Neural cue-reactivity in pathological gambling as evidence for behavioral addiction: a systematic review

Abstract

Increasing incidence of problem gambling has led to prioritizing the problem from the point of view of public health. Additionally, gambling disorder has been recently classified as a behavioral addiction, with implications for both its diagnosis and treatment. However, the shared neural substrate of addictions, to substances and behavioral, is still discussed. Thus, this systematic review aims to provide up-to-date knowledge from the past five years (2017–2022) concerning the neural correlates of gambling related stimuli (cue-reactivity) on the basis of a previous review (Brevers et al., Cognitive, Affective and Behavioral Neuroscience 18:718–729, 2019 ). A total of five studies were included in the review. Activation of brain areas related to memory, reward and executive functions could be the underlying mechanism of this behavioral addiction. Specifically, nucleus accumbens and striatum (ventral and dorsal), parahippocampal regions, the right amygdala and several prefrontal cortex regions have systematically been found more active in those subjects exposed to gambling-related cues. Also, the insula could play a pivotal role connecting these three systems in a highly integrated neural network with several implications for reward processing modulation, associative learning and top-down attentional regulation to improve saliency of addiction-related cues. These results are consistent with previous findings on other substance addictions, such as alcohol, tobacco, marijuana or cocaine. The study of neural reactivity to stimuli related to addiction could be useful as a biomarker of the severity of the disorder, the efficacy of the treatment, the risk of relapse, in addition to being an objective criterion to measure the effectiveness of prevention campaigns.

Increased ventral anterior insular connectivity to sports betting availability indexes problem gambling

“…This dynamic is also in line with the main assumption from the triadic models of addictions advance that the insular cortex plays a pivotal role in promoting the drive and motivation to get a reward by ‘hijacking’ goal‐oriented processes toward addiction‐related cues 35,37,38,64 . This dynamic should lead to increased or decreased insular coupling depending on whether a brain region triggers cognitive resources allowing for the enactment of addiction‐related behaviours 37,38,45 …”

“…This level of incentive salience is especially high in individuals who maintain their level of gambling habits despite experiencing gambling‐related harms. This pattern has been demonstrated by neuroimaging studies that highlighted increased functional connectivity in individuals with gambling disorder when exposed to gambling‐related cues (for a review, see the literature 24,45 ). For example, Limbrick‐Oldfield and colleagues 46 observed increased positive functional coupling between the insular cortex, and ‘impulsive’ (the striatum) and ‘reflective’ (the superior frontal gyrus) brain regions in problem gamblers, as compared with non‐gambling controls, when these individuals were exposed to gambling‐related cues.…”

“…35,37,38,64 This dynamic should lead to increased or decreased insular coupling depending on whether a brain region triggers cognitive resources allowing for the enactment of addictionrelated behaviours. 37,38,45 A limitation of the present findings is that functional connectivity does not allow to infer causality on the PPI patterns. Nevertheless, the PPI patterns observed in this study allowed to identify seed regions that could be used for running effective connectivity analyses, 31 allowing to shed light on the causal relation of the observed vAI coupling in our task.…”

“… 35 , 37 , 38 , 64 This dynamic should lead to increased or decreased insular coupling depending on whether a brain region triggers cognitive resources allowing for the enactment of addiction‐related behaviours. 37 , 38 , 45 …”

Exploring the Loss Aversion Scale’s psychometric properties in Spain

“…Meyerowitz and Chaiken discovered that individuals who received information emphasizing loss were more inclined to perform breast self-examinations compared to those receiving information emphasizing benefits 5 . Recent topics reviewed include behavioral addiction 6 , immunotherapy 7 , and hearing aids 8 .…”