psyc335 midterm 2

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Last updated 1:12 AM on 11/5/25
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history of ‘gambling addiction’ as a diagnosis

  • pathological gambling = first introduced in ICD-9 and DSM-3 → as an IMPULSE CONTROL disorder

  • DSM-5: renamed gambling disorder + moved to substance-related and addictive disorders category 

  • ‘problem gambling’ = used as a lower threshold (full criteria not met) 

  • gambling disorder = new condition in DSM-5 and ICD-11 

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DSM-5 criteria of gambling disorder

4 or more of: symptoms and observable signs

a. pre-occupied with gambling 

b. needs to gamble with increasing amounts [tolerance]

c. repeated attempts to reduce or quit gambling 

d. restless or irritable when attempting to stop gambling [withdrawal]

e. gamble as means of escape or to alleviate mood 

f. frequently returns to get even [loss chasing]

g. lies to conceal involvement

h. jeopardised/lost r/s or job due to gambling 

i. forced to borrow money due to gambling debt 

*exclusion criteria: not better explained by manic episode (bipolar disorder) → risk-taking and spending 

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loss chasing (desperate pursuit)

  • hallmark of point when casual gambling becomes problematic

  • ‘a spiral of intensifying gambling until all financial options are exhausted’

  • can chase WITHIN and BETWEEN sessions (increase bet size/go back sooner)

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withdrawal from gambling

physiological and psychological symptoms

  • approx 50% feelings of irritability and restlessness

  • 2/3 gamblers reporting >1 SOMATIC symptom (nausea, shaking, sweating)

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what is the inequality of items

loss chasing: too sensitive 

  • too many gamblers say yes to it (even if they only have 1 symptom, 50% of the time its loss chasing)

illegal acts: insensitive

  • no leverage to make diagnosis until >8 symptoms 

  • removed in DSM-5

withdrawal symptoms: just right 

  • increases as gambling severity increases 

<p>loss chasing: too sensitive&nbsp;</p><ul><li><p>too many gamblers say yes to it (even if they only have 1 symptom, 50% of the time its loss chasing) </p></li></ul><p>illegal acts: insensitive </p><ul><li><p>no leverage to make diagnosis until &gt;8 symptoms&nbsp;</p></li><li><p>removed in DSM-5</p></li></ul><p>withdrawal symptoms: just right&nbsp;</p><ul><li><p>increases as gambling severity increases&nbsp;</p></li></ul><p></p>
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5 pieces of evidence for re-classification into addictions category

  1. symptom hallmarks (withdrawal, tolerance) 

  2. co-morbidities (other MH probs) 

  3. shared heritability/genetics (twin studies) 

  4. neuroimaging/neurocognitive similarities 

  5. effective treatments  

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DSM diagnosis of gambling problems

involves face to face INTERVIEW w clinician who is trained and qualified (expert judgement) 

  • cannot be self-report questionnaire 

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2 short self-report tools for diagnosis

  1. south oaks gambling screen (SOGS)

  • binary ratings, lifetime gambling 

  • translated into many other languages → may be used in countries with little gambling research

  1. problem gambling severity index (PGSI) 

  • gold standard; prevalence surveys 

  • detects various LEVELS of PG 

  • scores range from 0-27 

  • NOT mapped directly to DSM criteria 

  • poker players: length of time spend playing more harmful than financial losses 

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2014 BC prevalence survey (via PGSI)

telephone survey, n = 3058

  • “risk” implied likelihood of developing it in future VS actual meaning = currently have signs of gambling harm 

<p>telephone survey, n = 3058</p><ul><li><p>“risk” implied likelihood of developing it in future VS actual meaning = currently have signs of gambling harm&nbsp;</p></li></ul><p></p>
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demographic predictors of gambling problems

robust factors → reliable across provinces

  1. men 

  2. younger age (20s vs 50s/60s)

  3. lower SES (hhld income)

  4. racialized groups (indg ppl, asian communities, migrant communities) 

  5. other MH problems 

*risk factors = statistical and NOT absolute 

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latest data (2024) MHRC online survey

n = 8211 adults

  • correlates to more ONLINE behaviour → not directly comparable 

  • measure: PGSI

  • 27% reported online gambling, 14% in last month 

<p>n = 8211 adults </p><ul><li><p>correlates to more ONLINE behaviour → not directly comparable&nbsp;</p></li><li><p>measure: PGSI</p></li><li><p>27% reported online gambling, 14% in last month&nbsp;</p></li></ul><p></p>
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age of onset (“how old were you when you first gambled”)

78% lifetime gambling, 2.3% lifetime gambling problems (meeting more than 1 symptom on DSM) 

  • earlier start to gambling = risk factor for future GP

  • start past 30 years = smaller likelihood of developing PG 

  • gambling disorder as DEVELOPMENTAL

<p>78% lifetime gambling, 2.3% lifetime gambling problems (meeting more than 1 symptom on DSM)&nbsp;</p><ul><li><p>earlier start to gambling = risk factor for future GP </p></li><li><p>start past 30 years = smaller likelihood of developing PG&nbsp;</p></li><li><p>gambling disorder as DEVELOPMENTAL</p></li></ul><p></p>
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co-morbidities and temporal ordering

0.6% diagnosed w pathological gambling

  • ¾ of them have co-existing drug problems

  • 96% of them have any other DSM diagnosis

temporal ordering → which diagnosis came first

i. gambling first

  • financial strain, debt → anxiety, depression

ii. gambling second

  • to cope/escape negative emotions

  • evidence for this

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genes or environment (slutske et al study)

6744 twins from vietnam database (military sample of men)

  • environment same, no adoption involved

  1. rate of lifetime PG diagnoses = 1.4%

  • any symptom = 6.2%

  1. PG heritability = 40-50% (estimated from MZ-DZ disparity)

  2. overlap in genetics of PG and alc dependence = 12-20% (addiction vulnerability)

<p>6744 twins from vietnam database (military sample of men) </p><ul><li><p>environment same, no adoption involved </p></li></ul><ol><li><p>rate of lifetime PG diagnoses = 1.4% </p></li></ol><ul><li><p>any symptom = 6.2%</p></li></ul><ol start="2"><li><p>PG heritability = 40-50% (estimated from MZ-DZ disparity) </p></li><li><p>overlap in genetics of PG and alc dependence = 12-20% (addiction vulnerability) </p></li></ol><p></p>
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environmental risk factors for gambling

  1. exposure to parental gambling in childhood/adolescence

  • social learning theory/modeling 

  • parental gambling PROBLEMS predicted child gambling problems (not parental gambling in general)

  1. childhood adversity 

  • adult sample: 61% reported childhood maltreatment 

  • youth pathological gamblers: 20% reported physical abuse, 18% sexual abuse 

*likely role of genes x environment interactions 

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5 main actors shaping gambling policy in BC

  1. provincial gov

  • main proponent of expansion and main recipient of growing revenue

  1. municipal gov

  • supportive of expansion as source of new rev BUT some opposed expansion due to neg effects

  1. private gambling operators

  • lobbied for expansion

  1. charities (e.g. bingo venues)

  • conflicted w provincial gov over dist of revenues

  1. academic researchers

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problematic types of legal gambling in canada

  1. casino-based table and EGMs

  2. non-casino EGMs and VLTs

  3. single sporting event betting (legalized federally in 2021)

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allocation of net gambling revenue

community chess model → gov = major provider + expanded availability of gambling

  • drives policy → more profitable than alc, tobacco and cannabis combined

  • revenue disproportionately taken from those who have problems with it → morally acceptable ?

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reasons for needing a public health focused gambling policy

  • gov policies influence benefits and harms of gambling → availability/access, funding for prevention and treatment

  • harms and costs of PG mainly PRIVATE + hard to measure rel to benefits (revenue) → creates systemic bias toward expansion

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4 main economic impacts of gambling

  1. increased gov revenue

  2. increased public services

  3. increased regulatory costs (when expanding)

  4. pos and neg impacts on non-gambling biz depending on whether complimentary/competitive w gambling

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4 main social impacts of gambling

  1. increased PG and associated harms (e.g. bankruptcy, suicide)

  2. increased crime (except illegal gambling)

  3. increased socio-economic inequality

  4. more negative attitudes toward gambling

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policy issues in canada

  • proportion of revenue from problem gamblers: approx 30% in canada

  • % rev dedicated to prevention, treatment and research

  • expansion of avail of casino games and EGMs (esp expansion in smaller centres)

    • rev from locals vs tourists

  • promotion and expansion of sports betting

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treatment program limitations

  • hard to engage ppl who need the help

  • presence of stigma

  • expensive to promote and find those who need help

  • co-morbidities w other problems

*should aim to reduce stigma in order to help more ppl

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gambling traditions in canada’s first nations

lahal ‘the bone game’

  • 2 teams, played at social gatherings incl funerals + accompanied by gambling songs

  • element of perception → trick opponent to guess the wrong hand that the bone is in

  • nowadays: ‘pot’ won might b based on entry fee → traditionally valuable items put up by hosts (resources)

    • similar to lukuchuko

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westernization of indigenous gambling

11% of sample participated in traditional first nation games in past year

  • only 25% considered them to be gambling 

  • ‘gambling’ term connected to western, commercial forms, disconnected from traditional games 

  • non-commercial games w no house-edge VS modern commercial games (neg consequences arise from house edge) 

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gambling revenue from people with gambling problems

profits concentrated among pop of problem gamblers → contribute DISPROPORTIONATELY to gambling revenue 

  • calc use prevalence estimates of PG rate

  • questionnaire estimates of typical monthly spending on gambling (inaccurate self-report) 

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‘hyper pareto’: gambling conc in a small number of whales (very profitable customers) 

  • standard pareto: rev conc in top 20% of users (80%)

  • netflix: subscription model (flat rate) 

  • weekly lottery: top 20% = approx 60% of rev

  • online gambling: top 20% = 90% of revenue, 92% bets 

    • exact record of what each gambler spent → hard to get diagnosis data on PG 

<ul><li><p>standard pareto: rev conc in top 20% of users (80%)</p></li><li><p>netflix: subscription model (flat rate)&nbsp;</p></li><li><p>weekly lottery: top 20% = approx 60% of rev</p></li><li><p>online gambling: top 20% = 90% of revenue, 92% bets&nbsp;</p><ul><li><p>exact record of what each gambler spent → hard to get diagnosis data on PG&nbsp;</p></li></ul></li></ul><p></p>
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indigenous gambling and PG in canada

data from 2018 canada community health survey

  • rel popularity of gambling (basic involevement) FAIRLY SIMILAR to non-indigenous canadians 

    • some elevation for EGMs, bingo, instant lotteries 

  • rate of PG MUCH HIGHER among indigenous canadians (2.0%) vs 0.5% 

    • highest of any racial/ethnic grp in canada 

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BC youth data for gambling

BC adolescent health survey 2018

  • 21% of BC youth aged 12-18 gambled for money in past year 

  • youth employment 20+ hrs per week linked to gambling for money → access to disposable income 

  • involvement in sports on weekly basis associated w sports betting 

  • monthly gambling → sedentary lifestyle, less social connection, excessive tech use 

  • gambling problems in 3% of those who gambled → highest in NON-BINARY youth 

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gambling and gender identity

non-binary gender: 2.7%

  • youth identifying as non-binary showed HIGHER rates of PG 5.7% vs 1.8% → esp transgender youth assigned male at birth 

  • interaction b/w biological sex and gender identity 

<p>non-binary gender: 2.7% </p><ul><li><p>youth identifying as non-binary showed HIGHER rates of PG 5.7% vs 1.8% → esp transgender youth assigned male at birth&nbsp;</p></li><li><p>interaction b/w biological sex and gender identity&nbsp;</p></li></ul><p></p>
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intersectionality definition

overlap of social identities

  • ppl may identify w multiple under-represented and or marginalized grps at the same time 

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geospatial analysis of SES (aus study)

in lower SES neighbourhoods:

  • higher losses (higher slot machine revenue)

  • more slot machine venues

  • for lottery too

businesses want to open more gambling sites in less affluent areas → not randomly distributed

<p>in lower SES neighbourhoods:</p><ul><li><p>higher losses (higher slot machine revenue)</p></li><li><p>more slot machine venues</p></li><li><p>for lottery too</p></li></ul><p>businesses want to open more gambling sites in less affluent areas → not randomly distributed </p><p></p>
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diversity in the gambling research field 

‘gender gap’: can be measured in academic papers from inferring first names (gender neutral names excluded) 

  • senior authors more likely to be men 

  • researchers who were men published 16% more papers overall 

  • stronger gender bias for gambling papers than non-gambling ones → reflects systemic biases against women in academic careers 

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key points of disproportionate gambling effects

  • on many racialized and minoritized groups

  • ppl who are socio-economically disadvantaged

    • high income grps spend MORE on gambling but lower income grps spend a GREATER PROPORTION of their income → experience more financial harm

  • ppl w gambling problems account for a disproportionate slice of revenue (~20-40%)

**high levels of gambling lead inevitably to financial strain and debt → can further amplify social inequalities (vicious cycle)

  • ^for commercial games w built-in house-edge

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3 distinct theoretical approaches to gambling and PG

  1. psychodynamic account (freudian)

  2. behavioural account (conditioning, learning)

  3. cognitive account

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theory 1: psychodynamic account

bergler: PG as MASOCHISM → unconscious desire to lose (to punish yourself)

  • driven by denial/rebellion against parental authority → rejecting values of family unit hence driven to humiliate themselves 

    • limitation: UNFALSIFIABLE (cannot be tested) 

  • recognizes that PG not necessarily abt WINNING money → but rather obsessed with losing 

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pathways model 

  • proposes 3 subgroups of and routes into PG 

  • specifies key roles for conditioning, arousal, cognitions, depression/anxiety, neurobiology and impulsivity

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pathways model: pw 1 [behaviourally conditioned PG]

all gamblers go through this pathways (final common pw)

  • ecological factors (availability and accessibility) → conditioning (excitement/arousal from experience) → HABIT FORMATION → (loss) chasing → PG symptoms 

  • may not have vulnerability factors but happened to be at the wrong place at the wrong time 

  • can occur at any age

<p>all gamblers go through this pathways (final common pw) </p><ul><li><p>ecological factors (availability and accessibility) → conditioning (excitement/arousal from experience) → HABIT FORMATION → (loss) chasing → PG symptoms&nbsp;</p></li><li><p>may not have vulnerability factors but happened to be at the wrong place at the wrong time&nbsp;</p></li><li><p>can occur at any age</p></li></ul><p></p>
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pathways model: pw 1 evidence

early ‘big wins’ in first experiences w gambling → predictor of PG in future 

  • retrospective interviews (turner 2006)

    • social gambler (casual w no symptoms: $139 first win (0%)

    • subclinical (@ risk): $499 first win (12%)

    • pathological: $620 (26%) 

    • powerful one trial conditioning event + skews expected value calculations 

e.g. getting a job at a betting shop w no prior inclination to gambling → want to practice tips picked up (wrong place at the wrong time) 

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pathways model: pw 2 [the ‘emotionally vulnerable’ gambler]

piggyback onto first pathway (dispositions present)

  • posits an emotional disturbance that predisposes gambling engagement and persistence

  • emotional predispositions (depression, anxiety, childhood trauma, poor coping, life stresses) - negative reinforcement → gamble for first time OR bring you back to gambling → conditioning → habit formation → chasing → PG symptoms 

<p>piggyback onto first pathway (dispositions present) </p><ul><li><p>posits an emotional disturbance that predisposes gambling engagement and persistence </p></li></ul><ul><li><p>emotional predispositions (depression, anxiety, childhood trauma, poor coping, life stresses) - negative reinforcement → gamble for first time OR bring you back to gambling → conditioning → habit formation → chasing → PG symptoms&nbsp;</p></li></ul><p></p>
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pathways model: pw 2 evidence

depression and ‘dark flow’

  • study on casino visitors: depressed group had sig HIGHER flow ratings → immersion and potentially negative reinforcement 

<p>depression and ‘dark flow’ </p><ul><li><p>study on casino visitors: depressed group had sig HIGHER flow ratings → immersion and potentially negative reinforcement&nbsp;</p></li></ul><p></p>
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pathways model: pw 3 [the ‘antisocial impulsive’ gambler]

biologically driven predispositions

  • gambling commences at early age, rapidly escalates in intensity 

  • IMPULSIVITY (+ executive dysfunction, genetic vulnerability, substance use, antisocial behaviour) → gamble for first time OR bring you back to gambling → conditioning → habit formation → chasing → PG symptoms 

<p>biologically driven predispositions</p><ul><li><p>gambling commences at early age, rapidly escalates in intensity&nbsp;</p></li><li><p>IMPULSIVITY (+ executive dysfunction, genetic vulnerability, substance use, antisocial behaviour)&nbsp;→ gamble for first time OR bring you back to gambling → conditioning → habit formation → chasing → PG symptoms&nbsp;</p></li></ul><p></p>
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pathways model: pw 3 evidence 

impulsivity as the ‘addictive personality’ 

  • prospective design (long-drawn; across time) using Dunedin birth cohort 

  • multidimensional personality questionnaire (MPQ) at 18yrs old 

    • 3 superfactors: negative emotionality (neuroticism), positive emotionality (extraversion), constraint (opp of impulsivity) 

  • drug use and gambling assessment at 21yrs old 

    • alc dependence (10%), cannabis dependence (9%), nicotine dependence (18%), gambling problems (6%)

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pathways model: pw 3 evidence (personality profile)

personality/risk profile for: (similar pattern across) 

  • alcohol problems 

  • cannabis dependence 

  • problem gambling 

*low constraint (high impulsivity), high neg emotionality (proneness to stress), positive emotionality (no predictive value) 

<p>personality/risk profile for: (similar pattern across)&nbsp;</p><ul><li><p>alcohol problems&nbsp;</p></li><li><p>cannabis dependence&nbsp;</p></li><li><p>problem gambling&nbsp;</p></li></ul><p>*low constraint (high impulsivity), high neg emotionality (proneness to stress), positive emotionality (no predictive value)&nbsp;</p><p></p>
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testing the pathways model 

TYPE THEORY: puts ppl into 3 diff categories (often turns out to be dimensions/traits instead) 

reasons for long length of model

  • measurement is tricky due to many components + hard to test 

  • complex statistics for testing types, require large samples 

3 cluster solution 

  • pw 1 (44%), pw 2 (40%), pw 3 (16%) 

  • pw 3 CLEARLY DISTINCT from pw 2 → distinct vulnerabilities (independent) 

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gambling in parkinson’s disease

L-dopa (standard pharmaco treatment) turns into DA/precursor for DA

  • DA agonist meds can trigger EXCESSIVE gambling 

  • most linked to 2 drugs: pramipexole and ropinirole → bind to DA D3 receptors 

  • constellation w other impulse control/reward problems (sex-related)

    • men: hyper-sexuality

    • women: compulsive shopping buying

  • drug stimulating DA → drives gambling problems

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fMRI of reward in PG (case control design - 1 illness grp, 1 no illness)

task w no house-edge (win > lose)

  • reduced striatum and vmPFC reward activity in PG → corr w gambling severity 

  • HC: strong response to reward

  • PG: most severe patients = weakest brain response to reward 

  • supports reward deficiency hypothesis (underactive system)

<p>task w no house-edge (win &gt; lose)</p><ul><li><p>reduced striatum and vmPFC reward activity in PG → corr w gambling severity&nbsp;</p></li><li><p>HC: strong response to reward </p></li><li><p>PG: most severe patients = weakest brain response to reward&nbsp;</p></li><li><p>supports reward deficiency hypothesis&nbsp;(underactive system)</p></li></ul><p></p>
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DA PET binding in gambling disorder

hypothesis: reduced DA binding in grp w gambling disorder (not seen)

  • NO grp diffs in extracted DA D2 in striatum but related to trait impulsivity 

  • most impulsive control person scored lower than the least impulsive gambler → 2 groups completely separated 

    • PG: sig neg correlation

** DA very sensitive to age 

<p>hypothesis: reduced DA binding in grp w gambling disorder (not seen)</p><ul><li><p>NO grp diffs in extracted DA D2 in striatum but <strong>related to trait impulsivity&nbsp;</strong></p></li><li><p><span style="color: purple;"><span>most impulsive control person scored lower than the least impulsive gambler → 2 groups completely separated&nbsp;</span></span></p><ul><li><p>PG: sig neg correlation</p></li></ul></li></ul><p>** DA very sensitive to age&nbsp;</p><p></p>
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fMRI to natural rewards

**winning money = addiction relevant reward

task: response time to earn monetary reward or sexual reward

  • men w gambling disorder: IMBALANCED response to gambling-related ($) vs natural (sexual) rewards 

    • gamblers: faster response to money than erotic rewards → reward sys BIASED toward addiction relevant rewards 

    • control: no diff

    • SAME pattern in ventral striatum response

      • controls: activated to both rewards

      • gamblers: only activated when given money cues

  • reward repertoire shrinks to only target of addiction vs HC w many diff things we get reward from 

  • both reward deficiency and incentive salience happening ??

<p><span style="color: purple;"><span>**winning money = addiction relevant reward</span></span></p><p><span style="color: rgb(0, 0, 0);"><span>task: response time to earn monetary reward or sexual reward</span></span></p><ul><li><p>men w gambling disorder: IMBALANCED response to gambling-related ($) vs natural (sexual) rewards&nbsp;</p><ul><li><p>gamblers: faster response to money than erotic rewards → reward sys BIASED toward addiction relevant rewards&nbsp;</p></li><li><p>control: no diff</p></li><li><p>SAME pattern in ventral striatum response </p><ul><li><p>controls: activated to both rewards</p></li><li><p>gamblers: only activated when given money cues </p></li></ul></li></ul></li><li><p>reward repertoire shrinks to only target of addiction vs HC w many diff things we get reward from&nbsp;</p></li><li><p>both reward deficiency and incentive salience happening ?? </p></li></ul><p></p>
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BC resources for gambling problems

  • telephone helpline (gambling support) → not needed to be gambler themselves

  • voluntary self-exclusion program → gamblers block themselves from casino and online gambling access

    • no contact incl lack of treatment options

    • who’s responsible if somehow allowed back in (legal issues)

  • ‘responsible gambling’ tools like limit-setting options → e.g. limit to gamble in a month

  • psychological treatment → free counselling programs

  • financial support (debt management loans), family therapy

  • no residential facilities for gambling in BC → expensive

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2 forms of psychological treatments

  1. cognitive-behavioural therapy (CBT) → most dominant

  • C: testing and restructuring false beliefs (distortions)

    • write what person is thinking → challenge that belief

  • B: exposure (imagined at first) and desensitization

    • conditioning: take client to casino foyer → flooding for phobias

  • feed into each other → cannot be independently used

  1. motivational interviewing (MI) / enhancement

  • enhancing motivation to CHANGE, exploring AMBIVALENCE (pros and cons of gambling)

  • assessing ‘change talk’: are the pros really beneficial → move them along change continuum

  • any treatment most effective when client is motivated to change their behaviour → MI used in combination w other therapies

    • many drop out prematurely

*many open questions on effectiveness

  1. indiv vs group setting

  2. in-person vs online delivery

  3. (complete) abstinence vs controlled gambling

  • anonymous programs vs not complete removal of gambling/returning to previous state

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pharmacotherapy for gambling disorder (medications)

placebo vs drug trials

  • measure symptom severity

  • classes of drugs: opioid, serotonin, dopamine

    • opioid medications have the best results → block opioid receptors (drug 2x better than placebo)

    • serotonin (SSRIs, anti-depressant meds) → not effective 68% drugs, 66% placebo

    • dopamine (treat schizophrenia) → placebo more effective than drug

  • from placebo-controlled trials: most promising meds = opioid antagonists → REDUCE URGE (to gamble) + CRAVINGS

  • reasons for variability b/w placebos

    • diff duration of treatments

    • background of study (education, no response, MI)

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biggest issue w treatment

even though treatment = FOC and good quality …

  • few people w addictions actually seek help

    • awareness of programs + how to access

    • stigma surrounding admitting harm and consequences

  • bijker et al (2022) systematic review and meta-analysis of prevalence of help seeking for gambling

    • moderate-risk gamblers: 3.7%

    • problem gambling (highest classification on PGSI): 20.6%

    • 1 in 25 moderate-risk gamblers and 1 in 5 ppl w PG have sought help for gambling related problems

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theory 2: behavioural account (learning)

gambling and pavlovian conditioning

  • cues associated w gambling should become CS → visual stimulus of casino lobby (smells, colours, sounds)

    • reward salience

  • DA involved in this learning

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theory 2: behavioural account - gambling cues and craving in the brain

UK: clinic patients majority men vs much less skewed in vancouver

  • gambling culture differences and gender norms

  • only men recruited bc thought not enough women to do stats by gender

  • gambling cues TAILORED to preferred games of each participant

    • vs smoking (generic cues)

    • shop fronts of high street betting shops → powerful trigger for gamblers

  • used highly appetizing food images to test whether other reward processing altered

  • took CRAVINGS rating after each block of images (during brain scan)

  • analyzed brain connectivity changes (striatum as ‘seed’ region) + simple contrast analysis

<p>UK: clinic patients majority men vs much less skewed in vancouver</p><ul><li><p>gambling culture differences and gender norms</p></li><li><p>only men recruited bc thought not enough women to do stats by gender</p></li><li><p>gambling cues TAILORED to preferred games of each participant</p><ul><li><p>vs smoking (generic cues)</p></li><li><p>shop fronts of high street betting shops → powerful trigger for gamblers</p></li></ul></li><li><p>used highly appetizing food images to test whether other reward processing altered</p></li><li><p>took CRAVINGS rating after each block of images (during brain scan)</p></li><li><p>analyzed brain connectivity changes (striatum as ‘seed’ region) + simple contrast analysis</p></li></ul><p></p>
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results of gambling cues and cravings study

2 sets of neutral images used → some visually matched to gambling images (same colours and visual complexity), others matched to food images

  • HC: at lowest levels

  • gambling disorder: increased craving ratings overall → ESP after blocks of gambling images (cue reactivity) 

<p>2 sets of neutral images used → some visually matched to gambling images (same colours and visual complexity), others matched to food images </p><ul><li><p>HC: at lowest levels </p></li><li><p>gambling disorder: increased craving ratings overall → ESP after blocks of gambling images (cue reactivity)&nbsp;</p></li></ul><p></p>
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fMRI analysis - gambling cues

  • all subjects: gambling cues - neutral cues → brain activity: frontal lobe, striatum, visual cortex 

  1. interaction test: brain areas more responsive to gambling cues (vs neutral cues) in GD MORE than in HC → insula, medial PFC 

  2. correlation w craving (gamblers): areas where brain activity to gambling contrast correlate w craving intensity → INSULA (bilaterally - both hemispheres)

    • more activity = more craving in gamblers (pos correlation)

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neuropsychology on INSULA and craving 

study on stroke patients who used to be smokers (medical records) 

  • if stroke affected INSULA → more likely to spontaneously quit

    • no cravings/urge to smoke

    • forgot they used to smoke (not amnesia) 

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gambling advertisement (classical conditioning) 

packed w learned cues tho now banned and heavily regulated 

  • 3 factors: involvement, awareness, knowledge

  • factor analysis across diff elements of gambling 

  • results:

    • involvement: grp w PG show STRONGER impact of ads 

    • involvement and knowledge: younger age and men had higher scores 

<p>packed w learned cues tho now banned and heavily regulated&nbsp;</p><ul><li><p>3 factors: involvement, awareness, knowledge </p></li><li><p>factor analysis across diff elements of gambling&nbsp;</p></li><li><p>results: </p><ul><li><p>involvement: grp w PG show STRONGER impact of ads&nbsp;</p></li><li><p>involvement and knowledge: younger age and men had higher scores&nbsp;</p></li></ul></li></ul><p></p>
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theory 2: behavioural theory (operant conditioning) and role of arousal

  • gambling = operant response that SOMETIMES results in a win → potential for POSITIVE REINFORCEMENT

  • skinner’s schedules of reinforcement

    • fixed interval: 1 reward avail every 10s → e.g. salaries at end of month

    • variable interval: unpredictable interval → e.g. songs on radio

    • fixed ratio: 1 prize every 10 presses

    • variable ratio: unpredictable reward (unsure which bet is going to win) → e.g. slot machine/gambling

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VR schedules characteristics 

  • ratio schedules yield HIGHER RATES of response than IS → can ‘slack off’ after reward received 

  • VR schedules: HIGHLY RESISTANT TO EXTINCTION → persistent 

    • uncertainty = key to effect 

  • not easy to establish for animals → trng required to get animal to that point (built up) 

    • early ‘big wins’ may be a key conditioning event 

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DA release (raclopride PET) to unpredictable rewards

long boring task (task releasing natural DA → competes w radio tracer at receptors; reduce PET signal via competition) 

  • VR minus control: increase DA in L striatum 

  • FR minus control: no sig DA release 

*only PET scan during task 

<p>long boring task (task releasing natural DA → competes w radio tracer at receptors; reduce PET signal via competition)&nbsp;</p><ul><li><p>VR minus control: increase DA in L striatum&nbsp;</p></li><li><p>FR minus control: no sig DA release&nbsp;</p></li></ul><p>*only PET scan during task&nbsp;</p><p></p>
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effects of uncertainty on DA cell signals

DA cell activity during appetitive pavlovian conditioning (purple squiggle and fruit juice)

  • 5 stimuli w diff probabilities of reward 

  • not always tied to juice BUT cue learning still exists (CS response) → DA cell activated during the “pause” (unsure if getting reward) 

  • at peak uncertainty (0.5) → CS + anticipatory activity in pause b/w CS and juice 

    • surplus DA activity (double hit) 

<p>DA cell activity during appetitive pavlovian conditioning (purple squiggle and fruit juice) </p><ul><li><p>5 stimuli w diff probabilities of reward&nbsp;</p></li><li><p>not always tied to juice BUT cue learning still exists (CS response) → DA cell activated during the&nbsp;“pause” (unsure if getting reward)&nbsp;</p></li><li><p><span style="color: purple;">at peak uncertainty (0.5) → CS + anticipatory activity in pause b/w CS and juice&nbsp;</span></p><ul><li><p><span style="color: purple;">surplus DA activity (double hit)&nbsp;</span></p></li></ul></li></ul><p></p>
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gambling and hyper-learning (double hit)

  • evidence for pavlovian cue learning in gambling

  • uncertain rewards: both cue learning AND anticipation (additional activity during delay period) → potential DA double hit created

<ul><li><p>evidence for pavlovian cue learning in gambling </p></li><li><p>uncertain rewards: both cue learning AND anticipation (additional activity during delay period) → potential DA double hit created </p></li></ul><p></p>
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“its all about the pause” - how gamblers describe playing slot machines 

  • neg reinforcement: gamble to alleviate neg emotions, relieve stress/low mood/boredom

  • pos reinforcement: winning, cheering 

  • physiological arousal during gambling play 

  • excitement = commodity that gambler is prepared to pay for (source of UTILITY) 

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psychophysiology of blackjack (measure HR change)

measure HR change from baseline

  • substantial HR INCREASE → biggest change = 55bpm (intense cardio level)

    • mostly in casino setting → need for ECOLOGICAL VALIDITY

    • when replicated in lab → not as intense changes in HR

<p>measure HR change from baseline</p><ul><li><p>substantial HR INCREASE → biggest change = 55bpm (intense cardio level)</p><ul><li><p>mostly in casino setting → need for ECOLOGICAL VALIDITY</p></li><li><p><span style="color: red;">when replicated in lab → not as intense changes in HR</span></p></li></ul></li></ul><p></p>
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monetary bet/prize as prerequisite for physiological arousal

playing for real money → big INCREASE in HR compared to just playing for credits

<p>playing for real money → big INCREASE in HR compared to just playing for credits </p>
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processing of physiological arousal

physiological changes (SIGNAL) → detection of that change (INTEROCEPTION) - insula → COGNITIVE APPRAISAL (do you like that feeling)

  • lots of studies on PG measured SIGNAL but inconsistent findings 

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cognitive appraisal theory of emotion

capilano bridge study

  • misattribution of cognitive responses as other feelings (e.g. romantic attraction) 

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capilano bridge of gambling

slot machine gamblers (PGSI >1) visiting australian crocodile sanctuary

  • aim: cognitive appraisal → not physiological arousal directly 

  • play at entry foyer OR after holding baby croc for awhile 

  • measure: emotion rating scale 

  • crocodile grp: significant difference reps some MISATTRIBUTION of arousal → affects gambling behaviour 

<p>slot machine gamblers (PGSI &gt;1) visiting australian crocodile sanctuary</p><ul><li><p>aim: cognitive appraisal → not physiological arousal directly&nbsp;</p></li><li><p>play at entry foyer OR after holding baby croc for awhile&nbsp;</p></li><li><p>measure: emotion rating scale&nbsp;</p></li><li><p>crocodile grp: significant difference reps some MISATTRIBUTION of arousal → affects gambling behaviour&nbsp;</p></li></ul><p></p>
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‘think aloud’ technique

gambler plays in natural environment for 5min + VOCALIZES all thoughts 

  • thoughts coded as mathematically accurate of faulty 

  • anthropomorphizing machine → giving consciousness to machine

  • gamblers fallacy; hindsight bias (knew that was gg to happen)

results 

  • 70-90% of gamblers’ thoughts are erroneous → tied to actual play and preferred game 

  • erroneous thoughts elevated in ppl w disordered gambling 

    • CEILING EFFECT: harder to detect any effect in PG 

  • those w greatest HR increases made most erroneous thoughts

  • when identifying results → perceived self as more accurate even tho irl more erroneous 

    • “not me” bias → lack insight into distortions 

*levels of gambling cognitions elevated in problem gambling

<p>gambler plays in natural environment for 5min + VOCALIZES all thoughts&nbsp;</p><ul><li><p>thoughts coded as mathematically accurate of faulty&nbsp;</p></li><li><p>anthropomorphizing machine → giving consciousness to machine</p></li><li><p>gamblers fallacy; hindsight bias (knew that was gg to happen)</p></li></ul><p>results&nbsp;</p><ul><li><p>70-90% of gamblers’ thoughts are erroneous → tied to actual play and preferred game&nbsp;</p></li><li><p>erroneous thoughts elevated in ppl w disordered gambling&nbsp;</p><ul><li><p>CEILING EFFECT: harder to detect any effect in PG&nbsp;</p></li></ul></li><li><p>those w greatest HR increases made most erroneous thoughts</p></li><li><p>when identifying results → perceived self as more accurate even tho irl more erroneous&nbsp;</p><ul><li><p>“not me” bias → lack insight into distortions&nbsp;</p></li></ul></li></ul><p><span style="color: purple;">*levels of gambling cognitions elevated in problem gambling</span></p><p></p>
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‘think aloud’ critique

  1. requirement to verbalize = UNNATURAL 

  • demand characteristics: responding in ways they think the researchers want

  1. relatively few ways to express accurate thoughts abt the game

  • bias in procedure

  1. healthy ppl express SO MANY irrational beliefs during gambling

  • ceiling effect: hard to show PG do it even more 

  1. cognitions as a way of rationalizing unconscious operant responding? 

  • lack of empirical evidence establishing CAUSAL significance 

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gambling related cognitions scale (self-report questionnaire) [GRCS]

5 subscales

[cognitive distortions] → PG score higher than avg on these items

  1. illusion of control (IC)

  • specific RITUALS and BEHAVIOURS that may increase chances of winning (praying, superstitions, lucky charms)

  1. predictive control (PC)

  • losses when gambling bound to be followed by series of wins (patterns, predictions)

  1. interpretive bias (IB)

  • relating winnings to skill and ability makes person continue gambling

[beliefs about the self]

  1. gambling expectancies (GE)

  • gambling makes things seem better

  1. inability to stop gambling (IS)

  • not strong enough to stop gambling

*levels of gambling cognitions elevated in problem gambling

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dice-throwing behaviour (henslin)

qualitative study of st louis taxi drivers → played craps during breaks

  • dice game: throw particular dice + bet on totals thrown

  • believed that a hard throw produces a large number, soft one produces a low number

  • other techniques involve evidencing concentration and effort (e.g. blowing on dice)

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ellen langer’s illusion of control

IC + IB (illusion of control + interpretive bias)

  • “an expectancy of a personal success probability inappropriately higher than the objective probability”

  • skill vs chance

    • skill: you believe you can do smthg to change chance

    • chance: ppl behave as if they were in a situation requiring skill

  • hypothesis: if skilful features are inserted into chance situations, ppl shd feel inappropriately confident → cause the illusion of control

    • 4 features

      • choice

      • motor involvement (smthg dextrous)

      • familiarity

      • competition

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illusory control: feature 1 - irrelevant choice

lottery based on football cards (cost $1)

  • either chose their card or given a card (yoked to previous participant)

  • asked how much they would sell their ticket for

  • choosers: $8.67, non-chooser: $1.96 (p<.005)

  • endowment effect: choice = ownership → cog mechanism

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illusory control: feature 2 - motor involvement

field study in vegas casino + using own money

craps: players place higher bets and bet more riskily (on single numbers) on their OWN throw

roulette: higher bets when player vs croupier (casino staff) throws ball onto wheel

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attribution of random sequence 

to basketball or coin toss 

  • 0.58 = switchier than chance

  • 0.2 = bball

  • 0.8 = coin flip

sequential effects: template for randomness not very accurate (too switchy) 

<p>to basketball or coin toss&nbsp;</p><ul><li><p>0.58 = switchier than chance </p></li><li><p>0.2 = bball</p></li><li><p>0.8 = coin flip</p></li></ul><p>sequential effects: template for randomness not very accurate (too switchy)&nbsp;</p><p></p>
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roulette predictions and confidence ratings

  1. colour runs 

  • the gambler’s fallacy: likelihood of choosing either colour DECREASES as a function of run length of that colour 

  • negative recency 

  1. winning streaks 

  • the ‘hot hand’: confidence in one’s predictions INCREASES as a function of past success (in the zone) → more confident in next prediction 

  • the ‘cold hand’ effect: after a streak of LOSSES → less confident in their next colour prediction 

**more than 1 sequential bias shown even within same task 

<ol><li><p>colour runs&nbsp;</p></li></ol><ul><li><p>the gambler’s fallacy: likelihood of choosing either colour DECREASES as a function of run length of that colour&nbsp;</p></li><li><p>negative recency&nbsp;</p></li></ul><ol start="2"><li><p>winning streaks&nbsp;</p></li></ol><ul><li><p>the&nbsp;‘hot hand’: confidence in one’s predictions INCREASES as a function of past success (in the zone) → more confident in next prediction&nbsp;</p></li><li><p>the&nbsp;‘cold hand’ effect: after a streak of LOSSES → less confident in their next colour prediction&nbsp;</p></li></ul><p>**more than 1 sequential bias shown even within same task&nbsp;</p><p></p>
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the hot hand ‘fallacy’/bias/effect

gilovich et al: bball player scores 3 consecutive shots → likelihood of scoring next shot 

  • players, fans, coaches: yes 

  • NBA shooting records and field study: no 

    • opponents attacking strat

    • increased anxiety

  • “the outcomes of previous shots influenced PREDICTIONS but not performance” 

  • ‘fallacy’ → categorical mistake (no control here)

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human action vs machine

human: expect streaks to continue

vs

coin flip/roulette wheel: assume randomness (revert back)

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losing streaks can also cause LOSS CHASING

3 experiments

  • gamblers fallacy = very ROBUST in all 3

  • experiment 3: place a bet

    • how much you bet not sensitive to winning BUT jumps up in long losing streaks → loss chasing

    • not visible in confidence

<p>3 experiments </p><ul><li><p>gamblers fallacy = very ROBUST in all 3 </p></li><li><p>experiment 3: place a bet </p><ul><li><p>how much you bet not sensitive to winning BUT jumps up in long losing streaks → loss chasing </p></li><li><p>not visible in confidence </p></li></ul></li></ul><p></p>
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reference points and ‘wiping the slate’ (prospect theory - value function) - practice drawing

  1. person ‘re-references’ after each outcome 

  • choices NOT influenced by past gains or losses → NO loss chasing 

  • go back to origin after each decision 

  1. person does NOT re-reference b/w each decision 

  • after 3 successive losses, curve flattens which may make person INSENSITIVE to further losses → YES loss chasing 

  • make decision from R3 → not worried about losses that much (not loss averse)

<ol><li><p>person&nbsp;‘re-references’ after each outcome&nbsp;</p></li></ol><ul><li><p>choices NOT influenced by past gains or losses → NO loss chasing&nbsp;</p></li><li><p>go back to origin after each decision&nbsp;</p></li></ul><ol start="2"><li><p>person does NOT re-reference b/w each decision&nbsp;</p></li></ol><ul><li><p>after 3 successive losses, curve flattens which may make person INSENSITIVE to further losses → YES loss chasing&nbsp;</p></li><li><p>make decision from R3 → not worried about losses that much&nbsp;(not loss averse) </p></li></ul><p></p>
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reference points and physical exchange of money

physical exchange of money b/w gambles forces gamblers to ‘re'-reference’ and abolish loss-chasing 

  • control: balance with interruption → same pattern as balance/original 

    • when money becomes abstract (cannot see it physically) → weight attached to losing it not the same 

  • cash transfer (‘realization’) → not just the time delay 

  • positive change score = loss chasing 

<p>physical exchange of money b/w gambles forces gamblers to ‘re'-reference’ and abolish loss-chasing&nbsp;</p><ul><li><p>control: balance with interruption → same pattern as balance/original&nbsp;</p><ul><li><p>when money becomes abstract (cannot see it physically) → weight attached to losing it not the same&nbsp;</p></li></ul></li><li><p>cash transfer (‘realization’) → not just the time delay&nbsp;</p></li><li><p>positive change score = loss chasing&nbsp;</p></li></ul><p></p>
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gambling regulation and gambling harms (Marks curve) - practice drawing

horizontal axis: degree of regulation in society (prohibition - unregulated expansion and promotion) 

vertical axis: potential harms 

sweet spot = offered in a controlled and regulated way 

BC’s stance: more towards right side 

<p>horizontal axis: degree of regulation in society (prohibition - unregulated expansion and promotion)&nbsp;</p><p>vertical axis: potential harms&nbsp;</p><p>sweet spot = offered in a controlled and regulated way&nbsp;</p><p>BC’s stance: more towards right side&nbsp;</p>
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rat gambling task (rGT) - rat ver of IGT

4 nose-poke holes to choose from:

  • reward: number of food pellets + probability

  • loss: time-out → cannot win any food 

  • deck 2 = best deck

  • deck 4 = worst (big costs even tho large reward) 

<p>4 nose-poke holes to choose from:</p><ul><li><p>reward: number of food pellets + probability </p></li><li><p>loss: time-out → cannot win any food&nbsp;</p></li><li><p>deck 2 = best deck</p></li><li><p>deck 4 = worst (big costs even tho large reward)&nbsp;</p></li></ul><p></p>
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rat gambling task (rGT) - addition of bells and whistles

uncued condition: no lights

cued condition: amount of lights and jingles depends on the deck

results: 

  • adding audiovisual feedback REDUCED preference for the best ‘deck’ → more attracted to risky decks 

  • large individual differences → personality dimensions 

  • later experiments: preference for P2 vs P3 shifted by dopamine D3 drugs (complicated)

<p>uncued condition: no lights </p><p>cued condition: amount of lights and jingles depends on the deck </p><p>results:&nbsp;</p><ul><li><p>adding audiovisual feedback REDUCED preference for the best&nbsp;‘deck’ → more attracted to risky decks&nbsp;</p></li><li><p>large individual differences → personality dimensions&nbsp;</p></li><li><p>later experiments: preference for P2 vs P3 shifted by dopamine D3 drugs (complicated) </p></li></ul><p></p>
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slot machine simulations (stripped down version w 2 reels) 

outcomes: 

  • win 

  • near-miss

  • full-miss 

*two misses categorically the same as any loss (no win)

rating: how much do you want to continue gambling

  • near misses are aversive (feel bad) but enhance motivation to play

<p>outcomes:&nbsp;</p><ul><li><p>win&nbsp;</p></li><li><p>near-miss</p></li><li><p>full-miss&nbsp;</p></li></ul><p>*two misses categorically the same as any loss (no win) </p><p>rating: how much do you want to continue gambling </p><ul><li><p>near misses are aversive (feel bad) but enhance motivation to play </p></li></ul><p></p>
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<p>fMRI for slot machine simulations&nbsp;</p>

fMRI for slot machine simulations 

near miss compared to full miss: increase brain activity in ventral striatum 

  • near miss brain activity: increased reactivity in men with gambling disorder compared to control 

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treatment for pathways model

pw 1: reduce gambling advertisements

pw 2: antidepressants, CBT for depression 

pw 3: intensive and structured programs to prevent them from dropping out