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Similarities and differences between pathological gambling and substance use disorders: a focus on impulsivity and compulsivity

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Abstract

Rationale

Pathological gambling (PG) has recently been considered as a “behavioral” or nonsubstance addiction. A comparison of the characteristics of PG and substance use disorders (SUDs) has clinical ramifications and could help advance future research on these conditions. Specific relationships with impulsivity and compulsivity may be central to understanding PG and SUDs.

Objectives

This review was conducted to compare and contrast research findings in PG and SUDs pertaining to neurocognitive tasks, brain function, and neurochemistry, with a focus on impulsivity and compulsivity.

Results

Multiple similarities were found between PG and SUDs, including poor performance on neurocognitive tasks, specifically with respect to impulsive choice and response tendencies and compulsive features (e.g., response perseveration and action with diminished relationship to goals or reward). Findings suggest dysfunction involving similar brain regions, including the ventromedial prefrontal cortex and striatum and similar neurotransmitter systems, including dopaminergic and serotonergic. Unique features exist which may in part reflect influences of acute or chronic exposures to specific substances.

Conclusions

Both similarities and differences exist between PG and SUDs. Understanding these similarities more precisely may facilitate treatment development across addictions, whereas understanding differences may provide insight into treatment development for specific disorders. Individual differences in features of impulsivity and compulsivity may represent important endophenotypic targets for prevention and treatment strategies.

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Acknowledgments

This work was supported in part by the NIH (K01 AA 019694, K05 AA014715, R01 DA019039, P20 DA027844, and RC1 DA028279), the VA VISN1 MIRECC, the Connecticut Department of Mental Health and Addiction Services, and a Center of Research Excellence Award from the National Center for Responsible Gaming and its affiliated Institute for Research on Gambling Disorders. The contents of the manuscript are solely the responsibility of the authors and do not necessarily represent the official views of any of the funding agencies.

Disclosures

The authors report that they have no financial conflicts of interest with respect to the content of this manuscript. Dr. Potenza has received financial support or compensation for the following: He has consulted for and advised Boehringer Ingelheim; has consulted for and has financial interests in Somaxon; has received research support from the National Institutes of Health, Veteran’s Administration, Mohegan Sun Casino, the National Center for Responsible Gaming and its affiliated Institute for Research on Gambling Disorders, and Psyadon, Forest Laboratories, Ortho-McNeil, Oy-Control/Biotie, and Glaxo-SmithKline pharmaceuticals; has participated in surveys, mailings, or telephone consultations related to drug addiction, impulse control disorders, or other health topics; has consulted for law offices and the federal public defender’s office in issues related to impulse control disorders; provides clinical care in the Connecticut Department of Mental Health and Addiction Services Problem Gambling Services Program; has performed grant reviews for the National Institutes of Health and other agencies; has guest-edited journal sections; has given academic lectures in grand rounds, CME events and other clinical or scientific venues; and has generated books or book chapters for publishers of mental health texts.

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  1. Department of Psychiatry, Yale University School of Medicine, CMHC, 34 Park Street, New Haven, CT, 06405, USA

    Robert F. Leeman & Marc N. Potenza

  2. Department of Neurobiology, Yale University School of Medicine, New Haven, CT, USA

    Marc N. Potenza

  3. Child Study Center, Yale University School of Medicine, New Haven, CT, USA

    Marc N. Potenza

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Correspondence to Robert F. Leeman.

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Leeman, R.F., Potenza, M.N. Similarities and differences between pathological gambling and substance use disorders: a focus on impulsivity and compulsivity. Psychopharmacology 219, 469–490 (2012). https://doi.org/10.1007/s00213-011-2550-7

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