ADHD: prevalence and effect on opioid use disorder treatment outcome in a French sample of patients receiving medication for opioid use disorder-the influence of impulsivity as a mediating factor.

BACKGROUND: Opioid use disorder (OUD) poses a global health challenge, and despite medications for opioid use disorder (MOUD) and psychosocial interventions, relapse remains a significant concern. Comorbid psychiatric disorders, including attention deficit hyperactivity disorder (ADHD), are one of the major factors associated with poor OUD treatment outcome. We aimed to estimate the frequency of probable ADHD (in childhood and in adulthood) in patients with OUD; to assess the factors associated with this comorbidity; and to explore the factors that mediate the relationship between ADHD and OUD treatment outcome. METHODS: We conducted an observational study using a sample of 229 patients aged 18 years and older who were diagnosed with OUD and had received MOUD for at least six months. Participants were assessed through a structured interview and self-report questionnaires. Multivariate logistic regressions and a mediation analysis were performed. RESULTS: Almost half of the participants reported probable ADHD in childhood, and ADHD persisted into adulthood among two-thirds of the patients. The factors associated with poor OUD treatment outcome included earlier onset of OUD, lower education, and greater impulsivity. There was no direct effect of probable ADHD in childhood on OUD treatment outcome, but there was an indirect effect through negative urgency, the tendency to respond impulsively to negatively connoted emotional experiences. CONCLUSIONS: The findings suggest that ADHD symptoms, particularly impulsivity, may contribute to vulnerability in opioid use and play a crucial role in treatment outcomes for this population. TRIAL REGISTRATION: ClinicalTrials identifier NCT01847729.

Impact of Gambling on the Internet on Middle-Term and Long-Term Recovery from Gambling Disorder: A 2-Year Longitudinal Study.

Online gamblers are more likely to experience gambling problems. The main objective was to compare the frequency of recovery one (middle-term) and two (long-term) years after treatment initiation, according to the gambling medium (Internet vs. land-based gambling). The secondary objectives were (i) to compare online and offline gamblers at inclusion and (ii) to investigate whether the gambling medium was a predictive factor of recovery. Outpatients beginning treatment for a GD (n = 237) were assessed at inclusion (treatment initiation) and after 1 and 2 years. Bivariate analyses were performed to compare online and offline gamblers at inclusion and on the frequency of recovery at one and two years. Two multivariate logistic regressions were then performed to identify factors associated with middle- and long-term recovery. The majority of patients achieved middle (74.2%) and long-term (78.9%) recovery, with no difference between online and offline gamblers. The gambling medium was not a predictive factor of recovery. Patients with a higher perceived self-efficacy (OR = 1.04 [1.01-1.07], p = .046) and having no history of mood disorders (OR = 11.18 [2.53-49.50], p < .001) at inclusion were more likely to achieve middle-term recovery, while long-term recovery was associated with a lower level of sensation seeking (OR = 0.67 [0.48-0.92], p = .015) at treatment initiation. Online gambling did not seem to influence middle- and long-term recovery compared to offline gambling. Enhancement of perceived self-efficacy and treatment of mood disorders, and treatment strategies focused on sensation-seeking may represent helpful care strategies for favouring achievement of middle-term recovery and maintenance of long-term recovery, respectively. ClinicalTrials.gov NCT01248767, date of first registration: November 25, 2010.

Systematic Review of Gaming and Neuropsychological Assessment of Social Cognition.

Playing video games is associated with cognitive changes and possibly psychosocial difficulties. Problematic gaming occurs upon the loss of control over videogame playing; gaming disorder is considered a behavioral addiction in the 11th version of the International Classification of Diseases. Models used to understand behavioral addictions include cognition as an essential factor in the development, maintenance, and relapse of addiction. Nevertheless, some aspects of cognition, such as social cognition, remain underexplored, despite evidence of alterations in cognitive and social function among patients with problematic gaming. This review aimed to describe the current understanding of social cognition in individuals exposed to videogames. We included all studies assessing social cognition in participants of any age with a wide range of exposure to video games (from simple use of video games (such as at least two exposures) to problematic gaming, defined according to the included study). This wide range of exposure allowed us to explore the whole process from repeated exposure to addiction. We included only studies that used neuropsychological tasks to assess social cognition. Patient-reported outcomes that could be biased by subjective self-report data were not included. The search was conducted from inception to January 2022 in three databases (PubMed, PsycINFO, and Web of Science). The systematic search identified 39 studies that assessed facial emotion processing, empathy, theory of mind, social decision-making, aggressive behavior, and moral competence. In general, results have been mixed, and a number of questions remain unanswered. Nevertheless, several studies showed cerebral changes when processing facial emotion that were linked with problematic gaming, while no link was obtained between nonproblematic gaming and empathy alterations. The influences of cooperation patterns, theory of mind, moral competence, and gaming frequency were highlighted. Finally, there was substantial heterogeneity in the population assessed and the methods used.

Is history of abuse predictive of eating disorders with binge-eating episodes through an effect mediated by impulsivity? A French longitudinal study.

BACKGROUND: In recent years, many studies have explored the associations among impulsivity, history of abuse, the emergence of eating disorders with episodes of binge eating (EDBE) and their severity. Nevertheless, factors associated with successful clinical outcomes of EDBE are still unknown. Our study aimed to test the hypothesis that a history of abuse is associated with unsuccessful clinical outcomes of EDBE through an effect mediated by impulsivity. METHODS: We assessed patients older than 15 years, 3 months with EDBE at inclusion and at 1 year. Recovery was defined as the absence of eating disorders at 1 year. A mediation analysis was performed by means of structural equation modelling. RESULTS: We included 186 patients in our analyses (54% bulimia nervosa, 29% anorexia nervosa binge eating/purging type and 17% binge-eating disorder); 179 (96%) were female. One-third (n = 63) of patients reported a history of abuse, and recovery was observed for 20% of the sample (n = 38). Contrary to our assumption, a history of abuse was not associated with the absence of recovery of EDBE at 1 year. Factors unfavourable for achieving recovery were anxiety disorders (odds ratio [OR] 0.41), vomiting (OR 0.39), physical hyperactivity (OR 0.29), negative urgency and a lack of perseverance (OR 0.85 for both). Only positive urgency was positively associated with recovery (OR 1.25). LIMITATIONS: We excluded 219 patients lost to the 1-year follow-up. CONCLUSION: Our findings may help to deconstruct the empirical belief that traumatic events may interfere with the successful course of treatment for eating disorders. A high level of positive urgency may be associated with more receptivity to care.

Frequency of and Factors Associated with the Presence of a History of Probable Attention-Deficit Hyperactivity Disorder in a Population of Patients with Sex Addiction.

INTRODUCTION: Since the first description of sex addiction (SA) by Carnes, research on this problematic behaviour has continued to grow, and the association with attention-deficit hyperactivity disorder (ADHD) appears to be frequent. This study aimed to estimate the frequency of a history of probable ADHD in a population of patients with SA and to explore the factors associated with it. METHODS: One hundred 85 patients referred to the Nantes University Hospital for SA between 2011 and 2020 were included. Patients completed the Sexual Addiction Screening Test (SAST) or its revised version (SAST-R) to establish the presence of SA. As the SAST-R was not validated in French, we conducted a validation study for the French version. ADHD was screened using the Wender-Utah Rating Scale in childhood and the Adult ADHD Self-Report Scale in adulthood. A multivariate logistic regression model was used to identify factors associated with the presence of a history of probable ADHD. RESULTS: Childhood ADHD was identified in 36% of patients with SA. Factors associated with the presence of a history of probable ADHD were a low education level, an earlier age of onset of problematic sexual behaviour, another addictive disorder, an anxiety disorder, impulsivity (high negative urgency score), and high scores on harm avoidance and novelty-seeking temperament scales. Furthermore, the French version of the SAST-R displayed good psychometric properties, especially excellent sensitivity. CONCLUSION: The frequency of a history of probable ADHD among patients with SA is consistent with the literature and close to the highest range. Specific personality traits in patients with both SA and a history of probable ADHD could induce lasting problems of adaptation, which may precipitate the development of SA or maintain it.

Online Assessment of Social Cognition in a Population of Gamers and Gamblers: Results of the eSMILE Study.

The purpose of the eSMILE study was to explore social cognition (SC) in the two behavioural addictions (BAs) included in international classifications: gaming disorder and gambling disorder. In these disorders, cognitive functioning is involved in the development and maintenance of addiction. Nevertheless, SC have received less attention than other cognitive functions. The eSMILE study was conducted online and included 105 participants (gamers and gamblers). This study included: the Penn emotion recognition task, the Condensed and Revised Multifaced Empathy Test, the Interpersonal Reactivity Index, the Chicken Game, social metacognition questions, and the Toronto Alexithymia Scale. We analysed the relationships among SC measures, addiction levels, and behaviour frequency. For gamers, we showed that the higher their level of addiction was, the lower their self-confidence following the identification of basic emotions, although the more frequently they played, the better their performance on this task. Additionally, we found lower performance on the identification of more complex emotions by gamblers, which seems to be the result of their levels of addiction rather than the frequency of their gambling behaviour. This study contributes to our understanding of the cognitive processes underlying BAs. Additionally, working on SC abilities may be an additional management mode for BAs that could be added to existing treatments.

Evaluation of the link between the Guttman errors and response shift at the individual level.

PURPOSE: Methods for response shift (RS) detection at the individual level could be of great interest when analyzing changes in patient-reported outcome data. Guttman errors (GEs), which measure discrepancies in respondents' answers compared to the average sample responses, might be useful for detecting RS at the individual level between two time points, as RS may induce an increase in the number of discrepancies over time. This study aims to establish the link between recalibration RS and the change in the number of GEs over time (denoted index [Formula: see text]) via simulations and explores the discriminating ability of this index. METHODS: We simulated the responses of individuals affected or not affected by recalibration RS (defined as changes in the patients' standard of measurement) to determine whether simulated individuals with recalibration had a greater change in the number of GEs over time than individuals without recalibration. The effects of factors related to the sample, the questionnaire structure and recalibration were investigated. As an illustrative example, the change in the number of GEs was computed in patients suffering from eating disorders. RESULTS: Within simulations, simulated individuals affected by recalibration had, on average, a greater change in the number of GEs over time than did individuals without RS. Some of the parameters related to the questionnaire structure and recalibration magnitude appeared to have substantial effects on the values of [Formula: see text]. Discriminating abilities appeared, however, globally low. CONCLUSION: Some evidence of the link between recalibration and the change in GEs was found in this study. GEs could be a valuable nonparametric tool for RS detection at a more individual level, but further investigation is needed.

How do people who use drugs receiving Opioid Medication Therapy perceive their treatment ? A multicentre study.

BACKGROUND: The resurgence of heroin use and the misuse of pharmaceutical opioids are some of the reasons for a worldwide increase in opioid dependence. Opioid Medication Therapies (OMT) have amply demonstrated their efficacy. From a medical point of view, the main objectives of OMT concern medical and social outcomes, centred on risk reduction and the cessation of opioid use. But patient points of view can differ and few studies have explored opioid-dependent patient viewpoints on their OMT. This variable seems important to consider in a patient-centred approach. The aim of our study was to explore points of view of people who use drugs (PWUD) treated with OMT, in a large multicentre sample. METHOD: A cross-sectional multicentre study explored the points of view of PWUD with Opioid Use Disorder following OMT. Data regarding the patients' points of view were collected using a self-administered questionnaire developed by the scientific committee of the study. A descriptive analysis and an exploratory factor analysis were performed to explore the structure of items exploring patient viewpoints. RESULTS: 263 opioid dependent PWUD were included, a majority were men consuming heroin prior to being prescribed OMT. 68% were on methadone, 32% were on buprenorphine. Most PWUD identified a positive impact on their lives, with 92.8% agreeing or strongly agreeing that OMT had changed a lot of things in their lives. The exploratory factor analysis identified three factors: (F1) items related to points of views concerning the objectives and efficacy of OMT; (F2) items related to the legitimacy of OMT as a treatment compared to a drug, (F3) items related to experiences and relationships with OMT. CONCLUSION: Patient viewpoints on efficacy were correlated with the pharmacological benefits of OMT and with the associated psychosocial measures. The implications of OMT in relationships, such as the feeling of being judged, concerned a majority. Points of view were ambivalent concerning the role of OMT as a treatment or as a drug. Involving patient points of view in therapeutic strategies decisions could help enhance positive views among PWUD on OMT and help PWUD towards their recovery. TRIAL REGISTRATION: OPAL study was registered: (NCT01847729).

Buying-Shopping Disorder among Women: The Role of Vulnerability to Marketing, Buying Motives, Impulsivity, and Self-Esteem.

INTRODUCTION: The influence of marketing on addictive behaviours has been studied among tobacco and alcohol users. Although the fashion industry is highly influenced by marketing, research has poorly studied vulnerability to fashion marketing as a factor related to buying-shopping disorder (BSD) while considering psychological characteristics (buying motives, impulsivity, and self-esteem). OBJECTIVE: The objective of the present work is to investigate the relationship between vulnerability to marketing and BSD. METHODS: Women (n = 242) were exclusively recruited through social networking. They completed an online survey exploring the severity of BSD using the Compulsive Buying Scale (CBS) and the psychological factors associated with BSD (impulsivity, self-esteem, and buying motives) and an experimental task designed to investigate the intention to purchase in several situations, where marketing modalities such as price, brand, and packaging fluctuate. RESULTS: Among the 242 participants in the study, 34 were identified as compulsive buyers (14%). Income level was considered, and compulsive buyers displayed a higher level of vulnerability to marketing, except for the packaging modality. High levels of positive urgency, lack of premeditation, and coping motivation were found to be significant predictors of the CBS score, but vulnerability to marketing was not. DISCUSSION AND CONCLUSIONS: Compulsive buyers seem to be more sensitive to marketing strategies, although vulnerability to marketing was not identified as a predictor of the severity of BSD. Given the enormous literature on the role of marketing in other addictive behaviours, further studies are needed to better understand the role of marketing in BSD to develop appropriate public health policies.

Positive and negative urgency as a single coherent construct: Evidence from a large-scale network analysis in clinical and non-clinical samples.

AIMS: Negative and positive urgency are emotion-related impulsivity traits that are thought to be transdiagnostic factors in psychopathology. However, it has recently been claimed that these two traits are closely related to each other and that considering them separately might have limited conceptual and methodological value. The present study aimed to examine whether positive and negative urgency constructs constitute separate impulsivity traits. METHODS: In contrast to previous studies that have used latent variable approaches, this study employed an item-based network analysis conducted in two different samples: a large sample of non-clinical participants (N = 18,568) and a sample of clinical participants with psychiatric disorders (N = 385). RESULTS: The network analysis demonstrated that items denoting both positive and negative urgency cohere as a single cluster of items termed "general urgency" in both clinical and non-clinical samples, thereby suggesting that differentiating positive and negative urgency as separate constructs is not necessary. CONCLUSION: These findings have important implications for the conceptualization and assessment of urgency and, more broadly, for future research on impulsivity, personality, and psychopathology.

Modeling Early Gambling Behavior Using Indicators from Online Lottery Gambling Tracking Data: Longitudinal Analysis.

BACKGROUND: Individuals who gamble online may be at risk of gambling excessively, but internet gambling also provides a unique opportunity to monitor gambling behavior in real environments which may allow intervention for those who encounter difficulties. OBJECTIVE: The objective of this study was to model the early gambling trajectories of individuals who play online lottery. METHODS: Anonymized gambling-related records of the initial 6 months of 1152 clients of the French national lottery who created their internet gambling accounts between September 2015 and February 2016 were analyzed using a two-step approach that combined growth mixture modeling and latent class analysis. The analysis was based upon behavior indicators of gambling activity (money wagered and number of gambling days) and indicators of gambling problems (breadth of involvement and chasing). Profiles were described based upon the probabilities of following the trajectories that were identified for the four indicators, and upon several covariates (age, gender, deposits, type of play, net losses, voluntary self-exclusion, and Playscan classification-a responsible gambling tool that provides each player with a risk assessment: green for low risk, orange for medium risk and red for high risk). Net losses, voluntary self-exclusion, and Playscan classification were used as external verification of problem gambling. RESULTS: We identified 5 distinct profiles of online lottery gambling. Classes 1 (56.8%), 2 (14.8%) and 3 (13.9%) were characterized by low to medium gambling activity and low values for markers of problem gambling. They displayed low net losses, did not use the voluntary self-exclusion measure, and were classified predominantly with green Playscan tags (range 90%-98%). Class 4 (9.7%) was characterized by medium to high gambling activity, played a higher breadth of game types (range 1-6), and had zero to few chasing episodes. They had high net losses but were classified with green (66%) or orange (25%) Playscan tags and did not use the voluntary self-exclusion measure. Class 5 (4.8%) was characterized by medium to very high gambling activity, played a higher breadth of game types (range 1-17), and had a high number of chasing episodes (range 0-5). They experienced the highest net losses, the highest proportion of orange (32%) and red (39%) tags within the Playscan classification system and represented the only class in which voluntary self-exclusion was present. CONCLUSIONS: Classes 1, 2, 3 may be considered to represent recreational gambling. Class 4 had higher gambling activity and higher breadth of involvement and may be representative of players at risk for future gambling problems. Class 5 stood out in terms of much higher gambling activity and breadth of involvement, and the presence of chasing behavior. Individuals in classes 4 and 5 may benefit from early preventive measures.

Relevance of CYP2B6 and CYP2D6 genotypes to methadone pharmacokinetics and response in the OPAL study.

AIMS: Our study aimed to evaluate the impacts of the cytochrome P450 (CYP) 2B6-G516T and CYP2D6 genetic polymorphisms on pharmacokinetic and clinical parameters in patients receiving methadone maintenance treatment. METHODS: Opioid PhArmacoLogy (OPAL) was a clinical survey of the sociodemographic characteristics, history and consequences of pathology associated with methadone maintenance treatment response and current addictive comorbidities. A subgroup of 72 methadone patients was genotyped. RESULTS: When comparing the three CYP2B6 genotype groups, the methadone (R)- and (S)-methadone enantiomer concentrations/doses (concentrations relative to doses) were different (P = .029, P = .0019). The CYP2D6 phenotypes did not seem to be relevant with regard to methadone levels. On multivariate analysis, neither the CYP2B6 genotype nor the CYP2D6 phenotype explained the (R)-methadone concentration/dose values (P = .92; P = .86); the (S)-methadone concentration/dose values (P = .052; P = .95 [although there was a difference between the TT group and GT and GG groups {P = .019}]); or opiate cessation (P = .12; P = .90). CONCLUSION: The genotyping of CYP2B6 G516T could be an interesting tool to explore methadone intervariability.

Prevalence of hypobetalipoproteinemia and related psychiatric characteristics in a psychiatric population: results from the retrospective HYPOPSY Study.

BACKGROUND: Hypobetalipoproteinemia (HBL) is defined by plasma concentrations of LDL-cholesterol (LDL-C) lower than the fifth percentile for age and sex. Several psychiatric symptoms have been reported in association with HBL. The objective was to assess the prevalence of primary HBL in patients hospitalized in a psychiatric population and to better characterize the related psychiatric disorders. METHODS: HYPOPSY is a retrospective study including 839 adults hospitalized in the Psychiatry department of Nantes University Hospital during the year 2014, except patients with eating disorders. The prevalence of primary HBL was defined by a plasma LDL-C concentration ≤ 50 mg/dL. Secondary causes of HBL were excluded after a review of medical records (n=2). Related-psychiatric disorders in patients with and without HBL were recorded using the ICD-10 classification. RESULTS: Twenty cases of primary HBL (mean [SD] LDL-C: 42 [7] mg/dL) were diagnosed, leading to a prevalence of 2.39%. In comparison, the prevalence of HBL in a healthy control population was 0.57%. Psychiatric patients with HBL were characterized by a higher frequency of schizophrenia (p=0.044), hetero-aggression (p=0.015) and pervasive and specific developmental disorders (including autism) (p=0.011). CONCLUSIONS: The prevalence of HBL is 4-fold higher in psychiatric than in general population. More specifically, some statistically significant associations were found between low LDL-C concentrations and schizophrenia, autism and hetero-aggression. These data reinforce the hypothesis for a link between genetically low LDL-C levels and psychiatric disorders.

Cognitive Characteristics of Strategic and Non-strategic Gamblers.

Participation in strategic and non-strategic games is mostly explained in the literature by gender: men gamble on strategic games, while women gamble on non-strategic games. However, little is known about the underlying cognitive factors that could also distinguish strategic and non-strategic gamblers. We suggest that cognitive style and need for cognition also explain participation in gambling subtypes. From a dual-process perspective, cognitive style is the tendency to reject or accept the fast, automatic answer that comes immediately in response to a problem. Individuals that preferentially reject the automatic response use an analytic style, which suggest processing information in a slow way, with deep treatment. The intuitive style supposes a reliance on fast, automatic answers. The need for cognition provides a motivation to engage in effortful activities. One hundred and forty-nine gamblers (53 strategic and 96 non-strategic) answered the Cognitive Reflection Test, Need For Cognition Scale, and socio-demographic questions. A logistic regression was conducted to evaluate the influence of gender, cognitive style and need for cognition on participation in strategic and non-strategic games. Our results show that a model with both gender and cognitive variables is more accurate than a model with gender alone. Analytic (vs. intuitive) style, high (vs. low) need for cognition and being male (vs. female) are characteristics of strategic gamblers (vs. non-strategic gamblers). This study highlights the importance of considering the cognitive characteristics of strategic and non-strategic gamblers in order to develop preventive campaigns and treatments that fit the best profiles for gamblers.

Pathological Gambling Associated With Aripiprazole or Dopamine Replacement Therapy: Do Patients Share the Same Features? A Review.

BACKGROUND: In the last 10 years, dopamine replacement therapy (DRT) has become a well-known risk factor for developing an impulse control disorder, such as gambling disorder (GD). Another medication, aripiprazole (ARI), has been more recently identified as another risk factor. Dopamine replacement therapy and ARI share a dopamine agonist action. Our work aimed at comparing patients with PG according to their treatment with DRT or ARI. METHODS: Two methods were combined-a systematic review concentrated on case reports and the analysis of a French disordered gamblers cohort focused on patients using ARI or DRT at inclusion. RESULTS: We reported 48 cases of GD possibly due to DRT and 17 cases of GD possibly due to ARI. Because of their standardized assessment, only the EVALJEU patients could be compared. Two clinical patterns emerged. Patients in the ARI group were young, impulsive, and high novelty seekers and had a history of substance misuse. Their first gambling experience occurred during adolescence. Conversely, patients in the DRT group were old, and they began gambling late in life. They showed low levels of gambling-related cognition. CONCLUSIONS: Patients in the ARI group seemed to be more severe pathological gamblers than patients in the DRT group. Aripiprazole is a partial D2 receptor agonist, whereas DRT includes full D2 receptor agonist. The trigger mechanism of PG development is complex and cannot only be attributed only to the pharmacodynamic effects of dopaminergic drugs. Indeed, individual vulnerability factors and environmental factors need to be considered.

Towards a Validation of the Three Pathways Model of Pathological Gambling.

With the aim of validating the three pathways hypothesis of pathological gambling (Blaszczynski and Nower in Addiction 97:487-499, 2002) 372 pathological gamblers meeting DSM IV (2000) criteria were assessed via a structured clinical interview as well as being subjected to personality tests and evaluation of their gambling practices. Our results show that it is possible to identify three subgroups corresponding to the three pathways: behaviourally conditioned problem gamblers, emotionally vulnerable problem gamblers and antisocial impulsivist problem gamblers. Our results particularly demonstrate that impulsivist gamblers preferentially choose semi-skilful gambling (horse racing and sports gambling) whereas emotionally vulnerable gamblers are significantly more attracted to games of chance (one-armed bandits, scratch cards, etc.) This led us to propose a functional presentation of the three pathways model which differs somewhat from the Blaszczynski and Nower presentation.

Online gambling's moderators: how effective? Study protocol for a randomized controlled trial.

BACKGROUND: Online gambling has been legalized in France in 2010. Licenses are issued to gambling operators who demonstrate their ability to respect the legal framework (security, taxation, consumer protection, etc.). The preventive measures to protect vulnerable gamblers include an obligation to provide online gambling moderators. These moderators should allow gamblers to limit their bets, exclude themselves from the website for 7 days, and consult the balance of the gambler's account at any time. However, there are only a few published reports of empirical research investigating the effectiveness of Internet-based protective measures implemented by French law. Moreover, no empirical research has yet studied the impact of bonuses on gambling behaviors. METHODS/DESIGN: This research is an experimental randomized controlled trial, risk prevention targeted. The research is divided into four sub-studies depending on the studied moderator: limiting bonuses, self-exclusion, self-limitation and information. The study sample consists of 485 volunteers. For each experimental condition and the control groups, the sample is composed of gamblers equally recruited from gamblers having preferences in each of the three major forms of games (lottery and scratch tickets, sports and horserace betting, and poker). For each form of gambling, the gamblers are recruited in order to obtain as many problem gamblers as non-problem gamblers. According to the randomization, the experimental session begins. The experimental session is a gambling situation on a computer in our research center. The gambler is invited to play on his favorite gambling site as usual, with his own gambler account and his own money. Data collected comprise sociodemographic characteristics, gambling habits, an interview about enjoyment and feeling out of control during the gambling session, moderator impact on gambling practice, statement of gambling parameters and questionnaires (BMIS, GRCS, CPGI, GACS). Moderator efficiency is assessed based on the two major characteristics of gambling behavior: money wagered and time spent in gambling. DISCUSSION: The results of this research will be important to prevent online problem gambling and influence policy-makers. TRIAL REGISTRATION NUMBER: NCT01789580. Registered 8 February 2013.

A Gamblers Clustering Based on Their Favorite Gambling Activity.

The objective of this study was to identify profiles of gamblers to explain the choice of preferred gambling activity among both problem and non-problem gamblers. 628 non-problem and problem gamblers were assessed with a structured interview including "healthy" (sociodemographic characteristics, gambling habits and personality profile assessed with the Temperament and Character Inventory-125) and "pathological" [diagnosis of pathological gambling, gambling-related cognitions (GRCs) and psychiatric comorbidity] variables. We performed a two-step cluster analysis based solely on "healthy" variables to identify gamblers' profiles which typically reflect the choice of preferred gambling activity. The obtained classes were then described using both "healthy" and "pathological" variables, by comparing each class to the rest of the sample. Clusters were generated. Class 1 (Electronic Gaming Machines gamblers) showed high cooperativeness, a lower level of GRC about strategy and more depressive disorders. Class 2 (games with deferred results gamblers) were high novelty seekers and showed a higher level of GRC about strategy and more addictive disorders. Class 3 (roulette gamblers) were more often high rollers and showed a higher level of GRC about strategy and more manic or hypomanic episodes and more obsessive-compulsive disorders. Class 4 (instant lottery gamblers) showed a lower tendency to suicide attempts. Class 5 (scratch cards gamblers) were high harm avoiders and showed a lower overall level of GRC and more panic attacks and eating disorders. The preference for one particular gambling activity may concern different profiles of gamblers. This study highlights the importance of considering the pair gambler-game rather than one or the other separately, and may provide support for future research on gambling and preventive actions directed toward a particular game.

Study protocol: the JEU cohort study--transversal multiaxial evaluation and 5-year follow-up of a cohort of French gamblers.

BACKGROUND: There is abundant literature on how to distinguish problem gambling (PG) from social gambling, but there are very few studies of the long-term evolution of gambling practice. As a consequence, the correlates of key state changes in the gambling trajectory are still unknown. The objective of the JEU cohort study is to identify the determinants of key state changes in the gambling practice, such as the emergence of a gambling problem, natural recovery from a gambling problem, resolution of a gambling problem with intermediate care intervention, relapses or care recourse. METHODS/DESIGN: The present study was designed to overcome the limitations of previous cohort study on PG. Indeed, this longitudinal case-control cohort is the first which plans to recruit enough participants from different initial gambling severity levels to observe these rare changes. In particular, we plan to recruit three groups of gamblers: non-problem gamblers, problem gamblers without treatment and problem gamblers seeking treatment.Recruitment takes place in various gambling places, through the press and in care centers. Cohort participants are gamblers of both sexes who reported gambling on at least one occasion in the previous year and who were aged between 18 and 65. They were assessed through a structured clinical interview and self-assessment questionnaires at baseline and then once a year for five years. Data collection comprises sociodemographic characteristics, gambling habits (including gambling trajectory), the PG section of the DSM-IV, the South Oaks Gambling Screen, the Gambling Attitudes and Beliefs Survey - 23, the Mini International Neuropsychiatric Interview, the Wender-Utah Rating Scale-Child, the Adult ADHD Self-report Scale, somatic comorbidities (especially current treatment and Parkinson disease) and the Temperament and Character Inventory - 125. DISCUSSION: The JEU cohort study is the first study which proposes to identify the predictive factors of key state changes in gambling practice. This is the first case-control cohort on gambling which mixes non-problem gamblers, problem gamblers without treatment and problem gamblers seeking treatment in almost equal proportions. This work may help providing a fresh perspective on the etiology of pathological gambling, which may provide support for future research, care and preventive actions. TRIAL REGISTRATION: (ClinicalTrials.gov): NCT01207674.

Definitions and assessments of recovery from gambling disorder: A scoping review.

Background and aims: While the concept of recovery is receiving increasing attention in the context of gambling disorder (GD), no consensus has yet been reached regarding its definition. This scoping review aims to map the literature on GD recovery, identify gaps, and provide insights for a more holistic and patient-centred perspective. Methods: A systematic search of three databases was conducted (PubMed, PsycINFO, and ScienceDirect). Based on the method by which the results of these studies were produced, the studies included were sorted into four categories (quantitative, instrument validation, qualitative, and mixed studies) and subsequently examined using conceptual analysis. Results: One hundred thirteen articles were included in this research after the screening process. In the quantitative and instrument validation studies, recovery was defined or operationalized in terms of abstinence, the absence of a GD diagnosis, or mild GD severity, or by reference to treatment outcomes or controlled gambling. A meta-synthesis of the results of the qualitative studies revealed four core features of recovery (insight, empowerment and commitment, wellbeing enhancement, and reconsideration of the issue of relapse). Discussion: Discrepancies in definitions, outcomes, and variables used were evident across studies. Additionally, the quantitative and standardized approaches employed in most studies exhibited severe limitations with regard to defining recovery from the subjective and multidimensional perspectives of people recovering from GD. Conclusions: This lack of definitional clarity emphasizes the necessity for further qualitative research. This research should encompass multiple stakeholder perspectives to develop a working definition promoting recovery from a holistic, patient-centred, and tailored approach.