lecture 7 Flashcards
(35 cards)
why is the recategorization of Gambling Addiction (GA) from a impulse control disorder to a behavioral addiction important? what was it based?
- it is significant because it sets a precedent for including other behavioral addictions (like Internet gaming disorder) in the same category
- recategorization is based on clear overlaps with substance use disorders (SUDs), such as similar symptoms, underlying neurobiology, and treatment responses
What is the main DSM-5 diagnostic difference between Gambling Disorder (GD) and Substance Use Disorders (SUDs)?
“Craving” is a criterion for SUDs but not for GD in DSM-5, despite evidence of craving-like symptoms in GD
What are the DSM criteria of gambling disorder?
persistent recurrent problematic gambling behaviour leading to clinically significant impairment or distress, meet min 4 out of these in 1y
1. Need to gamble w increasing amount of money to achieve the desired excitement (tolerance)
2. Restless or irritable when trying to cut down or stop gambling (withdrawal)
3. Repeated unsuccessful efforts to control, cut back on or stop gambling
4. Frequent thoughts about gambling (such as reliving past gambling experiences, planning the next gambling venture, thinking of ways to get money to gamble) (craving)
5. Often gambling when feeling distressed
6. After losing money gambling, often returning to get even (referred to as “chasing” one’s losses) -> chasing losses
7. Lying to conceal gambling activity
8. Jeopardizing or losing a significant relationship, job or educational/career opportunity because of gambling
9. Relying on others to help with money problems caused by gambling
How can problematic gambling be measured?
questionnaries:
- problem gambling severity index (9 items based on DSM criteria, often used for general pop)
- south oaks gambling screen (16 items, often used for clinical pop)
Why is craving in Gambling Disorder still a debated concept?
- it’s unclear what triggers it (e.g., visual cues, the thrill of winning, emotional escape)
- craving is also complex in SUDs, and more research is needed to understand both parallels and distinctions
how is GD explained (model)?
- using a biopsychosocial model (just like SUDs)
what does the three-pathway model by Blaszczynski and Nower identify?
- Behaviorally conditioned gamblers with no major biological issues, but who gamble due to early exposure and environmental factors
- Emotionally vulnerable gamblers, who have traits like anxiety, depression, or risk-taking, often with underlying neurobiological susceptibilities
- Antisocial-impulsivist gamblers, who also show impulsivity, ADHD traits, and antisocial behaviors
what’s the overlap between the three-pathway model of GD and the dual-process models like I-RISA in SUDs?
- Both recognize conditioning, impulsivity, and abnormal reward processing;
- biased evaluation in GD mirrors salience attribution in SUDs.
What are the factors that contribute to the addictive potential of gambling?
- machine design features: random reinforcement schedules leading to gamblers fallacy; short time between bet & outcome; high stakes; audiovisual stimuli that increase arousal; losses disguised as wins
- human design features: executive function impairment, cognitive distortions, abnormal cue reactivity and reward processing
What’s the gambler’s fallacy?
expecting a reversal after a streak (e.g., thinking black must come after several reds)
What social factors contribute to the development of gambling disorder?
- availability and cultural normalization of gambling,
- early wins that reinforce gambling behavior.
What is the role of genetic and neurobiological vulnerability in gambling disorder?
- increase sensitivity to gambling rewards, contributing to craving and pathological gambling behavior
How does gambling-related craving develop neurologically?
Through changes in the brain’s reward circuitry, leading to heightened attention to gambling cues and increased motivation to gamble
What neuropsychological traits are linked to the development and relapse of gambling disorder?
- Poor planning,
- delay discounting,
- impulsivity,
- lack of inhibitory control.
What are somatic markers and how are they altered in GD?
- Somatic markers are physiological responses before risky decisions (e.g. elevated heart rate);
- in GD, these are diminished, making it harder to avoid bad choices
How do problem gamblers respond to anticipated losses neurologically?
- They show increased ventral striatum activity and reduced prefrontal cortex response
- abnormal neural
processing of loss anticipation and loss outcomes is present, which may fuel chasing losses
what are cognitive misperceptions unique to GD?
- Illusion of control: belief that effort or attention affects random outcomes
- Near misses: interpreted similarly to wins, reinforcing gambling
- Win salience bias: gamblers remember wins better than losses
- These distortions are rooted in neural responses, not just faulty logic (supported by abnormal brain activity patterns.)
two main impairements in SUD and their brain regions?
- Impaired response inhibition = cognitive dysfunction -> dorsal prefrontal circuit (executive control)
- exaggerated salience attribution = motivational dysfunction -> subcortical motivational circuit (striatum, amygdala, hippocampus, orbitofrontal cortex)
tools to measure impulsivity?
- Barratt Impulsiveness Scale (BIS-11): assesses dimensions like motor, attentional, and non-planning impulsivity -> doesn’t correlate well with actual behavioral measures
- UPPS Impulsive Behavior Scale: personality based, focusing on urgency, premeditation, perseverance, and sensation seeking
- Studies show that gamblers and people with SUDs score higher on both BIS-11 and UPPS, especially on urgency-related traits -> shared vulnerabiity
what do response inhibition studies show for SUDs?
- diminished response inhibition in users of cocaine, heroin, alcohol, MDMA, and sometimes methamphetamine.
- linked to lower dorsolateral prefrontal and anterior cingulate activity
- Polydrug users tend to show more impairment
- Recovery of response inhibition post-abstinence is possible but varies
- longer abstinence can help, but those with more detoxes or polydrug use often show longer-term deficits
reponse inhibition research in GD?
- mixed evidence
- some studies show diminished inhibition;
- others attribute it to comorbid ADHD or basic cognitive issues
- meta-analyses show general impairment in both GD and SUDs, except for opioids, cannabis, and Internet addiction
- variability in findings supports the idea of subtypes in GD, reinforcing the need for personalized treatment
whats delay discounting in SUDs and GD?
- measures how much someone devalues a delayed reward compared to an immediate one (5$ now vs 10$ in a week)
- higher discounting means a stronger preference for instant gratification
- observed across substances
- people with an alcohol use disorder, who are not abstinent, have a higher delay discounting than people who have an alcohol use disorder, but are recently abstinent -> BUT both groups still have a higher delay discounting compared to persons
without an alcohol use disorder - Similar patterns are found in GD: gamblers, especially when exposed to gambling cues, show more impulsive discounting
Decision making in SUDs and GD?
- complex facet of impulsivity, often treated as a distinct concept
- in SUDs and GD: impaired decision-making (especially in tasks involving risk and reward like the Iowa Gambling Task) -> they often favor short-term gains despite long-term losses
- reduced cognitive flexibility as shown by Wisconsin Card Sorting Task
- Comorbid personality disorders exacerbate decision-making problems
what are the differences between types of gamblers in decision making?
- Strategic gamblers (e.g., card players) show intact decision-making.
- Non-strategic gamblers (e.g., slot machine users) show greater impairment.
- This highlights phenotypic and endophenotypic subtypes relevant for treatment approaches.
