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Bickl AM, Schwarzkopf L, Loy JK, Grüne B, Braun-Michl B, Sleczka P, Örnberg JC, Kraus L. Changes in gambling behaviour and related problems in clients seeking help in outpatient addiction care: Results from a 36-month follow-up study in Bavaria. J Behav Addict 2021; 10:690-700. [PMID: 34319902 PMCID: PMC8997214 DOI: 10.1556/2006.2021.00043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 06/09/2021] [Accepted: 06/13/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND AIM Evidence on the course of gambling disorder (GD) in clients seeking help from outpatient addiction care facilities is sparse. To close this knowledge gap, this longitudinal one-armed cohort study portrays the development of GD in help-seeking clients over a 3-year timeframe. METHODS We investigated changes in severity of GD as well as in gambling frequency and intensity in 145 gamblers in outpatient treatment in Bavaria using generalized estimation equations (GEEs). To investigate potentially different trajectories between study participants with and without migration background (MB), additional analyses were applied with time*migration interaction. All analyses were adjusted for age, gender, education, electronic gambling machine (EGM) gambling, MB, GD, related help sought before and treatment status. RESULTS Within the entire study population, improvements in severity of GD (reduction of 39.2%), gambling intensity (reduction of 75.6%) and gambling frequency (reduction of 77.0%) were observed between baseline and 36 months of follow-up. The declines were most pronounced between baseline and follow-up 1 and stabilized thereafter. Participants with MB improved consistently less than participants without MB. DISCUSSION AND CONCLUSION Our study suggests that severity of GD and gambling patterns improve in the context of outpatient treatment. The beneficial results furthermore persist for 36 months after treatment termination. As clients with MB seem to profit less than clients without MB, improvements in outpatient gambling services to the specific needs of this clientele are required.
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Affiliation(s)
- Andreas M. Bickl
- IFT Institut für Therapieforschung, München, Germany,Corresponding author. E-mail:
| | | | | | - Bettina Grüne
- German Youth Institute (DJI), Department of Youth and Youth Services, München, Germany
| | | | - Pawel Sleczka
- German University of Health and Sport, Ismaning, Germany,Seeburg Castle University, Seekirchen am Wallersee, Austria
| | - Jenny Cisneros Örnberg
- Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Sweden
| | - Ludwig Kraus
- IFT Institut für Therapieforschung, München, Germany,Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Sweden,Institute of Psychology, ELTE, Eötvös Loránd University, Budapest, Hungary
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Schwarzkopf L, Loy JK, Braun-Michl B, Grüne B, Sleczka P, Kraus L. Gambling disorder in the context of outpatient counselling and treatment: Background and design of a prospective German cohort study. Int J Methods Psychiatr Res 2021; 30:e1867. [PMID: 33439510 PMCID: PMC8170573 DOI: 10.1002/mpr.1867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 10/19/2020] [Accepted: 12/18/2020] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE The prospective naturalistic study 'Katamnese-Studie' conducted between 2014 and 2019 gathers evidence on the course of gambling disorder in German routine outpatient addiction care. This study elucidates design and methodological advantages and caveats of the study. METHODS Participants of the multi-centre cohort received written questionnaires at admission and at 6-, 12-, 24- and 36-month follow-up to assess socio-demographic data, gambling behaviour, gambling-related consequences and care offers sought. Subsequently, self-reports were linked to client-individual routine documentation for the German Addiction Care Statistical Service. Furthermore, employees of participating outpatient addiction care facilities were surveyed regarding experiences with and attitudes towards gambling disorder. Multivariate longitudinal regression models will portray changes in the severity of gambling disorder and gambling behaviour and explore associated client- and care-related factors. CONCLUSION The 'Katamnese-Studie' covers the whole spectrum of outpatient gambling care. Keeping the design-related caveats in mind (reliability of self-reports, loss-to-follow-up and issues regarding causal inference), the study is anticipated to draw a comprehensive picture of routine outpatient gambling care and key factors related to sustained remission. In the medium term, this information might support the development and subpopulation-specific adaptation of recommendations on how to structure process and content of outpatient gambling care.
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Affiliation(s)
- Larissa Schwarzkopf
- IFT Institut Fuer Therapieforschung, Munich, Germany.,Helmholtz Zentrum Muenchen, Institute of Health Economics and Health Care Management, Munich, Germany
| | - Johanna K Loy
- IFT Institut Fuer Therapieforschung, Munich, Germany
| | | | - Bettina Grüne
- Department of Palliative Medicine, Ludwig Maximilians University Hospital, Munich, Germany
| | - Pawel Sleczka
- German University of Health and Sport, Ismaning, Germany
| | - Ludwig Kraus
- IFT Institut Fuer Therapieforschung, Munich, Germany.,Department for Public Health Sciences, Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Sweden.,Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
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Sleczka P, Braun-Michl B, Kraus L. Gamblers' attitudes towards money and their relationship to gambling disorder among young men. J Behav Addict 2020; 9:744-755. [PMID: 32692711 PMCID: PMC8943678 DOI: 10.1556/2006.2020.00042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 06/04/2020] [Accepted: 06/13/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND AIMS Money plays a central role in gambling, and understanding the different attitudes of gamblers towards it might benefit both prevention and treatment of gambling-related problems. This study describes the development of a new German measure of attitudes to money and the differences in these attitudes between male non-gamblers, occasional, frequent and problem gamblers. Furthermore, it investigates the cross-sectional and longitudinal associations between attitudes towards money and the severity of gambling disorder. METHODS An online study was conducted among 2,584 men aged 18-25 years, recruited via the Munich citizen registry. Additionally, a sample of n = 105 Facebook users was included in part of the analyses. Frequent and problem gamblers were invited to a 12-month follow-up. Apart from gambling participation and related problems, the questionnaire included items from existing scales measuring attitudes to money. RESULTS Three factors underlying a new 12-item German Scale of Money Attitudes (SMAG) were identified: success, budgeting and evil. Compared with other groups, participants reporting any gambling problems scored highest in success and lowest in budgeting. Budgeting was associated with gambling-related problems in both cross-sectional and longitudinal analyses and strengthened the relationship between associating money with success and gambling disorder. DISCUSSION For problem gamblers, money is important as a personal symbol of success. This attitude has an especially negative effect on gambling-related problems in individuals who handle money irresponsibly. Spending and winning money might play an important role in maintaining self-esteem among gamblers and thus hinder their attempts to quit.
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Affiliation(s)
- Pawel Sleczka
- German University of Health and
Sport, Ismaning, Germany
| | | | - Ludwig Kraus
- IFT Institut für
Therapieforschung, Munich,
Germany
- Department of
Public Health Sciences, Centre for Social Research on Alcohol and Drugs, Stockholm
University, Stockholm, Sweden
- Institute of
Psychology, ELTE Eötvös Loránd University, Budapest,
Hungary
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Abstract
Objectives Male sex, young age, and frequent gambling are considered as risk factors for gambling disorder (GD) and stress might be one of the triggers of gambling behavior among problem gamblers. Conversely, well-developed coping with stress might counteract gambling problems. The Proactive Coping Theory provides a promising approach for the further development of preventive and treatment measures. The objective of the study was to investigate different facets of proactive coping (PC) in young male gamblers. Methods Young men from Bavaria were recruited via the Munich citizens' registry (n = 2,588) and Facebook invitations (n = 105). In total, 173 out of 398 individuals were positively screened for frequent gambling and/or signs of related problems and completed the baseline questionnaire of the Munich Leisure-time Study. Factors investigated include gambling problems, PC, impulsiveness, social support, and psychological distress. Results Gambling problems were associated with lower levels of preventive coping as well as of adaptive reaction delay. The associations were also significant when controlled for impulsiveness and general psychological distress. Preventive coping moderated the association between social support and gambling problems. Discussion and conclusions Young men with gambling problems less frequently prevent the occurrence of stressors and more often react hasty when these occur. While the investigated group reported good social support, this factor was negatively associated with GD only among individuals with good preventive coping. Preventive coping poses a useful construct for selective prevention and treatment as it can be modified in professional interventions.
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Affiliation(s)
- Pawel Sleczka
- IFT Institut für Therapieforschung, München, Germany,Corresponding author: Pawel Sleczka; IFT Institut für Therapieforschung, Parzivalstr. 25, D-80804 München, Germany; Phone: +49 89 36 08 04 35; Fax: +49 89 36 08 04 46; E-mail:
| | - Barbara Braun
- IFT Institut für Therapieforschung, München, Germany
| | - Bettina Grüne
- IFT Institut für Therapieforschung, München, Germany
| | - Gerhard Bühringer
- IFT Institut für Therapieforschung, München, Germany,Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Ludwig Kraus
- IFT Institut für Therapieforschung, München, Germany,Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Sweden
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BRAUN BARBARA, LUDWIG MONIKA, SLECZKA PAWEL, BÜHRINGER GERHARD, KRAUS LUDWIG. Gamblers seeking treatment: Who does and who doesn't? J Behav Addict 2014; 3:189-98. [PMID: 25317343 PMCID: PMC4189314 DOI: 10.1556/jba.3.2014.3.7] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 08/18/2014] [Accepted: 08/19/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND AIMS As only a minority of pathological gamblers (PGr) presents for treatment, further knowledge about help-seeking behavior is required in order to enhance treatment utilization. The present study investigated factors associated with treatment participation in gamblers in Germany. As subclinical pathological gamblers (SPGr, fulfilling one to four DSM-IV-criteria) are target of early intervention due to high risk of transition to pathological gambling, they were subject of special interest. METHODS The study analyzed data from a general population survey (n = 234, SPGr: n = 198, PGr: n = 36) and a treatment study (n = 329, SPGr: n = 22, PGr: n = 307). A two-step weighting procedure was applied to ensure comparability of samples. Investigated factors included socio-demographic variables, gambling behavior, symptoms of pathological gambling and substance use. RESULTS In PGr, regular employment and non-German nationality were positively associated with being in treatment while gambling on the Internet and gaming machines and fulfilling more DSM-IV-criteria lowered the odds. In SPGr, treatment attendance was negatively associated with married status and alcohol consumption and positively associated with older age, higher stakes, more fulfilled DSM-IV criteria and regular smoking. CONCLUSIONS In accordance to expectations more severe gambling problems and higher problem awareness and/or external pressure might facilitate treatment entry. There are groups with lower chances of being in treatment: women, ethnic minorities, and SPGr. We propose target group specific offers, use of Internet-based methods as possible adaptions and/or extensions of treatment offers that could enhance treatment attendance.
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Affiliation(s)
- BARBARA BRAUN
- IFT Institut fűr Therapieforschung, Munich, Germany,Corresponding author: Barbara Braun; IFT Institut für Therapieforschung, Parzivalstr.25, 80804 Munich, Germany; E-mail:
| | - MONIKA LUDWIG
- Institut fűr Psychologie, Universität Hildesheim, Germany
| | | | - GERHARD BÜHRINGER
- IFT Institut fűr Therapieforschung, Munich, Germany,Addiction Research Unit, Institut fűr Klinische Psychologie und Psychotherapie, Technische Universität Dresden, Germany
| | - LUDWIG KRAUS
- IFT Institut fűr Therapieforschung, Munich, Germany,Centre for Social Research on Alcohol and Drugs (SoRAD), Stockholm University, Sweden
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Bischof A, Meyer C, Bischof G, Guertler D, Kastirke N, John U, Rumpf HJ. Association of sociodemographic, psychopathological and gambling-related factors with treatment utilization for pathological gambling. Eur Addict Res 2014; 20:167-73. [PMID: 24401333 DOI: 10.1159/000356904] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 10/25/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Only a small percentage of pathological gamblers utilizes professional treatment for gambling problems. Little is known about which social and gambling-related factors are associated with treatment utilization. The aim of this study was to look for factors associated with treatment utilization for pathological gambling. METHODS The study followed a sampling design with 3 different recruitment channels, namely (1) a general population-based telephone sample, (2) a gambling location sample and (3) a project telephone hotline. Pathological gambling was diagnosed in a telephone interview. Participants with pathological gambling (n=395) received an in-depth clinical interview concerning treatment utilization, comorbid psychiatric disorders and social characteristics. RESULTS Variables associated with treatment were higher age [odds ratio (OR) 1.05, 95% confidence interval (CI) 1.03-1.08], an increased number of DSM-IV criteria for pathological gambling (OR 1.34, 95% CI 1.06-1.70), more adverse consequences from gambling (OR 1.10, 95% CI 1.03-1.16) and more social pressure from significant others (OR 1.17, 95% CI 1.07-1.27). Affective disorders were associated with treatment utilization in the univariate analysis (OR 1.81, 95% CI 1.19-2.73), but multivariate analysis showed that comorbid psychiatric disorders were not independently associated. CONCLUSION These results indicate that individuals with more severe gambling problems utilize treatment at an older age when more adverse consequences have occurred. Further research should focus on proactive early interventions.
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Affiliation(s)
- Anja Bischof
- Research Group Substance Abuse and Related Disorders: Treatment, Epidemiology and Prevention, Center for Integrative Psychiatry, Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
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Inpatient treatment for pathological gamblers in Germany: setting, utilization, and structure. J Gambl Stud 2014; 31:257-79. [PMID: 24375259 DOI: 10.1007/s10899-013-9430-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In Germany, there are two different approaches to inpatient treatment of pathological gambling (PG): Facilities focusing on addiction or on psychosomatic illness. However, little is known about how these differences influence utilization and structure of treatment. Therefore, in our study, we analyzed all known German gambling inpatient treatment centers concerning patients' sex, age and number of comorbid disorders and evaluated an expert assessment of the treatment system, access to treatment, and structure characteristics of inpatient treatment facilities. In 2011, 2,229 pathological gamblers were treated. This amounts to 1 % of all past-year pathological gamblers. 90 % of the patients were men, 93 % had at least one comorbid disorder. Access to treatment was mostly gained via psychosocial counseling centers, but was not readily available. Facilities with addiction departments treated less pathological gamblers per year (29.3 gamblers) than facilities with psychosomatic departments (53.3 gamblers) or with both departments (76.4 gamblers). Treatment duration was significantly longer in addiction departments treating PG as secondary diagnosis only, with a low rate of gamblers on all patients, or treating few gamblers. Some facilities specialized on PG and treated more gamblers, had a higher rate of gamblers on all patients, and offered specific treatment programs. The impact of this specialization on treatment outcome is still unclear. Although treatment numbers have risen steadily for the past years, only a small fraction of affected gamblers seek inpatient treatment. Therefore, awareness to the disease and access to treatment needs to be improved.
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