Gambling Treatment Research Articles

Epidemiological Associations between Gambling Behavior, Substance Use & Mood and Anxiety Disorders

To compare gambling behaviors in a random sample of community residents with and without mental disorders identified by the Composite International Diagnostic Interview (CIDI). A large national community survey conducted by Statistics Canada included questions about problems arising from gambling activities as per the Canadian Problem Gambling Index (CPGI). We compared respondents within three gambling severity categories (non-problem, low severity and moderate/high severity gambling) across three diagnostic groupings (mood/anxiety disorders, substance dependence/harmful alcohol use, no selected psychiatric disorder). Of the 14,934 respondents age 18-64 years who engaged in at least one type of gambling activity in the previous 12 months, 5.8% fell in the low severity gambling category while 2.9% fell in the moderate/high severity category. Females accounted for 51.7% of the sample. The risk of moderate/high severity gambling was 1.7 times higher in persons with mood or anxiety disorder compared to persons with no selected disorder. For persons with substance dependence or harmful alcohol use, the risk of moderate/high severity gambling was 2.9 times higher. Persons with both mood/anxiety and substance/alcohol disorders were five times more likely to be moderate/high severity gamblers. The odds ratio for females was 0.6 and for those with less than post-secondary education it was 1.52. Differences in age and personal income were not significant. Individuals in the community suffering from mood/anxiety disorders and substance dependence/harmful alcohol, and especially those with both, experience a higher risk for gambling problems. The treatment of these comorbidities should be integrated into any problem gambling treatment program.

Treatment of Female Pathological Gambling: The Efficacy of a Cognitive-Behavioural Approach

Given that a substantial proportion of current pathological gamblers are female, it is evident that women are underrepresented in the treatment outcome literature. The current study was designed to redress the limited information on the treatment of female pathological gambling. Although the use of cognitive-behavioural therapy is the most highly recommended approach as 'best practice' for the treatment of pathological gambling, no attempt to date has been made to evaluate the efficacy of this approach for female pathological gambling. Nineteen female pathological gamblers with electronic gaming machine problems were treated with a cognitive-behavioural program. While pathological gamblers placed on a waiting list did not show significant improvement on gambling behaviour and psychological functioning measures, the female pathological gamblers showed significant improvement on these measures over the treatment period, and maintained this improvement at the 6-month follow-up evaluation. By the completion of the follow-up period, 89% of participants no longer met diagnostic criteria for pathological gambling. Although further scientific demonstration and replication are required, the outcomes of this study indicate that the therapy that is considered 'best practice' in the treatment of pathological gambling is effective for female pathological gambling.

Problem gambling treatment research: An annotated bibliography

Problem gambling treatment research: An annotated bibliography

Escitalopram treatment of pathological gambling with co-occurring anxiety: an open-label pilot study with double-blind discontinuation

Although co-occurring disorders are common in pathological gambling (PG), investigations of the response to pharmacotherapy in individuals with PG and co-occurring psychiatric symptomatology are limited. Thirteen subjects with DSM-IV PG and co-occurring anxiety were treated in a 12-week open-label trial of escitalopram. Subjects were assessed with the Yale-Brown Obsessive Compulsive Scale Modified for Pathological Gambling (PG-YBOCS; primary outcome measure), the Hamilton Anxiety Rating Scale (HAM-A), the Clinical Global Impressions scale (CGI), and measures of psychosocial functioning and quality of life. Those subjects who 'responded' (defined as a 30% or greater reduction in PG-YBOCS total score at endpoint) were offered inclusion in an 8-week double-blind discontinuation phase. PG-YBOCS scores decreased from a mean of 22.2+/-4.5 at baseline to 11.9+/-10.7 at endpoint (P=0.002) and 61.5% were responders. Scores on the HAM-A decreased by 82.8% over the 12-week period (mean of 15.9+/-3.2 at baseline to a mean of 2.8+/-3.6 at endpoint) (P<0.001). On the CGI, 38.5% of subjects (n=5) were 'very much improved' and 23.1% (n=3) were 'much improved' by study endpoint. The Sheehan Disability Scale, Perceive Stress Scale and Quality of Life Inventory all showed improvement (P< or = 0.001, P=0.002 and P=0.029, respectively). The mean end-of-study dose of escitalopram was 25.4+/-6.6 mg/day. Of three subjects assigned to escitalopram during the discontinuation phase, none reported statistically significant worsening of gambling symptoms. However, one subject assigned to placebo reported that gambling symptoms returned within 4 weeks. Open-label escitalopram treatment was associated with improvements in gambling and anxiety symptoms and measures of psychosocial functioning and quality of life. Larger, longer, placebo-controlled, double-blind studies are needed to evaluate further the safety and tolerability of escitalopram in the treatment of PG and co-occurring anxiety.

Characteristics of Older Adult Problem Gamblers Calling a Gambling Helpline

Few investigations have characterized groups of older adults with gambling problems, and published reports are currently limited by small samples of older adult problem gamblers. Gambling helplines represent a widespread mechanism for assisting problem gamblers to move into treatment settings. Given data from older adult problem gamblers in treatment, we hypothesized that older as compared with younger adult problem gamblers calling a gambling helpline would be less likely to report gambling-related problems. Logistic regression analyses were performed on data obtained from January 1, 2000 to December 31, 2001, inclusive, from callers with gambling problems (N = 1,084) contacting the Connecticut Council on Problem Gambling Helpline. Of the 1,018 phone calls used in the logistic regression analyses, 168 (16.5%) were from older adults and 850 (83.5%) from younger adults. Age-related differences were observed in demographic features, types and patterns of gambling reported as problematic, gambling-related problems and psychiatric symptoms, substance use problems, patterns of indebtedness, and family histories of addictive disorders. Older as compared with younger adult problem gamblers were more likely to report having lower incomes, longer durations of gambling, fewer types of problematic gambling, and problems with casino slot machine gambling and less likely to report gambling-related anxiety, family problems, illegal behaviors and arrests, drug problems, indebtedness to bookies or acquaintances, family histories of drug abuse, and problems with casino table gambling. Older as compared with younger adult problem gamblers calling a gambling helpline differ on many clinically relevant features. The findings suggest the need for improved and unique prevention and treatment strategies for older adults with gambling problems.

Severity of Gambling Problems and Psychosocial Functioning in Older Adults

This study examined the relationship between severity of gambling problems and psychosocial functioning in older adults. Twenty-one current pathological gamblers and 10 current problem gamblers over 60 years of age completed the Addiction Severity Index (ASI), Geriatric Depression Scale (GDS), Brief Symptom Inventory (BSI), UCLA Loneliness Scale (UCLA-LS), and Social Provisions Scale (SPS). Compared with problem gamblers, pathological gamblers reported increased severity of gambling and family/social problems on the ASI; scored higher on the GDS, BSI, and UCLA-LS; and scored lower on the SPS. Although they were not seeking treatment at the time of the interview, three fourths of pathological gamblers and 30% of problem gamblers were interested in gambling treatment. These results suggest that severity of gambling problems is associated with increased psychosocial distress in older adults and that a significant proportion of older adults with a gambling disorder may be cognizant of their gambling problem and interested in treatment.

The Proxy Effect: Gender and Gambling Problem Trajectories of Iowa Gambling Treatment Program Participants

Recent research has found that men and women who end up in gambling treatment tend to follow different trajectories to that endpoint: women generally begin gambling later in life, but progress to problems and seek treatment more quickly. With women's prevalence rates of gambling and disordered gambling increasing, it has become important to identify the causes and consequences of these trajectory differences. The current study used a sample of 2,256 gamblers enrolled in the Iowa Gambling Treatment Program to examine the relationship of gender and other demographic, economic and health-related (i.e., psychosocial) factors to empirically-identified gambling problem trajectories. The results indicated that gender made a statistically significant contribution to the prediction of trajectory, but increased predictive accuracy by only 1-2% beyond a model with psychosocial predictors. Gender's contribution was limited to its relationship to age of initiation; men and women's problem progression did not differ meaningfully once age of gambling initiation was taken into account. Gender is a unique contributor to the development of gambling problems among treatment seekers, but it is only one small part of the myriad psychosocial characteristics that influence gambling problem development.

Impulsivity and Pathological Gambling: A Descriptive Model

The DSM-IV-TR classifies pathological gambling as a disorder of impulse control. Empirical studies have noted elevated levels of impulsivity in pathological gamblers and putative functional relationships between impulsivity, severity of gambling problems and treatment attrition. However the concept of impulsivity has been variably defined with a persistent failure to clearly articulate the specific nature of impulsivity as a state or trait or its role in the etiology and maintenance of pathological gambling. This paper: (a) reviews the literature on impulsivity as it relates to gambling behaviour; and (b) proposes a descriptive model that integrates predisposing factors, individual differences, sociological influences, cognitive factors, and affective interpretations that combine to generate dysfunctional forms of impulsivity that fuels the gambling cycle; and (c) explores directions for further theoretical and empirical investigation.

Retaining Pathological Gamblers in Cognitive Behavior Therapy Through Motivational Enhancement

Treatment for pathological gambling is in its infancy. Several cognitive and behavioral interventions have shown promise, but high attrition and relapse rates suggest that gamblers requesting treatment are not uniformly committed to change. This article describes an exploratory study with 9 severe pathological gamblers--in their majority horse race bettors--who were recruited from a community treatment center. The gamblers were treated with a hybrid intervention consisting of motivational enhancement and cognitive behavior therapy. All gamblers were retained in treatment and during a 12-month follow-up period. This retention rate was significantly higher than that of a control group of gamblers who received treatment as usual in the same community setting. Of the gamblers who received the experimental treatment, 6 maintained total abstinence during the 12-month follow-up period, 2 were significantly improved, and 1 remained unimproved. In addition to changing their gambling behavior, many clients made successful lifestyle changes. The possible benefits of combining a motivational intervention with cognitive behavior therapy are discussed.

A review of work-force development literature for the Māori addiction treatment field in Aotearoa/New Zealand

Māori, like Indigenous Australians and other indigenous people world-wide, are simultaneously over-represented among those presenting with addiction-related problems and under-represented within various health professions. Providing the opportunity for individuals and whanau (family/extended family) to work with ethnically matched health workers is likely to increase service accessibility and to improve treatment outcomes. In New Zealand, a number of initiatives have been instigated to increase the capacity of the Māori health work-force and reduce related barriers to treatment. This article provides an analysis of relevant literature and policy documents, and identifies five strategic imperatives currently informing work-force development in the Māori alcohol and other drug (AOD) and gambling treatment sector.

Characteristics of people seeking treatment for problem gambling in Ontario: Trends from 1998 to 2002

This report summarizes the characteristics of individuals who sought help within Ontario's specialized problem gambling treatment system during its first four years of operation. All clients recorded in the provincial information system database as having entered a gambling treatment program between April 1, 1998, and March 31, 2002, are included. Broad trends and gender differences in demographic characteristics, gambling behaviours, and problem severity are considered and compared by fiscal year. Compared to population-based estimates of problem gambling, the number of clients served by this specialized treatment system is low but steadily increasing. Women have consistently made up approximately one third of clients entering treatment in each fiscal year, and their sociodemographic profile, their gaming preferences, and the duration of their problem gambling careers differ from those of male clients. The growing proportion of clients of both genders seeking help for problems related to slot machines is of primary concern and warrants further study.

Nalmefene worth a bet for the treatment of gambling

Nalmefene worth a bet for the treatment of gambling

A framework for reporting outcomes in problem gambling treatment research: the Banff, Alberta Consensus

The objective is provide a framework concerning the minimum features of reporting efficacy of treatment in the problem gambling field. Research to date has not used uniform outcome measures and it is, therefore, difficult to compare the relative efficacy of various approaches. Some studies emphasize self-reported behavioural measures such as frequency and intensity of gambling whereas others emphasise change with respect to the criteria used to diagnose problem gambling or use composite measures of symptom severity in multiple domains involving gambling-related thoughts, urges, and behaviours. An expert panel consensus. The proposed minimum features of reporting the efficacy of treatment outcome studies are: measures of gambling behaviour - the net expenditure each month, the frequency (in days per month) with which gambling takes place, and the time spent thinking about or engaged in the pursuit of gambling each month; measures of the problems caused by gambling - especially problems in the areas of personal health, relationships, financial, and legal; these measures can be complemented by additional measures of quality of life. measures of the processes of change - whatever mechanisms of change are assumed to occur. We believe that these guidelines are broad enough to allow clinical research conducted from diverse perspectives to allow valid cross study evaluations of intervention studies. Such conditions will facilitate the development of empirically validated best practice guidelines for use by clinicians in the management of problem gambling.

Multicenter Investigation of the Opioid Antagonist Nalmefene in the Treatment of Pathological Gambling

Pathological gambling is a disabling disorder experienced by approximately 1%-2% of adults and for which there are few empirically validated treatments. The authors examined the efficacy and tolerability of the opioid antagonist nalmefene in the treatment of adults with pathological gambling. A 16-week, randomized, dose-ranging, double-blind, placebo-controlled trial was conducted at 15 outpatient treatment centers across the United States between March 2002 and April 2003. Two hundred seven persons with DSM-IV pathological gambling were randomly assigned to receive nalmefene (25 mg/day, 50 mg/day, or 100 mg/day) or placebo. Scores on the primary outcome measure (Yale-Brown Obsessive Compulsive Scale Modified for Pathological Gambling) were analyzed by using a linear mixed-effects model. Estimated regression coefficients showed that the 25 mg/day and 50 mg/day nalmefene groups had significantly different scores on the Yale-Brown Obsessive Compulsive Scale Modified for Pathological Gambling, compared to the placebo group. A total of 59.2% of the subjects who received 25 mg/day of nalmefene were rated as "much improved" or "very much improved" at the last evaluation, compared to 34.0% of those who received placebo. Adverse experiences included nausea, dizziness, and insomnia. Subjects who received nalmefene had a statistically significant reduction in severity of pathological gambling. Low-dose nalmefene (25 mg/day) appeared efficacious and was associated with few adverse events. Higher doses (50 mg/day and 100 mg/day) resulted in intolerable side effects.

Lifetime Histories of Trauma among Pathological Gamblers

This study extends the work completed with pathological gamblers and substance abusers, looking at associations between a history of trauma and comorbid substance dependence, impulsivity, measures of problem severity, and personality variables. We studied 111 patients admitted to the gambling treatment program at the Brecksville VA Medical Center and found that 64% of gamblers reported a history of emotional trauma; 40.5%, physical trauma; and 24.3%, sexual trauma. Most of this trauma occurred in childhood. A history of trauma was associated with a greater relative frequency of suicide attempts and drug and alcohol dependence, more severe scores in measures of psychiatric distress, and limited effects on personality functioning.

Men &amp; Women Playing Games: Gender and the Gambling Preferences of Iowa Gambling Treatment Program Participants

Historically, gambling has been a predominantly male pastime; however, as legalized gambling has expanded, female participation has increased. Nevertheless, some research suggests that a divide remains between the play patterns of men and women. For example, research suggests that men gravitate towards casino table games and track betting and women are attracted to games such as bingo and casino slots. Researchers have hypothesized that play pattern disparities exist because of inherent differences between the natures of men and women. Using data from 2256 (1309 male) problem gambling treatment participants, this research examines the influence of gender on play patterns. We tested the ability of gender and a series of demographic, economic, and health-related factors to discriminate among three groups of gamblers with different game preferences: casino preferred, slots preferred, and non-institutional preferred. The results of multiple discriminant function analyses indicated that gender provided a minimal contribution to discrimination beyond that of specific demographic, economic, and health-related factors. This finding suggests that for understanding gambling patterns, gender is less informative than descriptive gambler profiles.

Sustained-release Bupropion Versus Naltrexone in the Treatment of Pathological Gambling

Pathological gambling (PG) is a relatively common and highly disabling impulse control disorder. A range of psychotherapeutic agents, including selective serotonin reuptake inhibitors, mood stabilizers, and opioid antagonists, has been shown to be effective in the treatment of PG. The use of selective serotonin reuptake inhibitors and opioid antagonists for PG is consistent with the observation that PG shares features of both the obsessive-compulsive spectrum disorders and addictive disorders. The aim of the study is to compare the effectiveness of sustained-release bupropion versus naltrexone in the treatment of PG. Thirty-six male pathological gamblers were enrolled in our study. A comprehensive psychiatric diagnostic evaluation was performed at baseline on all patients, and patients were screened for symptoms of gambling, depression, and anxiety using the South Oaks Gambling Screen, the Hamilton Depression Rating Scale, the Hamilton Anxiety Rating Scale, and the Clinical Global Impression-Severity Scale. In addition, the patients completed self-report questionnaires about their demographic status. Patients were randomized in 2 groups and received either naltrexone (n = 19) or sustained-release bupropion (n = 17) for 12 weeks in a parallel fashion. Treatment response was monitored using the Clinical Global Impression-Improvement Scale which was performed at weeks 2, 4, 8, and 12. Patients were also assessed for the presence of gambling behavior via an unstructured interview, which was also performed at weeks 2, 4, 6, 8, and 12. Raters were blind to the study treatment. The majority of patients responded well to the drug treatment. Twelve of 17 patients in the sustained-release bupropion group completed the 12-week study, and 13 of 19 naltrexone patients completed the study. Nine (75%) of the 12 completers were rated as full responders in the sustained-release bupropion group versus 10 (76%) of 12 in the naltrexone group. Three (25%) of 12 completers in the bupropion group were rated as partial responders. In the naltrexone group, 3 (23%) of 13 completers were rated as partial responders. Full response was defined as the absence of gambling for a 2-week duration together with improvement on the Clinical Global Impression-Improvement Scale. Partial response was defined as a decrease in the frequency of gambling behavior and a decrease in the amount of money spent on gambling. This preliminary study shows that sustained-release bupropion may be effective as naltrexone in the treatment of PG. Further studies are needed to confirm our findings.

Brief interventions for problem gambling

Brief interventions for problem gambling

The Relationship among Negative Affect, Distress Tolerance, and Length of Gambling Abstinence Attempt

The present study tested the theory that negative affect and one's ability to tolerate distress is associated with failure to quit gambling during an abstinence attempt. Specifically, 16 current pathological gamblers who had at least one sustained period of gambling abstinence lasting a minimum of 3 months (i.e., delayed relapsers) and 16 current pathological gamblers who had never remained abstinent for a period longer than 2 weeks (i.e., immediate relapsers), were assessed for baseline levels of negative affect and stress reactivity, as well as faced with a psychological (mental arithmetic) and physical (breath holding) stressor. Compared to the delayed relapsers, the immediate relapsers displayed higher levels of negative affect and stress reactivity. Immediate relapsers also were less likely to persist on the psychological stressor, suggesting that one's ability to tolerate the initial discomfort of an abstinence attempt may play an important role in gambling treatment outcome.

Development of the Drake Beliefs about Chance Inventory

The present research describes the development and validation of a cognitive assessment instrument, the Drake Beliefs about Chance (DBC) inventory, designed to determine and quantify erroneous beliefs about games of chance. Principal components analyses showed that the DBC assesses two primary dimensions, Illusion of Control and Superstition. Correlation analyses showed that scores on these two dimensions are related to higher frequency of gambling behaviors in both adults from the general population and clients from gambling treatment centers. Of the two sets of erroneous beliefs, Illusion of Control was a better predictor of gambling than Superstition. This investigation provides additional evidence that participants in games of chance such as casino gamblers possess certain classes of erroneous beliefs regarding the games they play.