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Gamblers, Alcoholics Share Risk/Reward Brain Changes, Differ on Cost Assessment

Addiction researchers have firmly established that some of the damaging brain changes found in people with non-substance-based behavioral addictions are roughly equivalent to the damaging changes found in the brains of people addicted to drugs, medications or alcohol. In a study published in 2014 in the journal Addiction Biology, a team of German researchers compared the brain effects of one specific form of behavioral addiction, called gambling disorder,  to the brain effects of alcoholism. These researchers found a general similarity between certain aspects of the two conditions, but also found significant differences in the particulars of their brain impact.

Gambling Disorder

As of 2014, gambling disorder is the only form of behavioral addiction in the U.S. with a set of symptoms defined by the American Psychiatric Association (APA), although addictions related to other common, non-substance-based behaviors such as having sex, shopping or using the Internet may officially receive APA definitions in the future. Symptoms of the disorder usually appear over time in people who participate in at least one form of gambling activity, including a game of skill, such as poker, or a random-chance game like a slot machine. Depending on the individual, symptoms may include receiving an emotional charge from risky gambling, mentally reliving gambling episodes while not participating in gambling, diverting important personal or social resources for gambling purposes, hiding the extent of gambling involvement, losing control over the extent of gambling involvement, using gambling to avoid everyday problems or unwanted moods, making bigger and bigger gambling wagers and relying on the financial resources of others to fund gambling activities.


Alcoholism is part of a larger condition called alcohol use disorder, which also includes non-addicted alcohol abuse. The American Psychiatric Association placed alcoholism under the heading of this disorder because some of the symptoms of non-dependent abuse and dependent alcoholism can overlap or appear in essentially the same form in any single person affected by drinking problems. Specific symptoms of alcohol use disorder that are more or less unique to alcoholism include a physical need to consume more alcohol, decreasing sensitivity to the mind-altering effects of alcohol, persistent cravings that promote continued drinking and the appearance of some form of mild-to-severe withdrawal when pre-established physical needs for drinking go unmet. The severity of any given case of alcohol use disorder varies with the number of alcoholism/alcohol abuse symptoms present in the individual.

Comparing the Brain Effects

In the study published in Addiction Biology, researchers from two German universities used brain scans called fMRI (functional magnetic resonance imaging) to compare the brain changes in people affected by gambling disorder to the brain changes in people affected by alcoholism. Specifically, the researchers looked for altered function in the parts of the brain responsible for making accurate risk/reward assessments. All told, three groups of individuals participated in the study: 18 people with a gambling disorder diagnosis, 15 people with an alcoholism diagnosis and 17 people unaffected by gambling disorder or alcoholism. The researchers subjected all three groups to tests designed to measure the effectiveness of the brain’s risk/reward circuitry under conditions that require the ability to anticipate harmful or losing situations, as well as the ability to avoid such situations when they arise. After comparing the three groups, the researchers concluded that, relative to healthy people and people affected by alcoholism, individuals affected by gambling disorder experience an unusual increase in brain activity when trying to anticipate losing/harmful situations. Conversely, compared to healthy individuals, people affected by gambling disorder or alcoholism experience an unusual decline in brain activity when successfully removing themselves from losing/harmful situations. In individuals with gambling disorder, this decrease in activity increases as the number of related symptoms rises. The study’s authors note the similarities between the risk/reward-related brain changes in people with gambling disorder and the changes found in people with alcoholism. However, they also note the specific differences in the costs of risk/reward assessment between the two groups. They believe their work significantly advances the scientific understanding of gambling disorder and the underlying changes that mark the presence of the disorder. It’s worth noting that the researchers used a now-outdated definition of problem gambling, called pathological gambling, during their study. This definition differs in some ways from the now-current diagnosis of gambling disorder, but also includes the same basic set of symptoms.

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