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1.  Impulsivity and cognitive distortions in pathological gamblers attending the UK National Problem Gambling Clinic: a preliminary report 
Psychological Medicine  2011;41(12):2625-2635.
Pathological gambling (PG) is a form of behavioural addiction that has been associated with elevated impulsivity and also cognitive distortions in the processing of chance, probability and skill. We sought to assess the relationship between the level of cognitive distortions and state and trait measures of impulsivity in treatment-seeking pathological gamblers.
Thirty pathological gamblers attending the National Problem Gambling Clinic, the first National Health Service clinic for gambling problems in the UK, were compared with 30 healthy controls in a case-control design. Cognitive distortions were assessed using the Gambling-Related Cognitions Scale (GRCS). Trait impulsivity was assessed using the UPPS-P, which includes scales of urgency, the tendency to be impulsive in positive or negative mood states. Delay discounting rates were taken as a state measure of impulsive choice.
Pathological gamblers had elevated impulsivity on several UPPS-P subscales but effect sizes were largest (Cohen's d>1.4) for positive and negative urgency. The pathological gamblers also displayed higher levels of gambling distortions, and elevated preference for immediate rewards, compared to controls. Within the pathological gamblers, there was a strong relationship between the preference for immediate rewards and the level of cognitive distortions (R2=0.41).
Impulsive choice in the gamblers was correlated with the level of gambling distortions, and we hypothesize that an impulsive decision-making style may increase the acceptance of erroneous beliefs during gambling play.
PMCID: PMC3206226  PMID: 21733207
Behavioural addiction; decision making; delay discounting; problem gambling; risk taking
2.  Temperament and Impulsivity Predictors of Smoking Cessation Outcomes 
PLoS ONE  2014;9(12):e112440.
Temperament and impulsivity are powerful predictors of addiction treatment outcomes. However, a comprehensive assessment of these features has not been examined in relation to smoking cessation outcomes.
Naturalistic prospective study. Treatment-seeking smokers (n = 140) were recruited as they engaged in an occupational health clinic providing smoking cessation treatment between 2009 and 2013. Participants were assessed at baseline with measures of temperament (Temperament and Character Inventory), trait impulsivity (Barratt Impulsivity Scale), and cognitive impulsivity (Go/No Go, Delay Discounting and Iowa Gambling Task). The outcome measure was treatment status, coded as “dropout” versus “relapse” versus “abstinence” at 3, 6, and 12 months endpoints. Participants were telephonically contacted and reminded of follow-up face to face assessments at each endpoint. The participants that failed to answer the phone calls or self-reported discontinuation of treatment and failed to attend the upcoming follow-up session were coded as dropouts. The participants that self-reported continuing treatment, and successfully attended the upcoming follow-up session were coded as either “relapse” or “abstinence”, based on the results of smoking behavior self-reports cross-validated with co-oximetry hemoglobin levels. Multinomial regression models were conducted to test whether temperament and impulsivity measures predicted dropout and relapse relative to abstinence outcomes.
Higher scores on temperament dimensions of novelty seeking and reward dependence predicted poorer retention across endpoints, whereas only higher scores on persistence predicted greater relapse. Higher scores on the trait dimension of non-planning impulsivity but not performance on cognitive impulsivity predicted poorer retention. Higher non-planning impulsivity and poorer performance in the Iowa Gambling Task predicted greater relapse at 3 and 6 months and 6 months respectively.
Temperament measures, and specifically novelty seeking and reward dependence, predict smoking cessation treatment retention, whereas persistence, non-planning impulsivity and poor decision-making predict smoking relapse.
PMCID: PMC4256301  PMID: 25474540
3.  Time Devours Things: How Impulsivity and Time Affect Temporal Decisions in Pathological Gamblers 
PLoS ONE  2014;9(10):e109197.
Impulsivity is associated with several psychiatric disorders in which the loss of control of a specific behavior determines the syndrome itself. One particularly interesting population characterized by reported high impulsivity and problematic decision-making are those diagnosed with pathological gambling. However the association between impulsivity and decision making in pathological gambling has been only partially confirmed until now. We tested 23 normal controls and 23 diagnosed pathological gamblers in an intertemporal choice task, as well as other personality trait measurements. Results showed that gamblers scored higher on impulsivity questionnaires, and selected a higher percentage of impatient choices (higher percentage of smaller, sooner rewards), when compared to normal controls. Moreover, gamblers were faster in terms of reaction times at selecting the smaller, sooner options and discounted rewards more rapidly over time. Importantly, regression analyses clarified that self-reported measures of impulsivity played a significant role in biasing decisions towards small but more rapidly available rewards. In the present study we found evidence for impulsivity in personality traits and decisions in pathological gamblers relative to controls. We conclude by speculating on the need to incorporate impulsivity and decision biases in the conceptualization of pathological gambling for a better understanding and treatment of this pathology.
PMCID: PMC4189922  PMID: 25296184
4.  Problem gamblers share deficits in impulsive decision-making with alcohol-dependent individuals 
Addiction (Abingdon, England)  2009;104(6):1006-1015.
Problem 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.
Cross-sectional study.
Out-patient addiction treatment centres and university behavioural testing facilities.
A naturalistic sample of 21 male problem and pathological gamblers, 21 male alcohol-dependent out-patients and 21 healthy male control participants.
Neurocognitive battery assessing decision-making, impulsivity and working memory.
The 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.
Gambling 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.
PMCID: PMC2773538  PMID: 19466924
Addiction; alcohol; decision-making; impulsivity; pathological gambling; prefrontal cortex; risk-taking; vulnerability
5.  Study protocol: the JEU cohort study – transversal multiaxial evaluation and 5-year follow-up of a cohort of French gamblers 
BMC Psychiatry  2014;14:226.
There is abundant literature on how to distinguish problem gambling (PG) from social gambling, but there are very few studies of the long-term evolution of gambling practice. As a consequence, the correlates of key state changes in the gambling trajectory are still unknown. The objective of the JEU cohort study is to identify the determinants of key state changes in the gambling practice, such as the emergence of a gambling problem, natural recovery from a gambling problem, resolution of a gambling problem with intermediate care intervention, relapses or care recourse.
The present study was designed to overcome the limitations of previous cohort study on PG. Indeed, this longitudinal case–control cohort is the first which plans to recruit enough participants from different initial gambling severity levels to observe these rare changes. In particular, we plan to recruit three groups of gamblers: non-problem gamblers, problem gamblers without treatment and problem gamblers seeking treatment.
Recruitment takes place in various gambling places, through the press and in care centers.
Cohort participants are gamblers of both sexes who reported gambling on at least one occasion in the previous year and who were aged between 18 and 65. They were assessed through a structured clinical interview and self-assessment questionnaires at baseline and then once a year for five years. Data collection comprises sociodemographic characteristics, gambling habits (including gambling trajectory), the PG section of the DSM-IV, the South Oaks Gambling Screen, the Gambling Attitudes and Beliefs Survey – 23, the Mini International Neuropsychiatric Interview, the Wender-Utah Rating Scale-Child, the Adult ADHD Self-report Scale, somatic comorbidities (especially current treatment and Parkinson disease) and the Temperament and Character Inventory – 125.
The JEU cohort study is the first study which proposes to identify the predictive factors of key state changes in gambling practice. This is the first case–control cohort on gambling which mixes non-problem gamblers, problem gamblers without treatment and problem gamblers seeking treatment in almost equal proportions. This work may help providing a fresh perspective on the etiology of pathological gambling, which may provide support for future research, care and preventive actions.
Trial Registration
( NCT01207674.
Electronic supplementary material
The online version of this article (doi:10.1186/s12888-014-0226-7) contains supplementary material, which is available to authorized users.
PMCID: PMC4147162  PMID: 25141820
Gambling; State changes; Cohort; Problem gambling; Recourse to treatment; Predictive factors
6.  Neurocognitive Dysfunction in Strategic and Non-Strategic Gamblers 
It has been theorized that there may be subtypes of pathological gambling, particularly in relation to the main type of gambling activities undertaken. Whether or not putative pathological gambling subtypes differ in terms of their clinical and cognitive profiles has received little attention.
Subjects meeting DSM-IV criteria for pathological gambling were grouped into two categories of preferred forms of gambling – strategic (e.g., cards, dice, sports betting, stock market) and non-strategic (e.g., slots, video poker, pull tabs). Groups were compared on clinical characteristics (gambling severity, and time and money spent gambling), psychiatric comorbidity, and neurocognitive tests assessing motor impulsivity and cognitive flexibility.
Seventy-seven subjects were included in this sample (45.5% females; mean age: 42.7±14.9) which consisted of the following groups: strategic (n=22; 28.6%) and non-strategic (n=55; 71.4%). Non-strategic gamblers were significantly more likely to be older, female, and divorced. Money spent gambling did not differ significantly between groups although one measure of gambling severity reflected more severe problems for strategic gamblers. Strategic and non-strategic gamblers did not differ in terms of cognitive function; both groups showed impairments in cognitive flexibility and inhibitory control relative to matched healthy volunteers.
These preliminary results suggest that preferred form of gambling may be associated with specific clinical characteristics but are not associated dissociable in terms of cognitive inflexibility and motor impulsivity.
PMCID: PMC3389298  PMID: 22613186
cognition; impulsivity; gambling
7.  Selective decision-making deficits in at-risk gamblers 
Psychiatry Research  2011;189(1):115-120.
Despite reasonable knowledge of pathological gambling (PG), little is known of its cognitive antecedents. We evaluated decision-making and impulsivity characteristics in people at risk of developing PG using neuropsychological tests. Non-treatment seeking volunteers (18-29 years) who gamble ≥5 times/year were recruited from the general community, and split into two groups: those “at risk” of developing PG (n=74) and those social, non-problem gamblers (n=112). Participants undertook the Cambridge Gamble and Stop-signal tasks and were assessed with the Mini-International Neuropsychiatric Interview and the Yale Brown Obsessive Compulsive Scale Modified for Pathological Gambling. On the Cambridge Gamble task, the at- risk subjects gambled more points overall, were more likely to go bankrupt, and made more irrational decisions under situations of relative risk ambiguity. On the Stop-signal task, at- risk gamblers did not differ from the social, non-problem gamblers in terms of motor impulse control (stop-signal reaction times). Findings suggest that selective cognitive dysfunction may already be present in terms of decision-making in at-risk gamblers, even before psychopathology arises. These findings implicate selective decision-making deficits and dysfunction of orbitofronto-limbic circuitry in the chain of pathogenesis between social, non-problematic and pathological gambling.
PMCID: PMC3401062  PMID: 21715016
Pathological Gambling; Pathogenesis; Addiction; Cognitive Dysfunction; Cognition; Inhibition
8.  Impulsivity in bipolar disorder: relationships with neurocognitive dysfunction and substance use history 
Bipolar disorders  2013;15(8):10.1111/bdi.12124.
Impulsivity is a core feature in bipolar disorder. Although mood symptoms exacerbate impulsivity, self-reports of impulsivity are elevated even during euthymia. Neurocognitive processes linked to impulsivity (e.g., attention, inhibition) are also impaired in patients with bipolar disorder and a high frequency of comorbidities associated with impulsivity, such as substance use disorders, further highlight the clinical relevance of this dimension of the illness. Our objective was to assess the relationship between impulsivity and cognition in bipolar disorder.
We evaluated impulsivity in 98 patients with bipolar disorder and its relationship with symptoms, cognition, and substance use history. We assessed self reports of trait-impulsivity [Barrett Impulsiveness Scale (BIS)] and impulsive behaviors on the Iowa Gambling Task (IGT). A comprehensive clinical and neurocognitive battery was also completed. Patients were compared with 95 healthy controls.
Patients with bipolar disorder had higher scores versus healthy controls on all BIS scales. Performance on the IGT was significantly impaired and patients showed a tendency toward more erratic choices. Depressive symptoms were positively correlated with trait-impulsivity and with an increased tendency to attend more readily to losses versus gains on the IGT. We found no significant associations between impulsivity and neurocognition in the full bipolar sample; however, when sub-grouped based on substance abuse history, significant relationships were revealed only in subjects without a substance abuse history.
Our data support prior reports of increased trait-impulsivity and impairment on behavioral tasks of impulsiveness in bipolar disorder and suggest a differential relationship between these illness features that is dependent upon history of substance abuse.
PMCID: PMC3855192  PMID: 24028391
decision making; depression; impulsivity; Iowa Gambling Task; substance use
9.  Money for nothing — Atrophy correlates of gambling decision making in behavioural variant frontotemporal dementia and Alzheimer's disease☆ 
NeuroImage : Clinical  2013;2:263-272.
Neurodegenerative patients show often severe everyday decision making problems. Currently it is however not clear which brain atrophy regions are implicated in such decision making problems. We investigated the atrophy correlates of gambling decision making in a sample of 63 participants, including two neurodegenerative conditions (behavioural variant frontotemporal dementia — bvFTD; Alzheimer's disease — AD) as well as healthy age-matched controls. All participants were tested on the Iowa Gambling Task (IGT) and the behavioural IGT results were covaried against the T1 MRI scans of all participants to identify brain atrophy regions implicated in gambling decision making deficits. Our results showed a large variability in IGT performance for all groups with both patient groups performing especially poor on the task. Importantly, bvFTD and AD groups did not differ significantly on the behavioural performance of the IGT. However, by contrast, the atrophy gambling decision making correlates differed between bvFTD and AD, with bvFTD showing more frontal atrophy and AD showing more parietal and temporal atrophy being implicated in decision making deficits, indicating that both patient groups fail the task on different levels. Frontal (frontopolar, anterior cingulate) and parietal (retrosplenial) cortex atrophy covaried with poor performance on the IGT. Taken together, the atrophy correlates of gambling decision making show that such deficits can occur due to a failure of different neural structures, which will inform future diagnostics and treatment options to alleviate these severe everyday problems in neurodegenerative patients.
► bvFTD and AD patients are both impaired in gambling decision making. ► However, atrophy correlates for gambling decision making differ between groups. ► Poor performance in decision making covaried with frontal atrophy in bvFTD. ► Poor performance in decision making covaried with parietal/temporal atrophy in AD. ► Gambling decision deficits can occur due to atrophy in different brain regions.
PMCID: PMC3778267  PMID: 24179781
Behavioural variant frontotemporal dementia; Alzheimer's disease; Voxel-based morphometry; Gambling decision making; Iowa Gambling Task
10.  A model-based analysis of impulsivity using a slot-machine gambling paradigm 
Impulsivity plays a key role in decision-making under uncertainty. It is a significant contributor to problem and pathological gambling (PG). Standard assessments of impulsivity by questionnaires, however, have various limitations, partly because impulsivity is a broad, multi-faceted concept. What remains unclear is which of these facets contribute to shaping gambling behavior. In the present study, we investigated impulsivity as expressed in a gambling setting by applying computational modeling to data from 47 healthy male volunteers who played a realistic, virtual slot-machine gambling task. Behaviorally, we found that impulsivity, as measured independently by the 11th revision of the Barratt Impulsiveness Scale (BIS-11), correlated significantly with an aggregate read-out of the following gambling responses: bet increases (BIs), machines switches (MS), casino switches (CS), and double-ups (DUs). Using model comparison, we compared a set of hierarchical Bayesian belief-updating models, i.e., the Hierarchical Gaussian Filter (HGF) and Rescorla–Wagner reinforcement learning (RL) models, with regard to how well they explained different aspects of the behavioral data. We then examined the construct validity of our winning models with multiple regression, relating subject-specific model parameter estimates to the individual BIS-11 total scores. In the most predictive model (a three-level HGF), the two free parameters encoded uncertainty-dependent mechanisms of belief updates and significantly explained BIS-11 variance across subjects. Furthermore, in this model, decision noise was a function of trial-wise uncertainty about winning probability. Collectively, our results provide a proof of concept that hierarchical Bayesian models can characterize the decision-making mechanisms linked to the impulsive traits of an individual. These novel indices of gambling mechanisms unmasked during actual play may be useful for online prevention measures for at-risk players and future assessments of PG.
PMCID: PMC4080386  PMID: 25071497
Hierarchical Gaussian Filter; Hierarchical Bayesian Model; Barratt Impulsiveness Scale; impulsivity; pathological gambling
11.  Risk-taking and pathological gambling behavior in Huntington’s disease 
Huntington’s disease (HD) is a genetic, neurodegenerative disorder, which specifically affects striatal neurons of the indirect pathway, resulting in a progressive decline in muscle coordination and loss of emotional and cognitive control. Interestingly, predisposition to pathological gambling and other addictions involves disturbances in the same cortico-striatal circuits that are affected in HD, and display similar disinhibition-related symptoms, including changed sensitivity to punishments and rewards, impulsivity, and inability to consider long-term advantages over short-term rewards. Both HD patients and pathological gamblers also show similar performance deficits on risky decision-making tasks, such as the Iowa Gambling Task (IGT). These similarities suggest that HD patients are a likely risk group for gambling problems. However, such problems have only incidentally been observed in HD patients. In this review, we aim to characterize the risk of pathological gambling in HD, as well as the underlying neurobiological mechanisms. Especially with the current rise of easily accessible Internet gambling opportunities, it is important to understand these risks and provide appropriate patient support accordingly. Based on neuropathological and behavioral findings, we propose that HD patients may not have an increased tendency to seek risks and start gambling, but that they do have an increased chance of developing an addiction once they engage in gambling activities. Therefore, current and future developments of Internet gambling possibilities and related addictions should be regarded with care, especially for vulnerable groups like HD patients.
PMCID: PMC3980094  PMID: 24765067
Huntington’s disease; risk-taking; gambling; prefrontal cortex; basal ganglia; disinhibtion
12.  Elucidating Poor Decision-Making in a Rat Gambling Task 
PLoS ONE  2013;8(12):e82052.
Although poor decision-making is a hallmark of psychiatric conditions such as attention deficit/hyperactivity disorder, pathological gambling or substance abuse, a fraction of healthy individuals exhibit similar poor decision-making performances in everyday life and specific laboratory tasks such as the Iowa Gambling Task. These particular individuals may provide information on risk factors or common endophenotypes of these mental disorders. In a rodent version of the Iowa gambling task – the Rat Gambling Task (RGT), we identified a population of poor decision makers, and assessed how these rats scored for several behavioral traits relevant to executive disorders: risk taking, reward seeking, behavioral inflexibility, and several aspects of impulsivity. First, we found that poor decision-making could not be well predicted by single behavioral and cognitive characteristics when considered separately. By contrast, a combination of independent traits in the same individual, namely risk taking, reward seeking, behavioral inflexibility, as well as motor impulsivity, was highly predictive of poor decision-making. Second, using a reinforcement-learning model of the RGT, we confirmed that only the combination of extreme scores on these traits could induce maladaptive decision-making. Third, the model suggested that a combination of these behavioral traits results in an inaccurate representation of rewards and penalties and inefficient learning of the environment. Poor decision-making appears as a consequence of the over-valuation of high-reward-high-risk options in the task. Such a specific psychological profile could greatly impair clinically healthy individuals in decision-making tasks and may predispose to mental disorders with similar symptoms.
PMCID: PMC3855331  PMID: 24339988
13.  Comparative analysis of distinct phenotypes in gambling disorder based on gambling preferences 
BMC Psychiatry  2015;15:86.
Studies examining gambling preferences have identified the importance of the type of gambling practiced on distinct individual profiles. The objectives were to compare clinical, psychopathological and personality variables between two different groups of individuals with a gambling disorder (strategic and non-strategic gamblers) and to evaluate the statistical prediction capacity of these preferences with respect to the severity of the disorder.
A total sample of 2010 treatment-seeking patients with a gambling disorder participated in this stand-alone study. All were recruited from a single Pathological Gambling Unit in Spain (1709 strategic and 301 non-strategic gamblers). The design of the study was cross-sectional and data were collected at the start of treatment. Data was analysed using logistic regression for binary outcomes and analysis of variance (ANOVA) for quantitative responses.
There were significant differences in several socio-demographic and clinical variables, as well as in personality traits (novelty seeking and cooperativeness). Multiple regression analysis showed harm avoidance and self-directedness were the main predictors of gambling severity and psychopathology, while age at assessment and age of onset of gambling behaviour were predictive of gambling severity. Strategic gambling (as opposed to non-strategic) was significantly associated with clinical outcomes, but the effect size of the relationships was small.
It is possible to identify distinct phenotypes depending on the preference of gambling. While these phenotypes differ in relation to the severity of the gambling disorder, psychopathology and personality traits, they can be useful from a clinical and therapeutic perspective in enabling risk factors to be identified and prevention programs targeting specific individual profiles to be developed.
PMCID: PMC4406168  PMID: 25886577
Gambling disorder; Subtypes; Gambling preferences; Strategic games
14.  Impulsivity Trajectories and Gambling in Adolescence among Urban Male Youth 
Addiction (Abingdon, England)  2013;108(4):780-788.
Building on the recent emerging literature on the impulsivity trajectory-gambling association, this study investigated the association between developmental trajectories of teacher-rated impulsivity in early adolescence (ages 11–15) and subsequent gambling and gambling problems (i.e. at-risk and problem gambling) by age 19.
Prospective cohort design.
Urban communities in Baltimore, Maryland.
The sample consists of 310 predominately minority (87%) and low SES (70%) males followed from first grade to late adolescence.
Impulsivity was measured using teacher ratings of classroom behavior. Self-reported gambling behavior was assessed using the South Oaks Gambling Screen-Revised for Adolescents (SOGS-RA).
Results from a conventional growth model suggest the intercept of the impulsivity development (as measured by the repeated assessments of impulsivity across the entire developmental period) was significantly associated with gambling. Results from a general growth mixture model evidenced two distinct trajectories: a high impulsivity trajectory (41% the sample) and a low impulsivity trajectory (59% of the sample). Despite its non-significant association with any gambling, heterogeneity in impulsivity development was significantly associated with gambling problems. Specifically, being in the high impulsivity trajectory doubled the odds of meeting criteria for at-risk or problem gambling (OR= 2.09[1.02, 4.27]) and tripled the odds of meeting criteria for problem gambling (OR=2.84[1.02, 7.91])
Development in impulsivity is strongly associated with problem/at-risk gambling in adolescence among urban male youth. Findings highlight the importance of distinguishing gambling problems from any gambling when evaluating programs aimed at reducing youth gambling problems through reducing impulsivity.
PMCID: PMC3586388  PMID: 23130867
Impulsivity; Gambling; Problem gambling; Convention growth model; General growth mixture model
15.  Longitudinal patterns of gambling activities and associated risk factors in college students 
Addiction (Abingdon, England)  2009;104(7):1219.
To investigate which clusters of gambling activities exist within a longitudinal study of college health, how membership in gambling clusters change over time and whether particular clusters of gambling are associated with unhealthy risk behaviour.
Four-year longitudinal study (2002–2006).
Large, public university.
Undergraduate college students.
Ten common gambling activities were measured during 4 consecutive college years (years 1–4). Clusters of gambling activities were examined using latent class analyses. Relations between gambling clusters and gender, Greek membership, alcohol use, drug use, personality indicators of behavioural undercontrol and psychological distress were examined.
Four latent gambling classes were identified: (1) a low-gambling class, (2) a card gambling class, (3) a casino/slots gambling class and (4) an extensive gambling class. Over the first college years a high probability of transitioning from the low-gambling class and the card gambling class into the casino/slots gambling class was present. Membership in the card, casino/slots and extensive gambling classes were associated with higher scores on alcohol/drug use, novelty seeking and self-identified gambling problems compared to the low-gambling class. The extensive gambling class scored higher than the other gambling classes on risk factors.
Extensive gamblers and card gamblers are at higher risk for problem gambling and other risky health behaviours. Prospective examinations of class membership suggested that being in the extensive and the low gambling classes was highly stable across the 4 years of college.
PMCID: PMC2818490  PMID: 19438422
College student population; gambling; gambling activities; longitudinal; risk factors
16.  Interactions between risky decisions, impulsiveness and smoking in young tattooed women 
BMC Psychiatry  2013;13:278.
According to previous studies, one of the common problems of everyday life of persons with tattoos is risky behavior. However, direct examination of the decision making process, as well as factors which determine women’s risk-taking decisions to get tattoos, have not been conducted. This study investigates whether risk taking decision-making is associated with the self-assessment impulsiveness in tattooed women.
Young women (aged 18–35 years) with (N = 60) and without (N = 60) tattoos, performed the Iowa Gambling Task (IGT), as a measure of decision-making processes, as well as completing the Barratt Impulsivity Scale (BIS-11).
Tattooed women showed significantly higher scores in the BIS-11 and preference for disadvantageous decks on the IGT compared to non-tattooed women. There was no significant correlation between risky decision-making in the IGT and BIS-11 impulsivity measures. A significantly higher rate of smoking was observed in the tattooed women. However, the analysis did not reveal a group effect after adjustment for smoking in the IGT and the BIS-11 measures.
The present study was specifically designed to resolve questions regarding associations between impulsiveness and risky decision-making in tattooed women. It shows that in tattooed women, risky decisions are not a direct result of their self-reported impulsiveness. Smoking does not explain the psychometric differences between tattooed women and controls.
PMCID: PMC3829656  PMID: 24180254
Tattoo; The Iowa Gambling Task; Impulsivity; Smoking
17.  A counselling line for problem and pathological gambling in South Africa: Preliminary data analysis 
Journal of Behavioral Addictions  2014;3(3):199-202.
Objective: Various countries and states have established telephone counselling lines for people with pathological or problem gambling. Data from such services may contribute to describing systematically the nature of gambling problems in a particular area. To date, however, few data have been published on such a telephone counselling line in a low or middle income country. Method: Data on calls to the telephone counselling line of the National Responsible Gambling Foundation of South Africa were captured over a 6-month period. Such data include socio-demographic variables, the primary reason for calling, the source of the referral, preferred method of gambling, impairment as a consequence of gambling, and history of treatment for psychiatric disorders, comorbid alcohol abuse and illicit drug use. Results: Calls were received from a broad range of people; the mean age of callers was 37 years, the majority were male (62%) and many were married (45%). Primary reasons for calling included the feeling of being unable to stop gambling without the help of a professional (41%), financial concerns (32%), legal problems (13%), pressure from family (10%), and suicidal thoughts (2%). The majority of callers contacted the counselling line after having heard about it by word of mouth (70%). The most common forms of gambling were slot machines (51%) and casino games (21%). Fourteen percent of callers reported having received help for other psychiatric disorders, 11% reported alcohol use disorders and 6% illicit drug use. Conclusion: These data from South Africa are consistent with prior research indicating that pathological and problem gambling are seen in a range of socio-demographic groups, and that such behaviour is associated with significant morbidity and comorbidity. More work is needed locally to inform younger gamblers, gamblers using the informal gambling sector, and unemployed gamblers of the existing telephone counselling lines.
PMCID: PMC4189313  PMID: 25317344
behaviour addictive/therapy; counselling; comorbidity; gambling/psychology; South Africa
18.  Recreational gamblers with and without parental addiction 
Psychiatry Research  2012;196(2-3):290-295.
Research has found that children who have parents with an addiction may be more vulnerable to developing psychopathology compared to children without parental addiction. We compared young adult, recreational gamblers with and without parental addiction on measures of gambling behavior and impulsivity. A total of 286 recreational gamblers (defined as having gambled at least five times in the past 12 months) between the ages of 18 and 29 participated in an initial intake of a longitudinal study assessing susceptibility to pathological gambling. Trained staff interviewed subjects and subjects completed cognitive testing and self-report measures. Fifty-three subjects (18.53%) reported at least one parent with an addiction (including alcohol and substance dependence and pathological gambling). Subjects with at least one addicted parent were significantly more likely to report problems resulting from gambling, have significantly greater rates of psychiatric comorbidity, and report significantly more current marijuana and tobacco use. Subjects with an addicted parent were not significantly different on measures of impulsivity. These findings suggest that even at a stage of low-risk gambling, before what has been considered a psychopathology arises, those with a possible environmental and/or genetic risk of addiction exhibit a range of problematic behaviors.
PMCID: PMC3380340  PMID: 22401973
Pathological Gambling; Psychopathology; Addiction; Family History; Young Adults
19.  Is Executive Cognitive Function Associated with Youth Gambling? 
Journal of Gambling Studies  2012;28(2):225-238.
Our objectives for this report were to identify trajectories of youth gambling behavior, and to examine their relation to executive cognitive function (ECF) and associated problem behaviors. Philadelphia school children, enrolled at ages 10–12 years (n = 387; 49% male), completed three annual assessments of risk behaviors, ECF, impulsivity, problem behaviors and demographics. Across ages 10–15 years, using methods from Nagin et al., two groups were identified: Early Gamblers (n = 111) initiated early and continued in later assessments, and Later Gamblers (n = 276) initiated at later ages and gambled less. Betting money on cards and sports were the most frequently reported gambling behaviors. Using gambling group as outcome, final backward selection logistic regression model showed Early Gamblers are more likely male (P = 0.001), report more active coping (P = 0.042), impulsive behaviors (P ≤ 0.008), and have friends who gamble (P = 0.001). Groups were similar in ECF, parental monitoring, marital status, SES, and race. Early Gamblers had higher incidence of problem behaviors and drug use (all P ≤ 0.006). Two gambling groups were identified in early adolescence with Early Gamblers showing higher levels of impulsivity and comorbid problems but similar levels of ECF compared to Late Gamblers. As more gambling groups are identified through later adolescence, ECF may emerge as a relevant precursor of problem gambling at this later time.
PMCID: PMC3217082  PMID: 21698342
Youth gambling; Trajectories; Executive cognitive function; Impulsivity; Adolescence
20.  Iowa Gambling Task (IGT): twenty years after – gambling disorder and IGT 
The Iowa Gambling Task (IGT) involves probabilistic learning via monetary rewards and punishments, where advantageous task performance requires subjects to forego potential large immediate rewards for small longer-term rewards to avoid larger losses. Pathological gamblers (PG) perform worse on the IGT compared to controls, relating to their persistent preference toward high, immediate, and uncertain rewards despite experiencing larger losses. In this contribution, we review studies that investigated processes associated with poor IGT performance in PG. Findings from these studies seem to fit with recent neurocognitive models of addiction, which argue that the diminished ability of addicted individuals to ponder short-term against long-term consequences of a choice may be the product of an hyperactive automatic attentional and memory system for signaling the presence of addiction-related cues (e.g., high uncertain rewards associated with disadvantageous decks selection during the IGT) and for attributing to such cues pleasure and excitement. This incentive-salience associated with gambling-related choice in PG may be so high that it could literally “hijack” resources [“hot” executive functions (EFs)] involved in emotional self-regulation and necessary to allow the enactment of further elaborate decontextualized problem-solving abilities (“cool” EFs). A framework for future research is also proposed, which highlights the need for studies examining how these processes contribute specifically to the aberrant choice profile displayed by PG on the IGT.
PMCID: PMC3786255  PMID: 24137138
gambling disorder; Iowa Gambling Task; decision-making; dual-process model; willpower
21.  The Neural Basis of Decision-Making and Reward Processing in Adults with Euthymic Bipolar Disorder or Attention-Deficit/Hyperactivity Disorder (ADHD) 
PLoS ONE  2012;7(5):e37306.
Attention-deficit/hyperactivity disorder (ADHD) and bipolar disorder (BD) share DSM-IV criteria in adults and cause problems in decision-making. Nevertheless, no previous report has assessed a decision-making task that includes the examination of the neural correlates of reward and gambling in adults with ADHD and those with BD.
Methodology/Principal Findings
We used the Iowa gambling task (IGT), a task of rational decision-making under risk (RDMUR) and a rapid-decision gambling task (RDGT) which elicits behavioral measures as well as event-related potentials (ERPs: fERN and P3) in connection to the motivational impact of events. We did not observe between-group differences for decision-making under risk or ambiguity (RDMUR and IGT); however, there were significant differences for the ERP-assessed RDGT. Compared to controls, the ADHD group showed a pattern of impaired learning by feedback (fERN) and insensitivity to reward magnitude (P3). This ERP pattern (fERN and P3) was associated with impulsivity, hyperactivity, executive function and working memory. Compared to controls, the BD group showed fERN- and P3-enhanced responses to reward magnitude regardless of valence. This ERP pattern (fERN and P3) was associated with mood and inhibitory control. Consistent with the ERP findings, an analysis of source location revealed reduced responses of the cingulate cortex to the valence and magnitude of rewards in patients with ADHD and BD.
Our data suggest that neurophysiological (ERPs) paradigms such as the RDGT are well suited to assess subclinical decision-making processes in patients with ADHD and BD as well as for linking the cingulate cortex with action monitoring systems.
PMCID: PMC3356275  PMID: 22624011
22.  The prevalence and correlates of DSM-IV Pathological Gambling in the National Comorbidity Survey Replication 
Psychological medicine  2008;38(9):1351-1360.
Little is known about the prevalence or correlates of DSM-IV pathological gambling (PG).
Data from the US National Comorbidity Survey Replication (NCS-R), a nationally representative US household survey, were used to assess lifetime gambling symptoms and PG along with other DSM-IV disorders. Age-of-onset (AOO) of each lifetime disorder was assessed retrospectively. AOO reports were used to study associations between temporally primary disorders and the subsequent risk of secondary disorders.
Most respondents (78.4%) reported lifetime gambling. Lifetime problem gambling (at least one Criterion A symptom of PG) (2.3%) and PG (0.6%) were much less common. PG was significantly associated with being young, male, and Non-Hispanic Black. People with PG reported first gambling significantly earlier than non-problem gamblers (mean age: 16.7 vs. 23.9, z = 12.7, p < .001), with gambling problems typically beginning during the mid-20s and persisting for an average of 9.4 years. During this time the largest annual gambling losses averaged $4800. Onset and persistence of PG were predicted by a variety of prior DSM-IV anxiety, mood, impulse-control, and substance use disorders. PG also predicted the subsequent onset of generalized anxiety disorder, post-traumatic stress disorder, and substance dependence. Although none of the NCS-R respondents with PG ever received treatment for gambling problems, 49.0% were treated at some time for other mental disorders.
DSM-IV PG is a comparatively rare, seriously impairing, and under-treated disorder whose symptoms typically start during early adulthood and is frequently secondary to other mental or substance disorders that are associated with both PG onset and persistence.
PMCID: PMC2293303  PMID: 18257941
Epidemiology; National Comorbidity Survey Replication (NCS-R); Pathological Gambling
23.  An analysis of problem gambling among the Finnish working-age population: a population survey 
BMC Public Health  2013;13:519.
Gambling problems currently affect approximately 100 000 Finns. In order to prevent and reduce gambling-related harms it is crucial for the Finnish public health authorities to gain a stronger understanding of the association between gambling problems and related socio-demographic factors, other commonly co-occurring dependencies (e.g. alcohol and nicotine) and the type of games gambled. In this article the prevalence of problem gambling in Finland and the socio-demographic profiles of problem gamblers are studied.
An annual postal survey entitled Health Behaviour and Health among the Finnish Adult Population AVTK was sent to a random sample of Finnish adults (N=5000) aged between 15 and 64. The sample was derived from the Finnish Population Register. The survey was mailed to the participants in April 2010. Gender differences in socio-demographic variables and Problem Gambling Severity Index PGSI were assessed. A multinomial regression model was created in order to explore the association between socio-demographic factors and the severity of gambling.
A total of 2826 individuals (1243 males and 1583 females) replied to the survey. Of the respondents, 1.1% (2.1% of males, 0.3% of females) were identified as problem gamblers. Those who were of younger age, gender, had less than twelve years of education, consumed alcohol at risk level and smoked had higher odds of having low or moderate levels of gambling problems. Whereas, unemployment and smoking predicted significantly for problem gambling. Females gambled Lotto and slot machines less frequently than males and had more low level gambling problems. Males gambled more with a higher frequency and had a more severe level of gambling problems. Females were more attracted to scratch card gambling and daily Keno lotteries compared to males. In comparison, males gambled more on internet poker sites than females. Overall, a high frequency of gambling in Lotto, daily lotteries, slot machines, horse race betting and internet gambling was significantly associated with a more severe level of problem gambling.
Gambling problems affect tens of thousands of individuals annually, therefore certain vulnerabilities should be noted. Comorbid dependencies, smoking in particular, ought to be screened for and recognised in the public health sector. Regulating the availability of slot machine gambling and enforcement of the age limit should be acknowledged. In establishing new gambling venues, prevalence rates in those particular areas should be actively monitored.
PMCID: PMC3673882  PMID: 23714573
24.  Disadvantageous decision-making on a rodent gambling task is associated with increased motor impulsivity in a population of male rats 
Impulsivity is understood as a range of behaviours, but the association between these behaviours is not well understood. Although high motor impulsivity is a key symptom of disorders like pathological gambling and addiction, in which decision-making on laboratory tasks is compromised, there have been no clear demonstrations that choice and motor impulsivity are associated in the general population. We examined this association in a large population of rodents.
We performed a meta-analysis on behavioural data from 211 manipulation-naive male animals that performed a rodent gambling task in our laboratory between 2008 and 2012. The task measures an aspect of both impulsive decision-making and impulsive action, making it possible to evaluate whether these 2 forms of maladaptive behaviour are related.
Our meta-analysis revealed that motor impulsivity was positively correlated with poor decision-making under risk. Highly motor impulsive rats were slower to adopt an advantageous choice strategy and quicker to make a choice on individual trials.
The data analyzed were limited to that produced by our laboratory and did not include data of other researchers who have used the task.
This work may represent the first demonstration of a clear association between choice and motor impulsivity in a nonclinical population. This lends support to the common practice of studying impulsivity in nonclinical populations to gain insight into impulse control disorders and suggests that differences in impulsive behaviours between clinical and nonclinical populations may be ones of magnitude rather than ones of quality.
PMCID: PMC4354816  PMID: 25703645
25.  Clinical and Cognitive Correlates of Suicide Attempts in Bipolar Disorder: Is Suicide Predictable? 
The Journal of clinical psychiatry  2011;72(8):1027-1033.
We conducted a retrospective investigation of potential clinical, demographic, and neuropsychological risk factors for suicide attempts in patients diagnosed with bipolar disorder.
Participants included 67 adult inpatients and outpatients aged 18–60 years meeting DSM-IV criteria for bipolar disorder (bipolar I and II disorders, bipolar disorder not otherwise specified). We assessed demographic factors, mood symptoms, psychosis, trauma history, trait impulsivity, trait aggression, and reasons for living. The primary outcome measures were the Barratt Impulsiveness Scale-version II, Aggression Questionnaire, and 10 cognitive outcome variables. The cognitive outcome variables assessed cognitive performance across several domains, including processing speed, attention, verbal learning, and executive function. Another aspect of cognitive function, decision making, was assessed using the Iowa Gambling Task. The study was conducted from July 2007–July 2009.
We found that nonattempters reported significantly higher trait impulsivity scores on the Barratt Impulsiveness Scale compared to attempters (t57 = 2.2, P = .03) and that, among attempters, lower trait impulsivity score was associated with higher scores of lethality of prior attempts (r25 = −0.53, P = .01). Analyses revealed no other group differences on demographic, clinical, or neurocognitive variables when comparing attempters versus nonattempters. Regression models failed to identify any significant predictors of past suicide attempt.
The largely negative results of our study are particularly important in highlighting the clinical dilemma faced by many clinicians when trying to predict which patients will make serious suicide attempts and which patients are at a lower risk for acting on suicidal thoughts. A limitation of our work is that we examined stable trait measures of impulsivity among a euthymic sample rather than mood state or the impact of mood state on traits. Overall, we conclude that suicidal behavior is extremely difficult to predict, even when comprehensive clinical and neurocognitive information is available.
PMCID: PMC4035109  PMID: 21813075

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