Identifying Associated Factors for Illegal Acts among Patients with Gambling Disorder and ADHD.

Illegal behaviors have been reported in gambling disorder (GD) as well as in individuals with attention deficit hyperactivity disorder (ADHD). Likewise, ADHD symptomatology has been observed in patients with GD. We aimed to examine the association between ADHD symptomatology, personality traits and impulsivity in a sample of treatment-seeking patients with GD (n = 204) with and without a criminal report. The subjects were evaluated before starting treatment using different self-administered instruments. Among those who had committed an illegal act, two groups were made depending on whether or not the criminal conduct had legal repercussions (n = 64 without legal consequences; n = 32 with legal consequences). Structural equation modeling (SEM) was used to explore the interrelationships between personality traits, ADHD, impulsivity levels, gambling-related criminal behavior and other gambling-related factors. Greater ADHD symptomatology was found in patients with reported illegal behaviors, as well as higher impulsivity levels. Those individuals who presented legal consequences due to the criminal behavior showed higher impulsivity levels and harm avoidance and lower persistence and cooperativeness. Our findings uphold that patients with GD and ADHD symptomatology have greater impulsivity and are more vulnerable to committing an illegal act. Therefore, specific harm-prevention interventions and treatment approaches are needed for this population.

Clustering Treatment Outcomes in Women with Gambling Disorder.

The rising prevalence of gambling disorder (GD) among women has awakened considerable interest in the study of therapeutic outcomes in females. This study aimed to explore profiles of women seeking treatment for GD based on a set of indicators including sociodemographic features, personality traits, clinical state at baseline, and cognitive behavioral therapy (CBT) outcomes. Two-step clustering, an agglomerative hierarchical classification system, was applied to a sample of n = 163 women of ages ranging from 20 to 73 years-old, consecutively attended to by a clinical unit specialized in the treatment of G. Three mutually exclusive clusters were identified. Cluster C1 (n = 67, 41.1%) included the highest proportion of married, occupationally active patients within the highest social status index. This cluster was characterized by medium GD severity levels, the best psychopathological functioning, and the highest mean in the self-directedness trait. C1 registered 0% dropouts and only 14.9% relapse. Cluster C2 (n = 63; 38.7%) was characterized by the lowest GD severity, medium scores for psychopathological measures and a high risk of dropout during CBT. Cluster C3 (n = 33; 20.2%) registered the highest GD severity, the worst psychopathological state, the lowest self-directedness level and the highest harm-avoidance level, as well as the highest risk of relapse. These results provide new evidence regarding the heterogeneity of women diagnosed with GD and treated with CBT, based on the profile at pre- and post-treatment. Person-centered treatments should include specific strategies aimed at increasing self-esteem, emotional regulation capacities and self-control of GD women.

Gambling disorder duration and cognitive behavioural therapy outcome considering gambling preference and sex.

Gambling Disorder (GD) is a behavioural addiction that leads to high level of clinical distress and, in general, it is characterized by enduring symptomatology that presents high rates of chronicity. However, there is high variability of illness duration among patients who seek treatment for GD. Previous studies reported mixed results about the relevance of illness duration in GD treatment outcome. However, there are different profiles of patients who are diagnosed with GD. For this reason, this study aimed to evaluate the effect of illness duration in the treatment outcome of different profiles of GD patients according to their gambling preference and sex. The sample were 1699 patients diagnosed with GD. All patients received cognitive-behavioural therapy in a group format. Treatment outcome was evaluated in terms of relapsing to gambling behaviours and dropout from treatment. Results showed higher probability of poor outcome in the first years of the disorder for strategic gambling compared to non-strategic or mixed forms of gambling. Moreover, women also showed higher probability of poor outcomes than men since the first stages of the disorder. This study draws attention to the relevance of illness duration in the treatment outcome of specific profiles of GD patients. In particular, patients who presented a preference for strategic forms of gambling and women who are diagnosed with GD would have a higher risk of poor treatment outcomes since the first stages of the disorder. These results highlight the importance of an early intervention in these patients in order to prevent the chronicity of the disorder.

Latent Classes for the Treatment Outcomes in Women with Gambling Disorder and Buying/Shopping Disorder.

BACKGROUND: The risk for behavioral addictions is rising among women within the general population and in clinical settings. However, few studies have assessed treatment effectiveness in females. The aim of this work was to explore latent empirical classes of women with gambling disorder (GD) and buying/shopping disorder (BSD) based on the treatment outcome, as well as to identify predictors of the different empirical groups considering the sociodemographic and clinical profiles at baseline. METHOD: A clinical sample of n = 318 women seeking treatment for GD (n = 221) or BSD (n = 97) participated. Age was between 21 to 77 years. RESULTS: The four latent-classes solution was the optimal classification in the study. Latent class 1 (LT1, good progression to recovery) grouped patients with the best CBT outcomes (lowest risk of dropout and relapses), and it was characterized by the healthiest psychological state at baseline, the lowest scores in harm avoidance and self-transcendence, and the highest scores in reward dependence, persistence, self-directedness and cooperativeness. Latent classes 3 (LT3, bad progression to drop-out) and 4 (LT4, bad progression to relapse) grouped women with the youngest mean age, earliest onset of the addictive behaviors, and worst psychological functioning. CONCLUSIONS: GD and BSD are complex conditions with multiple interactive causes and impacts, which need wide and flexible treatment plans. Specific interventions should be designed according to the specific profiles of women for achieving early inclusion, retention and well-maintained long-term effects.

Suicidal behavior in patients with gambling disorder and their response to psychological treatment: The roles of gender and gambling preference.

Suicidal ideation and attempts are prevalent among patients with gambling disorder (GD). However, patients with GD and a history of lifetime suicidal events are not a homogeneous group. The main objective of this study was to compare sociodemographic, clinical, personality, and psychopathological features among different profiles of adults with GD with and without a history of suicidal behavior, taking into account two relevant variables: gender and gambling preference. The second aim was to examine how the different profiles of patients with a history of suicidal events responded to cognitive-behavioral therapy (CBT). A total of 1112 treatment-seeking adults who met the criteria for GD were assessed at a hospital specialized unit for the treatment of behavioral addictions. The participants completed self-reported questionnaires to explore GD, personality traits, and psychopathological symptomatology. The lifetime histories of suicidal ideation and attempts, and gambling preferences, were assessed during semi-structured face-to-face clinical interviews. Of the total sample, 229 patients (26.6%) reported suicidal ideation and 74 patients (6.7%), suicide attempts. The likelihood of presenting suicidal ideation was higher for women than men, but no differences were observed based on gambling preference. Regarding suicide attempts, the odds were higher among women with non-strategic forms of gambling. Suicidal ideation and attempts were associated with higher GD severity, a worse psychopathological state and higher self-transcendence levels. In terms of treatment outcomes, neither gambling preference nor past suicidal behavior had an influence on dropouts and relapses. Nevertheless, female gender and a lack of family support constitute two good predictors of a worse treatment outcome.