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Getting inside the head of a pathological gambler

Robin Wulffson MD's picture
pathological gambler, addiction, compulsive gambler, brain imaging, fMRI

A similarity exists between alcohol consumption and gambling. Some individuals can engage in them responsibly while others become excessively involved. A new study by researchers affiliated with the Amsterdam Institute for Addiction Research (The Netherlands) found that the brains of pathological gamblers differ from those who are not. They presented their findings at the 25th European College of Neuropsychopharmacology (ECNP) Congress, which ran from October 13 through October 17 in Vienna, Austria.

The researchers found that pathological gamblers have abnormally increased reward expectancy, making them “overoptimistic with regard to gambling outcomes.” The researchers employed functional magnetic resonance imaging (fMRI) to image brain activity in 15 individuals who were pathological gamblers and 16 who were not. The participants underwent fMRI scans during a gambling game to assess brain activity when expecting monetary wins or losses. When anticipating a win, the pathological gamblers were found to have more activation in the bilateral ventral striatum, the bilateral ventromedial prefrontal cortex, and the left insula than did those without the disorder. When anticipating a loss, there were no between-group differences in either the left insula or the right amygdala.

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Co-investigator Anna E. Goudriaan, PhD, explained to attendees that when the brain responds to a higher degree to potential rewards, it may trigger an increased desire to gamble. She noted that pathological gambling will be classified under “addiction and related disorders” in the upcoming Diagnostic and Statistical Manual of Disorders, Fifth Edition. She explained that this change was very significant because pathological gambling will be “the first non-substance-related addiction to be put into this category.”

During the panel discussion, John E. Grant, MD, from the Department of Psychiatry and Behavioral Neuroscience at the University of Chicago, Illinois, noted that physicians should start screening all patients for this disorder. He noted that clinicians already ask patients if they are smoking, drinking, or using drugs; therefore, it is a simple matter to ask if there are other behaviors they feel are out of control.

In a press release, Dr. Goudriaan explained, “When the brain of problem gamblers was activated more during the expectation phase of gambling [before the outcome of the game], this was associated with a higher level of intense, urgent, or abnormal desire (craving) to take up gambling activities.” The release also noted that the finding may have important implications for future treatments of the disorder. Dr. Goudriaan noted, “When thinking of neuromodulation, the possibility of stimulating the cognitive-control system by implementing high-frequency repeated Transcranial Magnetic Stimulation (rTMS), and thus diminishing the responsivity of the response system, may provide a new way of normalizing the abnormal neural mechanism...as an add-on treatment combined with cognitive behavioral therapy.” Dr. Goudriaan and her team added that studies are currently being conducted to test whether rTMS can change reward-responsivity in patients who are alcohol dependent.

Reference: 25th European College of Neuropsychopharmacology (ECNP) Congress