Problem gamblers share deficits in impulsive decision-making with alcohol-dependent individuals

Andrew J Lawrence, Jason Luty, Nadine A Bogdan, Barbara J Sahakian, Luke Clark, Andrew J Lawrence, Jason Luty, Nadine A Bogdan, Barbara J Sahakian, Luke Clark

Abstract

Aims: Problem gambling has been proposed to represent a 'behavioural addiction' that may provide key insights into vulnerability mechanisms underlying addiction in brains that are not affected by the damaging effects of drugs. Our aim was to investigate the neurocognitive profile of problem gambling in comparison with alcohol dependence. We reasoned that shared deficits across the two conditions may reflect underlying vulnerability mechanisms, whereas impairments specific to alcohol dependence may reflect cumulative effects of alcohol consumption.

Design: Cross-sectional study.

Setting: Out-patient addiction treatment centres and university behavioural testing facilities.

Participants: A naturalistic sample of 21 male problem and pathological gamblers, 21 male alcohol-dependent out-patients and 21 healthy male control participants.

Measurements: Neurocognitive battery assessing decision-making, impulsivity and working memory.

Findings: The problem gamblers and alcohol-dependent groups displayed impairments in risky decision-making and cognitive impulsivity relative to controls. Working memory deficits and slowed deliberation times were specific to the alcohol-dependent group.

Conclusions: Gambling and alcohol-dependent groups shared deficits in tasks linked to ventral prefrontal cortical dysfunction. Tasks loading on dorsolateral prefrontal cortex were selectively impaired in the alcohol-dependent group, presumably as a consequence of long-term alcohol use.

Figures

Figure 1
Figure 1
Wagering on the Cambridge Gamble Task was elevated in both alcohol-dependent (AD) and problem gambler (PG) groups, compared to healthy controls (HC). (a) Problem gamblers placed higher bets than healthy controls regardless of task condition or box ratio. (b) Betting behaviour in the ascending and descending conditions, collapsed across box ratios. Alcohol-dependent subjects placed higher bets, particularly in the descend condition. SED: standard error of the difference after Cardinal & Aitken (2006 [67]) p. 98 [SED = √(2MSerror/nh) where nh is the harmonic mean of the group sizes]
Figure 2
Figure 2
Reflection impulsivity on the Information Sampling Task. Problem gamblers (PG) and alcohol-dependent (AD) groups sampled less information than healthy controls (HC), responding at a lower certainty of being correct. P(correct) calculated using the formula: where Z = 25 (number of boxes opened) and A = 13 (number of boxes of the chosen colour). Error bars represent ±1 standard error of the mean
Figure 3
Figure 3
Spatial Working Memory Task performance was impaired in the alcohol-dependent (AD) group compared to problem gamblers (PG) and healthy controls (HC). Between-search errors are responses to box locations that have previously yielded tokens. Error bars represent ±1 standard error of the mean

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