Neuroscience and Biobehavioral Reviews 45 (2014) 343–349 Contents lists available at ScienceDirect Neuroscience and Biobehavioral Reviews jou rn al h om epage: www.elsevier.com/locate/neubiorev Review Applying incentive sensitization models to behavioral addiction Kristine Rømer Thomsen a,* , Lone O. Fjorback b , Arne Møller a , Hans C. Lou a a Centre of Functionally Integrative Neuroscience, University of Aarhus, 8000 Aarhus C, Denmark b Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Denmark a r t i c l e i n f o Article history: Received 17 February 2014 Received in revised form 1 July 2014 Accepted 8 July 2014 Available online 15 July 2014 Keywords: Addiction Incentive salience Gambling Sensitization Craving Mindfulness a b s t r a c t The incentive sensitization theory is a promising model for understanding the mechanisms underlying drug addiction, and has received support in animal and human studies. So far the theory has not been applied to the case of behavioral addictions like Gambling Disorder, despite sharing clinical symptoms and underlying neurobiology. We examine the relevance of this theory for Gambling Disorder and point to predictions for future studies. The theory promises a significant contribution to the understanding of behavioral addiction and opens new avenues for treatment. © 2014 Elsevier Ltd. All rights reserved. Contents 1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 343 2. The incentive sensitization theory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 343 3. Gambling Disorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 344 4. Incentive sensitization in Gambling Disorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 345 4.1. Existing evidence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 346 4.2. Future directions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 346 5. Implications for treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 347 Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 347 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 347 1. Introduction Gambling Disorder 1 (GD) was recently classified as a behavioral addiction (American Psychiatric Association, 2013), due to overlap with drug addiction regarding symptoms and underlying neuro- biology. Accordingly, it is pertinent to take a look at some of the influential theories that have formed our understanding of drug addiction. Incentive sensitization (Robinson et al., 2013; Robinson and Berridge, 1993) is one such theory. Here we examine the relevance of this theory for GD by reviewing the relevant studies and outlining its predictions for future studies. Last, we discuss * Corresponding author. Tel.: +45 29916092. E-mail address: krth@cfin.dk (K. Rømer Thomsen). 1 In the recently released DSM-V the term ‘Pathological Gambling’ has been replaced by ‘Gambling Disorder’ (American Psychiatric Association, 2013). implications for treatment. By stressing the role of unconscious craving the theory points to new treatment strategies such as mindfulness-based interventions that aim at enhancing awareness of bodily and emotional signals. 2. The incentive sensitization theory Most people have experimented with recreational drugs at some point in their life (if we include alcohol), and for the vast majority this does not raise serious concerns. But for a small group of people the casual use leads to compulsive patterns of abuse with detri- mental consequences. The incentive sensitization theory offers a promising explanation of how drug-induced alterations in psycho- logical functioning can cause a transition to addiction, and pose a major risk for relapse. http://dx.doi.org/10.1016/j.neubiorev.2014.07.009 0149-7634/© 2014 Elsevier Ltd. All rights reserved.