Skip to main content Accessibility help

The role of self-reported impulsivity and reward sensitivity versus neurocognitive measures of disinhibition and decision-making in the prediction of relapse in pathological gamblers

  • A. E. Goudriaan (a1) (a2) (a3), J. Oosterlaan (a2), E. De Beurs (a4) and W. Van Den Brink (a1)



Disinhibition and decision-making skills play an important role in theories on the cause and outcome of addictive behaviors such as substance use disorders and pathological gambling. In recent studies, both disinhibition and disadvantageous decision-making strategies, as measured by neurocognitive tests, have been found to influence the course of substance use disorders. Research on factors affecting relapse in pathological gambling is scarce.


This study investigated the effect of both self-reported impulsivity and reward sensitivity, and neurocognitively assessed disinhibition and decision-making under conflicting contingencies, on relapse in a group of 46 pathological gamblers.


Logistic regression analysis indicated that longer duration of the disorder and neurocognitive indicators of disinhibition (Stop Signal Reaction Time) and decision-making (Card Playing Task) were significant predictors of relapse (explaining 53% of the variance in relapse), whereas self-reported impulsivity and reward sensitivity did not significantly predict relapse. Overall classification accuracy was 76%, with a positive classification accuracy of 76% and a negative classification accuracy of 75%.


Duration of the disorder and neurocognitive measures of disinhibition and decision-making are powerful predictors of relapse in pathological gambling. The results suggest that endophenotypical neurocognitive characteristics are more promising in the prediction of relapse in pathological gambling than phenotypical personality characteristics. Neurocognitive predictors may be useful to guide treatment planning of follow-up contacts and booster sessions.


Corresponding author

*Address for correspondence: A. E. Goudriaan, Ph.D., Academic Medical Center, Department of Psychiatry, University of Amsterdam, Room PB0-433, PO Box 75867, 1070 AWAmsterdam, The Netherlands. (Email: or


Hide All
Aharonovich, E, Nunes, E, Hasin, D (2003). Cognitive impairment, retention and abstinence among cocaine abusers in cognitive-behavioral treatment. Drug and Alcohol Dependence 71, 207211.
Allsop, S, Saunders, B, Phillips, M (2000). The process of relapse in severely dependent male problem drinkers. Addiction 95, 95106.
APA (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn (DSM-IV). American Psychiatric Association: Washington, DC.
Babor, TF, Cooney, NL, Lauerman, RJ (1987). The dependence syndrome concept as a psychological theory of relapse behaviour: an empirical evaluation of alcoholic and opiate addicts. British Journal of Addiction 82, 393405.
Bachorowski, JA, Newman, JP (1990). Impulsive motor behavior: effects of personality and goal salience. Journal of Personality and Social Psychology 58, 512518.
Bates, ME, Barry, D, Labouvie, EW, Fals-Stewart, W, Voelbel, G, Buckman, JF (2004). Risk factors and neuropsychological recovery in clients with alcohol use disorders who were exposed to different treatments. Journal of Consulting and Clinical Psychology 72, 10731080.
Bates, ME, Bowden, SC, Barry, D (2002). Neurocognitive impairment associated with alcohol use disorders: implications for treatment. Experimental and Clinical Psychopharmacology 10, 193212.
Bauer, LO (2001). Predicting relapse to alcohol and drug abuse via quantitative electroencephalography. Neuropsychopharmacology 25, 332340.
Bechara, A, Damasio, H (2002). Decision-making and addiction (Part I): impaired activation of somatic states in substance dependent individuals when pondering decisions with negative future consequences. Neuropsychologia 40, 16751689.
Bechara, A, Damasio, AR, Damasio, H, Anderson, SW (1994). Insensitivity to future consequences following damage to human prefrontal cortex. Cognition 50, 715.
Bechara, A, Dolan, S, Hindes, A (2002). Decision-making and addiction (Part II): myopia for the future or hypersensitivity to reward? Neuropsychologia 40, 16901705.
Blanco, C, Moreyra, P, Nunes, EV, Saiz-Ruiz, J, Ibanez, A (2001). Pathological gambling: addiction or compulsion? Seminars in Clinical Neuropsychiatry 6, 167176.
Blaszczynski, A, McConaghy, N, Frankova, A (1991). A comparison of relapsed and non-relapsed abstinent pathological gamblers following behavioural treatment. British Journal of Addiction 86, 14851489.
Blum, K, Braverman, ER, Holder, JM, Lubar, JF, Monastra, VJ, Miller, D, Lubar, JO, Chen, TJ, Comings, DE (2000). Reward deficiency syndrome: a biogenetic model for the diagnosis and treatment of impulsive, addictive, and compulsive behaviors. Journal of Psychoactive Drugs 32 (Suppl.), 1112.
Bolla, KI, Eldreth, DA, London, ED, Kiehl, KA, Mouratidis, M, Contoreggi, C, Matochik, JA, Kurian, V, Cadet, JL, Kimes, AS, Funderburk, FR, Ernst, M (2003). Orbitofrontal cortex dysfunction in abstinent cocaine abusers performing a decision-making task. Neuroimage 19, 10851094.
Bottlender, M, Soyka, M (2005). Out-patient alcoholism treatment: predictors of outcome after 3 years. Drug and Alcohol Dependence 80, 8389.
Bowden-Jones, H, McPhillips, M, Rogers, R, Hutton, S, Joyce, E (2005). Risk-taking on tests sensitive to ventromedial prefrontal cortex dysfunction predicts early relapse in alcohol dependency: a pilot study. Journal of Neuropsychiatry and Clinical Neuroscience 17, 417420.
Busemeyer, JR, Stout, JC (2002). A contribution of cognitive decision models to clinical assessment: decomposing performance on the bechara gambling task. Psychological Assessment 14, 253.
Carver, CS, White, TL (1994). Behavioral inhibition, behavioral activation, and affective responses to impending reward and punishment: the bis/bas scales. Journal of Personality and Social Psychology 67, 319333.
Deckel, AW, Bauer, L, Hesselbrock, V (1995). Anterior brain dysfunctioning as a risk factor in alcoholic behaviors. Addiction 90, 13231334.
Delucchi, KL, Matzger, H, Weisner, C (2004). Dependent and problem drinking over 5 years: a latent class growth analysis. Drug and Alcohol Dependence 74, 235244.
Doran, N, Spring, B, McChargue, D, Pergadia, M, Richmond, M (2004). Impulsivity and smoking relapse. Nicotine and Tobacco Research 6, 641647.
Fals-Stewart, W (1993). Neurocognitive deficits and their impact on substance abuse treatment. Journal of Addictions and Offender Counseling 13, 4657.
Fals-Stewart, W, Schafer, J (1992). The relationship between length of stay in drug-free therapeutic communities and neurocognitive functioning. Journal of Clinical Psychology 48, 539543.
Giancola, PR, Moss, HB (1998). Executive cognitive functioning in alcohol use disorders. Recent Developments in Alcohol Research 14, 227251.
Goldstein, RZ, Volkow, ND (2002). Drug addiction and its underlying neurobiological basis: neuroimaging evidence for the involvement of the frontal cortex. American Journal of Psychiatry 159, 16421652.
Goldstein, RZ, Volkow, ND, Wang, GJ, Fowler, JS, Rajaram, S (2001). Addiction changes orbitofrontal gyrus function: involvement in response inhibition. Neuroreport 12, 25952599.
Gottesman, II, Gould, TD (2003). The endophenotype concept in psychiatry: etymology and strategic intentions. American Journal of Psychiatry 160, 636645.
Gottlieb, LD, Horwitz, RI, Kraus, ML, Segal, SR, Viscoli, CM (1994). Randomized controlled trial in alcohol relapse prevention: role of atenolol, alcohol craving, and treatment adherence. Journal of Substance Abuse Treatment 11, 253258.
Goudriaan, AE, Oosterlaan, J, de Beurs, E, van den Brink, W (2005). Decision-making in pathological gambling: a comparison between pathological gamblers, alcohol dependents, persons with Tourette syndrome, and normal controls. Brain Research: Cognitive Brain Research 23, 137151.
Goudriaan, AE, Oosterlaan, J, De Beurs, E, van den Brink, W (2006). Neurocognitive functions in pathological gambling: a comparison with alcohol dependence, Tourette syndrome, and normal controls. Addiction 101, 534547.
Groth-Marnat, G (1997). Handbook of Psychological Assessment. John Wiley & Sons: New York.
Hammes, JW (1971). De stroop kleur-woord test: Handleiding [The Stroop color-word test: Manual]. Swets & Zeitlinger: Lisse, The Netherlands.
Hesselbrock, V, Begleiter, H, Porjesz, B, O'Connor, S, Bauer, L (2001). P300 event-related potential amplitude as an endophenotype of alcoholism – evidence from the collaborative study on the genetics of alcoholism. Journal of Biomedical Science 8, 7782.
Horner, MD, Waid, LR, Johnson, DE, Latham, PK, Anton, RF (1999). The relationship of cognitive functioning to amount of recent and lifetime alcohol consumption in out-patient alcoholics. Addictive Behaviors 24, 449453.
Hosmer, DW, Lemeshow, S (2000). Applied Logistic Regression. Wiley: New York.
Hser, YI, Hoffman, V, Grella, CE, Anglin, MD (2001). A 33-year follow-up of narcotics addicts. Archives of General Psychiatry 58, 503508.
Kambouropoulos, N, Staiger, PK (2001). The influence of sensitivity to reward on reactivity to alcohol-related cues. Addiction 96, 11751185.
Kubota, M, Nakazaki, S, Hirai, S, Saeki, N, Yamaura, A, Kusaka, T (2001). Alcohol consumption and frontal lobe shrinkage: study of 1432 non-alcoholic subjects. Journal of Neurology, Neurosurgery, and Psychiatry 71, 104106.
Langenbucher, J, Sulesund, D, Chung, T, Morgenstern, J (1996). Illness severity and self-efficacy as course predictors of DSM-IV alcohol dependence in a multisite clinical sample. Addictive Behaviors 21, 543553.
Latimer, WW, Winters, KC, Stinchfield, R, Traver, RE (2000). Demographic, individual, and interpersonal predictors of adolescent alcohol and marijuana use following treatment. Psychology of Addictive Behaviors 14, 162173.
Ledgerwood, DM, Petry, NM (2006). What do we know about relapse in pathological gambling? Clinical Psychology Review 26, 216228.
Logan, GD, Cowan, WB, Davis, KA (1984). On the ability to inhibit simple and choice reaction time responses: a model and a method. Journal of Experimental Psychology: Human Perception and Performance 10, 276291.
Markianos, M, Lykouras, L, Moussas, G, Hatzimanolis, J (2001). Changes in dopamine receptor responsivity during alcohol detoxification may predict relapse. Drug and Alcohol Dependence 64, 363365.
Marks, I (1990). Behavioural (non-chemical) addictions. British Journal of Addiction 85, 13891394.
Martin-Soelch, C, Leenders, KL, Chevalley, AF, Missimer, J, Kunig, G, Magyar, S, Mino, A, Schultz, W (2001). Reward mechanisms in the brain and their role in dependence: evidence from neurophysiological and neuroimaging studies. Brain Research Reviews 36, 139149.
Moeller, FG, Dougherty, DM, Barratt, ES, Schmitz, JM, Swann, AC, Grabowski, J (2001). The impact of impulsivity on cocaine use and retention in treatment. Journal of Substance Abuse Treatment 21, 193198.
Monterosso, J, Ehrman, R, Napier, KL, O'Brien, CP, Childress, AR (2001). Three decision-making tasks in cocaine-dependent patients: do they measure the same construct? Addiction 96, 18251837.
Monti, PM, Rohsenow, DJ, Hutchison, KE, Swift, RM, Mueller, TI, Colby, SM, Brown, RA, Gulliver, SB, Gordon, A, Abrams, DB (1999). Naltrexone's effect on cue-elicited craving among alcoholics in treatment. Alcoholism, Clinical and Experimental Research 23, 13861394.
National Research Council, Committee on the Social and Economic Impact of Pathological Gambling (1999). Pathological Gambling: A Critical Review. National Academy Press: Washington, DC.
Newman, JP, Patterson, CM, Kosson, DS (1987). Response perseveration in psychopaths. Journal of Abnormal Psychology 96, 145148.
O'Neill, J, Cardenas, VA, Meyerhoff, DJ (2001). Separate and interactive effects of cocaine and alcohol dependence on brain structures and metabolites: quantitative MRI and proton MR spectroscopic imaging. Addiction Biology 6, 347361.
Ooteman, W, Verheul, R, Naasila, M, Daoust, M, Schippers, G, Koeter, MWJ, van den Brink, W (2005). Patient-treatment matching with anti-craving medications in alcohol-dependent patients: a review on phenotypic, endophenotypic and genetic indicators. Journal of Substance Use 10, 7596.
Paraherakis, A, Charney, DA, Gill, K (2001). Neuropsychological functioning in substance-dependent patients. Substance Use and Misuse 36, 257271.
Patton, JH, Stanford, MS, Barratt, ES (1995). Factor structure of the Barratt impulsiveness scale. Journal of Clinical Psychology 51, 768774.
Paulus, MP, Tapert, SF, Schuckit, MA (2005). Neural activation patterns of methamphetamine-dependent subjects during decision-making predict relapse. Archives of General Psychiatry 62, 761768.
Potenza, MN, Leung, HC, Blumberg, HP, Peterson, BS, Fulbright, RK, Lacadie, CM, Skudlarski, P, Gore, JC (2003). An fMRI Stroop task study of ventromedial prefrontal cortical function in pathological gamblers. American Journal of Psychiatry 160, 19901994.
Putman, P, Hermans, E, van Honk, J (2004). Emotional Stroop performance for masked angry faces: it's bas, not bis. Emotion 4, 305.
Reuter, J, Raedler, T, Rose, M, Hand, I, Glascher, J, Buchel, C (2005). Pathological gambling is linked to reduced activation of the mesolimbic reward system. Nature Neuroscience 8, 147148.
Robins, L, Cottler, L, Bucholz, K, Compton, W (1998). Diagnostic Interview Schedule for DSM-IV (DIS-IV – Revision 11 Sep 1998). Department of Psychiatry, School of Medicine, Washington University: St Louis, MO.
Scheres, A, Oosterlaan, J, Sergeant, JA (2001). Response execution and inhibition in children with AD/HD and other disruptive disorders: the role of behavioural activation. Journal of Child Psychology and Psychiatry 42, 347357.
Simpson, DD, Joe, GW, Fletcher, BW, Hubbard, RL, Anglin, MD (1999). A national evaluation of treatment outcomes for cocaine dependence. Archives of General Psychiatry 56, 507514.
Smith, DE, McCrady, BS (1991). Cognitive impairment among alcoholics: impact on drink refusal skill acquisition and treatment outcome. Addictive Behaviors 16, 265274.
Stroop, JR (1935). Studies of interference in serial verbal reactions. Journal of Experimental Psychology 18, 643661.
Tamminga, CA, Nestler, EJ (2006). Pathological gambling: focusing on the addiction, not the activity. American Journal of Psychiatry 163, 180181.
Tapert, SF, Brown, SA, Myers, MG, Granholm, E (1999). The role of neurocognitive abilities in coping with adolescent relapse to alcohol and drug use. Journal of Studies on Alcohol 60, 500508.
Tarter, RE, Kirisci, L, Habeych, M, Reynolds, M, Vanyukov, M (2004). Neurobehavior disinhibition in childhood predisposes boys to substance use disorder by young adulthood: direct and mediated etiologic pathways. Drug and Alcohol Dependence 73, 121132.
Teichner, G, Horner, MD, Harvey, RT (2001). Neuropsychological predictors of the attainment of treatment objectives in substance abuse patients. International Journal of Neuroscience 106, 253263.
Teichner, G, Horner, MD, Roitzsch, JC, Herron, J, Thevos, A (2002). Substance abuse treatment outcomes for cognitively impaired and intact out-patients. Addictive Behaviors 27, 751763.
Vitaro, F, Arseneault, L, Tremblay, RE (1999). Impulsivity predicts problem gambling in low SES adolescent males. Addiction 94, 565575.
Volkow, ND, Fowler, JS, Wang, GJ, Goldstein, RZ (2002 a). Role of dopamine, the frontal cortex and memory circuits in drug addiction: insight from imaging studies. Neurobiology of Learning and Memory 78, 610624.
Volkow, ND, Wang, GJ, Maynard, L, Fowler, JS, Jayne, B, Telang, F, Logan, J, Ding, YS, Gatley, SJ, Hitzemann, R, Wong, C, Pappas, N (2002 b). Effects of alcohol detoxification on dopamine D2 receptors in alcoholics: a preliminary study. Psychiatry Research 116, 163172.
Waters, AJ, Shiffman, S, Sayette, MA, Paty, JA, Gwaltney, CJ, Balabanis, MH (2003). Attentional bias predicts outcome in smoking cessation. Health Psychology 22, 378387.
WHO (1997). Composite International Diagnostic Interview – Version 2.L. World Health Organization: Geneva.
Zuckerman, M, Kuhlman, M, Joireman, J, Teta, P, Kraft, M (1993). A comparison of three structural models for personality: the big three, the big five, and the alternative five. Journal of Personality and Social Psychology 65, 757768.


The role of self-reported impulsivity and reward sensitivity versus neurocognitive measures of disinhibition and decision-making in the prediction of relapse in pathological gamblers

  • A. E. Goudriaan (a1) (a2) (a3), J. Oosterlaan (a2), E. De Beurs (a4) and W. Van Den Brink (a1)


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed