Problem gamblers share deficits in impulsive decision‐making with alcohol‐dependent individuals

Abstract

AimsProblem gambling has been proposed to represent a ‘behavioural addiction’ that may provide key insights into vulnerability mechanisms underlying addiction in brains that are not affected by the damaging effects of drugs. Our aim was to investigate the neurocognitive profile of problem gambling in comparison with alcohol dependence. We reasoned that shared deficits across the two conditions may reflect underlying vulnerability mechanisms, whereas impairments specific to alcohol dependence may reflect cumulative effects of alcohol consumption.DesignCross-sectional study.SettingOut-patient addiction treatment centres and university behavioural testing facilities.ParticipantsA naturalistic sample of 21 male problem and pathological gamblers, 21 male alcohol-dependent out-patients and 21 healthy male control participants.MeasurementsNeurocognitive battery assessing decision-making, impulsivity and working memory.FindingsThe problem gamblers and alcohol-dependent groups displayed impairments in risky decision-making and cognitive impulsivity relative to controls. Working memory deficits and slowed deliberation times were specific to the alcohol-dependent group.ConclusionsGambling and alcohol-dependent groups shared deficits in tasks linked to ventral prefrontal cortical dysfunction. Tasks loading on dorsolateral prefrontal cortex were selectively impaired in the alcohol-dependent group, presumably as a consequence of long-term alcohol use.

Damage to insula abolishes cognitive distortions during simulated gambling

“…In the patients with injury to the vmPFC and amygdala, the effects of near misses and the gambler's fallacy were comparable to those of participants in the healthy and lesion comparison groups. Data from neuropsychological testing and functional neuroimaging in pathological gamblers provide much evidence for disruption of the vmPFC and orbitofrontal cortex (16,27,28,56), as well as preliminary evidence for amygdala involvement in loss aversion (57) and gain expectancies (17). Nevertheless, our data do not support the involvement of these regions in either the near-miss effect or gambler's fallacy.…”

“…We identified cases with focal brain damage affecting the vmPFC, the insula, or the amygdala; injury to these regions impairs real-life decision-making and emotional behavior (24)(25)(26). Furthermore, neuropsychological testing in pathological gamblers has identified a profile of impaired risky choice that is highly reminiscent of vmPFC damage in particular (27,28). Given the exaggeration of gambling-related cognitive distortions in problem gamblers, an intuitive prediction might be that the lesion groups would show an enhanced sensitivity to near-miss outcomes, illusory control, and gambler's fallacy.…”

Understanding Within-Session Loss-Chasing: An Experimental Investigation of the Impact of Stake Size on Cognitive Control

“…It is widely accepted that specific executive processes such as response inhibition and reflection impulsivity can be observed within laboratory settings (Holmes et al 2014;Lawrence et al 2009b), including changes in performance and efficiency (Stevens et al 2015). The aim of the current study is to begin to understand the individual contribution of size of stake on cognitive control when gambling, specifically focussing upon the immediate impact on response inhibition and reflection impulsivity.…”

“…When attempting to understand if specific executive control processes contribute to within-session loss-chasing behaviour it is prudent to begin exploring two of the most commonly observed executive function deficits observed in addiction populations, including problem gamblers, principally Response Inhibition (Billieux et al 2012;Conversano et al 2012;Goudriaan et al 2006;Kertzman et al 2008) and Reflection Impulsivity (Lawrence et al 2009b;Clark et al 2009a;Cohen et al 2010;Quednow et al 2007).…”

The gambling control bill: time for action

“…First, functional magnetic resonance imaging demonstrated impairment of ventromedial prefrontal cortex functioning, an area of the brain thought to be critical in risk processing (Potenza, 2008). Second, various neuropsychological data support faulty risk evaluation and persistence with gambling in the face of adverse consequences (Bowden-Jones et al 2005;Goudriaan et al 2006;Lawrence et al 2009). The reclassification of gambling addiction in DSM 5 as an addictive disorder further strengthens calls on the current Government to modernise gambling legislation, alongside alcohol and drug legislation.…”