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The genetics of gambling and behavioral addictions.

Behavioral addictions are considered as the repetitive occurrence of impulsive behaviors without consideration of their potential negative consequences. These addictions represent an increasing cost to society and are an important new field of research in psychiatric genetics. There has been a growing body of evidence on the familial aggregation and genetic influences on the development of behavioral addictions and mainly on pathological gambling. The aim of this article is to critically review findings of family and molecular genetic studies on behavioral addictions, focusing on pathological gambling and commenting on other disorders where appropriate. This review provides a comprehensive approach to genetic studies on behavioral addiction and points out the necessity of expanding the genetic research in this field. Future directions for genetic studies in this field are also discussed.

Behavior, Addictive↗

The neurobiology of substance and behavioral addictions.

Behavioral addictions, such as pathological gambling, kleptomania, pyromania, compulsive buying, and compulsive sexual behavior, represent significant public health concerns and are associated with high rates of psychiatric comorbidity and mortality. Although research into the biology of these behaviors is still in the early stages, recent advances in the understanding of motivation, reward, and addiction have provided insight into the possible pathophysiology of these disorders. Biochemical, functional neuroimaging, genetic studies, and treatment research have suggested a strong neurobiological link between behavioral addictions and substance use disorders. Given the substantial co-occurrence of these groups of disorders, improved understanding of their relationship has important implications not only for further understanding the neurobiology of both categories of disorders but also for improving prevention and treatment strategies.

Arousal↗

[Epidemiologic research, disorders of eating behavior and addictive behavior].

The tremendous increase in interest in eating disorders, and especially in bulimia nervosa, that has occurred since the last 1970s has resulted in a large and contradictory literature about the relationships between eating disorders and addictive disorders, especially alcohol and drug abuse. At first sight, according to the differences observed between these disorders in most of their phenomenological characteristics (age, sex, socio-cultural factors), it may seem difficult to draw a parallel between them. However, studies showed that eating behavior problems, alcohol and drug abuse nowadays shared some common features in adolescents and young people. However that may be, epidemiological studies demonstrated a high prevalence of substance abuse among patients with bulimia. In anorexia nervosa, this prevalence seemed to be lower. However, significant differences have been observed between bulimic and restricting anorexics: substance abuse occurred significantly more frequently in bulimic anorexics than in restricting anorexics and this characteristic was associated with a higher prevalence of impulsive behaviors (i.e. stealing, self-mutilation and suicide attempt), laxative or diuretic use and impairments in social relationships. These clinical features are quite similar to those observed in bulimic patients with substance abuse problems. Follow-up studies also showed that substance abuse problems in anorexia nervosa were associated with the occurrence of bulimic behaviors. On the other hand, family studies reported that a high prevalence of patients with bulimia had at least one first degree relatives with substance abuse problems or an affective disorder. In anorexia nervosa, the prevalence of substance abuse or depression among the family members seemed to be higher in bulimic anorexics than in restricting anorexics.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

The effects of macro-level interventions on addictive behavior.

Drug addictions are often viewed as compulsive behaviors, not sensitive to the typical rules of self-discipline or market forces. Nonetheless, many governments try to discourage consumption of addictive substances through macro policy tools, such as taxation, regulation and prohibition, in an effort to reduce the harmful consequences that result from their consumption. The government's ability to discourage this type of behavior through these macro policies depends critically on the responsiveness of addictive consumption to market interventions. This paper reviews the growing literature that applies economic principles to the analysis of "substance abuse." Specifically, we review the impact of prices and public policies on the demands for tobacco, alcohol, and illicit drugs. The findings from these studies clearly demonstrate that even addictive behaviors are sensitive to changes in the price of substances being abused. When the full price of the addictive good rises, consumption of that good falls, even among abusers. Therefore, public policies that raise the full price of a drug to a consumer, particularly youth, are likely to result in long run reductions in rates of addiction.

Adolescent↗

The use of restricted environmental stimulation therapy in treating addictive behaviors.

Successful treatment of addictive behaviors is difficult because of the complexity of relevant contributing variables. Restricted environmental stimulation therapy (REST) is offered as a useful, flexible tool that can facilitate change in addictive variables at each level of complexity, from habitual acts through attitudes to self-concept and spirituality. The nature of REST is discussed in terms of processes and effects. Basically two processes, refocusing and rebalancing, contribute to the various physical and mental effects of restricted environmental stimulation. These effects include profound relaxation, relief from pain, and a shift in consciousness to a state that is more introspective, less defensive, and more receptive. Research in treating addictive behaviors with REST is reviewed with smoking, overeating, alcohol consumption, and drug misuse. There is a substantial body of literature demonstrating the effectiveness of REST in modifying smoking behavior. Very little research has been done on REST and drug misuse. Each of the other areas has a small number of preliminary studies that suggest REST as a promising treatment. In general, chamber REST proves to be effective in facilitating attitudinal and behavioral change, and maintaining those changes. The scant research with flotation REST show it to be less effective in modifying behavior but more relaxing and pain alleviating than chamber REST. The characteristics of the REST experience that make it effective in treating addictions are discussed as follows: (1) the induction of a general relaxation response, (2) substance misusers find serenity and relief by nonchemical means, (3) internal refocusing to concentrate on personal problems, (4) disruption of habits through removal of trigger cues and response possibilities, (5) increased feelings of control over addictive behaviors, and (6) enhanced learning processes. REST is a versatile, cost-effective treatment modality with demonstrated effectiveness in modifying some addictive behaviors and promising applications with others.

Arousal↗

In search of how people change. Applications to addictive behaviors.

How people intentionally change addictive behaviors with and without treatment is not well understood by behavioral scientists. This article summarizes research on self-initiated and professionally facilitated change of addictive behaviors using the key trans-theoretical constructs of stages and processes of change. Modification of addictive behaviors involves progression through five stages--pre-contemplation, contemplation, preparation, action, and maintenance--and individuals typically recycle through these stages several times before termination of the addiction. Multiple studies provide strong support for these stages as well as for a finite and common set of change processes used to progress through the stages. Research to date supports a trans-theoretical model of change that systematically integrates the stages with processes of change from diverse theories of psychotherapy.

Aftercare↗

Studies of the potential role of the dopamine D1 receptor gene in addictive behaviors.

Abnormalities in the dopaminergic reward pathways have frequently been implicated in substance abuse and addictive behaviors. Recent studies by Self and coworkers have suggested an important interaction between the dopamine D1 and D2 receptors in cocaine abuse. To test the hypothesis that the DRD1 gene might play a role in addictive behaviors we examined the alleles of the Dde I polymorphism in three independent groups of subjects with varying types of compulsive, addictive behaviors-Tourette syndrome probands, smokers and pathological gamblers. In all three groups there was a significant in the frequency of homozygosity for the DRD1 Dde I 1 or 2 alleles in subjects with addictive behaviors. The DRD1 11 or 22 genotype was present in 41.3% of 63 controls and 57.3% of 227 TS probands (P = 0.024). When 23 quantitative traits were examined by ANOVA those carrying the 11 genotype consistently had the highest scores. Based on these results, we examined the prevalence of the 11 genotype in controls, TS probands without a specific behavior, and TS probands with a specific behavior. There was a progressive, linear increase, significant at alpha < or = 0.005 for scores for gambling, alcohol use and compulsive shopping. Problems with three additional behaviors, drug use, compulsive eating and smoking were significant at alpha < or = 0.05. All six variables were related to addictive behaviors. In a totally separate group of controls and individuals attending a smoking cessation clinic, and smoking at least one pack per day, 39.3% of the controls versus 66.1% of the smokers carried the 11 or 22 genotype (P = 0.0002). In a third independent group of pathological gamblers, 55.8% carried the 11 or 22 genotype (P = 0.009 vs the combined controls). In the TS group and smokers there was a significant additive effect of the DRD1 and DRD2 genes. The results for both the DRD1 and DRD2 genes, which have opposing effects on cyclic AMP, were consistent with negative and positive heterosis, respectively. These results support a role for genetic variants of the DRD1 gene in some addictive behaviors, and an interaction of genetic variants at the DRD1 and DRD2 genes.

Adult↗

Dietary restraint and addictive behaviors: the generalizability of Tiffany's cue reactivity model.

UNLABELLED: Two studies are presented, which examine cue reactivity in dieting. METHODS: Experiment 1 investigated whether the presence of a preferred food affected dieters' performance on measures of attention, reaction time, and motor speed. The manipulation did not affect the performance. Experiment 2 investigated the performance of dieters (N = 19), highly restrained non-dieters (N = 18) and low-to-medium restrained eaters (N = 34) on two simple reaction time tasks. Subjects were either required to imagine their favorite food or to imagine their favorite holiday while completing a reaction time task. RESULTS: In the food condition, both dieters and restrained nondieters displayed significantly slower reaction times during the first three of five blocks of the task than the low-to-medium restrained eaters. CONCLUSIONS: The results are discussed in terms of Tiffany's (Psychological Review 97:147-168, 1990) model of cue reactivity in that different abstinent states produce comparable effects upon performance.

Adolescent↗

Online therapy for addictive behaviors.

Clinicians working in the field of addictive behaviors cannot afford to ignore the Internet. Psychological advice, help, and treatment for addicts are no exceptions, with both counseling and psychotherapy entering the computer age. This paper reviews the main issues in the area and approaches the discussion acknowledging that online therapy has to be incorporated within the overall framework of the need for clinical assistance. The paper also provides brief overviews of some websites as illustrative examples of what types of online therapy are available.

Behavior, Addictive↗

[Different explanatory models for addictive behavior in Turkish and German youths in Germany: significance for prevention and treatment].

Due to cultural and social barriers, immigrants seldom frequent centers for information, counseling, and treatment of addictive disorders. We examine cultural differences in the explanatory models of addictive behavior among Turkish and German youths in Germany with statistical devices that map the concepts associated with problems of addiction. Relevant differences were found between the disorder concepts of Turkish and German youth. German but not Turkish youths classified eating disorders among severe addictive disorders and associated them with embarrassment and shame. Concerning substance abuse, German but not Turkish youths clearly differentiated between illegal drug abuse and the abuse of alcohol and nicotine. Nearly half of all Turkish youths rejected central medical concepts such as "physical dependence" or "reduced control of substance intake" as completely inadequate to characterize problems of addictive behavior. Preventive information programs must consider these differences and use concepts that are accepted and clearly associated with addictive behavior by immigrant populations.

Adolescent↗

Evolution meets biopsychosociality: an analysis of addictive behavior.

Evolutionary theory can inform the biopsychosocial approach to addictive behavior through the use of adaptationist thinking, or how natural selection has shaped the mechanisms and processes underlying addiction. Covering how evolutionary theory relates to biology, psychology and sociality, this paper examines three components to drug use and abuse: a biological mechanism (mesolimbic dopamine), a developmental trajectory (attachment) and a social phylogeny (dominance, submission, social dependence). The paper argues for a salience (or wanting) view of the function of dopamine; outlines how attachment affects time perspective, closure of internal models and self-regulation; and examines how inequality affects drug abuse and how social dependence and manipulative behaviors can play a role in relationships with drugs. The article concludes with an analysis of how the adaptive approach applies to interventions against addictive behavior.

Adaptation, Psychological↗

Issues and strategies in the genetic analysis of alcoholism and related addictive behaviors.

Research into the genetics of alcoholism susceptibility and related behaviors has become highly contentious for a number of reasons: at issue is the identification of factors that may ultimately determine human behaviors, the limitations of the technologies being used to conduct relevant studies have not been assessed exhaustively, and independent studies have produced widely different results. Addressing these and other questions of relevance in the dissection of the genetic basis of alcoholism susceptibility will be nothing if not difficult. In this article, we consider issues related to one not-so-minor research angle being used more and more in investigations of alcoholism and related disorders: the identification of susceptibility loci through the use of anonymous (or seemingly anonymous) DNA markers. We also consider issues that might promote (or resist) the reconcilability of independent study results, and describe some basic strategies that might help make study results more compelling in light of the complexity of alcoholism and related behaviors.

Alcoholism↗

Automatic and controlled processes and the development of addictive behaviors in adolescents: a review and a model.

This paper presents a review and a model of the development of addictive behaviors in (human) adolescents, with a focus on alcohol. The model proposes that addictive behaviors develop as the result of an imbalance between two systems: an appetitive, approach-oriented system that becomes sensitized with repeated alcohol use and a regulatory executive system that is not fully developed and that is compromised by exposure to alcohol. Self-regulation critically depends on two factors: ability and motivation to regulate the appetitive response tendency. The motivational aspect is often still weak in heavy drinking adolescents, who typically do not recognize their drinking as problematic. Motivation to regulate use often develops only years later, after the individual has encountered serious alcohol-related problems. Unfortunately, at that point behavioral change becomes harder due to several neurocognitive adaptations that result from heavy drinking. As we document, there is preliminary support for the central elements of the model (appetitive motivation vs. self-regulation), but there is a paucity of research directly addressing these mechanisms in human adolescents. Further, we emphasize that adolescent alcohol use primarily takes place in a social context, and that therefore studies should not solely focus on intra-individual factors predicting substance use and misuse but also on interpersonal social factors. Finally, we discuss implications of the model for interventions.

Adolescent↗

Dopamine receptors and dopamine transporter in brain function and addictive behaviors: insights from targeted mouse mutants.

Recent advances in molecular biology have resulted in a number of genetically manipulated mice with defined changes at dopamine receptor and the dopamine transporter (DAT) loci. Mice with targeted mutations at the D1 receptor (D1R) are growth-retarded and show downregulated expression of dynorphin and substance P. Behavioral assessment indicates that mutants have deficiencies in spatial learning and initiating movement, as well as in responding to novel stimuli. D1R mutants do not become locomotor activated with cocaine or show upregulated immediate early gene (IEG) expression, but D2 receptor-dependent IEG changes are intact. Acute cocaine administration increases substance P levels, suggesting that striatal expression of this neuropeptide can be modulated by D1R-independent processes. Failure of locomotor activation is also seen with repeated amphetamine treatment. Surprisingly, D1R-deficient mice retain cocaine-conditioned place preference. In contrast, D2 receptor knockout mice are bradykinetic, show increased striatal enkephalin expression and an absence of opiate rewarding effects. D3 receptor mutants are hyperactive when assessed in an exploratory assay and display reduced anxiety-associated behavior in an elevated plus maze test. The recently described D4 receptor homozygous mutants exhibit a reduction in baseline locomotor activity and were shown to be supersensitive to the locomotor activating effects of alcohol and psychostimulant drugs. As expected, DAT knockout mice are hyperactive and do not respond to cocaine or amphetamine. The observation that D2 and D4 dopamine receptor and DAT mutants show compensatory effects, together with the complicating issue of their hybrid genetic background may temper conclusions regarding the direct effects of the targeted mutation on phenotype.

Animals↗