Gambling-Related Cognitive Distortions in Residential Treatment for Gambling Disorder

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.

Mapping and conceptualizing recovery capital of recovered gamblers

Recovery capital (RC) is an emerging conceptual framework in the addiction field that pinpoints the internal and external (i.e., human, community, cultural, social, financial) resources individuals can draw on throughout the recovery process. The concept of RC was developed and applied primarily to individuals who have recovered from substance addiction. The aim of this study was to extend the RC conceptual framework to gambling disorder (GD)-which is classified in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013) as a behavioral addiction-and to identify and conceptualize RC resources implemented by individuals who have recovered from GD. Ninety-one individuals who reported a lifetime history of DSM-5 GD but who had not exceeded the DSM-5 GD threshold criteria in the previous year, were interviewed about the factors that helped them throughout their recovery. Directed content analyses identified 12 main RC resources that were classified under 4 RC domains: human capital (subjective well-being, self-efficacy, self-control skills, proactive coping skills, socioemotional skills, reconstruction skills), community capital (prorecovery environment, professional therapeutic milieu), social capital (recovering gamblers' peer group, friends without a GD, family), and financial capital (prorecovery financial state). These findings are the first step toward formulating a comprehensive conceptual model of RC applicable to GD. This study extends the RC and the gambling literature by presenting a holistic view of recovery from GD in many facets of life, and underscores the importance of observing strengths and resources in treating people with GD. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Does gender moderate the subjective measurement and structural paths in behavioural and cognitive aspects of gambling disorder in treatment-seeking adults?

INTRODUCTION

Gender differences have been observed in the pathogenesis of gambling disorder and gambling related urge and cognitions are predictive of relapse to problem gambling. A better understanding of these mechanisms concurrently may help in the development of more directed therapies.

METHODS

We evaluated gender effects on behavioural and cognitive paths to gambling disorder from self-report data. Participants (N=454) were treatment-seeking problem gamblers on first presentation to a gambling therapy service between January 2012 and December 2014. We firstly investigated if aspects of gambling related urge, cognitions (interpretive bias and gambling expectancies) and gambling severity were more central to men than women. Subsequently, a full structural equation model tested if gender moderated behavioural and cognitive paths to gambling severity.

RESULTS

Men (n=280, mean age=37.4years, SD=11.4) were significantly younger than women (n=174, mean age=48.7years, SD=12.9) (p<0.001). There was no gender difference in conceptualising latent constructs of problem gambling severity, gambling related urge, interpretive bias and gambling expectancies. The paths for urge to gambling severity and interpretive bias to gambling severity were stronger for men than women and statistically significant (p<0.001 and p=0.004, respectively) whilst insignificant for women (p=0.164 and p=0.149, respectively). Structural paths for gambling expectancies to gambling severity were insignificant for both men and women.

CONCLUSION

This study detected an important signal in terms of theoretical mechanisms to explaining gambling disorder and gender differences. It has implications for treatment development including relapse prevention.

[Self-help program: a new tool to facilitate the access to treatment for problem gamblers]

Shame, fear of stigmatization, denial, accessibility to and the cost of treatment program may explain why only a small proportion of problem gamblers sought clinical treatment. In the hope to overcome these barriers, the Gambling Clinic and Other Behavioral Addictions of C.H.U. Brugmann (Brussels) has developed its own self-help program for excessive gamblers. Our goals were to foster readiness to change gambling behaviors and when appropriate to facilitate the transition from self-help program to classical face-to-face clinical intervention. In a sample of 172 problem gamblers who participated, 40% had never sought help (e.g., clinical treatment) and/or never attempted quit gambling. Interestingly, for some, internet-based self-help treatment preceded their determination for seeking a traditional face-to-face therapeutic setting. Those results led us to discuss this program as a valid clinical tool within a broader health care setting in excessive gamblers.

[Recovering helpers in the addiction treatment system in Hungary: an interpretative phenomenological analysis]

INTRODUCTION

The work of recovering helpers who work in the addiction rehabilitation centres was studied. The aim was to investigate the process of addicts becoming recovering helpers, and to study what peer help means to them.

METHODS

According to interpretative phenomenological analysis (IPA) design, subjects were selected, data were collected and analysed.

SUBJECTS

6 (5 males, 1 female), working as recovering helpers at least one year at addiction rehabilitation centres. Semi-structured life interviews were carried out and analysed according to IPA.

RESULTS

Emerging themes from the interviews were identified and summarized, then interpreted as central themes: important periods and turning points of the life story interviews: the experience of psychoactive drugs use, the development of the addiction (which became " Turning Point No 1") then the "rock bottom" experience ("Turning Point No 2"). Then the experience of the helping process was examined: here four major themes were identified: the development of the recovering self and the helping self, the wounded helper and the skilled helper, the experience of the helping process.

DISCUSSION

IPA was found to be a useful method for idiographic exploration of the development and the work of the recovering helpers. The work of the recovering helpers can be described as mentoring of the addict clients. Our experiences might be used for the training programs for recovering helpers as well as to adopt their professional role in addiction services.

[Pathological gambling and addiction to cannabis: common psychosocial profile?]

Addiction can involve substances (heroin, cannabis, cocaine) or be characterised by behaviour (pathological gambling, addiction to sport, etc.). The question is to establish whether or not there is a specific personality profile (character, temperament) and emotional functioning (anxiety, depression, alexithymia) in subjects presenting addictive behaviour with and without substance use. To find some answers, a team from Sainte-Marguerite General Hospital in Marseille carried out a study comparing a group of cannabis addicts and a group of pathological gamblers.

Mental health management of pathological gamblers by counseling and relaxation practices

The present study examines the mental health management of pathological gamblers by counseling and relaxation practices. Fifty-five treated and 55 non-treated pathological gamblers were evaluated at S. I. Mental and Physical Health Society, Varanasi, India. The two groups were matched by age, ranging 20 to 53 years with a mean age of 36.2 years and mean length of uncontrollable gambling of 7.3 years. The Middlesex Hospital Questionnaire and the Death Anxiety Scale were administered to ascertain mental health and death anxiety on seven selected dimensions, including: anxiety, obsession, phobia, somatization, depression, hysteria, and death anxiety. Mean scores obtained on different variables were analyzed using a t-test of significance. Results indicated that the characteristic associated with treated pathological gamblers was phobia whereas the characteristics associated with non-treated pathological gamblers were anxiety, obsession, somatization, depression, and death anxiety.

Gaming progress

Victoria Sharman travelled to Las Vegas on a scholarship to learn about treatment and support for problem gamblers. She discovered high-quality, accessible services, but was most impressed by the city's attitude to gambling.

[Similarities and differences between pathological gambling and substance dependance: A clarification]

Similarities and differences between pathological gambling and substance dependence: a clarification. A critical analysis of a French review of the international literature on gambling.

INTRODUCTION

The integration of pathological gambling in the spectrum of addictive disorders modeled by substance dependence is currently discussed.

OBJECTIVE

To perform a systematic review of the similarities and differences between pathological gambling and substance dependence, and to classify and analyze them, based on the data collected by a previously published French systematic analysis of the international literature on pathological gambling.

METHOD

We established a checklist of each comparison of pathological gambling with substance dependence within the report. Then, every entry was classified as similarity or difference, analyzed and discussed.

RESULTS

Similarities retrieved were epidemiological characteristics (gender, age, socio-demographic characteristics of subjects), diagnostic criteria from DSM-IV (five criteria in common), frequent co-occurrence of pathological gambling and substance dependence, neurobiological and genetic characteristics, cases of spontaneous recovery, and similarities of therapeutic care. Differences retrieved were a more elevated prevalence of mood disorders and suicide among pathological gamblers, intrinsic risk factors related to gambling activity (delay between bid and result, gambling device, big win), cognitive distortion of pathological gamblers (notably chasing), specificities of cognitive behavioral therapies focused on these cognitive distortions, and specificities of social care of pathological gamblers.

DISCUSSION

Pathological gambling shared many similarities with substance dependence, but also some differences. However, our critical analysis of these elements, reported to be specific to pathological gambling, showed significant commonalities with substance dependence. Also, the existence of key symptoms of substance dependence such as craving and loss of control in pathological gambling was not discussed in the review, although other data suggest a common ground. These could be key elements to group together pathological gambling and substance dependence within the addictive disorders.

Haloperidol modifies instrumental aspects of slot machine gambling in pathological gamblers and healthy controls

Instrumental conditioning has been implicated in persistence at slot machine gambling, but its specific role remains unclear. Dopamine (DA) mediates aspects of instrumental responding, and D2 antagonists reliably alter this process. This study investigated the effects of the preferential D2 antagonist, haloperidol (3 mg) on reward-related betting behavior in 20 subjects with pathological gambling (PG) and 18 healthy controls. Hierarchical regression assessed the prospective relationship between Payoff and Bet Size on consecutive trials, along with potential moderating effects of Cumulative Winnings and Phase of game (early/late) under drug and placebo. Payoff predicted Bet Size on the next trial regardless of other factors, consistent with an instrumental view of slot machine gambling. Under placebo, this correlation varied as a function of Winnings and Phase in PG subjects but was strong and invariant in Controls. Under haloperidol, the Payoff-Bet Size correlation in PG subjects resembled the invariant pattern of Controls under placebo. In contrast, the Payoff-Bet Size correlation rose then fell sharply over trials under haloperidol in controls. The correlation of Payoff with Bet Size is remarkable given that there is no actual contingency between winning and betting, and suggests that reward expectancies largely drive slot machine gambling. By blocking inhibitory D2 receptors, haloperidol may have reversed 'tolerance' to monetary reward mediated by increased tonic DA in PG subjects. Disturbance of the Payoff-Bet Size correlation in controls may reflect indiscriminate reward signaling under haloperidol in subjects with normal DA function. Indirect enhancement of DA transmission may reduce undue reward-related responding in PG subjects.

[Gambling in children and adolescents]

Gambling in children and adolescents is a serious and relatively common problem especially among Czech boys. Psychotherapy, family therapy and prevention are more important than pharmacotherapy here. The prevention includes also the restrictions of gambling availability. We present a brief case report and the instructions for the parents of children with a gambling problem.

Memantine shows promise in reducing gambling severity and cognitive inflexibility in pathological gambling: a pilot study

RATIONALE

Although pathological gambling (PG) is relatively common, pharmacotherapy research for PG is limited. Memantine, an N-methyl D-aspartate receptor antagonist, appears to reduce glutamate excitability and improve impulsive decision making, suggesting it may help individuals with PG.

OBJECTIVE

This study sought to examine the safety and efficacy of Memantine in PG.

METHODS

Twenty-nine subjects (18 females) with DSM-IV PG were enrolled in a 10-week open-label treatment study of memantine (dose ranging from 10 to 30 mg/day). Subjects were enrolled from January 2009 until April 2010. Change from baseline to study endpoint on the Yale Brown Obsessive Compulsive Scale Modified for Pathological Gambling (PG-YBOCS) was the primary outcome measure. Subjects underwent pre- and post-treatment cognitive assessments using the stop-signal task (assessing response impulsivity) and the intra-dimensional/extra-dimensional (ID/ED) set shift task (assessing cognitive flexibility).

RESULTS

Twenty-eight of the 29 subjects (96.6%) completed the 10-week study. PG-YBOCS scores decreased from a mean of 21.8 ± 4.3 at baseline to 8.9 ± 7.1 at study endpoint (p < 0.001). Hours spent gambling per week and money spent gambling both decreased significantly (p < 0.001). Subjects also demonstrated a significant improvement in ID/ED total errors (p = 0.037) at study endpoint. The mean effective dose of memantine was 23.4 ± 8.1 mg/day. The medication was well-tolerated. Memantine treatment was associated with diminished gambling and improved cognitive flexibility.

CONCLUSIONS

These findings suggest that pharmacological manipulation of the glutamate system may target both gambling and cognitive deficits in PG. Placebo-controlled, double-blind studies are warranted in order to confirm these preliminary findings in a controlled design.

Brain activation patterns associated with cue reactivity and craving in abstinent problem gamblers, heavy smokers and healthy controls: an fMRI study

Abnormal cue reactivity is a central characteristic of addiction, associated with increased activity in motivation, attention and memory related brain circuits. In this neuroimaging study, cue reactivity in problem gamblers (PRG) was compared with cue reactivity in heavy smokers (HSM) and healthy controls (HC). A functional magnetic resonance imaging event-related cue reactivity paradigm, consisting of gambling, smoking-related and neutral pictures, was employed in 17 treatment-seeking non-smoking PRG, 18 non-gambling HSM, and 17 non-gambling and non-smoking HC. Watching gambling pictures (relative to neutral pictures) was associated with higher brain activation in occipitotemporal areas, posterior cingulate cortex, parahippocampal gyrus and amygdala in PRG compared with HC and HSM. Subjective craving in PRG correlated positively with brain activation in left ventrolateral prefrontal cortex and left insula. When comparing the HSM group with the two other groups, no significant differences in brain activity induced by smoking cues were found. In a stratified analysis, the HSM subgroup with higher Fagerström Test for Nicotine Dependence scores (FTND M = 5.4) showed higher brain activation in ventromedial prefrontal cortex, rostral anterior cingulate cortex, insula and middle/superior temporal gyrus while watching smoking-related pictures (relative to neutral pictures) than the HSM subgroup with lower FTND scores (FTND M = 2.9) and than non-smoking HC. Nicotine craving correlated with activation in left prefrontal and left amygdala when viewing smoking-related pictures in HSM. Increased regional responsiveness to gambling pictures in brain regions linked to motivation and visual processing is present in PRG, similar to neural mechanisms underlying cue reactivity in substance dependence. Increased brain activation in related fronto-limbic brain areas was present in HSM with higher FTND scores compared with HSM with lower FTND scores.

Treatment for the addictions in a psychiatric setting

The Alcoholism, Chemical Dependency and Compulsive Gambling Services at South Oaks Hospital (a 334-bed private psychiatric facility in Amityville, New York) are discussed. Psychodrama and other group methods are integral parts of the program the interdisciplinary treatment team, headed by a psychiatrist, includes addiction counsellors. Outpatient continuing care and self-help groups are stressed.

The Gamblers Treatment Clinic of St. Vincent's North Richmond Community Mental Health Center: characteristics of the clients and outcome of treatment

Data were analyzed from gamblers treated as outpatients: 128 for whom admission data were available and 88 for whom both admission and termination data were available. This group consisted mostly of White males. The average age of the clients was about 42 years. These clients were frequent and heavy bettors whose lives were deeply disrupted by gambling. The clients reported significantly less gambling at termination of treatment than they did at initiation. Improvements in social relations were reported at termination of treatment. There was some evidence that improvements in life-style were related to reports of less gambling at termination of treatment.