Gambling Addiction Treatment – Near Misses Elicit Reward Response in Brain

A non 12 step approach to addiction treatment teaches people to distinguish the difference between positive and negative outcomes related to addictive behavior.

Pathological gambling, or gambling addiction, occurs when recreational activity becomes dysfunctional and detrimental, and many pathological gamblers need addiction treatment to overcome their addictive behavior. Pathological gamblers typically face a variety of cognitive distortions in which they overestimate their chances of winning. Some speculate that the excitement of “near-miss” outcomes in gambling games encourage such cognitive distortions. In a previous study with healthy participants, researchers found that near-miss outcomes in recreational gamblers shared overlapping brain circuitry with monetary wins. Researchers from the University of Nottingham and University of Cambridge in the United Kingdom set out to determine if these findings also applied to regular gamblers and if they could relate “near-miss” brain responses to an index of pathological gambling severity (Chase & Clark, 2010).

The researchers recruited 20 regular gamblers. Participants ranged from recreational gamblers to probable pathological gamblers. Brains of participants were scanned using functional magnetic resonance imaging (fMRI) while they performed a slot machine task that delivered occasional monetary wins, near-misses, and non-wins.

Results of the study showed that near-miss outcomes were associated with a significant response in the ventral striatum, which is considered to be the reward center of the brain. The ventral striatum also showed a response for monetary wins. Further, the researchers found that gambling severity (measured by the South Oaks Gambling Screen) predicted a greater response to near-misses in the dopaminergic midbrain. However, oddly enough, gambling severity did not predict win-related brain responses. These results suggest that near-miss outcomes during gambling activate the brain’s reward circuitry in regular players, and near-miss outcomes may enhance dopamine transmission in pathological gambling. Thus, in terms of brain circuitry, gambling addiction and drug addiction may be quite similar. Future research will need to determine if this brain response is caused by pathological gambling or if it is a pre-existing condition that leads to pathological gambling.

“These findings are exciting because they suggest that near-miss outcomes may elicit a dopamine response in the more severe gamblers, despite the fact that no actual reward is delivered,” said co-author Luke Clark, PhD, of the University of Cambridge. “If these bursts of dopamine are driving addictive behavior, this may help to explain why problem gamblers find it so difficult to quit.”

Many people associate addiction with substance addiction and are unaware that addictions can occur beyond drugs and alcohol. In recent years, addictions incorporate any substance or activity including gambling, sex and spending. Alcoholics Anonymous uses the traditional definition of addiction where it’s all or nothing; you either are an alcoholic or you are not. In an alternative to AA, the definition of addiction includes cravings, consequences and loss of control. Because there can be an array of addictions in one’s life, it is important to determine which ones are harmful addictions. Some individuals may want to attempt to treat multiple addictions at once; however it is important to focus on the addiction with the greatest costs. In a non 12 step approach to addiction treatment, one can increase self-awareness, identify and resolve conflict, discover and develop alternative behaviors, experience support from others, and learn to resist temptation.

Chase HW, Clark L. Gambling severity predicts midbrain response to near-miss outcomes. The Journal of Neuroscience. 5 May 2010; 30(18): 6180-6187.
http://www.jneurosci.org/cgi/content/abstract/30/18/6180