Experiences of patient organizations' involvement in medicine appraisal and reimbursement processes in Finland - a qualitative study.

BACKGROUND: This study investigated how patient representatives have experienced their involvement in medicines appraisal and reimbursement processes with the Council for Choices in Health Care in Finland (COHERE) and the Pharmaceuticals Pricing Board (PPB) and how authorities perceive the role of patient organizations' input. METHODS: Semi-structured thematic individual and pair interviews were conducted in 2021 with representatives (n = 14) of patient organizations and government officials (n = 7) of the Ministry of Social Affairs and Health. The interview data were analyzed using qualitative content analysis. RESULTS: Patient representatives expressed their appreciation for the PPB and the COHERE in creating consultation processes and systematic models that support involvement. However, there were many challenges: patient representatives were uncertain about how their submissions were utilized in official processes and whether their opinions had any significance in decision-making. Patients or patient organizations lack representation in appraisal and decision-making bodies, and patient representatives felt that decision-making lacked transparency. The importance of patient involvement was highlighted by the authorities, but they also emphasized that the patient organizations' contributions were complementary to the other materials. Submissions regarding the medications used to treat rare diseases and those with limited research evidence were considered particularly valuable. However, the submissions may not necessarily have a direct impact on decisions. CONCLUSIONS: The interviews provided relevant input for the development of involvement processes at the PPB and COHERE. The interviews confirmed the need for increased transparency in the medicines assessment, appraisal, and decision-making procedures in Finland.

A Randomised, Double-Blind, Placebo-Controlled Trial of As-Needed Naltrexone in the Treatment of Pathological Gambling.

BACKGROUND/AIMS: Effective treatment strategies are needed for the treatment of pathological gambling (PG). The efficacy of as-needed naltrexone was assessed in a single-centre, randomised, double-blind, placebo-controlled trial. METHODS: The participants (n = 101) received either as-needed placebo or naltrexone (50 mg) and psychosocial support for 20 weeks. The primary outcome measure was the severity of PG assessed by the Yale-Brown Obsessive Compulsive Scale adapted for PG (PG-YBOCS). Secondary gambling-related outcome measures included thoughts/urges and behaviour subscales of PG-YBOCS as well as the highest daily expenditure and gambling frequency. In addition, RAND-36 scales of emotional well-being and social functioning were used as outcomes. The results were analysed using the intention-to-treat principle and linear random effects modelling. RESULTS: No significant treatment group differences were found. In an exploratory analysis, emotional well-being increased in a subgroup of participants with AA genotype of opioid receptor, mu 1 (OPRM1) A118G polymorphism (p = 0.02). CONCLUSION: Overall, the as-needed naltrexone may not provide substantial additional benefit for PG patients receiving psychosocial support. Replication by larger scale studies is warranted to further evaluate naltrexone administration schedules for the treatment of PG and the role of OPRM1.

Eveningness relates to burnout and seasonal sleep and mood problems among young adults.

AIMS: Diurnal preference towards eveningness among adults has been associated with unhealthy habits and a range of health hazards, such as sleeping problems and higher odds for depression. We wanted to analyse whether diurnal preference towards eveningness is associated with more severe symptoms regarding sleep problems and mental disorders among young adults. METHODS: Our sample consists of 469 young adults, aged 18-29 years, from the Mental Health in Early Adulthood Study in Finland (MEAF) conducted in 2003-2005. Chronotype was based on the assessment of one question that was asked first in 2000-2001 and the second time in 2003-2005. Those 73 participants who changed their chronotype were excluded from the main analysis, but separate analyses were performed with this group. RESULTS: Concerning sleep, E-types reported higher dependency on alarm clocks (p < 0.001), and E-types and I-types had more problems in feeling refreshed after waking up (p < 0.0001 and p < 0.05 respectively) than M-types. Regarding mental health, E-types and I-types had lower odds for any lifetime DSM-IV Axis I disorder (p < 0.05 and p < 0.01 respectively) than M-types. CONCLUSIONS: Our results are in line with previous findings that those with the diurnal preference towards eveningness have more frequently three or more lifetime mental disorders, more sleeping problems, more seasonal variation in mood and behaviour, and more burnout compared with those with the diurnal preference towards morningness.

[The Finnish first year junior high school students gambling behaviour is associated with substance use and low academic performance]. / Seitsemäsluokkalaisten rahapelaaminen on yhteydessä pähteiden käyttöön ja heikkoon koulumenestykseen.

BACKGROUND: The study investigated Finnish 7th grade school children's gambling behaviour and gambling prevalence. METHOD: Participants (N = 988) in this study were from eleven schools in Finland.Χ2X-tests, mean comparisons and correlations were used to analyse the data. The retention rate was 9.,6%. RESULTS: Nearly one-third of the participants had gambled once or twice. .,0% of the participants were problem gamblers and .,8% gambled at-risk level. Significant others' gambling was associated with participants 'problem gambling. CONCLUSIONS: Adolescent problem gambling prevalence and at-risk level of gambling were higher compared to the adult population. Replication of this study with the larger sample is needed in order to confirm the results.

Concerned significant others of people with gambling problems in Finland: a cross-sectional population study.

BACKGROUND: Problem gambling not only impacts those directly involved, but also the concerned significant others (CSOs) of problem gamblers. The aims of this study were to investigate the proportion of male and female CSOs at the population level; to investigate who the CSOs were concerned about; and to investigate sociodemographic factors, gender differences, gambling behaviour, and health and well-being among CSOs and non-CSOs. METHODS: The data (n = 4484) were based on a cross-sectional population study. Structured telephone interviews were conducted in 2011-2012. The data were weighted based on age, gender and residency. The respondents were defined as CSOs if they reported that at least one of their significant others (father, mother, sister/brother, grandparent, spouse, own child/children, close friend) had had gambling problems. Statistical significance was determined by chi-squared and Fisher's exact tests, and logistic regression analysis. RESULTS: Altogether, 19.3% of the respondents were identified as CSOs. Most commonly, the problem gambler was a close friend (12.4%) of the CSO. The percentage of close friends having a gambling problem was larger among male CSOs (14.4%) compared with female CSOs (10.3%; p ≤ 0.001), while the percentage of partners with gambling problem was larger among females (2.6%) than among males (0.8%; p ≤ 0.001). In the best fitting model, the odds ratio (95% CI) of being a male CSO was 2.03 (1.24-3.31) for past-year gambling problems, 1.46 (1.08-1.97) for loneliness and 1.78 (1.38-2.29) for risky alcohol consumption. The odds ratio (95% CI) of being a female CSO was 1.51 (1.09-2.08) for past-year gambling involvement, 3.05 (1.18-7.90) for past-year gambling problems, 2.21 (1.24-3.93) for mental health problems, 1.39 (1.03-1.89) for loneliness and 1.97 (1.43-2.71) for daily smoking. CONCLUSIONS: CSOs of problem gamblers often experience cumulating problems such as their own risky gambling behaviour, health problems and other addictive disorders. The clearest gender difference was seen in smoking by CSO. In order to develop efficient and targeted support and services for CSOs, it is necessary to understand the correlates related to different subgroups of CSOs.

Attitudes towards gambling in Finland: a cross-sectional population study.

BACKGROUND: Attitudes towards gambling influence gambling behaviour but also reflect the existing gambling policy in a society. However, studies examining general attitudes towards gambling at the population level are scarce. The first aim of this study was to investigate general attitudes of the Finnish population towards gambling. The second aim was to explore the association of socio-demographics, gambling behaviours, being a concerned significant other (CSO) of a problem gambler and perceived health and lifestyle with attitudes towards gambling among the Finnish population. METHODS: A cross-sectional study was performed by structured telephone interview on a random sample of 15-74-year-old Finns between October 2011 and January 2012. The data (n = 4484) was weighted based on age, gender and region of residence. Attitudes towards gambling were measured with the eight-item version of the Attitude Towards Gambling Scale (ATGS-8). A factor analysis was performed to test the structure of the Finnish version of the ATGS-8. The data were analysed using one-way ANOVA test, t-test and multiple regression analysis. RESULTS: On average, attitudes of Finns towards gambling were negative. The most significant factors associated with positive attitudes towards gambling were male gender, young age, 12 years or more education and net income more than 2000€, low score on gambling severity, being a non-CSO of a problem gambler and high alcohol consumption CONCLUSIONS: The association between young age, male gender, high net income and risky alcohol consumption, and favourable gambling attitudes was strong, and also reflects risky gambling behaviour. Experiencing gambling-related harms caused by one's own or significant other's excessive gambling seems to indicate unfavourable attitudes towards gambling.

Consumption of fruits and vegetables and its association with sleep duration among Finnish adult population: a nationwide cross-sectional study.

Introduction: Sleep and diet are crucial determinants of overall health and wellbeing, with the potential to mutually influence each other. This study examined the association between sleep duration and fruits and vegetables (FV) consumption among Finnish adults. Methods: The study analyzed data from the National FinHealth 2017 Study involving 5,043 adults aged 18 years and above. Participants reported their habitual sleep duration, and dietary consumption through a validated self-administered questionnaire. Confounders such as demographic, socio-economic factors, and chronotype were considered. A sensitivity analysis, which excluded energy under-reporters, was conducted to validate the findings. Results: Mean dietary consumption was compared across three sleep duration categories (short, normal, long), revealing that short sleepers consumed 37 g/d fewer FV, and long sleepers consumed 73 g/d fewer FV than normal sleepers. Binary logistic regression analyses consistently demonstrated significant negative association between FV consumption and both short and long sleep duration across all models, even when adjusted for a range of covariates. Linear regression analyses revealed a positive but non-significant association between sleep duration and FV consumption that became significant when excluding energy under-reporters, particularly in model 1. Discussion: This study suggests a consistent pattern where deviation from normal sleep duration was associated with decreased FV consumption, suggesting the need for considering sleep patterns in dietary intervention. The substantial role of accurate energy reporting in explaining these associations is highlighted. Further research, including longitudinal studies, is needed to better understand the mechanisms underlying these associations.

An analysis of problem gambling among the Finnish working-age population: a population survey.

BACKGROUND: Gambling problems currently affect approximately 100,000 Finns. In order to prevent and reduce gambling-related harms it is crucial for the Finnish public health authorities to gain a stronger understanding of the association between gambling problems and related socio-demographic factors, other commonly co-occurring dependencies (e.g. alcohol and nicotine) and the type of games gambled. In this article the prevalence of problem gambling in Finland and the socio-demographic profiles of problem gamblers are studied. METHOD: An annual postal survey entitled Health Behaviour and Health among the Finnish Adult Population AVTK was sent to a random sample of Finnish adults (N=5000) aged between 15 and 64. The sample was derived from the Finnish Population Register. The survey was mailed to the participants in April 2010. Gender differences in socio-demographic variables and Problem Gambling Severity Index PGSI were assessed. A multinomial regression model was created in order to explore the association between socio-demographic factors and the severity of gambling. RESULTS: A total of 2826 individuals (1243 males and 1583 females) replied to the survey. Of the respondents, 1.1% (2.1% of males, 0.3% of females) were identified as problem gamblers. Those who were of younger age, gender, had less than twelve years of education, consumed alcohol at risk level and smoked had higher odds of having low or moderate levels of gambling problems. Whereas, unemployment and smoking predicted significantly for problem gambling. Females gambled Lotto and slot machines less frequently than males and had more low level gambling problems. Males gambled more with a higher frequency and had a more severe level of gambling problems. Females were more attracted to scratch card gambling and daily Keno lotteries compared to males. In comparison, males gambled more on internet poker sites than females. Overall, a high frequency of gambling in Lotto, daily lotteries, slot machines, horse race betting and internet gambling was significantly associated with a more severe level of problem gambling. CONCLUSION: Gambling problems affect tens of thousands of individuals annually, therefore certain vulnerabilities should be noted. Comorbid dependencies, smoking in particular, ought to be screened for and recognised in the public health sector. Regulating the availability of slot machine gambling and enforcement of the age limit should be acknowledged. In establishing new gambling venues, prevalence rates in those particular areas should be actively monitored.

Internet-based CBT intervention for gamblers in Finland: experiences from the field.

From September 2007 to May 2011 a total of 471 participants (325 males and 146 females) signed up for an 8-week Internet-based cognitive behavioral therapy offered for gamblers in Finland. Sixty-four percent of the participants were pathological gamblers (PGs) (NODS 5> points), 14% were problem gamblers (NODS 3-4 points) and 10% were at risk of gambling problems (NODS 1-2 points). Two hundred and twenty four participants completed the treatment and after the treatment period significant changes were found in the following variables: gambling related problems (NODS), gambling urge, impaired control of gambling, alcohol consumption (AUDIT-C), social consequences, gambling-related cognitive erroneous thoughts and depression (MARD-S). In this sample co-morbid alcohol consumption was stronger among males. The main finding of this study was that the onset age of gambling was associated with a greater amount of gambling-related cognitive erroneous thoughts.

[Virtual support for problem gamblers]. / Virtuaalituki rahapeliongelmissa: nykytilanne Suomessa ja tulevaisuuden kehityssuunnat.

Low threshold virtual support is an emerging form of treatment for problem gamblers. The advantages of virtual support are cost-efficacy and good availability. A special advantage of web-environment is the possibility to modify the virtual support programs separately for diverse subgroups of problem gamblers.

Influence of seasonal variation in mood and behavior on cognitive test performance among young adults.

BACKGROUND: Seasonal variations in mood and behavior are common among the general population and may have a deteriorating effect on cognitive functions. AIMS: In this study the effect of seasonal affective disorder (SAD-like symptoms) on cognitive test performance were evaluated in more detail. METHODS: The data were derived from the study Mental Health in Early Adulthood in Finland. Participants (n = 481) filled in a modified Seasonal Pattern Assessment Questionnaire (SPAQ) and performed cognitive tests in verbal and visual skills, attention and general intelligence. RESULTS: SAD-like symptoms, especially regarding the seasonal variations in weight and appetite, had a significant effect on working memory (Digit Span Backward, P = 0.008) and auditory attention and short-term memory (Digit Span Forward, P = 0.004). The seasonal variations in sleep duration and mood had an effect on auditory attention and short-term memory (Digit Span Forward, P = 0.02 and P = 0.0002, respectively). The seasonal variations in social activity and energy level had no effect. CONCLUSIONS: Seasonal changes in mood, appetite and weight have an impairing effect on auditory attention and processing speed. If performance tests are not to repeated in different seasons, attention needs to be given to the most appropriate season in which to test.

Quantitative online survey of self-perceived knowledge and knowledge gaps of medicines research and development among Finnish general public.

OBJECTIVES: This study explored self-reported knowledge and interest to learn more about medicines research, development and health technology assessment among Finnish general public. It also aimed to define possible knowledge gaps and needs for public education regarding these topics. DESIGN: Online survey with 503 participants. The questionnaire was originally developed as a part of the Needs Assessment Work Package of the European Patients' Academy on Therapeutic Innovation Project. The survey was carried out in Finland in 2019. METHODS: The survey was conducted as an online survey by Kantar TNS Gallup Forum online panel. The data were analysed by using the freely available programming language R. Relationships between the demographic characteristics (such as age, gender and education level) of respondents and their knowledge or interest in medicines research and development were determined using Pearson's χ2 tests. Statistically significant responses of demographic characteristics in the respondents' knowledge or interest in medicines research were determined by logistic regression. RESULTS: Of the 503 respondents (age 16-64) only 12% reported having good or very good knowledge of medicines research and development in general. Regarding health technology assessment, pharmacoeconomics and regulation, the percentage of respondents reporting good or very good knowledge was as low as 8%. Respondents were most interested in learning more about predictive and personalised medicine (47%) and least interested in medicines regulation (30%) and pharmacoeconomics (31%). CONCLUSIONS: Self-reported knowledge about medicines research and development and health technology assessment appears to be very low in Finland. Patient and public participation is recognised as an important and essential element in up-to-date medical research and assessment of new treatments. In order to participate as an active and equal partner in these processes, the public needs more information and education in these topics.

[Evolution of sleep]. / Evoluution säilyttämä uni.

Evolution is a continuous process that changes population genetics towards greater adaptation. Sleep is an example of a conservative trait that appears everywhere and is regulated similarly in the animal kingdom. Because of this similarity in sleep regulation different animal models and genetic modification can be used in basic research and in studies of sleep related diseases. Recent research has enlightened the function of the clock genes and the synaptic plasticity during sleep, so that we can better understand the need for sleep and the effects of sleep loss. This knowledge is needed in order to prevent and treat sleep related diseases.

Night-time work predisposes to non-Hodgkin lymphoma.

Our aim was to find out whether non-Hodgkin lymphoma (NHL) was more common than expected among night-time shift workers. The Finnish job-exposure matrix (FINJEM) provided estimates of the proportion of exposed persons and the mean level of exposure among the exposed in each occupation. The probability of night-time work in each occupation was assessed, the observed and expected numbers of cancer cases in a cohort of persons born in 1906-1945 during the years of 1971-1995 were calculated, and the cumulative index of night-time work was scored. The cohort compromised of 1,669,272 persons of whom 6,307 (3,813 men and 2,494 women) had NHL during the follow-up. Night-time work increased significantly (p = 0.01) the risk of NHL in men, the overall relative risk being 1.10 (95% confidence interval of 1.03-1.19). Using the lag period of 10 years, the risk ratio was 1.28 (1.03-1.59) for men who worked in night-time shifts to a high degree as compared with those who had not been exposed to night-time work. Night-time workers are cancer prone and have a greater risk of NHL than population on average.

Transitions into and out of daylight saving time compromise sleep and the rest-activity cycles.

BACKGROUND: The aim of this study was to analyze the effects of transition out of and into daylight saving time on the rest-activity cycles and sleep. Rest-activity cycles of nine healthy participants aged 20 to 40 years were measured around transitions out of and into daylight saving time on fall 2005 and spring 2006 respectively. Rest-activity cycles were measured using wrist-worn accelerometers. The participants filled in the Morningness-Eveningness and Seasonal Pattern Assessment Questionnaires before starting the study and kept a sleep diary during the study. RESULTS: Fall transition was more disturbing for the more morning type and spring transition for the more evening type of persons. Individuals having a higher global seasonality score suffered more from the transitions. CONCLUSION: Transitions out of and into daylight saving time enhanced night-time restlessness and thereby compromised the quality of sleep.

Daylight saving time transitions and hospital treatments due to accidents or manic episodes.

BACKGROUND: Daylight saving time affects millions of people annually but its impacts are still widely unknown. Sleep deprivation and the change of circadian rhythm can trigger mental illness and cause higher accident rates. Transitions into and out of daylight saving time changes the circadian rhythm and may cause sleep deprivation. Thus it seems plausible that the prevalence of accidents and/or manic episodes may be higher after transition into and out of daylight saving time. The aim of this study was to explore the effects of transitions into and out of daylight saving time on the incidence of accidents and manic episodes in the Finnish population during the years of 1987 to 2003. METHODS: The nationwide data were derived from the Finnish Hospital Discharge Register. From the register we obtained the information about the hospital-treated accidents and manic episodes during two weeks before and two weeks after the transitions in 1987-2003. RESULTS: The results were negative, as the transitions into or out of daylight saving time had no significant effect on the incidence of accidents or manic episodes. CONCLUSION: One-hour transitions do not increase the incidence of manic episodes or accidents which require hospital treatment.

Seasonality, morningness-eveningness, and sleep in common non - communicable medical conditions and chronic diseases in a population.

The seasonal pattern for mood and behaviour, the behavioural trait of morningness-eveningness, and sleep are interconnected features, that may serve as etiological factors in the development or exacerbation of medical conditions. Methods: The study was based on a random sample of inhabitants aged 25 to 74 years living in Finland. As part of the national FINRISK 2012 study participants were invited (n=9905) and asked whether the doctor had diagnosed or treated them during the past 12 months for chronic diseases. Results: A total of 6424 participants filled in the first set of questionnaires and 5826 attended the physical health status examination, after which the second set of questionnaires were filled. Regression models were built in which each condition was explained by the seasonal, diurnal and sleep features, after controlling for a range of background factors. Of the chronic diseases, depressive disorder was associated with longer total sleep duration (p<.0001) and poor sleep quality (p<.0001). Of the measurements for health status assessment, none associated with sleep features, but systolic blood pressure yielded significant (p<.0001) associations with both seasonal and diurnal features at large. Conclusion: Sleep quality was the most sensitive probe in yielding associations with chronic diseases in this population-based study. The seasonal variations in mood and social activity, and the ease in getting up and tiredness in the morning were the most sensitive probes in yielding associations with blood pressure and waist circumference. Assessment of sleep quality, seasonal and diurnal features provides thus added value for health surveys of the general population.

Field trial of timed bright light exposure for jet lag among airline cabin crew.

OBJECTIVES: Commercial airlines' flight crew members on transmeridian long-haul flights are constantly exposed to rapid changes in external time. Following rapid changes in circadian rhythm may lead to several symptoms known as jet lag. Our aim was to alleviate jet-lag symptoms by timed exposure to bright light (natural sunlight if present, otherwise artificial bright light). STUDY DESIGN: Observational field trial with bright light against jet lag. METHODS: Information on the effects of bright lights on health was delivered through corporate level wellness programs. Volunteer study subjects were cabin crew members on long-haul flights. Subjects filled in a 16-Item Columbia Jet Lag Scale (maximum score 64) before the flight (expected symptoms based on previous flights), on the third day at the destination and again on the third day after returning home. Changes in scores were compared relative to the timed exposure to bright light, and to flights eastwards or westwards, and in summer or winter. RESULTS: Out of 75 subjects, 15 returned the questionnaires for a total of 28 flights. The mean estimated effect of bright light was a decrease of 5.3 points on the symptom scale. The difference was not significant (SE = 3.4, df = 11, t = -1.6, p = 0.15). The flight had no influence on the estimate. CONCLUSIONS: The results do not give support to the hypothesis that timed exposure to bright light would alleviate jet lag symptoms, although the small sample size was a problem. More field studies are needed to establish the feasibility of bright light for reducing jet lag.

Associations of common noncommunicable medical conditions and chronic diseases with chronotype in a population-based health examination study.

Chronotype is an emerging predictor of health and longevity, and understanding its influence on chronic diseases is important for constructing conceptual models of long-term pathways to health. We assessed the associations of chronotype with health status in the general Finnish adult population. Our population-based data were derived from the National FINRISK 2012 study and consisted of 4414 participants, aged 25-74 years, living in Finland. As part of their health examination, participants were asked about their circadian preference to the daily activities (morningness-eveningness) and a diagnosis or treatment for a set of common noncommunicable medical conditions and chronic diseases during the past 12 months. We found that there were 1935 (43.8%) morning types (MTs) and 595 (13.5%) evening types (ETs) and that 1884 (42.7%) were intermediates. As compared with the MTs, the ETs had significantly greater odds for depression (OR = 2.44, 95% CI = 1.52-3.90, p < 0.001) and other mental disorders (OR = 5.18, 95% CI = 2.32-11.52, p < 0.001). The odds were also increased for gallstones, and chronic obstructive pulmonary disease, but these did not remain significant after controlling for multiple testing. Responses to the single-item subjective estimation on the chronotype yielded the association of the definitely evening type of persons with the diagnosis or treatment of cardiac insufficiency (OR = 1.99, 95% CI = 1.02-3.88, p = 0.044) that was corroborated as the greater the eveningness score was, the more common the diagnosis or treatment of cardiac insufficiency was (ß = 0.92, 95% CI = 0.85-0.98, p = 0.013). This exploratory study adds further support to the role of evening chronotype in chronic disease risk, albeit underlying mechanisms remain to be elucidated.

Dopamine and Opioid Neurotransmission in Behavioral Addictions: A Comparative PET Study in Pathological Gambling and Binge Eating.

Although behavioral addictions share many clinical features with drug addictions, they show strikingly large variation in their behavioral phenotypes (such as in uncontrollable gambling or eating). Neurotransmitter function in behavioral addictions is poorly understood, but has important implications in understanding its relationship with substance use disorders and underlying mechanisms of therapeutic efficacy. Here, we compare opioid and dopamine function between two behavioral addiction phenotypes: pathological gambling (PG) and binge eating disorder (BED). Thirty-nine participants (15 PG, 7 BED, and 17 controls) were scanned with [11C]carfentanil and [18F]fluorodopa positron emission tomography using a high-resolution scanner. Binding potentials relative to non-displaceable binding (BPND) for [11C]carfentanil and influx rate constant (Ki) values for [18F]fluorodopa were analyzed with region-of-interest and whole-brain voxel-by-voxel analyses. BED subjects showed widespread reductions in [11C]carfentanil BPND in multiple subcortical and cortical brain regions and in striatal [18F]fluorodopa Ki compared with controls. In PG patients, [11C]carfentanil BPND was reduced in the anterior cingulate with no differences in [18F]fluorodopa Ki compared with controls. In the nucleus accumbens, a key region involved in reward processing, [11C]Carfentanil BPND was 30-34% lower and [18F]fluorodopa Ki was 20% lower in BED compared with PG and controls (p<0.002). BED and PG are thus dissociable as a function of dopaminergic and opioidergic neurotransmission. Compared with PG, BED patients show widespread losses of mu-opioid receptor availability together with presynaptic dopaminergic defects. These findings highlight the heterogeneity underlying the subtypes of addiction and indicate differential mechanisms in the expression of pathological behaviors and responses to treatment.