Operationalization and measurement of compulsivity across video gaming and gambling behavioral domains.

BACKGROUND: Compulsivity is the hallmark of addiction progression and, as a construct, has played an important role in unveiling the etiological pathways from learning mechanisms underlying addictive behavior to harms resulting from it. However, a sound use of the compulsivity construct in the field of behavioral addictions has been hindered to date by the lack of consensus regarding its definition and measurement. Here we capitalize on a previous systematic review and expert appraisal to develop a compulsivity scale for candidate behavioral addictions (the Granada Assessment for Cross-domain Compulsivity, GRACC). METHODS: The initial scale (GRACC90) consisted of 90 items comprising previously proposed operationalizations of compulsivity, and was validated in two panel samples of individuals regularly engaging in gambling and video gaming, using exploratory structural equation modeling (ESEM) and convergence analyses. RESULTS: The GRACC90 scale is unidimensional and structurally invariant across samples, and predicted severity of symptoms, lower quality of life, and negative affect, to similar degrees in the two samples. Additionally, poorer quality of life and negative affect were comparably predicted by compulsivity and by severity of symptoms. A shorter version of the scale (GRACC18) is proposed, based on selecting the 18 items with highest factor loadings. CONCLUSIONS: Results support the proposal that core symptoms of behavioral addictions strongly overlap with compulsivity, and peripheral symptoms are not essential for their conceptualization. Further research should clarify the etiology of compulsive behavior, and whether pathways to compulsivity in behavioral addictions could be common or different across domains.

The associative learning roots of affect-driven impulsivity and its role in problem gambling: A replication attempt and extension of Quintero et al. (2020).

Background and aims: Negative/positive urgency (NU/PU) refers to the proneness to act rashly under negative/positive emotions. These traits are proxies to generalized emotion dysregulation, and are well-established predictors of gambling-related problems. We aimed to replicate a previous work (Quintero et al., 2020) showing NU to be related to faulty extinction of conditioned stimuli in an emotional conditioning task, to extend these findings to PU, and to clarify the role of urgency in the development of gambling-related craving and problems. Methods: 81 gamblers performed an acquisition-extinction task in which neutral, disgusting, erotic and gambling-related images were used as unconditioned stimuli (US), and color patches as conditioned stimuli (CS). Trial-by-trial predictive responses were analyzed using generalized linear mixed-effects models (GLME). Results: PU was more strongly related than NU to craving and severity of gambling problems. PU did not influence acquisition in the associative task, whereas NU slightly slowed it. Extinction was hampered in individuals with high PU, and a follow-up analysis showed this effect to depend on relative preference for skill-based and casino games. Discussion and conclusions: Results suggest that resistance to extinction of emotionally conditioned cues is a sign of malfunctioning emotion regulation in problematic gambling. In our work, the key effect was driven by PU (instead of NU), and gambling craving and symptoms were also more closely predicted by it. Future research should compare the involvement of PU and NU in emotion regulation and gambling problems, for gamblers with preference for different gambling modalities (e.g., pure chance vs skill games).

Computational mechanisms underpinning greater exploratory behaviour in excess weight relative to healthy weight adolescents.

Obesity in adolescence is associated with cognitive changes that lead to difficulties in shifting unhealthy habits in favour of alternative healthy behaviours, similar to addictive behaviours. An outstanding question is whether this shift in goal-directed behaviour is driven by over-exploitation or over-exploration of rewarding outcomes. Here, we addressed this question by comparing explore/exploit behaviour on the Iowa Gambling Task in 43 adolescents with excess weight against 38 adolescents with healthy weight. We computationally modelled both exploitation behaviour (e.g., reinforcement sensitivity and inverse decay parameters), and explorative behaviour (e.g., maximum directed exploration value). We found that overall, adolescents with excess weight displayed more behavioural exploration than their healthy-weight counterparts - specifically, demonstrating greater overall switching behaviour. Computational models revealed that this behaviour was driven by a higher maximum directed exploration value in the excess-weight group (U = 520.00, p = .005, BF10 = 5.11). Importantly, however, we found substantial evidence that groups did not differ in reinforcement sensitivity (U = 867.00, p = .641, BF10 = 0.30). Overall, our study demonstrates a preference for exploratory behaviour in adolescents with excess weight, independent of sensitivity to reward. This pattern could potentially underpin an intrinsic desire to explore energy-dense unhealthy foods - an as-yet untapped mechanism that could be targeted in future treatments of obesity in adolescents.

How to pin a compulsive behavior down: A systematic review and conceptual synthesis of compulsivity-sensitive items in measures of behavioral addiction.

Experimental models identify the transition from choice to compulsivity as the main mechanism underlying addiction. In behavioral addictions research, however, the adjective compulsive is used to describe virtually any kind of excessive or dysregulated behavior, which hinders the connection between experimental and clinical models. In this systematic review, we adopted a preliminary definition of compulsive behavior based on previous theoretical work. Subsequently, a systematic review following PRISMA guidelines was conducted (a) to identify the validated instruments, currently used in behavioral addictions research, that include items that are sensitive (intendedly or not) to compulsivity, and (b) to categorize those items into differentiable operationalizations of compulsivity. Six operationalizations of compulsivity emerged from item content analysis: 1. Automatic or habitual behavior occurring in absence of conscious instrumental goals; 2. Behavior insensitive to negative consequences despite conscious awareness of them; 3. Overwhelming urge or desire that impels the individual to initiate the activity and jeopardizes control attempts; 4. Bingeing, or inability to stop or interrupt the activity once initiated, resulting in an episode substantially longer or more intense than intended; 5. Attentional capture and cognitive hijacking; and 6. Inflexible rules, stereotyped behaviors, and rituals related to task completion or execution. Subsequently, a list of 15 representative items per operationalization was elaborated for independent assessment and identification of delimitation problems. A high degree of agreement was reached in assessing them as instantiating compulsivity, as well as in their assignment to the corresponding categories. However, many of them were also considered overinclusive, i.e., uncapable of distinguishing compulsivity from value-based momentary choice. To increase their discriminative value, items in future compulsivity scales should be refined to explicitly mention disconnection between behavior and declarative goals. Further research on factorial structure of a pool of items derived from these operational definitions is warranted. Such a factorial structure could be used as an intermediate link between specific behavioral items and explanatory psychobiological, learning, and cognitive mechanisms.

The evidential value of research on cognitive training to change food-related biases and unhealthy eating behavior: A systematic review and p-curve analysis.

Cognitive bias modification (CBM), which retrains implicit biases towards unhealthy foods, has been proposed as a promising adjunct to improve the efficacy of weight loss interventions. We conducted a systematic review of research on three CBM approaches (i.e., cue-specific inhibitory control, approach bias modification, and attentional bias modification) for reducing unhealthy eating biases and behavior. We performed a p-curve analysis to determine the evidential value of this research; this method is optimally suited to clarify whether published results reflect true effects or false positives due to publication and reporting biases. When considering all CBM approaches, our results suggested that the findings of CBM trials targeting unhealthy eating are unlikely to be false positives. However, only research on attentional bias modification reached acceptable levels of power. These results suggest that CBM interventions may be an effective strategy to enhance the efficacy of weight loss interventions. However, there is room for improvement in the methodological standards of this area of research, especially increasing the statistical power can help to fully clarify the clinical potential of CBM, and determine the role of potential moderators.

Decision-making (in)flexibility in gambling disorder.

BACKGROUND: Behavioral flexibility -the ability to dynamically readjust our behavior in response to reward contingency changes- is often investigated using probabilistic reversal learning tasks (PRLT). Poor PRLT performance has been proposed as a proxy for compulsivity, and theorized to be related to perseverative gambling. Previous attempts to measure inflexibility with the PRLT in patients with gambling disorder have, however, used a variety of indices that may conflate inflexibility with more general aspects of performance in the task. METHODS: Trial-by-trial PRLT acquisition and reacquisition curves in 84 treatment-seeking patients with gambling disorder and 64 controls (non-gamblers and non-problem recreational gamblers) were analyzed to distinguish between (a) variability in acquisition learning, and (b) reacquisition learning in reversed contingency phases. Complementarily, stay/switch responses throughout the task were analyzed to identify (c) premature switching, and (d) sensitivity to accumulated negative feedback. RESULTS AND INTERPRETATION: Even after controlling for differences in acquisition learning, patients were slower to readjust their behavior in reversed contingency phases, and were more prone to maintain their decisions despite accumulated negative feedback. Inflexibility in patients with gambling disorder is thus a robust phenomenon that could predate gambling escalation, or result from massive exposure to gambling activities.

Decision-making inflexibility in a reversal learning task is associated with severity of problem gambling symptoms but not with a diagnosis of substance use disorder.

BACKGROUND: Decisions made by individuals with disordered gambling are markedly inflexible. However, whether anomalies in learning from feedback are gambling-specific, or extend beyond gambling contexts, remains an open question. More generally, addictive disorders-including gambling disorder-have been proposed to be facilitated by individual differences in feedback-driven decision-making inflexibility, which has been studied in the lab with the Probabilistic Reversal Learning Task (PRLT). In this task, participants are first asked to learn which of two choice options is more advantageous, on the basis of trial-by-trial feedback, but, once preferences are established, reward contingencies are reversed, so that the advantageous option becomes disadvantageous and vice versa. Inflexibility is revealed by a less effective reacquisition of preferences after reversal, which can be distinguished from more generalized learning deficits. METHODS: In the present study, we compared PRLT performance across two groups of 25 treatment-seeking patients diagnosed with an addictive disorder and who reported gambling problems, and 25 matched controls [18 Males/7 Females in both groups, Mage(SDage) = 25.24 (8.42) and 24.96 (7.90), for patients and controls, respectively]. Beyond testing for differences in the shape of PRLT learning curves across groups, the specific effect of problematic gambling symptoms' severity was also assessed independently of group assignment. In order to surpass previous methodological problems, full acquisition and reacquisition curves were fitted using generalized mixed-effect models. RESULTS: Results showed that (1) controls did not significantly differ from patients in global PRLT performance nor showed specific signs of decision-making inflexibility; and (2) regardless of whether group affiliation was controlled for or not, gambling severity was specifically associated with more inefficient learning in phases with reversed contingencies. CONCLUSION: Decision-making inflexibility, as revealed by difficulty to reacquire decisional preferences based on feedback after contingency reversals, seems to be associated with gambling problems, but not necessarily with a substance-use disorder diagnosis. This result aligns with gambling disorder models in which domain-general compulsivity is linked to vulnerability to develop gambling-specific problems with exposure to gambling opportunities.

The associative underpinnings of negative urgency and its role in problematic gambling behavior.

BACKGROUND: Negative urgency -the tendency to lose control under the influence of strong negative emotions- has been proposed to be a sign of malfunctioning emotion regulation mechanisms, and to contribute to severity and complications of gambling disorder and other externalizing behaviors. AIMS AND METHOD: This study is aimed at (1) testing whether negative urgency is linked to resistance to extinction in an emotional associative learning task in a sample of 70 participants, 65 of whom were active gamblers (with emotional pictures as unconditioned stimuli, and color patches as conditioned stimuli [CS]); and (b) exploring the link between these two variables (negative urgency and resistance to emotional extinction) and clinical manifestations of gambling (severity and craving). Mixed-effects generalized models were used to analyze trial-by-trial predictive responses during acquisition and extinction for erotic, disgusting, and gambling-related pictures. RESULTS AND CONCLUSIONS: Acquisition of CS-elicited responses remained unaffected by negative urgency, whereas extinction was hampered in individuals with high negative urgency, especially for CSs associated with erotic and gambling-related pictures. Moreover, negative urgency predicted higher craving scores, and these predicted more severe gambling-related symptoms. This finding resonates with the well-known involvement of emotion regulation processes in craving control. However, extinction was not independently related to craving. This lacking effect suggests that negative urgency is a broad construct, and although some of its components are directly related to faulty extinction (and generalized emotion dysregulation), such components are not the same negative urgency shares with difficulties of craving control.

The quality of research on mental health related to the COVID-19 pandemic: A note of caution after a systematic review.

BACKGROUND AND AIMS: SARS-CoV-2 pandemic has spurred scientific production in diverse fields of knowledge, including mental health. Yet, the quality of current research may be challenged by the urgent need to provide immediate results to understand and alleviate the consequences of the pandemic. This study aims to examine compliance with basic methodological quality criteria and open scientific research practices on the mental health effects of the COVID-19 pandemic. METHOD AND RESULTS: Twenty-eight studies were identified through a systematic search. Most of them met the requirements related to reporting key methodological and statistical information. However, the widespread use of convenience samples and the lack of a priori power analysis, coupled with low compliance with open science recommendations, such as pre-registration of studies and availability of databases, raise concerns about the validity, generalisability, and reproducibility of the findings. CONCLUSIONS: While the importance of offering rapid evidence-based responses to mitigate mental health problems stemming from the COVID-19 pandemic is undeniable, it should not be done at the expense of sacrificing scientific rigor. The results of this study may stimulate researchers and funding agencies to try to orchestrate efforts and resources and follow standard codes of good scientific practice.

Emotional and non-emotional facets of impulsivity in eating disorders: From anorexia nervosa to bulimic spectrum disorders.

OBJECTIVE: Impulsivity and difficulties in regulating emotions are considered to be transdiagnostic characteristics of patients with eating disorders (EDs). The study aimed to investigate trait impulsivity and inhibitory components of impulsivity, related or unrelated to emotions in patients with EDs. METHOD: A total of 17 patients with anorexia nervosa (AN), 16 patients with bulimic-spectrum EDs (BSD) and 20 healthy control (HC) participants completed an impulsivity scale (UPPS-P) before performing an emotional inhibitory control task during electroencephalography (EEG) acquisition. RESULTS: Higher trait impulsivity in EDs than HC (with higher scores among BSD patients) was observed. However, no differences in behavioural measures or neural indexes [event-related potential (ERP)] of emotional and non-emotional inhibitory control were observed between patients and HC. CONCLUSION: The present results highlighted negative urgency, an impulsive personality trait related to emotions, as a common feature of AN and BSD. Lack of perseverance, a trait which is less related to emotions, specifically characterises patients with BSD. On the other hand, behavioural and ERP data did not show altered inhibitory control in EDs, for either general or emotional-related response inhibition.

Gambling-Specific Cognitions Are Not Associated With Either Abstract or Probabilistic Reasoning: A Dual Frequentist-Bayesian Analysis of Individuals With and Without Gambling Disorder.

BACKGROUND: Distorted gambling-related cognitions are tightly related to gambling problems, and are one of the main targets of treatment for disordered gambling, but their etiology remains uncertain. Although folk wisdom and some theoretical approaches have linked them to lower domain-general reasoning abilities, evidence regarding that relationship remains unconvincing. METHOD: In the present cross-sectional study, the relationship between probabilistic/abstract reasoning, as measured by the Berlin Numeracy Test (BNT), and the Matrices Test, respectively, and the five dimensions of the Gambling-Related Cognitions Scale (GRCS), was tested in a sample of 77 patients with gambling disorder and 58 individuals without gambling problems. RESULTS AND INTERPRETATION: Neither BNT nor matrices scores were significantly related to gambling-related cognitions, according to frequentist (MANCOVA/ANCOVA) analyses, performed both considering and disregarding group (patients, non-patients) in the models. Correlation Bayesian analyses (bidirectional BF10) largely supported the null hypothesis, i.e., the absence of relationships between the measures of interest. This pattern or results reinforces the idea that distorted cognitions do not originate in a general lack of understanding of probability or low fluid intelligence, but probably result from motivated reasoning.

Learning to lose control: A process-based account of behavioral addiction.

Learning psycho(bio)logy has developed a solid corpus of evidence and theory regarding behavior control modes. The present article briefly reviews that literature and its influence on recent models in which the transition from goal-directed to compulsive behavior is identified as the main process underlying substance use disorders. This literature is also relevant to non-substance addictive disorders, and serves as basis to propose a restricted definition of behavioral addiction relying on the presence of behavior-specific compulsivity. Complementarily, we consider whether some activities can become disordered while remaining mostly goal-driven. Based on reinforcement learning models, relative outcome utility computation is proposed as an alternative mechanism through which dysfunctional behaviors (even not qualifying as addictive) can override adaptive ones, causing functional impairment. Beyond issues of conceptual delimitation, recommendations are made regarding the importance of identifying individual etiological pathways to dysregulated behavior, the necessity of accurately profiling at-risk individuals, and the potential hazards of symptom-based diagnosis. In our view, the validity of these recommendations does not depend on the position one takes in the nosological debate.

Brief group-delivered motivational interviewing is equally effective as brief group-delivered cognitive-behavioral therapy at reducing alcohol use in risky college drinkers.

College students are particularly vulnerable to risky alcohol use, which increases their likelihood of developing an alcohol use disorder in the future. As such, preventing and reducing alcohol use among college students should be a priority for health and social policies. This work was aimed to show that brief group-delivered MI is as effective as brief-group CBT at reducing alcohol use in college students. Eighty-nine college students (69 females; mean age = 21.01, SD = 2.85) with risky alcohol use, as measured by the AUDIT-C, were assigned to two groups, receiving three sessions of either brief group-delivered MI or CBT (bMI/bCBT). Alcohol use was assessed 3 and 6 months after the interventions, and analyzed according to an Intention-to-treat design. Changes in alcohol use at both points (relative to baseline) as well as post-intervention scores of intention to continue treatment and satisfaction with the psychologist were compared across groups, using one-sided Bayesian t-tests. Alcohol use decreased in both groups at the 3- and 6-months measurement points (relative to baseline). However, using bCBT superiority as an alternative hypothesis and the absence of such superiority as a point-null hypothesis, the Bayes factors supported the null at both the 3- and the 6-months follow-up (BF01 = 7.13, and BF01 = 5.22 respectively). Furthermore, the intention to continue treatment was substantially higher in the bMI group (BF10 = 9.77). These results are considerably robust to changes in analyses' priors. This study suggests that bCBT is not more effective than bMI at reducing alcohol use in our college student group (in which females are overrepresented). Additionally, bMI showed higher intention to continue treatment scores. The comparable results of brief and group-delivered CBT and MI interventions in alcohol use reduction allows clinicians to select treatments based on their own skills or preferences without any detriment to efficacy.

The paradoxical relationship between emotion regulation and gambling-related cognitive biases.

BACKGROUND: Gambling behavior presents substantial individual variability regarding its severity, manifestations, and psychological correlates. Specifically, differences in emotion regulation, impulsivity, and cognitive distortions have been identified as crucial to describe individual profiles with implications for the prevention, prognosis, and treatment of gambling disorder (GD). AIMS AND METHOD: The aim of the present study was to investigate the associations of gambling-related cognitions (measured according to the GRCS model) with impulsivity (UPPS-P model) and emotion regulation (CERQ model), in a sample of 246 gamblers with different levels of gambling involvement, using mixed-effects modelling to isolate theoretically relevant associations while controlling for the potentially confounding effects of sociodemographic and clinical covariates. RESULTS: Affective/motivational dimensions of UPPS-P impulsivity positive urgency and sensation seeking, on the one hand, and CERQ emotion regulation strategies reappraisal, rumination and blaming others, on the other, independently and significantly predicted distorted gambling-related cognitions. CONCLUSIONS: These results (a) reinforce the ones of previous studies stressing the relevance of emotional and motivational processes in the emergence of gambling-related cognitive distortions; and (b) replicate the seemingly paradoxical finding that gamblers use emotion regulation strategies customarily considered as adaptive (i.e. reappraisal) to strengthen and justify their biased beliefs about gambling outcomes and controllability.

Types of Emotion Regulation and Their Associations with Gambling: A Cross-Sectional Study with Disordered and Non-problem Ecuadorian Gamblers.

This cross-sectional study was aimed at investigating the role of emotional regulation in regular gambling in a sample of 197 disordered and non-problem gamblers from Ecuador. Two proxies were used as measures of behavioral signs of generalized emotion dysregulation (UPPS-P emotion-driven impulsivity) and intentional emotion regulation strategies (ERQ), and their associations with gambling cognitions (as measured by the GRCS questionnaire), gambling behavior (SOGS), and comorbid alcohol and drug misuse (MultiCAGE), were explored. For analyses, impulsivity traits, including emotion-driven impulsivity scores, were used as inputs to predict dispositional variables (ERQ strategies and GRCS cognitions), and clinically relevant behavioral outputs, while controlling for gambling severity. Hypotheses were based on previously published work, although the analysis has been improved (using hierarchical linear mixed-effects modelling), and homogenized in covariate control, and decision threshold stringency. Results were as follows: (1) After controlling for relevant covariates, UPPS-P sensation seeking was positively associated with gambling cognitions, whereas positive urgency was positively associated with cognitive biases (interpretative bias, control illusion, and predictive control) but not with other gambling cognitions. (2) Among emotion regulation strategies, reappraisal, but not suppression, was associated with gambling cognitions. (3) Negative urgency was distinctively associated with suppression, but not with reappraisal. And (4), no impulsivity dimensions significantly predicted drug or alcohol misuse, although negative urgency fell just below the decision threshold. These results reinforce the importance of emotion regulation processes in the cognitive and behavioral manifestations of gambling. Most importantly, they suggest a dissociation between the role of model-free dysregulation of negative emotions (as measured by UPPS-P negative urgency), as a key contributor to gambling complication and general psychopathology; and the one of strategic emotion regulation, in fueling gambling-related cognitive distortions.

Corrigendum: Phenotypes in Gambling Disorder Using Sociodemographic and Clinical Clustering Analysis: An Unidentified New Subtype?

[This corrects the article DOI: 10.3389/fpsyt.2019.00173.].

Phenotypes in Gambling Disorder Using Sociodemographic and Clinical Clustering Analysis: An Unidentified New Subtype?

Background: Gambling disorder (GD) is a heterogeneous disorder which has clinical manifestations that vary according to variables in each individual. Considering the importance of the application of specific therapeutic interventions, it is essential to obtain clinical classifications based on differentiated phenotypes for patients diagnosed with GD. Objectives: To identify gambling profiles in a large clinical sample of n = 2,570 patients seeking treatment for GD. Methods: An agglomerative hierarchical clustering method defining a combination of the Schwarz Bayesian Information Criterion and log-likelihood was used, considering a large set of variables including sociodemographic, gambling, psychopathological, and personality measures as indicators. Results: Three-mutually-exclusive groups were obtained. Cluster 1 (n = 908 participants, 35.5%), labeled as "high emotional distress," included the oldest patients with the longest illness duration, the highest GD severity, and the most severe levels of psychopathology. Cluster 2 (n = 1,555, 60.5%), labeled as "mild emotional distress," included patients with the lowest levels of GD severity and the lowest levels of psychopathology. Cluster 3 (n = 107, 4.2%), labeled as "moderate emotional distress," included the youngest patients with the shortest illness duration, the highest level of education and moderate levels of psychopathology. Conclusion: In this study, the general psychopathological state obtained the highest importance for clustering.

Reconsidering the roots, structure, and implications of gambling motives: An integrative approach.

RATIONALE AND METHOD: Accurately identifying motives to gamble is crucial in the functional analysis of gambling behavior. In this study, a data-driven approach was followed to clarify the factor structure underlying a pool of motives for gambling, selected from the Gambling Motives Questionnaire-Financial (GMQ-F), and the Reasons for Gambling Questionnaire (RGQ), in a sample of regular problem and non-problem gamblers. Additionally, the role of gambling motives in the relationship between root behavioral activation/inhibition systems (BIS/BAS) and gambling severity, frequency, and preferences was explored using structural equation modelling (SEM). RESULTS AND CONCLUSIONS: The present study identified Social, Financial, and Fun/thrill-related gambling motives factors, but also a fourth factor in which some positive and negative reinforcement-based motives were grouped into a single and broader Affect regulation factor. This Affect regulation factor shared variance both with BIS and BAS-related measures, and was the only direct predictor of disordered gambling symptoms. The Fun/thrill factor was directly related to frequency of participation in high-arousal, skill-based games, and all factors were related to participation in lower-arousal, chance games (with Social motives negatively predicting both participation in the latter and total severity). In the SEM model, measures of BIS/BAS sensitivity were connected to gambling behavior only through gambling motives. Based on measures of items' specificity, a shortened Spanish scale (the brief Gambling Motives Inventory, bGMI) is proposed to assess gambling motives in accordance with the observed 4-factor structure.

Sex differences in the association between impulsivity and driving under the influence of alcohol in young adults: The specific role of sensation seeking.

INTRODUCTION: There is an outstanding need to identify predictors of driving under the influence of alcohol (DUI) among young adults, particularly women. Impulsivity, or the tendency to act without thinking, is a predictor of DUI, but the specific facets of impulsivity that predict DUI and their interaction with sex differences remain unclear. We aimed to investigate sex differences in the link between impulsivity facets and DUI. Moreover, we sought to replicate previous findings regarding sex differences on impulsivity, and associations between impulsivity facets and DUI. METHOD: A total of 506 university students participated in the study (males, n = 128; females, n = 378). Participants completed measures of impulsivity (UPPS-P short version), alcohol use (AUDIT-C), frequency of DUI episodes and related perception of risk. The UPPS-P assesses five facets of impulsivity: sensation seeking, (lack of) premeditation and perseverance and positive and negative urgency. RESULTS: Men showed higher sensation seeking and lack of perseverance, alcohol use and DUI frequency and lower risk perception than women. DUI frequency was negatively associated with perception of risk and positively associated with alcohol use and the five impulsivity facets. After controlling for alcohol use and risk perception, only lack of premeditation was associated with DUI frequency in the whole sample. Sensation seeking was positively associated with DUI frequency only in women. DISCUSSION: The link between lack of premeditation and DUI suggest that pre-drinking planning strategies can contribute to prevent risky driving. In women, specific links between sensation seeking and DUI suggest the need for personality-tailored prevention strategies.

Visceral adiposity and insular networks: associations with food craving.

BACKGROUND/OBJECTIVES: Accumulation of visceral adiposity can disrupt the brain's sensitivity to interoceptive feedback, which is coded in the insula. This study aimed to test the link between visceral fat and the functional connectivity of two insulae regions relevant for eating behavior: the middle-dorsal insula (mIns), which codes homeostatic changes, and the rostral insula (rIns), which codes stable representations of food properties. We also assessed the impact of visceral adiposity-associated insulae networks on food craving. SUBJECTS/METHODS: Seventy-five adults ranging in weight status (normal and excess weight) underwent resting-state functional magnetic resonance imaging (fMRI) and subjective food craving measures. We examined the association between visceral fat and seed-based functional connectivity of the mIns and the rIns, controlling for BMI, age, and sex, using multiple regressions in SPM8. We also tested if visceral fat mediated the association between insulae connectivity and food craving. RESULTS: Higher visceral adiposity was associated with decreased connectivity between the mIns and a cluster involving the hypothalamus and the bed nucleus of the stria terminalis. Decreased connectivity in this network was associated with greater food craving, a relation mediated by visceral adiposity. Visceral adiposity was also associated with increased connectivity between the mIns and the middle frontal gyri and the right intraparietal cortex, and between the rIns and the right amygdala. CONCLUSIONS: Accumulation of visceral adiposity is linked to disrupted functional connectivity within the mIns and rIns networks. Furthermore, the link between the mIns network and food craving is mediated by visceral fat. Findings suggest that visceral fat disrupts insula coding of bodily homeostatic signals, which may boost externally driven food cravings.