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Diaz-Sanahuja L, Suso-Ribera C, Lucas I, Jiménez-Murcia S, Tur C, Gual-Montolio P, Paredes-Mealla M, García-Palacios A, Bretón-López JM. A Self-Applied Psychological Treatment for Gambling-Related Problems via The Internet: A Pilot, Feasibility Study. J Gambl Stud 2024:10.1007/s10899-024-10318-2. [PMID: 38795233 DOI: 10.1007/s10899-024-10318-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2024] [Indexed: 05/27/2024]
Abstract
The main purpose of this study was to evaluate the feasibility of an online psychological intervention for individuals with gambling-related problems, supported by ecological momentary assessments and interventions (EMAs and EMIs), along with weekly phone-calls, before conducting a randomized controlled trial. Participants were required to complete 3 of the 8 modules of the program based on cognitive-behavioral therapy (CBT) and extensions and innovations of CBT. The study measured the outcomes of feasibility (i.e., reach, appropriateness, technology literacy and technology usability, fidelity, and adherence). In terms of reach, 19.8% (n = 11) of the initial population met the inclusion criteria and completed the three modules (mean age = 41; 90.9% men). The perceived appropriateness and the technology usability after the first use were both excellent, fidelity and adherence to the online treatment (73.3%) were adequate. Adherence to the EMAs and the weekly phone calls were more modest (54.51% and 66.67%, respectively). The results of the present study show that an online treatment for gambling problems enhanced by EMA and EMI might be feasible but challenges were noted in terms of reach and adherence to these assessments and calls. These challenges are important to consider for future trials and the scalability of treatments for individuals with gambling disorders.
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Affiliation(s)
- Laura Diaz-Sanahuja
- Department of Basic and Clinical Psychology and Psychobiology, Universitat Jaume I, Av. Vicent Sos Baynat, S/N, 12071, Castellón de La Plana, Spain.
| | - Carlos Suso-Ribera
- Department of Basic and Clinical Psychology and Psychobiology, Universitat Jaume I, Av. Vicent Sos Baynat, S/N, 12071, Castellón de La Plana, Spain
| | - Ignacio Lucas
- CIBER de Fisiopatología de La Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Susana Jiménez-Murcia
- CIBER de Fisiopatología de La Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Department of Clinical Psychology and Psychobiology, Universidad de Barcelona, Barcelona, Spain
| | - Cintia Tur
- Department of Basic and Clinical Psychology and Psychobiology, Universitat Jaume I, Av. Vicent Sos Baynat, S/N, 12071, Castellón de La Plana, Spain
| | - Patricia Gual-Montolio
- Department of Basic and Clinical Psychology and Psychobiology, Universitat Jaume I, Av. Vicent Sos Baynat, S/N, 12071, Castellón de La Plana, Spain
| | - Macarena Paredes-Mealla
- Department of Basic and Clinical Psychology and Psychobiology, Universitat Jaume I, Av. Vicent Sos Baynat, S/N, 12071, Castellón de La Plana, Spain
| | - Azucena García-Palacios
- Department of Basic and Clinical Psychology and Psychobiology, Universitat Jaume I, Av. Vicent Sos Baynat, S/N, 12071, Castellón de La Plana, Spain
- CIBER de Fisiopatología de La Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Juana María Bretón-López
- Department of Basic and Clinical Psychology and Psychobiology, Universitat Jaume I, Av. Vicent Sos Baynat, S/N, 12071, Castellón de La Plana, Spain
- CIBER de Fisiopatología de La Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
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Mestre-Bach G, Potenza MN. Pharmacological management of gambling disorder: an update of the literature. Expert Rev Neurother 2024; 24:391-407. [PMID: 38357896 DOI: 10.1080/14737175.2024.2316833] [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] [Received: 06/06/2023] [Accepted: 02/05/2024] [Indexed: 02/16/2024]
Abstract
INTRODUCTION Gambling disorder (GD) is a mental health condition characterized by persistent and problematic betting behavior. GD generates distress and impairment, and treatment options include psychological and pharmacological interventions. AREAS COVERED This narrative review explores existing pharmacological treatments for GD. The following classes of medications were considered: opioid-receptor antagonists (e.g. naltrexone and nalmefene), serotonin reuptake inhibitors (e.g. fluvoxamine, paroxetine, sertraline, escitalopram, and citalopram), glutamatergic agents (e.g. N-acetylcysteine (NAC), acamprosate, and memantine), mood stabilizers (e.g. topiramate, carbamazepine, lithium), and other medications (e.g. modafinil, nefazodone, olanzapine, haloperidol, tolcapone, and bupropion). EXPERT OPINION Due to the limitations of the studies reviewed, solid conclusions regarding the optimal choice of pharmacotherapy for individuals with GD are challenging to draw at this time. Despite some medications, such as naltrexone and nalmefene, showing promising results, efficacy has varied across studies. The review highlights current gaps/limitations, including small sample sizes, limited diversity in participant demographics, the need for exploring different gambling subtypes and treatment responses, high placebo response rates, lack of longer-term longitudinal information, limited investigation of neurobiological correlates and co-occurring disorders, and the importance of implementation research. Further research is needed to address these gaps and explore additional medications, as well as interventions like neuromodulation.
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Affiliation(s)
- Gemma Mestre-Bach
- Instituto de Investigación, Transferencia e Innovación, Universidad Internacional de La Rioja, La Rioja, Spain
| | - Marc N Potenza
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA
- Connecticut Mental Health Center, New Haven, CT, USA
- Connecticut Council On Problem Gambling, Wethersfield, CT, USA
- Department of Neuroscience, Yale University, New Haven, CT, USA
- Wu Tsai Institute, Yale University, New Haven, CT, USA
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3
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Condron I, Lyons S, Carew AM. Gambling in Ireland: profile of treatment episodes from a national treatment reporting system. Ir J Psychol Med 2024; 41:94-101. [PMID: 35616217 DOI: 10.1017/ipm.2022.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Globally, problem gambling prevalence is estimated at between 0.1% and 5.8%. Problem gambling can have many negative consequences; including on physical, and psychological health, and social functioning. There is a need to better understand treatment uptake as only a small proportion seek treatment. This is the first Irish national study using routinely gathered health surveillance data to describe treated problem gambling. Results will inform service policy and planning. METHODS An analysis of episodes treated for problem gambling collected by the National Drug Treatment Reporting System was undertaken. Included were episodes entering treatment between 2008 and 2019 (n = 2999). Variables of interest included service types accessed, demographics, socioeconomic information, referral and assessment details, current problems (up to five) and treatment history. RESULTS The majority (93.8%) were male. One fifth (20.9%) lived with dependent children, 7.4% were homeless. There were high levels of employment (35.4%) and formal education qualifications; half (53.8%) had completed second or third level education. Problem gambling frequently co-occurred with problem use of other substances (47.3%), which was most commonly alcohol (85.6%), followed by cannabis (32.3%), cocaine (28.0%) and benzodiazepines (10.9%). The majority were treated at inpatient settings (56.1%) with many self-referrals (46.3%). CONCLUSIONS This study provides insights into treated problem gambling nationally. Monitoring and surveillance can play a crucial role in measuring the successful efforts and help inform planning and treatment. The findings may have implications for treatment pathways.
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Bellringer ME, Janicot S, Ikeda T. Changes in some health and lifestyle behaviours are significantly associated with changes in gambling behaviours: Findings from a longitudinal New Zealand population study. Addict Behav 2024; 149:107886. [PMID: 37832399 DOI: 10.1016/j.addbeh.2023.107886] [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] [Received: 03/23/2023] [Revised: 09/28/2023] [Accepted: 10/06/2023] [Indexed: 10/15/2023]
Abstract
Although a large number of studies have investigated associations between risky gambling behaviours and health, lifestyle and social factors, research has not focused on changes in these factors and associations with changes in gambling risk level. This study utilised existing data from the four waves of the longitudinal New Zealand National Gambling Study to examine associations between changes in substance use, mental and physical health, and quality of life and deprivation with changes in gambling risk level over time. A Markov chain transition model was used to perform these analyses using data from participants who had completed all four waves (11,080 data transitions). Although changes in various covariates were associated with changes in all gambling risk levels, the highest number of significant factors was for transitioning into risky gambling from non-problematic gambling, including development, or continuation, of several negative health and lifestyle factors that may possibly be alleviated by transitioning out of risky gambling. These findings highlight the importance of screening for gambling behaviours when assisting people with substance use, health issues, or social situations or conditions in order to provide appropriate and effective social, health and treatment supports for people whose gambling behaviour increases over time.
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Affiliation(s)
- Maria E Bellringer
- Gambling and Addictions Research Centre, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland 1142, New Zealand.
| | - Stéphane Janicot
- Department of Biostatistics and Epidemiology, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland 1142, New Zealand
| | - Takayoshi Ikeda
- Department of Biostatistics and Epidemiology, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland 1142, New Zealand
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Yarbakhsh E, van der Sterren A, Bowles D. Screening and Treatment for Co-occurring Gambling and Substance Use: A Scoping Review. J Gambl Stud 2023; 39:1699-1721. [PMID: 37493839 PMCID: PMC10628029 DOI: 10.1007/s10899-023-10240-z] [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: 07/04/2023] [Indexed: 07/27/2023]
Abstract
There is a high prevalence of gambling harms co-occurring with substance use harms. Where harms are co-occurring, they may be experienced as more severe. However, there is little evidence that services are systematically screening for such co-occurring harms in treatment-seeking populations. Furthermore, treatment modalities remain relatively under-developed, with treatment usually addressing only one source of harm.This scoping review looks at the current literature on screening and therapeutic interventions for co-occurring gambling and substance use harms to understand how co-occurring harms may be managed in a treatment setting. It draws together available data on the intersections of substance use harms and gambling related harms, in a treatment context.This research identifies a range of potentially useful validated tools for clinicians in substance use treatment settings to screen for gambling harms. For workers in gambling treatment settings who are seeking validated tools to screen for co-occurring substance use harms, the literature provides less guidance.The validated toolbox of therapeutic interventions for those experiencing co-occurring substance use and gambling harms is relatively sparse. Psychosocial interventions appear to offer the best outcomes on gambling measures for those experiencing co-occurring substance use harms. Further research is needed to establish the benefits of different combinations of treatment and treatment types in achieving reductions across both substance use and gambling harms, when these harms are experienced concurrently.
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Affiliation(s)
- Elisabeth Yarbakhsh
- Alcohol, Tobacco and Other Drug Association, ACT (ATODA), Canberra, Australia.
- College of Arts and Social Sciences, Australian National University, Canberra, Australia.
| | - Anke van der Sterren
- Alcohol, Tobacco and Other Drug Association, ACT (ATODA), Canberra, Australia
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Devin Bowles
- ACT Council of Social Service (ACTCOSS), Canberra, Australia
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Vieira C, Kuss DJ, Griffiths MD. Early maladaptive schemas and behavioural addictions: A systematic literature review. Clin Psychol Rev 2023; 105:102340. [PMID: 37776578 DOI: 10.1016/j.cpr.2023.102340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 09/06/2023] [Accepted: 09/22/2023] [Indexed: 10/02/2023]
Abstract
As observed in other mental health difficulties, behavioural addiction is a complex construct with several potential predisposing factors, which include biological factors (e.g., genetic predispositions), psychological factors (e.g., personality traits), and social factors (e.g., family, and social history). One factor that may play a significant role in both developing and perpetuating behavioural addiction is the activation of early maladaptive schemas (EMSs). The aim of the present review was to synthesize the evidence concerning the relationship between behavioural addiction and EMSs. A comprehensive literature search using keywords and subject headings was performed with three electronic databases, resulting in 20 studies that met the inclusion criteria. In relation to specific behavioural addiction, the 20 studies examined: binge-eating/food addiction (n = 6), sexual addiction/compulsive sexual behaviours (n = 3), multiple addictive behaviours (n = 2), internet addiction (n = 2), smartphone addiction (n = 2), social networking/Facebook addiction (n = 2), exercise dependence (n = 1), gambling (n = 1), and videogame addiction (n = 1). The patterns of association between EMS and behavioural addiction were examined in both clinical and non-clinical population. The 'Disconnection and Rejection' domain was the most strongly related schema domain across all addictive behaviours, followed by 'Impaired Limits'. The present review suggests a positive relationship between schema activation and several addictive behaviours, including addictions to gambling, gaming, social media use sex, exercise, and food. The clinical implications of the findings are discussed, but further research is needed to inform treatment plans and interventions for those who struggle with behavioural addictions.
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Affiliation(s)
- Claudio Vieira
- International Gaming Research Unit, Psychology Department, Nottingham Trent University, 50 Shakespeare Street, Nottingham NG1 4FQ, UK.
| | - Daria J Kuss
- Psychology, Cyberpsychology Research Group, Psychology Department, Nottingham Trent University, 50 Shakespeare Street, Nottingham NG1 4FQ, UK.
| | - Mark D Griffiths
- Behavioural Addiction, International Gaming Research Unit Psychology Department, Nottingham Trent University, 50 Shakespeare Street, Nottingham NG1 4FQ, UK.
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Thomas AC, Portogallo H, Read F, Avisar J, Merkouris SS, Dowling NA. Lived Experience Performance to Reduce Stigma, Enhance Understanding of Gambling Harm and Change Attitudes and Behaviours of Professionals and Community Members. J Gambl Stud 2023:10.1007/s10899-023-10223-0. [PMID: 37278850 DOI: 10.1007/s10899-023-10223-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2023] [Indexed: 06/07/2023]
Abstract
Gamblers and their family members or friends (affected others) can experience stigma and shame due to gambling which can result in a reluctance to seek timely support. However, gamblers and affected others access intersecting health services and talk to friends or family, thereby providing opportunities for early intervention. Three sides of the coin is a group of storytellers with lived experience of gambling harm who use dramatic performance to share personal stories to enhance the understanding of gambling-related harm in allied professions and the broader community. They do this to encourage attitude and behaviour change so that gamblers and affected others receive empathy and support during encounters with these groups. A mixed-methods study was used to explore whether these performances were successful in increasing understanding and changing attitudes and behaviour of allied professionals and the community in the short and longer-term. Data collected immediately post-performance revealed that performances increased understanding of gambling, and improved attitudes and behavioural intent of audience members in relation to gamblers and affected others. Professionals also reported an increased willingness and confidence to discuss gambling harm with clients. Follow-up data demonstrated potential longer-term impact, with respondents continuing to report more positive attitudes towards those affected by gambling harm and professionals being confident to explore gambling issues in their clients and provide appropriate referrals. These finding demonstrate that performance based on lived experience can be a powerful education tool, encouraging deep connection to the issue, resulting in a nuanced understanding and sustained attitudinal and behavioural change.
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Affiliation(s)
- Anna C Thomas
- School of Psychology, Faculty of Health, Deakin University, Geelong, Australia.
| | - Hannah Portogallo
- School of Psychology, Faculty of Health, Deakin University, Geelong, Australia
| | - Fiona Read
- Link Health and Community, Glen Waverley, VIC, Australia
- Access Health and Community, Hawthorn, VIC, Australia
| | - Judy Avisar
- Link Health and Community, Glen Waverley, VIC, Australia
- Self Help Addiction Resource Centre (SHARC), Carnegie, Australia
| | | | - Nicki A Dowling
- School of Psychology, Faculty of Health, Deakin University, Geelong, Australia
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Sussman S, Galimov A, Ayala N, Sinclair DL. Web-based Evidence on the Treatment of Behavioral Addictions in United States Model Treatment Centers. Eval Health Prof 2023; 46:23-29. [PMID: 36189854 DOI: 10.1177/01632787221130543] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Behavioral addictions are highly comorbid with substance use disorders, presenting in as many as 54% of service users receiving substance use treatment. Few studies have examined whether treatment centers are attentive to such other addictions, which may undermine treatment. This study examined the mention and treatment of behavioral addictions on United States treatment center websites. The 2021 Newsweek America's Best Addiction Treatment Centers website was utilized to examine the mention and treatment of behavioral addictions in 300 leading treatment centers across 25 states in the United States. Of 289 active websites, only 61 (21.1%) treatment centers mentioned anything about behavioral addictions. The highest prevalence was for gambling (n = 38), sex (n = 22), food/eating (n = 21), and internet gaming (n = 12). A total of 49 treatment centers reported treating those addictions. The most prevalent treatments involved 12-step programming (n = 18), cognitive behavioral therapy (CBT; n = 16), individual counseling (n = 16), and group therapy (n = 15). Little formalized importance via websites was provided regarding the mention or treatment of behavioral addictions at treatment centers. A greater emphasis on concurrent and substitute behavioral addictions is needed to improve the quality of life and lower the possibility of relapse among those persons in addictions treatment.
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Affiliation(s)
- Steve Sussman
- Departments of Population and Public Health Sciences, and Psychology, and School of Social Work, 12223University of Southern California, Los Angeles, CA, USA
| | - Artur Galimov
- Departments of Population and Public Health Sciences, and Psychology, and School of Social Work, 12223University of Southern California, Los Angeles, CA, USA
| | - Nayeli Ayala
- Departments of Population and Public Health Sciences, and Psychology, and School of Social Work, 12223University of Southern California, Los Angeles, CA, USA
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Leino T, Torsheim T, Griffiths MD, Pallesen S. The relationship between substance use disorder and gambling disorder: A nationwide longitudinal health registry study. Scand J Public Health 2023; 51:28-34. [PMID: 34590511 PMCID: PMC9900184 DOI: 10.1177/14034948211042249] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Aim: This study aimed to examine the co-morbidity and temporal relationship between substance abuse disorders (SUDs) and gambling disorder (GD). Method: Cross-tabulated census data were retrieved from the Norwegian Patient Registry. The data included the number of patients by year of first-time incidence of GD and/or SUD diagnoses, age and sex from 2008 to 2017. Results: Approximately 22.5% of GD patients were also diagnosed with SUD, whereas 0.7% of SUD patients were also diagnosed with GD. Among GD patients, males had a greater risk of SUD in the same year compared to females, whereas the risk of SUD a year or more after the onset of GD was greater among females compared to males. Among SUD patients, males had a greater risk of GD in all age categories and across all time periods except among those aged 40-66 years. The risk of GD three to four years after the onset of SUD among those aged 40-66 years was similar between SUD males and females. Discussion: The overall co-morbidity of SUD and GD was low. However, the risk of the other addictive disorder was contingent upon the nature of the first disorder. The risk of SUD among GDs over time was greater among females compared to males. Conclusions: The risk of the other addictive disorder appears to be contingent upon the first addictive disorder. There are sex differences in the risk trajectories of the other addictive disorder over time between GD patients and SUD patients.
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Affiliation(s)
- Tony Leino
- Department of Psychosocial Science,
University of Bergen, Norway,Tony Leino, Department of Psychosocial
Sciences, University of Bergen, Christiesgate 12, 5015 Bergen, Norway. E-mail:
| | | | - Mark D. Griffiths
- International Gaming Research Unit,
Psychology Department, Nottingham Trent University, UK
| | - Ståle Pallesen
- Department of Psychosocial Science,
University of Bergen, Norway,Norwegian Competence Center for Sleep
Disorders, University of Bergen, Norway,Optentia Research Focus Area,
North-West University, Vanderbijlpark Campus, South Africa
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Problem gambling severity, gambling behavior, substance use, and mental health in gamblers who do and do not use cannabis: Evidence from a Canadian national sample. Addict Behav 2023; 137:107520. [PMID: 36257248 DOI: 10.1016/j.addbeh.2022.107520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 08/31/2022] [Accepted: 10/04/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Cannabis use frequently co-occurs with gambling, and evidence indicates that both acute and chronic cannabis use may influence gambling behavior. The primary aim of the present study was to further contribute to the literature on this relationship by examining data collected from a Canadian national study of gambling. METHODS Respondents consisted of 10,054 Canadian gamblers recruited from Leger Opinion's (LEO) online panel. In this study, gamblers who used cannabis were compared with non-users across a number of gambling as well as demographic and mental health variables. RESULTS Of the total sample, 25.4 % reported past 12-month cannabis use. Among the 2,553 cannabis-users, 21.3 % reported daily use, and 69.9 % reported using once a month or more. A total of 56.2 % indicated they had used cannabis while gambling in the past 12 months. Bivariate analysis found significant differences between cannabis use and non-use on numerous demographic, mental health, and gambling-related variables. Individuals with greater problem gambling severity scores, more hours gambling, and a larger range of gambling activities were more likely to endorse using cannabis. Hierarchical logistic regression revealed that tobacco use, and having experienced significant child abuse were predictors of cannabis use. Non-use of cannabis was associated with older age, less engagement in online gambling, and being less likely to consume alcohol. CONCLUSION The present findings both corroborate previous studies and expand upon the relationship between cannabis and gambling.
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Penfold KL, Ogden J. Exploring gamblers’ experiences of problem gambling interventions: A qualitative study. COGENT PSYCHOLOGY 2022. [DOI: 10.1080/23311908.2022.2138805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Affiliation(s)
- Katy. L. Penfold
- Professor Jane Ogden, School of Psychology, University of Surrey, Guildford, United Kingdom
| | - Jane Ogden
- Professor Jane Ogden, School of Psychology, University of Surrey, Guildford, United Kingdom
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12
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Bijker R, Booth N, Merkouris SS, Dowling NA, Rodda SN. Global prevalence of help-seeking for problem gambling: A systematic review and meta-analysis. Addiction 2022; 117:2972-2985. [PMID: 35830876 PMCID: PMC9796401 DOI: 10.1111/add.15952] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 04/27/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND AIMS Multiple studies have examined barriers and facilitators to help-seeking, but the prevalence of help-seeking for problem gambling (PG) is not well established. We aimed to estimate the international prevalence of help-seeking for PG among the general population and among subgroups of people at risk for PG (i.e. low-risk, moderate-risk and PG). METHODS Systematic search of grey literature (through gambling repositories, gambling research institutes and Google) and peer-reviewed literature (through ProQuest, PsycINFO, PubMed and Scopus) for gambling prevalence studies that reported on help-seeking for PG. This review adhered to the Preferred Reporting Items for Systematic Review and Meta-Analyses. Studies used representative sampling methods to determine the prevalence of gambling participation and data collection 2010 onward. Twenty-four studies met the inclusion criteria. The main outcome was population prevalence of help-seeking for PG. Help-seeking was defined as any intentional action to change gambling behaviours, including professional services (inclusive of in-person or distance help), non-professional help (e.g. from family and friends) and self-help. Subgroup analyses were conducted to explain variability in help-seeking prevalence estimates. RESULTS Measurement of help-seeking was inconsistent across included studies and, overall, there was high risk of bias. We estimated a general population help-seeking prevalence for PG of 0.23% (95% CI, 0.16-0.33). Prevalence estimates were significantly higher in studies assessing lifetime (0.50%; 95% CI, 0.35-0.71) compared with current help-seeking (0.14%; 95% CI, 0.10-0.20, P < 0.001), but there was no evidence of difference in prevalence estimates by gambling participation, region, type of help-seeking, or year of data collection. Compared with people with low-risk gambling (0.27%; 95% CI, 0.07%-1.04%), prevalence estimates were significantly higher in those with moderate-risk (3.73%; 95% CI, 2.07%-6.63%) and problem gambling (20.63%; 95% CI, 12.89%-31.35%, P < 0.001). CONCLUSIONS One in 25 moderate-risk gamblers and 1 in 5 people with problem gambling have sought help for problems related to their gambling.
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Affiliation(s)
- Rimke Bijker
- School of Population HealthUniversity of AucklandAucklandNew Zealand
| | - Natalia Booth
- School of Population HealthUniversity of AucklandAucklandNew Zealand
| | | | - Nicki A. Dowling
- School of PsychologyDeakin UniversityGeelongAustralia,Melbourne Graduate School of EducationUniversity of MelbourneParkvilleAustralia
| | - Simone N. Rodda
- School of Population HealthUniversity of AucklandAucklandNew Zealand,School of PsychologyDeakin UniversityGeelongAustralia
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Rueda Ruiz MB, Larracoechea UA, Herrero M, Estévez A. Problematic Gambling Behavior in a Sample with Substance Use Disorder: The Role of Attachment Style and Alexithymia. J Gambl Stud 2022; 39:513-529. [PMID: 36152111 PMCID: PMC10175442 DOI: 10.1007/s10899-022-10154-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/28/2022] [Accepted: 08/02/2022] [Indexed: 11/24/2022]
Abstract
Gambling disorder is a high comorbid disorder in substance abusers which conjunct appearance is related to worse symptomatology and evolution. Nevertheless, the research on the risk factors that may explain this comorbidity is scarce. We build of the self-regulation theory of attachment and addiction to examine if insecure attachment is related to gambling comorbidity in substance abuse disorder and the mediating role of alexithymia in this process. A cross-sectional study was carried out with 369 clinical patients with substance use disorder of which 69 presented comorbid gambling disorder diagnosed with the DSM-5 criteria. Results showed that insecure attachment was more prevalent in the group with comorbid gambling. In this group, the alexithymia levels were also higher and mediated the relationship in between attachment and gambling disorder comorbidity even controlling for several sociodemographic variables. This research indicates that insecure attachment enhances the risk of gambling comorbidity on substance abusers due to the detrimental effect on the self-regulation of emotion. Thus, interventions directed to increase the identification, expression and awareness of emotions might help to reduce comorbidity of gambling of substance use disorders.
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Affiliation(s)
- Mª Begoña Rueda Ruiz
- Psychiatry Service of the Barrualde-Galdakao Hospital, Galdakao Hospital, Labeaga Auzoa 46A - 48960, Galdakao, Bizkaia, Spain.
| | - Urko Aguirre Larracoechea
- Psychiatry Service of the Barrualde-Galdakao Hospital, Galdakao Hospital, Labeaga Auzoa 46A - 48960, Galdakao, Bizkaia, Spain
| | - Marta Herrero
- Faculty of Health Sciences, Deusto University, Bilbao, Spain
| | - Ana Estévez
- Faculty of Health Sciences, Deusto University, Bilbao, Spain
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Augner C, Vlasak T, Aichhorn W, Barth A. Psychological online interventions for problem gambling and gambling disorder - A meta-analytic approach. J Psychiatr Res 2022; 151:86-94. [PMID: 35472684 DOI: 10.1016/j.jpsychires.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 03/24/2022] [Accepted: 04/06/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The Covid-19 pandemic has reignited discussions about the prevalence of and treatment options for problem gambling and gambling disorder (PGGD). Since affected persons seldom seek professional help, online interventions can improve accessibility. Thus, this study aimed to investigate the effectiveness of psychological online interventions on PGGD. METHODS We conducted a systematic review and meta-analysis and searched in PubMed, PsycINFO, and Google Scholar for peer-reviewed experimental and quasi-experimental research published between 2010 and 2021. We calculated two meta-anlyses, one for treatment control comparisons (TCC), and one for pre-post-comparisons (PCC). RESULTS We included six studies (ten TCC and n = 2076) in meta-analysis 1 and five studies (six PCC and n = 781) in meta-analysis 2. Online interventions turned out to be effective in both analyses with Hedges g = 0.41, 95% confidence interval = [0.22 to 0.60], p < .001, for meta-anaylsis 1 and Hegdes g = 1.28, 95% confidence interval = [0.85 to 1.71], p < .001, for meta-analysis 2. CONCLUSIONS We identified significant effects of online interventions on PGGD in both analyses, indicating the potential of online applications. We discuss methodological aspects and further research directions.
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Affiliation(s)
- Christoph Augner
- Department of Psychiatry, Psychotherapy & Psychosomatics, Christian-Doppler Medical Centre, University Clinics of the Paracelsus Medical University, Salzburg, Austria; Institute for Human Resources Research in Health Care, University Clinics of the Paracelsus Medical University, Salzburg, Austria.
| | - Thomas Vlasak
- Institute for Psychology, Sigmund Freud University Linz, Austria
| | - Wolfgang Aichhorn
- Department of Psychiatry, Psychotherapy & Psychosomatics, Christian-Doppler Medical Centre, University Clinics of the Paracelsus Medical University, Salzburg, Austria
| | - Alfred Barth
- Institute for Psychology, Sigmund Freud University Linz, Austria
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15
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Bowden-Jones H, Hook RW, Grant JE, Ioannidis K, Corazza O, Fineberg NA, Singer BF, Roberts A, Bethlehem R, Dymond S, Romero-Garcia R, Robbins TW, Cortese S, Thomas SA, Sahakian BJ, Dowling NA, Chamberlain SR. Gambling disorder in the UK: key research priorities and the urgent need for independent research funding. Lancet Psychiatry 2022; 9:321-329. [PMID: 35180386 PMCID: PMC7612512 DOI: 10.1016/s2215-0366(21)00356-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 07/31/2021] [Accepted: 08/10/2021] [Indexed: 12/24/2022]
Abstract
Gambling in the modern era is pervasive owing to the variety of gambling opportunities available, including those that use technology (eg, online applications on smartphones). Although many people gamble recreationally without undue negative effects, a sizeable subset of individuals develop disordered gambling, which is associated with marked functional impairment including other mental health problems, relationship problems, bankruptcy, suicidality, and criminality. The National UK Research Network for Behavioural Addictions (NUK-BA) was established to promote understanding of, research into, and treatments for behavioural addictions including gambling disorder, which is the only formally recognised behavioural addiction. In this Health Policy paper, we outline the status of research and treatment for disordered gambling in the UK (including funding issues) and key research that should be conducted to establish the magnitude of the problem, vulnerability and resilience factors, the underlying neurobiology, long-term consequences, and treatment opportunities. In particular, we emphasise the need to: (1) conduct independent longitudinal research into the prevalence of disordered gambling (including gambling disorder and at-risk gambling), and gambling harms, including in vulnerable and minoritised groups; (2) select and refine the most suitable pragmatic measurement tools; (3) identify predictors (eg, vulnerability and resilience markers) of disordered gambling in people who gamble recreationally, including in vulnerable and minoritised groups; (4) conduct randomised controlled trials on psychological interventions and pharmacotherapy for gambling disorder; (5) improve understanding of the neurobiological basis of gambling disorder, including impulsivity and compulsivity, genetics, and biomarkers; and (6) develop clinical guidelines based on the best contemporary research evidence to guide effective clinical interventions. We also highlight the need to consider what can be learnt from approaches towards mitigating gambling-related harm in other countries.
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Affiliation(s)
- Henrietta Bowden-Jones
- National Problem Gambling Clinic & National Centre for Gaming Disorders, London, UK; Department of Psychiatry, University of Cambridge, Cambridge, UK; Faculty of Brain Sciences, University of Sussex, Brighton, UK
| | - Roxanne W Hook
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Jon E Grant
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, IL, USA
| | - Konstantinos Ioannidis
- Department of Psychiatry, University of Cambridge, Cambridge, UK; Department of International Health, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Ornella Corazza
- Department of Clinical, Pharmacological and Biological Sciences, University of Hertfordshire, Hatfield, UK
| | - Naomi A Fineberg
- Department of Psychiatry, University of Cambridge, Cambridge, UK; School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK; Hertforshire Partnership University NHS Foundation Trust, Welwyn Garden City, UK
| | - Bryan F Singer
- School of Psychology, University of Sussex, Brighton, UK; Sussex Addiction Research and Intervention Centre, University of Sussex, Brighton, UK; Sussex Neuroscience, University of Sussex, Brighton, UK
| | - Amanda Roberts
- School of Psychology, College of Social Science, University of Lincoln, Lincoln, UK
| | | | - Simon Dymond
- Department of Psychology, Swansea University, Swansea, UK; Department of Psychology, Reykjavík University, Reykjavík, Iceland
| | - Rafa Romero-Garcia
- Department of Psychiatry, University of Cambridge, Cambridge, UK; Departamento de Fisiología Médica y Biofísica, Instituto de Biomedicina de Sevilla, Universidad de Sevilla, Seville, Spain
| | - Trevor W Robbins
- Department of Psychology and Behavioural and Clinical Neuroscience Institute, University of Cambridge, UK
| | - Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK; Solent NHS Trust, Southampton, UK; Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York City, NY, USA; Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Shane A Thomas
- School of Health, Federation University, Ballarat, VIC Australia
| | | | - Nicki A Dowling
- School of Psychology, Deakin University, Geelong, VIC, Australia; Melbourne Graduate School of Education, University of Melbourne, VIC, Australia
| | - Samuel R Chamberlain
- Department of Psychiatry, Faculty of Medicine, University of Southampton, Southampton, UK; Southern Health NHS Foundation Trust, Southampton, UK.
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16
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Vandenberg B, Livingstone C, Carter A, O'Brien K. Gambling and homelessness: A systematic review and meta-analysis of prevalence. Addict Behav 2022; 125:107151. [PMID: 34700154 DOI: 10.1016/j.addbeh.2021.107151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 09/16/2021] [Accepted: 10/11/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION There is growing concern internationally about co-occurring gambling and homelessness. We systematically review prevalence estimates in help-seeking and community samples. METHODS Adopting PRISMA guidelines, we searched CINAHL Plus, Cochrane Library, Embase, Ovid MEDLINE, PsychINFO, Proquest Central, PubMed, Scopus, Web of Science, and Google Scholar for relevant peer-reviewed articles in English. Primary outcomes examined in narrative and quantitative syntheses included prevalence of: (i) gambling in persons experiencing homelessness; (ii) harmful gambling in persons experiencing homelessness; and, (iii) homelessness in persons experiencing harmful gambling. RESULTS Searches identified 917 records after removing duplicates. After screening, 45 articles providing 54 prevalence estimates across 12 countries were included, with help-seeking (k = 37) and community based sample (k = 8) estimates pooled separately. Gambling prevalence (all timeframes) in help-seeking samples of persons experiencing homelessness is low (28.7%, 95% CI: 17.3-41.7, k = 14) compared to the general population (approximately 60-80%). However, harmful gambling prevalence (including problem, pathological, and disordered gambling) in help-seeking samples of persons experiencing homelessness is high (16.5%, 95% CI: 10.2-24.2, k = 20) compared to the general population (approximately 1-7%). Additionally, homelessness prevalence is high in help-seeking samples of persons experiencing harmful gambling (23.6%, 95% CI: 18.4-29.2, k = 4) compared to the general population (<1%). Meta-analysis found high between-study heterogeneity and risk of bias from small samples sizes. CONCLUSIONS There are high rates of harmful gambling in persons experiencing homelessness and, concurrently, high rates of homelessness in persons experiencing harmful gambling. Improvements in sampling and measurement are needed to strengthen robustness and generalizability of prevalence estimates, which can potentially inform the scale and targeting of clinical interventions, support services, and policy responses.
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17
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Davies NH, Roderique-Davies G, Drummond LC, Torrance J, Sabolova K, Thomas S, John B. Accessing the invisible population of low-risk gamblers, issues with screening, testing and theory: a systematic review. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-021-01678-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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18
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Håkansson A, Durand-Bush N, Kenttä G. Problem Gambling and Problem Gaming in Elite Athletes: a Literature Review. Int J Ment Health Addict 2021; 21:1-17. [PMID: 34867124 PMCID: PMC8634748 DOI: 10.1007/s11469-021-00692-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/11/2021] [Indexed: 11/25/2022] Open
Abstract
Researchers have raised concerns about mental health in elite athletes, including problem gambling, where research hitherto is scarce. While gambling has been assessed in the younger student-athlete population, neither gambling nor the recently recognized behavioral addiction of gaming disorder has been sufficiently addressed in the elite athlete population. The present systematic literature review aimed to summarize research knowledge on the prevalence and correlates of problem gambling and problem gaming in elite athletes. Research papers were searched systematically using the Scopus, PsycINFO, and PubMed/MEDLINE databases and evaluated following a PRISMA paradigm. For the elite athlete population, eight reports on problem gambling and one report on problem gaming were found. While at least five papers indicated an increased risk of problem gambling in elite athletes compared to the general population, one study from Australia indicated the opposite. Problem gambling was generally more common in male athletes. Knowledge of problem gaming prevalence is thus far limited. It is concluded that increased research in problem gambling and problem gaming in elite athletes is warranted.
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Affiliation(s)
- Anders Håkansson
- Dept. of Clinical Sciences Lund, Psychiatry, Faculty of Medicine, Lund University, Lund, Sweden
- Clinical Sports and Mental Health Unit, Malmö Addiction Center, Region Skåne, Malmö, Sweden
- Malmö Addiction Center, Region Skåne, Södra Förstadsgatan 35, plan 4. S-205 02, Malmö, Sweden
| | - N. Durand-Bush
- School of Human Kinetics, University of Ottawa, Ottawa, Canada
- Canadian Centre for Mental Health and Sport, Orleans, Canada
| | - G. Kenttä
- School of Human Kinetics, University of Ottawa, Ottawa, Canada
- The Swedish School of Sport and Health Sciences, Stockholm, Sweden
- Swedish Sport Federation, Stockholm, Sweden
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19
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Changes in secondary outcomes associated with brief interventions for problem gambling in methadone patients. Addict Behav 2021; 120:106953. [PMID: 34022757 DOI: 10.1016/j.addbeh.2021.106953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 03/23/2021] [Accepted: 04/09/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Patients in methadone maintenance treatment (MMT) with problem gambling (PG) experience worse psychosocial outcomes than their non-PG counterparts. Interventions targeting PG in MMT may enhance psychosocial functioning beyond gambling reduction and abstinence. The present study was a secondary data analysis that examined the trajectories of non-gambling outcomes of three brief PG interventions (i.e., brief psychoeducation, brief advice, motivational enhancement therapy plus cognitive-behavioral therapy [MET + CBT]) among MMT patients. METHODS Participants (N = 109) were engaged in substance use disorder treatment, met criteria for PG, and had a current or lifetime history of MMT. Latent growth curve models examined outcome trajectories of psychiatric, medical, legal, employment, and social problems, as well as psychological distress and quality of life. Follow-up analyses examined clinically significant change. RESULTS MET + CBT patients reported lower medical problems at baseline and over time than the brief interventions. There was no evidence of differences between interventions on the other outcomes. Psychiatric problems and psychological distress decreased over time for the entire sample, regardless of the PG intervention. About 24% and 13% of the sample demonstrated clinically significant improvements in psychological distress from baseline to 5 months, and 5 months to 12 months, respectively. Nearly 21% of the sample showed clinically significant improvements in psychiatric problems from 5 months to 12 months. Among all patients, men and those with more severe opioid dependence symptoms demonstrated the greatest psychological improvements. CONCLUSIONS Many patients in MMT with PG experience improvements in psychological problems, including long-term improvement, regardless of the PG intervention offered.
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20
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Adult Gambling Problems and Histories of Mental Health and Substance Use: Findings from a Prospective Multi-Wave Australian Cohort Study. J Clin Med 2021; 10:jcm10071406. [PMID: 33915774 PMCID: PMC8037618 DOI: 10.3390/jcm10071406] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 03/24/2021] [Accepted: 03/25/2021] [Indexed: 01/08/2023] Open
Abstract
Little is known about the cumulative effect of adolescent and young adult mental health difficulties and substance use problems on gambling behaviour in adulthood. We use data from one of Australia's longest running studies of social and emotional development to examine the extent to which: (1) mental health symptoms (depressive and anxiety symptoms) and substance use (weekly binge drinking, tobacco, and cannabis use) from adolescence (13-18 years) into young adulthood (19-28 years) predict gambling problems in adulthood (31-32 years); and (2) risk relationships differ by sex. Analyses were based on responses from 1365 adolescent and young adult participants, spanning seven waves of data collection (1998-2014). Persistent adolescent to young adult binge drinking, tobacco use and cannabis use predicted gambling at age 31-32 years (OR = 2.30-3.42). Binge drinking and tobacco use in young adulthood also predicted gambling at age 31-32 years (OR = 2.04-2.54). Prior mental health symptoms were not associated with gambling and no risk relationships differed by sex. Findings suggest that gambling problems in adulthood may be related to the earlier development of other addictive behaviours, and that interventions targeting substance use from adolescence to young adulthood may confer additional gains in preventing later gambling behaviours.
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21
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Cowlishaw S, Metcalf O, Lawrence-Wood E, Little J, Sbisa A, Deans C, O'Donnell M, Sadler N, Van Hooff M, Crozier M, Battersby M, Forbes D, McFarlane AC. Gambling problems among military personnel after deployment. J Psychiatr Res 2020; 131:47-53. [PMID: 32920277 DOI: 10.1016/j.jpsychires.2020.07.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/18/2020] [Accepted: 07/25/2020] [Indexed: 12/01/2022]
Abstract
Military and veteran populations may exhibit heightened vulnerability to gambling problems; however, there is scant relevant evidence outside the US, and few studies of transition periods, including return from operational deployment. The aim of this study was thus to highlight the extent, risk-factors, and implications of gambling problems among current members of the Australian Defence Force (ADF) following deployment to the Middle East Area of Operations (MEAO). It involved analyses of data from n = 1324 ADF personnel who deployed between 2010 and 2012, and completed surveys within four months of returning to Australia. The Problem Gambling Severity Index (PGSI) identified Problem Gambling (PG: PGSI ≥5) and At-Risk Gambling (ARG: PGSI 1-4), alongside measures of Depression (PHQ-9), Posttraumatic Stress Disorder (PCL-C), alcohol use problems (AUDIT), distress (K10), and post-deployment stressors. Analyses indicated that 7.7% of personnel reported at least some gambling problems post-deployment, including 2.0% that were distinguished by PG, and 5.7% indicating ARG. These figures were comparable to conditions including probable depression and alcohol dependence, while levels of any gambling problems were high relative to harmful drinking. Higher levels were observed among personnel who were aged 18-24, reported 0-4 years of military service, served in the Army, and comprised Non-Commissioned Officers/Other Ranks. There were strong associations with gambling problems and various indicators of mental health and wellbeing, and self-reported post-deployment difficulties. The findings indicate that gambling problems are salient concerns for some Australian military personnel post-deployment, and highlight the need for increased recognition and responses to these problems.
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Affiliation(s)
- Sean Cowlishaw
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Australia; Population Health Sciences, Bristol Medical School, University of Bristol, United Kingdom.
| | - Olivia Metcalf
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Australia
| | - Ellie Lawrence-Wood
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Australia
| | - Jonathon Little
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Australia
| | - Alyssa Sbisa
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Australia
| | - Carolyn Deans
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Australia
| | - Meaghan O'Donnell
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Australia
| | - Nicole Sadler
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Australia
| | - Miranda Van Hooff
- Australian Centre for Excellence in Posttraumatic Stress, The Road Home, The Hospital Research Foundation, Australia
| | - Matilda Crozier
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Australia
| | - Malcolm Battersby
- College of Medicine and Public Health, Flinders University, Australia
| | - David Forbes
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Australia
| | - Alexander C McFarlane
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Australia; University of Adelaide, Adelaide, Australia
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22
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Ou H, Zhang Y, He W. Commentary: Clinical Improvements in Comorbid Gambling/Cocaine Use Disorder (GD/CUD) Patients Undergoing Repetitive Transcranial Magnetic Stimulation (rTMS). Front Neural Circuits 2020; 14:39. [PMID: 32848631 PMCID: PMC7396627 DOI: 10.3389/fncir.2020.00039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 05/29/2020] [Indexed: 11/28/2022] Open
Affiliation(s)
- Hang Ou
- Research Center of Brain and Cognitive Neuroscience, Liaoning Normal University, Dalian, China.,Key Laboratory of Brain and Cognitive Neuroscience, Liaoning Province, Shanghai, China
| | - Yi Zhang
- Shanghai Mental Health Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Weiqi He
- Research Center of Brain and Cognitive Neuroscience, Liaoning Normal University, Dalian, China.,Key Laboratory of Brain and Cognitive Neuroscience, Liaoning Province, Shanghai, China
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23
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John B, Holloway K, Davies N, May T, Buhociu M, Cousins AL, Thomas S, Roderique-Davies G. Gambling Harm as a Global Public Health Concern: A Mixed Method Investigation of Trends in Wales. Front Public Health 2020; 8:320. [PMID: 32793537 PMCID: PMC7387499 DOI: 10.3389/fpubh.2020.00320] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 06/12/2020] [Indexed: 12/17/2022] Open
Abstract
Background: Recent research evidence has suggested that gambling is a public health concern. A number of studies report the association between gambling activity and increased instances of various other harms, including substance misuse and psychological disorders. In parallel to alcohol misuse, it is also becoming clear that gambling related harm is more of a continuum of harm, as opposed to traditionally accepted categorisations of gambling behavior: safe and responsible or "problem" and harmful. Previous effective treatment models for alcohol misuse have considered a public health approach to develop interventions. As such, the current research seeks to use a public health approach to both investigate the extent of gambling harm across Wales, and to identify upstream predictors of harm to inform future interventions. Method: A triangulation of data collection methods was utilized across Wales, UK. Two hundred and forty-eight participants completed a quantitative survey relating to gambling behavior and related harm, which included the Problem Severity Gambling Index, the Gambling Commission measure of frequency, The Gambling Motives Questionnaire and the Fast Alcohol Screening tool. Ninety-eight of these participants completed a qualitative subsection. Structured interviews were conducted with 20 individuals from 11 service providers. Semi-structured interviews were conducted for the five case studies of individuals who had previously sought help for gambling. The geographical density and distribution of Licensed Gambling Outlets was also mapped in local areas. Results: The findings provide further evidence of a continuum of gambling related harm. Twenty seven percent of survey participants demonstrate some indicators of risk of gambling harm. Social, cultural and environmental contexts play a role in initiation and maintenance of gambling behavior and the subsequent related harm. Accounts from individuals corroborated the quantitative findings. Conclusions: Findings from this Welsh sample are in line with and add support to the growing international research evidence that gambling harms are a universal issue that cross cultures. It is clear that action is needed by legislators at a policy level and that broadening the focus of intervention to a public health level is necessary to develop effective strategies for harm reduction.
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Affiliation(s)
- Bev John
- Addictions Research Group, Faculty of Life Sciences and Education, School of Psychology and Therapeutic Studies, University of South Wales, Pontypridd, United Kingdom
| | - Katy Holloway
- Substance Use Research Group, Faculty of Life Science and Education, Centre for Criminology, University of South Wales, Pontypridd, United Kingdom
| | - Nyle Davies
- Addictions Research Group, Faculty of Life Sciences and Education, School of Psychology and Therapeutic Studies, University of South Wales, Pontypridd, United Kingdom
| | - Tom May
- Substance Use Research Group, Faculty of Life Science and Education, Centre for Criminology, University of South Wales, Pontypridd, United Kingdom
| | - Marian Buhociu
- Substance Use Research Group, Faculty of Life Science and Education, Centre for Criminology, University of South Wales, Pontypridd, United Kingdom
| | - Alecia L Cousins
- Addictions Research Group, Faculty of Life Sciences and Education, School of Psychology and Therapeutic Studies, University of South Wales, Pontypridd, United Kingdom
| | - Samantha Thomas
- Addictions Research Group, Faculty of Life Sciences and Education, School of Psychology and Therapeutic Studies, University of South Wales, Pontypridd, United Kingdom.,Faculty of Health, School of Health and Social Development, Deakin University, Melbourne, VIC, Australia
| | - Gareth Roderique-Davies
- Addictions Research Group, Faculty of Life Sciences and Education, School of Psychology and Therapeutic Studies, University of South Wales, Pontypridd, United Kingdom
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24
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Punia K, DeVillaer M, MacKillop J, Balodis IM. Understanding the Overlap Between Cannabis Use and Gambling Behaviour: A Systematic Review of Empirical Findings and Consideration of Policy Implications. CURRENT ADDICTION REPORTS 2020. [DOI: 10.1007/s40429-020-00323-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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25
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Molander O, Lindner P, Ramnerö J, Bjureberg J, Carlbring P, Berman AH. Internet-based cognitive behavior therapy for problem gambling in routine care: protocol for a non-randomized pilot and feasibility trial. Pilot Feasibility Stud 2020; 6:106. [PMID: 32699645 PMCID: PMC7372781 DOI: 10.1186/s40814-020-00647-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 07/06/2020] [Indexed: 12/16/2022] Open
Abstract
Background Problem gambling and gambling disorder are major public health concerns worldwide, and awareness of associated negative consequences is rising. In parallel, treatment demand has increased, and Internet interventions offer a promising alternative for providing evidence-based treatment at scale to a low cost. Method We developed a novel Internet-delivered cognitive behavioral treatment for gambling, based on qualitative interviews with treatment-seeking gamblers, behavioral research on gambling behavior, and the pathway model for problem gambling. This research protocol describes a non-randomized pilot and feasibility trial conducted in routine addiction care with adult treatment-seeking patients (max N = 25) with problem gambling. The primary aim is to ensure acceptability and safety, measured by satisfaction, credibility, working alliance, and possible negative effects. Secondary aims are feasibility of study procedures in terms of recruitment and measurement procedures as well as potential effectiveness measured weekly by gambling symptoms as primary outcome and gambling behavior, quality of life, symptoms of depression and anxiety, alcohol, and drug use as secondary outcomes. Potential mediators measured weekly are loss of control, verbal rules, and well-being. Discussion This study is innovative in several respects, regarding both treatment development and implementation. The results of the study will guide a future randomized controlled trial, as well as the development of the intervention and intervention implementation within ordinary addiction care. Trial registration Clinical trials.gov, NCT ID: NCT03946098. Registered 10 May 2019
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Affiliation(s)
- Olof Molander
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.,Stockholm Centre for Dependency Disorders, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Philip Lindner
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.,Stockholm Centre for Dependency Disorders, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.,Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Jonas Ramnerö
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.,Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Johan Bjureberg
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Per Carlbring
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Anne H Berman
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.,Stockholm Centre for Dependency Disorders, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.,Department of Public Health Sciences, Stockholm University, Stockholm, Sweden.,Department of Psychology, Uppsala University, Uppsala, Sweden
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26
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Rosen LA, Weinstock J, Peter SC. A Randomized Clinical Trial Exploring Gambling Attitudes, Barriers to Treatment, and Efficacy of a Brief Motivational Intervention Among Ex-Offenders with Disordered Gambling. J Forensic Sci 2020; 65:1646-1655. [PMID: 32539157 DOI: 10.1111/1556-4029.14476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/13/2020] [Accepted: 05/19/2020] [Indexed: 02/03/2023]
Abstract
Correctional populations are disproportionately burdened by disordered gambling; yet, problem awareness is minimal among both offenders and professionals within the criminal justice system. The aims of the current study were twofold: (i) to examine gambling attitudes and problem awareness among ex-offenders, and (ii) to determine the efficacy of a brief online gambling intervention for ex-offenders. Participants (N = 126) were ex-offenders on probation and parole. Gambling attitudes, attitudes toward treatment, and disorder gambling status were assessed. Disordered gamblers (n = 102) were randomly assigned to (i) a brief intervention plus referral to treatment or (ii) referral to treatment only, and these individuals were re-assessed at a 30-day follow-up. Lifetime disordered gambling was highly prevalent (86%) in the ex-offender sample, and providing information regarding disordered gambler status and referral to treatment was effective in decreasing gambling attitudes, as well as gambling severity and frequency. The current study has direct implications for treatment and intervention efforts among ex-offenders with disordered gambling and yields a greater understanding of attitudes toward gambling among ex-offenders.
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Affiliation(s)
- Laura April Rosen
- Department of Psychology, Saint Louis University, 3700 Lindell Blvd., Morrissey Hall, St. Louis, MO
| | - Jeremiah Weinstock
- Department of Psychology, Saint Louis University, 3700 Lindell Blvd., Morrissey Hall, St. Louis, MO
| | - Samuel Cody Peter
- Department of Psychology, The University of Memphis, 400 Innovation Dr., Memphis, TN, 38111
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Cowlishaw S, Little J, Sbisa A, McFarlane A, Van Hooff M, Lawrence-Wood E, O'Donnell M, Hinton M, Sadler N, Savic A, Forbes D, Metcalf O. Prevalence and implications of gambling problems among firefighters. Addict Behav 2020; 105:106326. [PMID: 32004832 DOI: 10.1016/j.addbeh.2020.106326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 01/13/2020] [Accepted: 01/17/2020] [Indexed: 12/12/2022]
Abstract
Firefighting is a high-risk occupation that accounts for vulnerability to a range of mental health problems and addictive behaviours. However, no research has addressed whether this vulnerability extends to gambling problems, and the aim of this study was thus to provide new data on frequency and implications of such problems in this occupational context. The sample consisted of n = 566 career and retained firefighters who participated in a cross-sectional survey of an Australian metropolitan fire service. The Problem Gambling Severity Index (PGSI) was used to operationalise both clinically significant levels of problem gambling (PGSI ≥ 5), and 'at-risk' gambling (PGSI 1-4); alongside measures of major depression (PHQ-9), anxiety (GAD-7), Posttraumatic Stress Disorder (PCL-5) and alcohol problems (AUDIT), as well as other addictive behaviours, wellbeing and psychosocial issues. Results indicated 12.3% of firefighters that reported any gambling problems across a continuum of severity (PGSI ≥ 1), including 2.3% that were problems gamblers, and 10.0% reporting at-risk gambling. The weighted prevalence of problem gambling was comparable to other significant mental health conditions including depression and PTSD, while the rate of any gambling problems was high relative to other addictive behaviours. Gambling problems were associated with poor mental health and wellbeing, but not psychosocial indicators (e.g., financial difficulties). The findings suggest that gambling problems across a spectrum of severity may be significant yet hidden issues among emergency service workers, and thus require increased recognition and responses at the organisational level.
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Savolainen I, Oksanen A, Kaakinen M, Sirola A, Paek HJ. The Role of Perceived Loneliness in Youth Addictive Behaviors: Cross-National Survey Study. JMIR Ment Health 2020; 7:e14035. [PMID: 31895044 PMCID: PMC6966551 DOI: 10.2196/14035] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 07/30/2019] [Accepted: 09/24/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND In the ever-growing and technologically advancing world, an increasing amount of social interaction takes place through the Web. With this change, loneliness is becoming an unprecedented societal issue, making youth more susceptible to various physical and mental health problems. This societal change also influences the dynamics of addiction. OBJECTIVE Employing the cognitive discrepancy loneliness model, this study aimed to provide a social psychological perspective on youth addictions. METHODS A comprehensive survey was used to collect data from American (N=1212; mean 20.05, SD 3.19; 608/1212, 50.17% women), South Korean (N=1192; mean 20.61, SD 3.24; 601/1192, 50.42% women), and Finnish (N=1200; mean 21.29, SD 2.85; 600/1200, 50.00% women) youths aged 15 to 25 years. Perceived loneliness was assessed with the 3-item Loneliness Scale. A total of 3 addictive behaviors were measured, including excessive alcohol use, compulsive internet use, and problem gambling. A total of 2 separate models using linear regression analyses were estimated for each country to examine the association between perceived loneliness and addiction. RESULTS Loneliness was significantly related to only compulsive internet use among the youth in all 3 countries (P<.001 in the United States, South Korea, and Finland). In the South Korean sample, the association remained significant with excessive alcohol use (P<.001) and problem gambling (P<.001), even after controlling for potentially confounding psychological variables. CONCLUSIONS The findings reveal existing differences between youths who spend excessive amounts of time online and those who engage in other types of addictive behaviors. Experiencing loneliness is consistently linked to compulsive internet use across countries, although different underlying factors may explain other forms of addiction. These findings provide a deeper understanding in the mechanisms of youth addiction and can help improve prevention and intervention work, especially in terms of compulsive internet use.
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Affiliation(s)
- Iina Savolainen
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Atte Oksanen
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Markus Kaakinen
- Institute of Criminology and Legal Policy, University of Helsinki, Helsinki, Finland
| | - Anu Sirola
- Faculty of Social Sciences, Tampere University, Tampere, Finland
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Abstract
Eleven US States and the District of Columbia legally allow personal (i.e., recreational) cannabis use by adults, and an additional 22 states allow use of cannabis for medicinal purposes. Of these jurisdictions, only two do not have some form of legalized gambling available (https://www.casino.org/local/guide/). In contrast to this rapid increase in legally available marijuana is the limited knowledge about the intersection of cannabis use and gambling. This paper strives to define the current status of the relevant literatures and consider the implication for future gambling research. We describe the research literature on the prevalence of cannabis use and co-existing gambling problems and the effects of cannabis use on gambling-related cognitive functions and decision-making. We also discuss clinical considerations with treating problem gamblers with a cannabis use disorder. Finally, the potential implications for responsible gambling practices and policies and the most pressing gaps in the research literature are offered.
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Affiliation(s)
- Ken C Winters
- Oregon Research Institute (MN location), 1575 Northrop St., Falcon Heights, MN, 55108, USA.
| | - James P Whelan
- Department of Psychology, University of Memphis, 400 Innovation Drive, Memphis, TN, 38152-3032, USA
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Dowling NA, Merkouris SS, Dias S, Rodda SN, Manning V, Youssef GJ, Lubman DI, Volberg RA. The diagnostic accuracy of brief screening instruments for problem gambling: A systematic review and meta-analysis. Clin Psychol Rev 2019; 74:101784. [PMID: 31759246 DOI: 10.1016/j.cpr.2019.101784] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 10/22/2019] [Accepted: 10/26/2019] [Indexed: 02/06/2023]
Abstract
Non-gambling specialist services, such as primary care, alcohol and other drug use, and mental health services, are well placed to enhance the identification of people with gambling problems and offer appropriate generalist first level interventions or referral. Given time and resource demands, many of these clinical services may only have the capacity to administer very short screening instruments. This systematic review was conducted to provide a resource for health service providers and researchers in identifying the most accurate brief (1-5 item) screening instruments to identify problem and at-risk gambling for their specific purposes and populations. A systematic search of peer-reviewed and grey literature from 1990 to 2019 identified 25 articles for inclusion. Meta-analysis revealed five of the 20 available instruments met criteria for satisfactory diagnostic accuracy in detecting both problem and at-risk gambling: Brief Problem Gambling Screen (BPGS-2), NODS-CLiP, Problem Gambling Severity Index-Short Form (PGSI-SF), NODS-PERC, and NODS-CLiP2. Of these, the NODS-CLiP and NODS-PERC have the largest volume of diagnostic data. The Lie/Bet Questionnaire and One-Item Screen are also promising shorter options. Because these conclusions are drawn from a relatively limited evidence base, future studies evaluating the diagnostic accuracy of existing brief instruments across settings, age groups, and timeframes are needed.
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Affiliation(s)
- N A Dowling
- School of Psychology, Deakin University, 1 Gheringhap St, Geelong, VIC 3220, Australia; Melbourne Graduate School of Education, University of Melbourne, Kwong Lee Dow Building, 234 Queensberry Street, Parkville, VIC 3053, Australia.
| | - S S Merkouris
- School of Psychology, Deakin University, 1 Gheringhap St, Geelong, VIC 3220, Australia
| | - S Dias
- School of Psychology, Deakin University, 1 Gheringhap St, Geelong, VIC 3220, Australia
| | - S N Rodda
- School of Population Health, Faculty of Medical and Health Sciences, 216 Morrin Road, Auckland 1142, New Zealand.
| | - V Manning
- Eastern Health Clinical School, Faculty of Medicine, Nursing & Health Sciences, Monash University, Level 2, 5 Arnold Street, Box Hil, 3128 Melbourne, Victoria, Australia; Turning Point, Eastern Health, 110 Church Street, Richmond 3121, VIC, Australia
| | - G J Youssef
- School of Psychology, Deakin University, 1 Gheringhap St, Geelong, VIC 3220, Australia; Centre for Adolescent Health, Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Road, Parkville 3052, Victoria, Australia
| | - D I Lubman
- Eastern Health Clinical School, Faculty of Medicine, Nursing & Health Sciences, Monash University, Level 2, 5 Arnold Street, Box Hil, 3128 Melbourne, Victoria, Australia; Turning Point, Eastern Health, 110 Church Street, Richmond 3121, VIC, Australia
| | - R A Volberg
- School of Public Health and Health Sciences, University of Massachusetts, 715 N. Pleasant Street, Amherst, MA 01003, USA.
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The Reciprocal Association between Problem Gambling and Mental Health Symptoms/Substance Use: Cross-Lagged Path Modelling of Longitudinal Cohort Data. J Clin Med 2019; 8:jcm8111888. [PMID: 31698740 PMCID: PMC6912817 DOI: 10.3390/jcm8111888] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 10/29/2019] [Accepted: 10/30/2019] [Indexed: 02/01/2023] Open
Abstract
To date, studies have highlighted cross-sectional and unidirectional prospective relationships between problem gambling and mental health symptoms or substance use. The current study aims to: (1) examine the reciprocal relationships between problem gambling and mental health symptoms (depression, generalized anxiety)/substance use variables (hazardous alcohol use, daily tobacco use, and drug use) using cross-lagged path models in a prospective general population cohort sample; and (2) determine whether these associations are moderated by age and gender. This study involved secondary data analysis from 1109 respondents who provided data during Wave 2 or 3 (12-months apart) of the Tasmanian Longitudinal Gambling Study (Australia). Depression (odds ratio (OR) = 2.164) and generalized anxiety (OR = 2.300) at Wave 2 were found to have cross-lagged associations with the subsequent development of any-risk gambling (low-risk, moderate-risk, or problem gambling) at Wave 3. Hazardous alcohol use, daily tobacco use, and drug use at Wave 2 were not associated with the development of any-risk gambling at Wave 3. Any-risk gambling at Wave 2 was not associated with the subsequent development of any mental health symptoms or substance use variables at Wave 3. Age and gender failed to be significant moderators in the associations between any-risk gambling and mental health symptoms or substance use variables. Future longitudinal and event-level research is required to further substantiate these prospective relationships, with a view to developing targeted preventions and interventions.
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Cowlishaw S, McCambridge J, Kessler D. Identification of Gambling Problems in Primary Care: Properties of the NODS-CLiP Screening Tool. J Addict Med 2019; 12:442-446. [PMID: 29944480 DOI: 10.1097/adm.0000000000000429] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION There are several brief screening tools for gambling that possess promising psychometric properties, but have uncertain utility in generalist healthcare environments which prioritize prevention and brief interventions. This study describes an examination of the National Opinion Research Centre Diagnostic and Statistical Manual of Mental Disorders Screen for Gambling Problems (NODS-CLiP), in comparison with the Problem Gambling Severity Index (PGSI), when used to operationalize gambling problems across a spectrum of severity. METHODS Data were obtained from 1058 primary care attendees recruited from 11 practices in England who completed various measures including the NODS-CLiP and PGSI. The performance of the former was defined by estimates of sensitivity, specificity, positive predictive values (PPVs), and negative predictive values (NPVs), when PGSI indicators of problem gambling (5+) and any gambling problems (1+), respectively, were reference standards. RESULTS The NODS-CLiP demonstrated perfect sensitivity for problem gambling, along with high specificity and a NPV, but a low PPV. There was much lower sensitivity when the indicator of any gambling problems was the reference standard, with capture rates indicating only 20% of patients exhibiting low to moderate severity gambling problems (PGSI 1-4) were identified by the NODS-CLiP. CONCLUSIONS The NODS-CLiP performs well when identifying severe cases of problem gambling, but lacks sensitivity for less severe problems and may be unsuitable for settings which prioritize prevention and brief interventions. There is a need for screening measures which are sensitive across the full spectrum of risk and severity, and can support initiatives for improving identification and responses to gambling problems in healthcare settings such as primary care.
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Affiliation(s)
- Sean Cowlishaw
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Australia (SC); Centre for Academic Primary Care, Bristol Medical School, University of Bristol, UK (SC, DK); Department of Health Sciences, University of York, UK (JM)
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Latvala T, Lintonen T, Konu A. Public health effects of gambling - debate on a conceptual model. BMC Public Health 2019; 19:1077. [PMID: 31399026 PMCID: PMC6688345 DOI: 10.1186/s12889-019-7391-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 07/26/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Gambling for money is a popular leisure time activity in most countries, which has major social and economic impacts not only affecting the gambler, but his/her significant others, and the society. Gambling impact studies can help researchers and policymakers compare the health and social costs and benefits of different gambling policies and can be used when considering which gambling policies will reduce or increase costs or benefits the most. In a public health approach, the impacts of gambling, negative and positive, are assessed across the entire severity spectrum of the activity. Although some studies have created basic principles for conducting impact studies, a theoretical model is currently lacking. The aim of this debate is to review complementing and contrasting views on the effects of gambling to create a conceptual model, where a public health perspective is applied. MAIN TEXT The effects of gambling can be structuralized using a conceptual model, where impacts are divided into negative and positive; costs and benefits. Costs and benefits are categorized into three classes: financial, labor and health, and well-being. These classes manifest in personal, interpersonal, and societal levels. Individual impacts cause effects on a personal level to gamblers themselves. External impacts influence the interpersonal and society/community levels and concern other people. The temporal level refers to the development, severity and scope of the gambling impact. These include general impacts, impacts of problem gambling and long-term impacts of gambling. CONCLUSIONS The conceptual model offers a base on which to start building common methodology for assessing the impact of gambling on the society. While measuring monetary impacts is not always straightforward, the main issue is how to measure the social impacts, which are typically ignored in calculations, as are personal and interpersonal impacts. The reviewed empirical work largely concentrated on the costs of gambling, especially costs on the community level. The Model can be used to identify areas where research is scarce. Filling the gaps in knowledge is essential in forming a balanced evidence base on the impacts of gambling. Ideally, this evidence could be the starting point in formulating public policies on gambling.
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Affiliation(s)
- Tiina Latvala
- Finnish Foundation for Alcohol Studies, P.O. Box 30, FI-00271 Helsinki, Finland
| | - Tomi Lintonen
- Finnish Foundation for Alcohol Studies, P.O. Box 30, FI-00271 Helsinki, Finland
| | - Anne Konu
- Faculty of Social Sciences, Health Sciences, Tampere University, FI-33014 Tampere, Finland
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Matheson FI, Hamilton-Wright S, Kryszajtys DT, Wiese JL, Cadel L, Ziegler C, Hwang SW, Guilcher SJT. The use of self-management strategies for problem gambling: a scoping review. BMC Public Health 2019; 19:445. [PMID: 31035978 PMCID: PMC6489359 DOI: 10.1186/s12889-019-6755-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 04/08/2019] [Indexed: 12/18/2022] Open
Abstract
Background Problem gambling (PG) is a serious public health concern that disproportionately affects people experiencing poverty, homelessness, and multimorbidity including mental health and substance use concerns. Little research has focused on self-help and self-management in gambling recovery, despite evidence that a substantial number of people do not seek formal treatment. This study explored the literature on PG self-management strategies. Self-management was defined as the capacity to manage symptoms, the intervention, health consequences and altered lifestyle that accompanies a chronic health concern. Methods We searched 10 databases to identity interdisciplinary articles from the social sciences, allied health professions, nursing and psychology, between 2000 and June 28, 2017. We reviewed records for eligibility and extracted data from relevant articles. Studies were included in the review if they examined PG self-management strategies used by adults (18+) in at least a subset of the sample, and in which PG was confirmed using a validated diagnostic or screening tool. Results We conducted a scoping review of studies from 2000 to 2017, identifying 31 articles that met the criteria for full text review from a search strategy that yielded 2662 potential articles. The majority of studies examined self-exclusion (39%), followed by use of workbooks (35%), and money or time limiting strategies (17%). The remaining 8% focused on cognitive, behavioural and coping strategies, stress management, and mindfulness. Conclusions Given that a minority of people with gambling concerns seek treatment, that stigma is an enormous barrier to care, and that PG services are scarce and most do not address multimorbidity, it is important to examine the personal self-management of gambling as an alternative to formalized treatment. Electronic supplementary material The online version of this article (10.1186/s12889-019-6755-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Flora I Matheson
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
| | - Sarah Hamilton-Wright
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - David T Kryszajtys
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Jessica L Wiese
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Lauren Cadel
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Carolyn Ziegler
- Health Information Sciences Library, University of Toronto, Toronto, ON, Canada
| | - Stephen W Hwang
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Sara J T Guilcher
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
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Najavits LM, Krinsley K, Waring ME, Gallagher MW, Skidmore C. A Randomized Controlled Trial for Veterans with PTSD and Substance Use Disorder: Creating Change versus Seeking Safety. Subst Use Misuse 2018; 53:1788-1800. [PMID: 29461920 DOI: 10.1080/10826084.2018.1432653] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) and substance use disorder (SUD) co-occur in military veterans and other populations. OBJECTIVE To conduct a randomized controlled trial to compare a new past-focused treatment (Creating Change; CC), to a well-established, evidence-based present-focused treatment for PTSD/SUD (Seeking Safety; SS), on symptoms of both disorders. CC guides patients to process the past through exploration of PTSD/SUD life themes and memories whereas SS focuses on coping skills in the present. METHODS Fifty-two male and female veterans with current PTSD/SUD were randomized (n = 26 per treatment) and assessed at baseline, end-of-treatment and 3-month follow-up. They received 17 individual one-hour sessions. RESULTS Intent-to-treat analyses indicated that both conditions improved over time, with no difference between conditions, on PTSD, alcohol use, and drug use (our primary outcomes) as well as mental health symptoms, quality of life, self-efficacy, and SUD cognitions. Effect sizes were medium except for alcohol use, which was large. Change over time reflected improvement from baseline to end-of-treatment, with gains sustained at follow-up, although alcohol use showed continued improvement from end-of-treatment to follow-up. Both treatments evidenced a strong safety profile; and attendance, alliance, and treatment satisfaction were also very strong. Conclusions/importance: CC has promise as a PTSD/SUD therapy with strong public health relevance and the potential to fill important gaps in the field. We used minimal exclusionary criteria to obtain a real-world sample, which was severe-predominantly substance-dependent with chronic PTSD and additional psychiatric diagnoses. Future research is warranted, especially on nonveteran samples and treatment mechanisms of action.
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Affiliation(s)
- Lisa M Najavits
- a Veterans Affairs Boston Healthcare System , Boston , Massachusetts , USA.,b Department of Psychiatry , Boston University School of Medicine , Boston , Massachusetts , USA.,d Center for Healthcare Organization and Implementation Research , Edith Nourse Rogers Memorial Veterans Hospital , Bedford , Massachusetts , USA
| | - Karen Krinsley
- a Veterans Affairs Boston Healthcare System , Boston , Massachusetts , USA
| | - Molly E Waring
- c Departments of Quantitative Health Sciences and Obstetrics & Gynecology , University of Massachusetts Medical School , Worcester , Massachusetts , USA.,d Center for Healthcare Organization and Implementation Research , Edith Nourse Rogers Memorial Veterans Hospital , Bedford , Massachusetts , USA
| | - Matthew W Gallagher
- e Department of Psychology, Texas Institute for Measurement , Evaluation, and Statistics, University of Houston , Houston , Texas , USA
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Granero R, Fernández-Aranda F, Mestre-Bach G, Steward T, García-Caro B, Prever F, Gavriel-Fried B, del Pino-Gutiérrez A, Moragas L, Aymamí N, Gómez-Peña M, Mena-Moreno T, Martín-Romera V, Menchón JM, Jiménez-Murcia S. Clustering of treatment-seeking women with gambling disorder. J Behav Addict 2018; 7:770-780. [PMID: 30238785 PMCID: PMC6426395 DOI: 10.1556/2006.7.2018.93] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The prevalence of gambling disorder (GD) in women has increased, but, to date, few studies have explored the features of clinical GD subtypes in female samples. AIMS The aim of this study is to identify empirical clusters based on clinical/sociodemographic variables in a sample of treatment-seeking women with GD. METHODS Agglomerative hierarchical clustering was applied to a sample of n = 280 patients, using sociodemographic variables, psychopathology, and personality traits as indicators for the grouping procedure. RESULTS Three mutually exclusive groups were obtained: (a) Cluster 1 (highly dysfunctional; n = 82, 29.3%) endorsed the highest levels in gambling severity, comorbid psychopathology, novelty seeking, harm avoidance, and self-transcendence, and the lowest scores in self-directedness and cooperativeness; (b) Cluster 2 (dysfunctional; n = 142, 50.7%) achieved medium mean scores in gambling severity and psychopathological symptoms; and (c) Cluster 3 (functional; n = 56, 20.0%) obtained the lowest mean scores in gambling severity and in psychopathology, and a personality profile characterized by low levels in novelty seeking, harm avoidance, and self-transcendence, and the highest levels in self-directedness and cooperativeness. DISCUSSION AND CONCLUSIONS This study sheds light on the clinical heterogeneity of women suffering from GD. Identifying the differing features of women with GD is vital to developing prevention programs and personalized treatment protocols for this overlooked population.
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Affiliation(s)
- Roser Granero
- Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Barcelona, Spain,Department of Psychobiology and Methodology of Health Science, Autonomous University of Barcelona, Barcelona, Spain
| | - Fernando Fernández-Aranda
- Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Barcelona, Spain,Department of Psychiatry, Bellvitge University Hospital/IDIBELL, Barcelona, Spain,Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Gemma Mestre-Bach
- Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Barcelona, Spain,Department of Psychiatry, Bellvitge University Hospital/IDIBELL, Barcelona, Spain
| | - Trevor Steward
- Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Barcelona, Spain,Department of Psychiatry, Bellvitge University Hospital/IDIBELL, Barcelona, Spain
| | - Bárbara García-Caro
- Department of Psychobiology and Methodology of Health Science, Autonomous University of Barcelona, Barcelona, Spain
| | - Fulvia Prever
- National Health System Addictions Clinic, Milan, Italy
| | - Belle Gavriel-Fried
- The Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel
| | - Amparo del Pino-Gutiérrez
- Department of Psychiatry, Bellvitge University Hospital/IDIBELL, Barcelona, Spain,Nursing Department of Mental Health, Public Health, Maternal and Child Health, Nursing School, University of Barcelona, Barcelona, Spain
| | - Laura Moragas
- Department of Psychiatry, Bellvitge University Hospital/IDIBELL, 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
| | - Teresa Mena-Moreno
- Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Barcelona, Spain,Department of Psychiatry, Bellvitge University Hospital/IDIBELL, Barcelona, Spain
| | - Virginia Martín-Romera
- Department of Psychobiology and Methodology of Health Science, Autonomous University of Barcelona, Barcelona, Spain
| | - José M. Menchón
- Department of Psychiatry, Bellvitge University Hospital/IDIBELL, Barcelona, Spain,Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain,Ciber de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Barcelona, Spain
| | - Susana Jiménez-Murcia
- Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Barcelona, Spain,Department of Psychiatry, Bellvitge University Hospital/IDIBELL, Barcelona, Spain,Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain,Corresponding author: Susana Jiménez-Murcia; Department of Psychiatry, Bellvitge University Hospital/IDIBELL; Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, c/ Feixa Llarga s/n, 08907, Hospitalet de Llobregat, Barcelona, Spain; Phone: +34 93 260 79 88; Fax: +34 93 260 76 58; E-mail:
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Rodda SN, Manning V, Dowling NA, Lee SJ, Lubman DI. Barriers and Facilitators of Responding to Problem Gambling: Perspectives from Australian Mental Health Services. J Gambl Stud 2018; 34:307-320. [PMID: 28884260 DOI: 10.1007/s10899-017-9713-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Despite high rates of comorbidity between problem gambling and mental health disorders, few studies have examined barriers or facilitators to the implementation of screening for problem gambling in mental health services. This exploratory qualitative study identified key themes associated with screening in mental health services. Semi-structured interviews were undertaken with 30 clinicians and managers from 11 mental health services in Victoria, Australia. Major themes and subthemes were identified using qualitative content analysis. Six themes emerged including competing priorities, importance of routine screening, access to appropriate screening tools, resources, patient responsiveness and workforce development. Barriers to screening included a focus on immediate risk as well as gambling being often considered as a longer-term concern. Clinicians perceived problem gambling as a relatively rare condition, but did acknowledge the need for brief screening. Facilitators to screening were changes to system processes, such as identification of an appropriate brief screening instrument, mandating its use as part of routine screening, as well as funded workforce development activities in the identification and management of problem gambling.
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Affiliation(s)
- S N Rodda
- School of Population Health, University of Auckland, Auckland, New Zealand.,Turning Point, Eastern Health, Fitzroy, Australia.,School of Psychology, Deakin University, Geelong, Australia
| | - V Manning
- Turning Point, Eastern Health, Fitzroy, Australia.,Eastern Health Clinical School, Monash University, Fitzroy, Australia
| | - N A Dowling
- School of Psychology, Deakin University, Geelong, Australia.,Melbourne Graduate School of Education, Melbourne, Australia
| | - S J Lee
- Monash Alfred Psychiatry Research Centre, The Alfred and Monash University Central Clinical School, Melbourne, Australia
| | - D I Lubman
- Turning Point, Eastern Health, Fitzroy, Australia. .,Eastern Health Clinical School, Monash University, Fitzroy, Australia.
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Dowling NA, Merkouris SS, Manning V, Volberg R, Lee SJ, Rodda SN, Lubman DI. Screening for problem gambling within mental health services: a comparison of the classification accuracy of brief instruments. Addiction 2018; 113:1088-1104. [PMID: 29274182 DOI: 10.1111/add.14150] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 10/22/2017] [Accepted: 12/14/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIMS Despite the over-representation of people with gambling problems in mental health populations, there is limited information available to guide the selection of brief screening instruments within mental health services. The primary aim was to compare the classification accuracy of nine brief problem gambling screening instruments (two to five items) with a reference standard among patients accessing mental health services. DESIGN The classification accuracy of nine brief screening instruments was compared with multiple cut-off scores on a reference standard. SETTING Eight mental health services in Victoria, Australia. PARTICIPANTS A total of 837 patients were recruited consecutively between June 2015 and January 2016. MEASUREMENTS The brief screening instruments were the Lie/Bet Questionnaire, Brief Problem Gambling Screen (BPGS) (two- to five-item versions), NODS-CLiP, NODS-CLiP2, Brief Biosocial Gambling Screen (BBGS) and NODS-PERC. The Problem Gambling Severity Index (PGSI) was the reference standard. FINDINGS The five-item BPGS was the only instrument displaying satisfactory classification accuracy in detecting any level of gambling problem (low-risk, moderate-risk or problem gambling) (sensitivity = 0.803, specificity = 0.982, diagnostic efficiency = 0.943). Several shorter instruments adequately detected both problem and moderate-risk, but not low-risk, gambling: two three-item instruments (NODS-CLiP, three-item BPGS) and two four-item instruments (NODS-PERC, four-item BPGS) (sensitivity = 0.854-0.966, specificity = 0.901-0.954, diagnostic efficiency = 0.908-0.941). The four-item instruments, however, did not provide any considerable advantage over the three-item instruments. Similarly, the very brief (two-item) instruments (Lie/Bet and two-item BPGS) adequately detected problem gambling (sensitivity = 0.811-0.868, specificity = 0.938-0.943, diagnostic efficiency = 0.933-0.934), but not moderate-risk or low-risk gambling. CONCLUSIONS The optimal brief screening instrument for mental health services wanting to screen for any level of gambling problem is the five-item Brief Problem Gambling Screen (BPGS). Services wanting to employ a shorter instrument or to screen only for more severe gambling problems (moderate-risk/problem gambling) can employ the NODS-CLiP or the three-item BPGS. Services that are only able to accommodate a very brief instrument can employ the Lie/Bet Questionnaire or the two-item BPGS.
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Affiliation(s)
- Nicki A Dowling
- School of Psychology, Deakin University, Geelong, Australia.,Melbourne Graduate School of Education, University of Melbourne, Australia
| | | | - Victorian Manning
- Turning Point, Eastern Health, Fitzroy, Australia.,Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Rachel Volberg
- School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA, USA
| | - Stuart J Lee
- Monash Alfred Psychiatry Research Centre, The Alfred and Monash University Central Clinical School, Melbourne, Australia
| | - Simone N Rodda
- School of Psychology, Deakin University, Geelong, Australia.,Turning Point, Eastern Health, Fitzroy, Australia.,School of Public Health and Psychosocial Studies, Auckland University of Technology, Auckland, New Zealand
| | - Dan I Lubman
- Turning Point, Eastern Health, Fitzroy, Australia.,Eastern Health Clinical School, Monash University, Melbourne, Australia
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Amphetamine primes enhanced motivation toward uncertain choices in rats with genetic alcohol preference. Psychopharmacology (Berl) 2018; 235:1361-1370. [PMID: 29427080 DOI: 10.1007/s00213-018-4847-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 01/31/2018] [Indexed: 12/21/2022]
Abstract
RATIONALE Comorbidity with gambling disorder (GD) and alcohol use disorder (AUD) is well documented. OBJECTIVE The purpose of our study was to examine the influence of genetic alcohol drinking tendency on reward-guided decision making behavior of rats and the impact of dopamine releaser D-amphetamine on this behavior. METHODS In this study, Alko alcohol (AA) and Wistar rats went through long periods of operant lever pressing training where the task was to choose the profitable of two options. The lever choices were guided by different-sized sucrose rewards (one or three pellets), and the probability of gaining the larger reward was slowly changed to a level where choosing the smaller reward would be the most profitable in the long run. After training, rats were injected (s.c.) with dopamine releaser D-amphetamine (0.3, 1.0 mg/kg) to study the impact of rapid dopamine release on this learned decision making behavior. RESULTS Administration of D-amphetamine promoted unprofitable decision making of AA rats more robustly when compared to Wistar rats. At the same time, D-amphetamine reduced lever pressing responses. Interestingly, we found that this reduction in lever pressing was significantly greater in Wistar rats than in AA rats and it was not linked to motivation to consume sucrose. CONCLUSIONS Our results indicate that conditioning to the lever pressing in uncertain environments is more pronounced in AA than in Wistar rats and indicate that the reinforcing effects of a gambling-like environment act as a stronger conditioning factor for rats that exhibit a genetic tendency for high alcohol drinking.
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Håkansson A, Karlsson A, Widinghoff C. Primary and Secondary Diagnoses of Gambling Disorder and Psychiatric Comorbidity in the Swedish Health Care System-A Nationwide Register Study. Front Psychiatry 2018; 9:426. [PMID: 30258370 PMCID: PMC6143815 DOI: 10.3389/fpsyt.2018.00426] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 08/20/2018] [Indexed: 01/03/2023] Open
Abstract
Background: Psychiatric comorbidity is common in gambling disorder, a condition with low rates of treatment seeking. There is a paucity of documented nationwide data on gambling disorder and its co-occurring psychiatric comorbidities in the health care system. Methods: This is a nationwide register-based study of all patients aged above 18 years who were diagnosed with gambling disorder (corresponding to pathological gambling, code F63.0, in the ICD-10) in Swedish specialized out-patient health care or in-patient care, from 2005 through 2016. All psychiatric disorders co-occurring with the diagnoses were recorded, along with age, gender and the type of medical specialty. Results: A total of 2,099 patients were included (1,784 in out-patient care and 629 patients in in-patient care), among whom 77 percent were men. Treatment uptake during the study period increased significantly in out-patient care, with an increasing uptake of younger individuals, whereas in-patient treatment uptake remained stable. A co-occurring psychiatric diagnosis was registered in 73 percent of patients, more commonly in females (77 vs. 71 percent, p < 0.01). Several diagnostic subgroups were more common in women, with anxiety and affective disorders being the most common subgroups. Prevalence of substance use disorders did not differ with respect to gender. Conclusions: Despite a large gap between probable population prevalence of gambling disorder and the number of treated patients, the number of patients treated in out-patient health care with a gambling disorder diagnosis increased over time, with an increasing treatment uptake in younger individuals. Psychiatric comorbidity is common in gambling disorder patients in the health care system, with a higher prevalence in women.
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Affiliation(s)
- Anders Håkansson
- Department of Clinical Sciences Lund, Psychiatry, Faculty of Medicine, Lund University, Lund, Sweden.,Malmö Addiction Center, Clinical Research Unit, Malmö, Sweden
| | - Anna Karlsson
- Department of Clinical Sciences Lund, Psychiatry, Faculty of Medicine, Lund University, Lund, Sweden.,Malmö Addiction Center, Clinical Research Unit, Malmö, Sweden
| | - Carolina Widinghoff
- Department of Clinical Sciences Lund, Psychiatry, Faculty of Medicine, Lund University, Lund, Sweden.,Malmö Addiction Center, Clinical Research Unit, Malmö, Sweden
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Maremmani AGI, Gazzarrini D, Fiorin A, Cingano V, Bellio G, Perugi G, Maremmani I. 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? Ann Gen Psychiatry 2018; 17:3. [PMID: 29371875 PMCID: PMC5769351 DOI: 10.1186/s12991-018-0173-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 01/03/2018] [Indexed: 12/21/2022] Open
Abstract
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.
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Affiliation(s)
- Angelo G I Maremmani
- Department of Psychiatry, North-Western Tuscany Region Local Health Unit, Versilian Zone, Viareggio, Italy.,Association for the Application of Neuroscientific Knowledge To Social Aims (AU-CNS), Pietrasanta, Italy.,G. De Lisio Institute of Behavioural Sciences, Pisa, Italy
| | | | - Amelia Fiorin
- Drug Addiction Unit, Castelfranco Veneto, Treviso, Italy
| | | | | | - Giulio Perugi
- G. De Lisio Institute of Behavioural Sciences, Pisa, Italy.,5Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Icro Maremmani
- Association for the Application of Neuroscientific Knowledge To Social Aims (AU-CNS), Pietrasanta, Italy.,G. De Lisio Institute of Behavioural Sciences, Pisa, Italy.,6Vincent P. Dole Dual Diagnosis Unit, Department of Specialty Medicine, Santa Chiara University Hospital, University of Pisa, Via Roma, 67, 56100 Pisa, Italy
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The Economic Burden of Pathological Gambling and Co-occurring Mental Health and Substance Use Disorders. J Addict Med 2018; 12:53-60. [DOI: 10.1097/adm.0000000000000363] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Manning V, Dowling N, Lee S, Rodda S, Garfield J, Volberg R, Kulkarni J, Lubman D. Problem gambling and substance use in patients attending community mental health services. J Behav Addict 2017; 6:678-688. [PMID: 29254361 PMCID: PMC6034952 DOI: 10.1556/2006.6.2017.077] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background and aims Relatively little is known about co-occurring gambling problems and their overlap with other addictive behaviors among individuals attending mental health services. We aimed to determine rates of gambling and substance use problems in patients accessing mental health services in Victoria, Australia. Methods A total of 837 adult patients were surveyed about their gambling and administered standardized screening tools for problem gambling and harmful tobacco, alcohol, and drug use. Prevalence of gambling problems was estimated and regression models used to determine predictors of problem gambling. Results The gambling participation rate was 41.6% [95% CI = 38.2-44.9]. The Problem Gambling Severity Index identified 19.7% [CI = 17.0-22.4] as "non-problem gamblers," 7.2% [CI = 5.4-8.9] as "low-risk" gamblers, 8.4% [CI = 6.5-10.2] as "moderate-risk" gamblers, and 6.3% [CI = 4.7-8.0] as "problem gamblers." One-fifth (21.9%) of the sample and 52.6% of all gamblers were identified as either low-risk, moderate-risk, or problem gamblers (PGs). Patients classified as problem and moderate-risk gamblers had significantly elevated rates of nicotine and illicit drug dependence (p < .001) according to short screening tools. Current diagnosis of drug use (OR = 4.31 [CI = 1.98-9.37]), borderline personality (OR = 2.59 [CI = 1.13-5.94]), bipolar affective (OR = 2.01 [CI = 1.07-3.80]), and psychotic (OR = 1.83 [CI = 1.03-3.25]) disorders were significant predictors of problem gambling. Discussion and conclusions Patients were less likely to gamble, but eight times as likely to be classified as PG, relative to Victoria's adult general population. Elevated rates of harmful substance use among moderate-risk and PG suggest overlapping vulnerability to addictive behaviors. These findings suggest mental health services should embed routine screening into clinical practice, and train clinicians in the management of problem gambling.
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Affiliation(s)
- Victoria Manning
- Turning Point, Eastern Health, Melbourne, VIC, Australia,Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia,Corresponding author: Victoria Manning; Turning Point, Eastern Health, 110 Church Street, Richmond 3121, VIC, Australia; Phone: +61 3 8413 8413; Fax: +61 3 9416 3420; E-mail:
| | - Nicki. A. Dowling
- School of Psychology, Deakin University, Geelong, VIC, Australia,Melbourne Graduate School of Education, University of Melbourne, Melbourne, VIC, Australia
| | - Stuart Lee
- Monash Alfred Psychiatry Research Centre, Alfred Health and Monash University Central Clinical School, Melbourne, VIC, Australia
| | - Simone Rodda
- Turning Point, Eastern Health, Melbourne, VIC, Australia,School of Psychology, Deakin University, Geelong, VIC, Australia,School of Population Health, University of Auckland, Auckland, New Zealand
| | - Joshua Benjamin Bernard Garfield
- Turning Point, Eastern Health, Melbourne, VIC, Australia,Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Rachel Volberg
- School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Jayashri Kulkarni
- Monash Alfred Psychiatry Research Centre, Alfred Health and Monash University Central Clinical School, Melbourne, VIC, Australia
| | - Dan Ian Lubman
- Turning Point, Eastern Health, Melbourne, VIC, Australia,Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
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Abstract
The present paper is the third in a series on the evaluation of new tests designed to detect the disordered gambler. The present paper has two objectives. First, the observed variation in test performance between settings and populations is described in general terms and an explanation of the observed variation is presented in terms of what is referred to as spectrum effects. Second the expected variation in test performance between settings and populations is illustrated with several examples and the implications emphasized for the purpose of test evaluation.
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Yakovenko I, Hodgins DC. A scoping review of co-morbidity in individuals with disordered gambling. INTERNATIONAL GAMBLING STUDIES 2017. [DOI: 10.1080/14459795.2017.1364400] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Igor Yakovenko
- School of Public Health, University of Alberta, Edmonton, Canada
| | - David C. Hodgins
- School of Public Health, University of Alberta, Edmonton, Canada
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Abstract
Available evidence suggests that self-help treatments may reduce problem gambling severity but inconsistencies of results across clinical trials leave the extent of their benefits unclear. Moreover, no self-help treatment has yet been validated within a French Canadian setting. The current study therefore assesses the efficacy of a French language self-help treatment including three motivational telephone interviews spread over an 11-week period and a cognitive-behavioral self-help workbook. At-risk and pathological gamblers were randomly assigned to the treatment group (n = 31) or the waiting list (n = 31). Relative to the waiting list, the treatment group showed a statistically significant reduction in the number of DSM-5 gambling disorder criteria met, gambling habits, and gambling consequences at Week 11. Perceived self-efficacy and life satisfaction also significantly improved after 11 weeks for the treatment group, but not for the waiting list group. At Week 11, 13% of participants had dropped out of the study. All significant changes reported for the treatment group were maintained throughout 1, 6 and 12-month follow-ups. Results support the efficacy of the self-help treatment to reduce problem gambling severity, gambling behaviour and to improve overall functioning among a sample of French Canadian problem gamblers over short, medium and long term. Findings from this study lend support to the appropriateness of self-help treatments for problem gamblers and help clarify inconsistencies found in the literature. The low dropout rate is discussed with respect to the advantages of the self-help format. Clinical and methodological implications of the results are put forth.
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Rodriguez-Monguio R, Errea M, Volberg R. Comorbid pathological gambling, mental health, and substance use disorders: Health-care services provision by clinician specialty. J Behav Addict 2017; 6:406-415. [PMID: 28856904 PMCID: PMC5700728 DOI: 10.1556/2006.6.2017.054] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background and aims Pathological gambling (PG) is an impulse control disorder. This study assessed the burden of co-occurring behavioral addictions and mental health disorders in treatment-seeking patients and estimated the likelihood of receiving care for these disorders by clinician specialty. Methods Study data were derived from the Massachusetts All-Payer Claims Database, a representative database, for the period 2009-2013. The sample included commercially insured adult residents of Massachusetts. Univariate and multivariate logistic regressions were used to estimate the likelihood of provision of care by clinician specialty adjusting for patient's demographic characteristics and level of care. Bonferroni correction was applied to adjust for multiple testing. Results The study sample included 869 patients. Treatment-seeking patients who had a diagnosis of PG were mostly males (71%), aged 45-54 years (26.7%) and enrolled in a health maintenance organization (47%). The most prevalent co-occurring disorders among patients with PG as principal diagnosis were anxiety disorders (28%), mood disorders (26%), and substance use disorders (18%). PG was associated with a more than twofold likelihood of receiving care from social workers and psychologists (p < .05). Depressive disorders were associated with a three times greater likelihood of receiving care from primary care physicians (PCPs) (p < .05). Having three and four or more diagnosis was associated with a greater likelihood of receiving care from PCPs. Discussion and conclusions Psychiatric and substance use disorders are prevalent among treatment-seeking pathological gamblers. The likelihood of receiving care from specialty clinicians significantly varies by clinical diagnosis and patient clinical complexity.
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Affiliation(s)
- Rosa Rodriguez-Monguio
- School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, USA,Corresponding author: Rosa Rodriguez-Monguio, PhD, MS; School of Public Health and Health Sciences, University of Massachusetts Amherst, 715 N. Pleasant Street, 322 Arnold House, Amherst, MA 01003, USA; Phone: +1 413 545 7427; E-mail:
| | - Maria Errea
- School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Rachel Volberg
- School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, USA
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Rawat V, Greer N, Langham E, Rockloff M, Hanley C. What is the harm? Applying a public health methodology to measure the impact of gambling problems and harm on quality of life. JOURNAL OF GAMBLING ISSUES 2017. [DOI: 10.4309/jgi.2017.36.2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
While the PGSI is indeed an established index of problem-gambling symptoms, it nevertheless does not quantify the degree of harm experienced by individuals at different points on the spectrum of gambling problems. The purpose of the present study was to establish the relationship between the PGSI category and health-related quality of life (HRQoL) decrements using a population health (PH) method. Harms reported by gamblers and affected others across the PGSI spectrums were transformed into 798 vignettes. A general population panel (N=786) and experts who work with gamblers (N=51) rated the impact of these vignette descriptions on quality of life using the Time Trade-Off task, and a Visual Analogue Scale incorporating 27 comparison conditions. Disability weights (DW) were then estimated for different levels of gambling symptoms. A DW of 0.44 was estimated for problem gamblers (PG), suggesting a reduction in the effective enjoyment of life by over 4 years for every 10 years in lifespan. Lower—but non-negligible—DWs of .14 and .29 were determined for low- and moderate-risk gamblers. Gambling is compared with a number of other conditions with respect to HRQoL impact. On average, PG harm appears to be similar to that of a manic episode of bipolar disorder and severe alcohol abuse disorder. We discuss advantages, and methodological challenges, in applying PH methods to measuring the severity of gambling problems in terms of HRQoL.Bien que l'indice du jeu excessif (PGSI) soit en effet un indice établi des symptômes liés aux problèmes de jeu, il ne quantifie pas le niveau de préjudice subi par les personnes situées à différents points sur le spectre des problèmes de jeu. Le but de l'étude a été d’établir la relation entre la catégorie PGSI et les écarts à la baisse en lien avec la qualité de vie liée à la santé (QVLS) en utilisant une méthode de santé de la population. Les torts signalés par les joueurs et les personnes touchées dans le spectre PGSI ont été transformés en 798 vignettes. Un groupe de population en général (N = 786) et des experts qui travaillent avec des joueurs compulsifs (N = 51) ont évalué l’incidence de ces descriptions de vignette sur la qualité de vie à l’aide de la tâche Time Trade-Off (marchandage de temps) et une échelle visuelle analogue intégrant 27 conditions de comparaison. Les poids d’incapacité (DW) ont ensuite été estimés pour différents niveaux de symptômes du jeu. Un DW de 0,44 a été estimé pour les joueurs compulsifs, ce qui laisse supposer une diminution de la jouissance réelle de la vie de plus de 4 ans pour chaque tranche de vie de 10 ans. Les DW inférieurs, mais non négligeables, de 0,14 et 0,29 ont été déterminés pour les joueurs à risque faible et modéré. Le jeu est comparé à un certain nombre d’autres conditions en ce qui concerne l’incidence de la qualité de vie liée à la santé (QVLS). En moyenne, le préjudice causé par un joueur compulsif s'apparente à celui d’un épisode maniaque de trouble bipolaire et d’un trouble sévère d’abus d’alcool. Nous discutons des avantages et des défis méthodologiques, en appliquant des méthodes de santé de la population pour mesurer la gravité des problèmes de jeu en termes de QVLS.
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