Why gamblers fail to win: evidence from neuroscience
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1 Why gamblers fail to win: evidence from neuroscience Anna E. Goudriaan Principal Investigator Arkin Mental Health Academic Medical Center, Department of Psychiatry Universitty of Amsterdam Jellinek
2 Gambling in the Netherlands Gambling addiction? Neuroscience: New neuroimaging research in problem gamblers
3 Gambling in the Netherlands 17 million inhabitants Lifetime prevalence of pathological gambling: Annual turnover of gambling revenues: 2 billion US Dollars 120 million US Dollars state tax income Source: LADIS 2001,Dutch Ministry of Finance,IVV
4 Casino s and gambling arcades 14 Holland Casino s: State is stakeholder 300 gambling halls: slot machines Slot machines in liquor-licensed bars and restaurants legal: slot machines Source: Holland Casino, Slot machine Organisation Netherlands (VAN)
5 Gambling: a real addiction?
6 Pathological gambling: a disorder of self-regulation DSM-IV: persistent and recurrent maladaptive gambling behavior preoccupation with gambling gambling with increasing amounts -> achieve desired excitement unsuccessful efforts to control or stop gambling restless or irritated when trying to stop financial and social problems due to gambling Returning after losing to try to win back money that was lost
7 Comorbidity PG-SUD: general population Path Gamblers Non PG 80 Alcohol Use Disorders Drug Use Disorders N= 7,214 2,954 2,417 43,093 2,016 2,638 % SUD Bland et al. 93 Cunningham-Williams 98 Gerstein et al. 99 Petry, Stinson, Grant 05 Smart & Ferris 96 Welte et al. 01 Bland et al 93 Cunningham-Williams 98 Petry, Stinson, Grant 05 Petry, 2007
8 Pathological Gambling as a behavioral addiction DSM-5 to reclassify PG with Addiction and Related Disorders based on similarities: Core symptoms (criteria) Co-morbidities Shared heritability / genetics functional imaging and neurocognitive profile Effective treatments (CBT, nalmefene)
9 What s the fun in gambling? Winning? Excitement? Prospect of a different life? Stress release? Rewarding effect when gambling? What s different in problem gambling?
10 Pathological Gambling as a behavioral addiction DSM-5 to reclassify PG with Addiction and Related Disorders based on similarities: Core symptoms Co-morbidities Shared heritability / genetics functional imaging and neurocognitive profile Effective treatments (CBT, nalmefene)
11 Similar brain processes in (pathological) gambling as in substance dependence? Reward circuitry activated when winning money, and when anticipating winning money
12 Impaired Response Inhibition- Salience Attribution model (Goldstein & Volkow, 2002, 2006) Control: Dorsolateral Prefrontal Cortex DLPFC / ACC Motivation: Orbital Frontal Cortex - OFC Reward circuitry: Nucleus Acc Ventral Tegm. Striatum
13 Brain activity after winning money in (problem) gamblers Reuter et al. (2005, Nat Neurosc): Diminished activity of reward related brain areas Ventral striatum VMPFC
14 Reward: Probabilistic Reversal Learning Task Controls Smokers Problem Gamblers Reward associated with activation Right VLPFC, Right Occipital/Parietal Cortex, Right Frontal Operculum, Bilateral Caudate Nuclues and Subthalamic Regions Significantly less activation of VLPFC in gamblers compared to smokers and controls (figures) Findings similar to studies by Reuter (2005) and Tanabe (2007) who found reduced activation in PG in the VMPFC, a structure incompletely covered in our study. Similar finding in OCD (Remijnse, 2006)!
15 Punishment Probabilistic Reversal Learning Task Controls Smokers Problem Gamblers Loss associated with activation Right Frontal Operculum, Insula en Subthalamic Region Significantly less activation VLPFC in smokers and gamblers compared to controls (figures)
16 Cue reactivity in problem gamblers
17 Cue reactivity in problem gamblers Control Problem group Gamblers Ventral route, dorsal route, Limbic: striatum, hippocampus, amygdala More craving: higher activation in limbic areas Goudriaan, De Ruiter, Veltman, Oosterlaan, van den Brink, 2009 (Addiction Biology)
18 Error Monitoring: Stop Signal Task OR
19 Error Monitoring: Stop Task Activation in response to errors Controls Smokers Problem Gamblers Significantly less activation dacc following errors in gamblers compared to smokers and normal controls (figures) Finding consistent with Potenza et al (2003) - Stroop Task PG vs HC De Ruiter, Oosterlaan, Veltman, van den Brink, Goudriaan, 2012, Drug Alc Dep
20 Differences?
21 Slot machine gambling in MRI What is the effect of near wins in your brain?
22 Win Stronger response to near-wins: stronger propensity to keep gambling Near- Win Clark, Lawrence, Astley-Jones, Gray, 2009
23 What about the anticipation of winning? Does overestimation of winning play a role?
24 Win or lose? WAIT Van Holst, Veltman, van den Brink, Goudriaan, Biol Psychiatry, 2012
25 Behavioural results No group differences guessing to win HC PG
26 Van Holst, Veltman, van den Brink, Goudriaan Biol Psychiatry in press fmri results: Expectation of winning PRGs compared to HCs activate more brain reward areas: -bilateral ventral striatum -bilateral VMPFC -left Insula
27 Expectation of losing Both groups activate the left insula and right amygdala: no group differences
28 In summary, problem gamblers: Show less reactivity in reward areas during monetary gains (Reuter et al., 2005) and losses (De Ruiter et al., 2008) Show diminished activity of the cognitive control network during response inhibition (De Ruiter et al., 2012) show diminished executive functions in neurocognitive studies (Goudriaan et al., 2006; Lawrence et al., 2009; Ledgerwood et al., 2012)
29 Conclusions The addictive is also in the Near-win: Recruit reward areas during nearmisses (Clark et al., 2010) Anticipation: Problem gamblers show heightened activity in reward system during expectation of winning (Van Holst et al., 2012) Imbalance between control and motivation crucial for continued gambling (Reuter et al., Potenza et al., de Ruiter et al., Goudriaan et al.) Neuroimaging, neurocognitive, comorbidity patterns, genetics all point to similarities between PG and substance use disorders
30 Acknowledgements: Colleagues/Collaborators: Wim van den Brink Jaap Oosterlaan Ruth van Holst Edwin de Beurs Johan van der Meer Kenneth J. Sher Aart Nederveen Emily R. Grekin Wendy Slutske Jellinek Addiction Treatment Center (Mostafa Handoume, Henri Neelissen, Ragna Stam) Funding: NWO / ZonMw (National Institute for Health Research, the Netherlands) - Institute for Research on Pathological Gambling (New Investigator Grant) - ERAB Thank you for your attention! Questions a.e.goudriaan@amc.uva.nl agoudriaan@gmail.com
31 Questions and Discussion!
32 Demographics PRGs (n=15) HCs (n=16) Age, mean (SD) (13.42) (11.98) T(26)= p=0.37 SOGS, mean (SD)* (4.03) 0.08 (0.28) H(1)=19.33, p<0.001 BDI, mean (SD) 8.87 (7.03) 6.00 (4.04) H(1)=1.91, p=0.16
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