Childhood impulsive behavior and problem gambling by adulthood: a 30-year prospective community-based study

The effects of cognitive bias and cognitive style on trait impulsivity in moderate-risk gambling: The moderating effect of self-control

Background

Impulsivity has been defined as a tendency to respond with little forethought, often with disregard to the negative consequences to the impulsive individual or others. Problem gambling patients are characterized with impulse control and absent inhibition control, a tendency to react to stimuli in a rapid and unplanned fashion without complete processing of information.

Method

Based on the information processing theory and the dual-systems model of self-control, 208 moderate-risk gambling were investigated by questionnaire to explore the moderating effect of self-control in the process of cognitive bias and cognitive style affecting the gambling impulse of moderate-risk gambling.

Conclusion

Using hierarchical regression analysis, it is found that: (a) The gambling impulse of male moderate-risk gambling was stronger than female moderate-risk gambling. (b) Self-control negatively predicted trait impulsivity, and the stronger the individual self-control, the lower the level of trait impulsivity. (c) Cognitive bias positively predicted trait impulsivity, and high cognitive bias induced high-level trait impulsivity. Self-control played a moderating role between cognitive bias and trait impulsivity. (d) Compared with field-independent gambling, field-dependent gambling were more likely to have impulsive thoughts of gambling activities. Self-control played a moderating role between cognitive style and trait impulsivity.

Maternal smoking during pregnancy, offspring smoking, adverse childhood events, and risk of major depression: a sibling design study

BACKGROUND

Evidence of a biologically plausible association between maternal smoking during pregnancy (MSP) and the risk of depression is discounted by null findings from two sibling studies. However, valid causal inference from sibling studies is subject to challenges inherent to human studies of MSP and biases particular to this design. We addressed these challenges in the first sibling study of MSP and depression conducted among adults past the peak age for the onset of depression, utilizing a prospectively collected and biologically validated measure of MSP and accounting for non-shared as well as mediating factors.

METHODS

We fit GEE binomial regression models to correct for dependence in the risk of depression across pregnancies of the same mother. We also fit marginal structural models (MSM) to estimate the controlled direct effect of MSP on depression that is not mediated by the offspring's smoking status. Both models allow the estimation of within- and between-sibling risk ratios.

RESULTS

The adjusted within-sibling risk ratios (RR_W) from both models (GEE: RR_W = 1.97, CI 1.16-3.32; MSM: RR_W = 2.08, CI 1.04-4.17) evinced an independent association between MSP and risk of depression. The overall effects from a standard model evinced lower associations (GEE: RR_T = 1.12, CI 0.98-1.28; MSM: RR_T = 1.18, CI 1.01-1.37).

CONCLUSIONS

Based on within-sibling information free of unmeasured shared confounders and accounting for a range of unshared factors, we found an effect of MSP on the offspring's risk of depression. Our findings, should they be replicated in future studies, highlight the importance of considering challenges inherent to human studies of MSP and affective disorders.

The Use of Smartphone Serious Gaming Apps in the Treatment of Substance Use Disorders: Observational Study on Feasibility and Acceptability

Background

Addiction is a worldwide problem with major health complications. Despite intensive treatment, relapse rates remain high. The prevalence of cognitive impairment is high in patients with substance use disorders (SUDs) and is associated with treatment dropout and relapse. Evidence indicates that cognitive function training in persons with SUDs may support treatment. Therefore, the use of web-based tools to test and train cognitive functions is of increasing interest.

Objective

The goal of this study was to determine the feasibility and acceptability of a serious gaming smartphone app to test and train cognitive functions in addition to the treatment of SUDs.

Methods

A prospective observational study was conducted with 229 patients seeking addiction treatment. The patients were offered 2 smartphone apps in addition to regular care: MyCognition Quotient (MyCQ) assessed cognitive functions and AquaSnap trained these functions. The feasibility was determined based on acceptance rates. The acceptability of the smartphone apps was qualitatively analyzed based on the answers to a questionnaire. Patient characteristics were compared between patients who played and did not play smartphone games. Explorative correlation analyses were performed between the playing time and cognitive assessment scores.

Results

Of the 229 patients who were offered the apps, 110 completed the MyCQ assessment, and 59 started playing AquaSnap, yielding acceptance rates of 48.0% and 25.8%, respectively. The group that completed the MyCQ assessment was significantly more educated than the group that did not download the apps (χ²₂=7.3; P=.03). The education level did not differ significantly between the group that played AquaSnap and the group that did not (P=.06). There were relatively more women in the AquaSnap playing group than in the nonplaying group (χ²₁=6.5; P=.01). The groups did not differ in terms of age, substance use, treatment setting, mood, or quality of life. With respect to acceptability, 83% (38/46) of the patients who filled out the questionnaire enjoyed taking the MyCQ measurement, whereas 41% (14/34) enjoyed playing the AquaSnap game. Furthermore, 76% (35/46) and 68% (23/34) rated the apps MyCQ and AquaSnap, respectively, as easy. More playing minutes was associated with decreased working memory reaction time and executive functioning accuracy.

Conclusions

Our study showed that the use of a smartphone app for cognitive assessment in patients with SUDs who are interested and highly educated is feasible and acceptable for the subgroup that was asked to fill out a perception questionnaire. However, the use of a smartphone app for cognitive training was less feasible for this group of patients. Improvement of the training application and enhancement of the motivation of clients are needed. Despite these limitations, the present results provide support for future research investigating the use of smartphone apps for cognitive assessment and training in relation to the treatment of SUDs.

Moderating Effect of Impulsivity on the Association Between Entrapment and Problem Gambling

Impulsivity as measure by delay discounting and entrapment have been known to influence gambling, but their individual and joint influence on problem gambling among Soccer gamblers are not yet understood. We examine the direct and moderation influences of entrapment and delay discounting on problem gambling among 174 Soccer gamblers in Nigeria. Data were obtained by means of self-report questionnaires of entrapment, delay discounting and problem gambling. Results from Hayes PROCESS moderated regression showed that delay discounting moderated the association between entrapment and problem gambling such that the association between entrapment and problem gambling was strong when delay discounting was high and diminished when delay discounting was low. Our findings provide insight into the conditional effect of delay discounting on the entrapment-problem gambling association.

A Longitudinal Analysis of Gambling Predictors among Adolescents

Although gambling is forbidden for minors, the prevalence of gambling among adolescents is increasing. In order to improve preventive interventions, more evidence on predictors of gambling onset is needed. A longitudinal study was proposed to (1) establish the prevalence of gambling; (2) identify factors associated with gambling behavior the following year; and (3) adjust a model to predict gambling behavior. A cohort of 1074 students (13-18 years old) was followed for 12 months. The prevalence of gambling reached 42.0% in the second measure. Boys gambled 2.7 times more than girls, and the highest percentages of gambling onset showed up between 13 and 14 years old. Gambling onset and maintenance was associated with gender, age, sensation-seeking, risk perception, self-efficacy for not gambling, parents' attitude towards gambling, group pressure (friends), subjective norm, exposure to advertising, accessibility, normative perception, gambling in T₁ and parents gambling behavior. Gender, gambling in T₁ and risk perception were significant in all three logistic adjusted regression models, with the fourth variable being sensation seeking, peer pressure (friends) and accessibility, respectively. It is suggested that universal prevention should be aimed preferably at children under 15 years old and to alert regulators and public administrations to the directly proportional relationship between accessibility and gambling onset.

Impulsivity, Lack of Premeditation, and Debts in Online Gambling Disorder

Background and Objectives: Gambling disorder (GD) is a recurrent and persistent problematic gambling behavior that impairs multiple areas of an individual's life. GD can persist through two modes: online or offline. This study aims to compare sociodemographic, clinical, and psychological characteristics between treatment-seeking online and offline gamblers and analyze the effect of the gambling mode (online or offline) on anxiety, depression, impulsivity, and debts. Methods: Seventy-nine treatment-seeking gamblers (96.2% males), who were simultaneously receiving treatment at a specialized Pathological Gambling and Behavioral Addictions Unit, participated in this study. The sample was divided into two subsamples: online (n = 29, 100% males) and offline (n = 50, 94% males); the characteristics of these two groups were compared and analyzed using Chi-Square test (χ²), t-Test or Mann-Whitney U-test (p < 0.05). Multiple linear regression analyses were performed to determine the effects of gambling mode on significant variables (lack of premeditation and debts). Results: The online sample with a mean age of 29.4 years mainly chose to engage in sports betting (45%, p < 0.05) and showed a higher lack of premeditation levels (25.8 points, p < 0.05) than the offline sample. In addition, the online sample was younger with respect to their onset to gambling (20.2 years, p < 0.05) and the beginning of their gambling problems (25 years, p < 0.05) compared to the offline sample. Online gambling increased the levels of lack of premeditation by an average of 5.43 points compared to offline gambling (p < 0.05). Accumulated debts of the online sample were lower (€11,000) than those of the offline sample (€12,000). However, the interaction between age and gambling mode revealed that online gamblers increased their debt amounts with age at an average increase of €2,726.33 per year compared to offline gamblers (p < 0.05). No significant influence of gambling mode was found on GD severity, anxiety, and depression levels. Conclusions: Gambling mode has a significant relationship with lack of premeditation-a component of impulsivity-and accumulation of debts in treatment-seeking people with GD; however, no relationship was found with the rest of the variables analyzed. Future research with larger samples is needed to confirm these findings.

The Intergenerational Association Between Parents' Problem Gambling and Impulsivity-Hyperactivity/Inattention Behaviors in Children

Despite the well-established association between problem gambling and ADHD core categories of impulsivity-hyperactivity and inattention, the link between parents' problem gambling and impulsivity-hyperactivity/inattention (IH/I) behaviors in children has not been investigated. This study investigated the association between parents' problem gambling and children's IH/I behaviors while controlling for potential confounding variables. A population-based prospective cohort followed-up from kindergarten to age 30, the Quebec Longitudinal Study of Kindergarten Children (QLSKC), provided data over three generations. Among 1358 participants at age 30, parents with a child aged 1 year or older (N = 468; Mean age = 4.65 years; SD = 2.70) were selected. Generalized Linear Models included measures of grandparents' and parents' problem gambling, parents' IH/I behaviors in childhood, and a host of risk factors and comorbidities to predict IH/I in children. Intergenerational bivariate associations were observed between grandparents' problem gambling, parents' IH/I in childhood and problem gambling at age 30, and between parents' IH/I, problem gambling, and children's IH/I behaviors. Parents' problem gambling predicted children's IH/I behaviors above and beyond the effects of covariates such as family and socioeconomic characteristics, alcohol and drug use, depression symptoms and parents' gambling involvement. Parents' IH/I behaviors in childhood also predicted children's IH/I and had a moderating, enhancing effect on parents' problem gambling association with their offspring's IH/I behaviors. Problem gambling is a characteristic of parents' mental health that is distinctively associated with children's IH/I behaviors, above and beyond parents' own history of IH/I and of typically related addictive, psychopathological or socioeconomic risk factors and comorbidities.

Allelic variation in dopamine D2 receptor gene is associated with attentional impulsiveness on the Barratt Impulsiveness Scale (BIS-11)

OBJECTIVES

Previous studies have postulated that noradrenergic and/or dopaminergic gene variations are likely to underlie individual differences in impulsiveness, however, few have shown this. The current study examined the relationship between catecholamine gene variants and self-reported impulsivity, as measured by the Barratt Impulsiveness Scale (Version 11; BIS-11) Methods: Six hundred and seventy-seven non-clinical adults completed the Barratt Impulsiveness Scale (BIS-11). DNA was analysed for a set of 142 single-nucleotide polymorphisms (SNPs) across 20 autosomal catecholamine genes. Association was tested using an additive regression model with permutation testing used to control for the influence of multiple comparison.

RESULTS

Analysis revealed an influence of rs4245146 of the dopamine D2 receptor (DRD2) gene on the BIS-11 attention first-order factor, such that self-reported attentional impulsiveness increased in an additive fashion with each copy of the T allele.

CONCLUSIONS

These findings provide preliminary evidence that allelic variation in DRD2 may influence impulsiveness by increasing the propensity for attentional lapses.

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.

Reactive and proactive control mechanisms of response inhibition in gambling disorder

Response inhibition, one component of cognitive control, refers to the ability to inhibit automatic responses and has been found to be impaired in gambling disorder. Recent models of cognitive control distinguish between two mechanisms: reactive control, the ability to stop in response to a stop-stimulus, and proactive control, the ability to anticipate and prepare for a stop. Previous studies have primarily focused on reactive modes of control in gambling disorder. The aim of the current study was to assess both reactive and proactive modes of response inhibition in individuals with gambling disorder (n = 27) and community controls (n = 21) using a variant of the stop-signal task. Second, the relationship between trait impulsivity, and reactive and proactive control was examined. No group differences in reactive or proactive control were found. However, premeditation, one domain of trait impulsivity, was associated with worse proactive control in the gambling group. These results suggest that difficulties with response inhibition may not be a core deficit in all forms of gambling disorder. Future research should continue to develop and test tasks that involve cognitive control processes in different presentations of gambling disorder.

Impulsivity profiles in pathological slot machine gamblers

INTRODUCTION

In gambling disorder (GD), impulsivity has been related with severity, treatment outcome and a greater dropout rate. The aim of the study is to obtain an empirical classification of GD patients based on their impulsivity and compare the resulting groups in terms of sociodemographic, clinical and gambling behavior variables.

METHODS

126 patients with slot machine GD attending the Pathological Gambling Unit between 2013 and 2016 were included. The UPPS-P Impulsive Behavior Scale was used to assess impulsivity, and the severity of past-year gambling behavior was established with the Screen for Gambling problems questionnaire (NODS). Depression and anxiety symptoms and executive function were also assessed. A two-step cluster analysis was carried out to determine impulsivity profiles.

RESULTS

According to the UPPS-P data, two clusters were generated. Cluster 1 showed the highest scores on all the UPPS-P subscales, whereas patients from cluster 2 exhibited only high scores on two UPPS-P subscales: Negative Urgency and Lack of premeditation. Additionally, patients on cluster 1 were younger and showed significantly higher scores on the Beck Depression Inventory and on the State-Trait Anxiety Inventory questionnaires, worse emotional regulation and executive functioning, and reported more psychiatric comorbidity compared to patients in cluster 2. With regard to gambling behavior, cluster 1 patients had significantly higher NODS scores and a higher percentage presented active gambling behavior at treatment start than in cluster 2.

CONCLUSIONS

We found two impulsivity subtypes of slot machine gamblers. Patients with high impulsivity showed more severe gambling behavior, more clinical psychopathology and worse emotional regulation and executive functioning than those with lower levels of impulsivity. These two different clinical profiles may require different therapeutic approaches.

Exploring the Relationship between Reward and Punishment Sensitivity and Gambling Disorder in a Clinical Sample: A Path Modeling Analysis

Most individuals will gamble during their lifetime, yet only a select few will develop gambling disorder. Gray's Reinforcement Sensitivity Theory holds promise for providing insight into gambling disorder etiology and symptomatology as it ascertains that neurobiological differences in reward and punishment sensitivity play a crucial role in determining an individual's affect and motives. The aim of the study was to assess a mediational pathway, which included patients' sex, personality traits, reward and punishment sensitivity, and gambling-severity variables. The Sensitivity to Punishment and Sensitivity to Reward Questionnaire, the South Oaks Gambling Screen, the Symptom Checklist-Revised, and the Temperament and Character Inventory-Revised were administered to a sample of gambling disorder outpatients (N = 831), diagnosed according to DSM-5 criteria, attending a specialized outpatient unit. Sociodemographic variables were also recorded. A structural equation model found that both reward and punishment sensitivity were positively and directly associated with increased gambling severity, sociodemographic variables, and certain personality traits while also revealing a complex mediational role for these dimensions. To this end, our findings suggest that the Sensitivity to Punishment and Sensitivity to Reward Questionnaire could be a useful tool for gaining a better understanding of different gambling disorder phenotypes and developing tailored interventions.

The Blurred Future of Adolescent Gamblers: Impulsivity, Time Horizon, and Emotional Distress

The main purpose of this study was to investigate the interplay of functional and dysfunctional impulsivity, delay discounting, time perspective, and emotional negative states on gambling severity in Italian adolescents. A second aim of the study was to analyze the developmental trajectories of gambling involvement, functional and dysfunctional impulsivity, delay discounting, consideration of future consequences, and negative affectivity in a cross-sectional perspective. One thousand and ten Italian adolescents aging between 12 and 19 years were administered the South Oaks Gambling Screen Revised for Adolescents (SOGS-RA), the Functional and Dysfunctional Impulsivity Scale (FDIS), the Monetary Choice Questionnaire (MCQ), the Consideration of Future Consequences Scale (CFC-14), and the Depression, Anxiety and Stress Scales-21 (DASS-21). Data analyses were conducted using correlational analysis, Chi-square test, analysis of variance, and hierarchical regression analysis. Results indicated that, relative to non-gamblers and non-problem gamblers, at-risk and problem gamblers showed higher levels of impulsivity, steeper delay discounting, shorter time horizon, and reported experiencing significantly higher levels of depression, anxiety, and stress. Results of hierarchical regression analysis, with SOGS-RA scores as the dependent variable, and gender, age, FDIS, MCQ, CFC-14, and DASS-21 scores as independent variables, indicated that, along with gender and age, low scores of future orientation and high scores of dysfunctional impulsivity, depression, anxiety, present orientation, and delay discounting significantly predicted gambling severity. These findings provide further evidence that the higher the gambling involvement, the greater the tendency to devalue delayed rewards and to focus on the immediate consequences of one's behavior. Interestingly, for the first time these results reveal an association between gambling severity and both dysfunctional impulsivity and negative affective states across adolescence. Finally, results of cross-sectional analyses suggest that gambling severity contributes more than age in shaping the developmental trajectories of functional and dysfunctional impulsivity, delay discounting, time perspective, and negative affective states.

Co-morbidity Between Gambling Problems and Depressive Symptoms: A Longitudinal Perspective of Risk and Protective Factors

In both adolescents and adults, gambling problems and depressive symptoms co-occur and share some common risk factors (e.g., impulsivity and socio-family risk). However, little is known about (1) the developmental course of the co-morbidity of these problems; (2) variables that may moderate the effect of these common risk factors on gambling problems and depressive symptoms. Of specific interest could be individuals' social relationships with significant others such as parents and friends, because research shows that they moderate the effect of other risk factors on gambling problems and depressive symptoms. The goals of this study were to: (a) identify developmental pathways for gambling problems and depressive symptoms, with a focus on co-morbidity; (b) assess the moderating effect of relationship quality with parents and friends on the link between common risk factors and the trajectories of gambling problems and depressive symptoms. Study participants were 878 males. Predictors were assessed during childhood and adolescence and gambling problems and depressive symptoms were assessed in late adolescence and young adulthood. Latent class analysis revealed four distinct joint trajectories of gambling problems and depressive symptoms. Subsequent logistic regression revealed that impulsivity predicted membership in all pathogenic trajectories, and quality of the relationship with parents predicted membership in depressogenic trajectories. In addition, we found that the membership in the comorbid trajectory can be predicted by an interaction between friendship quality and socio-family risk.

Gambling Risk Amongst Adolescents: Evidence from a School-Based Survey in the Malaysian Setting

There has been emerging evidence regarding gambling experiences of young people in Asia recently, but to date, none in Malaysia. This study aimed to estimate the prevalence of gambling, and to identify individual, familial and high-risk behaviours factors among Malaysian adolescents. A cross-sectional study was conducted over 4 months at randomly selected secondary schools in Seremban in Negeri Sembilan state. A total of 2265 self-administered, anonymous questionnaires were distributed to the students. The students completed the questionnaire consisting of sociodemographic and family background, gambling behaviours, high risk behaviours and mental health questions. Approximately 29.6 % (95 % CI 27.7-31.5) of respondents reported participating in some forms of gambling activities in the previous 12 months. Among these, 3.6 % (95 % CI 2.8-4.3) of them were problem gamblers. Parental gambling was the strongest correlate with adolescent gambling behaviour. Signification association was found between gambling behaviour and gender (being males), but interestingly, not with ethnicity. Adolescents who reported engaging in high risk behaviours (such as smoking, alcohol consumption, involvement in physical fights, illegal vehicular racing) were also more likely to gamble. Gambling is not an uncommon phenomenon amongst Malaysian adolescents. Public awareness campaign, health education to targeted groups, revision of existing laws, and screening at primary care level should be implemented to address the issue of gambling among adolescents. This study also highlights the need to examine the national scope of the problem in Malaysia.

Positive association between trait impulsivity and high gambling-related cognitive biases among college students

The present study examined whether people with high gambling-related cognitive bias are more likely to have higher levels of impulsivity than are those with low gambling-related cognitive bias. We used Barratt Impulsiveness Scale version 11, Zuckerman-Kuhlman Personality Questionnaire and the Iowa gambling task to explore differences in impulsivity between high and low gambling-related cognitive bias groups. Extreme group design was applied. 110 participants (high gambling related cognition group=58, low one=52) were recruited to complete the gambling related cognition scale, impulsivity self-rating scales and Iowa gambling task. Impulsivity self-rating scores were higher among subjects with high than among those with low gambling-related cognitive bias. Compared with individuals with low gambling-related cognitive bias, those with high levels of such bias showed greater degrees of trait impulsivity. We are unable to identify group differences on IGT. State and trait impulsivity may be dissociated.

Addictive behaviors and personality traits in adolescents

INTRODUCTION

Behavioral addictions refer to repeated dysfunctional behaviors that do not involve the ingestion of addictive substances. Studies on the association between behavioral addictions and personality traits have noted in individuals with problematic behaviors a high proclivity toward impulsivity and sensation-seeking and a low predisposition to harm avoidance. The majority of these studies have focused on adults, while far fewer have involved adolescents.

METHODS

The study population was 109 high school students (age range 15-18 years) in Turin, Italy. Participants completed an assessment that comprised a demographic questionnaire and 3 self-report questionnaires: the Shorter PROMIS Questionnaire (SPQ), the Internet Addiction Test (IAT), and the Multidimensional Questionnaire for Adolescents (QMA).

RESULTS

A gender-related difference in the risk of developing an addictive behavior was observed, with a significantly higher percentage of risk seen for several addiction tendencies among the males. Statistically significant correlations emerged between some personality determinants and certain addictive behaviors.

DISCUSSION

The study pinpoints epidemiological indicators for the extent of this growing problem among adolescents.

CONCLUSIONS

The findings have implications for identifying protection factors and risk factors for addictive behaviors and related psychiatric disorders, and the development of primary prevention strategies derived from such factors.

Elevated risk of nicotine dependence among sib-pairs discordant for maternal smoking during pregnancy: evidence from a 40-year longitudinal study

BACKGROUND

Compelling evidence links maternal smoking during pregnancy with elevated risk of nicotine dependence among the offspring. However, no study to date has examined the maternal smoking during pregnancy-nicotine dependence link among sibling-pairs discordant for maternal smoking during pregnancy. We tested two hypotheses that, if supported, suggest that the maternal smoking during pregnancy-nicotine dependence link may be physiologically mediated.

METHODS

Study participants were adult offspring of women enrolled in the Providence and Boston sites of the Collaborative Perinatal Project (1959-1966). Approximately 10% of these adult offspring (average age: 39.6 years) were enrolled in the New England Family Study (n = 1,783), a follow-up study that oversampled families with multiple siblings. Logistic regression models predicting maternal smoking during pregnancy risk on various prospectively collected smoking and marijuana use outcomes, including nicotine dependence, were fit using models that allowed between-mother effects of maternal smoking during pregnancy exposure to differ from within-mother effects. In the absence of significant effect heterogeneity, we calculated a combined estimate.

RESULTS

Maternal smoking during pregnancy predicted progression from weekly smoking to nicotine dependence (odds ratio = 1.4 [95% confidence interval = 1.2, 1.8]), but not weekly smoking or progression to marijuana dependence.

CONCLUSIONS

Current evidence from sibling-pairs discordant for maternal smoking during pregnancy is consistent with previous reports of a dose-response association between maternal smoking during pregnancy and nicotine dependence, as well as of up-regulation of nicotine receptors among animals exposed to maternal smoking during pregnancy. Together, they provide support for the existence of a physiologically mediated link between maternal smoking during pregnancy and nicotine dependence.

Psychosoziale Risikoindikatoren regelmäßiger und riskanter Glücksspielnutzung im Jugendalter

Mit der vorliegenden Studie werden die regelmäßige, riskante und problematische Glücksspielnutzung sowie psychosoziale Risikoindikatoren des Glücksspielkonsums im Jugendalter untersucht. Datengrundlage bildet eine für Niedersachsen repräsentative Dunkelfeldbefragung mit 11 003 Neuntklässlern. Zur Klassifikation wurde der Glücksspiel-Screen DSM-IV-MR-J eingesetzt. Auf Basis theoretisch abgeleiteter Risikoindikatoren aus den Bereichen Soziodemographie, Person, Freizeit-, Problemverhalten, Familie, Peers und Schule/Nachbarschaft wurden binär logistische Mehrebenen-Regressionsanalysen zur Vorhersage regelmäßiger und riskanter Glücksspielnutzung durchgeführt. Die Ergebnisse zeigen, dass das Glücksspielverhalten bei Jugendlichen von kommerziellen Angeboten dominiert wird. 3.5 % der Jugendlichen weisen eine regelmäßige, 1.1 % eine riskante und 0.3 % eine problematische Glücksspielnutzung auf. Jungen sind in allen glücksspielaffinen Gruppen deutlich stärker vertreten. Bedeutsame Prädiktorvariablen für regelmäßige und riskante Glücksspielnutzung sind neben dem Geschlecht und dem Migrationshintergrund, eine erhöhte Gewaltakzeptanz und eine Sportvereinsmitgliedschaft. Alkohol- und Drogenkonsum sowie insbesondere der Freundeskreis prädizieren ein regelmäßiges Glücksspielverhalten, während Gewalttäterschaft sowie Variablen aus dem Bereich Schule/Nachbarschaft ein riskantes Glücksspielverhalten vorhersagen.

Relationship of gambling with tobacco, alcohol, and illicit drug use among adolescents in the USA: Review of the literature 2000-2014

BACKGROUND AND OBJECTIVES

Adolescence is a time during which not only gambling, but also tobacco, alcohol, and illicit drug use, usually begin. The purpose of this paper is to provide an updated review of the literature on gambling and its associations with tobacco, alcohol, and illicit drug use among US youth.

METHODS

An electronic literature search of PubMed and PsycInfo was conducted for studies since 2000 using the keywords "smoking," "tobacco," "nicotine," "cigarette," "gambling," "adolescence," "adolescent," "alcohol," and "substance use." Ten articles with unique adolescent samples were located. Because the articles varied in regard to definitions of gambling, tobacco, alcohol, and drug use, we provide a qualitative review of included studies.

RESULTS

Gambling prevalence rates ranged from 44.3% to 68% in national telephone-based surveys, from 24.4% to 86% among students in school-based surveys, and from 22.5% to 47.4% in surveys of convenience samples. Significant associations were reported between gambling and tobacco use (4/7 articles), gambling and alcohol use (7/8 articles), and gambling and illicit drug use (7/8 articles).

CONCLUSIONS

The wide range in rates of gambling and problem gambling may be due in part to differences among the studies in participant samples, sampling techniques, assessment time frames, and definitions of gambling. Despite methodological differences, most studies showed significant associations of gambling with tobacco, alcohol, and other illicit drug use.

SCIENTIFIC SIGNIFICANCE

As accessibility to gambling increases, more research is needed to inform prevention efforts and identify youth at-risk for gambling and other high-risk behaviors.

Evolutionary and neuropsychological perspectives on addictive behaviors and addictive substances: relevance to the "food addiction" construct

It has been argued that food cannot be "addictive", unlike conventional drugs of abuse, because it is an essential part of life. In this paper, evidence is reviewed, largely from an evolutionary psychobiological perspective, that plant-based psychoactive drugs (such as those derived from the opium poppy and the coca leaf) and gambling-related behaviors were once adaptive for human health and survival in a similar manner as energy-based foods were for nourishment. "Evolutionary mismatch" viewpoints contend that certain behaviors were enhanced during the hunter-gatherer lifestyle - from which our genetic endowment had its origins - because they bestowed both survival and reproductive advantages to the species. However, in the context of advanced technology and other rapid environmental changes, these same behaviors have tended to become maladaptive and greatly overexpressed. Similar to the manufactured purification of psychotropic plant-based substances, the reward impact of processed and hyperpalatable foods, with their high levels of sugar, fat, and salt, is much increased from foods produced in nature. It is concluded therefore that what was once beneficial and necessary for our survival has been altered and ultraprocessed into edible products that may be disadvantageous and potentially addictive.

Dimensions and disorder specificity of impulsivity in pathological gambling

Impulsivity is a core characteristic of pathological gambling (PG), even though the underlying structure and disorder specificity is unclear. This study aimed to explore different dimensions of impulsivity in a clinical sample including PG. Furthermore, we aimed to test which alterations of the impulsivity-related dimensions are disorder specific for PG. Participants were individuals diagnosed with PG (n=51) and two groups also characterized by various impulsive behaviors: an alcohol dependence (AD; n=45) and a Gilles de la Tourette syndrome (GTS; n=49) group. A healthy control (HC; n=53) group was recruited as comparison group. A comprehensive assessment was used including impulsivity-related and antipodal parameters of the Stop Signal Task, Stroop Task, Tower of London Task, Card Playing Task, Iowa Gambling Task and the Barratt Impulsiveness Scale-11. Principal axis factor analysis revealed four impulsivity-related dimensions that were labeled 'self-reported impulsivity', 'prepotent response impulsivity', 'choice impulsivity' and 'motor impulsivity'. The PG group scored significantly higher on all four dimensions compared to the HC group. In contrast, the PG group did not differ on any of the dimensions from the AD or the GTS group, except for 'choice impulsivity' where the PG group exhibited higher factor scores compared to the GTS group. Altogether, PG is associated with generally heightened impulsivity profiles compared to a HC group, which may be further used for intervention strategies. However, heightened scores in the impulsivity dimensions are not disorder specific for PG. Further research on shared or different underlying mechanisms of these overlapping impulsivity impairments is necessary.

Getting a grip on problem gambling: what can neuroscience tell us?

In problem gamblers, diminished cognitive control and increased impulsivity is present compared to healthy controls. Moreover, impulsivity has been found to be a vulnerability marker for the development of pathological gambling (PG) and problem gambling (PrG) and to be a predictor of relapse. In this review, the most recent findings on functioning of the brain circuitry relating to impulsivity and cognitive control in PG and PrG are discussed. Diminished functioning of several prefrontal areas and of the anterior cingulate cortex (ACC) indicate that cognitive-control related brain circuitry functions are diminished in PG and PrG compared to healthy controls. From the available cue reactivity studies on PG and PrG, increased responsiveness towards gambling stimuli in fronto-striatal reward circuitry and brain areas related to attentional processing is present compared to healthy controls. At this point it is unresolved whether PG is associated with hyper- or hypo-activity in the reward circuitry in response to monetary cues. More research is needed to elucidate the complex interactions for reward responsivity in different stages of gambling and across different types of reward. Conflicting findings from basic neuroscience studies are integrated in the context of recent neurobiological addiction models. Neuroscience studies on the interface between cognitive control and motivational processing are discussed in light of current addiction theories.

Clinical implications: We suggest that innovation in PG therapy should focus on improvement of dysfunctional cognitive control and/or motivational functions. The implementation of novel treatment methods like neuromodulation, cognitive training and pharmacological interventions as add-on therapies to standard treatment in PG and PrG, in combination with the study of their effects on brain-behavior mechanisms could prove an important clinical step forward towards personalizing and improving treatment results in PG.

Multidimensional examination of impulsivity in relation to disordered gambling

Impulsivity has been consistently associated with pathological gambling (PG), but the diversity of definitions and measures of impulsivity has led to ambiguity with regard to which indices are independently relevant. Toward clarifying this relationship, the current study examined indices from an array of commonly used impulsivity measures in relation to PG severity in an adult community sample of frequent gamblers (N = 353). These included both survey assessments and behavioral tasks. Using a factor analytic approach, 4 latent factors were identified among 19 indices and were designated reward sensitivity, punishment sensitivity, delay discounting, and cognitive impulsivity. All 4 latent variables were positively and independently related to PG severity, albeit at a trend level for cognitive impulsivity in a combined model. These findings reveal 4 generally independent domains of impulsivity that are related to PG severity, clarify which assessment measures aggregate in each domain, and illustrate the importance of measurement specificity in studying impulsivity in relation to PG and other psychiatric disorders.

Cross-species approaches to pathological gambling: a review targeting sex differences, adolescent vulnerability and ecological validity of research tools

Decision-making plays a pivotal role in daily life as impairments in processes underlying decision-making often lead to an inability to make profitable long-term decisions. As a case in point, pathological gamblers continue gambling despite the fact that this disrupts their personal, professional or financial life. The prevalence of pathological gambling will likely increase in the coming years due to expanding possibilities of on-line gambling through the Internet and increasing liberal attitudes towards gambling. It therefore represents a growing concern for society. Both human and animal studies rapidly advance our knowledge on brain-behaviour processes relevant for understanding normal and pathological gambling behaviour. Here, we review in humans and animals three features of pathological gambling which hitherto have received relatively little attention: (1) sex differences in (the development of) pathological gambling, (2) adolescence as a (putative) sensitive period for (developing) pathological gambling and (3) avenues for improving ecological validity of research tools. Based on these issues we also discuss how research in humans and animals may be brought in line to maximize translational research opportunities.

Serotonin system gene polymorphisms are associated with impulsivity in a context dependent manner

Impulsivity is a risk factor for adverse outcomes and characterizes several psychiatric disorders and risk for suicide. There is strong evidence that genetic variation influences individual differences in impulsivity, but the details are not yet understood. There is growing interest in better understanding the context dependency of genetic effects that is reflected in studies examining gender specificity, gene×environment interaction and epistasis (gene-gene interaction). In a cross-sectional study we examined whether polymorphisms in six serotonin system candidate genes and the experience of early life trauma (age 0-12) were associated with individual differences in impulsivity in a non-clinical sample of Caucasian university students (N=424). We specifically tested potential gender specific, gene-gene, and gene×environment (early life trauma) effects. In our main analyses with Barratt Impulsiveness Scale (BIS-11) total score, there were significant (i.e. p<.01 and False Discovery Rate <.10) interactions between (1) gender and TPH2 (rs1386483) genotype; (2) gender and HTR2A (rs6313) genotype; and epistatic interactions among (3) 5-HTTLPR and MAOA uVNTR; (4) 5-HTTLPR and rs6313 and (5) HTR1B (rs6296) and rs6313 genotypes. Our results strongly support the explicit investigation of context dependent genetic effects on impulsivity and may help to resolve some of the conflicting reports in the literature.

The relationship between age of gambling onset and adolescent problematic gambling severity

The aim of this study was to characterize the association between problem gambling severity and multiple health, functioning and gambling variables in adolescents aged 13-18 stratified by age of gambling onset. Survey data in 1624 Connecticut high school students stratified by age of gambling onset (≤ 11 years vs. ≥ 12 years) were analyzed in descriptive analyses and in logistic regression models. Earlier age of onset was associated with problem gambling severity as indexed by a higher frequency of at-risk/problem gambling (ARPG). Most health, functioning and gambling measures were similarly associated with problem gambling severity in the earlier- and later-age-of-gambling-onset groups with the exception of participation in non-strategic forms of gambling, which was more strongly associated with ARPG in the earlier-onset (OR = 1.74, 95%CI = [1.26, 2.39]) as compared to later-onset (OR = 0.94, 95%CI = [0.60, 1.48]) group (Interaction OR = 1.91, 95%CI = [1.18, 3.26]). Post-hoc analysis revealed that earlier-onset ARPG was more strongly associated with multiple forms of non-strategic gambling including lottery (instant, traditional) and slot-machine gambling. The finding that problem gambling severity is more closely associated with multiple non-strategic forms of gambling amongst youth with earlier-onset gambling highlights the relevance of these types of youth gambling. The extent to which non-strategic forms of gambling may serve as a gateway to other forms of gambling or risk behaviors warrants additional study, and efforts targeting youth gambling should consider how best to address non-strategic gambling through education, prevention, treatment and policy efforts.

Pathological gambling: a systematic review of biochemical, neuroimaging, and neuropsychological findings

Pathological gambling is an emerging psychiatric disorder that has recently gained much attention because of its increasing prevalence and devastating personal, familial, and social consequences. Although its pathophysiology is largely unknown, the shared similarities with both addiction and obsessive-compulsive spectrum disorders have suggested the possibility of common psychobiological substrates. As with many other psychiatric disorders, it is believed that pathological gambling may result from the interplay between individual vulnerability and environmental factors. The aim of this article is to offer a comprehensive review of the main neurobiological aspects of pathological gambling, with particular attention to neuropsychological and related findings. A deeper understanding of the biological correlates of pathological gambling is required in order to develop effective treatment strategies.