516 resultados para Compulsive gambling


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Mental dependence, characterized by craving and impulsive seeking behavior, is the matter of intensive study in the field of drug addiction. The mesolimbic dopamine system has been suggested to play an important role in rewarding of drugs and relapse. Although chronic drug use can induce neuroadaptations of the mesolimbic system and changes of drug reinforcement, these mechanisms cannot fully account for the craving and the compulsive drug-using behavior of addicts. Acknowledging the reinforcement effects of drugs, most previous studies have studied the impact of environmental cues and conditioned learning on addiction behavior, often using established classical or operant conditioning model. These studies, however, paid little attention to the role of cognitive control and emotion in addiction. These mental factors that are believed to have an important influence on conditioned learning. The medial prefrontal cortex (mPFC) has close anatomic and functional connections with the mesolimbic dopamine system. A number of the cognitive neurological studies demonstrate that mPFC is involved in motivation, emotional regulation, monitoring of responses and other executive functions. Thus we speculated that the function of abnormality in mPFC following chronic drug use would cause related to the abnormal behavior in addicts including impulse and emotional changes. In the present study of a series of experiments, we used functional magnetic resonance imaging to examine the hemodynamic response of the mPFC and related circuits to various cognitive and emotional stimuli in heroin addicts and to explore the underlying dopamine neuromechnism by microinjection of tool drugs into the mPFC in laboratory animals. In the first experiment, we found that heroin patients, relative to the normal controls, took a much shorter time and committed more errors in completing the more demanding of cognitive regulation in the reverse condition of the task, while the neural activity in anterior cingulate cortex (ACC) was attenuated. In the second experiment, the scores of the heroin patients in self-rating depression scale (SDS) and Self-rating anxiety scale (SAS) were significantly higher than the normal controls and they rated the negative pictures more aversive than the normal controls. Being congruent with the behavioral results, hemodynamic response to negative pictures showed significant difference between the two groups in bilateral ventral mPFC (VMPFC), amygdala, and right thalamus. The VMPFC of patients showed increased activation than normal controls, whereas activation in the amygdala of patients was weaker than that in normal subjects. Our third experiment showed that microinjection of D1 receptor agonist SKF38393 into the mPFC of rats decreased hyperactivity, which was induced by morphine injection, in contrast, D1 receptor antagonist SCH23390 increased the hyperactivity, These findings suggest: (1) The behavior and neural activity in ACC of addicts changed in chronic drug users. Their impulsive behavior might result from the abnormal neural activity in the mPFC especially the ACC. (2) Heroine patients were more depress and anxiety than normal controls. The dysfunction of the mPFC---amygdala circuit of heroine addicts might be related to the abnormal emotion response. (3) Dopamine in the mPFC has an inhibitory effect on morphine induced behavior. The hyperactivity induced by chronic morphine was reduced by dopamine increase with D1 receptor agonist, confirm the first experiment that the neuroadaption of mPFC system induced by chronic morphine administration appears to be the substrate the impulse behavior of drug users.

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That relapse still exists even after prolonged withdrawal is a difficult issue in the medical cure of drug addiction. Neuro-adaptation induced by prolonged exposure to addictive drugs is the neural mechanisms of both compulsive drug seeking and relapse.Neuro-adaptation caused by addictive drugs increases the individuals’ response to drugs and on the other hand, it reduces the response to natural reward in withdrawn individuals.There must be common neural mechanisms between the co-existing phenomena, and there must also be unique neural mechanisms in the drugs.To reveal the neuro-adaptation arising in the process from random, controllable drug-use to uncontrollable compulsive drug seeking is of great significance both theoretically and practically.Based on the above hypothesis, in order to reveal the function of alpha adrenergic receptor in compulsive drug-seeking motivation during the process of drug addiction, using sensitization of morphine-induced psychomotor activity as behavioral model, through the method of behavioral pharmacology, the neural mechanisms of alpha adrenergic receptor’s involvement in the process of addiction has been studied.The adjustment function caused by alpha receptors in medial prefrontal cortex and nucleus accumbens to morphine-induced psychomotor activity has been compared in the period of first use of drugs and in repetitive-use period. Furthermore, the effect on novelty seeking caused by alpha-receptors in relevant brain areas has also been compared. Major results are as follow: 1 After prolonged morphine exposure, rats’ response to morphine-induced psychomotor activity is strengthened and response to novel object induced reward weakened. 2 Injection of prazosin in medial prefrontal cortex will block morphine-induced psychomotor activity of naïve rats, however, it will not block that of morphine-withdrawn rats, but it will block the novelty seeking behavior of morphine-withdrawn rats. 3 Injection of clonidine in medial prefrontal cortex will block morphine-induced psychomotor effect of both naïve rats and morphine-withdrawn rats, and will block the novelty seeking behavior of morphine-withdrawn rats. 4 Injection of prazosin in nucleus accumbens will not affect the morphine-induced psychomotor effect of either naïve rats or morphine-withdrawn rats, nor will it affect the novelty seeking behavior of morphine-withdrawn rats. 5 Injection of clonidine in nucleus accumbens will block morphine-induced psychomotor effect of naïve rats, however, it will not block that of morphine-withdrawn rats, nor will it affect the novelty seeking behavior of morphine-withdrawn rats. These results show: 1 The weakening of the function of alpha1 receptors in medial prefrontal cortex and alpha2 receptors in nucleus accumbens caused by repetitive exposure to morphine is probably the cause of compulsive drug-seeking activity. 2 Blocking alpha1 receptors in medial prefrontal cortex accelerates the loss of interest in natural reward after morphine withdrawal. 3 Blocking alpha2 receptors in medial prefrontal cortex not only restrains drug-seeking motivation, but also blocks the individual’s seeking motivation for novelty stimulus, which suggests that, while selecting medicine for curing addiction, it should be considered to reduce the influence on natural reward as much as possible and to avoid major side-effect.

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In recent years, the deficit of inhibition has become an important reason for explaining addiction. Response inhibition resembles the compulsive drug seeking behavior and it is the basement of addiction inhibition deficits. However, there were no enough evidence for the relationship between addiction and response inhibition deficits and the results of the neuro mechanisms studies remains unclear. Few studies has focused on the exploring the heroin users. Among those paradigms for study response inhibition deficits, stop signal is a very suitable model for the representation of compulsive drug seeking, but only a few researches has worked on this paradigm. In this study, we selected about 100 heroin abusers and had behaviour and neuro imaging scannings for investigating the response inhibition deficits. The behaviour researches found: first, the chronic heroin users had longer reaction time than control group and this reaction time were not affected by stop signals in heroin users. Second, heroin users had less waiting time than control group and they were more impulsive but less flexibility. Their erro monitoring and flexibale adjustment ability decreased. Third, the SSRT of heroin users was significantly longer than control group. These results suggested that the inhibition of heroin users were impaired. Further investigation showed that the SSRT of heroin users had positive correlation of four factor scores of ASI and the macro correlation coefficient was factor three of drug use. This correlation suggested that drug use was the main reason of inhibition deficits. fMRI results mainly focused on the ANOVA analysis for group difference. First, there was no intensity difference in M1 and SMA brain areas between the two groups. Second, heroin users had less activation in right dorsalateral prefrontal cortex, right inferior prefrontal cortex and anterior cingulated cortex, while in bilateral striatum and amygdala, heroin users had more activation than control group. The right prefrontal cortex was indentified as the main inhibition brain area. The anterior cingulated cortex has relationship with erro monitoring and amygdale was an important brain area for impulsivity and emotion control. The network of these brain areas was envovled in impulsivity and inhibition and it was suggested the mainly damaged network for heroin users’ disinhibition. We also investigated the gray matter changes of heroin users and found that chonic heroin use made their gray matter density decreased in prefrontal cortex (including bilateral dorsalateral prefrontal cortex, obital frontal cortex, inferior prefrontal cortex) and anterior cingulated cortex. The gray matter density in these brain regions had negative correlation with drug use duration. In conclusion, we indentified the disinhibition of heroin users and its neuro mechanism. Their compulsivity brain areas had more activation than control group and their inhibition brain areas had less activation than normal control. On the other side, the biological mechanism of this activation changes was the gray matter density decrease in these brain areas.

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In Kermer, Driver-Linn, Wilson and Gilbert’s (2006) study on affective forecast, they found that people have a tendency to overestimate affective reactions in gains and losses, and people expect losses to have greater hedonic impact than gains of equal magnitude. Because of thus affective forecasting error, people prefer to irrationally avoid losses. Loss aversion is then seen as both a wealth-maximizing error and an affect-maximizing error. The present study examined the relationships among affective forecast, affective experience and loss aversion, and tested Kermer et al.’s (2006) conclusion that people’s loss aversion is an affective forecasting error. In experiment 1, we examined the relationship between affective forecast and loss aversion. Kermer et al.’s (2006) hypothesized that when people expect losses to have greater hedonic impact than gains, they will accept the gambling task, and when people expect gains to have greater hedonic impact than losses, they will refuse the gambling task. We found that (1) individuals with lower loss aversion had a greater tendency to accept a gambling task than those with higher loss aversion; (2) individuals with lower loss aversion expected losses and gains to have smaller affective impacts than those with higher loss aversion. Thus, people never exactly calculated their forecasting affective. In experiment 2, we examined the relationship between affective forecast and affective experience. Consistent with Kermer et al.’s (2006) finding, we found that our participants tended to overestimate affective reactions in gains as well as losses. More interestingly, Kermer et al.’s (2006) found that participants’ predictions for a loss were significantly more distant from experienced emotions than were their predictions for a win, we, however, found the opposite —participants’ predictions for a win were significantly more distant from the experienced emotions than were their predictions for a loss. These experiments further validated the relations between affection and decision making, and contributed to our understanding on the affective reactions to future events. Our study imply that it was not the exact calculation of affective forecast on decision outcomes, but rather the magnitude of affection on outcomes, that influenced people’s affective decision making. It indicated that those with lower magnitude of affection would less like to avoid losses, and thus more like to accept a gambling task.

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The present research firstly reviewed the experimental literature on probability expression and probability judgment, hypothesizing that individuals’ preference of probability expressions (verbal probability vs. numerical probability) and tendency for overextremity in probability judgment might differ with respect to different types of uncertainty. Five studies were conducted to test this hypothesis. In Study 1, questionnaires were used to explore the communication preference among Chinese-speaking people. Study 2 adapted the View of Uncertainty Questionnaire to explore the difference of verbal answers to three kinds of uncertainty. Study 3 and Study 4 used methods of the paper-and-pencil questionnaire and the laboratory experiment, respectively, to test the effects of uncertainty types on the preference of probability expressions and on the tendency for over-extreme probability judgment. Finally, Study 5 focused on individuals’ preference of probability expressions under various kinds of scenarios. The results were as follows: 1. The Communication Model Preference paradox phenomenon appears to be even more pronounced in the Chinese culture than in American English cultural settings. 2. The Chinese prefer more verbal probability expressions when communicating uncertainty in a weather-forecasting context than in a general context. 3. Sample groups with lower level of westernization tend to give more extreme answers and less probabilistic answers. 4. Types of uncertainty did have effects on individuals’ tendency for over-extreme probability judgment: under a traditional probability judgment task, people tend to be more over-extreme on internal uncertainty events than on external uncertainty events; however, this result is reversed under a gambling task. 5. Individuals’ preference for verbal probability expressions is more salient on internal uncertain events than on external uncertain events.

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Addiction can be investigated from the perspective of decision making. Addicts usually make incorrect decisions when facing drug-related cues or they are driven to drugs, resulting in repeated drug seeking and taking. The present study adopted temporal discounting as behavioral task and on the basis of the fact that heroin addicts discounted more steeply than health participants (addicts preferred to choose immediate but smaller reward, regarded as myopia) which was consistent with previous research, three questions was raised and being concentrated on in this study. The first question was whether the character of myopia would be revealed in a somewhat complicated task? We designed a card game in which the participants were tested whether they would play the trump card in order to win a trick but not the whole game. Addicts played the trump card significantly earlier than controls did, indicating they focused on immediate single trick but not the game. Moreover, the performance in the card game and temporal discounting correlated significantly, suggesting addicts would display myopic decision not only in simply task like temporal discounting but also in task more complicated and similar to daily-life decision. Secondly, the present study adopted various kinds of temporal discounting tasks. In previous research, temporal discounting gain task was usually adopted. In the present study, we also adopted temporal discounting loss task. In either gain or loss task, there are two delayed amounts. Results showed in each decision condition addicts made poorer performance compared with control but in larger amount condition, addicts actually improved their decision performance. Meanwhile, addicts did not show loss aversion due to their close discount rates in gain and loss task while for controls, the discount rates were much lower in loss task than those in gain task. Thus we demonstrated that addicts were insensitive to negative outcomes by the method of temporal discounting. Finally, we investigated three mechanisms which exerted impacts on decision making. We adopted Go/NoGo task to test impulsivity and found addicts commits more errors (higher impulsivity) than controls did. We also designed a behavioral task which could be used to test drug-related compulsive behavior on human participants. Results showed addicts produced stereotyped key-pressing behavior when presented with drug-related cues. Furthermore, it was found participants with higher impulsivity displayed poorer performance in decision making but addicts with higher compulsivity only made poorer performance in smaller amount decision and the correlation between compulsivity and decision making was relative weak. In order to investigate the role of susceptibility and effect of drugs, we adopted years of abusing heroin as the indictor and discovered addicts with longer history of heroin abusing made poorer performance in smaller amount condition than addicts with shorter history. Also, the earlier the addicts began to use drug, the worse they would do in the smaller amount decision. The results here indicated drug itself could exert impact on decision making in certain condition. The present study revealed three characters of heroin addicts from the aspect of decision making: (1) focusing upon current benefit due to they preferred to choose immediate gain and delayed loss; (2) showed no loss aversion compared with healthy participants (3) inability to inhibit inappropriate response particularly when facing drug-related cue. These characters contribute to the facts that addicts seek and take drugs repeatedly while ignoring the negative consequences caused by abusing drugs.

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Obsessive-Compulsive Symptoms, which are one of common factors effected on mental health of secondary school students, have been rarely studied at home and abroad. In accordance with the problems existed in these literature up till now, the thesis had mainly studied the measured tool, contents and structure, developmental features, psychosocial risk factors and integrated model of obsessive-compulsive symptoms from them by means of investigation with quetionnaires. The entire research was divided into three phases. 3185 students(age 14.68±1.75 years) were firstly measured with the 20-item Leyton Obsessional Inventory-Child Version(LOI-CV) at four secondary schools including six grades in Beijing city, which was applied to revise LOI-CV, and to study the structure and contents, developmental features and screen of obsessive-compulsive symptoms. Then, 216 subjects with obsessive-compulsive symptoms, paired with controls in the light of school, grade and gender, were investigated with 10 self-rating scales on obsessive-compulsive symptoms, anxiety, depression, personality, coping and attributional style, negative life events, parent's rearing style, family environment and life adaptation in school, and with an inventory on social demography. The results were used to explore psychosocial risk factors and integrated model of obsessive-compulsive symptoms. The third survey was only carried out, about two months after the second, among 264 subjects with obsessive-compulsive symptoms through MMOCI and Negative Life Event Scale for Adolescents, in order to probe into the integrated model. The research had mainly found: (1) LOI-CV can be used as a screen tool for obsessive-compulsive symptoms in urban adolescents in China; (2) Total screening-out ratio of obsessive-compulsive symptoms was 13.6% (male:15.0%, female:12.2%). The most common manifestations of obsessive-compulsive symptoms were hating dirt and contamination, doing things in exact manner, angry if someone messes desk, bad conscience but no one else, worry about cleanliness, repeated thoughts or words; the least were favorite or special number, spending extra time on homework, special number or words to avoid, talking or moving to avoid bad luck, fussy about hands. The checking and repetition, cleanliness and tidiness, general obsessions were more common forms than numbers-luck; (3) No differences were existed in serious degree of obsessive-compulsive symptoms, but the screening-out ratio in male was higher than it in female; (4) No differences were detected in the serious degree of obsessive-compulsive symptoms except the scores of cleanliness and tidiness among grades, but the screening-out ratio of the grades justly entering secondary school or going to graduate were higher than other ones; (5) The main psychosocial risk factors for obsessive-compulsive symptoms included anxiety, mother's over-protecting and over-interfering, fantasy, flexibility, self-actualization, peers relationship, sense of responsibility, negative life events, mother's occupation, help-seeking, and (6) The integrated model on psychosocial risk factors suggested that the possible developed and sustained mechanism of obsessive-compulsive symptoms was that personality, coping and attributional styles constructed the developmental diathesis foundation of obsessive-compulsive symptoms; negative life events were promoting factors of them. There was a dynamic interaction between personality and environmental factors. Negative emotion played a core role in the developmental process of them. The continued existence of obsessive-compulsive symptoms was related to pre-existed obsessive-compulsive symptoms and negative life events experienced by an individual. Therefore, this research not only let us get a deeper understanding of obsessive-compulsive symptoms and more entirely find out psychosocial risk factors, firstly applied diathesis-stress theory to comprehend the psychological mechanism of obsessive-compulsive symptoms and, moreover, elaborate and expand it, but also has more important practice significance of treatment, prevent and education for obsessive-compulsive symptoms in secondary school students.

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null RAE2008

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We use information from the television game show with the highest guaranteed average payoff in the United States, Hoosier Millionaire, to analyze risktaking in a high-stakes experiment. We characterize gambling decisions under alternative assumptions about contestant behavior and preferences, and derive testable restrictions on individual risk attitudes based on this characterization. We then use an extensive sample of gambling decisions to estimate distributions of risk-aversion parameters consistent with the theoretical restrictions and revealed preferences. We find that although most contestants display risk-averse preferences, the extent of the risk aversion implied by our estimates varies substantially with the stakes involved in the different decisions.

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BACKGROUND: Most information about the lifetime prevalence of mental disorders comes from retrospective surveys, but how much these surveys have undercounted due to recall failure is unknown. We compared results from a prospective study with those from retrospective studies. METHOD: The representative 1972-1973 Dunedin New Zealand birth cohort (n=1037) was followed to age 32 years with 96% retention, and compared to the national New Zealand Mental Health Survey (NZMHS) and two US National Comorbidity Surveys (NCS and NCS-R). Measures were research diagnoses of anxiety, depression, alcohol dependence and cannabis dependence from ages 18 to 32 years. RESULTS: The prevalence of lifetime disorder to age 32 was approximately doubled in prospective as compared to retrospective data for all four disorder types. Moreover, across disorders, prospective measurement yielded a mean past-year-to-lifetime ratio of 38% whereas retrospective measurement yielded higher mean past-year-to-lifetime ratios of 57% (NZMHS, NCS-R) and 65% (NCS). CONCLUSIONS: Prospective longitudinal studies complement retrospective surveys by providing unique information about lifetime prevalence. The experience of at least one episode of DSM-defined disorder during a lifetime may be far more common in the population than previously thought. Research should ask what this means for etiological theory, construct validity of the DSM approach, public perception of stigma, estimates of the burden of disease and public health policy.

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BACKGROUND: Serotonin is a neurotransmitter that has been linked to a wide variety of behaviors including feeding and body-weight regulation, social hierarchies, aggression and suicidality, obsessive compulsive disorder, alcoholism, anxiety, and affective disorders. Full understanding of serotonergic systems in the central nervous system involves genomics, neurochemistry, electrophysiology, and behavior. Though associations have been found between functions at these different levels, in most cases the causal mechanisms are unknown. The scientific issues are daunting but important for human health because of the use of selective serotonin reuptake inhibitors and other pharmacological agents to treat disorders in the serotonergic signaling system. METHODS: We construct a mathematical model of serotonin synthesis, release, and reuptake in a single serotonergic neuron terminal. The model includes the effects of autoreceptors, the transport of tryptophan into the terminal, and the metabolism of serotonin, as well as the dependence of release on the firing rate. The model is based on real physiology determined experimentally and is compared to experimental data. RESULTS: We compare the variations in serotonin and dopamine synthesis due to meals and find that dopamine synthesis is insensitive to the availability of tyrosine but serotonin synthesis is sensitive to the availability of tryptophan. We conduct in silico experiments on the clearance of extracellular serotonin, normally and in the presence of fluoxetine, and compare to experimental data. We study the effects of various polymorphisms in the genes for the serotonin transporter and for tryptophan hydroxylase on synthesis, release, and reuptake. We find that, because of the homeostatic feedback mechanisms of the autoreceptors, the polymorphisms have smaller effects than one expects. We compute the expected steady concentrations of serotonin transporter knockout mice and compare to experimental data. Finally, we study how the properties of the the serotonin transporter and the autoreceptors give rise to the time courses of extracellular serotonin in various projection regions after a dose of fluoxetine. CONCLUSIONS: Serotonergic systems must respond robustly to important biological signals, while at the same time maintaining homeostasis in the face of normal biological fluctuations in inputs, expression levels, and firing rates. This is accomplished through the cooperative effect of many different homeostatic mechanisms including special properties of the serotonin transporters and the serotonin autoreceptors. Many difficult questions remain in order to fully understand how serotonin biochemistry affects serotonin electrophysiology and vice versa, and how both are changed in the presence of selective serotonin reuptake inhibitors. Mathematical models are useful tools for investigating some of these questions.

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Background: Serotonin signaling influences social behavior in both human and nonhuman primates. In humans, variation upstream of the promoter region of the serotonin transporter gene (5-HTTLPR) has recently been shown to influence both behavioral measures of social anxiety and amygdala response to social threats. Here we show that length polymorphisms in 5-HTTLPR predict social reward and punishment in rhesus macaques, a species in which 5-HTTLPR variation is analogous to that of humans. Methodology/Principal Findings: In contrast to monkeys with two copies of the long allele (L/L), monkeys with one copy of the short allele of this gene (S/L) spent less time gazing at face than non-face images, less time looking in the eye region of faces, and had larger pupil diameters when gazing at photos of a high versus low status male macaques. Moreover, in a novel primed gambling task, presentation of photos of high status male macaques promoted risk-aversion in S/L monkeys but promoted risk-seeking in L/L monkeys. Finally, as measured by a "pay-per-view" task, S/L monkeys required juice payment to view photos of high status males, whereas L/L monkeys sacrificed fluid to see the same photos. Conclusions/Significance: These data indicate that genetic variation in serotonin function contributes to social reward and punishment in rhesus macaques, and thus shapes social behavior in humans and rhesus macaques alike. © 2009 Watson et al.

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Three hundred participants, including volunteers from an obsessional support group, filled in questionnaires relating to disgust sensitivity, health anxiety, anxiety, fear of death, fear of contamination and obsessionality as part of an investigation into the involvement of disgust sensitivity in types of obsessions. Overall, the data supported the hypothesis that a relationship does exist between disgust sensitivity and the targeted variables. A significant predictive relationship was found between disgust sensitivity and total scores on the obsessive compulsive inventory (OCI; Psychological Assessment 10 (1998) 206) for both frequency and distress of symptomatology. Disgust sensitivity scores were significantly related to health anxiety scores and general anxiety scores and to all the obsessional subscales, with the exception of hoarding. Additionally, multiple regression analyses revealed that disgust sensitivity may be more specifically related to washing compulsions: frequency of washing behaviour was best predicted by disgust sensitivity scores. Washing distress scores were best predicted by health anxiety scores, though disgust sensitivity entered in the second model. It is suggested that further research on the relationship between disgust sensitivity and obsessionality could be helpful in refining the theoretical understanding of obsessions.

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Rapid tryptophan (Trp) depletion (RTD) has been reported to cause deterioration in the quality of decision making and impaired reversal learning, while leaving attentional set shifting relatively unimpaired. These findings have been attributed to a more powerful neuromodulatory effect of reduced 5-HT on ventral prefrontal cortex (PFC) than on dorsolateral PFC. In view of the limited number of reports, the aim of this study was to independently replicate these findings using the same test paradigms. Healthy human subjects without a personal or family history of affective disorder were assessed using a computerized decision making/gambling task and the CANTAB ID/ED attentional set-shifting task under Trp-depleted (n=17; nine males and eight females) or control (n=15; seven males and eight females) conditions, in a double-blind, randomized, parallel-group design. There was no significant effect of RTD on set shifting, reversal learning, risk taking, impulsivity, or subjective mood. However, RTD significantly altered decision making such that depleted subjects chose the more likely of two possible outcomes significantly more often than controls. This is in direct contrast to the previous report that subjects chose the more likely outcome significantly less often following RTD. In the terminology of that report, our result may be interpreted as improvement in the quality of decision making following RTD. This contrast between studies highlights the variability in the cognitive effects of RTD between apparently similar groups of healthy subjects, and suggests the need for future RTD studies to control for a range of personality, family history, and genetic factors that may be associated with 5-HT function.

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This article examines the two main reasons for the setting up of the Irish sweepstakes in 1930; the financial crisis facing voluntary hospitals and the tradition of using sweepstake gambling to raise funds for charitable purposes. Such gambling, although technically illegal, was prevalent and widely tolerated during the late 19th and early 20th centuries. The change of government that accompanied Irish independence in 1921 led to much confusion surrounding the law on gambling and large-scale sweepstakes proliferated during the early 1920s, many of them selling tickets illegally in Britain. At the same time the Irish voluntary hospitals faced a financial crisis that threatened their future, brought about by the adverse impact of war-time inflation on the value of their endowments, the emigration of supporters of the Protestant voluntary hospitals after independence, the political upheaval of the revolutionary period, the decline in fees from medical students and the increasing cost of and demand for hospital treatment. This article provides a detailed account of the enactment of the sweepstake legislation and of the first sweepstake on the 1930 Manchester November Handicap.