Problem gambling: Is the addictive in the anticipation? · Pathological gambling: a disorder of...
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EASG, sept 2010 Problem gambling: Is the addictive in the anticipation? Anneke E. Goudriaan, PhD Ruth J. van Holst, Msc. Dick Veltman, MD, PhD Wim van den Brink, MD, PhD Department of Psychiatry, UvA, AMC, Amsterdam [email protected] [email protected]
Transcript of Problem gambling: Is the addictive in the anticipation? · Pathological gambling: a disorder of...
EASG, sept 2010
Problem gambling: Is the addictive in the anticipation?
Anneke E. Goudriaan, PhD Ruth J. van Holst, Msc.Dick Veltman, MD, PhD Wim van den Brink, MD, PhD
Department of Psychiatry,UvA, AMC, Amsterdam
EASG, sept 2010
◼ Neuroimaging in Pathological gambling: predictors of the course of addictive disorders
◼ Effect of rimonabant and modafinil on impulsivity and craving in alcohol and cocaine addiction: neuroimaging
◼ Neurotoxicity of ecstasy
◼ E-health interventions for problematic alcohol users
◼ Neuromodulation in chronic heroine dependence:
deap brain stimulation
◼ Effectiveness of treatments
Research Areas
EASG, sept 2010
Overview
◼ Similarities in symptoms of substance dependence and pathological gambling
◼ Neurobiological addiction model
◼ Neuroimagin in (problem) gambling: cue reactivity, near wins
◼ What happens in the brain when expecting rewards or losses?
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Pathological gambling: a disorder of self-regulation
◼ DSM-IV: persistent and recurrent maladaptive gambling behavior
• preoccupation with gambling
• gambling with increasing amounts -> achieve desired excitement
• unsuccessful efforts to control or stop gambling
• restless or irritated when trying to stop
• financial and social problems due to gambling
Tolerance
Withdrawal
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Impaired Response Inhibition
and Salience Attribution Model Goldstein & Volkow (2004)
Non addicted brain Addicted Brain
Salience/
Attention
Control
Memory
Drive STOP
Memory
Control
DriveSalience/
Attention GO
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Do similar brain processes take place in (pathological) gambling?
◼ Reward circuitry activated when winning money (Reuter et al., 2005; De Ruiter
et al., 2009)
◼ What happens when anticipating winning money?
◼ Similar brain processes in the transition from gambling to problem gambling?
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Magnetic
Resonance
Imaging
(MRI)
◼ functional MRI: sensitive for changes in oxygen levels in blood, in active brain areas
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Slot machine gambling in MRI
◼ What is the effect of near wins in your brain?
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How near wins trick your brain
◼ Insula activity correlates with gambling propensity: higher brain activity during near misses -> higher desire to gamble
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Cue reactivity in pathological gamblers
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Cue reactivity to gambling pictures in
problem gamblers
Controls Smokers Problem
GamblersVentral route, dorsal route,
Limbic: striatum, hippocampus, amygdala
More craving: higher activation in limbic areas
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Neuroscientific Findings in PG
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Neuroscience evidence in PG
◼ Diminished reward sensitivity and punishment sensitivity
◼ Diminished cognitive control over behavior
◼ Evidence of higher cue reactivity
◼ Disadvantageous decision making skills
-> Similar to findings in substance dependence
Van Holst, Veltman, van den Brink, Goudriaan, 2009
What are crucial differences between substance dependence and pathological gambling?
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Research question:
◼ Do problem gamblers anticipate differently on possible reward or losses compared to alcohol dependents and controls?
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fMRI study in 20 problem gamblers, 20 alcohol dependents, 20 healthy controls
Outcome of
gain or loss
Anticipation of 30% or
70% chance of winning
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Results anticipation
Normal Controls = 17
Problem Gamblers = 16
Problem gamblers < Controls Problem Gamblers > Controls
Putamen
/striatum
More reward
related
activation
DLPFC
Less
cognitive
processing
Results anticipation
Alcohol Dependents < Controls Alcohol Dependents > Controls
No
differences
DLPFC
&
Amygdala
Normal Controls = 17
Alcohol Dependents = 19
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(Preliminary) Conclusions
◼ Alcohol dependents show bluntedactivation during anticipation of winning
◼ Gamblers show more activity during anticipation of winning in reward related areas
◼ The ‘high’ of problem gambling seems to be in the anticipation of gains:◼ But: Is the anticipation the result of PG?
◼ Or: Is the anticipation a predictor of addictive behavior?
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Future implementations
◼ Brain scans to cue reactivity:
◼ risk for relapse high or low based on brain responses?
◼ -> extra treatment sessions for high risk persons
◼ Does treatment result in disappearance of overactivity in anticipation of gains?
◼ Could neuroscience be used as an objective indicator of presence/absence of gambling pathology
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Interventions to improve neurocognition
◼ Medication:◼ to improve impulsivity?
◼ to reduce craving/cue reactivity?
◼ Improving brain functioning:◼ EEG Biofeedback / neurofeedback
• Effects of an EEG biofeedback protocol on a mixed substance abusing population. Scott et al., Am J Drug Alcohol Abuse. 2005
Thank you for your
attention!
Questions…
Email (reprints articles):
Acknowledgements:Colleagues/collaborators: Wim van den Brink, AMC
Maarten Koeter, AMC
Jaap Oosterlaan, Vrije Universiteit, Amsterdam, NL
Edwin de Beurs, LUMC, Leiden, NL
Kenneth J. Sher, University of Missouri, USA
Wendy Slutske, PhD, University of Missouri, USA
Emily R. Grekin, Wayne State University, MI, USA
Funding: -ZonMw (National Institute for Health Research, the Netherlands)
- NWO (Dutch Scientific Association)
- Institute for Research on Pathological Gambling (New Investigator Grant 2007)
