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Çıtak Ş. Latent profile analysis of gambling. Front Psychol 2023; 14:1293933. [PMID: 37965671 PMCID: PMC10641010 DOI: 10.3389/fpsyg.2023.1293933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 10/16/2023] [Indexed: 11/16/2023] Open
Abstract
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.
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Affiliation(s)
- Şenel Çıtak
- Psychological Counseling and Guidance, Department of Educational Sciences, Ordu University, Ordu, Türkiye
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Bellmunt-Gil A, Majuri J, Arponen E, Kaasinen V, Joutsa J. Abnormal frontostriatal connectivity and serotonin function in gambling disorder: A preliminary exploratory study. J Behav Addict 2023; 12:670-681. [PMID: 37561637 PMCID: PMC10562820 DOI: 10.1556/2006.2023.00037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 04/04/2023] [Accepted: 06/26/2023] [Indexed: 08/12/2023] Open
Abstract
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.
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Affiliation(s)
- Albert Bellmunt-Gil
- Turku Brain and Mind Center, University of Turku, Turku, Finland
- Clinical Neurosciences, University of Turku, Turku, Finland
| | - Joonas Majuri
- Turku Brain and Mind Center, University of Turku, Turku, Finland
- Turku PET Centre, Turku University Hospital, Turku, Finland
| | | | - Valtteri Kaasinen
- Turku Brain and Mind Center, University of Turku, Turku, Finland
- Clinical Neurosciences, University of Turku, Turku, Finland
- Turku PET Centre, Turku University Hospital, Turku, Finland
- Neurocenter, Turku University Hospital, Turku, Finland
| | - Juho Joutsa
- Turku Brain and Mind Center, University of Turku, Turku, Finland
- Clinical Neurosciences, University of Turku, Turku, Finland
- Turku PET Centre, Turku University Hospital, Turku, Finland
- Neurocenter, Turku University Hospital, Turku, Finland
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de Sá RRC, Coelho S, Parmar PK, Johnstone S, Kim HS, Tavares H. A Systematic Review of Pharmacological Treatments for Internet Gaming Disorder. Psychiatry Investig 2023; 20:696-706. [PMID: 37559452 PMCID: PMC10460977 DOI: 10.30773/pi.2022.0297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 05/05/2023] [Accepted: 05/15/2023] [Indexed: 08/11/2023] Open
Abstract
OBJECTIVE Internet gaming disorder (IGD) is an increasingly common behavioral addiction, with an estimated global prevalence of 3%. A variety of pharmacological treatments have been used to treat IGD, yet no review to date has synthesized clinical trials evaluating their efficacy. This systematic review therefore synthesized the literature reporting on clinical trials of pharmacological treatments for IGD. METHODS We reviewed articles from MEDLINE, Embase, PubMed Central, CINAHL, and PsycINFO that were published as of March of 2022. A total of 828 articles were retrieved for review and 12 articles were included, reporting on a total of 724 participants. RESULTS Most participants were male (98.6%), and all were currently living in South Korea. The most common drugs used to treat IGD were bupropion, methylphenidate, and a range of selective serotonin reuptake inhibitors. The Young Internet Addiction Scale was the most frequently used to measure gaming-related outcomes. All studies reported reduced symptoms of IGD from pre- to post-treatment. Across all clinical trials, IGD symptom reductions following the administration of pharmacological treatments ranged from 15.4% to 51.4%. A risk of bias assessment indicated that only four studies had a low risk of bias. CONCLUSION Preliminary results suggest that a wide array of pharmacological interventions may be efficacious in the treatment of IGD. Future studies using double-blind randomized controlled trial designs, recruiting larger and more representative samples, and controlling for psychiatric comorbidities are needed to better inform understanding of pharmacological treatments for IGD.
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Affiliation(s)
| | - Sophie Coelho
- Department of Psychology, York University, Toronto, ON, Canada
| | - Puneet Kaur Parmar
- Department of Psychology, Toronto Metropolitan University Toronto, ON, Canada
| | - Samantha Johnstone
- Department of Psychology, Toronto Metropolitan University Toronto, ON, Canada
| | - Hyoun Soo Kim
- Department of Psychology, Toronto Metropolitan University Toronto, ON, Canada
| | - Hermano Tavares
- Department of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
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Farkouh R, Audette-Chapdelaine S, Brodeur M. Pharmacotherapy and gambling disorder: a narrative review. J Addict Dis 2023:1-15. [PMID: 37423770 DOI: 10.1080/10550887.2023.2229725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
BACKGROUND Gambling disorder (GD) is a psychiatric disorder classified in the DSM-5 as a non-substance-related and addictive disorder with extensive health and socioeconomic impacts. Its chronic and high-relapsing nature makes it essential to find treatment strategies that improve functioning and reduce impairment associated with it. The purpose of this narrative review is to evaluate and summarize the available evidence on the effectiveness and safety of pharmacotherapy in GD. METHODS An electronic literature search of Medline, Embase, and Cochrane Central was conducted to identify systematic reviews, meta-analyses, and reviews on pharmacological interventions in patients with gambling disorder. A similar search of these databases and of Prospero, Clinicaltrials.gov, and Epistemonikos was conducted to identify clinical trials that were published since 2019. RESULTS The initial search identified 1925 articles. After screening and duplicate removal, 18 articles were included in the review (11 studies were systematic reviews and meta-analyses, 6 were reviews, and 1 was an open-label trial). Eight pharmacological agents (naltrexone, nalmefene, paroxetine, fluvoxamine, citalopram, escitalopram, lithium, and topiramate) that were studied in randomized controlled trials and open-label trials showed small to moderate effect sizes in reducing GD symptoms in some studies during post-hoc analyses. CONCLUSION The overall sum of evidence in the literature on the use of pharmacotherapy in GD is conflicting and inconclusive. Some studies have shown that pharmacotherapy's role in GD is promising, especially when the choice of the agent is guided by comorbid psychiatric disorders. However, significant limitations exist in the study designs, which need to be addressed in future research on the topic. Conducting future and more rigorous trials that address the limitations in the existing literature is necessary to establish more accurate efficacy data on the use of pharmacotherapy in this population.
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Affiliation(s)
- Rezkalla Farkouh
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Sophie Audette-Chapdelaine
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Magaly Brodeur
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
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Dowling N, Merkouris S, Lubman D, Thomas S, Bowden-Jones H, Cowlishaw S. Pharmacological interventions for the treatment of disordered and problem gambling. Cochrane Database Syst Rev 2022; 9:CD008936. [PMID: 36130734 PMCID: PMC9492444 DOI: 10.1002/14651858.cd008936.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Pharmacological interventions for disordered and problem gambling have been employed in clinical practice. Despite the availability of several reviews of the efficacy of pharmacological interventions for disordered or problem gambling, few have employed systematic search strategies or compared different categories of pharmacological interventions. Systematic reviews of high-quality evidence are therefore essential to provide guidance regarding the efficacy of different pharmacological interventions for disordered or problem gambling. OBJECTIVES The primary aims of the review were to: (1) examine the efficacy of major categories of pharmacological-only interventions (antidepressants, opioid antagonists, mood stabilisers, atypical antipsychotics) for disordered or problem gambling, relative to placebo control conditions; and (2) examine the efficacy of these major categories relative to each other. SEARCH METHODS: We searched the Cochrane Common Mental Disorders Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE, Embase, and PsycINFO (all years to 11 January 2022). SELECTION CRITERIA We included randomised trials evaluating a pharmacological intervention for the treatment of disordered or problem gambling. Eligible control conditions included placebo control groups or comparisons with another category of pharmacological intervention. DATA COLLECTION AND ANALYSIS We used standard methodological procedures, including systematic extraction of included study characteristics and results and risk of bias assessment. Our primary outcome was reduction in gambling symptom severity. Our secondary outcomes were reduction in gambling expenditure, gambling frequency, time spent gambling, depressive symptoms, anxiety symptoms, and functional impairment; and responder status. We evaluated treatment effects for continuous and dichotomous outcomes using standardised mean difference (SMD) and risk ratios (RR), respectively, employing random-effects meta-analyses. A minimum of two independent treatment effects were required for a meta-analysis to be conducted (with only meta-analytic findings reported in this abstract). MAIN RESULTS We included 17 studies in the review (n = 1193 randomised) that reported outcome data scheduled for end of treatment. Length of treatment ranged from 7 to 96 weeks. Antidepressants: Six studies (n = 268) evaluated antidepressants, with very low to low certainty evidence suggesting that antidepressants were no more effective than placebo at post-treatment: gambling symptom severity (SMD -0.32, 95% CI -0.74 to 0.09, n = 225), gambling expenditure (SMD -0.27, 95% CI -0.60 to 0.06, n = 144), depressive symptoms (SMD -0.19, 95% CI -0.60 to 0.23, n = 90), functional impairment (SMD -0.15, 95% CI -0.53 to 0.22, n = 110), and responder status (RR 1.24, 95% CI 0.93 to 1.66, n = 268). Opioid antagonists: Four studies (n = 562) evaluated opioid antagonists, with very low to low certainty evidence showing a medium beneficial effect of treatment on gambling symptom severity relative to placebo at post-treatment (SMD -0.46, 95% CI -0.74 to -0.19, n = 259), but no difference between groups in responder status (RR 1.65, 95% CI 0.86 to 3.14, n = 562). Mood stabilisers: Two studies (n = 71) evaluated mood stabilisers (including anticonvulsants), with very low certainty evidence suggesting that mood stabilisers were no more effective than placebo at post-treatment: gambling symptom severity (SMD -0.92, 95% CI -2.24 to 0.39, n = 71), depressive symptoms (SMD -0.15, 95% CI -1.14 to 0.83, n = 71), and anxiety symptoms (SMD -0.17, 95% CI -0.64 to 0.30, n = 71). Atypical antipsychotics:Two studies (n = 63) evaluated the atypical antipsychotic olanzapine, with very low certainty evidence showing a medium beneficial effect of treatment on gambling symptom severity relative to placebo at post-treatment (SMD -0.59, 95% CI -1.10 to -0.08, n = 63). Comparative effectiveness: Two studies (n = 62) compared antidepressants with opioid antagonists, with very low certainty evidence indicating that antidepressants were no more effective than opioid antagonists on depressive symptoms (SMD 0.22, 95% CI -0.29 to 0.72, n = 62) or anxiety symptoms (SMD 0.21, 95% CI -0.29 to 0.72, n = 62) at post-treatment. Two studies (n = 58) compared antidepressants with mood stabilisers (including anticonvulsants), with very low certainty evidence indicating that antidepressants were no more effective than mood stabilisers on depressive symptoms (SMD 0.02, 95% CI -0.53 to 0.56, n = 58) or anxiety symptoms (SMD 0.16, 95% CI -0.39 to 0.70, n = 58) at post-treatment. Tolerability and adverse events: Several common adverse effects were reported by participants receiving antidepressants (e.g. headaches, nausea, diarrhoea/gastrointestinal issues) and opioid antagonists (e.g. nausea, dry mouth, constipation). There was little consistency in the types of adverse effects experienced by participants receiving mood stabilisers (e.g. tiredness, headaches, concentration difficulties) or atypical antipsychotics (e.g. pneumonia, sedation, increased hypomania). Discontinuation of treatment due to these adverse events was highest for opioid antagonists (10% to 32%), followed by antidepressants (4% to 31%), atypical antipsychotics (14%), and mood stabilisers (13%). AUTHORS' CONCLUSIONS This review provides preliminary support for the use of opioid antagonists (naltrexone, nalmefene) and atypical antipsychotics (olanzapine) to produce short-term improvements in gambling symptom severity, although a lack of available evidence precludes a conclusion regarding the degree to which these pharmacological agents can improve other gambling or psychological functioning indices. In contrast, the findings are inconclusive with regard to the effects of mood stabilisers (including anticonvulsants) in the treatment of disordered or problem gambling, and there is limited evidence to support the efficacy of antidepressants. However, these conclusions are based on very low to low certainty evidence characterised by a small number of included studies, high risk of bias, modest pooled sample sizes, imprecise estimates, moderate between-study heterogeneity, and exclusion of participants with psychiatric comorbidities. Moreover, there were insufficient studies to conduct meta-analyses on many outcome measures; to compare efficacy across and within major categories of interventions; to explore dosage effects; or to examine effects beyond post-treatment. These limitations suggest that, despite recommendations related to the administration of opioid antagonists in the treatment of disordered or problem gambling, pharmacological interventions should be administered with caution and with careful consideration of patient needs. A larger and more methodologically rigorous evidence base with longer-term evaluation periods is required before definitive conclusions can be drawn about the effectiveness and durability of pharmacological treatments for disordered or problem gambling.
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Affiliation(s)
- Nicki Dowling
- School of Psychology, Deakin University, Geelong, Australia
- Melbourne Graduate School of Education, University of Melbourne, Melbourne, Australia
| | | | - Dan Lubman
- Turning Point, Eastern Health, Melbourne, Australia
- Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Shane Thomas
- School of Health, Federation University, Melbourne, Australia
- Research School of Population Health, Australian National University, Melbourne, Australia
- Peking University, Beijing, China
| | - Henrietta Bowden-Jones
- National Problem Gambling Clinic UK, Faculty of Brain Sciences, UCL, London, UK
- Department of Psychiatry, Cambridge University, Cambridge, UK
| | - Sean Cowlishaw
- Department of Psychiatry, University of Melbourne, Melbourne, Australia
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Wizła M, Kraus SW, Lewczuk K. Perspective: Can psychedelic-assisted therapy be a promising aid in compulsive sexual behavior disorder treatment? Compr Psychiatry 2022; 115:152303. [PMID: 35334305 DOI: 10.1016/j.comppsych.2022.152303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/24/2021] [Accepted: 03/01/2022] [Indexed: 11/03/2022] Open
Abstract
Recently, there has been an increase in studies yielding evidence for psychedelics' anxiolytic and anti-depressive qualities. Preliminary evidence for treatment in substance addiction is also available. In our manuscript, we present a perspective on the possible effectiveness and mechanisms of action of psychedelics' introduction in the treatment of Compulsive Sexual Behavior Disorder (CSBD) and other p roblematic sexual behaviors, which are considered representative of the so-called "behavioral addiction" category. Evidence for the efficacy of Mindfulness Based Interventions in CSBD treatment is promising. Psychedelics- and mindfulness-induced states share common characteristics on both a subjective and objective level. One of the proposed mechanisms regards reduction of experiential avoidance through the promotion of exposure and acceptance. On the neurophysiological level, a shift from higher- to lower-level association regions and an impact on 5- HT2A receptors is observed. Elaborated mechanisms explain the possible enhancement of therapeutic processes by psychedelics. Psychedelics' relative safety and low addictive potential support their introduction into traditional forms of therapy for CSBD and other out of control behaviors.
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Affiliation(s)
- Magdalena Wizła
- Institute of Psychology, Cardinal Stefan Wyszynski University, Warsaw, Poland.
| | - Shane W Kraus
- Department of Psychology, University of Nevada, Las Vegas, NV, USA.
| | - Karol Lewczuk
- Institute of Psychology, Cardinal Stefan Wyszynski University, Warsaw, Poland.
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Grant Weinandy JT, Grubbs JB. Religious and spiritual beliefs and attitudes towards addiction and addiction treatment: A scoping review. Addict Behav Rep 2021; 14:100393. [PMID: 34938850 PMCID: PMC8664870 DOI: 10.1016/j.abrep.2021.100393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/09/2021] [Accepted: 11/11/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Throughout history, ideas about addiction have been informed and influenced by religious belief and practice. Even continuing into the present, religion and spirituality are often thought to impact attitudes towards addiction and its treatment, particularly given the use of religion and spirituality in various well-known treatments such as Alcoholics Anonymous. Although research has flourished with regards to the role that addiction and spirituality might play in vulnerability to addiction or the treatment of addiction, there has been comparatively less research examining how religion might impact attitudes toward addiction more broadly. METHOD The present work sought to examine the current state of empirical literature evaluating the relationships between religion and attitudes toward addiction and addiction treatment. In service of the above aim, a scoping review was conducted. RESULTS This summary of peer-reviewed, quantitative studies (n = 36) found that higher religiosity is related to more belief in the disease model of addiction in providers, negative attitudes towards addiction, and a stronger support for spiritually-based treatments. However, results varied based on the measures used and many relationships tested were not significant. There also appeared to be differences in the interaction between religion and spirituality and other variables, such as the respondent's sex or whether the individual was a student or provider, in terms of attitudes. CONCLUSIONS Further research is needed to fully understand the nuances in the relationship between these variables, including more clear operationalization and standardized measurement. Until such research is conducted, no cohesive conclusions can be drawn, and clinical implications remain unclear.
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Pharmacological and Psychosocial Treatment of Adults With Gambling Disorder: A Meta-Review. J Addict Med 2021; 14:e15-e23. [PMID: 31651561 DOI: 10.1097/adm.0000000000000574] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND OBJECTIVES Gambling disorder (GD) leads to impaired socioeconomical functioning and increased social costs. Although the research on GD has been rising over the years, approved treatment guidelines are currently not available. The aim of this study was to systematically review the literature on the pharmacological and psychosocial treatment of adults with GD, and to identify possible agreed-upon standards of care. METHODS MEDLINE, PubMed, Cochrane, Web of Science, Embase, and CINAHL electronic databases were searched up to April 2019 for systematic reviews on pharmacological, psychosocial, and combined treatment of adults with GD. Twenty-six studies were eventually included in this meta-review. RESULTS Studies reported promising results of opioid antagonists and mood stabilizers in reducing GD-related symptomatology. Lithium was particularly effective in subjects with comorbid bipolar disorders. Cognitive behavioral therapy (CBT) was the most commonly used psychological intervention and reduced global severity, gambling frequency, and financial loss. Motivational interviewing (MI) seemed to improve several GD domains, alone or in combination with CBT. Self-help interventions (SHIs) showed some efficacy in promoting treatment-seeking, and in combination with other treatments. CONCLUSIONS We found moderate evidence of effect for CBT, but weaker evidence for pharmacotherapy and SHIs. Results suggested some efficacy for MI in the short but not in the long term. It is likely that certain interventions might be more effective than others on specific features of GD. Further studies are needed to compare the efficacy and acceptability of individual and combined psychosocial and pharmacological interventions, to deliver patient-tailored treatments.
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Yoo JH, Chun JW, Choi MR, Cho H, Kim JY, Choi J, Kim DJ. Caudate nucleus volume mediates the link between glutamatergic neurotransmission and problematic smartphone use in youth. J Behav Addict 2021; 10:338-346. [PMID: 33905351 PMCID: PMC8996795 DOI: 10.1556/2006.2021.00024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 12/27/2020] [Accepted: 03/23/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND AIMS Problematic smartphone use (PSU) is growing rapidly among teens. It has similar presentations as other behavioral addictions in terms of excessive use, impulse control problems, and negative consequences. However, the underlying neurobiological mechanisms remain undiscovered. We hypothesized that structural changes in the striatum might serve as an important link between alteration in glutamate signaling and development of PSU. METHODS Among 88 participants, twenty (F:M, 12:8; age 16.2 ± 1.1) reported high scores in the smartphone addiction proneness scale (SAPS) with a cut-off score of 42; the other 68 (F:M, 19:49; age 15.3 ± 1.7) comprised the control group. Sociodemographic data and depression, anxiety, and impulsivity traits were measured. Striatal volumes (caudate, putamen, and nucleus accumbens) were estimated from T1 imaging data. Serum glutamate levels were estimated from peripheral blood samples. Group comparisons of each data were performed after controlling for age and gender. Mediation analyses were conducted to test the indirect effects of glutamate level alteration on PSU through striatal volumetric alteration. RESULTS The PSU group showed a decrease in both caudate volumes than the control group. Left caudate volume was positively correlated with serum glutamate level, and negatively with impulsivity traits and SAPS scores. The mediation model revealed a significant indirect effect of serum glutamate on SAS scores through the reduced left caudate volume. DISCUSSION AND CONCLUSIONS This study suggests that altered glutamatergic neurotransmission may be associated with PSU among teens, possibly through reduced left caudate volume. Current findings might support neural mechanisms of smartphone addiction.
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Affiliation(s)
- Jae Hyun Yoo
- Department of Psychiatry, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji-Won Chun
- Department of Psychiatry, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Mi Ran Choi
- Department of Psychiatry, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun Cho
- Department of Psychiatry, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jin-Young Kim
- Department of Psychiatry, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jihye Choi
- Department of Psychiatry, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dai-Jin Kim
- Department of Psychiatry, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea,Corresponding author. E-mail:
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Qin K, Zhang F, Chen T, Li L, Li W, Suo X, Lei D, Kemp GJ, Gong Q. Shared gray matter alterations in individuals with diverse behavioral addictions: A voxel-wise meta-analysis. J Behav Addict 2020; 9:44-57. [PMID: 32359230 PMCID: PMC8935193 DOI: 10.1556/2006.2020.00006] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND AIMS Numerous studies on behavioral addictions (BAs) have reported gray matter (GM) alterations in multiple brain regions by using voxel-based morphometry (VBM). However, findings are poorly replicated and it remains elusive whether distinct addictive behaviors are underpinned by shared abnormalities. In this meta-analysis, we integrated VBM studies on different BAs to investigate common GM abnormalities in individuals with BAs. METHODS Numerous studies on behavioral addictions (BAs) have reported gray matter (GM) alterations in multiple brain regions by using voxel-based morphometry (VBM). However, findings are poorly replicated and it remains elusive whether distinct addictive behaviors are underpinned by shared abnormalities. In this meta-analysis, we integrated VBM studies on different BAs to investigate common GM abnormalities in individuals with BAs. RESULTS Twenty studies including 505 individuals with BAs and 564 healthy controls met the inclusion criteria. Compared with healthy controls, individuals with BAs showed GM atrophy in the left anterior cingulate (extending to the left medial superior frontal gyrus and bilateral orbitofrontal gyrus), right putamen and right supplementary motor area. Subgroup analysis found heterogeneity in gender and subtypes of BAs. Meta-regression revealed that GM decreases in the left anterior cingulate and right supplementary motor area were positively correlated with addictive severity. Higher impulsivity was associated with smaller volume of the left anterior cingulate. DISCUSSION AND CONCLUSIONS Our findings on BAs were mainly derived from internet gaming disorder (IGD) and pathological gambling (PG) studies, preliminarily suggesting that GM atrophy in the prefrontal and striatal areas might be a common structural biomarker of BAs.
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Affiliation(s)
- Kun Qin
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Feifei Zhang
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Taolin Chen
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Lei Li
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Wenbin Li
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Xueling Suo
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Du Lei
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China,Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA,Corresponding author. Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 260 Stetson St., Suite 3326, Cincinnati, OH, USA. E-mail:
| | - Graham J. Kemp
- Liverpool Magnetic Resonance Imaging Centre (LiMRIC), Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China,Psychoradiology Research Unit of Chinese Academy of Medical Sciences, West China Hospital of Sichuan University, Chengdu, Sichuan, China,Corresponding author. Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, China. E-mail:
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Kraus SW, Etuk R, Potenza MN. Current pharmacotherapy for gambling disorder: a systematic review. Expert Opin Pharmacother 2020; 21:287-296. [PMID: 31928246 DOI: 10.1080/14656566.2019.1702969] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Introduction: Gambling disorder is classified as an addictive disorder and is associated with significant distress and impairment in personal, social, occupational or other important areas of functioning. Although no pharmacotherapy has a formal indication for gambling disorder, data suggest potential benefits of specific medications.Area covered: This systematic review evaluated findings from 19 randomized controlled trials testing pharmacotherapies for the treatment of gambling disorder.Expert opinion: Few randomized controlled trials have studied pharmacotherapies for gambling disorder. Though results are limited, opioid antagonists like naltrexone showed promise in the pharmacological treatment of gambling disorder. Pharmacotherapy combined with psychotherapy treatments for gambling disorder may provide better rates of patient retention in comparison to pharmacology-only treatments, though further research is needed in this area. Future studies should address gaps relating to considerations of racial, ethnic, gender and other individual differences in clinical studies. Because gambling disorder often co-occurs with other psychiatric disorders, additional research is needed to test treatments for dually diagnosed patients.
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Affiliation(s)
- Shane W Kraus
- Department of Psychology, University of Nevada, Las Vegas, NV, USA
| | - Repairer Etuk
- Department of Psychology, University of Nevada, Las Vegas, NV, USA
| | - Marc N Potenza
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.,Department of Neuroscience, Yale University School of Medicine, New Haven, CT, USA.,Yale Child Study Center, Yale University School of Medicine, New Haven, CT, USA.,The Connecticut Council on Problem Gambling, Wethersfield, CT, USA.,The Connecticut Mental Health Center, New Haven, CT, USA
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13
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Effects of 5-HT 2C, 5-HT 1A receptor challenges and modafinil on the initiation and persistence of gambling behaviours. Psychopharmacology (Berl) 2020; 237:1745-1756. [PMID: 32123974 PMCID: PMC7239826 DOI: 10.1007/s00213-020-05496-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 02/19/2020] [Indexed: 11/07/2022]
Abstract
RATIONALE Problematic patterns of gambling are characterised by loss of control and persistent gambling often to recover losses. However, little is known about the mechanisms that mediate initial choices to begin gambling and then continue to gamble in the face of losing outcomes. OBJECTIVES These experiments first assessed gambling and loss-chasing performance under different win/lose probabilities in C57Bl/6 mice, and then investigated the effects of antagonism of 5-HT2CR with SB242084, 5-HT1AR agonism with 8-OH-DPAT and modafinil, a putative cognitive enhancer. RESULTS As seen in humans and other species, mice demonstrated the expected patterns of behaviour as the odds for winning were altered increasing gambling and loss-chasing when winning was more likely. SB242084 decreased the likelihood to initially gamble, but had no effects on subsequent gambling choices in the face of repeated losses. In contrast, 8-OH-DPAT had no effects on choosing to gamble in the first place, but once started 8-OH-DPAT increased gambling choices in a dose-sensitive manner. Modafinil effects were different to the serotonergic drugs in both decreasing the propensity to initiate gambling and chase losses. CONCLUSIONS We present evidence for dissociable effects of systemic drug administration on different aspects of gambling behaviour. These data extend and reinforce the importance of serotonergic mechanisms in mediating discrete components of gambling behaviour. They further demonstrate the ability of modafinil to reduce gambling behaviour. Our work using a novel mouse paradigm may be of utility in modelling the complex psychological and neurobiological underpinnings of gambling problems, including the analysis of genetic and environmental factors.
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14
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Goslar M, Leibetseder M, Muench HM, Hofmann SG, Laireiter AR. Pharmacological Treatments for Disordered Gambling: A Meta-analysis. J Gambl Stud 2019; 35:415-445. [PMID: 30570700 PMCID: PMC6517351 DOI: 10.1007/s10899-018-09815-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Disordered gambling is a public health concern associated with detrimental consequences for affected individuals and social costs. Currently, opioid antagonists are considered the first-line treatments to reduce symptoms of uncontrolled gambling. Only recently, glutamatergic agents and combined pharmacological and psychological treatments have been examined appearing promising options for the management of gambling disorder. A multilevel literature search yielded 34 studies including open-label and placebo-controlled trials totaling 1340 participants to provide a comprehensive evaluation of the short- and long-term efficacies of pharmacological and combined treatments. Pharmacological treatments were associated with large and medium pre-post reductions in global severity, frequency, and financial loss (Hedges's g: 1.35, 1.22, 0.80, respectively). The controlled effect sizes for the outcome variables were significantly smaller (Hedges's g: 0.41, 0.11, 0.22), but robust for the reduction of global severity at short-term. In general, medication classes yielded comparable effect sizes independent of predictors of treatment outcome. Of the placebo controlled studies, results showed that opioid antagonists and mood stabilizers, particularly the glutamatergic agent topiramate combined with a cognitive intervention and lithium for gamblers with bipolar disorders demonstrated promising results. However, more rigorously designed, large-scale randomized controlled trials with extended placebo lead-in periods are necessary. Moreover, future studies need to monitor concurrent psychosocial treatments, the type of comorbidity, use equivalent measurement tools, include outcome variables according to the Banff, Alberta Consensus, and provide follow-up data in order to broaden the knowledge about the efficacy of pharmacological treatments for this disabling condition.
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Affiliation(s)
- Martina Goslar
- Department of Psychology, University of Salzburg, Hellbrunnerstrasse 34, 5020 Salzburg, Austria
| | - Max Leibetseder
- Department of Psychology, University of Salzburg, Hellbrunnerstrasse 34, 5020 Salzburg, Austria
| | - Hannah M. Muench
- Department of Clinical Psychology and Psychotherapy, Eberhard Karls University of Tuebingen, Schleichstraße 4, 72076 Tuebingen, Germany
| | - Stefan G. Hofmann
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Avenue, 2nd Fl., Boston, MA 02215 USA
| | - Anton-Rupert Laireiter
- Department of Psychology, University of Salzburg, Hellbrunnerstrasse 34, 5020 Salzburg, Austria
- Faculty of Psychology, University of Vienna, Liebiggasse 5, 1010 Vienna, Austria
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15
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Powell GL, Leyrer‐Jackson JM, Goenaga J, Namba MD, Piña J, Spencer S, Stankeviciute N, Schwartz D, Allen NP, Del Franco AP, McClure EA, Olive MF, Gipson CD. Chronic treatment with N-acetylcysteine decreases extinction responding and reduces cue-induced nicotine-seeking. Physiol Rep 2019; 7:e13958. [PMID: 30632301 PMCID: PMC6328917 DOI: 10.14814/phy2.13958] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 11/25/2018] [Accepted: 12/03/2018] [Indexed: 12/20/2022] Open
Abstract
N-acetylcysteine (NAC), a promising glutamatergic therapeutic agent, has shown some clinical efficacy in reducing nicotine use in humans and has been shown to reverse drug-induced changes in glutamatergic neurophysiology. In rats, nicotine-seeking behavior is associated with alterations in glutamatergic plasticity within the nucleus accumbens core (NAcore). Specifically, cue-induced nicotine-seeking is associated with rapid, transient synaptic plasticity (t-SP) in glutamatergic synapses on NAcore medium spiny neurons. The goal of the present study was to determine if NAC reduces nicotine-seeking behavior and reverses reinstatement-associated NAcore glutamatergic alterations. Rats were extinguished from nicotine self-administration, followed by subchronic NAC administration (0 or 100 mg/kg/d) for 4 days prior to cue-induced reinstatement. NAcore synaptic potentiation was measured via dendritic spine morphology and mRNA and protein of relevant glutamatergic genes were quantified. Nicotine-seeking behavior was not reduced by subchronic NAC treatment. Also, NAcore transcript and protein expression of multiple glutamatergic genes, as well as spine morphological measures, were unaffected by subchronic NAC. Finally, chronic NAC treatment (15 days total) during extinction and prior to reinstatement significantly decreased extinction responding and reduced reinstatement of nicotine-seeking compared to vehicle. Together, these results suggest that chronic NAC treatment is necessary for its therapeutic efficacy as a treatment strategy for nicotine addiction and relapse.
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Affiliation(s)
- Gregory L. Powell
- Department of PsychologyArizona State UniversityTempeArizona
- School of Life SciencesArizona State UniversityTempeArizona
| | | | | | - Mark D. Namba
- Department of PsychologyArizona State UniversityTempeArizona
| | - Jose Piña
- Department of PsychologyArizona State UniversityTempeArizona
| | - Sade Spencer
- Department of NeuroscienceMedical University of South CarolinaCharlestonSC
| | | | - Danielle Schwartz
- Department of NeuroscienceMedical University of South CarolinaCharlestonSC
| | - Nicholas P. Allen
- School of Dental MedicineLake Erie College of Osteopathic MedicineBradentonFlorida
| | | | - Erin A. McClure
- Department of PsychiatryMedical University of South CarolinaCharlestonSouth Carolina
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16
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Victorri-Vigneau C, Spiers A, Caillet P, Bruneau M, Ignace-Consortium, Challet-Bouju G, Grall-Bronnec M. Opioid Antagonists for Pharmacological Treatment of Gambling Disorder: Are they Relevant? Curr Neuropharmacol 2018; 16:1418-1432. [PMID: 28721822 PMCID: PMC6295935 DOI: 10.2174/1570159x15666170718144058] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 05/05/2017] [Accepted: 07/12/2017] [Indexed: 12/21/2022] Open
Abstract
Background: To date, no drugs have been approved for gambling disorder. Numerous publications have described the value of opioid antagonists. Indeed, the mesocorticolimbic dopaminergic pathway has been suggested as the underlying cause of reward-seeking behaviour, and it is modulated by the opioid system. Objective: This study aims to evaluate the relevance of opioid antagonists for treating GD. Method: A systematic literature review was conducted. A search of the PubMed electronic database, PsycINFO and the Cochrane Systematic Review Database without any limits was performed. Results: There is little information concerning the effects of opioid antagonists on GD. The total search with “nalmefene and gambling” without any limits revealed only 11 articles. The search with “naltrexone and gambling” without any limits gener-ated 47 articles. Nevertheless, the best available data support the use of opioid antagonists, particularly in individuals with a history of alcohol use disorder or strong gambling urges. Conclusion: Future trials are still needed. Indeed, opioid antagonists effectiveness has been investigated in only a limited number of patients, clinical trials do not reflect the heterogeneity of GD and there is little knowledge of the predictive factors of response to treatments. Moreover, differential affinity to nalmefene for kappa receptors may be associated with a particular effect in a yet to be defined addiction phenotype. Head to head comparisons between naltrexone and nalmefene would be helpful in combining other medication or psychotherapy. The identification of subgroups of patients that are more likely to benefit from opioid antagonists should be a goal
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Affiliation(s)
- Caroline Victorri-Vigneau
- Pharmacology Department, Nantes University Hospital, Nantes, France.,INSERM UMR1246 SPHERE Methods in Patients-centered outcomes and Health Research, University of Nantes and Tours, Nantes, France
| | - Andrew Spiers
- Pharmacology Department, Nantes University Hospital, Nantes, France
| | - Pascal Caillet
- Pharmacology Department, Nantes University Hospital, Nantes, France
| | - Mélanie Bruneau
- Addictology and Psychiatry Department, Nantes University Hospital, Nantes, France
| | - Ignace-Consortium
- Service de Pharmacologie Clinique, Institut de Biologie, 9 quai moncousu, 44093 Nantes cedex, France
| | - Gaëlle Challet-Bouju
- INSERM UMR1246 SPHERE Methods in Patients-centered outcomes and Health Research, University of Nantes and Tours, Nantes, France.,Addictology and Psychiatry Department, Nantes University Hospital, Nantes, France
| | - Marie Grall-Bronnec
- INSERM UMR1246 SPHERE Methods in Patients-centered outcomes and Health Research, University of Nantes and Tours, Nantes, France.,Addictology and Psychiatry Department, Nantes University Hospital, Nantes, France
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17
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Abstract
BACKGROUND AND AIMS To investigate the potential indications and adverse effects of using the opioid antagonist naltrexone to treat problem gamblers. CASE PRESENTATION The files of the 1,192 patients who were referred to the National Problem Gambling Clinic between January 2015 and June 2016 were audited. Seventeen patients were considered appropriate for treatment with naltrexone, having attended and failed to respond to psychological therapies at the clinic. Fourteen patients were placed on a regimen of 50 mg/day naltrexone. DISCUSSION Of the 14 patients who were treated with naltrexone, there were 10 for whom sufficient follow-up existed to analyze the treatment efficacy and side effects of naltrexone. Patients showed significant decreases in their craving to gamble and the majority (60%) were able to abstain completely from gambling in the treatment period, with a further 20% reducing their gambling to almost nothing. The reported side effects from the naltrexone included: loss of appetite, gastrointestinal pain, headaches, sedation, dizziness, and vivid dreams. Two patients with concurrent alcohol-use disorder relapsed during the treatment. One patient relapsed after the treatment period. CONCLUSIONS The study showed significant outcomes in reducing gambling cravings for the sample set. Given the design of the study as a case series, there was no control group, and a number of patients were on other psychotropic medications. We recommend care when prescribing to those suffering from concurrent alcohol-use disorder.
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Affiliation(s)
- Sophie Ward
- National Problem Gambling Clinic, Central and North West London NHS Foundation Trust, London, UK,Institute of Medical and Biomedical Education, St. George’s University of London, London, UK,Corresponding author: Sophie Ward; National Problem Gambling Clinic, Central and North West London NHS Foundation Trust, Cranmer Terrace, London SW17 0RE, UK; E-mail:
| | - Neil Smith
- National Problem Gambling Clinic, Central and North West London NHS Foundation Trust, London, UK
| | - Henrietta Bowden-Jones
- National Problem Gambling Clinic, Central and North West London NHS Foundation Trust, London, UK,Faculty of Medicine, Imperial College London, London, UK
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18
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Christensen DR. A review of opioid-based treatments for gambling disorder: an examination of treatment outcomes, cravings, and individual differences. INTERNATIONAL GAMBLING STUDIES 2018. [DOI: 10.1080/14459795.2018.1470662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Darren R. Christensen
- Faculty of Health Sciences, University of Lethbridge, Alberta Gambling Research Institute , Lethbridge, Canada
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19
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Balodis IM, Linnet J, Arshad F, Worhunsky PD, Stevens MC, Pearlson GD, Potenza MN. Relating neural processing of reward and loss prospect to risky decision-making in individuals with and without Gambling Disorder. INTERNATIONAL GAMBLING STUDIES 2018; 18:269-285. [PMID: 31485192 DOI: 10.1080/14459795.2018.1469658] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Neuroimaging studies demonstrate alterations in fronto-striatal neurocircuitry in gambling disorder (GD) during anticipatory processing, which may influence decision-making impairments. However, to date little is known about fronto-striatal anticipatory processing and emotion-based decision-making. While undergoing neuroimaging, 28 GD and 28 healthy control (HC) participants performed the Monetary Incentive Delay Task (MIDT). Pearson correlation coefficients assessed out-of-scanner Iowa Gambling Task (IGT) performance with the neural activity during prospect (A1) processing on the MIDT across combined GD and HC groups. The HC and GD groups showed no significant difference in out-of-scanner IGT performance, although there was a trend for higher IGT scores in the HC group on the last two IGT trial blocks. Whole-brain correlations across combined HC and GD groups showed that MIDT BOLD signal in the ventral striatum/caudate/ventromedial prefrontal cortex and anterior cingulate regions during the prospect of winning positively correlated with total IGT scores. The GD group also contained a higher proportion of tobacco smokers, and correlations between neural activations in prospect on the MIDT may relate in part to gambling and/or smoking pathology. In this study, fronto-striatal activity during the prospect of reward and loss on the MIDT was related to decision-making on the IGT, with blunted activation linked to disadvantageous decision-making. The findings from this work are novel in linking brain activity during a prospect-of-reward phase with performance on a decision-making task in individuals with and without GD.
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Affiliation(s)
- Iris M Balodis
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.,Peter Boris Centre for Addiction Research, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Jakob Linnet
- Research Clinic on Gambling Disorders, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Fiza Arshad
- Peter Boris Centre for Addiction Research, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Patrick D Worhunsky
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Michael C Stevens
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.,Institute of Living/Hartford Hospital & Olin Neuropsychiatry Research Center, Hartford, CT, USA
| | - Godfrey D Pearlson
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.,Institute of Living/Hartford Hospital & Olin Neuropsychiatry Research Center, Hartford, CT, USA.,Department of Neuroscience, Yale University School of Medicine, New Haven, CT, USA
| | - Marc N Potenza
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.,Department of Neuroscience, Yale University School of Medicine, New Haven, CT, USA.,Child Study Center, Yale University School of Medicine, New Haven, CT, USA.,Connecticut Mental Health Center, New Haven, CT, USA
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20
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Aragay N, Barrios M, Ramirez-Gendrau I, Garcia-Caballero A, Garrido G, Ramos-Grille I, Galindo Y, Martin-Dombrowski J, Vallès V. Impulsivity profiles in pathological slot machine gamblers. Compr Psychiatry 2018; 83:79-83. [PMID: 29625378 DOI: 10.1016/j.comppsych.2018.03.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 02/16/2018] [Accepted: 03/17/2018] [Indexed: 12/13/2022] Open
Abstract
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.
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Affiliation(s)
- Núria Aragay
- Pathological Gambling Unit, Consorci Sanitari de Terrassa, Barcelona, (Spain); Department of Mental Health, Consorci Sanitari de Terrassa, Barcelona, (Spain).
| | - Maite Barrios
- Quantitative Psychology Unit, Faculty of Psychology, University of Barcelona, Barcelona, Spain; Institute of Neurosciences (Neuro UB), University of Barcelona, Barcelona, Spain
| | - Isabel Ramirez-Gendrau
- Pathological Gambling Unit, Consorci Sanitari de Terrassa, Barcelona, (Spain); Department of Mental Health, Consorci Sanitari de Terrassa, Barcelona, (Spain)
| | - Anna Garcia-Caballero
- Pathological Gambling Unit, Consorci Sanitari de Terrassa, Barcelona, (Spain); Department of Mental Health, Consorci Sanitari de Terrassa, Barcelona, (Spain)
| | - Gemma Garrido
- Department of Mental Health, Consorci Sanitari de Terrassa, Barcelona, (Spain)
| | - Irene Ramos-Grille
- Department of Mental Health, Consorci Sanitari de Terrassa, Barcelona, (Spain)
| | - Yésika Galindo
- Department of Mental Health, Consorci Sanitari de Terrassa, Barcelona, (Spain)
| | | | - Vicenç Vallès
- Department of Mental Health, Consorci Sanitari de Terrassa, Barcelona, (Spain)
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21
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Menchon JM, Mestre-Bach G, Steward T, Fernández-Aranda F, Jiménez-Murcia S. An overview of gambling disorder: from treatment approaches to risk factors. F1000Res 2018; 7:434. [PMID: 30090625 PMCID: PMC5893944 DOI: 10.12688/f1000research.12784.1] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/03/2018] [Indexed: 12/26/2022] Open
Abstract
Gambling disorder (GD) has been reclassified recently into the "Substance-Related and Addictive Disorders" category of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), a landmark occurrence for a behavioral addiction. GD is characterized by recurrent, maladaptive gambling behavior that results in clinically significant distress. Although the number of randomized controlled trials assessing the effectiveness of pharmacological treatments is limited, some pharmacological treatments, notably opiate antagonists, have been employed in the treatment of GD. Patients with GD often present cognitive distortions and specific personality traits, making treatment more difficult. Cognitive behavioral therapy has become the most common psychological intervention for treating gambling problems, and it is effective in reducing gambling behavior. In this brief overview, we provide a report on the state of pharmacological and psychological treatments for gambling disorder. Risk factors and potential future lines of research are addressed.
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Affiliation(s)
- José M Menchon
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.,Departament of Clinical Sciences, School of Medicine, University of Barcelona , Barcelona, Spain.,CIBER Salud Mental (CIBERSAM), Instituto Carlos III, Barcelona, Spain
| | - Gemma Mestre-Bach
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.,Ciber Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Barcelona, Spain
| | - Trevor Steward
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.,Ciber Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Barcelona, Spain
| | - Fernando Fernández-Aranda
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.,Departament of Clinical Sciences, School of Medicine, University of Barcelona , Barcelona, Spain.,Ciber Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Barcelona, Spain
| | - Susana Jiménez-Murcia
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.,Departament of Clinical Sciences, School of Medicine, University of Barcelona , Barcelona, Spain.,Ciber Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Barcelona, Spain
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22
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Di Ciano P, Le Foll B. The Rat Gambling Task as a model for the preclinical development of treatments for gambling disorder. INTERNATIONAL GAMBLING STUDIES 2018. [DOI: 10.1080/14459795.2018.1448428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Patricia Di Ciano
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health (CAMH) , Toronto, Canada
| | - Bernard Le Foll
- Addiction Division, Centre for Addiction and Mental Health (CAMH) , Toronto, Canada
- Departments of Pharmacology and Toxicology, Psychiatry, Family and Community Medicine, Institute of Medical Sciences, University of Toronto , Toronto, Canada
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23
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Sauvaget A, Bulteau S, Guilleux A, Leboucher J, Pichot A, Valrivière P, Vanelle JM, Sébille-Rivain V, Grall-Bronnec M. Both active and sham low-frequency rTMS single sessions over the right DLPFC decrease cue-induced cravings among pathological gamblers seeking treatment: A randomized, double-blind, sham-controlled crossover trial. J Behav Addict 2018; 7:126-136. [PMID: 29463098 PMCID: PMC6035030 DOI: 10.1556/2006.7.2018.14] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 11/27/2017] [Accepted: 01/25/2018] [Indexed: 12/11/2022] Open
Abstract
Background Craving is a core symptom of addictive disorders, such as pathological gambling for example. Over the last decade, several studies have assessed the efficacy of repetitive transcranial magnetic stimulation (rTMS) in the addiction field, which triggers the dorsolateral prefrontal cortex (DLPFC) to decrease craving. The STIMJEU study investigated whether a single session of low-frequency (LF, i.e., 1 Hz) rTMS applied to the right DLPFC reduced cue-induced gambling craving in a sample of treatment-seeking pathological gamblers. Methods Thirty patients received both active and sham rTMS in random order and were blinded to the condition in a within-subject crossover design. Outcome measures included self-reported gambling craving (Visual Analog Scale and Gambling Craving Scale) and physiological measures (heart rate and blood pressure). Results The rTMS sessions were associated with a significant decrease in the gambling urge, regardless of whether the session was active or sham. When controlling cue-induced craving levels, no effects were observed on craving for active rTMS. Overall, rTMS was well-tolerated, and the credibility of the sham procedure was assessed and appeared to be appropriate. Conclusions We failed to demonstrate the specific efficacy of one session of LF rTMS to decrease cue-induced craving in pathological gamblers. A strong placebo-effect and rTMS parameters may partly explain these results. Yet, we are convinced that rTMS remains a promising therapeutic method. Further studies are required to examine its potential effect.
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Affiliation(s)
- Anne Sauvaget
- Psychiatry Neuromodulation Unit, Addictology and Liaison Psychiatry Department, CHU Nantes, Nantes, France
- Faculty of Sport Sciences, Laboratory “Movement, Interactions, Performance” (E.A. 4334), University of Nantes, Nantes, France
| | - Samuel Bulteau
- Psychiatry Neuromodulation Unit, Addictology and Liaison Psychiatry Department, CHU Nantes, Nantes, France
- SPHERE MethodS in Patients-centered outcomes and HEalth ResEarch, Université de Nantes, Université de Tours, Nantes, France
| | - Alice Guilleux
- SPHERE MethodS in Patients-centered outcomes and HEalth ResEarch, Université de Nantes, Université de Tours, Nantes, France
| | - Juliette Leboucher
- Pathological Gambling Treatment Unit, Addictology and Liaison Psychiatry Department, CHU Nantes, Nantes, France
| | - Anne Pichot
- Psychiatry Neuromodulation Unit, Addictology and Liaison Psychiatry Department, CHU Nantes, Nantes, France
| | - Pierre Valrivière
- Psychiatry Neuromodulation Unit, Addictology and Liaison Psychiatry Department, CHU Nantes, Nantes, France
| | - Jean-Marie Vanelle
- Psychiatry Neuromodulation Unit, Addictology and Liaison Psychiatry Department, CHU Nantes, Nantes, France
| | - Véronique Sébille-Rivain
- SPHERE MethodS in Patients-centered outcomes and HEalth ResEarch, Université de Nantes, Université de Tours, Nantes, France
| | - Marie Grall-Bronnec
- SPHERE MethodS in Patients-centered outcomes and HEalth ResEarch, Université de Nantes, Université de Tours, Nantes, France
- Pathological Gambling Treatment Unit, Addictology and Liaison Psychiatry Department, CHU Nantes, Nantes, France
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Pickering D, Keen B, Entwistle G, Blaszczynski A. Measuring treatment outcomes in gambling disorders: a systematic review. Addiction 2018; 113:411-426. [PMID: 28891116 PMCID: PMC5836978 DOI: 10.1111/add.13968] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 06/29/2017] [Accepted: 08/02/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND AIMS Considerable variation of outcome variables used to measure recovery in the gambling treatment literature has precluded effective cross-study evaluations and hindered the development of best-practice treatment methodologies. The aim of this systematic review was to describe current diffuse concepts of recovery in the gambling field by mapping the range of outcomes and measurement strategies used to evaluate treatments, and to identify more commonly accepted indices of recovery. METHODS A systematic search of six academic databases for studies evaluating treatments (psychological and pharmacological) for gambling disorders with a minimum 6-month follow-up. Data from eligible studies were tabulated and analysis conducted using a narrative approach. Guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were adhered to. RESULTS Thirty-four studies were reviewed systematically (RCTs = 17, comparative designs = 17). Sixty-three different outcome measures were identified: 25 (39.7%) assessed gambling-specific constructs, 36 (57.1%) assessed non-gambling specific constructs, and two instruments were used across both categories (3.2%). Self-report instruments ranged from psychometrically validated to ad-hoc author-designed questionnaires. Units of measurement were inconsistent, particularly in the assessment of gambling behaviour. All studies assessed indices of gambling behaviour and/or symptoms of gambling disorder. Almost all studies (n = 30; 88.2%) included secondary measures relating to psychiatric comorbidities, psychological processes linked to treatment approach, or global functioning and wellbeing. CONCLUSIONS In research on gambling disorders, the incorporation of broader outcome domains that extend beyond disorder-specific symptoms and behaviours suggests a multi-dimensional conceptualization of recovery. Development of a single comprehensive scale to measure all aspects of gambling recovery could help to facilitate uniform reporting practices across the field.
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Affiliation(s)
| | - Brittany Keen
- School of PsychologyUniversity of SydneySydneyAustralia
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Ssewanyana D, Bitanihirwe B. Problem Gambling among Young People in Sub-Saharan Africa. Front Public Health 2018; 6:23. [PMID: 29479527 PMCID: PMC5811642 DOI: 10.3389/fpubh.2018.00023] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 01/23/2018] [Indexed: 12/30/2022] Open
Abstract
Gambling is a cross-cultural and global activity which typically involves the wagering of money or an item of monetary value on an outcome that is governed by chance. Although gambling is positioned as a legitimate recreational and leisure activity within sub-Saharan Africa (SSA), there is widespread recognition among healthcare professionals and policy-makers that gambling has the capacity to become dysfunctional in a minority. Emerging knowledge suggests that problem gambling is rapidly evolving in to a public health concern in SSA, especially among youth. This article focuses on problem gambling among young people in SSA with an emphasis on three key themes: (1) gambling behavior and patterns in SSA; (2) public health and socioeconomic implications of gambling in SSA; and (3) public health policies and interventions for addressing this issue. We believe that collaborative efforts between government, prevention specialists, legislators, researchers, treatment providers, and other stake holders can influence the uptake of research findings necessary to implement social policies and design effective public health intervention options to combat problem gambling and its associated implications among young people in SSA.
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Affiliation(s)
- Derrick Ssewanyana
- Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya.,Utrecht Centre for Child and Adolescent Studies, Utrecht University, Utrecht, Netherlands
| | - Byron Bitanihirwe
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, PA, United States
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Effects of disulfiram on choice behavior in a rodent gambling task: association with catecholamine levels. Psychopharmacology (Berl) 2018; 235:23-35. [PMID: 29085979 PMCID: PMC5750121 DOI: 10.1007/s00213-017-4744-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 09/08/2017] [Indexed: 10/18/2022]
Abstract
RATIONALE Gambling disorder is a growing societal concern, as recognized by its recent classification as an addictive disorder in the DSM-5. Case reports have shown that disulfiram reduces gambling-related behavior in humans. OBJECTIVES The purpose of the present study was to determine whether disulfiram affects performance on a rat gambling task, a rodent version of the Iowa gambling task in humans, and whether any changes were associated with alterations in dopamine and/or norepinephrine levels. METHODS Rats were administered disulfiram prior to testing on the rat gambling task or prior to analysis of dopamine or norepinephrine levels in brain homogenates. Rats in the behavioral task were divided into two subgroups (optimal vs suboptimal) based on their baseline levels of performance in the rat gambling task. Rats in the optimal group chose the advantageous strategy more, and rats in the suboptimal group (a parallel to problem gambling) chose the disadvantageous strategy more. Rats were not divided into optimal or suboptimal groups prior to neurochemical analysis. RESULTS Disulfiram administered 2 h, but not 30 min, before the task dose-dependently improved choice behavior in the rats with an initial disadvantageous "gambling-like" strategy, while having no effect on the rats employing an advantageous strategy. The behavioral effects of disulfiram were associated with increased striatal dopamine and decreased striatal norepinephrine. CONCLUSIONS These findings suggest that combined actions on dopamine and norepinephrine may be a useful treatment for gambling disorders.
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Challet-Bouju G, Bruneau M, Victorri-Vigneau C, Grall-Bronnec M. Cognitive Remediation Interventions for Gambling Disorder: A Systematic Review. Front Psychol 2017; 8:1961. [PMID: 29255433 PMCID: PMC5723090 DOI: 10.3389/fpsyg.2017.01961] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 10/25/2017] [Indexed: 11/18/2022] Open
Abstract
Various therapeutic approaches are available for the treatment of gambling disorder (GD), especially cognitive behavioral therapy (CBT; the most widely used treatment). However, CBT has high dropout and relapse rates as well as non-compliance issues, which may be partly due to resistance to changing core characteristics, such as executive functioning, attention, and emotional regulation abnormalities. Finding new therapeutic approaches to treat GD is thus a key challenge. Cognitive remediation (CR) interventions represent a promising approach to GD management, which has recently been demonstrated to have efficacy for treating other addictive disorders. The objective of this review is to describe the possible benefits of CR interventions for GD management. Two systematic searches in MEDLINE and ScienceDirect databases were conducted up until January 2017. Potential neurocognitive targets of CR interventions for GD were reviewed, as is the use and efficacy of such interventions for GD. While there is evidence of several neurocognitive deficits in individuals with GD in terms of impulsive, reflective, and interoceptive processes, the literature on CR interventions is virtually absent. No clinical studies were found in the literature, apart from a trial of a very specific program using Playmancer, a serious videogame, which was tested in cases of bulimia nervosa and GD. However, neurocognitive impairments in individuals with addictive disorders are highly significant, not only affecting quality of life, but also making abstinence and recovery more difficult. Given that CR interventions represent a relatively novel therapeutic approach to addiction and that there is currently a scarcity of studies on clinical populations suffering from GD, further research is needed to examine the potential targets of such interventions and the effectiveness of different training approaches. So far, no consensus has been reached on the optimal parameters of CR interventions (duration, intensity, frequency, group vs. individual, pencil-and-paper vs. computerized delivery, etc.). Although no firm conclusions can be drawn, CR interventions represent a promising adjunct treatment for GD. Such a novel therapy could be associated with common interventions, such as CBT and educational and motivational interventions, in order to make therapies more effective and longer-lasting and to decrease the risk of relapse.
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Affiliation(s)
- Gaëlle Challet-Bouju
- Clinical Investigation Unit "Behavioral Addictions/Complex Affective Disorders", Department of Addictology and Psychiatry, CHU Nantes, Nantes, France.,Université de Nantes, Université de Tours, Institut National de la Santé et de la Recherche Médicale (INSERM) UMR 1246 SHERE, Nantes, France
| | - Mélanie Bruneau
- Clinical Investigation Unit "Behavioral Addictions/Complex Affective Disorders", Department of Addictology and Psychiatry, CHU Nantes, Nantes, France
| | | | - Caroline Victorri-Vigneau
- Université de Nantes, Université de Tours, Institut National de la Santé et de la Recherche Médicale (INSERM) UMR 1246 SHERE, Nantes, France.,Department of Pharmacology, Center for Evaluation and Information on Pharmacodependence, CHU Nantes, Nantes, France
| | - Marie Grall-Bronnec
- Clinical Investigation Unit "Behavioral Addictions/Complex Affective Disorders", Department of Addictology and Psychiatry, CHU Nantes, Nantes, France.,Université de Nantes, Université de Tours, Institut National de la Santé et de la Recherche Médicale (INSERM) UMR 1246 SHERE, Nantes, France
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28
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Worley J. The Role of Pleasure Neurobiology and Dopamine in Mental Health Disorders. J Psychosoc Nurs Ment Health Serv 2017; 55:17-21. [PMID: 28850647 DOI: 10.3928/02793695-20170818-09] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Recent evidence and research has demonstrated that the pleasure response and associated neurotransmitters and brain circuits play a significant role in substance use disorders (SUDs). It was thought that negative behaviors associated with SUDs resulted from negative choices, but it is now known that chemical changes in the brain drive those behaviors. Several mental health disorders (e.g., eating disorders, non-suicidal self-injury, compulsive sex behaviors, internet gaming, gambling) are also thought to involve those same pleasure responses, neurotransmitters, and brain regions. Studies have shown that the use of naltrexone, a dopamine antagonist, can reduce symptoms of these disorders. It is important for nurses to understand the underlying physiology of mental health disorders that are thought to have an addictive or craving component. This understanding can help reduce stigma. Educating patients about likely neurobiological causes for their disorders can also help reduce guilt and shame. Nurses should educate patients about these disorders and evidence-based treatments, including off-label use of naltrexone. [Journal of Psychosocial Nursing and Mental Health Services, 55(9), 17-21.].
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Yücel M, Carter A, Allen AR, Balleine B, Clark L, Dowling NA, Gainsbury SM, Goudriaan AE, Grant J, Hayes A, Hodgins D, van Holst R, Lattimore R, Livingstone C, Lorenzetti V, Lubman D, Murawski C, Parkes L, Petry N, Room R, Singh B, Thomas A, Townshend P, Youssef G, Hall W. Neuroscience in gambling policy and treatment: an interdisciplinary perspective. Lancet Psychiatry 2017; 4:501-506. [PMID: 28219609 DOI: 10.1016/s2215-0366(16)30369-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 10/28/2016] [Accepted: 10/28/2016] [Indexed: 01/05/2023]
Abstract
Neuroscientific explanations of gambling disorder can help people make sense of their experiences and guide the development of psychosocial interventions. However, the societal perceptions and implications of these explanations are not always clear or helpful. Two workshops in 2013 and 2014 brought together multidisciplinary researchers aiming to improve the clinical and policy-related effects of neuroscience research on gambling. The workshops revealed that neuroscience can be used to improve identification of the dangers of products used in gambling. Additionally, there was optimism associated with the diagnostic and prognostic uses of neuroscience in problem gambling and the provision of novel tools (eg, virtual reality) to assess the effectiveness of new policy interventions before their implementation. Other messages from these workshops were that neuroscientific models of decision making could provide a strong rationale for precommitment strategies and that interdisciplinary collaborations are needed to reduce the harms of gambling.
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Affiliation(s)
- Murat Yücel
- Brain and Mental Health Laboratory, Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Clayton, VIC, Australia.
| | - Adrian Carter
- Brain and Mental Health Laboratory, Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Clayton, VIC, Australia; UQ Centre for Clinical Research, University of Queensland, Brisbane, QLD, Australia
| | - Amy R Allen
- Brain and Mental Health Laboratory, Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Bernard Balleine
- Behavioural Neuroscience Laboratory, Brain and Mind Research Institute, University of Sydney, Camperdown, NSW, Australia
| | - Luke Clark
- Centre for Gambling Research, University of British Columbia, Vancouver, BC, Canada
| | - Nicki A Dowling
- Faculty of Health, School of Psychology, Deakin University, Burwood, VIC, Australia; Melbourne Graduate School of Education, University of Melbourne, Parkville, VIC, Australia; Centre for Gambling Research, Australian National University, Canberra, ACT, Australia
| | - Sally M Gainsbury
- School of Psychology, University of Sydney, Camperdown, NSW, Australia
| | - Anna E Goudriaan
- Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands; Arkin Mental Health Care, Amsterdam, Netherlands
| | - Jon Grant
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| | - Alan Hayes
- Family Action Centre, University of Newcastle, Callaghan, NSW, Australia
| | - David Hodgins
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Ruth van Holst
- Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands; Donders Institute for Cognition, Brain and Behaviour, Radboud University, Netherlands
| | - Ralph Lattimore
- Productivity Commission, Australian Government, Canberra, ACT, Australia
| | - Charles Livingstone
- School of Public Health and Preventive Medicine, Monash University, Clayton, VIC, Australia
| | - Valentina Lorenzetti
- Brain and Mental Health Laboratory, Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Clayton, VIC, Australia; Department of Psychological Sciences, Institute of Psychology Health and Society, University of Liverpool, Liverpool, UK
| | - Dan Lubman
- Eastern Health Clinical School, Monash University, Clayton, VIC, Australia; Turning Point, Eastern Health, Fitzroy, VIC, Australia
| | - Carsten Murawski
- Decision Neuroscience Laboratory, Department of Finance, University of Melbourne, Parkville, VIC, Australia
| | - Linden Parkes
- Brain and Mental Health Laboratory, Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Nancy Petry
- Department of Medicine, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Robin Room
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, VIC, Australia
| | - Bruce Singh
- Victorian Responsible Gambling Foundation, North Melbourne, VIC, Australia
| | - Anna Thomas
- Australian Gambling Research Centre, Australian Institute of Family Studies, Melbourne, VIC, Australia
| | - Phil Townshend
- Victorian Responsible Gambling Foundation, North Melbourne, VIC, Australia
| | - George Youssef
- Faculty of Health, School of Psychology, Deakin University, Burwood, VIC, Australia
| | - Wayne Hall
- UQ Centre for Clinical Research, University of Queensland, Brisbane, QLD, Australia; Centre for Youth Substance Abuse Research, University of Queensland, Brisbane, QLD, Australia
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Nautiyal KM, Okuda M, Hen R, Blanco C. Gambling disorder: an integrative review of animal and human studies. Ann N Y Acad Sci 2017; 1394:106-127. [PMID: 28486792 PMCID: PMC5466885 DOI: 10.1111/nyas.13356] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 03/08/2017] [Accepted: 03/22/2017] [Indexed: 11/29/2022]
Abstract
Gambling disorder (GD), previously called pathological gambling and classified as an impulse control disorder in DSM-III and DSM-IV, has recently been reclassified as an addictive disorder in the DSM-5. It is widely recognized as an important public health problem associated with substantial personal and social costs, high rates of psychiatric comorbidity, poor physical health, and elevated suicide rates. A number of risk factors have been identified, including some genetic polymorphisms. Animal models have been developed in order to study the underlying neural basis of GD. Here, we discuss recent advances in our understanding of the risk factors, disease course, and pathophysiology. A focus on a phenotype-based dissection of the disorder is included in which known neural correlates from animal and human studies are reviewed. Finally, current treatment approaches are discussed, as well as future directions for GD research.
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Affiliation(s)
- Katherine M. Nautiyal
- New York State Psychiatric Institute, New York, New York
- Department of Psychiatry, Columbia University, New York, New York
| | - Mayumi Okuda
- New York State Psychiatric Institute, New York, New York
- Department of Psychiatry, Columbia University, New York, New York
| | - Rene Hen
- New York State Psychiatric Institute, New York, New York
- Department of Psychiatry, Columbia University, New York, New York
- Departments of Neuroscience and Pharmacology, Columbia University, New York, New York
| | - Carlos Blanco
- National Institute on Drug Abuse, Rockville, Maryland
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Cocker PJ, Tremblay M, Kaur S, Winstanley CA. Chronic administration of the dopamine D 2/3 agonist ropinirole invigorates performance of a rodent slot machine task, potentially indicative of less distractible or compulsive-like gambling behaviour. Psychopharmacology (Berl) 2017; 234:137-153. [PMID: 27714426 DOI: 10.1007/s00213-016-4447-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 09/19/2016] [Indexed: 01/11/2023]
Abstract
RATIONALE Whilst dopamine agonist therapies can successfully manage the symptoms of diseases such as Parkinson's disease (PD), fibromyalgia and restless leg syndrome, they can also cause impulse control and addiction disorders such as gambling disorder (GD). These compulsive behaviours seriously undermine the utility of such treatments. OBJECTIVES The objective of the study was to model this phenomenon using a rodent slot machine task (rSMT) in order to investigate the neurobiological basis underlying such behavioural changes. METHODS Male Long Evans rats were trained to perform the rSMT. The D2-like agonist ropinirole, or saline, was then delivered continuously for 28 days via osmotic mini-pump. The effects of ropinirole on baseline rSMT performance, as well as extinction and reinstatement sessions, were determined during this time. Brain samples from key frontostriatal regions implicated in GD and PD were then harvested immediately or after a 4-week washout period during which behaviour returned to pre-drug baseline. RESULTS Ropinirole invigorated task performance, in that drug treatment resulted in a robust and sustained increase in the number of trials completed. Ex vivo analyses revealed that chronic ropinirole treatment led to a pattern of changes indicative of upregulation within the β-arrestin-AKT-GSK3β intracellular cascade, recently theorised to dominate D2-mediated signalling under hyperdopaminergic conditions, in the dorsal striatum, rather than the canonical PKA-dependent signalling pathway associated with D2 receptor activation. CONCLUSIONS Such findings provide novel insight into the role of dopamine signalling in mediating compulsive-like gambling behaviour and may inform more directed pharmacotherapies for the treatment of both idiopathic and iatrogenic GD.
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Affiliation(s)
- Paul J Cocker
- Department of Psychology, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, 2215 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.
| | - M Tremblay
- Department of Psychology, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, 2215 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - S Kaur
- Department of Psychology, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, 2215 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Catharine A Winstanley
- Department of Psychology, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, 2215 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.
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Galetti AM, Tavares H. Development and validation of the Gambling Follow-up Scale, Self-Report version: an outcome measure in the treatment of pathological gambling. ACTA ACUST UNITED AC 2016; 39:36-44. [PMID: 27828667 PMCID: PMC7112728 DOI: 10.1590/1516-4446-2016-1911] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 05/11/2016] [Indexed: 11/30/2022]
Abstract
Objective: To validate the Gambling Follow-up Scale, Self-Report version (GFS-SR), a 10-item scale designed to assess gambling frequency, time and money spent on gambling, gambling craving, debts, emotional distress, family relationships, autonomy, and frequency of and satisfaction with leisure activities in individuals diagnosed with gambling disorder according to the DSM-5 criteria. Methods: One hundred and twenty treatment-seeking gamblers were evaluated, 84 of whom proceeded to treatment. Fifty-two relatives provided collateral informant reports at baseline. Six months later, the 50 patients who completed the program were reassessed. Results: The GFS-SR showed good inter-rater agreement and internal consistency. Factor analysis presented a three-factor solution: gambling behavior (factor 1); social life (factor 2); and personal hardship (factor 3). There was a high degree of convergence between GFS-SR scores and those of reference scales. The GFS-SR scores showed excellent sensitivity to change (factor 1), predictive validity for treatment response (factor 2), and ability to distinguish recovered from unrecovered patients after treatment (factor 3). A cutoff score of 33 was found to have 87% sensitivity and 80% specificity for gambling recovery. Conclusion: The GFS-SR is well suited to providing reliable follow-up of gamblers under treatment and assessing the efficacy of their treatment.
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Affiliation(s)
- Ana M Galetti
- Programa Ambulatorial do Jogo, Instituto e Departamento de Psiquiatria, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Hermano Tavares
- Programa Ambulatorial do Jogo, Instituto e Departamento de Psiquiatria, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
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de Brito AMC, de Almeida Pinto MG, Bronstein G, Carneiro E, Faertes D, Fukugawa V, Duque A, Vasconcellos F, Tavares H. Topiramate Combined with Cognitive Restructuring for the Treatment of Gambling Disorder: A Two-Center, Randomized, Double-Blind Clinical Trial. J Gambl Stud 2016; 33:249-263. [DOI: 10.1007/s10899-016-9620-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Blunted Endogenous Opioid Release Following an Oral Amphetamine Challenge in Pathological Gamblers. Neuropsychopharmacology 2016; 41:1742-50. [PMID: 26552847 PMCID: PMC4869041 DOI: 10.1038/npp.2015.340] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 10/08/2015] [Accepted: 10/09/2015] [Indexed: 01/22/2023]
Abstract
Pathological gambling is a psychiatric disorder and the first recognized behavioral addiction, with similarities to substance use disorders but without the confounding effects of drug-related brain changes. Pathophysiology within the opioid receptor system is increasingly recognized in substance dependence, with higher mu-opioid receptor (MOR) availability reported in alcohol, cocaine and opiate addiction. Impulsivity, a risk factor across the addictions, has also been found to be associated with higher MOR availability. The aim of this study was to characterize baseline MOR availability and endogenous opioid release in pathological gamblers (PG) using [(11)C]carfentanil PET with an oral amphetamine challenge. Fourteen PG and 15 healthy volunteers (HV) underwent two [(11)C]carfentanil PET scans, before and after an oral administration of 0.5 mg/kg of d-amphetamine. The change in [(11)C]carfentanil binding between baseline and post-amphetamine scans (ΔBPND) was assessed in 10 regions of interest (ROI). MOR availability did not differ between PG and HV groups. As seen previously, oral amphetamine challenge led to significant reductions in [(11)C]carfentanil BPND in 8/10 ROI in HV. PG demonstrated significant blunting of opioid release compared with HV. PG also showed blunted amphetamine-induced euphoria and alertness compared with HV. Exploratory analysis revealed that impulsivity positively correlated with caudate baseline BPND in PG only. This study provides the first evidence of blunted endogenous opioid release in PG. Our findings are consistent with growing evidence that dysregulation of endogenous opioids may have an important role in the pathophysiology of addictions.
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Di Ciano P, Le Foll B. Evaluating the Impact of Naltrexone on the Rat Gambling Task to Test Its Predictive Validity for Gambling Disorder. PLoS One 2016; 11:e0155604. [PMID: 27191857 PMCID: PMC4871457 DOI: 10.1371/journal.pone.0155604] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 05/02/2016] [Indexed: 12/27/2022] Open
Abstract
Gambling Disorder has serious consequences and no medications are currently approved for the treatment of this disorder. One factor that may make medication development difficult is the lack of animal models of gambling that would allow for the pre-clinical screening of efficacy. Despite this, there is evidence from clinical trials that opiate antagonists, in particular naltrexone, may be useful in treating gambling disorder. To-date, the effects of naltrexone on pre-clinical models of gambling have not been evaluated. The purpose of the present study was to evaluate the effects of naltrexone in an animal model of gambling, the rat gambling task (rGT), to determine whether this model has some predictive validity. The rGT is a model in which rats are given a choice of making either a response that produces a large reward or a small reward. The larger the reward, the greater the punishment, and thus this task requires that the animal inhibit the ‘tempting’ choice, as the smaller reward option produces overall the most number of rewards per session. People with gambling disorder chose the tempting option more, thus the rGT may provide a model of problem gambling. It was found that naltrexone improved performance on this task in a subset of animals that chose the ‘tempting’, disadvantageous choice, more at baseline. Thus, the results of this study suggest that the rGT should be further investigated as a pre-clinical model of gambling disorder and that further investigation into whether opioid antagonists are effective in treating Gambling Disorder may be warranted.
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Affiliation(s)
| | - Bernard Le Foll
- Translational Addiction Research Laboratory, CAMH, Toronto, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Campbell Family Mental Health Research Institute, CAMH, Toronto, Canada
- Ambulatory Care and Structured Treatment Program, CAMH, Toronto, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
- * E-mail:
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36
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Piquet-Pessôa M, Fontenelle LF. Opioid antagonists in broadly defined behavioral addictions: a narrative review. Expert Opin Pharmacother 2016; 17:835-44. [PMID: 26798982 DOI: 10.1517/14656566.2016.1145660] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Naltrexone (NTX), a mu-opioid receptor antagonist, has been approved for the treatment of alcoholism and opioid dependence. More recently, however, NTX and a related drug, nalmefene (NMF), have also shown positive results for the treatment of gambling disorders. AREAS COVERED In this study, we reviewed the trials testing the effect of opioid antagonists (OA) in gambling disorders and in other broadly defined behavioral addictions, including selected DSM-5 disruptive, impulse-control, and conduct disorders, obsessive-compulsive and related disorders, eating disorders, and other conditions not currently recognized by official classification schemes. We found six randomized controlled trials (RCTs) of OA in gambling disorder, two RCTs of OA in trichotillomania (hair pulling disorder), two RCTs of OA in binge eating disorder, and one RCT of OA for kleptomania. We also reviewed case reports on hypersexual disorder, compulsive buying and skin picking disorders. EXPERT OPINION The reviewed data supported the use of OA, namely NTX and NMF, in gambling disorder (both) and kleptomania (NTX). We did not find enough evidence to support the use of NTX or NMF in trichotillomania (hair pulling disorder), excoriation (skin-picking) disorder, compulsive buying disorder, hypersexual disorder, or binge eating disorder.
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Affiliation(s)
- Marcelo Piquet-Pessôa
- a Obsessive, Compulsive, and Anxiety Spectrum Disorders Research Program, Institute of Psychiatry , Federal University of Rio de Janeiro (UFRJ) , Rio de Janeiro , Brasil
| | - Leonardo F Fontenelle
- a Obsessive, Compulsive, and Anxiety Spectrum Disorders Research Program, Institute of Psychiatry , Federal University of Rio de Janeiro (UFRJ) , Rio de Janeiro , Brasil.,b D'Or Institute for Research and Education (IDOR) , Rio de Janeiro , Brasil.,c Monash Institute of Cognitive and Clinical Neurosciences (MICCN), School of Psychological Sciences & Monash Biomedical Imaging (MBI) Facility , Monash University , Victoria , Australia
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Choi SW, Shin YC, Youn H, Lim SW, Ha J. Pharmacotherapy and group cognitive behavioral therapy enhance follow-up treatment duration in gambling disorder patients. Ann Gen Psychiatry 2016; 15:20. [PMID: 27525032 PMCID: PMC4982000 DOI: 10.1186/s12991-016-0107-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 07/27/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Longer treatment duration is important for the successful treatment of gambling disorder (GD). This retrospective study investigated the factors and interventions that might enhance treatment duration in GD patients in South Korea. METHODS A total of 758 outpatients with a primary diagnosis of GD, who were treated in a clinical practice from 2002 to 2011, were assessed by retrospective chart review. We compared the treatment duration according to pharmacotherapy and group cognitive behavioral therapy (CBT). RESULTS Pharmacotherapy contributed to a longer duration of treatment maintenance, despite the patients' gambling severity (p < 0.001). Participation in group CBT (p < 0.001) and antidepressants (p = 0.009) were associated with a longer treatment duration after adjusting for age, depression, and gambling severity. The treatment maintenance duration was the longest in those receiving combined antidepressant pharmacotherapy and group CBT (F = 35.79, p < 0.001). CONCLUSIONS Group CBT and antidepressants seem to enhance treatment follow-up duration in GD patients. Additional studies are needed to advance GD prevention and treatment strategies.
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Affiliation(s)
- Sam-Wook Choi
- Korea Institute on Behavioral Addictions, True Mind Clinic, F7, KR Tower, 1 141, Teheran-ro, Gangnam-gu, Seoul, 06132 South Korea ; Healthcare and Information Research Institute, Namseoul University, 91, Daehak-ro, Seonghwan-eup, Seobuk-gu, Cheonan-si, Chungcheongnam-do 31021 South Korea
| | - Young-Chul Shin
- Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29, Saemunan-ro, Jongno-gu, Seoul, 03181 South Korea
| | - HyunChul Youn
- Chungmugong Leadership Center, Naval Education and Training Command, Republic of Korea Navy, P.O. Box 211, 111, Jinhui-ro, Jinhae-gu, Changwon-si, Gyeongsangnam-do 51655 South Korea
| | - Se-Won Lim
- Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29, Saemunan-ro, Jongno-gu, Seoul, 03181 South Korea
| | - Juwon Ha
- Yonsei Forest Mental Health Clinic, Metroplaza 601, Jinkwan 2-ro 15-46, Eunpyeong-gu, Seoul, 03306 South Korea
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Raposo-Lima C, Castro L, Sousa N, Morgado P. SCRATCH THAT!—Two case reports of scratch-card gambling disorder. Addict Behav 2015; 45:30-3. [PMID: 25637885 DOI: 10.1016/j.addbeh.2015.01.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 11/16/2014] [Accepted: 01/12/2015] [Indexed: 12/20/2022]
Abstract
Gambling disorder is a common, clinically relevant condition that impacts significantly one's life. Given that approved pharmacological interventions are lacking, it is crucial to readily identify these cases to provide available interventions in psychiatric care services. Here, we present two uncommon cases of unique scratch-card gambling disorder, a specific type of pathological gambling that could be increasing as availability of these games are growing.
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Abstract
OBJECTIVES This study examined differences in the clinical and treatment-related features of pathological gambling (PG) on the basis of the age of PG onset among pathological gamblers who sought treatment. METHODS A total of 702 male outpatients with a primary diagnosis of PG and who were treated in a clinical practice were assessed by retrospective chart review. We selected the age of 25 years and younger as the threshold for "group 1." We then stratified the participants into 4 groups on the basis of the age of PG onset in 10-year intervals. Analysis of covariance with a covariant of age and the Pearson χ test were used for analyses. RESULTS We found that the earlier-onset gamblers were less likely to be escape type (P < 0.05), used significantly more Internet-based gambling (P < 0.001), and were less likely to engage in nonstrategic gambling (P < 0.05) than the later-onset gamblers. In addition, the earlier-onset gamblers took anticraving medication, such as naltrexone, significantly more often (P < 0.05), and sought treatment significantly more slowly after the onset of PG than the later-onset group (P < 0.01). Regarding adherence to treatment, however, there was no significant difference among the 4 groups on the basis of the age of PG onset. CONCLUSIONS The age of PG onset is associated with several important clinical and treatment features. More studies are needed to advance prevention and treatment strategies for each age group.
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Pharmacological treatments in gambling disorder: a qualitative review. BIOMED RESEARCH INTERNATIONAL 2014; 2014:537306. [PMID: 24955359 PMCID: PMC4052082 DOI: 10.1155/2014/537306] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 04/23/2014] [Indexed: 12/17/2022]
Abstract
Gambling disorder (GD) is a psychiatric condition associated with both social and family costs; DSM-5 currently includes GD among addictive disorders. Despite the high burden of this condition, to date there are no treatment guidelines approved by Food and Drug Administration (FDA). Purpose of this paper is to offer a qualitative overview about the different pharmacologic agents used for the treatment of GD. Our analysis, conducted on a final selection of 75 scientific papers, demonstrates that a variety of pharmaceutical classes have been utilised, with different results. Published data, although limited by brief duration of the studies and small number of enrolled subjects, shows mixed evidence for serotonergic antidepressants, opioid antagonists, and mood stabilizers. Other compounds, such as glutamatergic agents and psychostimulants, deserve further studies.
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Malizia AL, Ferro A. Drugs for addiction: a therapeutic area in need of a 'shot in the arm'. Br J Clin Pharmacol 2014; 77:225-7. [PMID: 24450545 DOI: 10.1111/bcp.12316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
- Andrea L Malizia
- Clinical Psychopharmacology and Neurostimulation, Department of Neurosurgery, Frenchay hospital, North Bristol NHS Trust, Bristol, BS16 1LE, UK
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