An Empirical Investigation of the Three-Pathway Model and its Contribution to the Gambling Disorder Psychopathology.

BACKGROUND: Blaszczynski and Nower (2002) proposed a theoretical model that leads to problem gambling via three pathways: (1) operant conditioning; (2) emotional vulnerability; and (3) impulsivity and psychopathy. In the current investigation, we explored the relationship between these three putative causative dimensions and clinical core features of Gambling Disorder (GD): gambling craving, gambling-related cognitive distortions, gambling (wagering) behavior, and gambling severity. RESULTS: Data on 343 people with disordered gambling were analyzed. Measures representing the three pathways were analyzed using principal component analysis (PCA). The PCA generated three profiles. The original dimension of impulsivity/psychopathy was divided into two parts; the impulsivity-related traits were combined with symptoms of depression and anxiety to form one single component representing a volatile emotional, cognitive and behavioral style, named the Affect-instability component. The other two components were Psychopathy and Operant Behavior. Linear regression models for each PCA component found that the Affect-instability component was associated with all core features of GD, i.e., craving, cognitive distortions, gambling behavior and severity (standardized Β range: 0.298-0.448, all p < 0.001). Operant Behavior was significantly associated with gambling behavior (standardized Β=-0.137, p = 0.038) and gambling severity (standardized Β=-0.157, p = 0.006). Psychopathy was associated only with gambling cognitive distortions (standardized Β=-0.300, p < 0.001), suggesting a wider dimension of cognitive challenges in GD. DISCUSSION: An instability component encompassing emotional and cognitive dysregulation was the strongest predictor of all clinical features of GD. The correlation between operant conditioning and gambling severity suggests that behavioral conditioning plays a role in the persistence of maladaptive gambling.

Interplay between alexithymia, emotion regulation, and positive and negative affect as predictors of gambling and gaming disorders in adolescents and young adults

Introduction/Objectives: Gambling and gaming disorder are usually comorbid addictive behaviours in which alexithymia and emotional regulation have been proved to be of relevance. The present study aimed to analyse the relationship between those variables and their differences depending on the presence or absence of gambling and gaming behaviours. Method: The sample consisted of 1,219 people between 12 and 20 years of age (M = 15.55, SD = 2.07; 51.8% females). Results: The results showed significant differences between players and non-players in gambling disorder, alexithymia and emotional regulation. The findings also indicated that there were differences in alexithymia, emotional regulation, negative affect, gambling disorder and gaming disorder among the different profiles of video game players. The comparison of participants with gaming disorder, gambling disorder, both, or neither of them, showed differences in alexithymia, emotional regulation, negative affect, gambling disorder and gaming disorder. Furthermore, correlations between gambling disorder and age, gaming disorder, negative affect, alexithymia and emotional regulation were found. Similarly, gaming dis-order was associated with gambling disorder, negative affect, alexithymia, emotional regulation and age. Conclusions: The hierarchical regression analyses demonstrated the predictive role of alexithymia and age in gambling disorder as well as the predictive role of age, sex and negative affect in gaming disorder.

Introducción/Objetivos: Los trastornos de juego y videojuego son conductas adictivas habitualmente comórbidas en las que se ha demostrado la relevancia de la alexitimia y la regulación emocional. Este estudio analiza la relación entre dichas variables y sus diferencias en función de la presencia o ausencia de conductas de juego y videojuego. Método: La muestra estuvo formada por 1219 personas de entre 12 y 20 años (M = 15.55, SD = 2.07; 51.8 % mujeres). Resultados: Los resultados mostraron diferencias significativas entre jugadores y no jugadores en el juego patológico, la alexitimia y la regulación emocional. Los resultados también indicaron que había diferencias en alexitimia, regulación emocional, afecto negativo, trastorno de juego y videojuego entre los distintos perfiles de jugadores de videojuegos. La comparación de los participantes con trastorno de juego y videojuego, con ambos o con ninguno de ellos, mostró diferencias en la alexitimia, la regulación emocional, el afecto negativo, el trastorno de juego y videojuego. Además, se encontraron correlaciones entre el juego patológico y la edad, el trastorno por videojuego, el afecto negativo, la alexitimia y la regulación emocional. Del mismo modo, el trastorno por videojuego se asoció con el juego patológico, el afecto negativo, la alexitimia, la regulación emocional y la edad. Conclusiones: Los análisis de regresión jerárquica demostraron el papel predictivo de la alexitimia y la edad en el trastorno de juego y el papel predictivo de la edad, el sexo y el afecto negativo en el trastorno por videojuego.

A Systematic Review of Eye-Tracking Studies of Gambling-Related Attentional Biases.

Previous research has identified attentional biases towards addiction-related stimuli, including gambling-related stimuli. Eye-tracking is considered the gold standard methodology for measuring attentional biases, yet no review to date has examined its use in measuring gambling-related attentional biases. This systematic review synthesized the literature using eye-tracking to examine attentional biases among people who gamble. We reviewed articles from Web of Science and PubMed that were published from 1990 to 2021. A total of 11 articles were included, with sample sizes ranging from 38 to 173 participants. Of these studies, seven examined attentional biases for gambling-related visual stimuli. These seven studies provided support that gambling can result in the development of an attentional bias for gambling-related stimuli. With respect to correlates of gambling-related attentional biases, there were mixed results. Some studies identified significant positive associations between gambling-related attentional biases and psychosocial variables, such as problem gambling severity, gambling expectancies, gambling cravings, gambling motives, depressive symptom severity, alcohol use severity, daily stress, affective impulsivity, and immersion. Four studies examined attentional biases for responsible gambling messaging and advertisements, finding that both people who do and do not gamble attend less to responsible gambling messaging compared to other types of information such as the betting odds. Research using eye-tracking to examine attentional biases among people who gamble is in its infancy. Yet, the preliminary results support the identification of attentional biases using the gold-standard methodology. Further studies are needed to examine the correlates and potential clinical utility of assessing gambling-related attentional biases using eye-tracking.

Neuroimaging of Dopamine Transporter Density in the Striatum of Disordered Gamblers.

The aim of the present research was to add to the growing literature on dopamine and gambling disorder (GD) by assessing whether GD is associated with dopamine transporter (DAT) density in the ventral striatum compared to healthy controls and whether DAT density was associated with key characteristics of GD (e.g., abstinence, craving). In a cross-sectional investigation using single-photon emission computed tomography with a technetium-99m-labeled tropane derivative as a radiotracer with SPECT imaging, fifteen participants with GD and 15 controls (non-gambling individuals, matched for age, gender, handedness, and smoking status) were measured. The GD group completed self-reported questionnaires regarding gambling. Striatal DAT density did not differ between the two groups. Conversely, striatal DAT density correlated significantly with various measures of recent gambling, but not with measures of chronic gambling. Multivariate analysis, adjusted for age and smoking status, showed that DAT density in the left striatum correlated positively with time spent gambling and gambling craving in the last month, whereas DAT density in the right striatum correlated negatively with abstinence self-efficacy. The results suggests that DAT density in the striatum is associated with recent gambling activity and gambling expectation.

Transtorno de Jogo: contribuição da abordagem psicodinâmica no tratamento / Gambling Disorder: contributions of the psychodynamic approach to treatment / Jeu Pathologique: contributions de l'approche psychodynamique au traitement / Trastorno de Juego: contribución del enfoque psicodinámico al tratamiento

Resumo Jogos de azar podem ser uma atividade de lazer, mas sua prática em excesso pode levar a consequências adversas, como o Transtorno de Jogo. Apesar dos sérios prejuízos provocados por esse quadro, tanto o Transtorno de Jogo em si quanto estratégias de tratamento são pouco conhecidos no Brasil. Este trabalho aborda o Transtorno de Jogo e seu tratamento, tendo como objetivo explicitar a contribuição da abordagem psicodinâmica. São apresentadas as principais hipóteses psicodinâmicas existentes na literatura e tecidas considerações sobre a psicoterapia psicodinâmica realizada em um serviço que atende jogadores em São Paulo, o Programa Ambulatorial do Jogo Patológico (PRO-AMJO) do Instituto de Psiquiatria do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (IPq HC-FMUSP). Por fim, alguns exemplos de perfis de jogadores patológicos são apresentados.

Abstract Gambling may be a leisure activity, but overdoing it can lead to adverse consequences such as Gambling Disorder. Despite the serious damage caused by the disorder, both Gambling Disorder and its treatment strategies are little known in Brazil. This study investigates Gambling Disorder and its treatment, emphasizing the contributions of the psychodynamic approach. The paper presents the main psychodynamic hypotheses in the literature and comments on the psychodynamic psychotherapy carried out in facilities treating pathological gamblers in São Paulo, such as the Pathological Gambling Outpatient Program (PRO-AMJO) of the Psychiatric Institute of Hospital das Clínicas (IPq HC-FMUSP). Finally, some examples of pathological gambler profiles are discussed.

Résumé Le jeu de hasard peut être un loisir, mais l'excès peut avoir des conséquences néfastes, comme le Jeu Pathologique. Malgré les graves consequences causés par ce trouble, le Jeu Pathologique et ses stratégies de traitement sont peu connus au Brésil. Cettte étude porte sur la Dépendence au jeu et son traitement, en mettant l'accent sur les contributions de l'approche psychodynamique. L'article présente les principales hypothèses psychodynamiques dans la littérature et reflète sur la psychothérapie psychodynamique réalisée dans les services qui s'occupent de joueurs à São Paulo, telles que le Programma ambulatoire sur la dépendance au jeu (PRO-AMJO) del'Institut de psychiatrie de l'Hospital das clínicas (IPq HC-FMUSP). Enfin, quelques exemples de profils de joueurs pathologiques sont discutés.

Resumen Los juegos de azar pueden ser una actividad de diversión, pero su práctica excesiva puede traer consecuencias adversas como el Trastorno de Juego. A pesar de los graves daños causados por este comportamiento, tanto el Trastorno de Juego en sí como las estrategias de tratamiento son poco conocidos en Brasil. Este trabajo aborda el Trastorno de Juego y su tratamiento, con el objetivo de hacer explícito la contribución del enfoque psicodinámico. Se presentan las principales hipótesis psicodinámicas en la literatura y se hacen consideraciones sobre la psicoterapia psicodinámica realizada en un servicio que atiende a jugadores en São Paulo, como el Programa del Hospital das Clínicas de la Facultad de Medicina de la Universidad de São Paulo (IPq HC-FMUSP). Finalmente, se presentan algunos ejemplos de perfiles de jugadores patológicos.

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.

Juego online : tratamiento de un caso de adicción a apuestas deportivas / Online gambling: A treatment for sports betting addiction

Resumen Antecedentes : el juego de azar online (apuestas, juegos de casino, póquer, etc.) es una actividad que se está extendiendo mundialmente, incluso en los países en los cuales todavía no está legalizado. A pesar de que la situación en Latinoamérica es de lo más diversa, es probable que conforme se desarrolle y promocione el juego online aparezcan problemas de adicción, de forma similar a lo que está ocurriendo en España desde que este tipo de juegos se legalizó en 2011. De manera que la ciencia psicológica debe ir desarrollando programas de tratamiento que hagan frente a la nueva realidad. Objetivo: el artículo presenta el procedimiento seguido para el tratamiento de un joven con problema de adicción a las apuestas deportivas. Método: la propuesta de tratamiento tiene una orientación conductual-cognitiva, en la que se produjo descondicionamiento de las situaciones de juego, entrenamiento en habilidades para prevenir recaídas y superar situaciones de riesgo, así como información de los riesgos del juego, cambio de actitudes hacia las apuestas y promoción de un estilo de vida saludable incompatible con el juego excesivo. Resultados: se describen tanto las fases del tratamiento como el fundamento teórico de la propuesta de intervención. El paciente, con un diagnóstico de trastorno de juego grave, redujo los criterios de trastorno por juegos de apuesta, así como el Índice de Gravedad de Síntomas clínicos. Conclusiones: se ha desarrollado un protocolo de tratamiento de la adicción al juego online basado en los principios de la motivación y el aprendizaje que ha resultado ser eficaz en la reducción de la conducta de juego y la consolidación de un nuevo estilo de vida saludable.

Abstract Background : Online gambling (bets, casino games, poker, etc.) is an activity that is spreading worldwide, even in countries where it is not yet legalized. Although the situation in Latin America is very heterogeneous, it is possible that, as online gambling is developed and promoted, addiction problems arise. This has already happened in Spain since the legalization of online gambling in 2011. Thus, psychology should be developing intervention programs to face this new scenario. Goal: This paper describes the treatment protocol for a young man with sports betting addiction. Method: The treatment proposal consisted in a cognitive behavioral therapy which focused on deconditioning of gambling situations; training of skills needed to prevent relapses and overcome risky situations; information on gambling risks; change of attitude towards gambling; and promotion of a healthy lifestyle incompatible with gambling addiction. Results: Both the treatment phases and the theoretical basis of the intervention proposal are described. The patient, diagnosed with a severe gambling disorder, showed improvements in the gambling disorder criteria and the Symptom Severity Scale Score. Conclusions: A treatment protocol for online gambling addiction, which is based on the principles of motivation and learning, has been developed. This protocol has demonstrated to be effective in reducing gambling behavior and promoting a new healthy lifestyle.

Uncovering Underlying Processes Before Illusion of Control Begins in Gambling Disorder: A Pilot Study.

Gambling Disorder (GD) is characterized by persistent betting even in face of accruing debts and psychosocial hardship. Gambling Disorder behavior has been linked to conditioning, cognitive distortions and superstitious behavior. Previous studies have demonstrated that during response-outcome analytical tests (ROAT), non-gambling individuals are precluded from response extinction when failure feedback is suppressed, and develop superstitious behaviors and illusion of control instead. Gambling can be regarded as a ROAT paradigm in which disordered gamblers (DGs) fail to compute failure feedback; hence they do not perceive the independence between response and outcome. In order to investigate early phenomena on response and outcome processing in DGs, we developed two short ROAT versions, one with a controllable outcome and one with an uncontrollable outcome, both with explicit failure feedback. Twenty DGs and twenty healthy controls were assessed using this novel paradigm. Compared to controls, DGs reported higher distress during the controllable ROAT, less self-confidence in the uncontrollable ROAT, and more random responses and less use of analytical strategies in both tests, evidencing potential deficits in cognitive control. In contrast to previous findings, DGs did not demonstrate more superstitious beliefs, or illusion of control, and were generally more skeptical than controls regarding the controllability of both ROAT versions. Taken together, our findings provide some support for deficits in cognitive control in GD that precede illusion of control and superstitious behaviors.

Gambling disorder and comorbid behavioral addictions: Demographic, clinical, and personality correlates.

Gambling disorder (GD) frequently co-occurs with substance use disorders. However, the extent to which GD co-occurs with behavioral addictions (BAs) and the demographic, clinical, and personality correlates of comorbid GD and BA is largely unknown. The aims of the present research were to address this gap among people seeking treatment for GD (N = 458) in São Paulo, Brazil. Structured clinical interviews diagnosed individuals with GD and other psychiatric disorders. The Shorter PROMIS questionnaire was used to identify BAs (work, exercise, food bingeing, sex, and shopping). Questionnaires assessed demographic characteristics, gambling behavior, and personality. Of the total sample, 206 (45.0%) participants met the criteria of having at least one behavioral addiction (GD+BA). The most common comorbid BA was food bingeing (8.1%) with the least common being exercise (3.6%). In a multivariate logistic regression, individuals with GD+BA tended to be younger, and had greater rates of comorbid post-traumatic stress disorder and bulimia nervosa compared to participants who did not present with a comorbid BA. Taken together, individuals with GD+BA present with increased psychopathology. These results may have important implications for the assessment and treatment of individuals with GD and comorbid BAs.

Demographic and psychiatric correlates of compulsive sexual behaviors in gambling disorder.

BACKGROUND AND AIMS: Gambling disorder (GD) and compulsive sexual behavior (CSB) may commonly co-occur. Yet, the psychiatric correlates of these co-occurring disorders are an untapped area of empirical scrutiny, limiting our understanding of appropriate treatment modalities for this dual-diagnosed population. This study examined the demographic and clinical correlates of CSB in a sample of treatment-seeking individuals with GD (N = 368) in São Paulo, Brazil. METHODS: Psychiatrists and psychologists conducted semi-structured clinical interviews to identify rates of CSB and other comorbid psychiatric disorders. The Shorter PROMIS Questionnaire was administered to assess additional addictive behaviors. The TCI and BIS-11 were used to assess facets of personality. Demographic and gambling variables were also assessed. RESULTS: Of the total sample, 24 (6.5%) met diagnostic criteria for comorbid CSB (GD + CSB). Compared to those without compulsive sexual behaviors (GD - CSB), individuals with GD + CSB were more likely to be younger and male. No differences in gambling involvement emerged. Individuals with GD + CSB tended to have higher rates of psychiatric disorders (depression, post-traumatic stress disorder, and bulimia nervosa) and engage in more addictive behaviors (problematic alcohol use, drug use, and exercise) compared to GD - CSB. Those with GD + CSB evidenced less self-directedness, cooperativeness, self-transcendence, and greater motor impulsivity. Logistic regression showed that the predictors of GD + CSB, which remained in the final model, were being male, a diagnosis of bulimia, greater gambling severity, and less self-transcendence. DISCUSSION AND CONCLUSION: Given those with GD + CSB evidence greater psychopathology, greater attention should be allocated to this often under studied comorbid condition to ensure adequate treatment opportunities.

Review: brain neurobiology of gambling disorder based on rodent models.

Different literature reviews of gambling disorder (GD) neurobiology have been focused on human studies, others have focused on rodents, and others combined human and rodent studies. The main question of this review was: which are the main neurotransmitters systems and brain structures relevant for GD based on recent rodent studies? This work aims to review the experimental findings regarding the rodent´s neurobiology of GD. A search in the Pub Med database was set (October 2012-October 2017) and 162 references were obtained. After screening, 121 references were excluded, and only 41 references remained from the initial output. More, other 25 references were added to complement (introduction section, neuroanatomical descriptions) the principal part of the work. At the end, a total of 66 references remained for the review. The main conclusions are: 1) according to studies that used noninvasive methods for drug administration, some of the neurotransmitters and receptors involved in behaviors related to GD are: muscarinic, N-methyl-D-aspartate (NMDA), cannabinoid receptor 1 (CB1), cannabinoid receptor 2 (CB2), dopamine 2 receptor (D2), dopamine 3 receptor (D3), and dopamine 4 receptor (D4); 2) moreover, there are other neurotransmitters and receptors involved in GD based on studies that use invasive methods of drug administration (eg, brain microinjection); example of these are: serotonin 1A receptor (5-HT1A), noradrenaline receptors, gamma-aminobutyric acid receptor A (GABAA), and gamma-aminobutyric acid receptor B (GABAB); 3) different brain structures are relevant to behaviors linked to GD, like: amygdala (including basolateral amygdala (BLA)), anterior cingulate cortex (ACC), hippocampus, infralimbic area, insular cortex (anterior and rostral agranular), nucleus accumbens (NAc), olfactory tubercle (island of Calleja), orbitofrontal cortex (OFC), medial prefrontal cortex (mPFC), prefrontal cortex (PFC) - subcortical network, striatum (ventral) and the subthalamic nucleus (STN); and 4) the search for GD treatments should consider this diversity of receptor/neurotransmitter systems and brain areas.

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.

Gambling-related cognitive distortions mediate the relationship between depression and disordered gambling severity.

BACKGROUND AND OBJECTIVES: Symptoms of depression are highly prevalent among individuals with gambling disorder, and severity of depression is associated with severity of gambling problem. Yet, little is known about the psychological mechanisms by which symptoms of depression lead to greater gambling severity. In this study, we tested whether cognitive distortions represent one such mechanism, as cognitive distortions are key characteristics in both depression and gambling disorder and have been shown to be associated with gambling severity. METHODS: A mediation model was tested among 345 treatment-seeking individuals with gambling disorder in Sao Paulo, Brazil. The diagnosis of gambling disorder was made using semi-structured clinical interviews and participants completed psychometrically sound self-report measures of depression symptoms (Beck Depression Inventory-I), gambling-related cognitive distortions (Gamblers' Beliefs Questionnaire), and gambling severity (Gambling Symptom Assessment Scale). RESULTS: As hypothesized, increased symptoms of depression were significantly associated with both increased disordered gambling severity and increased gambling-related cognitive distortions. Further, gambling-related cognitive distortions predicted greater disordered gambling severity when controlling for depression symptomology. Results from the bootstrapping method indicated that the relationship between symptoms of depression and increased disordered gambling severity is mediated by gambling-related cognitive distortions. CONCLUSIONS: Consistent with our predictions, gambling-related cognitive distortions mediated the relationship between depression symptoms and gambling severity among a sample of treatment-seeking disordered gamblers. These results suggest that cognitive distortions may be a key intervention target for the treatment of concurrent depression and gambling disorder.

Magnitude and extent of gambling disorder in the Mexican population / Magnitud y extensión del juego patológico en la población mexicana

Abstract: Introduction: Gambling disorder is characterized by an uncontrollable need to gamble, lack of control over gambling, prioritizing gambling over other activities, and continuing to gamble despite the negative consequences this entails. Worldwide, between .1% and 5% of people show signs of problem gambling and between .1% and 2.2% present a positive result in gambling disorder criteria. Objective: To determine the extent of the problem of gambling disorder in Mexico and to identify and analyze the demographic groups in which it occurs. Method: ENCODAT 2016-2017 is a probabilistic, multi-stage survey with national and state representativeness. The sample comprises 56 877 people who answered a standardized questionnaire that collects information on addictive substance use and other areas such as gambling disorder. Results: A total of 24.5% of the population aged 12 to 65 have played a betting game at lifetime. Men have higher statistically significant prevalences than women in nearly all types of gambling and in six of the nine symptoms of gambling disorder. In Mexico, .3% of the target population meet the criteria for gambling disorder, with adolescents showing the highest percentage (.4%). Discussion and conclusion: It is necessary to reinforce public policies for this issue that include the development of preventive actions targeting the adolescent and youth population in Mexico, and to ensure the adequate monitoring of authorized centers.

Resumen: Introducción: El juego patológico se caracteriza por la necesidad incontrolable de jugar, la falta de control sobre el juego, la prioridad de jugar sobre otras actividades y de continuar jugando a pesar de las consecuencias negativas. A nivel mundial, entre .1% y el 5% de las personas muestra señales de juego problemático y del .1% al 2.2% presenta un resultado positivo en los criterios de juego patológico. Objetivo: Conocer la extensión del problema del juego patológico en México e identificar y analizar los grupos demográficos en los que se presenta. Método: La ENCODAT 2016-2017 es una encuesta probabilística y polietápica con representatividad nacional y estatal. La muestra fue de 56 877 personas, las cuales contestaron un cuestionario estandarizado que recaba información sobre consumo de sustancias adictivas y otras áreas como el juego patológico o ludopatía. Resultados: El 24.5% de la población de 12 a 65 años ha jugado algún juego de azar alguna vez en la vida. Los hombres presentan prevalencias estadísticamente significativas más altas que las mujeres en casi todos los tipos de juegos y en 6 de los 9 síntomas de juego patológico. En el país, el .3% de la población objetivo cumple con los criterios para juego patológico, y los adolescentes muestran el mayor porcentaje (.4%). Discusión y conclusión: Es necesario reforzar políticas públicas sobre el tema que incluyan el desarrollo de acciones preventivas dirigidas a la población adolescente y joven del país, así como incidir en el monitoreo adecuado de los centros autorizados.

Current psychological therapeutic approaches for gambling disorder with psychiatric comorbidities: A narrative review / Tratamientos psicológicos actuales para el trastorno del juego c on comorbilidad psiquiátrica: una revisión narrativa

Abstract: Background: Although the presence of a gambling disorder (GD) together with another mental disorder poses special treatment challenges, such as relapses, severe outcomes for patients and families, and increased number of hospitalizations, there are only a few critical reviews in the literature. Objective: To review empirical evidence of psychological approaches to cope specifically with these dual disorders. Method: A narrative review of the relevant bibliography on this topic was carried out. A systematic search of original articles (2010-October 2017) was conducted in MEDLINE and PsycInfo. Key terms were: 1. gambling/gamblers, 2. treatment/intervention/therapy/therapeutics, and 3. dual diagnosis/comorbidity. Results: Current treatment for GD involves a number of different options, including inpatient treatments, intensive outpatient therapy, individual and group cognitive-behavioral options (CBT), self-help groups, and pharmacotherapy. Inpatient care is generally limited to patients with severe acute crises, treatment failures, and severe comorbid disorders, particularly depression and attempted suicide. Treatment for GD with other mental disorder needs more research. CBT, motivational enhancement therapy and self-help groups have some empirical support when GD is comorbid with other addiction, mood disorder, or schizophrenia. Programs that combine pharmacotherapy and psychosocial treatments for GD into a single comprehensive package are most likely to have good treatment outcomes, at least with regard to treatment retention. Discussion and conclusion: Interventions should be tailored to the needs of the patients. Future research should be concerned about the statistical power of the studies, implement motivational strategies for patients with poor medication adherence, and design measures to study treatment fidelity in the CBT groups.

Resumen: Antecedentes: La presencia comórbida del juego patológico (JP) con otro trastorno mental plantea diversos desafíos al tratamiento, como las recaídas, las repercusiones negativas para los pacientes y sus familias y un mayor número de hospitalizaciones. Objetivo: Revisar la evidencia empírica existente sobre el papel que cumplen las terapias psicológicas en el tratamiento de estos trastornos duales. Método: Se realizó una revisión narrativa de la bibliografía relevante sobre este tema. Se llevó a cabo una búsqueda sistemática de artículos originales (2010-octubre 2017) en MEDLINE y PsycInfo con las palabras clave: 1. gambling or gamblers, 2. Treatment, intervention, therapy or therapeutics, y 3. dual diagnosis or comorbidity. Resultados: Hay diversas terapias para el JP: tratamiento hospitalario, terapia intensiva ambulatoria, terapia cognitivo-conductual (TCC) individual y en grupo, Jugadores Anónimos y farmacoterapia. La hospitalización se limita a los pacientes con una crisis aguda, fracasos terapéuticos previos y trastornos comórbidos graves, como la depresión y los intentos de suicidio. El tratamiento para el JP comórbido con otro trastorno (depresión, abuso de sustancias o esquizofrenia) requiere más investigación. Las terapias más efectivas en estos casos son al parecer la TCC, la entrevista motivacional y los grupos de autoayuda. Los programas que combinan farmacoterapia con tratamientos psicológicos parecen aumentar la retención del tratamiento. Discusión y conclusión: La intervención debe adaptarse a las necesidades específicas de cada paciente y la investigación debe mejorar las estrategias motivacionales cuando los pacientes muestran una deficiente adherencia a la medicación, así como diseñar medidas para mejorar la fidelidad al tratamiento psicológico.

Gambling Disorder Due to Brazilian Animal Game ("Jogo do bicho"): Gambling Behavior and Psychopathology.

Gambling is currently widespread across the globe and despite legally restricted, it is significantly common in Brazil. A traditional and common form of gambling in Brazil is the Brazilian animal game (BAG)--"Jogo do bicho" in Portuguese. In 2013, BAG activities collected approximately 19 billion Brazilian reais--equivalent to more than 8 billon American dollars, a figure almost 60 % higher than legal lotteries. Although a common form of gambling, the gambling behavior and psychopathology of gambling disorder (GD) associated with BAG has never been systematically studied. The aim of this study is to conduct, the first research approaching GD due to BAG. We assessed 897 participants of whom 63 subjects (7.0 %) presented with GD due to BAG and 834 with GD associated with other forms of gambling. After comparing these two groups, major differences were found in demographics, gambling behavior elements and psychopathological variables. This research reinforces the need for further research on BAG and the need for specific approaches in GD. The particularities of BAG may affect treatment strategies as, for example, suggest some adaptations in social and psychotherapeutic approaches. We also highlight the need to acknowledge the "hidden" BAG as a potential addictive game.

Electronic gaming machines and gambling disorder: A cross-cultural comparison between treatment-seeking subjects from Brazil and the United States.

AIMS: The objective of this paper is to perform a cross-cultural comparison of gambling disorder (GD) due to electronic gaming machines (EGM), a form of gambling that may have a high addictive potential. Our goal is to investigate two treatment-seeking samples of adults collected in Brazil and the United States, countries with different socio-cultural backgrounds. This comparison may lead to a better understanding of cultural influences on GD. METHODS: The total studied sample involved 733 treatment-seeking subjects: 353 men and 380 women (average age=45.80, standard deviation ±10.9). The Brazilian sample had 517 individuals and the American sample 216. Subjects were recruited by analogous strategies. RESULTS: We found that the Brazilian sample was younger, predominantly male, less likely to be Caucasian, more likely to be partnered, tended to have a faster progression from recreational gambling to GD, and were more likely to endorse chasing losses. CONCLUSION: This study demonstrated that there are significant differences between treatment-seeking samples of adults presenting GD due to EGM in Brazil and in the United States. These findings suggest that cultural aspects may have a relevant role in GD due to EGM.