Anja Kräplin

Dysfunctional decision-making in pathological gambling: Pattern specificity and the role of impulsivity

Dysfunctional decision-making in individuals with pathological gambling (PGs) may result from dominating reward-driven processes, indicated by higher impulsivity. In the current study we examined (1) if PGs show specific decision-making impairments related to dominating reward-driven processes rather than to strategic planning deficits and (2) whether these impairments are related to impulsivity. Nineteen PGs according to DSM-IV and 19 matched control subjects undertook the Cambridge Gambling Task (CGT) to assess decision-making. The delay discounting paradigm (DDP) as well as the UPPS Impulsive Behavior Scale (measuring urgency, premeditation, perseverance and sensation seeking) were administered as multidimensional measures of impulsivity. Results revealed that (1) PGs exhibited higher risk seeking and an immediate reward focus in the CGT and, in contrast, comparable strategic planning to the control group. (2) Decision-making impairments were related to more severe delay discounting and, specifically, to increased urgency and less premeditation. Our findings suggest (1) the necessity to disentangle decision-making components in order to improve etiological models of PGs, and (2) that urgency and premeditation are specifically related to disadvantageous decision-making and should be tackled in intervention strategies focusing on emotion tolerance and control strategies.

Gambling experiences, problems, research and policy: gambling in Germany.

AIMS The objective of this paper is to present an overview of gambling in Germany, including historical development, legislative and economic changes as well as treatment options and their effectiveness. METHODS The available scientific literature and research reports on gambling in Germany were reviewed to obtain relevant information on history, commercialization, legislation, treatment and research agenda. RESULTS Gambling in Germany is characterized by compromises between protective and economic efforts. At present, gambling is illegal in Germany, and provision is subject to the state monopoly. Mere gaming machines (specific slot machines) are not classified as gambling activity, permitting commercial providers. In recent years, implementing regulations for state gambling and gaming machines have been changed. Concerning the treatment of pathological gambling, various options exist; treatment costs have been covered by health and pension insurance since 2001. Information on the effectiveness of treatment in Germany is limited. Similarly, the number of peer-reviewed publications on gambling is small. CONCLUSIONS German gambling legislation was subject to major changes in the past years. Based on the available body of research (longitudinal), studies on risk and protective factors and the aetiology of pathological gambling are needed. The effectiveness of pathological gambling treatment in Germany and the impact of gambling regulations on gambling behaviour also need to be investigated.

Increased impulsivity in pathological gambling: Considering nicotine dependence

Introduction: It has been highlighted that increased impulsivity is an important etiological factor in pathological gambling (PG). However, the role of the highly prevalent comorbid mental disorders in PG remains unclear. This is of special concern as the highest comorbidity was found between PG and nicotine dependence (ND), which, in turn, has also been associated with heightened impulsivity. This study aimed to find out whether increased impulsivity in PG is a specific characteristic related to comorbid mental disorders in general or especially to ND. Method: A cross-sectional study was designed that included a healthy control group and three disorder groups with comorbid PG excluding ND, comorbid PG including ND, and ND alone according to the Diagnostic and Statistical Manual of Mental Disorders–Fourth Edition. Impulsivity was assessed according to the dimensions response and choice impulsivity applying behavioral and self-report measures. Results: We found (a) increased response impulsivity in the comorbid PG group when compared to the control group. Furthermore, increased choice impulsivity was found (b) in comorbid PG excluding ND and (c) in comorbid PG including ND when compared to ND alone. Other group differences did not reach significance. Conclusions: Our findings highlight that comorbid PG shares deficits in inhibitory control with ND. In contrast, maladaptive choices are a specific disorder characteristic of comorbid PG when compared to ND. If replicated in further studies, intervention strategies strengthening cognitive control skills might be effective for comorbid PG as well as ND whereas strategies enhancing maladaptive valuation of rewards might be specifically effective in comorbid PG.

Conceptualizing behavioural addiction in children and adolescents

Kardefelt-Winther and colleagues raise the important issue that current conceptualizations and diagnostic methods applied in behavioural addiction research increase the inflationary use of an insufficiently defined clinical diagnosis and result in the pathologizing of normal behaviour [1]. To prevent this critical trend in our field of research, the authors propose a common definition of behavioural addiction with specific exclusion criteria and invite other researchers to contribute to this definition. The proposed definition focuses on two main components: (a) a significant functional impairment or distress as direct consequence of the behaviour and (b) the persistence of the behaviour over a significant amount of time. From a developmental psychological perspective, two issues of this definition should additionally be considered if research is conducted in children and adolescents. The first issue concerns the age-specific definition of behavioural addiction and the age-specific validation of diagnostic instruments. Excessive behaviours, especially regarding internet applications, may be normal, transient phenomena in children and adolescents, resulting from individual factors (e.g. frontal cortex not yet fully matured, development of autonomy) and social factors (e.g. digital environment, peer group). To separate this majority of young individuals with regular or even excessive behavioural patterns from those with behavioural addiction, the diagnostic instruments require validation in younger age groups. The process of developing and validating these instruments could profit from the existing literature about longitudinal studies on diagnostic items, symptoms and diagnoses of substance use disorders in children and adolescents. Research on substance use disorders has shown that core features of addiction are operationalized in a way that may result in erroneous symptom assignments in adolescents [2,3]. Moreover, research on diagnostic instruments for substance use disorders has indicated age-specific symptom profiles [4]. Similar research is needed on behavioural addiction and the recent changes within the diagnostic categories for addictive disorders in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5 [5]) should not be seen as proof of validity. To date, relatively few studies are available on this validity issue in behavioural addiction which solely focus on gambling disorder. These studies have shown similar discrepancies in applying diagnostic criteria for adults to younger individuals [6] and even adapted instruments have been critically questioned [7]. However, more studies on other problematic behaviours are needed. Improving the validity of diagnostic instruments to assess behavioural addiction requires a clear description of the age-specific manifestations of the clinically significant symptoms [2] and the age-specific validation of diagnostic instruments with clinical interviews. As second issue, the component ‘significant timeframe’ of the authors’ definition of behavioural addiction has to be discussed and balanced even more carefully for children and adolescents. For adults, the authors report a study that has shown that excessive behaviours seem to be fairly transient for most people [8]. This may especially be true for children and adolescents. Studies on substance use disorders indicate that this could result from age-specific changes in the individual symptomatology [9] or from unstable diagnoses in younger ages [10], which may be especially true for the transition from adolescence to early adulthood. Like the first issue of invalid measures, an inadequate time-frame for the diagnosis of behavioural addiction could also result in false positive or negative symptom assignments. A false positive application of a clinical diagnosis, e.g. resulting from too shortly defined diagnostic time-frames, may have a negative impact on the psychosocial development. In contrast, false negative symptom assignments may result in delayed interventions and in even more detrimental and long-lasting consequences in a young person (e.g. school dropout). Longitudinal studies on the course of behavioural addiction symptoms in children and adolescents are needed urgently. To conclude, Kardefelt-Winther and colleagues took an important first step to contradict the methodological issues and problematic research practices that can be observed currently in behavioural addiction research. It is important that critical research continues combining qualitative and quantitative approaches. The focus on age-specific issues is only one aspect that has been highlighted here. Other aspects may concern culture, gender or disorder severity. I would like to encourage all researchers in the field to contribute to the debate and the definition of behavioural addiction.

A Systematic Review of Land-Based Self-Exclusion Programs: Demographics, Gambling Behavior, Gambling Problems, Mental Symptoms, and Mental Health

Systematic and quantitative reviews on the effects of land-based self-exclusion are scarce. Therefore, the current review aimed to provide a comprehensive summary of (1) the demographic characteristics of land-based self-excluders and changes after exclusion, including (2) gambling behavior, (3) gambling problems, (4) mental symptoms, and (5) mental health. A systematic database and literature search was performed following PRISMA guidelines. Nineteen naturalistic studies met the eligibility criteria. The quality of all included records was rated via adaption of the Newcastle–Ottawa Scale. Results from higher-quality records were more heavily weighted. Self-excluders were predominantly men in their early or middle forties. Changes after exclusion revealed wide ranges in the rates of abstinence (13–81%), rates of gambling reduction (29–92%), and rates of exclusion breaches (8–59%). The records consistently demonstrated significant changes in pathological gambling from before exclusion (61–95%) to after exclusion (13–26%). Up to 73% of self-excluders exhibited symptoms of anxiety, depression, and substance use disorders at program enrollment. Several aspects of mental health improved after exclusion, e.g., quality of life. Problem and pathological gambling are most prevalent in young men, but self-exclusion was most prominent in middle-aged men. The magnitude of effects widely differed between studies despite overall benefits of self-exclusion, and many individuals continued gambling after exclusion. This shortcoming could be minimized using improved access controls and the extension of exclusion to other gambling segments. High rates of pathological gambling and other mental disorders in self-excluders highlight the need for improved early detection and treatment accessibility.

Decision-making and inhibitory control after smoking-related priming in nicotine dependent smokers and never-smokers

Impaired decision-making and inhibitory control are important characteristics of nicotine dependence (ND). We aimed to test 1) the effects of smoking-related priming cues on subsequent decision-making and inhibitory control in ND and 2) how these priming effects are related to valence ratings, nicotine deprivation and craving. A sample of 27 smokers with ND according to DSM-IV and a control group of 33 never-smokers performed an intertemporal choice task and a go/no-go task. Before each trial of the tasks, a priming cue appeared that was either smoking-related or neutral. Valence ratings, nicotine deprivation and craving were assessed with self-reports. After smoking-related compared to neutral primes, the ND group exhibited increased delay discounting (β = 0.07, 95% confidence-interval (CI): 0.01-0.14) and shorter go reaction times (β = -0.13, CI: -0.32 to -0.01) compared to the never-smoker group. The speed-up in go trials after smoking-related compared to neutral cues was significantly related to more pleasant valence ratings (β = 0.07, CI:0.01-0.13), a longer time since last cigarette (β = -0.17, CI:-0.30 to -0.03), and increased craving (β = -0.19, CI: -0.33 to -0.06) within the ND group. We found evidence for small group effects indicating that individuals with ND compared to never-smokers decide more dysfunctional and react faster after smoking-related compared to neutral cues. Faster reactions after smoking-related cues within the ND group, especially in states of increased nicotine deprivation and craving, without more errors could be explained by an increased attentional focus. Cue-induced alterations in decision-making and inhibitory control in ND highly depend on the temporal sequence of cue presentation.

Negative interpersonal scenes decrease inhibitory control in healthy individuals but not in gambling disorder patients

ABSTRACT While impaired cognitive control and decision-making are clearly related to gambling disorder (GD), it remains unclear how they are affected by interpersonal problems as contextual cues for gambling. This study tested whether these impairments in GD are specifically present following presentations of negative interpersonal scenes. Inpatients with GD (n = 49) and healthy individuals (n = 29) performed a go/no-go and an intertemporal choice task with randomly presented pictures depicting either neutral scenes or negative interpersonal scenes related to a lack of autonomy (e.g. prison scene) or appreciation (e.g. thumb downwards). The reduction of inhibitory control in the go/no-go task after negative autonomy-related compared to neutral interpersonal scenes was significantly larger in the control compared to the GD group. Within the control group, we also found a reduction of inhibitory control after negative appreciation-related compared to neutral scenes. There were no further significant between- or within- group-effects. Unexpectedly, negative interpersonal scenes decreased inhibitory control in healthy individuals but not in GD patients that may be explained post hoc by differences in stress responses or emotion regulation in reaction to the negative scenes. The effects of interpersonal problems on gambling behaviour in GD cannot directly be explained by cue-induced impairments of inhibitory control or decision-making.

Monitor yourself! Deficient error-related brain activity predicts real-life self-control failures

Despite their immense relevance, the neurocognitive mechanisms underlying real-life self-control failures (SCFs) are insufficiently understood. Whereas previous studies have shown that SCFs were associated with decreased activity in the right inferior frontal gyrus (rIFG; a region involved in cognitive control), here we consider the possibility that the reduced implementation of cognitive control in individuals with low self-control may be due to impaired performance monitoring. Following a brain-as-predictor approach, we combined experience sampling of daily SCFs with functional magnetic resonance imaging (fMRI) in a Stroop task. In our sample of 118 participants, proneness to SCF was reliably predicted by low error-related activation of a performance-monitoring network (comprising anterior mid-cingulate cortex, presupplementary motor area, and anterior insula), low posterror rIFG activation, and reduced posterror slowing. Remarkably, these neural and behavioral measures predicted variability in SCFs beyond what was predicted by self-reported trait self-control. These results suggest that real-life SCFs may result from deficient performance monitoring, leading to reduced recruitment of cognitive control after responses that conflict with superordinate goals.

Performance of Smokers with DSM-5 Tobacco Use Disorder in Time-Based Complex Prospective Memory

Abstract Studies that investigate time-based complex prospective memory (PM) functioning in participants with substance use disorders (SUD) in consideration of different PM-phases (planning, retention, initiation, execution) are lacking. This study was designed to investigate performance of young adults with DSM-5 tobacco use disorder (TUD) and healthy controls (HC) in different phases of complex PM. Community participants aged 18–35 (N = 43) completed the modified Six Elements Test that includes the PM-phases planning, retention, initiation, and execution of a time-based complex PM-task (with delay phases and background activities). TUD participants were current daily smokers and fulfilled at least two DSM-5 TUD criteria. TUD did not differ significantly from HC in task planning errors and timely task initiation. No group differences showed in rule adherence and completeness during task conduction (execution). During execution, TUD showed significantly more deviations (Coef. 0.45; p = 0.005) from their originally remembered plans than HC. Young adults with relatively mild TUD do not show general impairments in all phases of short-term, complex, and time-based PM. Future research may investigate whether a greater risk of deviation from originally remembered plans in TUD could play a role in the progression and cessation of smoking behavior.

Verhaltensprävention von pathologischem Glücksspielen

Nach einer Ubersicht uber personenbezogene Korrelate und Risikofaktoren fur pathologisches Glucksspielen (PG) werden universelle, selektive und indizierte verhaltenspraventive Masnahmen anhand aktueller Uberblicksarbeiten vorgestellt. Ein weiterer Schwerpunkt ist die Frage nach der Verbesserung der derzeit geringen Erreichbarkeit von Glucksspielern, die erste Anzeichen einer beginnenden Storung zeigen. Weiterhin erfolgt eine Darstellung der in der Literatur empfohlenen Leitlinien fur Praventionsstrategien. Aufgrund des hohen Anteils von Glucksspielern (etwa 45 %) und des geringen Anteils von Personen mit PG (etwa 0,3 %) in der Bevolkerung werden als Schwerpunkt selektive und indizierte Praventionsmasnahmen empfohlen. Abschliesend wird u. a. diskutiert, wie und in welcher Abfolge verhaltens- und verhaltnispraventive Masnahmen sinnvoll kombiniert werden konnten.