Reduced loss aversion in pathological gambling and alcohol dependence is associated with differential alterations in amygdala and prefrontal functioning.

Diagnostic criteria for pathological gambling and alcohol dependence (AD) include repeated addictive behavior despite severe negative consequences. However, the concept of loss aversion (LA) as a facet of value-based decision making has not yet been used to directly compare these disorders. We hypothesized reduced LA in pathological gamblers (PG) and AD patients, correlation of LA with disorder severity, and reduced loss-related modulation of brain activity. 19 PG subjects, 15 AD patients and 17 healthy controls (HC) engaged in a LA task in a functional magnetic resonance imaging setting. Imaging analyses focused on neural gain and loss sensitivity in the meso-cortico-limbic network of the brain. Both PG and AD subjects showed reduced LA. AD subjects showed altered loss-related modulation of activity in lateral prefrontal regions. PG subjects showed indication of altered amygdala-prefrontal functional connectivity. Although we observed reduced LA in both a behavioral addiction and a substance-related disorder our neural findings might challenge the notion of complete neuro-behavioral congruence of substance-use disorders and behavioral addictions.

To gamble or not to gamble: at risk for craving and relapse--learned motivated attention in pathological gambling.

In recent research similarities between pathological gambling and drug addiction have been identified, suggesting excessive gambling to constitute an addiction. So far, we have insufficient knowledge concerning the psychophysiological mechanisms underlying this kind of non-substance-related addiction. The objective of the study was to investigate emotional processing of gambling-relevant and -irrelevant stimuli in pathological gamblers and non-gambling controls using an EEG cue-reactivity paradigm. Whereas gambling-irrelevant stimuli were processed similarly in non-gambling controls (HC) and pathological gamblers (PG), PG showed significantly stronger gambling-relevant stimulus-induced psychophysiological cue-reactivity (larger gambling stimulus-induced late positive potential, LPP, higher arousal and more positively toned valence ratings as well as higher stimulus-induced craving for gambling cues compared to HC--but not the expectable increase of general craving over time and after stimulus presentation). Our findings suggest enhanced cue-reactivity in pathological gamblers indicative of learned motivated attention that may induce subjective craving and relapse.

The influence of current mood on affective startle modulation.

The affect-modulated startle response is a reliable indicator of the affective processing of stimuli. It may be influenced by trait and state affective variables as well as psychopathological status. The aim of the present study was to determine the influence of the current mood state on startle modulation. Forty-five healthy volunteers viewed affective stimuli while eye blink responses and subjective emotional ratings were assessed. In addition, the current state of mood was assessed, pre and post the experimental procedure. Subjects were divided into those that were in a more positive and those that were in a more negative mood based on a median split. Compared to subjects in a positive mood those in a more negative mood showed significantly reduced startle amplitudes after viewing the negative and neutral stimuli. The results of the present study show that changes in startle responses are not only related to the current state of psychopathology but also to the general affective state of the participants during the assessments.

The relationship of stress, coping, effect expectancies and craving.

Based on theoretical models of craving and addiction, this study investigated the association between stress-related variables and negatively and positively reinforcing dimensions of craving (relief and reward craving) in 150 opiate addicts, 150 alcohol addicts and 150 non-addicted controls. Stress-distress was the most powerful predictor of both dimensions of craving, followed by a lack of positive coping strategies whereas expectancies of substance effects seemed to be less important. Positive coping strategies were related to reduced craving only when they were accompanied by low stress-distress. In non-addicted subjects, only positive coping strategies were negatively related to craving. This study confirms the important role of stress-distress for the occurrence of craving in addicts.

Alcohol craving in problem and occasional alcohol drinkers.

AIMS: The impact of emotional states on alcohol craving has so far mainly been investigated in abstinent and actively consuming alcohol addicts. Alcohol craving and the variables that influence alcohol craving have not yet been examined in non-addicted, alcohol abusing drinkers and non-abusing occasional alcohol drinkers. METHODS: In this study 50 problem drinkers and 50 occasional alcohol drinkers were investigated. The impact of various craving-related variables such as stress and distress, alcohol effect expectancies, and stress coping strategies on reward and relief craving was examined and compared between the groups. RESULTS: Whereas most occasional drinkers reported little alcohol craving, problem drinkers showed a significantly higher amount of reward and relief craving accompanied by increased levels of stress-distress and a stronger tendency to use negative (inadequate) coping strategies. Stress-distress and alcohol effect expectancies were significant predictors of reward and relief craving in problem drinkers. In occasional drinkers alcohol craving was not related to any of these variables. These variables were also found to be predictive of craving in alcohol addicts. CONCLUSIONS: We hypothesized, that in non-addicted problem drinkers the expected rewarding and reinforcing alcohol effects lead to an early stage of addictive behaviour. Therefore, in this stage therapeutic interventions focussing on the awareness of the function of alcohol intake as well as alternative coping skills might be useful to prevent alcohol dependence in problem drinkers.

Immigration-associated variables and substance dependence.

OBJECTIVE: Drug-dependent patients show increased negative mood states such as anxiety and depression that interact with drug craving and quality of life. In this study, we compared immigrants with and without drug dependence and assessed whether drug dependence and social status after immigration contributed independently to negative mood states, stress-coping strategies and satisfaction with life in Germany. METHOD: Immigrants (N = 80) who had emigrated from the former Soviet Union to Germany were participants in the study. Drug-dependent immigrants (24 men, 16 women, mean [SD] age 33 [9] years) were compared with healthy immigrants (26 men, 14 women, mean age 35 [12] years) on current emotional status, trait-anxiety, depression, stress-coping strategies, drug craving and immigration-associated data. RESULTS: Compared with healthy immigrants, drug-dependent immigrants showed significantly higher levels of anxiety, depression and negative stress-coping strategies, independent of differences in education or employment status. Satisfaction with being in Germany was associated with both drug dependence and employment status. The severity of drug craving was significantly associated with negative mood states but not with any other measured sociodemographic variable. CONCLUSIONS: This study shows that drug dependence is associated with increased negative mood states and poor stress-coping strategies, independent of the assessed sociodemographic variables. Drug dependence may thus severely interfere with acculturation in the host country. Because immigrants often face reduced treatment options as a result of cultural and language barriers, our findings underline the importance of adequate drug treatment facilities for dependent immigrants.

[Psychometric properties and initial validation of the questionnaire on differentiated assessment of addiction]. / Psychometrische Kennwerte und erste Ergebnisse zur Validität des Fragebogens zur Differenzierten Drogenanamnese (FDDA).

The "Questionnaire on Differentiated Assessment of Addiction (QDAA)" is a multi-modal, selfrating instrument for the Assessment of addiction and abuse of psychotropic substances. The QDAA provides the diagnosis of addiction as well as an overview of relevant information needed for the treatment of addiction. Several subscales assess variables that contribute to the development and maintenance of addiction such as mood, stress, expectancy of drug effects, self-esteem, life satisfaction and coping ability. In the present study validity and reliability of the QDAA was tested in several dependent and non-dependent samples. A total of 575 non-dependent, alcohol-, heroin- and cannabis-dependent subjects was available for the present study. Six criteria (craving, tolerance, withdrawal, loss of control, addictive behavior, negative consequences), that form the basis of the addiction diagnosis were shown to have high internal consistency and can be reduced to one dimension by factor analysis. The resulting diagnosis of addiction is significantly correlated with the external criterion "dependence syndrome" of the ICD-10 by external experts. The assumed structure of the QDAA-subscales could be confirmed by factor analysis. In addition, the results of the subscale analysis provide empirical evidence for convergent validity. All subscales showed moderate to high internal consistency. The results suggest that the QDAA is a valid and reliable instrument for the differential assessment of substance addiction, abuse as well as relevant information in the context of addiction and its treatment.