Gamblor’s World

Posted: 21 November 2007 | Subscribe Online writes Natalie Valios

You probably don’t see yourself as a gambler. But many of us - about 32 million to be precise - have participated in some form of gambling in the past year. And when you look at the number of ways in which we can lose our money - from playing the National Lottery, bingo or gaming machines to betting on the horses, doing the football pools or visiting casinos - odds are that most of us gamble more often than we believe.

Since the Gambling Act 2005 relaxed rules on advertising for casinos and online gambling sites and introduced powers to license so-called super-casinos, fears have been raised about a possible surge in problem gamblers. Just before the British Gambling Prevalence Survey 2007 was published two months ago there was a flurry of media stories predicting exactly this.

But they were wrong. Contrary to speculation, the number classed as problem gamblers - more than 250,000 - is about the same as in the last prevalence survey in 1999. And the number of adults who gamble has fallen by about one million in the past eight years.

However, with more than £10bn expected to be lost by punters next year, Mark Griffiths, professor of gambling studies at Nottingham Trent University, denies claims of scaremongering over the problem.

“People seem to think there’s no problem because it has stabilised,” says Griffiths, who co-authored the prevalence study. “But a quarter of a million adult problem gamblers is a public health issue.

“Problem gambling can negatively affect significant areas of a person’s life, including their physical and mental health, employment, finances and relationships.”

continued at

from http://news.yahoo.com/s/nm/20070624/tc_nm/addiction_videogames_dc_1&printer=1;_ylt=AtaXCrGaowz9GvVrnObpxQJU.3QA

By Julie Steenhuysen
Sun Jun 24, 7:55 PM ET

Doctors backed away on Sunday from a controversial proposal to designate video game addiction as a mental disorder akin to alcoholism, saying psychiatrists should study the issue more.

Addiction experts also strongly opposed the idea at a debate at the American Medical Association’s annual meeting.

They said more study is needed before excessive use of video and online games — a problem that affects about 10 percent of players — could be considered a mental illness.

“There is nothing here to suggest that this is a complex physiological disease state akin to alcoholism or other substance abuse disorders, and it doesn’t get to have the word addiction attached to it,” said Dr. Stuart Gitlow of the American Society of Addiction Medicine and Mt. Sinai School of Medicine in New York.

continued ….

from http://tc.bmj.com/cgi/reprint/1/1/37
Tobacco Control 1992; 1: 37-45

Recent developments in tobacco litigation: 1991
Richard A. Daynard

Ivanhoe Newswire, February 12, 2007

(Ivanhoe Newswire) — Roughly 3 million U.S. adults are problem gamblers, according to the National Council on Problem Gambling. Now, a new study reveals a type of medication used to treat restless legs syndrome could add to that number.

Researchers from the Mayo Clinic in Rochester, Minn., report a small number of patients became compulsive gamblers after starting treatment for restless legs syndrome, also known as RLS. The three patients were taking dopamine agonists, a class of medications used to treat restless legs syndrome and Parkinson’s.

Dopamine agonists essentially mimic the behavior of dopamine in the brain. Dopamine helps the brain control movements, which is why patients with Parkinson’s disease are prescribed dopamine agonists. Dopamine is also involved in the reward functions of the brain. The newest medications of this kind, pramipexole (Mirapex) and ropinirole (Requip), target the motivation, emotion, and reward centers of the brain. Researchers speculate the strong stimulation of those areas of the brain encourage patients to seek out pleasurable behaviors, like gambling.

Mayo Clinic researchers describe the case of a woman who, after starting treatment for restless legs syndrome, developed an uncontrollable urge to gamble. The patient reported no previous history of gambling. She eventually gambled away more than $140,000. Once she stopped taking ropinirole, she completely lost the urge to gamble.

This article was reported by Ivanhoe.com, which offers Medical Alerts by e-mail every day of the week. To subscribe, click on: http://www.ivanhoe.com/newsalert/.

SOURCE: NEUROLOGY, 2007; 68:301-303

ED. - One of the factors contributing to RLS is low iron consumption (easily checked through blood tests for ferriten and RBC). I do hope that physicians are ruling out physical factors such as low iron before putting patients on dopamine agonists. Low iron is endemic in most societies at this time for women but many physicians do not run these routine blood tests. Fatigue, depression, shortness of breath on exertion, hair loss, bruising, restless leg syndrome can all be related to low ferritin levels.

Peter Andrew Sacco, Ph.D.

February 16, 2007, American Chronicle

So much concern is placed on the individual who has a gambling addiction. Of course, treating an individual with a gambling addiction is very important. What about the families of those with gambling addictions? Often times as a society we forget about the loved ones of those with addictions. Like alcoholism, concern must be shown for the family members of those with gambling addictions.

I have heard so many anecdotal stories, fact and fiction about how gamblers attend places like casinos and Bingos and leave their children in the car while they go and engage in their habit or addiction. I have also heard stories of how some gamblers blow their weekly savings or social security cheques on gambling. Instead of buying food and clothing for their children, many spend it on gambling, as well as alcohol and cigarettes, the other two vices which often times trigger and co-exist with gambling addictions.

There is no doubt that gambling is a mental illness. No matter how hard people try to avoid gambling, they seem to find their way back to their specific gambling niche. Gambling is a very unique addiction in that anything can become a potential wager! Think about it…a gambler is trying to kick the addiction and is doing well. Whenever someone is striving for total abstinence, they are to avoid any and all triggers and stimulus which are associated with gambling. So, you have this individual who does not buy lottery tickets, avoids raffles and most of all, avoids casinos. They are doing really well. One day, a friend or co-worker challenges them to something saying…” I’ll bet you a cup of coffee I can get my work done faster than you..” or something like that. As harmless as this sounds, this has the potential for the gambler to throw themselves right back into their addiction. Remember, it is usually not the winning or losing which produces the high, rather the anticipation and adrenaline rush which satiates and drives the gambler. In reality, they are always one wager away from falling back into the vice.

Gamblers have to be aware at all times what there addiction means to the loved ones around them. Often times, addicts neglect their loved ones either emotionally and/or physically. Children are affected the most. Children are not able to think logically and abstractly and often times perceive themselves as a contributing factor toward their parent’s miserable moods. Addictions have a powerful influence on a child’s self-esteem and self-confidence. The attitudes and beliefs children develop being around an individual with a chronic addiction often times leads to problematic behaviors in the child.

All addictions are bad and very detrimental to one’s health. Gambling however is one of those types of addictions where immediate effects are felt in the family. Bottom line: You can lose your house and the shirt off of your back in minutes. More so with gambling than the other addictions are there greater consequences. In other addictions, it usually takes time for the individual to progress and develop a tolerance, whereby they require more and more to produce the same high. Eventually, they hit rock bottom in time. With gambling, one doesn’t have to wait to hit rock bottom over a period of time.

One can go from financially secure to broke in a matter of minutes. With many addictions, addicts take a false sense of pride in trying to cover it up. With gambling, addicts feel a false sense of pride when they are losing and for many, they this pride kicks into desperation as they try to recoup their loses. They bargain with themselves and feel the need to win back what they lost, if not for themselves, for their family. I have heard stories about people losing so much money in one gambling episode, they could not face their loved ones and they chose to run away or even commit suicide.

When I hear stories about people trying to support themselves and families through gambling, it makes me cringe. In essence, those using entire social security cheques, unemployment cheques, and savings to “better” their lives are only fooling themselves. Worst of all, they literally are “gambling” with their children’s lives! There is a famous quote which asserts, “today’s catchers are tomorrow’s pitchers”. This translated… children and teens learn through what they see and who they look up too! Don’t believe me, refer to Albert Bandura’s Social Learning Theory.

On-line gaming has become one of Internet’s biggest businesses next to pornography. Every child and teen from this generation on will be exposed to on-line gaming. The amount of children and teens playing on-line games is staggering. At what point will children and teens stumble into on-line gaming, or better yet find it purposefully because their parent(s) taught them gambling was a great, exciting activity?

As Editor-in-Chief of Vices magazine and President of the Vices Foundation (www.vicesmagazine.com) I am concerned with our most prized possession and resource, children. Children truly are our future. We have reaped and raped our planet, environment and earth of natural resources and nature’s wonders. Children are a commodity to be loved, cherished and mentored. We need to monitor today’s child and prevent them from becoming tomorrow’s problem gambler! If anyone wants to join our foundation which focuses on addiction, habits and mental health, I invite you to visit www.vicesmagazine.com or e-mail me at psychedr@caninet.com. We are always looking for new writers who have something positive to say, fundraisers and volunteers who want to help out in some capacity, and people helping us help others with illness. I extend my gratitude and warmest regards to your continued happiness and good health!

American Chronicle

ED. I have a problem with the statement: “There is no doubt that gambling is a mental illness.” It is my opinion that gambling and problem gambling, like alcohol and drug problems, exist along a continuum from not gambling at all to spending much of one’s time, energy and resources in gambling activities (problem/pathological gambling). Imagine if the author stated categorically: “There is no doubt the drinking alcohol is a mental illness”. This simply is not true. Many people drink alcohol socially, with meals and in moderation. Conversely, many people do gamble (play the lottery, etc.) without harming themselves or others.

Another problem with such a categorical statement, in my opinion, is that it lumps all forms of gambling into one category. The current research in the problem gambling field indicates that Electronic Gambling Machines (EGMs) or slots/video lottery terminals have the highest risk potential for gambling addiction at this time.

The WAGER Volume 12, Number 1 - January 3, 2007

Where the Chips Fall:
Another Look at Disordered Gambling and Other Psychiatric Disorders

Past research has shown that people with gambling problems are at higher risk for comorbid disorders, particularly substance use disorders, than the rest of the population (see WAGER 10(12)), and that people with psychiatric disorders are at higher risk than others for gambling problems (Crockford & el-Guebaly, 1998; Shaffer, Hall, & Vander Bilt, 1999). However, this research is constrained by small samples and questionable measures. This week’s WAGER focuses on a recent study of pathological gambling among a large sample of psychiatric outpatients using a structured diagnostic interview.

Zimmerman, Chelminski, and Young (2006) measured psychiatric disorders among a sample of 1,709 people seeking treatment as outpatients at a psychiatric clinic in Rhode Island. Patients in the sample either carried health insurance or were able to afford services at the clinic. Sixty-two percent of participants were female and 87% were White. Interviewers assessed participants for all DSM Axis I disorders using the Structured Clinical Interview for DSM-IV (SCID) and a DSM-IV-based module for pathological gambling (PG). Table 1 displays the prevalence rates of the assessed disorders and their comorbidity with PG.

Zimmerman and colleagues found that 2.3% of the outpatient sample qualified for a lifetime diagnosis of PG. As Table 1 shows, PGs were more likely to have experienced bipolar disorder, social phobias, alcohol use disorders, and other impulse control disorders in their lifetime than the rest of the sample. PGs also experienced significantly more comorbidity during their lifetime than others in the sample, averaging 4.7 disorders. Twelve outpatients (0.7%) had current diagnoses of PG, but only three were seeking treatment through the clinic for PG.

These results indicate that lifetime PG rates are slightly elevated among psychiatric outpatients compared to rates found in the general population (i.e., 1.35%-1.85%: Shaffer et al., 1999), but that current rates are not (i.e., 0.7% compared to 0.90-1.38%: Shaffer et al., 1999). However, psychiatric outpatients who qualify for PG have significantly greater comorbidity than other outpatients.

There are a few limitations to the current study. The sample was located in a single geographic area. Because the clinic required insurance or out-of-pocket expense, the clinic population had higher SES than many people with psychiatric disorders. Both of these factors limit the generalizability of the findings. Finally, the clinic did not specialize in substance use disorders, which are known to be highly comorbid with PG; it is plausible that the comorbidity pattern would be different in a population with primary diagnoses of substance use disorders.

The findings from this study confirm the comorbidity of PG with other psychiatric disorders, but provide some evidence that PG is not particularly elevated among psychiatric samples compared to the rest of the population. Future research needs to begin to examine the temporal patterns of PG and other psychiatric disorders, identifying how much these disorders co-occur in time and whether certain disorders tend to precede or follow PG.

What do you think? Comments on this article can be addressed to Sarah Nelson at basis@basisonline.org.

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References

Crockford, D. N., & el-Guebaly, N. (1998). Psychiatric comorbidity in pathological gambling: A critical review. Canadian Journal of Psychiatry, 43(1), 43-50.

Shaffer, H. J., Hall, M. N., & Vander Bilt, J. (1999). Estimating the prevalence of disordered gambling behavior in the United States and Canada: A research synthesis. American Journal of Public Health, 89(9), 1369-1376.

Zimmerman, M., Chelminski, I., & Young, D. (2006). Prevalence and diagnostic correlates of DSM-IV pathological gambling in psychatric outpatients. Journal of Gambling Studies, 22, 255-262.

http://www.basisonline.org/wager/current.htm

By SHAWN LOGAN, Calgary Sun, Wed, January 3, 2007, Calgary Sun

Anti-smoking advocates are fuming over the city’s new smoking bylaw they say may be too hazy because it allows too many exemptions.

The fast-tracked legislation, which came into effect on New Year’s Day, included one-year exemptions for bingos, casinos and facilities with pre-existing smoking rooms.

And with some establishments spoiling to oppose the bylaw over concerns city council has created an uneven playing field, crusaders that pushed for the butt ban say the city should have cleared the air by declaring all of Calgary smoke-free.

Linette Soldan of Smoke Free Calgary said the exemptions may have watered down the spirit of the bylaw and could cause problems.

“Unfortunately, as soon as the amendments started to come in, this is where the loopholes come about,” she said.

“It’s nice that we’re getting it a year earlier than we thought, but it might not be going the way we hoped it would.”

Soldan said her group will continue to work with the city’s bylaw enforcement department to ensure businesses are complying.

Copyright © 2006, Canoe Inc. All rights reserved.

http://www.northernlife.ca/News/PoliceandCourt/2006/01-03-07-tribunal.asp?NLStory=01-03-07-tribunal

Tribunal agrees Sudbury men discriminated against

Date Published | Jan. 2, 2007

BY KEITH LACEY

After a seven-year battle, a provincial tribunal has ruled two Greater Sudbury men were discriminated against and had their human rights violated after being denied a disability pension based on the fact both are alcoholics.

However, the Ontario government ruled it would be appealing a decision of Ontario’s Social Benefits Tribunal (SBT), which oversees appeals from citizens who have been denied access to the Ontario Disability Support Program (ODSP) and Ontario Works (OW).

The two local men, Norm Werberski and Robert Tranchemontagne, both applied for a disability pension back in 1999.

Tranchemontagne claimed he suffered from back pain, seizures and alcoholism. His claim was denied by the director of ODSP of the Ministry of Community and Social Services in September 1999 on the basis he did not have a substantial physical or mental impairment as defined by the ODSP Act.

Werberski applied for ODSP benefits in October of 1999 as a person with a disability relying on impairments related to alcohol and drug dependence, antisocial personality disorder, depression, insomnia and poor motivation.

His application was denied in December of 1999. The tribunal found Werberski’s only substantial impairment was due to his alcoholism and, therefore, he was ineligible for ODSP benefits.

Werberski has qualified for ODSP for some time now, but based on other health problems.

Both men approached the Sudbury Legal Clinic and for the past seven years, lawyers, including Terry Copes, have been fighting their case, first before Ontario’s Divisional court, Ontario Court of Appeal, then the Supreme Court of Canada and earlier this year before the SBT.

Copes received the news recently the government would be appealing, which will likely drag this case on for at least another year.

Canada’s highest court ruled earlier this year, the SBT “is presumed able to consider any legal source that might influence its decision on eligibility” and Ontario’s Human Rights Code is one such source. The Supreme Court also ordered the SBT to again fully review appeals by Tranchemontagne and Werberski.

In a 23-page ruling released a couple of weeks ago, the SBT ruled a section of the ODSP Act contravenes the Human Rights Code.

That section included a clause that a person would not be eligible for income support if the person is dependent on alcohol or addicted to alcohol, a drug or some other chemically active substance.

After reviewing testimony from the appeal process and applying legal tests, the SBT ruled both Sudbury men had their human rights violated by being denied ODSP benefits.

“In reaching this conclusion, the tribunal finds the appellants have been discriminated against not just because of their addiction, but because of how they became addicted…the ODSP act accords different treatment to the appellants on the basis of how they became addicted rather than on the basis of disability.

“The tribunal has no difficulty in accepting this treatment not only places the appellants at a disadvantage as compared to other persons with the same disability, but also stigmatizes the appellants.

“The tribunal is satisfied the appellants would have been found to be persons with a disability at the initial tribunal hearings had it not been for subsection 5(2) of the ODSPA. Now that that section has been found to violate the appellants’ rights under the code, the tribunal finds the appellants are persons with a disability and are entitled to income support under the ODSPA.”

Copes, who made final arguments on this case back in September, said both clients are thrilled with the decision.
The provincial government has made it clear the SBT doesn’t have the authority to “make blanket decisions” and other citizens who believe they have been denied ODSP benefits because of alcoholism would have to present their own cases, said Copes.

“The decision only binds the provinces on these two individuals and anyone else with similar claims in a similar situation will have to go through the process and bring their case to the SBT,” he said. “The province has made it clear the SBT can only rule on each case on its own merits, but that being said, the SBT decision is clear and others in similar circumstances who make similar arguments should expect similar decisions,” he said.

Both clients continue to have problems with their alcoholism, which has long ago been recognized in society as a disease, said Copes.

This case has long-reaching ramifications, said Copes.

“I think it clearly shows the government can’t single out one particular group, in this case people with alcohol addictions, and treat them differently from everyone else,” he said.

In this case, government lawyers didn’t try and argue alcoholism wasn’t a disease, but instead strongly suggested there were treatment and counselling programs available, said Copes.

The problem was the programs they suggested are only now available in 15 of 47 municipalities across Ontario and none of them were available to either Sudbury men when benefits were denied back in 1999, said Copes.

Both men will “automatically qualify” for substantial retroactive benefits dating back to 1999 if the SBT decision stands following the appeal process, he said

ED. - I expect that the same argument could be made in terms of problem gamblers.

http://ajp.psychiatryonline.org/cgi/content/full/164/1/4

Am J Psychiatry 164:4-6, January 2007
doi: 10.1176/appi.ajp.164.1.4
© 2007 American Psychiatric Association

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Editorial

To Do or Not To Do? The Complexities of Addiction, Motivation, Self-Control, and Impulsivity
Marc N. Potenza, M.D., Ph.D.
Addictions exact tremendous individual and familial suffering, costing U.S. society over $500 billion annually (1). An improved understanding of the neurobiological correlates of addictions should substantially inform the development of improved prevention and treatment strategies for these disorders that often respond suboptimally to currently available interventions. The study of cocaine-abusing and nonaddicted subjects by Goldstein and colleagues makes important contributions to the understanding of addictions. The study examines the relationship between motivation and self-control and brain activations during the processing of monetary rewards. Self-reported task engagement and reward-related performance were correlated in nonaddicted subjects but not among cocaine-abusing ones. Nonaddicted subjects showed correlated activation of prefrontal and orbitofrontal cortical circuitry during reward processing that was disrupted among cocaine-abusing people. In contrast, among cocaine-abusing subjects but not comparison ones, trait measures of motivation and self-control were associated with lateral prefrontal cortical activation. Thus, this study provides empirical support for disrupted neural processing of nondrug rewards in cocaine abuse.

Addictions involve continued behavioral engagement despite adverse consequences and have been conceptualized as disorders of misdirected motivation and impaired self-control (2–4). Addicted individuals tend to select preferentially small immediate rewards over larger delayed ones, a process termed delay discounting (4). This tendency has important clinical implications because risky, disadvantageous, or impulsive decision-making has been correlated with adverse measures of real-life functioning in addicted groups and those at risk for addiction, such as adolescents (5, 6). Moreover, treatments that provide small immediate rewards for abstinence, such as contingency management, have demonstrated efficacy in the short-term treatment of addiction (7). As such, the identification of differences in the neural correlates of monetary reward processing and their relationships to measures of self-control and motivation in cocaine-abusing versus nonaddicted groups lays important groundwork for the development of improved prevention and treatment strategies. Future important steps in this process involve parsing reward processing into its core components in addicted individuals (8); examining specific elements of motivation and self-control in relationship to addictions; evaluating the generalizability to other addictions; and studying the relationships between motivation, self-control, and reward processing in individuals at various stages of the addiction process. In particular, the extent to which reward processing differences related to motivation and self-control are evident in at-risk individuals and may be “normalized” in addicted people with behavioral and/or pharmacological interventions warrants additional investigation.

The article by Goldstein et al. has important psychiatric implications extending beyond addictions. Impulsivity represents a quantifiable phenotype early in the path leading to addictions and other psychiatric conditions (8). Impulsivity is relevant to many psychiatric disorders and has been defined as “a predisposition toward rapid, unplanned reactions to internal or external stimuli [with diminished] regard to the negative consequences of these reactions to the impulsive individual or others” (9). This definition not only overlaps with ones for addiction (4) but also indicates that impulsivity is complex and multifaceted. Hence, understanding how specific elements contributing to impulsivity (e.g., response inhibition, reward saliency, punishment sensitivity) relate to specific psychiatric disorders should help optimize prevention and treatment strategies for not only addictions but also other mental health disorders. The articles authored by Hong et al., Leibenluft et al., and Pat-Horenczyk et al. highlight the complexity of impulse regulation and its relevance across diagnostic boundaries. Hong and colleagues report that two measures of sensory gating in schizophrenia are inversely or largely unrelated, suggesting that there exist multiple independent components of inhibitory function in schizophrenia. These findings echo those in the article by Goldstein and colleagues, in which one measure related to impulsivity (reaction time) was inversely correlated with another (subject-reported self-control) in cocaine-abusing subjects but not nonaddicted ones. Leibenluft and colleagues report neural correlates of unsuccessful motor inhibition in children with bipolar disorder in medicated and unmedicated states and with and without attention deficit hyperactivity disorder. Because these two disorders are each characterized by impaired impulse control and treated with medications that diminish impulsive behaviors, dissecting the relative contributions of co-occurrence and pharmacotherapy is not only important in understanding the neuroimaging findings but also clinically relevant. Pat-Horenczyk and colleagues examine the relationship between terrorism exposure and risk-taking behaviors. These findings highlight the impact of exposure to potentially stressful or traumatic events on risk-taking during adolescence. The importance of considering sex differences in understanding the relationship between environmental risk factors and engagement in behaviors characterized by impaired impulse control is highlighted as boys showed a stronger correlation than girls between posttraumatic symptoms and risk-taking. Together, these four studies reinforce the notion that impulsivity and related constructs are not only relevant to multiple psychiatric disorders but are also complex phenomena influenced by multiple environmental and biological factors. A society devoted to the study of impulsivity and impulse control disorders (the International Society for Research on Impulsivity; http://www.impulsivity.org) was recently created to advance scientific work in this area. It is anticipated that such work will better define the biology of impulsivity and its relationship to psychiatric health and illness and that this understanding will help generate improved prevention and treatment strategies for addictions and other disorders characterized by impaired impulse control.
Footnotes

From the Problem Gambling Clinic and the Women and Addictive Disorders Core, Women’s Health Research, Yale University; the Neuroimaging Section, MIRECC, West Haven Veterans Affairs Hospital, West Haven, Conn.; and the Department of Psychiatry, Yale University School of Medicine. Address correspondence and reprint requests to Dr. Potenza, Yale University School of Medicine, Connecticut Mental Health Center, Rm. S-104, 34 Park St., New Haven, CT 06519; marc.potenza@yale.edu (e-mail).Dr. Potenza has received research support from the NIH (National Institute on Drug Abuse, National Institute on Alcohol Abuse and Alcoholism), the U.S. Department of Veterans Affairs, the Connecticut Department of Mental Health and Addictive Services, Women’s Health Research at Yale University, OrthoMcNeil, and Mohegan Sun. He has consulted for Boehringer Ingelheim and Somaxon and has financial interests in Somaxon. Dr. Freedman has reviewed this editorial and found no evidence of influence from these relationships.

References

Uhl GR, Grow RW: The burden of complex genetics in brain disorders. Arch Gen Psychiatry 2004; 61:223–229[Abstract/Free Full Text]
Goldstein RZ, Volkow ND: Drug addiction and its underlying neurobiological basis: neuroimaging evidence for the involvement of the frontal cortex. Am J Psychiatry 2002; 159:1642–1652[Abstract/Free Full Text]

Chambers RA, Taylor JR, Potenza MN: Developmental neurocircuitry of motivation in adolescence: a critical period of addiction vulnerability. Am J Psychiatry 2003; 160:1041–1052[Abstract/Free Full Text]

Potenza MN: Should addictive disorders include non-substance-related conditions? Addiction 2006; 101(suppl 1):142-151

Bechara A: Risky business: emotion, decision-making, and addiction. J Gambling Stud 2003; 19:23–51[CrossRef]

Lejuez C, Aklin WM, Zvolensky MJ, Pedulla CM: Evaluation of the balloon analogue risk task (BART) as a predictor of adolescent real-world risk-taking behavior. J Adolesc 2003; 26:475–479[CrossRef][Medline]

Carroll KM, Onken LS: Behavioral therapies for drug abuse. Am J Psychiatry 2005; 162:1452–1460[Abstract/Free Full Text]

Kreek MJ, Nielsen DA, Butelman ER, LaForge KS: Genetic influences on impulsivity, risk-taking, stress responsivity and vulnerability to drug abuse and addiction. Nat Neurosci 2005; 8:1450–1457[CrossRef][Medline]

Moeller FG, Barratt ES, Dougherty DM, Schmitz JM, Swann AC: Psychiatric aspects of impulsivity. Am J Psychiatry 2001; 158:1783–1793[Abstract/Free Full Text]

Related Article:

In This Issue
Am J Psychiatry 2007 164: 52. [Full Text]

By David Helwig, SooToday.com, Tuesday, December 19, 2006

NEWS RELEASE, UNIVERSITY OF PITTSBURGH, MEDICAL CENTER

Deal or no deal? Need for immediate reward linked to more active brain region

Individual preferences correspond to magnitude of activity and may indicate risk for addictions, gambling problems

PITTSBURGH, Dec. 19 - Deal or No Deal? How people might play this popular game show - whether they would likely accept an offer for quick cash or opt to hold out for the chance to take home $1 million - probably has less to do with what could be inside each briefcase than what’s inside each contestant’s brain, suggests results of a new study.

University of Pittsburgh investigators didn’t study any of the game’s players nor did they offer stakes nearly as high, but their research in 45 normal adult volunteers, who were taunted with the prospect of getting between 10 cents and $105 at that very moment or waiting one week to five years for a sure $100, provides new insight about reward-based decision making and may have implications for understanding and treating addiction disorders.

Not only do people differ in their preferences for immediate over delayed rewards of larger value, say the researchers in the Journal of Neuroscience, but these individual traits are mirrored by the level of activity in the ventral striatum, a key part of the brain’s circuitry involved in mediating behavioural responses and physiological states associated with reward and pleasure.

Research volunteers classified as more impulsive decision makers, who tend to seek rewards in the here and now, had significantly more activity in the ventral striatum.

The preference for immediate over delayed rewards of larger value, which researchers term “delay discounting,” has already been linked to impulse-control problems, such as substance abuse, addiction and pathological gambling.

And separate studies have shown that people with addiction disorders have a more active ventral striatum.

The current study is the first to look at the relationship between individual differences in discounting behavior and individual ventral striatum activity, which in finding a strong connection between brain and behavior in normal subjects suggests the same neurocognitive mechanism could contribute to increased risk for addiction as well.

“The ventral striatum appears to be a nexus where we balance acting impulsively to achieve instant gratification and making prudent choices that may delay rewards. Understanding what drives individual differences in ventral striatal sensitivity could aid efforts to treat people who have difficulty controlling impulsive behavior, by adjusting the circuitry,” explained lead author, Ahmad R. Hariri, Ph.D., assistant professor of psychiatry and director of the Developmental Imaging Genetics Program at the University of Pittsburgh School of Medicine and Western Psychiatric Institute and Clinic.

Based on their findings, Dr. Hariri and his colleagues are now looking at whether ventral striatum activity can help predict substance abuse disorders in those at risk.

Since the activity of the ventral striatum is modulated by dopamine, a brain chemical also associated with reward, they plan to explore the role that variations in dopamine-related genes may play in determining differences in ventral striatum reactivity.

“Addiction and problem gambling represent behaviors on the extreme end of the continuum. But even in the most common, day-to-day situations, reward-based decisions dictate how we behave. For example, individual preferences for immediate versus delayed rewards could explain why some can’t resist the temptation of dessert, an immediate gratification, while others will opt for a five-mile run knowing it will help shed pounds, a delayed gratification,” added Dr. Hariri. “Food, sex and money are all sources of pleasure, yet individuals differ greatly in the rewarding aspects they derive from these pleasures.”

In the study, subjects completed a computer-based task of delay discounting that required choices between immediate and postponed rewards - a laboratory version of Deal or No Deal that gives investigators a reliable index of each volunteer’s impulsive tendencies.

Subjects had to choose between hypothetical amounts of money available to them that day, ranging from 10 cents to $105, and $100 that would be given after seven days, one month, three months, six months, one year or five years.

Based on their cumulative choices, a switch-point value was calculated for each volunteer - the specific dollar amount that caused indifference about receiving the money now or later.

After several months, fMRI brain imaging studies were performed to determine each subject’s ventral striatum activity during a task that measures positive and negative feedback in anticipation of a monetary reward.

Each volunteer was told that the amount they would receive depended on how well they performed in a card guessing game, yet the researchers fixed the odds and all subjects were paid $10.

The researchers found that individual differences in discounting behavior, as determined by the first test, corresponded with the magnitude of ventral striatum activity.

Positive feedback produced the greatest activity, especially in those with a preference for immediate rewards.

The study’s volunteers comprised participants in the Adult Health and Behavior project, in which researchers being led by Stephen Manuck, Ph.D., professor of psychology at the University of Pittsburgh’s School of Arts and Sciences and a co-author of the Journal of Neuroscience paper, are assessing a wide range of behavioral and biological traits among non-patient, middle-aged, community volunteers.

In addition to Drs. Hariri and Manuck, other authors were Sarah M. Brown, and Douglas E. Williamson, Ph.D., department of psychiatry, University of Pittsburgh School of Medicine; Janine D. Flory, Ph.D., formerly of Mount Sinai School of Medicine and now at Queens College, New York City; and Harriet de Wit, Ph.D., department of psychiatry, University of Chicago.

The research was supported by the National Institute of Mental Health and the National Heart, Lung, and Blood Institute, both of the National Institutes of Health, and by a NARSAD Young Investigators Award given to Dr. Hariri.

Copyright ©2005 SooToday.com