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Impaired Decision-Making, Higher Impulsivity, and Drug Severity in Substance Dependence and Pathological Gambling
Open accessAbstract
OBJECTIVES: Substance use disorder is characterized by impaired decision making, impulsivity, and risk taking. Pathological gambling shares many of these characteristics, and having both diagnoses may be associated with greater problems than either diagnosis alone. We investigated whether among substance-dependent individuals, comorbid pathological gambling would be associated with worse decision making, greater impulsivity, risk taking, and drug severity. METHODS: Ninety-six substance-dependent individuals were recruited from a residential treatment program and divided into 1 of the 2 groups depending on whether they met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for pathological gambling (SDPG, n = 26) or not (SD, n = 70). Ninety-two controls were recruited from the community. Participants completed a decision-making task (modified Iowa Gambling Task), measures of impulsivity (Barratt Impulsivity Scale and Delay Discounting), and risk taking (Balloon Analog Risk Task). Decision making was analyzed using a computational model. We tested for group differences using analysis of covariance or Kruskal-Wallis and appropriate post-hoc tests. RESULTS: The groups differed in decision-making parameters (P < 0.001) and self-reported impulsivity (P < 0.001). All post-hoc comparisons were significant on these measures, and indicated stepwise changes in controls, followed by SD, followed by SDPG, with SDPG performing worse on decision making and being more impulsive. Compared with SD, SDPG had greater drug severity (P < 0.001). No group differences were observed in delay discounting or risk taking. CONCLUSIONS: Compared with individuals with substance dependence without pathological gambling, those with both disorders demonstrated worse decision making and significantly more drug-related symptoms. When evaluating patients with substance dependence, clinicians should consider diagnostic assessments for gambling, as the co-occurrence of both disorders may impact clinical characteristics.
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“Similarly, individuals with nicotine or alcohol related substance use disorders are also more likely to meet the diagnostic criteria for GD compared to the general population (Krmpotich et al., 2015; Petry et al., 2005; Rennert et al., 2014).”
From Cued for Risk: Evidence for an Incentive Sensitization Framework to Explain the Interplay between Stress and Anxiety, Substance Abuse, and Reward Uncertainty in Disordered Gambling Behavior (2019) · cites this paper as Krmpotich et al., 2015
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“Similarly, individuals with nicotine- or alcohol-related substance-use disorders are also more likely to meet the diagnostic criteria for GD compared to the general population (Krmpotich et al., 2015; Petry et al., 2005; Rennert et al., 2014).”
Metadata
- Authors
- Krmpotich, T., Mikulich-Gilbertson, S., Sakai, J., Thompson, L., Banich, M. T., & Tanabe, J.
- Affiliations
- University of Colorado Boulder (US)
- Corresponding author
- Tanabe, Jody
- Venue
- Journal of Addiction Medicine
- Published
- 2015-07
- Volume
- 9
- Issue
- 4
- Pages
- 273-280
- ISSN
- 1932-0620 (ISSN-L)
- PMC
- PMC4523448
- OpenAlex
- W2320363169
- Cited by
- 61
- References
- 43
- Citations by year
- 2026: 2 · 2025: 6 · 2024: 5 · 2023: 5 · 2022: 8 · 2021: 3 · 2020: 7 · 2019: 4 · 2018: 6 · 2017: 5 · 2016: 10
- FWCI
- 8.68
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Addiction Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- University of Colorado Denver
- National Institute on Drug Abuse (R21DA024104, DA02774, DA024104, R01DA027748)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Gambling Behavior and Treatments
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Social Sciences › Decision Sciences › General Decision Sciences › Decision-Making and Behavioral Economics
- Keywords
- substance dependence, gambling addiction, decision-making, impulsivity, risk-taking, comorbidities, Iowa Gambling Task, delay discounting, Balloon Analogue Risk Task, computational modeling of decision making, Barratt Impulsiveness Scale
- MeSH terms
- Adult, Decision Making, Female, Gambling, Humans, Impulsive Behavior, Male, Risk-Taking, Comorbidity, Substance-Related Disorders
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