Suicidality among individuals with gambling problems: A meta-analytic literature review.

Gambling problems have consistently been linked to suicidality, including suicidal ideation, attempts, and suicide. However, the magnitude of the relationship has varied significantly across studies and the potential causal link between gambling problems and suicidality is currently unclear. A meta-analytic literature review was conducted to (a) synthesize pooled prevalence rates of suicidality among individuals with gambling problems; (b) determine if individuals with gambling problems had an increased likelihood of reporting suicidality compared to individuals without gambling problems; and (c) review evidence on causality and directionality. A search in Web of Science, APA PsycInfo, APA PsycNet, Medline, CINAHL, ProQuest, Embase, and Google Scholar electronic databases identified 107 unique studies (N = 4,691,899) that were included for review. Studies were included if they were available in any European language and provided sufficient data for the calculation of prevalence rates or effect sizes. Two researchers extracted the data independently using a predefined coding schema that included the Newcastle-Ottawa Quality Assessment Scale. Random-effects meta-analyses yielded pooled prevalence rates of 31.6% (95% CI [29.1%, 34.3%]) for lifetime suicidal ideation and 13.2% (95% CI [11.3%, 15.5%]) for lifetime suicide attempts. Individuals with gambling problems had significantly increased odds of reporting lifetime suicidal ideation (OR = 2.17, 95% CI [1.90, 2.48]) and lifetime suicide attempts (OR = 2.81, 95% CI [2.23, 3.54]) compared to individuals without gambling problems. Two studies reported that individuals with pathological gambling had an increased risk of dying by suicide. Metaregression analyses suggested that the risk of study bias was positively related to the prevalence rates of suicidal ideation. Sex proportions were found to moderate the odds of suicidal ideation, but the direction of the effect was inconsistent. For suicide attempts, psychiatric comorbidity and sample size were positively and inversely, respectively, associated with prevalence rates. The synthesis indicates that suicidality is common among individuals with gambling problems and hence should be addressed by help agencies. Inferences on causality and directionality are hampered by a lack of longitudinal studies. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Plasma concentration of leptin is related to food addiction in gambling disorder: Clinical and neuropsychological implications.

Background: Data implicate overlaps in neurobiological pathways involved in appetite regulation and addictive disorders. Despite different neuroendocrine measures having been associated with both gambling disorder (GD) and food addiction (FA), how appetite-regulating hormones may relate to the co-occurrence of both entities remain incompletely understood. Aims: To compare plasma concentrations of ghrelin, leptin, adiponectin, and liver-expressed antimicrobial peptide 2 (LEAP-2) between patients with GD, with and without FA, and to explore the association between circulating hormonal concentrations and neuropsychological and clinical features in individuals with GD and FA. Methods: The sample included 297 patients diagnosed with GD (93.6% males). None of the patients with GD had lifetime diagnosis of an eating disorder. FA was evaluated with the Yale Food Addiction Scale 2.0. All patients were assessed through a semi-structured clinical interview and a psychometric battery including neuropsychological tasks. Blood samples to measure hormonal variables and anthropometric variables were also collected. Results: From the total sample, FA was observed in 23 participants (FA+) (7.7% of the sample, 87% males). When compared participants with and without FA, those with FA+ presented both higher body mass index (BMI) (p < 0.001) and leptin concentrations, after adjusting for BMI (p = 0.013). In patients with FA, leptin concentrations positively correlated with impulsivity, poorer cognitive flexibility, and poorer inhibitory control. Other endocrine measures did not differ between groups. Discussion and conclusions: The present study implicates leptin in co-occurring GD and FA. Among these patients, leptin concentration has been associated with clinical and neuropsychological features, such as impulsivity and cognitive performance in certain domains.

Longitudinal associations between psychiatric comorbidity and the severity of gambling disorder: Results from a 36-month follow-up study of clients in Bavarian outpatient addiction care.

Background and aims: Individuals with gambling disorder (GD) often suffer from psychiatric comorbidities. Previous studies demonstrated greater severity of GD among gamblers with psychiatric comorbidities. However, evidence on the association between psychiatric comorbidity and course of GD severity during and after outpatient treatment is sparse. This study analyses data from a longitudinal one-armed cohort study on outpatient addiction care clients over three years. Methods: We investigated the course of GD severity using data from 123 clients in 28 outpatient addiction care facilities in Bavaria using generalized estimation equations (GEE). We applied time* interaction analyses to examine different development profiles in participants with and without (1) affective disorders, or (2) anxiety disorders, and (3) to account for the co-occurrence of both. Results: All participants benefitted from outpatient gambling treatment. Improvement in GD severity was poorer in participants with anxiety disorders compared to participants without anxiety disorders. The co-occurrence of affective and anxiety disorders was linked to a less favourable course of GD than the presence of affective disorders alone. However, the combined occurrence of both disorders was more favourable than the presence of anxiety disorders alone. Discussion and conclusions: Our study suggests that clients with GD, with and without psychiatric comorbidities, benefit from outpatient gambling care. Psychiatric comorbidity, especially comorbid anxiety disorders, seems to be negatively associated with the course of GD within outpatient gambling care. Addressing psychiatric comorbidity within the treatment of GD and offering individualised help are required to meet the needs of this clientele.

Relationship of gambling disorder with traumatic life events and emotion regulation in adolescents and young adults.

Introduction: Traumatic life events (TLE) and difficulties in emotion regulation (ER) can be considered risk factors for the development of gambling disorder in adolescents and young adults. Methods: The aim of the present study was to examine the differences in TLE, ER strategies, positive and negative affect, and gambling severity in a clinical sample of individuals undergoing treatment for gambling disorder (92.8% males; Mage = 24.83, SD = 3.80) and a healthy control group (52.4% males; Mage = 15.65, SD = 2.22). The relationship between the variables was assessed and the mediating role of ER in the relationship between TLE and gambling in the clinical sample was analysed. Results: The results showed higher scores in gambling severity, positive and negative affect, ER strategies and TLE in the clinical sample. In addition, the severity of gambling was positively correlated with TLE, negative affect and with rumination. TLE were also correlated positively with negative and positive affect, rumination ER strategies, plan focus, positive reinterpretation, and catastrophizing. Finally, rumination mediated the relationship between TLE and gambling severity. Conclusions: These findings may have relevant implications for the prevention, understanding and treatment of gambling disorder.

Acceptance and commitment therapy for co-occurring gambling disorder and posttraumatic stress disorder in veterans: a narrative review.

Background: PTSD and gambling disorder (GD) are frequently comorbid. Gambling may provide escape-based coping for the emotions experienced by PTSD sufferers. Military personnel may be at increased risk of PTSD and/or GD. Acceptance and Commitment Therapy (ACT) has been found to improve both PTSD and GD outcomes, yet research into the potential effectiveness of ACT for PTSD and/GD in veterans is scarce.Objective: This review aimed to systematically assess and describe the evidence relating to the use of ACT and acceptance-based therapy for military populations with PTSD and/or GD.Method: Six databases were searched. Selection criteria included studies that featured the armed forces/military, delivered ACT/acceptance-based therapy, and aimed to improve PTSD and/or GD outcomes. A narrative synthesis approach was adopted.Results: From 1,117 results, 39 studies were fully screened and 14 met inclusion criteria. All studies originated from the USA and 9 were associated with United States Department of Veterans Affairs. Therapy use within each study produced an improvement in PTSD and/or GD, yet only one study examined GD and no studies considered comorbid PTSD/GD. The broad range of study designs made it difficult to compare the findings or make generalisations from the collective results. It is unclear which method of ACT delivery is superior (app-based, telehealth, face-to-face, groups, one-to-one, manualised, or unstructured), or what the true effect size is of ACT for PTSD and/or GD.Conclusions: These preliminary findings are promising, yet more research is needed on the delivery format and content of ACT sessions, and whether findings generalise beyond USA-recruited military samples. The cost-effectiveness of remote-based ACT also warrants investigation.HIGHLIGHTS Among veterans, psychological interventions such as Acceptance and Commitment Therapy (ACT) may be effective for Post-Traumatic Stress Disorder (PTSD) and/or Gambling Disorder (GD).There is a paucity of evidence on ACT approaches for treating PTSD and GD in veterans.Further work is needed on context-specific delivery (in-person vs. group), method of ACT intervention (manualised vs unstructured, digital therapeutics) with non-US samples.

Problem gambling among people with first-episode psychosis: protocol for a prospective multicenter cohort study.

BACKGROUND: The limited available data suggest that the prevalence of problem gambling is increased among young adults with first-episode psychosis, possibly due in part to several risk factors for problem gambling that are common in this population. Aripiprazole, a widely used antipsychotic drug, has also been linked to cases of problem gambling, but causality remains uncertain. Although the consequences of problem gambling further hinder the recovery of people with first-episode psychosis, there is a paucity of research about this comorbidity and its risk factors. Additionally, to our knowledge, no screening instrument for problem gambling tailored to these individuals exists, contributing to its under-recognition. Further, treatment approaches for problem gambling adapted to this population are at an embryonic stage, while existing treatments effectiveness remains to be documented. Using an innovative screening and assessment procedure for problem gambling, this study aims to identify risk factors for problem gambling among people with first-episode psychosis and to document the effectiveness of standard treatment approaches. METHODS: This is a multicenter prospective cohort study conducted in two first-episode psychosis clinics, including all patients admitted between November 1st, 2019, and November 1st, 2023, followed for up to 3 years until May 1st, 2024. These 2 clinics admit approximately 200 patients annually, for an expected sample size of 800 individuals. The primary outcome is the occurrence of a DSM-5 diagnosis of gambling disorder. All patients are screened and evaluated for problem gambling using a systematic procedure at admission, and every 6 months thereafter. Socio-demographic and clinical variables are prospectively extracted from the patients' medical records. The nature and effectiveness of treatments for problem gambling offered to affected individuals are also documented from medical records. Survival analyses with Cox regression models will be used to identify potential risk factors for problem gambling. Descriptive statistics will document the effectiveness of treatments for problem gambling in this population. DISCUSSION: A better understanding of potential risk factors for problem gambling among people with first-episode psychosis will allow for better prevention and detection of this neglected comorbidity. Results of this study will also hopefully raise clinicians' and researchers' awareness and serve as the basis to adapted treatments that will better support recovery. TRIAL REGISTRATION: ClinicalTrials.gov, NCT05686772. Retrospectively registered, 9 January 2023.

Adult ADHD Diagnosis, Symptoms of Impulsivity, and Emotional Dysregulation in a Clinical Sample of Outpatients Consulting for a Behavioral Addiction.

OBJECTIVE: This study aimed to investigate ADHD in adult outpatients seeking treatment for a behavioral addiction and to identify the specificity of psychopathological features if the behavioral addiction cooccurs with adult ADHD. METHOD: Sixty-five outpatients consulting for a behavioral addiction were assessed for ADHD (DIVA-5), addictive disorder (alcohol, tobacco, cannabis, gambling, gaming, food, and sex), impulsivity (UPPS-P), and emotion dysregulation (DERS-36). RESULTS: In our sample of outpatients seeking treatment for a behavioral addiction, adult ADHD was independently associated with higher compulsive sexual behavior disorder severity, "sensation seeking," "positive urgency," difficulties in "goal-directed behavior," "impulse control," and use of "emotion regulation strategies" in the context of intense emotions. A 29% of the sample was diagnosed for adult ADHD. CONCLUSION: The association of adult ADHD with specific dimensions of impulsivity and emotion dysregulation, pave the way for future clinical and research perspectives.

Risk Factors for Excessive Social Media Use Differ from Those of Gambling and Gaming in Finnish Youth.

PURPOSE: Adolescents' excessive social media use has characteristics similar to other addictive behaviours. This study aims to explore whether the same risk factors are associated with excessive social media use as with excessive gaming and gambling among Finnish adolescents. METHODS: Multinomial logistic regression analyses were carried out using the European School Survey Project on Alcohol and Other Drugs data, collected from Finnish adolescents aged 15-16 in 2019 (n = 4595). RESULTS: Excessive use of social media was more common among girls (reported by 46% of respondents) than boys of the same age (28%), whereas boys reported both excessive gaming (23%) and gambling (6%) more often than girls (4% and 1%, respectively). All differences between genders were statistically significant (p < 0.0001). Daily smoking was associated with a high risk of excessive gambling (AOR = 3.23) and low risk of excessive gaming (AOR = 0.27) but had no significant effect on excessive social media use. Cannabis use in the past 12 months was positively associated only with excessive gambling (AOR = 2.39), while past 12 months alcohol consumption increased the risk for excessive social media use (AOR = 1.25). CONCLUSIONS: Adolescent girls are at greater risk of excessive social media use than boys, while boys are at greater risk of excessive gaming and gambling. The associations with known risk factors are somewhat different for excessive use of social media as compared to excessive gambling and gaming and should be acknowledged when developing preventive measures for adolescents.

Computational basis of decision-making impairment in multiple sclerosis.

BACKGROUND: Multiple sclerosis (MS) is commonly associated with decision-making, neurocognitive impairments, and mood and motivational symptoms. However, their relationship may be obscured by traditional scoring methods. OBJECTIVES: To study the computational basis underlying decision-making impairments in MS and their interaction with neurocognitive and neuropsychiatric measures. METHODS: Twenty-nine MS patients and 26 matched control subjects completed a computer version of the Iowa Gambling Task (IGT). Participants underwent neurocognitive evaluation using an expanded version of the Brief Repeatable Battery. Hierarchical Bayesian Analysis was used to estimate three established computational models to compare parameters between groups. RESULTS: Patients showed increased learning rate and reduced loss-aversion during decision-making relative to control subjects. These alterations were associated with: (1) reduced net gains in the IGT; (2) processing speed, executive functioning and memory impairments; and (3) higher levels of depression and current apathy. CONCLUSION: Decision-making deficits in MS patients could be described by the interplay between latent computational processes, neurocognitive impairments, and mood/motivational symptoms.

Transdiagnostic Perspective of Impulsivity and Compulsivity in Obesity: From Cognitive Profile to Self-Reported Dimensions in Clinical Samples with and without Diabetes.

Impulsive and compulsive behaviors have both been observed in individuals with obesity. The co-occurrence of obesity and type 2 diabetes (T2D) is more strongly associated with impulsivity, although there are no conclusive results yet. A multidimensional assessment of impulsivity and compulsivity was conducted in individuals with obesity in the absence or presence of T2D, compared with healthy, normal-weight individuals, with highly impulsive patients (gambling disorders), and with highly compulsive patients (anorexia nervosa). Decision making and novelty seeking were used to measure impulsivity, and cognitive flexibility and harm avoidance were used for compulsivity. For impulsivity, patients with obesity and T2D showed poorer decision-making ability compared with healthy individuals. For compulsivity, individuals with only obesity presented less cognitive flexibility and high harm avoidance; these dimensions were not associated with obesity with T2D. This study contributes to the knowledge of the mechanisms associated with diabetes and its association with impulsive-compulsive behaviors, confirming the hypothesis that patients with obesity and T2D would be characterized by higher levels of impulsivity.

Association patterns of cannabis abuse and dependence with risk of problematic non-substance-related dysregulated and addictive behaviors.

Co-occurrence of drug misuse with other dysregulated behaviors is common. This study was aimed at exploring the associations between the risk of presenting a clinically relevant condition involving non-substance-related addictive or dysregulated behaviors (as measured by the MultiCAGE CAD-4 screening), and cannabis abuse/dependence (CAST/SDS) scores, and the role of gender therein. Participants were recruited using stratified probabilistic sampling at the University of Granada. Mann-Whitney's U tests were used to compare male and female students in SDS and CAST scores. Associations between gender and MultiCAGE scores were estimated using the γ ordinal correlation index, and tested with χ2. For each MultiCAGE dimension, a Poisson-family mixed-effects model was built with either SDS or CAST as the main input variable, while controlling for nicotine and alcohol dependence, and relevant sociodemographic variables. Incidence rate ratios (IRR) were computed for SDS/CAST effects, and the significance threshold was family-wise Bonferroni-corrected. Gender differences were significant for cannabis dependence/abuse and all MultiCAGE scores for non-substance-related conditions, with males showing higher risk scores for excessive gambling, excessive internet use, excessive video gaming, and hypersexuality, and females presenting higher scores in dysregulated eating and compulsive buying. Cannabis dependence and abuse were significantly associated with a higher risk of problematic video gaming. These associations were mostly driven by males. Importantly, although risk of problematic video gaming was specifically associated with cannabis abuse/dependence, there was only a weak non-significant association between problematic video gaming and alcohol use scores. Risk of alcohol use problems, in turn, was strongly associated with all other non-substance-related problems (problematic gambling, excessive Internet use, dysregulated eating, compulsive buying, and hypersexuality). These differential associations can cast light on the etiological similarities and dissimilarities between problematic substance use and putative addictive behaviors not involving drugs.

The societal costs of problem gambling in Sweden.

BACKGROUND: Problem gambling is a public health issue affecting both the gamblers, their families, their employers, and society as a whole. Recent law changes in Sweden oblige local and regional health authorities to invest more in prevention and treatment of problem gambling. The economic consequences of gambling, and thereby the potential economic consequences of policy changes in the area, are unknown, as the cost of problem gambling to society has remained largely unexplored in Sweden and similar settings. METHODS: A prevalence-based cost-of-illness study for Sweden for the year 2018 was conducted. A societal approach was chosen in order to include direct costs (such as health care and legal costs), indirect costs (such as lost productivity due to unemployment), and intangible costs (such as reduced quality of life due to emotional distress). Costs were estimated by combining epidemiological and unit cost data. RESULTS: The societal costs of problem gambling amounted to 1.42 billion euros in 2018, corresponding to 0.30% of the gross domestic product. Direct costs accounted only for 13% of the total costs. Indirect costs accounted for more than half (59%) of the total costs, while intangible costs accounted for 28%. The societal costs were more than twice as high as the tax revenue from gambling in 2018. Direct and indirect costs of problem gambling combined amounted to one third of the equivalent costs of smoking and one sixth of the costs of alcohol consumption in Sweden. CONCLUSIONS: Problem gambling is increasingly recognized as a public health issue. The societal costs of it are not negligible, also in relation to major public health issues of an addictive nature such as smoking and alcohol consumption. Direct costs for prevention and treatment are very low. A stronger focus on prevention and treatment might help to reduce many of the very high indirect and intangible costs in the future.

Tilt in Online Poker: Loss of Control and Gambling Disorder.

Online poker is a form of gambling where an element of skill may influence the outcome of the game. 'Tilt' in poker describes an episode during which the player can no longer control their game by rational decisions. It leads to a loss of control over the game, a loss of emotional regulation, higher cognitive distortion, and a loss of money. This phenomenon, experienced by most players, could be the gateway to excessive gambling. The aim of this study was to assess the links between the frequency of tilt episodes, cognitive distortion, anxiety, depression, sensation seeking and excessive online poker gambling. Our sample is composed of 291 online poker players, with a mean age of 33.8 years (SD = 10.6). Participants completed an online self-assessment questionnaire, measuring the frequency of tilt episodes, cognitive distortion, anxiety, depression and impulsivity. The findings indicated that the frequency of tilt episodes and cognitive distortion were the only significant predictors of excessive online gambling (respectively, r = 0.49 and r = 0.20). Tilt frequency and cognitive distortion were strongly correlated (GRCS, r = 0.60), moderate to low correlations were found for tilt and anxiety (HADS, r = 0.40), and positive and negative urgency (UPPS, r = 0.27). To date, tilt has seldom been studied, and could improve our understanding of online poker gamblers. It could be a new means of identifying at risk gamblers, and thus facilitating preventive measures specifically adapted to this population.

The influence of chronological age on cognitive biases and impulsivity levels in male patients with gambling disorder.

BACKGROUND AND AIMS: Due to the contribution of age to the etiology of gambling disorder (GD), there is a need to assess the moderator effect of the aging process with other features that are highly related with the clinical profile. The objective of this study is to examine the role of the chronological age into the relationships between cognitive biases, impulsivity levels and gambling preference with the GD profile during adulthood. METHODS: Sample included n = 209 patients aged 18-77 years-old recruited from a Pathological Gambling Outpatients Unit. Orthogonal contrasts explored polynomial patterns in data, and path analysis implemented through structural equation modeling assessed the underlying mechanisms between the study variables. RESULTS: Compared to middle-age patients, younger and older age groups reported more impairing irrational beliefs (P = 0.005 for interpretative control and P = 0.043 for interpretative bias). A linear trend showed that as people get older sensation seeking (P = 0.006) and inability to stop gambling (P = 0.018) increase. Path analysis showed a direct effect between the cognitive bias and measures of gambling severity (standardized effects [SE] between 0.12 and 0.17) and a direct effect between impulsivity levels and cumulated debts due to gambling (SE = 0.22). CONCLUSION: Screening tools and intervention plans should consider the aging process. Specific programs should be developed for younger and older age groups, since these are highly vulnerable to the consequences of gambling activities and impairment levels of impulsivity and cognitive biases.

Testing the transdiagnostic hypothesis of inhibitory control deficits in addictions: An experimental study on gambling disorder.

BACKGROUND AND AIMS: Many psychopathologies, including addictions, are characterized by inhibitory control deficits. In this regard, recent studies on substance-related disorders (SRD) have shown an impairment in the ability to inhibit potentially interfering memories, despite preserved motor inhibition. To investigate whether the same dissociation could also characterize gambling disorder (GD) in a transdiagnostic perspective, we tested both cognitive and motor inhibitory processes through dedicated tasks, for the first time in this behavioral addiction. METHODS: 30 outpatients with GD and 30 healthy controls performed a go/no-go task addressing the integrity of motor inhibition, and the Retrieval Practice Paradigm, a task addressing the integrity of memory inhibition as indexed by the Retrieval-Induced Forgetting (RIF) effect. Self-report questionnaires assessing impulsivity were also administered. RESULTS: Whereas RIF was similar across the two groups, patients showed more commission errors in the go/no-go task, and higher self-rated scores of impulsivity than controls. DISCUSSION: The present findings suggest preserved memory inhibition and impaired motor response inhibition in GD, a pattern of inhibitory deficits opposite to that previously reported for SRD. Therefore, although both GD and SRD are characterized by altered inhibitory processing, a more fine-grained analysis revealed a specific inhibitory profile indicating vulnerability in different inhibitory components. CONCLUSION: The present study highlights the need to investigate the multifaceted construct of inhibition more thoroughly, using performance measures able to assess its various components. This approach would enable to both better characterize different psychopathologies and orient their treatment.

Increased functional connectivity in gambling disorder correlates with behavioural and emotional dysregulation: Evidence of a role for the cerebellum.

Gambling disorder (GD) is a psychiatric disease that has been recently classified as a behavioural addiction. So far, a very few studies have investigated the alteration of functional connectivity in GD patients, thus the concrete interplay between relevant function-dependent circuitries in such disease has not been comprehensively assessed. The aim of this research was to investigate resting-state functional connectivity in GD patients, searching for a correlation with GD symptoms severity. GD patients were assessed for gambling behaviour, impulsivity, cognitive distortions, anxiety and depression, in comparison with healthy controls (HC). Afterwards, they were assessed for resting-state functional magnetic resonance imaging; functional connectivity was assessed through a data-driven approach, by using independent component analysis. The correlation between gambling severity and the strength of specific resting-state networks was also investigated. Our results show that GD patients displayed higher emotional and behavioural impairment than HC, together with an increased resting state functional connectivity in the network including anterior cingulate cortex, the caudate nucleus and nucleus accumbens, and within the cerebellum, in comparison with the control group. Moreover, a significant correlation between behavioural parameters and the strength of the resting-state cerebellar network was found. Overall, the functional alterations in brain connectivity involving the cerebellum observed in this study underpin the emotional and behavioural impairment recorded in GD patients. This evidence suggests the employment of novel neuromodulatory therapeutic approaches involving specific and salient targets such as the cerebellum in addictive disorders.

Neurobiological influence of comorbid conditions in young patients diagnosed with gaming disorder: A whole-brain functional connectivity study based on a data driven method.

Gaming disorder, which is characterized by multiple cognitive and behavioral symptoms, often has comorbid psychiatric conditions such as depression and attention-deficit hyperactivity disorder. Neurobiological effects of the comorbid disorders so far reported are not converging, exhibiting positive and negative alterations of the connectivity in brain networks. In this study, we conducted resting-state functional magnetic-resonance imaging and whole brain functional connectivity analyses for young participants consisting of 40 patients diagnosed with the gaming disorder, with and without comorbid conditions, and 29 healthy controls. Compared to healthy controls, the gaming disorder-alone patients had partially diminished connectivities in the reward system and executive control network, within which there existed central nodes that served as a hub of diminished connections. In the gaming disorder patients who had comorbidity of autism spectrum disorder, the diminished connections were enlarged, with alteration of the hub nodes, to the entire brain areas involved in the reward system including cortical, subcortical and limbic areas that are crucial for reward processing, and to the whole cortical areas composing the executive control network. These observations suggest that the neurodevelopmental condition coexisting with the gaming disorder induced substantial impairment of the neural organizations associated with executive/cognitive and emotional functions, which are plausibly causal to the behavioral addiction, by rearranging and diminishing functional connectivities in the network.

The Effects of Perceived Gambling Availability on Problem Gambling Severity.

The aim of this study was to determine the moderating effects of sociodemographic characteristics, substance use, and psychosocial problems on the relationship between perceived gambling availability and problem gambling severity. Bivariate and multivariate regression analyses of the 2008 and 2009 Social and Economic Impacts of Gambling in Alberta surveys found problem gambling severity was 1.25-1.39 times higher for those reporting gambling opportunities were 'too widely available'. Factors such as age, gender, place of residence, and psychosocial problems had significant moderating effects. Our findings indicate that the perception of gambling availability has a statistically significant impact on problem gambling severity.