Childhood Adversity, Addiction Severity, and Comorbidity Among Patients Receiving Opioid Use Disorder Treatment: The Role of Emotion Regulation.

ABSTRACT: Patients in opioid use disorder (OUD) treatment report high rates of childhood adversity, and women experience greater exposure to certain types of childhood adversity ( e.g. , sexual abuse). Childhood adversity is associated with clinical severity, but the mechanisms explaining this association are not well understood. Participants ( N = 171) in opioid agonist treatment completed measures of childhood adversity, emotion regulation, and clinical severity ( i.e. , addictive behaviors, depression, and anxiety). Women endorsed greater childhood adversity and higher current psychopathology than men. The association between childhood adversity and clinical severity varied as a function of symptom type, although emotion regulation was a strong predictor in all models. Women reported higher levels of anxiety after controlling for covariates, childhood adversity, and emotion dysregulation. Future research should investigate treatment strategies to address emotion dysregulation among patients in OUD treatment, particularly women who may present with greater childhood adversity exposure and anxiety.

A Randomized Controlled Trial for Gambling Disorder and PTSD: Seeking Safety and CBT.

Studies show a compelling association between gambling disorder and posttraumatic stress disorder. However, there have been no randomized controlled trials for this co-morbidity. The aim of the current study was to compare two evidence-based models, one that addresses both disorders and another that addresses gambling alone. Sixty-five men and women with gambling disorder and posttraumatic stress disorder were randomized to one of two treatment conditions delivered via telehealth, Seeking Safety (integrated treatment for gambling and posttraumatic stress disorder) or Cognitive-Behavioral Therapy for Pathological Gambling (for gambling alone), in a randomized controlled non-inferiority trial. Primary outcomes were net gambling losses and number of sessions gambling. Secondary outcomes were posttraumatic stress disorder symptoms, coping skills, general psychiatric symptoms, global functioning, and gambling cognitions. Assessment occurred at baseline, 6-weeks, 3 months (end of treatment) and 1-year. On most measures, including primary outcomes, participants improved significantly over time with no difference between treatment conditions. Seeking Safety patients had significantly higher session attendance. Effect sizes were large for gambling, posttraumatic stress disorder and coping. All other measures except one showed medium effect sizes. Therapeutic alliance, treatment satisfaction, and the telehealth format were all rated positively. This was the first randomized trial of Seeking Safety in a gambling disorder population. Seeking Safety showed comparable efficacy to an established gambling disorder intervention; and significantly higher Seeking Safety attendance indicates especially strong engagement. Our finding of overall comparable results between the two treatments is consistent with the comorbidity treatment literature.Trial registration: ClinicalTrials.gov NCT02800096; Registration date: June 14, 2016.

Juvenile Probation Officer Perception of Contingency Management to Target Caregiver Engagement and Training Outcomes.

Few community-based substance use treatment programs are available or skilled in treating justice-involved youth, highlighting the need to equip juvenile probation officers with the skills to deliver evidence-based substance use treatment. Contingency management (CM) is evidence-based for treating substance use and shows promise for juvenile probation officers' successful uptake (positive opinions and trainability). However, research has not examined whether probation officers' positive beliefs and trainability generalize to target behaviors beyond those displayed by youth, but that nevertheless affect youth outcomes. This study examined probation officers' perceptions of using CM to engage caregivers and assessed probation officers' CM knowledge and CM delivery after training in a protocol-specific CM program for caregivers of substance-using youth on probation. Results showed probation officers were ambivalent about CM for caregivers. Results also showed that age, training format and how competency is assessed may be essential to consider. Implications for the dissemination of CM and future research are discussed.

Electronic cigarette use among sexual minority and heterosexual young adults in a U.S. national sample: Exploring the modifying effects of advertisement exposure.

Sexual minorities demonstrate disparities in traditional cigarette use and nicotine-related health consequences. Electronic cigarette (e-cigarette) use is increasing, particularly among adolescents and young adults. Sexual minorities have been found to use e-cigarettes at higher rates than heterosexuals, but little is known about reasons for this disparity. The present study examined characteristics of current and lifetime e-cigarette use between sexual minority and heterosexual young adults (18-34; N = 14,174) using a U.S. national sample from the Population Assessment of Tobacco and Health (PATH) Survey-Wave 3. Sexual minority young adults were hypothesized to have higher rates of current and lifetime e-cigarette use and higher rates of exposure to e-cigarette advertisements. These exposures were hypothesized to moderate the relationship between sexual minority status and current e-cigarette use. Results revealed that sexual minority respondents demonstrated greater risk of current e-cigarette use after adjusting for several covariates (e.g., sex, age, lifetime cigarette use). However, advertisement exposures did not moderate the relationship between sexual minority status and current e-cigarette use. In contrast, sexual minority status was not associated with lifetime e-cigarette use after controlling for covariates. Post-hoc tests revealed that sexual minority status was associated with heightened risk of current and lifetime e-cigarette use only among females. This is the first study to examine the impact of e-cigarette advertising across expanded settings, including point of sale locations (e.g., retail, bars, festivals), while exploring differences in current and lifetime e-cigarette use among sexual minority and heterosexual males and females.

Gender Differences in Reasons for Using Electronic Cigarettes: A Systematic Review.

INTRODUCTION: Differential reasons for electronic cigarette (e-cigarette) use for men and women have seldom been examined, and there is no systematic overview of this research literature. AIMS AND METHODS: The aim of this review is to conduct a systematic review of the literature to identify gender differences in the reasons for e-cigarette use. Systematic searches covered in three databases found 866 unique articles: Web of Science, PubMed, and PsycINFO. Twenty-six studies met the inclusion criteria and were reviewed. Reasons for e-cigarette use were sorted into 17 distinct categories. RESULTS AND CONCLUSIONS: Sixteen studies identified statistically significant differences in reasons between men and women. Frequently assessed reasons for e-cigarette use across studies included Health/Smoking Cessation, Experimentation/Curiosity, Enjoyment/Pleasure, Use in Specific Locations, Acceptable to Others, and Cost. Of those that identified statistically significant differences in reasons between men and women, the findings varied considerably, and some reasons for e-cigarette use were found to be significant in only one or two studies. Most of the reasons identified were only measured in a small number of studies, complicating our ability to make intervention recommendations based on gender. Additionally, we limited our literature search to peer-reviewed studies. Of the reason categories that did find significant differences between gender, such as reasons related to Health/Smoking Cessation, the outcomes were not consistent across studies. Future studies are needed to identify potentially important differences in the reasons for e-cigarette use among men and women. IMPLICATIONS: This systematic review aims to uncover gender differences in e-cigarette use to understand important differences in motivation for use that may help us better understand strategies for prevention and treatment of tobacco use disorder. This review is the first on this topic and could provide further insight on patterns of e-cigarette use across gender.

Substance Use, Gambling, Binge-Eating, and Hypersexuality Symptoms Among Patients Receiving Opioid Agonist Therapies.

BACKGROUND AND OBJECTIVES: Patients receiving opioid agonist therapies have high rates of psychiatric comorbidity. Some data suggest that comorbidity is associated with poorer treatment outcomes. The current study assessed predictors of multiple putative addictive behaviors among patients receiving opioid agonist therapies. METHODS: Adults (N = 176) recruited from an outpatient clinic providing opioid agonist therapy completed self-report measures of depression, anxiety, impulsivity, adverse childhood events, and the Recognizing Addictive Disorders (RAD) scale, which includes seven subscales assessing symptoms related to alcohol use, drug use, tobacco use, gambling, binge-eating, hypersexual behavior, and excessive video-gaming. Linear regression and hurdle models identified significant predictors of RAD subscales. Hurdle models included logistic regression estimation for the presence/absence of symptoms and negative binomial regression for estimation of the severity of symptoms. RESULTS: Most patients did not report significant symptoms beyond drug or tobacco use. However, 7% to 47% of participants reported some symptoms of other addictive behaviors (subscale score > 0). Higher impulsivity predicted the presence and/or increased severity of symptoms of drug use, gambling, binge-eating, and hypersexuality. Higher depression significantly predicted increased severity of drug use and binge-eating symptoms. Increased anxiety predicted lower severity of alcohol use and binge-eating and higher severity of smoking symptoms. CONCLUSION AND SCIENTIFIC SIGNIFICANCE: A broader range of potentially addictive symptoms may be present among patients engaged in treatment for opioid use disorder. Few studies have assessed symptoms of binge-eating, hypersexuality, and excessive video-gaming among patients receiving opioid agonist therapy. This study contributes to preliminary findings and highlights important future directions. (Am J Addict 2021;00:00-00).

A systematic review of rural-specific barriers to medication treatment for opioid use disorder in the United States.

BACKGROUND: Opioid-related deaths have risen dramatically in rural communities. Prior studies highlight few medication treatment providers for opioid use disorder in rural communities, though literature has yet to examine rural-specific treatment barriers. OBJECTIVES: We conducted a systematic review to highlight the state of knowledge around rural medication treatment for opioid use disorder, identify consumer- and provider-focused treatment barriers, and discuss rural-specific implications. METHODS: We systematically reviewed the literature using PsycINFO, Web of Science, and PubMed databases (January 2018). Articles meeting inclusion criteria involved rural samples or urban/rural comparisons targeting outpatient medication treatment for opioid use disorder, and were conducted in the U.S. to minimize healthcare differences. Our analysis categorized consumer- and/or provider-focused barriers, and coded barriers as related to treatment availability, accessibility, and/or acceptability. RESULTS: Eighteen articles met inclusion, 15 which addressed consumer-focused barriers, while seven articles reported provider-focused barriers. Availability barriers were most commonly reported across consumer (n = 10) and provider (n = 5) studies, and included the lack of clinics/providers, backup, and resources. Acceptability barriers, described in three consumer and five provider studies, identified negative provider attitudes about addiction treatment, and providers' perceptions of treatment as unsatisfactory for rural patients. Finally, accessibility barriers related to travel and cost were detailed in four consumer-focused studies whereas two provider-focused studies identified time constraints. CONCLUSIONS: Our findings consistently identified a lack of medication providers and rural-specific implementation challenges. This review highlights a lack of rural-focused studies involving consumer participants, treatment outcomes, or barriers impacting underserved populations. There is a need for innovative treatment delivery for opioid use disorder in rural communities and interventions targeting provider attitudes.

Development and Validation of the Recognizing Addictive Disorders Scale: A Transdiagnostic Measure of Substance-Related and Other Addictive Disorders.

OBJECTIVE: Substance use disorders and behavioral addictions commonly co-occur. However, few available self-report measures reliably and validly assess the full range of addictive conditions. The development and initial validation of a new measure-Recognizing Addictive Disorders (RADs) scale addresses a significant gap in the literature. Method: After items were generated and evaluated in Study 1, Study 2 (N = 300), applied exploratory factor analysis to the item pool using an online-based community sample. In Study 3 (N = 427), the factor structure was validated using an independent online-based community sample and confirmatory factor analysis. Results: The scale demonstrated good internal consistency (a = .92) and construct validity, including replication of the factor structure (χ2 (553) = 760.83, p < .001, CFI = .997, TLI = .997, RMSEA = .030) and correlation with a related transdiagnostic measure of addiction (r = .72). Discussion: Overall, results support the preliminary validity of a brief transdiagnostic measure of addiction that considers a diverse range of behaviors. For patients presenting to substance abuse treatment, this tool may be useful in identifying symptoms of other types of non-substance problems, which could ultimately aid in treatment planning.

Gambling-Related Cognitive Distortions in Residential Treatment for Gambling Disorder.

Gambling-related cognitive distortions are associated with gambling disorder severity, but few studies have provided an in-depth examination of the interrelationship between cognitive distortions, gambling severity, psychiatric comorbidity and treatment outcomes. The present study sought to identify factors associated with elevated cognitive distortions among problem gamblers entering residential treatment, examine changes in cognitive distortions through treatment, and explore the association between cognitive distortions and treatment outcomes. Pre- and post-treatment data were extracted from the charts of 125 individuals who participated in a 21-day residential treatment program for gambling disorder. Assessments included measures of demographics, gambling disorder severity, psychiatric symptoms and gambling-related cognitive distortions. Several significant associations were found between baseline cognitive distortions and psychiatric symptoms. Cognitive distortions decreased significantly from pre- to post-treatment. Pre- to post-treatment changes on several cognitive distortion scales were positively associated with greater baseline psychiatric symptomology. Treatment drop-out was associated with higher scores on measures reflecting greater impulsivity/addiction and greater perceived predictive control. Gambling-related cognitive distortions represent an important mechanism of gambling disorder and its treatment and provide a target for the development and refinement of treatment for gambling disorder.

Clinical and Personality Characteristics of Problem and Pathological Gamblers With and Without Symptoms of Adult ADHD.

The study examined the differential clinical and personality characteristics of problem and pathological gamblers (PPGs) with and without clinically significant symptoms of adult attention deficit hyperactive disorder (ADHD). Adults (N = 150, n = 75 women) with PPG were assessed by the SCID-IV, Conners' Adult ADHD Rating Scales, Multidimensional Personality Questionnaire, Gambling Motivation Questionnaire, and the Barratt Impulsiveness Scale. PPGs who reported symptoms of ADHD were more likely to be male, endorse psychiatric comorbidities (i.e., alcohol dependence, anxiety disorders, and antisocial personality disorder), report maladaptive personality traits (i.e., higher negative emotionality and lower positive emotionality), as well as higher impulsivity (attention impulsiveness, motor impulsiveness, and nonplanning impulsiveness). PPGs with symptoms of ADHD reported gambling for social, coping, and enhancement reasons. A multivariate binary logistic regression revealed that sex, higher scores on social reasons for gambling, and lack of premeditation were associated with an increased likelihood of reporting ADHD symptoms. The findings demonstrate important differences of PPGs with symptoms of ADHD and provide information for treatment consideration.

Gender-specific predictors of methadone treatment outcomes among African Americans at an urban clinic.

Background: African American patients with opioid use disorder (OUD) have demonstrated poorer methadone maintenance treatment (MMT) outcomes compared with white patients. This issue is further complicated in urban settings, where African Americans experience high rates of poverty and publicly funded treatment. Despite interrelated factors that disadvantage African Americans, the literature focusing on this population is scant. To address this shortcoming, we conducted the first investigation of gender differences and gender-specific MMT outcome predictors among African Americans (or any racial minority population). This study provides gender-specific findings to improve African American MMT outcomes. Methods: We studied 211 African American patients (male: n = 137, 64.9%) at an urban, university-affiliated MMT clinic. We used existing intake data to assess baseline demographic, substance use, mental health, and interpersonal factors. Primary outcomes were 3-month drug+ (positive) urine drug screen (UDS) results and treatment retention. Results: Women were more likely (than men) to endorse histories of interpersonal violence, substance abuse in their social network, and mental health problems. Men reported a greater likelihood (than women) for early opioid-use onset and a lack of prior MMT. There were no gender differences in 3-month drug+ UDS or treatment retention. In multivariable analyses among women, no baseline factors predicted 3-month opioid+ UDS and physical abuse history predicted a higher proportion of 3-month cocaine+ UDS. Among men, primary injection opioid use and older age best predicted a higher proportion of 3-month cocaine+ UDS and parent substance abuse predicted shorter retention. In both gender-stratified analyses, higher proportions of 3-month opioid+ UDS and cocaine+ UDS predicted shorter retention. Conclusions: This study offers an analysis of gender differences in risk factors, MMT outcomes, and gender-specific predictors among African American patients. MMT clinics should tailor assessment and treatment protocols to address gender-specific needs.

Suicidality among gambling helpline callers: A consideration of the role of financial stress and conflict.

BACKGROUND AND OBJECTIVES: High rates of suicidal ideation and attempts secondary to gambling are well established among those with gambling disorders. The present study explores potential risk factors for suicidal ideation and/attempt among a sample of help-line callers. METHODS: Participants (N = 202) completed measures assessing demographics; gambling behavior; and financial, family/social, employment, substance use, and legal difficulties related to gambling. Bivariate analyses, logistic regression, and mediation analyses were used to explore relationship between predictors and risk of suicidal ideation and attempt. RESULTS: Female gender, gambling severity (including engagement in illegal behaviors), a history of mental health problems, financial problems, and conflict related to gambling were associated with current suicidality in this sample. Mediation analyses revealed that financial problems were associated with increased familial conflict, which was in turn associated with increased suicidality. CONCLUSIONS: Family and social conflict may be one important way in which financial problems confer risk for suicidality among problem gamblers. These results align with findings from the substance use disorder (SUD) literature and highlight one potential factor that may merit further assessment and/or intervention. SCIENTIFIC SIGNIFICANCE: Researchers and clinicians may want to consider the overall level of conflict a patient is experiencing when assessing suicide risk among individuals with gambling problems. Professionals may also want to consider the suitability of interventions to address conflict within the context of gambling treatment. (Am J Addict 2018;27:531-537).

Characteristics and Triage of Children Presenting in Mental Health Crisis to Emergency Departments at Detroit Regional Hospitals.

OBJECTIVES: The number of children in the United States utilizing emergency department (ED) services for psychiatric crises is increasing, and psychiatric-related ED visits disproportionately burden hospital resources. Yet, there is limited available information on the epidemiology and outcomes of pediatric mental health emergencies. The present study sought to characterize pediatric mental health-related ED presentations in a large urban center and identify factors predictive of inpatient hospitalization. METHODS: Data were analyzed from a sample of 225 children (120 female and 105 male children), aged 5 to 18 years, who presented in mental health crisis to Detroit regional EDs over a 27-month period. A trained mental health professional used the Crisis Assessment Tool to assess all children. RESULTS: Thirty-eight percent of children presented with severe depression symptoms, and 52% were judged to be at acute risk of suicide, most of whom were female. Sixteen percent of the sample presented with severe psychotic features, and 34% were assessed as being at risk of harming others. Following assessment, 86% of the sample was directed to inpatient treatment, and no sex differences were found in treatment disposition. Risk of suicide, poor judgment, symptoms of psychosis, and risk of danger to others were all found to be significant predictors of subsequent inpatient hospitalization. CONCLUSIONS: Results provide descriptive information regarding child psychiatric emergency presentations in the city of Detroit. The identified factors that help determine triage to inpatient hospitalization suggest areas for possible resource allocation and potential ED-based intervention.

Assessing the Need for Higher Levels of Care Among Problem Gambling Outpatients.

Most treatment for gambling disorder is provided on an outpatient basis. Only a small number of jurisdictions in North America provide higher levels of gambling treatment, such as residential or intensive outpatient (IOP) care, despite the potential need for these services. Further, there appear to be few guidelines for determining appropriate level of gambling treatment. The aim of the present study was to assess the appropriateness of higher levels of problem gambling care among clients receiving outpatient treatment. Problem gamblers and their therapists independently completed questionnaires that assessed the need and desire for residential and IOP treatment. About 42% of problem gambling outpatients noted that they would be "probably" or "definitely" willing to attend residential treatment, and about half indicated they would be equally likely to attend IOP. Therapists recommended about a third of their clients as appropriate for higher levels of care. For both client and therapist assessments, there was a significant association between desire or recommendation for level of treatment and severity of gambling and co-occurring problems. Further, therapist recommendations for level of care were significantly associated with client willingness to attend higher levels of treatment. Our data reveal the potential need for higher levels of care for problem gambling, as evaluated by clients and their therapists. Policy implications for the funding of residential and IOP treatment are discussed.

Subtyping Non-treatment-seeking Problem Gamblers Using the Pathways Model.

This study examined whether distinct subgroups could be identified among a sample of non-treatment-seeking problem and pathological/disordered gamblers (PG) using Blaszczynski and Nower's (Addiction 97:487-499, 2002) pathways model (N = 150, 50% female). We examined coping motives for gambling, childhood trauma, boredom proneness, risk-taking, impulsivity, attention-deficit/hyperactivity disorder (ADHD), and antisocial personality disorder as defining variables in a hierarchical cluster analysis to identify subgroups. Subgroup differences in gambling, psychiatric, and demographic variables were also assessed to establish concurrent validity. Consistent with the pathways model, our analyses identified three gambling subgroups: (1) behaviorally conditioned (BC), (2) emotionally vulnerable (EV), and (3) antisocial-impulsivist (AI) gamblers. BC gamblers (n = 47) reported the lowest levels of lifetime depression, anxiety, gambling severity, and interest in problem gambling treatment. EV gamblers (n = 53) reported the highest levels of childhood trauma, motivation to gamble to cope with negative emotions, gambling-related suicidal ideation, and family history of gambling problems. AI gamblers (n = 50) reported the highest levels of antisocial personality disorder and ADHD symptoms, as well as higher rates of impulsivity and risk-taking than EV gamblers. The findings provide evidence for the validity of the pathways model as a framework for conceptualizing PG subtypes in a non-treatment-seeking sample, and underscore the importance of tailoring treatment approaches to meet the respective clinical needs of these subtypes.

Smoking Cessation for People Living With HIV/AIDS: A Literature Review and Synthesis.

INTRODUCTION: People living with HIV/AIDS (PLWHA) are more likely to smoke cigarettes than are individuals in the general population. The health implications of tobacco use are substantially more dire among PLWHA than among otherwise healthy smokers, including higher rates of various cancers, cardiovascular disease, inflammation, and lung infections. Efficacious behavioral and medication treatments for treating nicotine dependence have rarely been investigated in PLWHA. METHODS: We present a review of studies examining the efficacy of smoking cessation interventions. RESULTS AND CONCLUSIONS: The literature reveals some limited evidence for the efficacy of behavioral interventions. However, the research literature on these interventions is sparse and the efficacy findings are mixed. Studies exploring the use of mobile technologies for reducing treatment barriers are becoming more prevalent. Few published trials have directly examined the efficacy of pharmacological smoking cessation interventions among PLWHA. Specific gaps in the treatment literature are discussed in detail, and a strategy is presented for developing a greater understanding of factors that contribute to the efficacy of smoking cessation among PLWHA. IMPLICATIONS: This paper provides the most comprehensive review to date on smoking cessation intervention research conducted with PLWHA. It also discusses specific gaps in the literature that should be a priority for future research.

Depressive symptoms affect changes in nicotine withdrawal and smoking urges throughout smoking cessation treatment: Preliminary results.

BACKGROUND: Individuals who report more depressive symptoms consistently demonstrate higher rates of nicotine dependence and less successful smoking cessation than do individuals who report fewer depressive symptoms. Nicotine withdrawal and smoking urges are two potential factors that may account for the differences observed between these two groups. This study assessed whether elevated depression symptoms among nicotine dependent smokers are associated with changes in withdrawal and urges to smoke when undergoing smoking cessation treatment. METHOD: Data on 81 nicotine dependent smokers were collected as part of a smoking cessation randomized trial that compared standard and contingency management treatment across one baseline week and four treatment weeks. Linear mixed model analyses were conducted with high and low depression scores predicting changes in withdrawal and urge ratings from a baseline week and four treatment weeks. RESULTS: Participants with elevated depression symptoms reported more intense nicotine withdrawal and smoking urges throughout treatment. Further, participants with greater depressive symptoms exhibited an increase in smoking urges at the start of treatment, compared with a gradual decline in urges among participants with fewer depressive symptoms. CONCLUSIONS: Smokers with elevated depressive symptoms experience significantly elevated discomfort during smoking cessation efforts in the form of increased withdrawal and craving. This discomfort has the potential to make quitting smoking more difficult. Clinical Trial Identifier: NCT00865254.

Psychological Characteristics of Problem Gamblers With and Without Mood Disorder.

OBJECTIVE: Problem and pathological gamblers are significantly more likely to experience mood disorders, compared with the general population. Our study examined the relation of psychological characteristics (personality, trait impulsiveness, and gambling motives) to current co-occurring mood disorder (major depression and dysthymia) status among problem and pathological gamblers. METHOD: Problem and pathological gamblers (N = 150) underwent a clinical interview to assess current co-occurring mood disorders; participants completed measures of problem gambling severity, personality, impulsiveness, and gambling motives. RESULTS: Problem and pathological gamblers with a current co-occurring mood disorder were more likely to be female, older, and to report higher lifetime and past-year gambling severity. A co-occurring mood disorder was associated with higher personality scores for alienation and stress reaction, lower scores for well-being, social closeness, and control, as well as higher impulsiveness scores for urgency and lack of premeditation, and lower sensation seeking scores. Participants with a co-occurring mood disorder also reported higher coping motives for gambling. Multivariate logistic regression analyses demonstrated that personality factors (lower social closeness and higher alienation) contributed to the greatest likelihood of being diagnosed with a co-occurring mood disorder. CONCLUSIONS: Mood disorders frequently co-occur with problem and pathological gambling, and they are associated with greater gambling severity. These findings highlight that interpersonal facets of personality contribute substantially to co-occurring mood disorder status. Implications for treatment will be discussed.

Barriers to and Reasons for Treatment Initiation Among Gambling Help-line Callers.

Identifying barriers to seeking treatment is essential for increasing problem gambler treatment initiation in the community, given that as few as 1 in 10 problem gamblers ever seek treatment. Further, many problem gamblers who take the initial step of contacting problem gambling help-lines do not subsequently go on to attend face-to-face treatment. There is limited research examining reasons for attending treatment among this population. This study addressed these gaps in the literature by examining barriers and attractions to treatment among callers to the State of Michigan Problem Gambling Help-line. In total, 143 callers (n = 86 women) completed the Barriers to Treatment for Problem Gambling (BTPG) questionnaire and responded to open-ended questions regarding barriers to and reasons for treatment initiation, as part of a telephone interview. Greater endorsement of barriers to treatment was associated with a lower likelihood of initiating treatment, especially perceived absence of problem and treatment unavailability. Correspondingly, problem gamblers who identified more reasons to attend treatment were more likely to attend, with positive treatment perceptions being the most influential. These findings can help get people into treatment by addressing barriers and fostering reasons for attending treatment, as well as reminding clinicians of the importance of identifying and addressing individual treatment barriers among patients with problem gambling.

Clinical and personality characteristics associated with post traumatic stress disorder in problem and pathological gamblers recruited from the community.

Problem and pathological gamblers (PPGs) are more likely than the general population to experience co-occurring psychiatric problems. However, the problem gambling literature has largely overlooked the importance of trauma and post-traumatic stress disorder (PTSD) as a prevalent co-occurring condition among PPGs. This study examined clinical differences between PPGs with and without a history of co-occurring PTSD. Lifetime PPGs (N = 150) recruited from community sources completed clinical assessments including measures of problem gambling severity, co-occurring psychiatric conditions, gambling motivations and personality traits. Over 19% of the participants met criteria for a lifetime diagnosis of PTSD. Those presenting with PTSD histories were more likely to be women, and were more likely to have lifetime substance use disorder (abuse and/or dependence) and substance dependence, lifetime major depressive disorder, current dysthymic disorder, and lifetime and current anxiety disorder. Those with lifetime PTSD also were more likely to use gambling as a way to cope with negative emotions and experienced greater negative emotionality. Few PPGs (16%) had ever sought treatment for their gambling problems. PTSD is a prevalent condition among individuals with lifetime PPG recruited from the community, and is associated with greater psychiatric co-morbidity among these populations. More research is needed to further understand the relationship between gambling and trauma, and better outreach is needed to encourage these individuals to seek treatment.