Alcohol-use disorders - preventing the development of hazardous and harmful drinking

Behavioral Economic Considerations of Novel Addictions and Nonaddictive Behavior: Research and Analytic Methods

The Prevention and Treatment of Gambling Disorders: Some Art, Some Science

Sensitization of Incentive Salience and the Transition to Addiction

Precision Behavioral Management (PBM): A Novel Genetically Guided Therapy to Combat Reward Deficiency Syndrome (RDS) Relevant to the Opiate Crisis

Background and aims Extreme sports athletes are often labeled "adrenaline junkies" by the media, implying they are addicted to their sport. Research suggests during abstinence these athletes may experience withdrawal states characteristic of individuals with an addiction (Celsi, Rose, & Leigh, 1993; Franken, Zijlstra, & Muris, 2006; Willig, 2008). Despite this notion, no research has directly explored withdrawal experiences of extreme sports athletes. Methods Using semi-structured interviews, we explored withdrawal experiences of high (n = 4) and average-ability (n = 4) male rock climbers during periods of abstinence. We investigated the psychological and behavioral aspects of withdrawal, including craving, anhedonia, and negative affect; and differences in the frequency and intensity of these states between groups. Results Deductive content analysis indicated support for each of the three categories of anhedonia, craving, and negative affect. Consistent with existing substance addiction literature, high-ability climbers recalled more frequent and intense craving states and negative affect during abstinence compared with average-ability climbers. No differences in anhedonic symptoms between high and average-ability participants were found. Conclusions Rock climbing athletes appear to experience withdrawal symptoms when abstinent from their sport comparable to individuals with substance and behavioral addictions. The implications of these findings and suggestions for future research are discussed.

Addiction in Extreme Sports: An Exploration of Withdrawal States in Rock Climbers

Background: Neuropsychological assessment is central to identifying and determining the extent of Alcohol-Related Cognitive Impairment (ARCI). The present systematic review aimed to synthesize and discuss the evidence appraising the neuropsychological tests used to assess ARCI in order to support clinicians and researchers in selecting appropriate tests for use with this population. Methods: We searched for studies investigating the psychometric, diagnostic and practical values of tools used in the screening, diagnosis, and assessment of Korsakoff's Syndrome (KS), Alcohol-Related Dementia (ARD), and those with a specific diagnosis of Alcohol-Related Brain Damage (ARBD). The following databases were searched in March 2016 and again in August 2018: MEDLINE, EMBASE, Psych-INFO, ProQuest Psychology, and Science Direct. Study quality was assessed using a checklist designed by the authors to evaluate the specific factors contributing to robust and clearly reported studies in this area. A total of 43 studies were included following the screening of 3646 studies by title and abstract and 360 at full-text. Meta-analysis was not appropriate due to heterogeneity in the tests and ARCI samples investigated in the studies reviewed. Instead, review findings were narratively synthesized and divided according to five domains of assessment: cognitive screening, memory, executive function, intelligence and test batteries, and premorbid ability. Effect sizes (d) were calculated to supplement findings. Results: Overall, several measures demonstrated sensitivity to the cognitive deficits associated with chronic alcoholism and an ability to differentiate between gradations of impairment. However, findings relating to the other psychometric qualities of the tests, including those important for the accurate assessment and monitoring of ARCI (e.g., test-retest reliability), were entirely absent or limited. Additionally, the synthesis of neuropsychological outcomes presented here supports the recent impetus for a move away from discrete diagnoses (e.g., KS, ARD) and the distinctions between them toward more broad and inclusive diagnostic conceptualizations of ARCI, thereby recognizing the heterogeneity in presentation. Conclusions: Based on the evidence reviewed, provisional recommendations for appropriate tests in each domain of assessment are presented, though further validation of most tests is warranted. Review findings can support efficient and evidenced-based test-selection and guide future research in this area.

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Identification and Evaluation of Neuropsychological Tools Used in the Assessment of Alcohol-Related Cognitive Impairment: A Systematic Review.

Several prominent researchers in the problem gambling field have recently called for high-quality replications of existing gambling studies. This call should be extended to the entire field of addi...

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A call for replications of addiction research: which studies should we replicate and what constitutes a ‘successful’ replication?

Aims We tested the effectiveness of three different messages designed to increase limit-setting on gambling sites and sent these via e-mail or in-account notification to compare delivery modes. As a secondary aim, we examined the effects of limit-setting on gambling behaviour. Design A pre-registered, naturalistic randomized control trial using a 3 × 2 plus control design. Setting Four on-line Australian sports and racing wagering websites. Participants A total of 31 989 wagering customers (reduced to 26,560 after eligibility screening) who had placed bets on at least 5 days in the past 30 [mean age = 41.4, standard deviation (SD) = 14.3; 79% male]. Interventions and comparators Messages were sent via e-mail or in-account notification by on-line gambling operators and were designed to either: (1) be informative, describing the availability and purpose of the tool (informative messages), (2) highlight the benefits other people receive from using the tool (social messages) or (3) promote the benefit individuals could receive from using the tool (personal messages). A control group who did not receive messages was monitored for comparison. Measurements Our primary outcome was the number of customers who set a deposit limit within 5 days of receiving messages and secondary outcomes included pre- and post-message betting behaviour (e.g. average daily wager). Findings One hundred and sixty-one (0.71%) customers sent messages set limits compared to three (0.08%) controls [adjusted odds ratio (aOR) = 8.17, 95% confidence interval (CI) = 2.99, 33.76)]. Social and personal messages were no more effective than informative messages (aOR = 0.98, 95% CI = 0.65, 1.48; aOR = 0.93, 95% CI = 0.60, 1.44) and in-account messages were no more effective than e-mails (aOR = 1.02, 95% CI = 0.71, 1.49). Customers who set limits significantly decreased their average daily wager, the SD of daily wager, net loss and betting intensity compared with non-limit-setters. Conclusions Messages to on-line gambling website customers are inexpensive, and may lead to small but impactful increases in setting deposit limits. Limit-setting may be an effective strategy for reducing gambling expenditure and intensity.

Encouraging and evaluating limit-setting among on-line gamblers: a naturalistic randomized controlled trial.

Background and aims Recent investigations have highlighted the value of neuropsychological testing for the assessment and screening of Alcohol-Related Brain Damage (ARBD). The aim of the present study was to evaluate the suitability of the Addenbrooke's Cognitive Examination (ACE-III) and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) for this purpose. Methods Comparing 28 participants with ARBD (11 with Korsakoff's Syndrome and 17 with the umbrella "ARBD" diagnosis) and 30 alcohol-dependent participants without ARBD (ALs) we calculated Area Under the Curve (AUC) statistics, sensitivity and specificity values, base-rate adjusted predictive values, and likelihood ratios for both tests. Results High levels of screening accuracy were found for the total scores of both the ACE-III (AUC = 0.823, 95% CIs [0.714, 0.932], SE = 0.056; optimal cut-off ≤86: sensitivity = 82%, specificity = 73%) and RBANS (AUC = 0.846, 95% CIs [0.746, 0.947], SE = 0.052; optimal cut-off ≤83: sensitivity = 89%, specificity = 67%) at multiple cut-off points. Removing participants with a history of polysubstance from the samples (10 ALs and 1 ARBD) improved the diagnostic capabilities of the RBANS substantially (AUC = 0.915, 95% CIs [0.831, 0.999], SE = 0.043; optimal cut-off ≤85: sensitivity = 98%, specificity = 80%), while only minor improvements to the ACE-III's accuracy were observed (AUC = 0.854, 95% CIs [0.744, 0.963], SE = 0.056; optimal cut-off ≤88: sensitivity = 85%, specificity = 75%). Conclusion Overall, both the ACE-III and RBANS are suitable tools for ARBD screening within an alcohol-dependent population, though the RBANS is the superior of the two. Clinicians using these tools for ARBD screening should be cautious of false-positive outcomes and should therefore combine them with other assessment methods (e.g., neuroimaging, clinical observations) and more detailed neuropsychological testing before reaching diagnostic decisions.

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Robert Heirene

Papers

Addiction in Extreme Sports: An Exploration of Withdrawal States in Rock Climbers

Identification and Evaluation of Neuropsychological Tools Used in the Assessment of Alcohol-Related Cognitive Impairment: A Systematic Review.

A call for replications of addiction research: which studies should we replicate and what constitutes a ‘successful’ replication?

Encouraging and evaluating limit-setting among on-line gamblers: a naturalistic randomized controlled trial.

Applicability of the ACE-III and RBANS Cognitive Tests for the Detection of Alcohol-Related Brain Damage.