We Might Have a Sports Gambling Problem and It Is Not What You Think: A Commentary.

The 2018 Supreme Court decision on Murphy v. National Collegiate Athletic Association brought not only a change in the United States commercial gambling landscape, but also considerable speculation across public forums about whether expanded sports gambling causes new, distinct, and greater harm than existing legal forms of gambling. This commentary brings into the focus that the definition of this form of gambling has recently begun to shift without a theoretical basis or empirical evidence. To bring evidence to bear, there is a need for a precise operational definition of sport gambling and greatly clarity to the questions that can drive knowledge generation.

Contrasting the Effects of Alcohol and Alcohol Expectancies on Gambling Behavior.

The influence of alcohol on risk-taking may be through both pharmacological action and individual expectancies. A recent meta-analysis highlighted the need for evidence about the precise role of alcohol expectations on individuals' gambling behavior while under the influence of alcohol and a need to understand what specific gambling behaviors are influenced. This laboratory study investigated the effects of alcohol consumption and alcohol expectancies on gambling behavior in a sample of young adult men. Thirty-nine participants were randomly assigned to one of three experimental conditions in which they consumed alcohol, alcohol-placebo, or no-alcohol beverages and then played a computerized roulette game. The roulette game provided each participant with the same pattern of wins and losses and recorded gambling behavior including wagers made, number of spins, and final dollar amount remaining. Significant main effects were found between conditions on total number of spins with the alcohol and alcohol-placebo groups gambling significantly more than the no-alcohol group. The alcohol and alcohol-placebo groups were not statistically different. These findings support that individuals' expectations play an important role in understanding the effects of alcohol consumption on gambling; this effect may be primarily associated with persistence in wagering.

The Influence of Gambling on Mood State and Alcohol Cravings.

Several decades of research have experimentally investigated the influence of alcohol on gambling. However, there has been only minimal experimental exploration of how gambling influences alcohol use. The aim of the current project was to evaluate how gambling influenced mood state and alcohol cravings through randomized experimental design when analyzed with comparison conditions.College students (N = 76) who reported regular alcohol use, gambling within the past year, and being college basketball fans were randomly assigned to watch a video of an exciting basketball game, watch a nondysphoric basketball game, watch a movie, or engage in slot machine gambling. Participants who watched exciting sports or engaged in gambling to reported more energized mood states and higher urges to drink compared to those who watched nondysphoric sports or a movie. These results suggest that the context of gambling may prime individuals to want to consume alcohol.

Mechanisms of Behavior Change in Substance Use Disorder With and Without Formal Treatment.

This article provides a narrative review of studies that examined mechanisms of behavior change in substance use disorder. Several mechanisms have some support, including self-efficacy, craving, protective behavioral strategies, and increasing substance-free rewards, whereas others have minimal support (e.g., motivation, identity). The review provides recommendations for expanding the research agenda for studying mechanisms of change, including designs to manipulate putative change mechanisms, measurement approaches that expand the temporal units of analysis during change efforts, more studies of change outside of treatment, and analytic approaches that move beyond mediation tests. The dominant causal inference approach that focuses on treatment and individuals as change agents could be expanded to include a molar behavioral approach that focuses on patterns of behavior in temporally extended environmental contexts. Molar behavioral approaches may advance understanding of how recovery from substance use disorder is influenced by broader contextual features, community-level variables, and social determinants of health.

Text Comprehension Analyses to Improve Assessment Accuracy: Demonstration Using Gambling Disorder Screening.

Many individuals diagnosed with an addictive disorder are members of disadvantaged groups and obtain a high school education or less, yet self-report questionnaires widely used to identify symptoms of addictive disorders do not use best practices to ensure item clarity and comprehension. In the present study, we explore how advanced text-analysis technology can be used to guide the development of a diagnostic questionnaire with an emphasis on maximizing its readability and then test the accuracy of this questionnaire. In Study 1, a self-report questionnaire for symptoms of gambling disorder was created using best practices for item clarity and comprehension. In study 2 an experimental design was used to test whether the measure with enhanced readability, compared to a commonly used screening instrument, improved diagnostic symptom accuracy among samples of high school and college educated individuals. Subsequent analyses revealed that education was positively related to item comprehension, and participants who completed the maximized readability questionnaire correctly identified more symptoms of gambling disorder than participants who completed the comparison questionnaire, regardless of educational attainment. These studies indicate that the rate at which individuals accurately identify symptoms of psychopathology is strongly related to their educational attainment and the readability of the questionnaire items themselves.

The Predicted Future of Psychotherapy: A Decennial e-Delphi Poll.

Whither psychotherapy in the 2030s? Following a decennial tradition, the authors conducted an e-Delphi poll on the future of psychotherapy in the United States. A panel of 56 psychotherapy experts participated in two rounds of predictions and achieved consensus on most items. The experts forecast multicultural, mindfulness, and cognitive-behavior therapies to increase the most, whereas classical psychoanalysis, reality therapy, and gestalt therapy to decrease the most. Technological, relationship-building, strength-oriented, skill-building, and self-change interventions were expected to rise. Master-level clinicians of multiple professions were projected to expand while psychiatrists to decline in the proportion of psychotherapy rendered. Therapy platforms with the highest likelihood of flourishing were videoconferencing, texting, smartphone applications, and multiple or flexible platforms. Short-term therapy, crisis intervention, and very short-term therapy were predicted to increase the most. Forecast scenarios with the highest likelihood were therapy personalization, treatment of health problems, requirement of evidence-based practices for insurance reimbursement, and integration of psychotherapy into primary care. Limitations of the Delphi methodology are elucidated, and practice implications for health-service psychologists are advanced.

Integrative data analysis of self-efficacy in 4 clinical trials for alcohol use disorder.

BACKGROUND: Self-efficacy has been proposed as a key predictor of alcohol treatment outcomes and a potential mechanism of success in achieving abstinence or drinking reductions following alcohol treatment. Integrative data analysis, where data from multiple studies are combined for analyses, can be used to synthesize analyses across multiple alcohol treatment trials by creating a commensurate measure and controlling for differential item functioning (DIF) to determine whether alcohol treatments improve self-efficacy. METHOD: The current study used moderated nonlinear factor analysis (MNLFA) to examine the effect of treatment on self-efficacy across four different treatment studies (N = 3720; 72.5% male, 68.4% non-Hispanic white). Self-efficacy was measured using the Alcohol Abstinence Self-Efficacy Scale (AASE) in the COMBINE Study (n = 1383) and Project MATCH (n = 1726), and the Drug Taking Confidence Questionnaire (DTCQ) in two studies of Telephone Continuing Care (TEL Study 1: n = 303; TEL Study 2: n = 212). DIF was examined across time, study, treatment condition, marital status, age, and sex. RESULTS: We identified 12 items from the AASE and DTCQ to create a commensurate measure of self-efficacy using MNLFA. All active treatments, including cognitive-behavioral treatment, a combined behavioral intervention, medication management, motivation enhancement treatment, telephone continuing care, twelve-step facilitation, and relapse prevention, were associated with significant increases in self-efficacy from baseline to posttreatment that were maintained for up to a year. Importantly, treatment as usual in community settings, which consisted of weekly group therapy that included addiction counseling and twelve-step recovery support, was not associated with significant increases in self-efficacy. CONCLUSIONS: Alcohol self-efficacy increases following treatment and numerous evidence-based treatments are associated with significant increases in self-efficacy, which are maintained over time. Community treatment that focuses solely on addiction counseling and twelve-step support may not promote increases in self-efficacy.

Increased Demographic Representation in Randomized Control Trials for Gambling Disorder in the United States is Needed: A Systematic Review.

Participants in randomized control trials (RCTs) should be representative of those most likely to experience the disorder of focus, yet reviews of psychology research studies consistently find certain demographic groups are overrepresented at the price of others being unincluded. The present review aimed to characterize the demographic representation of US-based RCTs for gambling disorder and compare findings to the population of individuals most likely to experience the disorder. Thirteen US-based RCTs comprising a total of 2,343 participants were reviewed. We found that although gambling disorder is most prevalent among low SES racial minorities, RCTs are mostly conducted among populations who are white, employed, and have some level of college education. Demographic variables that are related to the likelihood of experiencing gambling disorder are not consistently reported, and there are many groups of individuals who experience gambling disorder that have been virtually left out of all treatment study samples to date. We conclude with recommendations for future gambling focused treatment studies, which are geared towards increasing the convergence between characteristics of participants in RCTs and those who experience gambling disorder in the United States.

Challenges to Conducting Contingency Management Treatment for Substance Use Disorders: Practice Recommendations for Clinicians.

A growing empirical literature supports contingency management (CM) as an efficacious treatment for substance use disorders, especially when reinforcers are immediate, frequent, and of sufficient magnitude on escalating schedules. However, in real world-practice, CM is often conducted in ways that are inconsistent with research protocols. One reason for these inconsistencies may be due to pragmatic challenges inherent in conducting CM. In this article, we described an outpatient CM treatment program for drug use disorders and several specific challenges associated with adherence to CM parameters from research protocols. Finally, we propose possible solutions for these challenges and discuss implications for practice.

Public Stigma Across Addictive Behaviors: Casino Gambling, eSports Gambling, and Internet Gaming.

The negative psychological effects of public stigma on disordered gamblers have been well documented. Public stigma deters treatment-seeking and other help-seeking behaviors, and negatively impacts individuals' view of themselves. Different types of disordered gambling activities may attract different degrees of stigma. One increasingly popular form of gambling involves placing bets on the outcomes of competitive video games, also called eSports gambling. This activity shares characteristics with Internet gaming and gambling. The purpose of this study was to compare the degree of public stigma held towards traditional casino gamblers, eSports gamblers, and Internet gamers, as compared to an individual experiencing comparable levels of impairment and distress due to a financial crisis. Using an experimental between-groups vignette study design, we found that all three types of behavioral addictions were more heavily stigmatized than the control condition. The three behavioral addictions were seen as being highly controllable, engendered a significant amount of anger and blame, and resulted in higher levels of desired social distance. Traditional casino gamblers were seen as significantly more dangerous to be around and created a higher level of desired social distance than the Internet gamer. Differences between the Internet gamer and eSports better were less pronounced. These findings underscore the importance of reducing public stigma for gambling and other behavioral addictions, and provide information that can be used when developing interventions to impact stigma.

When Does Premature Treatment Termination Occur? Examining Session-by-Session Dropout Among Clients with Gambling Disorder.

Premature termination challenges the successful outcomes of psychological treatments for gambling disorder. To date, research has primarily identified clients who are at particular risk for dropping out of treatment. A smaller but growing body of literature has investigated when dropout occurs. Typically, those studies have not considered improvement in psychological distress within their operationalizations of dropout and therefore may have misrepresented when dropout occurs. The current study examined when dropout occurs using an operationalization based on the criteria of attaining reliable change in a naturalistic sample of clients with gambling disorder, and the classification rates yielded from that operationalization were compared to the rates from a more common operationalization. Participants (n = 334) were clients meeting diagnostic criteria for gambling disorder at an outpatient private practice who completed a measure of psychological distress at baseline and prior to each subsequent treatment session. A survival analysis was conducted to determine temporal patterns of treatment dropout (i.e., clients who discontinued treatment before realizing reliable changes in psychological distress) and completion (i.e., clients who discontinued treatment after realizing reliable changes in distress) at each treatment session. Forty-nine percent of clients were classified as dropouts, and the majority of those clients did so in the first few sessions. The more common operationalization of dropout classified clients as dropouts when they had improved in their distress and clients as completers when they had not improved in their distress. Discussion centers on the implications of dropout occurring at various stages of treatment and future directions.

Psychological Distress as an Indicator of Co-Occurring Psychopathology among Treatment-Seeking Disordered Gamblers.

Disordered gamblers frequently present with concurrent anxiety, depressive, personality, and substance use disorders, which may complicate treatment. Although there is a need for a thorough assessment, some questionnaires may prove lengthy for clients and clinicians. Thus, there is a need for brief screens for identifying co-occurring psychopathology. The present study sought to examine whether a brief, self-report measure of psychological distress could indicate the presence of co-occurring psychopathology among an outpatient sample of disordered gamblers. At intake, 69 participants completed self-report measures of distress and gambling symptomatology, a personality inventory, and a structured interview for the diagnostic criteria for disordered gambling. Gamblers with greater elevations of psychological distress evidenced greater severity of gambling pathology. Clinically significant elevations were present for symptoms of depression, deviancy, and anxiety, but not substance abuse. Greater scores of psychological distress significantly predicted elevations of depression, deviancy, and anxiety. Sensitivity and specificity were evaluated and the findings supported that an average psychological distress score of 16 corresponded with the presence of co-occurring psychopathology. Clinicians treating disordered gamblers should consider screening for co-occurring psychopathology with brief, self-report measures of psychological distress.

Expectations of How Acute Cannabis Use Affects Gambling Experiences and Behaviors.

Emerging research shows that many individuals commonly consume cannabis while gambling. However, individuals' expectations for how cannabis consumption will impact their gambling behavior remain unknown. Participants who gambled weekly (N = 472) were recruited from Amazon Mechanical Turk and completed assessments of gambling behaviors, cannabis consumption, and expectations about the influence of cannabis on gambling. Almost all participants (94%) screened positive for problem gambling. Over half of participants (55%) reported lifetime cannabis consumption, and almost all those participants (99%) reported gambling under the influence of cannabis (GUIC) in the past month. Most participants agreed with positive expectations of gambling; they expected that they would feel calmer when under the influence of cannabis (61.4%), that gambling would be more enjoyable (61.0%), and that their gambling skills would increase when GUIC (60.6%). At the same time, most participants also agreed with negative expectations of GUIC. They expected cannabis use would make them more careless (56.4%), more anxious (54.8%), and less able to concentrate (53.7%) while gambling. Negative cannabis expectancies were significantly associated with the severity of cannabis consumption. Both positive and negative cannabis expectancies were significantly associated with gambling problems and time spent gambling under the influence of cannabis. These findings indicate that expectations may influence the decision to consume cannabis and gamble simultaneously. This study contributes to the need for addressing cannabis expectations during treatment of gambling problems.

Minimizing measurement error in treatment outcome estimates: A meta-analysis comparing estimates between the gambling timeline followback and other self-report assessments of gambling behavior.

OBJECTIVE: The aim of the current meta-analysis was to examine potential differences in posttreatment effect size estimates for gambling frequency (i.e., the number of days gambled) and gambling expenditure (i.e., the amount of money gambled) when using the gambling timeline followback (G-TLFB) versus other self-report assessments. METHOD: Using an open-access meta-analysis database of studies on cognitive behavioral treatment for gambling disorder, 22 studies representing 2,824 participants were identified for inclusion. Hedges's g effect sizes representing posttreatment differences on gambling frequency and expenditure between cognitive behavioral treatment versus inactive and minimal treatment controls were calculated, and mixed-effect subgroup analyses examined the effect sizes for each outcome between studies using the G-TLFB versus other self-report assessments. RESULTS: Mixed-effect subgroup analyses indicated that the effect size for gambling frequency was significantly lower for studies using the G-TLFB (g = -0.15) than studies using other self-report assessments (g = -0.71). When examining whether the use of the G-TLFB was associated with the posttreatment effect size for gambling frequency in a random-effect metaregression model that controlled for study grant funding status, the use of the G-TLFB was not significantly associated with effect size. The effect size for gambling expenditure was not significantly different between studies using the G-TLFB (g = -0.22) versus studies using other self-report assessments (g = -0.38). CONCLUSIONS: The G-TLFB yields more conservative and precise effect size estimates of posttreatment gambling frequency, but not gambling expenditure, than other self-report assessments. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Contingency Management for Drug Use Disorders: Meta-Analysis and Application of Tolin's Criteria.

Several professional organizations and federal agencies recommend contingency management (CM) as an empirically supported treatment for drug use disorder. However, the release of the "Tolin criteria" warrants an updated recommendation. Using this methodology, five meta-analyses (84 studies, 11,000 participants) were reviewed. Two meta-analyses were rated moderate quality, and three were rated low or critically low quality. Comparator conditions included active treatment, placebo, treatment as usual, and no treatment. The primary outcome was abstinence. Considering only the moderate quality meta-analyses, the effect of CM versus control on posttreatment abstinence was d = 0.54 [0.43, 0.64] and follow-up abstinence was d=0.08 [0.00, 0.16]. A "strong" recommendation was provided for CM as an empirically supported treatment for drug use disorder.

Prevalence of Cannabis Use Disorder: A Meta-Analysis of Population Surveys.

OBJECTIVE: Epidemiologic surveys aim to estimate the population prevalence of cannabis use and cannabis use disorder. Prevalences estimates are important for understanding trends, such as the impact of policy change. Existing epidemiologic surveys have produced discrepant and potentially unreliable estimates. The current meta-analysis (PROSPERO CRD42022364818) aims to identify potential sources of unreliability in prevalence estimates of cannabis use and use disorder among the general population (aged 12+). There was no specific hypothesis about overall prevalence estimate, but we expected significant variability (i.e., heterogeneity) in estimates based on factors such as country, year of data collection, and specific methodological factors (e.g., diagnostic instrument). METHOD: Systematic searches identified manuscripts and reports documenting nationally representative lifetime or past-year cannabis use disorder prevalence estimates. Meta-analysis was used to synthesize prevalence estimates, evaluate heterogeneity, and test moderators. RESULTS: There were 39 manuscripts/reports included in analyses which resulted in 259 unique prevalence estimates spanning 1980-2013 and an aggregated sample size of 973,281 individuals. Past-year and lifetime prevalence estimates for cannabis use were 12.83% (95% CI: 11.15%, 14.71%) and 38.31% (95% CI: 35.92%, 40.76%) and those for cannabis use disorder were 2.59% (95% CI:2.30%, 2.90%) and 6.77% (95% CI: 4.89%, 9.30%), respectively. There was significant heterogeneity in estimates, which was partially explained by factors such as country, year of data collection, and methodological characteristics. CONCLUSIONS: The significant heterogeneity in prevalence estimates as a function of methodological characteristics raises concerns about the generalizability of estimates. Recommendations for enhancing validity and reliability of these estimates are offered.

Absolute and relative outcomes of psychotherapies for eight mental disorders: a systematic review and meta-analysis.

Psychotherapies are first-line treatments for most mental disorders, but their absolute outcomes (i.e., response and remission rates) are not well studied, despite the relevance of such information for health care users, providers and policy makers. We aimed to examine absolute and relative outcomes of psychotherapies across eight mental disorders: major depressive disorder (MDD), social anxiety disorder, panic disorder, generalized anxiety disorder (GAD), specific phobia, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), and borderline personality disorder (BPD). We used a series of living systematic reviews included in the Metapsy initiative (www.metapsy.org), with a common strategy for literature search, inclusion of studies and extraction of data, and a common format for the analyses. Literature search was conducted in major bibliographical databases (PubMed, PsycINFO, Embase, and the Cochrane Register of Controlled Trials) up to January 1, 2023. We included randomized controlled trials comparing psychotherapies for any of the eight mental disorders, established by a diagnostic interview, with a control group (waitlist, care-as-usual, or pill placebo). We conducted random-effects model pairwise meta-analyses. The main outcome was the absolute rate of response (at least 50% symptom reduction between baseline and post-test) in the treatment and control conditions. Secondary outcomes included the relative risk (RR) of response, and the number needed to treat (NNT). Random-effects meta-analyses of the included 441 trials (33,881 patients) indicated modest response rates for psychotherapies: 0.42 (95% CI: 0.39-0.45) for MDD; 0.38 (95% CI: 0.33-0.43) for PTSD; 0.38 (95% CI: 0.30-0.47) for OCD; 0.38 (95% CI: 0.33-0.43) for panic disorder; 0.36 (95% CI: 0.30-0.42) for GAD; 0.32 (95% CI: 0.29-0.37) for social anxiety disorder; 0.32 (95% CI: 0.23-0.42) for specific phobia; and 0.24 (95% CI: 0.15-0.36) for BPD. Most sensitivity analyses broadly supported these findings. The RRs were significant for all disorders, except BPD. Our conclusion is that most psychotherapies for the eight mental disorders are effective compared with control conditions, but absolute response rates are modest. More effective treatments and interventions for those not responding to a first-line treatment are needed.

What was a gap is now a chasm: Remote schooling, the digital divide, and educational inequities resulting from the COVID-19 pandemic.

COVID-19 resulted in the unexpected transition to remote learning for K-12 schools, exacerbating the existing digital divide and impacting the educational outcomes of marginalized youth. This article reviews the literature on the impacts of the pandemic on the educational outcomes of marginalized youth due to remote learning and the digital divide. Here, we provide an overview of the pandemic and remote schooling from an intersectional lens, discuss the impacts of the digital divide on learning for students during the pandemic, and then consider impacts on the delivery of special education supports. Additionally, we review the literature on the widening achievement gap in relation to the COVID-19 pandemic. Future directions for research and practice are discussed.

Cognitive-behavioral treatment for gambling harm: Umbrella review and meta-analysis.

The aim of the current umbrella review and meta-analysis was to evaluate the methodological rigor of existing meta-analyses on cognitive-behavioral treatment (CBT) for gambling harm. The Cochrane Database of Systematic Reviews, PsycINFO, and PubMed were searched for meta-analyses of CBT for gambling harm among individuals aged 18 years and older. The search yielded five meta-analyses that met inclusion criteria, representing 56 unique studies and 5389 participants. The methodological rigor for one meta-analyses was rated high, two were moderate, and two were critically low. Including only moderate- to high-quality meta-analyses, a robust variance estimation meta-analysis indicated that CBT significantly reduced gambling disorder severity (g = -0.91), gambling frequency (g = -0.52), and gambling intensity (g = -0.32) relative to minimal and no treatment control at posttreatment, suggesting 65%-82% of participants receiving CBT will show greater reductions in these outcomes than minimal or no treatment controls. Overall, there is strong evidence for CBT in reducing gambling harm and gambling behavior, and this evidence provides individuals, clinicians, managed care companies, and policymakers with clear recommendations about treatment selection.

Relative and Interactive Associations of Psychosocial Intervention and Alcoholics Anonymous Attendance With Alcohol Use Disorder Outcomes.

OBJECTIVE: Psychosocial intervention and Alcoholics Anonymous (AA)/mutual help organization attendance are both associated with alcohol use disorder (AUD) outcomes. However, no research has explored the relative or interactive associations of psychosocial intervention and AA attendance with AUD outcomes. METHOD: This was a secondary analysis of data from the Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity) outpatient arm participants (N = 952), who were randomly assigned to complete 12-session cognitive-behavioral therapy (CBT, n = 301), 12-session 12-step facilitation (TSF, n = 335), or 4-session motivational enhancement therapy (MET, n = 316). Regression analyses tested the association of psychosocial intervention attendance only, AA attendance only (measured as past-90-day attendance immediately after psychosocial intervention, as well as 1 and 3 years after intervention), and their interaction with the percentage of drinking days and percentage of heavy drinking days after intervention, 1 year after intervention, and 3 years after intervention. RESULTS: When accounting for AA attendance and other variables, attending more psychosocial intervention sessions was consistently associated with fewer drinking days and heavy drinking days after intervention. AA attendance was consistently associated with a lower percentage of drinking days at 1 and 3 years after intervention, when accounting for psychosocial intervention attendance and other variables. Analyses failed to identify an interaction between psychosocial intervention attendance and AA attendance with AUD outcomes. CONCLUSIONS: Psychosocial intervention and AA attendance are robustly associated with better AUD outcomes. Replication studies comprising samples of individuals who attend AA more than once per week are needed to further test the interactive association of psychosocial intervention attendance and AA attendance with AUD outcomes.