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Pharmacological and Psychosocial Treatment of Adults With Gambling Disorder: A Meta-Review. J Addict Med 2021; 14:e15-e23. [PMID: 31651561 DOI: 10.1097/adm.0000000000000574] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND OBJECTIVES Gambling disorder (GD) leads to impaired socioeconomical functioning and increased social costs. Although the research on GD has been rising over the years, approved treatment guidelines are currently not available. The aim of this study was to systematically review the literature on the pharmacological and psychosocial treatment of adults with GD, and to identify possible agreed-upon standards of care. METHODS MEDLINE, PubMed, Cochrane, Web of Science, Embase, and CINAHL electronic databases were searched up to April 2019 for systematic reviews on pharmacological, psychosocial, and combined treatment of adults with GD. Twenty-six studies were eventually included in this meta-review. RESULTS Studies reported promising results of opioid antagonists and mood stabilizers in reducing GD-related symptomatology. Lithium was particularly effective in subjects with comorbid bipolar disorders. Cognitive behavioral therapy (CBT) was the most commonly used psychological intervention and reduced global severity, gambling frequency, and financial loss. Motivational interviewing (MI) seemed to improve several GD domains, alone or in combination with CBT. Self-help interventions (SHIs) showed some efficacy in promoting treatment-seeking, and in combination with other treatments. CONCLUSIONS We found moderate evidence of effect for CBT, but weaker evidence for pharmacotherapy and SHIs. Results suggested some efficacy for MI in the short but not in the long term. It is likely that certain interventions might be more effective than others on specific features of GD. Further studies are needed to compare the efficacy and acceptability of individual and combined psychosocial and pharmacological interventions, to deliver patient-tailored treatments.
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Di Ciano P, Le Foll B. The Rat Gambling Task as a model for the preclinical development of treatments for gambling disorder. INTERNATIONAL GAMBLING STUDIES 2018. [DOI: 10.1080/14459795.2018.1448428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Patricia Di Ciano
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health (CAMH) , Toronto, Canada
| | - Bernard Le Foll
- Addiction Division, Centre for Addiction and Mental Health (CAMH) , Toronto, Canada
- Departments of Pharmacology and Toxicology, Psychiatry, Family and Community Medicine, Institute of Medical Sciences, University of Toronto , Toronto, Canada
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Abstract
Pathological gambling has so far received scant attention in the psychiatric literature. It has a prevalence rate of about 1% in most countries, and with the deregulation of gambling in the UK the prevalence is set to rise here. Pathological gambling can adversely affect the individual, family and society, and also carries high rates of psychiatric comorbidity. Early identification and appropriate treatment can limit the long-term adverse consequences and improve outcome. This article reviews assessment techniques and tools, and treatment strategies for pathological gambling.
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The Clinical Significance of Craving Across the Addictive Behaviors: a Review. CURRENT ADDICTION REPORTS 2017. [DOI: 10.1007/s40429-017-0138-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Deng LY, Liu L, Xia CC, Lan J, Zhang JT, Fang XY. Craving Behavior Intervention in Ameliorating College Students' Internet Game Disorder: A Longitudinal Study. Front Psychol 2017; 8:526. [PMID: 28443046 PMCID: PMC5385373 DOI: 10.3389/fpsyg.2017.00526] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Accepted: 03/22/2017] [Indexed: 12/25/2022] Open
Abstract
Craving, as a central feature of addiction and a precursor of relapse, is targeted recently in addiction intervention. While Internet gaming disorder (IGD), conceptualized as a behavioral addiction, is lack of effective treatment practice and exploration of its mechanism. This research aims to test the effectiveness and detect the active ingredients of craving behavior intervention (CBI) in mitigation of IGD among young adults. A total of 63 male college students with IGD were assigned into the intervention group (six-session CBI intervention) or the waiting-list control group. Structured questionnaires were administered at pre-intervention (T1), post-intervention (T2), 3-month follow-up (T3), and 6-month follow-up (T4). Compared to the control group, a significant decrease in the severity of IGD in intervention group was found at post-intervention and lasting to 6 months after intervention. The value changes of craving could partially mediate the relationship between intervention and changes of IGD among all effects tests (immediate, T2-T1; short-term, T3-T1; and long-term effects, T4-T1). Further, explorations of the active ingredients of intervention found depression relief and shift of psychological needs from Internet to real life significantly predict craving amelioration at both post-intervention and 6-month follow-up. Although preliminary, the current study provides evidence for the value of craving-aimed intervention practice in IGD treatment and identifies two potential active ingredients for mitigation of craving, and the long-term therapeutic benefits are further conferred. Registry name: The behavioral and brain mechanism of IGD; URL: https://www.clinicaltrials.gov/ct2/show/NCT02550405; Registration number: NCT02550405.
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Affiliation(s)
- Lin-Yuan Deng
- Faculty of Education, Beijing Normal UniversityBeijing, China
| | - Lu Liu
- Faculty of Psychology, Institute of Developmental Psychology, Beijing Normal UniversityBeijing, China
| | - Cui-Cui Xia
- Faculty of Psychology, Institute of Developmental Psychology, Beijing Normal UniversityBeijing, China.,Students Counseling Center, Beijing Normal UniversityBeijing, China
| | - Jing Lan
- Faculty of Psychology, Institute of Developmental Psychology, Beijing Normal UniversityBeijing, China
| | - Jin-Tao Zhang
- State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research, Beijing Normal UniversityBeijing, China.,Center for Collaboration and Innovation in Brain and Learning Sciences, Beijing Normal UniversityBeijing, China
| | - Xiao-Yi Fang
- Faculty of Psychology, Institute of Developmental Psychology, Beijing Normal UniversityBeijing, China
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Di Ciano P, Le Foll B. Evaluating the Impact of Naltrexone on the Rat Gambling Task to Test Its Predictive Validity for Gambling Disorder. PLoS One 2016; 11:e0155604. [PMID: 27191857 PMCID: PMC4871457 DOI: 10.1371/journal.pone.0155604] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 05/02/2016] [Indexed: 12/27/2022] Open
Abstract
Gambling Disorder has serious consequences and no medications are currently approved for the treatment of this disorder. One factor that may make medication development difficult is the lack of animal models of gambling that would allow for the pre-clinical screening of efficacy. Despite this, there is evidence from clinical trials that opiate antagonists, in particular naltrexone, may be useful in treating gambling disorder. To-date, the effects of naltrexone on pre-clinical models of gambling have not been evaluated. The purpose of the present study was to evaluate the effects of naltrexone in an animal model of gambling, the rat gambling task (rGT), to determine whether this model has some predictive validity. The rGT is a model in which rats are given a choice of making either a response that produces a large reward or a small reward. The larger the reward, the greater the punishment, and thus this task requires that the animal inhibit the ‘tempting’ choice, as the smaller reward option produces overall the most number of rewards per session. People with gambling disorder chose the tempting option more, thus the rGT may provide a model of problem gambling. It was found that naltrexone improved performance on this task in a subset of animals that chose the ‘tempting’, disadvantageous choice, more at baseline. Thus, the results of this study suggest that the rGT should be further investigated as a pre-clinical model of gambling disorder and that further investigation into whether opioid antagonists are effective in treating Gambling Disorder may be warranted.
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Affiliation(s)
| | - Bernard Le Foll
- Translational Addiction Research Laboratory, CAMH, Toronto, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Campbell Family Mental Health Research Institute, CAMH, Toronto, Canada
- Ambulatory Care and Structured Treatment Program, CAMH, Toronto, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
- * E-mail:
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Dixon MR, Whiting SW, Gunnarsson KF, Daar JH, Rowsey KE. Trends in Behavior-Analytic Gambling Research and Treatment. THE BEHAVIOR ANALYST 2015; 38:179-202. [PMID: 27606170 PMCID: PMC4883474 DOI: 10.1007/s40614-015-0027-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The purpose of the present review was to analyze research outcomes for all gambling studies reported in the behavior analysis literature. We used the search term "gambling" to identify articles that were published in behaviorally oriented journals between the years 1992 and 2012 and categorized the content of each article as empirical or conceptual. Next, we examined and categorized the empirical articles by inclusion of an experimental manipulation and treatment to alleviate at least some aspect of pathological gambling, participant population used, type of gambling task employed in the research, whether the participants in the study actually gambled, and the behavioral phenomena of interest. The results show that the rate of publication of gambling research has increased in the last 6 years, and a vast majority of articles are empirical. Of the empirical articles, examinations of treatment techniques or methods are scarce; slot machine play is the most represented form of gambling, and slightly greater than half of the research included compensation based on gambling outcomes within experiments. We discuss implications and future directions based on these observations of the published literature.
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Affiliation(s)
- Mark R. Dixon
- />Southern Illinois University Carbondale, Carbondale, IL USA
- />Behavior Analysis and Therapy, Rehabilitation Institute, Southern Illinois University, Carbondale, 62901 IL USA
| | - Seth W. Whiting
- />Southern Illinois University Carbondale, Carbondale, IL USA
| | | | - Jacob H. Daar
- />Southern Illinois University Carbondale, Carbondale, IL USA
| | - Kyle E. Rowsey
- />Southern Illinois University Carbondale, Carbondale, IL USA
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Wieczorek Ł, Dąbrowska K. Zaburzenia hazardowe – rozpowszechnienie, oferta terapeutyczna, dostępność leczenia i predyktory podjęcia leczenia. Przegląd literatury. ALCOHOLISM AND DRUG ADDICTION 2015. [DOI: 10.1016/j.alkona.2015.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Abstract
Although addictive syndromes have been traditionally related to substance-use disorders, during the last few decades a novel addictive group, including the so-called "behavioral or no-drug addictions," has been recognized and has attracted increasing attention for its relevant social impact. This group includes pathological gambling, compulsive shopping, TV/Internet/social network/videogame addictions, workaholism, sex and relationship addictions, orthorexia, and overtraining syndrome. Substance and behavioral addictions show similar phenomenological features, such as craving, dependence, tolerance, and abstinence, and perhaps they share a common possible pathophysiology. It is, however, controversial whether all or at least some of them should be considered real disorders or just normal, albeit extreme, behaviors. The aim of this article is to review current data on pharmacological treatment of behavioral addictions. As no specific and validated treatment algorithms are currently available, only an improved knowledge on their psychopathological, clinical, and neurobiological features may have relevant implications for more focused preventive and therapeutic strategies.
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Wynn J, Hudyma A, Hauptman E, Nicole Houston T, Michael Faragher J. Treatment of problem gambling: development, status, and future. DRUGS AND ALCOHOL TODAY 2014. [DOI: 10.1108/dat-10-2013-0044] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– The purpose of this paper is to seek to present an overview of past, present, and future approaches to the treatment of problem gambling.
Design/methodology/approach
– This paper reviews the literature concerning conceptual, historical, and clinical research perspectives on the treatment of problem gambling.
Findings
– Perspectives on the etiology, maintenance, conceptualization, and treatment of problem gambling have evolved over time. Once seen as a failure of moral character, problem gambling is now considered to be an addictive disorder with similarities to substance abuse disorders. Empirical research into the treatment of problem gambling is progressing, but is relatively sparse compared to the body of research in other addictive disorders. Methodological issues have been identified that will need to be addressed in future research. Currently, cognitive-behavioral approaches have received the most attention and have the greatest amount of research support. Brief interventions, pharmacological interventions, family therapy, and Gamblers Anonymous are also in use. Future directions for problem gambling treatment that are being researched and implemented are mindfulness-based interventions and internet-based treatment approaches.
Originality/value
– This review should be useful to those seeking general information about problem gambling treatment, its development, status, and future directions.
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Grant JE, Schreiber LRN, Odlaug BL. Phenomenology and treatment of behavioural addictions. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2013; 58:252-9. [PMID: 23756285 DOI: 10.1177/070674371305800502] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Behavioural addictions are characterized by an inability to resist an urge or drive resulting in actions that are harmful to oneself or others. Behavioural addictions share characteristics with substance and alcohol abuse, and in areas such as natural history, phenomenology, and adverse consequences. Behavioural addictions include pathological gambling, kleptomania, pyromania, compulsive buying, compulsive sexual behaviour, Internet addiction, and binge eating disorder. Few studies have examined the efficacy of pharmacological and psychological treatment for the various behavioural addictions, and therefore, currently, no treatment recommendations can be made.
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Affiliation(s)
- Jon E Grant
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA.
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13
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Impulse control disorders in Parkinson's disease: seeking a roadmap toward a better understanding. Brain Struct Funct 2011; 216:289-99. [PMID: 21541715 PMCID: PMC3197927 DOI: 10.1007/s00429-011-0314-0] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Accepted: 03/23/2011] [Indexed: 01/02/2023]
Abstract
The development of an impulse control disorder (ICD) is now recognized as a potential nonmotor adverse effect of dopamine replacement therapy in Parkinson's disease (PD). Here, recent epidemiological, neurophysiological and genetic advances are summarized to outline potential mechanisms involved. It is safe to say that dopaminergic drugs, particularly dopamine agonists, are able to induce ICDs only in a minority of patients, while the majority are somehow protected from this adverse effect. While it seems clear that men with early-onset PD are more vulnerable, other predisposing factors, such as various current or pre-PD personality traits, are a matter of debate. In terms of neurophysiological advances, one may find striking analogies to the addiction literature suggesting a causal chain beginning with certain predisposing conditions of striatal dopamine synapses, an "unnatural" increase of dopamine stimulation and a characteristic pattern of resulting functional changes in remote networks of appetitive drive and impulse control. Future prospects include potential add-on medications and the possible identification of genetic predispositions at a genome-wide scale. Functional imaging of pharmacogenetic interactions (imaging pharmacogenomics) may be an important tool on that road.
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15
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A pilot study of impulsivity and compulsivity in pathological gambling. Psychiatry Res 2009; 167:161-8. [PMID: 19339053 PMCID: PMC3039479 DOI: 10.1016/j.psychres.2008.04.023] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2007] [Revised: 04/15/2008] [Accepted: 04/23/2008] [Indexed: 10/21/2022]
Abstract
We examined the relationship between gambling severity, impulsivity and obsessionality/compulsivity in 38 pathological gamblers, representing the complete Minnesota sample of a randomized, placebo-controlled clinical trial of paroxetine for the treatment of pathological gambling (PG), using Pearson correlations and linear regression models at baseline and treatment endpoint. At baseline, Pathological Gambling Modification of the Yale-Brown Obsessive-Compulsive Scale (PG-YBOCS) scores correlated significantly with those of the Eysenck Impulsiveness Questionnaire (EIQ) Impulsiveness subscale and Padua Inventory (PI) factors I and IV (corresponding to impaired control over mental and motor activities, respectively). None of the associations between PI factors and the PG-YBOCS were significant after adjusting for Impulsiveness scores. There were no differences in changes in the PG-YBOCS between the paroxetine and placebo group. Changes in PG-YBOCS scores after treatment correlated with changes in Impulsiveness scores. These changes appeared independent of paroxetine treatment. The results suggest that, although PG exhibits features of both obsessionality/compulsivity and impulsivity and elements of both decrease with treatment, impulsivity predominates and changes in gambling severity are most associated with changes in impulsivity.
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16
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Iancu I, Lowengrub K, Dembinsky Y, Kotler M, Dannon PN. Pathological gambling: an update on neuropathophysiology and pharmacotherapy. CNS Drugs 2008; 22:123-38. [PMID: 18193924 DOI: 10.2165/00023210-200822020-00004] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Neurobiological research has shown the potential involvement of serotonergic, dopaminergic and opioid dysfunction in the pathophysiology of pathological gambling. In this review, we present current theories of the neuropathology of pathological gambling, paying particular attention to the role of the neural circuitry underlying motivation, reward, decision-making and impulsivity. This review also presents a literature review of current pharmacological treatment strategies for pathological gambling, such as selective serotonin reuptake inhibitors (SSRIs), opioid receptor antagonists, anti-addiction drugs and mood stabilizers, and also discusses the role of nonpharmacological interventions.A hypothetical model of the clinical subtypes of pathological gambling is presented, e.g. the impulsive subtype, the obsessive-compulsive subtype and the addictive subtype. This model attempts to integrate current knowledge in the field of pathological gambling regarding neuropathology, psychiatric co-morbidity, family history, genetics, course of illness, gender and response to pharmacological treatment. Finally, it is proposed that the existence of possible clinical subtypes of pathological gambling may provide a potential framework for matching the various subtypes with specific pharmacotherapies.
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Affiliation(s)
- Iulian Iancu
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Desai RA, Potenza MN. Gender differences in the associations between past-year gambling problems and psychiatric disorders. Soc Psychiatry Psychiatr Epidemiol 2008; 43:173-83. [PMID: 18080792 PMCID: PMC3700360 DOI: 10.1007/s00127-007-0283-z] [Citation(s) in RCA: 156] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/12/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Psychiatric disorders frequently co-occur with pathological gambling. The extent to which co-occurence extends to subsyndromal levels of gambling or differs between women and men is incompletely understood. AIM To examine whether the association between psychiatric disorders and past-year gambling problems is stronger in women than men. METHODS Data from the national epidemiological survey of alcoholism and related disorders (NESARC) (n = 43,093) were analyzed. RESULTS Increasing severity of past-year gambling problems was associated with increasing odds of most past-year Axis I and lifetime Axis II disorders, regardless of gender. Associations between gambling problems and major depression, dysthymia, panic disorder, and nicotine dependence were statistically stronger in women than in men. CONCLUSIONS A severity-related association exists between past-year gambling problems and psychiatric disorders. The stronger associations in women suggest that gambling research, prevention and treatment efforts consider gender differences.
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Affiliation(s)
- Rani A Desai
- Dept. of Psychiatry and Women and Addictive Disorders, Core of Women's Health Research, Yale University School of Medicine, New Haven, CT, USA.
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Abstract
Pathological gambling is classified as a disorder of impulse control, though many of its diagnostic criteria parallel those found in substance use disorders. A number of unitary and complex biopsychosocial conceptual models have been postulated to account for the multifactorial nature of gambling pathology. These models have implications for varied treatment approaches in the management of pathological gambling. Recovery is a diffused concept that has been variously and inconsistently determined by the remission or absence of clinical symptoms, the absence of diagnostic criteria, or the achievement of personal development, independence, and function. The lack of conceptual clarity and definitional precision make it difficult to ascertain the actual efficacy of interventions or their relative effectiveness when compared to similar treatments in different population settings or to different treatment approaches. Future investigations should clearly conceptualize the concept of recovery to evaluate the nature and extent of improvement along a spectrum that includes measurement of (a) decreases in frequency of and the time spent gambling, (b) abstinence or controlled gambling that meets financial obligations, (c) absence of symptoms of impaired control and cross-addicted behaviors, and (d) absence of negative consequences and improved quality of life over time.
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Affiliation(s)
- Lia Nower
- Centre for Gambling Studies, Rutgers University, New Brunswick, New Jersey, USA
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Abstract
BACKGROUND Pathological gambling (PG) is a relatively common and highly disabling impulse control disorder. A range of psychotherapeutic agents including selective serotonin reuptake inhibitors, antiepileptic drugs, and opioid antagonists are shown to be effective in the short-term treatment of PG. The use of a wide range of pharmacological treatments for PG is consistent with the observation that PG shares features of obsessive-compulsive spectrum disorders, impulse control disorders, and addictive disorders. The aim of the study is to assess the rate of relapse in treatment-responder pathological gamblers after discontinuation of the active treatment. METHODS Our study sample was composed of 43 male pathological gamblers who had been full responders to 1 of 4 drug treatment regimens (fluvoxamine, topiramate, bupropion SR, or naltrexone) from several previous acute open-label (12-week) comparison studies. Full response was defined as the absence of gambling for a 1-month duration together with improvement on the Clinical Global Improvement scale. The 43 full responders were then followed prospectively for an additional 9 months, which included a 3-month open-label continuation phase and a 6-month medication-free follow-up phase. Follow-up visits were performed on a monthly basis throughout the duration of study. At every follow-up visit, a comprehensive psychiatric diagnostic evaluation was performed on all patients, and patients were assessed for symptoms of gambling using a self-report instrument and collateral family reports. The Clinical Global Impression Improvement scale was also administered at every follow-up visit. Raters were blind to the previous drug treatment. RESULTS Most patients did not relapse during the 6-month medication-free follow-up phase. Three of 6 patients with fluvoxamine, 3 of 9 with topiramate, 7 of 18 with bupropion SR, and 4 of 10 with naltrexone relapsed. Relapse was strictly defined as gambling behavior at any time during the 6-month medication-free follow-up period. Most of the patients did not gamble during the follow-up period, and the patients that did gamble reported a decrease in gambling losses. CONCLUSIONS This naturalistic long-term follow-up outcome study demonstrates that among pathological gamblers who respond to a 6-month trial of medication, most patients seem to maintain full-response during a 6-month medication-free follow-up phase. Further studies are needed to confirm our findings.
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Pallanti S, DeCaria CM, Grant JE, Urpe M, Hollander E. Reliability and validity of the pathological gambling adaptation of the Yale-Brown Obsessive-Compulsive Scale (PG-YBOCS). J Gambl Stud 2007; 21:431-43. [PMID: 16311876 DOI: 10.1007/s10899-005-5557-3] [Citation(s) in RCA: 174] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The Yale Brown Obsessive Compulsive Scale adapted for Pathological Gambling (PG-YBOCS) was developed to measure the severity and change in severity of pathological gambling symptoms. The PG-YBOCS is a 10-item clinician-administered questionnaire that measures the severity of PG over a recent time interval (usually within the past one/two week(s)). In order to assess and validate the scale, it was administered to 337 subjects: 188 pathological gamblers and 149 healthy controls. Internal consistency and correlations between individual items and total score were assessed for various permutations of the sample. Other scales were administered to assess convergent, discriminant and content validity. Sensitivity to change was evaluated in treatment studies with fluovoxamine, lithium, and valproate. Each item was frequently endorsed across a range of severity. Good inter-rater reliability and internal consistency were obtained. The PG-YBOCS showed high validity and reliability for total score, item-total correlations, and for each subscale (Thoughts/Urges and Behavior). PG-YBOCS scores correlated with global severity and South Oaks Gambling Screen (SOGS) scores. The scale was also sensitive to change in pathological gambling severity. PG-YBOCS thus appears to be a reliable and valid measure of pathological gambling severity, and can be regarded as an important tool for clinicians and researchers treating pathological gamblers.
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Hollander E, Sood E, Pallanti S, Baldini-Rossi N, Baker B. Pharmacological treatments of pathological gambling. J Gambl Stud 2007; 21:99-110. [PMID: 15789195 DOI: 10.1007/s10899-004-1932-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Medication treatment studies have demonstrated short-term efficacy of various SRIs, opioid antagonists, and mood stabilizers in sub-samples of adult treatment seeking pathological gamblers. Pathological gambling is frequently comorbid with bipolar spectrum disorders, substance abuse/dependence, and attention-deficit/hyperactivity disorder (ADHD), and comorbidity may influence treatment response in pathological gambling. This review focuses on recent research examining the treatment of pathological gambling and highlights methodological challenges for future studies.
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MESH Headings
- Antidepressive Agents, Second-Generation/therapeutic use
- Behavior, Addictive/complications
- Behavior, Addictive/diagnosis
- Behavior, Addictive/drug therapy
- Bupropion/therapeutic use
- Comorbidity
- Disruptive, Impulse Control, and Conduct Disorders/complications
- Disruptive, Impulse Control, and Conduct Disorders/diagnosis
- Disruptive, Impulse Control, and Conduct Disorders/drug therapy
- Dose-Response Relationship, Drug
- Fluvoxamine/therapeutic use
- Gambling/psychology
- Humans
- Naltrexone/therapeutic use
- Outcome Assessment, Health Care
- Paroxetine/therapeutic use
- Piperazines
- Research Design
- Selective Serotonin Reuptake Inhibitors/therapeutic use
- Substance-Related Disorders/complications
- Substance-Related Disorders/diagnosis
- Substance-Related Disorders/drug therapy
- Triazoles/therapeutic use
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Affiliation(s)
- Eric Hollander
- Department of Psychiatry, Compulsive, Impulsive and Anxiety Disorders Program, Mount Sinai School of Medicine, Box 1230, One Gustave L. Levy Place, New York, NY, USA.
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Janiri L, Martinotti G, Dario T, Schifano F, Bria P. The Gamblers' Temperament and Character Inventory (TCI) personality profile. Subst Use Misuse 2007; 42:975-84. [PMID: 17613958 DOI: 10.1080/10826080701202445] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In a cross-comparison study, the Cloninger's Temperament and Character Inventory (TCI) personality profile was administered to 28 probable pathological gamblers (PPGs), 32 nonpathological gamblers (non-PGs), and 65 controls. As a screening device, the validated Italian version of the South Oak Gambling Screen was administered to all subjects. Novelty Seeking (NS) values were higher in PPGs in comparison with both non-PGs (p < .05) and controls (p < .001). PPGs showed lower Self-Directedness (SD) and Cooperativeness (CO) values with respect to both non-PGs (p < .05 and p = .001, respectively) and controls (p < .001 and p = .001, respectively). The subsamples of PPGs reporting either a current substance misuse condition or a parental involvement in gambling/substance misuse showed higher NS (p = .01) and lower CO (p = .005) values than the remaining PPGs. A duration of problem gambling in excess of 20 years was associated with lower (p = .001) CO values. Specific temperamental (NS) and character (SD; CO) dimensions differentiated PPGs from both non-PGs and controls; assessment of personality profile with the TCI may identify at-risk social gamblers.
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Affiliation(s)
- L Janiri
- Department of Psychiatry, Catholic University Medical School, Rome, Italy
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Martinotti G, Andreoli S, Giametta E, Poli V, Bria P, Janiri L. The dimensional assessment of personality in pathologic and social gamblers: the role of novelty seeking and self-transcendence. Compr Psychiatry 2006; 47:350-6. [PMID: 16905396 DOI: 10.1016/j.comppsych.2005.12.005] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2005] [Revised: 11/07/2005] [Accepted: 12/29/2005] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE A few personality traits are characteristic of pathologic gamblers (PGs), but it is not clear if and how their personality profile differs from that of non-pathologic gamblers (non-PGs). METHODS Sixty-five non-clinical subjects, differentiated into non-PGs and PGs with the means of the South Oak Gambling Screen (SOGS) and Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition-Text Revision (DSM-IV-TR) criteria, were administered with the Temperament and Character Inventory; their values were compared with those of control subjects (CS). RESULTS Novelty seeking (NS) and self-transcendence (ST) values were higher whereas self-directedness and cooperativeness values were lower in PGs with respect to both non-PGs and CS. A positive correlation was noted between SOGS score and NS (r = 0.40) and ST (r = 0.50) values, as well as a significant positive dependence between SOGS score and a family history of gambling (t = 2.816; P = .007). The subsamples of PGs reporting a parental involvement in gambling showed higher NS than the remaining PGs. CONCLUSIONS Specific temperamental and character dimensions, especially NS and ST, differentiated PGs from both non-PGs and CS; the identification of a personality profile at risk for problem gambling may represent an important predictor of outcome and constitute a possible target for specific treatment approaches.
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Affiliation(s)
- Giovanni Martinotti
- Department of Psychiatry, Catholic University Medical School, 00167 Rome, Italy.
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Abstract
AIMS In anticipation of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), to consider whether addictive disorders should include non-substance use disorders. METHODS The author reviewed data and provided perspective to explore whether disorders such as pathological gambling (PG) should be grouped together with substance dependence, given that they share many features. RESULTS PG and substance dependence currently reside in the DSM, fourth edition, text revision (DSM-IV-TR) within separate categories, with PG classified as an impulse control disorder (ICD) and substance dependence as a substance use disorder (SUD). Arguments can be forwarded to support each categorization, as well as to justify their inclusion together as addictions. CONCLUSIONS The current state of knowledge suggests that there exist substantial similarities between PG and SUDs. Further research is indicated prior to categorizing PG and other ICDs together with SUDs.
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Abstract
PURPOSE OF REVIEW To increase awareness and knowledge of the growing problem of adolescent gambling. RECENT FINDINGS Some risk factors have been established for adolescent gambling. Many of the risk factors for gambling behavior can be addressed in effective prevention of problem gambling. There is an association between some psychiatric comorbid conditions and problem gambling (i.e. depression). Current treatment modalities are based on adult experiences and need further investigation for adolescents. Prevention strategies and education of youth, parents, teachers, educators, and professionals are essential in targeting this serious problem. SUMMARY Given the increasing overall prevalence of adolescent gambling, it is imperative that pediatricians appreciate that gambling problems can also afflict adolescents. There is a clear link between problem gambling in adolescence and pathologic gambling in adulthood. Thus, like other addictive behaviors (cigarette smoking, alcohol and drug use), youth and parents should be screened and counseled about the risks associated with excessive gambling.
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Affiliation(s)
- Renee M Turchi
- Drexel University College of Medicine, St Christopher's Hospital for Children, Philadelphia, Pennsylvania, USA.
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Walker M, Toneatto T, Potenza MN, Petry N, Ladouceur R, Hodgins DC, el-Guebaly N, Echeburua E, Blaszczynski A. A framework for reporting outcomes in problem gambling treatment research: the Banff, Alberta Consensus. Addiction 2006; 101:504-11. [PMID: 16548930 DOI: 10.1111/j.1360-0443.2005.01341.x] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective is provide a framework concerning the minimum features of reporting efficacy of treatment in the problem gambling field. Research to date has not used uniform outcome measures and it is, therefore, difficult to compare the relative efficacy of various approaches. Some studies emphasize self-reported behavioural measures such as frequency and intensity of gambling whereas others emphasise change with respect to the criteria used to diagnose problem gambling or use composite measures of symptom severity in multiple domains involving gambling-related thoughts, urges, and behaviours. METHODS An expert panel consensus. RESULTS The proposed minimum features of reporting the efficacy of treatment outcome studies are: measures of gambling behaviour - the net expenditure each month, the frequency (in days per month) with which gambling takes place, and the time spent thinking about or engaged in the pursuit of gambling each month; measures of the problems caused by gambling - especially problems in the areas of personal health, relationships, financial, and legal; these measures can be complemented by additional measures of quality of life. measures of the processes of change - whatever mechanisms of change are assumed to occur. CONCLUSIONS We believe that these guidelines are broad enough to allow clinical research conducted from diverse perspectives to allow valid cross study evaluations of intervention studies. Such conditions will facilitate the development of empirically validated best practice guidelines for use by clinicians in the management of problem gambling.
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Abstract
BACKGROUND Impulse Control Disorders (ICDs) are an eclectic group of conditions in which a person has a drive, urge, or temptation, to perform a potentially harmful act, or fails to resist an impulse. METHODS Authors reviewed the current medical literature addressing this diverse group of disorders. RESULTS Although the behaviors associated with these conditions can cause a great deal of suffering for patients and their families, they have remained relatively under-researched and poorly characterized. CONCLUSIONS Recent studies have explored both pharmacological and psychosocial treatments, giving rise to greater hope for the development of more effective treatments for these challenging disorders.
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Affiliation(s)
- John M Kuzma
- University of Iowa Health Care, Iowa City, IA, USA
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Affiliation(s)
- Dan J Stein
- University of Stellenbosch, Cape Town, South Africa
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29
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Abstract
Experiences from treatment trials are described. The use of structured instruments for subject characterization and symptom change assessment is discussed and the challenges of treating specific groups (e.g., those with co-occurring alcohol use disorders) explored. Treatment for pathological gambling might be advanced most rapidly through collaborative multi-center efforts.
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Affiliation(s)
- Marc N Potenza
- Connecticut Mental Health Center, Problem Gambling Clinic, Women's Health Research at Yale, Yale University School of Medicine, Room S-104, 34 Park Street, New Haven, CT 06519, USA.
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30
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Toneatto T, Millar G. Assessing and treating problem gambling: empirical status and promising trends. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2004; 49:517-25. [PMID: 15453101 DOI: 10.1177/070674370404900803] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Ways to clinically assess and treat problem gambling evolve as our knowledge about this disorder increases. This paper summarizes current knowledge about treating problem gambling and describes developments in the assessment, psychology, and biology of problem gambling that may be important for treatment. METHODS We reviewed recent published literature reporting advances in the assessment, psychology, and biology of problem gambling. We retained for review only controlled clinical trials in which subjects were randomized to either psychological or pharmacologic treatment. RESULTS Although several gambling treatments were found to be efficacious, support for any specific treatment modality is still limited. Cognitive-behavioural treatments were most effective. Although diagnostic assessment has improved, there are still very few measures of gambling-related variables. The contribution to gambling of sex, concurrent psychiatric disorders, cognitive distortions, and impulsivity has been described. Evidence implicating decision-making areas of the cortex and disturbances in serotonin and dopamine functioning has been reviewed. Available evidence for a genetic contribution to problem gambling is weak. CONCLUSIONS Improvements in the methodology of gambling-treatment research were discussed to advance the clinical approach to this disorder. Developments in the area of assessment, psychology, and biology of gambling should inform clinical approaches to a greater degree than they currently do. We identified the need to study different types of gambling separately, rather than combining them, as an important goal.
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Affiliation(s)
- Tony Toneatto
- Clinical Research Department, Center for Addiction and Mental Health, Toronto, Ontario.
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Grant JE, Grosz R. Pharmacotherapy outcome in older pathological gamblers: a preliminary investigation. J Geriatr Psychiatry Neurol 2004; 17:9-12. [PMID: 15018691 DOI: 10.1177/0891988703262000] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Although pharmacotherapy is often effective for pathological gambling, little is known about how it affects older populations. The present study examines the response to pharmacotherapy in a series of pathological gamblers age 60 years and older. Fourteen older patients who fulfilled DSM-IV criteria for pathological gambling were treated in an outpatient clinic. Subjects were assessed retrospectively with the Clinical Global Impressions scale (both severity and improvement measures) using information collected on gambling symptoms during clinic visits. Eight (57.1%) older patients achieved sustained response to pharmacotherapy. The present findings indicate that many older pathological gamblers respond to "off-label" use of pharmacotherapy. The present findings are preliminary. Further studies with larger samples are needed to confirm these findings.
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MESH Headings
- Aged
- Antidepressive Agents/therapeutic use
- Antimanic Agents/therapeutic use
- Bipolar Disorder/diagnosis
- Bipolar Disorder/drug therapy
- Bipolar Disorder/psychology
- Comorbidity
- Depressive Disorder, Major/diagnosis
- Depressive Disorder, Major/drug therapy
- Depressive Disorder, Major/psychology
- Disruptive, Impulse Control, and Conduct Disorders/diagnosis
- Disruptive, Impulse Control, and Conduct Disorders/drug therapy
- Disruptive, Impulse Control, and Conduct Disorders/psychology
- Drug Therapy, Combination
- Female
- Follow-Up Studies
- Gambling/psychology
- Humans
- Male
- Middle Aged
- Naltrexone/therapeutic use
- Personality Assessment
- Phobic Disorders/diagnosis
- Phobic Disorders/drug therapy
- Phobic Disorders/psychology
- Psychotropic Drugs/therapeutic use
- Selective Serotonin Reuptake Inhibitors/therapeutic use
- Treatment Outcome
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Affiliation(s)
- Jon E Grant
- Department of Psychiatry and Human Behavior, Butler Hospital and Brown Medical School, 345 Blackstone Blvd., Providence, RI 02906, USA.
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Abstract
Compulsive disorders include a diverse group of conditions characterized by excessive thoughts or preoccupations combined with poorly controlled behaviors. They include trichotillomania, kleptomania, pathologic gambling, compulsive buying disorder, compulsive sexual behavior, and compulsive computer use. Some investigators have suggested that these conditions constitute a spectrum of disorders linked to obsessive-compulsive disorder. Others have questioned the validity of this conceptualization, and have debated the relationship between these disorders. Nevertheless, much has been learned about compulsive disorders, and there have been some successes with psychotherapeutic and psychopharmacologic treatments. Recent therapy-based interventions have moved from psychodynamic treatments toward cognitive-behavioral modalities. Serotonin reuptake inhibitors remain the best-studied pharmacologic treatment, but researchers have also explored other antidepressants, opioid agonists, mood stabilizers, and atypical antipsychotics.
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Affiliation(s)
- John M Kuzma
- Department of Psychiatry, University of Iowa Carver College of Medicine, Psychiatry Research MEB, Iowa City, IA 52242, USA.
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Potenza MN, Fiellin DA, Heninger GR, Rounsaville BJ, Mazure CM. Gambling: an addictive behavior with health and primary care implications. J Gen Intern Med 2002; 17:721-32. [PMID: 12220370 PMCID: PMC1495100 DOI: 10.1046/j.1525-1497.2002.10812.x] [Citation(s) in RCA: 129] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Over the past several decades, and particularly during the last 10 to 15 years, there has been a rapid increase in the accessibility of legalized gambling in the United States and other parts of the world. Few studies have systematically explored the relationships between patterns of gambling and health status. Existing data support the notion that some gambling behaviors, particularly problem and pathological gambling, are associated with nongambling health problems. The purpose of this article is to provide a perspective on the relationship between gambling behaviors and substance use disorders, review the data regarding health associations and screening and treatment options for problem and pathological gambling, and suggest a role for generalist physicians in assessing problem and pathological gambling. A rationale for conceptualization of pathological gambling as an addictive disorder and a model proposing stress as a possible mediating factor in the relationship between gambling and health status are presented. More research is needed to investigate directly the biological and health correlates associated with specific types of gambling behaviors and to define the role for generalist physicians in the prevention and treatment of problem and pathological gambling.
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Affiliation(s)
- Marc N Potenza
- Yale University School of Medicine, New Haven, CT 06519, USA.
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