Week 8 Flashcards
What is the study of non substance-based addiction? (3)
Excessive and problematic consumption of psychoactive substances is a major focus of addiction theory and research
People can engage excessively in problematic behaviors as well (gambling, gaming, sex, shopping)
Can we use an addiction lens to understand these behaviors?
Who is Stanton Peele? (2) What are his 6 conditions of addictive behavior? (IAGPSI)
Leader in this area of addiction
States that all addictions are behavioral as treatment is addressing behavior not the substance
Says that any activity that can detract from the ability to carry through other involvements, eradicates a person’s awareness, provides predictive gratification, avoids pain and unpleasantness, damages self-esteem and destroys other involvement can take over someone’s life
What are the differences between gambling and substance addictions? (6) HOFWTI
Gambling is a hidden addiction that doesn’t visibly show its impacts as drug use does
Can’t overdose as there is no saturation point
Huge financial problems result at another level entirely
Can function at work
Can’t be tested in concrete ways like you can test for drugs
Doesn’t require ingestion
What are the similarities between gambling and substance addictions? (5)
Preoccupation (always on the mind)
Negative impact on major life areas
Tolerance (could be argued there is no research based evidence for this however)
Immediate gratification
Loss of control
What is a broader concept of addiction? (4)
States that non substance-based addiction resembles substance based addiction
Sees addiction as about enacting or performing a behavior, whether that is the behavioral aspect of substance addiction (taking the drugs) or the behavior itself that is addictive
All addiction is behavioral as addiction results from being absorbed by and dependent on a behavior to the extent of crowding out other involvements
This is why treatment usually involves stopping or changing behavior with alternative behaviors as replacement
How was disordered gambling classified in the DSM IV? How is it classified in the DSM V? (2)
DSM IV: under impulse control disorder section with other disorders like kleptomania, pyromania, etc.
DSM V: under Substance-Related and Addictive Disorders as a Non-Substance Related Disorder
This is the first formal recognition of a behavioral addiction resulting from increased research after mass legalization of gambling (sports, online, etc.)
What are the 9 DSM V criteria (and the 1 left out)?
Tolerance (needing to gamble with more money to achieve the desired excitement)
Restless or irritable when trying to stop or cut down
Repeated unsuccessful attempts to stop or control gambling
Preoccupation with gambling
Gambling when feeling distressed
Chasing (gambling more to get even after losing a lot of money)
Lying to conceal the extent of gambling
Jeopardized or lost a significant relationship, job or educational/career opportunity because of gambling
Reliance on others to provide money to relieve desperate financial situations caused by gambling
Left out illegal activities as it didn’t have a discriminating effect
What is the question of tolerance regarding gambling? (3)
Some research shows that people reported increased bet sizes to increase their chance of winning, not because of tolerance
Tolerance is seldom a characteristic of non-substance gambling
Take gaming by for example which does not have people needing to play more and more
What is the prevalence of disordered gambling? (5)
A lot of world developments has increased the accessibility of gambling (casino in your pocket with your phone, sports betting legalized, COVID closing the in person casinos down)
Prevalence rate around the world is usually low, from 1-2%
In Canada, it is a bit higher at 2.6%
In Ontario, a CAMH report found that 68.1% of adults gamble and 1.7% are disordered, showing that many people are gambling but not everyone becomes addicted due to risk/protective factors
For youths in Ontario, 31.8% of youths gamble and 1.1% have a problem (which is hard since it’s illegal to gamble underage)
What is the course of disordered gambling regarding exposure vs. adaptation? (2)
There are several different paths to harmful gambling and the relationship between exposure and harm is not a straight one
Not everyone who is exposed develops a harmful addiction
Does the “total consumption/single distribution” model apply to disordered gambling? (4)
There is mixed evidence for a single linear distribution where as consumption goes up, harm goes up at the same rate
Some people can increasingly gamble or game without any harm until a breaking point much later
Others, because of risk factors, experience immediate harm from initial consumption of the addictive behavior
The consumption/harm distribution is all dependent on risk factors, kind of gambling, amount of games, etc.
What is the epidemic curve? (6)
An exposure event creates rapid infection and increases exposure/illness among the most vulnerable
This leads to infection among the resistant and a rising number of cases
After the curve of number of cases peaks, there is population evidence for recovery
The whole point is to control the spread at the initial event and get ahead of the curve
This curve has been seen in COVID, obesity and can be seen in gambling like in the 1980s
Exposure events could be increase in casinos opened (which is what happened in the 80s), legalization of sports betting, etc.
What is the influence of consumption regarding gambling? (3)
As exposure to a stimulus (gambling apps, casinos, etc.) increases, the most vulnerable are the first to be “infected” (people who need to cope, who need money, with addictive personalities, etc.)
We may see increases in gambling participation near epicenters of gambling
Then there is a period of adaptation and resistance where society tries to intervene and address the problem
How did COVID impact gambling? (4)
Government closed the casinos, resulting in people with gambling problems who couldn’t go to the casino
People turned to online gambling, which had a drastic increase in Ontario after 2020
People were calling CAMH more with online gambling problems as it was so accessible
Online gambling became a big main problem
What is the problem with online sports betting? (6)
Became legalized in Ontario and has become very popular since
Very accessible as you only need a credit card and a phone (which most people have or can get)
Many incentives to get people in the door (free bet credits for signing up)
Changed how people consumed and watched sports
Heightened exposure with so many ads for sports betting everywhere you turn with celebrities and role models
These high rates of exposure and access are creating a curve (can be seen from increase in CAMH calls) and effect that we should be talking about and addressing
How does biology and dopamine impact disordered gambling? (4)
fMRI imaging has shown that change monetary rewards activate the brain’s dopamine reward system
Since the reward is never predictable, it gives a burst of dopamine into the brain every time you play
This is reinforced by social environmental cues resulting in the development and maintenance of a strong response that is very resistant to change
Not about how much money you make or spend but the chance factor and anticipation of reward when dopamine fires
How is gambling related to genetics? (3)
A meta analysis of 18 twin studies found that gambling behavior is moderately heritable as one identical twin who was a gambler was more likely to have a twin who is also a gambler than non-identical twins
Also found it is moderately influenced by non-shared environmental factors unique to each twin
Unique life experiences are important for understanding gambling
Does gambling disorder have comorbidities? (3)
People living with GD have a high rate and wide range of comorbidities (the norm, not the exception)
More likely to have nicotine dependence (60.1%), substance use disorders (57.5%), mood disorders (37.9%) and anxiety disorders (37.4%)
Coexists at a high rate with alcohol dependence and problematic substance use
What is the Pathways Model of Gambling? What is the base pathway? What are the three subtypes of people identified?
Acknowledged that there are different paths to gambling and people with GD are a heterogenous group in terms of risk factors and motives leading to GD
Ecological factors (availability, accessibility) plus sometimes traits and vulnerability leads to conditioning, which leads to habituation, which leads to chasing; which leads to problem and pathological gambling
There are 3 subtypes of people who develop GD:
Behaviorally conditioned
Emotionally vulnerable
Anti-social impulsivist
What is the behaviorally conditioned gambling addict (pathways model)? (5)
Don’t have etiologies risk factors like premorbid psychopathy
Gambling problems develop mainly in response to reinforcement contingencies of gambling
Role of cognitive distortions related to gambling (illusion of control over odds, beliefs in luck, erroneous beliefs that they can beat the house with their strategies)
Related to Skinner’s idea of operant conditioning (try gambling, win big, and that excitement you get from gambling is positively reinforcing that gambling is good and you should keep doing it until you lose everything)
Also related to variable ratio of reinforcement (you don’t know when the reward is coming so you keep going because the next win might be right around the corner)
What is the emotionally vulnerable gambling addict (pathways model)? (5)
Like behaviorally conditioned in that there is erroneous beliefs, chasing and habits but also adds:
Biological vulnerability (family history of gambling)
Emotional vulnerability (personality, mood/anxiety disorders, life stress, ACEs)
These people are not in a good place, they come upon gambling as a form of escape and use it to cope
Negative reinforcement is a big part
What is the anti-social impulsivist gambling addict (pathways model)? (4)
Like the first two but with more risk and severe presentations of gambling problems due to added:
Also have impulsivity traits
Anti-social personality traits
Engage in many maladaptive behaviors like drug taking and criminal activitiy
What did the Tabri meta analysis do? (2) What did it find? (4)
Studies associations between gambling motives, frequency and level of problem gambling
Questions the role of money and financial success in developing GD
A substantial portion of gamblers claim that making money was a main reason behind their disorder
Great financial gambling motives are moderately and positively correlated with greater gambling frequency and gambling problems
Correlations remained even when controlling for shared variance with coping, enhancement, and social motives
Cannot ignore the role of money and financial success just because it isn’t in substance related disorders
What are the psychosocial aspects of gambling disorder? (3)
Personal relative depravation (the belief that one is worse off than other people in similar positions) has been shown to lead to gambling motivated by financial gain
Not everyone who feels deprived will turn to gambling as some go though conventional means of making money (job, education, social climbing)
When people have perceptions of upward economic mobility being unattainable (cannot work their way up the usual way)c they are more likely to try gambling
What is the risk sensitivity theory? (4)
A general theory of decision making under risk that involved evolutionary considerations
Situations of high need induce a shift towards preferences for riskier goal attainment strategies
When people are in a state of high need and believe that they will come up short by pursuing low-risk options of meeting that need, they will turn to high risk options that have a small chance of completely eliminating that need
When you are desperate to get to the desired state you feel deprived of, you will take risky actions to get to that state/goal
What is the role of a financially focused self-concept? (5)
Different parts of who we are makes up who we are a whole, our self-concept
When it comes to gambling, people become overly invested in financial gain and money
The way they view themselves and everything they do becomes completely financially focused
People with a more FFS are more likely to score higher in disordered gambling and develop more gambling problems in the future
People with gambling problems tend to have more of a FFS (goes both ways and are bidirectionally related)
Can gaming have benefits? (4)
Educational (learning to drive)
Rehabilitation (retraining the brain)
Cognitive (maintenance of cognitive functioning)
Psychological (sense of belonging in a community as a gamer)
Can excessive gaming be harmful? What are the 4 potential harms?
Hard to say because what is excessive and what is normal? There are no definitions for that yet besides looking at what others do
Mental health (depression, anxiety, ADHD, addiction)
Behavioral problem (violence/crime, addict/injury, online risky behavior)
Physical health (vision, musculoskeletal problems, sleep problems, sudden death)
Functional problem (cognitive functioning, familial/social problems, academic problems, occupational problems)
What is the proposed DSM criteria for internet gaming disorder? (9)
Preoccupation
Withdrawal
Tolerance
Unsuccessful attempts at control
Loss of interest in other hobbies
Continued use despite knowledge of psychosocial problems
Deceived others regarding amount of use
Use to escape or relieve a negative mood
Has jeopardized or lost a significant relationship/job/education or career opportunity
How is gaming addiction similar to gambling? (2) How is it different?
Similar criteria in preoccupation, withdrawal, tolerance, unsuccessful control, escape, etc.
Also similar in that there is greater risk of harm from different kinds of vices (more risk for multiplayer, mission based games)
They are unique as well (chasing for gambling, loss of interest for gaming)
What is the Internet Gaming Disorder Test? (2)
A test composed of 9 questions regarding the proposed criteria to inquire about problematic gaming
Not diagnostic but can indicate possibility of a problem
What is the game transfer phenomenon? (3)
When virtual worlds bleed into real life
Carry-over effect from video games into real life (like seeing health bars over sports opponents or seeing shooting scopes when trying to get a better look at something)
People with severe GTP are more likely to have problematic or addictive gaming habits
What are the three categories in the Game Transfer Phenomenon Scale?
Altered perceptions (visual, body and auditory)
Automatic mental processes
Actions and behaviors
What are the issues with gaming disorder? (8)
Quality of research base is low (scarcely clinical and low sample sizes)
Current operalization (definition) of gaming disorder leans to heavily on SUD and GD criteria (doesn’t look at how its unique)
No consensus on the symptomatology and assessment of problematic gaming (is it a disorder or symptom of something else?)
Moral panics around the harm of video gaming might result in premature application of a clinical diagnosis and the treatment of false-positive cases
Research will be locked into a confirmatory approach rather than an exploration of the boundaries of normal vs. pathological
The healthy majority of gamers will be affected by the stigma and perhaps changes in policy even though it is rare
Not everyone will exhibit the same exact symptoms of addictive games (it is a spectrum)
It is not a new disorder as there is evidences from the 1980s
What is the prevalence of excessive gaming in Asia? (2)
Extremely high rate of problematic internet use among adolescents
Development of Internet cafes and accessible internet in the late 90s and early 2000s in South Korea saw concern about development of gaming addiction for teen boys promoting strategies that haven’t worked
What is the prevalence of online gaming disorder in North America and Europe?
Low overall as it is so common and normalized, it is hard to identify problematic use
What is the global prevalence of gaming disorder? (4)
3.05% overall but 1.96% for more rigorous studies
2.5 times higher for males
Higher among youth
Higher in Asian countries
What are the biological aspects of gaming disorder? (4)
Activation of dopamine reward systems
Reduced activity in impulse control areas and impaired decision making
Decreased functional connectivity in brain networks related to cognitive control, executive function, motivation and reward (don’t know if it’s a risk factor or result)
Structural changes, such as reductions in gray-matter volume and white-matter density
What are the psychological aspects of gaming disorder? (2)
Psychological factors (emotional vulnerability, impulsivity, socializing need) can impact motives and gaming preferences, which can impact development of gambling problems
Need more research to really pin this down
What are the social aspects of gaming disorder? (4)
Associated with problems with peers, bullying, and having friends with similar addictions (does not lend itself to treatment and recovery)
Low social self-efficacy, loneliness, and reduced family relationship quality associated
More likely to live in socially isolated environments (which is bad as we need social interactions)
Low socioeconomic status and living in rural areas is associated with IGD
What are the physical and mental health consequences of gaming disorder? (4)
Sleep deprivation and day-night reversal
Dehydration and malnutrition
Seizures and pressure sores
Irritability, physical aggression, depression, a range of social problems
Can gaming disorder cause death? (2)
In extreme cases of binge gaming, death can be caused by deep vein thrombosis (blood clots that go into the heart and cause a heart attack)
Sitting down for long periods of time without getting up, sleeping or eating sufficiently can kill you
What are the societal consequences of gaming disorder? (3)
Loss of productivity and economic gain
Create health problems, which puts a strain on the health system
Social losses (family, friends, social life)
