Efficacy of a novel online integrated treatment for problem gambling and tobacco smoking: Results of a randomized controlled trial.

Background and aims: Problem gambling and tobacco use are highly comorbid among adults. However, there are few treatment frameworks that target both gambling and tobacco use simultaneously (i.e., an integrated approach), while also being accessible and evidence-based. The aim of this two-arm open label RCT was to examine the efficacy of an integrated online treatment for problem gambling and tobacco use. Methods: A sample of 209 participants (Mage = 37.66, SD = 13.81; 62.2% female) from North America were randomized into one of two treatment conditions (integrated [n = 91] or gambling only [n = 118]) that lasted for eight weeks and consisted of seven online modules. Participants completed assessments at baseline, after treatment completion, and at 24-week follow-up. Results: While a priori planned generalized linear mixed models showed no condition differences on primary (gambling days, money spent, time spent) and secondary outcomes, both conditions did appear to significantly reduce problem gambling and smoking behaviours over time. Post hoc analyses showed that reductions in smoking and gambling craving were correlated with reductions in days spent gambling, as well as with gambling disorder symptoms. Relatively high (versus low) nicotine replacement therapy use was associated with greater reductions in gambling behaviours in the integrated treatment condition. Discussion and conclusions: While our open label RCT does not support a clear benefit of integrated treatment, findings suggest that changes in smoking and gambling were correlated over time, regardless of treatment condition, suggesting that more research on mechanisms of smoking outcomes in the context of gambling treatment may be relevant.

A longitudinal approach to understanding risk factors for problem alcohol use during the COVID-19 pandemic.

BACKGROUND: We conducted a longitudinal study to examine person-centered heterogeneity in problem drinking risk during the 2019 Coronavirus disease (COVID-19) pandemic. We aimed to differentiate high- from low-risk subgroups of drinkers during the pandemic, to report on the longitudinal follow-up of the baseline sample reported in Wardell et al. (Alcohol Clin Exp Res, 44, 2020, 2073), and to examine how subgroups of drinkers differed on coping-related and pre-pandemic alcohol vulnerability factors. METHODS: Canadian alcohol users (N = 364) were recruited for the study. Participants completed surveys at four waves (spaced 3 months apart), with the first being 7 to 8 weeks after the COVID-19 state of emergency began in Canada. The data were analyzed using a parallel process latent growth class analysis followed by general linear mixed models analysis. RESULTS: We found evidence for three latent classes: individuals who increased drinking (class 1; n = 23), low-risk drinkers (class 2; n = 311), and individuals who decreased drinking (class 3; n = 30). Participants who increased (vs. those who decreased) problem drinking during the pandemic struggled with increasing levels of social disconnection and were also increasingly more likely to report drinking to cope with these issues. Those in the increasing class (relative to low-risk drinkers) reported increasing levels of depression during the study. Relative to low-risk drinkers, participants in the increasing class had higher pre-pandemic AUDIT scores, greater frequency of solitary drinking, and higher alcohol demand. Interestingly, participants in the decreasing class had the highest pre-pandemic AUDIT scores. CONCLUSIONS: We examined longitudinal data to identify subgroups of drinkers during the pandemic and to identify factors that may have contributed to increased problem drinking. Findings suggest that while most of the sample did not change their alcohol use, a small portion of individuals escalated use, while a small portion decreased their drinking. Identifying the vulnerability factors associated with increased drinking could aid in the development of preventative strategies and intervention approaches.

Shame's Associations with Depression and Problem Drinking: An Ecological Momentary Study.

INTRODUCTION: Depression and problem drinking are comorbid in emerging adulthood, yet the processes that link them are not well understood. Research has argued that shame has a unique influence on the experience of problematic drinking, but this has rarely been assessed at the state level. Using ecological momentary assessments (EMAs), we assessed whether shame, and not guilt, mediated the association between baseline depression and alcohol use and problems. METHODS: One hundred and eighty-four emerging adults (Mage= 19.27) completed a 12-day EMA study. Multilevel models were used to test hypotheses. RESULTS: In a model with alcohol use as the outcome, there were no significant associations between shame or guilt and alcohol use at the within- or between-subjects level. In a model with alcohol problems as the outcome, guilt was positively associated with alcohol problems but only at the daily level. At the between-subjects level and after controlling for guilt, there was a significant association between depression, shame, and alcohol problems; average levels of shame mediated the association between depression and alcohol problems. In post-hoc reverse directionality models, average alcohol problems mediated the relationship between depression and shame and guilt at the between-person level. No mediation was present for alcohol use. CONCLUSION: After controlling for guilt, shame is an emotion that helps explain risk for alcohol problems among depressed emerging adults, which has implications for targeted interventions. Reciprocal associations between shame, guilt, and alcohol problems emerged highlighting the need for more fulsome assessments of shame and guilt in future EMA research.

Developing and testing the effectiveness of a novel online integrated treatment for problem gambling and tobacco smoking: a protocol for an open-label randomized controlled trial.

BACKGROUND: Gambling and tobacco smoking are highly comorbid among North American adults. However, there is a paucity of treatment options that are integrated (i.e. targeting both gambling and tobacco smoking simultaneously), accessible, and evidence based. METHODS: The aim of this two-arm open-label randomized controlled trial is to examine the effectiveness of an online, self-guided integrated treatment for problem gambling and tobacco smoking. A target sample of 214 participants will be recruited and be randomized into either an 8-week integrated or gambling only control condition. Both conditions will consist of seven online modules following cognitive behavioural therapy and motivational interviewing principles. Our three primary outcomes are (1) the number of days gambled, (2) money spent on gambling activities, and (3) time spent in gambling activities. Secondary outcomes include gambling disorder symptoms, cigarette use, and nicotine dependence symptoms. Assessments will be completed at baseline, at completion (i.e. 8 weeks from baseline), and at follow-up (i.e. 24 weeks from baseline). Generalized linear mixed modelling will be used to evaluate our primary and secondary outcomes. We expect that participants receiving online integrated treatment will show larger reductions in gambling relative to those receiving a control gambling only intervention. We further hypothesize that reductions in smoking will mediate these group differences. DISCUSSION: The rates of problem gambling and tobacco smoking are high in North America; yet, the treatment options for both are limited, with no integrated treatments available. If supported, our pilot study will be a cost-effective and accessible way to improve treatments for co-occurring problem gambling and tobacco use. TRIAL REGISTRATION: ClinicalTrials.gov NCT03614884 . Registered on August 3, 2019.

Drinking to Cope During COVID-19 Pandemic: The Role of External and Internal Factors in Coping Motive Pathways to Alcohol Use, Solitary Drinking, and Alcohol Problems.

BACKGROUND: The COVID-19 pandemic has resulted in massive disruptions to society, to the economy, and to daily life. Some people may turn to alcohol to cope with stress during the pandemic, which may put them at risk for heavy drinking and alcohol-related harms. Research is needed to identify factors that are relevant for coping-motivated drinking during these extraordinary circumstances to inform interventions. This study provides an empirical examination of coping motive pathways to alcohol problems during the early stages of the COVID-19 pandemic. METHODS: Participants (N = 320; 54.7% male; mean age of 32 years) were Canadian adult drinkers who completed an online survey assessing work- and home-related factors, psychological factors, and alcohol-related outcomes over the past 30 days, covering a time period beginning within 1 month of the initiation of the COVID-19 emergency response. RESULTS: The results of a theory-informed path model showed that having at least 1 child under the age of 18, greater depression, and lower social connectedness each predicted unique variance in past 30-day coping motives, which in turn predicted increased past 30-day alcohol use (controlling for pre-COVID-19 alcohol use reported retrospectively). Income loss was associated with increased alcohol use, and living alone was associated with increased solitary drinking (controlling for pre-COVID-19 levels), but these associations were not mediated by coping motives. Increased alcohol use, increased solitary drinking, and greater coping motives for drinking were all independently associated with past 30-day alcohol problems, and indirect paths to alcohol problems from having children at home, depression, social connectedness, income loss, and living alone were all supported. CONCLUSIONS: Findings provide insight into coping-motivated drinking early in the COVID-19 pandemic and highlight the need for longitudinal research to establish longer term outcomes of drinking to cope during the pandemic.