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Background and aims: This is the first nation‐wide register study based on a total population sample measuring the gender‐specific incidences of chronic diseases and conditions among adults diagnosed with gambling disorder (GD). Design, setting and participants: The study used aggregated data for 2011–22 retrieved from the Register of Primary Health Care visits, Care Register for Health Care and Care Register for Social Welfare, including specialized outpatient and inpatient health care, inpatient social care and institutional care and housing services with 24‐hour or part‐time assistance, set in mainland Finland. Participants comprised people aged 18–90+ years with GD diagnosis [corresponding to pathological gambling, International Classification of Diseases 10th revision (ICD‐10) code F63.0, n = 3605; men n = 2574, women n = 1031] and the general population (n = 4 374 192). Measurements: Incidences of somatic diseases and psychiatric disorders were calculated for the people with diagnosed GD and for the general population, separately for women and men. Findings After standardizing for age, the incidence of each diagnostic group was systematically higher for people with GD compared with the general population, except for cancer. The highest standardized incidence ratio (SIR) values were for psychiatric disorders [SIR = 234.2; 95% confidence interval (CI) = 226.1–242.4], memory disorders (SIR = 172.1; 95% CI = 119.1–234.8), nervous system diseases (SIR = 162.8; 95% CI = 152.8–173.1), chronic respiratory diseases (SIR = 150.6; 95% CI = 137.6–164.2), diabetes (SIR = 141.4; 95% CI = 127.9–155.5) and digestive diseases (SIR = 134.5; 95% CI = 127.1–142.2). Conclusions: In Finland, the incidence of chronic diseases and conditions among people with gambling disorder is higher compared with the general population, apart from cancer. [ABSTRACT FROM AUTHOR]

Objectives: The Gambling Disorder Identification Test (GDIT) is a recently developed self‐report measure. The GDIT includes items with multiple response options that are either based on frequency or time, and item response theory evaluations of these could yield vital knowledge on its measurement performance. Methods: The GDIT was evaluated using Rasch analysis in a study involving 597 Swedish gamblers. Results: In a three‐dimensional Rasch model, the item response difficulty range extended from −1.88 to 4.06 and increased with higher time‐ and frequency‐based responses. Differential item functioning showed that some GDIT items displayed age and gender‐related differences. Additionally, person‐separation reliability indicated the GDIT could reliably be divided into three to four diagnostic levels. Conclusions: The frequency‐ and time‐based item response options of the GDIT offer excellent measurement, allowing for elaborate assessment across both lower and higher gambling severity. The GDIT can be used to detect DSM‐5 Gambling Disorder, thereby holding significance from both epidemiological and clinical standpoints. Notably, the 3‐item GDIT Gambling Behavior subscale also shows potential as a brief screening tool for identifying at‐risk gambling behavior. [ABSTRACT FROM AUTHOR]

Objective: This study protocol describes the RIGAB study, a prospective case‐control‐study assessing online sports betting behaviour and underlying risk factors for the development of gambling disorder (GD). It has two aims: (1) to characterise sports bettors concerning putative risk factors and their gambling behaviour, and (2) to predict the development of GD from these factors. Methods: At baseline, online sports bettors took part in an online survey comprising a GD screening (DSM‐5), questions on gambling behaviour and on the putative risk factors emotion regulation, impulsivity, comorbidities, stress, and substance use. Participants were reinvited for a 1‐year follow‐up online survey. In a nested design, a subsample was invited in‐person to take part in a cognitive‐behavioural task battery and a clinical interview. Results: Of the initial 6568 online sports bettors invited, 607 participated at baseline (rate: 9.2%), 325 took part in the 1‐year follow‐up and 54 participated in the nested in‐person assessment. Conclusion: The RIGAB study combines different fields of GD studies: player tracking data and putative risk factors from self‐report and behavioural tasks. The results of this study will support the development of preventive measures for participants of online gambling based on the combined findings from previously rather distinct research fields. [ABSTRACT FROM AUTHOR]

The author comments on an article by D. Zendle and P. Newall which provides evidence for understanding the link between gambling spending and harm using novel methods. He discusses why Zendle and Newall's article provides an important contribution to the gambling literature, concern on the net-spend values computed by the authors, and basis of the authors' conclusion that affordability checks will not impact no-/low-risk gamblers.

Study of change mechanisms is important to advance theory development and to reveal the active components that make a critical difference in treatment. Improved outcomes in a randomized controlled trial that favored Congruence Couple Therapy (CCT) vs individual‐based Treatment‐as‐Usual (TAU) were correlated within each group. Partial correlations were used to test for mediation effects. The aggregate correlation coefficient of improved variables in addiction and mental health, couple adjustment, emotion regulation (ER) and life stress was moderate for CCT and weak for TAU. CCT showed greater number of mediating effects among improved variables than TAU. The prominence of the process mechanism of improved ER with its mediating effects for addiction and psychiatric symptoms evidenced in both groups is noteworthy, but ER improvement was significantly associated with improved couple adjustment only in CCT. Reduction in life stress in CCT was associated with a broader range of improvements in CCT compared to TAU. Correlation patterns were substantiated by CCT participants' endorsement of treatment targets emphasizing relationship, communication, emotion, problem solving, addiction and intergenerational issues of trauma. TAU participants reported significantly lower endorsements for these treatment targets. The correlation of ER and couple adjustment suggested as a key process mechanism should be further elucidated in future studies to differentiate relationship‐based vs individual‐based models and their respective outcomes for primary clients and partners. These findings are considered preliminary, requiring larger samples and advanced modelling among variables to provide a more profound mechanism analysis. [ABSTRACT FROM AUTHOR]

A nonblinded randomized trial was conducted at two Canadian provincial outpatient addiction clinics that tested the effectiveness of a systemic congruence couple therapy (CCT) versus individual‐based treatment‐as‐usual (TAU) on nine clinical outcomes: (1) primary outcomes—alcohol use and gambling, psychiatric symptoms, and couple adjustment; (2) secondary outcomes—emotion regulation, substance use, depression, post‐traumatic stress symptoms, and life stress. Data of primary clients and partners (N = 46) were analyzed longitudinally across baseline, posttreatment (5 months), and follow‐up (8 months). Alcohol use disorder (95%) and gambling disorder (5%) were in the severe range at baseline, and co‐addiction was 27%. Psychiatric comorbidity was 100%, and 18% of couples were jointly addicted. Between‐group comparison favored CCT in primary outcomes with medium‐to‐large effect sizes (Cohen's h = 0.74–1.44). Secondary outcomes were also significantly stronger for CCT (Cohen's h = 0.27–1.53). Within‐group, for all primary outcomes, a significant proportion of symptomatic CCT clients and partners improved, converging with ANOVA results of large effect sizes (0.14–0.29). All secondary outcomes improved significantly in CCT with large effect sizes (0.14–0.50). TAU showed significant within‐group improvement in alcohol use, other substance use, and life stress with large effect sizes (0.16–0.40). Primary clients and partners made largely equivalent improvement within CCT and within TAU. Results were triangulated with clients' satisfaction ratings and counselors' reports. Overall, significant within‐group effects were detected for CCT both clinically and statistically and between‐group difference favored CCT. Future trials are required to validate these promising findings. [ABSTRACT FROM AUTHOR]

Gambling disorder (GD) is major public health issue. The disorder is often characterized by elevated impulsivity with evidence from analogous substance use disorders underlining prominent roles of brain monoamines in addiction susceptibility and outcome. Critically, GD allows the study of addiction mechanisms without the confounder of the effects of chronic substances. Here, we assessed the roles of striatal dopamine transporter binding and extrastriatal serotonin transporter binding in GD as a function of impulsivity using [123I]FP‐CIT SPECT imaging in 20 older adults with GD (DSM‐5 criteria; mean age 64 years) and 40 non‐GD age‐ and sex‐matched controls. We focused on GD in older individuals because there are prominent age‐related changes in neurotransmitter function and because there are no reported neuroimaging studies of GD in older adults. Volume‐of‐interest‐based and voxelwise analyses were performed. GD patients scored clearly higher on impulsivity and had higher tracer binding in the ventromedial prefrontal cortex than controls (p < 0.001), likely reflecting serotonin transporter activity. The binding in the medial prefrontal cortex positively correlated with impulsivity over the whole sample (r = 0.62, p < 0.001) as well as separately in GD patients (r = 0.46, p = 0.04) and controls (r = 0.52, p < 0.001). Striatal tracer binding, reflecting dopamine transporter activity was also positively correlated with impulsivity but showed no group differences. These findings highlight the role of prefrontal serotonergic function in GD and impulsivity. They identify cerebral coordinates of a potential target for neuromodulation for both GD and high impulsivity, a core phenotypic dimensional cognitive marker in addictions. [ABSTRACT FROM AUTHOR]

Gambling's impact on a couple's relationship is an essential element in the gambling disorder (GD). Gamblers tend to lie to their partner to conceal the extent of their gambling problems and debts, which can lead to a serious relational transgression for the couple. One promising avenue is a couple treatment focusing on forgiveness processes. The objective of this study was to determine whether the Integrative Couple Treatment for Pathological Gamblers (ICT‐PG) with an emphasis on forgiveness processes helped couples to enhance these processes. A Single‐Case Research Design (SCRD) was used with three couples in which one of the members had a GD. The results highlight the importance of jointly analyzing the forgiveness processes between the gamblers and their partner, which constantly influenced each other. These promising results illustrate the relevance of integrating forgiveness processes in treatment for couples where one of the members has a GD. [ABSTRACT FROM AUTHOR]

Aims: Compulsivity is a common phenotype among psychiatric disorders, such as obsessive–compulsive disorder (OCD) and gambling disorder (GD). Deficiencies in metacognition, such as the inability to estimate one's performance via confidence judgments could contribute to pathological decision‐making. Earlier research has shown that patients with OCD exhibit underconfidence, while patients with GD exhibit overconfidence. Moreover, it is known that motivational states (e.g. monetary incentives) influence metacognition, with gain (respectively loss) prospects increasing (respectively decreasing) confidence. Here, we reasoned that OCD and GD symptoms might correspond to an exacerbation of this interaction between metacognition and motivation. Methods: We hypothesized GD's overconfidence to be exaggerated during gain prospects, while OCD's underconfidence to be worsened in loss context, which we expected to see represented in ventromedial prefrontal cortex (VMPFC) blood‐oxygen‐level‐dependent activity. We tested those hypotheses in a task‐based functional magnetic resonance imaging (fMRI) design (27 patients with GD, 28 patients with OCD, 55 controls). The trial is registered in the Dutch Trial Register (NL6171). Results: We showed increased confidence for patients with GD versus patients with OCD, which could partly be explained by sex and IQ. Although our primary analyses did not support the hypothesized interaction between incentives and groups, exploratory analyses did show increased confidence in patients with GD specifically in gain context. fMRI analyses confirmed a central role for VMPFC in the processing of confidence and incentives, but no differences between the groups. Conclusion: Patients with OCD and those with GD reside at opposite ends of the confidence spectrum, while no interaction with incentives was found, nor group differences in neuronal processing of confidence. [ABSTRACT FROM AUTHOR]

Background and Aims: The pathways model is a highly cited etiological model of problem gambling. In the past two decades, a number of studies have found support for the model's utility in classifying gambling subtypes. The aims of this paper were to refine empirically the model subtypes and to revise and update the model based on those findings. Design and Measurement: Observational study using data collected from treatment‐seeking problem gamblers using the Problem Gambling Severity Index (PGSI) and the Gambling Pathways Questionnaire (GPQ). Setting: Treatment clinics in Canada, Australia and the United States. Participants: A convenience sample of 1168 treatment‐seeking problem gamblers, aged 18 years or older. Findings Empirically validated risk factors were analyzed using latent class analyses, identifying a three‐class solution as the best‐fitting model. Those in the largest class (class 1: 44.3%, n = 517) reported the lowest levels of all etiological risk factors. Participants in class 2 (39.5%, n = 461) reported the highest rates of anxiety and depression, both before and after gambling became a problem, as well as childhood maltreatment, and a high level of gambling for stress‐coping. Those in class 3 (16.3%, n = 190) reported high levels of impulsivity; risk‐taking, including sexual risk‐taking; antisocial traits; and coping to provide meaning in life and to alleviate stress. Conclusions: The revised pathways model of problem gambling includes three classes of gamblers similar to the three subtypes in the original pathways model, but class 3 in the revised pathways model is distinct from class 2, showing higher levels of risk‐taking and antisocial traits and gambling motivated by a desire for meaning/purpose and/or to alleviate stress. Class 2 in the revised pathways model demonstrates high levels of childhood maltreatment as well as gambling for stress‐coping. [ABSTRACT FROM AUTHOR]

Aim: Recently, a machine‐learning (ML) technique has been used to create generalizable classifiers for psychiatric disorders based on information of functional connections (FCs) between brain regions at resting state. These classifiers predict diagnostic labels by a weighted linear sum (WLS) of the correlation values of a small number of selected FCs. We aimed to develop a generalizable classifier for gambling disorder (GD) from the information of FCs using the ML technique and examine relationships between WLS and clinical data. Methods: As a training dataset for ML, data from 71 GD patients and 90 healthy controls (HCs) were obtained from two magnetic resonance imaging sites. We used an ML algorithm consisting of a cascade of an L1‐regularized sparse canonical correlation analysis and a sparse logistic regression to create the classifier. The generalizability of the classifier was verified using an external dataset. This external dataset consisted of six GD patients and 14 HCs, and was collected at a different site from the sites of the training dataset. Correlations between WLS and South Oaks Gambling Screen (SOGS) and duration of illness were examined. Results: The classifier distinguished between the GD patients and HCs with high accuracy in leave‐one‐out cross‐validation (area under curve (AUC = 0.89)). This performance was confirmed in the external dataset (AUC = 0.81). There was no correlation between WLS, and SOGS and duration of illness in the GD patients. Conclusion: We developed a generalizable classifier for GD based on information of functional connections between brain regions at resting state. [ABSTRACT FROM AUTHOR]

Aims: To estimate whether the use of wagering inducements has a significant impact on the gambling behaviors of on‐line gamblers and describe this temporal relation under naturalistic conditions. Design This longitudinal observational study is part of the second stage of the Screening for Excessive Gambling Behaviors on the Internet (EDEIN) research program. Setting: Gambling tracking data from the French national on‐line gambling authority (poker, horse race betting and sports betting) and from the French national lottery operator (lotteries and scratch games). Participants: A total of 9306 gamblers who played poker, horse race or sports betting and 5682 gamblers who played lotteries and scratch games completed an on‐line survey. The gender ratio was largely male (between 87.1% and 92.9% for poker, horse race betting and sports betting, and equal to 65.1% for lotteries). Median age ranged from 35 (sports betting) to 53 (horse race betting and lotteries). Measurements The survey used the Problem Gambling Severity Index (PGSI) to determine the status of the gamblers (at‐risk or not). Gambling tracking data included weekly gambling intensity (wagers, deposits), gambling frequency (number of gambling days), proxies of at‐risk gambling behaviors (chasing and breadth of involvement) and use of wagering inducements. Findings The use of wagering inducements was associated with an increase of gambling intensity [β between −0.06 (−0.08; –0.05) and 0.57 (0.54; 0.60)], gambling frequency [β between 0.12 (0.10; 0.18) and 0.29 (0.28; 0.31)] and at‐risk gambling behaviors [odds ratio between 1.32 (1.16; 1.50) and 4.82 (4.61; 5.05)] at the same week of their use. This effect was stronger for at‐risk gambling behaviors and at‐risk gamblers. Conclusions: Wagering inducements may represent a risk factor for developing or exacerbating gambling problems. [ABSTRACT FROM AUTHOR]

A review of the article "The illusion of control," written by EJ Langer and printed in a 1975 issue of the "Journal of Personality and Social Psychology" is presented.

Aims: To evaluate and compare the effects of three cognitive boosting intervention approaches (computerised cognitive training, cognitive remediation and pharmacological cognitive enhancers) on measures of impulsive action and impulsive choice. Design Systematic review and meta‐analysis of publications that reported original controlled trials of cognitive boosting interventions. Setting: Studies conducted anywhere in the world. No language restrictions were applied. Participants: Treatment‐seeking adults with substance use disorder or gambling disorder. Measurements Our primary outcome was a reduction in impulsive action or choice on a validated cognitive measure post‐intervention. We assessed risk of bias using the Cochrane Collaboration tool and determined pooled estimates from published reports. We performed random‐effects analyses for impulsive action and impulsive choice outcomes and planned moderator analyses. Findings Of 2204 unique studies identified, 60 were included in the full‐text review. Twenty‐three articles were considered eligible for inclusion in the qualitative synthesis and 16 articles were included in our meta‐analysis. Articles eligible for pooled analyses included five working memory training (computerised cognitive training) studies with 236 participants, three goal management training (cognitive remediation) studies with 99 participants, four modafinil (cognitive enhancer) studies with 160 participants and four galantamine (cognitive enhancer) studies with 131 participants. Study duration ranged from 5 days to 13 weeks, with immediate follow‐up assessments. There were no studies identified that specifically targeted gambling disorder. We only found evidence for a benefit on impulsive choice of goal management training, although only in two studies involving 66 participants (standardised mean difference (SMD) = 0.86; 95% CI = 0.49–1.23; P = 0.02; I2 = 0%, P = 0.95). Conclusion: Cognitive remediation, and specifically goal management training, may be an effective treatment for addressing impulsive choice in addiction. Preliminary evidence does not support the use of computerised cognitive training or pharmacological enhancers to boost impulse control in addiction. [ABSTRACT FROM AUTHOR]

Background and Aims: Few meta‐analyses have been conducted to pool the most constant risk factors for problem gambling. The present meta‐analysis summarizes effect sizes of the most frequently assessed problem gambling risk factors, ranks them according to effect size strength and identifies any differences in effects across genders. Method: A random‐effects meta‐analysis was conducted on jurisdiction‐wide gambling prevalence surveys on the general adult population published until March 2019. One hundred and four studies were eligible for meta‐analysis. The number of participants varied depending on the risk factor analyzed, and ranged from 5327 to 273 946 (52% female). Weighted mean odds ratios were calculated for 57 risk factors (socio‐demographic, psychosocial, gambling activity and substance use correlates), allowing them to be ranked from largest to smallest with regard to their association with problem gambling. Results: The highest odds ratio (OR) was for internet gambling [OR = 7.59, 95% confidence interval (CI) = 5.24, 10.99, P < 0.000] and the lowest was for employment status (OR = 1.03, 95% CI = 0.87, 1.22, P = 0.718). The largest effect sizes were generally in the gambling activity category and the smallest were in the socio‐demographic category. No differences were found across genders for age‐associated risk. Conclusions: A meta‐analysis of 104 studies of gambling prevalence indicated that the most frequently assessed problem gambling risk factors with the highest effect sizes are associated with continuous‐play format gambling products. [ABSTRACT FROM AUTHOR]

Objectives: Diverse instruments are used to measure problem gambling and Gambling Disorder intervention outcomes. The 2004 Banff consensus agreement proposed necessary features for reporting gambling treatment efficacy. To address the challenge of including these features in a single instrument, a process was initiated to develop the Gambling Disorder Identification Test (GDIT), as an instrument analogous to the Alcohol Use Disorders Identification Test and the Drug Use Disorders Identification Test. Methods: Gambling experts from 10 countries participated in an international two‐round Delphi (n = 61; n = 30), rating 30 items proposed for inclusion in the GDIT. Gambling researchers and clinicians from several countries participated in three consensus meetings (n = 10; n = 4; n = 3). User feedback was obtained from individuals with experience of problem gambling (n = 12) and from treatment‐seekers with Gambling Disorder (n = 8). Results: Ten items fulfilled Delphi consensus criteria for inclusion in the GDIT (M ≥ 7 on a scale of 1–9 in the second round). Item‐related issues were addressed, and four more items were added to conform to the Banff agreement recommendations, yielding a final draft version of the GDIT with 14 items in three domains: gambling behavior, gambling symptoms and negative consequences. Conclusions: This study established preliminary construct and face validity for the GDIT. [ABSTRACT FROM AUTHOR]

In addiction, there are few human studies on the neural basis of cue-induced changes in value-based decision making (Pavlovian-to-instrumental transfer, PIT). It is especially unclear whether neural alterations related to PIT are due to the physiological effects of substance abuse or rather related to learning processes and/or other etiological factors related to addiction. We have thus investigated whether neural activation patterns during a PIT task help to distinguish subjects with gambling disorder (GD), a nonsubstance-based addiction, from healthy controls (HCs). Thirty GD and 30 HC subjects completed an affective decision-making task in a functional magnetic resonance imaging (fMRI) scanner. Gambling-associated and other emotional cues were shown in the background during the task. Data collection and feature modeling focused on a network of nucleus accumbens (NAcc), amygdala, and orbitofrontal cortex (OFC) (derived from PIT and substance use disorder [SUD] studies). We built and tested a linear classifier based on these multivariate neural PIT signatures. GD subjects showed stronger PIT than HC subjects. Classification based on neural PIT signatures yielded a significant area under the receiver operating curve (AUC-ROC) (0.70, p = 0.013). GD subjects showed stronger PIT-related functional connectivity between NAcc and amygdala elicited by gambling cues, as well as between amygdala and OFC elicited by negative and positive cues. HC and GD subjects were thus distinguishable by PIT-related neural signatures including amygdala-NAcc-OFC functional connectivity. Neural PIT alterations in addictive disorders might not depend on the physiological effect of a substance of abuse but on related learning processes or even innate neural traits. [ABSTRACT FROM AUTHOR]

Gambling is a popular pastime in India and the number of problem gamblers is on the rise. Although the impact of gambling disorder on families is grossly under‐researched in India, drawing on international evidence it is only reasonable to assume that this is an important area deserving further clinical and research attention. Of the several types of interventions possible with families of persons with gambling disorder, in our clinical experience, the 5‐step intervention is a feasible and culturally adaptable psychotherapeutic intervention. In this paper we have looked at the theoretical aspects of this intervention and also raise some of the practical challenges of offering psychological interventions to families of persons with gambling disorder in India. Albeit limited, we discuss the evidence base to have emerged from India in this field. Finally, we suggest some intervention measures as the way forward. [ABSTRACT FROM AUTHOR]

While an increased impact of cues on decision-making has been associated with substance dependence, it is yet unclear whether this is also a phenotype of non-substance-related addictive disorders, such as gambling disorder (GD). To better understand the basic mechanisms of impaired decision-making in addiction, we investigated whether cue-induced changes in decision-making could distinguish GD from healthy control (HC) subjects. We expected that cue-induced changes in gamble acceptance and specifically in loss aversion would distinguish GD from HC subjects. Thirty GD subjects and 30 matched HC subjects completed a mixed gambles task where gambling and other emotional cues were shown in the background. We used machine learning to carve out the importance of cue dependency of decision-making and of loss aversion for distinguishing GD from HC subjects. Cross-validated classification yielded an area under the receiver operating curve (AUC-ROC) of 68.9% (p = .002). Applying the classifier to an independent sample yielded an AUC-ROC of 65.0% (p = .047). As expected, the classifier used cue-induced changes in gamble acceptance to distinguish GD from HC. Especially, increased gambling during the presentation of gambling cues characterized GD subjects. However, cue-induced changes in loss aversion were irrelevant for distinguishing GD from HC subjects. To our knowledge, this is the first study to investigate the classificatory power of addiction-relevant behavioral task parameters when distinguishing GD from HC subjects. The results indicate that cue-induced changes in decision-making are a characteristic feature of addictive disorders, independent of a substance of abuse. [ABSTRACT FROM AUTHOR]

Background and aims: There is evidence that cognitive behavioral therapy (CBT) is effective for treating problem gambling (PG). Some research points to the possible benefits of involving concerned significant others (CSOs) in treatment. This study compared the efficacy of behavioral couples therapy (BCT) and CBT for both the gambler and the CSO. Design Two parallel‐group randomized controlled study comparing two different internet‐based treatments for PG. Follow‐up measures were conducted at treatment finish, and at 3‐, 6‐ and 12‐month post‐treatment. Setting: Stockholm, Sweden. Participants: A total of 136 problem gamblers and 136 CSOs were included in the study: 68 gamblers and 68 CSOs for each treatment condition. The gamblers were on average 35.6 years old and 18.4% were female. CSOs were on average 45.3 years old and 75.7% were women. Interventions: A treatment based on BCT was compared with a CBT intervention. Both treatments were internet‐based, with 10 therapist‐guided self‐help modules accompanied by weekly telephone and e‐mail support from a therapist. CSOs were given treatment in the BCT condition, but not in the CBT condition. Measurements The primary outcome measures were time‐line follow‐back for gambling (TLFB‐G) and the NORC Diagnostic Screen for Gambling Problems (NODS) for problem gamblers, corresponding to DSM‐IV criteria for pathological gambling. Secondary outcomes measures were the Patient Health Questionnaire‐9 (PHQ‐9), the Generalized Anxiety Disorder seven‐item scale (GAD‐7), the Relation Assessment Scale Generic (RAS‐G), the Alcohol Use Disorders Identification Test (AUDIT), the Inventory of Consequences of Gambling for the Gambler and CSO (ICS) and adherence to treatment for both the problem gambler and the CSO. Findings The outcomes of both gambler groups improved, and differences between the groups were not statistically significant: TLFB‐G: multiplicative effect = 1.13, 95% confidence interval (CI) = 0.30;4.31); NODS: multiplicative effect = 0.80, 95%, 95% CI = 0.24;2.36. BCT gamblers began treatment to a higher proportion than CBT gamblers: P = 0.002. Conclusions: Differences in the efficacy of internet‐based behavioral couples therapy and cognitive behavioral therapy for treatment of problem gambling were not significant, but more gamblers commenced treatment in the behavioral couples therapy group. [ABSTRACT FROM AUTHOR]

Keywords: bipolar disorder; gambling disorder; obsessive-compulsive disorder; ziprasidone EN bipolar disorder gambling disorder obsessive-compulsive disorder ziprasidone 425 428 4 06/12/20 20200601 NES 200601 Key message Bipolar disorder (BD) with comorbid obsessive-compulsive disorder (OCD) and gambling disorder (GD) is a severe and complex condition in clinical practice. In addition, the co-occurrence of other psychiatric disorders with BD is very high, with as many as 65%-95% meeting the diagnostic criteria for comorbid conditions.[1] Of these, about 25% are comorbid with obsessive-compulsive disorder (OCD), and 10.6% with gambling disorder (GD).[2] Moreover, BD patients with OCD are more likely to be comorbid with impulse-control disorder, including GD, than those without OCD. Recently, risperidone, quetiapine, olanzapine, and aripiprazole have been reported to be effective in the treatment of BD with OCD as an add-on therapy,[4] suggesting atypical antipsychotics might play a role in the treatment of BD with comorbid OCD. Learning points Bipolar disorder with comorbid obsessive-compulsive disorder (OCD) and gambling disorder (GD) is a severe and complex condition that confronts clinical psychiatrists. [Extracted from the article]

A number of researches showed high prevalence of personality disorders among addicted gamblers. However, there are still few studies investigating the role of pathological personality facets in Gambling Disorder (GD). Moreover, the nature of the relationship between GD and pathological personality is not clear. We administered to a group of addicted gamblers (N = 79) and a group of healthy participants (N = 101) a battery of self‐report questionnaires encompassing the South Oaks Gambling Screen (SOGS), The Personality Inventory for DSM‐V (PID‐5), the Difficulties in Emotion Regulation Scale (DERS) and the Emotion Regulation Questionnaire (ERQ). Analyses of variance showed that addicted gamblers, compared to healthy participants, scored higher on most of the subscales of the DERS, on the Suppression Dimension of the ERQ and on the five main domains of the PID‐5 whereas they obtained lower scores on the Reappraisal subscale of the ERQ. Moreover, multiple regression analyses indicated that some specific facets of pathological personality, emotion dysregulation and lack of cognitive reappraisal, significantly predict GD's severity. Finally, emotion dysregulation levels and lack of cognitive reappraisal partially mediated the relationship between these and GD's severity. Our results confirmed the central roles played by both pathological personality and deficit in emotion regulation capacities in GD. Specifically, Impulsivity, Lack of Perseverance and Suspiciousness may be important predictors of GD severity. Moreover, emotion dysregulation and lack of adaptive emotion regulation strategies partially explained such relationship. As such, training for emotion regulation abilities appears strategically useful in the treatment of addicted gamblers with pathological personality traits. [ABSTRACT FROM AUTHOR]

Gambling disorder (GD), currently considered a behavioral addiction, shows substantial similarities with substance use disorders (SUDs) in terms of neurobiology and phenomenology. These similarities have been recognized in the DSM‐5, although several relevant differences still exist in the diagnostic criteria, in particular, with regard to the role of cue‐ and stress‐ induced craving. Craving, recently included as a new criterion for SUDs diagnosis only, is a key construct also in the pathophysiology of GD. Furthermore, brain imaging studies indicate that similar alterations in cortico‐limbic‐striatal and prefrontal control circuits underlie the emergence of craving states in both disorders. This has important implications for the identification of neurobiologically based anti‐craving interventions, which may be used for both GD and SUDs. In this regard, a novel neuromodulation intervention, named repetitive transcranial magnetic stimulation (rTMS), is emerging as a promising treatment for craving in SUDs, and could potentially be effective also in treating gambling urges. Here, we review the clinical neurobiological research on GD, with a specific emphasis on the neural circuits implicated in cue‐ and stress‐craving, taking SUDs as the major comparative example. Furthermore, we describe the studies that have evaluated rTMS as a therapeutic tool for targeting and restoring the neural alterations underlying gambling urge. The manuscript concludes discussing some of the limitations of the current studies, and suggests directions for future rTMS research in GD. [ABSTRACT FROM AUTHOR]

Video slot machines are associated with both accelerated transition into problematic forms of gambling, as well as psychosocial harm above and beyond other forms of gambling. A growing body of evidence is uncovering how key design features of multiline slot machines produce an inflated experience of reward, despite the fact that these features offer no overall financial benefit to the player. A pernicious example of this are 'losses disguised as wins' (LDWs), which occur when simultaneous bets placed on multiple lines result in a winning combination that returns an amount greater than zero, but less the total wager. These events are usually accompanied by the same celebratory sounds and animations that accompany true wins. We argue that LDWs may leverage neuropsychological phenomena that underlie reinforcement learning and contribute to extended or repetitive use and gambling‐related harm. While other characteristics of slot machine gambling have been examined by cognitive neuroscientists, this feature has not yet received attention. Neuroscientific methods can be used to assess the impact of LDWs on the human reward system, to assess the claim that these events are a reinforcing and contributing factor in the development of harmful play. Positive findings would provide further persuasive evidence in support of strategies to minimise gambling harm through the regulation of machine design. [ABSTRACT FROM AUTHOR]

Gambling disorder (GD) is characterized by continual gambling despite negative consequences. Risky decision-making is a hallmark of the disorder. We applied a tool from behavioral economics for assessing probability cognition in both gain and loss domains to GD. We aimed to examine the alteration of probability cognition and its relationship with brain structure in GD. Forty-six GD patients and 52 age-matched healthy controls (HCs) conducted a risky choice task in which subjects should choose between a sure and a risky option in both loss and gain domains. The distortion and elevation parameters of the probability weighting function were estimated. We compared the parameters between GD and HC and examined their relationships with the striatum and amygdala volumes in GD. GD showed greater elevation parameter in the gain domain and smaller regional gray matter volume in the left amygdala than HC. The elevation parameter in the gain domain showed a negative correlation with the left amygdala volume in GD. Altered probability cognition in the gain domain but not in the loss domain might be more relevant to risky decision-making in GD. Our findings indicate that alteration in the amygdala might play a significant role in risky decision-making of GD. Longitudinal studies are recommended to examine the causal relationship between brain abnormalities and risky decision-making in GD. [ABSTRACT FROM AUTHOR]

Abstract: Preliminary evidence suggests that binge/purge type eating disorders and gambling disorder may commonly co‐occur. However, this dual‐diagnosis population remains understudied. The present research examined the prevalence rates and correlates of binge/purge type eating disorders (i.e., bulimia nervosa, binge‐eating disorder, and anorexia nervosa binge/purge type) among adults seeking treatment for their gambling (N = 349). In total, 11.5% of the sample (n = 40) met criteria for a binge/purge type eating disorder, most commonly bulimia nervosa (n = 33). There was a higher preponderance of binge/purge type eating disorders in women. People with a comorbid binge/purge type eating disorder reported more days gambling, gambling‐related cognitive distortions, impulsivity, suicidality, and other current psychiatric comorbidities including addictive behaviours. These findings suggest that binge/purge type eating disorders in people seeking treatment for gambling may be more common than previously believed. Furthermore, the increased psychopathology among people with binge/purge type eating disorder and gambling disorder identify vulnerabilities of this dual‐diagnosed population that may require clinical attention. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

The authors respond to commentaries on their study published within the issue which aimed to refine the pathways model subtypes of problem gambling and to revise and update the model based on the findings of studies which found support for the model's utility in classifying gambling subtypes. Topics covered include a range of risk factors considered and tested by the revised pathways model, and the relevant factors found in the model, such as attention deficit hyperactivity disorder (ADHD).

The authors comment on a study published within the issue which aimed to refine the pathways model subtypes of problem gambling and to revise and update the model based on the findings of studies which found support for the model's utility in classifying gambling subtypes. Topics covered include the strong assertion of the study that the model is aimed to classify relevant gambling patterns, and the need for research designs and approaches that can characterize key factors in the model.

The authors comment on a study published within the issue which aimed to refine the pathways model subtypes of problem gambling and to revise and update the model based on the findings of studies which found support for the model's utility in classifying gambling subtypes. Topics covered include the important diagnostic and treatment implications of the model for disordered gambling and the relevance of the connection with attention deficit hyperactivity disorder (ADHD) to gambling disorder.

As a behavioural addiction, gambling disorder (GD) provides an opportunity to characterize addictive processes without the potentially confounding effects of chronic excessive drug and alcohol exposure. Impulsivity is an established precursor to such addictive behaviours, and GD is associated with greater impulsivity. There is also evidence of GABAergic dysregulation in substance addiction and in impulsivity. This study therefore investigated GABAA receptor availability in 15 individuals with GD and 19 healthy volunteers (HV) using [11 C]Ro15-4513, a relatively selective α5 benzodiazepine receptor PET tracer and its relationship with impulsivity. We found significantly higher [11 C]Ro15-4513 total distribution volume (VT ) in the right hippocampus in the GD group compared with HV. We found higher levels of the 'Negative Urgency' construct of impulsivity in GD, and these were positively associated with higher [11 C]Ro15-4513 VT in the amygdala in the GD group; no such significant correlations were evident in the HV group. These results contrast with reduced binding of GABAergic PET ligands described previously in alcohol and opiate addiction and add to growing evidence for distinctions in the neuropharmacology between substance and behavioural addictions. These results provide the first characterization of GABAA receptors in GD with [11 C]Ro15-4513 PET and show greater α5 receptor availability and positive correlations with trait impulsivity. This GABAergic dysregulation is potential target for treatment. [ABSTRACT FROM AUTHOR]

Following the recent changes to the diagnostic category for addictive disorders in DSM-5, it is urgent to clarify what constitutes behavioural addiction to have a clear direction for future research and classification. However, in the years following the release of DSM-5, an expanding body of research has increasingly classified engagement in a wide range of common behaviours and leisure activities as possible behavioural addiction. If this expansion does not end, both the relevance and the credibility of the field of addictive disorders might be questioned, which may prompt a dismissive appraisal of the new DSM-5 subcategory for behavioural addiction. We propose an operational definition of behavioural addiction together with a number of exclusion criteria, to avoid pathologizing common behaviours and provide a common ground for further research. The definition and its exclusion criteria are clarified and justified by illustrating how these address a number of theoretical and methodological shortcomings that result from existing conceptualizations. We invite other researchers to extend our definition under an Open Science Foundation framework. [ABSTRACT FROM AUTHOR]

Gambling disorder (GD) is a topical problem in developed countries and may be present in 1-3% of the general population. The pathophysiology of this disorder is largely unknown but it shares similarities to other behavioral addictions. Multiple neurotransmitter systems, including dopaminergic, serotonergic, noradrenergic, glutamatergic, and opioidergic, have been implicated in GD. Based on available articles, only the opioid antagonist naltrexone has been documented to demonstrate clinical efficacy in multiple studies including double-blind studies. Nalmefene, another opioid antagonist, may be active as well but its dose-response effect remains unclear. Contrarily, current test results do not support the therapeutic use of any antidepressant drug. Some positive data has been made available supporting the use of N-acetylcystein, but more studies are needed to confirm this. No clear or definite information is currently available for other drugs. [ABSTRACT FROM AUTHOR]

Background and Aims Gambling disorder is characterized by poor regulation of negative emotions and impulsive behaviours. This study aimed to (1) compare gambling disorder patients (GDPs) and healthy controls (HCs) in self-report and brain activation measures of emotion regulation; and (2) establish its relationship with negative emotion-driven impulsivity. Design Two cross-sectional case-control studies including GDPs and HCs. Setting and Participants GDPs and HCs were recruited from specialized gambling clinics in Andalusia (Spain), where they were following out-patient treatment, and from the community, respectively. Study 1 included 41 GDPs and 45 HCs [All males; Mage = 35.22, 33.22; standard deviation (SD) = 11.16, 8.18; respectively]. Study 2 included 17 GDPs and 21 HCs (16/20 males; Mage = 32.94, 31.00; SD = 7.77, 4.60; respectively). Measurements In study 1, we compared both groups on suppression and re-appraisal emotion regulation strategies [Emotion Regulation Questionnaire (ERQ)]. In study 2, we compared GDPs with HCs on brain activation associated with down-regulation of negative emotions in a cognitive re-appraisal task, measured with functional magnetic resonance imaging (fMRI). In both studies, we correlated the measures of emotion regulation with mood-related impulsivity indicated by negative urgency (UPPS-P impulsive behaviour scale). Findings GDPs relative to HCs showed higher levels of emotional suppression [ F = 4.525; P = 0.036; means difference MHCs-MGDPs = −2.433, 95% confidence interval (CI) = −4.706, −0.159] and higher activation of the premotor cortex and middle frontal gyrus during negative emotion regulation in the fMRI task [ P ≤ 0.005, cluster size (CS) > 50 voxels]. Negative urgency correlated positively with emotional suppression ( r = 0.399, 95% CI = 0.104, 0.629, one-tailed P = 0.005) and middle frontal gyrus activation during negative emotion regulation ( P ≤ 0.005, CS > 50) in GDPs. Conclusions Gambling disorder is associated with greater use of emotional suppression and stronger pre-motor cortex and middle frontal gyrus activation for regulating negative emotions, compared with healthy controls. Emotional suppression use and middle frontal gyrus activation during negative emotion regulation are linked with negative emotion-driven impulsivity in this disorder. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

The incidence of pathological gambling in Parkinson's patients is significantly greater than in the general population. A correlation has been observed between dopamine agonist medication and the development of pathological gambling. However, scientists conjecture that the affected patients have underlying risk factors. Studies analysing Parkinson's patients have detected that patients who developed pathological gambling are younger, score higher on novelty-seeking tests, are more impulsive and are more likely to have a personal or family history of alcohol addiction. In addition, some genetic variations have been associated with the susceptibility of developing pathological gambling, which include mutations of DRD3, 5- HTTLPR and GRIN2B. Studies focusing on neurofunctional discrepancies between Parkinson's patients with and without pathological gambling have found increased functional activation and dopamine release in regions associated with the mesolimbic reward system. Furthermore, there is also evidence showing increased processing of reward and decreased activation elicited by punishment, suggesting altered learning processes. Furthermore, the role of deep brain stimulation of the nucleus subthalamicus ( STN DBS) is controversial. In most Parkinson's patients, pathological gambling resolved after the initiation of the STN DBS, which might be explained by discontinuation or decrease in dopamine agonist medication. However, it has been also shown that some patients are more impulsive while the STN DBS is activated. These differences may depend on the DBS localization in the more limbic or motor part of the STN and their regulative effects on impulsivity. Further research is needed to clarify susceptibility factors for the development of pathological gambling in Parkinson's patients. [ABSTRACT FROM AUTHOR]

A commentary on an article by Heirene & Gainsbury is presented, which explores the prevention of gambling.

Aim The objective of the study was to analyse shared commonalities and differences between bulimia nervosa (BN) and certain impulse-related disorders, namely compulsive buying (CB) and gambling disorder (GD), with respect to general psychopathology and personality traits. Methods A total of 188 female patients [50 BN without comorbid CB (BN−CB), 49 BN with comorbid CB (BN+CB), 53 GD and 36 CB] and 50 comparison non-psychiatric women participated in the current study. All patients were diagnosed using the Diagnostic and Statistical Manual of Mental Disorders, Fourth revised edition, the Temperament and Character Inventory-Revised, and other clinical indices. Results A positive-growing trend was observed in psychopathology and personality traits across the four clinical groups. Comorbid BN with CB was associated with highest eating psychopathology and social anxiety. On Novelty Seeking, the CB, GD and BN+CB were similar to each other, whereas BN−CB presented a distinct profile. Moreover, the BN+CB group displayed more dysfunctional personality traits and higher general psychopathology. The clinical groups demonstrated overall higher levels of psychopathology compared with the control group. Conclusions The results of this study demonstrate that disorders with impulsive traits (CB, GD, BN+CB and BN−CB) follow a linear trend in general psychopathology and specific personality traits, but differ along specific personality and psychopathological dimensions. Copyright © 2014 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Objectives To examine the effect of proposed the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) changes to pathological gambling relative to DSM-IV criteria in a large gambling helpline sample ( N = 2,750). Changes in prevalence rates, the diagnostic utility of the illegal acts criterion, and severity of alternative diagnostic formulation thresholds were examined. Method Callers to the helpline completed a semistructured interview and DSM-IV criteria were assessed. Results Without lowering the diagnostic threshold, removal of the illegal acts criterion resulted in loss of diagnostic status in less than 2% of helpline callers. The DSM-IV prevalence rate in this sample was 81.2%, and DSM-5 formulations with lowered thresholds of 4, 3, and 2 symptoms increased prevalence rates by 9% to 17%. However, item-level symptom endorsement suggested that subclinical gamblers experience significant adverse consequences. Conclusions Lowered thresholds may lead to earlier provision of treatment to gamblers and prevent escalation of the disorder, while being more consistent with diagnostic thresholds of other addiction disorders. [ABSTRACT FROM AUTHOR]

Aims To derive empirical subtypes of problem gamblers based on etiological and clinical characteristics described in the Pathways Model, using data from a nationally representative survey of US adults. Design & measurement Data were collected from structured diagnostic face-to-face interviews using the Alcohol Use Disorder and Associated Disabilities Interview Schedule DSM- IV version IV ( AUDADIS- IV). Setting The study utilized data from US National Epidemiologic Survey on Alcohol and Related Conditions ( NESARC). Participants All disordered gambling participants ( n = 581) from a nationally representative cross-sectional sample of civilian non-institutionalized adults aged 18 years or older. Findings Latent class analyses indicated that the best-fitting model was a three-class solution. Those in the largest class (class 1: 50.76%, n = 295) reported the lowest overall levels of psychopathology including gambling problem severity and mood disorders. In contrast, respondents in class 2 (20.06%, n = 117) had a high probability of endorsing past-year substance use disorders, moderate probabilities of having parents with alcohol/drug problems and of having a personality disorder, and the highest probability for past-year mood disorders. Respondents in class 3 (29.18%, n = 169) had the highest probabilities of personality and prior-to-past year mood disorders, substance use disorders, separation/divorce, drinking-related physical fights and parents with alcohol/drug problems and/or a history of antisocial personality disorder ( ASPD). Conclusions Three subtypes of disordered gamblers can be identified, roughly corresponding to the subtypes of the Pathways Model, ranging from a subgroup with low levels of gambling severity and psychopathology to one with high levels of gambling problem severity and comorbid psychiatric disorders. [ABSTRACT FROM AUTHOR]

The article presents an overview of the periodical's series on National Gambling Experiences, a commentary on the development and effect of gambling in various countries. It notes how authors detailed the periods of restriction, prohibition, and legalization of gambling. Particular attention is given to the trend of expansion in the late 1980s as well as subsequent studies on the harms, addiction, and treatment.

In many countries, it is currently possible to gamble on every sport event while being exposed to a high number of sports betting advertisements. Research is needed to examine how the increased popularity of sports betting is currently reframing the way that sports are being experienced by (young) sports fans. [ABSTRACT FROM AUTHOR]

Highly realistic slot machine simulations are a powerful way to test the impact of gambling structural features.‘ Nudging’ may provide a framework to mitigate the effects of Losses Disguised as Wins and, more broadly, to translate research findings into gambling policy. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "McCarthyism, Conflict of Interest and Addiction's New Transparency Declaration Procedures" by T.E. Babor and P.G. Miller in volume 109 of the periodical.

Similarities between gambling disorder and substance use disorders have been extensively described. To date, however, few studies using large clinical samples have been carried out that reliably assess the relationship between different levels of alcohol consumption and gambling disorders. The present study aimed to assess the impact of baseline alcohol consumption levels on the clinical profile in a large sample of treatment-seeking individuals. Nine hundred and fifty-one consecutive outpatients diagnosed with gambling disorder according to DSM-IV criteria were compared after being included in three alcohol consumption groups (low risk, abuse and risk of dependence) based on their total raw scores on the AUDIT questionnaire. Results showed a high prevalence of risk of alcohol dependence in GD patients who were immigrants, unemployed, and had a low level of education. A positive linear trend was also found between alcohol consumption level and the prevalence of other current and life-time comorbid mental disorders, and for the presence of drug abuse. Statistically significant differences were found between the three alcohol consumption groups in terms of the evolution and severity of the gambling disorder, self-directedness personality trait, and levels of general psychopathology, hostility and paranoid ideation. In conclusion, the results showed an association between increased alcohol consumption and greater dysfunction. [ABSTRACT FROM AUTHOR]

The article presents a psychological autopsy study which examines the relationship between suicide and gambling in Hong Kong, China. The study revealed that a gambling disorder is completed suicides' third most contributory psychiatric disorder in Hong Kong, after depressive and psychotic disorders. It showed that 20% of 3,686 clients who seek treatment from problem gambling services had suicidal thoughts.