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      Problem gamblers share deficits in impulsive decision-making with alcohol-dependent individuals

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          Abstract

          Aims

          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.

          Design

          Cross-sectional study.

          Setting

          Out-patient addiction treatment centres and university behavioural testing facilities.

          Participants

          A naturalistic sample of 21 male problem and pathological gamblers, 21 male alcohol-dependent out-patients and 21 healthy male control participants.

          Measurements

          Neurocognitive battery assessing decision-making, impulsivity and working memory.

          Findings

          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.

          Conclusions

          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.

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          Most cited references64

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          Diagnostic and statistical manual of mental disorders.

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            Impulsivity as a vulnerability marker for substance-use disorders: review of findings from high-risk research, problem gamblers and genetic association studies.

            There is a longstanding association between substance-use disorders (SUDs) and the psychological construct of impulsivity. In the first section of this review, personality and neurocognitive data pertaining to impulsivity will be summarised in regular users of four classes of substance: stimulants, opiates, alcohol and 3,4-methylenedioxymethamphetamine (MDMA). Impulsivity in these groups may arise via two alternative mechanisms, which are not mutually exclusive. By one account, impulsivity may occur as a consequence of chronic exposure to substances causing harmful effects on the brain. By the alternative account, impulsivity pre-dates SUDs and is associated with the vulnerability to addiction. We will review the evidence that impulsivity is associated with addiction vulnerability by considering three lines of evidence: (i) studies of groups at high-risk for development of SUDs; (ii) studies of pathological gamblers, where the harmful consequences of the addiction on brain structure are minimised, and (iii) genetic association studies linking impulsivity to genetic risk factors for addiction. Within each of these three lines of enquiry, there is accumulating evidence that impulsivity is a pre-existing vulnerability marker for SUDs.
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              Nucleus accumbens D2/3 receptors predict trait impulsivity and cocaine reinforcement.

              Stimulant addiction is often linked to excessive risk taking, sensation seeking, and impulsivity, but in ways that are poorly understood. We report here that a form of impulsivity in rats predicts high rates of intravenous cocaine self-administration and is associated with changes in dopamine (DA) function before drug exposure. Using positron emission tomography, we demonstrated that D2/3 receptor availability is significantly reduced in the nucleus accumbens of impulsive rats that were never exposed to cocaine and that such effects are independent of DA release. These data demonstrate that trait impulsivity predicts cocaine reinforcement and that D2 receptor dysfunction in abstinent cocaine addicts may, in part, be determined by premorbid influences.
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                Author and article information

                Journal
                Addiction
                add
                Addiction (Abingdon, England)
                Blackwell Publishing Ltd
                0965-2140
                1360-0443
                June 2009
                : 104
                : 6
                : 1006-1015
                Affiliations
                [1 ]simpleBehavioural and Clinical Neuroscience Institute, University of Cambridge Cambridge, UK
                [2 ]simpleDepartment of Experimental Psychology, University of Cambridge Cambridge, UK
                [3 ]simpleSouthend Community Drug and Alcohol Service, South Essex Partnership NHS Trust Essex, UK
                [4 ]simpleDerwent Centre, North Essex Partnership Foundation Trust Harlow, Essex, UK
                [5 ]simpleDepartment of Psychiatry, University of Cambridge School of Clinical Medicine Cambridge, UK
                Author notes
                Correspondence to: Luke Clark, Behavioural and Clinical Neuroscience Institute, Department of Experimental Psychology, University of Cambridge, Downing Street, Cambridge CB2 3EB, UK. E-mail: lc260@ 123456cam.ac.uk
                Article
                10.1111/j.1360-0443.2009.02533.x
                2773538
                19466924
                2d12b3b6-4183-4c77-840b-c714309ccd9c
                Journal compilation © 2009 Society for the Study of Addiction

                Re-use of this article is permitted in accordance with the Creative Commons Deed, Attribution 2.5, which does not permit commercial exploitation.

                History
                : 11 June 2008
                : 25 September 2008
                : 09 January 2009
                Categories
                Research Reports

                Clinical Psychology & Psychiatry
                impulsivity,prefrontal cortex,vulnerability,decision-making,risk-taking,addiction,pathological gambling,alcohol

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