The role of emotional inhibitory control in specific internet addiction - an fMRI study.

BACKGROUND: Addicts to specific internet applications involving communication features showed increased social anxiety, emotional competence deficits and impaired prefrontal-related inhibitory control. The dorsal Anterior Cingulate Cortex (dACC) likely plays an important role in cognitive control and negative affect (such as social exclusion, pain or anxiety). AIM: To assess (social) anxiety-related inhibitory control in specific internet addiction (addicted use of games and social networks) and its relation to altered dACC activation. METHODS: N=44 controls and n=51 specific internet addicts completed an anxious words-based Affective Go/No-Go task (AGN). A subsample of n=23 healthy controls and n=25 specific internet addicts underwent functional Magnetic Resonance Imaging (fMRI) while completing an Emotional Stroop Task (EST) with socially anxious, positive, negative and neutral words. Subgroups of internet gaming and social network addicts were exploratively assessed. Psychometric measures of social anxiety, emotional competence and impulsivity were additionally explored. RESULTS: Specific internet addicts showed higher impulsivity, social anxiety and reduced emotional competence. Between-group differences in AGN and EST behavioral measures were not detected. No group differences were found in the dACC, but explorative analyses revealed decreased left middle and superior temporal gyrus activation during interference of socially anxious words in internet gaming and relative to social network addicts. CONCLUSION: Given the function of the left middle temporal gyrus in the retrieval of words or expressions during communication, our findings give a first hint that social words might be less retrievable in the semantic storage of internet gaming addicts, possibly indicating deficiencies in handling speech in social situations.

Exploring the Neural Basis of Avatar Identification in Pathological Internet Gamers and of Self-Reflection in Pathological Social Network Users.

Background and aims Internet gaming addiction appears to be related to self-concept deficits and increased angular gyrus (AG)-related identification with one's avatar. For increased social network use, a few existing studies suggest striatal-related positive social feedback as an underlying factor. However, whether an impaired self-concept and its reward-based compensation through the online presentation of an idealized version of the self are related to pathological social network use has not been investigated yet. We aimed to compare different stages of pathological Internet game and social network use to explore the neural basis of avatar and self-identification in addictive use. Methods About 19 pathological Internet gamers, 19 pathological social network users, and 19 healthy controls underwent functional magnetic resonance imaging while completing a self-retrieval paradigm, asking participants to rate the degree to which various self-concept-related characteristics described their self, ideal, and avatar. Self-concept-related characteristics were also psychometrically assessed. Results Psychometric testing indicated that pathological Internet gamers exhibited higher self-concept deficits generally, whereas pathological social network users exhibit deficits in emotion regulation only. We observed left AG hyperactivations in Internet gamers during avatar reflection and a correlation with symptom severity. Striatal hypoactivations during self-reflection (vs. ideal reflection) were observed in social network users and were correlated with symptom severity. Discussion and conclusion Internet gaming addiction appears to be linked to increased identification with one's avatar, evidenced by high left AG activations in pathological Internet gamers. Addiction to social networks seems to be characterized by emotion regulation deficits, reflected by reduced striatal activation during self-reflection compared to during ideal reflection.

Insula and striatum activity in effort-related monetary reward processing in gambling disorder: the role of depressive symptomatology.

The neurobiological underpinnings of effort-related monetary reward processing of gambling disorder have not been previously studied. To date neuroimaging studies lack in large sample sizes and as a consequence less attention has been given to brain reward processing that could potentially be attributed to comorbid conditions such as depressive mood state. We assessed monetary reward processing using an effort-dependent task during 3 tesla functional magnetic resonance imaging. We investigated a large sample of male, right-handed, slot-machine-playing disordered gamblers (DGs; N = 80) as well as age- and smoking-matched male healthy controls (HCs; N = 89). Depressive symptoms were assessed using the Beck Depression Inventory (BDI). DGs and HCs were divided into subgroups ("high" and "low") based on their BDI scores. Effort-related monetary reward processing did not differ between the complete groups of HCs and DGs. Brain activation during receipt of monetary reward though revealed a significant Group × BDI interaction: DGs with higher BDI scores compared to DGs with lower BDI scores showed greater brain activity in the right insula cortex and dorsal striatum while no differences were observed for HCs with higher versus lower BDI scores. Our results suggest that effort-related aspects of monetary motivation, i.e. when monetary output is tied to performance, are not altered in DG. Additionally, our findings strengthen the need for subgroup comparisons in future investigations of the disorder as part of a personalized medicine approach.

Decision-making deficits in patients diagnosed with disordered gambling using the Cambridge Gambling task: the effects of substance use disorder comorbidity.

BACKGROUND: Disordered gambling (DG) has often been associated with impaired decision-making abilities, suggesting a dysfunction in the ventromedial prefrontal cortex (vmPFC). AIMS: To our knowledge, no previous study has accurately considered the effect of substance use disorder (SUD) comorbidity (including nicotine dependence) on decision-making impairments in DG. METHODS AND MATERIALS: We employed the Cambridge Gambling Task (CGT) to assess a big cohort of patients diagnosed with DG (N = 80) against matched healthy controls (HCs) (N = 108). The cohort included DG patients with nicotine and alcohol dependence, alcohol dependence only and 12 "pure" nonsmokers with only DG diagnosis. RESULTS: Pure nonsmoking, nicotine dependent as well as alcoholic DGs with current nicotine dependence, demonstrated a decision making profile, characterized by poor decision-making abilities and failure to make right choices (rational), closely resembling that of patients with vmPFC damage. DISCUSSION: This suggests that DGs with and without SUD comorbidity are equally affected in that domain of decision making abilities. Additionally, gambling diagnosis combined with alcohol and nicotine dependence involves a group of gambling patients with a relatively riskier decision making profile, showing that these patients apart from making irrational decisions take also more risks. Our findings highlight the importance of accounting for SUD comorbidities with useful implications for future research and therapy. Limitations of the current investigation are discussed.

Client satisfaction with substance abuse treatment. Baseline results from the IQMS study conducted in seven counselling centres.

OBJECTIVES: Our study was carried out to evaluate client satisfaction with substance abuse treatment before introducing a quality management (QM) program. METHODS: Between October and November 2004 a complete sample of 247 substance abusers completed a self-administered questionnaire in seven counselling centres in Baden-Württemberg (Germany). Routine data from the counselling centres were also included. Analyses were conducted by using chi2-tests, logistic regression models adjusted for covariates and t-tests for paired samples. RESULTS: Our results suggested a high client satisfaction with counselling and highly rated positive effects of counselling. The satisfaction with the treatment in hospitals for substance abuse was significantly lower. Patients felt that there was lack of appropriate information in hospitals. There seems to be room for improvement particularly in the cooperation between General Practitioners and counselling centres as well as between hospitals for substance abuse and aftercare institutions. CONCLUSIONS: To increase the quality of care for addicts particularly the exchange of information and the transfer of patients between different institutions involved in care should be improved.