Problem and Pathological Gambling in Schizophrenia: Exploring Links with Substance Use and Impulsivity

Abstract

High rates of both problem and pathological gambling (PPG) and substance-use disorders (SUDs) have been reported in schizophrenia, and yet PPG frequently goes undetected in clinical practice and unexamined in research. Here, we aimed to examine the relationship between PPG and SUDs in a large sample of patients across several factors related to both gambling and substance use, including poly-substance use. Additionally, delay discounting is a form of impulsivity known to positively associate with both PPG and SUDs and thought to underlie mechanisms of addiction in both contexts. We aimed to investigate the relationship between PPG and delay discounting in schizophrenia. 337 individuals with schizophrenia completed structured face-to-face interviews regarding gambling behaviors, substance use, and delay discounting. PPG in schizophrenia was associated with substance use, in particular with poly-substance use, and with delay discounting among males. Factors related to substance use were strongly linked with gambling in this sample, but not always with PPG more than recreational gambling. Our findings overall support the notions that multiple forms of gambling in schizophrenia are clinically relevant, that gambling may share common substrates with substance use, and that delay discounting represents a potential mechanism of this association in males.

Polygenic Risk Scores for Psychiatric Disorders Reveal Novel Clues About the Genetics of Disordered Gambling

“…The SCZ PRS has been shown to be associated with various forms of substance use and dependence (Carey, et al, 2016;Hartz, et al, 2017;Regnisson, et al, 2017). The current findings extend this work, demonstrating that polygenic risk for SCZ associates with a behavioral addiction, DG, that is highly comorbid with substance use disorders in the general population (Kessler, et al, 2008;Petry, et al, 2005) and among individuals with psychosis (Fortgang, et al, 2018). Together, findings to date might indicate that common genetic risk for SCZ confers a general liability to impaired control over rewarding behaviors rather than modulating response to a particular drug or drug class.…”

Polygenic Risk Scores for Psychiatric Disorders Reveal Novel Clues About the Genetics of Disordered Gambling

“…The SCZ PRS has been shown to be associated with various forms of substance use and dependence (Carey, et al, 2016;Hartz, et al, 2017;Regnisson, et al, 2017). The current findings extend this work, demonstrating that polygenic risk for SCZ associates with a behavioral addiction, DG, that is highly comorbid with substance use disorders in the general population (Kessler, et al, 2008;Petry, et al, 2005) and among individuals with psychosis (Fortgang, et al, 2018). Together, findings to date might indicate that common genetic risk for SCZ confers a general liability to impaired control over rewarding behaviors rather than modulating response to a particular drug or drug class.…”

Delay discounting abnormalities are seen in first-episode schizophrenia but not in bipolar disorder

“…On the other hand, four studies reported no DD difference between chronic SZ and HC (Avsar et al, 2013;MacKillop & Tidey, 2011;Wing et al, 2012). Specifically, while no group difference was observed between SZ and HC, one study found that pathological and recreational gamblers showed higher DD than non-gamblers within SZ (Fortgang, Hoff & Potenza, 2018). Interestingly, another study found that current and past smokers showed lower DD than nonsmokers in SZ (Wing et al, 2012), a pattern that is the opposite of the gamblers (Wing et al, 2012).…”