Module 8: Pathological gambling Flashcards
Be able to list [paraphrase] the DSM-V criteria of gambling disorder, and indicate the extent to which they correspond to the criteria of substance abuse [evaluate]. Describe how problematic gambling can be measured [paraphrase]. Be able to name and explain psychological factors that contribute to the addictive potential of gambling [paraphrase]. Be able to recognise and explain what the gambler's fallacy and illusion of control are and how they can contribute to the emergence of pathological ga
Criteria for gambling disorder
Can have negative consequences, especially financially. To be diagnosed with a gambling disorder, one has to meet four of the following criteria during the past year:
Need to gamble with increasing amount of money to achieve the desired excitement
Restless or irritable when trying to cut down or stop gambling
Repeated unsuccessful efforts to control, cut back on or stop gambling
Frequent thoughts about gambling (such as reliving past gambling experiences, planning the next gambling venture, thinking of ways to get money to gamble)
Often gambling when feeling distressed
After losing money gambling, often returning to get even (referred to as “chasing” one’s losses)
Lying to conceal gambling activity
Jeopardizing or losing a significant relationship, job or educational/career opportunity because of gambling
Relying on others to help with money problems caused by gambling
Risk factors for gambling disorder
Use of fruit machines, mostly male. Report having more mental mental disorders like mood disorders and substance abuse. Disadvantaged neighbourhood and psychical proximity to casino are risk factors
What is the most effective treatment for gambling?
CBT and its most important components are:
- request for help and motivation to achieve goal
- psychoeducation
- functional analysis to identify triggering and sustaining factors
-exerting stimulus control to stop gambling and regain control over behaviour short-term also by increasing reward value of alternative activities
- challenging gambling illusions or irrational thoughts
- relapse prevention to train patients to identify high risk situations for relapse like social pressure, negative emotions, conflict and strategies to deal with problematic situations
What are the detrimental effects of addictive drugs?
- alcohol dependence linked to tissue shrinkage in frontal and cerebellar networks
- histological markers of cell death in orbitofrontal cortex
- cocaine regimens induce changes in inhibitory control
- seen as neurotoxicity even though cell atrophy cannot be inferred for neuroimaging
How is gambling related to neuroplasticity?
Gambling linked to sympathetic nervous system activation and cortisol release and other nongenomic changes. Also comorbid with substance use disorders. Assumption that actively damaging effects should be nonexistent for gambling disorder
How are those with gambling disorder and substance us disorder similar?
Through impulsivity which is a multifactorial trait consisting of unplanned responding and decision-making with risky consequences. Risky decision-making seen in Cambridge gambling task, alcohol group with deficits in response inhibition and spatial working memory. But those with gambling disorder show more deficits in delay discounting, deficits in inhibition and trait-related impulsivity in gambling group. Linked to deficit white matter integrity of lateral PFC and related to sensation-seeking and poor self-control from a young age
Brain areas linked to gambling and nicotine dependence
Reduced recruitment of ventrolateral PFC and reduced activation of dorsomedial PFC, increased grey matter in striatum and PFC. Changes in white matter tracts and resting state connectivity
What has other research found about the role of the brain reward system in gambling disorder?
Behavioural data found that financial rewards drove behaviour which was linked to the orbitofrontal cortex, more so than erotic rewards linked to ventral striatum and had hypoactivity. When gambling images were presented and made more impulsive choices and cues reversed usual pattern of value coding in midbrain and ventral striatum. Irrational thoughts about chance and skill are exacerbated by gambling play. No differences in D2 receptor but more dopamine release and suggests drug-induced changes than pre-existing vulnerability
What is the potency argument and evidence linked to it?
Natural rewards only produce a weak response in neural circuity, so more factors needed to transition into an addicted state. Research has supported that there is a lower dopamine increase with food compared to heroine, but animals choose sucrose over heroine. Other research emphasises the significance of the ventral striatum and that there is little difference in response to cocaine cues and sucrose cues.
What has research found about Pavlovian processes in gambling disorder?
One study looked at a card-guessing game for small or large financial gains and losses. After a delay, the outcome was revealed. Those who practiced more with the slot-machine showed reduced striatal and amygdala activity to wins. Linked to big win hypothesis which is having early wins when gambling which involves positive prediction errors which activate machinery of reinforcement. Asymmetry in temporal difference learning as financial gains promote learning acquisition and financial losses do not trigger unlearning (state splitting and hindsight bias to explain losses).
Gambling related cognitive distortions
Systematic errors in processing conditions of chance and those with gambling disorder are more likely to develop gambling distortions. Includes: illusion of control which is irrelevant features of game that develops sense of skill when determined by chance. Presence of competititors or background info can exacerbate this. Gamblers fallacy is observing patterns in random outcomes and related to law of small numbers which is that small fragments from a distribution are representative. Near misses also lead to continuation of games and seen are more aversive, linked to anterior insula.
What is one account of the role of the insula in gambling?
Plays a role in interoception, detection and awareness of bodily, visceral states and found to be physiologically arousal and were seen to drive phasic arousal signals. Also balance between subcortical accelerator system (nucleus accumbens and amygdala and prefrontal cortical braking system. The braking system is damaged by drugs and the reflexive system becomes sensitized. Also role of hippocampus in holding drug-related memories. Seen as mediator between subcortical reward system and prefrontal system for decision-making and inhibitory control
When is gambling considered an addiction?
When causing a clinically significant impact on daily functioning and acquiring debt which has undeniable consequences for financial stability and family integrity
Is obesity and binge eating considered addictive?
Food rewards seen to be comparable to drug self-administration methods. Also found reduced striatal dopamine D2 receptor binding. Obese group showed heightened somatosensory response to anticipation of food intake with blunting of caudate response to actual consumption. Also linked to dopaminergic gene polymorphisms linked to addiction. These differed between those with binge eating to not.
Can compulsive shopping be seen as an addiction?
- impulsive behaviours side effect of dopamine agonist medication, when this was administer to those with shopping addiction it increased prediction error in ventral striatum, which differed to the Parkinson’s group. Can be predicted by trait-reward sensitivity and reduced sensitivity to winning probabilities in Cambridge Gamble task, working memory and response inhibition deficits. Similar to profile seen in severe alcohol dependence than gambling disorder, More research needed to assess choice uncertainty and psychological distortions.
