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Review
. 2013 Mar 5:2:385-93.
doi: 10.1016/j.nicl.2013.02.005. eCollection 2013.

Fronto-striatal dysregulation in drug addiction and pathological gambling: Consistent inconsistencies?

Eve H Limbrick-Oldfield  1 , Ruth J van Holst, Luke Clark
Affiliations
Review

Fronto-striatal dysregulation in drug addiction and pathological gambling: Consistent inconsistencies?

Eve H Limbrick-Oldfield et al. Neuroimage Clin. .

Abstract

Alterations in appetitive processing are central to the major psychological theories of addiction, with differential predictions made by the reward deficiency, incentive salience, and impulsivity hypotheses. Functional MRI has become the chief means of testing these predictions, with experiments reliably highlighting disturbances at the level of the striatum, medial prefrontal cortex, and affiliated regions. However, demonstrations of hypo-reactivity and hyper-reactivity of this circuitry in drug addicted groups are reported in approximately equal measure. Similar findings are echoed in the emergent neuroimaging literature on pathological gambling, which has recently witnessed a coming of age. The first aim of this article is to consider some of the methodological aspects of these experiments that could influence the observed direction of group-level effects, including the baseline condition, trial structure and timing, and the nature of the appetitive cues (drug-related, monetary, or primary rewards). The second aim is to highlight the conceptual traction that is offered by pathological gambling, as a model of a 'toxicity free' addiction and an illness where tasks of monetary reinforcement afford a more direct mapping to the abused commodity. Our conclusion is that relatively subtle decisions in task design appear capable of driving group differences in fronto-striatal circuitry in entirely opposing directions, even with tasks and task variants that look ostensibly similar. Differentiation between the psychological theories of addiction will require a greater breadth of experimental designs, with more research needed on processing of primary appetitive cues, aversive processing, and in vulnerable/at-risk groups.

Keywords: Addiction; Appetitive processing; Pathological gambling; Ventral striatum; fMRI.

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Figures

Fig. 1
Fig. 1
Structural differences between two typical tasks used to investigate appetitive processing in addiction. a) A guessing task adapted from Yacubian et al. (2006), and used by van Holst et al. (2012) in the study of pathological gamblers. On each trial, participants were presented with a representation of the chances (30% or 70%) and amounts (€1 or €5) that they could win or lose. Subjects indicated whether they expected to win or lose with a button press. This was followed by a 4 second anticipation period followed by the trial outcome. A win occurred when a red ace was within the highlighted area. b) A monetary incentive delay task adapted from Knutson et al. (2001) used by Balodis et al. (2012). On each trial, participants were presented with the amount they could win or lose (the first anticipation, A1, phase). During the second anticipation (A2) phase, the participants pressed a button when a target appeared. If the response was quick enough, they won, or avoided losing, the cued amount, with titration of the reaction time to ensure participants were correct on 66% of trials.
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