New Research Shows Connections Between Gambling Disorders And Schizophrenia

As the body of research on gambling disorders continues to grow, scientific evidence is beginning to show that some vulnerable and special needs populations appear to be at a higher risk for developing gambling disorders than the general population. The National Center for Responsible Gaming (NCRG) and the Institute for Research on Gambling Disorders have made research on these groups a priority, supporting investigations of gambling problems among young people, women, homeless individuals and African-American adolescents.

Psychiatric patients constitute another population that has been identified by several studies as more vulnerable to excessive gambling. Numerous studies have documented the high rate of co-occurring psychiatric and addictive disorders among individuals with gambling problems.1, 2However, to date, there has been no systematic examination of gambling behaviors in individuals in outpatient treatment for psychotic disorders.

A new study by Yale University researchers Rani Desai, PhD, MPH and Marc Potenza, MD, PhD has filled this gap. The results of their study were recently published online in theJournal of Clinical Psychiatry, the third most cited psychiatric journal in the world,3in the article “A Cross-Sectional Study of Problem and Pathological Gambling in Patients with Schizophrenia/Schizoaffective Disorder.”4The study was funded by the NCRG.

The researchers interviewed a sample of 337 patients diagnosed with and in outpatient treatment for schizophrenia/schizoaffective disorder. Using the DSM-IV criteria for pathological gambling and structured psychiatric assessments, the researchers found that these patients may be at a particularly high risk for gambling disorders. While 46 percent of the participants were categorized as non-gamblers and 34.7 percent as recreational gamblers (i.e., those who gamble and are able to do so without adverse consequences), 19.3 percent were classified as either problem or pathological gamblers.4Of the group with gambling problems, 9.8 percent met the threshold for pathological gambling, the most severe form of the disorder.4Recent national studies have estimated the rate of pathological gambling among the general adult population at one percent and lower.5, 6

Desai and Potenza conjecture that several reasons might predispose this population to gambling problems. First, the cognitive disturbances associated with psychotic disorders may make it difficult for these patients to control their gambling or understand the risks of excessive gambling. Second, both schizophrenia/schizoaffective disorder and pathological gambling show evidence of impaired impulse control. The authors note that, “Clinically, this finding is important, because co-occurring addictions can complicate treatment of schizophrenia/schizoaffective disorder itself, and because even if patients are in recovery from one addictive behavior (eg, alcoholism), they may be vulnerable to substituting another (eg, problem gambling).”4

They also note that clinicians should be aware of the potential for excessive gambling in patients with schizophrenia/schizoaffective disorder and screen such patients for gambling problems, especially those who are either in recovery or actively abusing drugs or alcohol.

Third, the study showed significantly higher scores for depression among the patients with gambling problems, which can increase vulnerability to excessive gambling. The authors also note that depressive symptoms can be a response to the typical consequences of pathological gambling, such as financial stress.

This study represents a great advance as one of the largest to directly examine gambling patterns in a sample of people with schizophrenia/schizoaffective disorder. It demonstrates the importance of screening patients with psychotic disorders for gambling problems. These findings also provide a roadmap for future research, suggesting that future investigations should identify the factors that place these patients at risk for developing a gambling disorder. Finding effective therapies for this population is another priority for future investigations because current clinical trials for treatment of gambling disorders typically exclude subjects with psychotic disorders.

References

1.Cunningham-Williams RM, Cottler LB, Compton WM, 3rd, Spitznagel EL. Taking chances: problem gamblers and mental health disorders–results from the St. Louis Epidemiologic Catchment Area Study.Am J Public Health.Jul 1998;88(7):1093-1096.

2.Grant JE, Levine L, Kim D, Potenza MN. Impulse control disorders in adult psychiatric inpatients.Am J Psychiatry.Nov 2005;162(11):2184-2188.

3.ISI Web of Knowledge.Journal of Citation Reports: Thomas Reuters; 2008. Available athttp://thomsonreuters.com/products_services/science/science_products/scholarly_research_analysis/research_evaluation/journal_citation_repoAccessed September 4, 2009.

4.Desai RA, Potenza MN. A cross-sectional study of problem and pathological gambling in patients with schizophrenia/schizoaffective disorder.J Clin Psychiatry.Jun 16 2009.

5.Petry NM, Stinson FS, Grant BF. Comorbidity of DSM-IV pathological gambling and other psychiatric disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions.J Clin Psychiatry.May 2005;66(5):564-574.

6.Kessler RC, Hwang I, LaBrie R, et al. DSM-IV pathological gambling in the National Comorbidity Survey Replication.Psychol Med.Sep 2008;38(9):1351-1360.

Christine Reilly Executive Director, Institute for Research on Gambling DisordersIssues & Insightscomorbiditynew research

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Cultivating The Next Generation Of Gambling Researchers

When the New Investigator category of our project grants program debuted in 2004, we sought to attract talented young researchers to the field of gambling studies. This year, with the award of a grant to Dr. Serena King of Hamline University in St. Paul, Minn., the National Center for Responsible Gaming and the Institute for Research on Gambling Disorders have supported a total of five new investigators with more than $250,000 in project grants.

The New Investigator award category is modeled on the career development grants awarded by the National Institutes of Health (NIH), including the requirement to work with a senior scientist as a mentor. But this award is more than a training grant. Past recipients of this award have made significant contributions to the field. Dr. Catharine Winstanley at the University of British Columbia, whose groundbreaking research on animal models of gambling was published in the highly regarded journal Neuropsychopharmacologyand featured in last month’sIssues & Insights, told me that the support “was invaluable to me in terms of getting my research program off the ground.” Other past New Investigator grantees, Drs. Shelly Flagel (University of Michigan) and Anna Goudriaan (University of Amsterdam) also have published their findings in competitive journals.

In addition to publishing in highly competitive journals, some have used the grant as seed money for support from the National Institutes of Health. I was very excited to learn that Dr. Silvia Martins, assistant scientist at the John Hopkins University School of Public Health, was recently awarded a grant from the National Institute on Child Health and Human Development for the expansion of the project, “Predictors of Pathological Gambling among African-American Young Adults,” for which she received a New Investigator grant in 2004.

King, our 2009 New Investigator grant recipient, is focusing her research project on one of the oldest questions in the field – why do some people develop a gambling disorder? It’s the type of fundamental issue that will not be resolved overnight. But King’s research represents a significant step forward. An assistant professor of psychology at Hamline University, King will work with mentor Dr. Ken Winters of the University of Minnesota to examine the roles that behavioral problems, genes and environment play in gambling behaviors from adolescence to young adulthood by reviewing data collected in the Minnesota Twin Family Study. King’s research will help fill a gap in the field as there has been little research to-date that specifically examines the developmental periods of adolescence to early adulthood and contribute insights that will help in the development of more effective screening and prevention strategies. As one of the peer reviewers for the New Investigator grant applications noted, “This developmental approach is important if we are to gain a foothold on understanding the precursors to pathological gambling.”

The need for more research regarding how and why people develop gambling disorders is echoed in the second project grant awarded by the Institute this year, this time in the Public Health category. In his research proposal, Dr. Adam Goodie of the University of Georgia argued there is little evidence to support the notion of a single “addictive personality,” but there is a great deal of evidence to support connections between specific personality traits and an increased likelihood of gambling problems. Goodie’s project will test whether certain personality types may have a direct, causal link to pathological gambling. The goal of the project is to improve understanding of the determining factors that contribute to the development of gambling disorders to help inform prevention and treatment of different kinds of disordered gamblers. The peer review panel convened by the Institute to review the public health research proposals praised Goodie’s project for its innovative approach, sophisticated statistical modeling procedures, and strong team of researchers.

Details about the 2009 grant recipients are available in our recentpress release, as well as in theProject Grantssection of the Web site. TheProjects Grantssection also provides information about past grant awards.

Christine Reilly Executive Director, Institute for Research on Gambling DisordersIssues & InsightsInstitute grantsnew investigatornew researchNIH

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A New Chapter In Gambling Research

Welcome to the Institute for Research on Gambling Disorders and the first edition ofIssues & Insights. Here we’ll keep you updated on the latest issues and research on gambling disorders and related topics, including feature posts from some of the leading researchers in this field. For this inaugural edition, we’re reflecting on a new chapter for both the Institute and the field of research on gambling disorders.

In 1996, when I was appointed the executive director of theNational Center for Responsible Gaming(NCRG)—the organization that provides the Institute’s funding—our understanding of why some people develop a gambling addiction was very limited. To remedy this knowledge gap, we launched the first competitive grants program for research on the disorder. At our first review meeting, Dr. Jim Langenbucher of Rutgers University, a member of the distinguished peer review panel, likened the field of gambling research to the “Wild, Wild West” and recommended a grants program that welcomed all types of investigations, from studies of the genetics of gambling disorders, to drug trials, to public health research.

The infusion of money, the openness to a wide range of topics and a commitment to the most rigorous scientific standards have created a burgeoning field that continues to expand thanks to the work of scientists around the world. NCRG-funded grants awarded through the Institute have yielded the publication of more than 150 articles in influential, peer-reviewed journals. We’re proud that the NCRG and Institute have played a role in launching the gambling research field.

After 13 years of grant-making, the NCRG decided that sustained focus on key issues should be the next step to promote seminal research. Consequently, we restructured and renamed the Institute (formerly the Institute for Research on Pathological Gambling and Related Disorders) to support the newNCRG Centers of Excellence in Gambling Research, which currently are located at Yale University and the University of Minnesota. The centers will zero in on basic issues such as how to identify young adults at risk for disordered gambling and what factors affect treatment outcomes. Although we have retooled our funding strategy to better meet the needs of a changing research landscape, our commitment to the highest standards and to the ultimate goal of effective prevention and treatment remains paramount.

Those familiar with the NCRG and the Institute may be asking, why the name change? Like our refocused grant-making strategy, our new moniker also has a direct correlation with the changing research landscape. The new name, Institute for Research on Gambling Disorders, reflects recent research that questions the term “pathological gambling” as used in the American Psychiatric Association’sDiagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). This diagnostic code does not provide for the levels of severity of disordered gambling behavior that have been observed in research and in clinical practice. The new name better conveys this concept and, as such, more accurately reflects the conditions of the individuals we hope will be helped by our research and programs.

I hope you’ll continue to visit us atwww.gamblingdisorders.orgfor updates on our research and education programs, as well as new editions ofIssues & Insightsand our other publications.

Christine Reilly Executive Director, Institute for Research on Gambling DisordersIssues & Insights

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Risk-taking Rats May Help Advance Treatments For Gambling Disorders

At first glance, research on lab rats who “gamble” might seem either fodder for jokes or irrelevant to the search for solutions for gambling disorders; however, recently published findings of an NCRG-funded investigation at the University of British Columbia demonstrates that such research represents, as Dr. Marc Potenza of Yale University observed, a “significant step forward” that could eventually lead to new treatments for pathological gambling.

The article, “Serotonergic and Dopaminergic Modulation of Gambling Behavior as Assessed Using a Novel Rat Gambling Task,”1was published last month in Neuropsychopharmacology, the fifth-most cited psychiatry journal in the world. The authors reported that rats were able to successfully learn to “play the odds” in a gambling task, modeling human gambling behavior. According to theVancouver Sun, Dr. Catharine Winstanley, one of the study’s authors, called the study “an important first step in offering clues into what neurotransmitters or what brain chemicals are involved in regulating gambling behavior.” In 2006, Winstanleyreceived a New Investigator Grantof $57,500 from the National Center for Responsible Gaming (NCRG), through the Institute for Research on Pathological Gambling and Related Disorders (now the Institute for Research on Gambling Disorders), to help support this investigation.

During the task, the rats were able to choose from four options that differed in the probability and magnitude of food rewards and timeouts (i.e., penalty periods during which no food would be dispensed). High-stake options offered more sugar pellets, but choosing the high-stakes options also was more likely to trigger longer timeouts. According to the study, rats learned how to be “successful” gamblers, selecting the option with the optimum level of risk and reward to maximize their sugar pellet profits over time.

The study also found the rats’ decision-making became significantly impaired in the gambling task when they were treated with drugs that affected the levels of dopamine and serotonin – two neurotransmitters in the brain implicated in impulse control and drug addiction. According to the study, this suggests a role for these neurochemicals in moderating gambling behavior and a potential method of researching new leads for the development of pharmacological treatments for this disorder.

Michael Bozarth, associate professor of psychology at the University of Buffalo, the State University of New York, underscored the significance of animal models for research on gambling: “The development of adequate animal models such as that reported by Winstanley and her coworkers opens the door to studying the impact of direct manipulation of brain function and to exploring the effects of illicit drugs on gambling behavior. These types of studies, not possible in human subjects, are likely to lead to important breakthroughs in our understanding of pathological gambling just like comparable animal models were crucial to a better understanding of drug addiction.”

Dr. Winstanley established the Laboratory of Molecular and Behavioural Neuroscience at the University of British Columbia. She currently is a Michael Smith Early Career Scholar and has received numerous awards for her research, including the 2008 Wyeth Award for outstanding research in Preclinical Psychopharmacology.

References

1Zeeb FD, Robbins TW, Winstanley CA. Serotonergic and Dopaminergic Modulation of Gambling Behavior as Assessed Using a Novel Rat Gambling Task. Neuropsychopharmacology. Jun 17 2009.

Christine Reilly Executive Director, Institute for Research on Gambling DisordersIssues & Insightsanimal modelnew research

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