1
|
An Examination of Clinician Responses to Problem Gambling in Community Mental Health Services. J Clin Med 2020; 9:jcm9072075. [PMID: 32630354 PMCID: PMC7408856 DOI: 10.3390/jcm9072075] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/26/2020] [Accepted: 06/29/2020] [Indexed: 11/16/2022] Open
Abstract
Gambling problems commonly co-occur with other mental health problems. However, screening for problem gambling (PG) rarely takes place within mental health treatment settings. The aim of the current study was to examine the way in which mental health clinicians respond to PG issues. Participants (n = 281) were recruited from a range of mental health services in Victoria, Australia. The majority of clinicians reported that at least some of their caseload was affected by gambling problems. Clinicians displayed moderate levels of knowledge about the reciprocal impact of gambling problems and mental health but had limited knowledge of screening tools to detect PG. Whilst 77% reported that they screened for PG, only 16% did so “often” or “always” and few expressed confidence in their ability to treat PG. However, only 12.5% reported receiving previous training in PG, and those that had, reported higher levels of knowledge about gambling in the context of mental illness, more positive attitudes about responding to gambling issues, and more confidence in detecting/screening for PG. In conclusion, the findings highlight the need to upskill mental health clinicians so they can better identify and manage PG and point towards opportunities for enhanced integrated working with gambling services.
Collapse
|
2
|
Guilcher SJT, Cadel L, Everall AC, Wiese JL, Hamilton-Wright S, Salmon CC, Matheson FI. Factors related to screening for problem gambling among healthcare and social service providers in Ontario, Canada: A concept mapping study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:791-802. [PMID: 31833129 DOI: 10.1111/hsc.12909] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 11/12/2019] [Accepted: 11/19/2019] [Indexed: 06/10/2023]
Abstract
Problem gambling is a major public health concern, especially among persons who are precariously housed, living in poverty or have complex health and social needs. Problem gambling has been connected to negative health and social outcomes; however, current healthcare services rarely screen for problem gambling. With support from community partners, the purpose of this study was to understand factors related to screening for problem gambling. Concept mapping, a mixed-method approach driven by participatory involvement, was conducted with healthcare and social service providers from Ontario, Canada in 2019. Three phases were conducted with participants either in-person or online: Brainstorming, Sorting/Rating and Mapping. Brainstorming sessions were conducted to generate statements, guided by the focal prompt: "If you were directed to routinely screen for problem gambling, what would help you do this in your daily practice?" Participants sorted statements into categories and rated them based on their importance and feasibility. A mapping session was conducted with participants to co-create visual representations of the data. Thirty participants took part in the in-person or online concept mapping sessions. During the brainstorming sessions, participants generated 213 statements, which the research team condensed into a final list of 45 statements. Participants decided that the five-cluster map best represented these 45 statements and labelled the five clusters: (a) top level (macro), (b) screening tool, (c) staff skills and training, (d) screening, and (e) team resources and support. Staff skills and training was rated as the most important and the most realistic cluster to implement, while screening was rated relatively as the least important when compared to the other clusters. Team resources and support was rated relatively as the least realistic cluster. By identifying the needs of healthcare and social service providers, this study co-developed actionable suggestions that will assist providers in routinely screening for problem gambling.
Collapse
Affiliation(s)
- Sara J T Guilcher
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada
| | - Lauren Cadel
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Amanda C Everall
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Jessica L Wiese
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada
| | | | - Christina C Salmon
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada
| | - Flora I Matheson
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada
- Criminology and Sociolegal Studies, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
3
|
Dowling NA, Merkouris SS, Dias S, Rodda SN, Manning V, Youssef GJ, Lubman DI, Volberg RA. The diagnostic accuracy of brief screening instruments for problem gambling: A systematic review and meta-analysis. Clin Psychol Rev 2019; 74:101784. [PMID: 31759246 DOI: 10.1016/j.cpr.2019.101784] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 10/22/2019] [Accepted: 10/26/2019] [Indexed: 02/06/2023]
Abstract
Non-gambling specialist services, such as primary care, alcohol and other drug use, and mental health services, are well placed to enhance the identification of people with gambling problems and offer appropriate generalist first level interventions or referral. Given time and resource demands, many of these clinical services may only have the capacity to administer very short screening instruments. This systematic review was conducted to provide a resource for health service providers and researchers in identifying the most accurate brief (1-5 item) screening instruments to identify problem and at-risk gambling for their specific purposes and populations. A systematic search of peer-reviewed and grey literature from 1990 to 2019 identified 25 articles for inclusion. Meta-analysis revealed five of the 20 available instruments met criteria for satisfactory diagnostic accuracy in detecting both problem and at-risk gambling: Brief Problem Gambling Screen (BPGS-2), NODS-CLiP, Problem Gambling Severity Index-Short Form (PGSI-SF), NODS-PERC, and NODS-CLiP2. Of these, the NODS-CLiP and NODS-PERC have the largest volume of diagnostic data. The Lie/Bet Questionnaire and One-Item Screen are also promising shorter options. Because these conclusions are drawn from a relatively limited evidence base, future studies evaluating the diagnostic accuracy of existing brief instruments across settings, age groups, and timeframes are needed.
Collapse
Affiliation(s)
- N A Dowling
- School of Psychology, Deakin University, 1 Gheringhap St, Geelong, VIC 3220, Australia; Melbourne Graduate School of Education, University of Melbourne, Kwong Lee Dow Building, 234 Queensberry Street, Parkville, VIC 3053, Australia.
| | - S S Merkouris
- School of Psychology, Deakin University, 1 Gheringhap St, Geelong, VIC 3220, Australia
| | - S Dias
- School of Psychology, Deakin University, 1 Gheringhap St, Geelong, VIC 3220, Australia
| | - S N Rodda
- School of Population Health, Faculty of Medical and Health Sciences, 216 Morrin Road, Auckland 1142, New Zealand.
| | - V Manning
- Eastern Health Clinical School, Faculty of Medicine, Nursing & Health Sciences, Monash University, Level 2, 5 Arnold Street, Box Hil, 3128 Melbourne, Victoria, Australia; Turning Point, Eastern Health, 110 Church Street, Richmond 3121, VIC, Australia
| | - G J Youssef
- School of Psychology, Deakin University, 1 Gheringhap St, Geelong, VIC 3220, Australia; Centre for Adolescent Health, Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Road, Parkville 3052, Victoria, Australia
| | - D I Lubman
- Eastern Health Clinical School, Faculty of Medicine, Nursing & Health Sciences, Monash University, Level 2, 5 Arnold Street, Box Hil, 3128 Melbourne, Victoria, Australia; Turning Point, Eastern Health, 110 Church Street, Richmond 3121, VIC, Australia
| | - R A Volberg
- School of Public Health and Health Sciences, University of Massachusetts, 715 N. Pleasant Street, Amherst, MA 01003, USA.
| |
Collapse
|
4
|
Rodda SN, Manning V, Dowling NA, Lee SJ, Lubman DI. Barriers and Facilitators of Responding to Problem Gambling: Perspectives from Australian Mental Health Services. J Gambl Stud 2018; 34:307-320. [PMID: 28884260 DOI: 10.1007/s10899-017-9713-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Despite high rates of comorbidity between problem gambling and mental health disorders, few studies have examined barriers or facilitators to the implementation of screening for problem gambling in mental health services. This exploratory qualitative study identified key themes associated with screening in mental health services. Semi-structured interviews were undertaken with 30 clinicians and managers from 11 mental health services in Victoria, Australia. Major themes and subthemes were identified using qualitative content analysis. Six themes emerged including competing priorities, importance of routine screening, access to appropriate screening tools, resources, patient responsiveness and workforce development. Barriers to screening included a focus on immediate risk as well as gambling being often considered as a longer-term concern. Clinicians perceived problem gambling as a relatively rare condition, but did acknowledge the need for brief screening. Facilitators to screening were changes to system processes, such as identification of an appropriate brief screening instrument, mandating its use as part of routine screening, as well as funded workforce development activities in the identification and management of problem gambling.
Collapse
Affiliation(s)
- S N Rodda
- School of Population Health, University of Auckland, Auckland, New Zealand.,Turning Point, Eastern Health, Fitzroy, Australia.,School of Psychology, Deakin University, Geelong, Australia
| | - V Manning
- Turning Point, Eastern Health, Fitzroy, Australia.,Eastern Health Clinical School, Monash University, Fitzroy, Australia
| | - N A Dowling
- School of Psychology, Deakin University, Geelong, Australia.,Melbourne Graduate School of Education, Melbourne, Australia
| | - S J Lee
- Monash Alfred Psychiatry Research Centre, The Alfred and Monash University Central Clinical School, Melbourne, Australia
| | - D I Lubman
- Turning Point, Eastern Health, Fitzroy, Australia. .,Eastern Health Clinical School, Monash University, Fitzroy, Australia.
| |
Collapse
|
5
|
Stansbury KL, Beecher B, Schumacher M, Martin F, Clute MA. Social service providers' perspectives on casino gambling in older adult clients. JOURNAL OF GAMBLING ISSUES 2015. [DOI: 10.4309/jgi.2015.30.11] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
There has been an upward trend in gambling, particularly among older adults. With the baby-boomer generation moving toward retirement, this trend is expected to increase. Availability and social acceptability of casinos in the United States are 2 of many precipitating factors for older adults' increased enthusiasm for gambling. Noticeably absent from the literature on casino gambling is the perspective of senior social service providers (SSSPs). The present study used a cross-sectional open-ended questionnaire completed by 88 SSSPs in Washington State. The purpose of this study was to describe the SSSPs' (a) perceptions of older adults' motivations to participate in casino gambling, (b) experience with older adults who have gambling problems, (c) views and knowledge of problem gambling, and (d) perception of the need for training on gambling problems. The most prevalent reasons cited for older adults to patronize casinos were the entertainment of gambling and the desire to win money. The least prevalent reasons included peer pressure, to learn new things, and for a public smoking environment. Many respondents (42.0%) felt that their clients were aware of the risks of casino gambling. However, almost one third (29.5%) reported that their clients were largely unaware of the risks. Almost all of the respondents (85.2%) reported they had not received any training regarding problem gambling. The findings indicate the need to educate SSSPs about the potential positive and negative consequences of casino gambling.
Collapse
|
6
|
Mackay TL, Petermann L, Hurrell C, Hodgins D. Knowledge translation in gambling research: a scoping review. INTERNATIONAL GAMBLING STUDIES 2015. [DOI: 10.1080/14459795.2014.1003575] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
7
|
Early detection of pathological gambling: betting on GPs' beliefs and attitudes. BIOMED RESEARCH INTERNATIONAL 2014; 2014:360585. [PMID: 25243136 PMCID: PMC4160611 DOI: 10.1155/2014/360585] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 06/30/2014] [Accepted: 07/02/2014] [Indexed: 11/17/2022]
Abstract
Pathological gambling (PG) is an addictive disorder with harm related to the high psychiatric comorbidity and increased suicidal risk. Prevalence rates in general population range from 0.2% to 2.1%. Problem gamblers are hard to attract to treatment programs for several proper reasons and for obstacles (e.g., accessibility). To address these obstacles, primary care (where the problem gambling (PrG) prevalence seems to be 6.2%) has a crucial role to play (i.e., identifying and referring patients to specialized treatment programs and treating at first line when needed and possible) in the era of online gambling offer expansion. The present work aimed to collect data on resources in the field from GPs themselves, using a 24-item online questionnaire. Swiss French-speaking participants were asked about their screening practice and knowledge. The results state that the vast majority of them are aware of the existence and the potential impact of PrG on their patients. However, PrG screening is not systematic and their knowledge of adequate treatments or referral methods is scarce. GPs being central to health screening in general, targeted advice and training on short screening tools and better knowledge of referral pathways should be promoted and continued to empower the GP's management skills in a public health approach.
Collapse
|
8
|
Hagedorn WB, Juhnke GA. Treating the Sexually Addicted Client: Establishing a Need for Increased Counselor Awareness. JOURNAL OF ADDICTIONS & OFFENDER COUNSELING 2011. [DOI: 10.1002/j.2161-1874.2005.tb00194.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
9
|
Hagedorn WB. The Call for a New Diagnostic and Statistical Manual of Mental Disorders Diagnosis: Addictive Disorders. JOURNAL OF ADDICTIONS & OFFENDER COUNSELING 2011. [DOI: 10.1002/j.2161-1874.2009.tb00049.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
10
|
Seale JP, Shellenberger S, Clark DC. Providing competency-based family medicine residency training in substance abuse in the new millennium: a model curriculum. BMC MEDICAL EDUCATION 2010; 10:33. [PMID: 20459842 PMCID: PMC2885404 DOI: 10.1186/1472-6920-10-33] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2009] [Accepted: 05/11/2010] [Indexed: 05/29/2023]
Abstract
BACKGROUND This article, developed for the Betty Ford Institute Consensus Conference on Graduate Medical Education (December, 2008), presents a model curriculum for Family Medicine residency training in substance abuse. METHODS The authors reviewed reports of past Family Medicine curriculum development efforts, previously-identified barriers to education in high risk substance use, approaches to overcoming these barriers, and current training guidelines of the Accreditation Council for Graduate Medical Education (ACGME) and their Family Medicine Residency Review Committee. A proposed eight-module curriculum was developed, based on substance abuse competencies defined by Project MAINSTREAM and linked to core competencies defined by the ACGME. The curriculum provides basic training in high risk substance use to all residents, while also addressing current training challenges presented by U.S. work hour regulations, increasing international diversity of Family Medicine resident trainees, and emerging new primary care practice models. RESULTS This paper offers a core curriculum, focused on screening, brief intervention and referral to treatment, which can be adapted by residency programs to meet their individual needs. The curriculum encourages direct observation of residents to ensure that core skills are learned and trains residents with several "new skills" that will expand the basket of substance abuse services they will be equipped to provide as they enter practice. CONCLUSIONS Broad-based implementation of a comprehensive Family Medicine residency curriculum should increase the ability of family physicians to provide basic substance abuse services in a primary care context. Such efforts should be coupled with faculty development initiatives which ensure that sufficient trained faculty are available to teach these concepts and with efforts by major Family Medicine organizations to implement and enforce residency requirements for substance abuse training.
Collapse
Affiliation(s)
- J Paul Seale
- Department of Family Medicine, Mercer University School of Medicine & Medical Center of Central Georgia, 3780 Eisenhower Parkway, Macon, GA 31206, USA
| | - Sylvia Shellenberger
- Department of Family Medicine, Mercer University School of Medicine & Medical Center of Central Georgia, 3780 Eisenhower Parkway, Macon, GA 31206, USA
| | | |
Collapse
|
11
|
|
12
|
Tolchard B, Thomas L, Battersby M. GPs and problem gambling: can they help with identification and early intervention? J Gambl Stud 2007; 23:499-506. [PMID: 17453326 DOI: 10.1007/s10899-007-9062-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2006] [Accepted: 04/02/2007] [Indexed: 12/28/2022]
Abstract
General Practitioners (GPs) are well placed to identify problem gamblers and provide early intervention. To date there is no evidence to suggest that GP's are routinely screening patients for potential gambling problems. This paper discusses the prevalence of problem gambling, the links with other health problems and ways that GPs can assist. Results from a pilot project that provided educational resources to GPS are also discussed. Suitable screening tools are available that could easily be used by GPs to assess the possibility of gambling problems in patients who may be at increased risk but do not seek help. Early identification and intervention may help prevent a gambling habit escalating to a serious problem. More work needs to be done to increase awareness with GPs of the extent of problem gambling in our community and to alert patients to the fact that gambling can affect their health and that GPs can help.
Collapse
Affiliation(s)
- Barry Tolchard
- Department of Health & Human Sciences, University of Essex, Colchester, UK.
| | | | | |
Collapse
|
13
|
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.
Collapse
Affiliation(s)
- Marc N Potenza
- Yale University School of Medicine, New Haven, CT 06519, USA.
| | | | | | | | | |
Collapse
|