Insular activation during reward anticipation reflects duration of illness in abstinent pathological gamblers

Abstract

Pathological gambling (PG) is a chronic mental disorder characterized by a difficulty restraining gambling behavior despite negative consequences. Although brain abnormalities in patients with substance use disorders are caused by repetitive drug use and recover partly with drug abstinence, the relationship between brain activity and duration of illness or abstinence of gambling behavior in PG patients remains unclear. Here, using functional magnetic resonance imaging, we compared the brain activity of 23 PG patients recruited from a treatment facility with 27 demographically-matched healthy control subjects during reward anticipation, and examined the correlations between brain activity and duration of illness or abstinence in PG patients. During reward anticipation, PG patients showed decreased activity compared to healthy controls in a broad range of the reward system regions, including the insula cortex. In PG patients, activation in the left insula showed a significant negative correlation with illness duration. Our findings suggest that insular activation during reward anticipation may serve as a marker of progression of pathological gambling.

Meta-analyses of the functional neural alterations in subjects with Internet gaming disorder: Similarities and differences across different paradigms

“…Rauscent et al 2016). Insular activation during reward anticipation reflects the duration of illness in abstinent pathological gamblers (Tsurumi et al 2014). The increased functional connection between the left frontoparietal network and anterior insula predicts steeper devaluation of delayed rewards in smokers (Clewett et al 2014).…”

The somatic marker theory in the context of addiction: contributions to understanding development and maintenance

“…For example, Janes et al 126 demonstrated that increased anterior insular cortex activation to smoking cues predicted slips among abstinent nicotine addicts, while Claus et al 127 showed that increased insular activation was associated with addiction severity in alcohol addiction. Furthermore, Tsurumi et al 128 found that insular activation in a reward anticipation task was inversely related to the duration of illness among abstinent pathological gamblers. While this finding seems somewhat at odds with the finding reported earlier, 112 we suggest that this discrepancy may be due to the nature of the task.…”

“…While this finding seems somewhat at odds with the finding reported earlier, 112 we suggest that this discrepancy may be due to the nature of the task. Tsurumi et al 128 used points instead of money as the incentive and, thus, the decrease in activation may due to the specificity in the reward responses mentioned earlier. 116 …”

Brain Imaging in Gambling Disorder

“…During reward outcome, gambling disorder patients showed increased activation in the posterior orbitofrontal cortex to monetary gain outcome compared with controls. In a modified version of the monetary incentive delay task (points instead of money to express the amount of reward) [ 66 •], gambling disorder patients did not differ from controls in striatal activation during reward anticipation but displayed reduced activation in the insula, which was negatively related to the duration of the illness, suggesting that this alteration may result from excessive gambling.…”