Gambling Associated Risk-taking Behaviors Correlate with Emotional Regulation and the Iowa Gambling Task but not Wisconsin Card Sorting.

It is not known why some novice gamblers eventually develop Gambling Disorder while most do not. This study tested predictions from two competing models of Gambling Disorder etiology: the Pathways Model of Problem and Pathological Gambling (Blaszczynski & Nower, 2002) and the Allostatic Model of addictions (Koob & Schulkin, 2019) applied to Gambling Disorder. Participants were drawn from introductory psychology courses and screened as non-gamblers (N = 91). They completed computerized versions of the Iowa Gambling Task (IGT-2), Wisconsin Sorting Task (WCST-64), and a Difficulties with Emotional Regulation Scale (DERS). Risk-taking tendencies were observed by having participants play a typical electronic slots game for up to 15 min. Higher betting on the slots game was correlated with the frequency of Deck A selections on the IGT-2 and lower total DERS scores. There were no significant correlations involving slots betting and the WCST-64. Greater risk-taking on the slots game was correlated with more frequent wins, partial losses that were disguised as wins, bonus game features, and the largest nominal amount won on a single spin. However, there were no significant correlations between betting behaviors and the 'payback percentage', defined as total winnings as a proportion of total wagers made throughout the session. Post-game ratings were positively correlated with frequency of reinforcing outcomes. These findings suggest that novice gamblers' likelihood of further gambling participation may be elevated by high sensitivity to immediate rewards and low difficulty self-regulating negative emotions. These findings are consistent with the Allostatic Model; they are not consistent with Pathways Model.

Adherence to prescription guidelines for medical cannabis in disability claimants.

OBJECTIVE: To examine a case series of 70 disability claimants who were referred to a clinic for multidisciplinary medical evaluation for physician compliance with cannabis prescription guidelines for pre-existing cannabis prescriptions. DESIGN: Retrospective case series analysis. SETTING: A private clinic in New Brunswick specializing in multidisciplinary medical assessment for institutional third-party insurers. PARTICIPANTS: All referrals for independent review of cannabis prescriptions between May 2016 and February 2018 (N = 70). MAIN OUTCOME MEASURES: Compliance with the cannabis prescription guidelines. RESULTS: Treating physicians were found to have not adhered to the guidelines in 53 of 61 patients (86.9%) who were prescribed cannabis products for pain management and in 8 of 9 patients (88.9%) who were prescribed cannabis products for treatment of posttraumatic stress disorder. Clinical assessment and radiologic review failed to identify a neuropathic cause of pain in 70.5% of pain cases. Adequate trials of noncannabinoid medications had not been attempted for 72.1% of patients with pain nor for any of the patients with posttraumatic stress disorder. Contraindications to cannabis were identified in 65.7% of cases, including evidence suggesting a past or present cannabis use disorder or currently active substance use disorder in 34.3% of cases. The prescriptions were found to be consistent with prescription guidelines in just 12.9% of cases. CONCLUSION: Very few of the reviewed cannabis prescriptions were found to be consistent with cannabis prescription guidelines. Respectful attention to guidelines might avoid unwarranted overprescribing, limit the secondary increase in comorbidity, and facilitate future scientific study and evaluation of medical cannabis.

Exaggerated Functional Impairment due to Malingered Neurocognitive Dysfunction Following Mild Traumatic Brain Injury.

OBJECTIVE: Functional impairment associated with Neurocognitive Disorder is often claimed in medico-legal settings after mild Traumatic Brain Injury (mTBI). This case-control study examined self-reported functional impairment and the plausibility of chronic disability claims following uncomplicated mTBI. METHOD: Independent Medical Evaluations included a battery of performance and symptom validity tests, along with self-reports of physical or emotional complaints and functional impairment. Slick and colleagues' (Slick, D. J., Sherman, E. M., & Iverson, G. L. (1999). Diagnostic criteria for malingered neurocognitive dysfunction: Proposed standards for clinical practice and research. The Clinical Neuropsychologist, 13, 545-561.) criteria ruled out probable malingering in 21 mTBI cases without psychiatric comorbidity and their self-reports were compared to those of seven non-malingering cases with a psychiatric comorbidity, 17 who were probable malingerers, and 31 orthopedic pain sufferers. Coherence Analysis of medical documentation corroborated assignment of mTBI cases to non-malingering versus probable malingering groups. RESULTS: Probable malingerers reported more postconcussion symptoms than non-malingerers (d = 0.79) but they did not differ significantly on tests of neurocognitive performance. Probable malingerers and orthopedic pain patients gave significantly higher ratings of functional impairment (d = 1.28 and 1.26) than non-malingerers. Orthopedic pain patients reported more disability due to pain than non-malingerers (d = 1.03), but pain catastrophizing was rated more highly by the probable malingerers (d = 1.21) as well as by the orthopedic pain patients (d = 0.98). The non-malingerers reported lower emotional distress than the other three groups, but only the probable malingerers reported elevated depression symptoms compared to the non-malingerers (d = 1.01). CONCLUSIONS: The combined evaluation of performance validity, function, and coherence analysis would appear to enhance the difficult clinical evaluation of postconcussion symptoms in the medical-legal setting.

Video Lottery is the Most Harmful Form of Gambling in Canada.

This paper summarizes the degree to which different forms of legal gambling contribute to Problem and Pathological Gambling (PPG) in Canada. Legal gambling activities were compared using meta-analysis of publicly available data concerning Canada's legal gambling industry. The majority of revenues in the decade spanning 2002-2012 were drawn from Video Lottery Terminals and casino slot machines. Population surveys indicated that three quarters of Canadians reported some form of past-year gambling participation, but most did not play Electronic Gambling Machines. Annual revenues divided by estimated numbers of participants in various gambling activities showed that Video Lottery players spent more money on average than did participants in other forms of gambling. The relative risk of PPG was higher among Video Lottery players than it was for other common forms of gambling. Results from a community study of frequent Video Lottery players showed that the risk of frequent players reporting symptoms of PPG was elevated if they reported playing weekly, spending $50 or more per session, or playing for more than an hour per session. These studies provide converging evidence that Video Lottery is more hazardous to consumers than other forms of gambling that are commonly practised in Canada.

Gamble While You Gamble: Electronic Games in Ontario Charitable Gaming Centres.

Electronic Bingo games have recently appeared in Ontario Charitable Gaming Centres. Here we summarize the characteristics of this novel form of electronic gambling, and give a detailed characterization of one game. We contend that these games have structural characteristics that make them similar to modern Electronic Gaming Machines (EGMs) that feature multiline slots games. These features include a fast and continuous gaming experience, with player adjustable win size and reinforcement rate, a high frequency of losses disguised as wins, and highly salient near misses. Some of these games also have bonus rounds and provide players with a list of recent wins. We conclude that provincial and state gaming authorities should be aware that the placement of Bingo EGMs in existing Bingo facilities may increase problem gambling among an already well-established community of Bingo enthusiasts.

Experienced EGM Players Know How to Control the Reinforcement Rate and Time on Device.

This experiment used motivational instructions to test whether experienced slot machine players are able to manipulate the frequency of winning outcomes and the time taken to deplete funds while playing a popular slot machine game. Twenty-four participants played in four conditions intended to motivate them to play the game as they normally do, to deplete funds quickly, to get a long losing streak, and to avoid getting a bonus round. Compared to how they normally play, participants significantly reduced the number of bought paylines when trying to get losing streaks or avoid bonus rounds. They also wagered significantly more credits per line when trying to deplete their funds quickly. This experiment shows that experienced slots gamblers have an implicit understanding of reinforcement rate and time on device, and that they are able to manipulate these game outputs at will by adjusting the number of paylines they buy and how many credits they choose to wager. When playing normally, they try to maximize reinforcement rate by purchasing the opportunity to win on many paylines. Player control over reinforcement rate and time on device does not alter payback percentage so there is no monetary advantage to manipulating these game outputs.

The frustrating effects of just missing the jackpot: slot machine near-misses trigger large skin conductance responses, but no post-reinforcement pauses.

Near-misses in slot machines resemble jackpot wins but fall just short. Previous research has demonstrated that near-misses are behaviorally reinforcing despite the absence of monetary reward. We assessed the hedonic properties of near-misses by measuring the time between outcome delivery and the initiation of the next spin-the post-reinforcement pause (PRP) and skin conductance responses (SCRs) for losses, near-misses, and a range of wins (5, 15, 25, 50 or 250 credits) while participants (N = 122) played a slot machine simulator. PRPs and SCRs were compared for 40 low frequency and 22 high frequency slots players who were non-problem gamblers, 37 at risk players, and 23 problem gamblers. For winning outcomes, PRPs and SCRs tracked monotonically with win size such that progressively larger wins were associated with progressively larger PRPs and SCRs. Near-misses with jackpot symbols landing on the first two reels had significantly larger SCRs than regular losses, and other types of near misses. Crucially, PRPs for this kind of near-miss were significantly smaller than all wins, and when non-parametric statistics were used, significantly smaller than regular losses. This pattern of large SCRs and small PRPs suggest that these are highly frustrating outcomes that stimulate appetitive components of the reward system to promote continued gambling.

The personality of pathological gamblers: a meta-analysis.

This review summarizes studies of pathological gambling and personality. Meta-analyses were conducted on 44 studies that reported personality traits of pathological gamblers (N = 2134) and nonpathological gambling control groups (N = 5321). Effect size estimates were calculated for 128 comparisons and organized according to the factors associated with two integrative accounts of personality. Four of the meta-analyses examined traits that have previously been found to load on the Urgency, Premeditation, Perseverance, and Sensation Seeking aspects of impulsivity (Whiteside & Lynam 2001). Substantial effects were found for traits associated with Negative Urgency (Cohen's d =.99) and Low Premeditation (d =.84), but not for Low Perseverance or Sensation Seeking. A second set of meta-analyses examined broad domains of personality that have previously been found to load on Negative Affect, Positive Affect, Disagreeable Disinhibition, and Unconscientious Disinhibition (Markon, Krueger, & Watson, 2005). Substantial effects were found for Unconscientious Disinhibition (d =.79), Negative Affect (d =.50), and Disagreeable Disinhibition (d =.50), but not Positive Affect. It was concluded that these individual personality characteristics may be important in the etiology of pathological gambling. The personality profile implicated in the etiology of pathological gambling is similar to that found in a recent meta-analysis of substance use disorders (Kotov, Gamez, Schmidt, & Watson, 2010). These results suggest that pathological gambling may be part of a broad cluster of externalizing psychopathology, and also call into question the current classification of pathological gambling as an Impulse Control Disorder in the DSM-IV.

Multiple addictive behaviors in young adults: student norms for the Shorter PROMIS Questionnaire.

The Shorter PROMIS Questionnaire (SPQ; Christo, Jones, Haylett, Stephenson, Lefever & Lefever, 2003) is a multidimensional self report that measures 16 addictive behaviors. This study examined the psychometric properties of the SPQ and collected normative data from 948 students at two Canadian universities. Factor analysis confirmed the existence of two categories of addictive behavior, which Haylett and her colleagues (2004) labelled hedonistic and nurturant. The hedonistic categories included behaviors such as the use of prescription drugs, gambling, caffeine, illegal drugs, alcohol, tobacco and compulsive sex. The nurturant group included behaviors such as compulsive helping, work, relationships, shopping, disordered eating and exercise. Men (N=250) scored higher than women on dominant relationships, exercise, gambling, illegal drugs, alcohol, tobacco and sex. Women (N=698) scored higher on compulsive shopping, food binging and starving. These results suggest that the SPQ may be a useful index of multiple addictive behaviors in college-age people.

Female students' disordered eating and the big five personality facets.

Female undergraduate students at two Canadian universities (N = 378) completed the NEO PI-R (Costa, P.T. & McCrae, R.R. (1992). NEO PI-R Professional Manual. Lutz, FL: Psychological Assessment Resources) and the Eating Attitudes Test (EAT-26; Garner, D. M., Olmstead, M. P., Bohr, Y. & Garfinkel, P. E. (1982). The Eating Attitudes Test: Psychometric features and clinical correlates. Psychological Medicine, 12, 871-878.). Eating disorder symptomatic (N = 43) and nonsymptomatic (N = 335) women differed on facets of Neuroticism, Extraversion, and Agreeableness. Among symptomatic women, the Oral Control subscale of the EAT-26 was correlated significantly with facets of Neuroticism, Agreeableness and Conscientiousness. Specifically, the Impulsivity facet of Neuroticism was positively correlated with the Bulimia and Food Preoccupation subscale of EAT-26, but negatively correlated with the Oral Control and Dieting subscales. Overall, results suggest that high scores on Neuroticism may be a risk factor for development of disordered eating behavior and that the degree of Impulsiveness may predict the eating disorder subtype to which one is most susceptible.

Inhibition in adults with attention deficit/hyperactivity disorder: event-related potentials in the stop task.

The core deficit in Attention Deficit/Hyperactivity Disorder (ADHD) may be a deficiency in executive functions, particularly the processes that are associated with the inhibition of predominant responses. To test this notion in the adult population, healthy undergraduate volunteers and students with ADHD symptoms performed a visual Stop Signal Task (Logan et al. J Exp Psychol: Hum Percept Perform 10:276-291, 1984) while Event-Related brain Potentials were recorded. The two groups did not differ on behavioral measures of performance, but there was a significant difference in the N2-P3 component. These results underline the robustness of an N2-P3 difference between healthy adults and people with ADHD symptoms that have persisted into young adulthood.

Symptoms of exercise dependence and physical activity in students.

Health professionals recognize the benefits of moderate physical activity and encourage clients to engage in some form of activity on a regular basis. In spite of these recognized benefits, there are growing concerns that some may exercise at levels detrimental to health. The term exercise dependence refers to those individuals whose extreme exercise schedules interfere with their social, occupational, and family lives. The purpose of this study was to examine the relationship between weekly exercise habits and scores on the Exercise Dependence Questionnaire in a sample of undergraduate students (213 women and 79 men). Overall, participants who reported high activity scored higher than those reporting low activity on subscales measuring interference with family and social life, positive reward, withdrawal, exercise for social reasons, exercise for health reasons, and stereotyped behavior.