Gambling Symptom Assessment Scale Research Articles

Silymarin (Milk Thistle) Treatment of Adults With Gambling Disorder: A Double-Blind, Placebo-Controlled Trial.

Data on the pharmacological treatment of gambling disorder are limited. Silymarin (derived from milk thistle) has antioxidant properties. The goal of the current study was to determine the efficacy and tolerability of silymarin in adults with gambling disorder. Forty-three individuals (18 [41.9%] women; mean age=49.61 [±13.1] years) with gambling disorder entered an 8-week, double-blind, placebo-controlled study. Dosing of silymarin ranged from 150 to 300 mg twice a day. The primary outcome measure was the Yale Brown Obsessive Compulsive Scale Modified for Pathological Gambling (PG-YBOCS). Secondary outcome measures comprised the Gambling Symptom Assessment Scale and measures of depression and anxiety. Outcomes were examined using mixed-effect models. Silymarin did not statistically differentiate from the placebo on any of the outcome measures of interest, in terms of treatment group×time interactions. There was a robust response in the placebo group (57% reduction on the PG-YBOCS), and on average there was a 56% reduction in YBOCS score for the milk thistle. The findings of this study do not support the use of silymarin/milk thistle in the treatment of gambling disorder but highlight the large placebo response seen in gambling disorder. Treatment interventions for gambling disorder need to better understand and address the placebo response. ClinicalTrials.gov identifier: NCT02337634.

Validation of a Spanish Adaptation of the Gambling Symptom Assessment Scale (G-SAS) in Persons with Recent History of Gambling

Gambling is becoming increasingly frequent and problematic, especially due to the explosion of online alternatives. Evaluating the severity of gambling symptomatology is therefore more important than ever. However, innovations in the gambling field have generally focused on its treatment rather than its evaluation. The Gambling Symptom Assessment Scale (G-SAS) is a well-established measure of gambling-related symptomatology (e.g., gambling urges, gambling-related thoughts and behaviours, and interpersonal functioning). The aim of this study is to validate a Spanish adaptation of the G-SAS so that individual differences in gambling symptomatology can be assessed by clinicians and researchers. The internal structure of the G-SAS was investigated using an exploratory factor analysis with a sample of 364 individuals from the general population in Spain (mean age = 28.84 years, SD = 11.73; 54% males). A four-factor structure was preferred considering fit indices (Chi-square = 22.62, p = .162, RMSEA = 0.030, CFI = 0.998, TLI = 0.995) and internal consistency estimates (0.67 ≤ α ≤ 0.89). The factors were labelled gambling-related symptoms, control of gambling urges/thoughts, interference, and arousal. Regarding construct validity, the four factors of the G-SAS were positively and significantly (all p < .001) correlated with measures of problematic gambling severity (0.40 ≤ r ≤ .73), problematic gambling diagnostic (0.40 ≤ r ≤ .67), gambling cognitions (0.48 ≤ r ≤ .57), impulsivity (0.26 ≤ r ≤ .42), anxiety (0.22 ≤ r ≤ .38), and depression (0.16 ≤ r ≤ .42), and negatively with quality of life (-0.24 ≤ r≤-.42). In sum, this study provides Spanish clinicians and researchers with a tool that serves to assess the status of individuals in relation to gambling symptomatology, which can be used to screen for at-risk profiles and evaluate treatment response.

Relationships of Problematic Internet Use, Online Gaming, and Online Gambling with Depression and Quality of Life Among College Students

Young adults on college campuses have easy access to information and communications technology (ICT) which they use extensively for study, work, and leisure. The purpose of this study was to investigate the prevalence and extent of problematic Internet use, online gaming behavior, and online gambling behavior (together referred to as dysfunctional online behaviors), and their relationships with depression and quality of life among college students. Two hundred and twenty two valid surveys were used in the data analyses. Five instruments, Beck Depression Inventory-II (BDI-II), the WHO Quality of Life Scale-BREF (WHOQOL-BREF), the Internet Addiction Test (IAT), the Problematic Online Gaming Questionnaire (POGQ), and the Online Gambling Symptom Assessment Scale (OGSAS), were selected to measure the variables being studied. A non-experimental research design was employed to answer one descriptive and two research questions. The results of the analyses indicated that dysfunctional online behaviors predicted a higher level of depression (R2 = .14, p &lt; .05) and a lower level of quality of life (R2 = .20, p &lt; .05). The findings of the current study inform clinical practice and the treatment of dysfunctional online behaviors among college students.

Efficacy of Cognitive Behaviour Therapy in Gambling Disorder (A Case study)

Context: Gambling disorder is a mental health condition in which a person repeatedly engages in gambling behaviour despite various negative consequences. The condition is also known as gambling addiction, pathological gambling or compulsive gambling. Recent studies have demonstrated the efficacy of Cognitive Behaviour Therapy in treating gambling disorder. Aim: In the present study, the efficacy of cognitive behaviour therapy in treatment of an adult patient with gambling disorder was examined. Settings and Designs: A single case design with pre- and post-assessments on clinician-rated scales were adopted. Materials and Methods: Fourteen bi-weekly sessions of Cognitive Behaviour Therapy were conducted on an inpatient basis. Assessments were carried out on Gambling Symptom Assessment Scale and Hamilton Anxiety Rating Scale, at pre- and post-therapy points. Analysis: Pre- and post-therapy changes were examined using the method of clinical significance. Results: A significant decline was seen on the Gambling Symptom Assessment Scale, and Hamilton Anxiety Rating Scale Conclusion: Application of CBT was effective in treating the anxiety, and gambling symptoms in the patient with Gambling Disorder

Intranasal as needed naloxone in the treatment of gambling disorder: A randomised controlled trial

BackgroundGambling disorder (GD) is a global phenomenon affecting millions of people. GD can result in severe social and financial difficulties and efficacious treatments are warranted. Psychosocial treatments form the basis of treatment. Opioid antagonists (OAs) have however shown promise in previous studies. In a recent imaging study intranasal naloxone was found to rapidly and fully occupy brain μ-opioid receptors. This trial investigates the effect and safety of as needed naloxone in the treatment of gambling disorder. MethodsThis was a 12-week double blind, randomised control trial comparing intranasal naloxone to placebo. The primary endpoint was gambling urge measured by the Gambling symptom Assessment Scale (G-SAS). Secondary outcome measures were gambling severity measures (PGSI) as well as quality of life (WHO:EUROHIS-8), alcohol consumption (AUDIT), depression (MARDS) and internet use (IDS-9SF). In addition, safety of treatment was assessed. Both treatment groups received psychosocial support. Results126 participants were randomised to treatment groups in a 1:1 ratio. 106 patients completed the study. Gambling urge (GSAS) and other gambling related measured improved in both groups, but no statistically significant difference could be found. Intranasal naloxone was well tolerated, no subjects discontinued the study due to adverse events. No serious adverse drug reactions were observed. ConclusionsThis study found no difference between the as-needed administration of intranasal naloxone and placebo in reducing gambling urge in persons with GD. Intranasal naloxone was safe and well tolerated.

Gambling disorder (GD) in youth with borderline personality disorder: Understanding comorbidity

IntroductionEpidemiological data suggest that in youth the prevalence of co-occurring borderline personality disorder (BPD) is particularly high in people with gambling disorder (GD).ObjectivesThe objective of this study was to investigate clinical presentations of GD in youth patients with BPD.MethodsClinical psychopathological interview, SCID-II, The Gambling Symptom Assessment Scale (G-SAS), Hamilton Depression Rating Scale (HDRS), Zung Anxiety Rating Scale (ZARS). Sample: N=65 male and female, age: 18-25 with GD and BPD.ResultsGD clinical presentation in BPD patients in youth have age and individual specific signs, like polymorphism and high conjugacy with comorbid mental disorders (including, but not limited to MDD, OCD, anxiety disorders, body dysmorphic disorder and etc.) Types of GD in BPD varied due to these comorbid syndrome: 1. Subjects with GD, BPD and MDD in youth demonstrated severity progression in anticipatory tension emotional distress (mental pain, shame, guilt) and lower level in pleasure on winning the bet (G-SAS:SD/Mean 35± 3). 2. Group with OCR and Anxiety Disorders showed different profile: urges to gamble and emotional distress dominated here (G-SAS SD/Mean 32.5± 1). 3. Individuals with no clear co-occurring clinical syndromes revealed combination low level control thoughts of gambling with much excitement and pleasure on winning the bet (G-SAS:SD/Mean 41.2± 2).ConclusionsOur research provides further insight on GD structure in youth BPD patients with comorbid psychiatric syndromesDisclosureNo significant relationships.

Assessment of the Effectiveness of Group Cognitive Behavioural Therapy in Reducing Pathological Gambling.

Pathological gambling is a developmental disorder usually associated with a continuous loss of control over gambling; it also involves a preoccupation with gambling and with obtaining money for the same purpose of gambling, irrational thinking, and a continuation of the behaviour despite being aware of its adverse consequences. This study examined the effectiveness of group cognitive-behavioural therapy (GCBT) on pathological gambling among Nigerian students. The study used a group randomised controlled trial design to assign participants to intervention and control groups. A total of 40 undergraduate students, aged 18-30, were classified as pathological gamblers (participants) in this study. Participants completed self-report scales titled South oaks gambling screen and Gambling Symptom Assessment Scale at three-time points. The intervention lasted for 8weeks. The data collected were statistically analysed using repeated-measures ANOVA. Results revealed that GCBT has a significant effect in decreasing the symptoms of pathological gambling among the participants in GCBT compared to those in the control group and that the improvements were maintained at follow-up. The study concluded that group cognitive-behavioural therapy is impactful therapy in reducing pathological gambling among students. It has also validated the effectiveness of cognitive-behavioural therapy in altering erroneous thoughts and replacing it with a better alternative realistic way of thinking.

Examining Change in Self-Reported Gambling Measures Over Time as Related to Socially Desirable Responding Bias.

Socially desirable responding is a response bias that can affect the accuracy of self-reports. It is especially likely when questions address sensitive topics, such as gambling attitudes, problems and behaviours. A sample of 321 participants were recruited from Amazon's mTurk crowdsourcing platform for a randomized controlled trial investigating an online gambling intervention. Data from this study was used to examine the influence of socially desirable responding on gambling self-report measures over time. At baseline, self-deception (SD), a factor of socially desirable responding, was significantly higher among males than females and among those with household incomes greater than $20,000 per year. Controlling for demographic variability, mixed effects models examining the relationship between socially desirable responding factors [SD and impression management (IM)] and time were conducted. Among males, there were significant interactions between IM with the NORC DSM-IV screen for gambling problems (NODS) and the gambling symptom assessment scale (G-SAS) scores respectively, over time. In other words, males with higher IM scores, demonstrated less change in NODS and G-SAS scores from baseline to 6-month follow-up compared to males with lower IM scores. There were no significant interactions in any models among females or among the full sample. Controlling the well-documented effect of socially desirable responding on self-reported measures in addictions research should be considered as a method to help reduce error and improve validity. Future research should continue to examine the effect of this bias on gambling measures over time and in each gender.Trial registration: https://ClinicalTrials.gov/NCT03124589 , registered 19 January 2017.

Unguided Chatbot-Delivered Cognitive Behavioural Intervention for Problem Gamblers Through Messaging App: A Randomised Controlled Trial.

Internet-delivered intervention may be an acceptable alternative for the more than 90% of problem gamblers who are reluctant to seek face-to-face support. Thus, we aimed to (1) develop a low-dropout unguided intervention named GAMBOT integrated with a messaging app; and (2) investigate its effect. The present study was a randomised, quadruple-blind, controlled trial. We set pre-to-post change in the Problem Gambling Severity Index (PGSI) as the primary outcome and pre-to-post change in the Gambling Symptom Assessment Scale (G-SAS) as a secondary outcome. Daily monitoring, personalised feedback, and private messages based on cognitive behavioural theory were offered to participants in the intervention group through a messaging app for 28days (GAMBOT). Participants in the control group received biweekly messages only for assessments for 28days (assessments only). A total of 197 problem gamblers were included in the primary analysis. We failed to demonstrate a significant between-group difference in the primary outcome (PGSI -1.14, 95% CI -2.75 to 0.47, p = 0.162) but in the secondary outcome (G-SAS -3.14, 95% CI -0.24 to -6.04, p = 0.03). Only 6.7% of the participants dropped out during follow-up and 77% of the GAMBOT group participants (74/96) continued to participate in the intervention throughout the 28-day period. Integrating intervention into a chatbot feature on a frequently used messaging app shows promise in helping to overcome the high dropout rate of unguided internet-delivered interventions. More effective and sophisticated contents delivered by a chatbot should be sought to engage over 90% of problem gamblers who are reluctant to seek face-to-face support.

Manaaki \u2013 a cognitive behavioral therapy mobile health app to support people experiencing gambling problems: a randomized control trial protocol

BackgroundThe low utilisation of current treatment services by people with gambling problems highlights the need to explore new modalities of delivering treatment interventions. This protocol presents the design of a pragmatic randomized control trial aimed at assessing the effectiveness and acceptability of cognitive behavioral therapy (CBT) delivered via a mobile app for people with self-reported gambling problems.MethodsAn innovative CBT mobile app, based on Deakin University’s GamblingLess online program, has been adapted with end-users (Manaaki). Six intervention modules have been created. These are interwoven with visual themes to represent a journey of recovery and include attributes such as avatars, videos, and animations to support end-user engagement. An audio facility is used throughout the app to cater for different learning styles. Personalizing the app has been accomplished by using greetings in the participant’s language and their name (e.g. Kia ora Tāne) and by creating personalized feedback.A pragmatic, randomized control two-arm single-blind trial, will be conducted in New Zealand. We aim to recruit 284 individuals. Eligible participants are ≥18 years old, seeking help for their gambling, have access to a smartphone capable of downloading an app, able to understand the English language and are willing to provide follow-up information at scheduled time points. Allocation is 1:1, stratified by ethnicity, gender, and gambling symptom severity based on the Gambling Symptom Assessment Scale (G-SAS). The intervention group will receive the full mobile cognitive behavioural programme and the waitlist group will receive a simple app that counts down the time left before they have access to the full app and the links to the data collection tools. Data collection for both groups are: baseline, 4-, 8-, and 12-weeks post-randomisation. The primary outcome is a change in G-SAS scores. Secondary measures include changes in gambling urges, frequency, expenditure, and readiness to change. Indices of app engagement, utilisation and acceptability will be collected throughout the delivery of the intervention.DiscussionIf effective, this study will contribute to the improvement of health outcomes for people experiencing gambling problems and have great potential to reach population groups who do not readily engage with current treatment services.Ethics approvalNZ Health and Disability Ethics Committee (Ref: 19/STH/204)Trial registrationAustralian New Zealand Clinical Trial Registry (ANZCTRN 12619001605189) Registered 1 November 2019.

Enhancing the utility of the problem gambling severity index in clinical settings: Identifying refined categories within the problem gambling category

BackgroundThe Problem Gambling Severity Index (PGSI) was intended for use in epidemiological research with gamblers across the continuum of risk. Its utility within clinical settings, where the majority of clients are problem gamblers, has been brought into question. Aims(1) Identify refined categories for the problem gambling category of the PGSI in help-seeking gamblers; (2) Validate these categories using the Gambling Symptom Assessment Scale (G-SAS); (3) Explore the relationship of these categories with indices of gambling and help-seeking behaviour. MethodsSecondary data analysis of help-seeking problem gamblers from the Australian online gambling counselling/support service (Gambling Help Online [GHO]) from October 2012 to December 2015 (n = 5,881) and trial data evaluating an Australian online self-directed program for gambling (GamblingLess; n = 198). Both datasets included the PGSI, gambling frequency and expenditure. The GamblingLess dataset also included the G-SAS and help-seeking behaviour. ResultsA Latent Class Analysis, using GHO data, identified a 2-class solution. Multiple analytical methods identified a cut-off value of ≥ 19 distinguishing this 2-class solution (low problem severity: Median = 16; high problem severity: Median = 23). High problem severity gamblers had increased odds of being categorised in the higher GSAS category, greater gambling expenditure and having sought face-to-face support. The refined categories were not associated with gambling frequency, distance-based or self-directed help-seeking. ConclusionThese findings are consistent with a stepped-care approach, whereby individuals with higher severity may be better suited to more intensive interventions and individuals with lower severity could commence with less intensive interventions and step-up to intensive interventions.

Efficacy of a web-based self-help tool to reduce problem gambling in Switzerland: study protocol of a two-armed randomised controlled trial

IntroductionThe past-year prevalence of problem gambling worldwide averages 2.3%. Switzerland exhibits a slightly lower past-year prevalence rate, of 1.1%, among adults. Only a minority of these adults attend outpatient treatment....

Clinical Improvements in Comorbid Gambling/Cocaine Use Disorder (GD/CUD) Patients Undergoing Repetitive Transcranial Magnetic Stimulation (rTMS).

(1) Background: Pathological gambling behaviors may coexist with cocaine use disorder (CUD), underlying common pathogenic mechanisms. Repetitive transcranial magnetic stimulation (rTMS) has shown promise as a therapeutic intervention for CUD. In this case series, we evaluated the clinical effects of rTMS protocol stimulating the left dorsolateral prefrontal cortex (DLPFC) on the pattern of gambling and cocaine use. (2) Methods: Gambling severity, craving for cocaine, sleep, and other negative affect symptoms were recorded in seven patients with a diagnosis of gambling disorder (South Oaks Gambling Screen (SOGS) >5), in comorbidity with CUD, using the following scales: Gambling-Symptom Assessment Scale (G-SAS), Cocaine Craving Questionnaire (CCQ), Beck Depression Inventory-II (BDI-II), Self-rating Anxiety Scale (SAS), and Symptoms checklist-90 (SCL-90). The measures were assessed before the rTMS treatment and after 5, 30, and 60 days of treatment. Patterns of gambling and cocaine use were assessed by self-report and regular urine screens. (3) Results: Gambling severity at baseline ranged from mild to severe (mean ± Standard Error of the Mean (SEM), G-SAS score baseline: 24.42 ± 2.79). G-SAS scores significantly improved after treatment (G-SAS score Day 60: 2.66 ± 1.08). Compared to baseline, consistent improvements were significantly seen in craving for cocaine and in negative-affect symptoms. (4) Conclusions: The present findings provide unprecedent insights into the potential role of rTMS as a therapeutic intervention for reducing both gambling and cocaine use in patients with a dual diagnosis.

Factor structure and validation of the Japanese version of the Gambling Symptom Assessment Scale (GSAS-J)

The Gambling Symptom Assessment Scale (GSAS) is a 12-item self-rated measure designed to assess gambling symptoms. This study was designed to translate the GSAS into Japanese and to examine the factor structure and validity of the Japanese version of the GSAS (GSAS-J) for a Japanese sample population. We examined the measurement invariance in the GSAS-J between a probable disordered and a non-disordered gambling sample. Seven hundred and seven participants (380 men, 327 women; mean age = 48.41, SD = 10.79) living in Japan were recruited online and included in the analyses. Confirmatory factor analysis results indicated that the GSAS-J factor structure (one-factor structure model) was appropriate for the data (χ2(48) = 195.49, p &lt; .05; CFI = .927; RMSEA = .066; SRMR = .036). Results of multi-group confirmatory factor analysis indicated that the GSAS-J demonstrated strong factorial invariance between probable disordered gamblers and non-disordered gamblers. The Cronbach a coefficient was .96 for the total scale. Good concurrent validity was found for the GSAS-J in relation with other variables: the Kruskal-Wallis H test showed severe and extreme gamblers spent more days and much more money than those of moderate or mild gamblers, and the GSAS-J was significantly correlated with South Oaks Gambling Screen (r = .57), Gambling Related Cognitions Scale (r = .71), and Gambling Urge Scale (r = .72). Furthermore, t-test results indicated significant gender differences in GSAS-J scores. These results indicate GSAS-J is a valid measure for assessing gambling symptoms in Japanese sample populations.Résumé La Gambling Symptom Assessment Scale (GSAS) (échelle d’évaluation des symptômes du jeu pathologique) est une mesure d’auto-évaluation en 12 points, conçue pour évaluer les symptômes du jeu. Cette étude visait à traduire le GSAS en japonais et à examiner la structure factorielle et la validité de la version japonaise du GSAS (GSAS-J) pour un échantillon de population japonaise. Nous avons examiné l’invariance des mesures du GSAS-J entre un échantillon de jeu problématique probable et un échantillon de jeu non problématique. Sept-cent-sept participants (380 hommes, 327 femmes; âge moyen = 48,41, SD = 10,79) vivant au Japon ont été recrutés en ligne et inclus dans les analyses. Les résultats de l’analyse factorielle confirmatoire ont indiqué que la structure factorielle du GSAS-J (modèle de structure à un facteur) était appropriée pour les données (χ2(48) = 195,49, p &lt; 0,05; CFI = 0,927; RMSEA = 0,066; SRMR = 0,036). Les résultats de l’analyse factorielle confirmatoire multi-groupes ont indiqué que le GSAS-J démontrait une forte invariance factorielle entre les joueurs probablement pathologiques et les joueurs non pathologiques. Le coefficient de Cronbach a était de 0,96 pour l’échelle totale. Une bonne validité convergente a été trouvée pour le GSAS-J en fonction de relation avec d’autres variables: Test Kruskal-Wallis H – le groupe de joueurs montant de graves et à très graves symptômes du jeu a passé plus de jours et dépensé beaucoup plus d’argent que les joueurs des groupes ayant des symptômes modérés ou légers; analyses de corrélation – South Oaks Gambling Screen (r = 0,57), échelle des cognitions liées au jeu (Gambling Related Cognitions Scale) (r = 0,71) et échelle de jeu compulsif (r = 0,72). En outre, les résultats du test de Student indiquaient des différences significatives entre les sexes dans les scores GSAS-J. Ces résultats indiquent que le GSAS-J est une mesure valable pour évaluer les symptômes du jeu dans les échantillons de la population japonaise.

Gambling-related cognitive distortions mediate the relationship between depression and disordered gambling severity

Background and objectivesSymptoms of depression are highly prevalent among individuals with gambling disorder, and severity of depression is associated with severity of gambling problem. Yet, little is known about the psychological mechanisms by which symptoms of depression lead to greater gambling severity. In this study, we tested whether cognitive distortions represent one such mechanism, as cognitive distortions are key characteristics in both depression and gambling disorder and have been shown to be associated with gambling severity. MethodsA mediation model was tested among 345 treatment-seeking individuals with gambling disorder in Sao Paulo, Brazil. The diagnosis of gambling disorder was made using semi-structured clinical interviews and participants completed psychometrically sound self-report measures of depression symptoms (Beck Depression Inventory-I), gambling-related cognitive distortions (Gamblers' Beliefs Questionnaire), and gambling severity (Gambling Symptom Assessment Scale). ResultsAs hypothesized, increased symptoms of depression were significantly associated with both increased disordered gambling severity and increased gambling-related cognitive distortions. Further, gambling-related cognitive distortions predicted greater disordered gambling severity when controlling for depression symptomology. Results from the bootstrapping method indicated that the relationship between symptoms of depression and increased disordered gambling severity is mediated by gambling-related cognitive distortions. ConclusionsConsistent with our predictions, gambling-related cognitive distortions mediated the relationship between depression symptoms and gambling severity among a sample of treatment-seeking disordered gamblers. These results suggest that cognitive distortions may be a key intervention target for the treatment of concurrent depression and gambling disorder.

The Psychometric Properties of the Online Gambling Symptom Assessment Scale (OGSAS)

Over the last decade, many psychometric instruments have been developed that assess various online problematic behaviors. Despite the many scales assessing gambling disorder (and its equivalents), no instrument assessing the consequences of problematic online gambling currently exists. In order to assess the symptoms and consequences of online gambling disorder, the Gambling Symptom Assessment Scale (G-SAS) was modified and its psychometric properties were assessed using exploratory factor analysis. The data were collected from 326 undergraduate and graduate students from a large public Midwestern university in the USA. Results suggest that the newly developed Online Gambling Symptom Assessment Scale (OGSAS) is reliable and valid as regards assessing the symptoms of online gambling disorder.

Gambling-related cognitive distortions predict level of function among US veterans seeking treatment for gambling disorders.

Gambling Disorder (GD) is characterized by recurrent gambling behavior that is associated with significant impairment and distress, high psychiatric comorbidities, and high functional disability. The military veteran population appears particularly susceptible to developing the disorder, but relatively little has been studied among this population. The purpose of the present study is to investigate the clinical psychopathologies and comorbidities of veterans seeking treatment for problem gambling and how problem gambling may impact functioning. Treatment-seeking veterans meeting criteria for GD (N = 61) underwent a structured clinical interview and completed the South Oaks Gambling Screen (SOGS), the Gambling Symptom Assessment Scale (G-SAS), the Yale-Brown Obsessive-Compulsive Scale for Gambling Disorder (PG-YBOCS), the Gambling Belief Questionnaire (GBQ), the Barratt Impulsiveness Scale (BIS-11), and the Sheehan Disability Scale (SDS). Veterans seeking treatment for GD had high rates of psychiatric and addiction disorder comorbidities. Few veterans had previously sought treatment and most reported substantive challenges in social and occupational functioning. When determining how gambling-related characteristics (ie, severity and cognitive distortions) impact function, severity of cognitive distortions was the strongest statistical predictor of overall functional disability. The findings from this study indicate that there is high comorbidity between GD and other psychiatric and addictive disorders, as well as social and occupational functioning. In addition, cognitive distortions related to gambling relate importantly to overall functioning and should be considered in the development of interventions for veterans with GD. (Am J Addict 2018;27:108-115).

Assessing the Relationship between Disordered Gamblers with Psychosis and Increased Gambling Severity: The Mediating Role of Impulsivity.

Recent research suggests that disordered gambling and psychosis co-occur at higher rates than expected in the general population. Gamblers with psychosis also report greater psychological distress and increased gambling severity. However, the mechanism by which psychosis leads to greater gambling symptomology remains unknown. The objective of the present research was to test whether impulsivity mediated the relationship between comorbid psychosis and gambling severity. The sample consisted of 394 disordered gamblers voluntarily seeking treatment at a large university hospital in São Paulo, Brazil. A semistructured clinical interview (Mini-International Neuropsychiatric Interview) was used to diagnosis the presence of psychosis by registered psychiatrists. Severity of gambling symptoms was assessed using the Gambling Symptom Assessment Scale, and the Barratt Impulsiveness Scale-11 provided a measure of impulsivity. Of the sample, 7.2% met diagnostic criteria for psychosis. Individuals with a dual diagnosis of psychosis did not report greater gambling severity. Conversely, dual diagnoses of psychosis were associated with greater levels of impulsivity. Higher levels of impulsivity were also associated with greater gambling severity. Importantly, support for our hypothesised mediation model was found such that impulsivity mediated the association between disordered gambling and psychosis and gambling severity. Impulsivity appears to be a transdiagnostic process that may be targeted in treatment among disordered gamblers with a dual diagnosis of psychosis to reduce problematic gambling behaviours.

The placebo effect and its clinical associations in gambling disorder.

Although gambling disorder is prevalent and functionally impairing, no FDA-approved medications exist for its treatment. The ability of clinical trials to detect the benefits of active treatment has been hindered by an unusually high placebo response. Virtually nothing is known about baseline clinical characteristics that might predict placebo response in those with gambling disorder. Participants (N = 152) assigned to placebo were pooled from multiple double-blind trials of gambling disorder. Participants were classified as placebo responders or non-responders based on a cut-off of 35% reduction in symptom severity on the Gambling Symptom Assessment Scale. Baseline group differences were characterized using t tests and equivalent non-parametric tests as appropriate. Fifty-one percent of individuals assigned to placebo showed a significant clinical response. Compared with non-responders, placebo responders remained in treatment for significantly longer, were more likely to report "enjoyment" as a trigger for gambling, and were less likely to state that "boredom" or "loneliness" triggered their gambling. Placebo responders and non-responders did not differ significantly in age, sex, age at symptom onset, baseline symptom severity, comorbidities, or likelihood of having received a previous treatment. Predictors of placebo response for gambling disorder appear markedly different from those reported for other mental illnesses.

GAMBLINGLESS: FOR LIFE study protocol: a pragmatic randomised trial of an online cognitive–behavioural programme for disordered gambling

IntroductionThe prevalence of disordered gambling worldwide has been estimated at 2.3%. Only a small minority of disordered gamblers seek specialist face-to-face treatment, and so a need for alternative treatment delivery...