and generally did not interact with participants' recollected rates of machine use. These findings extend prior research on potential public health concerns around children's legal engagement with coin pusher and crane grab machines to a new country, the USA.

Wanna Bet? Investigating the Factors Related to Adolescent and Young Adult Gambling

For many adolescents and young adults, gambling can represent an attractive and exciting form of entertainment, a way to take risks and explore new experiences. However, gambling also poses a significant risk for this age group. Research suggests that adolescents and young adults are particularly vulnerable to the negative consequences of gambling, including addiction, financial difficulties, and mental health issues. This paper aims to critically examine data on adolescent and young adult gambling, focusing on the risk factors associated with gambling behavior. A total of 326 subjects (Mage = 19.01; SD =2.72), of whom 65.5% were female, completed a protocol containing a demographic sheet, the Lie/Bet Questionnaire, the Seven Domains Addiction Scale (7DAS), a subscale of the Addictive Behavior Questionnaire and the Coping Inventory for Stressful Situations (CISS). Specifically, we explored the impact of sociodemographic, environmental, psychological, and cognitive factors on adolescent and young adult gambling behavior. Clinical implications and future directions are discussed.

The relation between stress and impulsivity during the first year of college

OBJECTIVE

Previous research has established that short-term and persistent stress negatively impact mental health, with one proposed consequence being increased impulsivity. The present study tests the short-term and persistent associations between stress and three facets of global self-reports of impulsivity: negative urgency, lack of premeditation, and lack of perseverance, among young adults across 6 months of their first year of college.

METHOD

College freshmen (n = 362) completed self-report questionnaires assessing stress, negative urgency, lack of premeditation, and lack of perseverance three times over a 6-month period. Pre-registered analyses were conducted using multilevel growth curve models.

RESULTS

Confirmatory analyses suggested that persistent stress was associated with higher levels of negative urgency and trajectories of worsening lack of perseverance over time, while short-term stress was associated with higher negative urgency. Lack of premeditation was not robustly associated with stress.

CONCLUSIONS

While both persistent and short-term exposure to stress may be associated with some facets of global self-reports of impulsivity, the relations vary across facets of impulsivity. Overall, negative urgency was the most robustly associated with stress on both time scales, which suggests that this facet of impulsivity may be the most impacted in the context of stress in the first year of college.

Pattern and predictors of internet addiction among secondary school adolescents in Enugu, Nigeria

Background

Internet addiction has negative effects on adolescents. These range from psychological and social impediments to school absenteeism.

Aim

To ascertain the pattern of Internet addiction and the factors that predict Internet addiction among secondary school adolescents in southeast Nigeria.

Subjects and Methods

This was a cross-sectional study that involved 796 secondary school adolescents drawn from six secondary schools in Enugu, Nigeria. The data were analyzed using IBM Statistical Package for Social Sciences (SPSS) software.

Results

The highest proportion of the respondents (36.3%) had a moderate level of Internet addiction, while the least proportion (2.1%) had severe dependence on the Internet. Adolescents who were less than 15 years of age have 1.1 odds of having Internet addiction when compared to those who were 20 years and above (AOR = 1.1; 95% CI: 0.4-2.8). The respondents who were of the low socioeconomic class were 1.2 times more likely to have Internet addiction when compared with those in the high socioeconomic class (AOR = 1.2; 95% CI: 0.9-1.7). About 20.1% of adolescents were always depressed when they are not using the Internet, while 16.3% of adolescents who were addicted to the Internet developed insomnia.

Conclusion

There is a rising prevalence of Internet addiction among secondary school adolescents. Younger adolescents tend to be more addicted to the Internet than their older counterparts. A small number of them had severe Internet addiction. A subpopulation of adolescents who were addicted to the Internet presents with depression and sleep disorders.

Parental divorce and smoking dependence in Lebanese adolescents: the mediating effect of mental health problems

BACKGROUND

Lebanon has the highest prevalence estimates among Middle Eastern countries and Arab women regarding cigarette smoking, with 43% of men and 28% of women involved in such trends. Marital disruption is a tremendous source of irritability and discomfort that may hinder a child's healthy development, creating perturbing distress and increasing disobedience that may exacerbate smoking addiction. Additionally, Lebanese adolescents are inflicted by high emotional and economic instability levels, rendering increased susceptibility to distress and propensity to engage in addictive behavior. This study aims to investigate the association between parental divorce and smoking dependence among Lebanese adolescents, along with exploring the potential mediating effect of mental health disorders of such correlation.

METHODS

A total of 1810 adolescents (14 and 17 years) enrolled in this cross-sectional survey-based study (January-May 2019). Linear regressions were conducted to check for variables associated with cigarette and waterpipe dependence. PROCESS v3.4 model 4 was used to check for the mediating effect of mental health disorders between parental divorce and smoking dependence.

RESULTS

Higher suicidal ideation and having divorced parents vs living together were significantly associated with more cigarette and waterpipe dependence. Higher anxiety was significantly associated with more waterpipe dependence. Insomnia and suicidal ideation played a mediating role between parental divorce and cigarette/waterpipe dependence.

CONCLUSION

Our results consolidate the results found in the literature about the association between parental divorce and smoking addiction and the mediating effect of mental health issues. We do not know still in the divorce itself or factors related to it are incriminated in the higher amount of smoking in those adolescents. Those results should be used to inspire parents about the deleterious effect of divorce on their children to lower their risk of smoking addiction. Further longitudinal studies are needed to better understand the complexity of such associations and to see whether the divorce experience by itself or the factors that accompany it are involved in the increased smoking addiction among adolescents.

Personality Predictors of Sports-Related Concussion Incidence: Analysis of Data From a Large, Heterogeneous Undergraduate Sample

OBJECTIVE

Studies investigating the associations between personality and sports-related concussion are limited. The current study aimed to address this gap by examining whether specific personality dimensions predicted self-reported sports-related concussion outcomes.

DESIGN

This study included 1141 undergraduate students ( Mage = 19.47, SD = 2.14, female = 64.5%) who completed a battery of online personality measures and self-reported sports-related concussion items. The self-reported sports-related concussion outcomes included a single diagnosed sports-related concussion incident (i.e., "diagnosed sports-related concussion incidence") and incidents of multiple diagnosed sports-related concussions (i.e., "multiple diagnosed sports-related concussion incidents"). Analyses included splitting data randomly into training and validation data sets. Multivariate logistic regression models were then fit to each data set to determine predictors of sports-related concussion.

RESULTS

In both training and validation data sets, extraversion and experience seeking were found to be positively and most strongly associated with both sports-related concussion outcomes, whereas motor inhibition was found to be negatively associated with both outcomes. Additional personality dimensions showed differential relations with each sports-related concussion outcome.

CONCLUSIONS

The current study highlights the importance of considering personality dimensions in the context of self-reported sports-related concussion outcomes, as there are differential relations between personality dimensions and these outcomes. Thus, prevention efforts for sports-related concussion may benefit from evaluating additional athlete factors, like personality traits.

Adolescent gambling behavior: a gender oriented prevention strategy is required?

BACKGROUND

Studies published on gender-related differences in the gambling behavior of adolescents have focused mainly on psychological and social factors. The aim of this study was to develop separate risk factor models for male and female adolescents, considering the environmental, psychological, behavioral and socio-economic factors related to their gambling.

METHODS

A survey was conducted through a questionnaire developed on a dedicated web site in 2014 on a representative sample of the Italian 15-19-years-old population, including 34,922 students attending 438 secondary schools. The SOGS-RA questionnaire was used to measure gambling behavior. To verify the risk factors associated with gambling a logistic regression stratified by gender was performed.

RESULTS

In our representative sample of Italian adolescents nationwide, the prevalence of each level of gambling was higher in males than in females. The logistic regression stratified by gender found that for both genders, gambling was positively associated with internet surfing, playing sports, getting into a fight, having unprotected sex, pulling stunts, drinking alcohol at least once in the previous month, having not a satisfactory relationship with teachers, receiving pocket money from parents, spending each week much money and having someone in the family (father, sister/brother, other relatives) who gambles. On the other hand, having poor or average school marks, going to ED in the previous year, smoking at least once in the previous month, having dissatisfied with relationships with father and having a lower family income than their friends was only associated with gambling in boys. Having an accident or injury in the previous year and having a mother who gambled was associated only in girls with higher odd of at risk or problem gambling behavior. A low psychological distress is protective only in girls for risk of gambling.

CONCLUSIONS

Understanding the gender-related differences, and how they emerge in younger people at the start of their gambling careers, can suggest how best to educate individuals, families and the community on the topic of gambling. Programs to prevent substance use and abuse should be multifaceted, and include efforts to prevent gambling with a gender perspective approach.

An Exploratory Study of Shopping to Relieve Tension or Anxiety in Adolescents: Health Correlates and Gambling-Related Perceptions and Behaviors

The desire to escape from pressures/anxiety represents an important motivation for problematic engagement with short-term rewarding behaviors that could contribute to the development of recognized and candidate behavioral addictions, including problematic shopping, a prevalent condition among youth in the U.S.A. characterized by excessive shopping cognitions/behaviors that lead to distress/impairment. However, to date, the specific correlates of shopping to relieve anxiety or tension have yet to be evaluated. We aimed at addressing this gap by analyzing data (N = 2556) from a high-school survey from Connecticut in an exploratory fashion. Adolescents who acknowledged experiencing a growing tension or anxiety that could only be relieved by shopping were classified as having negative-reinforcement shopping and compared to the remaining students. Data were analyzed in chi-square and logistic regression models to examine negative-reinforcement shopping in relation to socio-demographics, health correlates, gambling-related perceptions/attitudes, and problem-gambling severity/gambling behaviors. Negative-reinforcement shopping was more frequent in female and Hispanic students, was linked to more permissive gambling attitudes and at-risk/problematic gambling, and was associated with the use of alcohol, tobacco, marijuana, and other drugs, dysphoria/depression, and weapon-carrying and physical fighting. Taken together, these findings highlight adverse measures of health and functioning linked to negative-reinforcement shopping that may be particularly relevant to girls and Hispanic youth. Additional efforts to prevent negative outcomes are warranted.

The enduring behavioral and neurobiological effects of a flavor cue paired with alcohol drinking during adolescence on the incentive properties of the flavor cue in adulthood in female alcohol-preferring (P) rats

BACKGROUND

Alcohol use disorders (AUDs) affect 15 million people nationwide, 4% of which are adolescents (ages 12-17) and adolescents who binge drink significantly increase their likelihood of suffering from an AUD in adulthood. Research shows that cues (i.e. flavors) paired with alcohol (EtOH) produce significant cue-induced alcohol craving and contribute to relapse in adolescent and adult populations. However, there is a lack of research focused on how cues that accompany EtOH drinking during adolescence, affect EtOH craving later in life. The current study sought to examine the sex- and developmental-dependent effects of adolescent exposure to flavor cues associated with EtOH on operant-lick behavior and cue-induced dopamine (DA) levels within the nucleus accumbens shell (AcbSh; reward structure) in adulthood.

METHODS

Adolescent alcohol-preferring (P) rats were randomly assigned to one of 4 groups and received 24 hr. access to three bottles on their home cage: Paired: 0.1% blueberry flavor extract (BB) + 15% v/v EtOH and 2 water bottles; Unpaired: 0.1% BB, 15% v/v EtOH, and water; 15% EtOH alone, and 2 water bottles; BB alone and 2 water bottles. Home cage fluid consumption was measured for 2-weeks. On the third week bottles were removed and all animals underwent 9 days of operant training using an operant sipper paradigm. This consisted of two sipper spouts connected to the computer by a lickometer, which registered tongue contacts with the sipper tube (Paired: BB+EtOH or water; Unpaired BB or EtOH; EtOH alone: EtOH or water; BB alone: BB or water). When the fixed ratio (FR) requirement for number of licks/tongue contacts was met, a liquid delivery solenoid dispensed 0.05 ml of fluid into the sipper tube. Following the final operant session all rats remained in their home-cage for approximately 40 days until adulthood at which point they were returned to the operant chambers and tested for appetitive and consummatory behavior in response to the flavor cue (all rats: BB or water; NO EtOH). Two weeks after the final operant session all rats underwent microdialysis testing to examine cue-induced DA levels in the AcbSh.

RESULTS

Data indicated that animals in the paired group exhibited a significantly greater level of licking at the BB sipper and a significantly greater level of DA release in response to the flavor cue compared to the other groups.

CONCLUSIONS

Overall, the data suggest that cues paired with EtOH during adolescence may produce persistent changes to the behavioral and neurobiological mechanisms that contribute to an increased risk of developing an AUD later in life.

Loot box engagement: A scoping review of primary studies on prevalence and association with problematic gaming and gambling

Background

Loot boxes are an increasingly common type of random microtransaction in videogames. There is some concern about their expansion and entailed risks, especially among adolescents. The actual prevalence of engagement with loot boxes among child and adult population is uncertain, and there is still controversy over the nature of their relationship with problematic gaming and gambling.

Objectives

The aims of this scoping review are to summarize the characteristics and findings of published primary empirical studies about the prevalence of engagement with loot boxes and/or their relationship with problematic gaming and gambling, taking in account the type of sample, time frame and measured variables.

Methods

This study follows the Joanna Briggs Institute’s “Guidance for conducting systematic scoping reviews” and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Three academic databases provided 299 articles.

Results

Sixteen primary empirical studies met the inclusion criteria for this review. All studies used cross-sectional designs, and most used convenience samples. Twelve study samples were comprised exclusively of gamers, and two were comprised of gamers and/or gamblers. Only six studies included adolescents. The annual prevalence rate of loot box purchases was higher for adult gamers than for adolescents (22.7%–44.2% and 20%–33.9%, respectively), but in studies with general population samples, the opposite was true (24.9% for players aged 13–14 versus 7.8% for adults). In general, the studies suggested a significant positive relationship between engagement with loot boxes and problematic gaming and gambling, but this may be related to the type of engagement (open/purchase/sell), and the characteristics of the study participants (male/female, adolescents/adults, gamers/gamers-gamblers/general population).

Conclusions

This scoping review summarizes the results of recent empirical studies on engagement with loot boxes and discusses how methodological issues may affect their results and interpretation. Recommendations for future research are also provided.

Relations Among Gambling Behavior, Associated Problems, Game Type, and Risk Factors in a Rural, African American, Adolescent Sample

Problem gambling is a rising concern among adolescent populations; youth gamble more frequently than adults, and those who gamble are more susceptible than adults to maladaptive outcomes. Research shows that gambling problems are exacerbated among minorities, despite lower rates of gambling frequency. Minority youth are at especially high risk for problematic gambling outcomes, though they have not been widely studied. The objectives of this study were to (a) investigate gambling frequency and rates of associated problems among rural, African American youth, (b) examine risk factors associated with gambling problems, and (c) explore preferences for game type. Hypotheses were tested with survey data from 270 African American youth from rural communities in Georgia, ages 14-17. Past-year gambling prevalence was 38% (48% of males and 28% of females), and 30% of those who gambled (11% of the total sample) reported at least one problem behavior associated with gambling. Confirmatory factor analysis established a distinction between games of skill versus luck. Gambling problems were associated with skill games, and youth played skill games more than luck games. Substance use and anger scores predicted gambling frequency, and gambling frequency predicted gambling problems. Depression scores provided no predictive utility. Poverty status was negatively associated with skill gambling, and there was no association between poverty status and luck gambling. Males gambled more frequently, had more gambling problems, and were more likely to engage in skill gambling relative to females.

The long-term associations between parental behaviors, cognitive function and brain activation in adolescence

Parenting behavior has a vital role in the development of the brain and cognitive abilities of offspring throughout childhood and adolescence. While positive and aggressive parenting behavior have been suggested to impact neurobiology in the form of abnormal brain activation in adolescents, little work has investigated the links between parenting behavior and the neurobiological correlates of cognitive performance during this age period. In the current longitudinal fMRI study, associations between parenting behaviors and cognitive performance and brain activation across mid- and late-adolescence were assessed. Observed measures of maternal aggressive and positive behavior were recorded in early adolescence (12 years) and correlated with fMRI activation and in-scanner behavioral scores on the multi-source interference task (MSIT) during mid- (16 years; 95 participants) and late-adolescence (19 years; 75 participants). There was a significant reduction in inhibitory-control-related brain activation in posterior parietal and cingulate cortices as participants transitioned from mid- to late-adolescence. Positive maternal behavior in early-adolescence was associated with lower activation in the left parietal and DLPFC during the MSIT in mid-adolescence, whereas maternal aggressive behavior was associated with longer reaction time to incongruent trials in late-adolescence. The study supports the notion that maternal behavior may influence subsequent neurocognitive development during adolescence.

Excitement-Seeking Gambling in Adolescents: Health Correlates and Gambling-Related Attitudes and Behaviors

Motivational characteristics such as excitement-seeking are key components of models of addiction, including problem gambling. Previous studies have established associations between excitement-seeking and problem gambling in youth. However, these studies have employed dimensional psychological assessments which are unlikely to be routinely administered. Other approaches to conceptualize excitement-seeking could be of value. In the present study, we employed a single question (What are the reasons that you gamble?) to identify adolescents who reported excitement-seeking motivation for gambling. Cross-sectional data from 2030 adolescent gamblers who participated in a Connecticut high-school survey were examined. Gambling perceptions and correlates of problem-gambling severity were examined relative to excitement-seeking and non-excitement-seeking gambling. Gambling perceptions were more permissive and at-risk/problem gambling was more frequent among adolescents with excitement-seeking gambling versus non-excitement-seeking gambling. A weaker relationship between problem-gambling severity and moderate and heavy alcohol use was observed for excitement-seeking versus non-excitement-seeking gambling. Excitement-seeking gambling is associated with more permissive gambling-related attitudes and riskier gambling behaviors and may account for some variance in adolescent risk of heavy alcohol use. A single question may provide important information for identifying adolescents who are at elevated risk of problem gambling and associated negative outcomes, although the utility of the question in specific settings warrants direct examination, especially given the observed high prevalence of excitement-seeking motivations for gambling.

Impulsivity in heroin-dependent individuals: structural and functional abnormalities within frontostriatal circuits

High levels of impulsivity are a risk factor for the initiation of heroin use and a core behavioral characteristic of heroin dependence. Impulsivity also contributes to the maintenance of drug use and hinders effective therapy. Here we sought to identify neuroimaging markers of impulsivity in heroin-dependent individuals (HDI), with a focus on the nucleus accumbens (NAc), a key region implicated in impulsivity and drug addiction generally. Volume and resting-state functional connectivity (RSFC) differences of the bilateral NAc were investigated between 21 HDI and 21 age-, gender-, nicotine-, alcohol-matched healthy controls (HC). The neuroimaging results were then correlated with the Barratt Impulsivity Scales (BIS-11). Higher motor impulsivity (t = 2.347, p = 0.0253) and larger right NAc volume (F (1,38) = 4.719, p = 0.036) was observed in HDI. The right NAc volume was positively correlated with BIS total (r = 0.6196, p = 0.0239) /motor (r = 0.5921, p = 0.0330) scores in HC and BIS motor (r = 0.5145, p = 0.0170) score in HDI. A negative correlation was found between RSFC of the right NAc-bilateral superior frontal gyrus (SFG) and motor impulsivity in HDI (left: r=-0.6537, p = 0.0013; right: r=-0.6167, p = 0.0029) and HC (left: r=-0.6490,p = 0.0164; right: r=-0.6993, p = 0.0078). We aimed to reveal novel multimodality neuroimaging biomarkers of the higher impulsivity in HDI by focusing on the NAc and corresponding functional circuits. Higher motor impulsivity was observed in HDI. Furthermore, the volume of the right NAc and the RSFC strength of right NAc-SFG could be neuroimaging biomarkers for the severity of impulsivity in HDI. These potential biomarkers could be a target for novel treatments in HDI.

Is Subtyping of Gamblers Based on the Pathways Model of Problem and Disordered Gambling Valid? A Systematic Review

Gamblers are a heterogenous group in terms of the presence of comorbid psychopathology, maladaptive personality traits, and motivation to gamble. The Pathways Model, the most promising comprehensive framework to explain this heterogeneity, classifies gamblers into three subtypes. The aim of this review was to determine whether or not subtyping of gamblers based on the Pathways Model of problem and disordered gambling is valid. A literature review was conducted using the following online databases: Academic Search Complete, PubMed, Web of Science, and PsychINFO. Studies were selected or excluded based on meeting predetermined criteria. Fourteen studies examining subtyping of gamblers based on the Pathways Model were reviewed and evaluated. Results suggest that in the adult population there are three subtypes of gamblers that largely coincide with the subtypes defined in the Pathways Model. Of these, the emotionally vulnerable subtype is the most problematic and inconsistent. In contrast, for adolescents, at least four gambler subtypes have been identified. The extant literature on subtyping of gamblers suffers from some severe limitations. Further research is required to fully validate the Pathways Model.

Trans-diagnostic measurement of impulsivity and compulsivity: A review of self-report tools

INTRODUCTION

Impulsivity and compulsivity are important constructs, relevant to understanding behaviour in the general population, as well as in particular mental disorders (e.g. attention deficit hyperactivity disorder, obsessive-compulsive disorder). The current paper provides a narrative review of self-report impulsivity and compulsivity scales.

METHODS

A literature search was conducted using the following terms: ("impulsivity" OR "compulsivity") AND ("self-report" OR "questionnaire" OR "psychometric" OR "scale").

RESULTS

25 impulsive and 11 compulsive scales were identified, which varied considerably in psychometric properties, convenience, and validity. For impulsivity, the most commonly used scales were the BIS and the UPPS-P, whilst for compulsivity, the Padua Inventory was commonly used. The majority of compulsivity scales measured OCD symptoms (obsessions and compulsions) rather than being trans-diagnostic or specific to compulsivity (as opposed to obsessions). Scales capable of overcoming these limitations were highlighted.

DISCUSSION

This review provides clarity regarding relative advantages and disadvantages of different scales relevant to the measurement of impulsivity and compulsivity in many contexts. Areas for further research and refinement are highlighted.

Gambling in children and adolescents

INTRODUCTION

Children are susceptible to problems with gambling because of developmental and cognitive immaturities, as well as a sensitivity to peer pressure and marketing.

SOURCES OF DATA

This review uses recent UK data from the Gambling Commission and from the Avon Longitudinal Study of Parents and Children, and evidence from recent reviews of gambling in children and adolescents.

AREAS OF AGREEMENT

The prevalence of gambling in children worldwide and in the UK is stable, having generally decreased since 2013. Online gambling is increasing in children and young people. A small minority of adolescents who gamble develop a gambling disorder. Adolescents who have problems with gambling tend to have lower self-esteem and a history of hyperactivity and impulsivity, are more likely to have parents who gamble, report less parental supervision and to use more alcohol than their peers.

AREAS OF CONTROVERSY

Children's access to slot machines, the relationship between gaming and gambling, and social media advertizing of gambling targeting children.

GROWING POINTS

An increase in online gambling and in-play sports betting by adolescents and the use of skins betting in video gaming.Areas timely for developing research: impact on young people of betting on e-gaming. How best to protect children from early exposure to gambling in the current internet age.

IMPLICATIONS FOR CLINICIANS

Need to be aware of the growing and complex phenomenon of gaming and gambling, and implications for the mental health of children and adolescents. The effective management of gambling disorders in children and adolescents requires close working with families.

Gambling in Young Adults Aged 17-24 Years: A Population-Based Study

A large contemporary UK cohort study, the Avon Longitudinal Study of Parents and Children, was used to investigate gambling behavior and to explore the antecedents of regular gambling in the 17–24-year age group. Participants completed computer-administered gambling surveys in research clinics, on paper, and online. The sample sizes were 3566 at age 17 years, 3940 at 20 years, and 3841 at 24 years; only 1672 completed all three surveys. Participation in gambling in the last year was reported by 54% of 17-year-olds, rising to 68% at 20 years, and 66% at 24 years, with little overall variance. Regular (weekly) gambling showed a strong gender effect, increasing among young men from 13% at 17 years to 18% at 20 years, and 17% at 24 years. Although gambling frequency increased between the ages of 17 and 20 years, gambling behaviors showed little variance between 20 and 24 years, except online gambling and betting on horseraces. The commonest forms of gambling were playing scratchcards, playing the lottery, and private betting with friends. Gambling on activities via the internet increased markedly between 17 and 24 years, especially among males. In the fully adjusted model, individual antecedents of regular gambling were being male, and having a low IQ, an external locus of control, and high sensation seeking scores. Parental gambling behavior and maternal educational background were associated with regular gambling in both sexes. Regular gambling was associated with smoking cigarettes and frequent and harmful use of alcohol, but no associations with depression were found.

Problem Gambling in Early Adulthood: a Population-Based Study

The aims of this study were to investigate stability of problem gambling between 20 and 24 years of age, and the antecedents and consequences of problem gambling at age 20 years. Young adult participants in the Avon Longitudinal Study of Parents and Children (ALSPAC) completed computer-administered gambling surveys on paper, or online. Responses to the Problem Gambling Severity Index (PGSI) were complete for 2624 participants at 20 years, and 1921 participants at 24 years. Responses were categorized into ‘non-problem’ (71–78%), ‘low-risk gambling’ (16–21%), ‘moderate-risk gambling’ (4–5.5%), and ‘problem gambling’ (1–1.5%). The overall frequency of moderate-risk/problem gambling varied little between age 20 and 24 years, and scratch cards, online betting and gambling were the most frequent activities. Problem gamblers at age 20 years had a history of hyperactivity and conduct problems in adolescence, high sensation seeking, and an external locus of control. They were more likely to have mothers who had problems with gambling, reported less parental supervision, and higher social media usage. Moderate-risk/problem gambling at age 20 years was associated with regular cigarette smoking, high levels of illicit drug use, and problematic use of alcohol at age 24 years. A significant minority of young adults (mainly males) showed problem gambling behaviours which appeared to be established by the age of 20 years and were associated with other potentially addictive behaviours.

Gambling in Transition: Assessing Youth Narratives of Gambling in Nigeria

Nigeria has witnessed some significant changes in gambling which have resulted in more people becoming interested in the activity. In an attempt to increase participation, bookmakers have introduced a variety of innovations. Literature has established that this increased participation is inter-generational, cross-cultural, and inter-religious. Particularly among Nigerian youth, participation in gambling cuts across all age groups, socio-economic status, and gender. Both financial and social rewards have been identified as reasons why many youths gamble. Through a qualitative lens, this study investigates how the dynamics of gambling in recent times have affected the biographies of youth within a relatively deprived socio-economic locality in Kwara State, Nigeria. Thirty young gamblers between the ages of 15 and 29 were engaged in a semi-structured interview session. Drawing from the meaning of 'youth' from a sociological lexicon, one can advance this unique narrative of the transitions in gambling activities which can occur as a result of the youths' biographies and socio-economic status. Nigerian youth adopt three specific gambling types as a coping strategy in the face of a crisis-ridden socio-economic structure characterised by poverty, and unemployment. As such, gambling has become a normative activity experimented by the youth to survive the harsh economic conditions. This study therefore argues the need to situate the discourse of youth gambling within the social, cultural, and economic context in which they are located in Nigeria. In addition, the authors provide a framework for understanding the complexity of youth gambling in Nigeria.

Gambling in adolescence: a narrative review of the last 20 years

BACKGROUND

Gambling has increasingly become a problem in adolescence over the last 20 years. Previous research has failed to identify exactly the level of involvement of adolescents in gambling, yet a relevant presence of addictive behaviors was noticed.

OBJECTIVE

This narrative review highlights the implications of adolescent gambling, taking into consideration the main risk and protection factors aimed at limiting gambling activity, as well as the main links with the impulse-control disorder, addiction, and behavioral addiction.

METHODS

The review process was conducted through Medline, Scopus, Web of Science and Google Scholar search engines. The considered keywords were "Gambling" AND "Adolescence," "Behavioral addiction," AND "Adolescence." The articles related to gambling and adolescence in the last 20 years were included in compliance with inclusion and exclusion criteria, to perform a consistent analysis of the phenomenon and the related maintenance factors.

RESULTS

Starting from 1067 articles, 107 were selected to denote the main thematic areas involved in the gambling problem. The online search was completed on December 13, 2019.

CONCLUSIONS

The narrative review of literature can facilitate the analysis of gambling problems in adolescence, as the main studies in the last 20 years showed the complexity of the problem, the links between addiction, and the most effective methods of prevention and treatment.

Gambling and substance use: Comorbidity and treatment implications

Gambling disorder is a common condition that was previously listed as an impulse control disorder, but is now considered a substance-related and addictive disorder. Gambling disorder has been associated with various untoward long-term outcomes including impaired quality of life, relationship break-ups, debt and mortgage foreclosure, and elevated risk of suicidality. This paper provides a concise primer on gambling disorder, with a special focus on its parallels with substance use disorders. We consider clinical presentations, comorbid expression, heritability, and treatment approaches (psychological and pharmacological). Lastly, we highlight new treatment directions suggested by the literature.

Gambling Dual Disorder: A Dual Disorder and Clinical Neuroscience Perspective

Several behaviors, including compulsive gambling, have been considered non-substance-related addictive disorders. Categorical mental disorders (e.g., DSM-5) are usually accompanied by very different symptomatic expressions (affective, behavioral, cognitive, substance abuse, personality traits). When these mental disorders occur with addictive disorders, either concomitantly or sequentially over the life span, this clinical condition is called a dual disorder. Gambling disorder (GD) has been associated with other categorical psychiatric diagnoses: attention deficit hyperactivity disorder, depression, bipolar disorder, social anxiety, schizophrenia, substance use disorder, antisocial personality disorder; and dimensional symptoms including higher impulsivity, poorer emotional wellbeing, cognitive distortion, psychosis, deficient self-regulation, suicide, poorer family environment, and greater mental distress. We are calling this clinical condition Gambling Dual Disorder. From a clinical perspective, it is clear that Gambling Dual Disorder is not the exception but rather the expectation, and this holds true not just for GD, but also for other mental disorders including other addictions. Mental disorders are viewed as biological disorders that involve brain circuits that implicate specific domains of cognition, emotion, and behavior. This narrative review presents the state of the art with respect to GD in order to address current matters from a dual disorder, precision psychiatry, and clinical neuroscience perspective, rather than the more subjective approach of symptomatology and clinical presentation. This review also presents Gambling Dual Disorder as a brain and neurodevelopmental disorder, including from the perspectives of evolutionary psychiatry, genetics, impulsivity as an endophenotype, the self-medication hypothesis, and sexual biological differences. The wide vision of the disease advances a paradigm shift, highlighting how GD and dual disorders should be conceptualized, diagnosed, and treated. Rethinking GD as part of a dual disorder is crucial for its appropriate conceptualization from the perspective of clinical neuroscience and precision psychiatry.

Pathways connecting socioeconomic variables, substance abuse and gambling behaviour: a cross-sectional study on a sample of Italian high-school students

OBJECTIVES

The aim of this study was to elucidate the pathway of associations linking gambling, alcohol intake, smoking habit, cannabis consumption between each other and with demographic and socioeconomic variables.

SETTING AND PARTICIPANTS

A survey was conducted in 2017 on a representative sample of 15 602 Italian 14-year-olds to 17-year-olds attending 201 secondary schools.

OUTCOME MEASURES

Structural Equation Models analysis was used to assess the pathway between gambling, alcohol intake, smoking, cannabis consumption, demographics and socioeconomic factors.

RESULTS

Irrespective of socioeconomic or demographic variables, gambling is positively associated with alcohol and cannabis consumption, while cannabis consumption is predicted by smoking and by alcohol intake, smoking is predicted by alcohol intake. Adolescents with a higher weekly income are more at risk of gambling, drinking alcohol and smoking, while the degree of economic dissatisfaction was positively associated with alcohol intake, cannabis consumption and smoking. Maternal employment appeared to be positively associated with adolescents' smoking, alcohol intake and cannabis consumption.

CONCLUSIONS

This is one of the first studies to shed light on the pathways of associations connecting various health-risk behaviours among adolescents with demographic and socioeconomic factors.

Machine-Learning-Based Detection of Craving for Gaming Using Multimodal Physiological Signals: Validation of Test-Retest Reliability for Practical Use

Internet gaming disorder in adolescents and young adults has become an increasing public concern because of its high prevalence rate and potential risk of alteration of brain functions and organizations. Cue exposure therapy is designed for reducing or maintaining craving, a core factor of relapse of addiction, and is extensively employed in addiction treatment. In a previous study, we proposed a machine-learning-based method to detect craving for gaming using multimodal physiological signals including photoplethysmogram, galvanic skin response, and electrooculogram. Our previous study demonstrated that a craving for gaming could be detected with a fairly high accuracy; however, as the feature vectors for the machine-learning-based detection of the craving of a user were selected based on the physiological data of the user that were recorded on the same day, the effectiveness of the reuse of the machine learning model constructed during the previous experiments, without any further calibration sessions, was still questionable. This “high test-retest reliability” characteristic is of importance for the practical use of the craving detection system because the system needs to be repeatedly applied to the treatment processes as a tool to monitor the efficacy of the treatment. We presented short video clips of three addictive games to nine participants, during which various physiological signals were recorded. This experiment was repeated with different video clips on three different days. Initially, we investigated the test-retest reliability of 14 features used in a craving detection system by computing the intraclass correlation coefficient. Then, we classified whether each participant experienced a craving for gaming in the third experiment using various classifiers—the support vector machine, k-nearest neighbors (kNN), centroid displacement-based kNN, linear discriminant analysis, and random forest—trained with the physiological signals recorded during the first or second experiment. Consequently, the craving/non-craving states in the third experiment were classified with an accuracy that was comparable to that achieved using the data of the same day; thus, demonstrating a high test-retest reliability and the practicality of our craving detection method. In addition, the classification performance was further enhanced by using both datasets of the first and second experiments to train the classifiers, suggesting that an individually customized game craving detection system with high accuracy can be implemented by accumulating datasets recorded on different days under different experimental conditions.

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.

Students Choosing Courses: Real-Life Academic Decision Making

We examined how high school and college students make an important real-life decision: choosing the courses they will take in the upcoming academic year. Current high school and college students completed an online survey. Participants listed their course choices and the criteria they used to make their decisions (e.g., time a course meets, subject matter of a course) and also responded to a modified version of the Reactions to Decision instrument (Galotti, Tandler, & Weiner, 2014), which measured their affective reactions to the decision-making process. College students tended to list more options and criteria when describing their decisions than did high school students. High school students rated the future importance of their decisions higher and their independence in the decision-making process lower than did college students. College students reported using information specific to courses, such as instructor, time a class is scheduled, and the requirements a course met, as criteria when using courses more than did high school students. High school and college students who listed more criteria tended to be less certain and comfortable with the decision-making process than their peers. We discuss the context of this decision for each group of students.

The Effectiveness of the Game of Dice Task in Predicting At-Risk and Problem Gambling Among Adolescents: The Contribution of the Neural Networks

The Game of Dice Task (GDT; Brand et al. in Neuropsychology 19:267-277, 2005a; Psychiatry Res 133:91-99, 2005b) measures decision-making under objective risk conditions. Although disadvantageous decision-making has been shown in individuals with substance dependency, such as pathological dependency, any studies have been conducted with adolescents by using the GDT to investigate the relationship between the performance on the task and gambling behavior. Moreover, all the previous studies have considered only the GDT net score and not the single choices. In the current study, focusing on adolescents, we wanted to investigate the relationship between the sequence of the choices at the GDT and gambling behavior, measured with the SOGS-RA. To analyze the predictive power of the sequence of choices made in the GDT and problem gambling and gambling frequency, we used the Neural Networks (NNs), which are often used to find relationships between a series of input actions and the correspondent empirical outputs in order to discover behavioral patterns that may be predictive of at-risk behaviors. Results showed that neither a linear or a non-linear relationship could be detected between the GDT performance and the SOGS-RA classification both in terms of gambling problem severity and gambling frequency. Indeed, different training algorithms produced different performances of the NN on the training sets, but all of them showed a very low prediction capability on new samples. Thus, the performance at the GDT did not discriminate between adolescent gamblers with different and progressive levels of problematic gambling behavior and gambling frequency. Limitations and future studies are discussed.

Time Perspectives and Gambling in Adolescent Boys: Differential Effects of Present- and Future-Orientation

Adolescent boys are characterised by increased risk-taking behavior, including a relatively high propensity to develop problem gambling habits. The association between gambling and sensitivity to immediately available rewards is well-established, suggesting that gamblers are less influenced by potential future consequences than non-gamblers. Nevertheless, existing studies have considered present- and future-orientation as two ends of the same continuum, and have not investigated the possibility that present and future perspectives might make independent contributions to gambling behavior. In the current study, we adopted Zimbardo's multidimensional approach, which discriminates between not only present and future perspectives, but also between a hedonistic and fatalistic present-orientation (in addition to positive and negative orientations towards the past). The participants were 223 male adolescents (mean age = 16.7 years). We investigated the effects of time perspectives on gambling frequency and gambling problem severity, after taking into account the effects of age, sensation seeking, and gambling-related cognitive distortions. Gambling frequency was significantly predicted by the present fatalistic perspective, and problem gambling was significantly (negatively) related to the future perspective. The present hedonistic and past negative perspectives were also significantly related to both gambling frequency and gambling problems, although they did not explain additional variance in gambling behavior when the effects of the other factors were controlled. Overall, these results offer a fresh perspective on the role of time perspectives in gambling behavior, with potential implications for understanding the origins of gambling problems and the development of novel interventions.

Adolescents and loot boxes: links with problem gambling and motivations for purchase

Loot boxes are items in video games that can be paid for with real-world money but contain randomized contents. Many games that feature loot boxes are played by adolescents. Similarities between loot boxes and gambling have led to concern that they are linked to the development of problem gambling in adolescents. Previous research has shown links between loot boxes and problem gambling in adult populations. However, thus far, there is no empirical evidence of either the size or existence of a link between loot box spending and problem gambling in adolescents. A large-scale survey of 16- to 18-year-olds (n = 1155) found evidence for such a link (η 2 = 0.120). The link between loot box spending and problem gambling among these older adolescents was of moderate to large magnitude. It was stronger than relationships previously observed in adults. Qualitative analysis of text data showed that gamers bought loot boxes for a variety of reasons. Several of these motivations were similar to common reasons for engaging in gambling. Overall, these results suggest that loot boxes either cause problem gambling among older adolescents, allow game companies to profit from adolescents with gambling problems for massive monetary rewards, or both of the above. Possible strategies for regulation and restriction are given.

Developmental perspectives on risky and impulsive choice

Epidemiological data suggest that risk taking in the real world increases from childhood into adolescence and declines into adulthood. However, developmental patterns of behaviour in laboratory assays of risk taking and impulsive choice are inconsistent. In this article, we review a growing literature using behavioural economic approaches to understand developmental changes in risk taking and impulsivity. We present findings that have begun to elucidate both the cognitive and neural processes that contribute to risky and impulsive choice, as well as how age-related changes in these neurocognitive processes give rise to shifts in choice behaviour. We highlight how variability in task parameters can be used to identify specific aspects of decision contexts that may differentially influence risky and impulsive choice behaviour across development. This article is part of the theme issue 'Risk taking and impulsive behaviour: fundamental discoveries, theoretical perspectives and clinical implications'.

Epidemiology of technology addiction among school students in rural India

OBJECTIVE

Penetration of mobile technology is rapidly rising. Excessive use leads to Technology addiction, which often start early in adolescence. The purpose of the present study was to assess Technology addiction and its correlates among school students in rural India.

METHODS

This cross sectional study was conducted among 885 school students in north India. Four schools were selected and participants aged 13-18 years, were enrolled randomly. A self-designed 45 item questionnaire was used to evaluate dependence syndrome (intense desire, impaired control, tolerance, withdrawal, persistence despite harm, neglect of alternate pleasure) as used for substance dependence in ICD-10. Screening for depression and anxiety was done by using patient health questionnaire (PHQ-9) and generalized anxiety disorder scale (GAD-7) respectively. Descriptive and logistic regression analyses were done.

RESULTS

The mean age of the study participants was 15.1 years. Among the participants, 30.3% (95% Confidence Interval = 27.2%-33.3%) met the dependence criteria. One-third (33%) of the students stated that their grades had gone down due to gadget use. Technology addiction was more among male students (odds ratio = 2.82, 95% CI = 1.43, 5.59), those having a personal mobile phone (2.98, (1.52-5.83), use smart phone (2.77, 1.46-5.26), use one additional gadget (2.12, 1.14-3.94) and those who were depressed (3.64, 2.04-6.49).

CONCLUSION

Increased mobile phone access in rural India is leading to technology addiction among school students. Certain demographic and gadget specific factors predict addiction. The technology addiction possibly contributes to poor academic performance and depression. This warrants studies on a larger scale, with interventions for judicious use of gadgets.

Myths about "The myths about work addiction"

The present paper encompasses a response to the debate paper by Griffiths et al. about work addiction myths. Generally, we found weak empirical basis for the statement that there exist major myths and controversies regarding work addiction. Although we agree with Griffiths et al. on several issues, we argue that: (a) although work addiction is not a new behavioral addiction, work addiction research is still in its infancy; (b) work addiction is largely similar to other behavioral addictions; (c) work addiction and workaholism are actually the same; and (d) there is no compelling evidence that work addiction occurs before adulthood.

Ten myths about work addiction

BACKGROUND AND AIMS

Research into work addiction has steadily grown over the past decade. However, the literature is far from unified and there has been much debate on many different issues.

AIM AND METHODS

This paper comprises a narrative review and focuses on 10 myths about work addiction that have permeated the psychological literature and beyond. The 10 myths examined are (a) work addiction is a new behavioral addiction, (b) work addiction is similar to other behavioral addictions, (c) there are only psychosocial consequences of work addiction, (d) work addiction and workaholism are the same thing, (e) work addiction exclusively occurs as a consequence of individual personality factors, (f) work addiction only occurs in adulthood, (g) some types of work addiction are positive, (h) work addiction is a transient behavioral pattern related to situational factors, (i) work addiction is a function of the time spent engaging in work, and (j) work addiction is an example of overpathogizing everyday behavior and it will never be classed as a mental disorder in the DSM.

RESULTS

Using the empirical literature to date, it is demonstrated that there is evidence to counter each of the 10 myths.

CONCLUSION

It appears that the field is far from unified and that there are different theoretical constructs underpinning different strands of research.

Adolescent methylmercury exposure: Behavioral mechanisms and effects of sodium butyrate in mice

Methylmercury (MeHg), an environmental neurotoxicant primarily found in fish, produces neurobehavioral impairment when exposure occurs during gestation. Whether other developmental periods, such as adolescence, display enhanced vulnerability to the behavioral effects of MeHg exposure is only beginning to be explored. Further, little is known about the effects of repeated administration of lysine deacetylase inhibitors, such as sodium butyrate (NaB), on operant behavior. In Experiment 1, male C57BL6/n mice were exposed to 0, 0.3, and 3.0 ppm MeHg (n = 12 each) via drinking water from postnatal days 21 to 60 (murine adolescence). As adults, mice were trained to lever press under an ascending series of fixed-ratio schedules of milk reinforcement selected to enable the analysis of three important parameters of operant behavior using the framework provided by Mathematical Principles of Reinforcement. Adolescent MeHg exposure dose-dependently increased saturation rate, a measure of the retroactive reach of a reinforcer, and decreased minimum response time relative to controls. In Experiment 2, the behavioral effects of repeated NaB administration both alone and following adolescent MeHg exposure were examined. Male C57BL6/n mice were given either 0 or 3.0 ppm MeHg during adolescence and, before behavioral testing, two weeks of once daily i.p. injections of saline or 0.6 g/kg NaB (n = 12 in each cell). Adolescent MeHg exposure again increased saturation rate but did not significantly alter minimum response time. NaB also increased saturation rate in both MeHg exposure groups. These data suggest that the behavioral mechanisms of adolescent MeHg exposure and NaB may be related to the impact of reinforcement on prior responses. Specifically, MeHg and NaB concentrated the effects of reinforcers onto the most recent responses.

A Latent Class Analysis of Gambling Activity Patterns in a Canadian University Sample of Emerging Adults: Socio-demographic, Motivational, and Mental Health Correlates

This analysis of gambling habits of Canadian university students (ages 18-25) dovetails two recent developments in the field of gambling studies. First, the popularity of latent class analysis to identify heterogeneous classes of gambling patterns in different populations; second, the validation of the Gambling Motives Questionnaire (with financial motives) among university students-specifically to understand both how and why emerging adults gamble. Our results support a four-class model of gambling activity patterns, consisting of female-preponderant casual and chance-based gambling groups, and male-preponderant skill-based and extensive gambling groups. Each class shows a specific combination of motives, underscoring the necessity for nuanced responses to problem gambling among emerging adults. More specifically, gambling for the skill-based group appears primarily to be a source of thrill and a way to cope; for the chance-based group, gambling appears but one symptom of a set of wider issues involving depression, anxiety, substance use, and low self-esteem; while extensive gamblers seem to seek excitement, sociality, and coping, in that order. Only the chance-based group was significantly more likely than casual gamblers to be motivated by financial reasons. Situating our analysis in the literature, we suggest that interventions for the predominantly male subtypes should address gambling directly (e.g. re-focusing excitement seeking into other activities, instilling more productive coping mechanisms) while interventions for predominantly female subtypes should address low self-esteem in conjunction with depression, substance abuse, and problematic levels of gambling. We conclude future research should focus on links between self-esteem, depression, substance abuse, and financial motives for gambling among female emerging adults.

Component Model of Addiction Treatment: A Pragmatic Transdiagnostic Treatment Model of Behavioral and Substance Addictions

Behavioral addictions such as gambling, video games, sex, and shopping share many clinical features with substance use addictions including etiology, course, and neurobiology. Yet, the treatment of behavioral and substance use addictions tends to be separated. However, we argue that a more effective and efficient treatment approach is to conceptualize behavioral and substance use addictions as different expressions of a common underlying disorder and, in treatment, to address the underlying mechanisms common to both. To this end, the article presents a developing transdiagnostic treatment model of addictions that targets underlying similarities between behavioral and substance use addictions, called the component model of addiction treatment (CMAT). The CMAT is transdiagnostic in that it can be used in the treatment of both behavioral and substance use addictions. It is pragmatic in that it targets component vulnerabilities, which are enduring, yet malleable, individual psychological, cognitive, and neurobiological characteristics that are common to all addictive disorders and have been demonstrated to be modifiable. A working model of CMAT is presented, including proposed component vulnerabilities: lack of motivation, urgency, maladaptive expectancies, deficits in self-control, deficits in social support, and compulsivity, as well as their potential intervention possibilities. Future directions and potential implications of the CMAT are discussed.

Calorie Intake and Gambling: Is Fat and Sugar Consumption 'Impulsive'?

Excessive calorie intake constitutes a global public health concern, due to its associated range of untoward outcomes. Gambling is commonplace and gambling disorder is now considered a behavioral addiction in DSM-5. The relationships between calorie intake, gambling, and other types of putatively addictive and impulsive behaviors have received virtually no research attention. Two-hundred twenty-five young adults who gamble were recruited from two Mid-Western university communities in the United States using media advertisements. Dietary intake over the preceding year was quantified using the Dietary Fat and Free Sugar Short questionnaire (DFS). Clinician rating scales, questionnaires, and cognitive tests germane to impulsivity were completed. Relationships between dietary fat/sugar intake and gambling behaviors, as well as other measures of psychopathology and cognition germane to addiction, were evaluated using correlational analyses controlling for multiple comparisons. Greater dietary fat and sugar intake were associated with lower educational levels and with male gender. Controlling for these variables, higher dietary fat and sugar intake were correlated significantly with worse gambling pathology and anxiety scores. Dietary sugar intake was also significantly associated with higher depressive scores, more alcohol intake, lower self-esteem, and with greater risk of having one or more mental disorders in general. Dietary intake did not correlate significantly with ADHD symptoms, presence of one or more impulse control disorders, Barratt impulsiveness, or cognitive functioning. These data suggest a particularly strong relationship between fat/sugar intake and symptoms of gambling pathology, but not most other forms of impulsivity and behavioral addiction (excepting alcohol intake). Providing education about healthy diet may be especially valuable in gamblers and in community settings where gambling advertisements feature prominently. Future work should explore the mediating mechanisms between calorie intake and gambling symptoms, such as whether this could be driven by environmental factors (e.g. advertising) or common dysfunction of brain reward pathways.

Stress, Motivation, and the Gut-Brain Axis: A Focus on the Ghrelin System and Alcohol Use Disorder

Since its discovery, the gut hormone, ghrelin, has been implicated in diverse functional roles in the central nervous system. Central and peripheral interactions between ghrelin and other hormones, including the stress-response hormone cortisol, govern complex behavioral responses to external cues and internal states. By acting at ventral tegmental area dopaminergic projections and other areas involved in reward processing, ghrelin can induce both general and directed motivation for rewards, including craving for alcohol and other alcohol-seeking behaviors. Stress-induced increases in cortisol seem to increase ghrelin in the periphery, suggesting a pathway by which ghrelin influences how stressful life events trigger motivation for rewards. However, in some states, ghrelin may be protective against the anxiogenic effects of stressors. This critical review brings together a dynamic and growing literature, that is, at times inconsistent, on the relationships between ghrelin, central reward-motivation pathways, and central and peripheral stress responses, with a special focus on its emerging role in the context of alcohol use disorder.

Development of an effective virtual environment in eliciting craving in adolescents and young adults with internet gaming disorder

Internet gaming disorder (IGD) is a new disorder that warrants further investigation, as recently noted in the research criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Offering controlled environments that increase cue-induced craving, virtual reality cue-exposure therapy has been shown to be effective for some addiction disorders. To assess the feasibility of virtual reality for patients with IGD, this study aimed to develop virtual environments that represent risk situations for inducing craving, and assess the effect of virtual reality in cue reactivity. A total of 64 male adolescents and young adults (34 with IGD and 30 without) were recruited for participation. We developed a virtual internet café environment and the participants were exposed to four different tasks. As the primary feasibility outcome, cravings were measured with a visual analogue scale measuring current urge to play a game after exposure to each task. The virtual internet café induced significantly greater cravings in patients with IGD compared to controls. Additionally, patients exhibited a significantly higher acceptance rate of an avatar's invitation to play a game together than that of controls. In IGD, craving response to the tasks was positively associated with the symptom severity score as measured by Young's Internet Addiction Test. These findings reveal that virtual reality laden with complex game-related cues could evoke game craving in patients with IGD and could be used in the treatment of IGD as a cue-exposure therapy tool for eliciting craving.

Potential for diagnosis versus therapy monitoring of attention deficit hyperactivity disorder: a new epigenetic biomarker interacting with both genotype and auto-immunity

In view of the need for easily accessible biomarkers, we evaluated in ADHD children the epigenetic status of the 5'-untranslated region (UTR) in the SLC6A3 gene, coding for human dopamine transporter (DAT). We analysed buccal swabs and sera from 30 children who met DSM-IV-TR criteria for ADHD, assigned to treatment according to severity. Methylation levels at six-selected CpG sites (among which, a CGGCGGCGG and a CGCG motif), alone or in combination with serum titers in auto-antibodies against dopamine transporter (DAT aAbs), were analysed for correlation with CGAS scores (by clinicians) and Conners' scales (by parents), collected at recruitment and after 6 weeks. In addition, we characterized the DAT genotype, i.e., the variable number tandem repeat (VNTR) polymorphisms at the 3'-UTR of the gene. DAT methylation levels were greatly reduced in ADHD patients compared to control, healthy children. Within patients carrying at least one DAT 9 allele (DAT 9/x), methylation at positions CpG2 and/or CpG6 correlated with recovery, as evident from delta-CGAS scores as well as delta Conners' scales ('inattentive' and 'hyperactive' subscales). Moreover, hypermethylation at CpG1 position denoted severity, specifically for those patients carrying a DAT 10/10 genotype. Intriguingly, high serum DAT-aAbs titers appeared to corroborate indications from high CpG1 versus high CpG2/CpG6 levels, likewise denoting severity versus recovery in DAT 10/10 versus 9/x patients, respectively. These profiles suggest that DAT 5'UTR epigenetics plus serum aAbs can serve as suitable biomarkers, to confirm ADHD diagnosis and/or to predict the efficacy of treatment.

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).

Animal models of drug addiction: Where do we go from here?

Compulsion and impulsivity are both primary features of drug addiction. Based on decades of animal research, we have a detailed understanding of the factors (both environmental and physiological) that influence compulsive drug use, but still know relatively little about the impulsive aspects of drug addiction. This review outlines our current knowledge of the relationship between impulsivity and drug addiction, focusing on cognitive and motor impulsivity, which are particularly relevant to this disorder. Topics to be discussed include the influence of chronic drug administration on impulsivity, the mechanisms that may explain drug-induced impulsivity, and the role of individual differences in the development of impulsive drug use. In addition, the manner in which contemporary theories of drug addiction conceptualize the relationship between impulsivity and compulsion is examined. Most importantly, this review emphasizes a critical role for animal research in understanding the role of impulsivity in the development and maintenance of drug addiction.