Lecture 7: Behavioural Addictions Flashcards
2 questionnaires to measure gambling related problems
- Problem Gambling Severity Index (PGSI): a questionnaire consisting of 9 items based on the DSM-criteria; it is often used in the general population.
- South Oaks Gambling Screen (SOGS): a questionnaire consisting of 16 items that is more detailed than the PGSI; it is often used in the clinical population
wat zijn de addiction symptoms, als je kijkt naar GD en SUD
- tolerance
- withdrawal
- loss of control
- craving
- neglect of life
- continued use despite harm
However, by applying these DSM criteria to other behaviors, we run the risk of over-
pathologizing behaviors as addictions.
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similarities underlying GD en SUDs
- Comorbidity: the percentage of people with GD that also suffers from another SUD is high. This points to some underlying genetic similarities.
- Risk factors: being male and being younger are risk factors of both GD and SUDs.
- Treatment: the effective treatments are also similar; CBT is the most effective for both.
- Neuropsychology: there are lots of similarities in the underlying neuropsychology.
- Reinforcement: both drugs and gambling can be negatively reinforcing (relief of stress).
most important difference GD en SUD
there is no neurotoxicity in GD
wat zijn in totaal de grootste verschillen tussen GD en SUD
reinforcement SUD: direct by dopamine system via substance
reinforcement GD: indirect by dopamine system via rewards
predictability SUD: the drug is the reward, therefore it is always delivered and predictable. cue value is higher because it always predicts a reward
predictability GD: rewards are determined by chance and therefore unpredictable
waarom is er nog een addictive ingredient nodig is GD naast winnen
Because of the differences in reinforcement and predictability, it is likely that there must be another addictive ingredient to gambling disorder. Because GD is associated with continued gambling despite (huge) losses, winning money is unlikely to explain the addictiveness of GD.
reward uncertainty experiment
Monkeys learned that stimuli (CSs) predict a reward (lemonade) with different probabilities (100%, 50% and 0%). Results showed that:
* 100%: dopamine release only occurs at presentation of the CS.
* 50%: dopamine is released at presentation of the CS and at the moment leading up to the outcome (reward anticipation).
* 0%: dopamine release only occurs at presentation of the reward.
-> When there is reward uncertainty, there is an increased release in dopamine, because dopamine is released at both the presentation of the CS and at the moment leading up to the outcome
machine design features to incease arousal, reinforce behaviour and overestimate chances of winning:
- reinforcement schedule (games of chance have variable or random ratio schedules of paying out rewards; these can lead to gambler’s fallacy)
- timing (the shorter the time between the bet and the outcome, the more addictive the game is. this can explain why lottery-related addictions are nonexistent)
- stakes (higher the stakes, the more addictive)
- near-misses (can reinforce gambling in the absent of winning. there is higher activity in the reward system compared to losing)
- disguised losses (gambling games often state both gains and actual wins in terms of wins (you bet 10 euros, win 2, then you see ‘win 2’ ipv ‘lose 8’). ook wel conditioned reinforcers contingent on betting to mask losses. leads to overestimation of win frequencies)
- audiovisual reinforcers (sounds/lights/animations make one feel like they are almost winning, when they are losing)
human design features/individual risk factors for developing GD:
- illusion of control
- gamblers fallacy (reinforced door reinforcement schedules)
- impaired executive control (decreased PFC activation, response inhibition, decision making and increased delay discounting)
- incentive salience/cue reactivity ( react more strongly to cues related to their addiction than to neutral cues). therefore increases in mesolimbic reward system
- distorted reward processing (decreased activation of the mesolimbic reward system (reward deficiency), might be a risk factor)
gambling fMRI differences in GD and healthy controls
1) Healthy controls show increased activity in the nucleus accumbens when winning and decreased activation in both near- and full-misses.
2) In contrast, gamblers show lower activity after winning than these controls (thus, they are not gambling to win). Instead, they show increased activation in the reward system during anticipation of a gambling outcome and after near-misses.
NOTE: importantly, patients with GD show decreased activation during reward anticipation in general, but increased activation during the anticipation of gambling-rewards in actual gambling.
definition of compulsivity
Common underlying processes play a role in behavior that is continued despite explicit knowledge of devastating negative consequences in various disorders
endophenotype =
biological or psychological phenomena of a disorder believed to be in the causal chain between genetic contributions to a disorder and diagnosable symptoms of psychopathology
dus: genes - endophenotypes - phenotypes
wat zijn de meest voorkomende comorbidities bij GD
- alcohol use disorder
- nicotine dependence
- drug use
- MDD
waarop was gebaseerd dat gambling disorder in de dsm 5 zou moeten
- Core symptoms
- Co-morbidities
- Shared heritability / genetics
- Effective treatments (CBT, nalmefene)
- Functional neuroimaging and neurocognitive profil
