Behavioral assessment of impulsivity in pathological gamblers with and without substance use disorder histories versus healthy controls

“The Paced Auditory Serial Addition Task (PASAT; Brown et al., 2002; Gronwall, 1977) is a mental arithmetic task presented in three levels of increasing duration and difficulty and was used as a distress tolerance task.”

“There are several different ways of operationalizing impulsivity (Evenden, 1999).”

“Further, some PGs appear to use gambling as a way to escape from negative emotional experiences (Blaszczynski and Nower, 2002; Ledgerwood and Petry, 2006a).”

“Further, many of the studies cited above did not control for substance use disorders, despite recent prelavence data that suggests up to 73% of pathological gamblers have a lifetime comorbid alcohol use disorder and up to 38% have a lifetime substance use disorder (Petry et al., 2005).”

“…it intuitively makes sense to study distress tolerance as a potential correlate of impulsivity in PGs. Recent research has examined the basis of the relationship between the experience of intense negative emotional experience and impulsive decision-making (see Cyders and Smith, 2008for a review).”

“Most studies of gambling have used paper and pencil measures, including Barratt’s impulsivity scales (Barratt, 1985; Patton et al., 1995) and Eysenck’s scale (Eysenck and Eysenck, 1978).”

“The Paced Auditory Serial Addition Task (PASAT; Brown et al., 2002; Gronwall, 1977) is a mental arithmetic task presented in three levels of increasing duration and difficulty and was used as a distress tolerance task.”

“PGs discounted future, larger rewards in favor of immediate, smaller ones at a rate significantly higher than comparable control participants, a finding that is similar to past studies (Alessi and Petry, 2003; Petry, 2001a; Petry, 2001b; Petry and Casarella, 1999).”

“PGs discounted future, larger rewards in favor of immediate, smaller ones at a rate significantly higher than comparable control participants, a finding that is similar to past studies (Alessi and Petry, 2003; Petry, 2001a; Petry, 2001b; Petry and Casarella, 1999).”

“We found, however, that PGs did not have significantly more difficulty inhibiting responses when faced with a stop signal than control participants, a finding that is contrary to some prior published studies that found poorer response inhibition in PGs (Fuentes et al., 2006; Goudriaan et al., 2006).”

“PGs discounted future, larger rewards in favor of immediate, smaller ones at a rate significantly higher than comparable control participants, a finding that is similar to past studies (Alessi and Petry, 2003; Petry, 2001a; Petry, 2001b; Petry and Casarella, 1999).”

“However, some recent studies have reported a significant relationship between impulsivity and unsuccessful treatment outcomes (Moeller et al., 2001; Patkar et al., 2004), necessitating additional study on this issue.”

“PGs discounted future, larger rewards in favor of immediate, smaller ones at a rate significantly higher than comparable control participants, a finding that is similar to past studies (Alessi and Petry, 2003; Petry, 2001a; Petry, 2001b; Petry and Casarella, 1999).”

“…by persistent gambling behavior that significantly disrupts social, family and vocational pursuits (American Psychiatric Association, 1994), and is frequently associated with increased financial, legal and psychological problems (Ladd and Petry, 2002; Potenza et al., 2001; Shaffer et al., 2002).”

“rewards is a measure of greater impulsivity (Green et al., 1994).”

“, 1998) but not all (Petry, 2001b; Steel and Blaszczynski, 1998) previous studies.”

“Co-occurring psychopathology may also be associated with greater impulsivity, further exacerbating such problems (Crean et al., 2000).”

“…used to explore the question of impulsivity in a number of populations, and several studies have found significant relationships between response inhibition tasks and scores on paper and pencil measures of impulsivity (Finn et al., 1999; Finn et al., 2002; Horn et al., 2003; Marsh et al., 2002).”

“The NODS is based on DSM-IV criteria for PG, and is a valid assessment of lifetime and current PG (Gerstein et al., 1999; Hodgins, 2004).”

“Our findings have implications for the treatment for PG. Higher impulsivity in PGs may place treatment-seeking gamblers at high risk for relapse (Ledgerwood and Petry, 2006b), and treatment failure (Leblond et al., 2003).”

“The single key impulsivity paradigm (SKIP) is another behavioral-choice measure in which participants make a response to obtain money (Dougherty, 2003; Dougherty et al., 2003; Mathias et al., 2002; Swann et al., 2002).”

“…used to explore the question of impulsivity in a number of populations, and several studies have found significant relationships between response inhibition tasks and scores on paper and pencil measures of impulsivity (Finn et al., 1999; Finn et al., 2002; Horn et al., 2003; Marsh et al., 2002).”

“…by persistent gambling behavior that significantly disrupts social, family and vocational pursuits (American Psychiatric Association, 1994), and is frequently associated with increased financial, legal and psychological problems (Ladd and Petry, 2002; Potenza et al., 2001; Shaffer et al., 2002).”

“As many as 20% of PGs have a history of attention deficit disorder (ADD; Specker et al., 1995), and rates of ADD in PGs with co-occurring cocaine dependence are as high as 50% (Steinberg et al., 1992), suggesting that PG may be associated with significant attention difficulties.”

“High impulsivity is associated with greater risk taking activities (e.g., suicide attempt, sexual risk taking) among PGs (Martins et al., 2004).”

“However, some recent studies have reported a significant relationship between impulsivity and unsuccessful treatment outcomes (Moeller et al., 2001; Patkar et al., 2004), necessitating additional study on this issue.”

“Additionally, with regard to sensation seeking, it is also notable that other studies have also failed to find PGs score higher than controls (e.g., Blanco et al., 1996; Powell et al., 1999), suggesting that sensation seeking may be distinguishable from impulsivity and is not necessarily…”

“Several studies have found correlations between PG and these self-report measures (e.g., Blaszczynski and Steel, 1998; Steel and Blaszczynski, 1998; Petry, 2001a; Vitaro et al., 1998).”

“…with regard to sensation seeking, it is also notable that other studies have also failed to find PGs score higher than controls (e.g., Blanco et al., 1996; Powell et al., 1999), suggesting that sensation seeking may be distinguishable from impulsivity and is not necessarily characteristic of PGs.”

“Several studies have found correlations between PG and these self-report measures (e.g., Blaszczynski and Steel, 1998; Steel and Blaszczynski, 1998; Petry, 2001a; Vitaro et al., 1998).”

“We found, however, that PGs did not have significantly more difficulty inhibiting responses when faced with a stop signal than control participants, a finding that is contrary to some prior published studies that found poorer response inhibition in PGs (Fuentes et al., 2006; Goudriaan et al., 2006).”

“Higher impulsivity in PGs may place treatment-seeking gamblers at high risk for relapse (Ledgerwood and Petry, 2006b), and treatment failure (Leblond et al., 2003).”

“Our findings have implications for the treatment for PG. Higher impulsivity in PGs may place treatment-seeking gamblers at high risk for relapse (Ledgerwood and Petry, 2006b), and treatment failure (Leblond et al., 2003).”

“, 50 through 350 msec) as measures of response inhibition (Marsh et al., 2002).”

“Sensation seeking is a trait characterized by a need for novel, varied and complex experiences that are often associated with significant risk taking (Langewisch and Frisch, 1998; Zuckerman, 1979).”

“The validity and reliability of the SSS-V are acceptable and have been demonstrated in previous studies (Roberti et al., 2003; Zuckerman, 1979; Zuckerman, 1994).”

“Lower numbers of hits, shorter response latencies, and higher numbers of misses, and commission errors are indicative of greater impulsivity (Dougherty et al., 2000).”

“As many as 20% of PGs have a history of attention deficit disorder (ADD; Specker et al., 1995), and rates of ADD in PGs with co-occurring cocaine dependence are as high as 50% (Steinberg et al., 1992), suggesting that PG may be associated with significant attention difficulties.”

“Longest time duration (in seconds) between two responses assesses impulsivity on this task (Dougherty, 2003; Mathias et al., 2002).”

“…choice task $1,000 k MacKillop et al. 2006 Gambling Potential pathological gamblers vs. controls No 37 vs. 34 Multi-item choice task $1,000 k Ledgerwood et al. 2009 Gambling Pathological gamblers vs. controls Yes 30 vs. 41 Multi-item choice task $1,000 AUC Dixon et al. 2003 Gambling…”

“Ledgerwood et al. (2009) replicated Petry’s (2001b) observed difference between the discounting rates of pathological gamblers and controls, but Ledgerwood et al. (2009) did not observe a difference between gamblers with and without a substance abuse disorder.”

“Behavioral choice theory has primarily focused on problems of drug abuse [1,2] and gambling [3,4] but has beenextended to other healthbehaviors, suchaseating, physical activity and obesity [5,6].”

“…see also Andrade et al., 2013) but not of smoking and other forms of substance misuse (Businelle et al., 2010), and the combination of gambling problems and substance misuse appears highly predictive of impulsive choice (Petry and Casarella, 1999; Petry, 2001; however see Ledgerwood et al., 2009).”

“…30 (100) 33.4 Convenience GA20 SSS-V disinhibition 0.37 LaBudda et al. 2007 22 (100) 40.5 Clinical 19 (100) 42.9 Convenience DSM-IV SSS-V total 0.10 Ledgerwood et al. 2009 30 (46.7) 48.4 Community 41 (41.5) 45.7 Community NODS SSS-V total −0.03 Leiserson and Pihl 2007 12 (100) 26.4 Community…”

“Steeper discounting on the KirbyMCQ procedure replicates previous work in PG using other variants of the delay discounting paradigm (Petry, 2001a ; Alessi & Petry, 2003 ; Dixon et al. 2003 ; MacKillop et al. 2006 ; Ledgerwood et al. 2009), and patients with Parkinson’s disease with medication-induced PG also show stee…”

“Furthermore, although some studies have found that the interrelationship among these measures is modest [3,20,36,37], others have found significant overlap between self-report and laboratorybased behavioural measures [38].”

“Individuals with GD also exhibit deficits in EFs, 71 including decision making, 72 inhibitory control, 73 and mental flexibility; 74 however, no studies to date have examined the impact of prolonged abstinence from gambling on these deficits.”

“The failure to find group differences in delay discounting is inconsistent with previous reports in problem and pathological gamblers (Alessi and Petry 2003; Dixon et al. 2003; Ledgerwood et al. 2009; Petry 2001a; Petry and Casarella 1999) and may have been related to the small sample size included in the study.”

“Accordingly, high delay discounting has been found in individuals suffering from pathologic gambling (e.g. Holt et al. 2003; Ledgerwood et al. 2009), substance use (e.g. Kirby et al. 1999; Reynolds, 2006), borderline personality disorder (Lawrence et al. 2010), ADHD (Demurie et al. 2012) and…”

“Consistent with previous studies, PG subjects scored signifi cantly higher than controls on all three BIS-11 subscales (Motor, Cognitive, and Non-planning Impulsiveness; Fuentes et al. 2006; Ledgerwood et al. 2009).”

“Lawrence et al. (2009) noted that PGs performed similarly to healthy controls on a measure of response inhibition despite scoring higher on impulsivity measures, a finding that recently was reported by Ledgerwood et al. (2009), and found again in the current investigation.”

“…L, Fernández-Aranda F, Granero R, Giner-Bartolomé C, Aymamí N, Gómez-Peña M, Santamaría JJ, Forcano L, Steward T, Menchón JM and Jiménez-Murcia S (2015) A Serious Videogame as an Additional Therapy Tool for Training Emotional Regulation and Impulsivity Control in Severe Gambling Disorder.”

“…al., 2013), alcohol abusers (Courtney et al., 2012), and gamblers (Brevers et al., 2012; Ledgerwood, Alessi, Phoenix, & Petry, 2009; Torres et al., 2013) better than response inhibition and risk-taking (c.f., Christiansen et al., 2012; Fernie, Cole, Goudie, & Field, 2010; Ledgerwood et al., 2009).”

“This parameter may relate to impulsivity [47] and high self-reported impulsivity is common in problem gamblers [58,59], which may be a greater issue for strategic problem gamblers.”

“6) for average number of pumps and explosions, respectively, are consistent with samples of college students and healthy control participants (Ledgerwood et al., 2009; Lejuez et al., 2002).”

“…various personality traits such as impulsivity (Loree et al., 2014), more objective, behavioral measures may be useful complements to capture different dimensions of psychological phenomena without relying on individuals to accurately characterize their own behavior (Ledgerwood et al., 2009).”

“, 2009;Petry, 2001); Ledgerwood et al. (2009) did not report k values so their data were not included in this range.”

“Area under the curve (AUC) was derived and analyzed as an overall measure of impulsivity (i.e., lower scores indicate greater impulsivity) consistent with past studies (Ledgerwood et al. 2009).”

“Interestingly, pathological gambling is associated with high levels negative urgency [81] and is associated with poor performance on neurocognitive impulse assessments, such as the Iowa Gambling Task [82,83].”

“Risk taking in the form of betting might not be associated with pure behavioral addiction but rather SUD comorbidity in line with previous findings (Ledgerwood et al. 2009).”

“All of these alterations lead to lower decision-making performances in gambling-like situations, but the performance is preserved in other contexts (Ledgerwood et al., 2009; Fauth-Bühler et al., 2014).”

“Sensation Seeking may be independent from other self-reported impulsivity traits (Hammelstein, 2004; Ledgerwood et al., 2009), and our results provide further support that gambling problems are not associated with a need to experience excitement.”

“…as model of human obesity: Effects of a free-choice high-fat high-sugar diet on meal patterns International Journal of Obesity, 38 (2014), pp. 643-649 Ledgerwood et al., 2009 D.M. Ledgerwood, S.M. Alessi, N. Phoenix, et al.Behavioral assessment of impulsivity in pathological gamblers with and…”

“Additionally, one study found no BART difference between those with comorbid substance use disorders (SUDs) (including alcohol) and gambling problems compared to healthy controls (Ledgerwood et al., 2009).”

“The role of sensation seeking, as assessed by the UPPS-P, is not clear in the case of GD and some studies do not support higher levels of this trait in comparison with healthy controls [20,23,24].”

“The less robust relationships with performance-based measures might reflect differences between trait measures like the BIS-Brief and the more state-sensitive performance-based measures (e.g., Cyders & Coskunpinar, 2011; Lane et al., 2003; Ledgerwood et al., 2009; Marsh, Dougherty, Mathias, Moeller, & Hicks, 2002; Rey…”

“Within the delay discounting literature, we found AUCs ranging between 0.21 and 0.32 among problem and disordered gambling samples (Krmpotich et al., 2015; Ledgerwood, Alessi, Phoenix, & Petry, 2009), similar to our reported mean AUC in this study (0.23).”

“Additionally, impulsivity (i.e., the failure to resist an urge) is frequently increased in PPGs (e.g., Ledgerwood et al. 2009) and in some individuals with PTSD (Miller et al. 2003), and has been considered a relevant personality trait in etiological theories of PPG (Blaszczynski et al. 1997) and…”

“However, other research suggests important roles for response inhibition (Christiansen et al., 2012) and risk taking (Fernie et al., 2010; Ledgerwood et al., 2009) as well.”

“For example, previous work has linked problem-gambling severity to other psychiatric comorbidities, including mood (Bischof et al., 2013; Lister et al., 2015), anxiety (Giddens et al., 2012; Bischof et al., 2013), and substance-use disorders (Ledgerwood et al., 2009; Bischof et al., 2013).”

“Further, in contrast to two prior studies using behavioral DI measures (Bagge et al., 2013; Ledgerwood et al., 2009), selfreported DI was unrelated to commission errors in the present study, which may be attributable to method variance or different underlying constructs assessed by self-report…”

“…et al.’s first three factors; however, investigators have not considered how these specific measures intersect to predict different gambling behaviors (e.g., Blanco et al. 2009; Breen and Zuckermann 1999; Langewisch and Frisch 1998; Ledgerwood et al. 2009; Loxton et al. 2008; Powell et al. 1999).”

“Castelani and Rugle (1986) and others (Ledgerwood et al., 2009) point out that these attributes have important implications for gambling treatment programs.”

“…discounting are seen in GD with and without concurrent substance abuse compared to controls ( Albein-Urios et al., 2014 ; Andrade and Petry, 2012 ; Ledgerwood et al., 2009 ; Michalczuk et al., 2011 ; Miedl et al., 2012 ; Miedl et al., 2015 ; Petry, 2001 ; Petry and Casarella, 1999 ), while at…”

“Whereas pathological gamblers with past substance abuse disorder pumped more than pathological gamblers without substance use disorder, although both groups were similar to the control group, whose number of pumps was between the two (Ledgerwood et al. 2009).”

“Problem and pathological gamblers also discount delayed rewards at higher rates than non-problem gambling controls (Ledgerwood et al. 2009; Alessi & Petry 2003; Dixon, Marley & Jacobs 2003; Petry 2001; Petry & Casarella 1999).”

“While a majority of articles found links between risk-taking behavior in the BART and real-world risk behaviors (substance abuse: alcohol, tobacco, drug) and gambling (Lejuez et al., 2002, 2003b; Aklin et al., 2005; Bornovalova et al., 2005; Hunt et al., 2005; Crowley et al., 2006; Lejuez et al., 2007; Skeel et al., 2…”

“For example, in a factor-analytic framework, Meda et al. (2009) reported a significant overlap between certain selfreport and laboratory measures as well as similar impulsivity constructs between healthy subjects and those with current or former cocaine or alcohol addiction.”

“…& Stanovich, 2007), and various studies showed that addicted gamblers differ from others with regard to the steep discount of monetary rewards (Alessi & Petry, 2003; Dixon, Jacobs, & Sanders, 2006; Ledgerwood, Alessi, Phoenix, & Petry, 2009; Nigro & Cosenza, 2016; Petry & Casarella, 1999).”

“2015), alcohol and drug use while gambling (Barnes et al. 2009; Ledgerwood et al. 2009; Cronce and Corbin 2010; Kairouz et al. 2012; Welte et al. 2011; Afifi et al. 2016), problem gambling symptoms (Breyer et al.”

“…marijuana use (Johnson et al., 2010), reduced physical activity (Bosworth Garza et al., 2013), overeating (Epstein et al., 2010), and gambling (Ledgerwood et al., 2009; MacKillop et al., 2011), future self-continuity interventions, which can reduce temporal discounting, have the potential to…”

“Furthermore, individuals with ADHD (Crone et al., 2003; Luman et al., 2005) and PPG (Dixon et al., 2006; Goudriaan et al., 2004; Ledgerwood et al., 2009) both demonstrate preference for smaller, immediate rewards, rather than larger delayed rewards, regardless of future consequences, on delay…”

“Indeed, multiple studies have documented the contribution of cognitive control to distress tolerance (Ledgerwood et al., 2009; Bagge et al., 2013; Macatee et al., 2018).”

“Impulsivity (BIS-11) and gambling-related beliefs (GBQ) scores were consistent with gambling samples (Ledgerwood et al. 2009; Steenbergh et al. 2002).”

“Gambling is a prevalent recreational activity in many countries and across diverse cultures (Clark, 2010; Frascella et al., 2010; Ledgerwood et al., 2009).”

“…failed to find impairments in PG and OCD groups (Bohne et al., 2008; Hermann, Jacob, Unterecker, & Fallgatter, 2003; Johannes et al., 2001; Kim, Kim, Yoo, & Kwon, 2007; Lawrence et al., 2009; Ledgerwood et al., 2009; Maltby, Tolin, Worhunsky, O’Keefe, & Kiehl, 2005; Ruchsow et al., 2005; 2007).”

“The same study also reported that problem gamblers delayed discounting at steeper rates than did non-problem gamblers (Ledgerwood et al., 2009).”

“However, two other studies (Bagge et al., 2013; Macatee et al., 2018) reported no relationship between distress tolerance and inhibition, and one of these studies found no relationship between distress tolerance and working memory (Ledgerwood et al., 2009).”

“…this paradigm observed that subjects craving for alcohol (Mitchell et al., 2005), methamphetamine (Hoffman et al., 2008), tobacco (Ohmura et al., 2005), heroin and cocaine (Kirby and Petry, 2015), and gambling (Ledgerwood et al., 2009) discounted delayed rewards faster than healthy volunteers.”