Treatment Outcome in Male Gambling Disorder Patients Associated with Alcohol Use

Substance use disorders among armed forces veterans with gambling disorder: Insights from an inpatient treatment sample

Armed forces veterans are especially prone to experiencing a variety of addictive disorders, including gambling disorder. Even so, gambling disorder in veterans remains understudied generally, and there remain significant gaps in the research literature with regards to how gambling disorder relates to the experience and expression of comorbid substance use disorders. The present work examines the prevalence, presentation, and clinical associations of substance use disorders in U.S. Armed Forces veterans receiving inpatient treatment for gambling disorder. Participants (N = 664) were veterans from all branches of the U.S. Armed Forces receiving inpatient treatment for gambling disorder through the Department of Veteran Affairs Healthcare System. Clinical data from the time of intake was analyzed. A substantial portion of veterans (36.1%) met current criteria for an SUD, with another 16.5% reporting a history of SUD. Alcohol use disorder was the most commonly reported SUD (76.1% of those with a current SUD), with polysubstance use disorders and stimulant use disorders each occurring in at least 25% of those with SUDs. SUD status was related to greater levels of impulsivity, but there was no evidence that SUD status was related to gambling symptom severity, gambling preferences, or further psychiatric comorbidities.

Definitions and assessments of recovery from gambling disorder: A scoping review

Background and aims

While the concept of recovery is receiving increasing attention in the context of gambling disorder (GD), no consensus has yet been reached regarding its definition. This scoping review aims to map the literature on GD recovery, identify gaps, and provide insights for a more holistic and patient-centred perspective.

Methods

A systematic search of three databases was conducted (PubMed, PsycINFO, and ScienceDirect). Based on the method by which the results of these studies were produced, the studies included were sorted into four categories (quantitative, instrument validation, qualitative, and mixed studies) and subsequently examined using conceptual analysis.

Results

One hundred thirteen articles were included in this research after the screening process. In the quantitative and instrument validation studies, recovery was defined or operationalized in terms of abstinence, the absence of a GD diagnosis, or mild GD severity, or by reference to treatment outcomes or controlled gambling. A meta-synthesis of the results of the qualitative studies revealed four core features of recovery (insight, empowerment and commitment, wellbeing enhancement, and reconsideration of the issue of relapse).

Discussion

Discrepancies in definitions, outcomes, and variables used were evident across studies. Additionally, the quantitative and standardized approaches employed in most studies exhibited severe limitations with regard to defining recovery from the subjective and multidimensional perspectives of people recovering from GD.

Conclusions

This lack of definitional clarity emphasizes the necessity for further qualitative research. This research should encompass multiple stakeholder perspectives to develop a working definition promoting recovery from a holistic, patient-centred, and tailored approach.

Clustering Treatment Outcomes in Women with Gambling Disorder

The rising prevalence of gambling disorder (GD) among women has awakened considerable interest in the study of therapeutic outcomes in females. This study aimed to explore profiles of women seeking treatment for GD based on a set of indicators including sociodemographic features, personality traits, clinical state at baseline, and cognitive behavioral therapy (CBT) outcomes. Two-step clustering, an agglomerative hierarchical classification system, was applied to a sample of n = 163 women of ages ranging from 20 to 73 years-old, consecutively attended to by a clinical unit specialized in the treatment of G. Three mutually exclusive clusters were identified. Cluster C1 (n = 67, 41.1%) included the highest proportion of married, occupationally active patients within the highest social status index. This cluster was characterized by medium GD severity levels, the best psychopathological functioning, and the highest mean in the self-directedness trait. C1 registered 0% dropouts and only 14.9% relapse. Cluster C2 (n = 63; 38.7%) was characterized by the lowest GD severity, medium scores for psychopathological measures and a high risk of dropout during CBT. Cluster C3 (n = 33; 20.2%) registered the highest GD severity, the worst psychopathological state, the lowest self-directedness level and the highest harm-avoidance level, as well as the highest risk of relapse. These results provide new evidence regarding the heterogeneity of women diagnosed with GD and treated with CBT, based on the profile at pre- and post-treatment. Person-centered treatments should include specific strategies aimed at increasing self-esteem, emotional regulation capacities and self-control of GD women.

Women and gambling disorder: Assessing dropouts and relapses in cognitive behavioral group therapy

BACKGROUND

Gender-specific literature focused on gambling disorder (GD) is scarce, and women with GD have been understudied. Therefore, the aim of this study was to estimate the short-term effectiveness in women with GD (n = 214) of a group standardized cognitive-behavioral therapy (CBT) and to identify the most relevant predictors of the primary therapy outcomes (dropout and relapse).

METHODS

The manualized CBT consisted of 16 weekly outpatient group sessions. Women were provided with resources to obtain a better understanding of the GD, to improve self-control and to manage risk situations.

RESULTS

The dropout risk was higher for women with lower GD severity and higher psychopathological distress. Among other factors, lower education levels were a significant predictor of the relapse risk and and the frequency of relapses was higher for divorced women with a preference for non-strategic gambling and with substances consumption.

CONCLUSIONS

Our findings evidence women-specific predictors of the primary therapy outcomes. The results highlight the need to design psychological interventions that address dropout and relapse risk factors in women.

Clinical Features of Gambling Disorder Patients with and Without Food Addiction: Gender-Related Considerations

Although food addiction (FA) is a debated condition and it is not currently recognized as a formal diagnosis, it shares features with other addictions, such as gambling disorder (GD). However, the prevalence of FA in GD and the clinical correlates are incompletely understood, especially within women versus men. To investigate FA in patients presenting with GD. The sample included 867 patients diagnosed with GD (798 males and 69 females) attending a specialized behavioral addictions unit. FA was observed in 8.3% of GD patients (18.8% of women, 7.4% of men). More psychopathology and harm avoidance, greater body mass indices and less self-directedness and cooperativeness were associated with FA. In women, FA was associated with a longer GD duration. In men, FA was associated with earlier GD onset, greater GD and problematic alcohol use severities. Among patients with GD, FA was associated with more psychopathology and gambling patterns suggestive of more protracted or severe GD. Screening for and addressing FA condition in patients with GD may help optimize preventive and therapeutic approaches. Future studies should consider testing guidelines to improve healthy eating habits, increase physical exercise and better manage stress and other negative emotions in order to target FA in GD.

Developmental trajectories of gambling severity after cognitive-behavioral therapy

AIMS

To estimate trajectories of the gambling disorder (GD) severity for 12 months following a manualized cognitive-behavior-therapy (CBT) program, and to identify the main variables associated with each trajectory.

METHODS

Latent Class Growth Analysis examined the longitudinal changes of n = 603 treatment-seeking patients with GD.

RESULTS

Five separate empirical trajectories were identified: T1 (n = 383, 63.5%) was characterized by the most highest baseline gambling severity levels and positive progress to recovery during the follow-up period; T2 (n = 154, 25.5%) featured participants with high baseline gambling severity and good progress to recovery; T3 (n = 30, 5.0%) was made up of patients with high gambling baseline severity and slow progress to recovery; T4 (n = 13, 2.2%) and T5 (n = 23, 3.8%) contained participants with high baseline gambling severity and moderate (T4) and poor (T5) progress in GD severity during the follow-up. Psychopathological state and personality traits discriminated between trajectories. Poor compliance with the therapy guidelines and the presence of relapses also differed between the trajectories.

CONCLUSIONS

Our findings show that patients seeking treatment for GD are heterogeneous and that trends in progress following treatment can be identified considering sociodemographic features, psychopathological state and personality traits. These results could be useful in developing more efficient interventions for GD patients.

Addiction-Like Mobile Phone Behavior - Validation and Association With Problem Gambling

Mobile phone use and its potential addiction has become a point of interest within the research community. The aim of the study was to translate and validate the Test of Mobile Dependence (TMD), and to investigate if there are any associations between mobile phone use and problem gambling. This was a cross-sectional study on a Swedish general population. A questionnaire consisting of a translated version of the TMD, three problem gambling questions (NODS-CLiP) together with two questions concerning previous addiction treatment was published online. Exploratory factor analysis based on polychoric correlations was performed on the TMD. Independent samples T-tests, Mann-Whitney test, logistic regression analyses and ANOVA were performed to examine mean differences between subjects based on TMD test score, gambling and previous addiction treatment. A total of 1,515 people (38.3% men) answered the questionnaire. The TMD showed acceptable internal consistency (Cronbach's alpha: 0.905), and significant correlation with subjective dependence on one's mobile phone. Women scored higher on the TMD and 15-18 year olds had the highest mean test score. The TMD test score was significantly associated with problem gambling, but only when controlling for age and sex. Various separated items related to mobile phone use were associated with problem gambling. The TMD had acceptable internal consistency and correlates with subjective dependence, while future confirmatory factor analysis is recommended. An association between mobile phone use and problem gambling may be possible, but requires further research.

Psychopathology of addiction: Can the SCL90-based five-dimensional structure differentiate Heroin Use Disorder from a non-substance-related addictive disorder such as Gambling Disorder?

BACKGROUND

In the Gambling Disorder (GD), there is no exogenous drug administration that acts as the central core of the traditional meaning of addiction. A specific psychopathology of Substance Use Disorders has been proposed recently. In a sample of Heroin Use Disorder (HUD) patients entering opioid agonist treatment, it became possible to identify a group of 5 mutually exclusive psychiatric dimensions: Worthlessness-Being trapped (W-BT), Somatic Symptoms (SS), Sensitivity-Psychoticism (SP), Panic Anxiety (PA) and Violence-Suicide (VS). The specificity of these dimensions was suggested by the absence of their correlations with treatment choice, active substance use, psychiatric comorbidity and the principal substance of abuse and by the opportunity, through their use, of fully discriminating HUD from Major Depression patients and, partially, from obese non-psychiatric patients. To further support this specificity in the present study, we tested the feasibility of discriminating HUD patients from those affected by a non-substance-related addictive behaviour, such as GD. In this way, we also investigated the psychopathological peculiarities of GD patients.

METHODS

We compared the severity and frequency of each of the five aspects found by us, in 972 (83.5% males; mean age 30.12 ± 6.6) HUD and 110 (50% males; average age 30.12 ± 6.6) GD patients at univariate (T test; Chi square) and multivariate (discriminant analysis and logistic regression) level.

RESULTS

HUD patients showed higher general psychopathology indexes than GD patients. The severity of all five psychopathological dimensions was significantly greater in HUD patients. Discriminant analysis revealed that SS and VS severity were able to discriminate between HUD (higher severity) and GD patients (lower severity), whereas PA and SP could not. W-BT severity was negatively correlated with SS and VS; GD patients were distinguished by low scores for SS and VS low scores associated with high ones for W-BT. Psychopathological subtypes characterized by SS and VS symptomatology were better represented in HUD patients, whereas PA symptomatology was more frequent in GD individuals. No differences were observed regarding the W-BT and SP dimensions. At multivariate level, the one prominent characteristic of HUD patients was the presence of SS (OR = 5.43) as a prominent qualification for psychopathological status.

CONCLUSIONS

Apart from the lower severity of all psychopathological dimensions, only the lower frequency of SS typology seems to be the prominent factor in GD patients. The SCL90-defined structure of opioid addiction seems to be useful even in non-substance-related addictive disorders, as in the case of GD patients, further supporting the possible existence of a psychopathology specific to addiction.