Abstract
Hintergrund: Pathologisches Glücksspielen (PG) wird in den internationalen Klassifikationssystemen bislang als Impulskontrollstörung klassifiziert. Erst in jüngster Zeit wird aufgrund der Ähnlichkeiten in Phänomenologie, Ätiologie, Verlauf sowie genetischen und neurobiologischen Faktoren mit der Substanzabhängigkeit eine Einordnung des PGs als Verhaltenssucht diskutiert. Insbesondere neurobiologische und neuropsychologische Befunde haben zu dieser veränderten Sichtweise beigetragen. Methode: Im vorliegenden Beitrag werden Befunde zu neurobiologischen Grundlagen PGs vorgestellt. Der Schwerpunkt liegt auf neurokognitiven Prozessen wie Belohnungs- und Bestrafungsverarbeitung, Cue-Reaktivität, Impulsivität und Entscheidungsfindung. Die Befunde werden im Hinblick auf Ähnlichkeiten und Unterschiede PGs zur Substanzabhängigkeit diskutiert. Ergebnisse: Ähnlich wie bei der Substanzabhängigkeit zeigt sich auch bei pathologischen Spielern Veränderungen mesolimbischer-präfrontaler Netzwerke, die sich in einer verminderten Belohnungs- und Bestrafungssensitivität, Impulshemmung und einer erhöhten Cue-Reaktivität auf glücksspielassoziierte Reize äußern können. Jedoch sind die Befunde teilweise nicht eindeutig und eine Vielzahl der Studien unterliegt methodischen Einschränkungen. Schlussfolgerungen: Bisherige Befunde stützen die Einordnung pathologischen Spielverhaltens als Verhaltenssucht.
Background: Pathological gambling is currently classified as an impulse control disorder in the international classification systems. Recently, pathological gambling is increasingly regarded as non-substance or behavioral addiction because of its phenomenological, etiological, genetic and neurobiological resemblance with substance dependence. Especially findings from neuropsychological and imaging studies have supported to view pathological gambling as an addiction. Method: This article reviews findings on neurobiological mechanisms of pathological gambling focusing on neurocognitive processes such as reward and punishment processing, cue-reactivity, impulsivity and decision-making. The findings are discussed with respect to resemblances and differences with substance dependence. Results: Changes in the function of mesolimbic-prefrontal circuits associated with blunted reward and punishment sensitivity, impulse control and increased cue-reactivity have been found in pathological gambling, which are similar to those in substance dependence. However, some findings are ambiguous and most of the studies have methodological limitations. Conclusions: Current findings generally support the classification of pathological gambling as a behavioral addiction.
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