Predicting the impact of cognitive functions and the gambling severity on the gambling craving with the moderating role of drug use history

Pathological gambling has captured the attention of researchers in recent years. Gambling craving is one of the fundamental and predictable factors of relapse.
Despite the abundance of craving research, most existing evidence has focused on a biomedical approach. Thus,  evidence concentrated on the physiological similarities between gambling disorder and substance use disorder rather than on the potential and unique features of gambling craving. Therefore, the study has not been specifically designed to provide an in-depth exploration of the cognitive processes involved in the initiation and persistence of gambling cravings. To our knowledge, most research in the field of gambling craving transferred what is known about drug craving into gambling craving, from scale development to hypothesis.
The literature assessmentreveals that craving remains a source of much dispute, and the evidence clearly suggests that a greater understanding of this concept has substantial implications for the prevention and treatment of many addictive disorders. Accordingly, the current study aims to predict the impact of gambling-related cognitive biases and gambling severity on gambling craving, with drug use history as a moderator.

In this study, 345 participants were evaluated with the gambling craving scale (GACS), gambling severity index (PGSI), and gambling-related cognitions scale (GRCS).
The study questionnaire has two parts and was distributed electronically; the return rate of questionnaires was 60%. After data preprocessing, 337 individuals remained in the study. It is noteworthy that due to the factor loading being lower than the cut-off point (R<0.7), the third and ninth questions of the GACS were excluded from the model. In addition,  due to Cronbach's alpha being lower than the cut-off point (α<0.7), the gambling desire variable was removed from the model becauseof the minimal number of unanswered questions in some variables (less than three). SPSS-26 and PLS-4 softwares were used for data analysis. Confirmatory factor analysis was performed on the 36 remaining model questions.

The present study aimed to estimate how gambling-related cognitive biases and the intensity of gambling will affect cravings for gambling, with drug use history acting as a moderator. The path analysis revealed that both gambling cognitions and gambling severity directly predicted gambling craving. In this study, 64.1% of respondents were females, and 35.9% were males. Moreover, the mean age was 31.06±9.23, and 48.9% were over 30 years; 63% were unmarried, and 37% were married. Regarding education, 4% had a degree under a high school diploma, 22.5% had a high school diploma, 5.1% had a post-highschool diploma, 27.5% had a Bachelor's, 32.2% had a Master's, and 8.7% had a PhD Furthermore, 39.5% were smokers, and 14.5% had a history of drug use. Among the participants, 50.4% had scores above 6 on the PGSI.
Data sphericity was examined (KMO=0.905 and P=0.001). Reliability and convergent validity were applied by Cronbach's alpha test (α>0.7), composite reliability indices (CR>0.7), and average variance extracted (AVE>0.5), and discriminate validity was calculated by HTMT (HTMT<0.9). R square of craving was average (r=0.377). The results showed that a drug use history increased the predictive power of gambling craving (r=0.376 to r=0.407). This study has five hypotheses, mentioned with significance, respectively; 1) Gambling cognitions affect gambling craving (β=0.622, P=0.001). 2) History of drug use affects gambling craving (β=-0.182, P=0.261). 3) Gambling severity affects gambling craving (β=0.441, P=0.004). 4) Drug use history has moderating effects on the relationship between gambling severity and gambling craving (β=-0.087, P=0.031). 5) Drug use history has moderating effects on the relationship between gambling cognitions and gambling craving (β=-0.355, P=0.688).
Gambling severity and gambling cognitions were direct predictors of gambling craving while having a considerable impact on craving. However, this predictive power increased among subjects with a drug use history and is claimed to be in the upper middle range. Unquestionably, those who have used drugs in the past who gamble report more acute cravings than those who have never used drugs. Additionally, a history of substance abuse cannot predict gambling desires, individually or in combination with cognitive deficits. Gamblers may suffer more extreme cravings if they have severe pathological gambling in addition to cognitive impairment. These findings suggest that the association of cognitive defects and the severity of gambling with a history of drug use increases the power of prediction.
According to the results of the current study, a systematic review that examined the role of desire in GD revealed that the tendency to gamble was connected to the severity, episodes of gambling, and pursuit of this condition. According to the literature, gambling craving is a component that affects gambling behavior. Because of the potential link between the severity of GD and craving, several writers have proposed craving as a diagnostic criterion for GD. The studies included in this systematic review, despite the differences in the structures, the sampled populations, and even the measurement scales, have almost aligned results. These overall findings indicate the importance of the craving in relapse and response to treatment in behavioral and substance addictions. Nevertheless, contrary to the findings of the current study, the results of a study that examined craving in drug users showed that continuous psychological stress is a predictor of changes in cognition, which is a predictor of craving.

Research on craving is necessary to develop new strategies for improving response to treatment and durability in treating individuals with GD. This structure is considered during therapy and evaluations; if necessary, alarm interventions should be carried out to control it.
Ethical considerations
Due to respect for privacy, the participants' identity information was not recorded, and all participants were assured that the information received would only be used for research purposes. Participation in this research was voluntary, and the participants were allowed to withdraw from the participation at any stage. This study was conducted with all ethical principles and the ethical code IR.ZUMS.REC.1399.449 of Zanjan University of Medical Sciences.
Authors' contributions
In this study, Mohsen Dadashi and Peyman Hassani-Abharian were responsible for choosing the topic, designing the study, defining the concepts, and writing the article. Rogheyeh Najafi-Dehjalali was responsible for data collecting, data analysis, and writing the initial text. Hojjatullah Farahani was a consultant for data analysis and took a share in writing the article, and Alireza Faridi took part in writing the article.

Funding
This study reports a part of the PhD dissertation of Rogheyeh Najafi-Dehjalali, supported by founding of Zanjan University of Medical Sciences.
Acknowledgments
The authors are grateful to all the respondents and Mohsen Moradi, who helped us conduct this study. In the end, this study was taken from a dissertation entitled "Investigation of cognitive, psychological and addiction complications of gambling, along with the validation and validation of questionnaires measuring the intensity of dependence, addiction, and cognitive behavioral complications of gambling in Iran" with the code 4193 of Zanjan University of Medical Sciences.
Conflict of interest
All authors declare that they have no conflict of interest.