The self-medication hypothesis of addictive disorders derives primarily from clinical observations of patients with substance use disorders. Individuals discover that the specific actions or effects of each class of drugs relieve or change a range of painful affect states. Self-medication factors occur in a context of self-regulation vulnerabilities--primarily difficulties in regulating affects, self-esteem, relationships, and self-care. Persons with substance use disorders suffer in the extreme with their feelings, either being overwhelmed with painful affects or seeming not to feel their emotions at all. Substances of abuse help such individuals to relieve painful affects or to experience or control emotions when they are absent or confusing. Diagnostic studies provide evidence that variously supports and fails to support a self-medication hypothesis of addictive disorders. The cause-consequence controversy involving psychopathology and substance use/abuse is reviewed and critiqued. In contrast, clinical observations and empirical studies that focus on painful affects and subjective states of distress more consistently suggest that such states of suffering are important psychological determinants in using, becoming dependent upon, and relapsing to addictive substances. Subjective states of distress and suffering involved in motives to self-medicate with substances of abuse are considered with respect to nicotine dependence and to schizophrenia and posttraumatic stress disorder comorbid with a substance use disorder.

The Self-medication Hypothesis of Substance Use Disorders: A Reconsideration and Recent Applications

Background The umbrella term "Internet addiction" has been criticized for its lack of specificity given the heterogeneity of potentially problematic behaviors that can be engaged in online as well as different underlying etiological mechanisms. This has led to the naming of specific online addictions, the most notable being Internet Gaming Disorder (IGD). Methods Using the contemporary literature concerning IGD and cognate topics, issues and concerns relating to the concept of IGD are examined. Results Internet addiction and IGD are not the same, and distinguishing between the two is conceptually meaningful. Similarly, the diagnosis of IGD as proposed in the appendix of the latest (fifth) edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) remains vague regarding whether or not games need to be engaged in online, stating that IGD typically involves specific Internet games, but can also include offline games, adding to the lack of clarity. A number of authors have voiced concerns regarding the viability of including the word "Internet" in IGD, and instead proposed to use the term "video gaming disorder" or simply "gaming disorder," suggesting addiction to video gaming can also occur offline. Conclusion The DSM-5 has caused more confusion than clarity regarding the disorder, reflected by researchers in the field contesting a supposedly reached consensus for IGD diagnosis.

Chaos and confusion in DSM-5 diagnosis of Internet Gaming Disorder: issues, concerns, and recommendations for clarity in the field

Background and aimsPrevious studies focused on examining the interrelationships between social networking site (SNS) addiction and Internet gaming disorder (IGD) in isolation. Moreover, little is known about the potential simultaneous differential effects of SNS addiction and IGD on psychological health. This study investigated the interplay between these two technological addictions and ascertained how they can uniquely and distinctively contribute to increasing psychiatric distress when accounting for potential effects stemming from sociodemographic and technology-related variables.MethodsA sample of 509 adolescents (53.5% males) aged 10–18 years (mean = 13.02, SD = 1.64) were recruited.ResultsIt was found that key demographic variables can play a distinct role in explaining SNS addiction and IGD. Furthermore, it was found that SNS addiction and IGD can augment the symptoms of each other, and simultaneously contribute to deterioration of overall psychological health in a similar fashion, further highlig...

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Investigating the differential effects of social networking site addiction and Internet gaming disorder on psychological health

The increasing sophistication of gambling products afforded by electronic technologies facilitates increased accessibility to gambling, as well as encouraging rapid and continuous play. This poses several challenges from a responsible gambling perspective, in terms of facilitating player self-awareness and self-control. The same technological advancements in gambling that may facilitate a loss of control may also be used to provide responsible gambling tools and solutions to reduce gambling-related harm. Indeed, several harm-minimisation strategies have been devised that aim to facilitate self-awareness and self-control within a gambling session. Such strategies include the use of breaks in play, 'pop-up' messaging, limit setting, and behavioural tracking. The present paper reviews the theoretical argument underpinning the application of specific harm-minimisation tools, as well as providing one of the first critical reviews of the empirical research assessing their efficacy, in terms of influencing gambling cognitions and behaviour.

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A Critical Review of the Harm-Minimisation Tools Available for Electronic Gambling

OBJECTIVE
Illicit drug use is identified in Healthy People 2010 as a leading health indicator because it is associated with multiple deleterious health outcomes, such as sexually transmitted diseases, human immunodeficiency virus, viral hepatitis, and numerous social problems among adolescents and adults. Improved understanding of the influence of stressful or traumatic childhood experiences on initiation and development of drug abuse is needed.


METHODS
We examined the relationship between illicit drug use and 10 categories of adverse childhood experiences (ACEs) and total number of ACEs (ACE score). A retrospective cohort study of 8613 adults who attended a primary care clinic in California completed a survey about childhood abuse, neglect, and household dysfunction; illicit drug use; and other health-related issues. The main outcomes measured were self-reported use of illicit drugs, including initiation during 3 age categories: <or=14 years, 15 to 18 years, or as an adult (>or=19 years); lifetime use for each of 4 birth cohorts dating back to 1900; drug use problems; drug addiction; and parenteral drug use.


RESULTS
Each ACE increased the likelihood for early initiation 2- to 4-fold. The ACE score had a strong graded relationship to initiation of drug use in all 3 age categories as well as to drug use problems, drug addiction, and parenteral drug use. Compared with people with 0 ACEs, people with >or=5 ACEs were 7- to 10-fold more likely to report illicit drug use problems, addiction to illicit drugs, and parenteral drug use. The attributable risk fractions as a result of ACEs for each of these illicit drug use problems were 56%, 64%, and 67%, respectively. For each of the 4 birth cohorts examined, the ACE score also had a strong graded relationship to lifetime drug use.


CONCLUSIONS
The ACE score had a strong graded relationship to the risk of drug initiation from early adolescence into adulthood and to problems with drug use, drug addiction, and parenteral use. The persistent graded relationship between the ACE score and initiation of drug use for 4 successive birth cohorts dating back to 1900 suggests that the effects of adverse childhood experiences transcend secular changes such as increased availability of drugs, social attitudes toward drugs, and recent massive expenditures and public information campaigns to prevent drug use. Because ACEs seem to account for one half to two third of serious problems with drug use, progress in meeting the national goals for reducing drug use will necessitate serious attention to these types of common, stressful, and disturbing childhood experiences by pediatric practice.

Childhood Abuse, Neglect, and Household Dysfunction and the Risk of Illicit Drug Use: The Adverse Childhood Experiences Study

Participation in fantasy sports has become increasingly popular. Typical gambling activities such as poker, sports wagering and, sports lotteries, share many similar characteristics with fantasy sports playing. Research has shown that not only are college students more likely to partake in risky behaviors (gambling, alcohol and drug use), but those who partake in fantasy sports are also more likely to experience gambling-related problems. However, no published studies have examined the relationship between student-athletes and fantasy sports participation. Using data from the 2004, 2008 and 2012 National Collegiate Athletic Association (NCAA) studies assessing gambling behaviors and problems among U.S college student-athletes, this study aims to explore the prevalence and growth in fantasy sports among student-athletes. Further, it examines whether, in the 2012 study, student-athletes qualifying as at-risk or having gambling problems participate more often in fantasy sports. Overall a steady increase in fantasy sports participation (for money or fun) in college was found looking at these three cross-sectional studies. Additionally, approximately half of college student-athletes who qualified as at risk or having gambling problems were found to have participated in fantasy sports wagering.

Fantasy Sports: A Growing Concern Among College Student-Athletes

Background and aims Personalized feedback interventions (PFI) have shown success as a low-cost, scalable intervention for reducing problematic and excessive consumption of alcohol. Recently, researchers have begun to apply PFI as an intervention method for problematic gambling behaviors. A systematic review of the literature on PFI as an intervention/prevention method for gambling behaviors was performed. Methods Studies were included if they met the following criteria: the design included both a PFI group and a comparison group, and the interventions focused on gambling prevention and/or reduction. Six relevant studies were found meeting all criteria. Results Results revealed that PFI treatment groups showed decreases in a variety of gambling behaviors as compared to control groups, and perceived norms on gambling behaviors significantly decreased after interventions as compared to control groups. Conclusions Overall, the research suggests that while PFI applied to gambling is still in its infancy, problematic gamblers appear to benefit from programs incorporating PFIs. Further, PFI may also be used as a promising source of preventative measures for individuals displaying at-risk gambling behaviors. While, evidence is still limited, and additional research needs to be conducted with PFI for gambling problems, the preliminary positive results along with the structure of PFI as a scalable and relatively inexpensive intervention method provides promising support for future studies.

Examining personalized feedback interventions for gambling disorders: A systematic review.

Fantasy sports is a growing industry with a reported 56.8 million individuals participating in the United States and Canada alone in 2015. Whereas this activity has attracted considerable public attention, little research has examined its impact on adolescents in spite of their high rates of gambling. The current study examined the relationship between regular participation (more than once a month) in sport-relevant gambling activities among adolescents and those identified as being at-risk for a gambling problem. Questionnaire responses were collected from high school students (N = 6818; 49 % male) in Wood County, Ohio, United States. Statistical analyses revealed that regular involvement in sports betting, fantasy sports betting, and daily fantasy sports betting among adolescents was associated with a higher risk of gambling problems. Further, although males participate more frequently in these activities, females who participate have a stronger likelihood of being at-risk. Students aged 16–19 years old are at a higher risk for developing a gambling problem compared to younger adolescents when regularly engaging in sports-related gambling. Moreover, regularly participating in daily fantasy sports is the strongest predictor of at-risk gambling behavior in 13–15 year old students. A hierarchical logistic regression supports that controlling for gender and age, all forms of sport-relevant gambling activities are significant predictors of at-risk gambling. This study contributes to a more comprehensive understanding of the impact of sports betting and fantasy sports on adolescents and establishes an initial step for future studies to further investigate these relationships.

Loredana Marchica

Papers

Fantasy Sports: A Growing Concern Among College Student-Athletes

Examining personalized feedback interventions for gambling disorders: A systematic review.

Understanding the Relationship Between Sports-Relevant Gambling and Being At-Risk for a Gambling Problem Among American Adolescents

The Role of Emotion Regulation in Video Gaming and Gambling Disorder: A Systematic Review

Emotion Regulation Interacts with Gambling Motives to Predict Problem Gambling Among Emerging Adults