The role of repetitive transcranial magnetic stimulation (rTMS) in the treatment of behavioral addictions: Two case reports and review of the literature.

BACKGROUND: Several behaviors, besides consumption of psychoactive substances, produce short-term reward that may lead to persistent aberrant behavior despite adverse consequences. Growing evidence suggests that these behaviors warrant consideration as nonsubstance or "behavioral" addictions, such as pathological gambling, internet gaming disorder and internet addiction. CASE PRESENTATION: Here, we report two cases of behavioral addictions (BA), compulsive sexual behavior disorder for online porn use and internet gaming disorder. A 57-years-old male referred a loss of control over his online pornography use, started 15 years before, while a 21-years-old male university student reported an excessive online gaming activity undermining his academic productivity and social life. Both patients underwent a high-frequency repetitive transcranial magnetic stimulation (rTMS) protocol over the left dorsolateral prefrontal cortex (l-DLPFC) in a multidisciplinary therapeutic setting. A decrease of addictive symptoms and an improvement of executive control were observed in both cases. DISCUSSION: Starting from these clinical observations, we provide a systematic review of the literature suggesting that BAs share similar neurobiological mechanisms to those underlying substance use disorders (SUD). Moreover, we discuss whether neurocircuit-based interventions, such as rTMS, might represent a potential effective treatment for BAs.

Sleep and new media usage in toddlers.

Several studies over the years have demonstrated the association between lack of sleep in children and certain physical, psychological, and behavioral disorders. The aim of this study was to disentangle the association between new screen-based electronic devices and sleep problems in toddlers, adjusting for other covariates already known to be associated with sleep quality. We conducted a cross-sectional study with the aid of a national sample of 1117 toddlers. Parents reported children's sleeping habits such as total sleep time and sleep onset latency, recreational activities, bedtime routines, and temperament. An ordered logistic regression was run to assess the associations between new media exposure and two sleep outcomes (total sleep time and sleep onset latency). Everyday use of a tablet or smartphone raised the odds of a shorter total sleep time (OR 1.95 [1.00-3.79], p < 0.05) and a longer sleep onset latency (OR 2.44 [1.26-4.73] p < 0.05) irrespective of other factors, such as temperament (restlessness, sociability), or traditional screen exposure (watching TV or playing videogames).Conclusion: New media usage is a factor associated in toddlers with sleeping fewer hours and taking longer to fall asleep, irrespective of other confounding factors. What is known • Studies have found an association between sleep behavior and the use of computers and video games in early childhood. • The blue light emitted from TV screens suppresses endogenous melatonin. What is new • The study found an association between daily new media (tablet and smartphone) usage and sleep quality in toddlers • New media usage exposes toddlers to the risk of fewer hours of sleep and taking longer to fall asleep, irrespective of other factors.

Problematic social networking site usage and substance use by young adolescents.

BACKGROUND: Substance use and abuse by young adolescents has become a serious issue for public health services, and several socio-environmental factors can influence how vulnerable a young adolescent may be to their appeal. The present study was devised to examine whether substance use in early adolescence is associated with problematic social networking site usage (PSNSU). METHODS: In the academic year 2013-2014, secondary schools in Padua (north-eastern Italy) were involved in a survey called "Pinocchio". A sample of 1325 pupils attending years 6 to 8 (i.e. aged from 11 to 13 years) completed self-administered questionnaires, in which PSNSU was measured by applying the DSM-IV criteria of dependence to identify any social network addiction disorder and its fallout on daily life. Multivariate analysis (ordered logistic regression) was performed to assess an adjusted association between young adolescents' substance use and PSNSU. RESULTS: The percentage of pupils classified as problematic social networking site users rose with age (from 14.6% in year 6 to 24.3% in year 7, and 37.2% in year 8), and it was higher in girls (27.1%) than in boys (23.6%). In a fully-adjusted model, PSNSU conferred a higher likelihood of being substance users (OR 2.93 95% CI 1.77-4.85). CONCLUSION: This study identified an association between PSNSU and the likelihood of substance use (smoking, alcohol and energy drink consumption), providing further evidence of the need to pay more attention to PSNSU in early adolescence.

Problematic Use of Video Games and Substance Abuse in Early Adolescence: A Cross-sectional Study.

OBJECTIVES: Problematic use of video games (PUVG) is associated with substance use in middle school students. The aim of our study was to examine the association between PUVG and substance abuse in children and young adolescents. METHODS: A survey was conducted during the 2014-2015 school year in Padua (northeastern Italy). The sample consisted of 1156 students in grades 6 to 8. A multivariate logistic regression model was applied to seek associations between PUVG (dependent variable) and independent variables. RESULTS: Logistic regression showed that lifetime drunkenness, combined energy drink and alcohol consumption (lifetime), reading comics, and disrespect for rules increased the odds of PUVG, whereas playing competitive sport, eating fruit and/or vegetables daily, finding it easy to talk with fathers and being female lowered the odds of PUVG in early adolescence. CONCLUSIONS: Our findings show that PUVG is more likely in young adolescents at risk of substance abuse. Prevention schemes focusing on early adolescence should be based on a multicomponent intervention strategy that takes PUVG into account.

Experience with Gambling in Late Childhood and Early Adolescence: Implications for Substance Experimentation Behavior.

OBJECTIVE: Previous research among late adolescents suggests an additive association between levels of engagement in gambling and vulnerability to substance use disorder. The aim of our research was to investigate the frequency of gambling experience in childhood and early adolescence and to examine the association between alcohol/cigarette/energy drink consumption and gambling in this young population. METHODS: A survey called "Pinocchio" was conducted during the 2013 to 2014 school year at primary and secondary schools in Padua (north-eastern Italy) on a sample of 1325 students in sixth to eighth grade (11-13 year olds). Multilevel analysis, taking the school-level variance into account, established an adjusted association between gambling and attitude to risk-taking among early adolescents. RESULTS: Among eighth graders, 45.8% of the boys and 35.4% of the girls reported at least 1 type of gambling. In a fully-adjusted model, having experience of gambling confers a higher likelihood of being consumers (at least once a month) of other substances (alcohol, cigarettes, energy drinks, or marijuana). CONCLUSION: Gambling behavior is widespread among adolescents. An association with other risk-taking behavior was found in this study, and this provides further evidence of the need for a greater awareness of gambling behavior in early adolescence.

Problematic cell phone use for text messaging and substance abuse in early adolescence (11- to 13-year-olds).

UNLABELLED: The aim of our study was to examine the association between problematic cell phone use (PCPU) for text messaging and substance abuse in young adolescents. This cross-sectional study was conducted on the basis of an ad hoc questionnaire, during the 2014-2015 school year in a province of the Veneto Region (Italy); it involved a sample of 1156 students in grades 6 to 8 (11 to 13 years old). A self-report scale based on the Short Message Service (SMS) Problem Use Diagnostic Questionnaire (SMS-PUDQ) was administered to assess the sample's PCPU. A multivariate logistic regression model was applied to seek associations between PCPU (as the dependent variable) and independent variables. The proportion of students who reported a PCPU increased with age in girls (13.5% in 6th grade, 16.4% in 7th grade, and 19.5% in 8th grade), but not in boys (14.3% in 6th grade, 18.0% in 7th grade, and 14.8% in 8th grade). Logistic regression showed that drunkenness at least once and energy drink consumption raised the odds of PCPU, whereas reading books, higher average school marks, and longer hours of sleep were associated with lower odds of PCPU in early adolescence. CONCLUSION: our findings confirm a widespread PCPU for text messaging among early adolescents. The odds of PCPU is greater in young people at risk of other substance abuse behavior.

Prevalence of substance use and abuse in late childhood and early adolescence: What are the implications?

The aim of the present study was to assess the prevalence by gender of substance use and misuse in late childhood and early adolescence. A survey was conducted in 2013-2014 at primary and secondary schools of Padova, Veneto region, North-East Italy, on a sample of 171 pupils in 5th grade and 1325 in 6th to 8th grade. Among the 8th graders, more than one in three males and one in four females had experimented with smoking, and more than half the boys and nearly half the girls had experience of alcohol. In this same age group, almost two in three males and one in three females had used energy drinks, and nearly 5% of the boys had experience of marijuana and/or stimulant drugs. In addition, almost one in four of the male students in 8th grade had experimented with three of these substances. The middle school years should be identified as the first period at risk concerning the use of these drugs. Prevention programs should begin in early adolescence, focusing on delaying the use or abuse of any of the "gateway drugs."

Energy drink consumption in children and early adolescents.

UNLABELLED: The aim of this study was to investigate the prevalence of energy drink consumption in children and very young adolescents and to study the sociodemographic and environmental-behavioral factors associated with regular, at least once a week, energy drink consumption in early adolescence. This survey was conducted during the 2011-2012 school year in the Province of Rovigo, in the Veneto Region (northeastern Italy), and involved a sample of 916 students. The usage of energy drinks increased significantly with age, from 17.8 % among sixth graders to 56.2 % among eighth graders. Among the male student population, 16.5 % of those in the eighth grade and 6.21 % of those in the sixth grade, respectively, drank them at least once a week. The independent variables conferring a higher likelihood of being at least once-a-week energy drink consumers were smoking and alcohol consumption. Awareness of the damage caused by energy drinks emerged as a protective factor that reduced the likelihood of young students consuming such drinks. CONCLUSIONS: This study showed that energy drink consumption is rising steadily in children and early adolescents. Energy drink consumption was found associated with the abuse of other substances, such as tobacco and alcohol.

Underage drinking on saturday nights, sociodemographic and environmental risk factors: a cross-sectional study.

BACKGROUND: Excessive alcohol consumption in underage people is a rising phenomenon. A major proportion of the disease burden and deaths of young people in developed nations is attributable to alcohol abuse. The aim of this study was to investigate social, demographic and environmental factors that may raise the risk of Saturday night drinking and binge drinking among Italian school students. METHODS: The study was conducted on a sample of 845 Italian underage school students, by means of an anonymous, self-test questionnaire. Multivariate logistic regression was applied to identify independent risk factors for alcohol drinking and binge drinking. Ordered logistic regression was used to identify independent risk factors for harmful drinking patterns. RESULTS: The independent variables that confer a higher risk of drinking in underage students are older age classes, male sex, returning home after midnight, belonging to a group with little respect for the rules, or to a group where young people are not seen as leaders. The higher the perception of alcohol consumption by the group, the higher the risk. Spending time in bars or discos coincides with a two-fold or four-fold increase, respectively, in the risk of alcohol consumption. CONCLUSION: Our findings show that certain environmental and social risk factors are associated with underage drinking. The most important role for preventing young people's exposure to these factors lies with the family, because only parents can exert the necessary control and provide a barrier against potentially harmful situations.