Pathological gambling, problem gambling and sleep complaints: an analysis of the National Comorbidity Survey: Replication (NCS-R)

Sleep Problems and Gambling Disorder: Cross-Sectional Relationships in a Young Cohort

AIMS

To investigate the potential association between gambling disorder and symptoms of sleep problems (including insomnia and excessive daytime sleepiness). It was hypothesised that, compared to controls, individuals with gambling disorder would have significantly greater disturbance of sleep, as indicated by increased scores in: (1) sleep items on the Hamilton Anxiety Rating Scale (HAM-A) and Hamilton Rating Scale for Depression (HAM-D); (2) total score on the HAM-A and HAM-D; and (3) the Epworth Sleepiness Scale (ESS).

METHODS

Secondary analysis of previously published data from 152 young adults, aged 18-29 years. Individuals were stratified into three groups: controls, those at risk of gambling disorder, and those with gambling disorder. One-way ANOVAs with post-hoc tests were conducted to determine whether groups differed significantly in sleep item scores and total scores of the HAM-A and HAM-D, and the ESS.

RESULTS

HAM-D scale insomnia item scores were significantly higher in the disorder group, when compared to controls, this being particularly marked for middle and late insomnia. The HAM-A item score indicated significantly worse sleep quality in the disorder group, compared to at risk and control groups. Total HAM-A and HAM-D scores were significantly higher in the disorder group, but ESS scores did not differ significantly.

CONCLUSION

Measures of disruptions in sleep were significantly higher in gambling disorder than controls. Anxiety and depressive symptom severity was also significantly higher in the gambling disorder group. Further research could have implications for identification and treatment of sleep disorders and psychiatric comorbidities in gambling disorder.

National study of sleep health for student servicemembers/veterans

Objective: Investigate sleep health for student servicemember/veterans (SSM/Vs). Method: Data from the National College Health Assessment was used, including 88,178 participants in 2018 and 67,972 in 2019. Propensity score matching was used to compare SSM/Vs (n = 2984) to their most similar non-SSM/V counterparts (n = 1,355). Responses were analyzed using a multivariate analysis of covariance (MANCOVA). Results: SSM/Vs reported significantly higher levels of some sleep health issues than the matched peer group, including more instances of trouble falling asleep, waking too early, and higher rates of insomnia and sleep disorders. However, SSM/Vs reported fewer days per week feeling sleepy and similar impacts of sleep issues on academics when compared to the peer group. Conclusion: Institutions of higher education should consider training faculty and staff to recognize impacts of poor sleep health for SSM/Vs to establish effective practices to support this unique population.

Gambling, tobacco use, and health among individuals in substance use disorder treatment

BACKGROUND AND OBJECTIVES

Gambling is highly comorbid with disordered use of tobacco and other drugs, and may increase relapse risk among substance use disorder (SUD) patients. We investigated associations between gambling and tobacco use behaviors among SUD patients to inform clinical care.

METHODS

Patients (N = 651, 170 female) from 25 residential SUD treatment programs in California completed surveys about tobacco use, health, and gambling. Using multivariate regression, we examined associations between gambling, tobacco use behaviors, and mental and physical health.

RESULTS

Past-year gamblers were more likely than non-gamblers to be current smokers (adjusted odds ratio [AOR] = 1.44, 95% confidence interval [CI] = 1.03, 2.01). Smokers who gambled had higher mean Heaviness of Smoking Index (HSI) scores (mean difference = +0.32, 95% CI = 0.04, 0.60), and more often reported smokeless tobacco use (AOR = 1.73, 95% CI = 1.16, 2.58), compared to non-gambling smokers. Past-year problem gamblers were more likely than all others (non-gamblers and non-problem gamblers) to be current smokers (AOR = 1.44, 95% CI = 1.08, 1.90) and to report high psychosocial stress (AOR = 1.87, 95% CI = 1.34, 2.61). Smokers with problem gambling also had higher HSI scores (mean difference = +0.54, 95% CI = 0.14, 0.95) compared to smokers without problem gambling.

DISCUSSION AND CONCLUSIONS

Gambling and problem gambling were associated with tobacco use and heavier smoking. SUD patients with gambling comorbidity may be heavier smokers and may need concurrent treatment for tobacco use and problem gambling.

SCIENTIFIC SIGNIFICANCE

This study provides novel data regarding gambling and tobacco use behaviors among SUD patients.

To Binge Watch TV Series: How a Leisure Activity May Affect Sleep, Mood and Quality of Life

Objective

New TV-watching patterns increased the practice of binge-watching (BW). Considering the adaptive-maladaptive continuum of BW, the relationship between BW and health outcomes is still unclear. This study aimed to analyze some features of BW related to quality of life, focusing on sleep quality.

Methods

Four-hundred eighty-two young adults were classified into four groups according to their BW approach. Then, sleep quality, mood, and quality of life were assessed.

Results

All the investigated variables were associated with problematic and moderate BW. No differences emerged between BW as a leisure activity and not watching TV series. Moreover, quality of life is directly affected by BW.

Conclusion

Accordingly, BW should be considered a continuum of behavioral patterns from a leisure activity characterized by positive outcomes to a maladaptive behavior characterized by negative outcomes for sleep, mood, and quality of life.

Psychiatric Drug Prescription and Temporal Associations with a First Diagnosis of Gambling Disorder—Results from a National Register Study

Psychiatric comorbidity is common in gambling disorder (GD), but there are few studies on larger nationwide samples of treatment-seeking patients. Also, temporal associations between GD and other psychiatric disorders are often difficult to study. To address the prevalence and the temporal associations of prescriptions for psychiatric disorders — both in specialized care and primary care — in patients with a GD diagnosis (ICD-10 F63.0). Data was derived from national health registers in Sweden. All patients who were diagnosed with GD in specialized health care in 2005–2016 were included and run against the nationwide database on prescription of pharmaceuticals aimed for psychiatric disorders (n = 2018). Prevalence of psychiatric drug prescription was used as a proxy for psychiatric comorbidity and studied for two 2-year periods (period 1 and 2) prior to GD and one 2-year period (period 3) after the diagnosis. Controlling for gender, age, and time periods, for eight drug categories (anti- epileptics, anti-psychotics, benzodiazepine derivatives, anxiolytics, hypnotics, anti- depressants and drugs used in addictive disorders), significant increases in drug prescription were seen. For central stimulants, a significant increase was seen upon receiving the GD diagnosis (from period 2 to 3), and for benzodiazepines, an increase was seen prior to the GD diagnosis (from period 1 to 2), but not upon diagnosis (from period 2 to 3). Psychiatric comorbidity in GD is common. Drug prescription for psychiatric problems increased markedly in the years temporarily associated with a first diagnosis of GD. The findings may call for early screening for problem gambling in patients with treatment contacts for increasingly poor mental health.

Gambling Problems Are Associated with Alcohol Misuse and Insomnia: Results from a Representative National Telephone Survey

Gambling has significant costs to the community, with a health burden similar in scale to major depression. To reduce its impact, it is necessary to understand factors that may exacerbate harm from gambling. The gambling environment of late-night licensed venues and 24/7 online gambling has the potential to negatively impact sleep and increase alcohol consumption. This study explored gambling, alcohol, and sleep problems to understand whether there is a relationship between these three factors. Telephone interviews were conducted with a representative sample of Australian adults (n = 3760) combined across three waves of the National Social Survey. Participants completed screening measures for at-risk gambling, at-risk alcohol consumption, insomnia (2015 wave only), and sleep quality. There were small but significant positive correlations between problem gambling and alcohol misuse, problem gambling and insomnia, and problem gambling and poor sleep quality. A regression model showed that gambling problems and alcohol misuse were significant independent predictors of insomnia. A separate regression showed gambling problems (and not alcohol misuse) were a significant predictor of poor sleep quality, but only in one survey wave. Findings suggest that gambling, alcohol, and sleep problems are related within persons. Further research should examine the mechanisms through which this relationship exists.

Sleep or Play Online Poker?: Gambling Behaviors and Tilt Symptoms While Sleep Deprived

Online poker has the convenience of being accessible 24/7 allowing a large proportion of players to gamble at night. Although some studies postulate a bi-directional relationship between excessive online poker playing and sleep disturbances, sleep has yet to be studied as a primary outcome variable in online poker studies. Sleep deprivation has been linked to alterations in emotional regulation, decision-making, and risk-taking behaviors. All of which are known to induce episodes of tilt. Conversely, online poker playing during regular sleep hours may interfere with sleep quality. The objectives of the present study are (a) to explore the effects of sleep deprivation on tilt symptoms and gambling behaviors and (b) to assess whether playing an online poker session shortly before bedtime (120 min) influences the player's sleep quality. Sleeping habits, tilt symptoms, and online poker behaviors of 23 regular online poker players (22 men, 1 woman) were monitored daily for 28 days using questionnaires and hand histories. Tilt and gambling behaviors during online poker sessions (n = 588) played while the player was sleep-deprived were compared to sessions played while not sleep-deprived. Different sleep variables were also compared for sessions (n = 897) played 2 h before bedtime to no sessions played before sleep. Sleep-deprived poker sessions revealed higher emotional and behavioral tilt, a higher number of hands played and unfavorable financial results than at-rest sessions. Also, emotional and behavioral tilt was higher when alcohol was consumed. Sessions played 2 h before bedtime revealed a shorter sleep onset latency than when no sessions were played before bedtime. Post-hoc mixed regression analyses revealed that emotional and behavioral tilt is associated with shorter total sleep time and shorter sleep onset latency, while cognitive tilt is associated with a decrease in sleep efficiency. This study is the first to specifically explore sleep variables with online poker players within an ecological study design. The findings shed light on the daily impacts of nighttime online gambling practices. Future studies are needed to further explore the interaction between subjective and objective sleep variables and online gambling habits as well as investigate players' motives for playing while sleep deprived.

[Gambling and Gaming disorders and physical health of players: A critical review of the literature]

CONTEXT

Gambling and gaming disorders have been introduced as addictions in the DSM-5 and have been announced for the next edition of the ICD. Links between gambling and gaming and psychiatric comorbidities have been thoroughly investigated, but so far the impact of gambling and gaming on physical health has been overlooked.

OBJECTIVE

Our aim was to evaluate the impact of gaming and gambling disorders on the physical health of gamers and gamblers.

SOURCES

We conducted a systematic review of the literature, using PubMed/Medline to retrieve studies with the following: keywords: "gambling" ; "pathological gambling" ; "gambling health" ; "gaming" ; "pathological gaming" and "gaming health".

PAPERS SELECTION

Selected studies all reported on the physical health of gamers and gamblers with addiction. We obtained 133 articles from the Medline database. After screening abstracts and introductions and full reading of papers we retrieved 25 articles for this review. Seventeen articles reporting 56,179 subjects with gambling disorder and 8 articles reporting 63,887 subjects with gaming disorder.

RESULTS

All papers described the physical health of individuals with gaming and gambling disorders. For gambling, data showed the existence of digestive disorder (20 to 40%), sleeping disorders (35 to 68%), headaches (20 to 30%) and cardiovascular disorders: tachycardia (9%) and coronary artery disease (2 to 23%). Results were mostly significant when compared to the general population. For gaming, available studies reported qualitative data. Most frequently reported symptoms were sleeping complaints, joint pain, headaches and visual problems. These symptoms were more frequently described for teenagers. Sleeping complaints were the most frequently reported symptom.

LIMITS

Although we found that the physical health of gamers and gamblers with addiction was impaired, no study investigated the causal role of addiction, gaming, and gambling. Further studies are needed to better understand how behavioral addictions impact physical heath.

CONCLUSION

Data reported in this review documented that individuals with gaming or gambling disorders have an impaired physical health. Knowledge of the symptoms reported could help primary care physicians to better screen for gambling and gaming disorders among their patients.

Health Outcomes in Individuals with Problem and Pathological Gambling: An Analysis of the 2014 North Carolina Behavioral Risk Factor Survey System (BRFSS)

Problem and pathological gambling refers to subclinical and clinical levels of maladaptive gambling, respectively, and is associated with specific sociodemographic characteristics as well as a number of poor health outcomes. We examined such demographic, physical health, mental health, and health-related behaviors in a sample of 7045 low-risk gamblers and 244 problem/pathological gamblers. Participants completed the 2014 North Carolina Behavioral Risk Factor Surveillance System telephone survey. Using the National Opinion Research Center's Diagnostic Screen for Gambling Disorders-CLiP, participants were categorized as either "problem/pathological gamblers" or "low-risk gamblers." Problem/pathological gamblers were younger, more likely to be male, of ethnic minority status, unmarried, and of lower education than low-risk gamblers. No physical health variables differentiated the groups but problem/pathological gamblers reported experiencing significantly more adverse childhood experiences and engaging in significantly more tobacco and alcohol use compared to low-risk gamblers. Moreover, gender moderated relationships between gambling group and several of the alcohol use variables such that male problem/pathological gamblers exhibited greater alcohol use behavior than male low-risk gamblers but no such relationship was present in females. Overall, this study expands the current knowledgebase on disordered gambling and highlights the need to assess disordered gambling in public health samples. Clinical implications are discussed.

Gambling Type, Substance Abuse, Health and Psychosocial Correlates of Male and Female Problem Gamblers in a Nationally Representative French Sample

Many studies carried out on treatment-seeking problem gamblers (PG) have reported high levels of comorbid substance use disorders, and mental and physical health problems. Nevertheless, general population studies are still sparse, most of them have been carried out in the United States or Canada, and gender differences have not always been considered. Thus, the aim of this study was to describe the type of games, and psychological and physical correlates in male and female PG in a nationally representative French sample. The total sample studied involved 25,647 subjects aged 15-85 years, including 333 PG and 25,314 non-problem gamblers (NPG). Data were extracted from a large survey of a representative sample of the French general population. They were evaluated for sociodemographic variables, gambling behavior, type of gambling activity, substance use, psychological distress, body mass index, chronic disease, and lack of sleep. Overall, there were significant differences between PG and NPG in gender, age, education, employment and marital status, substance use disorders (alcohol, tobacco, cannabis, cocaine and heroin), psychological distress, obesity, lack of sleep and type of gambling activity. Although male and female PG had different profiles, the gambling type, especially strategic games, appeared as an important variable in the relationship between gender and problem gambling. This research underlines the importance of considering gender differences and gambling type in the study of gambling disorders. Identifying specific factors in the relationship between gender, gambling type and gambling problems may help improve clinical interventions and health promotion strategies.

A nationwide study of health-related quality of life, stress, pain or discomfort and the use of medicine among problem gamblers

AIM

The aim of this study was to investigate the associations between problem gambling and health-related quality of life, stress, pain or discomfort and the use of analgesics and sleeping pills.

METHODS

Data derives from the Danish Health and Morbidity Survey 2010. The survey was based on a random sample of 25,000 adult Danes (response rate: 61%), and data were collected via a self-administered questionnaire. The Lie/Bet Questionnaire was used as the screening instrument for problem gambling. Respondents were categorised as current, previous or non-problem gamblers. The questionnaire also included topics such as health-related quality of life (Short Form-12), perceived stress, pain and discomforts within the past two weeks, as well as the use of medication within the past two weeks.

RESULTS

Current problem gambling was strongly associated with negative outcomes such as poor mental health, high perception of stress, headache, fatigue and sleeping problems. Furthermore, previous problem gambling was generally associated with poorer health outcomes. Thus, current and previous problem gamblers had 2.36 times (95% confidence interval [CI] 1.44-3.87) and 1.66 times (95% CI 1.07-2.55) higher odds than non-problem gamblers of reporting fair or poor health, respectively. The data revealed no clear association between problem gambling and the use of analgesics.

CONCLUSIONS

Both current and previous problem gambling were negatively associated with physical and mental-health problems. Health professionals should be alert to any signs of these complicating factors when planning the treatment of problem gamblers.

The Neurosteroidogenic Enzyme 5α-Reductase Mediates Psychotic-Like Complications of Sleep Deprivation

Acute sleep deprivation (SD) can trigger or exacerbate psychosis- and mania-related symptoms; the neurobiological basis of these complications, however, remains elusive. Given the extensive involvement of neuroactive steroids in psychopathology, we hypothesized that the behavioral complications of SD may be contributed by 5α-reductase (5αR), the rate-limiting enzyme in the conversion of progesterone into the neurosteroid allopregnanolone. We first tested whether rats exposed to SD may exhibit brain-regional alterations in 5αR isoenzymes and neuroactive steroid levels; then, we assessed whether the behavioral and neuroendocrine alterations induced by SD may be differentially modulated by the administration of the 5αR inhibitor finasteride, as well as progesterone and allopregnanolone. SD selectively enhanced 5αR expression and activity, as well as AP levels, in the prefrontal cortex; furthermore, finasteride (10-100 mg/kg, IP) dose-dependently ameliorated PPI deficits, hyperactivity, and risk-taking behaviors, in a fashion akin to the antipsychotic haloperidol and the mood stabilizer lithium carbonate. Finally, PPI deficits were exacerbated by allopregnanolone (10 mg/kg, IP) and attenuated by progesterone (30 mg/kg, IP) in SD-subjected, but not control rats. Collectively, these results provide the first-ever evidence that 5αR mediates a number of psychosis- and mania-like complications of SD through imbalances in cortical levels of neuroactive steroids.

Telecommunications Network Measurements of Online Gambling Behavior in Switzerland: A Feasibility Study

BACKGROUND

Methodological shortcomings of gambling studies relying on self-report or on data sets derived from gambling operators tend to result in biased conclusions. The aim of this study was to analyze online gambling behavior using a novel network database approach.

METHODS

From October 13 to October 26, 2014, telecommunications network data from a major telecommunications provider in Switzerland were analyzed. Netflows between mobile devices and a poker operator were quantified to measure the gambling duration and session number.

RESULTS

Time spent gambling during night and working hours was compared between devices with longest (red group), intermediate (orange group), and shortest gambling time (green group). Online gambling behavior differed depending on overall gambling time, F (2, 3,143). Night and working hours gambling was the highest in the red group (53%), compared to the orange (50.1%) and the green groups (41.5%). Post hoc analyses indicated significant differences between the orange and green groups (p < 0.05). No differences were observed between the red and orange groups (p = 0.850), and the red and green groups (p = 0.053).

CONCLUSIONS

On mobile devices, distinct gambling patterns were observed depending on the overall gambling time. This methodology could also be used to investigate online gaming, social media use, and online pornography.

Treatment modalities for patients with gambling disorder

BACKGROUND

Gambling disorder (GD) is defined as persistent and recurrent problematic gambling behavior leading to clinically significant impairment or distress. The prevalence of GD has been shown to be 1.2-7.1% in the general population. GD can severely impact on personal and vocational wellbeing as well as lead to financial problems, and has been known to be difficult to treat. This review describes the available pharmacotherapy/psychosocial treatments for GD patients, and summarizes data on the effectiveness of these GD treatments.

METHODS

This review refers to newly as well as previously published studies and guidelines.

RESULTS

The description of pharmacotherapy mainly focuses on opioid receptor antagonists, selective serotonin reuptake inhibitors, and mood stabilizers. Psychosocial treatments/strategies mainly include cognitive behavioral therapy, motivational interviewing, and Gamblers Anonymous. We also introduce relatively novel treatment modalities.

CONCLUSIONS

This review can help clinicians to decide treatment plans for their GD patients. In addition, it can be used as a reference for designing future research.

Insomnia among current and remitted common mental disorders and the association with role functioning: results from a general population study

OBJECTIVE AND BACKGROUND

Insomnia is a neglected topic in psychiatric epidemiological studies. Despite the fact that insomnia is a common phenomenon and usually co-occurs with mental disorders, it remains to be addressed to what extent insomnia is associated with remitted and current common mental disorders and with impaired functioning in the population, after considering a wide variety of confounders.

PATIENTS AND METHODS

Data were used from three waves of the Netherlands Mental Health Survey and Incidence Study-2 (N = 4618), a nationally representative face-to-face survey of the general population. Insomnia was assessed at the third wave with the Women's Health Initiative Insomnia Rating Scale. Mental disorders were assessed at all waves with the Composite International Diagnostic Interview version 3.0. Confounders included sociodemographic characteristics, physical health, and psychotropic medication use. Role functioning was assessed with the Medical Outcomes Study Short Form Health Survey and work loss with the World Health Organization Disability Assessment Schedule.

RESULTS

Forty-two per cent of the population reported none to mild insomnia, 35% moderate insomnia, and 23% severe insomnia. Both current and remitted anxiety disorder and current mood disorder were significantly associated with severe insomnia with adjusted odds ratios ranging from 1.8 to 3.3. Current and remitted substance use disorders were associated with moderate insomnia (adjusted OR range: 1.3-1.8). Moderate and severe insomnia were significantly associated with impaired role functioning and work loss after adjustment for confounders.

CONCLUSION

Insomnia is a prevalent problem across different categories of mental disorders, even in the remitted phase. As insomnia has a high impact on daily functioning, insomnia deserves wide clinical attention.

Development of the National Healthy Sleep Awareness Project Sleep Health Surveillance Questions

OBJECTIVES

For the first time ever, as emphasized by inclusion in the Healthy People 2020 goals, sleep health is an emphasis of national health aims. The National Healthy Sleep Awareness Project (NHSAP) was tasked to propose questions for inclusion in the next Behavioral Risk Factor Surveillance System (BRFSS), a survey that includes a number of questions that target behaviors thought to impact health, as a means to measure community sleep health. The total number of questions could not exceed five, and had to include an assessment of the risk for obstructive sleep apnea (OSA).

METHODS

An appointed workgroup met via teleconference and face-to-face venues to develop an inventory of published survey questions being used to identify sleep health, to develop a framework on which to analyze the strengths and weaknesses of current survey questions concerning sleep, and to develop recommendations for sleep health and disease surveillance questions going forward.

RESULTS

The recommendation was to focus on certain existing BRFSS questions pertaining to sleep duration, quality, satisfaction, daytime alertness, and to add to these other BRFSS existing questions to make a modified STOP-BANG questionnaire (minus the N for neck circumference) to assess for risk of OSA.

CONCLUSIONS

Sleep health is an important dimension of health that has previously received less attention in national health surveys. We believe that 5 questions recommended for the upcoming BRFSS question banks will assist as important measures of sleep health, and may help to evaluate the effectiveness of interventions to improve sleep health in our nation.

Sleepiness and cognition in young adults who gamble and use alcohol

BACKGROUND AND AIMS

Past research suggests that sleep problems are associated with increased risky decision-making. Similarly, gambling disorder and alcohol use disorder are also associated with increased risky decision-making. Individuals with gambling disorder or alcohol use disorder have also reported higher rates of sleep problems compared to normal healthy controls. As such, we sought to examine whether sleep problems play a role in the development of alcohol use disorder or gambling disorder.

METHODS

One hundred and forty-one individuals who gamble and use alcohol, yet do not meet criteria for gambling disorder or alcohol use disorder, were assessed to determine the correlation between sleepiness, amount of sleep obtained, decision-making, and alcohol or gambling behaviors.

RESULTS

Our results suggest that inconsistent sleep patterns may be associated with increased frequency of alcohol use and gambling. We did not, however, find a significant correlation between sleep factors and decision-making.

DISCUSSION

Further research is needed to examine the specific relationship between sleep patterns and alcohol use and gambling frequency. Overall these data suggest that sleepiness or sleep and risky decision-making is not a significant factor in gambling and alcohol use behaviors in individuals not meeting criteria for alcohol use disorder or gambling disorder.

Nocturnal sleep problems among university students from 26 countries

BACKGROUND

The aim of this study is to estimate the prevalence of nocturnal sleeping problems and its associated factors among university students in mainly low- and middle-income countries.

METHODS

A cross-sectional survey was conducted with 20,222 undergraduate university students (mean age, 20.8; SD = 2.8) from 27 universities in 26 countries across Asia, Africa and the Americas.

RESULTS

Overall, 10.4% reported severe or extreme nocturnal sleeping problems (male, 10.2%; female, 10.5%) in the past month. Noctural sleeping problems differed by country, from 32.9% in Indonesia to 3.0 % in Thailand among Asian countries, from 13.7% in Mauritius to 7.5% in South Africa, and from 11.8% in Jamaica to 6.1% in Columbia in the Americas. In multivariate logistic regression analysis, coming from a poor family background, staying off campus (on their own or with parents or guardians), stress (history of child sexual abuse), poor mental health (depression and PTSD symptoms), health risk behaviour (tobacco use, heavy internet use, gambling, skipping breakfast and having sustained an injury), lack of social support and poor academic performance were associated with nocturnal sleeping problems.

CONCLUSIONS

A significant prevalence of past-month nocturnal sleeping problems was found. Potential factors associated with the risk of reporting sleeping complaints were identified, which may assist in prevention strategies to promote a better quality of sleep.

Buddhist philosophy for the treatment of problem gambling

Purpose In the last five years, scientific interest into the potential applications of Buddhist-derived interventions (BDIs) for the treatment of problem gambling has been growing. This paper reviews current directions, proposes conceptual applications, and discusses integration issues relating to the utilisation of BDIs as problem gambling treatments. Method Aliterature search and evaluation of the empirical literature for BDIs as problem gambling treatments was undertaken. Results To date, research has been limited to cross-sectional studies and clinical case studies and findings indicate that Buddhist-derived mindfulness practices have the potential to play an important role in ameliorating problem gambling symptomatology. As an adjunct to mindfulness, other Buddhist-derived practices are also of interest including: (i) insight meditation techniques (e.g., meditation on 'emptiness') to overcome avoidance and dissociation strategies, (ii) 'antidotes' (e.g., patience, impermanence, etc.) to attenuate impulsivity and salience-related issues, (iii) loving-kindness and compassion meditation to foster positive thinking and reduce conflict, and (iv) 'middle-way' principles and 'bliss-substitution' to reduce relapse and temper withdrawal symptoms. In addition to an absence of controlled treatment studies, the successful operationalisation of BDIs as effective treatments for problem gambling may be impeded by issues such as a deficiency of suitably experienced BDI clinicians, and the poor provision by service providers of both BDIs and dedicated gambling interventions. Conclusions Preliminary findings for BDIs as problem gambling treatments are promising, however, further research is required.

How transparent is behavioral intervention research on pathological gambling and other gambling-related disorders? A systematic literature review

AIMS

To review the transparency of reports of behavioral interventions for pathological gambling and other gambling-related disorders.

METHODS

We used the Transparent Reporting of Evaluations with Nonrandomized Designs (TREND) Statement to develop the 59-question adapted TREND questionnaire (ATQ). Each ATQ question corresponds to a transparency guideline and asks how clearly a study reports its objectives, research design, analytical methods and conclusions. A subset of 23 ATQ questions is considered particularly important. We searched PubMed, PsychINFO and Web of Science to identify experimental evaluations published between 2000 and 2011 aiming to reduce problem gambling behaviors or decrease problems caused by gambling. Twenty-six English-language reports met the inclusion criteria and were reviewed by three abstractors using the ATQ.

RESULTS

The average report adhered to 38.4 (65.1%) of the 59 ATQ transparency guidelines. Each of the 59 ATQ questions received positive responses from an average of 16.9 (63.8%) of the reports. The subset of 23 particularly relevant questions received an average of 15.3 (66.5%) positive responses. Thirty-two of 59 (54%) ATQ questions were answered positively by 75% or more of the study reports, while 12 (20.3%) received positive responses by 25% or fewer. Publication year did not affect these findings.

CONCLUSIONS

Gambling intervention reports need to improve their transparency by adhering to currently neglected and particularly relevant guidelines. Among them are recommendations for comparing study participants who are lost to follow-up and those who are retained, comparing study participants with the target population, describing methods used to minimize potential bias due to group assignment, and reporting adverse events or unintended effects.

The Implementation of a Telephone-Delivered Intervention for Asian American Disordered Gamblers: A Pilot Study

This report will discuss the implementation and preliminary results of a community-based telephone-delivered gambling treatment program specifically designed for Asian Americans. The intervention was implemented by the NICOS Chinese Health Coalition, a nonprofit community organization based in Northern California, overseen by the UCLA (University of California, Los Angeles) Gambling Studies Program and the California Office of Problem Gambling, and launched in December 2010. It consisted of six 1-hr long telephone-delivered sessions conducted by a mental health provider using a translated version of the Freedom from Problem Gambling Self-Help Workbook. In the current study, 6 providers completed a 30-hr training program for gambling related disorders. One-hundred and 40 callers inquired about the intervention within the first 6 months of its launch, 19 clients expressed interest in participating, and 8 enrolled into the program. The results show that the majority of clients who enrolled into the program did not report any gambling behavior after baseline and improved on self-reported measures of overall life satisfaction, gambling urges, and self-control. This study suggests that the implementation of this type of intervention is feasible at a small community-based organization and may be effective in treating gambling-related disorders for Asian American populations. The low rate of clientele enrollment is addressed and potential remedies are discussed.

Behavioral addictions: where to draw the lines?

Behavioral addictions can present in a variety of subtle and deceptive patterns. Because of the intense shame, guilt, and embarrassment felt by patients, it may fall to providers to utilize screening tools and deeper interviewing techniques to uncover the extent of these behaviors. Identifying when the line is crossed from recreation/habit to psychopathology relies on understanding current diagnostic criteria and consideration of cultural, ethnic, and local community standards. Individuals are also likely to cross back and forth between this line of pathology and habit, further clouding provider’s opinions of diagnosis; therefore, tracking and monitoring these symptoms over time is critical to establishing patterns of use and documenting ongoing consequences. Treatment for these conditions is emerging slowly, and treatment outcomes for these conditions appear to be similar to those with other addictive disorders.