HC.2.2 Flashcards
(29 cards)
What is the DSM-V criteria of gambling disorder?
Persistent and recurrent problematic gambling behaviour leading to clinically significant impairment of distress.
9 symptoms:
1. Needs to gamble with increasing amounts of money in order to achieve desired excitement (tolerance)
2. Is restless or irritable when attempting to cut down or stop gambling (withdrawal)
3. Has made repeated unsuccessful efforts to control, cut back, or stop gambling
4. Is often preoccupied with gambling (e.g. having persistent thoughts of reliving past gambling experiences, thinking of ways to get money with which to gamble). (Craving)
5. Often gambles when feeling distressed (e.g. helpless, guilty, anxious, depressed)
6. After losing money gambling, often returns another day to get even (chasing one’s losses)
7. Lies to conceal the extent of involvement with gambling
8. Has jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling
9. Relies on others to provide money to relieve desperate financial situations caused by gambling.
Severity:
- Mild: 4-5 criteria met
- Moderate: 6-7 criteria met
- Severe: 8-9 criteria met
To what extent correspond the GD criteria to the SUD criteria?
How can problematic gambling be measured?
Through questionnaires:
1. Problem Gambling Severity Index (PGSI)
- 9 items based on DSM criteria
- Severity measure
- Often used for general population
- Examples:
— ‘Have you bet more than you could really afford to lose?’’
— ‘Have you needed to gamble with larger amounts of money to get the same feeling of excitement?’
2. South Oaks Gambling Screen (SOGS)
- 16 items: DSM criteria + gambling specific questions (type of gambling, amount of money spent in 1 day, parents)
- Severity measure
- Often used in clinical populations
Describe the prevalence of GD in the Netherlands
- 65% of the people says they gambled in the past 12 months
- 90% says they have gambled in their lifetime
- 34% gambled when you exclude loteries
- There are 80.000 problematic gamblers (that is 1% of people who gamble)
- There are 2.456 people in treatment for GD (that’s 5,6% of problematic gamblers)
- Minder dan 10% of gamblers who need help, seek treatment
What defines addiction and how can we see this in behaviours?
Symptoms:
- Tolerance
- Withdrawal
- Loss of control
- Craving
- Neglect of life
- Continued use despite harm
Using diagnostic criteria inappropriately can inflate the appearance of disorders and blur the line between normal and pathological behavior.
- Risk of over-pathologizing”
— The slide warns that normal behaviors (like enjoying time with friends) could be wrongly labeled as mental disorders if clinical criteria are applied too loosely or in the wrong context.
— This could lead to stigmatization, unnecessary treatment, or misunderstanding of human behavior.
So, we can not apply the symptoms of ACD to GD. But there are some other similarities between ACD and GD that makes GD an addiction, like Biology/genes, environmental factors, risk factors, and response to treatment.
Explain the comorbidity between GD and SUD
- They share characteristics such as impulsivity, loss of control, and persistence despite harm.
- The highest comorbidity rates are with alcohol use (73.22%), nicotine dependence (60.37%), and personality disorders (60.82%).
- Major depression: 36.99%
- social phobia: 10.55%
- Specific phobia
- Generalized anxiety
- personality disorders
- There is a strong overlap in psychiatric comorbidities between GD and SUDs.
- This supports the classification of gambling disorder alongside substance use disorders in diagnostic manuals like the DSM-5.
- The high prevalence of co-occurring disorders suggests that gambling disorder does not occur in isolation and may share underlying vulnerabilities (e.g., genetic, neurobiological, or psychological).
What are the similarities between Gambling Disorder and Substance Use Disorder in the DSM-5?
- Core symptoms
- Co-morbidities
- Shared heritability/ genetics
- Effective treatments (CBT, Nalmefene)
- Functional neuroimaging and neurocognitive profile
Explain the difference between GD and SUD: neurotoxic effects on the brain.
- Substance use can cause direct physical damage to brain tissue. (this complicates the study of addiction mechanisms.)
- Behavioural addictions, like gambling, don’t have neurotoxic effects on the brain.
- Therefore, GD is useful for studying addictive brain processes without the brain damge caused by drug toxicity
- This makes GD a model for understanding the psychological and neurobiological roots of addiction, since it’s not confounded by substance-induced brain changes.
Describe the differences between GD and SUD in pavlovian learning:
Substance:
- Direct reinforcing effects on dopamine system
— Drugs like alcohol, cocaine, or nicotine directly stimulate the brain’s dopamine reward pathway, producing immediate and powerful feelings of pleasure.
— This direct neurochemical reinforcement makes substances highly addictive.
- Predictability: reward is always delivered
— When a person takes a drug, the reward is consistent (e.g., a predictable high or relief).
— This certainty strengthens the learning that drives compulsive use.
Gambling:
- Indirect reinforcement through money rewards
- Gambling doesn’t directly affect the brain’s reward system the way drugs do.
- Instead, it relies on psychological rewards (e.g., money, excitement, anticipation).
- The outcome is unpredictable — sometimes you win, often you lose.
- This variable reinforcement schedule is still highly compelling and can create persistent addictive behavior.
How could gambling ‘hijack the reward system’ and be addictive?
What makes gambling addictive? Psychological reasons:
- Anticipation of winning?
- Reward uncertainty?
- Excitement/ arousal?
- Stress release?
- Escaping reality?
- Winning can’t explain the addiction of gambling.
Key point: It’s not the outcome (winning), but the process and anticipation, especially under uncertainty, that reinforces the behavior.
A study showed that dopamine neurons in monkeys respond most strongly when a reward is uncertain.
- Monkeys were trained to associate certain stimuli with lemonade rewards, but with different probabilities of receiving it
- When the CS was associated with 100% lemonade. The peak comes when the CS is presented.
- When there was 0 probability, the peak comes when the CS is presented, the reward is a surprise.
- When there is a 50% probability: dopamine firing both at CS and a little when anticipating the outcome.
- The uncertainty of a possible win — not the win itself — produces maximum dopamine response, which is highly reinforcing and addictive.
Describe the machine design feature: ‘Reinforcement schedules’ What can make gambling addictive.
Skinner’s theory:
- People gamble because of the schedule of reinforcement that follows.
- Casino’s use variable ratio schedules: In this schedule, rewards come after an unpredictable number of responses (e.g., pulling a slot machine lever). This unpredictability leads to persistent behavior because people never know when the next win will come
What is meant by ‘Gambler’s fallacy’?
- A cognitive bias where people wrongly believe that a win is due after a series of losses
- It’s a natural flaw in how our brain predicts outcomes > a human design feature
Explain the 4 different reinforcement schedules
- Fixed ratio
- Reward after a set number of actions. High, fast response rate. - Variable ratio
- Reward after a variable number of actions. Fastest, most persistent response rate. Seen in gambling.
- most addictive, because it leads to rapid, persistent behaviour, even without consistent reinforcement - Fixed interval:
- Reward after a set time. Responses increase near expected time. - Variable interval;
- Reward after varying time intervals. Steady, moderate response rate.
Describe the machine design feature: ‘Timing and Stakes’ What can make gambling addictive.
TIMING:
- The shorter the time between bet and outcome, the more addictive
— When rewards (or losses) come immediately after a bet, it creates a stronger learning loop and makes the behavior more reinforcing.
— Fast-paced gambling (e.g., slot machines) delivers rapid feedback and encourages continuous play.
- Regulation Example (Netherlands): Machines must maintain a minimum 4-second delay between bet and outcome to reduce rapid, compulsive play.
- Lotteries are less addictive because the delay between placing a bet (buying a ticket) and learning the outcome is long, breaking the reward-feedback loop. Hence, lottery-related gambling problems are rare.
STAKES
- There is a higher addiction potential with higher stakes
— The more money a person can bet and lose quickly, the greater the emotional and financial reinforcement, increasing the addiction risk.
- In the Netherlands, the maximum loss on slot machines is limited to 40 euros/hour to help control risk and financial harm.
> Fast outcomes + high stakes = more addictive gambling experience
Regulation focuses on slowing down play and limiting financial losses to mitigate addiction risk.
Explain the machine design feature: near-miss/ near-win
This is a powerful psychological effect that reinforces gambling behavior even when the person doesn’t actually win.
- Near-misses are perceived as close to winning (e.g., two cherries lining up on a slot machine with the third just missing).
- This perception tricks the brain into treating the event as almost-successful, maintaining engagement.
- Despite being losses, near-misses still trigger reward-related brain activity, making them reinforcing.
- The player feels encouraged to keep playing, as if a win is just around the corner.
- Research shows that near-misses can activate the brain and body more intensely than actual wins,
- This suggests a strong emotional and physiological impact, increasing their addictive potential.
- Near-misses motivate continued play, because they create a false sense of progress or skill, despite gambling being based on chance.
- Near-misses mimic wins neurologically — they trigger activity in the same reward systems.
- This helps explain why people feel encouraged to keep playing, even when they’re technically losing.
- Near-misses provide illusory reinforcement — players perceive themselves as “close,” boosting motivation and excitement.
Explain the machine design feature: audiovisual stimuli
Audiovisual stimuli are intentionally designed to increase arousal and engagement, thereby reinforcing gambling behavior
- Sound: Winning jingles, coin-drop noises, and upbeat music all trigger positive emotional and physiological responses
- Lights: Flashing lights, color changes, and visual feedback during wins or near-misses create excitement and stimulation.
- Animations: Visual effects like spinning reels or celebratory graphics capture attention and sustain interest, even during losses or neutral outcomes
- These stimuli don’t increase the odds of winning, but they make the experience more exciting and immersive.
- They heighten arousal, which:
— Makes the behavior more emotionally rewarding
— Distracts from losses or the passage of time
— Encourages longer play sessions
Explain the machine design feature: Losses disguised as wins
Slot machines and other electronic gambling devices can use “losses disguised as wins” (LDWs) to trick players into thinking they are winning, even when they are actually losing money
- Conditioned reinforcers (such as sounds, flashing lights, and animations) are triggered by any win on any payline, even if the overall outcome is a net loss.
- These reinforcers are contingent on betting multiple lines, which increases the chances of some payout — but not enough to cover the bet.
- This creates the illusion of winning and masks financial losses.
- As a result, players:
— Feel rewarded, even when losing.
— Overestimate how often they win, based on the frequency of visual and audio feedback. - This phenomenon is supported by research (Dixon et al., 2010; 2015), which shows that LDWs distort perception of gambling outcomes and contribute to problem gambling.
- example: the bet is 30 euros, and the machine displays a ‘win of 8’, but in fact you have lost 22 euros.
Name 5 human design features in gambling disorder
- Executive functions
- Cognitive distortions
- Incentive salience/ Cue reactivity
- General reward processing
- Gambling-specific reward processing
Explain the role of executive functioning in pathological gambling
Impairments in executive functions—especially response inhibition and decision-making—play a critical role in pathological gambling.
- Response inhibition
- Stop-Signal Task (SST): A well-known measure of inhibitory control, where participants must withhold a response when a stop signal appears.
- Key finding: Pathological gamblers show slower Stop-Signal Reaction Times (RTs), indicating impaired response inhibition.
- Clinical relevance: Those with poorer inhibition were more likely to relapse at 1-year follow-up, suggesting it’s a predictor of long-term outcomes.
- Shows fMRI brain scans comparing controls vs. problem gamblers during the Stop-Signal Task.
- Controls: Strong activation in the prefrontal cortex (especially regions involved in self-control).
- Gamblers: Reduced prefrontal activity, particularly in areas linked to executive control and inhibition.
- Interpretation: The neural basis of impaired inhibition is diminished activation in brain areas responsible for stopping behavior. - Decision making
- Iowa Gambling Task (IGT) is used to measure real-life decision making under uncertainty
- Pathological gamblers show suboptimal choices, often selecting risky decks with high short-term gains but greater long-term losses.
- This suggests deficits in:
— Risk evaluation
— Future planning
— Weighing consequences
SAMENVATTING:
1. Response Inhibition:
- Poor ability to stop or regulate impulsive behavior.
- Linked to greater relapse risk.
- Underpinned by reduced prefrontal brain activity.
2. Decision Making:
- Preference for high-risk, short-term gains over long-term benefit.
- Indicates impaired cognitive control and planning.
These deficits mirror dysfunctions seen in other addictions and suggest that cognitive control systems are compromised, making it harder for individuals to regulate gambling behavior—even when aware of the consequences.
Key Executive Function Deficits in Gamblers:
1. Cognitive Flexibility:
- Impairments in adapting to changing rules or feedback (e.g., in the Wisconsin Card Sorting Task).
- Gamblers struggle to shift strategies when the situation changes — relevant to persistence in losing behaviors.
2. Stroop Task Interference:
- Gamblers show greater interference on incongruent trials (e.g., when the word “red” is printed in blue ink).
- Suggests reduced ability to suppress automatic responses — a failure of inhibitory control.
3. Goal-Directed vs. Habitual Control (Not yet well studied):
- Preliminary findings suggest habitual behavior dominates in gambling disorder, with impaired goal-directed decision-making.
- Indicates a shift from flexible, value-based actions to rigid, cue-driven habits.
4. Research Gaps:
- More systematic research is needed, especially considering co-morbid conditions like ADHD or substance use.
Describe delay discounting
It measures how much a person devalues a reward the longer they have to wait for it.
- Steeper curves = greater impulsivity — the person strongly prefers smaller, immediate rewards over larger, delayed ones.
- Pathological gamblers (bold curve) show steeper discounting curves than both non-pathological and potentially pathological gamblers.
- This means they undervalue future rewards more extremely, favoring immediate gratification — a hallmark of impaired executive control.
- This behavior reflects impulsivity and short-term decision-making, which contribute to chasing losses or risky bets in gambling contexts.
Explain the cognitive distortion: Gambler’s fallacy
Gambler’s Fallacy = the incorrect belief that if one outcome (e.g., red) has occurred repeatedly, the opposite outcome (e.g., black) is now more likely, even though each spin is independent and random.
- For example, after five reds in roulette, players might believe black is “due,” which is false — roulette spins are statistically independent.
- Clusters or streaks naturally happen in random data, but humans tend to misinterpret them as patterns.
- People with more distorted beliefs about gambling outcomes are more likely to fall for this fallacy and make irrational bets.
- Problem gamblers are attracted to games that appear to show patterns (e.g., streaks), reinforcing the illusion of control or predictability
Explain the cognitive distortion: illusion of control
Illusion of control = the false belief that one can influence outcomes that are actually governed by pure chance.
- Gamblers may think they are using skill, strategy, or personal influence to affect outcomes in games of chance.
- This belief is fueled by irrelevant game features that make outcomes feel controllable.
Examples:
- Choosing lottery numbers: Some players believe certain numbers or rituals (e.g., birthdays, “lucky” numbers) increase their chances.
- Throwing dice: People may try to throw dice in specific ways to “control” the outcome, even though dice rolls are random.
- Research (Orgaz et al., 2013) shows that people with gambling disorder are more likely to fall for the illusion of control.
- They overestimate their influence over gambling results, which reinforces continued play and risk-taking.
Explain how cue reactivity contributes to a gambling addiction
cue reactivity — a key feature of incentive salience — contributes to gambling addiction by making gambling-related cues (like images of casinos or slot machines) trigger powerful brain responses in individuals with gambling problems.
- Incentive salience refers to how neutral cues (e.g., a roulette wheel, slot sounds) become motivationally charged through repeated associations with reward.
- In gambling disorder, these cues grab attention and trigger cravings, even in the absence of actual gambling.
- Gamblers show increased activation of the mesolimbic reward system during cue reactivity.”
- This means their brains are hyper-sensitive to gambling cues, causing craving and motivational pull, which can:
— Trigger relapse
— Sustain compulsive behavior
— Override rational decision-making
Describe reward anticipation in GD
- Gamblers show blunted activation in reward-related brain areas (e.g., ventral striatum) when anticipating rewards.
- This is referred to as Reward Deficiency Syndrome: a theory suggesting that individuals with addiction show less natural excitement in anticipation of rewards, potentially leading them to seek excessive stimulation (e.g., gambling).
- Implication: This deficiency may make gambling especially appealing, compensating for underactive reward systems.
A study Compared brain responses to monetary, erotic, and neutral cues.
- In controls, both monetary and erotic cues activate the reward system.
- In gamblers, there’s blunted response, especially to non-gambling (erotic) rewards — suggesting a narrowed reward sensitivity to money/gambling cues.
- Key insight: Severity of gambling correlates with diminished brain response to natural rewards — further evidence of reward system dysregulation.
