L8: Behavioural Addiction & Pathological Gambling

Question 1

Can any behaviour be addictive? Where do we draw the line? Does behavioural addiction really exist?

Answer 1

gambling is is DSM cause of similarities to other SUDs in symptoms, comorbidities etc
other behaviour addicitons (foodn, sex, shopping etc) are under consideration but data & research still inconclusive

Question 2

What are the DSM criteria of gambling disorder?

Answer 2

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

Question 3

To what extent do the DSM criteria of gambling disorder correspond to the criteria of substance abuse?

Answer 3

tolerance, craving, withdrawal, loss of control, neglect of life, continued use despite harm is important part in the symptom profile of both
chasing losses is unique to gamblin

Question 4

In what ways are gambling & substance use disorders similar?

Answer 4

• symptom profile
• comorbidities
• heritability
• genetics
• risk factors
• effective treatments (CBT)
• brain changes /neuropsychology
• impulsivity is shared marker
• negative reinforcement: relief of stress, negative feelings, etc.
  -> comorbidity between both

Question 5

In what ways are substance use disorders & gambling addiction different?

Answer 5

gambling
- no substances invovled in gambling so less neurotoxic effects of addiction on the brain -> so gambling can function as model for addiction without confound of long term effect of drugs; only indirect reinforcement through rewards (money)
- unpredictable reinforcement rate -> reward uncertainty
substance
- direct reinforcing effects on dopamine system
- predictability: reward is always delivered, so through pavlovian learning DA signal arises at cue presentation as well as drug infusion

Question 6

How can problematic gambling be measured?

Answer 6

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)

Question 7

What are the psychological factors that contribute to the addictive potential of gambling?

Answer 7

• machine design features (random reinforcement schedules leading to gamblers fallacy, short time between bet & outcome, high stakes, near misses (cause interpreted as near wins which enchance gambling motivation), audiovisual stimuli that increase arousal, losses disguised as wins )
• human design features (executive function impairment, cognitive distortions, incentive salience/heightened activation of mesolimbic reward system during cue reactivity, general impaired reward processing (decreased mesolimbic activiation in reward activiation), increased gambling-specific reward processing)
• ## general vs pathological processes

Question 8

What are the executive funciton impairments in gamblers?

Answer 8

• impaired response inhibition as measured by stop signal task and as shown by decreased prefrontal cortex activation
• suboptimal decision making as shown by Iowa gambling task
• steeper delay discounting
• reduced cognitive flexibility as shown by Wisconsin Card Sorting Task, so more compulsivity?

Question 9

What are the cognitive distortions in gamblers?

Answer 9

• gamblers fallacy
• illusion of control

Question 10

What is the gambler’s fallacy?

Answer 10

ppl gamble because of the schedule of reinforcement that follows - variable/random ratio schedules
- players think a run of the same outcome increases the chance of the other outcome occuring
- but each outcome is random, runs are common in random sequences

Question 13

What brain region plays a role in gambling related cognitive distortions?

Answer 13

the insula. its activated by n ear misses & gambling cues.
damage to this reduces the distortions