Striatal ups or downs? Neural correlates of monetary reward anticipation, cue reactivity and their interaction in alcohol use disorder and gambling disorder

van Timmeren, Tim and van Holst, Ruth J. and Goudriaan, Anna E. (2023) Striatal ups or downs? Neural correlates of monetary reward anticipation, cue reactivity and their interaction in alcohol use disorder and gambling disorder. Journal of Behavioral Addictions, 12 (2). pp. 571-583. ISSN 2062-5871

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Abstract

Background and aims: COVID-19 resulted in the shutdown of almost all sporting competitions and most venue-based gambling opportunities. This study examines how wagering operators in Australia responded, by examining their advertising. Methods: The study compared Twitter activity during lockdown (March–May 2020) to the previous year for four major wagering operators. Results: Wagering operators continued to advertise in earnest, changing their marketing mix to include more race betting content, as races continued to operate. Most also promoted the only sports available, such as table tennis or esports. When sports resumed, sports betting advertising quickly returned to normal, or exceeded previous levels. Despite more content being available in the case of two operators, engagement from the public during lockdown was similar to or lower than previously. Discussion and conclusion: These results indicate that gambling operators can adjust quickly to major changes. These shifts appear to have been successful, with the increase in race betting during this period almost completely offsetting the decreases in sports betting. This is likely due in part to changes in advertising, which have been associated with increased betting activity, particularly amongst vulnerable people. Responsible gambling messages were virtually non-existent on Twitter, which contrasts with mandatory requirements in other media. The study highlights that regulatory changes to advertising, e.g., banning some content, are likely to be met with substitution of content, rather than reduction, unless advertising volume is also capped. The study also highlights the adaptive capacity of the gambling industry in the face of major disruption to supply. Background and aims: Dysfunction of the striatum, a brain region part of the mesolimbic reward system, is a key characteristic of addictive disorders, but neuroimaging studies have reported conflicting findings. An integrative model of addiction points to the presence or absence of addiction-related cues as an explanation for hyper- or hypoactivation, respectively, of the striatum. Methods: To test this model directly, we inves- tigated striatal activation during monetary reward anticipation in the presence versus absence of addiction- related cues using functional MRI. Across two studies, we compared 46 alcohol use disorder (AUD) patients with 30 matched healthy controls; and 24 gambling disorder (GD) patients with 22 matched healthy controls. Results: During monetary reward anticipation, hypoactivation of the reward system was seen in AUD individuals compared to HCs. Additionally, a behavioral interaction was seen where gambling cues made participants, across groups, respond faster for bigger, but slower for smaller rewards. However, no striatal differences were seen in response to addiction-related cues between AUD or GD patients and their matched controls. Finally, despite substantial individual differences in neural activity to cue-reactivity and reward anticipation, these measures did not correlate, suggesting that they contribute independently to addiction aetiology. Discussion and Conclusions: Our findings replicate previous findings of blunted striatal activity during monetary reward anticipation in alcohol use disorder but do not support the idea that addiction-related cues explain striatal dysfunction as suggested by the model.

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