Gambling disorder and other behavioral addictions: recognition and treatment

Prevalence and clinical phenotypes of adult patients with attention deficit hyperactivity disorder and comorbid behavioral addictions

Background

Although the correlation between substance use disorder and attention deficit hyperactivity disorder (ADHD) has been largely studied, less is known about the correlation between behavioral addictions and ADHD. Thus, the aim of the present study was to investigate the prevalence of behavioral addictions in a large sample of adult patients with a primary diagnosis of ADHD and to compare the clinical profile of ADHD patients with and without behavioral addictions comorbidity.

Methods

248 consecutive adults newly diagnosed as ADHD patients were assessed through a series of validated scales for gambling disorder, internet, sex, shopping and food addictions. ADHD patients with at least one comorbid behavioral addiction were compared to non-comorbid patients on ADHD symptoms, impulsivity, mood and anxiety symptoms and functional impairment.

Results

58.9% of patients had at least one behavioral addiction comorbidity. Of the whole sample, 31.9% of the patients had a comorbidity with one behavioral addiction while the 27% showed a comorbidity with two or more behavioral addictions. Internet addiction was the most common comorbidity (33.9%) followed by food addiction (28.6%), shopping addiction (19%), sex addiction (12.9%) and gambling disorder (3.6%). ADHD patients with comorbid behavioral addictions showed higher ADHD current and childhood symptoms, higher cognitive and motor impulsivity, higher mood and anxiety symptoms and higher functional impairment.

Conclusions

Behavioral addictions are highly frequent in adult ADHD patients. Comorbid patients seem to have a more complex phenotype characterized by more severe ADHD, mood and anxiety symptoms, higher impulsivity levels and greater functional impairment.

Meta-analysis of structural and functional abnormalities in behavioral addictions

BACKGROUND

The incidence of behavioral addictions (BAs) associated with scientific and technological advances has been increasing steadily. Unfortunately, a large number of studies on the structural and functional abnormalities have shown poor reproducibility, and it remains unclear whether different addictive behaviors share common underlying abnormalities. Therefore, our objective was to conduct a quantitative meta-analysis of different behavioral addictions to provide evidence-based evidence of common structural and functional changes.

METHODS

We conducted systematic searches in PubMed, Web of Science and Scopus from January 2010 to December 2023, supplementing reference lists of high-quality relevant meta-analyses and reviews, to identify eligible voxel-based morphometry (VBM) and functional magnetic resonance imaging (fMRI) studies. Using anisotropic seed-based D-Mapping (AES-SDM) meta-analysis methods, we compared brain abnormalities between BAs and healthy controls (HCs).

RESULTS

There were 11 GMV studies (287 BAs and 292 HCs) and 26 fMRI studies (577 BAs and 545 HCs) that met inclusion criteria. Compared with HCs, BAs demonstrated significant reductions in gray matter volume (GMV) in (1) right anterior cingulate gyri extending into the adjacent superior frontal gyrus, as well as in the left inferior frontal gyrus and right striatum. (2) the bilateral precuneus, right supramarginal gyrus, and right fusiform gyrus were hyperfunction; (3) the left medial cingulate gyrus extended to the superior frontal gyrus, the left inferior frontal gyrus, and right middle temporal gyrus had hypofunction.

CONCLUSIONS

Our study identified structural and functional impairments in brain regions involved in executive control, cognitive function, visual memory, and reward-driven behavior in BAs. Notably, fronto-cingulate regions may serve as common biomarkers of BAs.

Large-scale network abnormality in behavioral addiction

BACKGROUND

Researchers have endeavored to ascertain the network dysfunction associated with behavioral addiction (BA) through the utilization of resting-state functional connectivity (rsFC). Nevertheless, the identification of aberrant patterns within large-scale networks pertaining to BA has proven to be challenging.

METHODS

Whole-brain seed-based rsFC studies comparing subjects with BA and healthy controls (HC) were collected from multiple databases. Multilevel kernel density analysis was employed to ascertain brain networks in which BA was linked to hyper-connectivity or hypo-connectivity with each prior network.

RESULTS

Fifty-six seed-based rsFC publications (1755 individuals with BA and 1828 HC) were included in the meta-analysis. The present study indicate that individuals with BAs exhibit (1) hypo-connectivity within the fronto-parietal network (FN) and hypo- and hyper-connectivity within the ventral attention network (VAN); (2) hypo-connectivity between the FN and regions of the VAN, hypo-connectivity between the VAN and regions of the FN and default mode network (DMN), hyper-connectivity between the DMN and regions of the FN; (3) hypo-connectivity between the reward system and regions of the sensorimotor network (SS), DMN and VAN; (4) hypo-connectivity between the FN and regions of the SS, hyper-connectivity between the VAN and regions of the SS.

CONCLUSIONS

These findings provide impetus for a conceptual framework positing a model of BA characterized by disconnected functional coordination among large-scale networks.

Associations between Adverse Childhood Experiences and Gambling Severity in Youth Online Gamblers: The Mediating Roles of Internalizing, Attention and Externalizing Problems

BACKGROUND

This study examined the association between Adverse Childhood Experiences (ACEs) and Gambling Severity (gambling severity), considering the mediating roles of internalizing, externalizing, and attention among youth online gamblers.

METHODS

762 youth (agemean±SD= 15.03 ± 2.40; agerange = 10-18 years; 75.3% boys) completed the Persian Gambling Disorder Screening Questionnaire (GDSQ-P), Pediatric Symptom Checklist - Youth Report (Y-PSC), and Behavioral Risk Factor Surveillance System Questionnaire (ACE's section, modified by authors). The analysis was done using the SMART PLS software.

RESULTS

The reliability and discriminant validity of the provided model were assessed using Partial Least Squares-Structural Equation Modeling (PLS-SEM). According to the results of the PLS-SEM analysis, the present model demonstrated suitable levels of reliability and validity. Adverse Childhood Experiences (ACEs) significantly affected attention, internalizing, externalizing problems, and gambling severity. Additionally, the level of gambling was directly correlated with ACEs. Moreover, the indirect influence of the independent variable on the dependent variable via the mediators was found to be statistically significant (P < .001).These findings suggest that externalizing behaviors, attention problems, and internalizing symptoms mediate the effect of ACEs on gambling severity. Lastly, fitness indices indicated that our proposed model fit the data well (SRMR = 0.06, d_ULS = 1.15, Chi-square = 1291.461, and NFI = 0.71).

CONCLUSION

Our study found that ACEs significantly influence gambling severity among youth online gamblers, with internalizing, externalizing, and attention problems mediating this relationship. Practical implications include integrating ACE screening and targeted interventions for associated mental health issues into youth gambling prevention programs to mitigate the risk of problematic gambling behavior.

Gambling in a U.S. Census Matched Sample: Examining Interactions between Means and Motives in Predicting Problematic Outcomes

The influence of socioeconomic status (SES) on risk of Problem Gambling (PG) is complex, particularly given recent evidence that SES should be understood in both objective and subjective terms. Likewise, financial gambling motives have been found to be predictive of PG; however, financial motives are less understood in comparison to other gambling motives. Preliminary findings on SES and gambling points towards a pattern of social inequality in which those with the least financial resources (e.g., income) or that feel financially deprived relative to others (e.g., perceived deprivation) experience greater harm and problems. In a weighted, census matched sample of adults in the U.S. (N = 1,348), the present study examined the interaction between financial gambling motives and income and financial gambling motives and perceived deprivation in predicting PG. Findings provided support for both financial gambling motives and perceived deprivation as robust predictors of PG. Further, results provided unique insights into the role subjective economic standing may play in the relationship between financial motives for gambling and risk of PG.

Genetics of gambling disorder and related phenotypes: The potential uses of polygenic and multifactorial risk models to enable early detection and improve clinical outcomes

Gambling Disorder (GD) is an impactful behavioural addiction for which there appear to be underpinning genetic contributors. Twin studies show significant GD heritability results and intergenerational transmission show high rates of transmission. Recent developments in polygenic and multifactorial risk prediction modelling provide promising opportunities to enable early identification and intervention for at risk individuals. People with GD often have significant delays in diagnosis and subsequent help-seeking that can compromise their recovery. In this paper we advocate for more research into the utility of polygenic and multifactorial risk modelling in GD research and treatment programs and rigorous evaluation of its costs and benefits.

Do Smartphone Addiction and Self-Regulation Failures Affect Students' Academic Life Satisfaction? The Role of Students' Mind Wandering and Cognitive Failures

Purpose

The purpose of this study is to investigate how smartphone addiction and self-regulation failure influence students' academic life satisfaction considering the impacts of students' mind wandering and cognitive failures. It also sought to look at how students' minds wander, and cognitive failures are affected by smartphone addiction and self-regulation failure among university students.

Methods

The WarpPLS-SEM software was used to analyze the research data retrieved from a sample of 950 undergraduate students from universities in Egypt and the Kingdom of Saudi Arabia (KSA).

Results

In both countries, the findings revealed that students' smartphone addiction and self-regulation failures negatively affect students' academic life satisfaction and positively affect students' mind wandering and cognitive failures. Additionally, smartphone addiction is positively related to failures of students' self-regulation. Besides the negative influences of students' cognitive failures on their academic life satisfaction, cognitive failures mediated negatively the relationship between mind wandering and students' academic life satisfaction. Finally, students' mind wandering mediated the relationship between smartphone addiction, self-regulation failure, and academic life satisfaction.

Discussion

The study introduces fresh insights into the study variables that can be used to expand the literature on academic life satisfaction. The study provides theoretical and practical contributions to students, educators, and policymakers of education.

Examination of the Factors That Encourage University Students to Sports Betting. A Q-Method Study

This study aimed to examine the factors that motivate university students to sports betting through the Q-method. The study is designed with the Q-methodology. According to this method, qualitative and quantitative research methods are applied in the same study. Interviews were conducted with the participants of the study, question expressions were created and similar studies in the literature were used. With this feature, the current study has both structural and non-structural pattern features. In the study, the snowball sampling method, one of the purposeful sampling methods, was employed as a sampling method. The people recommended by the participants with at least five years of sports betting history were included in the study. A total of 29 university students constituted the study group. In the analysis of the data, basic components analysis was applied and it was concluded that the participants were gathered under two factors, and the value of 0.55 was reached as the significance value. As a result, it can be stated that different factors motivate the participants to bet, such as making money, seeking excitement, having social relations, sports betting as a profession, endeavor, killing time, and betting because of addiction.

Income Inequality and the Odds of Online Gambling Among a Large Sample of Adolescents in Canada

Consistent evidence points to the detrimental effects of income inequality on population health. Income inequality may be associated with online gambling, which is of concern since gambling is a risk factor for adverse mental health conditions, such as depression and suicide ideation. Thus, the overall objective of this study is to study the role of income inequality on the odds of participating in online gambling. Data from 74,501 students attending 136 schools participating in the 2018/2019 Cannabis, Obesity, Mental health, Physical activity, Alcohol, Smoking, and Sedentary behaviour (COMPASS) survey were used. The Gini coefficient was calculated based on school census divisions (CD) using the Canada 2016 Census linked with student data. We used multilevel modeling to explore the association between income inequality and self-reported participation in online gambling in the last 30 days, while controlling for individual- and area-level characteristics. We examined whether mental health (depressive and anxiety symptoms, psychosocial wellbeing), school connectedness, and access to mental health programs mediate this relationship. Adjusted analysis indicated that a standardized deviation (SD) unit increase in Gini coefficient (OR = 1.17, 95% CI 1.05, 1.30) was associated with increased odds of participating in online gambling. When stratified by gender, the association was significant only among males (OR = 1.12, 95% CI 1.03, 1.22). The relationship between higher income inequality and greater odds for online gambling may be mediated by depressive and anxiety symptoms, psychosocial well-being, and school connectedness. Evidence points to further health consequences, such as online gambling participation, stemming from exposure to income inequality.

The role of contextual factors in avenues to recover from gambling disorder: a scoping review

Introduction

Recovery from complex conditions such as gambling disorders (GD) often entail considerable change and require a range of adaptable interventions in the health care system. Outcomes from such avenues to change are influenced by multifarious contextual factors, which are less frequently considered in treatment outcome studies. Accordingly, this scoping review aims to map the level of evidence and explore how contextual factors influence the provision and outcomes of GD interventions.

Methods

A systematic search in selected health and social science research databases yielded a total of 2.464 unique references. The results were screened in three selection steps-titles (n = 2.464), abstracts (n = 284) and full-text (n = 104). The scoping approach was applied to provide a narrative account of the final included references (n = 34).

Results and discussion

Findings suggest that the research on GD treatment is in the early stages of development. Additionally, studies on GD interventions are characterized by cultural biases (Region and ethnicity and Gender perspectives), while three key elements are described as successful avenues to recover from GD (Competence, Perception and Utilization). In line with these findings, proposals for future research and treatment designs are made.

Pramipexole restores behavioral inhibition in highly impulsive rats through a paradoxical modulation of frontostriatal networks

Impulse control disorders (ICDs), a wide spectrum of maladaptive behaviors which includes pathological gambling, hypersexuality and compulsive buying, have been recently suggested to be triggered or aggravated by treatments with dopamine D2/3 receptor agonists, such as pramipexole (PPX). Despite evidence showing that impulsivity is associated with functional alterations in corticostriatal networks, the neural basis of the exacerbation of impulsivity by PPX has not been elucidated. Here we used a hotspot analysis to assess the functional recruitment of several corticostriatal structures by PPX in male rats identified as highly (HI), moderately impulsive (MI) or with low levels of impulsivity (LI) in the 5-choice serial reaction time task (5-CSRTT). PPX dramatically reduced impulsivity in HI rats. Assessment of the expression pattern of the two immediate early genes C-fos and Zif268 by in situ hybridization subsequently revealed that PPX resulted in a decrease in Zif268 mRNA levels in different striatal regions of both LI and HI rats accompanied by a high impulsivity specific reduction of Zif268 mRNA levels in prelimbic and cingulate cortices. PPX also decreased C-fos mRNA levels in all striatal regions of LI rats, but only in the dorsolateral striatum and nucleus accumbens core (NAc Core) of HI rats. Structural equation modeling further suggested that the anti-impulsive effect of PPX was mainly attributable to the specific downregulation of Zif268 mRNA in the NAc Core. Altogether, our results show that PPX restores impulse control in highly impulsive rats by modulation of limbic frontostriatal circuits.

Internet, App-Based, and Casino Gambling: Associations Between Modality, Problem Gambling, and Substance Use

Technology-based gambling prevalence is not well understood since relevant questions are not included in health and disease surveillance studies. The current study sought to estimate the prevalence of internet-based and smartphone app-based gambling, along with casino gambling, in a sample of U.S. young adults and determine if gambling modality was associated with problem gambling symptoms or substance use. The 2022 Rhode Island Young Adult Survey included N = 1,022 students between the ages of 18 to 25 years old who had lived in Rhode Island, with n = 414 lifetime gamblers (40.5%) included in this study. Odds of gambling via a smartphone app and on the internet, respectively, were greater in heterosexual cis-males compared to heterosexual cis-females (OR[95%CI] = 3.14 [1.25,7.91]; OR[95%CI] = 6.30 [2.05,19.3]). Internet gambling amongst employed students was less common than among those who were not a student and not employed (OR[95%CI] = 0.25 [0.06,1.00]). Odds of problem gambling symptoms were higher among those who gambled via a smartphone app (OR[95%CI] = 3.23 [1.21,8.60]). All forms of gambling were associated with alcohol consumption, although the strength of the association was stronger in app and internet gamblers. Casino gamblers were more likely to be high risk marijuana and illicit drug users. The rising availability of app gambling coupled with its social, psychological, and cultural context may presents an alternative pathway to problem gambling. Bans on internet gambling and/or strict guidelines on the frequency of wagers and cash placed per wager, should be considered as viable methods to mitigate associated consequences.

"Sense for Gambling" Among Jewish Ultra-Orthodox Men With Gambling Disorder

Making sense of the social world is an intricate process heavily influenced by cultural elements. Gambling is a prevalent leisure-time activity characterized by risk-taking conduct. While some individuals who engage in it do so without experiencing any harm, others will develop gambling problems. Judaism tends to perceive gambling negatively since it contradicts fundamental Jewish principles. The current study focuses on the Jewish Ultra-Orthodox community in Israel which is characterized as a cultural enclave with minimal interaction with the secular world. Hence, it provides a unique and novel socio-cultural context to inquire how individuals with gambling disorder (GD) from this community make sense of gambling. Following constructivist grounded theory guidelines, 22 Ultra-Orthodox men with GD were interviewed using a purposeful sampling design. Sixteen Rabbis were also interviewed, illuminating the socio-cultural context of Halachic regulations and norms regarding gambling in this community. An abductive analysis of the data, interwoven with Bourdieu's concept of habitus, yielded an overarching theme that we dub as "sense for gambling," encompassing matrices of Ultra-Orthodox external (e.g., a conservative cultural structure with numerous prohibitions and life marked by poverty) and internal (e.g., feelings of loneliness, dissatisfaction, and deviance) dispositions imprinted onto the body, creating diverse embodied reactions (emotional and sensory) to gambling, and leading to developing GD. We recommend placing the body, as the locus of internalized dispositions, at the core of examination when researching pathways to GD. We propose that this intricate interplay between external and internal dispositions shapes the decision-making regarding gambling, thus mitigating individual responsibility for GD.

Moderating effect of alexithymia between problem gambling and psychotic experiences in university students

BACKGROUND

Most of the young individuals with problem gambling (PG) or psychotic experiences (PEs) are less prone to seek medical help. Therefore, community-based studies investigating the relationship between these entities in non-clinical young people across a continuum of severity are warranted. To this end, the present study proposes to advance knowledge on the mechanisms that potentially underlie the association between PG and PEs, by examining the role of a potential moderator, i.e. alexithymia, in this relationship.

METHODS

A total of 399 participants enrolled in this study (mean age = 21.58 ± 3.20 years) participated in an online cross-sectional survey. The South Oaks Gambling Screen (SOGS), the Prodromal Questionnaire-Brief (PQ-B), and the Toronto alexithymia scale (TAS-20) were used.

RESULTS

Thirty-three (8.3%) participants had problem-gambling, whereas 13 (3.3%) were probable pathological gamblers. Moderation analysis results adjusted over confounders (age, household crowding index, marital status, personal history of mental disorder, other illegal drug use) showed that the interaction PG by alexithymia (p = .018) was significantly associated with PEs scores. At moderate (Beta = 1.93) and high (Beta = 3.38) levels of alexithymia, more PG was significantly associated with more PEs scores.

CONCLUSION

Findings suggest that GP may have a different impact on PEs depending on the individual's level of alexithymia. As such, both alexithymia and gambling behavior should be considered in the clinical assessment of young people who present with PEs, which can help in implementing more tailored and individualized treatment plans.

Aripiprazole and Other Third-Generation Antipsychotics as a Risk Factor for Impulse Control Disorders: A Systematic Review and Meta-Analysis

BACKGROUND

Increasing evidence suggests an association between third-generation antipsychotics (TGAs) and impulse control disorders (ICDs). This is thought to be due to their partial agonism of dopamine receptors. However, neither the relative nor absolute risks of ICDs in those prescribed TGAs are well established. To inform clinical practice, this systematic review and meta-analysis summarizes and quantifies the current evidence for an association.

METHODS

An electronic search of Medline, PsychINFO, EMBASE, and the Cochrane Clinical Trials Database was undertaken from database inception to November 2022. Three reviewers screened abstracts and reviewed full texts for inclusion. A random-effects meta-analysis was conducted with eligible studies.

RESULTS

A total of 392 abstracts were retrieved, 214 remained after duplicates were removed. Fifteen full texts were reviewed, of which 8 were included. All 8 studies found that TGAs were associated with increased probability of ICDs. Risk of bias was high or critical in 7 of 8 studies. Three studies were included in the pooled analysis for the primary outcome, 2 with data on each of aripiprazole, cariprazine, and brexpiprazole. Exposure to TGAs versus other antipsychotics was associated with an increase in ICDs (pooled odds ratio, 5.54; 2.24-13.68). Cariprazine and brexpiprazole were significantly associated with ICDs when analyzed individually. Aripiprazole trended toward increased risk, but very wide confidence intervals included no effect.

CONCLUSIONS

Third-generation antipsychotics were associated with increased risk of ICDs in all studies included and pooled analysis. However, the risk of bias is high, confidence intervals are wide, and the quality of evidence is very low for all TGAs examined.

Do attention-deficit/hyperactivity symptoms influence treatment outcome in gambling disorder?

BACKGROUND AND AIMS

Numerous studies point to the comorbidity between gambling disorder (GD) and attention deficit hyperactivity disorder (ADHD). However, there is a lack of research exploring how ADHD symptoms might influence psychological treatment outcomes for GD. Therefore, we aimed to explore differences between patients with GD with and without self-reported ADHD symptoms regarding psychopathology, personality, sociodemographic and treatment outcome measures.

METHOD

This longitudinal study included 170 patients with GD receiving cognitive behavioral therapy. Multiple self-reported instruments were used to assess clinical variables and sociodemographic measures prior to treatment.

RESULTS

A clinical profile characterized by greater GD severity, higher psychopathology and impulsivity, and less adaptive personality features was observed in patients with self-reported ADHD symptoms compared to those without. No significant differences in treatment response (measured by dropout and relapse rates) were observed between the two groups. However, patients with self-reported ADHD symptoms experienced more severe relapses (i.e., gambled more money) and GD patients who relapsed scored higher on measures of ADHD, particularly inattention.

CONCLUSION

Individuals with GD and self-reported symptoms of ADHD may experience more severe relapses following treatment, suggesting a need for more vigilant follow-up and interventions for patients with this comorbidity.

Understanding the Co-occurrence of Gambling Disorder and Problematic Pornography Use: Exploring Sociodemographic and Clinical Factors

The co-occurrence between gambling disorder (GD) and problematic pornography use (PPU) has not yet been explored. Therefore, the present study compared (a) sociodemographic variables, (b) GD-related factors, (c) substance use, (d) psychopathology, (e) personality features, (f) impulsivity, and (g) emotion regulation between individuals with GD (GD group) and those with co-occurring GD and PPU (GD+PPU group). The sample consisted of 359 treatment-seeking individuals with GD: n = 332 individuals had GD only (GD group) and n = 37 individuals had GD and co-occurring PPU (GD+PPU group). GD severity, impulsivity, psychopathology, personality, emotion regulation, and other sociodemographic and clinical variables were assessed. No between-group differences in sociodemographic measures were observed. The GD+PPU group demonstrated greater GD severity and a higher likelihood of substance use compared to those without PPU. Furthermore, the presence of PPU was associated with worse psychopathology, higher impulsivity (except for lack of premeditation and positive urgency), more difficulties in emotion regulation (except for non-acceptance of emotions and limited access to emotions), and a personality profile characterized by lower levels of self-directedness and cooperativeness. The co-occurrence of GD and PPU seems associated with a more dysfunctional clinical profile.

The landscape of open science in behavioral addiction research: Current practices and future directions

Open science refers to a set of practices that aim to make scientific research more transparent, accessible, and reproducible, including pre-registration of study protocols, sharing of data and materials, the use of transparent research methods, and open access publishing. In this commentary, we describe and evaluate the current state of open science practices in behavioral addiction research. We highlight the specific value of open science practices for the field; discuss recent field-specific meta-scientific reviews that show the adoption of such practices remains in its infancy; address the challenges to engaging with open science; and make recommendations for how researchers, journals, and scientific institutions can work to overcome these challenges and promote high-quality, transparently reported behavioral addiction research. By collaboratively promoting open science practices, the field can create a more sustainable and productive research environment that benefits both the scientific community and society as a whole.

Latent profile analysis of gambling

Early age of gambling onset, ease of gambling with technological developments and lack of controlling online gambling games have led to unmanageable risk of gambling. Individual-centered approaches play a significant role in managing the risk that gambling poses on public health and discerning the heterogeneity of gambling addiction. Therefore, this study employed Latent Profile Analysis (LPA), one of the individual-centered approaches, to model the interactions across the psychosocial characteristics of gamblers. The study aims to reveal the latent profiles of gambling addiction. Unlike variable-centered approaches, LPA is a contemporary technique that provides objective information regarding individual psychological processes and behaviors. The profile indicators of the study involve psychosocial characteristics such as resilience, motives to gamble (excitement/fun, avoidance, making money, socializing), purposefulness, responsibility and worthiness. Data were collected from 317 volunteers (M = 68.9%; F = 31.1%; mean age = 25.16 ± 6.46) through the Brief Resilience Scale (BRS), Gambling Motives Scale (GMS) and Personal Virtues Scale (PVS). The emerging profiles were defined as adventurous players (14.2%), social gamblers (9.8%), professional gamblers (32.8%), problem gamblers (24.6%) and avoidant gamblers (18.6%). The individual-centered modeling is congruent with the literature on gambling and provides a complementary perspective to understand the heterogeneous structure of gambling. The results are expected to assist mental health professionals in developing educational and clinical intervention programs for gambling behavior. Finally yet importantly, it is recommended that new LPA models be offered through the use of different indicators related to gambling addiction.

Psychological intervention for gambling disorder: A systematic review and meta-analysis

Background and aims

Increasingly, gambling features migrate into non-gambling platforms (e.g., online gaming) making gambling exposure and problems more likely. Therefore, exploring how to best treat gambling disorder (GD) remains important. Our aim was to review systematically and quantitatively synthesize the available evidence on psychological intervention for GD.

Methods

Records were identified through searches for randomized controlled trials (RCTs) evaluating psychological intervention for GD via six academic databases without date restrictions until February 3, 2023. Study quality was assessed with the revised Cochrane risk-of-bias tool for randomized trials (RoB2). Primary outcomes were GD symptom severity and remission of GD, summarized as Hedges' g and odds ratios, respectively. The study was preregistered in PROSPERO (#CRD42021284550).

Results

Of 5,541 records, 29 RCTs (3,083 participants analyzed) were included for meta-analysis of the primary outcomes. The efficacy of psychological intervention across modality, format and mode of delivery corresponded to a medium effect on gambling severity (g = -0.71) and a small effect on remission (OR = 0.47). Generally, risk of bias was high, particularly amongst early face-to-face interventions studies.

Discussion and conclusions

The results indicate that psychological intervention is efficacious in treating GD, with face-to-face delivered intervention producing the largest effects and with strongest evidence for cognitive behavioral therapy. Much remains to be known about the long-term effects, and investigating a broader range of treatment modalities and digital interventions is a priority if we are to improve clinical practice for this heterogeneous patient group.

Abnormal frontostriatal connectivity and serotonin function in gambling disorder: A preliminary exploratory study

Background

The neurobiological mechanisms of gambling disorder are not yet fully characterized, limiting the development of treatments. Defects in frontostriatal connections have been shown to play a major role in substance use disorders, but data on behavioral addictions, such as gambling disorder, are scarce. The aim of this study was to 1) investigate whether gambling disorder is associated with abnormal frontostriatal connectivity and 2) characterize the key neurotransmitter systems underlying the connectivity abnormalities.

Methods

Fifteen individuals with gambling disorder and 17 matched healthy controls were studied with resting-state functional connectivity MRI and three brain positron emission tomography scans, investigating dopamine (18F-FDOPA), opioid (11C-carfentanil) and serotonin (11C-MADAM) function. Frontostriatal connectivity was investigated using striatal seed-to-voxel connectivity and compared between the groups. Neurotransmitter systems underlying the identified connectivity differences were investigated using region-of-interest and voxelwise approaches.

Results

Individuals with gambling disorder showed loss of functional connectivity between the right nucleus accumbens (NAcc) and a region in the right dorsolateral prefrontal cortex (DLPFC) (PFWE <0.05). Similarly, there was a significant Group x right NAcc interaction in right DLPFC 11C-MADAM binding (p = 0.03) but not in 18F-FDOPA uptake or 11C-carfentanil binding. This was confirmed in voxelwise analyses showing a widespread Group x right NAcc interaction in the prefrontal cortex 11C-MADAM binding (PFWE <0.05). Right NAcc 11C-MADAM binding potential correlated with attentional impulsivity in individuals with gambling disorder (r = -0.73, p = 0.005).

Discussion

Gambling disorder is associated with right hemisphere abnormal frontostriatal connectivity and serotonergic function. These findings will contribute to understanding the neurobiological mechanism and may help identify potential treatment targets for gambling disorder.

Be more mindful: Targeting addictive responses by integrating mindfulness with cognitive bias modification or cue exposure interventions

This review provides an overview of the most prominent neurocognitive effects of cognitive bias modification (CBM), cue-exposure therapy and mindfulness interventions for targeting addictive responses. It highlights the key insights that have stemmed from cognitive neuroscience and brain imaging research and combines these with insights from behavioural science in building a conceptual model integrating mindfulness with response-focused CBM or cue-exposure interventions. This furthers our understanding of whether and how mindfulness strategies may i) facilitate or add to the induced response-focused effects decreasing cue-induced craving, and ii) further weaken the link between craving and addictive responses. Specifically, awareness/monitoring may facilitate, and decentering may add to, response-focused effects. Combined awareness acceptance strategies may also diminish the craving-addiction link. The conceptual model presented in this review provides a specific theoretical framework to deepen our understanding of how mindfulness strategies and CBM or cue-exposure interventions can be combined to greatest effect. This is important in both suggesting a roadmap for future research, and for the further development of clinical interventions.

Genetic Correlates as a Predictor of Bariatric Surgery Outcomes after 1 Year

This study analyzed genetic risk assessments in patients undergoing bariatric surgery to serve as a predictive factor for weight loss parameters 1 year after the operation. Thirty (30) patients were assessed for Genetic Addiction Risk Severity (GARS), which analyzes neurogenetic polymorphisms involved in addiction and reward deficiency. Genetic and psychosocial data collected before the operation were correlated with weight loss data, including changes in weight, body mass index (BMI), and percent of expected weight loss (%EWL). Results examined correlations between individual gene risk alleles, 1-year body weight data, and psychosocial trait scores. Spearman's correlations revealed that the OPRM1 (rs1799971) gene polymorphism had significant negative correlation with 1-year weight (rs = -0.4477, p < 0.01) and BMI (rs = -0.4477, p < 0.05). In addition, the DRD2 risk allele (rs1800497) was correlated negatively with BMI at 1 year (rs = -0.4927, p < 0.05), indicating that one risk allele copy was associated with lower BMI. However, this allele was positively correlated with both ∆Weight (rs = 0.4077, p < 0.05) and %EWL (rs = 0.5521, p < 0.05) at 1 year post-surgery. Moreover, the overall GARS score was correlated with %EWL (rs = 0.4236, p < 0.05), ∆Weight (rs = 0.3971, p < 0.05) and ∆BMI (rs = 0.3778, p < 0.05). Lastly, Food Cravings Questionnaire (FCQ) scores were negatively correlated with %EWL (rs = -0.4320, p < 0.05) and ∆Weight at 1 year post-surgery (rs = -0.4294, p < 0.05). This suggests that individuals with a higher genetic addiction risk are more responsive to weight loss treatment, especially in the case of the DRD2 polymorphism. These results should translate clinically to improve positivity and attitude related to weight management by those individuals born with the risk alleles (rs1800497; rs1799971).

From Reward to Anhedonia-Dopamine Function in the Global Mental Health Context

When "hijacked" by compulsive behaviors that affect the reward and stress centers of the brain, functional changes in the dopamine circuitry occur as the consequence of pathological brain adaptation. As a brain correlate of mental health, dopamine has a central functional role in behavioral regulation from healthy reward-seeking to pathological adaptation to stress in response to adversity. This narrative review offers a spotlight view of the transition from healthy reward function, under the control of dopamine, to the progressive deregulation of this function in interactions with other brain centers and circuits, producing what may be called an anti-reward brain state. How such deregulation is linked to specific health-relevant behaviors is then explained and linked to pandemic-related adversities and the stresses they engendered. The long lockdown periods where people in social isolation had to rely on drink, food, and digital rewards via the internet may be seen as the major triggers of changes in motivation and reward-seeking behavior worldwide. The pathological adaptation of dopamine-mediated reward circuitry in the brain is discussed. It is argued that, when pushed by fate and circumstance into a physiological brain state of anti-reward, human behavior changes and mental health is affected, depending on individual vulnerabilities. A unified conceptual account that places dopamine function at the centre of the current global mental health context is proposed.

An Empirical Study of the Pathway Model Link Between Cognitive Distortions and Gambling Problems

This research empirically tests the relationship between gambling-related cognitive distortions and the development of gambling problems. In two separate studies using methodologies designed to support non-experimental causal inference, we demonstrate that holding false beliefs about gambling experiences is related to current and future risk of developing problems with gambling. In our first study, we use an instrumental variable estimation strategy on an internet sample (n = 184) and observe a statistically significant relationship between Gamblers' Belief Questionnaire scores and measures of loss chasing, overspending, and gambling problems. These findings were robust to linear and ordinal estimation strategies and multiple model specifications. In our second study, we examine five-year prospective longitudinal data (n = 1,431) to validate our initial findings and test whether irrational thoughts are also related to future problems with gambling. While controlling for current fallacies, we find that past Gambling Fallacies Measure scores are related to present gambling problems across two survey waves. The effect size of each of the past fallacy levels is roughly half of the effect size of present levels, suggesting meaningful impacts. Our findings support the Pathways Model of Problem and Pathological Gambling.

Development of gambling disorder after bariatric surgery: a call for research

The relationship between bariatric surgery and alcohol use disorder (AUD) suggests that there may be a parallel connection between bariatric surgery and gambling disorder (GD), although this has never been researched before. Here, we describe observations suggesting that patients undergoing bariatric surgery may develop gambling disorders after surgery. Obese, older adults, and women may be at particular risk of developing GD because of their higher susceptibility to somatic comorbidities. We call for research addressing factors affecting the development of GD in patients undergoing bariatric surgery and how this could be prevented.

Pilot data findings from the Gothenburg treatment for gaming disorder: a cognitive behavioral treatment manual

Background

Gaming disorder (GD) is a new diagnosis included in the latest edition of the International Classification of Disease -11. Recently conducted international studies suggest a prevalence rate close to 2% for GD, highlighting the need for effective treatments for this patient population. Internationally there are few studies investigating effective treatments specifically designed for this condition. In this pilot study, we wanted to test a newly developed method, the Gothenburg Treatment for Gaming Disorder (GOT-TO-GO) manual; a 15-week cognitive behavioral therapy treatment for GD.

Method

This study utilized a single group design with pretest, post-test and a three- and six-month follow-up, with measures of severity of GD and mood. The participants (n = 28) were treatment-seeking adults with GD, aged 17 to 49 years.

Results

The results show a statistically significant decrease in symptoms of GD after treatment. Hours of gaming per week also decreased concomitantly with a 100% increase in non-gaming leisure hours. The decrease in symptoms of GD was maintained at the 3-months follow-up after treatment. Correspondingly we saw a decrease in both depression and anxiety that also was upheld 3 months after treatment.

Conclusion

As GD is a new diagnostic concept more research is needed, also taking psychiatric comorbidity into consideration, to arrive at evidence-based conclusions regarding effective treatments. Considering the promising results in this small pilot study with large behavioral changes and reduced symptoms of GD, upheld at least 3 months after treatment, a larger randomized controlled study is warranted.Clinical Trial Registration: https://www.clinicaltrials.gov/ct2/show/study/NCT05328596?term=NCT05328596&draw=2&rank=1, identifier NCT05328596.

Temporal order of diagnosis between gambling disorder and substance use disorders: Longitudinal results from the Norwegian Patient Registry

Introduction

Previous research has established co-occurrence between substance use disorders (SUDs) and gambling disorder (GD). Less well understood is the temporal sequencing of onset between these disorders, and in particular whether SUD is a risk factor for GD. The present study examined the temporal order between registered diagnoses of SUD and GD, stratified by sex.

Methods

A study with a longitudinal design using objective registry data drawn from the Norwegian Patient Registry was carried out. Among the patients with a registered diagnosis of GD between 2008 and 2018 (N = 5,131; males = 81.8%), those (who in addition) had a registered diagnosis of any SUD (n = 1,196; males = 82.1%) were included. The measures included a registered diagnosis using the ICD-10 of both GD (code F63.0) and SUDs (codes F10-F19) by a health care professional. Binomial tests were used to identify the temporal order between SUD(s) and GD. Co-occurring cases (i.e., cases diagnosed within the same month) were removed in the main analyses.

Results

Results showed a significant directional path from SUD to GD but no support for the reversed path (i.e., from GD to SUD). This finding was similar overall for (i) both males and females, (ii) when different SUDs (alcohol, cannabis, sedatives, and polysubstance) were examined individually, and (iii) when specifying a 12-month time-lag between diagnoses.

Conclusions

The findings suggest that experiencing SUD(s) is a risk marker for GD given the temporal precedence observed for patients in specialised healthcare services seeking treatment. These results should be considered alongside screening and prevention efforts for GD.

Smartphone Apps for Problem Gambling: A Review of Content and Quality

Purpose of review

Problem gambling can have profound consequences for affected individuals, yet only a small proportion of people with problem gambling seek treatment. Mobile phone applications (apps) may provide an effective and scalable therapeutic option. The purpose of this study was to evaluate publicly available mobile apps aimed at improving problematic gambling behavior.

Recent findings

To date, there are no published studies that have evaluated the quality of publicly available smartphone apps for problem gambling in the US. There is thus a significant gap in knowledge of existing apps for addressing problem gambling.

Summary

This study included a review of 14 problem-gambling-specific apps. Apps that incorporated cognitive-behavioral therapy concepts and in-app communities were associated with better aesthetics and information quality scores. Additionally, in-app communities were associated with better engagement scores. Our results highlight the importance of evidence-based and engaging features in apps designed to help people with problem gambling.

A Comparative Event-Related Potentials Study between Alcohol Use Disorder, Gambling Disorder and Healthy Control Subjects through a Contextual Go/NoGo Task

(1) Background: Inhibitory and rewarding processes that mediate attentional biases to addiction-related cues may slightly differ between patients suffering from alcohol use (AUD) or gambling (GD) disorder. (2) Methods: 23 AUD inpatients, 19 GD patients, and 22 healthy controls performed four separate Go/NoGo tasks, in, respectively, an alcohol, gambling, food, and neutral long-lasting cueing context during the recording of event-related potentials (ERPs). (3) Results: AUD patients showed a poorer inhibitory performance than controls (slower response latencies, lower N2d, and delayed P3d components). In addition, AUD patients showed a preserved inhibitory performance in the alcohol-related context (but a more disrupted one in the food-related context), while GD patients showed a specific inhibitory deficit in the game-related context, both indexed by N2d amplitude modulations. (4) Conclusions: Despite sharing common addiction-related mechanisms, AUD and GD patients showed different patterns of response to (non-)rewarding cues that should be taken into account in the therapeutic context.

Use of experimental medicine approaches for the development of novel psychiatric treatments based on orexin receptor modulation

Despite progress in understanding the pathological mechanisms underlying psychiatric disorders, translation from animal models into clinical use remains a significant bottleneck. Preclinical studies have implicated the orexin neuropeptide system as a potential target for psychiatric disorders through its role in regulating emotional, cognitive, and behavioral processes. Clinical studies are investigating orexin modulation in addiction and mood disorders. Here we review performance-outcome measures (POMs) arising from experimental medicine research methods which may show promise as markers of efficacy of orexin receptor modulators in humans. POMs provide objective measures of brain function, complementing patient-reported or clinician-observed symptom evaluation, and aid the translation from preclinical to clinical research. Significant challenges include the development, validation, and operationalization of these measures. We suggest that collaborative networks comprising clinical practitioners, academics, individuals working in the pharmaceutical industry, drug regulators, patients, patient advocacy groups, and other relevant stakeholders may provide infrastructure to facilitate validation of experimental medicine approaches in translational research and in the implementation of these approaches in real-world clinical practice.

Running addiction

BACKGROUND

Running is a common physical activity of an aerobic nature that is carried out mostly outdoors and presents a healthy lifestyle. However, the positive effect of running often masks the downsides of potential addiction that can compromise an individual's physical, mental, and social functioning. Most often there is a thin and unclear line separating passionate athletes and running addicts. Thus, it is necessary to educate the running community to raise awareness of the negative effects of over-training, prevent complications and injuries and to seek the necessary help.

METHODS

The study sample consisted of runners from the Croatian population of both genders, aged 18 to 75, who have been running for more than a year. The respondents were divided into groups according to the favorite length of the racing race. Groups were compared in terms of nutritional supplements usage, running-related injuries, as well as the impact of Covid-19 pandemic on their running volume. Difference between groups in Exercise Addiction Inventory (EAI) questionnaire outcome scores was also accessed.

RESULTS

The statistical analysis included the answers of 644 people of both genders, among which 309 (48%) men and 335 (52%) women. The average age of the respondents was 42 years (18-75), and the average age of running was 5 years (1-42). Only among the respondents who started running most recently (1 to 10 years), and those who run the longest races (longer than 100 km) were found to use nutritional supplements significantly more (71.43%, P<0.001) and sustained injuries associated with running more than rest of the groups (100%, P=0.013). Due to the pandemic, only respondents who have been running for the longest time (31-42 years) and prefer to run races from 21 to 42 km significantly reduced the amount of training (75%, P=0.037). The risk for addiction was significantly positively associated with the use of dietary supplements, the favorite length of the race and the frequency of injuries, while there was no association with the length of running.

CONCLUSIONS

Running is a high-risk sport for addiction development. All the benevolent attitudes and positive effects of running often mask the downsides of addiction that can compromise an individual and his or her physical, mental, and social functioning. Due to the high percentage of addiction risk of 25%, it is necessary to educate the racing community to raise awareness of the negative effects of overtraining, prevent complications and seek the necessary help.

Features Linked to Treatment Outcomes in Behavioral Addictions and Related Disorders

Behavioral addictions are incompletely understood with respect to their underlying etiologies. This incomplete understanding may contribute to the frequent relapse and dropout rate often observed with behavioral addictions. The present state-of-the-art review aimed to review the literature that explored sociodemographic and clinical factors that link to poor treatment responses. Despite multiple studies, the definitions and evaluations of relapse and dropout are heterogeneous, complicating comparisons across studies. A scientific consensus on the conceptualization of both terms would help to better understand psychological features linked to treatment outcomes in behavioral addictions.

Predictors of adverse gambling behaviours amongst elite athletes

Problem gambling levels amongst elite sportspeople are above populational baseline. We assess gambling in an elite Irish sporting population. An anonymous web-based questionnaire including the validated Problem Gambling Severity Index was distributed. Univariate and multivariate analyses were performed to evaluate predictors of moderate/high risk gambling. 608 players (mean age 24) were included. Seventy nine percent of respondents were current gamblers and 6% problem gamblers. Amongst high-risk gamblers, significantly more were male (100% vs 76%, p = 0.003), fewer completed university (52% vs 69%, p = 0.024), and more were smokers (48% vs 24%, p = 0.002). They were also more likely to avail of free online gambling offers (90% vs 44%, p < 0.001), gamble with teammates (52% vs 21%, p < 0.001) and have placed their first bet before age 16 (41% vs 19%, p = 0.003). In multivariate analysis, moderate/high risk gambling was associated with: male gender (OR = 8.9 [1.1-69], p = 0.035), no 3rd level education (OR = 2.5 [1.4-5.0], p = 0.002), free online gambling use (OR = 4.3 [2.1-5.3], p < 0.001), gambling with teammates (OR = 3.0 [1.7-5.3], p < 0.001), and being under 18 at first bet (OR = 2.0 [1.1-3.3], p = 0.013). This study shows a harmful gambling culture amongst elite Irish athletes. Male gender, lower educational status, free online gambling use, gambling with teammates and first bet at less than age 18 were associated with moderate/high risk gambling. These groups may benefit from targeted interventions.

Worsened Anxiety and Loneliness Influenced Gaming and Gambling during the COVID-19 Pandemic

Aim: To study the prevalence and patterns of problematic gaming and gambling during the COVID-19 pandemic and the association with psychiatric traits and major types of anxiety categories. Method: 1067 young adults participated in both wave 3 (2018) and wave 4 (2021) of the SALVe Cohort. Associations with psychiatric symptoms and anxiety were examined using logistic regression and Chi-square tests. Results: Problematic gaming decreased by 1.3 percentage points to 23.2% since the start of the pandemic, while problematic gambling increased by 0.9 percentage points to 6.5% in w4. Average time spent playing video games/day decreased from 2.2 h (w3) to 1.7 h (w4), while increases in gaming activity were associated with worsened feelings of loneliness (p = 0.002), depression (p < 0.001), and anxiety (p < 0.01) during the pandemic. Predictors for problematic gaming at w4 were previous problematic gaming and social anxiety (p = < 0.001 and 0.01, respectively). Moreover, previous problem gambling also predicted problem gambling at w4 p < 0.001. All anxiety categories were associated with both problematic gaming and gambling when adjusted for age and sex. However, after adjusting for depression and insomnia, social anxiety was associated with problematic gaming (p < 0.001), while panic was associated with problem gambling (p < 0.001). Conclusion: Overall, problematic gaming has decreased since the start of the pandemic, while problem gambling has increased. Worsened feelings of loneliness, depression, and anxiety during the pandemic are associated with increased gaming. Moreover, the association between problematic gaming and gambling and anxiety is independent of depression and sleep problems.

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.

Genetic Addiction Risk and Psychological Profiling Analyses for "Preaddiction" Severity Index

Since 1990, when our laboratory published the association of the DRD2 Taq A1 allele and severe alcoholism in JAMA, there has been an explosion of genetic candidate association studies, including genome-wide association studies (GWAS). To develop an accurate test to help identify those at risk for at least alcohol use disorder (AUD), a subset of reward deficiency syndrome (RDS), Blum's group developed the genetic addiction risk severity (GARS) test, consisting of ten genes and eleven associated risk alleles. In order to statistically validate the selection of these risk alleles measured by GARS, we applied strict analysis to studies that investigated the association of each polymorphism with AUD or AUD-related conditions, including pain and even bariatric surgery, as a predictor of severe vulnerability to unwanted addictive behaviors, published since 1990 until now. This analysis calculated the Hardy-Weinberg Equilibrium of each polymorphism in cases and controls. Pearson's χ2 test or Fisher's exact test was applied to compare the gender, genotype, and allele distribution if available. The statistical analyses found the OR, 95% CI for OR, and the post risk for 8% estimation of the population's alcoholism prevalence revealed a significant detection. Prior to these results, the United States and European patents on a ten gene panel and eleven risk alleles have been issued. In the face of the new construct of the "preaddiction" model, similar to "prediabetes", the genetic addiction risk analysis might provide one solution missing in the treatment and prevention of the neurological disorder known as RDS.

A Systematic Review of Eye-Tracking Studies of Gambling-Related Attentional Biases

Previous research has identified attentional biases towards addiction-related stimuli, including gambling-related stimuli. Eye-tracking is considered the gold standard methodology for measuring attentional biases, yet no review to date has examined its use in measuring gambling-related attentional biases. This systematic review synthesized the literature using eye-tracking to examine attentional biases among people who gamble. We reviewed articles from Web of Science and PubMed that were published from 1990 to 2021. A total of 11 articles were included, with sample sizes ranging from 38 to 173 participants. Of these studies, seven examined attentional biases for gambling-related visual stimuli. These seven studies provided support that gambling can result in the development of an attentional bias for gambling-related stimuli. With respect to correlates of gambling-related attentional biases, there were mixed results. Some studies identified significant positive associations between gambling-related attentional biases and psychosocial variables, such as problem gambling severity, gambling expectancies, gambling cravings, gambling motives, depressive symptom severity, alcohol use severity, daily stress, affective impulsivity, and immersion. Four studies examined attentional biases for responsible gambling messaging and advertisements, finding that both people who do and do not gamble attend less to responsible gambling messaging compared to other types of information such as the betting odds. Research using eye-tracking to examine attentional biases among people who gamble is in its infancy. Yet, the preliminary results support the identification of attentional biases using the gold-standard methodology. Further studies are needed to examine the correlates and potential clinical utility of assessing gambling-related attentional biases using eye-tracking.

Behavioral Addictions Questionnaire (BAQ): Validation of a New Tool for the Screening of Multiple Addictive Behaviors in the Italian Population

This study deals with the uncertainty in defining behavioral addictions (BAs). BAs are characterized by specific compulsive behaviors, regardless of potential negative consequences. However, to differentiate a behavior from a leisure activity to an addictive one is still an object of debate in the literature. Accordingly, this study aimed to assess the psychometric properties of the Behavioral Addictions Questionnaire (BAQ) as a possible screening tool for multiple BAs (i.e., shopping, food addiction, gambling, sex, work, exercise, Internet, videogames, and smartphone). BAQ aims to give a dimensional and quantitative assessment of addictive behaviors in a continuum, including both the adaptive and maladaptive features of the behaviors. Five hundred and seventy-six healthy adults (age range: 18–88) participated in the study, completing a survey including the BAQ questionnaire. Considering both exploratory and confirmatory factor analyses, statistical examination suggested good psychometric properties, with adequate validity in all its subscales (i.e., the goodness of fit). Moreover, also higher reliability was confirmed for each dimension detected (i.e., all alpha over 0.65). The BAQ represents a comprehensive screening instrument that benefits from appropriate validity and reliability for assessing BAs. Therefore, it can be used in clinical fields and research. Moreover, the feature of BAs on a continuum, and the severity index adopted by the study, can help from a preventive perspective. However, further validation of the BAQ is needed in other countries and contexts.

Technological Addictions

PURPOSE OF REVIEW

Modern methods of communication and engagement, such as social media, video games, and online shopping, use a variety of behavioral techniques to encourage and reward frequent use, opening the door to addiction. The technological addictions (TAs) are a set of disorders that accompany the technological advances that define the digital age. The TAs are an active source of research in the literature, with promising treatment options already available.

RECENT FINDINGS

There are promising therapeutic and psychopharmacologic treatments for a broad range of TAs. Stimulants, antidepressants, and cognitive therapies may all be effective for internet gaming disorder (IGD). Cognitive therapies may be effective for other TAs, such as social media addiction (SMA), online shopping addiction (OSA), and online porn addiction. Society's dependence on addictive technologies will only increase. Many of the TAs can be addressed with medication and therapy, with more research and literature developing at a rapid pace.

Correlates of sedentary behavior in Asian preschool-aged children: A systematic review

This systematic review aims to identify the multilevel correlates of sedentary behavior (SB) and its sub-domains among preschool-aged children aged 0-7 years in Asia. We systematically searched for studies published from 2000 onwards using terms related to SB correlates and Asia in six databases. Eligible studies were observational and used quantitative methods to examine correlates of total, and domain-specific SB (screen viewing [SV] and non-screen-based SB) in Asian children living in Asia. Two reviewers independently screened identified references. Following quality assessment of included studies, we performed narrative synthesis to summarize the evidence on the intrapersonal, interpersonal, environmental correlates of total and domain-specific SB (PROSPERO: CRD42018095268). Twenty-two studies from 4 regions and 12 countries/territories were included. Out of the 94 correlates explored, the following associations were consistent: older age, being a boy, non-Chinese ethnicity (Southeast Asia), younger maternal age, higher maternal and paternal television-viewing time with higher SV; higher SV at earlier age with higher SV and total SB; and presence of TV/computer in the bedroom with higher leisure-time SB. We encourage more studies from low- and middle-income Asian countries with an increased focus on different SB domains, further exploration of environmental correlates, and the use of objective measurements to capture SB.

Technological Addictions

Modern technology rewards constant engagement and discourages sparing use, opening the door to unhealthy use and even addiction. The technological addictions (TAs) are a newly described set of disorders that come with the technological advances that define the new era. Internet gaming disorder (IGD) is already codified as a proposed diagnosis in the 5th Edition of the Diagnostic and Statistical Manual (DSM-5) of the American Psychiatric Association. Others, such as social media addiction (SMA), are in the earlier stages of our understanding. This article provides an overview of the more common TAs including their evaluation and treatment techniques.

Gender-related differences in involvement of addiction brain networks in internet gaming disorder: Relationships with craving and emotional regulation

BACKGROUND

Abnormal interactions among addiction brain networks associated with intoxication, negative affect, and anticipation may have relevance for internet gaming disorder (IGD). Despite prior studies having identified gender-related differences in the neural correlates of IGD, gender-related differences in the involvement of brain networks remain unclear.

METHODS

One-hundred-and-nine individuals with IGD (54 males) and 111 with recreational game use (RGU; 58 males) provided resting-state fMRI data. We examined gender-related differences in involvement of addiction brain networks in IGD versus RGU subjects. We further compared the strength between and within addiction brain networks and explored possible relationships between the strength of functional connectivities within and between addiction brain networks and several relevant behavioral measures.

RESULTS

The addiction brain networks showed high correct classification rates in distinguishing IGD and RGU subjects in men and women. Male subjects with versus without IGD showed stronger functional connectivities between and within addiction brain networks. Moreover, the strength of the connectivity within the anticipation network in male IGD subjects was positively related to subjective craving. However, female subjects with versus without IGD showed decreased functional connections between and within addiction brain networks. The strength of connectivity between the anticipation and negative-affect brain networks in female IGD subjects was negatively related to maladaptive cognitive emotion-regulation strategies.

CONCLUSIONS

Addiction brain networks have potential for distinguishing IGD and RGU individuals. Importantly, this study identified novel gender-related differences in brain-behavior relationships in IGD. These results help advance current neuroscientific theories of IGD and may inform gender-informed treatment strategies.

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.

Digital Addiction and Sleep

In 2020, the World Health Organization formally recognized addiction to digital technology (connected devices) as a worldwide problem, where excessive online activity and internet use lead to inability to manage time, energy, and attention during daytime and produce disturbed sleep patterns or insomnia during nighttime. Recent studies have shown that the problem has increased in magnitude worldwide during the COVID-19 pandemic. The extent to which dysfunctional sleep is a consequence of altered motivation, memory function, mood, diet, and other lifestyle variables or results from excess of blue-light exposure when looking at digital device screens for long hours at day and night is one of many still unresolved questions. This article offers a narrative overview of some of the most recent literature on this topic. The analysis provided offers a conceptual basis for understanding digital addiction as one of the major reasons why people, and adolescents in particular, sleep less and less well in the digital age. It discusses definitions as well as mechanistic model accounts in context. Digital addiction is identified as functionally equivalent to all addictions, characterized by the compulsive, habitual, and uncontrolled use of digital devices and an excessively repeated engagement in a particular online behavior. Once the urge to be online has become uncontrollable, it is always accompanied by severe sleep loss, emotional distress, depression, and memory dysfunction. In extreme cases, it may lead to suicide. The syndrome has been linked to the known chronic effects of all drugs, producing disturbances in cellular and molecular mechanisms of the GABAergic and glutamatergic neurotransmitter systems. Dopamine and serotonin synaptic plasticity, essential for impulse control, memory, and sleep function, are measurably altered. The full spectrum of behavioral symptoms in digital addicts include eating disorders and withdrawal from outdoor and social life. Evidence pointing towards dysfunctional melatonin and vitamin D metabolism in digital addicts should be taken into account for carving out perspectives for treatment. The conclusions offer a holistic account for digital addiction, where sleep deficit is one of the key factors.

Gambling, Gaming, and Internet Behavior in a Sexual Minority Perspective. A Cross-Sectional Study in Seven European Countries

Background

Addictive behavior of gambling, gaming and internet activity is partly a new research domain and has not been well investigated with regard to sexual minority populations. Although health disparities between sexual minorities and the general population are well documented, there is a lack of inclusion of sexual minorities in both research and clinic. Among lesbian, gay and bisexual populations certain features could be present that play a role for the development of addictive behaviors, such as social isolation and increased risk of other psychiatric problems. The aim of this study was to investigate problem gambling, problem gaming and problematic internet behavior in a European context and if it is affected by sexual orientation status.

Methods

An online web-survey was distributed among web-panels in England, Poland, Switzerland, Italy, Spain, Denmark, and Sweden in 2017-2018.

Result

10 983 complete answers were collected. 7.1% of the participants had a sexual minority status (n = 774). Regression models found that there was no difference in gambling, gaming and internet behavior among heterosexual and sexual minority men. Sexual minority women were associated with problematic gambling and gaming behavior, when also controlling for age and nationality. When also controlling for psychological distress, women defining as having another sexual minority status than lesbian and bisexual remained significant for having a problematic gaming behavior (AOR = 2.3).

Conclusion

An awareness of female sexual minority perspectives is relevant in facilities treating behavioral addiction as well as in future research in behavioral addiction. More research is needed in problematic gambling and gaming behavior in different sexual minority populations with regard to psychiatric comorbidity and living conditions. An inclusion of sexual minority groups defining as other than gay and bisexual is needed in future research. No significant differences were found between heterosexual and sexual minority men in adjusted analysis in this study.