Arguably the most empirically validated form of pharmacotherapy for PG involves opioid antagonists, although these appear efficacious for only a portion of individuals with PG and have not been examined for long-term efficacy. Data exist consistent with these proposed roles (see Table 1), although there appears to be a more complex relationship (e.g., drugs that act as D2-like dopamine receptor agonists and antagonists have both been linked to pro-gambling motivations and behaviors, suggesting that individual differences might be particularly important to consider ). Adrenergic systems have been hypothesized to contribute to arousal and excitement, serotonin to impulse control, dopamine to rewarding and reinforcing aspects, opioids to pleasure/urges, cortisol to stress responsiveness, and glutamate to cognitive functioning including cognitive flexibility. Multiple neurochemical systems have been implicated in gambling and PG ( Table 1). Here, we will summarize main findings from neurochemical and neural research of PG and subsyndromal gambling, using the tables to provide detailed information, and consider future directions. Recent articles have reviewed in depth the neurobiology of PG and its relationship with the neurobiologies of substance-use disorders and impulse-control disorders. Given the recently proposed changes to PG, this article will review the neurobiology of gambling and PG within the context of this changing landscape and will discuss future directions for research, with a view towards translating improved neurobiological understandings into better prevention and treatment strategies. In that PG may be conceptualized as an addiction without the drug, investigations into its neurobiology have often been based on understandings of drug addictions and/or have contrasted PG with substance-use disorders. This proposed reclassification is based on data from epidemiological, clinical and neurobiological domains. Third, PG is being proposed for reclassification into the category of “Addictions and Related Disorders”, a move from its current location currently in “Impulse Control Disorders Not Elsewhere Classified”. For comparison, a diagnosis of a substance-use disorder in DSM-5 may require meeting 2 or more inclusionary criteria. Second, the threshold for diagnosing a case is proposed to shift from 5 of 10 inclusionary criteria to 4 of 9, with the “commission of gambling-related illegal acts” criterion removed. First, the name of the condition is being proposed to change to “Gambling Disorder”, as some have found the term pathological stigmatizing. In anticipation of the forthcoming editions of the DSM (DSM-5), several changes to PG have been proposed. Those with more severe gambling problems may meet criteria for pathological gambling (PG), a diagnostic entity introduced in the Diagnostic and Statistical Manual (DSM) in 1980. While most people gamble without problems, a sizable minority (up to about 5%) develops gambling-related problems. Gambling, defined as placing something of value at risk in the hopes of gaining something of greater value, is a widely prevalent behavior that has been popular for millennia. Anticipated Changes in Gambling Disorder Nomenclature, Definition, and Classification
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