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Substance use disorder (SUD) is a significant public health concern. Unfortunately, there are few safe and effective medications to treat SUD and efficacy is suboptimal. There are important financial and scientific obstacles to develop new compounds, but recent advances in the discovery of new brain receptors and neurocircuits are offering opportunities to develop new pharmacotherapies. A systematic scientific approach to develop medications is required to demonstrate their safety and efficacy, bring it to market, and prescribe it to patients. The purpose of this manuscript is to provide a general overview of the challenges and opportunities in medications development for SUD, describe the phased approach of this development, the medications approved, and those that appear most promising. [ABSTRACT FROM AUTHOR]

Introduction: In México obesity rates have been increasing in the last years. Food addiction (FA) has been considered a factor that could explain processes or behaviors associated with obesity. Objectives: The aim of this study was the identification of risk patterns of FA and it association with other variables in healthy Mexican population. Methods: We hypothesized that a higher risk of FA will be higher levels of impulsivity, emotion dysregulation, and emotional and external eating styles. The sample consisted of 81 female (61) and male (20) volunteers universitary students from Pachuca city in México, with an average age of 20.0 years old (SD = 1,7). The questionnaires EDI-2, YFAS 2.0, DERS, UPPS-P, and DEBQ were applied. Results: Figure 1: Radar-chart (z-standardized means are plotted) (n=81) Three groups were defined by the FA severity (Figure 1). The presence of FA was more strongly associated to higher scores in the threeDEBQscales, in the DERS impulse control, emotion regulation and total score, and in the UPPS-P lack of premeditation and negative urgency. Compared with the group without FA, the FA-probable scoring was related to higher levels in the DEBQ external and restrained scales, and in the DERS total; FA-probable group also registered the highest mean score in the DERS non acceptance scale compared with the other groups. Conclusions: To our knowledge, this is the first study that explores FA in Mexican population. Considering that, the identification of different patterns of FA that could be associated with obesity, could lead to better prevention and treatment approaches. Disclosure: The present work was supported by a grant to the presenter author from the Mexican Institution: "Consejo Nacional de Ciencia y Tecnología" (CONACYT). [ABSTRACT FROM AUTHOR]

Background: Data implicate overlaps in neurobiological pathways involved in appetite regulation and addictive disorders. Despite different neuroendocrine measures having been associated with both gambling disorder (GD) and food addiction (FA), how appetite-regulating hormones may relate to the co-occurrence of both entities remain incompletely understood., Aims: To compare plasma concentrations of ghrelin, leptin, adiponectin, and liver-expressed antimicrobial peptide 2 (LEAP-2) between patients with GD, with and without FA, and to explore the association between circulating hormonal concentrations and neuropsychological and clinical features in individuals with GD and FA., Methods: The sample included 297 patients diagnosed with GD (93.6% males). None of the patients with GD had lifetime diagnosis of an eating disorder. FA was evaluated with the Yale Food Addiction Scale 2.0. All patients were assessed through a semi-structured clinical interview and a psychometric battery including neuropsychological tasks. Blood samples to measure hormonal variables and anthropometric variables were also collected., Results: From the total sample, FA was observed in 23 participants (FA+) (7.7% of the sample, 87% males). When compared participants with and without FA, those with FA+ presented both higher body mass index (BMI) (p < 0.001) and leptin concentrations, after adjusting for BMI (p = 0.013). In patients with FA, leptin concentrations positively correlated with impulsivity, poorer cognitive flexibility, and poorer inhibitory control. Other endocrine measures did not differ between groups., Discussion and Conclusions: The present study implicates leptin in co-occurring GD and FA. Among these patients, leptin concentration has been associated with clinical and neuropsychological features, such as impulsivity and cognitive performance in certain domains.

The presence of unsuitable coping and emotion regulation strategies in young populations with gambling disorder (GD) and in those who have experienced cyberbullying victimization has been suggested. However, this association has not been explored in depth. In this study, our aim was to analyze individual differences in emotion regulation, coping strategies, and substance abuse in a clinical sample of adolescents and young adult patients with GD (n = 31) and in a community sample (n = 250). Furthermore, we aimed to examine the association between cyberbullying and GD. Participants were evaluated using the Cyberbullying Questionnaire-Victimization, the Canadian Adolescent Gambling Inventory, the Coping Strategies Inventory, the Difficulties in Emotion Regulation Scale, the Alcohol Use Disorders Identification Test and the Drug Use Disorders Identification Test. Structural Equation Modeling was used to explore associations between these factors in a community sample and in a clinical group. In both groups, exposure to cyberbullying behaviors was positively associated with higher emotion dysregulation and the use of maladaptative coping styles. Our findings uphold that adolescents and young adults who were victims of cyberbullying show difficulties in emotion regulation and maladaptive coping strategies when trying to solve problems. The specific contribution of sex, age, gambling severity, emotion regulation, and coping strategies on cyberbullying severity is also discussed. Populations at vulnerable ages could potentially benefit from public prevention policies that target these risk factors., (© 2022. The Author(s).)

Sports betting is becoming increasingly widespread, and a growing number of individuals, both adolescents and adults, participate in this type of gambling. The main aim of this systematic review was to assess correlates of sports betting (sociodemographic features, gambling-related variables, co-occurring psychopathologies, and personality tendencies) through a systematic review conducted following the PRISMA guidelines. Relevant studies were identified via searches of NCBI/PubMed and APA PsycInfo databases. Individuals from the general population and/or with a clinical diagnosis of gambling disorder (GD) were included, irrespective of gender and age. In addition, the studies needed to have administered at least one clinical interview/psychometric instrument to assess the presence of problematic gambling/GD, contain at least one group of participants with sports betting, and directly analyze the association between sports betting and any of the following features: sociodemographics, gambling-related variables, co-occurring psychopathologies, and/or personality tendencies. Fifty-four articles were included. Multiple sociodemographic variables have been studied in relation to sports betting. In general, males with high impulsivity have greater tendencies for sports betting. The co-occurrence of certain pathologies, especially substance use or other addictive disorders, was also suggested. Most studies were cross-sectional, assessed participants using self-administered instruments, recruited samples using non-probability online panels, included small samples, had unbalanced samples, and included samples from only one country. Impulsive males may be particularly prone to sports gambling and related problems. Future research should examine prevention strategies that may help prevent the development of sport-betting-related GD and other addictive behaviors in vulnerable individuals., (© 2023. The Author(s).)

Illegal behaviors have been reported in gambling disorder (GD) as well as in individuals with attention deficit hyperactivity disorder (ADHD). Likewise, ADHD symptomatology has been observed in patients with GD. We aimed to examine the association between ADHD symptomatology, personality traits and impulsivity in a sample of treatment-seeking patients with GD (n = 204) with and without a criminal report. The subjects were evaluated before starting treatment using different self-administered instruments. Among those who had committed an illegal act, two groups were made depending on whether or not the criminal conduct had legal repercussions (n = 64 without legal consequences; n = 32 with legal consequences). Structural equation modeling (SEM) was used to explore the interrelationships between personality traits, ADHD, impulsivity levels, gambling-related criminal behavior and other gambling-related factors. Greater ADHD symptomatology was found in patients with reported illegal behaviors, as well as higher impulsivity levels. Those individuals who presented legal consequences due to the criminal behavior showed higher impulsivity levels and harm avoidance and lower persistence and cooperativeness. Our findings uphold that patients with GD and ADHD symptomatology have greater impulsivity and are more vulnerable to committing an illegal act. Therefore, specific harm-prevention interventions and treatment approaches are needed for this population., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

The rising prevalence of gambling disorder (GD) among women has awakened considerable interest in the study of therapeutic outcomes in females. This study aimed to explore profiles of women seeking treatment for GD based on a set of indicators including sociodemographic features, personality traits, clinical state at baseline, and cognitive behavioral therapy (CBT) outcomes. Two-step clustering, an agglomerative hierarchical classification system, was applied to a sample of n = 163 women of ages ranging from 20 to 73 years-old, consecutively attended to by a clinical unit specialized in the treatment of G. Three mutually exclusive clusters were identified. Cluster C1 (n = 67, 41.1%) included the highest proportion of married, occupationally active patients within the highest social status index. This cluster was characterized by medium GD severity levels, the best psychopathological functioning, and the highest mean in the self-directedness trait. C1 registered 0% dropouts and only 14.9% relapse. Cluster C2 (n = 63; 38.7%) was characterized by the lowest GD severity, medium scores for psychopathological measures and a high risk of dropout during CBT. Cluster C3 (n = 33; 20.2%) registered the highest GD severity, the worst psychopathological state, the lowest self-directedness level and the highest harm-avoidance level, as well as the highest risk of relapse. These results provide new evidence regarding the heterogeneity of women diagnosed with GD and treated with CBT, based on the profile at pre- and post-treatment. Person-centered treatments should include specific strategies aimed at increasing self-esteem, emotional regulation capacities and self-control of GD women., (© 2021. The Author(s).)

Gambling disorder (GD) is a modestly prevalent and severe condition for which neurobiology is not yet fully understood. Although alterations in signals involved in energy homeostasis have been studied in substance use disorders, they have yet to be examined in detail in GD. The aims of the present study were to compare different endocrine and neuropsychological factors between individuals with GD and healthy controls (HC) and to explore endocrine interactions with neuropsychological and clinical variables. A case−control design was performed in 297 individuals with GD and 41 individuals without (healthy controls; HCs), assessed through a semi-structured clinical interview and a psychometric battery. For the evaluation of endocrine and anthropometric variables, 38 HCs were added to the 41 HCs initially evaluated. Individuals with GD presented higher fasting plasma ghrelin (p < 0.001) and lower LEAP2 and adiponectin concentrations (p < 0.001) than HCs, after adjusting for body mass index (BMI). The GD group reported higher cognitive impairment regarding cognitive flexibility and decision-making strategies, a worse psychological state, higher impulsivity levels, and a more dysfunctional personality profile. Despite failing to find significant associations between endocrine factors and either neuropsychological or clinical aspects in the GD group, some impaired cognitive dimensions (i.e., WAIS Vocabulary test and WCST Perseverative errors) and lower LEAP2 concentrations statistically predicted GD presence. The findings from the present study suggest that distinctive neuropsychological and endocrine dysfunctions may operate in individuals with GD and predict GD presence. Further exploration of endophenotypic vulnerability pathways in GD appear warranted, especially with respect to etiological and therapeutic potentials.

Background and Aims: Mental disorders with high levels of impulsivity such as bulimic spectrum eating disorders (BSED) and gambling disorder (GD) are associated with high risk of suicidal behavior. The aim of the present study was to identify the common and differential vulnerability factors behind suicide attempts in a sample of patients with BSED compared to patients with GD., Methods: A total of 6,077 adults who sought treatment and met criteria either for BSED (n = 2,391) or GD (n = 3,686) were assessed at a specialized hospital unit. Personality traits, psychopathological symptomatology, lifetime history of suicide attempts and socio-demographic variables were evaluated., Results: The prevalence of suicide attempts was higher for BSED patients (26.2%) compared to GD patients (7.1%) being anorexia nervosa (Binge/Purge type) and bulimia nervosa the most affected subtypes. In the predictive model, the transdiagnostic vulnerability factors with the highest contribution to the risk of suicidal behavior both in BSED and GD were unemployment, early age of onset of the disorder, worse psychopathological state, and self-transcendence personality trait. However, specific risk factors for suicidal acts were identified in each disorder: longer duration of the disorder, lower education levels and reward dependence were exclusively associated with BSED while female gender, older age, and higher harm avoidance were associated with GD., Discussion: Patients with GD and BSED share certain vulnerability factors although certain factors are exclusive to each disorder., Conclusions: Interventions need to pay special attention to both common and specific vulnerability factors to mitigate the risk of suicidal acts in these disorders.

Background and Aims: The number of patients with gambling disorder (GD) whose gambling preference is sports betting is increasing. However, their clinical profile and their responses to psychological treatments -compared to patients with other forms of gambling- have not been thoroughly studied. Therefore, the aims of this study were: (1) to compare the clinical characteristics of GD patients whose primary gambling activity was sports betting (SB+; n = 113) with GD patients with other primary gambling activities (SB-; n = 1,135); (2) to compare treatment outcomes (dropout and relapses) between SB + and SB- patients; and (3) to explore relationships between specific variables (GD severity, psychological distress and personality features) and treatment outcome in SB + and SB- GD patients, through correlation models and path-analysis., Methods: The cognitive behavioral treatment consisted of 16 weekly sessions. Personality features, psychopathology, and sociodemographic and clinical factors were assessed., Results: The SB + group included higher proportions of younger patients who were single and had higher educational levels, older ages of GD onset, and greater GD severities. Regarding treatment outcomes, the dropout rate was lower in the SB + group, and no between-group differences were found regarding relapse. Dropout within the SB + group was related to being unemployed, and relapse was related to being unmarried and experiencing more psychological distress., Discussion and Conclusion: The differences between SB + and SB- GD patients suggest that GD patients with sports-betting problems may benefit from tailored therapeutic approaches., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Although food addiction (FA) is a debated condition and it is not currently recognized as a formal diagnosis, it shares features with other addictions, such as gambling disorder (GD). However, the prevalence of FA in GD and the clinical correlates are incompletely understood, especially within women versus men. To investigate FA in patients presenting with GD. The sample included 867 patients diagnosed with GD (798 males and 69 females) attending a specialized behavioral addictions unit. FA was observed in 8.3% of GD patients (18.8% of women, 7.4% of men). More psychopathology and harm avoidance, greater body mass indices and less self-directedness and cooperativeness were associated with FA. In women, FA was associated with a longer GD duration. In men, FA was associated with earlier GD onset, greater GD and problematic alcohol use severities. Among patients with GD, FA was associated with more psychopathology and gambling patterns suggestive of more protracted or severe GD. Screening for and addressing FA condition in patients with GD may help optimize preventive and therapeutic approaches. Future studies should consider testing guidelines to improve healthy eating habits, increase physical exercise and better manage stress and other negative emotions in order to target FA in GD., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Several studies have explored the association between gambling disorder (GD) and gambling-related crimes. However, it is still unclear how the commission of these offenses influences treatment outcomes. In this longitudinal study we sought: (1) to explore sociodemographic and clinical differences (e.g., psychiatric comorbidities) between individuals with GD who had committed gambling-related illegal acts (differentiating into those who had had legal consequences ( n = 31) and those who had not ( n = 55)), and patients with GD who had not committed crimes ( n = 85); and (2) to compare the treatment outcome of these three groups, considering dropouts and relapses. Several sociodemographic and clinical variables were assessed, including the presence of substance use, and comorbid mental disorders. Patients received 16 sessions of cognitive-behavioral therapy. Patients who reported an absence of gambling-related illegal behavior were older, and showed the lowest GD severity, the most functional psychopathological state, the lowest impulsivity levels, and a more adaptive personality profile. Patients who had committed offenses with legal consequences presented the highest risk of dropout and relapses, higher number of psychological symptoms, higher likelihood of any other mental disorders, and greater prevalence of tobacco and illegal drugs use. Our findings uphold that patients who have committed gambling-related offenses show a more complex clinical profile that may interfere with their adherence to treatment.

Background: Food addiction (FA) is a construct that has gained interest in recent years but its relevance in Mexican population is still unexplored., Aims: The present study has the aims of explore FA in a community of Mexican population, as well as identifying the risk patterns associated with it, in relation to the different etiological factors that have been described such as impulsivity, emotional regulation and eating styles. Furthermore, to identify a predictive model of FA severity., Methods: The sample consisted of 160 female and male university students of Pachuca city in México, who volunteered to participate in the study. Assessment included multidimensional measures for FA, eating disorder severity, eating disorder styles, emotional regulation and impulsivity., Results: A screening of FA-probable was registered for 13.8% of the sample, while 8.1% met criteria for FA-present. The FA-present group differed from FA-absent in the impulsivity levels and in emotional eating style. Patients with FA-present differed from FA-probable in the impulsivity levels. Differences between FA-probable versus FA-absent were found in the restrained eating style. Path analysis evidenced that FA severity was directly associated with older age, worse eating style profile and higher impulsivity levels, and indirectly related with the ED symptom levels., Conclusions: Our findings suggest that it is possible to establish a specific predictive model of the development of FA and its severity in Mexican population to implement adequate prevention and treatment strategies., Evidence Level: Level III: evidence obtained from well-designed cohort or case-control analytic studies., (© 2021. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Background and Aims: COVID-19 pandemic and confinement have represented a challenge for patients with gambling disorder (GD). Regarding treatment outcome, dropout may have been influenced by these adverse circumstances. The aims of this study were: (a) to analyze treatment dropout rates in patients with GD throughout two periods: during and after the lockdown and (b) to assess clinical features that could represent vulnerability factors for treatment dropout. Methods: The sample consisted of n =86 adults, mostly men ( n =79, 91.9%) and with a mean age of 45years old ( SD =16.85). Patients were diagnosed with GD according to DSM-5 criteria and were undergoing therapy at a Behavioral Addiction Unit when confinement started. Clinical data were collected through a semi-structured interview and protocolized psychometric assessment. A brief telephone survey related to COVID-19 concerns was also administered at the beginning of the lockdown. Dropout data were evaluated at two moments throughout a nine-month observational period (T1: during the lockdown, and T2: after the lockdown). Results: The risk of dropout during the complete observational period was R =32/86=0.372 (37.2%), the Incidence Density Rate ( IDR ) ratio T2/T1 being equal to 0.052/0.033=1.60 ( p =0.252). Shorter treatment duration ( p =0.007), lower anxiety ( p =0.025), depressive symptoms ( p =0.045) and lower use of adaptive coping strategies ( p =0.046) characterized patients who abandoned treatment during the lockdown. Briefer duration of treatment ( p =0.001) and higher employment concerns ( p =0.044) were highlighted in the individuals who dropped out after the lockdown. Treatment duration was a predictor of dropout in both periods ( p =0.005 and p <0.001, respectively). Conclusion: The present results suggest an impact of the COVID-19 pandemic on treatment dropout among patients with GD during and after the lockdown, being treatment duration a predictor of dropout. Assessing vulnerability features in GD may help clinicians identify high-risk individuals and enhance prevention and treatment approaches in future similar situations., Competing Interests: AH holds a position at Lund University, Sweden, sponsored by the state-owned Swedish gambling operator AB Svenska Spel and has funding from the research council of the same organization and from the research councils of the Swedish state-owned alcohol monopoly Systembolaget AB and the Swedish sports federation. MP notes the following disclosures. He has: consulted for and advised Game Day Data, the Addiction Policy Forum, AXA, Idorsia, and Opiant/Lakelight Therapeutics; received research support from the Veteran’s Administration, Mohegan Sun Casino, and the National Center for Responsible Gaming (on the International Center for Responsible Gambling); participated in surveys, mailings, or telephone consultations related to addictions, impulse-control disorders or other health topics; consulted for law offices and the federal public defender’s office in issues related to impulse-control and addictive disorders; provided clinical care in the Connecticut Department of Mental Health and Addiction Services Problem Gambling Services Program; performed grant reviews for the National Institutes of Health and other agencies; edited journals and journal sections; given academic lectures in grand rounds, CME events and other clinical/scientific venues; and generated books or chapters for publishers of mental health texts. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Baenas, Etxandi, Codina, Granero, Fernández-Aranda, Gómez-Peña, Moragas, Rivas, Potenza, Håkansson, del Pino-Gutiérrez, Mora-Maltas, Valenciano-Mendoza, Menchón and Jiménez-Murcia.)

Background and Aims: Gaming Disorder (GD) is characterized by a pattern of persistent and uncontrolled gaming behavior that causes a marked impairment in important areas of functioning. The evolution of the worldwide incidence of this disorder warrants further studies focused on examining the existence of different subtypes within clinical samples, in order to tailor treatment. This study explored the existence of different profiles of patients seeking treatment for GD through a data-driven approach., Methods: The sample included n = 107 patients receiving treatment for GD (92% men and 8% women) ranging between 14 and 60 years old (mean age = 24.1, SD = 10). A two-step clustering analysis approach explored the existence of different underlying GD profiles based on a broad set of indicators, including sociodemographic features, clinical course of the condition (e.g., onset or evolution), psychopathological symptoms, and personality traits., Results: Two GD profiles emerged. The first cluster grouped together patients who presented with a lower psychological impact (n = 72, 66.1%), whereas the second cluster comprised patients with a higher psychological impact (n = 35, 32.7%). Cluster comparisons revealed that those patients presenting the higher impact were older, with a later onset of pathological gaming patterns, and more pronounced psychopathological symptoms and dysfunctional personality profiles., Conclusions: GD severity is influenced by specific demographic, clinical, and psychopathological factors. The identification of two separate profiles provides empirical evidence that contributes to the conceptualization of this disorder, as well as to the development of reliable and valid screening tools and effective intervention plans focused on the precise characteristics of the treatment-seeking patients., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Gender-specific literature focused on gambling disorder (GD) is scarce, and women with GD have been understudied. Therefore, the aim of this study was to estimate the short-term effectiveness in women with GD (n = 214) of a group standardized cognitive-behavioral therapy (CBT) and to identify the most relevant predictors of the primary therapy outcomes (dropout and relapse)., Methods: The manualized CBT consisted of 16 weekly outpatient group sessions. Women were provided with resources to obtain a better understanding of the GD, to improve self-control and to manage risk situations., Results: The dropout risk was higher for women with lower GD severity and higher psychopathological distress. Among other factors, lower education levels were a significant predictor of the relapse risk and and the frequency of relapses was higher for divorced women with a preference for non-strategic gambling and with substances consumption., Conclusions: Our findings evidence women-specific predictors of the primary therapy outcomes. The results highlight the need to design psychological interventions that address dropout and relapse risk factors in women., (Copyright © 2021. Published by Elsevier Ltd.)

Suicidal ideation and attempts are prevalent among patients with gambling disorder (GD). However, patients with GD and a history of lifetime suicidal events are not a homogeneous group. The main objective of this study was to compare sociodemographic, clinical, personality, and psychopathological features among different profiles of adults with GD with and without a history of suicidal behavior, taking into account two relevant variables: gender and gambling preference. The second aim was to examine how the different profiles of patients with a history of suicidal events responded to cognitive-behavioral therapy (CBT). A total of 1112 treatment-seeking adults who met the criteria for GD were assessed at a hospital specialized unit for the treatment of behavioral addictions. The participants completed self-reported questionnaires to explore GD, personality traits, and psychopathological symptomatology. The lifetime histories of suicidal ideation and attempts, and gambling preferences, were assessed during semi-structured face-to-face clinical interviews. Of the total sample, 229 patients (26.6%) reported suicidal ideation and 74 patients (6.7%), suicide attempts. The likelihood of presenting suicidal ideation was higher for women than men, but no differences were observed based on gambling preference. Regarding suicide attempts, the odds were higher among women with non-strategic forms of gambling. Suicidal ideation and attempts were associated with higher GD severity, a worse psychopathological state and higher self-transcendence levels. In terms of treatment outcomes, neither gambling preference nor past suicidal behavior had an influence on dropouts and relapses. Nevertheless, female gender and a lack of family support constitute two good predictors of a worse treatment outcome., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Addictive disorders are characterized by severe consequences, including suicidal events, but most studies investigating the association between addiction and suicidal risk have focused on substance use disorders and gambling disorder at the expense of the rest of behavioral addictions. This study examined the prevalence and the associated clinical correlates of suicidal ideation and suicide attempts in a sample of patients with a diagnosis of behavioral addiction. The total sample consisted of 4404 individuals: 4103 of these patients with gambling disorder, 99 with gaming disorder, 44 with sex addiction, and 158 with buying-shopping disorder. All of them were assessed consecutively at a specialized hospital unit for the treatment of behavioral addictions. Participants attended two clinical interviews and completed self-reported questionnaires to explore clinical features of behavioral addictions, personality traits, psychopathological symptomatology, suicidal behavior, and sociodemographic variables. The highest prevalence of suicidal ideation was found in patients with gambling disorder (22.9%), followed by buying-shopping disorder (18.4%), sex addiction (18.2%), and gaming disorder (6.1%). The highest prevalence of suicide attempts was registered for sex addiction (9.1%), followed by buying-shopping disorder (7.6%), gambling disorder (6.7%), and gaming disorder (3.0%). Female gender and unemployment constituted two relevant sociodemographic factors associated with suicidal risk in gambling disorder, gaming disorder, and buying-shopping disorder. Lack of family support appeared as a relevant risk factor, except for gaming disorder. These results pointed out that suicide is a prevalent behavior in behavioral addictions, and clinicians and researchers need to pay particular attention to the specificities of each behavioral addiction when assessing suicidal risk.

Purpose: Although the role of illness perception in the clinical course of many physical diseases and certain mental disorders has been well described, little is known about illness perception in eating disorders (ED) so far. Therefore, the purpose of this study was to extend our understanding of illness perception in different ED diagnostic types and to explore its association between clinical, psychopathological, motivational, personality, and food addiction (FA) features., Methods: The sample consisted of 104 patients with ED [(23 anorexia nervosa (AN), 39 bulimia nervosa (BN), 19 binge eating disorder (BED), and 23 other specified feeding and eating disorders (OSFED)]. Illness perception was assessed by means of the revised version of the Illness Perception Questionnaire (IPQ-R)., Results: The results supported the association between illness perception and clinical, psychopathological, and personality factors. Patients with BN and BED showed greater illness perception than the other types. Improved illness perception was positively associated with a longer duration of the disorder and FA. Furthermore, a relevant finding suggests that at least half of the patients with ED did not achieve a good level of illness perception until after having the disorder for 20 years on average., Conclusion: Our findings suggest that higher levels of FA and longer duration of the ED are positively and directly associated with increased illness perception. This may explain the low levels of initial motivation in these patients and their high dropout rates in the early stages of treatment., Level of Evidence Iii: Case-control analytic study., (© 2021. Springer Nature Switzerland AG.)

Gambling motives and cognitive distortions are thought to be associated because both coping and financial motives to gamble appear to be predictors of gambling related cognitive distortions. Therefore, there is an argument to be made that gambling motives, cognitive distortions, and materialism share common attributes and might be related to problem gambling severity. The present paper aims to examine the relationship between these three variables, both in a clinical and community setting, to see if they can predict gambling severity. A sample of 250 participants from the general population and 31 participants from the clinical population was recruited. The results showed that the clinical sample scored higher on gambling severity, cognitive distortions, materialism, and gambling motives. It also showed that low scores in enhancement motives and higher scores in social motives and gambling related cognitions predicted gambling severity in older gamblers, whereas for younger patients, gambling severity was best predicted by higher scores in materialism and coping motives, and lower scores for enhancement and social motives. In the community sample, gambling severity correlated with gambling related cognitive distortions and with gambling motives (except for social and coping motives within the women subsample). These results testify to the importance of materialism, cognitive distortions, and gambling motives as risk factors for problem gambling both in community and clinical samples.

People with gambling disorder (GD) exhibit distorted cognitions and superstitious beliefs more often than the general population. Similarly, difficulties in coping and emotion dysregulation are more prevalent among those with GD, and could determine the onset of GD in particularly vulnerable groups such as adolescents. This study examines the relationship between gambling severity and gambling-related cognitions with coping strategies and emotion regulation. Also, it explores how accurately gambling severity and gambling-related cognitions were able to predict emotion regulation and coping strategies. Two groups were recruited and analyzed: a community sample comprising 250 adolescents and young adults from secondary education schools, and a clinical sample of 31 patients with similar age characteristics seeking treatment for GD. The participants from the clinical sample scored higher on gambling severity, emotion dysregulation, cognitive biases, and maladaptive coping strategies. In the community sample, cognitive biases mediated the relationship between sex and emotion dysregulation and disengagement. People with GD use more often than controls maladaptive emotion regulation strategies to manage negative emotional states. This perspective emphasizes the need to focus on coping with emotions, as opposed to coping with problems, as the best approach to tackle gambling problems.

Background and Aims: Gambling Disorder (GD) is considered a heterogeneous, multidimensional pathology with high personal and social consequences. The transition time (TT) between problematic gaming and pathological gambling, which varies significantly across patients, may predict the disorder's severity. As only limited studies have investigated the factors implicated in the TT, the current study set out to identify its predictors and their relationships with GD severity., Methods: Correlation were performed in 725 male GD patients to identify factors associated to TT and GD severity, including: age of onset of gambling behaviors, alcohol/drug use, personality traits and gambling preferences (i.e., strategic, non-strategic, and mixed). Then a regression analysis was performed to identify predictors of TT to GD., Results: Longer TT correlated with higher GD severity, early age of onset of problematic gambling, substance use and a non-strategic gambling preference. Personality traits including low self-directedness, high novelty seeking, and low cooperativeness were also related with longer TT. The strongest associations with GD severity were substance use, and some of the personality traits (i.e., low self-directedness and cooperativeness, high harm avoidance and self-transcendence). Factors significantly predicting longer transition to GD were older ages, low self-directedness, and non-strategic gambling., Conclusions: A clinical profile characterized by a longer TT and more severe GD symptoms pertains to older patients with low self-directedness, and preference for non-strategic gambling. Other relevant factors associated with this profile of patients included early age of onset problematic gambling, substance consumption, high novelty seeking and low cooperativeness., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background-Objectives: Few studies have analyzed the comorbid presence of gambling disorder (GD) with schizophrenia, its sociodemographic correlates and clinical implications. This study estimated the prevalence of the dual diagnosis (GD with schizophrenia) and the differences in the profiles of patients with and without the dual condition., Method: The sample included n = 3,754 patients consecutively accepted for treatment for GD. Sociodemographics, gambling-related variables, psychopathological state and personality traits were assessed and compared between the groups., Results: The prevalence of schizophrenia within patients who met clinical criteria for GD was 4.4% (95% confidence interval: 3.8%-5.1%). Variables related to the dual presence of GD with schizophrenia were single marital status, lower education level, inactive working status, socioeconomic disadvantage, younger age, earlier onset of gambling problems, worse global psychopathological state and more dysfunctional personality profile (higher level in harm avoidance and lower level in cooperativeness, reward dependence, persistence and self-directedness)., Conclusion: The presence of schizophrenia among patients with GD was around 4 times higher than the prevalence rate estimated in the reference general population. The differences in the profiles of GD patients with and without schizophrenia suggest that individuals with the dual diagnosis condition require unique assessment considerations and tailored treatment interventions specifically designed for the clinical and functioning higher risk., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background : Serious games have shown positive results in increasing motivation, adherence to treatment and strengthening the therapeutic alliance in multiple psychiatric disorders. In particular, patients with impulse control disorders and other disorders in which the patient suffers from inhibitory control deficits (e.g., behavioral addictions) have been shown to benefit from serious games. Aim : The aim of this study was to describe the characteristics and to evaluate the usability of a new serious videogame, e-Estesia. This serious videogame was designed to improve emotion regulation in patients with gambling disorder (GD). Preliminary results from a pilot sample are also reported. Method : A pilot sample of 26 patients undergoing treatment for GD was recruited (ranging from 22 to 74 years, mean = 41.2 and SD = 12.9; 80.8% men). Participants used e-Estesia on a tablet, which was connected to a thoracic band that sent heart rate (HR) and heart rate variability (HRV) data to the videogame platform in order to provide biofeedback. The System Usability Scale was completed by patients to determine the usability of e-Estesia. Results and Discussion : e-Estesia performed comparatively well for all the explored groups (i.e., sex, age, and online vs. offline gambling: mean usability score = 83.8, SD = 13.1). Around 84.6% of the patients endorsed that it was easy to use. Female patients with GD presented higher HRV during the use of the serious videogame compared to men., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Mena-Moreno, Fernández-Aranda, Granero, Munguía, Steward, López-González, del Pino-Gutiérrez, Lozano-Madrid, Gómez-Peña, Moragas, Giroux, Grall-Bronnec, Sauvaget, Mora-Maltas, Valenciano-Mendoza, Menchón and Jiménez-Murcia.)

Background and Aims: Sports betting has been barely explored independently from other gambling behaviors. Little evidence is available regarding the factors affecting its severity in a clinical sample. The current study explores new determinants for sports betting severity in Spain by the inclusion of psychopathological distress and personality factors., Methods: A sample of 352 Spanish sports bettors undergoing treatment for gambling disorder was recruited. Multiple regression models were used to evaluate the effects of sociodemographic variables, the age of onset of gambling behavior, the global psychopathological distress (SCL-90R GSI) and the personality profile (TCI-R) on sports betting severity and their influence over frequency (bets per episode) and debts due to gambling., Results: We found that older age, higher psychopathological distress, lower self-directedness level, and higher novelty seeking level were predictors of gambling severity in Spanish sports bettors. The highest betting frequency was found in men, with the lowest education levels but the highest social status, the highest psychopathological distress, reward dependence score, and self-transcendence trait and the lowest persistence score. Debts were also associated to higher score in cooperativeness as well as older age., Discussion and Conclusions: Our findings call for further exploration of factors affecting sports betting severity regarded as a separate gambling entity subtype, as some of the traditional factors typically found in gamblers do not apply to sports bettors or apply inversely in our country. Consequently, sports bettors might deserve specific clinical approaches to tackle the singularities of their gambling behavior.

Objectives: Tobacco smoking and gambling disorder (GD) often co-occur. However, few studies have assessed the extent to which cigarette smoking may serve to classify and/or better define GD behaviour profiles., Methods: Among a large sample of n = 3,652 consecutive treatment-seeking patients with GD (91% men). Smokers were compared to non-smokers across different sociodemographic, clinical, psychopathological and personality variables. The effect sizes for the means and the proportion differences between the groups were estimated. An evaluation of the smoking changes over the last 15 years was also performed., Results: From the total sample, 62.4% of gamblers reported tobacco use. A decreasing linear trend in tobacco use was observed within the studied period, women having a more irregular pattern. The use of tobacco was linked to the use of alcohol and other illegal drugs. Gamblers who smoke, as compared to those who don't, presented lower education levels, lower social position indexes and active employment. They were younger, with an earlier age of onset, shorter duration of the gambling behavior, higher GD severity, more psychological symptoms, higher scores in novelty seeking and lower scores in reward dependence, self-directedness and self-transcendence., Conclusions: Gamblers seeking treatment who smoke display particular social, clinical, psychological, temperamental and character features different from non-smoking gamblers, suggesting that the presence or absence of comorbid smoking condition in GD should always be considered when developing an optimal treatment, as gamblers who smoke might need treatment strategies different from non-smoking gamblers., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background and Aims: The commission of illegal acts has been associated with gambling disorder (GD). However, little is known about young adults with GD who commit GD-related crimes. Therefore, the main aim of this study was to compare sociodemographic, clinical, personality and psychopathological features among young adults with GD with and without a history of illegal behaviors. Our second aim was to analyze the specific associations between these factors through a path analysis., Methods: A total of 808 treatment-seeking young adults who met criteria for GD were assessed at a public hospital unit specialized in behavioral addictions. Participants completed self-reported questionnaires to explore GD, personality traits, and psychopathological symptomatology., Results: Of the total sample, 291 patients (36.0%) had committed GD-related offences. Illegal acts were related to younger age and unemployment status. Greater levels of psychopathology, as well as earlier GD onset, longer GD duration and greater GD severity were also associated with the presence of criminal behaviors. Differences in personality traits were also found between these two groups., Discussion and Conclusions: The GD group with a history of illegal acts showed dysfunctional personality traits and higher levels of psychopathology. Therefore, specific GD treatments and harm reduction interventions should be designed for these patients., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Objectives: To assess the natural grouping of Purging Disorder (PD) patients based on purging symptomatology and to evaluate the derived classes (a) against each other and (b) to a control group on a range of clinical and psychological measures., Method: Participants included 223 PD women consecutively admitted to a tertiary ED treatment centre and 822 controls. Purging behaviours (self-induced vomiting, laxative and diuretic use) were used as indicators, while the EDI-2 (ED symptoms), the SCL-90-R (general psychopathology), and the TCI-R (personality traits) were used as validators., Results: Three distinct PD clusters emerged: Cluster 1 (only self-induced vomiting), Cluster 2 (self-induced vomiting and laxative use) and Cluster 3 (all purging methods). Significant differences between Cluster 1 and Cluster 3 were found for the EDI-2 drive for thinness and perfectionism subscales, and the TCI-persistence scale. All clusters differed significantly from the controls on all the EDI-2 and the SCL-90-R scales, but findings for the TCI-R scales were less consistent., Conclusions: This study adds to a growing literature on the validity and distinctiveness of PD and provides evidence of dimensional symptom differences amongst PD clusters., (© 2020 Eating Disorders Association and John Wiley & Sons Ltd.)

Objective: The comorbidity between gambling disorder (GD) and buying-shopping disorder (BSD) has led to explore the core features that could be interacting between them. The main aim of this study was to examine the differences in both conditions considering emotion dysregulation, coping and materialism, as well as the relationship between these variables and their interaction with age and sex., Methods: A community sample ( n  = 281 adolescents) and a sample of individuals with GD ( n  = 31) was compared. Both samples were split into a group with BSD and a group without it., Results: The prevalence of participants who met the criteria for BSD was higher in the GD sample than in the community sample; the GD sample also presented higher values in the psychological variables studied. In the community sample group, positive associations were found between BSD severity and materialism and emotion dysregulation levels. In the GD sample, BSD severity was higher for participants who reported higher levels in materialism and lower scores in coping strategies. Variables impacted BSD severity differently according to sex and age covariates., Conclusions: The results of the interaction of the variables could be useful to design prevention and treatment approaches addressed to specific groups of age and sex. KEY POINTS Buying-shopping disorder (BSD) has been compared in clinical and community samples. The clinical sample was constituted by Gambling disorder (GD) patients. The variables emotion dysregulation, coping and materialism have been considered. Variables impacted BSD severity differently according to sex and age covariates.

Significant increasing prevalences have been observed in gambling disorder (GD) in the last decades. This study analyzed the underlying mechanisms of the gambling severity with path analysis (implemented through Structural Equation Modeling, SEM), and assessed the potential moderator effect of the patients' sex. A sample of n = 512 treatment-seeking patients was assessed for sociodemographics and clinical state previously to the treatment. Results obtained in two separate SEM (for men and women) revealed differences in the direct effects and the mediational links. Among the male subsample, higher GD severity was directly related to the higher cognitive bias and the younger age of onset of the problematic gambling, while impulsivity levels and age of onset achieved an indirect effect on the disordered gambling mediated by the cognitive bias. Among females, GD severity was directly increased by younger age of onset, higher cognitive bias and lower self-directedness, while lower socioeconomic positions, and higher levels in harm avoidance achieved an indirect effect on the gambling severity mediated also by the distortions related to the gambling activity. These results provide new empirical evidence for a better understanding of the GD etiology, suggesting that the underlying complex links mediating the GD severity are strongly related to the patients' sex. The results can also contribute to design more effectiveness and precise therapy programs of patient-centered care.

Participation in gambling is rising in older adults. Indeed, in the coming years, engagement in gambling as a social activity is expected to increase more sharply in the elderly than in any other age group. Due to their exposure to powerful age-specific risk factors such as isolation, inactivity and failing health, older people are highly vulnerable to gambling-related problems. This study aimed to explore the existence of empirical clusters related to gambling habits in a sample of elderly participants from the general population. The sample included n = 361 participants, age range 50-90 years (mean 73.8, SD 8.4). Empirical clusters were identified through a two-step clustering analysis based on a broad set of indicators, including sociodemographic features, psychopathological state, substance use, life events, gambling preferences and scores on screening measures of gambling severity. The prevalence of GD in the study was 1.4%. Two clusters were identified: (a) cluster 1 (labeled as "low risk of gambling problems", n = 265, 73.4%), which included the higher proportion of non-gamblers or individuals who engage only in non-strategic gambling, women, widowed, and lower levels of education (no individual into this group met criteria for GD); and (b) cluster 2 (labeled as "higher risk of gambling problems", n = 96, 26.6%), which included the higher proportion of men, who reported both non-strategic and strategic gambling preferences (all participants diagnosed of GD were grouped into this cluster), older age, longer history of gambling, higher gambling severity, higher use of substances and worse psychopathological state. The elderly constitute a heterogeneous group with regard to gambling phenotypes. The results of this study may prove particularly useful for developing reliable screening tools able to identify older patients at a high risk of gambling problems, and for designing effective prevention and intervention programs.

Background: There are no studies based on a person-centered approach addressing sex-related differences in the characteristics of treatment-seeking patients with gambling disorder (GD). The main objective of the current study is to identify empirical clusters of GD based on several measures of the severity of gambling behavior, and considering the potential role of patient sex as a moderator., Methods: An agglomerative hierarchical clustering method was applied to an adult sample of 512 treatment-seeking patients (473 men and 39 women) by using a combination of the Schwarz Bayesian Information Criterion and log-likelihood function., Results: Three clusters were identified in the subsample of men: cluster M1 (low-mild gambling severity level, 9.1%), cluster M2 (moderate level, 60.9%), and cluster M3 (severe level, 30.0%). In the women subsample, two clusters emerged: cluster W1 (mild-moderate level, 64.1%), and cluster W2 (severe level, 35.9%). The most severe GD profiles were related to being single, multiple gambling preference for nonstrategic plus strategic games, early onset of the gambling activity, higher impulsivity levels, higher dysfunctional scores in the personality traits of harm avoidance, and self-directedness, and higher number of lifespan stressful life events (SLE). Differences between the empirical men and women clusters were found in different sociodemographic and clinical measurements., Conclusions: Men and women have distinct profiles regarding gambling severity that can be identified by a clustering approach. The sociodemographic and clinical characterization of each cluster by sex may help to establish specific preventive and treatment interventions.

The use of instruments originally developed for measuring gambling activity in younger populations may not be appropriate in older age individuals. The aim of this study was to examine the presence of problematic and disordered gambling in seniors aged 50 or over, and study the reliability and validity properties of the SOGS (a screening measure to identify gambling related problems). Two independent samples were recruited: a clinical group of n = 47 patients seeking treatment at a Pathological Gambling Outpatient Unit, and a population-based group of n = 361 participants recruited from the same geographical area. Confirmatory factor analysis verified the bifactor structure for the SOGS with two correlated underlying dimensions [measuring the impact of gambling on the self primarily (Cronbach's alpha α = 0.87) or on both the self and others also (α = 0.82)], and a global dimension of gambling severity (also with excellent internal consistency, α = 0.90). The SOG obtained excellent accuracy/validity for identifying gambling severity based on the DSM-5 criteria (area under the ROC curve AUC = 0.97 for discriminating disordered gambling and AUC = 0.91 for discriminating problem gambling), and good convergent validity with external measures of gambling (Pearson's correlation R = 0.91 with the total number of DSM-5 criteria for gambling disorder, and R = 0.55 with the debts accumulated due to gambling) and psychopathology (R = 0.50, 0.43 and 0.44 with the SCL-90R depression, anxiety and GSI scales). The optimal cutoff point for identifying gambling disorder was 4 (sensitivity Se = 92.3% and specificity Sp = 98.6%) and 2 for identifying problem gambling (Se = 78.8% and Sp = 96.7%). This study provides empirical support for the reliability and validity of the SOGS for assessing problem gambling in elders, and identifies two specific factors that could help both research and clinical decision-making, based on the severity and consequences of the gambling activity., Competing Interests: The authors have declared that no competing interests exist.

Background and Aims: The significant increase in the prevalence of gambling disorder (GD) among young adults in recent years has attracted interest in determining therapeutic efficiency in this sector of the population. The aim of this work was to estimate the response trajectories of gambling severity during the six-month follow-up after a cognitive behavioral therapy (CBT) program in young adult patients and to identify the main variables associated with each trajectory., Methods: The sample included n = 192 patients, aged 19-35 years old, seeking treatment for GD. Response trajectories were identified through latent class growth analysis., Results: Three trajectories emerged: T1 (n = 118, 61.5%), composed of patients with severe GD at pre-treatment and good evolution to recovery; T2 (n = 62, 32.3%), with patients with moderate-high GD affectation at baseline and good evolution to recovery; and T3 (n = 12, 6.3%), with participants with severe baseline GD severity and poor evolution after CBT (Abbott, 2019). The highest risk of poor therapeutic outcomes was related to lower social index positions, high emotional distress, high scores in harm avoidance and low scores in self-directedness., Discussion and Conclusions: Differences in the response trajectories at short-term follow-up after CBT reveal heterogeneity in the samples including young and young-adult GD patients. Patients' phenotype at baseline should be considered when developing efficient, person-centered intervention programs, which should comprise strategies aimed at increasing emotional regulation capacities, self-esteem and self-efficacy, with the aim of avoiding relapses in the medium-long term after therapy.

Objectives: The study aimed to examine whether food addiction (FA) was associated with greater severity in both binge eating disorders (BED) and bulimia nervosa and, therefore, to determine if FA was predictive of treatment outcome., Method: Seventy-one adult patients with bulimia nervosa and BED (42 and 29, respectively) participated in the study. FA was assessed by means of the Yale Food Addiction Scale., Results: The results confirmed a high prevalence of FA in patients with binge disorders (around 87%) and also its association with a greater severity of the disorder (i.e., related to an increased eating psychopathology and greater frequency of binge eating episodes). Although FA did not appear as a predictor of treatment outcome in general terms, when the diagnostic subtypes were considered separately, FA was associated with poor prognosis in the BED group. In this vein, FA appeared as a mediator in the relationship between ED severity and treatment outcome., Discussions: Our findings suggest that FA may act as an indicator of ED severity, and it would be a predictor of treatment outcome in BED but not in BN., (© 2019 John Wiley & Sons, Ltd and Eating Disorders Association.)

Interpersonal distress is a common feature in gambling disorder and adding a concerned significant other (CSO) to the recovery process could be an effective tool for improving treatment outcome. However, little empirical evidence is available regarding the effectiveness of including a CSO to interventions. We aimed to compare treatment outcomes (i.e. compliance with therapy guidelines, dropout from treatment, and relapse during treatment) in a CBT program involving a CSO to CBT treatment as usual (TAU) without a CSO. The sample comprised male gambling disorder patients (N = 675). The manualized CBT intervention consisted of 16 weekly outpatient group sessions and a 3-month follow-up period. Patient CSOs attended a predetermined number of sessions with the patient and were provided with resources to acquire a better understanding of the disorder, to manage risk situations, and to aid patients in adhering to treatment guidelines. Patients with a CSO had significant higher treatment attendance and reduced dropout compared to patients receiving TAU. Moreover, patients whose spouse was involved in the treatment program were less likely to relapse and adhered to the treatment guidelines more than those with a non-spousal CSO. Our results suggest that incorporating interpersonal support to gambling disorder interventions could potentially improve treatment outcomes.