Gambling in a U.S. Census Matched Sample: Examining Interactions between Means and Motives in Predicting Problematic Outcomes.

The influence of socioeconomic status (SES) on risk of Problem Gambling (PG) is complex, particularly given recent evidence that SES should be understood in both objective and subjective terms. Likewise, financial gambling motives have been found to be predictive of PG; however, financial motives are less understood in comparison to other gambling motives. Preliminary findings on SES and gambling points towards a pattern of social inequality in which those with the least financial resources (e.g., income) or that feel financially deprived relative to others (e.g., perceived deprivation) experience greater harm and problems. In a weighted, census matched sample of adults in the U.S. (N = 1,348), the present study examined the interaction between financial gambling motives and income and financial gambling motives and perceived deprivation in predicting PG. Findings provided support for both financial gambling motives and perceived deprivation as robust predictors of PG. Further, results provided unique insights into the role subjective economic standing may play in the relationship between financial motives for gambling and risk of PG.

Anticipated Motives for Gambling Treatment in Adults from the U.S.

Prior works note that identifying problematic play is a leading barrier to treatment seeking, contributing to low treatment rates in those with gambling problems (e.g., Bijker et al., 2022; Suurvali et al., 2012a). While research has looked at treatment seekers' motives for treatment (Gainsbury et al., 2014; Suurvali et al., 2012b), the situations or signs (anticipated motives) individuals look for that suggest they would need treatment in the future remains unknown. Participants were gamblers (N = 1,791) from a census-matched U.S. sample of adults who reported no concerns about their gambling. Participants completed questions assessing how much money they would have to lose while gambling to think they might have a problem and what factors might motivate them to pursue treatment for gambling problems in the future. Participants reported a wide range of financial loss that would suggest they had a problem, and higher income men who gambled more frequently reported higher necessary losses. There was little variation in endorsement (40-60%) of 14 situations that may lead them to seek treatment in the future (e.g., felt guilty). However, income, gender identity, and problem gambling behavior were linked to the endorsement of some of these anticipated motives, with some differences in endorsement between those engaging in high- and low-level problem gambling. Collectively, results are consistent with the inference that many individuals may not be aware of what problematic gambling would look like for them, though income, gender identity, and problem gambling behavior may impact their consideration of anticipated motives.

Exploring the Differences in Positive Play among Various Sports Wagering Behaviors.

Recent technological advances and legislative changes have led to an increase of sports wagering across the United States, raising concerns about possible increases in problem gambling behaviors. This, in turn, points to an increased need to understand responsible gambling and how it relates to sports gambling behaviors. The present work utilizes the Positive Play Scale (PPS), a recent scale designed to measure the increasingly popular responsible gambling concept of Positive Play, to assess how various aspects of sports gambling relate to responsible gambling. Participants were recruited by YouGov Opinion polling and taken from two U.S. samples, and the present analyses look only at those who self-identified as sports gamblers (n = 561, Mage = 50.7). Gamblers' location of gambling, types of bets wagered on, timing of gambling, and website used to gamble were assessed. Those who bet online in any capacity, as well as participating in in-game wagering, were found to be significantly less positive in their gambling behaviors. In addition, certain types of sports wagers such as moneylines appeared to be associated with higher positive play, while other types such as parlays were associated with less positive play. Finally, certain websites, particularly offshore websites, were associated with lower positive play behavior. Collectively, these results suggest that there are various aspects of sports wagering behaviors that are associated with positive play variations in gambling.

A Network Comparison of Sexual Dysfunction, Psychological Factors, and Body Dissociation between Individuals with and without Sexual Trauma Histories.

Sexual dysfunction is associated with psychological symptoms, including depression and anxiety. Sexual dysfunctions are often attributed to dissociation symptoms in individuals who reported sexual trauma histories. This study utilized a network approach to analyze relationships between sexual and psychological symptoms and examine whether the identified network structures differed between individuals who reported a history of sexual trauma and those who did not. Sexual dysfunction, history of sexual trauma, internalizing symptoms, dissociation symptoms, sex-related shame, and negative body image were assessed in 1,937 United States college students (women = 69.5%). Nearly half (46.8%) of the participants reported a sexual trauma history in their lifetime. Using regularized partial correlation networks, the relationships between sexual and psychological symptoms were analyzed and compared between groups with and without trauma histories. Internalizing symptoms were positively correlated with sexual dysfunction regardless of the presence of sexual trauma history. Anxiety had a stronger influence in the trauma network than in the no-trauma network. Feeling separated from the body during sexual activity was a central symptom and was related to difficulties relaxing and enjoying sex only in the trauma network. Sex-related shame appeared to play a more important role in men compared to women. To improve clinical practice of assessing and treating sexual dysfunction, researchers and clinicians should consider core symptoms that connect different aspects of sexual and psychological functioning while being aware of the unique role of dissociation in the context of traumatic stress.

The relative risks of different forms of sports betting in a U.S. sample: A brief report.

BACKGROUND: The 21st century has brought substantial changes to the manners in which people gamble and the types of things on which people gamble. These changes are particularly stark in the United States, where, over the past five years, sports betting has gone from being legal in only one location to being legal throughout the majority of the country, often via mobile applications and online betting websites. METHOD: In March of 2022, a sample of the U.S. population (n = 2806, Mage[SD] = 48.9[17.2]; 1365[48.6%] men; response rate = 87.6%) and an oversample of sports-wagering adults in the U.S. (n = 1557, Mage[SD] = 41.7[15.3]; 1043[67%] men; response rate = 78.7%) were recruited via YouGov. Participants completed measures of gambling activities, including various forms of sports betting, as well as measures of problem gambling activities. RESULTS: In general, people who gamble on sports, when compared to people who do not bet on sports, reported greater frequency of gambling engagement (averaging between monthly and weekly play),a wider variety of gambling activities (with the majority reporting past year engagement in four or more gambling activities), and higher rates of problem gambling. Multinomial logistics regression revealed no distinct associations between any specific form of sports gambling and higher risk, instead demonstrating that breadth and depth of gambling engagement were the best predictors of high-risk gambling behaviors. CONCLUSIONS: In general, sports gambling is broadly associated with greater engagement in both breadth of gambling activities and frequency of gambling play. Additionally, people who gamble on sports seem to be at higher risk of problem gambling than people who do not bet on sports. However, in analyses controlling for breadth and depth of gambling activities, these links are attenuated, suggesting that the risks associated with sports gambling behaviors are related to the greater degree of gambling engagement.

Psychometric properties of the Alcohol Use Disorders Identification Test (AUDIT) across cross-cultural subgroups, genders, and sexual orientations: Findings from the International Sex Survey (ISS).

INTRODUCTION: Despite being a widely used screening questionnaire, there is no consensus on the most appropriate measurement model for the Alcohol Use Disorders Identification Test (AUDIT). Furthermore, there have been limited studies on its measurement invariance across cross-cultural subgroups, genders, and sexual orientations. AIMS: The present study aimed to examine the fit of different measurement models for the AUDIT and its measurement invariance across a wide range of subgroups by country, language, gender, and sexual orientation. METHODS: Responses concerning past-year alcohol use from the participants of the cross-sectional International Sex Survey were considered (N = 62,943; Mage: 32.73; SD = 12.59). Confirmatory factor analysis, as well as measurement invariance tests were performed for 21 countries, 14 languages, three genders, and four sexual-orientation subgroups that met the minimum sample size requirement for inclusion in these analyses. RESULTS: A two-factor model with factors describing 'alcohol use' (items 1-3) and 'alcohol problems' (items 4-10) showed the best model fit across countries, languages, genders, and sexual orientations. For the former two, scalar and latent mean levels of invariance were reached considering different criteria. For gender and sexual orientation, a latent mean level of invariance was reached. CONCLUSIONS: In line with the two-factor model, the calculation of separate alcohol-use and alcohol-problem scores is recommended when using the AUDIT. The high levels of measurement invariance achieved for the AUDIT support its use in cross-cultural research, capable also of meaningful comparisons among genders and sexual orientations.

Examining Responsible Gambling Program Awareness and Engagement Trends and Relationships with Gambling Beliefs and Behaviors: A Three-Wave Study of Customers from a Major Gambling Operator.

A considerable body of literature has examined elements of responsible gambling (RG) programs in land-based gambling venues. The present pre-registered study examines GameSense RG program awareness and engagement trends and relationships with gambling beliefs and behaviors, at MGM's U.S.-based casino properties using three samples of MGM's loyalty program members. We used a repeated cross-sectional approach including observational data collected from one sample (N = 3748) shortly before the rollout of GameSense in 2017-2018, and from two samples collected 1 year (N = 4795) and 2 years (N = 3927) after the program's implementation. We found that awareness of the GameSense program increased between pre- and 1-year post-implementation, yet did not increase further at 2-years post-implementation. Bivariate analyses showed that respondents who were aware of more GameSense components had a better understanding of gambling concepts and used more RG strategies, whereas respondents who engaged with GameSense used more RG strategies than those who did not, but did not display a better understanding of gambling concepts. The relationship between GameSense awareness and self-reported use of RG strategies remained significant in multivariate analyses with covariates. Moderation analyses indicated that a positive effect of overall GameSense engagement on gambling literacy was only found for respondents who had attended a regional property, as compared to respondents who attended Las Vegas or metropolitan properties. All effect sizes were weak, which suggests that practical impacts of the program currently are limited. Our findings have implications for research on land-based RG programs and we provide recommendations for enhancing such programs.

Understanding Differences in Problematic Pornography Use: Considerations for Gender and Sexual Orientation.

BACKGROUND: While preliminary research suggests non-heterosexual men and women view more pornography than their heterosexual counterparts, few studies have examined how problematic use differs across sexual and gender identity groups. AIM: We sought to test measurement invariance across popular measures of problematic pornography use (PPU) and examine mean PPU differences across heterosexual men, non-heterosexual men, heterosexual women, and non-heterosexual women. METHODS: We used 3 large archival datasets to examine psychometrics/group differences on the Brief Pornography Screen (BPS; N = 1,439), Problematic Pornography Use Scale (PPUS; N = 5,859), and Cyber Pornography Use Inventory-4 (CPUI-4; N = 893). OUTCOMES: Most PPU scales/subscales demonstrated acceptable fit, and non-heterosexual men and women tended to report more PPU than heterosexual men and women (though exceptions were evident). RESULTS: Confirmatory factor analyses revealed good fit across each group and instrument, with exception to sexual minority women on the CPUI-4. Each instrument demonstrated at least metric invariance between groups, with exception to one item between heterosexual and sexual minority men on the CPUI-4. Mean differences suggested that sexual minority men and women tend to report more PPU than heterosexual men and women, though several exceptions were evident depending on the PPU dimension. Men tended to report more PPU than women, though exceptions were also evident. Effect sizes ranged from large-to-non-significant depending on PPU dimension. CLINICAL IMPLICATIONS: Researchers and clinicians should consider sexual orientation, gender, and PPU dimension when addressing PPU concerns. STRENGTHS & LIMITATIONS: A primary strength of this study is the use of multiple large samples, meaning our results are likely highly generalizable. However, this study is limited in that it only examined sexual orientation groups broadly and did not account for non-cisgender identities. CONCLUSIONS: The BPS, PPUS, and CPUI-4 are all appropriate tools to measure PPU depending on researcher and clinician needs. Borgogna NC, Griffin KR, Grubbs JB, and Kraus SW. Understanding Differences in Problematic Pornography Use: Considerations for Gender and Sexual Orientation. J Sex Med 2022;19:1290-1302.

Cross-Sectional and Longitudinal Associations Between Posttraumatic Stress Symptoms and Hypersexual Behaviors Among Individuals Who have Gambled in Their Lifetimes.

BACKGROUND: Exposure to traumatic experiences represent one factor that may contribute to the development of hypersexual behaviors. AIM: We investigated the associations between posttraumatic stress symptoms and hypersexual behaviors by analyzing survey data from 2 samples. METHOD: The first sample consisted of n = 585 college students, and the second consisted of n = 786 adults recruited via Amazon's Mechanical Turk (MTurk), n = 337 of whom completed a 6-month follow-up survey. We conducted 3 hierarchical regression analyses adjusting for age, gender, sexual orientation, impulsivity, drug use, alcohol use, and gambling. OUTCOMES: The primary outcomes for this investigation were associations between posttraumatic stress symptoms, measured using the PTSD Checklist for DSM-IV and DSM-5 (PCL-C and PCL-5), and hypersexual behaviors, measured using the Hypersexual Behavior Inventory (HBI). RESULTS: A significant regression, R2 = 0.230, R2adjusted = 0.211, F (14,570) = 12.17, P < .001, revealed posttraumatic stress symptoms were associated with hypersexual behaviors in the university student sample (ß = 0.154). A significant regression using the MTurk sample, R2 = 0.403, R2adjusted = 0.392, F (14,771) = 37.13, P < .001, confirmed this finding (ß = 0.259). In addition, a significant regression, R2 = 0.562, R2adjusted = 0.541, F (15,321) = 27.42, P < .001, indicated that posttraumatic stress symptoms were longitudinally associated with increased hypersexual behaviors (ß = .190) after adjusting for all variables, including baseline hypersexuality. CLINICAL TRANSLATION: Results suggest that individuals experiencing posttraumatic stress symptoms are at increased risk for current and future hypersexual behaviors. STRENGTHS & LIMITATIONS: This investigation involved secondary analyses of adults who had gambled at least once in their lives and findings may not generalize to those who have never gambled. Furthermore, longitudinal findings may be impacted by selection bias (42% completion rate) and may not generalize to follow up periods longer than 6-months. CONCLUSION: This study provides support for the hypothesis that posttraumatic stress symptoms are associated with increased hypersexual behavior, and further research is indicated to explore the etiology and directionality of this relationship. Rosansky JA, Borgogna NC, Kraus SW, et al. Cross-Sectional and Longitudinal Associations Between Posttraumatic Stress Symptoms and Hypersexual Behaviors Among Individuals Who have Gambled in Their Lifetimes. J Sex Med 2022;19:1813-1823.

Porndemic? A Longitudinal Study of Pornography Use Before and During the COVID-19 Pandemic in a Nationally Representative Sample of Americans.

Of the many changes in daily life brought about by the COVID-19 pandemic, social distancing efforts and governmentally mandated lockdowns were among the most drastic. Coinciding with these changes, popular pornography websites made some previously premium content available for free, spurring dramatic increases in traffic to these websites. This increase in time spent at home and reported increases in traffic to specific pornographic websites led to some speculation that pornography use might generally increase over the course of the pandemic and that problematic use might also increase. To test these speculations and quantify the effects of the pandemic and its associated restrictions on social behaviors on pornography use, we analyzed data from a longitudinal sample of American adults. Baseline, nationally representative data were collected in August 2019 via YouGov (N = 2518). Subsequent data were collected in February 2020 (n = 1677), May 2020 (n = 1533), August 2020 (n = 1470), and October 2020 (n = 1269). Results indicated that, in May 2020, immediately following the height of the first wave of pandemic-related lockdowns, more people reported past-month pornography use than at other follow-up time points, but less did so than at baseline. Among those who reported use in May 2020, only 14% reported increases in use since the start of the pandemic, and their use returned to levels similar to all other users by August 2020. In general, pornography use trended downward over the pandemic, for both men and women. Problematic pornography use trended downward for men and remained low and unchanged in women. Collectively, these results suggest that many fears about pornography use during pandemic-related lockdowns were largely not supported by available data.

Perspective: Can psychedelic-assisted therapy be a promising aid in compulsive sexual behavior disorder treatment?

Recently, there has been an increase in studies yielding evidence for psychedelics' anxiolytic and anti-depressive qualities. Preliminary evidence for treatment in substance addiction is also available. In our manuscript, we present a perspective on the possible effectiveness and mechanisms of action of psychedelics' introduction in the treatment of Compulsive Sexual Behavior Disorder (CSBD) and other p roblematic sexual behaviors, which are considered representative of the so-called "behavioral addiction" category. Evidence for the efficacy of Mindfulness Based Interventions in CSBD treatment is promising. Psychedelics- and mindfulness-induced states share common characteristics on both a subjective and objective level. One of the proposed mechanisms regards reduction of experiential avoidance through the promotion of exposure and acceptance. On the neurophysiological level, a shift from higher- to lower-level association regions and an impact on 5- HT2A receptors is observed. Elaborated mechanisms explain the possible enhancement of therapeutic processes by psychedelics. Psychedelics' relative safety and low addictive potential support their introduction into traditional forms of therapy for CSBD and other out of control behaviors.

Sexual and physical revictimization in U.S. military veterans.

The present study examined revictimization, defined as sexual or physical assault in adulthood that followed a history of childhood maltreatment. We aimed to identify factors associated with revictimization over time in a group of U.S. military veterans deployed following the September 11, 2001, terrorist attacks (9/11). As revictimization is associated with multiple negative mental health outcomes in the literature, identifying risk and protective factors can aid in the prevention of revictimization and associated poor health outcomes among veterans. In this sample, the proportion of adult revictimization was 2.7% for men, 95% CI [2.0, 3.6] and 22.9% for women, 95% CI [20.5, 25.8]. Using multilevel logistic models, we found that women, ß = 2.2, p < .001; Navy veterans, ß = 1.5, p < .001; and participants who reported posttraumatic stress symptoms, ß = 0.2, p = .028, were at significantly higher risk of revictimization across time compared to nonrevictimized counterparts. Social support while in the military was protective, ß = -0.1, p < .001, against revictimization. In addition, childhood abuse experiences combined with characteristics such as female gender were related to an increased risk of revictimization during and following military service. The findings highlight opportunities for intervention and areas of strength within this population; social connection garnered during military service may serve as a protective factor against revictimization. Future research is needed to examine the role of social support in possibly lowering veterans' risk of revictimization over time, particularly for post-9/11 veterans struggling with transitioning from military to civilian life.

The psychometric properties of the Bergen-Yale sex addiction scale for the Iranian population.

BACKGROUND: The assessment of sex addiction among different populations requires a valid and reliable tool. Since the Bergen-Yale Sex Addiction Scale (BYSAS) was not available in Iran, this study aimed to evaluate the validity and reliability of the Persian version of the BYSAS. METHODS: After translation/back-translation procedure, a total of 756 Iranian men and women completed the BYSAS. The structural validity of this tool was evaluated by exploratory and confirmatory factor analyses. An expert panel review also examined content validity of the items. Psychometric properties of the scale including validity, reliability (internal consistency [Cronbach's alpha]) and test-retest) and factor structure were assessed. RESULTS: Content Validity Index (CVI) and Content Validity Ratio (CVR) scores for the BYSAS were 0.75 and 0.62, respectively. In the measure's structural validity, the results of exploratory and confirmatory factor analysis supported the One-factor structure. Data analysis demonstrated satisfactory internal consistency (Cronbach's alpha ranging from 0.88 to 0.89). DISCUSSION: Study findings suggest that the BYSAS is a valid and reliable instrument for assessing sex addiction among Persian speaking adults. Replication of research findings is needed to expand the BYSAS for clinical and non-clinical Iranian populations.

Buprenorphine Naloxone and Extended Release Injectable Naltrexone for the Treatment of Opioid Use Disorder Among a Veteran Patient Sample: A Retrospective Chart Review.

OBJECTIVE: Previous research has demonstrated the effectiveness of both extended-release injectable naltrexone (XR-NTX) and buprenorphine/naloxone (BUP-NX) in the treatment of opioid use disorder (OUD). However, studies using real-world samples with multiple medical and psychiatric comorbidities are lacking. The study's primary aims were to: (1) compare clinical presentations in an inclusive sample of OUD-diagnosed US military veterans receiving XR-NTX and BUP-NX, and (2) investigate differences in 90-day treatment outcomes between these two groups. Methods: The medical records of 79 patients receiving medications to treat OUD in a VA hospital's addiction outpatient treatment program were reviewed retrospectively. The analysis included all veterans who initiated medication treatment during the study period. Differences between medication groups on co-occurring diagnoses, treatment retention, and related outcomes were examined. Results: The two groups were similar in medical and psychiatric comorbidity, although the BUP-NX group were more likely to have a pain diagnosis. No statistically significant differences in retention or toxicology results were found between the two groups over the 90-day study period. The rate of positive urine screens for the BUP-NX group was 19.2% for opiates and 13.5% for other illicit substances, and 3.7% and 11.1% respectively for the XR- NTX group. Conclusion: There was no evidence that 90-days outcomes differed for veterans based on medication received, and there were more similarities than differences in clinical characteristics. Additional research is needed, including larger sample size and prospective randomized control trial to evaluate VA patients' treatment outcomes receiving BUP-NX or XR-NTX for OUD.

Post-9/11 military veterans' adjustment to civilian life over time following separation from service.

OBJECTIVES: US military veterans face many challenges in transitioning to civilian life; little information is available regarding veterans' reintegration experiences over time. The current study characterized veterans' postdeployment stressful life events and concurrent psychosocial wellbeing over one year and determined how stressors and wellbeing differ by demographic factors. METHODS: Recent Post-911 veterans (n = 402) were assessed approximately every three months for 1 year. Participants were 60% men, primarily White (78%), and 12% Latinx; the average age was 36 years. RESULTS: The frequency of stressful events decreased over time but was higher for men and minority-race veterans (independent of time since separation). Veterans reported high mean levels of posttraumatic stress disorder, anxiety, and insomnia symptoms, which improved slightly over time. Minority-race and Latinx veterans had higher symptom levels and slower rates of symptom reduction. CONCLUSION: Veterans remain distressed in their overall transition to civilian life. Interventions to promote resilience and help veterans manage readjustment to civilian life appear urgently needed.

Gender-Related Differences in Associations Between Sexual Abuse and Hypersexuality.

BACKGROUND: Individuals with histories of sexual abuse may be more likely to experience sexual-related problems including hypersexuality, but gender-related differences remain unclear. AIM: This online study examined sexual abuse history and hypersexuality by gender among 16,823 Hungarian adults, adjusting for age, sexual orientation, relationship status, education, employment status, and residence. METHODS: An online questionnaire on one of the largest Hungarian news portals advertised this study examining sexual activities in January 2017. 3 categorizations of age-related sexual abuse were examined: child sexual abuse (CSA) occurring at age 13 and earlier (compared to no abuse), adolescent/adult sexual abuse (AASA; compared to no abuse), and CSA and AASA (CSA/AASA; compared to one age-related category of abuse or the other). OUTCOMES: The outcome variable, hypersexuality, was examined as a continuous variable due to the low prevalence of clinical hypersexuality in this sample. 3 multivariate linear regression analyses adjusting for covariates aimed to predict hypersexuality from each category of abuse, along with gender and its interaction with each category. RESULTS: In all models, younger age, non-heterosexual sexual orientation, male gender, single relationship status, less than full-time work, and living in a capital city were associated with hypersexuality, and education was not a significant predictor. CSA, AASA, and CSA/AASA predicted hypersexuality in both men and women. There was a significant interaction between CSA/AASA and gender, such that the relationship between CSA/AASA and hypersexuality was stronger in men than in women. CLINICAL TRANSLATION: Sexual abuse at each developmental time-point may influence hypersexuality among men and women, although the cumulative impact of CSA and AASA on hypersexuality may be particularly relevant among men. STRENGTHS & LIMITATIONS: This is one of the largest studies to examine gender-related differences in the relationship between sexual abuse and hypersexuality. Nevertheless, our study is cross-sectional, and longitudinal work is needed to determine how sexual abuse affects children, adolescents, and adults throughout their lives. CONCLUSION: Developmental impacts of sexual abuse may be considered in a gender-informed fashion in order to develop and optimize effective prevention and treatment strategies for hypersexuality. Slavin MN, Blycker GR, Potenza MN, et al. Gender-Related Differences in Associations Between Sexual Abuse and Hypersexuality. J Sex Med 2020;17:2029-2038.

Posting Sexually Explicit Images or Videos of Oneself Online Is Associated With Impulsivity and Hypersexuality but Not Measures of Psychopathology in a Sample of US Veterans.

INTRODUCTION: Sending sexually explicit text messages ("sexting") is prevalent among US adults; however, the mental health correlates of this behavior among adults have not been studied adequately. Furthermore, there are few studies examining the related but distinct behavior of posting sexually explicit photos or videos of oneself online (posting sexual images [PSI]) and the mental health correlates of this behavior. AIM: To examine associations between sexting, PSI, impulsivity, hypersexuality, and measures of psychopathology. METHODS: Using a national convenience sample of 283 US post-deployment, post-9/11 military veterans, we evaluated the prevalence of 2 behaviors: sexting and PSI and the associations of these behaviors with psychopathology, suicidal ideation, sexual behaviors, hypersexuality, sexually transmitted infections, trauma history, and measures of impulsivity. MAIN OUTCOME MEASURE: Measures of psychopathology including depression, anxiety, post-traumatic stress disorder, insomnia, substance dependence, hypersexuality, and suicidal ideation, as well as measures of impulsivity, sexual behavior, and trauma. RESULTS: Sexting was found to be common among post-9/11 veterans (68.9%). A smaller number of veterans engaged in PSI (16.3%). PSI veterans were more likely to be younger, male, less educated, and unemployed. After adjusting for covariates, no associations were detected between PSI or sexting and the examined measures of psychopathology. However, PSI was associated with higher levels of impulsivity and hypersexuality, whereas sexting was not associated with these measures. CLINICAL IMPLICATIONS: Results from this study suggest that not all digital sexual behaviors are associated with psychopathology. However, PSI was associated with hypersexuality and impulsivity. Those who engage with PSI may benefit from guidance on how to manage their impulsivity to prevent ego-dystonic sexual behaviors. STRENGTHS & LIMITATIONS: The strengths of this study include differentiating PSI from sexting broadly, highlighting that digital sexual behaviors are heterogeneous. Limitations include the study's cross-sectional design, which limits causal interpretations. More research is also needed in civilian populations. CONCLUSION: PSI was less prevalent than sexting in our sample. This behavior was associated with impulsivity and hypersexuality but not with elevated levels of psychopathology. Sexting was not associated with any of these measures. Turban JL, Shirk SD, Potenza MN, et al. Posting Sexually Explicit Images or Videos of Oneself Online Is Associated with Impulsivity and Hypersexuality but Not Measures of Psychopathology in a Sample of US Veterans. J Sex Med 2020;17:163-167.

Trauma-informed Drug Screens for Veterans with Co-occurring Disorders: A Case Series.

Objective: This case series describes and illustrates the effective use of a trauma-informed approach, GLAPE, to provide drug screens for individuals in substance use treatment programs. The GLAPE approach recognizes that individuals who have experienced traumatic events and are recovering from substance use difficulties may also face unique challenges when engaging in mental health treatment. The nature of drug screening procedures in practice may feel invasive and triggering for clients with trauma histories. Finding ways to decrease barriers to treatment and increase engagement and retention are important components of effective substance use treatment. Methods: This case series involved three veteran cisgender men with posttraumatic stress disorder (PTSD) and co-occurring substance use conditions in an outpatient addiction recovery program in a Veterans' hospital. The cases illustrate how recovery can be aided by trauma-informed approaches for urine drug screens. The treatment team evaluated various monitoring modalities and collaborated with each client to form a treatment plan that implemented the GLAPE approach to bolster their recovery. The GLAPE approach includes five components: Giving detailed instructions prior to the urine screen procedure, listening to and eliciting questions and concerns of the client, articulating options and exhibiting flexibility in the procedure to accommodate the needs of the individual client, giving permission to the client to voice concerns at any point during the procedure, and evaluating the process in collaboration with the client, including what could be improved for next time. Results: Use of the GLAPE approach effectively helped to engage and retain military veterans with co-occurring PTSD and substance use disorder within a trauma informed outpatient program. Preliminary evidence from three cases provides that this approach may be useful for use in substance use treatment with clients who have trauma histories. Conclusions: Given widespread use of observed urine drug screens in substance use treatment programs, and prominent co-occurrence of substance use disorder and PTSD, it is essential that staff approach this procedure in a trauma-informed way. This case series illustrates an approach that can improve client experience, aid clients in treatment engagement, and assist staff in the provision of effective care.

Screening for Gambling Disorder in VA Primary Care Behavioral Health: A Pilot Study.

The current pilot study assessed the prevalence of at-risk/problem gambling using the Brief Biosocial Gambling Screen (BBGS) among a sample of U.S. military veterans seeking mental health treatment services in a primary care medical setting at a Veterans Affairs (VA) hospital in the Northeast. Out of the 260 veterans screened, 85 veterans (32.7%) reported gambling behaviors within the past 12 months. No significant differences were found between gambling and non-gambling veterans on demographics, medical, or mental health conditions collected in the study. Among veteran past-year gamblers, five veterans (5.9%) screened positive for at-risk/problem gambling. The estimated prevalence of problem gambling was 1.9% among veterans screened in a primary care behavioral health clinic. Results suggest that self-disclosure of problem gambling among veterans, as well as outreach efforts by VA health care providers, could serve to increase veterans' participation in treatment services for problem gambling. Larger, well-powered studies that examine the utility of the BBGS for detecting problem gambling among military populations are needed.

Awareness of Suicide Prevention Programs Among U.S. Military Veterans.

To assess U.S. veterans' awareness and participation in suicide prevention programs offered by the Department of Veterans Affairs (VA). A nationally representative sample of 1002 veterans was surveyed online in 2018. The majority of veterans reported knowing about Vet Centers (72%), the Veterans Crisis Line (65%), and the VA Center for Suicide Prevention (54%). However, only 5% had attended a community event related to veteran suicide and 2% had used VA's Virtual Hope Box. Veterans aware of the Veterans Crisis Line had more medical conditions and were more likely to report VA as their primary healthcare provider. Veterans aware of VA's Center for Suicide Prevention were younger, male, had more medical conditions, and more likely to screen positive for posttraumatic stress disorder, generalized anxiety disorder, and past homelessness. History of suicidal ideation or attempt was not associated with awareness of suicide prevention programs. VA's suicide prevention programs reach a broad segment of the veteran population, including those with and without histories of suicidality. More targeted outreach may be needed for veterans most at-risk for suicide who are unaware of available resources.