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Global concern about problematic usage of the internet (PUI), and its public health and societal costs, continues to grow, sharpened in focus under the privations of the COVID-19 pandemic. This narrative review reports the expert opinions of members of the largest international network of researchers on PUI in the framework of the European Cooperation in Science and Technology (COST) Action (CA 16207), on the scientific progress made and the critical knowledge gaps remaining to be filled as the term of the Action reaches its conclusion. A key advance has been achieving consensus on the clinical definition of various forms of PUI. Based on the overarching public health principles of protecting individuals and the public from harm and promoting the highest attainable standard of health, the World Health Organisation has introduced several new structured diagnoses into the ICD-11, including gambling disorder, gaming disorder, compulsive sexual behaviour disorder, and other unspecified or specified disorders due to addictive behaviours, alongside naming online activity as a diagnostic specifier. These definitions provide for the first time a sound platform for developing systematic networked research into various forms of PUI at global scale. Progress has also been made in areas such as refining and simplifying some of the available assessment instruments, clarifying the underpinning brain-based and social determinants, and building more empirically based etiological models, as a basis for therapeutic intervention, alongside public engagement initiatives. However, important gaps in our knowledge remain to be tackled. Principal among these include a better understanding of the course and evolution of the PUI-related problems, across different age groups, genders and other specific vulnerable groups, reliable methods for early identification of individuals at risk (before PUI becomes disordered), efficacious preventative and therapeutic interventions and ethical health and social policy changes that adequately safeguard human digital rights. The paper concludes with recommendations for achievable research goals, based on longitudinal analysis of a large multinational cohort co-designed with public stakeholders., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Pharmacological interventions for disordered and problem gambling have been employed in clinical practice. Despite the availability of several reviews of the efficacy of pharmacological interventions for disordered or problem gambling, few have employed systematic search strategies or compared different categories of pharmacological interventions. Systematic reviews of high-quality evidence are therefore essential to provide guidance regarding the efficacy of different pharmacological interventions for disordered or problem gambling., Objectives: The primary aims of the review were to: (1) examine the efficacy of major categories of pharmacological-only interventions (antidepressants, opioid antagonists, mood stabilisers, atypical antipsychotics) for disordered or problem gambling, relative to placebo control conditions; and (2) examine the efficacy of these major categories relative to each other.  SEARCH METHODS: We searched the Cochrane Common Mental Disorders Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE, Embase, and PsycINFO (all years to 11 January 2022)., Selection Criteria: We included randomised trials evaluating a pharmacological intervention for the treatment of disordered or problem gambling. Eligible control conditions included placebo control groups or comparisons with another category of pharmacological intervention., Data Collection and Analysis: We used standard methodological procedures, including systematic extraction of included study characteristics and results and risk of bias assessment. Our primary outcome was reduction in gambling symptom severity. Our secondary outcomes were reduction in gambling expenditure, gambling frequency, time spent gambling, depressive symptoms, anxiety symptoms, and functional impairment; and responder status. We evaluated treatment effects for continuous and dichotomous outcomes using standardised mean difference (SMD) and risk ratios (RR), respectively, employing random-effects meta-analyses. A minimum of two independent treatment effects were required for a meta-analysis to be conducted (with only meta-analytic findings reported in this abstract)., Main Results: We included 17 studies in the review (n = 1193 randomised) that reported outcome data scheduled for end of treatment. Length of treatment ranged from 7 to 96 weeks.  Antidepressants: Six studies (n = 268) evaluated antidepressants, with very low to low certainty evidence suggesting that antidepressants were no more effective than placebo at post-treatment: gambling symptom severity (SMD -0.32, 95% CI -0.74 to 0.09, n = 225), gambling expenditure (SMD -0.27, 95% CI -0.60 to 0.06, n = 144), depressive symptoms (SMD -0.19, 95% CI -0.60 to 0.23, n = 90), functional impairment (SMD -0.15, 95% CI -0.53 to 0.22, n = 110), and responder status (RR 1.24, 95% CI 0.93 to 1.66, n = 268). Opioid antagonists: Four studies (n = 562) evaluated opioid antagonists, with very low to low certainty evidence showing a medium beneficial effect of treatment on gambling symptom severity relative to placebo at post-treatment (SMD -0.46, 95% CI -0.74 to -0.19, n = 259), but no difference between groups in responder status (RR 1.65, 95% CI 0.86 to 3.14, n = 562). Mood stabilisers: Two studies (n = 71) evaluated mood stabilisers (including anticonvulsants), with very low certainty evidence suggesting that mood stabilisers were no more effective than placebo at post-treatment: gambling symptom severity (SMD -0.92, 95% CI -2.24 to 0.39, n = 71), depressive symptoms (SMD -0.15, 95% CI -1.14 to 0.83, n = 71), and anxiety symptoms (SMD -0.17, 95% CI -0.64 to 0.30, n = 71). Atypical antipsychotics:Two studies (n = 63) evaluated the atypical antipsychotic olanzapine, with very low certainty evidence showing a medium beneficial effect of treatment on gambling symptom severity relative to placebo at post-treatment (SMD -0.59, 95% CI -1.10 to -0.08, n = 63). Comparative effectiveness: Two studies (n = 62) compared antidepressants with opioid antagonists, with very low certainty evidence indicating that antidepressants were no more effective than opioid antagonists on depressive symptoms (SMD 0.22, 95% CI -0.29 to 0.72, n = 62) or anxiety symptoms (SMD 0.21, 95% CI -0.29 to 0.72, n = 62) at post-treatment. Two studies (n = 58) compared antidepressants with mood stabilisers (including anticonvulsants), with very low certainty evidence indicating that antidepressants were no more effective than mood stabilisers on depressive symptoms (SMD 0.02, 95% CI -0.53 to 0.56, n = 58) or anxiety symptoms (SMD 0.16, 95% CI -0.39 to 0.70, n = 58) at post-treatment. Tolerability and adverse events: Several common adverse effects were reported by participants receiving antidepressants (e.g. headaches, nausea, diarrhoea/gastrointestinal issues) and opioid antagonists (e.g. nausea, dry mouth, constipation). There was little consistency in the types of adverse effects experienced by participants receiving mood stabilisers (e.g. tiredness, headaches, concentration difficulties) or atypical antipsychotics (e.g. pneumonia, sedation, increased hypomania). Discontinuation of treatment due to these adverse events was highest for opioid antagonists (10% to 32%), followed by antidepressants (4% to 31%), atypical antipsychotics (14%), and mood stabilisers (13%)., Authors' Conclusions: This review provides preliminary support for the use of opioid antagonists (naltrexone, nalmefene) and atypical antipsychotics (olanzapine) to produce short-term improvements in gambling symptom severity, although a lack of available evidence precludes a conclusion regarding the degree to which these pharmacological agents can improve other gambling or psychological functioning indices. In contrast, the findings are inconclusive with regard to the effects of mood stabilisers (including anticonvulsants) in the treatment of disordered or problem gambling, and there is limited evidence to support the efficacy of antidepressants. However, these conclusions are based on very low to low certainty evidence characterised by a small number of included studies, high risk of bias, modest pooled sample sizes, imprecise estimates, moderate between-study heterogeneity, and exclusion of participants with psychiatric comorbidities. Moreover, there were insufficient studies to conduct meta-analyses on many outcome measures; to compare efficacy across and within major categories of interventions; to explore dosage effects; or to examine effects beyond post-treatment. These limitations suggest that, despite recommendations related to the administration of opioid antagonists in the treatment of disordered or problem gambling, pharmacological interventions should be administered with caution and with careful consideration of patient needs. A larger and more methodologically rigorous evidence base with longer-term evaluation periods is required before definitive conclusions can be drawn about the effectiveness and durability of pharmacological treatments for disordered or problem gambling., (Copyright © 2022 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.)

This cross-sectional study aimed to explore specific online behaviours and their association with a range of underlying psychological and other behavioural factors during the COVID-19 pandemic. Eight countries (Italy, Spain, the United Kingdom, Lithuania, Portugal, Japan, Hungary, and Brazil) participated in an international investigation involving 2223 participants ( M = 33 years old; SD = 11), 70% of whom were females. Participants were surveyed for specific type of Internet use severity, appearance anxiety, self-compassion, and image and use of performance-enhancing drugs (IPEDs). Results were compared cross-culturally. The mean time spent online was 5 h ( SD = ±3) of daily browsing during the pandemic. The most commonly performed activities included social networking, streaming, and general surfing. A strong association between these online behaviours and appearance anxiety, self-compassion, and IPEDs use was found after adjustment for possible confounders, with higher scores being associated with specific online activities. Significant cross-cultural differences also emerged in terms of the amount of time spent online during the initial stages of the COVID-19 pandemic.

Gaming activities have conferred numerous benefits during the COVID-19 pandemic. However, some individuals may be at greater risk of problem gaming due to disruption to adaptive routines, increased anxiety and/or depression, and social isolation. This paper presents a summary of 2019-2021 service data from specialist addiction centers in Germany, Switzerland, Japan, and the United Kingdom. Treatment demand for gaming disorder has exceeded service capacity during the pandemic, with significant service access issues. These data highlight the need for adaptability of gaming disorder services and greater resources and funding to respond effectively in future public health crises.

Gambling in the modern era is pervasive owing to the variety of gambling opportunities available, including those that use technology (eg, online applications on smartphones). Although many people gamble recreationally without undue negative effects, a sizeable subset of individuals develop disordered gambling, which is associated with marked functional impairment including other mental health problems, relationship problems, bankruptcy, suicidality, and criminality. The National UK Research Network for Behavioural Addictions (NUK-BA) was established to promote understanding of, research into, and treatments for behavioural addictions including gambling disorder, which is the only formally recognised behavioural addiction. In this Health Policy paper, we outline the status of research and treatment for disordered gambling in the UK (including funding issues) and key research that should be conducted to establish the magnitude of the problem, vulnerability and resilience factors, the underlying neurobiology, long-term consequences, and treatment opportunities. In particular, we emphasise the need to: (1) conduct independent longitudinal research into the prevalence of disordered gambling (including gambling disorder and at-risk gambling), and gambling harms, including in vulnerable and minoritised groups; (2) select and refine the most suitable pragmatic measurement tools; (3) identify predictors (eg, vulnerability and resilience markers) of disordered gambling in people who gamble recreationally, including in vulnerable and minoritised groups; (4) conduct randomised controlled trials on psychological interventions and pharmacotherapy for gambling disorder; (5) improve understanding of the neurobiological basis of gambling disorder, including impulsivity and compulsivity, genetics, and biomarkers; and (6) develop clinical guidelines based on the best contemporary research evidence to guide effective clinical interventions. We also highlight the need to consider what can be learnt from approaches towards mitigating gambling-related harm in other countries., Competing Interests: Declaration of interests HB is the director of the National Problem Gambling clinic and the national centre for gaming disorders. These clinics have received funding from NHS England, CNWL NHS Trust, and GambleAware. HB is the President of the Psychiatry Section at the Royal Society of Medicine and sits on several national and international Boards. HB has been on research teams funded by the Medical Research Council, the Wellcome Trust, and the Wolfson Family Trust. SRC's role in this paper was funded by a Clinical Fellowship from the Wellcome Trust (reference 110049/Z/15/Z & 110049/Z/15/A). SRC consults for Promentis on work unrelated to the content of this paper. SRC also receives stipends from Elsevier for editorial work at Comprehensive Psychiatry, and at Neuroscience & Biobehavioral Reviews. JEG has received research grants from Biohaven, Promentis, and Otsuka Pharmaceuticals. JEG receives yearly compensation from Springer Publishing for acting as Editor in Chief of the Journal of Gambling Studies and has received royalties from Oxford University Press, American Psychiatric Publishing, Norton Press, and McGraw Hill. SC declares honoraria and reimbursement for travel and accommodation expenses for lectures from the following non-profit associations: Association for Child and Adolescent Central Health, Canadian ADHD Alliance Resource, British Association of Pharmacology, and Healthcare Convention for educational activity on ADHD. OC has received royalties from Routledge, Springer, and Elsevier for editorial duties and advises the UK Parliament and the United Nations on addiction-related matters. OC held various research grants from the European Union, World Anti-Doping Agency, and University of Hertfordshire. SAT has received royalties from Elsevier and research grants from the National Health and Medical Research Council, Australian Research Council, and the Victorian and Australian Governments. SD has received funding from GambleAware and is the Director of the Gambling Research, Education and Treatment Network Wales, which is funded by the Welsh Government through Health and Care Research Wales. BJS consults for Cambridge Cognition, Greenfield Bioventures, and Cassava Sciences. BJS's research is funded by Eton College and the Wallitt Foundation, and is conducted within the National Institute for Health Research (NIHR) MedTech and in-vitro diagnostic Co-operative, and the NIHR Cambridge Biomedical Research Centre Mental Health Theme. In the past 3 years NAF has held research or networking grants from the European College of Neuropsychopharmacology (ECNP), UK NIHR, EU H2020 (COST), Medical Research Council, and University of Hertfordshire. In the past 3 years NAF has accepted travel and hospitality expenses from the British Association for Pharmacology, ECNP, Royal College of Psychiatrists, CINP, International Forum of Mood and Anxiety Disorders, World Psychiatric Association, Indian Association for Biological Psychiatry, and Sun. In the past 3 years NAF has received payment from Taylor and Francis and Elsevier for editorial duties and has accepted paid speaking engagements sponsored by Abbott and Sun. Previously, NAF has accepted paid speaking engagements in symposia supported by various pharmaceutical companies and has recruited patients for various pharmaceutical industry-sponsored studies in the field of obsessive compulsive disorder (OCD) treatment. NAF leads an NHS treatment service for OCD and holds Board membership for various registered charities linked to OCD. NAF gives expert advice on psychopharmacology to the UK Medicines and Healthcare products Regulatory Agency. NAD reports research funding from multiple sources, including government departments (through hypothecated taxes from gambling revenue), and is the recipient of a Deakin University Faculty of Health Mid-Career Fellowship. TWR consults for Cambridge Cognition, Takeda, Greenfield Bioventures, Cassava, Shionogi, Heptares, Arcadia. TWR reports grants from GlaxoSmithKline, Shionogi Royalties, and Cambridge Cognition; and Editorial Honoraria from Springer Nature and Elsevier. The rest of the authors declared no competing interests., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

With the global COVID-19 pandemic, governments from many countries in the world implemented various restrictions to prevent the SARS-Cov-2 virus's spread, including social distancing measures, quarantine, in-home lockdown, and the closure of services and public spaces. This led to an in-creased use of social media platforms to make people feel more connected, but also to maintain physical activity while self-isolating. Concerns about physical appearance and the desire to keep or reach a muscular and toned ideal body, might have further reinforced the engagement in fitness-related social media activities, like sharing progresses in training achievements or following more fitness contents on popular profiles. To better understand the underlying relation among these factors, the present study investigates 729 responses to the Exercise Addiction Inventory (EAI), the Appearance Anxiety Inventory (AAI), the Self-Compassion Scale (SCS) and their association to social media usage and compares the results cross-culturally in five countries (Spain, Lithuania, United Kingdom, Japan, and Hungary). Findings highlight significant differences between males and females, espe-cially in regard to the time spent online (U = 477.5, p = 0.036). Greater levels of appearance anxiety were associated with the exposure to fitness-related contents on social media. These results strongly confirm the previously highlighted association between fitspiration media and body image anxiety predominantly in females. Clinical implications and future considerations in terms of prevention and treatment in a situation of global emergency are also discussed., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

In response to the COVID-19 pandemic, the UK Government placed society on 'lockdown', altering the gambling landscape. This study sought to capture the immediate lockdown-enforced changes in gambling behaviour. UK adults ( n  = 1028) were recruited online. Gambling behaviour (frequency and weekly expenditure, perceived increase/decrease) was measured using a survey-specific questionnaire. Analyses compared gambling behaviour as a function of pre-lockdown gambling status, measured by the Brief Problem Gambling Scale. In the whole sample, gambling participation decreased between pre- and during-lockdown. Both gambling frequency and weekly expenditure decreased during the first month of lockdown overall, but, the most engaged gamblers did not show a change in gambling behaviour, despite the decrease in opportunity and availability. Individuals whose financial circumstances were negatively affected by lockdown were more likely to perceive an increase in gambling than those whose financial circumstances were not negatively affected. Findings reflect short-term behaviour change; it will be crucial to examine, at future release of lockdown, if behaviour returns to pre-lockdown patterns, or whether new behavioural patterns persist., Competing Interests: Conflict of InterestSS has received funding from the Society for the Study of Addiction (SSA), and the NIHR. He is currently employed at the NAC, part of the NIHR Biomedical Research Centre and declares no conflicts. AR has received funding from Santander, Public Health for Lincoln, The Royal Society, The Maurice and Jacqueline Bennett Charitable Trust, East Midlands RDS and internal University of Lincoln awards. She has no conflicts of interest. HB–J is the Director of The National Problem Gambling Clinic which receives funds from the National Health Service and GambleAware. She is Honorary Professor at University College London. Board member, International Society of Addiction Medicine, Board member of the International Society for the Study of Behavioural Addictions. President Elect of the Royal Society of Medicine Psychiatry Section. JS is a researcher and clinician who has worked with a range of governmental and non-governmental organizations, and with pharmaceutical and technology companies to seek to identify new or improved treatments from whom his employer (King’s College London) has received honoraria, travel costs and/or consultancy payments, but these do not have a relationship to the study and findings reported here. For a fuller account, see JS’s web-page at: http://www.kcl.ac.uk/ioppn/depts/addictions/people/hod.aspx. JS is a National Institute for Health Research (NIHR) Senior Investigator and is supported by the NIHR Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust and King’s College London., (© The Author(s) 2021.)

Background and Aim: The Coronavirus (COVID-19) pandemic has required drastic safety precautions to contain virus spread, involving a protracted self-isolation period. Those with greater perceived or actual life stress are vulnerable to develop problematic internet behaviors. Thus, we assessed how COVID-19 social isolation affected online gaming (OG) and pornography viewing (PV) in the general population., Methods: We developed an online cross-sectional survey, Habit Tracker (HabiT), completed by 1,344 adults (≥18 years). HabiT was released internationally with individuals from 80 countries participating; a majority residing in the United States and United Kingdom. We measured changes in OG (IGDS9-SF) and PV (CYPAT) behaviors before and during the COVID-19 quarantine period. We also assessed psychiatric factors such as anxiety, depression (HADS), and impulsivity (SUPPS-P). The primary outcome measures were change in amount of, and current OG and PV severity during quarantine. These measures were related to ten COVID-19-related stress factors., Results: Overall, we observed a large increase in OG and a minor increase in PV. Those who increased OG (63%) and PV (43%) during quarantine were younger individuals, males, those who left the quarantine household infrequently, those who reported low frequency or poor quality social interactions, and those with higher depression, anxiety, and urgency impulsivity., Discussion: Our findings highlight similarities between forms of problematic internet behaviors driven by stress, depression, anxiety; while highlighting distinct avenues which these behaviors can manifest., Conclusion: We emphasize the relevance of identifying those in need of emotional regulation interventions, to mitigate problematic internet behaviors in the context of COVID-19 isolation., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background and Aims: Following the recognition of 'internet gaming disorder' (IGD) as a condition requiring further study by the DSM-5, 'gaming disorder' (GD) was officially included as a diagnostic entity by the World Health Organization (WHO) in the 11th revision of the International Classification of Diseases (ICD-11). However, the proposed diagnostic criteria for gaming disorder remain the subject of debate, and there has been no systematic attempt to integrate the views of different groups of experts. To achieve a more systematic agreement on this new disorder, this study employed the Delphi expert consensus method to obtain expert agreement on the diagnostic validity, clinical utility and prognostic value of the DSM-5 criteria and ICD-11 clinical guidelines for GD., Methods: A total of 29 international experts with clinical and/or research experience in GD completed three iterative rounds of a Delphi survey. Experts rated proposed criteria in progressive rounds until a pre-determined level of agreement was achieved., Results: For DSM-5 IGD criteria, there was an agreement both that a subset had high diagnostic validity, clinical utility and prognostic value and that some (e.g. tolerance, deception) had low diagnostic validity, clinical utility and prognostic value. Crucially, some DSM-5 criteria (e.g. escapism/mood regulation, tolerance) were regarded as incapable of distinguishing between problematic and non-problematic gaming. In contrast, ICD-11 diagnostic guidelines for GD (except for the criterion relating to diminished non-gaming interests) were judged as presenting high diagnostic validity, clinical utility and prognostic value., Conclusions: This Delphi survey provides a foundation for identifying the most diagnostically valid and clinically useful criteria for GD. There was expert agreement that some DSM-5 criteria were not clinically relevant and may pathologize non-problematic patterns of gaming, whereas ICD-11 diagnostic guidelines are likely to diagnose GD adequately and avoid pathologizing., (© 2021 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.)

Introduction: Problematic Usage of the Internet (PUI) refers to a broad and likely heterogeneous group of Internet-related conditions associated with behavioural disturbances and functional impairment., Methods: Within PUI several conditions have been reported, including Gaming Disorder, Shopping Addiction, Cyberchondria, Gambling Disorder, Cyberpornography Addiction and Cyberbullying. While increasing reports in the field try to define the epidemiologic and clinical boundaries of these conditions, the rapid and continuous evolution of Internet related behaviours as well as their problematic/pathological expressions are often difficult to diagnose, assess, approach with treatment interventions and follow-up., Results: In addition, some of the PUI-related conditions show characteristics of addiction to the Internet as a preferential tool to engage in specific behaviours, while some others exclusively manifest on the Internet, making it necessary to find distinct assessment and treatment pathways., Conclusion: The inclusion of Internet Gaming Disorder in Section III by the DSM-5 and the recognition of Gaming Disorder by the ICD-11 opened the way for a systematic clinical investigation of this and other PUI-related conditions, particularly in terms of preventive and therapeutic strategies. The present article is aimed at offering an updated clinical overview on the main expressions of PUI, focussing on the latest acquisitions in this evolving field., (© 2021 Dell’Osso et al.)

To combat the spread of COVID-19, the UK Government implemented a range of "lockdown" measures. Lockdown has necessarily changed the gambling habits of gamblers in the UK, and the impact of these measures on the mental health of gamblers is unknown. To understand the impact of lockdown on gamblers, in April 2020, after ~6 weeks of lockdown, participants ( N = 1,028, 72% female) completed an online questionnaire. Gambling engagement data was collected for pre-lockdown via the Brief Problem Gambling Screen (BPGS) allowing participants to be classified as Non-Gamblers (NG), Non-Problem Gamblers (NPG) or Potential Problem Gamblers (PPG). The Depression, Stress, and Anxiety Scale (DASS21) was used to measure depression, stress, and anxiety scores both pre- and during-lockdown. Results indicate that depression, stress and anxiety has increased across the whole sample. Participants classified in the PPG group reported higher scores on each sub scale at both baseline and during lockdown. Increases were observed on each DASS21 subscale, for each gambler group, however despite variable significance and effect sizes, the magnitude of increases did not differ between groups. Lockdown has had a significant impact on mental health of participants; whilst depression stress and anxiety remain highest in potential problem gamblers, pre-lockdown gambler status did not affect changes in DASS21 scores., Competing Interests: In the last 3 years, SS has received funding from the Society for the Study of Addiction (SSA), and the NIHR. He is currently employed at the NAC, part of the NIHR Biomedical Research Centre and declares no conflicts. AR has received funding from Santander, Public Health for Lincoln, The Royal Society, The Maurice and Jacqueline Bennett Charitable Trust, East Midlands RDS and internal University of Lincoln awards. She has no conflicts of interest. HB-J is the Director of The National Problem Gambling Clinic which receives funds from the National Health Service and GambleAware. She is Honorary Professor at University College London. Board member, International Society of Addiction Medicine, Board member of the International Society for the Study of Behavioural Addictions. President Elect of the Royal Society of Medicine Psychiatry Section. JS is a researcher and clinician who has worked with a range of governmental and non-governmental organizations, and with pharmaceutical and technology companies to seek to identify new or improved treatments from whom his employer (King's College London) has received honoraria, travel costs, and/or consultancy payments, but these do not have a relationship to the study and findings reported here. For a fuller account, see JS's web-page at: http://www.kcl.ac.uk/ioppn/depts/addictions/people/hod.aspx. JS is a National Institute for Health Research (NIHR) Senior Investigator and is supported by the NIHR Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust and King's College London., (Copyright © 2021 Sharman, Roberts, Bowden-Jones and Strang.)

Objectives: The COVID-19 pandemic has required drastic safety measures to control virus spread, including an extended self-isolation period. Stressful situations increase alcohol craving and consumption in alcohol use disorder (AUD) and non-AUD drinkers. Thus, we assessed how COVID-19 related stress may have affected drinking behaviours in the general population., Design: We developed an online cross-sectional survey, Habit Tracker (HabiT), which measured changes in drinking behaviours before and during COVID-19 quarantine. We also assessed psychiatric factors such as anxiety, depression (Hospital Anxiety and Depression Scale) and impulsivity (Short-Impulsive Behavior Scale). Lastly, we related drinking behaviours to COVID-19 specific stress factors., Setting: HabiT was released internationally, with individuals from 83 countries participating., Participants: Participants were included if they were 18 years of age or older and confirmed they were proficient in English. The survey was completed by 2873 adults with 1346 usable data (46.9% accurately completed)., Primary Outcome Measures: Primary outcome measures were change in amount and severity of drinking behaviours before and during quarantine, and current drinking severity during quarantine., Results: Although drinking behaviours decreased overall during quarantine, 36% reported an increase in alcohol use. Those who increased alcohol use during quarantine were older individuals (95% CI 0.04 to 0.1, p<0.0001), essential workers (95% CI -0.58 to -0.1, p=0.01), individuals with children (95% CI -12.46 to 0.0, p=0.003), those with a personal relationship with someone severely ill from COVID-19 (95% CI -2 to -0.38, p=0.01) and those with higher depression (95% CI 0.67 to 1.45, p<0.0001), anxiety (95% CI 0.61 to 1.5, p=0.0002), and positive urgency impulsivity (95% CI 0.16 to 0.72, p=0.009). Furthermore, country-level subsample analyses indicated that drinking amount (95% CI 9.36 to 13.13, p=0.003) increased in the UK during quarantine., Conclusions: Our findings highlight a role for identifying those vulnerable for alcohol misuse during periods of self-isolation and underscore the theoretical mechanism of negative emotionality underlying drinking behaviours driven by stress. Limitations include a large degree of study dropout (n=1515). Future studies should assess the long-term effects of isolation on drinking behaviours., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.)

Background and Aims: The Pathways Model (Blaszczynski & Nower, 2002) posits that problem gambling is a heterogeneous disorder with distinct subgroups (behaviorally conditioned gamblers, emotionally vulnerable gamblers, and antisocial-impulsivist gamblers). Impulsivity traits and gambling-related cognitions are recognized as two key psychological factors in the onset and maintenance of problem gambling. To date, these constructs have been explored separately, and their joint role in determining problem gambling subtypes has received little attention. The goal of our study was to identify subgroups of gamblers based on impulsivity traits and gambling-related cognitions, and to determine whether this approach is consistent with the Pathways model., Methods: Gamblers from the community (N = 709) and treatment-seeking pathological gamblers (N = 122) completed questionnaires measuring gambling habits, disordered gambling symptoms, gambling-related cognitions, and impulsivity traits., Results: Cluster analyses revealed that three clusters globally aligned with the pathways proposed by Blaszczynski & Nower (2002). Two other clusters emerged: (1) impulsive gamblers without cognitive-related cognitions; and (2) gamblers without impulsivity or gambling-related cognitions. Gamblers with both heightened impulsive traits and gambling-related cognitions had more severe problem gambling symptoms., Conclusion: We successfully identified, based on an a priori theoretical framework, different subtypes of gamblers that varied in terms of problem gambling symptoms and clinical status. The diversity of the cluster profiles supports the development of personalized prevention strategies and psychological interventions., (Copyright © 2019. Published by Elsevier B.V.)

Psychological and neurobiological markers in individuals with gambling disorder (GD) could reflect transdiagnostic vulnerability to addiction or neuroadaptive consequences of long-term gambling. Using an endophenotypic approach to identify vulnerability markers, we tested the biological relatives of cases with GD. Male participants seeking treatment for GD (n = 20) were compared with a male control group (n = 18). Biological siblings of cases with GD (n = 17, unrelated to the current GD group) were compared with a separate control group (n = 19) that overlapped partially with the GD control group. Participants completed a comprehensive assessment of clinical scales, neurocognitive functioning, and fMRI of unexpected financial reward. The GD group displayed elevated levels of self-report impulsivity and delay discounting, and increased risk-taking on the Cambridge Gamble Task. We did not observe impaired motor impulsivity on the stop-signal task. Siblings of GD showed some overlapping effects; namely, elevated impulsivity (negative urgency) and increased risk-taking on the Cambridge Gamble Task. We did not observe any differences in the neural response to win outcomes, either in the GD or sibling analysis compared with their control group. Within the GD group, activity in the thalamus and caudate correlated negatively with gambling severity. Increased impulsivity and risk-taking in GD are present in biological relatives of cases with GD, suggesting these markers may represent pre-existing vulnerability to GD.

Although there is general consensus that altered brain structure and function underpins addictive disorders, clinicians working in addiction treatment rarely incorporate neuroscience-informed approaches into their practice. We recently launched the Neuroscience Interest Group within the International Society of Addiction Medicine (ISAM-NIG) to promote initiatives to bridge this gap. This article summarizes the ISAM-NIG key priorities and strategies to achieve implementation of addiction neuroscience knowledge and tools for the assessment and treatment of substance use disorders. We cover two assessment areas: cognitive assessment and neuroimaging, and two interventional areas: cognitive training/remediation and neuromodulation, where we identify key challenges and proposed solutions. We reason that incorporating cognitive assessment into clinical settings requires the identification of constructs that predict meaningful clinical outcomes. Other requirements are the development of measures that are easily-administered, reliable, and ecologically-valid. Translation of neuroimaging techniques requires the development of diagnostic and prognostic biomarkers and testing the cost-effectiveness of these biomarkers in individualized prediction algorithms for relapse prevention and treatment selection. Integration of cognitive assessments with neuroimaging can provide multilevel targets including neural, cognitive, and behavioral outcomes for neuroscience-informed interventions. Application of neuroscience-informed interventions including cognitive training/remediation and neuromodulation requires clear pathways to design treatments based on multilevel targets, additional evidence from randomized trials and subsequent clinical implementation, including evaluation of cost-effectiveness. We propose to address these challenges by promoting international collaboration between researchers and clinicians, developing harmonized protocols and data management systems, and prioritizing multi-site research that focuses on improving clinical outcomes., (Copyright © 2019 Verdejo-Garcia, Lorenzetti, Manning, Piercy, Bruno, Hester, Pennington, Tolomeo, Arunogiri, Bates, Bowden-Jones, Campanella, Daughters, Kouimtsidis, Lubman, Meyerhoff, Ralph, Rezapour, Tavakoli, Zare-Bidoky, Zilverstand, Steele, Moeller, Paulus, Baldacchino and Ekhtiari.)

Background: Previous research has indicated that disordered gamblers display deficits in impulsivity and risky decision-making, compared to healthy control groups. However, disordered gamblers are not a homogenous group, and differences in performance on neurocognitive tasks may be related to the form of gambling in which an individual chooses to engage. The present study used neurocognitive tasks and questionnaire measures to ascertain group differences in gamblers grouped by preferred form of gambling. Method: Treatment-seeking pathological gamblers from the National Problem Gambling Clinic, London (n = 101), completed a neurocognitive assessment comprising the Cambridge gamble task (CGT), the stop-signal task (SST), a probabilistic reversal learning task (PRL), and the Kirby Monetary Choice Questionnaire, as well as questionnaire measures of gambling severity, impulsivity, depression, and anxiety. Analyses compared gamblers who favored fixed-odds betting terminals (FOBTs) (the modal form) to gamblers who preferred other forms of gambling (non-FOBT). Results: The FOBT group showed impaired decision-making under risk on the CGT compared to the non-FOBT group, choosing the likely option less on more uncertain decisions. The FOBT group made fewer perseverative errors on the PRL task, had lower depression and anxiety scores, and were less likely to have a family history of problem gambling than the non-FOBT group. Discussion: Decision-making and cognitive flexibility differences between gamblers grouped by gambling type supports preferred form as an important source of heterogeneity in gambling disorder. Decision-making strategies and risk attitudes should be considered when approaching cognition-focused treatment strategies, allowing interventions to be targeted at specific cognitive deficits.

Background and Aims: To investigate the potential indications and adverse effects of using the opioid antagonist naltrexone to treat problem gamblers., Case Presentation: The files of the 1,192 patients who were referred to the National Problem Gambling Clinic between January 2015 and June 2016 were audited. Seventeen patients were considered appropriate for treatment with naltrexone, having attended and failed to respond to psychological therapies at the clinic. Fourteen patients were placed on a regimen of 50 mg/day naltrexone., Discussion: Of the 14 patients who were treated with naltrexone, there were 10 for whom sufficient follow-up existed to analyze the treatment efficacy and side effects of naltrexone. Patients showed significant decreases in their craving to gamble and the majority (60%) were able to abstain completely from gambling in the treatment period, with a further 20% reducing their gambling to almost nothing. The reported side effects from the naltrexone included: loss of appetite, gastrointestinal pain, headaches, sedation, dizziness, and vivid dreams. Two patients with concurrent alcohol-use disorder relapsed during the treatment. One patient relapsed after the treatment period., Conclusions: The study showed significant outcomes in reducing gambling cravings for the sample set. Given the design of the study as a case series, there was no control group, and a number of patients were on other psychotropic medications. We recommend care when prescribing to those suffering from concurrent alcohol-use disorder.

One of the main difficulties faced in treating gambling disorder is compliance with psychological treatment. Gambling takes many forms and can differ greatly in its features such as speed of play and skill requirements. The type of gambling a pathological gambler opts for may play a key role in treatment compliance. The aim of the present study was to determine whether within treatment seeking sample of gambling disorder clients, gambling activity has any correlation with their resultant treatment outcomes. The study incorporated 524 treatment-seeking individuals who are clients of the National Problem Gambling Clinic in London. All of the clients were assessed prior to treatment and fulfilled the Problem Gambling Severity Index criteria for problem gambling. Data concerning clients' gambling behavior over the previous year was gathered using self-reports. Subsequently, the data was fitted to a multinomial logistic regression model, with the treatment outcome (i.e. pre-treatment dropouts, during treatment dropouts, and completed treatment) as the dependent variable and gambling behavior as the independent variable, whilst controlling for socio-demographic factors. The use of gaming machines was a significant predictor of dropping out pre-treatment (p < 0.05, RRR 1.616), whilst betting on sports events was a significant predictor of dropping out during treatment (p < 0.01, RRR 2.435). Treatment outcomes have been found to significantly differ based on participation in certain gambling activities. Further research into the salient features of these gambling activities may help to further explain pre-treatment and during treatment dropouts within this population.

The proposed introduction of gaming disorder (GD) in the 11th revision of the International Classification of Diseases (ICD-11) developed by the World Health Organization (WHO) has led to a lively debate over the past year. Besides the broad support for the decision in the academic press, a recent publication by van Rooij et al. (2018) repeated the criticism raised against the inclusion of GD in ICD-11 by Aarseth et al. (2017). We argue that this group of researchers fails to recognize the clinical and public health considerations, which support the WHO perspective. It is important to recognize a range of biases that may influence this debate; in particular, the gaming industry may wish to diminish its responsibility by claiming that GD is not a public health problem, a position which maybe supported by arguments from scholars based in media psychology, computer games research, communication science, and related disciplines. However, just as with any other disease or disorder in the ICD-11, the decision whether or not to include GD is based on clinical evidence and public health needs. Therefore, we reiterate our conclusion that including GD reflects the essence of the ICD and will facilitate treatment and prevention for those who need it.

The aim of this study was to identify predictors of treatment dropout in a sample of gamblers attending a specialist clinic for gambling disorder. We analysed data on 846 treatment-seeking pathological gamblers. Firstly, we investigated differences in socio-demographic and clinical variables between treatment completers and pre-treatment dropouts, as well as between treatment completers and during-treatment dropouts. Subsequently, variables were entered into a multinomial logistic regression model to identify significant predictors of pre-treatment and in-treatment dropout. Overall, 44.8% of clients did not complete the treatment: 27.4% dropped out before starting it, while 17.4% dropped out during the treatment. Younger age and use of drugs were associated with pre-treatment dropout, while family history of gambling disorder, a lower PGSI score, and being a smoker were related with in-treatment dropout. Our findings suggest that pre-treatment dropouts differ from in-treatment dropouts, and, thus, further research will benefit from considering these groups separately. In addition, this newly gained knowledge will also be helpful in increasing treatment retention in specific subgroups of problem gamblers.

Introduction: The links between gambling problems, trauma and life stressors are known to exist but understanding the extent of these relationships will allow for greater efficacy in early intervention and treatment. We investigated these relationships among men and sought to determine whether links were attenuated by alcohol and drug use problems., Methods: A cross-sectional UK representative general population survey was conducted in 2009 with 3025 men aged 18-64years. Measurements included self-reported gambling behaviours, as measured by the South Oaks Gambling Scale (SOGS) and traumatic or stressful life events. Covariates included alcohol and drug dependence and socio-demographics. Binary logistic regression models were used to examine associations., Results: Problem gambling (SOGS 3-4) and probable pathological gambling (SOGS 5+) were associated with increased odds of trauma in childhood (e.g. violence in the home (Adjusted Odd Ratios (AOR) 3.0 (CI=1.8-5.0) and 2.6 (CI=1.7-4.1) respectively), and life stressors in adulthood (e.g. intimate partner violence (AORs 4.5 (CI=2.0-10.3) and 4.7 (CI=2.3-9.7) and homelessness (AORs 2.2 (CI=1.1-4.6) and 3.2 (CI=1.9-5.5)). Results were attenuated when adjusted for probable alcohol and drug dependence with the latter having largest effects., Conclusions: Among men in the United Kingdom, disordered gambling remains uniquely associated with trauma and life stressors in childhood and adulthood after adjusting for alcohol and drug dependence. The results support a need for disordered gambling treatment services to undertake routine screening for alcohol, drugs, IPV and traumatic life events and to tailor treatment that specifically targets the effects of stress for clients who present with such a cluster of issues., (Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.)

As a behavioural addiction, gambling disorder (GD) provides an opportunity to characterize addictive processes without the potentially confounding effects of chronic excessive drug and alcohol exposure. Impulsivity is an established precursor to such addictive behaviours, and GD is associated with greater impulsivity. There is also evidence of GABAergic dysregulation in substance addiction and in impulsivity. This study therefore investigated GABA A receptor availability in 15 individuals with GD and 19 healthy volunteers (HV) using [ 11 C]Ro15-4513, a relatively selective α5 benzodiazepine receptor PET tracer and its relationship with impulsivity. We found significantly higher [ 11 C]Ro15-4513 total distribution volume (V T ) in the right hippocampus in the GD group compared with HV. We found higher levels of the 'Negative Urgency' construct of impulsivity in GD, and these were positively associated with higher [ 11 C]Ro15-4513 V T in the amygdala in the GD group; no such significant correlations were evident in the HV group. These results contrast with reduced binding of GABAergic PET ligands described previously in alcohol and opiate addiction and add to growing evidence for distinctions in the neuropharmacology between substance and behavioural addictions. These results provide the first characterization of GABA A receptors in GD with [ 11 C]Ro15-4513 PET and show greater α5 receptor availability and positive correlations with trait impulsivity. This GABAergic dysregulation is potential target for treatment., (© 2016 The Authors. Addiction Biology published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.)

Background: Studies show higher lifetime prevalence of suicidality in individuals with pathological gambling. However, less is known about the relationship between pathological gambling and current suicidal ideation., Objectives: We investigated socio-demographic, clinical and gambling-related variables associated with suicidality in treatment-seeking individuals., Methods: Bivariate analyses and logistic regression models were generated on data from 903 individuals to identify measures associated with aspects of suicidality., Results: Forty-six percent of patients reported current suicidal ideation. People with current suicidal thoughts were more likely to report greater problem-gambling severity (p<0.001), depression (p<0.001) and anxiety (p<0.001) compared to those without suicidality. Logistic regression models suggested that past suicidal ideation (p<0.001) and higher anxiety (p<0.05) may be predictive factors of current suicidality., Conclusions: Our findings suggest that the severity of anxiety disorder, along with a lifetime history of suicidal ideation, may help to identify treatment-seeking individuals with pathological gambling with a higher risk of suicidality, highlighting the importance of assessing suicidal ideation in clinical settings., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

There is a paucity of research in the UK which examines problem gambling and that which does exist is mainly quantitative, focuses on male samples and fails to look at treatment seeking populations or obstacles preventing problem gamblers from seeking treatment. This paper presents findings from part of a larger qualitative study that explored the experience of treatment for female problem gamblers. Data were collected using semi-structured interviews with eight women who had received individual cognitive-behavioural therapy in the National Health Service for their gambling problem. An interpretative phenomenological analysis approach was applied in the research process, identifying three main themes, of which the subtheme 'Barriers to Treatment' is examined here. Internal and external barriers to treatment organically emerged in all female participants' accounts and appear to have an impact on service utilisation. Input directly from gamblers can be combined with findings from other studies to devise better ways of reaching female problem gamblers. A better understanding of barriers to treatment can also provide valuable direction for future research and suggest applications in clinical service provision and treatment planning.

Online gaming has greatly increased in popularity in recent years, and with this has come a multiplicity of problems due to excessive involvement in gaming. Gaming disorder, both online and offline, has been defined for the first time in the draft of 11th revision of the International Classification of Diseases (ICD-11). National surveys have shown prevalence rates of gaming disorder/addiction of 10%-15% among young people in several Asian countries and of 1%-10% in their counterparts in some Western countries. Several diseases related to excessive gaming are now recognized, and clinics are being established to respond to individual, family, and community concerns, but many cases remain hidden. Gaming disorder shares many features with addictions due to psychoactive substances and with gambling disorder, and functional neuroimaging shows that similar areas of the brain are activated. Governments and health agencies worldwide are seeking for the effects of online gaming to be addressed, and for preventive approaches to be developed. Central to this effort is a need to delineate the nature of the problem, which is the purpose of the definitions in the draft of ICD-11.

This commentary responds to Aarseth et al.'s (in press) criticisms that the ICD-11 Gaming Disorder proposal would result in "moral panics around the harm of video gaming" and "the treatment of abundant false-positive cases." The ICD-11 Gaming Disorder avoids potential "overpathologizing" with its explicit reference to functional impairment caused by gaming and therefore improves upon a number of flawed previous approaches to identifying cases with suspected gaming-related harms. We contend that moral panics are more likely to occur and be exacerbated by misinformation and lack of understanding, rather than proceed from having a clear diagnostic system.

Studies from the West suggest that significant numbers of high school students gamble, despite it being illegal in this age group. To date, there have been no studies on the prevalence of gambling among senior high school and higher secondary school students in India. This study reports point prevalence of gambling and its psychosocial correlates among high school students in the State of Kerala, India. 5043 high school students in the age group 15-19 years, from 73 schools, were selected by cluster random sampling from the district of Ernakulam, Kerala, South India. They completed questionnaires that assessed gambling, substance use, psychological distress, suicidality, and symptoms of Attention Deficit Hyperactivity Disorder (ADHD). Of a total of 4989 completed questionnaires, 1400 (27.9 %) high school students reported to have ever gambled and 353 (7.1 %) were problem gamblers. Of those who had ever gambled, 25.2 % were problem gamblers. Sports betting (betting on cricket and football) was the most popular form of gambling followed by the lottery. Problem gamblers when compared with non-problem gamblers and non-gamblers were significantly more likely to be male, have academic failures, have higher rates of lifetime alcohol and tobacco use, psychological distress, suicidality, history of sexual abuse and higher ADHD symptom scores. Gambling among adolescents in India deserves greater attention, as one in four students who ever gambled was a problem gambler and because of its association with a range of psychosocial variables.

Background and Aims: The relationship between violence and problem gambling in general population samples is under-researched and requires further attention to inform treatment and prevention efforts. We investigated the relationship between gambling problems and violence among men and sought to determine if the link can be accounted for by mental disorders, alcohol and drug dependence and impulsivity., Design: A cross-sectional survey., Setting: A UK representative general population survey conducted in 2009., Participants: A total of 3025 UK men aged 18-64 years., Measurements: Binary logistic regression was used to examine relationships. Outcome measures included gambling behaviour and self-reports of violence. Covariates included alcohol and drug dependence, mental illness, impulsivity and socio-demography., Findings: Problem gambling and probable pathological gambling were associated with increased odds of the perpetration of violence [adjusted odd ratios (AOR) = 3.09, confidence interval (CI) = 1.90-5.00 and 4.09, CI = 2.76-6.30, respectively] and a range of other behaviours, such as using a weapon (AORs = 4.93, CI = 2.52-9.63 and 6.33, CI = 3.52-11.38) and the perpetration of intimate partner violence (AOR = 9.80, CI =2.45-39.04). The results were attenuated when adjusted for comorbid mental illness and impulsivity, but remained statistically significant. Alcohol and drug dependence had the most impact; relationships were most attenuated when they added into the models, with the latter having the largest effect., Conclusions: Among men in the United Kingdom, self-reports of problem/pathological gambling remain predictive of a range of measures of violent behaviour after adjusting for alcohol and drug dependence, comorbid mental disorder and impulsivity; of the covariates, alcohol and drug dependence have the greatest effect in attenuating the gambling-violence association., (© 2016 Society for the Study of Addiction.)

Background and aim Previous international research emphasized that some forms of gambling are more "addictive" than others. More recently, research has shown that we should shift our attention from the type of gambling activity to the level of involvement in a number of different gambling activities. The aim of our study was to verify whether a higher Problem Gambling Severity Index (PGSI) score was associated with particular gambling activities and evaluate the impact of involvement on gambling behavior. Methods A total of 736 treatment-seeking individuals with gambling disorder were assessed at the National Problem Gambling Clinic in London. First, the independent two-sample t-test and the Mann-Whitney test were used to verify if the PGSI score changed significantly according to the gambling activity at a bivariate level. Second, we conducted a cluster analysis and finally, we fitted a linear regression model in order to verify if some variables are useful to predict gambling addiction severity. Results The PGSI score was significantly higher for lower stakes gaming machine gamblers (1% significance level) and for fixed-odds betting terminal (FOBT) gamblers (5% significance level) at a bivariate level. Moreover, such finding was confirmed by cluster and linear regression analyses. Conclusions The results of this study indicated that gambling addiction severity was related to gambling involvement and, for a given level of gambling involvement, gambling addiction severity may vary according to gambling type, with a particularly significant increase for FOBT and gaming machine gambling.

Treatment provision for individuals with gambling problems in Britain is at best inadequate. Here we call for gambling treatment provision to be integrated into mainstream drug and alcohol services, and for its commissioning responsibilities to fall under local public health departments.

Pathological gambling is a psychiatric disorder and the first recognized behavioral addiction, with similarities to substance use disorders but without the confounding effects of drug-related brain changes. Pathophysiology within the opioid receptor system is increasingly recognized in substance dependence, with higher mu-opioid receptor (MOR) availability reported in alcohol, cocaine and opiate addiction. Impulsivity, a risk factor across the addictions, has also been found to be associated with higher MOR availability. The aim of this study was to characterize baseline MOR availability and endogenous opioid release in pathological gamblers (PG) using [(11)C]carfentanil PET with an oral amphetamine challenge. Fourteen PG and 15 healthy volunteers (HV) underwent two [(11)C]carfentanil PET scans, before and after an oral administration of 0.5 mg/kg of d-amphetamine. The change in [(11)C]carfentanil binding between baseline and post-amphetamine scans (ΔBPND) was assessed in 10 regions of interest (ROI). MOR availability did not differ between PG and HV groups. As seen previously, oral amphetamine challenge led to significant reductions in [(11)C]carfentanil BPND in 8/10 ROI in HV. PG demonstrated significant blunting of opioid release compared with HV. PG also showed blunted amphetamine-induced euphoria and alertness compared with HV. Exploratory analysis revealed that impulsivity positively correlated with caudate baseline BPND in PG only. This study provides the first evidence of blunted endogenous opioid release in PG. Our findings are consistent with growing evidence that dysregulation of endogenous opioids may have an important role in the pathophysiology of addictions.

Backgrounds and aims Problem gambling occurs at higher levels in the homeless than the general population. Past work has not established the extent to which problem gambling is a cause or consequence of homelessness. This study sought to replicate recent observations of elevated rates of problem gambling in a British homeless sample, and extend that finding by characterizing (a) the temporal sequencing of the effect, (b) relationships with drug and alcohol misuse, and (c) awareness and access of treatment services for gambling by the homeless. Methods We recruited 72 participants from homeless centers in Westminster, London, and used the Problem Gambling Severity Index to assess gambling involvement, as well as DSM-IV criteria for substance and alcohol use disorders. A life-events scale was administered to establish the temporal ordering of problem gambling and homelessness. Results Problem gambling was evident in 23.6% of the sample. In participants who endorsed any gambling symptomatology, the majority were categorized as problem gamblers. Within those problem gamblers, 82.4% indicated that gambling preceded their homelessness. Participants displayed high rates of substance (31.9%) and alcohol dependence (23.6%); these were not correlated with PGSI scores. Awareness of treatment for gambling was significantly lower than for substance and alcohol use disorders, and actual access of gambling support was minimal. Discussion and conclusions Problem gambling is an under-recognized health issue in the homeless. Our observation that gambling typically precedes homelessness strengthens its role as a causal factor. Despite the elevated prevalence rates, awareness and utilization of gambling support opportunities were low compared with services for substance use disorders.

Background and aim Gambling is a widespread recreational activity in the UK. A significant percentage of gamblers develop subclinical or clinically relevant problem gambling issues, but only a low percentage of them seek treatment. Although characteristics of pathological gamblers from treatment-seeking population have been examined in some research, only a few studies have explored the differences between females and males. This study aimed to examine the gender-related differences in demographics, gambling measures, and clinical variables in an outpatient sample of pathological gamblers seeking treatment. Methods A total of 1,178 treatment-seeking individuals with gambling disorder were assessed at the National Problem Gambling Clinic in London. Sociodemographic characteristics, clinical variables, and gambling behavior habits were obtained during the assessment evaluation. Of the total sample, 92.5% were males and 7.5% were females. Results Males were more likely to be younger, white, and employed than females. In addition, compared to women, men showed a lower PGSI score, an earlier age of onset of gambling behavior, a higher gambling involvement, and preferred specific forms gambling. Female gamblers were more anxious and depressed, while men were more likely to use alcohol and illicit drugs. Conclusions Our findings support the importance of gender differences in a treatment-seeking population of pathological gamblers both in sociodemographic characteristics, gambling behavior variables, and clinical variables. Males and females might benefit from group-specific treatment.

The aim of this study was to explore the relations between gambling, brain emotion systems, personality, self/other perception, and hopelessness in an Italian community. Dimensions of gambling, positive and negative emotions, self/other perception, personality and hopelessness were assessed in a community sample of 235 adults aged 19-59 years. Two structural models were tested. We found a significant correlation between problem gambling and impulsivity, which in association with aggressivity and negative personality dimensions may help explain the psychopathology factor, i.e. a latent variable involving neurotic personality, hopelessness, high sensation seeking, low metacognitive responsiveness, and disorganized patterns of interpersonal relationships. These results contribute to develop a theoretical framework of gambling in relation with personality factors and provide a new approach for clinical intervention of problem gambling that relies on a solid multidimensional perspective.

The purpose of this study was to verify whether tobacco use influenced treatment outcome in a population of treatment seeking individuals with gambling disorder. Gambling disorder is defined as persistent and maladaptive gambling behaviour which meets four or more outlined criteria in the DSM-5. Tobacco use is the most frequent comorbidity with gambling disorder. A total of 676 treatment seeking individuals with gambling disorder were assessed at the National Problem Gambling Clinic in London. We analysed differences in socio-demographic, clinical and gambling variables between smokers and non-smokers and the relation between smoking behaviour and treatment completion and outcome. 46.4% (314) of our sample were daily tobacco users and were significantly younger, less likely to be in a stable relationship, more likely to be unemployed and have a lower education level. They were also significantly more likely to score higher on the AUDIT-C score and were significantly more likely to have used drugs in the last 30 days. There was no significant difference in PGSI score between smokers and non-smokers. We found that tobacco smokers did not have higher PGSI scores than non-smokers. Moreover, there was no significant difference between tobacco users and nonusers in terms of treatment completion and treatment outcome.

Homelessness and problem gambling are two public health concerns in the UK that are rarely considered concurrently, and little is known about the extent of gambling involvement and problematic gambling in the homeless. We recruited 456 individuals attending homelessness services in London, U.K. All participants completed a screen for gambling involvement, and where gambling involvement was endorsed, the Problem Gambling Severity Index (PGSI) was administered. The PGSI risk categories were compared against data from the 2010 British Gambling Prevalence Survey (BGPS). PGSI problem gambling was indicated in 11.6% of the homeless population, compared to 0.7% in the BGPS. Of participants endorsing any PGSI symptoms, a higher proportion of homeless participants were problem gamblers relative to the low and moderate risk groups, compared to the BGPS data. These results confirm that the homeless constitute a vulnerable population for problem gambling, and that diagnostic tools for gambling involvement should be integrated into homelessness services in the U.K.