1
|
Battaglia AM, Vedelago L, Coelho SG, Baumgartner C, Schaub MP, Stewart SH, MacKillop J, Hodgins DC, Wardell JD, O'Connor RM, Kim HS, Keough MT. Psychometric Validation of the Gambling Craving Scale in a Treatment-Seeking Sample. J Gambl Stud 2024; 40:1761-1778. [PMID: 38700740 DOI: 10.1007/s10899-024-10306-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2024] [Indexed: 09/12/2024]
Abstract
The Gambling Craving Scale (GACS) is a multifaceted measure of gambling craving. Initial validation work by Young and Wohl (2009) in university student samples showed that the GACS had a three-factor structure capturing dimensions of Desire, Anticipation, and Relief. Despite its potential clinical utility as a measure of craving, the GACS has yet to be validated in people seeking treatment for gambling problems. Accordingly, we examined the psychometric properties in a sample of people (N = 209; Mage = 37.66; 62.2% female) participating in a randomized controlled trial testing a novel online treatment for problem gambling. We predicted the GACS would have a three-factor structure. In addition, we also examined measurement invariance across sex and problem gambling risk status. Finally, we assessed concurrent validity of the factors with other measures of problem gambling severity and involvement. Exploratory structural equation modeling findings supported a three-factor structure that was invariant across the groups tested. Each of the Desire, Anticipation, and Relief subscales were significant positive predictors of problem gambling severity and symptoms, and some form of gambling behaviour. Findings show the GACS is a promising scale to assess multidimensional craving experiences among people in treatment for gambling problems.
Collapse
Affiliation(s)
- Anthony M Battaglia
- Department of Psychology, York University, 4700 Keele Street, Toronto, ON, M3J 1P1, Canada.
| | - Lana Vedelago
- Department of Psychology, York University, 4700 Keele Street, Toronto, ON, M3J 1P1, Canada
| | - Sophie G Coelho
- Department of Psychology, York University, 4700 Keele Street, Toronto, ON, M3J 1P1, Canada
| | - Christian Baumgartner
- Swiss Research Institute for Public Health and Addiction, associated to University of Zurich, Zurich, Switzerland
| | - Michael P Schaub
- Swiss Research Institute for Public Health and Addiction, associated to University of Zurich, Zurich, Switzerland
| | - Sherry H Stewart
- Departments of Psychiatry and Psychology & Neuroscience, Dalhousie University, Halifax, NS, Canada
| | - James MacKillop
- Peter Boris Centre for Addictions Research, McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - David C Hodgins
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Jeffrey D Wardell
- Department of Psychology, York University, 4700 Keele Street, Toronto, ON, M3J 1P1, Canada
- Insitute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Roisin M O'Connor
- Department of Psychology, Concordia University, Montreal, QC, Canada
| | - Hyoun S Kim
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Matthew T Keough
- Department of Psychology, York University, 4700 Keele Street, Toronto, ON, M3J 1P1, Canada
| |
Collapse
|
2
|
Snippe L, Boffo M, Galvin H, Willemen R, Pronk T, Dom G, Wiers RW. How We Lost 90% of Participants on a Bad Bet: Results from a Pilot Randomized Controlled Trial on Cognitive Bias Modification in Problem Gamblers. J Gambl Stud 2024; 40:521-554. [PMID: 38006537 DOI: 10.1007/s10899-023-10263-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2023] [Indexed: 11/27/2023]
Abstract
Whilst opportunities to participate in gambling have increased, access to support for problem gamblers is lacking behind. This lack of balance calls for improved and accessible intervention methods. The present double-blind randomized controlled trial (RCT) explored the effectiveness of two interventions targeting automatic cognitive processes, known as Attentional Bias Modification (AtBM) and Approach Bias Modification (ApBM). It was hypothesized these interventions would reduce gambling behavior and reduce or reverse targeted biases. Participants (N = 331) were community-recruited Flemish (35%) and Dutch (65%) adult problem gamblers motivated to reduce or stop their gambling who received either six sessions of active training (AtBM or ApBM) or of the corresponding sham-training (sham-AtBM or sham-ApBM). Due to high attrition rates (90.1% up to the intervention phase) the study was terminated before completion, since it would greatly limit the validity of any results. A post hoc qualitative study was performed on a subset of participants to gain insight into contributing factors for the high attrition rate. Issues negatively impacting participants' motivation to complete the program were identified, as well as elements of the program that received approval. The results from this study provide a first insight into the potential of the use of online cognitive bias modification (CBM) interventions in problem gambling (PG). Suggestions and directions for future studies are discussed.
Collapse
Affiliation(s)
- Leroy Snippe
- Addiction Development and Psychopathology (ADAPT) Lab, Department of Psychology, University of Amsterdam, Nieuwe Achtergracht 129, 1018 WS, Amsterdam, The Netherlands.
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp (UAntwerp), Wilrijk, Belgium.
| | - Marilisa Boffo
- Department of Psychology, Education and Child Studies (DPECS), Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Harriet Galvin
- Addiction Development and Psychopathology (ADAPT) Lab, Department of Psychology, University of Amsterdam, Nieuwe Achtergracht 129, 1018 WS, Amsterdam, The Netherlands
- Department of Psychology, Education and Child Studies (DPECS), Erasmus University Rotterdam, Rotterdam, The Netherlands
| | | | - Thomas Pronk
- Addiction Development and Psychopathology (ADAPT) Lab, Department of Psychology, University of Amsterdam, Nieuwe Achtergracht 129, 1018 WS, Amsterdam, The Netherlands
| | - Geert Dom
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp (UAntwerp), Wilrijk, Belgium
| | - Reinout W Wiers
- Addiction Development and Psychopathology (ADAPT) Lab, Department of Psychology, University of Amsterdam, Nieuwe Achtergracht 129, 1018 WS, Amsterdam, The Netherlands
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
3
|
Barrault S, Varescon I. Problem Gambling Poker Players: Do They Fit into Blaszczynski and Nower's Pathways Model? J Gambl Stud 2023; 39:249-263. [PMID: 35416621 DOI: 10.1007/s10899-022-10123-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2022] [Indexed: 11/26/2022]
Abstract
Blaszczynski and Nower's (Addiction 97:487-499, 2002) Pathways Model, an integrative model based on problem gamblers' paths and comorbidities, aids in understanding the heterogeneity of problem gamblers' profiles by classifying them into three subgroups. The profiles of problem gamblers may be linked to the type of gambling practiced. Poker is a popular game, primarily due to the involvement of both chance and strategy in its outcome. However, no study has attempted to fit poker players into the Pathways Model. We recruited an online sample of 245 regular poker players (including 146 non-problem gamblers, 83 problem-gambling poker players, and 16 probable pathological gamblers). We assessed multiple variables (impulsivity, sensation seeking, alcohol and tobacco consumption, anxiety, depression, cognitive distortions) from the Pathways Model to determine whether the profiles of poker players fit into one or more gambler subgroups. Cluster analysis showed that poker players had a unique profile with a gambling practice intensity gradient. Compared to non-problem gamblers, problem gamblers displayed significantly higher levels of depression, impulsivity, gambling-related cognitive distortions, and alcohol consumption. Our results suggest that problem-gambling poker players fit into Blaszczynski and Nower's behaviorally conditioned gamblers group. This study opens avenues for both research into and treatment for problem gambling among poker players.
Collapse
Affiliation(s)
- Servane Barrault
- Laboratory QualiPsy, EE1901, Psychology Department, University of Tours, 3 rue des Tanneurs, 37041, Tours, France.
- Centre de Soins d'Accompagnement et de Prévention en Addictologie (CSAPA 37), CHRU of Tours, 37044, Tours Cedex, France.
- Laboratory of Psychopathology and Health Processes, University of Paris, 92100, Boulogne-Billancourt, France.
| | - Isabelle Varescon
- Laboratory of Psychopathology and Health Processes, University of Paris, 92100, Boulogne-Billancourt, France
| |
Collapse
|
4
|
Mestre-Bach G, Potenza MN. Features Linked to Treatment Outcomes in Behavioral Addictions and Related Disorders. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2873. [PMID: 36833569 PMCID: PMC9957199 DOI: 10.3390/ijerph20042873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 01/28/2023] [Accepted: 02/04/2023] [Indexed: 06/18/2023]
Abstract
Behavioral addictions are incompletely understood with respect to their underlying etiologies. This incomplete understanding may contribute to the frequent relapse and dropout rate often observed with behavioral addictions. The present state-of-the-art review aimed to review the literature that explored sociodemographic and clinical factors that link to poor treatment responses. Despite multiple studies, the definitions and evaluations of relapse and dropout are heterogeneous, complicating comparisons across studies. A scientific consensus on the conceptualization of both terms would help to better understand psychological features linked to treatment outcomes in behavioral addictions.
Collapse
Affiliation(s)
- Gemma Mestre-Bach
- Facultad de Ciencias de la Salud, Universidad Internacional de La Rioja, 26006 La Rioja, Spain
| | - Marc N. Potenza
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, USA
- Connecticut Mental Health Center, New Haven, CT 06519, USA
- Connecticut Council on Problem Gambling, Wethersfield, CT 06109, USA
- Wu Tsai Institute, Yale University, New Haven, CT 06510, USA
- Yale Child Study Center, Yale University School of Medicine, New Haven, CT 06510, USA
- Department of Neuroscience, Yale University School of Medicine, New Haven, CT 06510, USA
| |
Collapse
|
5
|
Bergeron PY, Giroux I, Chrétien M, Bouchard S. Exposure Therapy for Gambling Disorder: Systematic Review and Meta-analysis. CURRENT ADDICTION REPORTS 2022. [DOI: 10.1007/s40429-022-00428-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Abstract
Purpose of Review
Cognitive behaviour therapy is the gold standard for the treatment of gambling disorder. Obstacles remain regarding its efficacy, namely relapses and difficulty in implementing cognitive restructuring for some clients. Given these observations, behavioural interventions for gambling disorder, such as exposure therapy, which aims to decrease gambling craving, may be effective as a complementary or alternative intervention to cognitive behaviour therapy. This systematic review and meta-analysis aims to explore how exposure therapy for gambling disorder has been studied and to evaluate its efficacy. To answer these questions, 3406 studies, retrieved using PsycNet, Medline and Google Scholar, were screened.
Recent Findings
After two screenings, 13 papers were selected for the systematic review and five were statistically combined for the meta-analysis. Quantitative results support exposure therapy’s efficacy to decrease gambling craving at post-intervention (g = − 0.955) and at last follow-up (6 or 12 months; − 1.010). Results also show a large decrease in gambling severity as documented by screening instruments (− 1.087) as well as time spent gambling (− 2.136) at post-intervention. Furthermore, a large decrease in gambling measured via screening instruments (− 1.162) and erroneous beliefs (− 1.308) was found at last follow-up.
Summary
This is the first meta-analysis on behavioural exposure therapy for gambling disorder. Results support that exposure therapy reduces gambling cravings and severity, as well as time spent gambling and erroneous beliefs. These results are discussed in comparison to other therapeutic approaches and are interpreted according to the high risk of bias in included studies.
Collapse
|
6
|
Dowling NA, Merkouris SS, Youssef GJ, Lubman DI, Bagot KL, Hawker CO, Portogallo HJ, Thomas AC, Rodda SN. GAMBLINGLESS IN-THE-MOMENT: Protocol for a micro-randomised trial of a gambling Just-In-Time Adaptive Intervention (Preprint). JMIR Res Protoc 2022; 11:e38958. [PMID: 35998018 PMCID: PMC9449828 DOI: 10.2196/38958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 06/30/2022] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
Background The presence of discrete but fluctuating precipitants, in combination with the dynamic nature of gambling episodes, calls for the development of tailored interventions delivered in real time, such as just-in-time adaptive interventions (JITAIs). JITAIs leverage mobile and wireless technologies to address dynamically changing individual needs by providing the type and amount of support required at the right time and only when needed. They have the added benefit of reaching underserved populations by providing accessible, convenient, and low-burden support. Despite these benefits, few JITAIs targeting gambling behavior are available. Objective This study aims to redress this gap in service provision by developing and evaluating a theoretically informed and evidence-based JITAI for people who want to reduce their gambling. Delivered via a smartphone app, GamblingLess: In-The-Moment provides tailored cognitive-behavioral and third-wave interventions targeting cognitive processes explicated by the relapse prevention model (cravings, self-efficacy, and positive outcome expectancies). It aims to reduce gambling symptom severity (distal outcome) through short-term reductions in the likelihood of gambling episodes (primary proximal outcome) by improving craving intensity, self-efficacy, or expectancies (secondary proximal outcomes). The primary aim is to explore the degree to which the delivery of a tailored intervention at a time of cognitive vulnerability reduces the probability of a subsequent gambling episode. Methods GamblingLess: In-The-Moment interventions are delivered to gamblers who are in a state of receptivity (available for treatment) and report a state of cognitive vulnerability via ecological momentary assessments 3 times a day. The JITAI will tailor the type, timing, and amount of support for individual needs. Using a microrandomized trial, a form of sequential factorial design, each eligible participant will be randomized to a tailored intervention condition or no intervention control condition at each ecological momentary assessment across a 28-day period. The microrandomized trial will be supplemented by a 6-month within-group follow-up evaluation to explore long-term effects on primary (gambling symptom severity) and secondary (gambling behavior, craving severity, self-efficacy, and expectancies) outcomes and an acceptability evaluation via postintervention surveys, app use and engagement indices, and semistructured interviews. In all, 200 participants will be recruited from Australia and New Zealand. Results The project was funded in June 2019, with approval from the Deakin University Human Research Ethics Committee (2020-304). Stakeholder user testing revealed high acceptability scores. The trial began on March 29, 2022, and 84 participants have been recruited (as of June 24, 2022). Results are expected to be published mid-2024. Conclusions GamblingLess: In-The-Moment forms part of a suite of theoretically informed and evidence-based web-based and mobile gambling interventions. This trial will provide important empirical data that can be used to facilitate the JITAI’s optimization to make it a more effective, efficient, and scalable tailored intervention. Trial Registration Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12622000490774; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380757&isClinicalTrial=False International Registered Report Identifier (IRRID) PRR1-10.2196/38958
Collapse
Affiliation(s)
- Nicki A Dowling
- School of Psychology, Deakin University, Geelong, Australia
- Melbourne Graduate School of Education, University of Melbourne, Melbourne, Australia
| | | | | | - Dan I Lubman
- Turning Point and Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia
| | | | - Chloe O Hawker
- School of Psychology, Deakin University, Geelong, Australia
| | | | - Anna C Thomas
- School of Psychology, Deakin University, Geelong, Australia
| | - Simone N Rodda
- School of Psychology, Deakin University, Geelong, Australia
- Psychology and Neuroscience, Auckland University of Technology, Auckland, New Zealand
- School of Population Health, University of Auckland, Grafton, New Zealand
| |
Collapse
|
7
|
Gori A, Topino E, Craparo G, Bagnoli I, Caretti V, Schimmenti A. A Comprehensive Model for Gambling Behaviors: Assessment of the Factors that can Contribute to the Vulnerability and Maintenance of Gambling Disorder. J Gambl Stud 2022; 38:235-251. [PMID: 33844125 PMCID: PMC8866302 DOI: 10.1007/s10899-021-10024-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2021] [Indexed: 12/21/2022]
Abstract
Gambling Disorder is a complex and multifaceted phenomenon which requires a careful understanding by analysing both the life experiences and the psychopathological components linked to this type of behaviour. This study aimed to apply a Comprehensive Model of Addiction and to delve deeper the dimensions involved in the vulnerability and maintenance of the disease. Therefore, the effect of alexithymia and traumatic experiences in mediating the relationship between insecure attachment and dissociation, as well as the roles of impulsiveness and compulsiveness in influencing obsessiveness were explored in pathological gamblers. A sample composed of 253 individuals with a mean age of 47.8 years (SD = 12.4) with a diagnosis of Gambling Disorder (82.6% males, 17.4% females) completed the battery of measures. Results showed that alexithymia significantly mediates the relationship between insecure attachment and dissociation, while no significance was found in the effect of complex trauma. Furthermore, a significant impact role of impulsiveness and compulsiveness in determining obsessiveness was found. Therefore, the data suggested that alexithymia may increase the risk of developing a gambling disorder, mediating the association between insecure attachment and dissociation. The model of craving which could have a core role in disease maintenance processes was also confirmed, highlighting a significant influence of impulsiveness and compulsiveness on obsessiveness. Such findings might have relevant implications to increase the effectiveness of both preventive interventions and therapeutic works, favouring positive results for a better mental health of the subjects.
Collapse
Affiliation(s)
- Alessio Gori
- Department of Health Sciences, University of Florence, Piazza S. Marco 4, 50121, Firenze, Italy.
| | - Eleonora Topino
- Department of Human Sciences, LUMSA University of Rome, Via della Traspontina, 21, 00193, Rome, Italy
| | - Giuseppe Craparo
- Faculty of Human and Social Sciences, UKE-Kore University of Enna, Cittadella Universitaria, 94100, Enna, Italy
| | - Ilaria Bagnoli
- Department of Human Sciences, LUMSA University of Rome, Via della Traspontina, 21, 00193, Rome, Italy
| | - Vincenzo Caretti
- Department of Human Sciences, LUMSA University of Rome, Via della Traspontina, 21, 00193, Rome, Italy
| | - Adriano Schimmenti
- Faculty of Human and Social Sciences, UKE-Kore University of Enna, Cittadella Universitaria, 94100, Enna, Italy
| |
Collapse
|
8
|
Campos MD, Williams RC, Joshi V, Hall E, Reid R, Rosenthal RJ, Fong TW. Dropout or Early Treatment Response Among Gamblers with Depressive Symptoms. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-021-00586-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
9
|
Månsson V, Molander O, Carlbring P, Rosendahl I, Berman AH. Emotion regulation-enhanced group treatment for gambling disorder: a non-randomized pilot trial. BMC Psychiatry 2022; 22:16. [PMID: 34991511 PMCID: PMC8734318 DOI: 10.1186/s12888-021-03630-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 11/29/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Despite the association of Gambling Disorder (GD) with poor mental health, treatment options generally lack components targeting emotional difficulties. This study investigated the feasibility and acceptability of adding strategies of emotion regulation to an eight-session weekly group treatment. METHOD This non-randomized pilot study recruited 21 treatment-seeking adults with GD, (mean age = 36.3, 19% females) from addiction care. In a mixed methods design, measures of within-group changes in self-reported symptoms of GD were complemented with thematic analysis of post-treatment interviews regarding the feasibility of the treatment. RESULTS Within-group scores on the Gambling Symptoms Assessment Scale (G-SAS) showed a 47% decrease (β: -0.1599, 95% CI: - 0.2526 to - 0.0500) from pre-treatment to 12-month follow-up, with Hedges' g = 1.07 (CI: 0.57-1.60). The number of GD-symptoms according to the Structured Clinical Interview for Gambling Disorder (SCI-GD) decreased from 7.0 (SD = 1.60) at pre-treatment to 2.1 (SD = 2.36) at 12-month follow-up. Participants completed an average of 6.3 sessions and rated the intervention high in satisfaction and acceptability. Feasibility interviews showed no noticeable negative effects or ethical issues. Furthermore, helpful components in the treatment were: increased awareness of emotional processes and strategies to deal with difficult emotions. CONCLUSIONS Adding emotion regulation strategies in the treatment of GD is feasible and acceptable and warrants further investigation in a controlled trial. TRIAL REGISTRATION This study was registered with ClinicalTrials.gov (Identifier NCT03725735 ).
Collapse
Affiliation(s)
- Viktor Månsson
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Norra Stationsgatan 69, 7tr, SE-113 64, Stockholm, Sweden.
| | - Olof Molander
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Norra Stationsgatan 69, 7tr, SE-113 64, Stockholm, Sweden
| | - Per Carlbring
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Ingvar Rosendahl
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Norra Stationsgatan 69, 7tr, SE-113 64, Stockholm, Sweden
| | - Anne H Berman
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Norra Stationsgatan 69, 7tr, SE-113 64, Stockholm, Sweden
- Department of Psychology, Uppsala University, Uppsala, Sweden
| |
Collapse
|
10
|
Baenas I, Etxandi M, Codina E, Granero R, Fernández-Aranda F, Gómez-Peña M, Moragas L, Rivas S, Potenza MN, Håkansson A, Del Pino-Gutiérrez A, Mora-Maltas B, Valenciano-Mendoza E, Menchón JM, Jiménez-Murcia S. Does Confinement Affect Treatment Dropout Rates in Patients With Gambling Disorder? A Nine-Month Observational Study. Front Psychol 2022; 12:761802. [PMID: 34970193 PMCID: PMC8712884 DOI: 10.3389/fpsyg.2021.761802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 11/11/2021] [Indexed: 11/30/2022] Open
Abstract
Background and Aims: COVID-19 pandemic and confinement have represented a challenge for patients with gambling disorder (GD). Regarding treatment outcome, dropout may have been influenced by these adverse circumstances. The aims of this study were: (a) to analyze treatment dropout rates in patients with GD throughout two periods: during and after the lockdown and (b) to assess clinical features that could represent vulnerability factors for treatment dropout. Methods: The sample consisted of n=86 adults, mostly men (n=79, 91.9%) and with a mean age of 45years old (SD=16.85). Patients were diagnosed with GD according to DSM-5 criteria and were undergoing therapy at a Behavioral Addiction Unit when confinement started. Clinical data were collected through a semi-structured interview and protocolized psychometric assessment. A brief telephone survey related to COVID-19 concerns was also administered at the beginning of the lockdown. Dropout data were evaluated at two moments throughout a nine-month observational period (T1: during the lockdown, and T2: after the lockdown). Results: The risk of dropout during the complete observational period was R=32/86=0.372 (37.2%), the Incidence Density Rate (IDR) ratio T2/T1 being equal to 0.052/0.033=1.60 (p=0.252). Shorter treatment duration (p=0.007), lower anxiety (p=0.025), depressive symptoms (p=0.045) and lower use of adaptive coping strategies (p=0.046) characterized patients who abandoned treatment during the lockdown. Briefer duration of treatment (p=0.001) and higher employment concerns (p=0.044) were highlighted in the individuals who dropped out after the lockdown. Treatment duration was a predictor of dropout in both periods (p=0.005 and p<0.001, respectively). Conclusion: The present results suggest an impact of the COVID-19 pandemic on treatment dropout among patients with GD during and after the lockdown, being treatment duration a predictor of dropout. Assessing vulnerability features in GD may help clinicians identify high-risk individuals and enhance prevention and treatment approaches in future similar situations.
Collapse
Affiliation(s)
- Isabel Baenas
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.,Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
| | - Mikel Etxandi
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
| | - Ester Codina
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
| | - Roser Granero
- Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain.,Department of Psychobiology and Methodology, Autonomous University of Barcelona, Barcelona, Spain
| | - Fernando Fernández-Aranda
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.,Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain.,Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain.,Psychiatry and Mental Health Group, Neurosciences Programme, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Barcelona, Spain
| | - Mónica Gómez-Peña
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
| | - Laura Moragas
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
| | - Sandra Rivas
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
| | - Marc N Potenza
- Department of Psychiatry and Child Study Center, Yale University School of Medicine, New Haven, CT, United States.,Connecticut Council on Problem Gambling, Wethersfield, CT, United States.,Connecticut Mental Health Center, New Haven, CT, United States.,Department of Neuroscience, Yale University, New Haven, CT, United States
| | - Anders Håkansson
- Department of Clinical Sciences Lund, Psychiatry, Faculty of Medicine, Lund University, Lund, Sweden.,Region Skåne, Gambling Disorder Unit, Malmö, Sweden
| | - Amparo Del Pino-Gutiérrez
- Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain.,Department of Public Health, Mental Health and Perinatal Nursing, School of Nursing, University of Barcelona, Barcelona, Spain
| | - Bernat Mora-Maltas
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
| | | | - José M Menchón
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain.,Psychiatry and Mental Health Group, Neurosciences Programme, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Barcelona, Spain.,Ciber Salut Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Susana Jiménez-Murcia
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.,Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain.,Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain.,Psychiatry and Mental Health Group, Neurosciences Programme, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Barcelona, Spain
| |
Collapse
|
11
|
Pfund RA, Peter SC, McAfee NW, Ginley MK, Whelan JP, Meyers AW. Dropout from face-to-face, multi-session psychological treatments for problem and disordered gambling: A systematic review and meta-analysis. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2021; 35:901-913. [PMID: 34881915 DOI: 10.1037/adb0000710] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE The aims of this systematic review and meta-analysis were to examine the overall prevalence of dropout from psychological treatments for problem gambling and gambling disorder and to examine how study, client, and treatment variables influenced dropout rates. METHOD A systematic search was conducted to identify studies of cognitive and/or behavioral therapies and motivational interventions for problem gambling and gambling disorder. Meta-analysis was used to calculate an overall weighted dropout rate. Random effect meta-regressions were used to examine covariates of dropout rates. Mixed-effect subgroup analyses were used to examine moderators of dropout rates. RESULTS The systematic search identified 24 studies (31 dropout rates) comprising 2,791 participants. Using a random-effects model, the overall weighted dropout rate was 39.1%, 95% CI [33.0%, 45.6%]. Increases in the percentage of married participants were significantly associated with lower dropout rates. Dropout rates were significantly higher when dropout was defined as attending all sessions of a treatment protocol compared to when defined as attending a prespecified number of sessions different from the total in the protocol and when defined as study therapists judging participants to be dropouts. Insufficient reporting of some gambling-related variables and other psychological symptom variables prevented a thorough examination of covariates and moderators. CONCLUSIONS A large proportion of individuals drop out of treatment for problem gambling and gambling disorder. Future research should examine the reasons for dropout across marital statuses and should adopt dropout definitions that consider session-by-session symptom change. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Collapse
Affiliation(s)
- Rory A Pfund
- Center on Alcohol, Substance use, and Addictions
| | | | | | | | | | | |
Collapse
|
12
|
Reasons for dropping out of internet-based problem gambling treatment, and the process of recovery – a qualitative assessment. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-02368-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AbstractProblem gambling (PG) is a condition affecting the economy, mental health, and relationships of both the individuals with gambling problems, and concerned significant others (CSOs). While PG is treatable, few individuals with gambling problems seek treatment, and many drop out of treatment. This qualitative study aims to investigate a) the reasons for individuals with gambling problems to drop-out from Internet-based PG treatment, and b) what individuals with gambling problems and CSOs find helpful and unhelpful processes in PG recovery. A total of 16 participants (8 individuals with gambling problems and 8 CSOs) who had participated in an Internet-based PG treatment were interviewed over the telephone in a semi-structured interview. The interviews were analyzed using thematic analysis. Drop-out from treatment was one aspect of an overarching theme identified as unstable path to recovery, where alternating periods of progress and setbacks delineate several aspects of PG. Relapses, negative emotions, and changing life circumstances were identified to separately, and in combination, contribute to drop-out. Drop-outs were also explained by participants’ experiences of a reduced need for treatment. Openness and a support from CSOs and peers were identified as themes important for recovery. The results suggest that PG treatments should consider the emotional state, and comorbidities of the patients, in order to reduce drop-out and improve chances of recovery.
Collapse
|
13
|
Cornil A, Rothen S, De Timary P, Billieux J. Interference-based methods to mitigate gambling craving: a proof-of-principle pilot study. INTERNATIONAL GAMBLING STUDIES 2021. [DOI: 10.1080/14459795.2021.1903063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Aurélien Cornil
- Louvain Experimental Psychopathology (LEP), Psychological Science Research Institute, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Stéphane Rothen
- Addictology Division, Department of Mental Health and Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Philippe De Timary
- Institute of Neuroscience, Université Catholique De Louvain and Department of Adult Psychiatry, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Joël Billieux
- Institute of Psychology, University of Lausanne, Lausanne, Switzerland
| |
Collapse
|
14
|
Çakıcı M, Çakıcı E, Babayiğit A, Karaaziz M. Gambling Behaviour: Prevalence, Risk Factors and Relation with Acculturation in 2007-2018 North Cyprus Adult Household Surveys. J Gambl Stud 2021; 37:1099-1111. [PMID: 33515175 DOI: 10.1007/s10899-021-10008-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2021] [Indexed: 10/22/2022]
Abstract
In this study, the prevalence of gambling behaviors among the North Cyprus (NC) in 2018 is compared with the data of 2007, 2012, 2014 and the relationship between acculturation and problem and pathological gambling (PPG) is examined. The population of the study consists of Turkish-speaking individuals between 18 and 65 years of age living in NC. 799 people were consequently selected according to gender, age and geographical region with a multi-stage stratified (randomized) quota. For the collection of the data, a demographic questionnaire, the Turkish version of the Revised South Oaks Gambling Screen (SOGS) and cultural attitude scale (CAS) were used. The prevalence data were compared with the research done by the same researchers in 2007 (n = 1012), 2012 (n = 996) and 2014 (n = 958) which were conducted by same method and questionnaire. The vast majority of participants (70.6%) participated in one or more of the 17 types of gambling activities at least once during their lifetime. Pathologic gambling doubled and rose to 4.5% in 2007-2018 periods. Being male, age range of 18-29, single, living alone and marry less than 5 years are the risk factors for PPG. Separation and integration attitude were related with PPG among Cyprus-born individuals. The study shows that gambling behavior is widespread in the NC and pathologic gambling is increasingly rapidly. High rates of gambling addiction, should be assessed in its own social structure for each community and it should be taken into consideration that acculturation is an effective factor in increasing PPG.
Collapse
Affiliation(s)
- Mehmet Çakıcı
- Arts and Science Faculty, Department of Psychology, Near East University, Nicosia-Cyprus, Mersin 10, Turkey.
| | - Ebru Çakıcı
- Arts and Science Faculty, Department of Psychology, Near East University, Nicosia-Cyprus, Mersin 10, Turkey
| | - Asra Babayiğit
- Arts and Science Faculty, Department of Psychology, Near East University, Nicosia-Cyprus, Mersin 10, Turkey
| | - Meryem Karaaziz
- Arts and Science Faculty, Department of Psychology, Near East University, Nicosia-Cyprus, Mersin 10, Turkey
| |
Collapse
|
15
|
Ledgerwood DM, Dyshniku F, McCarthy JE, Ostojic-Aitkens D, Forfitt J, Rumble SC. Gambling-Related Cognitive Distortions in Residential Treatment for Gambling Disorder. J Gambl Stud 2020; 36:669-683. [PMID: 31562578 DOI: 10.1007/s10899-019-09895-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Gambling-related cognitive distortions are associated with gambling disorder severity, but few studies have provided an in-depth examination of the interrelationship between cognitive distortions, gambling severity, psychiatric comorbidity and treatment outcomes. The present study sought to identify factors associated with elevated cognitive distortions among problem gamblers entering residential treatment, examine changes in cognitive distortions through treatment, and explore the association between cognitive distortions and treatment outcomes. Pre- and post-treatment data were extracted from the charts of 125 individuals who participated in a 21-day residential treatment program for gambling disorder. Assessments included measures of demographics, gambling disorder severity, psychiatric symptoms and gambling-related cognitive distortions. Several significant associations were found between baseline cognitive distortions and psychiatric symptoms. Cognitive distortions decreased significantly from pre- to post-treatment. Pre- to post-treatment changes on several cognitive distortion scales were positively associated with greater baseline psychiatric symptomology. Treatment drop-out was associated with higher scores on measures reflecting greater impulsivity/addiction and greater perceived predictive control. Gambling-related cognitive distortions represent an important mechanism of gambling disorder and its treatment and provide a target for the development and refinement of treatment for gambling disorder.
Collapse
Affiliation(s)
- David M Ledgerwood
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, 3901 Chrysler Service Drive, Suite 2A, Detroit, MI, 48201, USA.
- Department of Psychology, University of Windsor, Windsor, ON, Canada.
| | - Fiona Dyshniku
- Department of Psychology, University of Windsor, Windsor, ON, Canada
| | | | - Dragana Ostojic-Aitkens
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, 3901 Chrysler Service Drive, Suite 2A, Detroit, MI, 48201, USA
- Department of Psychology, University of Windsor, Windsor, ON, Canada
| | - Jennifer Forfitt
- Centre for Problem Gambling and Digital Dependency, Hotel Dieu Grace Healthcare, Windsor, ON, Canada
| | - Shawn C Rumble
- Centre for Problem Gambling and Digital Dependency, Hotel Dieu Grace Healthcare, Windsor, ON, Canada
| |
Collapse
|
16
|
Merkouris SS, Hawker CO, Rodda SN, Youssef GJ, Dowling NA. GamblingLess: Curb Your Urge: Development and usability testing of a smartphone-delivered ecological momentary intervention for problem gambling. INTERNATIONAL GAMBLING STUDIES 2020. [DOI: 10.1080/14459795.2020.1749293] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
| | | | - Simone N. Rodda
- School of Psychology, Deakin University, Geelong, Australia
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland New Zealand
| | - George J. Youssef
- School of Psychology, Deakin University, Geelong, Australia
- Centre for Adolescent Health, Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne, Australia
| | - Nicki A. Dowling
- School of Psychology, Deakin University, Geelong, Australia
- Melbourne Graduate School of Education, University of Melbourne, Parkville, Australia
| |
Collapse
|
17
|
Manaaki - a cognitive behavioral therapy mobile health app to support people experiencing gambling problems: a randomized control trial protocol. BMC Public Health 2020; 20:191. [PMID: 32028926 PMCID: PMC7006157 DOI: 10.1186/s12889-020-8304-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 01/30/2020] [Indexed: 11/14/2022] Open
Abstract
Background The low utilisation of current treatment services by people with gambling problems highlights the need to explore new modalities of delivering treatment interventions. This protocol presents the design of a pragmatic randomized control trial aimed at assessing the effectiveness and acceptability of cognitive behavioral therapy (CBT) delivered via a mobile app for people with self-reported gambling problems. Methods An innovative CBT mobile app, based on Deakin University’s GamblingLess online program, has been adapted with end-users (Manaaki). Six intervention modules have been created. These are interwoven with visual themes to represent a journey of recovery and include attributes such as avatars, videos, and animations to support end-user engagement. An audio facility is used throughout the app to cater for different learning styles. Personalizing the app has been accomplished by using greetings in the participant’s language and their name (e.g. Kia ora Tāne) and by creating personalized feedback. A pragmatic, randomized control two-arm single-blind trial, will be conducted in New Zealand. We aim to recruit 284 individuals. Eligible participants are ≥18 years old, seeking help for their gambling, have access to a smartphone capable of downloading an app, able to understand the English language and are willing to provide follow-up information at scheduled time points. Allocation is 1:1, stratified by ethnicity, gender, and gambling symptom severity based on the Gambling Symptom Assessment Scale (G-SAS). The intervention group will receive the full mobile cognitive behavioural programme and the waitlist group will receive a simple app that counts down the time left before they have access to the full app and the links to the data collection tools. Data collection for both groups are: baseline, 4-, 8-, and 12-weeks post-randomisation. The primary outcome is a change in G-SAS scores. Secondary measures include changes in gambling urges, frequency, expenditure, and readiness to change. Indices of app engagement, utilisation and acceptability will be collected throughout the delivery of the intervention. Discussion If effective, this study will contribute to the improvement of health outcomes for people experiencing gambling problems and have great potential to reach population groups who do not readily engage with current treatment services. Ethics approval NZ Health and Disability Ethics Committee (Ref: 19/STH/204) Trial registration Australian New Zealand Clinical Trial Registry (ANZCTRN 12619001605189) Registered 1 November 2019.
Collapse
|
18
|
|
19
|
Spagnolo PA, Gómez Pérez LJ, Terraneo A, Gallimberti L, Bonci A. Neural correlates of cue‐ and stress‐induced craving in gambling disorders: implications for transcranial magnetic stimulation interventions. Eur J Neurosci 2019; 50:2370-2383. [DOI: 10.1111/ejn.14313] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 09/28/2018] [Accepted: 11/26/2018] [Indexed: 12/22/2022]
Affiliation(s)
- Primavera A. Spagnolo
- Human Motor Control Section National Institute on Neurological Disorders and Stroke National Institutes of Health 10 Center Drive Room I3471:10CRC Bethesda MD 20892‐9412 USA
| | - Luis J. Gómez Pérez
- Novella Fronda Foundation for Studies and Applied Clinical Research in the Field of Addiction Medicine Padua Italy
| | - Alberto Terraneo
- Novella Fronda Foundation for Studies and Applied Clinical Research in the Field of Addiction Medicine Padua Italy
| | - Luigi Gallimberti
- Novella Fronda Foundation for Studies and Applied Clinical Research in the Field of Addiction Medicine Padua Italy
| | - Antonello Bonci
- Intramural Research Program National Institute on Drug Abuse US National Institutes of Health Baltimore MD USA
- Solomon H. Snyder Department of Neuroscience Johns Hopkins University School of Medicine Baltimore MD USA
- Department of Psychiatry Johns Hopkins University School of Medicine Baltimore MD USA
| |
Collapse
|
20
|
An Examination of Comorbid Psychiatric Disorders in Disordered Gamblers Versus Other Substance-Related Disorders. J Gambl Stud 2019; 35:829-847. [PMID: 30778813 DOI: 10.1007/s10899-019-09839-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
|
21
|
Grubbs JB, Chapman H, Shepherd KA. Post-traumatic stress and gambling related cognitions: Analyses in inpatient and online samples. Addict Behav 2019; 89:128-135. [PMID: 30292070 DOI: 10.1016/j.addbeh.2018.09.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 09/06/2018] [Accepted: 09/27/2018] [Indexed: 10/28/2022]
Abstract
Individuals with gambling disorder (GD) report much higher rates of post-traumatic stress symptoms and post-traumatic stress disorder (PTSS/D) than the general population, and individuals with both PTSS/D and GD often report much greater distress and impairment in daily life in comparison to individuals with GD alone (Grubbs, Chapman, Milner, Gutierrez, & Bradley, 2018). Despite these associations, little is known about the specific ways in which PTSS/D and GD might influence each other. To address this gap in research, the present work sought to examine how PTSD might be related to the expression and experience of gambling related cognitions. Specifically, it was hypothesized that individuals with PTSD or symptoms of PTSD (i.e., subclinical levels of post-traumatic stress) would demonstrate greater cognitive distortions and erroneous beliefs about gambling. To test these hypotheses, we analyzed data from two samples, an inpatient sample of U.S. Armed Forces veterans seeking treatment for gambling disorder (n = 332) and an online sample of largely recreational gambling U.S. adults (n = 589). Results consistently revealed that, in both samples, individuals with PTSD or symptoms of PTSD were likely to report greater gambling related cognitions. These findings persisted, even when gambling symptom severity and trait neuroticism were held constant. Collectively, these results suggest that PTSD is uniquely associated with greater cognitive distortions and erroneous beliefs about gambling behaviors. These findings bear distinct implications for current understandings of how PTSS/D and GD are related, as well as for treatment of individuals with dealing with this comorbidity.
Collapse
|
22
|
Bücker L, Westermann S, Kühn S, Moritz S. A self-guided Internet-based intervention for individuals with gambling problems: study protocol for a randomized controlled trial. Trials 2019; 20:74. [PMID: 30674348 PMCID: PMC6343284 DOI: 10.1186/s13063-019-3176-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 01/03/2019] [Indexed: 11/30/2022] Open
Abstract
Background Only a small fraction of individuals with pathological or problematic gambling seek professional help despite available evidence-based treatments such as cognitive behavioral therapy (CBT). Anonymous Internet-based interventions may help to overcome treatment barriers. Results of a pilot study using an Internet-based intervention for depression in a sample of individuals with problematic or pathological gambling behavior show that both depressive and gambling-related symptomatology can be reduced with a generic depression program compared with a wait-list control group. Based on encouraging results of the pilot study, we developed a low-threshold, anonymous and cost-free online self-help program (“Restart”) to test whether a program tailored to the needs of gamblers yields better results compared to the effects of the intervention evaluated in the pilot study. The online self-help program is based on CBT, targeting emotional problems and gambling-related symptoms and is accompanied by a smartphone application to sustain treatment benefits. Method A randomized controlled trial with two conditions (intervention group and wait-list control group), two assessment times (reassessment after 8 weeks) and a total of 136 participants is planned. The primary outcome will be change in pathological gambling measured with the Pathological Gambling Adaptation of Yale-Brown Obsessive-Compulsive Scale from pre to post intervention. The change in depressive symptoms (assessed with the Patient Health Questionnaire - 9 depression module) and gambling-related dysfunctional thoughts (assessed with the Gambling Attitudes and Beliefs Survey) will represent secondary outcomes. The intervention includes modules on debt management, impulse control, gambling-specific cognitive biases, self-esteem, social competence, sleep hygiene, mindfulness and positive activities. Discussion This study is one of the first investigations of Internet-based self-help programs in a sample of problematic gamblers. Self-guided Internet-based interventions represent a promising possibility to narrow the existing treatment gap while saving expensive and scarce resources (e.g., psychotherapists). The expected findings will add substantial knowledge in the development of effective Internet-based treatments for individuals with gambling problems. The empirical and clinical implications (e.g., broader use and promotion of such interventions in the future) and the limitations of the study will be discussed. Trial registration ClinicalTrials.gov, NCT03372226. Registered on 13 December 2017. Electronic supplementary material The online version of this article (10.1186/s13063-019-3176-z) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Lara Bücker
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Stefan Westermann
- Department of Psychology, UC Berkeley, 2121 Berkeley Way West, 94720, Berkeley, CA, USA
| | - Simone Kühn
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| |
Collapse
|
23
|
Wagner V, Acier D, Dietlin JE. Outpatient Addiction Treatment for Problematic Alcohol Use: What Makes Patients Who Dropped Out Different from Those Who Did Not? Subst Use Misuse 2018; 53:1893-1906. [PMID: 29469633 DOI: 10.1080/10826084.2018.1441310] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND A minority of individuals with problematic alcohol use effectively seek help. Moreover, dropouts from care are not uncommon. It remains a major concern for health professionals, as adherence to treatment is significantly associated with better physical and psychological outcomes. OBJECTIVES The main aim of this research was to assess what factors could distinguish patients with problematic alcohol use who dropped out from those who did not. METHODS The sample included 150 patients followed-up in an outpatient treatment center in France for a problematic alcohol use. Two measurement times were planned: at the first appointment and after six month of treatment. A large set of individual, environmental and institutional variables were considered to compare both subgroups. RESULTS Patients who dropped out mostly differ from patients who did not with a higher level of alcohol-related problems, ambivalence, inclinations to use the substance, number of missed appointments. Significant results were also observed regarding a lower time gap between the first contact with the center and the first appointment, as well as the season of the last appointment. CONCLUSIONS Tailored motivational interventions could be offered to ambivalent patients, especially during the beginning of the treatment and some significant periods of the year. A particular focus should be brought on patients presenting such profiles in terms of level of alcohol problems, inclinations to drink and motivation to change. Overall, the study provides elements to better understand what may bring one patient to drop out of the treatment, and to improve the continuity of care.
Collapse
Affiliation(s)
- Vincent Wagner
- a Department of Clinical Psychology , Laboratoire de Psychologie des Pays de la Loire, University of Nantes , Nantes , France.,b Beauséjour Addiction Care, Support and Prevention Center, Les Apsyades , Nantes , France
| | - Didier Acier
- a Department of Clinical Psychology , Laboratoire de Psychologie des Pays de la Loire, University of Nantes , Nantes , France
| | - Jean-Eric Dietlin
- b Beauséjour Addiction Care, Support and Prevention Center, Les Apsyades , Nantes , France
| |
Collapse
|
24
|
Mallorquí-Bagué N, Tolosa-Sola I, Fernández-Aranda F, Granero R, Fagundo AB, Lozano-Madrid M, Mestre-Bach G, Gómez-Peña M, Aymamí N, Borrás-González I, Sánchez-González J, Baño M, Del Pino-Gutiérrez A, Menchón JM, Jiménez-Murcia S. Cognitive Deficits in Executive Functions and Decision-Making Impairments Cluster Gambling Disorder Sub-types. J Gambl Stud 2018; 34:209-223. [PMID: 29058168 DOI: 10.1007/s10899-017-9724-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
To identify Gambling Disorder (GD) subtypes, in a population of men seeking treatment for GD, according to specific executive function domains (i.e., cognitive flexibility, inhibition and working memory as well as decision making) which are usually impaired in addictive behaviors. A total of 145 males ranging from 18 to 65 years diagnosed with GD were included in this study. All participants completed: (a) a set of questionnaires to assess psychopathological symptoms, personality and impulsivity traits, and (b) a battery of neuropsychological measures to test different executive functioning domains. Two clusters were identified based on the individual performance on the neuropsychological assessment. Cluster 1 [n = 106; labeled as Low Impaired Executive Function (LIEF)] was composed by patients with poor results in the neuropsychological assessment; cluster 2 patients [n = 46; labeled as High Impaired Executive Function (HIEF)] presented significantly higher deficits on the assessed domains and performed worse than the ones of LIEF cluster. Regarding the characterization of these two clusters, patients in cluster 2 were significantly older, unemployed and registered higher mean age of GD onset than patients in cluster 1. Additionally, patients in cluster 2 also obtained higher psychopathological symptoms, impulsivity (in both positive and negative urgency as well as sensation seeking) and some specific personality traits (higher harm avoidance as well as lower self-directedness and cooperativeness) than patients in cluster 1. The results of this study describe two different GD subtypes based on different cognitive domains (i.e., executive function performance). These two GD subtypes display different impulsivity and personality traits as well as clinical symptoms. The results provide new insight into the etiology and characterization of GD and have the potential to help improving current treatments.
Collapse
Affiliation(s)
- Núria Mallorquí-Bagué
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain. .,Ciber Fisiopatologia Obesidad y Nutrición (CB 06/03), Instituto Salud Carlos III, Madrid, Spain.
| | - Iris Tolosa-Sola
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain.,Ciber Fisiopatologia Obesidad y Nutrición (CB 06/03), Instituto Salud Carlos III, Madrid, Spain
| | - Fernándo Fernández-Aranda
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain.,Ciber Fisiopatologia Obesidad y Nutrición (CB 06/03), Instituto Salud Carlos III, Madrid, Spain.,Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Roser Granero
- Ciber Fisiopatologia Obesidad y Nutrición (CB 06/03), Instituto Salud Carlos III, Madrid, Spain.,Departament de Psicobiologia i Metodologia, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ana Beatriz Fagundo
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain.,Ciber Fisiopatologia Obesidad y Nutrición (CB 06/03), Instituto Salud Carlos III, Madrid, Spain
| | - María Lozano-Madrid
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain.,Ciber Fisiopatologia Obesidad y Nutrición (CB 06/03), Instituto Salud Carlos III, Madrid, Spain
| | - Gemma Mestre-Bach
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain.,Ciber Fisiopatologia Obesidad y Nutrición (CB 06/03), Instituto Salud Carlos III, Madrid, Spain
| | - Mónica Gómez-Peña
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | - Neus Aymamí
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | | | | | - Marta Baño
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | | | - José M Menchón
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | - Susana Jiménez-Murcia
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain. .,Ciber Fisiopatologia Obesidad y Nutrición (CB 06/03), Instituto Salud Carlos III, Madrid, Spain. .,Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain.
| |
Collapse
|
25
|
Ronzitti S, Soldini E, Smith N, Clerici M, Bowden-Jones H. Gambling Disorder: Exploring Pre-treatment and In-treatment Dropout Predictors. A UK Study. J Gambl Stud 2018; 33:1277-1292. [PMID: 28332064 DOI: 10.1007/s10899-017-9686-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The aim of this study was to identify predictors of treatment dropout in a sample of gamblers attending a specialist clinic for gambling disorder. We analysed data on 846 treatment-seeking pathological gamblers. Firstly, we investigated differences in socio-demographic and clinical variables between treatment completers and pre-treatment dropouts, as well as between treatment completers and during-treatment dropouts. Subsequently, variables were entered into a multinomial logistic regression model to identify significant predictors of pre-treatment and in-treatment dropout. Overall, 44.8% of clients did not complete the treatment: 27.4% dropped out before starting it, while 17.4% dropped out during the treatment. Younger age and use of drugs were associated with pre-treatment dropout, while family history of gambling disorder, a lower PGSI score, and being a smoker were related with in-treatment dropout. Our findings suggest that pre-treatment dropouts differ from in-treatment dropouts, and, thus, further research will benefit from considering these groups separately. In addition, this newly gained knowledge will also be helpful in increasing treatment retention in specific subgroups of problem gamblers.
Collapse
Affiliation(s)
- Silvia Ronzitti
- NPGC, National Problem Gambling Clinic, Central North West London NHS Foundation Trust, London, UK. .,Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy. .,Yale University, 300 George Street, New Haven, CT, USA.
| | - Emiliano Soldini
- Methodology and Statistics Laboratory (LABStat), Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland
| | - Neil Smith
- NPGC, National Problem Gambling Clinic, Central North West London NHS Foundation Trust, London, UK
| | - Massimo Clerici
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,Department of Mental Health, San Gerardo Hospital, Monza, Italy
| | - Henrietta Bowden-Jones
- NPGC, National Problem Gambling Clinic, Central North West London NHS Foundation Trust, London, UK.,Department of Medicine, Imperial College London, London, UK
| |
Collapse
|
26
|
Dunsmuir P, Smith D, Fairweather-Schmidt AK, Riley B, Battersby M. Gender differences in temporal relationships between gambling urge and cognitions in treatment-seeking adults. Psychiatry Res 2018; 262:282-289. [PMID: 29477071 DOI: 10.1016/j.psychres.2018.02.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 12/04/2017] [Accepted: 02/13/2018] [Indexed: 01/12/2023]
Abstract
Many gambling-specific CBT programs seek to target either gambling-related urge or cognitions or both. However, little is known of the influence of one symptom type on another across time and whether these differ for men and women help-seeking problem gamblers. The aim of this study was threefold: to determine presence of measurement invariance for urge and cognition measures over time; to investigate the effect of baseline urge on end-of-treatment gambling-related cognitions - and the reciprocal relationship; and, identify whether these pathways differ across gender. Self-reported gambling urge (GUS), and gambling-related cognitions (GRCS) data from treatment-seeking problem gamblers prior to and post treatment (N = 223; 62% men) were analyzed with cross-lagged panel models, moderated by gender. Conceptualization of urge and cognitions were found to be temporally stable. There was no significant association between baseline GUS scores and post-treatment GRCS scores, nor the reverse relationship. Putatively, this infers that coexisting urge and gambling-related cognition components of problem gambling operate independently over time. Analyses revealed gambling urge had a significantly stronger tracking correlation across time for men than women when adjusting for cognition paths. This investigation provides early evidence for tailoring CBT in response to sub-population gambling-related characteristics, demonstrated across men and women.
Collapse
Affiliation(s)
- Phoebe Dunsmuir
- Flinders Human Behaviour and Health Research Unit, Department of Psychiatry, Flinders University, GPO Box 2100, Adelaide, South Australia 5001, Australia
| | - David Smith
- Flinders Human Behaviour and Health Research Unit, Department of Psychiatry, Flinders University, GPO Box 2100, Adelaide, South Australia 5001, Australia
| | - A Kate Fairweather-Schmidt
- Flinders Human Behaviour and Health Research Unit, Department of Psychiatry, Flinders University, GPO Box 2100, Adelaide, South Australia 5001, Australia.
| | - Ben Riley
- Flinders Human Behaviour and Health Research Unit, Department of Psychiatry, Flinders University, GPO Box 2100, Adelaide, South Australia 5001, Australia
| | - Malcolm Battersby
- Flinders Human Behaviour and Health Research Unit, Department of Psychiatry, Flinders University, GPO Box 2100, Adelaide, South Australia 5001, Australia
| |
Collapse
|
27
|
Pickering D, Keen B, Entwistle G, Blaszczynski A. Measuring treatment outcomes in gambling disorders: a systematic review. Addiction 2018; 113:411-426. [PMID: 28891116 PMCID: PMC5836978 DOI: 10.1111/add.13968] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 06/29/2017] [Accepted: 08/02/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND AIMS Considerable variation of outcome variables used to measure recovery in the gambling treatment literature has precluded effective cross-study evaluations and hindered the development of best-practice treatment methodologies. The aim of this systematic review was to describe current diffuse concepts of recovery in the gambling field by mapping the range of outcomes and measurement strategies used to evaluate treatments, and to identify more commonly accepted indices of recovery. METHODS A systematic search of six academic databases for studies evaluating treatments (psychological and pharmacological) for gambling disorders with a minimum 6-month follow-up. Data from eligible studies were tabulated and analysis conducted using a narrative approach. Guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were adhered to. RESULTS Thirty-four studies were reviewed systematically (RCTs = 17, comparative designs = 17). Sixty-three different outcome measures were identified: 25 (39.7%) assessed gambling-specific constructs, 36 (57.1%) assessed non-gambling specific constructs, and two instruments were used across both categories (3.2%). Self-report instruments ranged from psychometrically validated to ad-hoc author-designed questionnaires. Units of measurement were inconsistent, particularly in the assessment of gambling behaviour. All studies assessed indices of gambling behaviour and/or symptoms of gambling disorder. Almost all studies (n = 30; 88.2%) included secondary measures relating to psychiatric comorbidities, psychological processes linked to treatment approach, or global functioning and wellbeing. CONCLUSIONS In research on gambling disorders, the incorporation of broader outcome domains that extend beyond disorder-specific symptoms and behaviours suggests a multi-dimensional conceptualization of recovery. Development of a single comprehensive scale to measure all aspects of gambling recovery could help to facilitate uniform reporting practices across the field.
Collapse
Affiliation(s)
| | - Brittany Keen
- School of PsychologyUniversity of SydneySydneyAustralia
| | | | | |
Collapse
|
28
|
Ronzitti S, Soldini E, Smith N, Bayston A, Clerici M, Bowden-Jones H. Are Treatment Outcomes Determined by Type of Gambling? A UK Study. J Gambl Stud 2018; 34:987-997. [DOI: 10.1007/s10899-018-9752-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
29
|
Del Pino-Gutiérrez A, Fernández-Aranda F, Granero R, Tárrega S, Valdepérez A, Agüera Z, Håkansson A, Sauvaget A, Aymamí N, Gómez-Peña M, Moragas L, Baño M, Honrubia M, Menchón JM, Jiménez-Murcia S. Impact of alcohol consumption on clinical aspects of gambling disorder. Int J Ment Health Nurs 2017; 26:121-128. [PMID: 26952336 DOI: 10.1111/inm.12221] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 11/26/2015] [Accepted: 01/03/2016] [Indexed: 11/27/2022]
Abstract
Similarities between gambling disorder and substance use disorders have been extensively described. To date, however, few studies using large clinical samples have been carried out that reliably assess the relationship between different levels of alcohol consumption and gambling disorders. The present study aimed to assess the impact of baseline alcohol consumption levels on the clinical profile in a large sample of treatment-seeking individuals. Nine hundred and fifty-one consecutive outpatients diagnosed with gambling disorder according to DSM-IV criteria were compared after being included in three alcohol consumption groups (low risk, abuse and risk of dependence) based on their total raw scores on the AUDIT questionnaire. Results showed a high prevalence of risk of alcohol dependence in GD patients who were immigrants, unemployed, and had a low level of education. A positive linear trend was also found between alcohol consumption level and the prevalence of other current and life-time comorbid mental disorders, and for the presence of drug abuse. Statistically significant differences were found between the three alcohol consumption groups in terms of the evolution and severity of the gambling disorder, self-directedness personality trait, and levels of general psychopathology, hostility and paranoid ideation. In conclusion, the results showed an association between increased alcohol consumption and greater dysfunction.
Collapse
Affiliation(s)
- Amparo Del Pino-Gutiérrez
- Nursing Department of Mental Health, Public Health, Maternal and Child Health, The Nursing School of the University of Barcelona, Barcelona, Spain.,Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
| | - Fernando Fernández-Aranda
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.,CIBER Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Barcelona, Spain.,Departament of Clinical Sciences, School of Medicine, University of Barcelona, Spain
| | - Roser Granero
- CIBER Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Barcelona, Spain.,Department of Psychobiology and Methodology, Autonomous University of Barcelona, Spain
| | - Salomé Tárrega
- Department of Psychobiology and Methodology, Autonomous University of Barcelona, Spain
| | - Ana Valdepérez
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Zaida Agüera
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.,CIBER Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Barcelona, Spain
| | - Anders Håkansson
- Division of Psychiatry, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Anne Sauvaget
- Addictology and Psychiatry Department, Nantes University Hospital, France
| | - Neus Aymamí
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
| | - Mónica Gómez-Peña
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
| | - Laura Moragas
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
| | - Marta Baño
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
| | - María Honrubia
- Nursing Department of Mental Health, Public Health, Maternal and Child Health, The Nursing School of the University of Barcelona, Barcelona, Spain
| | - José M Menchón
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.,Departament of Clinical Sciences, School of Medicine, University of Barcelona, Spain.,CIBER Mental Health (CIBERSAM), Institute of Health Carlos III, Barcelona, Spain
| | - Susana Jiménez-Murcia
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.,CIBER Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Barcelona, Spain.,Departament of Clinical Sciences, School of Medicine, University of Barcelona, Spain
| |
Collapse
|
30
|
Smith D, Woodman R, Harvey P, Battersby M. Self-Perceived Distress and Impairment in Problem Gamblers: A Study of Pre- to Post-treatment Measurement Invariance. J Gambl Stud 2017; 32:1065-1078. [PMID: 26971101 DOI: 10.1007/s10899-016-9598-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Gambling help services typically evaluate treatment outcomes using self-reported responses and measurements. However, gamblers' conceptualisations and prioritisations with respect to these measurements may shift over time. Thus, changes in the self-reported responses may not always reflect true change in the individuals. This study investigated for response shift in self-report measures of psychological distress and impairment in 293 help-seeking problem gamblers. We used confirmatory factor analysis to model data structures from pre-treatment to post-treatment. The findings indicated that a response shift had occurred. Two items became less important and one item became more important in measuring psychological distress. Measurement invariance was achieved for the complete set of items for impairment. These findings provide a more in-depth understanding of the nature of self-report outcomes in otherwise routinely collected data.
Collapse
Affiliation(s)
- David Smith
- Flinders Human Behaviour and Health Research Unit, Department of Psychiatry, Flinders University, GPO Box 2100, Adelaide, SA, 2001, Australia.
| | - Richard Woodman
- Flinders Human Behaviour and Health Research Unit, Centre for Epidemiology and Biostatistics, Flinders University, GPO Box 2100, Adelaide, SA, 2001, Australia
| | - Peter Harvey
- Flinders Human Behaviour and Health Research Unit, Department of Psychiatry, Flinders University, GPO Box 2100, Adelaide, SA, 2001, Australia
| | - Malcolm Battersby
- Flinders Human Behaviour and Health Research Unit, Department of Psychiatry, Flinders University, GPO Box 2100, Adelaide, SA, 2001, Australia
| |
Collapse
|
31
|
Abbott M, Bellringer M, Vandal AC, Hodgins DC, Battersby M, Rodda SN. Effectiveness of problem gambling interventions in a service setting: a protocol for a pragmatic randomised controlled clinical trial. BMJ Open 2017; 7:e013490. [PMID: 28255094 PMCID: PMC5353265 DOI: 10.1136/bmjopen-2016-013490] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION The primary purpose of this study is to evaluate the relative effectiveness of 2 of the best developed and most promising forms of therapy for problem gambling, namely face-to-face motivational interviewing (MI) combined with a self-instruction booklet (W) and follow-up telephone booster sessions (B; MI+W+B) and face-to-face cognitive-behavioural therapy (CBT). METHODS AND ANALYSIS This project is a single-blind pragmatic randomised clinical trial of 2 interventions, with and without the addition of relapse-prevention text messages. Trial assessments take place pretreatment, at 3 and 12 months. A total of 300 participants will be recruited through a community treatment agency that provides services across New Zealand and randomised to up to 10 face-to-face sessions of CBT or 1 face-to-face session of MI+W+up to 5 B. Participants will also be randomised to 9 months of postcare text messaging. Eligibility criteria include a self-perception of having a current gambling problem and a willingness to participate in all components of the study (eg, read workbook). The statistical analysis will use an intent-to-treat approach. Primary outcome measures are days spent gambling and amount of money spent per day gambling in the prior month. Secondary outcome measures include problem gambling severity, gambling urges, gambling cognitions, mood, alcohol, drug use, tobacco, psychological distress, quality of life, health status and direct and indirect costs associated with treatment. ETHICS AND DISSEMINATION The research methods to be used in this study have been approved by the Ministry of Health, Health and Disability Ethics Committees (HDEC) 15/CEN/99. The investigators will provide annual reports to the HDEC and report any adverse events to this committee. Amendments will also be submitted to this committee. The results of this trial will be submitted for publication in peer-reviewed journals and as a report to the funding body. Additionally, the results will be presented at national and international conferences. TRIAL REGISTRATION NUMBER ACTRN12615000637549.
Collapse
Affiliation(s)
- M Abbott
- Gambling and Addictions Research Centre, National Institute for Public Health and Mental Health Research, School of Public Health and Psychosocial Studies, Auckland, New Zealand
- Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - M Bellringer
- Gambling and Addictions Research Centre, National Institute for Public Health and Mental Health Research, School of Public Health and Psychosocial Studies, Auckland, New Zealand
- Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - A C Vandal
- Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
- Department of Biostatistics and Epidemiology, School of Public Health and Psychosocial Studies, Auckland, New Zealand
- Health Intelligence and Informatics, Ko Awatea, Counties Manukau District Health Board, Auckland, New Zealand
| | - D C Hodgins
- Department of Psychology, University of Calgary, Calgary, Canada
| | - M Battersby
- Department of Psychiatry, Flinders Human Behaviour and Health Research Unit, Flinders University, Adelaide, South Australia, Australia
| | - S N Rodda
- Gambling and Addictions Research Centre, National Institute for Public Health and Mental Health Research, School of Public Health and Psychosocial Studies, Auckland, New Zealand
- Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| |
Collapse
|
32
|
Salonen AH, Rosenström T, Edgren R, Volberg R, Alho H, Castrén S. Dimensions of the South Oaks Gambling Screen in Finland: A cross-sectional population study. Scand J Psychol 2017; 58:228-237. [PMID: 28247931 DOI: 10.1111/sjop.12357] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 01/12/2017] [Indexed: 11/27/2022]
Abstract
The underlying structure of problematic gambling behaviors, such as those assessed by the South Oaks Gambling Screen (SOGS), remain unknown: Can problem gambling be assessed unidimensionally or should multiple qualitatively different dimensions be taken into account, and if so, what do these qualitative dimensions indicate? How significant are the deviations from unidimensionality in practice? A cross-sectional random sample of Finns aged 15-74 (n = 4,484) was drawn from the Population Information Registry and surveyed in 2011-2012. Analyses were conducted using descriptive statistics, Confirmatory factor analysis (CFA) and multidimensional item response theory (MIRT) models. Altogether, 14.9% of the population endorsed at least one of the 20 SOGS items, but nine items had low endorsement rates (≤ 0.2%). CFA and MIRT techniques suggested that individuals differed from each other in two positively correlated (r = 0.70) underlying dimensions: "impact on self primarily" and "impact on others also". This two-factor correlated-factors model can be reinterpreted as a bifactor model with one general gambling-problem factor and two specific factors with similar interpretation as in the correlated-factors model but with non-overlapping items. The two specific factors may provide clinically useful information without extra costs of assessment.
Collapse
Affiliation(s)
- Anne H Salonen
- National Institute for Health and Welfare, Department of Public Health Solutions, Alcohol, Drugs and Addictions Unit, Finland.,Institute of Clinical Medicine, University of Helsinki, Finland
| | - Tom Rosenström
- Institute of Behavioral Sciences, University of Helsinki, Finland
| | - Robert Edgren
- National Institute for Health and Welfare, Department of Public Health Solutions, Alcohol, Drugs and Addictions Unit, Finland.,Institute of Behavioral Sciences, University of Helsinki, Finland
| | - Rachel Volberg
- School of Public Health and Health Sciences, University of Massachusetts Amherst, USA
| | - Hannu Alho
- National Institute for Health and Welfare, Department of Public Health Solutions, Alcohol, Drugs and Addictions Unit, Finland.,Institute of Clinical Medicine, University of Helsinki, Finland.,Abdominal Center, University of Helsinki, Finland
| | - Sari Castrén
- National Institute for Health and Welfare, Department of Public Health Solutions, Alcohol, Drugs and Addictions Unit, Finland.,Institute of Clinical Medicine, University of Helsinki, Finland
| |
Collapse
|
33
|
Gay A, Boutet C, Sigaud T, Kamgoue A, Sevos J, Brunelin J, Massoubre C. A single session of repetitive transcranial magnetic stimulation of the prefrontal cortex reduces cue-induced craving in patients with gambling disorder. Eur Psychiatry 2017; 41:68-74. [PMID: 28049084 DOI: 10.1016/j.eurpsy.2016.11.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 10/30/2016] [Accepted: 11/02/2016] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Gambling disorder (GD) is common and disabling addictive disorder. In patients with substance use disorders, the application of repetitive transcranial magnetic stimulation (rTMS) over the dorsolateral prefrontal cortex (DLPFC) offers promise to alleviate craving. We hypothesized that applying real compared to sham rTMS over the left DLPFC would reduce gambling craving in patients with GD. METHODS In a randomized sham-controlled crossover design, 22 treatment-seeking patients with GD received real or sham treatment with high frequency rTMS over the left DLPFC followed a week later by the other type of treatment. Before and after each rTMS session, participants rated their gambling craving (from 0 to 100) before and after viewing a gambling video used as a cue. We used the Yale-Brown Obsessive Compulsive Scale adapted for Pathological Gambling to assess gambling behavior before and 7 days after each rTMS session. RESULTS As compared to sham (mean +0.74; standard deviation±3.03), real rTMS significantly decreased cue-induced craving (-2.12±3.39; F(1,19)=4.87; P=0.04; partial η2=0.05; 95% CI: 0.00-0.21). No significant effect of rTMS was observed on gambling behavior. CONCLUSIONS Patients with GD reported decreased cue-induced craving following a single session of high frequency rTMS applied over the left DLPFC. Further large randomized controlled studies are needed to determine the usefulness of rTMS in GD.
Collapse
Affiliation(s)
- A Gay
- University hospital center of Saint-Étienne, university department of psychiatry and addiction, 42055 Saint-Étienne, France; TAPE laboratory, EA7423, Jean-Monnet university, Saint-Étienne, France.
| | - C Boutet
- INSERM, U1059, university of Lyon, 42023 Saint-Étienne, France; Radiology department, university hospital center of Saint-Étienne, 42055 Saint-Étienne, France
| | - T Sigaud
- University hospital center of Saint-Étienne, university department of psychiatry and addiction, 42055 Saint-Étienne, France; TAPE laboratory, EA7423, Jean-Monnet university, Saint-Étienne, France
| | - A Kamgoue
- University hospital center of Saint-Étienne, university department of psychiatry and addiction, 42055 Saint-Étienne, France
| | - J Sevos
- University hospital center of Saint-Étienne, university department of psychiatry and addiction, 42055 Saint-Étienne, France; TAPE laboratory, EA7423, Jean-Monnet university, Saint-Étienne, France
| | - J Brunelin
- INSERM, U1028, CNRS, UMR5292, Lyon neuroscience research center, university of Lyon, ΨR2 Team, 69000 Lyon, France; Lyon 1 university, 69000 Villeurbanne, France; Hospital center Le Vinatier, 69678 Bron, France
| | - C Massoubre
- University hospital center of Saint-Étienne, university department of psychiatry and addiction, 42055 Saint-Étienne, France; TAPE laboratory, EA7423, Jean-Monnet university, Saint-Étienne, France
| |
Collapse
|
34
|
Limbrick-Oldfield EH, Mick I, Cocks RE, McGonigle J, Sharman SP, Goldstone AP, Stokes PRA, Waldman A, Erritzoe D, Bowden-Jones H, Nutt D, Lingford-Hughes A, Clark L. Neural substrates of cue reactivity and craving in gambling disorder. Transl Psychiatry 2017; 7:e992. [PMID: 28045460 PMCID: PMC5545724 DOI: 10.1038/tp.2016.256] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 09/12/2016] [Accepted: 10/15/2016] [Indexed: 12/12/2022] Open
Abstract
Cue reactivity is an established procedure in addictions research for examining the subjective experience and neural basis of craving. This experiment sought to quantify cue-related brain responses in gambling disorder using personally tailored cues in conjunction with subjective craving, as well as a comparison with appetitive non-gambling stimuli. Participants with gambling disorder (n=19) attending treatment and 19 controls viewed personally tailored blocks of gambling-related cues, as well as neutral cues and highly appetitive (food) images during a functional magnetic resonance imaging (fMRI) scan performed ~2-3 h after a usual meal. fMRI analysis examined cue-related brain activity, cue-related changes in connectivity and associations with block-by-block craving ratings. Craving ratings in the participants with gambling disorder increased following gambling cues compared with non-gambling cues. fMRI analysis revealed group differences in left insula and anterior cingulate cortex, with the gambling disorder group showing greater reactivity to the gambling cues, but no differences to the food cues. In participants with gambling disorder, craving to gamble correlated positively with gambling cue-related activity in the bilateral insula and ventral striatum, and negatively with functional connectivity between the ventral striatum and the medial prefrontal cortex. Gambling cues, but not food cues, elicit increased brain responses in reward-related circuitry in individuals with gambling disorder (compared with controls), providing support for the incentive sensitization theory of addiction. Activity in the insula co-varied with craving intensity, and may be a target for interventions.
Collapse
Affiliation(s)
- E H Limbrick-Oldfield
- Centre for Gambling Research at UBC, Department of Psychology, University of British Columbia, Vancouver, BC, Canada,Department of Psychology, University of Cambridge, Cambridge, UK,Centre for Gambling Research at UBC, Department of Psychology, University of British Columbia, 2136 West Mall Vancouver, Vancouver, BC V6T 1Z4, Canada. E-mail:
| | - I Mick
- Centre for Neuropsychopharmacology, Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK
| | - R E Cocks
- Department of Psychology, University of Cambridge, Cambridge, UK,Centre for Neuropsychopharmacology, Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK
| | - J McGonigle
- Centre for Neuropsychopharmacology, Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK
| | - S P Sharman
- Department of Psychology, University of Cambridge, Cambridge, UK,School of Psychology, College of Social Science, University of Lincoln, Lincoln, UK
| | - A P Goldstone
- Centre for Neuropsychopharmacology, Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK,Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Imperial College London, London, UK
| | - P R A Stokes
- Centre for Neuropsychopharmacology, Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK,Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, Centre for Affective Disorders, King’s College London, London, UK
| | - A Waldman
- Division of Experimental Medicine, Department of Imaging, Imperial College London, London, UK
| | - D Erritzoe
- Centre for Neuropsychopharmacology, Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK
| | - H Bowden-Jones
- National Problem Gambling Clinic, CNWL NHS Foundation Trust, Imperial College London, London, UK
| | - D Nutt
- Centre for Neuropsychopharmacology, Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK
| | - A Lingford-Hughes
- Centre for Neuropsychopharmacology, Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK,Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Imperial College London, London, UK,National Problem Gambling Clinic, CNWL NHS Foundation Trust, Imperial College London, London, UK
| | - L Clark
- Centre for Gambling Research at UBC, Department of Psychology, University of British Columbia, Vancouver, BC, Canada,Department of Psychology, University of Cambridge, Cambridge, UK
| |
Collapse
|
35
|
Tolchard B. Cognitive-behavior therapy for problem gambling: a critique of current treatments and proposed new unified approach. J Ment Health 2016; 26:283-290. [DOI: 10.1080/09638237.2016.1207235] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Barry Tolchard
- School of Health, University of New England, Armidale, NSW, Australia
| |
Collapse
|
36
|
Abstract
Problem and pathological gamblers demonstrate high levels of depression, which may be related to coping styles, reactive emotional states, and/or genetics (Potenza et al., Arch Gen Psychiat 62(9):1015-1021, 2005; Getty et al., J Gambl Stud 16(4):377-391, 2000). Although depression impacts treatment outcomes (Morefield et al., Int J Men Healt Addict 12(3):367-379, 2013), research regarding depression among gamblers in residential treatment is particularly limited. This study attempts to address this deficit by examining the course of depressive symptoms among clients at a residential gambling program in the Western United States. Forty-four adults were administered a weekly measure of depression (Beck Depression Inventory-II, BDI-II) for eight consecutive weeks. Levels of depression were classified into three groups based on standard scoring criteria for the BDI-II: no/minimal, mild/moderate, and severe depression. Results from a mixed-model analysis indicated a main effect for group and time, as well as an interaction between group and time. Examination of the slopes for the rate of change for the three depression groups indicated no change in the non-depressed group and a decrease in depression scores over time for both the mild/moderate and severely depressed groups. The slopes for the two symptomatic depression groups were not significantly different, indicating a similar rate of change. We speculate that reductions in depression symptoms may be related to feelings of self-efficacy, environmental containment/stabilization, and therapeutic effects of treatment. These results help to illuminate the role of significant processes in residential treatment, including initial stabilization, insight, self-efficacy, and termination.
Collapse
|
37
|
Bruneau M, Grall-Bronnec M, Vénisse JL, Romo L, Valleur M, Magalon D, Fatséas M, Chéreau-Boudet I, Luquiens A, Challet-Bouju G, Hardouin JB, Hardouin JB. Gambling transitions among adult gamblers: A multi-state model using a Markovian approach applied to the JEU cohort. Addict Behav 2016; 57:13-20. [PMID: 26827154 DOI: 10.1016/j.addbeh.2016.01.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 01/19/2016] [Accepted: 01/20/2016] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The aim of this paper is to study transitions between two states of gambling in adulthood (problem gambling and non-problem gambling) and to identify factors that might influence these transitions. METHODS Data for this 2-year long longitudinal study were collected in a French Outpatient Addiction Treatment Center, in gambling establishments and through the press. Both problem gamblers and non-problem gamblers were evaluated using a structured interview and self-report questionnaires. The statistical analysis was carried out using a Markovian approach. RESULTS The analyzed cohort consisted of 304 gamblers with 519 observed transitions. Participants with no past-year gambling problems (based on the DSM-IV) had a probability of about 90% of also having no past-year gambling problems at the following assessment, whereas the observed percentage of problem gamblers transitioning to non-problem gambling was of 48%. We reported (i) vulnerability factors of transitioning to problem gambling (such as an anxiety disorder or an Attention Deficit Hyperactivity Disorder (ADHD) during the childhood), (ii) protective factors for non-problem gamblers, (iii) recovery factors (such as ongoing treatment and younger age) and (iv) persistence factors of a gambling problem (such as a persistent ADHD). CONCLUSIONS The status of problem gambler is unstable over time, whereas we found stability among non-problem gamblers. Our findings suggest the existence of vulnerability and protective factors in gambling. These results lead to think about preventive actions and adaptive care, such as cognitive-behavioral therapy or researching gambling problems in people with an anxiety disorder or ADHD.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Jean-Benoit Hardouin
- EA 4275 SPHERE "MethodS for Patients-centered outcomes and HEalth REsearch", University of Nantes, France; Unit of Methodology and Biostatistics, University Hospital of Nantes, France
| |
Collapse
|
38
|
Gender by Preferred Gambling Activity in Treatment Seeking Problem Gamblers: A Comparison of Subgroup Characteristics and Treatment Outcomes. J Gambl Stud 2016; 33:99-113. [DOI: 10.1007/s10899-016-9614-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
39
|
Jiménez-Murcia S, Del Pino-Gutiérrez A, Fernández-Aranda F, Granero R, Hakänsson A, Tárrega S, Valdepérez A, Aymamí N, Gómez-Peña M, Moragas L, Baño M, Sauvaget A, Romeu M, Steward T, Menchón JM. Treatment Outcome in Male Gambling Disorder Patients Associated with Alcohol Use. Front Psychol 2016; 7:465. [PMID: 27065113 PMCID: PMC4815556 DOI: 10.3389/fpsyg.2016.00465] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 03/15/2016] [Indexed: 11/15/2022] Open
Abstract
Aims: The primary objective of this study was to analyze the association between alcohol consumption and short-term response to treatment (post intervention) in male patients with gambling disorder enrolled in a group cognitive behavioral therapy (CBT) program. Methods: The sample consisted of 111 male individuals with a diagnosis of Gambling Disorder, with a mean age of 45 years (SD = 12.2). All participants were evaluated by a comprehensive assessment battery and assigned to CBT groups of 10–14 patients attending 16 weekly outpatient sessions lasting 90 min each. Results: The highest mean pre- and post-therapy differences were recorded for the alcohol risk/dependence group on the obsessive/compulsive and anxiety dimensions of the SCL-90-R. As regards the presence of relapses and dropouts over the course of the CBT sessions, the results show a significant association with moderate effect size: patients with risk consumption or alcohol dependence were more likely to present poor treatment outcomes. Conclusions: Alcohol abuse was frequent in GD, especially in patients with low family income and high accumulated debts. High levels of somatization and high overall psychopathology (measured by the SCL-90-R) were associated with increased risk of alcohol abuse. Alcohol abuse was also associated with poor response to treatment.
Collapse
Affiliation(s)
- Susana Jiménez-Murcia
- Department of Psychiatry, Bellvitge University Hospital-IDIBELLBarcelona, Spain; Ciber Fisiopatología Obesidad y Nutrición, Instituto de Salud Carlos IIIBarcelona, Spain; Departament of Clinical Sciences, School of Medicine, University of BarcelonaBarcelona, Spain
| | - Amparo Del Pino-Gutiérrez
- Department of Psychiatry, Bellvitge University Hospital-IDIBELLBarcelona, Spain; Nursing Department of Mental Health, Public Health, Maternal and Child Health, Nursing School, University of BarcelonaBarcelona, Spain
| | - Fernando Fernández-Aranda
- Department of Psychiatry, Bellvitge University Hospital-IDIBELLBarcelona, Spain; Ciber Fisiopatología Obesidad y Nutrición, Instituto de Salud Carlos IIIBarcelona, Spain; Departament of Clinical Sciences, School of Medicine, University of BarcelonaBarcelona, Spain
| | - Roser Granero
- Ciber Fisiopatología Obesidad y Nutrición, Instituto de Salud Carlos IIIBarcelona, Spain; Departament de Psicobiologia i Metodologia, Universitat Autònoma de BarcelonaBarcelona, Spain
| | - Anders Hakänsson
- Division of Psychiatry, Department of Clinical Sciences, Lund University Lund, Sweden
| | - Salomé Tárrega
- Departament de Psicobiologia i Metodologia, Universitat Autònoma de Barcelona Barcelona, Spain
| | - Ana Valdepérez
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau Barcelona, Spain
| | - Neus Aymamí
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL Barcelona, Spain
| | - Mónica Gómez-Peña
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL Barcelona, Spain
| | - Laura Moragas
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL Barcelona, Spain
| | - Marta Baño
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL Barcelona, Spain
| | - Anne Sauvaget
- Addictology and Psychiatry Department, Nantes University Hospital Nantes, France
| | - Maria Romeu
- Nursing Department of Mental Health, Public Health, Maternal and Child Health, Nursing School, University of Barcelona Barcelona, Spain
| | - Trevor Steward
- Department of Psychiatry, Bellvitge University Hospital-IDIBELLBarcelona, Spain; Ciber Fisiopatología Obesidad y Nutrición, Instituto de Salud Carlos IIIBarcelona, Spain
| | - José M Menchón
- Department of Psychiatry, Bellvitge University Hospital-IDIBELLBarcelona, Spain; Departament of Clinical Sciences, School of Medicine, University of BarcelonaBarcelona, Spain; CIBER Salud Mental, Instituto Carlos IIIBarcelona, Spain
| |
Collapse
|
40
|
Smith D, Woodman R, Drummond A, Battersby M. Exploring the measurement structure of the Gambling Related Cognitions Scale (GRCS) in treatment-seekers: A Bayesian structural equation modelling approach. Psychiatry Res 2016; 237:90-6. [PMID: 26921058 DOI: 10.1016/j.psychres.2016.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 01/31/2016] [Accepted: 02/03/2016] [Indexed: 12/13/2022]
Abstract
Knowledge of a problem gambler's underlying gambling related cognitions plays an important role in treatment planning. The Gambling Related Cognitions Scale (GRCS) is therefore frequently used in clinical settings for screening and evaluation of treatment outcomes. However, GRCS validation studies have generated conflicting results regarding its latent structure using traditional confirmatory factor analyses (CFA). This may partly be due to the rigid constraints imposed on cross-factor loadings with traditional CFA. The aim of this investigation was to determine whether a Bayesian structural equation modelling (BSEM) approach to examination of the GRCS factor structure would better replicate substantive theory and also inform model re-specifications. Participants were 454 treatment-seekers at first presentation to a gambling treatment centre between January 2012 and December 2014. Model fit indices were well below acceptable standards for CFA. In contrast, the BSEM model which included small informative priors for the residual covariance matrix in addition to cross-loadings produced excellent model fit for the original hypothesised factor structure. The results also informed re-specification of the CFA model which provided more reasonable model fit. These conclusions have implications that should be useful to both clinicians and researchers evaluating measurement models relating to gambling related cognitions in treatment-seekers.
Collapse
Affiliation(s)
- David Smith
- Department of Psychiatry, Flinders University, Adelaide, South Australia, Australia.
| | - Richard Woodman
- Centre for Epidemiology and Biostatistics, Flinders University, Adelaide, South Australia, Australia
| | - Aaron Drummond
- Department of Psychiatry, Flinders University, Adelaide, South Australia, Australia
| | - Malcolm Battersby
- Department of Psychiatry, Flinders University, Adelaide, South Australia, Australia
| |
Collapse
|
41
|
Smith D, Harvey P, Humeniuk R, Battersby M, Pols R. Effects of Affective and Anxiety Disorders on Outcome in Problem Gamblers Attending Routine Cognitive-Behavioural Treatment in South Australia. J Gambl Stud 2016; 31:1069-83. [PMID: 24788305 DOI: 10.1007/s10899-014-9465-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study evaluated the influence of 12-month affective and anxiety disorders on treatment outcomes for adult problem gamblers in routine cognitive-behavioural therapy. A cohort study at a state-wide gambling therapy service in South Australia. Primary outcome measure was rated by participants using victorian gambling screen (VGS) 'harm to self' sub-scale with validated cut score 21+ (score range 0-60) indicative of problem gambling behaviour. Secondary outcome measure was Work and Social Adjustment Scale (WSAS). Independent variable was severity of affective and anxiety disorders based on Kessler 10 scale. We used propensity score adjusted random-effects models to estimate treatment outcomes for sub-populations of individuals from baseline to 12 month follow-up. Between July, 2010 and December, 2012, 380 participants were eligible for inclusion in the final analysis. Mean age was 44.1 (SD = 13.6) years and 211 (56%) were males. At baseline, 353 (92.9%) were diagnosed with a gambling disorder using VGS. For exposure, 175 (46%) had a very high probability of a 12-month affective or anxiety disorder, 103 (27%) in the high range and 102 (27%) in the low to moderate range. For the main analysis, individuals experienced similar clinically significant reductions (improvement) in gambling related outcomes across time (p < 0.001). Individuals with co-varying patterns of problem gambling and 12 month affective and anxiety disorders who present to a gambling help service for treatment in metropolitan South Australia gain similar significant reductions in gambling behaviours from routine cognitive-behavioural therapy in the mid-term.
Collapse
Affiliation(s)
- David Smith
- Flinders Human Behaviour and Health Research Unit, Department of Psychiatry, Flinders University, GPO Box 2100, Adelaide, SA, 2001, Australia,
| | | | | | | | | |
Collapse
|
42
|
Tolchard B. Outcome of treatment seeking rural gamblers attending a nurse-led cognitive-behaviour therapy service: A pilot study. Int J Nurs Sci 2016. [DOI: 10.1016/j.ijnss.2016.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
|
43
|
Sundqvist K, Rosendahl I, Wennberg P. The association between at-risk gambling and binge drinking in the general Swedish population. Addict Behav Rep 2015; 2:49-54. [PMID: 29531993 PMCID: PMC5845958 DOI: 10.1016/j.abrep.2015.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 06/29/2015] [Accepted: 07/03/2015] [Indexed: 11/22/2022] Open
Abstract
While the association between problem gambling and alcohol use disorders has been studied previously, little is known about the association between risk gambling and risk drinking. This study aimed at examining the association between at-risk gambling and binge drinking in the general Swedish population and to test whether this association remained after controlling for demographic factors. The data was part of a larger ongoing survey in the general Swedish population. Respondents (N = 19 530) were recruited through random digit dialing and interviewed about their alcohol habits (binge drinking), at-risk gambling (the Lie/Bet questionnaire) and demographics (gender, age, education, residence size, marital status, labor market status, country of origin and smoking). There was an association between lifetime at-risk gambling and current (12 months) weekly binge drinking for both men (OR = 1.73; CI 95%: 1.27-2.35) and women (OR = 2.27; CI 95%: 1.05-4.90). After controlling for demographics this association no longer remained significant (OR = 1.38; CI 95%; .99-1.90 for men and OR = 1.99; CI 95%: .94-4.66 for women). Age and smoking had the largest impact on this association. At-risk gambling and binge drinking are associated behaviors. However, it seems as if this association may be confounded by demographic variables. We hypothesize that similarities in personality profiles and health aspects could account for an additional part of the association.
Collapse
Affiliation(s)
- Kristina Sundqvist
- Center for Social Research on Alcohol and Drugs, Stockholm University, Sweden
| | - Ingvar Rosendahl
- Center for Psychiatry Research & Education, Stockholm County Council, Karolinska Institutet, Sweden
| | - Peter Wennberg
- Center for Social Research on Alcohol and Drugs, Stockholm University, Sweden
| |
Collapse
|
44
|
Dowling NA, Cowlishaw S, Jackson AC, Merkouris SS, Francis KL, Christensen DR. Prevalence of psychiatric co-morbidity in treatment-seeking problem gamblers: A systematic review and meta-analysis. Aust N Z J Psychiatry 2015; 49:519-39. [PMID: 25735959 PMCID: PMC4438101 DOI: 10.1177/0004867415575774] [Citation(s) in RCA: 200] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of this paper was to systematically review and meta-analyse the prevalence of co-morbid psychiatric disorders (DSM-IV Axis I disorders) among treatment-seeking problem gamblers. METHODS A systematic search was conducted for peer-reviewed studies that provided prevalence estimates of Axis I psychiatric disorders in individuals seeking psychological or pharmacological treatment for problem gambling (including pathological gambling). Meta-analytic techniques were performed to estimate the weighted mean effect size and heterogeneity across studies. RESULTS Results from 36 studies identified high rates of co-morbid current (74.8%, 95% CI 36.5-93.9) and lifetime (75.5%, 95% CI 46.5-91.8) Axis I disorders. There were high rates of current mood disorders (23.1%, 95% CI 14.9-34.0), alcohol use disorders (21.2%, 95% CI 15.6-28.1), anxiety disorders (17.6%, 95% CI 10.8-27.3) and substance (non-alcohol) use disorders (7.0%, 95% CI 1.7-24.9). Specifically, the highest mean prevalence of current psychiatric disorders was for nicotine dependence (56.4%, 95% CI 35.7-75.2) and major depressive disorder (29.9%, 95% CI 20.5-41.3), with smaller estimates for alcohol abuse (18.2%, 95% CI 13.4-24.2), alcohol dependence (15.2%, 95% CI 10.2-22.0), social phobia (14.9%, 95% CI 2.0-59.8), generalised anxiety disorder (14.4%, 95% CI 3.9-40.8), panic disorder (13.7%, 95% CI 6.7-26.0), post-traumatic stress disorder (12.3%, 95% CI 3.4-35.7), cannabis use disorder (11.5%, 95% CI 4.8-25.0), attention-deficit hyperactivity disorder (9.3%, 95% CI 4.1-19.6), adjustment disorder (9.2%, 95% CI 4.8-17.2), bipolar disorder (8.8%, 95% CI 4.4-17.1) and obsessive-compulsive disorder (8.2%, 95% CI 3.4-18.6). There were no consistent patterns according to gambling problem severity, type of treatment facility and study jurisdiction. Although these estimates were robust to the inclusion of studies with non-representative sampling biases, they should be interpreted with caution as they were highly variable across studies. CONCLUSIONS The findings highlight the need for gambling treatment services to undertake routine screening and assessment of psychiatric co-morbidity and provide treatment approaches that adequately manage these co-morbid disorders. Further research is required to explore the reasons for the variability observed in the prevalence estimates.
Collapse
Affiliation(s)
- Nicki A Dowling
- School of Psychology, Deakin University, Burwood, VIC, Australia,Melbourne Graduate School of Education, University of Melbourne, Melbourne, VIC, Australia,School of Psychological Sciences, Monash University, Melbourne, VIC, Australia,Centre for Gambling Research, Australian National University, Canberra, ACT, Australia
| | - Sean Cowlishaw
- School of Social and Community Medicine, Bristol University, Bristol, UK
| | - Alun C Jackson
- Melbourne Graduate School of Education, University of Melbourne, Melbourne, VIC, Australia
| | - Stephanie S Merkouris
- School of Psychology, Deakin University, Burwood, VIC, Australia,Problem Gambling Research and Treatment Centre, Monash University, Melbourne, VIC, Australia
| | - Kate L Francis
- Melbourne Graduate School of Education, University of Melbourne, Melbourne, VIC, Australia
| | - Darren R Christensen
- Melbourne Graduate School of Education, University of Melbourne, Melbourne, VIC, Australia,Faculty of Health Sciences, University of Lethbridge, Lethbridge, AB, Canada
| |
Collapse
|
45
|
Smith DP, Battersby MW, Harvey PW, Pols RG, Ladouceur R. Cognitive versus exposure therapy for problem gambling: Randomised controlled trial. Behav Res Ther 2015; 69:100-10. [PMID: 25917008 DOI: 10.1016/j.brat.2015.04.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 03/18/2015] [Accepted: 04/13/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Problem gambling-specific cognitive therapy (CT) and behavioural (exposure-based) therapy (ET) are two core cognitive-behavioural techniques to treating the disorder, but no studies have directly compared them using a randomised trial. AIMS To evaluate differential efficacy of CT and ET for adult problem gamblers at a South Australian gambling therapy service. METHODS Two-group randomised, parallel design. Primary outcome was rated by participants using the Victorian Gambling Screen (VGS) at baseline, treatment-end, 1, 3, and 6 month follow-up. FINDINGS Of eighty-seven participants who were randomised and started intervention (CT = 44; ET = 43), 51 (59%) completed intervention (CT = 30; ET = 21). Both groups experienced comparable reductions (improvement) in VGS scores at 12 weeks (mean difference -0.18, 95% CI: -4.48-4.11) and 6 month follow-up (mean difference 1.47, 95% CI: -4.46-7.39). CONCLUSIONS Cognitive and exposure therapies are both viable and effective treatments for problem gambling. Large-scale trials are needed to compare them individually and combined to enhance retention rates and reduce drop-out.
Collapse
Affiliation(s)
- David P Smith
- Flinders University, Department of Psychiatry, Flinders Human Behaviour and Health Research Unit, GPO Box 2100, Adelaide SA 2001, Australia.
| | - Malcolm W Battersby
- Flinders University, Department of Psychiatry, Flinders Human Behaviour and Health Research Unit, GPO Box 2100, Adelaide SA 2001, Australia.
| | - Peter W Harvey
- Flinders University, Department of Psychiatry, Flinders Human Behaviour and Health Research Unit, GPO Box 2100, Adelaide SA 2001, Australia.
| | - Rene G Pols
- Flinders University, Department of Psychiatry, Flinders Human Behaviour and Health Research Unit, GPO Box 2100, Adelaide SA 2001, Australia.
| | - Robert Ladouceur
- Université Laval, School of Psychology, 2325, rue des Bibliothèques, Bureau 1328, Québec, Québec G1V 0A6, Canada.
| |
Collapse
|
46
|
Ramos-Grille I, Gomà-i-Freixanet M, Aragay N, Valero S, Vallès V. Predicting treatment failure in pathological gambling: the role of personality traits. Addict Behav 2015; 43:54-9. [PMID: 25555154 DOI: 10.1016/j.addbeh.2014.12.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 11/13/2014] [Accepted: 12/10/2014] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The aim of this study was twofold: First, to assess the personality profile of treatment-seeking adult outpatients with pathological gambling compared to a matched control group under the Alternative Five Factor Model perspective, and second, to determine which personality variables would predict treatment outcome. METHODS The final total sample consisted of 44 consecutive treatment-seeking pathological gamblers (PGs) and 88 controls paired by age and sex who completed the Zuckerman-Kuhlman Personality Questionnaire (ZKPQ). Twelve months after starting an open program of individual cognitive-behavioral therapy, PGs were categorized as abstinent or treatment failure. RESULTS PGs scored significantly higher on Neuroticism-Anxiety. Those who had relapsed or dropped out showed higher Impulsivity and Sensation Seeking scores. Impulsivity emerged as a significant predictor of treatment failure. Treatment-seeking PGs scored higher on Neuroticism-Anxiety and Impulsivity appeared as a risk factor of relapsing or dropping out. CONCLUSIONS Our findings support the importance of individual differences in personality on therapy outcomes. The ZKPQ may constitute a useful tool to identify these individual differences that might be considered when making personalized treatment decisions to improve the effectiveness and quality of treatment interventions.
Collapse
Affiliation(s)
- Irene Ramos-Grille
- Department of Psychiatry, Consorci Sanitari de Terrassa, Catalonia, Spain; Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Catalonia, Spain.
| | | | - Núria Aragay
- Department of Psychiatry, Consorci Sanitari de Terrassa, Catalonia, Spain.
| | - Sergi Valero
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, CIBERSAM. Universitat Autònoma de Barcelona, Catalonia, Spain.
| | - Vicenç Vallès
- Department of Psychiatry, Consorci Sanitari de Terrassa, Catalonia, Spain.
| |
Collapse
|
47
|
Aragay N, Jiménez-Murcia S, Granero R, Fernández-Aranda F, Ramos-Grille I, Cardona S, Garrido G, Anisul Islam M, Menchón JM, Vallès V. Pathological gambling: understanding relapses and dropouts. Compr Psychiatry 2015; 57:58-64. [PMID: 25434846 DOI: 10.1016/j.comppsych.2014.10.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 10/10/2014] [Accepted: 10/13/2014] [Indexed: 10/24/2022] Open
Abstract
There is little available information on the factors that influence relapses and dropouts during therapy for pathological gambling (PG). The aim of this study was to determine socio-demographic, clinical, personality, and psychopathological predictors of relapse and dropout in a sample of pathological gamblers seeking treatment. A total of 566 consecutive outpatients diagnosed with PG according to DSM-IV-TR criteria were included. All patients underwent an individualized cognitive-behavioral treatment program. We analyzed predictors of relapse during 6months of treatment and during the subsequent 6months of follow-up, and predictors of dropout over the entire therapeutic program. Eighty patients (14.1%) experienced at least one relapse during the entire follow-up of the study: 50 (8.8%) within the treatment period and 12 (2.1%) during the subsequent 6-month follow-up period. The main predictors of relapse were single marital status, spending less than 100euros/week on gambling, active gambling behavior at treatment inclusion, and high scores on the TCI-R Harm Avoidance personality dimension. One hundred fifty-seven patients (27.8%) missed 3 or more therapeutic sessions over the entire therapeutic program. The main predictors of dropout were single marital status, younger age, and high scores on the TCI-R Novelty Seeking personality dimension. The presence of these factors at inclusion should be taken into account by physicians dealing with PG patients.
Collapse
Affiliation(s)
- Núria Aragay
- Pathological Gambling Unit, Department of Psychiatry, Consorci Sanitari de Terrassa, Barcelona, Spain.
| | - Susana Jiménez-Murcia
- Pathological Gambling Unit, Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain; Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Barcelona, Spain; Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona,Spain
| | - Roser Granero
- Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Barcelona, Spain; Departament de Psicobiologia i Metodologia de les Ciències de la Salut, Universitat Autònoma de Barcelona, Barcelona,Spain
| | - Fernando Fernández-Aranda
- Pathological Gambling Unit, Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain; Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Barcelona, Spain; Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona,Spain
| | - Irene Ramos-Grille
- Pathological Gambling Unit, Department of Psychiatry, Consorci Sanitari de Terrassa, Barcelona, Spain
| | - Sara Cardona
- Pathological Gambling Unit, Department of Psychiatry, Consorci Sanitari de Terrassa, Barcelona, Spain
| | - Gemma Garrido
- Department of Psychiatry, Consorci Sanitari de Terrassa, Barcelona, Spain
| | - Mohammed Anisul Islam
- Pathological Gambling Unit, Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain; Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Barcelona, Spain
| | - José M Menchón
- Pathological Gambling Unit, Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain; Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona,Spain; CIBER Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Barcelona, Spain
| | - Vicenç Vallès
- Department of Psychiatry, Consorci Sanitari de Terrassa, Barcelona, Spain
| |
Collapse
|
48
|
Profiling Hello Sunday Morning: Who are the participants? THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015; 26:214-6. [DOI: 10.1016/j.drugpo.2014.07.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Accepted: 07/28/2014] [Indexed: 11/17/2022]
|
49
|
Jiménez-Murcia S, Granero R, Fernández-Aranda F, Arcelus J, Aymamí MN, Gómez-Peña M, Tárrega S, Moragas L, Del Pino-Gutiérrez A, Sauchelli S, Fagundo AB, Brewin N, Menchón JM. Predictors of Outcome among Pathological Gamblers Receiving Cognitive Behavioral Group Therapy. Eur Addict Res 2015; 21:169-78. [PMID: 25832435 DOI: 10.1159/000369528] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 11/02/2014] [Indexed: 11/19/2022]
Abstract
AIMS The aim of this study was to evaluate posttreatment changes of individuals with a diagnosis of gambling disorder (GD) treated with group cognitive behavioral therapy (CBT), to assess the potential moderator effect of sex on CBT outcome, and to explore the best predictors of posttreatment changes, relapse, and dropout rates. METHODS A cohort design was applied with a prospective follow-up. The sample comprised 440 patients and the CBT intervention consisted of 16 weekly outpatient group sessions and a 3-month follow-up period. RESULTS Patients showed significant improvements in both the level of psychopathology and the severity of the gambling behavior. High self-transcendence and the involvement of the spouse or partner in the therapy predicted a higher risk of relapse. Younger age and low education predicted a higher risk of dropout. CONCLUSION Many patients with GD can be treated with strategies to improve self-control and emotional regulation, but other techniques should be incorporated to address the individual characteristics of each patient. This is particularly important in group therapy, in which the same treatment is applied to several patients simultaneously. The involvement of a family member needs to be carefully considered since it may have a negative effect on the response to treatment if not adequately managed.
Collapse
Affiliation(s)
- Susana Jiménez-Murcia
- Pathological Gambling Unit, Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
A Resource Model of Change: Client Factors that Influence Problem Gambling Treatment Outcomes. J Gambl Stud 2014; 31:1651-69. [DOI: 10.1007/s10899-014-9493-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|