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Abstract Background Although males more frequently develop Internet gaming disorder (IGD) as compared with females, few studies have examined gender-related neurocognitive differences in IGD. Task and design fMRI and subjective data were collected from 119 subjects (IGD, male 29, female 25; recreational game use (RGU), male 34, female 31) when they were actively playing games and during a forced mandatory break. Analyses investigating effects of group (IGD, RGU) and gender (male, female) on the functional connectivity (FC) of executive control and reward systems linked to the dorsolateral prefrontal cortex (DLPFC) and striatum, respectively, were performed. Correlations between FC and subjective craving measures were also calculated. Results Gaming-group-by-gender interactions were observed. During gaming in males but not in females, the FC between the DLPFC and superior frontal gyrus was relatively decreased, and that between the striatum and thalamus was relatively increased. During the mandatory break, changes in the FC between DLPFC and superior frontal gyrus and the FC between the striatum and thalamus varied by gender with greater RGU-IGD differences observed in females. Significant correlations between FC and self-reported craving were observed. Conclusions During both gaming and a forced mandatory break, brain regions implicated in executive control and reward processing showed changes in FC that varied by gender. Brain regions implicated in executive control showed differential FC in males during gaming, and FC during the forced mandatory break appeared relevant to both genders, and perhaps particularly for females. The findings suggest possible neural mechanisms for why males appear more likely to develop IGD, and why it may be particularly difficult for individuals with IGD to cease gaming. Highlights • Males more frequently develop IGD as compared with females. • Gaming impaired IGD's executive control and enhanced their reward seeking. • The impaired executive control was largely observed in males during gaming. • The enhanced cravings were more obvious for females during abstinence. [ABSTRACT FROM AUTHOR]

Abstract: Background and aims: Despite the over‐representation of people with gambling problems in mental health populations, there is limited information available to guide the selection of brief screening instruments within mental health services. The primary aim was to compare the classification accuracy of nine brief problem gambling screening instruments (two to five items) with a reference standard among patients accessing mental health services. Design: The classification accuracy of nine brief screening instruments was compared with multiple cut‐off scores on a reference standard. Setting: Eight mental health services in Victoria, Australia. Participants: A total of 837 patients were recruited consecutively between June 2015 and January 2016. Measurements: The brief screening instruments were the Lie/Bet Questionnaire, Brief Problem Gambling Screen (BPGS) (two‐ to five‐item versions), NODS‐CLiP, NODS‐CLiP2, Brief Biosocial Gambling Screen (BBGS) and NODS‐PERC. The Problem Gambling Severity Index (PGSI) was the reference standard. Findings: The five‐item BPGS was the only instrument displaying satisfactory classification accuracy in detecting any level of gambling problem (low‐risk, moderate‐risk or problem gambling) (sensitivity = 0.803, specificity = 0.982, diagnostic efficiency = 0.943). Several shorter instruments adequately detected both problem and moderate‐risk, but not low‐risk, gambling: two three‐item instruments (NODS‐CLiP, three‐item BPGS) and two four‐item instruments (NODS‐PERC, four‐item BPGS) (sensitivity = 0.854–0.966, specificity = 0.901–0.954, diagnostic efficiency = 0.908–0.941). The four‐item instruments, however, did not provide any considerable advantage over the three‐item instruments. Similarly, the very brief (two‐item) instruments (Lie/Bet and two‐item BPGS) adequately detected problem gambling (sensitivity = 0.811–0.868, specificity = 0.938–0.943, diagnostic efficiency = 0.933–0.934), but not moderate‐risk or low‐risk gambling. Conclusions: The optimal brief screening instrument for mental health services wanting to screen for any level of gambling problem is the five‐item Brief Problem Gambling Screen (BPGS). Services wanting to employ a shorter instrument or to screen only for more severe gambling problems (moderate‐risk/problem gambling) can employ the NODS‐CLiP or the three‐item BPGS. Services that are only able to accommodate a very brief instrument can employ the Lie/Bet Questionnaire or the two‐item BPGS. [ABSTRACT FROM AUTHOR]

Premature termination challenges the successful outcomes of psychological treatments for gambling disorder. To date, research has primarily identified clients who are at particular risk for dropping out of treatment. A smaller but growing body of literature has investigated when dropout occurs. Typically, those studies have not considered improvement in psychological distress within their operationalizations of dropout and therefore may have misrepresented when dropout occurs. The current study examined when dropout occurs using an operationalization based on the criteria of attaining reliable change in a naturalistic sample of clients with gambling disorder, and the classification rates yielded from that operationalization were compared to the rates from a more common operationalization. Participants (n = 334) were clients meeting diagnostic criteria for gambling disorder at an outpatient private practice who completed a measure of psychological distress at baseline and prior to each subsequent treatment session. A survival analysis was conducted to determine temporal patterns of treatment dropout (i.e., clients who discontinued treatment before realizing reliable changes in psychological distress) and completion (i.e., clients who discontinued treatment after realizing reliable changes in distress) at each treatment session. Forty-nine percent of clients were classified as dropouts, and the majority of those clients did so in the first few sessions. The more common operationalization of dropout classified clients as dropouts when they had improved in their distress and clients as completers when they had not improved in their distress. Discussion centers on the implications of dropout occurring at various stages of treatment and future directions. [ABSTRACT FROM AUTHOR]

The problem of gambling addiction is especially noteworthy among college students, many of whom have the resources, proximity, free time, and desire to become involved in the myriad options of gambling now available. Although limited attention has been paid specifically to college student gambling in the body of literature, there have been three published meta-analyses estimating the prevalence of probable pathological gambling among college students. The research presented is the largest and most comprehensive, presenting an up-to-date proportion of those students worldwide exhibiting gambling pathology as assessed by the South Oaks Gambling Screen, and is the first to include estimates of sub-clinical problem gambling. A thorough literature review and coding procedure resulted in 124 independent data estimates retrieved from 72 studies conducted between 1987 and the present, surveying 41,989 university students worldwide. The estimated proportion of probable pathological gamblers among students was computed at 6.13%, while the rate of problem gambling was computed at 10.23%. Statistical significance was found in the influence of the percentage of non-white students on pathological gambling rates. The implications of this and other moderator analyses such as age and year of studies, as well as recommendations for future practice in dealing with college students and gambling disorder on campus are outlined and described in detail. Suggestions and rationales for future avenues of research in the area are also described. [ABSTRACT FROM AUTHOR]

Putting money at stake produces anticipatory uncertainty, a process that has been linked to key features of gambling. Here we examined how learning and individual differences modulate the stimulus preceding negativity (SPN, an electroencephalographic signature of perceived uncertainty of valued outcomes) in gambling disorder patients (GDPs) and healthy controls (HCs), during a non-gambling contingency learning task. Twenty-four GDPs and 26 HCs performed a causal learning task under conditions of high and medium uncertainty (HU, MU; null and positive cue-outcome contingency, respectively). Participants were asked to predict the outcome trial-by-trial, and to regularly judge the strength of the cue-outcome contingency. A pre-outcome SPN was extracted from simultaneous electroencephalographic recordings for each participant, uncertainty level, and task block. The two groups similarly learnt to predict the occurrence of the outcome in the presence/absence of the cue. In HCs, SPN amplitude decreased as the outcome became predictable in the MU condition, a decrement that was absent in the HU condition, where the outcome remained unpredictable during the task. Most importantly, GDPs' SPN remained high and insensitive to task type and block. In GDPs, the SPN amplitude was linked to gambling preferences. When both groups were considered together, SPN amplitude was also related to impulsivity. GDPs thus showed an abnormal electrophysiological response to outcome uncertainty, not attributable to faulty contingency learning. Differences with controls were larger in frequent players of passive games, and smaller in players of more active games. Potential psychological mechanisms underlying this set of effects are discussed. [ABSTRACT FROM AUTHOR]

Gambling disorder is a well-established behavioural addiction, which was classified with substance-related disorders in the fifth edition of theDiagnostic and Statistical Manual of Mental Disorders. Although craving was introduced as a new diagnostic criterion for substance-related disorders, it was not included for gambling disorder. This study aimed to explore the experience of gambling craving and to evaluate whether the elaborated intrusion theory of desire (EIT), a cognitive model of craving, fits gambling craving. A mixed methods study was conducted among 31 non-clinical gamblers. The qualitative part consisted of open-ended questions targeting the components of the EIT. The quantitative part consisted of a questionnaire designed to assess triggers and descriptions of gambling craving. Qualitative analysis revealed six distinct conceptual categories related to gambling craving: positive and negative affect, external cues, mental imageries, thoughts and physiological sensations. The quantitative analysis highlighted the most relevant triggers (e.g. spontaneous thoughts) and experiential characteristics (e.g. visual imagery) of gambling craving. The present study allowed the authors to support the relevance of the EIT as it applies to gambling craving by disentangling its core features. Findings from this study suggest that the use of interventions derived from the EIT may be relevant for problem gambling treatment. [ABSTRACT FROM PUBLISHER]

Individuals with disordered gambling often report at least one other lifetime psychiatric diagnosis. Although prevalence rates vary, there is substantial evidence for co-morbidity being the rule rather than the exception. Despite this known association, there has not been a recent comprehensive review of co-morbidity in disordered gambling other than prevalence surveys. The goal of this study was to broadly summarize and review the current literature on the extent, range and nature of disordered gambling co-morbidity. Following an initial search and screening of 6 databases, 251 articles were included in the final synthesis and evaluation. The main findings showed that few studies examine the mechanisms of co-morbidity in gambling beyond prevalence rates; few studies report on temporal sequencing of gambling and co-morbid disorders; there is a lack of treatment evaluation studies designed specifically for dual-diagnosis individuals; there is a need for system-level initiatives to address co-morbidity at the policy level; and the substance use literature may act as a useful model for guiding future gambling research on co-morbidity. The results suggest that despite a reasonable amount of published research on co-morbidity in disordered gambling, most study conclusions relegate to acknowledgements of high co-occurrence between disorders without follow-up. [ABSTRACT FROM PUBLISHER]

Background and Objectives: Gambling Disorder (GD) is characterized by recurrent gambling behavior that is associated with significant impairment and distress, high psychiatric comorbidities, and high functional disability. The military veteran population appears particularly susceptible to developing the disorder, but relatively little has been studied among this population. The purpose of the present study is to investigate the clinical psychopathologies and comorbidities of veterans seeking treatment for problem gambling and how problem gambling may impact functioning.Methods: Treatment-seeking veterans meeting criteria for GD (N = 61) underwent a structured clinical interview and completed the South Oaks Gambling Screen (SOGS), the Gambling Symptom Assessment Scale (G-SAS), the Yale-Brown Obsessive-Compulsive Scale for Gambling Disorder (PG-YBOCS), the Gambling Belief Questionnaire (GBQ), the Barratt Impulsiveness Scale (BIS-11), and the Sheehan Disability Scale (SDS).Results: Veterans seeking treatment for GD had high rates of psychiatric and addiction disorder comorbidities. Few veterans had previously sought treatment and most reported substantive challenges in social and occupational functioning. When determining how gambling-related characteristics (ie, severity and cognitive distortions) impact function, severity of cognitive distortions was the strongest statistical predictor of overall functional disability.Conclusions and Scientific Significance: The findings from this study indicate that there is high comorbidity between GD and other psychiatric and addictive disorders, as well as social and occupational functioning. In addition, cognitive distortions related to gambling relate importantly to overall functioning and should be considered in the development of interventions for veterans with GD. (Am J Addict 2018;27:108-115). [ABSTRACT FROM AUTHOR]

Background and aims: The DSM-5 includes criteria for diagnosing Internet gaming disorder (IGD) that are adapted from substance abuse and widely used in research and clinical contexts, although evidence supporting their validity remains scarce. This study compared online gamers who do or do not endorse IGD criteria regarding self-control-related abilities (impulsivity, inhibitory control, and decision-making), considered the hallmarks of addictive behaviors. Method: A double approach was adopted to distinguish pathological from recreational gamers: The first is the classic DSM-5 approach (=5 criteria required to endorse the IGD diagnosis), and the second consists in using latent class analysis (LCA) for IGD criteria to distinguish gamers' subgroups. We computed comparisons separately for each approach. Ninety-seven volunteer gamers from the community were recruited. Self-reported questionnaires were used to measure demographic- and game-related characteristics, problematic online gaming (with the Problematic Online Gaming Questionnaire), impulsivity (with the UPPS-P Impulsive Behavior Scale), and depression (with the Beck Depression Inventory-II). Experimental tasks were used to measure inhibitory control (Hybrid-Stop Task) and decisionmaking abilities (Game of Dice Task). Results: Thirty-two participants met IGD criteria (33% of the sample), whereas LCA identified two groups of gamers [pathological (35%) and recreational]. Comparisons that used both approaches (DSM-5 and LCA) failed to identify significant differences regarding all constructs except for variables related to actual or problematic gaming behaviors. Discussion: The validity of IGD criteria is questioned, mostly with respect to their relevance in distinguishing high engagement from pathological involvement in video games. [ABSTRACT FROM AUTHOR]

The ways in which addictive behaviours are perceived may decisively influence the ways they are handled. This study explores how treatment professionals' cultural and other background variables influence their beliefs about gambling and Internet addictions. Mailed surveys were conducted with addiction treatment professionals in Finland (n = 520) in 2007-2008 and France (n = 472) in 2010-2011. The data were analysed by descriptive statistical methods and logistic regression analysis. Cultural differences were the most consistent predictors of the responses concerning gambling and Internet addictions. The French professionals assessed the dependence risk in these behaviours as higher (P < 0.001) and they believed less than the Finns in the power of treatment (P < 0.001). The latter attributed more responsibility to the individual for solving these non-substance addictions (P < 0.001). The general views of gambling and Internet addictions mostly resembled each other but they varied with culture. The Finnish professionals' lower concern for the risk of dependence and the French professionals' distrust in treatment together with both groups' tendency to blame the individual for becoming addicted may all reduce professionals' willingness to help people who require treatment for their behavioural addictions. [ABSTRACT FROM AUTHOR]

This study aimed to examine associations between gambling level and clinically relevant measures, including psychiatric disorders and suicidality, in a nationally representative sample of U.S. veterans. Data on 3157 U.S. veterans were analyzed from the National Health and Resilience in Veterans Study. Chi square tests and analyses of variance were used to assess associations between gambling level, and demographic, military, and personality characteristics. Multinomial logistic regressions using stepwise selection were used to identify independent correlates of recreational gambling and at-risk/problem gambling (ARPG). A significant proportion of U.S. veterans engage in gambling activities, with 35.1% gambling recreationally and 2.2% screening positive for ARPG. ARPG was associated with greater prevalence of substance use, anxiety, and depressive disorders, as well as with a history of physical trauma or sexual trauma, having sought mental health treatment (particularly from the Veterans Administration), and minority group status. A similar pattern was found associated with recreational gambling, although the magnitudes of association were lower relative to ARPG. Younger age, self-identifying as black, being retired, and trauma burden were associated with increased odds of ARPG, whereas older age, being single, non-white Hispanic, being retired or not having a job, screening positive for alcohol- and drug-use disorders, and trauma burden were associated with increased odds of recreational gambling. More than a third of U.S. veterans gamble recreationally, with a significant minority (2.2%) screening positive for ARPG. Both recreational and ARPG were associated with elevated trauma burden and psychiatric comorbidities. These findings underscore the importance of routine screening and monitoring of gambling severity, and interventions for ARPG in this population. [ABSTRACT FROM AUTHOR]

In the current research, we examined whether the known link between relative deprivation and disordered gambling (via delay discounting; i.e., preferences for immediate smaller rewards relative to delayed larger rewards) is moderated by the extent to which gamblers have a financially focused self-concept. Specifically, we hypothesized that delay discounting would be a strong predictor of disordered gambling among those who base their self-worth on their financial success. To test this moderated-mediation model, a community sample of gamblers (N = 239) completed measures that assessed relative deprivation, delay discounting, financially focused self-concept, and disordered gambling severity. As predicted, people who felt more relative deprivation reported more severe symptoms of disordered gambling and this association was mediated by delay discounting. Importantly, this mediated relationship was moderated by the extent to which participants' self-concept was focused on financial success. Among participants whose self-concept was high in financial focus, greater delay discounting (stemming from relative deprivation) was a strong predictor of disordered gambling. Among people whose self-concept was low in financial focus, delay discounting (stemming from relative deprivation) was a weak predictor of disordered gambling. Thus, the magnitude of the indirect effect of relative deprivation on disordered gambling severity was larger among people with a more financially focused self-concept-an effect mediated by delay discounting. These findings suggest that targeting gamblers' financial focus in prevention and treatment interventions may be instrumental in curtailing the development and maintenance of disordered gambling. [ABSTRACT FROM AUTHOR]

Adverse childhood experiences (ACEs), such as sexual and physical abuse, have been established as risk factors for the development of disordered gambling. The underlying mechanism by which ACEs influence disordered gambling, however, remains unknown. The aims of the present research were to comprehensively investigate ten types of childhood adversity and their relationships to disordered gambling in adulthood, and to test whether emotion dysregulation mediated the relationship between ACEs and disordered gambling. A sample of community gamblers (N = 414) completed self-report measures of ACEs, emotion dysregulation, and gambling severity. Results revealed a significant association between all but one type (physical abuse) of ACEs and disordered gambling. Further, the results highlighted the cumulative impact of ACEs on gambling. Specifically, individuals who experienced three or more types of ACEs were more than three times as likely to report disordered gambling as compared to individuals with no history of childhood adversity. Importantly, as hypothesized, emotion dysregulation mediated the relationship between ACEs and disordered gambling. Findings from this research describe the association between ACEs and gambling and indicate a causal link between childhood adversity and disordered gambling. Results suggest that treatment initiatives may do well to address both ACEs and emotion dysregulation in the treatment of problem gambling. [ABSTRACT FROM AUTHOR]

The aim of this study was to identify predictors of treatment dropout in a sample of gamblers attending a specialist clinic for gambling disorder. We analysed data on 846 treatment-seeking pathological gamblers. Firstly, we investigated differences in socio-demographic and clinical variables between treatment completers and pre-treatment dropouts, as well as between treatment completers and during-treatment dropouts. Subsequently, variables were entered into a multinomial logistic regression model to identify significant predictors of pre-treatment and in-treatment dropout. Overall, 44.8% of clients did not complete the treatment: 27.4% dropped out before starting it, while 17.4% dropped out during the treatment. Younger age and use of drugs were associated with pre-treatment dropout, while family history of gambling disorder, a lower PGSI score, and being a smoker were related with in-treatment dropout. Our findings suggest that pre-treatment dropouts differ from in-treatment dropouts, and, thus, further research will benefit from considering these groups separately. In addition, this newly gained knowledge will also be helpful in increasing treatment retention in specific subgroups of problem gamblers. [ABSTRACT FROM AUTHOR]

Pathological gambling (PG) is a behavioral addiction characterized by an inability to stop gambling despite the negative consequences, which may be mediated by cognitive flexibility deficits. Indeed, impaired cognitive flexibility has previously been linked to PG and also to reduced integrity of white matter connections between the basal ganglia and the prefrontal cortex. It remains unclear, however, how white matter integrity problems relate to cognitive inflexibility seen in PG. We used a cognitive switch paradigm during functional magnetic resonance imaging in pathological gamblers (PGs; n = 26) and healthy controls (HCs; n = 26). Cognitive flexibility performance was measured behaviorally by accuracy and reaction time on the switch task, while brain activity was measured in terms of blood oxygen level-dependent responses. We also used diffusion tensor imaging on a subset of data (PGs = 21; HCs = 21) in combination with tract-based spatial statistics and probabilistic fiber tracking to assess white matter integrity between the basal ganglia and the dorsolateral prefrontal cortex. Although there were no significant group differences in either task performance, related neural activity or tract-based spatial statistics, PGs did show decreased white matter integrity between the left basal ganglia and prefrontal cortex. Our results complement and expand similar findings from a previous study in alcohol-dependent patients. Although we found no association between white matter integrity and task performance here, decreased white matter connections may contribute to a diminished ability to recruit prefrontal networks needed for regulating behavior in PG. Hence, our findings could resonate an underlying risk factor for PG, and we speculate that these findings may extend to addiction in general. [ABSTRACT FROM AUTHOR]

Background and aims: To estimate the prevalence of problem and pathological gambling, gender and age-group differences in gambling types, and comorbidities with other psychiatric disorders among the Thai general population. Methods: Analysis was conducted on 4,727 participants of Thailand's 2013 National Mental Health Survey, a multistage stratified cluster survey, using the Composite International Diagnostic Interview. Diagnoses of problem and pathological gambling and other psychiatric disorders were based on the DSM-IV-TR criteria with the following additional criteria for gamblers: more than 10 lifetime gambling episodes and a single year loss of at least 365 USD from gambling. Results: The estimated lifetime prevalence rates of pathological and problem gambling were 0.90% [95% confidence interval (CI): 0.51-1.29] and 1.14% (95% CI: 0.58-1.70), respectively. The most popular type of gambling was playing lotteries [69.5%, standard error (SE) = 1.9], the prevalence of which was significantly higher among females and older age groups. The most common psychiatric disorders seen among pathological gamblers were alcohol abuse (57.4%), nicotine dependence (49.5%), and any drug use disorder (16.2%). Pathological gambling was highly prevalent among those who ever experienced major depressive episodes (5.5%), any drug dependence (5.1%), and intermittent explosive disorder (4.8%). The association between pathological gambling was strongest with a history of major depressive episode [adjusted odds ratio (AOR) = 10.4, 95% CI: 2.80-38.4]. Conclusion: The study confirms the recognition of gambling disorders as a public health concern in Thailand and suggests a need for culturally specific preventive measures for pathological gamblers and those with a history of substance use disorders or major depression. [ABSTRACT FROM AUTHOR]

Background Pathological gambling is a behavioural addiction with negative economic, social, and psychological consequences. Identification of contributing genes and pathways may improve understanding of aetiology and facilitate therapy and prevention. Here, we report the first genome-wide association study of pathological gambling. Our aims were to identify pathways involved in pathological gambling, and examine whether there is a genetic overlap between pathological gambling and alcohol dependence. Methods Four hundred and forty-five individuals with a diagnosis of pathological gambling according to the Diagnostic and Statistical Manual of Mental Disorders were recruited in Germany, and 986 controls were drawn from a German general population sample. A genome-wide association study of pathological gambling comprising single marker, gene-based, and pathway analyses, was performed. Polygenic risk scores were generated using data from a German genome-wide association study of alcohol dependence. Results No genome-wide significant association with pathological gambling was found for single markers or genes. Pathways for Huntington's disease ( P -value = 6.63 × 10 −3 ); 5′-adenosine monophosphate-activated protein kinase signalling ( P -value = 9.57 × 10 −3 ); and apoptosis ( P -value = 1.75 × 10 −2 ) were significant. Polygenic risk score analysis of the alcohol dependence dataset yielded a one-sided nominal significant P -value in subjects with pathological gambling, irrespective of comorbid alcohol dependence status. Conclusions The present results accord with previous quantitative formal genetic studies which showed genetic overlap between non-substance- and substance-related addictions. Furthermore, pathway analysis suggests shared pathology between Huntington's disease and pathological gambling. This finding is consistent with previous imaging studies. [ABSTRACT FROM AUTHOR]

Self-report purchase tasks are a novel approach examining the reinforcing value of addictive behaviour relative to increasing monetary costs required to access the addictive behaviour (i.e. demand). These measures reveal a positive relationship between the indices of demand and addiction problem severity and can elucidate factors associated with motivation for substance use. Gambling is an addictive behaviour that has not been examined using this paradigm. This study seeks to adapt and examine the purchase task for gambling behaviour. A gambling purchase task was devised that asked individuals how often per month they would gamble at various cover charges. Participants were 73 adults from the community with either gambling disorder (n = 28) or alcohol use disorder (n = 24) or were a healthy control (n = 21). Both the alcohol and gambling purchase tasks were administered. Results demonstrate discriminant validity of the gambling purchase task, as individuals with gambling disorder have significantly greater demand for accessing gambling than other groups. The alcohol purchase task also evidenced discriminant validity in that individuals with alcohol use disorder have significantly greater demand for alcohol than other groups. These findings support the use of the gambling purchase task to assess the demand for gambling. [ABSTRACT FROM AUTHOR]

Several magnetic resonance imaging (MRI) studies to date have investigated brain abnormalities in association with the diagnosis of pathological gambling (PG), but very few of these have specifically searched for brain volume differences between PG patients and healthy volunteers (HV). To investigate brain volume differences between PG patients and HV, 30 male never-treated PG patients (DSM-IV-TR criteria) and 30 closely matched HV without history of psychiatric disorders in the past 2 years underwent structural magnetic resonance imaging with a 1.5-T instrument. Using Freesurfer software, we performed an exploratory whole-brain voxelwise volume comparison between the PG group and the HV group, with false-discovery rate correction for multiple comparisons ( p <0.05). Using a more flexible statistical threshold ( p <0.01, uncorrected for multiple comparisons), we also measured absolute and regional volumes of several brain structures separately. The voxelwise analysis showed no clusters of significant regional differences between the PG and HV groups. The additional analyses of absolute and regional brain volumes showed increased absolute global gray matter volumes in PG patients relative to the HV group, as well as relatively decreased volumes specifically in the left putamen, right thalamus and right hippocampus (corrected for total gray matter). Our findings indicate that structural brain abnormalities may contribute to the functional changes associated with the symptoms of PG, and they highlight the relevance of the brain reward system to the pathophysiology of this disorder. [ABSTRACT FROM AUTHOR]

IMPORTANCE: Because of shared characteristics, pathological gambling (PG) has been variously conceptualized as an obsessive-compulsive (OC) spectrum disorder or as an addictive disorder. Prior community-based studies have not systematically determined the association between PG and OC features and whether common genetic factors contribute to both conditions. OBJECTIVE: To examine the association and genetic correlation between PG and OC features. DESIGN, SETTING, AND PARTICIPANTS: We performed a latent class analysis (LCA) of OC features, cross-sectional tests of association, and classic twin genetic analysis using results of telephone interviews conducted from March 2002 through November 2003. Participants included 1675 male twin pairs from the Vietnam Era Twin Registry, aged 45 to 60 years. MAIN OUTCOMES AND MEASURES: Ten OC featureswere queried and used to derive OC classes identified via LCA. RESULTS: The best-fitting LCA model identified the following 4 OC classes: unaffected (class 1), ritual/symmetry compulsions (class 2), germ/contamination obsessions (class 3), and severe OC (class 4). All PG symptoms were more common in class 4 OC and 6 of 10 PG symptoms were significantly more common in class 4 OC (P < .01). Participants in the severe class were most likely to have 4 or more DSM-IV or DSM-5 PG diagnostic criteria (odds ratio, 3.8 [95%CI, 1.8-8.2]). The genetic correlation between phenotypes was 0.44 (95%CI, 0.16-0.75). CONCLUSIONS AND RELEVANCE: The association between OC features and diagnostic criteria for PG highlights a role of obsessions and compulsivity in PG, and the lifetime co-occurrence of these disorders results in part from common genetic variance. Phenotypic and genetic overlap between OC features and PG add to our understanding of the most appropriate classification of PG and offers insights for treatment development. [ABSTRACT FROM AUTHOR]

The reclassification of gambling disorder within the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) addictions category marks an important step for addiction science. The similarities between gambling disorder and the substance use disorders have been well documented. As gambling is unlikely to exert actively damaging effects on the brain, the cognitive sequelae of gambling disorder may provide insights into addictive vulnerabilities; this idea is critically evaluated in light of recent structural imaging data. The second part of the review analyzes a fundamental question of how a behavior can become addictive in the absence of exogenous drug stimulation. The relative potency of drug and nondrug rewards is considered, alongside evidence that cognitive distortions in the processing of chance (for example, the illusion of control and the gambler's fallacy) may constitute an important added ingredient in gambling. Further understanding of these mechanisms at neural and behavioral levels will be critical for the classification of future behavioral addictions, and I consider the current research data for obesity and binge eating, compulsive shopping, and internet gaming disorder. [ABSTRACT FROM AUTHOR]

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. © 2014 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

The present study examined the factor structure of the Gambling Related Cognitions Scale (GRCS); (Raylu and Oei in Addiction 99:757-769, ) in a large sample of adolescents ( N = 1,490) between the ages of 16 and 18 years (630 males, 860 females) attending several high schools in central Ontario. Problem gambling was measured using the DSM-IV-J (Fisher in J Gambl Stud 8:263-285, ). A 5-factor GRCS model was found to have the best fit to the data, and gambling-related cognitions were found to be powerful predictors of disordered gambling among adolescents. However, strong associations among GRCS subscales, as well as the small amount of variance in problem gambling accounted for by specific GRCS subscales, call into question the multidimensionality of the GRCS when used with adolescents. [ABSTRACT FROM AUTHOR]

The fifth revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is scheduled for publication in 2013. It will include several changes to the diagnosis of pathological gambling: the name of the disorder will be altered, the threshold for diagnosis will decrease, and one criterion will be removed. This paper reviews the rationale for these changes and addresses how they may impact diagnosis and treatment of the disorder, as well as potential for future research in the field. [ABSTRACT FROM AUTHOR]

Self-exclusion programs are required to be provided by gambling operators in many international jurisdictions in an attempt to provide an option for those who have gambling problems to avoid further gambling. However, minimal robust and comprehensive research has been conducted to evaluate the effectiveness of self-exclusion programs. There is much scope for reform and greater cohesion between jurisdictions, particularly neighbouring jurisdictions that would offer greater protection to individuals and industry bodies. This review outlines the evidence surrounding existing self-exclusion strategies, the benefits and limitations of such programs, and provides potential recommendations for an effective intervention program. Research suggests that self-exclusion programs are under-utilised by problem gamblers and are not completely effective in preventing individuals from gambling in venues from which they have excluded, or on other forms. Nonetheless, self-report indicates that self-excluders generally experience benefits from programs, including decreased gambling and increased psychological wellbeing and overall functioning. There are many areas in which existing programs could be improved, such as providing more resources for excluded individuals and reducing barriers to program entry, and more research is needed. However, self-exclusion programs are an important component of any public health strategy that aims to minimise gambling-related harms and these should be based as far as possible on empirical evidence for effective program components. [ABSTRACT FROM AUTHOR]

The age of a patient is a strong moderator of both the course and the evolution of disorders/diseases. However, the effects of current age in pathological gambling (PG) have rarely been examined. The aim of this study is to explore the moderating effects of the patients' current age in relation to personality traits and clinical outcomes of PG. A total sample of 2,309 treatment-seeking patients for PG, diagnosed according to DSM-IV criteria, participated in this study and were assessed with the Diagnostic Questionnaire for Pathological Gambling according to DSM-IV criteria, the South Oaks Gambling Screen, the Symptom Checklist, the Temperament and Character Inventory-R, and other clinical and psychopathological measures. Orthogonal polynomial contrasts showed linear trends in the relationship between age and PG: the older the patient, the more comorbid health problems were visible. The presence of additional quadratic trends also suggests that age plays a significant role in moderating the possibility of existing PG problems and general psychopathology. No interaction term was found between age and sex, but it was present for age and some personality traits: self-transcendence and reward dependence (these two traits were only relevant to the level of impairment due to PG at specific ages). This study suggests that the patients' age influences psychopathological and clinical aspects associated to PG. Intervention in the earliest manifestations of this complex problem is essential in order to better address the need of successful treatment planning. [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]

Background: Availability and access to gambling, due to new licensing laws, is increasing exponentially. Practicing counselling psychologists need to be prepared to treat what is expected to be an increasing prevalence of pathological gambling (PG), and this cannot be done without the appropriate research base to expand our understanding of the condition. Content and Focus: This paper examines available literature on pathological gambling and depression to investigate how depression and PG interact. Selected published papers on the role of depression in pathological gambling were reviewed. Results are suggestive of depression being more a cause for PG than a consequence. Conclusions: Lack of consensus in the literature was identified and discussed in light of a pathways model of PG for different types of gambler; emotionally vulnerable or behaviourally conditioned. The implications for counselling psychologists are discussed as the evidence provides validation for different treatment pathways, whether the depression is a cause or a consequence of the gambling behaviour. [ABSTRACT FROM AUTHOR]

Rationale: Although pathological gambling (PG) is relatively common, pharmacotherapy research for PG is limited. Memantine, an N-methyl d-aspartate receptor antagonist, appears to reduce glutamate excitability and improve impulsive decision making, suggesting it may help individuals with PG. Objective: This study sought to examine the safety and efficacy of Memantine in PG. Methods: Twenty-nine subjects (18 females) with DSM-IV PG were enrolled in a 10-week open-label treatment study of memantine (dose ranging from 10 to 30 mg/day). Subjects were enrolled from January 2009 until April 2010. Change from baseline to study endpoint on the Yale Brown Obsessive Compulsive Scale Modified for Pathological Gambling (PG-YBOCS) was the primary outcome measure. Subjects underwent pre- and post-treatment cognitive assessments using the stop-signal task (assessing response impulsivity) and the intra-dimensional/extra-dimensional (ID/ED) set shift task (assessing cognitive flexibility). Results: Twenty-eight of the 29 subjects (96.6%) completed the 10-week study. PG-YBOCS scores decreased from a mean of 21.8 ± 4.3 at baseline to 8.9 ± 7.1 at study endpoint ( p < 0.001). Hours spent gambling per week and money spent gambling both decreased significantly ( p < 0.001). Subjects also demonstrated a significant improvement in ID/ED total errors ( p = 0.037) at study endpoint. The mean effective dose of memantine was 23.4 ± 8.1 mg/day. The medication was well-tolerated. Memantine treatment was associated with diminished gambling and improved cognitive flexibility. Conclusions: These findings suggest that pharmacological manipulation of the glutamate system may target both gambling and cognitive deficits in PG. Placebo-controlled, double-blind studies are warranted in order to confirm these preliminary findings in a controlled design. [ABSTRACT FROM AUTHOR]

Objective: To develop a pathological gambling (PG) screen for efficient application to the household population and for clinicians to use with treatment seekers. Method: We applied a series of multivariate discriminant functions to past-12-month Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR)-based, gambling-related problems; the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) measured and collected this data. The NESARC conducted computer-assisted personal interviews with 43 093 households and identified the largest sample of pathological gamblers drawn from the general household population. Results: We created a 3-item, brief biosocial gambling screen (BBGS) with high sensitivity (Sensitivity = 0.96; 76 of 79 pathological gamblers correctly identified) and high specificiy (Specificity = 0.99; 10 892 of 11 027 nonpathological gamblers correctly identified). Conclusions: Major US studies reveal extensive comorbidity of PG with other mental illnesses. The BBGS features psychometric advantages for health care providers that should encourage clinicians and epidemiologists to consider current PG along with other problems. The BBGS is practical for clinical application because it uses only 3 items and they are easy to ask, answer, and include in all modes of interviewing, including self-administered surveys. The BBGS has a strong theoretical foundation because it includes 1 item from each of the addiction syndrome 3 domains: neuroadaptation (for example, withdrawal); psychosocial characteristics (for example, lying); and adverse social consequences of gambling (for example, obtaining money from others). [ABSTRACT FROM AUTHOR]

Abstract: Pathological gambling is an increasing concern with the growth of legalized gambling opportunities, and clinicians who provide general psychotherapy, as well as those specializing in some disorders, are likely to encounter patients with gambling problems. This review article describes the diagnostic criteria for pathological gambling and screening methods for identifying individuals with gambling problems. Problem and pathological gambling are more likely to occur in certain populations, such as among individuals with substance use, mood and anxiety disorders, and medical problems. However, few pathological gamblers seek specialized gambling treatment. This paper reviews different forms of treatments that have been applied to gamblers, along with evidence of their efficacy. Clinical guidelines for identifying and treating gambling problems are outlined as well. [Copyright &y& Elsevier]

The psychometric properties of two pathological gambling (PG) screening instruments, the South Oaks Gambling Screen (SOGS) and the Massachusetts Gambling Screen—DSM-IV subscale (MAGS), were explored in a sample of college students (N = 159). Participants completed the two screening instruments, a diagnostic interview for PG, the Gambling—Timeline Followback (G-TLFB), Gambling Self-E ficacy Questionnaire (GSEQ), and the Hopkins Symptom Checklist (HSCL). Both screening measures were found to have adequate internal consistency and were highly correlated with each other and the diagnostic interview. The screening measures demonstrated convergent and discriminant validity. Using the diagnostic interview as the criterion measure, the SOGS demonstrated better sensitivity in identifying PG college students than the MAGS. The MAGS demonstrated better specificity in identifying non-PG college students than the SOGS. The results of this study suggest that although neither measure is perfect in identifying PG college students, the SOGS is a more appropriate measure for screening purposes. [ABSTRACT FROM AUTHOR]

Abstract: The DSM-IV describes pathological gambling as a chronic condition with an insidious course. However, several extant studies characterize pathological and problem gambling as fluctuating over time. The present analyses expand on previous reports by evaluating changes in pathological gambling symptoms across the lifetime. DSM-IV pathological gambling symptoms were assessed retrospectively to derive diagnoses and capture changes in symptoms over time using the Lifetime Gambling History (LGH) in a sample of 1343 middle aged males from the Vietnam Era Twin (VET) Registry. Two to four weeks after initial assessment, 196 participants were re-assessed to determine test–retest reliability of the LGH. A greater number of lifetime symptoms was associated with a higher number of changes in gambling patterns. Fluctuations in pathological gambling symptoms were common among individuals who reported two or more gambling phases, with decreases in symptoms reported as frequently as increases. Reliability data revealed high reliability in reports of pathological gambling symptom endorsement and age of symptom onset. Results are consistent with findings from community based studies that describe the course of problem gambling behaviors as changing over time. Evidence is also provided for the utility of the LGH in assessing lifetime pathological gambling symptoms. [Copyright &y& Elsevier]

An evaluation of the hypothesis that adolescent gamblers are biased toward the production of false positive responses proposed by Derevensky et al. was tested. The results of secondary analysis of available data supported the hypothesis for items on the South Oaks Gambling Screen and items from the DSM-IV screening instrument. The conclusions were presented as tentative in view of the modest sizes of the observed effects. A number of limitations to the analysis are also described. [ABSTRACT FROM AUTHOR]

In this paper the most relevant findings of our research team on pathological gambling in the last decade are presented. There is no conclusive empirical evidence of a specific profile of the pathological gamblers. The choice treatment appears to be stimulus control and in vivo exposure with response prevention, followed by a cognitive-behavioral intervention in relapse prevention. Predictive variables for the therapeutic failure were the dissatisfaction with the treatment, the alcohol abuse and the neuroticism as a personality variable. Unanswered questions for future research in this field are commented upon. [ABSTRACT FROM AUTHOR]

The author reflects on the updating process of the fifth edition of the "Diagnostic and Statistical Manual of Mental Disorders" (DSM) by the American Psychiatric Association (APA). The author notes that the Substance Use Disorders Workgroup of the DSM committee recommended moving the chapter of the pathological gambling in DSM-V, as well as changing its name with disordered gambling. The author adds that the Workgroup also suggested reducing the criteria for diagnosis of pathological gambling.