Interactions between affective and cognitive processing systems in problematic gamblers: a functional connectivity study

Cue-induced craving and negative emotion disrupt response inhibition in methamphetamine use disorder: Behavioral and fMRI results from a mixed Go/No-Go task

BACKGROUND

Drug-related cue-reactivity, dysfunctional negative emotion processing, and response-disinhibition constitute three core aspects of methamphetamine use disorder (MUD). These phenomena have been studied independently, but the neuroscientific literature on their interaction in addictive disorders remains scant.

METHODS

62 individuals with MUD were scanned when responding to the geometric Go or No-Go cues superimposed over blank, neutral, negative-emotional and drug-related background images. Neural correlates of drug and negative-emotional cue-reactivity, response-inhibition and their interactions were estimated, and methamphetamine cue-reactivity was compared between individuals with MUD and 23 healthy controls. Relationships between behavioral characteristics and observed activations were investigated.

RESULTS

Individuals with MUD had longer reaction times and more errors in drug and negative-emotional compared to blank blocks, and more omission errors in drug compared to neutral blocks. They showed higher drug cue-reactivity than controls across prefrontal, fusiform, and visual regions (Z > 3.1, p-corrected<0.05). Response-inhibition was associated with precuneal, inferior parietal, anterior cingulate, temporal, and inferior frontal activations (Z > 3.1, p-corrected<0.05). Response-inhibition in drug cue blocks coincided with higher activations in the visual cortex and lower activations in the paracentral lobule and superior and inferior frontal gyri, while inhibition during negative-emotional blocks led to higher superior parietal, fusiform, and lateral occipital activations (Z > 3.1, p-corrected<0.05).

CONCLUSION

Drug cue-reactivity may impair response inhibition partly through activating dis-inhibitory regions, while temporal and parietal activations associated with response-inhibition in negative blocks suggest compensatory activity. Results suggest that drug and negative-emotional cue-reactivity influence response-inhibition, and the study of these interactions may aid mechanistic understanding of methamphetamine use disorder.

Distinct patterns of prefrontal cortical disengagement during inhibitory control in addiction: A meta-analysis based on population characteristics

Prefrontal cortical dysfunctions underlying inhibitory control deficits in addiction are complex and likely dependent on population characteristics. Here, we conducted a meta-analysis to examine alterations in brain activations during response inhibition in addicted individuals. We characterized imaging findings based on substance use status, diagnosis, substance classes, and task performance. Results revealed in those with active drug addiction hypoactivation of the left dorsal anterior cingulate cortex (dACC) and right middle frontal gyrus (MFG), compared with healthy controls. Weakening of the dACC and MFG activations was particularly pronounced in nicotine users, respectively. Impaired task performance was also associated with diminished MFG activation. In contrast, abstinent users did not exhibit any significant differences compared with healthy controls. Those with behavioral addictions were characterized by higher midcingulate cortical activation. Thus, the neural disengagement during response inhibition in active drug addiction was limited to a small number of prefrontal cortical regions and dependent on population characteristics. Finally, the evidence for potential normalization of hypofrontality following substance use cessation highlights the benefits of abstinence in restoring cerebral functions.

Brain Network Underlying Executive Functions in Gambling and Alcohol Use Disorders: An Activation Likelihood Estimation Meta-Analysis of fMRI Studies

BACKGROUND

Neuroimaging and neuropsychological studies have suggested that common features characterize both Gambling Disorder (GD) and Alcohol Use Disorder (AUD), but these conditions have rarely been compared.

METHODS

We provide evidence for the similarities and differences between GD and AUD in neural correlates of executive functions by performing an activation likelihood estimation meta-analysis of 34 functional magnetic resonance imaging studies involving executive function processes in individuals diagnosed with GD and AUD and healthy controls (HC).

RESULTS

GD showed greater bilateral clusters of activation compared with HC, mainly located in the head and body of the caudate, right middle frontal gyrus, right putamen, and hypothalamus. Differently, AUD showed enhanced activation compared with HC in the right lentiform nucleus, right middle frontal gyrus, and the precuneus; it also showed clusters of deactivation in the bilateral middle frontal gyrus, left middle cingulate cortex, and inferior portion of the left putamen.

CONCLUSIONS

Going beyond the limitations of a single study approach, these findings provide evidence, for the first time, that both disorders are associated with specific neural alterations in the neural network for executive functions.

Information Disclosure and Privacy Paradox

Self-disclosure of personal information is generally accepted as a security risk. Nonetheless, many individuals who are concerned about their privacy will often voluntarily reveal information to others. This inconsistency between individuals' expressed privacy concern and the willingness to divulge personal information is referred to as privacy paradox. Several arguments have been proposed to explain the inconsistency. One set of arguments centers around the possible effects of differences in personality characteristics, such as the Big Five factors. In the current article, we examine the role of one personality characteristic, impulsivity, in explaining the relationship between privacy concern and information disclosure. We report the results of a survey-based study that consisted of two hundred and forty-two (242) usable responses from subjects recruited on Amazon Mechanical Turk. The results show that one of the three dimensions of impulsivity, motor impulsivity, directly influences the extent of information disclosure and also moderates the relationship between privacy concern and information disclosure. Furthermore, our study shows impulsivity explains more variance in information disclosure than explained by the Big Five factors only.

Examining neural reactivity to gambling cues in the age of online betting

Purpose of Review

The goal of this review is to provide new insights as to how and why functional magnetic resonance imaging (fMRI) research on gambling cue reactivity can contribute to significant progress towards the understanding of gambling disorder. After having offered a detailed description of experimental paradigms and a comprehensive summary of findings related to gambling cue reactivity, the present review suggests methodological avenues for future research.

Recent Findings

The fMRI literature on problem gambling has identified the main neural pathways associated with reactivity to gambling cues. Yet, the current knowledge on the key factors underlying cue reactivity in gambling is still very incomplete. Here, we suggest that the recent expansion of online sports betting calls for a new line of research offering a fine-grained and up-to-date approach of neural cue reactivity in gambling disorder.

Summary

Experimental designs that investigate individual-specific and study-specific factors related to sports betting have the potential to foster progress towards efficient treatment and prevention of gambling disorder.

Behavioral Addictions as Mental Disorders: To Be or Not To Be?

Should excessive and problematic engagement in nonsubstance use behaviors be mental disorders? The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) repositioned gambling disorder in the substance use disorders section and introduced Internet gaming disorder in the research appendix; the International Classification of Diseases (ICD-11) is also considering it. This article outlines pros and cons of considering behavioral addictions as mental disorders and also reviews the DSM-5 decision-making processes. It focuses on three conditions: gambling disorder, Internet gaming disorder (IGD), and Internet addiction (IA). We detail assessment methods and prevalence rates for these conditions and outline psychiatric comorbidities, demographic and biological risk factors, and promising treatment approaches. We also briefly discuss other putative behavioral addictions: eating/food, sex, exercise, shopping, and tanning "addictions." Overall, data are inconclusive, and consistent terminology and methodology are needed to define and evaluate these conditions more fully prior to considering them mental disorders.

Anterior insula activation during inhibition to smoking cues is associated with ability to maintain tobacco abstinence

Relapse to smoking after initial abstinence is a major clinical challenge with significant public health consequences. At the brain and behavioral level, those who relapse to tobacco smoking have both greater cue-reactivity and lower inhibitory control than those who remain abstinent. Little is known about neural activation during inhibitory control tasks in the presence of drug-related cues. In the current study, tobacco smokers (SMK; n = 22) and non-smoking controls (CON; n = 19) completed a Go/NoGo task involving smoking cues during a functional magnetic resonance imaging (fMRI) scan. Following the scan session, smokers were required to quit smoking, and maintenance of abstinence was evaluated as part of a 12-week smoking cessation trial. We evaluated pre-cessation brain activity during NoGo trials in smokers who were versus were not able to quit smoking. We then compared fMRI and inhibitory control measures between smokers and non-smokers. We did not find differences between SMK and CON in performance or activation to smoking or neutral cues. However, compared to SMK who relapsed, SMK who attained biochemically-validated abstinence at the end of the smoking cessation trial had greater neural activation in the anterior insula during NoGo trials specifically with smoking-related cues. Results indicate that within SMK, decreased inhibitory control activation during direct exposure to drug-related stimuli may be a marker of difficulty quitting and relapse vulnerability.

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Smokers and controls showed no differences in performance or activation to smoking or neutral cues.

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Abstinent smokers compared to relapsers had greater activation in the insula during NoGo trials with smoking-related cues.

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Within smokers, decreased NoGo activation during exposure to drug-related cues may be a marker of relapse vulnerability.

Impulsivity and Stress Response in Pathological Gamblers During the Trier Social Stress Test

Gambling has been associated with increased sympathetic nervous system output and stimulation of the hypothalamic–pituitary–adrenal axis. However it is unclear how these systems are affected in pathological gambling. This study aimed to investigate the effect of the Trier Social Stress Test (TSST) on cortisol and on cardiac interbeat intervals in relation to impulsivity, in a sample of male pathological gamblers compared to healthy controls. In addition, we investigated the correlation between the TSST, duration of the disorder and impulsivity. A total of 35 pathological gamblers and 30 healthy controls, ranging from 19 to 58 years old and all male, participated in this study. Stress response was measured during and after the TSST by salivary cortisol and cardiac interbeat intervals; impulsivity was assessed with the Barratt Impulsiveness Scale (BIS-11). Exposure to the TSST produced a significant increase in salivary cortisol and interbeat intervals in both groups, without differences between groups. We found a negative correlation between baseline cortisol and duration of pathological gambling indicating that the longer the duration of the disorder the lower the baseline cortisol levels. Additionally, we found a main effect of impulsivity across groups on interbeat interval during the TSST, indicating an association between impulsivity and the intensity of the neurovegetative stress response during the TSST. Involvement of the hypothalamic–pituitary–adrenal axis in pathological gambling was confirmed together with evidence of a correlation between length of the disorder and diminished baseline cortisol levels. Impulsivity emerged as a personality trait expressed by pathological gamblers; however the neurovegetative response to the TSST, although associated with impulsivity, appeared to be independent of the presence of pathological gambling.

Flexible modulation of risk attitude during decision-making under quota

Risk attitude is often regarded as an intrinsic parameter in the individual personality. However, ethological studies reported state-dependent strategy optimization irrespective of individual preference. To synthesize the two contrasting literatures, we developed a novel gambling task that dynamically manipulated the quota severity (required outcome to clear the task) in a course of choice trials and conducted a task-fMRI study in human participants. The participants showed their individual risk preference when they had no quota constraint ('individual-preference mode'), while they adopted state-dependent optimal strategy when they needed to achieve a quota ('strategy-optimization mode'). fMRI analyses illustrated that the interplay among prefrontal areas and salience-network areas reflected the quota severity and the utilization of the optimal strategy, shedding light on the neural substrates of the quota-dependent risk attitude. Our results demonstrated the complex nature of risk-sensitive decision-making and may provide a new perspective for the understanding of problematic risky behaviors in human.

Brain Imaging in Gambling Disorder

Gambling disorder recently was reclassified under the category “substance-related and addictive disorders.” With regard to the diagnostic criteria, it overlaps a great deal with substance use disorder, i.e., loss of control, craving/withdrawal, and neglect of other areas of life. However, the gambling disorder symptom “chasing one’s losses” is the only criterion absent from substance use disorder. Therefore, special forms of reward (i.e., gain/loss) processing, such as the processing of loss avoidance and loss aversion, have just recently attracted attention among gambling disorder researchers. Because gambling disorder might be considered an addiction in its “pure” form, i.e., without the influence of a drug of abuse, investigating brain volume changes in people with this behavioral addiction is an important task for neuroimaging researchers in exploring the neural signatures of addiction. Because the brain is a complex network, investigation of alterations in functional connectivity has gained interest among gambling disorder researchers in order to get a more complete picture of functional brain changes in people with gambling disorder. However, only a few studies on brain structure and functional connectivity in gambling disorder have been performed so far. This review focuses on brain imaging studies of reward and loss processing, with an emphasis on loss avoidance and aversion as well as brain volume and functional connectivity in gambling disorder.

From symptoms to neurobiology: pathological gambling in the light of the new classification in DSM-5

Pathological gambling (PG), as defined until recently in the DSM-IV, shares many clinical characteristics with substance use disorders (SUDs), such as craving and loss of control. Moreover, an increasing body of literature also revealed neurobiological similarities between PG and substance-related addictions. Further, specific treatments for SUD are also effective in pathological gamblers. These observations resulted in a recent change in the diagnostic classification of PG in DSM-5: maladaptive gambling behavior is now subsumed as 'gambling disorder' (GD) under the category 'substance-related and addictive disorders'. On the basis of similarities in clinical characteristics between GD and SUDs, this article proposes 3 main clusters of diagnostic criteria: 'loss of control', 'craving/withdrawal' and 'neglect of other areas in life'. These symptom clusters can then be related to the experimental paradigms commonly used in the neuroscience of addiction, including neuropsychological, neurophysiological and neuroimaging studies. In this paper, we present the neurobiological evidence for PG by focusing on key functional magnetic resonance imaging studies related to these 3 symptom clusters. It is concluded that these symptom clusters provide a useful framework for systematic comparisons of new evidence in GD and SUDs in the future.

The neural bases of cognitive processes in gambling disorder

Functional imaging is offering powerful new tools to investigate the neurobiology of cognitive functioning in people with and without psychiatric conditions like gambling disorder. Based on similarities between gambling and substance-use disorders in neurocognitive and other domains, gambling disorder has recently been classified in the Diagnostic and Statistical Manual of Mental Disorders (5th edn) (DSM-5) as a behavioral addiction. Despite the advances in understanding, there exist multiple unanswered questions about the pathophysiology underlying gambling disorder and the promise for translating the neurobiological understanding into treatment advances remains largely unrealized. Here we review the neurocognitive underpinnings of gambling disorder with a view to improving prevention, treatment, and policy efforts.

Individual differences in gambling proneness among rats and common marmosets: an automated choice task

Interest is rising for animal modeling of pathological gambling. Using the operant probabilistic-delivery task (PDT), gambling proneness can be evaluated in laboratory animals. Drawing a comparison with rats, this study evaluated the common marmoset (Callithrix jacchus) using a PDT. By nose- or hand-poking, subjects learnt to prefer a large (LLL, 5-6 pellets) over a small (SS, 1-2 pellets) reward and, subsequently, the probability of occurrence of large-reward delivery was decreased progressively to very low levels (from 100% to 17% and 14%). As probability decreased, subjects showed a great versus little shift in preference from LLL to SS reinforcer. Hence, two distinct subpopulations (“non-gambler” versus “gambler”) were differentiated within each species. A proof of the model validity comes from marmosets' reaction to reward-delivery omission. Namely, depending on individual temperament (“gambler” versus “non-gambler”), they showed either persistence (i.e., inadequate pokes towards LLL) or restlessness (i.e., inadequate pokes towards SS), respectively. In conclusion, the marmoset could be a suitable model for preclinical gambling studies. Implementation of the PDT to species other than rats may be relevant for determining its external validity/generalizability and improving its face/construct validity.

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

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

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

The state of the art in organizational cognitive neuroscience: the therapeutic gap and possible implications for clinical practice

In the last decade, researchers in the social sciences have increasingly adopted neuroscientific techniques, with the consequent rise of research inspired by neuroscience in disciplines such as economics, marketing, decision sciences, and leadership. In 2007, we introduced the term organizational cognitive neuroscience (OCN), in an attempt to clearly demarcate research carried out in these many areas, and provide an overarching paradigm for research utilizing cognitive neuroscientific methods, theories, and concepts, within the organizational and business research fields. Here we will revisit and further refine the OCN paradigm, and define an approach where we feel the marriage of organizational theory and neuroscience will return even greater dividends in the future and that is within the field of clinical practice.

Elevated functional connectivity in a striatal-amygdala circuit in pathological gamblers

Both substance-based addiction and behavioural impulse control disorders (ICDs) have been associated with dysfunctions of the ventral striatum. Recent studies using functional connectivity techniques have revealed increased coupling of the ventral striatum with other limbic regions such as amygdala and orbitofrontal cortex in patients with substance abuse disorders and attention-deficit hyperactivity disorder. In the present study, we re-analyzed previously published functional magnetic resonance imaging data acquired in pathological gamblers and controls during value-based decision-making to investigate whether PG is associated with similar functional connectivity effects. In line with previous studies in other ICDs, we observed reliable increases in functional coupling between striatum and bilateral amygdala in gamblers vs. controls. Implications of these findings for neural models of self-control and addiction are discussed.

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

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