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.

Distinct cognitive performance and patterns of drug use among early and late onset cocaine users.

INTRODUCTION: Adolescence is a crucial period for neurodevelopment, but few studies have investigated the impact of early cocaine use on cognitive performance and patterns of substance use. METHODS: We evaluated 103 cocaine dependent inpatients divided in two groups: early-onset users (EOG; n=52), late-onset users (LOG; n=51), and 63 healthy controls. Neuropsychological functioning was evaluated using Digits Forward (DF) and Backward (DB), Trail Making Test (TMT), Stroop Color Word Test (SCWT), Controlled Oral Word Association Test (COWAT), Wisconsin Card Sorting Test (WCST), Rey Osterrieth Complex Figure Test (ROCFT), Frontal Assessment Battery (FAB), and Iowa Gambling Test (IGT). Use of alcohol and other drugs was assessed with the Addiction Severity Index (ASI-6). RESULTS: Analyses of covariance controlling for age, IQ and years of education showed that EOG presented worse performance in attention span (DF, p=0.020), working memory (DB, p=0.001), sustained attention (WCST, p=0.030), declarative memory (ROCFT, p=0.031) and general executive functioning (FAB, p=0.003) when compared with the control group. LOG presented impairments on divided attention (TMT, p=0.003) and general executive functioning (FAB, p=0.001) in relation to the control group. EOG presented higher use of cannabis and alcohol than LOG (p≤0.001). CONCLUSION: Early-onset cocaine users display more pronounced neuropsychological alterations than controls, as well as a greater frequency of polydrug consumption than LOG. The prominent cognitive deficits in EOG probably reflect the deleterious interference of cocaine use with early stages of neurodevelopment. This may be related to more severe clinical characteristics of substance disorder in this subgroup, including polysubstance abuse.