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1.  Gender-related Differences in the Associations between Sexual Impulsivity and Psychiatric Disorders 
Sexual impulsivity (SI) has been associated with conditions that have substantial public health costs, such as sexually transmitted infections and unwanted pregnancies. However, SI has not been examined systematically with respect to its relationships to psychopathology. We aimed to investigate associations between SI and psychopathology, including gender-related differences.
We performed a secondary data analysis of Wave-2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a national sample of 34,653 adults in the United States. DSM-IV-based diagnoses of mood, anxiety, drug and personality disorders were assessed using the Alcohol Use Disorder and Associated Disabilities Interview Scheduled DSM-IV Version.
The prevalence of SI was considerable (14.7%), with greater acknowledgment by men than women (18.9% versus 10.9%; p<0.0001). For both women and men, SI was positively associated with most Axis-I and Axis-II psychiatric disorders (OR range: Women, Axis-I:1.89-6.14, Axis-II:2.10-10.02; Men, Axis-I:1.92-6.21, Axis-II:1.63-6.05). Significant gender-related differences were observed. Among women as compared to men, SI was more strongly associated with social phobia, alcohol abuse/dependence, and paranoid, schizotypal, antisocial, borderline, narcissistic, avoidant and obsessive-compulsive personality disorders.
The robust associations between SI and psychopathology across genders suggest the need for screening and interventions related to SI for individuals with psychiatric concerns. The stronger associations between SI and psychopathology among women as compared to men emphasize the importance of a gender-oriented perspective in targeting SI. Longitudinal studies are needed to determine the extent to SI predates, postdates or co-occurs with specific psychiatric conditions.
PMCID: PMC4165523  PMID: 24793538
Sexual Impulsivity; Gender; Psychiatric Disorders; Co-Occurrence
2.  Trauma, PTSD, and Binge and Hazardous Drinking Among Women and Men: Findings from a National Study 
To examine whether trauma and posttraumatic stress disorder (PTSD) are differentially associated with binge and hazardous patterns of drinking among women and men.
Secondary analysis of the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC); the analytic sample included 31,487 respondents (54.6% female) without past-year alcohol abuse/dependence. Participants’ trauma-exposure/PTSD status was characterized as: no exposure to trauma in lifetime (reference), lifetime trauma exposure, PTSD before past-year, or past-year PTSD. Past-year binge and hazardous drinking were examined with multinomial logistic regression models (past-year abstinence was modeled as the non-event); models included the main effects of trauma-exposure/PTSD status and gender, the trauma-exposure/PTSD status-by-gender interaction, psychiatric comorbidity, and socio-demographic covariates.
The gender-specific effects of trauma, before past-year PTSD, and past-year PTSD were significantly elevated for all drinking behaviors in women (range of odds ratios (ORs)=1.8–4.8), and for some drinking behaviors in men (range of ORs=1.3–2.0), relative to no trauma exposure. Trauma exposure was more strongly associated with high-frequency binge drinking, low-frequency binge drinking, and non-binge drinking among women as compared to men. Past-year PTSD was also more strongly associated with low-frequency binge drinking and non-binge drinking among women compared to men. Findings for hazardous drinking followed a similar pattern, with significant gender-related differences in ORs for hazardous drinking and non-hazardous drinking observed with respect to trauma exposure and past-year PTSD.
Mental health practitioners should be mindful of the extent to which trauma-exposed individuals both with and without PTSD engage in binge and hazardous drinking, given the negative consequences associated with these patterns of drinking.
PMCID: PMC4094352  PMID: 24838049
Trauma; PTSD; Binge Drinking; Hazardous Drinking; Gender; Epidemiology
3.  The neural bases of cognitive processes in gambling disorder 
Trends in cognitive sciences  2014;18(8):429-438.
Functional imaging is offering powerful new tools to investigate the neurobiology of cognitive functioning in people with and without psychiatric conditions like gambling disorder. Based on similarities between gambling and substance-use disorders in neurocognitive and other domains, gambling disorder has recently been classified in DSM-5 as a behavioral addiction. Despite the advances in understanding, there exist multiple unanswered questions about the pathophysiology underlying gambling disorder and the promise for translating the neurobiological understanding into treatment advances remains largely unrealized. Here we review the neurocognitive underpinnings of gambling disorder with an eye towards improving prevention, treatment and policy efforts.
PMCID: PMC4112163  PMID: 24961632
Gambling; neuroimaging; neurobiology; cognition
4.  Pretreatment measures of brain structure and reward-processing brain function in cannabis dependence: An exploratory study of relationships with abstinence during behavioral treatment* 
Drug and alcohol dependence  2014;140:33-41.
Cannabis is widely abused, and efficacies of therapeutics for cannabis dependence remain suboptimal. Magnetic resonance imaging (MRI) may aid in the identification of biological markers for successful treatment outcomes (i.e., abstinence).
Twenty men with cannabis dependence and twenty non-substance-using healthy comparison (HC) men underwent MRI scanning. Cannabis-dependent individuals then participated in a 12-week randomized clinical trial of behavioral treatments (contingency management (CM), cognitive behavioral therapy (CBT) or both). Pretreatment functional and structural data were compared between the cannabis-dependent and HC participants. In addition, individuals with cannabis dependence were subdivided based on the successful achievement of 21 days of consecutive abstinence during treatment to assess whether abstinent versus nonabstinent cannabis-dependent participants displayed different pretreatment functional and structural characteristics when compared to HC participants.
In comparison to HC participants, cannabis-dependent participants demonstrated greater ventral striatal activation during the receipt of losing outcomes and smaller putamenal volumes. Cannabis-dependent participants who did not subsequently achieved 21 days of consecutive abstinence had increased activity within the striatum during the receipt of losing outcomes, relative to HC participants. Cannabis-dependent participants who did not achieve 21 days of abstinence had decreased bilateral putamen volumes prior to treatment, relative to HC participants.
Individual differences in pretreatment striatal function and structure may relate to individual differences in treatment responses for cannabis dependence. While mechanisms underlying these associations require further exploration, the striatum might mediate treatment responses via its role in associative reward-learning (e.g., through skills training in CBT or reinforcement of abstinence in CM).
PMCID: PMC4057888  PMID: 24793365
cannabis dependence; fMRI; FSL-FIRST; reward processing; contingency management; cognitive behavioral therapy
5.  Treatment of Gambling Disorders 
Opinion statement
Preclinical and clinical research implicate several neurotransmitter systems in the pathophysiology of gambling disorder (GD). In particular, neurobiological research suggests alterations in serotonergic, dopaminergic, glutamatergic and opioidergic functioning. The relative efficacy of medications targeting these systems remains a topic of ongoing research, and there is currently no Food and Drug Administration (FDA) approved medication with an indication for GD. Considering co-occurring disorders may be particularly important when devising a treatment plan for GD: extant data suggest that the opioid antagonist naltrexone may by the most effective form of current pharmacotherapy for GD, particularly for individuals with a co-occurring substance-use disorder (SUD) or with a family history of alcoholism. In contrast, lithium or other mood stabilizers may be most effective for GD for patients presenting with a co-occurring bipolar-spectrum disorder (BSD). Further, serotonin reuptake inhibitors (SRIs) may be efficacious in reducing GD symptoms for individuals also presenting with a (non-BSD) mood or anxiety disorder. Finally, elevated rates of GD (and other Impulse Control Disorders; ICDs) have been noted among individuals with Parkinson’s Disease (PD), and clinicians should assess for vulnerability to GD when considering treatment options for PD. Reducing levodopa or dopamine agonist (DA) dosages may partially reduce GD symptoms among patients with co-occurring PD. For GD patients not willing to consider drug treatment, n-acetyl cysteine or behavioral therapies may be effective. Ongoing research into the effectiveness of combined behavioral and pharmacotherapies is being conducted; thus combined treatments should also be considered.
PMCID: PMC4041397  PMID: 24904757
gambling disorder; behavioral treatment; pharmacotherapy; fluvoxamine; sertraline; escitalopram; paroxetine; lithium; valproate; bupropion; olanzapine; naltrexone; nalmefene; amantadine; memantine; n-acetyl cysteine; topiramate; tolcapone; ecopipam; cognitive behavioral therapy; motivational interviewing; Gambler’s Anonymous; subthalamic nucleus deep brain stimulation; Parkinson’s disease
6.  A pilot study linking reduced fronto-striatal recruitment during reward processing to persistent bingeing following treatment for binge-eating disorder 
The primary purpose of this study was to examine neurobiological underpinnings of reward processing that may relate to treatment outcome for binge-eating disorder (BED).
Prior to starting treatment, nineteen obese persons seeking treatment for BED performed a monetary incentive delay task during functional magnetic resonance imaging (fMRI). Analyses examined how the neural correlates of reward processing related to binge-eating status after four-month of treatment.
Ten individuals continued to report binge- eating (BEpost-tx) following treatment and nine individuals did not (NBEpost-tx). The groups did not differ in body mass index. The BEpost-tx group relative to the NBEpost-tx group showed diminished recruitment of the ventral striatum and the inferior frontal gyrus during the anticipatory phase of reward processing and reduced activity in the medial prefrontal cortex during the outcome phase of reward processing.
These results link brain reward circuitry to treatment outcome in BED and suggest that specific brain regions underlying reward processing may represent important therapeutic targets in BED.
PMCID: PMC3986812  PMID: 24729034
7.  Environmental Factors Selectively Impact Co-occurrence of Problem/Pathological Gambling with Specific Drug-Use Disorders in Male Twins 
Addiction (Abingdon, England)  2014;109(4):635-644.
Multiple forms of drug abuse/dependence frequently co-occur with problem/pathological gambling (PPG). The current study examines the extent to which genetic and environmental factors contribute to their co-occurrences.
Bivariate models investigated the magnitudes and correlations of genetic and environmental contributions to problem/pathological gambling and its co-occurrence with nicotine dependence, cannabis abuse/dependence, and stimulant abuse/dependence.
Computer-assisted telephone interviews in the community.
Participants were 7,869 male twins in the Vietnam Era Twin Registry, a USA-based national twin registry.
Lifetime DSM-III-R diagnoses for problem/pathological gambling, nicotine dependence, cannabis abuse/dependence, and stimulant abuse/dependence were determined using the Diagnostic Interview Schedule.
All drug-use disorders displayed additive genetic and non-shared environmental contributions, with cannabis abuse/dependence also displaying shared environmental contributions. Both genetic (genetic correlation rA=0.22; 95%CI:0.10–0.34) and non-shared environmental components (environmental correlation rE=0.24; 95%CI:0.10–0.37) contributed to the co-occurrence of problem/pathological gambling and nicotine dependence. This pattern was shared by cannabis abuse/dependence (rA=0.32; 95%CI:0.05–1.0; rE=0.36; 95%CI:0.16–0.55) but not stimulant abuse/dependence (SAD), which showed only genetic contributions to the co-occurrence with problem/pathological gambling (rA=0.58; 95%CI:0.45–0.73).
Strong links between gambling and stimulant-use disorders may relate to the neurochemical properties of stimulants or the illicit nature of using “hard” drugs like cocaine. The greater contribution of environmental factors to the co-occurrences between problem/pathological gambling and “softer” forms of drug abuse/dependence (cannabis, tobacco) suggest that environmental interventions (perhaps relating to availability and legality) may help diminish the relationship between problem/pathological gambling and tobacco- and cannabis-use disorders.
PMCID: PMC3951667  PMID: 24219015
8.  Biased Behaviors: Towards Understanding Vulnerability and Resilience Factors in Addictions 
Biological psychiatry  2014;75(2):94-95.
PMCID: PMC4088321  PMID: 24331645
stimulants; cocaine; attention; control; Stroop; fMRI
9.  Gender differences in the relationship between gambling problems and the incidence of substance-use disorders in a nationally representative population sample 
Drug and alcohol dependence  2013;133(1):204-211.
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.
PMCID: PMC3786018  PMID: 23755930
Problem/pathological gambling; gender differences; substance use disorders; incidence
10.  Increased incidence of cardiovascular conditions among older adults with pathological gambling features in a prospective study 
Journal of addiction medicine  2013;7(6):10.1097/ADM.0b013e31829e9b36.
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.
PMCID: PMC3818298  PMID: 24104190
At-risk/problem/pathological gambling; physical illness; older adults; addiction; aging
11.  Stress and Eating Behaviors 
Minerva endocrinologica  2013;38(3):255-267.
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.
PMCID: PMC4214609  PMID: 24126546
Obesity; Food Addiction; Stress; HPA axis; Mesolimbic Dopaminergic System
12.  Neural Correlates of Stress and Favorite-Food Cue Exposure in Adolescents: A Functional Magnetic Resonance Imaging Study 
Human brain mapping  2012;34(10):2561-2573.
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.
PMCID: PMC3479342  PMID: 22504779
Stress; Psychological; Adolescence; Motivation; Appetite; fMRI
13.  Serious Physical Fighting and Gambling-Related Attitudes and Behaviors in Adolescents 
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.
PMCID: PMC3840436  PMID: 24294502
Fighting; gambling; physical violence; adolescents; risk behaviors; high school
14.  A Human Alcohol Self-Administration Paradigm to Model Individual Differences in Impaired Control over Alcohol Use 
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.
PMCID: PMC4131292  PMID: 23937598
laboratory methods; young adult; negative consequences; protective strategies; subjective response
15.  Neurobiology of Gambling Behaviors 
Current opinion in neurobiology  2013;23(4):660-667.
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.
PMCID: PMC3803105  PMID: 23541597
Gambling; neuroimaging; neurobiology; treatment development
16.  Neurobiological considerations in understanding behavioral treatments for pathological gambling 
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.
PMCID: PMC3700568  PMID: 23586456
Gambling; neuroimaging; treatment development; behavioral therapy; cognitive control; nutraceuticals
17.  Functional Brain Networks Associated with Cognitive Control, Cocaine Dependence and Treatment Outcome 
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.
PMCID: PMC3743442  PMID: 22775772
fMRI; substance use disorders; cocaine dependence; cognitive control; cognitive behavioral therapy
18.  An exploratory examination of marijuana use, problem-gambling severity, and health correlates among adolescents 
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.
PMCID: PMC4117289  PMID: 25215219
marijuana; gambling; at-risk/problem gambling; adolescence; risk behaviors
19.  Monetary Reward Processing in Obese Individuals With and Without Binge Eating Disorder 
Biological psychiatry  2013;73(9):877-886.
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.
PMCID: PMC3686098  PMID: 23462319
Binge eating disorder; fMRI; inferior frontal gyrus; insula; obesity; reward; ventral striatum
20.  Gambling-Related Attitudes and Behaviors in Adolescents Having Received Instant (Scratch) Lottery Tickets as Gifts 
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.
PMCID: PMC3667499  PMID: 23299004
Gambling; Adolescence; Lottery; Risk behaviors; Gifts
21.  Problem gambling severity and the incidence of Axis I psychopathology among older adults in the general population 
Journal of psychiatric research  2013;47(4):534-541.
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.
PMCID: PMC3668329  PMID: 23333039
pathological gambling; older adults; mental health; incidence; epidemiology; substance abuse
22.  Risk-taking and decision-making in youth: relationships to addiction vulnerability 
Journal of behavioral addictions  2013;2(1):10.1556/JBA.2.2013.1.1.
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.
PMCID: PMC3840427  PMID: 24294500
adolescence; risk-taking; decision-making; behavioral addictions; addiction vulnerability
23.  Biological Contributions to Addictions in Adolescents and Adults: Prevention, Treatment and Policy Implications 
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.
PMCID: PMC3935152  PMID: 23332567
Addiction; Neurobiology; Adolescence; Public Health; Development
24.  Neural Correlates of Stress- and Food Cue–Induced Food Craving in Obesity 
Diabetes Care  2013;36(2):394-402.
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.
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.
PMCID: PMC3554293  PMID: 23069840
25.  Are Internet use and video-game-playing addictive behaviors? Biological, clinical and public health implications for youths and adults 
Minerva psichiatrica  2012;53(3):153-170.
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).
PMCID: PMC3840433  PMID: 24288435
Internet addiction; Video-games; Substance use disorder; Classification; Prevalence; Neurobiology; Growth and development

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