title: Decision-making deficits in patients diagnosed with disordered gambling using the Cambridge Gambling task: the effects of substance use disorder comorbidity.
abstract: BACKGROUND
  Disordered gambling (DG) has often been associated with impaired decision-making abilities, suggesting a dysfunction in the ventromedial prefrontal cortex (vmPFC).
  
  
  OBJECTIVE
  To our knowledge, no previous study has accurately considered the effect of substance use disorder (SUD) comorbidity (including nicotine dependence) on decision-making impairments in DG.
  
  
  METHODS
  We employed the Cambridge Gambling Task (CGT) to assess a big cohort of patients diagnosed with DG (N = 80) against matched healthy controls (HCs) (N = 108). The cohort included DG patients with nicotine and alcohol dependence, alcohol dependence only and 12 "pure" nonsmokers with only DG diagnosis.
  
  
  RESULTS
  Pure nonsmoking, nicotine dependent as well as alcoholic DGs with current nicotine dependence, demonstrated a decision making profile, characterized by poor decision-making abilities and failure to make right choices (rational), closely resembling that of patients with vmPFC damage.
  
  
  CONCLUSIONS
  This suggests that DGs with and without SUD comorbidity are equally affected in that domain of decision making abilities. Additionally, gambling diagnosis combined with alcohol and nicotine dependence involves a group of gambling patients with a relatively riskier decision making profile, showing that these patients apart from making irrational decisions take also more risks. Our findings highlight the importance of accounting for SUD comorbidities with useful implications for future research and therapy. Limitations of the current investigation are discussed.
authors.affiliation: Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University Mannheim, Germany.
authors.forename: Evangelos
authors.initials: E
authors.lastname: Zois
authors.affiliation: Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University Mannheim, Germany.
authors.forename: Noreen
authors.initials: N
authors.lastname: Kortlang
authors.affiliation: Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University Mannheim, Germany.
authors.forename: Sabine
authors.initials: S
authors.lastname: Vollstädt-Klein
authors.affiliation: Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University Mannheim, Germany.
authors.forename: Tagrid
authors.initials: T
authors.lastname: Lemenager
authors.affiliation: Kraichtal-Kliniken Am Mühlberg, 76703, Kraichtal, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Beutel
authors.affiliation: Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University Mannheim, Germany.
authors.forename: Karl
authors.initials: K
authors.lastname: Mann
authors.affiliation: Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University Mannheim, Germany.
authors.forename: Mira
authors.initials: M
authors.lastname: Fauth-Bühler
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000150:complications / Q000523:psychology*; D003657:Decision Making; D005715:Gambling / Q000150:complications / Q000175:diagnosis / Q000523:psychology*; D006801:Humans; D007600:Judgment; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D014029:Tobacco Use Disorder / Q000150:complications / Q000523:psychology*
keywords: Behavioral addiction; Cambridge gambling task; decision making; disordered gambling; substance use disorder