Background and aimsExtreme sports athletes are often labeled “adrenaline junkies” by the media, implying they are addicted to their sport. Research suggests during abstinence these athletes may experience withdrawal states characteristic of individuals with an addiction (Celsi, Rose, & Leigh, 1993; Franken, Zijlstra, & Muris, 2006; Willig, 2008). Despite this notion, no research has directly explored withdrawal experiences of extreme sports athletes.MethodsUsing semi-structured interviews, we explored withdrawal experiences of high (n = 4) and average-ability (n = 4) male rock climbers during periods of abstinence. We investigated the psychological and behavioral aspects of withdrawal, including craving, anhedonia, and negative affect; and differences in the frequency and intensity of these states between groups.ResultsDeductive content analysis indicated support for each of the three categories of anhedonia, craving, and negative affect. Consistent with existing substance addiction literature, high-ability climbers recalled more frequent and intense craving states and negative affect during abstinence compared with average-ability climbers. No differences in anhedonic symptoms between high and average-ability participants were found.ConclusionsRock climbing athletes appear to experience withdrawal symptoms when abstinent from their sport comparable to individuals with substance and behavioral addictions. The implications of these findings and suggestions for future research are discussed.

A call for replications of addiction research: which studies should we replicate and what constitutes a 'successful' replication? Addiction Research & Theory

Background: Neuropsychological assessment is central to identifying and determining the extent of Alcohol-Related Cognitive Impairment (ARCI). The present systematic review aimed to synthesize and discuss the evidence appraising the neuropsychological tests used to assess ARCI in order to support clinicians and researchers in selecting appropriate tests for use with this population.Methods: We searched for studies investigating the psychometric, diagnostic and practical values of tools used in the screening, diagnosis, and assessment of Korsakoff's Syndrome (KS), Alcohol-Related Dementia (ARD), and those with a specific diagnosis of Alcohol-Related Brain Damage (ARBD). The following databases were searched in March 2016 and again in August 2018: MEDLINE, EMBASE, Psych-INFO, ProQuest Psychology, and Science Direct. Study quality was assessed using a checklist designed by the authors to evaluate the specific factors contributing to robust and clearly reported studies in this area. A total of 43 studies were included following the screening of 3646 studies by title and abstract and 360 at full-text. Meta-analysis was not appropriate due to heterogeneity in the tests and ARCI samples investigated in the studies reviewed. Instead, review findings were narratively synthesized and divided according to five domains of assessment: cognitive screening, memory, executive function, intelligence and test batteries, and premorbid ability. Effect sizes (d) were calculated to supplement findings.Results: Overall, several measures demonstrated sensitivity to the cognitive deficits associated with chronic alcoholism and an ability to differentiate between gradations of impairment. However, findings relating to the other psychometric qualities of the tests, including those important for the accurate assessment and monitoring of ARCI (e.g., test-retest reliability), were entirely absent or limited. Additionally, the synthesis of neuropsychological outcomes presented here supports the recent impetus for a move away from discrete diagnoses (e.g., KS, ARD) and the distinctions between them toward more broad and inclusive diagnostic conceptualizations of ARCI, thereby recognizing the heterogeneity in presentation.Conclusions: Based on the evidence reviewed, provisional recommendations for appropriate tests in each domain of assessment are presented, though further validation of most tests is warranted. Review findings can support efficient and evidenced-based test-selection and guide future research in this area.

Background and AimsRecent investigations have highlighted the value of neuropsychological testing for the assessment and screening of Alcohol-Related Brain Damage (ARBD). The aim of the present study was to evaluate the suitability of the Addenbrooke’s Cognitive Examination (ACE-III) and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) for this purpose.MethodsComparing 28 participants with ARBD (11 with Korsakoff’s Syndrome and 17 with the umbrella “ARBD” diagnosis) and 30 alcohol-dependent participants without ARBD (ALs) we calculated Area Under the Curve (AUC) statistics, sensitivity and specificity values, base-rate adjusted predictive values, and likelihood ratios for both tests.ResultsHigh levels of screening accuracy were found for the total scores of both the ACE-III (AUC = 0.823, 95% CIs [0.714, 0.932], SE = 0.056; optimal cut-off ≤86: sensitivity = 82%, specificity = 73%) and RBANS (AUC = 0.846, 95% CIs [0.746, 0.947], SE = 0.052; optimal cut-off ≤83: sensitivity = 89%, specificity = 67%) at multiple cut-off points. Removing participants with a history of polysubstance from the samples (10 ALs and 1 ARBD) improved the diagnostic capabilities of the RBANS substantially (AUC = 0.915, 95% CIs [0.831, 0.999], SE = 0.043; optimal cut-off ≤85: sensitivity = 98%, specificity = 80%), while only minor improvements to the ACE-III’s accuracy were observed (AUC = 0.854, 95% CIs [0.744, 0.963], SE = 0.056; optimal cut-off ≤88: sensitivity = 85%, specificity = 75%).ConclusionOverall, both the ACE-III and RBANS are suitable tools for ARBD screening within an alcohol-dependent population, though the RBANS is the superior of the two. Clinicians using these tools for ARBD screening should be cautious of false-positive outcomes and should therefore combine them with other assessment methods (e.g., neuroimaging, clinical observations) and more detailed neuropsychological testing before reaching diagnostic decisions.

Study preregistration is one of several “open science” practices (e.g., open data, preprints) that researchers use to improve the transparency and rigour of their research. As more researchers adopt preregistration as a regular research practice, examining the nature and content of preregistrations can help identify strengths and weaknesses of current practices. The value of preregistration, in part, relates to the specificity of the study plan and the extent to which investigators adhere to this plan. We identified 53 preregistrations from the gambling studies field meeting our predefined eligibility criteria and scored their level of specificity using a 23-item protocol developed to measure the extent to which a clear and exhaustive preregistration plan restricts various researcher degrees of freedom (RDoF; i.e., the many methodological choices available to researchers when collecting and analysing data, and when reporting their findings). We also scored studies on a 32-item protocol that measured adherence to the preregistered plan in the study manuscript. We found that gambling preregistrations had low specificity levels on most RDoF. However, a comparison with a sample of cross-disciplinary preregistrations (N = 52; Bakker et al., 2020) indicated that gambling preregistrations scored higher on 12 (of 29) items. Thirteen (65%) of the 20 associated published articles or preprints deviated from the protocol without declaring as much (the mean number of undeclared deviations per article was 2.25, SD = 2.34). Overall, while we found improvements in specificity and adherence over time (2017-2020), our findings suggest the purported benefits of preregistration—including increasing transparency and reducing RDoF—are not fully achieved by current practices. Using our findings, we provide 10 practical recommendations that can be used to support and refine preregistration practices.

Objectives:The ability to accurately recall past gambling behavior and outcomes is essential for making informed decisions about future gambling. We aimed to determine whether online gambling customers can accurately recall their recent gambling outcomes and betting frequency. Methods: An online survey was distributed to 40,000 customers of an Australian sports and race wagering website which asked participants to recall their past 30-day net outcome (i.e., total amount won or lost) and number of bets. We compared responses to these questions with participants' actual outcomes as provided by the online site. Results: Among the 514 participants who reported their net outcome, only 21 (4.09%) were accurate within a 10% margin of their actual outcome. Participants were most likely to underestimate their losses (N = 333, 64.79%). Lower actual net losses were associated with greater under-and over-estimation of losses. Of the 652 participants who reported their gambling frequency, 48 (7.36%) were accurate within a 10% margin of their actual frequency. Most participants underestimated their number of bets (N = 454, 69.63%). Higher actual betting frequencies were associated with underestimating betting and lower actual frequencies with overestimating betting. Conclusions: The poor recall accuracy we observed suggests public health approaches to gambling harm minimization that assume people make informed decisions about their future bets based on past outcomes and available funds should be reconsidered. Findings also question the reliability of research outcomes predicated on self-reported gambling behavior. Research is needed to determine the best methods of increasing people's awareness of their actual expenditure and outcomes.

Objective: Consumer Protection Tools (CPTs; e.g., deposit limits, timeouts) are provided by gambling sites to assist customers to gamble without harms. We aimed to understand how CPTs are used, and by which customers, which is essential to determine their effectiveness. Method: We examined the account data of 39,853 customers (median age = 33 years; 84% male) across six Australian wagering sites over 1 year (2018/07/01-2019/06/30). Results: Most (83%) customers did not use any CPTs, with low rates of use for deposit limits (15.8%), timeouts (0.55%-1.57%), and self-exclusion tools (0.16%-0.57%) observed. Requiring customers to set a deposit limit or opt-out of setting one led to substantial increases in limit setting. Many customers who used limits later changed them, typically by increasing or removing them. Non-CPT users and deposit limit users were similar in their demographic and gambling characteristics, while comparatively, timeout and/or self-exclusion users were younger and displayed more risky gambling behaviors (e.g., higher net loss and betting frequency). Conclusions: Our findings suggest that voluntary deposit limits have inherent limitations in addressing harmful behaviors if consumers can easily increase or remove limits. The study suggests that greater efforts are needed to encourage CPT use among a broad customer base, including default limits requiring opt-out, greater restrictions on increasing or remove limits, and more persuasive communication of the benefits of timeouts. Public Health Significance StatementThis study of nearly 40,000 online gambling customers in Australia found that most (83%) customers do not use the consumer protection tools (CPTs) available to them. The findings highlight the need for gambling sites and policy makers to implement strategies that encourage the volitional uptake of CPTs. This study identified that a key limitation of current deposit limit tools is the ability to easily increase limits multiple times or remove them altogether, which supports the introduction of greater friction and delays to increase limits and messaging to assist customers to determine, set, and adhere to appropriate limits.

Aims We tested the effectiveness of three different messages designed to increase limit‐setting on gambling sites and sent these via e‐mail or in‐account notification to compare delivery modes. As a secondary aim, we examined the effects of limit‐setting on gambling behaviour. Design A pre‐registered, naturalistic randomized control trial using a 3 × 2 plus control design. Setting Four on‐line Australian sports and racing wagering websites. Participants A total of 31 989 wagering customers (reduced to 26,560 after eligibility screening) who had placed bets on at least 5 days in the past 30 [mean age = 41.4, standard deviation (SD) = 14.3; 79% male]. Interventions and comparators Messages were sent via e‐mail or in‐account notification by on‐line gambling operators and were designed to either: (1) be informative, describing the availability and purpose of the tool (informative messages), (2) highlight the benefits other people receive from using the tool (social messages) or (3) promote the benefit individuals could receive from using the tool (personal messages). A control group who did not receive messages was monitored for comparison. Measurements Our primary outcome was the number of customers who set a deposit limit within 5 days of receiving messages and secondary outcomes included pre‐ and post‐message betting behaviour (e.g. average daily wager). Findings One hundred and sixty‐one (0.71%) customers sent messages set limits compared to three (0.08%) controls [adjusted odds ratio (aOR) = 8.17, 95% confidence interval (CI) = 2.99, 33.76)]. Social and personal messages were no more effective than informative messages (aOR = 0.98, 95% CI = 0.65, 1.48; aOR = 0.93, 95% CI = 0.60, 1.44) and in‐account messages were no more effective than e‐mails (aOR = 1.02, 95% CI = 0.71, 1.49). Customers who set limits significantly decreased their average daily wager, the SD of daily wager, net loss and betting intensity compared with non‐limit‐setters. Conclusions Messages to on‐line gambling website customers are inexpensive, and may lead to small but impactful increases in setting deposit limits. Limit‐setting may be an effective strategy for reducing gambling expenditure and intensity.