Digital archive of theses discussed at the University of Pisa


Thesis etd-06282017-191334

Thesis type
Tesi di specializzazione (5 anni)
Thesis title
Towards a specific psychopathology of Substance-Related and Addictive Disorders. Comparison between Heroin Use Disorder and Gambling Disorder patients
Course of study
relatore Prof. Maremmani, Icro
  • gambling disorder
  • heroin use disorder
  • addiction
Graduation session start date
This dissertation aims, in its first part, to define Gambling Disorder on the basis of the terminology history, aetiology, clinical aspects, medical and psychiatric comorbidity and treatment options. In the second part comparison between psychopathology of Heroin Use Disorder and GD patients has been made.
Gambling, defined as placing something of value at risk in the hope of gaining something of greater value, has been observed across cultures for millennia. Gambling is a harmless form of entertainment for most consumers, but it has the capacity to become dysfunctional in a minority. The negative consequences could be severe, and include financial debt, bankruptcy, family dissolution, and criminal behaviour. In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), Pathological Gambling become Gambling Disorder (GD) and it moved from “Impulse Control Disorder” to the chapter of “Substance-Related and Addictive Disorders”. DSM-5 in this way is the first diagnostic system to recognize a behavioural addiction. As in addiction to substances, there are similar elements in term of clinical expression (e.g., craving, tolerance, withdrawal symptoms) and diagnostic criteria, comorbidity, neurobiological profile, heritability, natural history, treatment, and treatment outcome. Actually, 0.12-5.8% of the world’s population meets criteria for GD and in Italy, the prevalence estimated is between 0,5 and 2,2%. Neurobiological studies underline involvement of Serotoninergic, Dopaminergic, GABAergic, Glutamatergic and Noradrenergic systems both in GD and in Substance Use Disorder and GD’s heritability is similar to heritability rates of other Addictions. Indeed, several neuropsychological differences have been found between subjects with GD and control subjects and that have been linked to brain regions such as ventral striatum, ventromedial prefrontal cortex, orbitofrontal cortex, dopaminergic midbrain and insula, fundamental structures in the reward system and decision processes. GD is more frequent in males than females, in younger than in older people; 96% of individuals with lifetime GD also meet criteria for at least one other lifetime psychiatric disorder. High rates of co-occurrence between SUDs and GD are present in both directions. Similarities between GD and SUD are: (1) Euphoric state/ excitement or arousal-state; euphoric state such as ‘‘high’’. (2) Loss of control/ impaired control. (3) Craving/failure to resist an impulse, drive, or temptation to perform an act. (4) Recidivism/exacerbations and remissions. (5) Alteration in global functioning/impaired control. Currently, three main pharmacological approaches exist for GD derived from the psychopathological and phenomenological perspectives of the disorder itself: considering GD as a behavioural addiction, as belonging to the obsessive- compulsive disorder spectrum, or as the result of an emotional deregulation related to mood disorders. Opioid antagonist, SSRIs antidepressant and Mood Stabilizers are generally used. Cognitive Behavioural Therapy has been used to reduce gambling behaviour.
In the experimental study, the aim was to investigate psychopathology and to test if the specific psychopathology already found in HUD patients could be likewise detected in GD patients. The five psychopathological dimensions found, by our research group, in Substance-Related Disorders were applied to a Non-Substance-Related Disorder, comparing a sample of Heroin Use Disorder (HUD) with Gambling Disorder (GD) patients at univariate and multivariate level. At univariate level the number of psychopathological symptoms were more severe in HUD patients and all the five psychopathological dimensions were significantly more severe in HUD patients. Psychopathological subtypes were not the most important discriminant factor to differentiate HUD from GD patients. Psychopathological subtypes characterized by ‘Somatic Symptoms’ and ‘Violence- Suicide’ symptomatology were more frequent in HUD patients, whereas ‘Panic Anxiety’ symptomatology were more frequent in GD individuals. At multivariate level, prominentcharacteristic of PG individuals was only the absence of ‘Somatic Symptoms’ psychopathological subtype membership. The SCL-90-defined structure of opioid addiction seems to represent a trait-dependent, rather than a state-dependent psychopathology also in non-substance-related disorders of addictive disorders, further supporting the existence of a specific psychopathology of addiction.