Persons with Substance Abuse Disorders and Other Addictions: Coping with the COVID-19 Pandemic.

Cuba implemented policies mandating social distancing on March 11, 2020, which were still in place at the time of this study. During such periods of isolation, people with psychoactive substance-related disorders and other addictions may be tempted to reduce tension, stress, uncertainty and possible distress by increasing the use of substances or practices they have abused. This can mean relapses and setbacks for patients undergoing treatment. A multidisciplinary team of health professionals specializing in addiction at the Center for Academic Development in Drug Addiction, in Havana, Cuba, cares for people with these disorders and followed their evolution during the initial period of COVID-19 social isolation. With the aim of characterizing strategies employed by patients undergoing treatment for substance abuse and addictions, we conducted a qualitative study from April 2020 through May 2020, using a convenience sample of 37 patients (all students) who had been progressing towards recovery from addictive behaviors when face-to-face encounters were suspended due to COVID-19 restrictions. Contact was maintained through information and communication technologies. The research used telepsychology and focused on understanding patient life experiences. Patients were interviewed using a semi-structured survey, which was then transcribed and coded thematically using a grounded-theory approach. We found that patients' ability to cope successfully with challenges presented by COVID-19 were influenced by: 1) the individual's own methods for maintaining self-control (commitment to studies, projects, and work with therapists) that aided them in their goals concerning abstinence; 2) difficulties faced in addressing specific events and situations (doubts, uncertainties, disagreements, isolation and time use); 3) perpetuation and revivification of myths related to substances and addictive activities (exacerbation of supposed benefits of tobacco, alcohol, marijuana, overuse of social networks); and 4) tendencies toward irrationality and lack of emotional control (fear, sadness, anger, constant worry and self-imposed demands). Our findings suggest that despite the potential negative psychological impact of preventive social isolation during the COVID-19 pandemic, individual coping mechanisms developed by these patients, aiming at improved self-control, allowed most to avoid setbacks that could have affected their recovery. Nevertheless, patients faced challenges to their recovery that were compounded by difficulties in specific situations, myths related to substances and addictive activities, and tendencies toward irrationality or lack of emotional control.

Five-year follow-up on a sample of gamblers: predictive factors of relapse.

BACKGROUND AND AIMS: Few studies have been conducted on the long-term evolution of gambling disorder (GD). The aim of this study was to identify factors that could predict GD relapse. METHODS: Data were part of a dataset from a large 5-year cohort of gamblers who were assessed at inclusion and each year thereafter. Participants were recruited from an outpatient addiction treatment center, from various gambling places and through the press. For this specific study, inclusion criteria included (i) transitioning from GD to recovery at a follow-up time and (ii) undergoing at least one follow-up visit afterwards. Participants were evaluated using a structured clinical interview and self-report questionnaires assessing sociodemographic, gambling and clinical characteristics. "Relapse" was defined as the presence of GD (according to the DSM-5) at the N+1th visit following the absence of GD at the Nth visit. A Markov model-based approach was employed to examine predictive factors associated with relapse at a subsequent follow-up visit. RESULTS: The sample consisted of 87 participants, aged 47.6 years (sd = 12.6), who were predominantly male (65%). Among the participants, 49 remained in recovery, whereas 38 relapsed. Participants who reported not having experienced at least one month of abstinence and those with a low level of self-directedness at the previous follow-up visit were more likely to relapse. CONCLUSIONS: Our findings suggest the existence of factors that are predictive of relapse in individuals with GD who had previously achieved recovery. These results can inspire the development of measures to promote long-term recovery.

The rise of online sports betting, its fallout, and the onset of a new profile in gambling disorder: young people.

HYPOTHESIS: Since 2015 the gambling trend may have changed among young people between 18 and 30 years old. METHODOLOGY: Range of document review techniques obtained by therapeutic data regarding the personal development of each person in rehabilitation to analyze 13 different variables. FINDINGS: Due to the new regulations legalizing online gambling in Spain, and the constant increase in its advertising, a shift could have taken place in the gamblers' profile: a preference for online sports betting and placing other bets using devices connected to the Internet, such as smartphones, laptops, tablets, and similar technologies. Gamblers who use online media to place their bets also incur debts over the Internet. We find a possible proliferation of online betting services, that could imply an increase of social, psychological, and family relationship problems affecting young gamblers, which may constitute a new profile of gambling disorder.

Virtual reality for behavioral health workforce development in the era of COVID-19.

The coronavirus 2019 disease (COVID-19) pandemic emerged at a time of substantial investment in the United States substance use service infrastructure. A key component of this fiscal investment was funding for training and technical assistance (TA) from the Substance Abuse and Mental Health Services Administration (SAMHSA) to newly configured Technology Transfer Centers (TTCs), including the Addiction TTCs (ATTC Network), Prevention TTCs (PTTC Network), and the Mental Health TTCs (MHTTC Network). SAMHSA charges TTCs with building the capacity of the behavioral health workforce to provide evidence-based interventions via locally and culturally responsive training and TA. This commentary describes how, in the wake of the COVID-19 pandemic, TTCs rapidly adapted to ensure that the behavioral health workforce had continuous access to remote training and technical assistance. TTCs use a conceptual framework that differentiates among three types of technical assistance: basic, targeted, and intensive. We define each of these types of TA and provide case examples to describe novel strategies that the TTCs used to shift an entire continuum of capacity building activities to remote platforms. Examples of innovations include online listening sessions, virtual process walkthroughs, and remote "live" supervision. Ongoing evaluation is needed to determine whether virtual TA delivery is as effective as face-to-face delivery or whether a mix of virtual and face-to-face delivery is optimal. The TTCs will need to carefully balance the benefits and challenges associated with rapid virtualization of TA services to design the ideal hybrid delivery model following the pandemic.

Digital gaming interventions: a novel paradigm in mental health? Perspectives from India.

The mental health gap has been a persistent concern globally, especially in low and middle-income countries (LMIC). In an attempt to mitigate resource limitations, the psychiatric practice has been undergoing a paradigm shift into digitalized mental health interventions. One such innovation involves digital gaming utilizing the principles of 'gamification' to incorporate both the playfulness component of online gaming as well as the domain-targeted design of gaming elements. Digital gaming-based interventions have been to deliver psychotherapy, biofeedback, cognitive training and rehabilitation, as well as behavioural modification and social skills training. Research shows their utility in autism spectrum disorders, attention deficit disorders, schizophrenia, depression, anxiety disorders, post-traumatic stress, eating disorders, neurocognitive disorders and also to promote healthy aging. Though promising in scope, these interventions face pragmatic challenges for implementation in developing countries. Even though increased use of technology, internet penetration and growing digital literacy have enhanced their accessibility and feasibility, various factors like socio-cultural diversity, lack of standardization, poor infrastructural support, bandwidth issues and lack of practice can impair their use and acceptability. Keeping this in the background, this commentary critically discusses the scope, applications and challenges of digital gaming in mental healthcare delivery in one of the rapidly globalizing LMIC nations, India.

Addictive behaviors and craving during the COVID-19 pandemic of people who have recovered from substance use disorder.

Stressors caused by the coronavirus pandemic (COVID-19) contribute to increased addictive behaviors in the general population worldwide. Little is known, however, about addictive behaviors of people who have recovered a long time ago, even years, from substance use disorder (SUD). The goal of the present research was to examine the craving for drug use and addictive behaviors (tobacco and alcohol consumption, viewing of pornography, gambling, and shopping online) of people who recovered from SUD, before and after the outbreak of the COVID-19 pandemic.Methods: During one week of isolation imposed in Israel following the outbreak of COVID-19 in April, 2020, a self-report questionnaire was distributed to a convenience sample of 113 people who had recovered from SUD, aged 22-69, 78% men.Results Fifty-one percent of participants reported craving drugs during the isolation period and engaging in addictive behaviors. Significant differences were found in tobacco and alcohol consumption, gambling, and viewing of pornography online, before and after the outbreak of the pandemic, especially in participants who reported having engaged in these addictive behaviors to some extent before the outbreak. A hierarchical linear regression showed a significant explained variance (R2=44%, p<.001), with stronger feelings of loneliness and shorter length of time free from drug use being associated with stronger craving for drugs.Conclusions: The drug addiction treatment establishment should pay close attention and strengthen communication with people who recovered from SUD. It is necessary to develop real-time anti-craving and anti-replacement addiction interventions to prevent relapses.

COVID-19-related treatment service disruptions among people with single- and polysubstance use concerns.

Individuals with substance use disorders (SUDs), including those in long-term recovery, and their loved ones are facing rapid changes to treatment and support services due to COVID-19. To assess these changes, the Addiction Policy Forum fielded a survey to their associated patient and family networks between April 27 and May 13, 2020. Individuals who reported a history of use of multiple substances were more likely to report that COVID-19 has affected their treatment and service access, and were specifically more likely to report both use of telehealth services and difficulties accessing needed services. These findings suggest that individuals with a history of using multiple substances may be at greater risk for poor outcomes due to COVID-19, even in the face of expansion of telehealth service access.

Gambling-Related Cognitive Distortions in Residential Treatment for Gambling Disorder.

Gambling-related cognitive distortions are associated with gambling disorder severity, but few studies have provided an in-depth examination of the interrelationship between cognitive distortions, gambling severity, psychiatric comorbidity and treatment outcomes. The present study sought to identify factors associated with elevated cognitive distortions among problem gamblers entering residential treatment, examine changes in cognitive distortions through treatment, and explore the association between cognitive distortions and treatment outcomes. Pre- and post-treatment data were extracted from the charts of 125 individuals who participated in a 21-day residential treatment program for gambling disorder. Assessments included measures of demographics, gambling disorder severity, psychiatric symptoms and gambling-related cognitive distortions. Several significant associations were found between baseline cognitive distortions and psychiatric symptoms. Cognitive distortions decreased significantly from pre- to post-treatment. Pre- to post-treatment changes on several cognitive distortion scales were positively associated with greater baseline psychiatric symptomology. Treatment drop-out was associated with higher scores on measures reflecting greater impulsivity/addiction and greater perceived predictive control. Gambling-related cognitive distortions represent an important mechanism of gambling disorder and its treatment and provide a target for the development and refinement of treatment for gambling disorder.

Factors affecting treatment motivation among Turkish patients receiving inpatient treatment due to alcohol/substance use disorder.

Motivation is a significant factor in the treatment of addiction and has been proven to be a predictor of treatment outcomes. The present study investigated the effects of clinical variables, perceived social support, temperament, and personality traits on treatment motivation. This study included 100 patients whose detoxification treatment was completed following hospitalization in Alcohol and Drug Research, Treatment, and Training Center (AMATEM). Treatment motivations were assessed through Motivation for Treatment scale (MfT). Addiction Profile Index (API) was used to evaluate drug use characteristics, craving, and the effects of drug use on life. Temperament and character traits and perceived social support were evaluated by Temperament and Character Inventory (TCI) and Multidimensional Scale of Perceived Social Support (MSPSS), respectively. The number of treatment admissions, presence of a history of previous inpatient treatment, completed inpatient treatment, social support from the family, harm avoidance, substance use characteristics, craving, and the effect of substance on life showed differences while motivations of the patients were compared. Presence of a history of previously completed inpatient treatment, presence of high social support from the family, and significant recognition of the effects of substance on own life were evaluated as the factors predicting high motivation. The present study demonstrated that social support from family, previously completed inpatient treatment, and effect of substance in life had significant impact on motivation. Therefore, the assessment of these factors will aid in better understanding this population and in the design of long-term treatment plans.

Predictors of Dropout in Disordered Gamblers in UK Residential Treatment.

Within the cohort of individuals who seek treatment for disordered gambling, over half fail to complete treatment. The current study sought to identify predictors of treatment dropout in a sample of gamblers attending a residential treatment facility for disordered gamblers in the UK and to report differences in voluntary and enforced dropout. Data on 658 gamblers seeking residential treatment with the Gordon Moody Association (GMA) was analysed, collected between 2000 and 2015. Measurements included demographic data, self-reported gambling behavior, (including the Problem Gambling Severity Index), mental and physical health status, and a risk assessment. Binary logistic regression models were used to examine predictors of treatment termination. Results confirm a high percentage of treatment dropout among disordered gamblers (51.3%). Significant predictors of treatment dropout included older age of the client, higher levels of education, higher levels of debt, online gambling, gambling on poker, shorter duration of treatment, higher depression, experience of previous treatment programmes and medication, and adverse childhood experiences. Within non-completers, significant predictors of enforced dropout included lifetime homelessness, less debt, sports gambling, depression and lifetime smoking. Those who were on a longer treatment programme and had previously received gambling treatment or support were less likely to be asked to leave. Clinicians working in inpatient support need to be aware of the increased psychopathogical and psychosocial problems in those who are at risk of termination and make attempts to retain them in treatment and increase patient compliance.

DSM-5 in patients seeking their first treatment for alcohol use disorder. Sex differences in the multicenter CohRTA study. / DSM-5 en pacientes que solicitan el primer tratamiento del trastorno por uso de alcohol. Diferencias de sexo en el estudio multicéntrico CohRTA.

OBJECTIVE: We aimed to analyze sex differences in the DSM-5 criteria among patients admitted to  their first treatment of alcohol use disorder (AUD). METHODS: Assessment of AUD was carried out using DSM-5 diagnostic criteria in a multicenter study (CohRTA) within the Spanish Network on Addictive Disorders. Further, baseline questionnaires including socio-demographics, family history, lifetime alcohol consumption and other substance use, as well as clinical and laboratory parameters were obtained during admission. RESULTS: 313 patients (74.8%M) were eligible; mean age at first AUD treatment was 48.8 years (standard deviation (SD): 9.9 years). Age at onset of alcohol use was 15.9 years (SD: 3.3 years) and age at starting regular alcohol consumption was 25.6 years (SD: 9.6 years). Almost 69.3% of patients were tobacco smokers and 61% had family history of AUD. Regarding other substance use, 7.7% were current cocaine users and 18.2% were cannabis users. Women started regular alcohol consumption later than men (p<,001) and used benzodiazepines more frequently (p=.013). According to DSM-5, 89.5% of cases had severe AUD (≥6 criteria). In the adjusted analysis (logistic regression), men were more likely to neglect major rules (OR=1.92, 95%CI: 1.06-3.48) and to have hazardous alcohol use (OR=3.00, 95%CI: 1.65-5.46). DISCUSSION: DSM-5 detects sex differences in patients seeking their first AUD treatment. Social impairment and risky alcohol use are significantly more frequent in men.

Objetivo: Analizar las diferencias de sexo en los criterios diagnósticos del DSM-5 de los pacientes que solicitan un tratamiento para el trastorno por uso de alcohol (TUA) por primera vez. Métodos: Pacientes incluidos entre enero 2014 y marzo 2016 en el estudio multicéntrico CohRTA de la Red de Trastornos Adictivos. El diagnóstico del TUA se realizó mediante el DSM-5. Además, se recogieron datos sociodemográficos, sobre el consumo de alcohol y otras sustancias, variables clínicas y una analítica general. Resultados: se incluyeron 313 pacientes (74,8% hombres); la edad al inicio del primer tratamiento fue de 48,8 años (desviación estándar (DE): 9,9 años), la edad al inicio del consumo de alcohol de 15,9 años (DE: 3,3 años) y la de inicio del consumo regular de 25,6 años (DE: 9,6 años). Un 69,3% de los pacientes eran fumadores y un 61% tenían antecedentes familiares de TUA. Un 7,7% eran consumidores de cocaína y un 18,2% de cannabis. Las mujeres iniciaron el consumo regular de alcohol más tarde que los hombres (p<,001) y usaban benzodiacepinas con mayor frecuencia (p=,013). Según el DSM-5, el 89,5% de los pacientes presentaban un TUA grave (≥6 criterios). En el análisis ajustado (regresión logística), los hombres tenían mayor probabilidad de presentar el criterio diagnóstico relacionado con el incumplimiento de los deberes fundamentales en el trabajo o en el hogar (OR=1,92, IC95%: 1,06-3,48) y el criterio diagnóstico de consumir alcohol en situaciones de riesgo físico (OR=3,00, IC95%: 1,65-5,46). Discusión: El DSM-5 detecta diferencias de sexo en pacientes que solicitan el primer tratamiento del TUA. El deterioro social y el consumo de alcohol de riesgo son significativamente más frecuentes en hombres.

Mapping and conceptualizing recovery capital of recovered gamblers.

Recovery capital (RC) is an emerging conceptual framework in the addiction field that pinpoints the internal and external (i.e., human, community, cultural, social, financial) resources individuals can draw on throughout the recovery process. The concept of RC was developed and applied primarily to individuals who have recovered from substance addiction. The aim of this study was to extend the RC conceptual framework to gambling disorder (GD)-which is classified in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013) as a behavioral addiction-and to identify and conceptualize RC resources implemented by individuals who have recovered from GD. Ninety-one individuals who reported a lifetime history of DSM-5 GD but who had not exceeded the DSM-5 GD threshold criteria in the previous year, were interviewed about the factors that helped them throughout their recovery. Directed content analyses identified 12 main RC resources that were classified under 4 RC domains: human capital (subjective well-being, self-efficacy, self-control skills, proactive coping skills, socioemotional skills, reconstruction skills), community capital (prorecovery environment, professional therapeutic milieu), social capital (recovering gamblers' peer group, friends without a GD, family), and financial capital (prorecovery financial state). These findings are the first step toward formulating a comprehensive conceptual model of RC applicable to GD. This study extends the RC and the gambling literature by presenting a holistic view of recovery from GD in many facets of life, and underscores the importance of observing strengths and resources in treating people with GD. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Data sharing practices in randomized trials of addiction interventions.

INTRODUCTION: Transparent, open scientific research practices aim to improve the validity and reproducibility of research findings. A key component of open science is the public sharing of data and metadata that constitute the basis for research findings. METHODS: We conducted a 6 year cross-sectional investigation of the rates and methods of data sharing in 15 high-impact addiction journals that publish clinical trials. We extracted trial characteristics and whether the trial data were shared publicly in any form. We conducted a sensitivity analysis of only trials with public funding sources. RESULTS: In the included journals, zero (0/394, 0.0%) RCTs shared their data publicly. The large majority (315/394, 79.9%) of included trials received funding from public sources. Eight journals had data sharing policies and published 299 of the included trials (75.9%). CONCLUSION: Our finding has significant implications for the addiction research community. These implications are broad, ranging from possibly slowed scientific advancement to noncompliance with obligations to the public whose tax dollars funded a large majority of the included RCTs. To improve the rates of data sharing, we recommend studying incentive systems, while simultaneously working to cultivate a data sharing system that emphasizes scientific, rather than author, accuracy.

Papel de la reserva cognitiva en la recuperación cognitiva de pacientes que han sufrido una adicción grave a sustancias / The role of the cognitive reserve in the cognitive recovery of patients who have suffered a severe addiction to substances

Introducción: La reserva cognitiva resulta ser una variable de pronóstico en la recuperación cognitiva tras un daño cerebral. Pocos estudios han abordado su papel en el estado cognitivo tras un período sostenido de adicción a sustancias. Objetivo: Analizar el papel modulador de la reserva cognitiva sobre la relación entre el tiempo de abstinencia y el estado cognitivo de los pacientes con adicción grave a sustancias. Pacientes y métodos: Se valora a un total de 26 pacientes en recuperación tras una adicción grave a sustancias con un protocolo de evaluación neuropsicológica y cuestionarios de reserva cognitiva. Se emplea el análisis factorial exploratorio para conformar las variables y el análisis de regresión lineal para ver las relaciones predictivas. Resultados: Se obtienen tres factores de funcionamiento cognitivo: integridad de procesamiento, control inhibitorio y memoria verbal, así como un factor global de reserva. En los modelos de regresión, sólo se encuentran relaciones predictivas en un modelo de relación directa entre la abstinencia y la memoria verbal, y en un modelo de relación independiente entre la reserva cognitiva y el tiempo de abstinencia con la memoria verbal, pero no en la relación de modulación, ni en otras relaciones en el resto de los factores. Conclusión: Se debate el papel de la reserva cognitiva como mediadora en el estado cognitivo en los pacientes en período de abstinencia tras una adicción grave a sustancias: muestra una relación con la memoria, pero no una modulación del papel del tiempo de abstinencia sobre ese estado cognitivo

Introduction: Cognitive reserve has been shown to be a prognostic variable in cognitive recovery after brain damage. Few studies have addressed its role in the cognitive status after a sustained period of substance addiction. Aim: To analyse the modulating role of cognitive reserve in the relation between withdrawal time and the cognitive status of patients with severe substance addiction. Patients and methods: A total of 26 patients recovering from severe substance addiction were assessed using a neuropsychological assessment protocol and cognitive reserve questionnaires. Exploratory factor analysis is used to define the variables and linear regression analysis is employed to view the predictive relations. Results: Three cognitive functioning factors are obtained: processing integrity, inhibitory control and verbal memory, as well as an overall reserve factor. In the regression models, predictive relations are found only in a model of a direct relation between withdrawal and verbal memory, and in a model of an independent relation between cognitive reserve and withdrawal time and verbal memory, but not in the modulation relationship or in other relations in the rest of the factors. Conclusion: The article discusses the role of the cognitive reserve as a mediator in the cognitive status of patients in a period of withdrawal after a serious addiction to substances. A relationship with memory is shown, but no modulation of the role of withdrawal time on that cognitive status is detected

Mental health services in the Northwest Territories: a scoping review.

The impacts of colonization have had significant impacts on the mental health and community wellness Indigenous peoples in the Northwest Territories (NWT). It is important that all communities in the NWT have access to key services in a culturally relevant way in achieving mental and community wellness. A scoping review was conducted to identify mental health services available in the NWT. To guide the understanding of the landscape of mental health services in the NWT, the information on health services gathered was organized using the First Nations Mental Wellness Continuum (FNMWC) Model's Continuum of Essential Services. Documents accessed included grey literature, consisting of government documents, practice guidelines, education materials, community wellness reports, internet searches and expert consult interviews to collect data on mental health and wellness services in the NWT. 68 mental health services were included in this review, from 23 different sources. Results were summarized and described the Continuum of Essential Services from the FNMWC Model. This guided approach was found to be useful for mapping mental health services for communities in the NWT. The findings highlight and catagorize existing mental health services and gaps in relation to a First Nation's perspective using the FNMWC Model. Specific areas examined included the Continuum of Essential Services, Key Partners, Culture as a Foundation, and Indigenous Social Determinants of Health. Findings can guide communities and health authorities in planning, implementing and coordinating a full range of optimized mental health services in the NWT.

Prevención del consumo de sustancias adictivas en adolescentes: una mirada desde la Terapia Ocupacio / Prevention of addictive substances consumption in adolescents: a glance from the Occupational Therapy

La Terapia Ocupacional, además de desempeñar un rol importante en la rehabilitación, constituye una herramienta indispensable para realizar acciones preventivas direccionadas al consumo de sustancias adictivas en la adolescencia, desde los centros comunitarios de salud mental. En el presente trabajo se destacan el valor de la comunidad como escenario para la intervención, la clasificación científica de las drogas teniendo en cuenta sus efectos sobre el sistema nervioso central, así como las acciones desde la actividad y las ocupaciones, lo cual mejora la calidad del servicio que se presta a ese grupo etario.

The Occupational Therapy, besides carrying out an important role in rehabilitation, constitutes an indispensable tool to achieve preventive actions addressed to the consumption of addictive substances in adolescence, from the mental health community centers. In this work, the value of the community as scenario for the intervention, as well as the scientific classification of drugs are highlighted keeping in mind its effects on the central nervous system, as well as in the actions from the activity and occupations, which improves the service quality to that age group.

Prevención del consumo de sustancias adictivas en adolescentes: una mirada desde la Terapia Ocupacio / Prevention of addictive substances consumption in adolescents: a glance from the Occupational Therapy

La Terapia Ocupacional, además de desempeñar un rol importante en la rehabilitación, constituye una herramienta indispensable para realizar acciones preventivas direccionadas al consumo de sustancias adictivas en la adolescencia, desde los centros comunitarios de salud mental. En el presente trabajo se destacan el valor de la comunidad como escenario para la intervención, la clasificación científica de las drogas teniendo en cuenta sus efectos sobre el sistema nervioso central, así como las acciones desde la actividad y las ocupaciones, lo cual mejora la calidad del servicio que se presta a ese grupo etario(AU)

The Occupational Therapy, besides carrying out an important role in rehabilitation, constitutes an indispensable tool to achieve preventive actions addressed to the consumption of addictive substances in adolescence, from the mental health community centers. In this work, the value of the community as scenario for the intervention, as well as the scientific classification of drugs are highlighted keeping in mind its effects on the central nervous system, as well as in the actions from the activity and occupations, which improves the service quality to that age group(AU)

Functional neural changes and altered cortical-subcortical connectivity associated with recovery from Internet gaming disorder.

BACKGROUND AND AIMS: Although studies have suggested that individuals with Internet gaming disorder (IGD) may have impairments in cognitive functioning, the nature of the relationship is unclear given that the information is typically derived from cross-sectional studies. METHODS: Individuals with active IGD (n = 154) and those individuals no longer meeting criteria (n = 29) after 1 year were examined longitudinally using functional magnetic resonance imaging during performance of cue-craving tasks. Subjective responses and neural correlates were contrasted at study onset and at 1 year. RESULTS: Subjects' craving responses to gaming cues decreased significantly at 1 year relative to study onset. Decreased brain responses in the anterior cingulate cortex (ACC) and lentiform nucleus were observed at 1 year relative to onset. Significant positive correlations were observed between changes in brain activities in the lentiform nucleus and changes in self-reported cravings. Dynamic causal modeling analysis showed increased ACC-lentiform connectivity at 1 year relative to study onset. CONCLUSIONS: After recovery from IGD, individuals appear less sensitive to gaming cues. This recovery may involve increased ACC-related control over lentiform-related motivations in the control over cravings. The extent to which cortical control over subcortical motivations may be targeted in treatments for IGD should be examined further.