stimulants; cocaine; attention; control; Stroop; fMRI
Cross-sectional studies have demonstrated gender-related differences in the associations between problem-gambling severity and substance-use disorders; however, these associations have not been examined longitudinally. We aimed to examine the prospective associations between problem-gambling severity and incident substance-use disorders in women versus men.
Analyses were conducted using Wave-1 and Wave-2 NESARC data focusing on psychiatric diagnoses from 34,006 non-institutionalized US adults. Inclusionary criteria for pathological gambling were used to categorize Wave-1 participants as at-risk/problem gambling (ARPG) and non-ARPG (i.e. non-gambling/low-frequency gambling/low-risk gambling). Dependent variables included the three-year incidence of any substance-use disorder, alcohol-use disorders, nicotine dependence, drug-use disorders, prescription drug-use disorders, and illicit drug-use disorders.
Significant gender-by-ARPG status interactions were observed with respect to the three-year incidence of nicotine dependence and prescription drug-use disorders, and approached significance with respect to incident alcohol-use disorders. ARPG (relative to non-ARPG) was positively associated with nicotine dependence among women (OR=2.00; 95% CI=1.24-3.00). ARPG was negatively associated with incident prescription drug-use disorders among men (OR=0.30; 95% CI=0.10-0.88)). Finally, ARPG was positively associated with incident alcohol-use disorders among men (OR=2.20; 95% CI=1.39-3.48).
Gambling problems were associated with an increased 3-year incidence of nicotine dependence in women and alcohol dependence in men. These findings highlight the importance of considering gender in prevention and treatment initiatives for adults who are experiencing gambling problems. Moreover, the specific factors underlying the differential progressions of specific substance-use disorders in women and men with ARPG warrant identification.
Problem/pathological gambling; gender differences; substance use disorders; incidence
To evaluate the prospective associations between at-risk/problem/pathological gambling (ARPG) and incident medical conditions among older adults.
Secondary data analysis of the National Epidemiologic Survey of Alcohol and Related Conditions (NESARC), Waves 1 and 2, collected from 2001–2002 and 2004–2005, respectively. Participants are adults aged 55 years and older (n=10,231) who were selected from a nationally representative community sample of adults residing in the United States. Past-year DSM-IV diagnostic criteria for pathological gambling at Wave 1 were evaluated with the Alcohol Use Disorder and Associated Disabilities Interview Schedule—Diagnostic and Statistical Manual of Mental Disorders—Fourth Edition. Physical-health conditions were assessed at Wave 1 and Wave 2. Logistic regression modeling was conducted on groups categorized as ARPG (participants endorsing one or more inclusionary criteria for pathological gambling) and non-ARPG (non-gambling/low-frequency gambling or gambling without endorsement of pathological gambling criteria).
Relative to non-ARPG, ARPG is prospectively associated with elevated incidences of arteriosclerosis and any heart condition, independently of Wave-1 socio-demographic characteristics, psychiatric comorbidity, substance use, and body mass index.
Older adults who demonstrate risky or problematic levels of gambling may be at particular risk for the onset of some physical-health conditions. ARPG individuals should be monitored more closely for the development of these conditions and encouraged to adopt activities that confer health benefits. Efforts should be made to educate older adults and their caretakers on the adverse incident physical-health conditions associated with ARPG.
At-risk/problem/pathological gambling; physical illness; older adults; addiction; aging
Obesity is a heterogeneous construct that, despite multiple and diverse attempts, has been difficult to treat. One conceptualization gaining media and research attention in recent years is that foods, particularly hyperpalatable (e.g., high-fat, high sugar) ones, may possess addictive qualities. Stress is an important factor in the development of addiction and in addiction relapse, and may contribute to an increased risk for obesity and other metabolic diseases. Uncontrollable stress changes eating patterns and the salience and consumption of hyperpalatable foods; over time, this could lead to changes in allostatic load and trigger neurobiological adaptations that promote increasingly compulsively behavior. This association may be mediated by alterations in the hypothalamic-pituitary-adrenal (HPA) axis, glucose metabolism, insulin sensitivity, and other appetite-related hormones and hypothalamic neuropeptides. At a neurocircuitry level, chronic stress may affect the mesolimbic dopaminergic system and other brain regions involved in stress/motivation circuits. Together, these may synergistically potentiate reward sensitivity, food preference, and the wanting and seeking of hyperpalatable foods, as well as induce metabolic changes that promote weight and body fat mass. Individual differences in susceptibility to obesity and types of stressors may further moderate this process. Understanding the associations and interactions between stress, neurobiological adaptations, and obesity is important in the development of effective prevention and treatment strategies for obesity and related metabolic diseases.
Obesity; Food Addiction; Stress; HPA axis; Mesolimbic Dopaminergic System
Adolescence is a critical period of neurodevelopment for stress and appetitive processing, as well as a time of increased vulnerability to stress and engagement in risky behaviors. The current study was conducted to examine brain activation patterns during stress and favorite-food-cue experiences relative to a neutral-relaxing condition in adolescents. Functional magnetic resonance imaging was employed using individualized script-driven guided imagery to compare brain responses to such experiences in 43 adolescents. Main effects of condition and gender were found, without a significant gender-by-condition interaction. Stress imagery, relative to neutral, was associated with activation in the caudate, thalamus, left hippocampus/parahippocampal gyrus, midbrain, left superior/middle temporal gyrus, and right posterior cerebellum. Appetitive imagery of favorite food was associated with caudate, thalamus, and midbrain activation compared to the neutral-relaxing condition. To understand neural correlates of anxiety and craving, subjective (self-reported) measures of stress-induced anxiety and favorite-food-cue-induced craving were correlated with brain activity during stress and appetitive food-cue conditions, respectively. High self-reported stress-induced anxiety was associated with hypoactivity in the striatum, thalamus, hippocampus and midbrain. Self-reported favorite-food-cue-induced craving was associated with blunted activity in cortical-striatal regions, including the right dorsal and ventral striatum, medial prefrontal cortex, motor cortex, and left anterior cingulate cortex. The current findings in adolescents indicate the activation of predominantly subcortical-striatal regions in the processing of stressful and appetitive experiences and link hypoactive striatal circuits to self-reported stress-induced anxiety and cue-induced favorite-food craving.
Stress; Psychological; Adolescence; Motivation; Appetite; fMRI
Background and Aims
Physical fighting and gambling are common risk behaviors among adolescents. Prior studies have found associations among these behaviors in adolescents but have not examined systematically the health and gambling correlates of problem-gambling severity amongst youth stratified by fight involvement.
Survey data were used from 2,276 Connecticut high-school adolescents regarding their physical fight involvement, gambling behaviors and perceptions, and health and functioning. Gambling perceptions and correlates of problem-gambling severity were examined in fighting and non-fighting adolescents.
Gambling perceptions were more permissive and at-risk/problem gambling was more frequent amongst adolescents reporting serious fights versus those denying serious fights. A stronger relationship between problem-gambling severity and regular smoking was observed for adolescents involved in fights.
Discussion and Conclusions
The more permissive gambling attitudes and heavier gambling associated with serious fights in high-school students suggest that youth who engage in physical fights warrant enhanced prevention efforts related to gambling. The stronger relationship between tobacco smoking and problem-gambling severity amongst youth engaging in serious fights suggest that fighting youth who smoke might warrant particular screening for gambling problems and subsequent interventions.
Fighting; gambling; physical violence; adolescents; risk behaviors; high school
We developed an alcohol self-administration paradigm to model individual differences in impaired control. The paradigm includes moderate drinking guidelines meant to model limits on alcohol consumption, which are typically exceeded by people with impaired control. Possible payment reductions provided a disincentive for excessive drinking. Alcohol use above the guideline, despite possible pay reductions, was considered to be indicative of impaired control. Heavy-drinking 21–25 year-olds (N = 39) were randomized to an experimental condition including the elements of the impaired control paradigm or to a free-drinking condition without these elements. Alcohol self-administration was compared between these two conditions to establish the internal validity of the experimental paradigm. In both conditions, participants self-administered beer and non-alcoholic beverages for 3 hours in a bar setting with 1–3 other participants. Experimental condition participants self-administered significantly fewer beers and drank to lower blood-alcohol concentrations (BACs) on average than those in the free-drinking condition. Experimental condition participants were more likely than free-drinking condition participants to intersperse non-alcoholic beverages with beer and to drink at a slower pace. Although experimental condition participants drank more moderately than those in the free-drinking condition overall, their range of drinking was considerable (BAC range = .024–.097) with several participants drinking excessively. A lower initial subjective response to alcohol and earlier age of alcohol use onset were associated with greater alcohol self-administration in the experimental condition. Given the variability in response, the impaired control laboratory paradigm may have utility for preliminary tests of novel interventions in future studies and for identifying individual differences in problem-drinking risk.
laboratory methods; young adult; negative consequences; protective strategies; subjective response
For many, gambling is a recreational activity that is performed periodically without ill effects, but for some, gambling may interfere with life functioning. A diagnostic entity, pathological gambling, is currently used to define a condition marked by excessive and problematic gambling. In this review, the current status of understanding of the neurobiologies of gambling and pathological gambling is described. Multiple neurotransmitter systems (norepinephrine, serotonin, dopamine, opioid and glutamate) and brain regions (ventral striatum, ventromedial prefrontal cortex, insula, among others) have been implicated in gambling and pathological gambling. Considerations for future directions in gambling research, with a view towards translating neurobiological advances into more effective prevention and treatment strategies, are discussed.
Gambling; neuroimaging; neurobiology; treatment development
Pathological gambling (PG), a disorder currently categorized as an impulse-control disorder but being considered as a non-substance addiction in DSM-5 discussions, represents a significant public health concern. Over the past decade, considerable advances have been made with respect to understanding the biological underpinnings of PG. Research has also demonstrated the efficacies of multiple treatments, particularly behavioral therapies, for treating PG. Despite these advances, relatively little is known regarding how biological measures, particularly those assessing brain function, relate to treatments for PG. In this article, we present a conceptual review focusing on the neurobiology of behavioral therapies for PG. To illustrate issues related to study design, we present proof-of-concept preliminary data that link Stroop-related brain activations prior to treatment onset to treatment outcome in individuals with PG receiving a cognitive behavioral treatment incorporating aspects of imaginal desensitization and motivational interviewing. We conclude with recommendations about current and future directions regarding how to incorporate and translate biological findings into improved therapies for individuals with non-substance and substance addictions.
Gambling; neuroimaging; treatment development; behavioral therapy; cognitive control; nutraceuticals
Individuals with cocaine dependence often evidence poor cognitive control. The purpose of this exploratory study was to investigate networks of functional connectivity underlying cognitive control in cocaine dependence and examine the relationship of the networks to the disorder and its treatment. Independent component analysis (ICA) was applied to fMRI data to investigate if regional activations underlying cognitive control processes operate in functional networks, and whether these networks relate to performance and treatment outcome measures in cocaine dependence. Twenty patients completed a Stroop task during fMRI prior to entering outpatient treatment and were compared to 20 control participants. ICA identified five distinct functional networks related to cognitive control interference events. Cocaine-dependent patients displayed differences in performance-related recruitment of three networks. Reduced involvement of a “top-down” fronto-cingular network contributing to conflict monitoring correlated with better treatment retention. Greater engagement of two “bottom-up” subcortical and ventral prefrontal networks related to cue-elicited motivational processing correlated with abstinence during treatment. The identification of subcortical networks linked to cocaine abstinence and cortical networks to treatment retention suggests that specific circuits may represent important, complementary targets in treatment development for cocaine dependence.
fMRI; substance use disorders; cocaine dependence; cognitive control; cognitive behavioral therapy
Background and aims: Gambling is common in adolescents and at-risk and problem/pathological gambling (ARPG) is associated with adverse measures of health and functioning in this population. Although ARPG commonly co-occurs with marijuana use, little is known how marijuana use influences the relationship between problem-gambling severity and health- and gambling-related measures. Methods: Survey data from 2,252 Connecticut high school students were analyzed using chi-square and logistic regression analyses. Results: ARPG was found more frequently in adolescents with lifetime marijuana use than in adolescents denying marijuana use. Marijuana use was associated with more severe and a higher frequency of gambling-related behaviors and different motivations for gambling. Multiple health/functioning impairments were differentially associated with problem-gambling severity amongst adolescents with and without marijuana use. Significant marijuana-use-by-problem-gambling-severity-group interactions were observed for low-average grades (OR = 0.39, 95% CI = [0.20, 0.77]), cigarette smoking (OR = 0.38, 95% CI = [0.17, 0.83]), current alcohol use (OR = 0.36, 95% CI = [0.14, 0.91]), and gambling with friends (OR = 0.47, 95% CI = [0.28, 0.77]). In all cases, weaker associations between problem-gambling severity and health/functioning correlates were observed in the marijuana-use group as compared to the marijuana-non-use group. Conclusions: Some academic, substance use, and social factors related to problem-gambling severity may be partially accounted for by a relationship with marijuana use. Identifying specific factors that underlie the relationships between specific attitudes and behaviors with gambling problems and marijuana use may help improve intervention strategies.
marijuana; gambling; at-risk/problem gambling; adolescence; risk behaviors
An important step in obesity research involves identifying neurobiological underpinnings of nonfood reward processing unique to specific subgroups of obese individuals.
Nineteen obese individuals seeking treatment for binge eating disorder (BED) were compared with 19 non-BED obese individuals (OB) and 19 lean control subjects (LC) while performing a monetary reward/loss task that parses anticipatory and outcome components during functional magnetic resonance imaging. Differences in regional activation were investigated in BED, OB, and LC groups during reward/loss prospect, anticipation, and notification.
Relative to the LC group, the OB group demonstrated increased ventral striatal and ventromedial prefrontal cortex activity during anticipatory phases. In contrast, the BED group relative to the OB group demonstrated diminished bilateral ventral striatal activity during anticipatory reward/loss processing. No differences were observed between the BED and LC groups in the ventral striatum.
Heterogeneity exists among obese individuals with respect to the neural correlates of reward/loss processing. Neural differences in separable groups with obesity suggest that multiple, varying interventions might be important in optimizing prevention and treatment strategies for obesity.
Binge eating disorder; fMRI; inferior frontal gyrus; insula; obesity; reward; ventral striatum
gambling; internet use; video-gaming; eating; food; sex; shopping
With the popularity of Internet use among adolescents, there is concern that some youth may display problematic or addictive patterns of Internet use. Although excessive patterns of Internet use was considered for inclusion in the DSM-5 with pathological gambling and substance-use disorders in a category of addictive disorders, it was determined that more research was needed on Internet-use behaviors before such actions be further considered and possibly undertaken. The present study is the first to investigate whether at-risk/problematic Internet use (ARPIU) may moderate the strength of association between problem-gambling severity and gambling-related characteristics and health and well-being measures in adolescents. Survey data from 1884 Connecticut high-school student stratified by Internet use (ARPIU vs. non-ARPIU) were examined in bivariate analyses and logistic regression models. Gambling-related characteristics and health and well-being measures were mostly positively associated with problem-gambling severity in both Internet use groups. Interaction odds ratio revealed that the strength of the associations between problem-gambling severity and marijuana, alcohol and caffeine use were stronger amongst the non-ARPIU compared to the ARPIU group, suggesting that the relationships between these substance use behaviors and problem gambling may be partially accounted for by ARPIU. Future studies should examine the extent to which preventative interventions targeting both problematic Internet use and problem gambling may synergistically benefit measures of health and reduce risk-taking behaviors in adolescence.
Problem gambling severity; Internet; Behavioral addiction; Substance use
Studies of Asian-American adults have found high estimates of problematic gambling. However, little is known about gambling behaviors and associated measures among Asian-American adolescents. This study examined gambling perceptions and behaviors and health/functioning characteristics stratified by problem-gambling severity and Asian-American and Caucasian race using cross-sectional survey data of 121 Asian-American and 1,659 Caucasian high-school students. Asian-American and Caucasian adolescents significantly differed on problem-gambling severity, with Asian-American adolescents more often reporting not gambling (24.8% vs. 16.4%), but when they did report gambling, they showed higher levels of at-risk/problem gambling (30.6% vs. 26.4%). Parental approval or disapproval of adolescent gambling also significantly differed between races, with Asian-American adolescents more likely to perceive both parental disapproval (50.0% vs. 38.2%) and approval (19.3% vs. 9.6%) of gambling. Asian-American adolescents were also more likely to express concern about gambling among close family members (25.2% vs. 11.6%). Among Asian-American adolescents, stronger associations were observed between at-risk/problem gambling and smoking cigarettes (interaction odds ratio=12.6). In summary, differences in problem-gambling severity and gambling perceptions indicate possible cultural differences in familial attitudes towards gambling. Stronger links between cigarette smoking and risky/problematic gambling amongst Asian-American adolescents suggest that prevention and treatment efforts targeting youth addictions consider cultural differences.
gambling; adolescence; Asian American; family
Instant (scratch) lottery ticket gambling is popular among adolescents. Prior research has not determined whether adolescents’ gambling behavior and attitudes toward gambling are influenced by the receipt of scratch lottery tickets as gifts.
Cross-sectional survey data from 2,002 Connecticut high school students with past-year gambling were analyzed using bivariate approaches and logistic regression analyses. Interactions between gambling-problem severity and lottery-gift status were examined in relation to multiple outcomes.
Adolescents who received a scratch lottery ticket as a gift compared with those who did not were more likely to report features of problem gambling, buy scratch lottery tickets for themselves, and buy and receive other types of lottery tickets; they were also less likely to report parental disapproval of gambling and to see gambling prevention efforts as important. Later (≥15 years) age-at-gambling-onset was inversely linked to gambling-problem severity in the lottery gift group (odds ratio [OR] = .38) but not in the nongift group (OR = .91), yielding a significant severity by gift status interaction. Other academic, health, and gambling-related correlates of gambling-problem severity were similar in the gift and nongift groups.
For adolescents, the receipt of scratch lottery tickets as gifts during childhood or adolescence was associated with risky/problematic gambling and with gambling-related attitudes, behaviors, and views suggesting greater gambling acceptability. The extent to which the receipt of scratch lottery tickets may promote gambling behaviors and the development of gambling problems warrants consideration. Education, prevention, and treatment strategies should incorporate findings relating to receipt of gambling products by underage individuals.
Gambling; Adolescence; Lottery; Risk behaviors; Gifts
To examine the longitudinal relationship between past-year problem-gambling severity and incident Axis I psychopathology among older adults (aged 55 to 90), analyses were conducted on data from the National Epidemiologic Study of Alcohol and Related Conditions (NESARC). This nationally-representative population-based survey was conducted in two waves (Wave 1, 2000-2001; and Wave 2, 2004-2005). Past-year problem-gambling severity at Wave 1 and incident Axis I psychopathology at Wave 2 were evaluated with the Alcohol Use Disorder and Associated Disabilities Interview Schedule—Diagnostic and Statistical Manual of Mental Disorders—Fourth Edition. Multivariate logistic regression modeling was conducted on groups categorized into low-frequency gambling/non-gambling (LFG/NG), low-risk gambling (LRG), and at-risk/problem/pathological gambling (ARPG) based on DSM-IV criteria for pathological gambling. Relative to LFG/NG, ARPG at Wave 1 was positively associated with the incidence of generalized anxiety disorder (OR=2.51; p=.011) and any substance use disorder (OR=2.61; p=.0036); LRG was negatively associated with the incidence of hypomania (OR=0.33; p=.017). Models were adjusted for demographic characteristics, psychiatric comorbidity, health behaviors, physical health, and stressful life events assessed at baseline. While gambling may represent a positive activity for some older adults, data suggest that risky/problematic gambling behavior may be associated with the development of psychiatric problems in this population. Older-adult gamblers, as well as their clinicians, friends, and family, should be aware of potential risks associated with gambling, adopt strategies to prevent the onset of secondary disorders, and monitor themselves and others for signs of problems.
pathological gambling; older adults; mental health; incidence; epidemiology; substance abuse
Decision-making and risk-taking behavior undergo developmental changes during adolescence. Disadvantageous decision-making and increased risk-taking may lead to problematic behaviors such as substance use and abuse, pathological gambling and excessive internet use.
Based on MEDLINE searches, this article reviews the literature on decision-making and risk-taking and their relationship to addiction vulnerability in youth.
Decision-making and risk-taking behaviors involve brain areas that undergoing developmental changes during puberty and young adulthood. Individual differences and peer pressure also relate importantly to decision-making and risk-taking.
Brain-based changes in emotional, motivational and cognitive processing may underlie risk-taking and decision-making propensities in adolescence, making this period a time of heightened vulnerability for engagement in additive behaviors.
adolescence; risk-taking; decision-making; behavioral addictions; addiction vulnerability
Despite significant advances in our understanding of the biological bases of addictions, these disorders continue to represent a huge public health burden that is associated with substantial personal suffering. Efforts to target addictions require consideration of how the improved biological understanding of addictions may lead to improved prevention, treatment and policy initiatives.
In this article, we provide a narrative review of current biological models for addictions with a goal of placing existing data and theories within a translational and developmental framework targeting the advancement of prevention, treatment and policy strategies.
Data regarding individual differences, intermediary phenotypes, and main and interactive influences of genetic and environmental contributions in the setting of developmental trajectories that may be influenced by addictive drugs or behavior indicate complex underpinnings of addictions.
Consideration and further elucidation of the biological etiologies of addictions hold significant potential for making important gains and reducing the public health impact of addictions.
Addiction; Neurobiology; Adolescence; Public Health; Development
Obesity is associated with alterations in corticolimbic-striatal brain regions involved in food motivation and reward. Stress and the presence of food cues may each motivate eating and engage corticolimibic-striatal neurocircuitry. It is unknown how these factors interact to influence brain responses and whether these interactions are influenced by obesity, insulin levels, and insulin sensitivity. We hypothesized that obese individuals would show greater responses in corticolimbic-striatal neurocircuitry after exposure to stress and food cues and that brain activations would correlate with subjective food craving, insulin levels, and HOMA-IR.
RESEARCH DESIGN AND METHODS
Fasting insulin levels were assessed in obese and lean subjects who were exposed to individualized stress and favorite-food cues during functional MRI.
Obese, but not lean, individuals exhibited increased activation in striatal, insular, and hypothalamic regions during exposure to favorite-food and stress cues. In obese but not lean individuals, food craving, insulin, and HOMA-IR levels correlated positively with neural activity in corticolimbic-striatal brain regions during favorite-food and stress cues. The relationship between insulin resistance and food craving in obese individuals was mediated by activity in motivation-reward regions including the striatum, insula, and thalamus.
These findings demonstrate that obese, but not lean, individuals exhibit increased corticolimbic-striatal activation in response to favorite-food and stress cues and that these brain responses mediate the relationship between HOMA-IR and food craving. Improving insulin sensitivity and in turn reducing corticolimbic-striatal reactivity to food cues and stress may diminish food craving and affect eating behavior in obesity.
food addiction; food craving; naltrexone; bupropion; obesity; binge-eating disorder
Internet use and video-game playing are experiencing rapid growth among both youth and adult populations. Research suggests that a minority of users experience symptoms traditionally associated with substance-related addictions. Mental health professionals, policy makers and the general public continue to debate the issue of Internet addiction (IA) and problematic video-game playing (PVG). This review identifies existing studies into the clinical and biological characteristics of these disorders that may help guide decisions as to whether or not IA and PVG should be grouped together with substance use disorders (SUDs).
Internet addiction; Video-games; Substance use disorder; Classification; Prevalence; Neurobiology; Growth and development
This is an update to a previously published article discussing the
neuropsychopharmacology of pathological gambling (PG) (1). In the prior manuscript, we described how
cortico-limbic circuitry and neurotransmitter systems (norepinephrine,
serotonin, dopamine, opioids, glutamate, and gamma-aminobutyric acid (GABA))
have been implicated in PG. These systems represent potential targets for
psychopharmacological treatments for PG, with opioid antagonists arguably
showing the most consistent benefit in RCTs. In the past year and half since
this publication was prepared, there has been one additional randomized clinical
trial (RCT) published along with a single case study. Our original manuscript
did not describe in detail findings from case studies or open-label studies so
in addition to the new RCT data and a new case report involving naltrexone, here
we describe case and open-label findings. A PubMed search was conducted using
terms such as “pathological gambling treatment”,
“clinical trials and gambling”, and “gambling
psychopharmacology.” Using these search terms, numerous results were
obtained, necessitating further search modifiers. For example, using just
“pathological gambling treatment” results in over 1600 hits. In
order to focus in on the search modalities, we searched within the initial
results for specific phrases such as “psychopharmacology, clinical
trial, medication, serotonergic, dopaminergic, etc.” in addition to
searching for specific medications. Results not directly related to the
treatment of pathological gambling were not included. The study of pathological
gambling is relatively new. As such, our search did not exclude any studies due
to age of material, but with a few exceptions, the majority of the studies
discussed were published later than 2000. This resulted in 24 case studies
and/or RCTs not previously included in our original review article. These
findings in conjunction with our prior publication provide a comprehensive
overview of controlled investigations and exploratory reports of
pharmacotherapies for PG.
Neuropsychopharmacology; Pathological Gambling; Psychopharmacology; Treatment
Cocaine-dependent individuals demonstrate neural and behavioral differences compared to healthy comparison subjects when performing the Stroop color-word inference test. Stroop measures also relate to treatment outcome for cocaine dependence. Intrinsic connectivity analyses assess the extent to which task-related regional brain activations are related to each other in the absence of defining a priori regions-of-interest.
This study examined: 1) the extent to which cocaine-dependent and non-addicted individuals differed on measures of intrinsic connectivity during fMRI Stroop performance; and, 2) the relationships between fMRI Stroop intrinsic connectivity and treatment outcome in cocaine dependence.
Sixteen treatment-seeking cocaine-dependent patients and matched non-addicted comparison subjects completed an fMRI Stroop task. Between-group differences in intrinsic connectivity were assessed and related to self-reported and urine-toxicology-based cocaine-abstinence measures.
Cocaine-dependent patients vs. comparison subjects showed less intrinsic connectivity in cortical and sub-cortical regions. When adjusting for individual degree of intrinsic connectivity, cocaine-dependent vs. comparison subjects showed relatively greater intrinsic connectivity in the ventral striatum, putamen, inferior frontal gyrus, anterior insula, thalamus, and substantia nigra. Non-mean-adjusted intrinsic-connectivity measures in the midbrain, thalamus, ventral striatum, substantia nigra, insula, and hippocampus negatively correlated with measures of cocaine abstinence.
The diminished intrinsic connectivity in cocaine-dependent vs. comparison subjects suggests poorer communication across brain regions during cognitive-control processes. In mean-adjusted analyses, the cocaine-dependent group displayed relatively greater Stroop-related connectivity in regions implicated in motivational processes in addictions. The relationships between treatment outcomes and connectivity in the midbrain and basal ganglia suggest that connectivity represents a potential treatment target.
intrinsic connectivity; cocaine dependence; functional magnetic resonance imaging; Stroop color-word interference test; treatment outcome; addiction; cognitive control