Executive functioning in Asian pathological gamblers

Abstract

Two decades of neuropsychological research on predominantly Caucasian problem gamblers has unveiled significantly poorer performance on several domains of executive functioning (EF) relative to healthy controls. However, contradictory findings are widespread and evidence that pathological gamblers (PGs) are ‘impaired’ remains inconclusive. The study examined multiple facets of EF in 30 male, PGs seeking outpatient treatment in Singapore and 30 matched controls. CANTAB® tests of planning and organization/problem-solving, set-shifting, working memory and reflection impulsivity, were administered alongside the Barratt Impulsiveness Scale, Cognitive Failures Questionnaire and Dysexecutive Questionnaire. No significant group differences were found on any of the EF performance parameters, with performance falling in the healthy, unimpaired range for both groups. PGs did, however, report significantly greater impulsivity, everyday cognitive failures and symptoms of the dysexecutive syndrome. Exploratory analysis on a subgroup of PGs addicted to non-strategic gambling activities revealed poorer EF performance than among those addicted to strategic gambling activities. The findings suggest an absence of EF deficits despite higher trait impulsivity in Asian, predominantly strategic PGs. Hence, psychological interventions such as CBT and treatment approaches that emphasize the use of self-monitoring and informed decision-making to reduce impulsive behaviours should be suited to this population.

Keywords::

• strategic
• pathological gambling
• executive functioning
• reflection impulsivity
• Asian

Acknowledgements

The authors would like to express their gratitude to Mr Edimunsyah Abdin for his statistical consultation and the NAMS clinical staff for identification and referral of suitable patients.

Funding

This work was supported by the Institutional Block Grant, National Medical Research Council, Singapore, at the Institute of Mental Health and later by the Woodbridge Hospital Endowment Fund, Singapore. The authors have no conflict of interest.

Additional information

Notes on contributors

Victoria Manning

Victoria Manning is the Senior Research Manager at the National Addiction Management Service, Institute of Mental Health, and adjunct Assistant Professor at Duke-NUS Graduate Medical School, in Singapore. She holds visiting academic appointments at both Monash University, Australia and the Institute of Psychiatry, London, UK. She is a Chartered Psychologist, holds a PhD in addiction neuropsychology and a masters degree in health psychology. Her career in addictions research spans 15 years, with primary interests including the impact of substance abuse on cognitive functioning, identifying and enhancing treatment outcomes for substance and gambling disorder patients through both psychological and pharmacotherapy interventions.

Hui Chin Teoh

Teoh Hui Chin is a research officer at the National Addictions Management Service (NAMS), Institute of Mental Health, Singapore. She graduated from the National University of Singapore in 2009 with Bachelor of Social Science (Honors) majoring in psychology. Prior work experience in psychology includes areas of fMRI (neurocognition) and health sciences (stress and coping). She has completed two neuropsychological studies and another study of stress coping in family members of addiction patients. She is currently working on a validation study of neurocognitive screen for addiction patients and a clinical drug trial for opiate dependent inpatients.

Song Guo

Guo Song is a Consultant Psychiatrist and Head of Research at the National Addiction Management Service, Institute of Mental Health, as well as Assistant Professor of Duke-NUS, Singapore. He holds a PhD in psychopharmacology. Prior to working at NAMS he was a Senior Consultant and Professor of Psychiatry at Beijing Anding Hospital and Capital Medical University in China. His interests are primarily in pharmacogenetics, clinical trials and alternative medicine such as acupuncture for the treatment of addictions and the treatment outcomes of pathological gamblers.

Kim Eng Wong

Wong Kim Eng is an Emeritus Consultant Psychiatrist and the current Clinical Director of the National Addiction Management Service, Institute of Mental Health, which is the only tertiary service provider for patients with substance and behavioural addictions serving Singapore. She has an outstanding track record in clinical and leadership roles within Singapore's mental health care system, including a six-year term as the chairman of IMH medical board. Currently A/Prof. Wong has a specific interest in the co-morbidities of gambling and other addictive disorders.

Ting-Kai Li

Ting Kai Li has a distinguished career in addictions, being at the centre of advances that transform the understanding and means of investigating alcohol effects on the body and brain. One of Prof Li's many prominent leadership positions include an appointment as the director of the National Institute on Alcohol Abuse & Alcoholism (2002–2008). Currently as a Professor of Psychiatry & Behavioral Sciences at Duke University and Duke-NUS Singapore, Prof. Li has acted as a consultant advisor for the design and implementation of a programme of research on gambling and other addictions in Singapore for the past five years.