Gambling Treatment Research Articles

Pharmacological treatments in pathological gambling

Pathological gambling (PG) is a relatively common and often disabling psychiatric condition characterized by intrusive urges to engage in deleterious gambling behaviour. Although common and financially devastating to individuals and families, there currently exist no formally approved pharmacotherapeutic interventions for this disorder. This review seeks to examine the history of medication treatments for PG. A systematic review of the 18 double-blind, placebo-controlled pharmacotherapy studies conducted for the treatment of pathological gambling was conducted. Study outcome and the mean dose of medication administered was documented in an effort to determine a preferred medication choice in this population. A variety of medication classes have been examined in the treatment of PG with varying results. Antidepressants, atypical antipsychotics and mood stabilizers have demonstrated mixed results in controlled clinical trials. Although limited information is available, opioid antagonists and glutamatergic agents have demonstrated efficacious outcomes, especially for individuals with PG suffering from intense urges to engage in the behaviour. Given that several studies have demonstrated their efficacy in treating the symptoms associated with PG, opioid antagonists should be considered the first line treatment for PG at this time. Most published studies, however, have employed relatively small sample sizes, are of limited duration and involve possibly non-representative clinical groups (e.g. those without co-occurring psychiatric disorders). Response measures have varied across studies. Heterogeneity of PG treatment samples may also complicate identification of effective treatments. Identification of factors related to treatment response will help inform future studies and advance treatment strategies for PG.

Reliability and Validity of Three Instruments (DSM-IV, CPGI, and PPGM) in the Assessment of Problem Gambling in South Korea

Most research on the assessment, epidemiology, and treatment of problem gambling has occurred in Western jurisdictions. This potentially limits the cross-cultural validity of problem gambling assessment instruments as well as etiological models of problem gambling. The primary objective of the present research was to investigate the reliability and validity of three problem gambling assessment instruments within a South Korean context. A total of 4,330 South Korean adults participated in a comprehensive assessment of their gambling behavior that included the administration of the DSM-IV criteria for pathological gambling (NODS), the Canadian Problem Gambling Index (CPGI), and the Problem and Pathological Gambling Measure (PPGM). Cronbach alpha showed that all three instruments had good internal consistency. Concurrent validity was established by the significant associations observed between scores on the instruments and measures of gambling involvement (number of gambling formats engaged in; frequency of gambling; and gambling expenditure). Most importantly, kappa statistics showed that all instruments have satisfactory classification accuracy against clinical assessment of problem gambling conducted by South Korean clinicians (NODS κ = .66; PPGM κ = .62; CPGI κ = .51). These results confirm that Western-derived operationalizations of problem gambling have applicability in a South Korean setting.

EPA-0373 – Disulfiram in the treatment of pathological gambling, a new therapeutic option?

Pathological gambling and comorbide alcohol dependence are common occuring diseases. Disulfiram is one of the proven drugs for alcohol dependence. It was shown recently, that Disulfiram is also effective in relapse prevention of cocaine addiction. In addition to its inhibiting effect of the acetaldehyde dehydrogenase (ADH), disulfiram inhibits the dopamine β-hydroxylase (DBH) and thereby augments dopamine and depletes norepinephrine concentrations in the CNS. Inhibition of the DBH is suggested to be the responsible mechanism of Disulfiram acting in cocaine addiction. Previous research indicates common neurochemical substrates for pathological gambling and cocaine addiction. This suggests that dopamine substrates may directly govern the reinforcement process in pathological gambling. In this report we now present the clinical data of a patient who was treated with disulfiram in our outpatient unit for addiction treatment due to existing alcohol dependence. The patient suffered also from severe pathological gambling. Initialy we started to treat the patient with supervised disulfiram because of his alcohol dependence. During the treatment with disulfiram the patient’ desire for gambling disappeared entirely and he has not gambled anymore since then. However, the exact mechnism of action by which disulfiram reduces urge to gamble is not fully unterstood, yet. Because craving is a key contributor to relapse, strategies aimed at modulate dopamine increases are likely to be therapeutically beneficial in gambling. Although uncontrolled case observations can only be interpreted with caution disulfiram seems to deserve further investigation and may hold the potential for preventing relapse in gamblers suffering from additional alcohol dependence.

Contribution of Illegal Acts to Pathological Gambling Diagnosis: DSM-5 Implications

The purposes of this study were to examine the specific contribution of illegal acts to the diagnostic criteria of pathological gambling, to assess the possibility of differential item functioning across patients’ sex and age, and to explore the existence of different clinical phenotypes based on the presence of illegal acts. The sample consisted of 2,155 patients seeking treatment for pathological gambling at the University Hospital of Bellvitge in Barcelona, Spain. The illegal acts item did not show different item functioning, and younger patients presented higher latent means than middle-aged and older patients, whereas no differences were found across sex. This item also showed the lowest discrimination coefficient; its exclusion would maintain satisfactory internal consistency for the remaining 9 symptoms and was poorly related to psychopathology and the severity of the gambling behavior. The relevance of the illegal acts as a diagnostic criterion appears to be limited, and its elimination from the Diagnostic and Statistical Manual for Mental Disorders, 5th edition, seems justified. However, illegal acts have implications for both the clinical and legal domains and contribute to increase the patients’ impairment.

Inpatient Treatment for Pathological Gamblers in Germany: Setting, Utilization, and Structure

In Germany, there are two different approaches to inpatient treatment of pathological gambling (PG): Facilities focusing on addiction or on psychosomatic illness. However, little is known about how these differences influence utilization and structure of treatment. Therefore, in our study, we analyzed all known German gambling inpatient treatment centers concerning patients' sex, age and number of comorbid disorders and evaluated an expert assessment of the treatment system, access to treatment, and structure characteristics of inpatient treatment facilities. In 2011, 2,229 pathological gamblers were treated. This amounts to 1 % of all past-year pathological gamblers. 90 % of the patients were men, 93 % had at least one comorbid disorder. Access to treatment was mostly gained via psychosocial counseling centers, but was not readily available. Facilities with addiction departments treated less pathological gamblers per year (29.3 gamblers) than facilities with psychosomatic departments (53.3 gamblers) or with both departments (76.4 gamblers). Treatment duration was significantly longer in addiction departments treating PG as secondary diagnosis only, with a low rate of gamblers on all patients, or treating few gamblers. Some facilities specialized on PG and treated more gamblers, had a higher rate of gamblers on all patients, and offered specific treatment programs. The impact of this specialization on treatment outcome is still unclear. Although treatment numbers have risen steadily for the past years, only a small fraction of affected gamblers seek inpatient treatment. Therefore, awareness to the disease and access to treatment needs to be improved.

An Inpatient Treatment Program for People with Gambling Problems: Synopsis and Early Outcomes

The Statewide Gambling Therapy Service (SGTS) specialises in providing treatment for clients with gambling disorders and other co-related mental health conditions. During the period 2008–2009, approximately 1000 clients with gambling disorders diagnosed using the Victorian Gambling Screen (VGS) sought treatment through SGTS. Of these clients, 53 were admitted to an inpatient treatment program offered by the service. This paper reports initial clinical assessments and treatment outcomes from this inpatient program. A key consideration for inclusion in the inpatient treatment program was the complexity of client clinical diagnoses. Treatment involved cognitive behavioural therapy and graded exposure therapy with client progress in treatment being assessed using a range of standard clinical measures. Results include predicted values across a 12-month period (using the Victorian Gambling Screen, Kessler 10, and Work and Social Adjustment Scale) and indicate that scores across all measures might be expected to improve rapidly in the first 6 months post-treatment before slowing and levelling around 6–12 months. These findings suggest that the intensive inpatient gambling treatment program described here is a viable treatment option for participants presenting with a diagnosed gambling disorder and other co-occurring and complex mental health conditions.

Cognitive Behavioral Therapy (CBT) and Meditation Awareness Training (MAT) for the Treatment of Co-occurring Schizophrenia and Pathological Gambling: A Case Study

There is a paucity of interventional approaches that are sensitive to the complex needs of individuals with co-occurring schizophrenia and pathological gambling. Utilizing a single-participant design, this study conducted the first clinical evaluation of a novel and integrated non-pharmacological treatment for a participant with dual-diagnosis schizophrenia and pathological gambling. The participant underwent a 20-week treatment course comprising: (i) an initial phase of second-wave cognitive behavioral therapy (CBT), and (ii) a subsequent phase employing a meditation-based recovery model (involving the administering of an intervention known as Meditation Awareness Training). The primary outcome was diagnostic change (based on DSM-IV-TR criteria) for schizophrenia and pathological gambling. Secondary outcomes were: (i) psychiatric symptom severity, (ii) pathological gambling symptom severity, (iii) psychosocial functioning, and (iv) dispositional mindfulness. Findings demonstrated that the participant was successfully treated for both schizophrenia and pathological gambling. Significant improvements were also observed across all other outcome variables and positive outcomes were maintained at 3-month follow-up. An initial phase of CBT to improve social coping skills and environmental mastery, followed by a phase of meditation-based therapy to increase perceptual distance from mental urges and intrusive thoughts, may be a diagnostically-syntonic treatment for co-occurring schizophrenia and pathological gambling.

The Impulsivity and Sensation-Seeking Mediators of the Psychological Consequences of Pathological Gambling in Adolescence

Pathological gambling has severe consequences for adolescents and their families and friends. Despite its high prevalence, pathological gambling in adolescents has been insufficiently studied. Sensation seeking and impulsivity are two variables that are related to the appearance and maintenance of pathological gambling. However, few studies have determined the role these variables play in the development of the dysfunctional symptomatology of gambling behavior in adolescents and young adults. The aims of this study were to analyze the consequences of gambling in young adults and adolescents, and to evaluate the roles of sensation seeking and impulsivity in the appearance of dysfunctional symptomatology. The sample consisted of 1,241 young adults and adolescents recruited from scholar centers and free-time groups, as well as 71 subjects from associations that assist pathological gamblers. Pathological gambling, impulsive behavior, dysfunctional symptomatology and sensation seeking were assessed. The results confirmed that young adults and adolescents who gamble pathologically have more dysfunctional symptomatology related to anxiety, depression, hostility, obsessive-compulsive behavior and somatization, as well as sensation seeking, impulsivity and addictive behavior. Moreover, the results showed that sensation seeking did not mediate the appearance of dysfunctional symptomatology and that impulsivity partially mediated the appearance of anxiety, phobic anxiety, depression and psychosis and perfectly mediated somatization, obsessive-compulsive behavior, interpersonal sensitivity, paranoid ideation and hostility. These results have consequences for the development of treatment and prevention programs for adolescent pathological gambling.

The prevalence of problem gambling among substance abusing offenders

Research suggests that problem gambling is associated with substance and alcohol abuse, criminal activity, and involvement in the criminal justice system. The present study assessed the lifetime prevalence of pathological and problem gambling among a population in which these risk factors are compounded, specifically adults mandated to participate in drug court. A sample of 602 participants completed the South Oaks Gambling Screen. Nearly 72% of the participants were male, and the majority identified as White (53%) or Black (37%). Results indicated that the prevalence and severity of problem gambling may be elevated within this population. Over 30% of respondents were assessed as probable pathological or problem gamblers (20.1% and 10.3%, respectively), and 22% as being at low risk. Results suggest that problem gambling is a salient issue among substance-abusing offenders. Resources should be dedicated to screening and developing evidence based best practices for the prevention and treatment of problem gambling.

Physical accessibility of gaming opportunity and its relationship to gaming involvement and problem gambling: A systematic review

This paper presents the findings of a systematic search undertaken for the period January 1990 to June 2011 of references including original, empirical findings of the relationship between accessibility of electronic gaming machines and rates of gambling involvement, problem gambling, or gambling-related treatment seeking. Titles and abstracts of 2156 references were reviewed, yielding 39 references meeting inclusion criteria. The review has revealed that the relationships between the physical accessibility dimensions of proximity and density and gambling involvement and problem gambling are complex. Research is only beginning to elucidate these dimensions, and many questions and methodological challenges remain to be addressed. The strengths, limitations, and gaps in the literature are discussed, and recommendations are made for future research. Cet article présente les résultats d'une recherche documentaire systématique, effectuée entre janvier 1990 et juin 2011, incluant des résultats empiriques initiaux qui portaient sur la relation entre l'accessibilité aux appareils de jeu électroniques et les taux de participation au jeu, le jeu compulsif ou la recherche de traitement lié au jeu. On a étudié les titres et les résumés de 2 156 références, parmi lesquelles 39 correspondaient aux critères d'inclusion. Cette recherche a révélé la complexité des relations entre les dimensions d'accessibilité physique, c'est-à-dire la proximité et la densité d'une part, et la participation au jeu et le jeu compulsif d'autre part. La recherche commence à peine à élucider ces dimensions et de nombreuses questions et problèmes méthodologiques demeurent en suspens. L'article discute des forces, des limitations et des lacunes de la littérature spécialisée et formule des recommandations pour de futurs travaux de recherche.

The feasibility of providing gambling-related self-help information to college students who screen for disordered gambling via an online health survey: an exploratory study

Individuals with gambling disorders are reluctant to enter formal gambling treatment and often recover without it. For this reason, it is important to provide disordered gamblers with resources that facilitate treatment on their own (i.e., self-help). This exploratory study examined the feasibility of collecting contact information and providing gambling-related self-help information to a sample of college students who indicated possible disordered gambling behavior via an online health survey. Results indicated that among the 60 participants who met the threshold for possible disordered gambling behavior, 29 (48.3%) voluntarily provided their contact information. Subsequently, gambling-related resources were emailed to these participants. The findings of this exploratory study indicate that online health surveys completed by a large number of students might be advantageous for screening and intervening in disordered gambling in this population.

Waking Self-Hypnosis Efficacy in Cognitive-Behavioral Treatment for Pathological Gambling: An Effectiveness Clinical Assay

Cognitive-behavioral therapy for pathological gambling has a long-term success rate of more than 50%. This study evaluated the effect of self-hypnosis in cognitive-behavioral treatment of pathological gamblers. Forty-nine participants were assigned to 2 groups. Both groups received a cognitive-behavioral protocol, and Group 1, the no-hypnosis group, received an 11-session intervention and Group 2, the hypnosis group, received 7 sessions that included self-hypnosis. Both groups were equal in gambling chronicity, frequency, intensity, change motivation, and problems derived from gambling. All participants reported significant improvement in gambling behavior and consequences at both treatment end and 6-month follow-up. Data show no differences between the interventions in abstinence, therapeutic compliance, fulfillment, and satisfaction. Results suggest that self-hypnosis reinforces treatment and can be a supportive technique for future brief interventions.

Wait times for publicly funded addiction and problem gambling treatment agencies in Ontario, Canada

BackgroundThis study describes the definitions of wait times and intake processes used by drug and problem gambling treatment agencies in Ontario, Canada, as well as the various strategies employed to ameliorate client backlog.MethodsAn online survey was developed and distributed to 203 publicly-funded, provincial substance use and problem gambling treatment agencies from June to August, 2011. All aspects of the intake process were covered in the survey.ResultsBased on 139 responses, six different wait time periods were identified. Additional analyses were completed by type of service offered. Suggestions for effective interventions to shorten wait times and recommendations for future research are provided.ConclusionThe results of this study highlight a need for standardized definitions of wait times across substance use and problem gambling treatment services.

Problem Gambling and Families: A Systematic Review

Problem gambling is an important public health issue affecting many spheres of the gambling individual's life, including mental health, finances, and family. The family is a topic that has been given little attention in problem gambling research. After a comprehensive search of the literature, this review identified and analyzed 30 empirical studies conducted between 1998 and 2013 examining the effects of problem gambling on families, the impact of family involvement in problem gambling treatment, or both. The literature shows that (a) problem gambling has several adverse effects on individuals, families, and family functioning, and (b) family involvement in problem gambling treatment is linked with better treatment outcomes and improved individual and family functioning. Implications for research and clinical practice are discussed.

The relationship of tobacco use with gambling problem severity and gambling treatment outcome.

This study sought to examine the impact of tobacco use on gambling treatment. Pathological gambling (PG) is a psychiatric condition associated with significant financial, emotional, and psychosocial consequences. Elevated rates of nicotine dependence have been associated with increased gambling severity and more frequent psychiatric problems. A total of 385 treatment-seeking pathological gamblers enrolled in one of 11 gambling treatment providers in Minnesota were assessed. Linear regression modeling was used to examine demographic and clinical variables at treatment entry and the relationship between those variables and the number of days gambled at a 6-month posttreatment. Logistic regression was utilized to assess predictors of treatment completion. Daily tobacco use was reported in 244 (63.4%) subjects. Tobacco users presented with significantly more severe gambling and mental health symptoms at treatment intake. Daily tobacco use, however, was not significantly associated with the number of days gambled or with treatment completion. Although tobacco users present with greater gambling problem severity, they had similar rates of treatment completion and treatment outcomes as nonusers.

Measuring cognitive distortions in pathological gambling: Review and meta-analyses.

There is broad agreement that cognitive distortions are an integral component of the development, maintenance, and treatment of pathological gambling. There is no authoritative catalog of the distortions that are observed more frequently in pathological gamblers than in others, but several instruments have been successfully developed that measure various distortions of interest, which are reviewed. All of the prominent instruments include measures of the illusion of control (perceiving more personal control over events than is warranted), and almost all include measures of gambler's fallacy (the belief that after a string of one event, such as a coin landing heads, an alternative event, such as the coin landing tails, becomes more likely). Beyond these two errors, there is scant consensus on relevant errors, and a wide variety has been studied. Meta-analyses were conducted on differences between PGs and non-PGs in scores on six published instruments that were developed to measure distortions in gamblers. All instruments reveal large effects using Hedge's g statistic, suggesting that the impact of distortions on PG is robust. Several subscales, assigned diverse names by scale authors, can be viewed as reflecting common distortions. Those judged to assess gambler's fallacy show evidence of more robust effects sizes than those that assess illusion of control. It is recommended that future research focus more specifically on the impact of particular distortions on gambling disorders.

Assessing Randomised Clinical Trials of Cognitive and Exposure Therapies for Gambling Disorders: A Systematic Review

Aims:Problem or pathological gambling is associated with significant disruption to the individual, family and community with a range of adverse outcomes, including legal, financial and mental health impairment. It occurs more frequently in younger populations, and comorbid conditions are common. Cognitive–behaviour therapy (CBT) is the most empirically established class of treatments for problematic gambling. This article reports on a systematic review and evaluation of randomised clinical trials (RCTs) concerning two core techniques of CBT: cognitive and behavioural (exposure-based) therapies.Methods:PsycINFO, MEDLINE and the Cochrane library were searched from database inception to December 2012. The CONsolidated Standards Of Reporting Trials (CONSORT) for non-pharmacological treatments was used to evaluate each study.Results:The initial search identified 104 references. After two screening phases, seven RCTs evaluating either cognitive (n= 3), exposure (n= 3) or both (n= 1) interventions remained. The studies were published between 1983 and 2003 and conducted across Australia, Canada, and Spain. On average, approximately 31% of CONSORT items were rated as ‘absent’ for each study and more than 52% rated as ‘present with some limitations’. For all studies, 70.83% of items rated as ‘absent’ were in the methods section.Conclusions:The findings from this review of randomised clinical trials involving cognitive and exposure-based treatments for gambling disorders show that the current evidence base is limited. Trials with low risk of bias are needed to be reported before recommendations are given on their effectiveness and clinicians can appraise their potential utility with confidence.

Overall Gambling Behaviors and Gambling Treatment Needs Among a Statewide Sample of Drug Treatment Clients in Ohio

Casino gambling in Ohio became available for the first time in May 2012. This gambling expansion led the Ohio substance abuse monitoring (OSAM) Network, Ohio's drug abuse surveillance system that collects drug trend data on an ongoing basis, to amend its protocol in June 2011 to include collection of data related to problem and pathological gambling to inform current treatment and prevention needs. OSAM collected gambling data from July 2011 to June 2012 via focus group interviews of 714 drug users recruited from alcohol and other drug (AOD) treatment programs throughout Ohio. Participants who reported gambling during the past 6 months (N = 412) completed the South Oaks gambling screen. This study found a prevalence estimate of 12.1 % for probable pathological gambling among its statewide sample. Sizeable proportions of participants reported that they gambled more when using AOD (23.5 %) and used more AOD when gambling (19.4 %). A majority of study participants (59.2 %) reported participation in at least one type of gambling during the past 6 months, and of those participants, only 22.2 % reported ever having been asked about gambling while receiving AOD treatment services, with just 12.5 % reporting ever having had gambling treatment services offered to them. Men were 4.1 times more likely to screen positive for probable pathological gambling than women; non-Whites were 61.0 % more likely to screen positive than Whites. Findings presented in this report have the potential to help shape and strengthen problem and pathological gambling prevention and treatment measures in Ohio.

Meta-analysis: pharmacological treatment of pathological gambling

Background: This meta-analysis investigates the efficacy of pharmacological treatments for pathological gambling (PG). Methods: We searched for randomized, placebo-controlled trials examining pharmacotherapy of pathological gamblers. A fixed-effects model was used to calculate the standardized mean difference (SMD) of the benefit of medication (stratified by class) compared to placebo. Secondary analyses examined the effects of publication bias, year of publication and adherence to intention-to-treat (ITT) principles on reported efficacy of interventions. Results: Meta-analysis included 14 trials involving 1024 participants. Opiate antagonists demonstrated a small but significant benefit compared to placebo (SMD = 0.22 ± 0.10 (95% CI: 0.03–0.41), z = 2.3, p = 0.02). The reported efficacy of opiate antagonists was significantly associated with non-adherence to ITT principles in trials and earlier year of publication. Other medications had non-significant effect sizes compared to placebo but similar in magnitude to opiate antagonists. Conclusions: Current trial data provides limited support for the use of any pharmacological agent in the treatment of pathological gambling.

Erroneous Gambling-Related Beliefs as Illusions of Primary and Secondary Control: A Confirmatory Factor Analysis

Different classification systems for erroneous beliefs about gambling have been proposed, consistently alluding to 'illusion of control' and 'gambler's fallacy' categories. None of these classification systems have, however, considered the how the illusion of control and the gambler's fallacy might be interrelated. In this paper, we report the findings of a confirmatory factor analysis that examines the proposal that most erroneous gambling-related beliefs can be defined in terms of Rothbaum et al.'s (J Pers Soc Psychol, doi: 10.1037/0022-3514.42.1.5 , 1982) distinction between 'primary' and 'secondary' illusory control, with the former being driven to a large extent by the well-known gambler's fallacy and the latter being driven by a complex of beliefs about supernatural forces such as God and luck. A survey consisting of 100 items derived from existing instruments was administered to 329 participants. The analysis confirmed the existence of two latent structures (beliefs in primary and secondary control), while also offering support to the idea that gambler's fallacy-style reasoning may underlie both perceived primary control and beliefs about the cyclical nature of luck, a form of perceived secondary control. The results suggest the need for a greater focus on the role of underlying processes or belief structures as factors that foster susceptibility to specific beliefs in gambling situations. Addressing and recognising the importance of these underlying factors may also have implications for cognitive therapy treatments for problem gambling.