1
|
Pfund RA, Ginley MK, Kim HS, Boness CL, Horn TL, Whelan JP. Cognitive-behavioral treatment for gambling harm: Umbrella review and meta-analysis. Clin Psychol Rev 2023; 105:102336. [PMID: 37717456 PMCID: PMC11059187 DOI: 10.1016/j.cpr.2023.102336] [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] [Received: 06/13/2023] [Revised: 08/16/2023] [Accepted: 09/07/2023] [Indexed: 09/19/2023]
Abstract
The aim of the current umbrella review and meta-analysis was to evaluate the methodological rigor of existing meta-analyses on cognitive-behavioral treatment (CBT) for gambling harm. The Cochrane Database of Systematic Reviews, PsycINFO, and PubMed were searched for meta-analyses of CBT for gambling harm among individuals aged 18 years and older. The search yielded five meta-analyses that met inclusion criteria, representing 56 unique studies and 5389 participants. The methodological rigor for one meta-analyses was rated high, two were moderate, and two were critically low. Including only moderate- to high-quality meta-analyses, a robust variance estimation meta-analysis indicated that CBT significantly reduced gambling disorder severity (g = -0.91), gambling frequency (g = -0.52), and gambling intensity (g = -0.32) relative to minimal and no treatment control at posttreatment, suggesting 65%-82% of participants receiving CBT will show greater reductions in these outcomes than minimal or no treatment controls. Overall, there is strong evidence for CBT in reducing gambling harm and gambling behavior, and this evidence provides individuals, clinicians, managed care companies, and policymakers with clear recommendations about treatment selection.
Collapse
Affiliation(s)
- Rory A Pfund
- Tennessee Institute for Gambling Education & Research, USA; Department of Psychology, University of Memphis, USA.
| | - Meredith K Ginley
- Tennessee Institute for Gambling Education & Research, USA; Department of Psychology, East Tennessee State University, USA
| | - Hyoun S Kim
- Department of Psychology, Toronto Metropolitan University, Canada
| | - Cassandra L Boness
- Center on Alcohol, Substance use, And Addictions, University of New Mexico, USA
| | - Tori L Horn
- Tennessee Institute for Gambling Education & Research, USA; Department of Psychology, University of Memphis, USA
| | - James P Whelan
- Tennessee Institute for Gambling Education & Research, USA; Department of Psychology, University of Memphis, USA
| |
Collapse
|
2
|
Pfund RA, Forman DP, Whalen SK, Zech JM, Ginley MK, Peter SC, McAfee NW, Whelan JP. Effect of cognitive-behavioral techniques for problem gambling and gambling disorder: A systematic review and meta-analysis. Addiction 2023; 118:1661-1674. [PMID: 37381589 PMCID: PMC10524575 DOI: 10.1111/add.16221] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 04/14/2023] [Indexed: 06/30/2023]
Abstract
AIMS To measure the effect of cognitive-behavioral techniques (CBTs) on gambling disorder severity and gambling behavior at post-treatment and follow-up. METHOD Seven databases and two clinical trial registries were searched to identify peer-reviewed studies and unpublished studies of randomized controlled trials. The Cochrane Risk of Bias tool assessed risk of bias in the included studies. A random effect meta-analysis with robust variance estimation was conducted to measure the effect of CBTs relative to minimally treated or no treatment control groups. RESULTS Twenty-nine studies representing 3991 participants were identified. CBTs significantly reduced gambling disorder severity (g = -1.14, 95% CI = -1.68, -0.60, 95% prediction interval [PI] = -2.97, 0.69), gambling frequency (g = -0.54, 95% CI = -0.80, -0.27, 95% PI = -1.48, 0.40) and gambling intensity (g = -0.32, 95% CI = -0.51, -0.13, 95% PI = -0.76, 0.12) at post-treatment relative to control. CBTs had no significant effect on follow-up outcomes. Analyses supported the presence of publication bias and high heterogeneity in effect size estimates. CONCLUSIONS Cognitive-behavioral techniques are a promising treatment for reducing gambling disorder and gambling behavior; however, the effect of cognitive-behavioral techniques on gambling disorder severity and gambling frequency and intensity at post-treatment is overestimated, and cognitive-behavioral techniques may not be reliably efficacious for all individuals seeking treatment for problem gambling and gambling disorder.
Collapse
Affiliation(s)
- Rory A Pfund
- Department of Psychology, The University of Memphis, Memphis, Tennessee, USA
- Tennessee Institute for Gambling Education & Research, Tennessee, USA
| | - David P Forman
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Shelby K Whalen
- Department of Psychology, East Tennessee State University, Johnson City, Tennessee, USA
| | - James M Zech
- Department of Counseling and Clinical Psychology, Columbia University, New York, New York, USA
| | - Meredith K Ginley
- Tennessee Institute for Gambling Education & Research, Tennessee, USA
- Department of Psychology, East Tennessee State University, Johnson City, Tennessee, USA
| | | | - Nicholas W McAfee
- Department of Psychiatry, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - James P Whelan
- Department of Psychology, The University of Memphis, Memphis, Tennessee, USA
- Tennessee Institute for Gambling Education & Research, Tennessee, USA
| |
Collapse
|
3
|
The Mediating Role of Psychological Distress in Excessive Gambling among Young People: A Four-Country Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136973. [PMID: 34209896 PMCID: PMC8297312 DOI: 10.3390/ijerph18136973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/17/2021] [Accepted: 06/24/2021] [Indexed: 12/02/2022]
Abstract
Background and aims: Loneliness and a low sense of mastery are associated with excessive gambling, but the underlying processes of these relationships remain unstudied. Because psychological distress can increase vulnerability to excessive gambling, we investigated its mediating role in these relationships among young people. To meet the need for cross-country research, we also observed how these relationships occur in four countries with different cultures. Design, setting, and participants: Demographically balanced cross-sectional survey data were collected from 15–25-year-olds in Finland (n = 1200; 50% male), the United States (n = 1212; 49.8% male), South Korea (n = 1192; 49.6% male), and Spain (n = 1212; 51.2% male). Measurements: Excessive gambling was measured with the South Oaks Gambling Screen, psychological distress was assessed with the 12-item General Health Questionnaire, loneliness was measured with the three-item Loneliness Scale, and low sense of mastery was assessed with the Pearlin Mastery Scale. Associations were examined first using zero-inflated negative binomial regression analyses with excessive gambling as the outcome. In addition, path analyses were performed to study how loneliness and low sense of mastery relate to excessive gambling, with psychological distress as the mediating variable. Findings: Loneliness and low sense of mastery were associated indirectly with excessive gambling via psychological distress in all country samples. Low sense of mastery was also directly associated with excessive gambling. There was a direct association between loneliness and excessive gambling only in samples from South Korea and Spain. Conclusions: Psychological distress is an important factor in understanding how loneliness and sense of mastery relate to gambling.
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Zhai ZW, Hoff RA, Magruder CF, Steinberg MA, Wampler J, Krishnan-Sarin S, Potenza MN. Weapon-carrying is associated with more permissive gambling attitudes and perceptions and at-risk/problem gambling in adolescents. J Behav Addict 2019; 8:508-521. [PMID: 31505965 PMCID: PMC7044628 DOI: 10.1556/2006.8.2019.42] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND AND AIMS A recent call to action highlighted the need to understand the relationship between problem gambling, violence, and health/functioning. As weapon-carrying and gambling behaviors are prevalent in adolescents, this study systematically examined relationships between weapon-carrying status and measures of problem gambling severity and gambling perceptions and attitudes, as well as how weapon-carrying status moderated relationships between problem gambling severity and measures of health/functioning and gambling behavior. METHODS Participants were 2,301 Connecticut high-school adolescents. χ2 and logistic regression models were conducted. RESULTS Weapon-carriers reported greater problem gambling severity, more permissive gambling perceptions, greater parental approval of gambling, and more family gambling concerns, compared to non-weapon-carriers. At-risk/problem gambling was more strongly associated with family, peers, and adult gambling partners among non-weapon-carriers (vs. weapon-carriers) and with machine gambling among weapon-carriers (vs. non-weapon-carriers). DISCUSSION AND CONCLUSIONS Greater problem gambling severity and more permissive gambling perceptions and perceived parental approval of gambling in weapon-carrying adolescents suggest that parent-child relationships are important to be considered in prevention efforts. The moderated relationship by weapon-carrying status between problem gambling severity and gambling partners suggests a problem gambling risk group that may be less linked to gambling with traditional social support groups, and this group may benefit from targeted interventions.
Collapse
Affiliation(s)
- Zu Wei Zhai
- Department of Psychology, Middlebury College, Middlebury, VT, USA
| | - Rani A. Hoff
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | | | | | - Jeremy Wampler
- Department of Mental Health and Addiction Services, Problem Gambling Services, Middletown, CT, USA
| | | | - Marc N. Potenza
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA,The Connecticut Council on Problem Gambling, Wethersfield, CT, USA,The Connecticut Mental Health Center, New Haven, CT, USA,Department of Neuroscience and Child Study Center, Yale School of Medicine, New Haven, CT, USA,Corresponding author: Marc N. Potenza, MD, PhD; Connecticut Mental Health Center, 34 Park Street, New Haven, CT 06519, USA; Phone: +1 203 974 7356; Fax: +1 203 974 7366; E-mail:
| |
Collapse
|
6
|
Pullman RE, Potenza MN, Kraus SW. Recommendations for increasing research on co-occurring serious mental illness and gambling problems. J Behav Addict 2018; 7:897-899. [PMID: 30418072 PMCID: PMC6376370 DOI: 10.1556/2006.7.2018.104] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Psychiatric disorders frequently co-occur with gambling disorder. Although community and clinical samples show frequent co-occurrence between gambling and psychotic disorders, relatively little research has been conducted on this population. Here, we comment on a recent study conducted in Brazil on the clinical correlates of psychotic disorders in treatment-seeking individuals with gambling disorder, relate the findings to those from the northeastern region of the United States, and discuss implications with respect to promoting responsible gambling in the setting of the expansion of legalized gambling.
Collapse
Affiliation(s)
- Rebecca E. Pullman
- Mental Health Service Line, Manchester VA Medical Center, Manchester, NH, USA
| | - Marc N. Potenza
- Departments of Psychiatry and Neuroscience, 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
| | - Shane W. Kraus
- VISN 1 New England MIRECC, Edith Nourse Rogers Memorial VA Hospital, Bedford, MA, USA,Division of Addiction Psychiatry, Department of Psychiatry, University of Massachusetts Medical Psychology, Worcester, MA, USA,Corresponding author: Shane W. Kraus, PhD; VISN 1 New England MIRECC, Edith Nourse Rogers Memorial Veterans Hospital, 200 Spring Road, Building 5, Room 135B, Bedford 01730, MA, USA; Phone: +1 781 687 2000 ext. 5001; Fax: +1 781 687 3228; E-mail:
| |
Collapse
|