Pathological gambling: a review of the neurobiological evidence relevant for its classification as an addictive disorder

Abstract

In light of the upcoming eleventh edition of the International Classification of Diseases (ICD-11), the question arises as to the most appropriate classification of “Pathological Gambling” (“PG”). Some academic opinion favors leaving “PG” in the “Impulse Control Disorder” (“ICD”) category, as in ICD-10, whereas others argue that new data especially from the neurobiological area favor allocating it to the category of “Substance-related and Addictive Disorders” (“SADs”), following the decision in the fifth revision of the Diagnostic and Statistical Manual of Mental Disorders. The current review examines important findings in relation to “PG”, with the aim of enabling a well-informed decision to be made with respect to the classification of “PG” as a “SAD” or “ICD” in ICD-11. Particular attention is given to cognitive deficits and underlying neurobiological mechanisms that play a role in “SADs” and “ICDs”. These processes are impulsivity, compulsivity, reward/punishment processing and decision making. In summary, the strongest arguments for subsuming “PG” under a larger “SAD” category relate to the existence of similar diagnostic characteristics; the high co-morbidity rates between the disorders; their common core features including reward-related aspects (positive reinforcement: behaviors are pleasurable at the beginning which is not the case for “ICDs”); the findings that the same brain structures are involved in “PG” and “SADs”, including the ventral striatum. Research on compulsivity suggests a relationship with “PG” and “SAD”, particularly in later stages of the disorders. Although research is limited for “ICDs”, current data do not support continuing to classify “PG” as an “ICD”.

Luck, come here! Automatic approach tendencies toward gambling cues in moderate‐ to high‐risk gamblers

“…The results of the current study contribute to the existing evidence regarding shared neurocognitive and neurobiological processes between gambling and SUD . Similar to the presence of disturbances in reinforcement learning, reward processing and cognitive control, with similar changes in the neurocircuitry involved, gambling problems also involve the expression of endophenotypical markers of sensitized, implicit motivational processes towards gambling‐related cues , such as attentional and memory biases and, as of now, automatic approach tendencies.…”

“…Gambling and substance use disorders (SUD) share many psychopathological features and brain and behavioural mechanisms , which played a role in the re‐classification of gambling disorder into the substance‐related and addictive disorders category in the DSM‐5 . Cognitive and neurobiological theories of addiction, such as dual‐process models and the incentive sensitization theory , may offer a framework for understanding why some individuals transition to problematic gambling, with serious negative consequences for their personal life and/or health.…”

Cognitive neuroscience can support public health approaches to minimise the harm of ‘losses disguised as wins’ in multiline slot machines

“…Considering the importance of both reinforcement learning and addictive motivation in GD, both of these theories, or attempts to converge them (McClure et al, 2003;Zhang et al, 2009), may have important implications for gambling scholars (for a review see, Linnet, 2014). Both incorporate the activity of dopaminergic neurons in the ventral tegmental area that innervate the ventral striatum, and in turn, regions of the cortexsuch as the anterior cingulate cortex, orbitofrontal cortex, and insula cortexthat have been consistently implicated in reinforcement learning, and addictive behaviours, including gambling (Murch & Clark, 2016;Fauth-B€ uhler et al, 2017).…”

Neural correlates of cue‐ and stress‐induced craving in gambling disorders: implications for transcranial magnetic stimulation interventions

“…In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders [DSM-5; American Psychiatric Association (APA), 2013], GD, previously named pathological gambling, has been recategorized from an impulse control disorder to an addictionrelated disorder. This change reflects the increasing awareness that the neurobiology of GD substantially overlaps with substance use disorders (SUDs; Leeman & Potenza, 2012;Fauth-B€ uhler et al, 2017). Both GD and SUDs are characterized by alterations and malfunction in reward, stress and cognitive-control circuits, which underlie manifestations such as compulsive gambling or compulsive drug consumption, craving, altered reward sensitivity, impaired selfcontrol and decision-making processes (Fontenelle et al, 2011;Robbins et al, 2012;Smith et al, 2014).…”