Betting on Australian Rules Football: Can Expert Tipsters beat Randomness?

Betting on the various codes of football in Australia accounts for the majority of sports betting, with Australian rules football (AFL) by far the most popular sport in Australia. Several studies have revealed the heavy presence of gambling advertising during AFL broadcasts, and a frequently used advertising strategy involves the use of well-known AFL commentators outlining their tips and betting suggestions. To date, no research has examined the hypotheses that skill may help in predicting AFL matches and monetary outcomes from AFL betting. Rather than merely discounting such ideas, it is important to test them empirically. The aims of this study were therefore, to examine if (1) expert AFL tipsters made better predictions than random picks, (2) expert AFL tipsters gained greater monetary reward than random selection, and (3) expert tipsters' prediction accuracy improved with betting experience. To this end, six seasons of AFL matches, odds data, and expert tipster data were analysed retrospectively, totalling 1141 matches. Random selections were calculated for each match using an inbuilt random number generator within Microsoft Excel and a $2 simulated wager was applied for each AFL match. The results of mixed-effects modelling showed that experts picked more correct outcomes than random selection; experts' correct predictions were partially mediated by home-game selections; no difference in monetary outcome was observed for experts compared to random selection; experts' predictions did not improve over time. The results of this study may be used to inform both psychological interventions that target gamblers' illusions of control, and public health gambling harm prevention messaging.

The Australian version of IAPT: clinical outcomes of the multi-site cohort study of NewAccess.

BACKGROUND: The United Kingdom IAPT (Improving Access to Psychological Therapies) approach of delivering low intensity therapies for symptoms of depression and anxiety was adapted for Australia and named NewAccess. Clinical outcomes of the service were evaluated in three sites between October 2013 and 2016. AIMS: This paper describes the clinical outcomes in the Australian health setting. METHODS: Prospective cohort study with repeated measures. Both intent-to-treat and per protocol analyses were conducted for primary outcomes measures Patient Health Questionnaire-9 (nine item), and Generalised Anxiety Disorder (seven item). Secondary measures were Phobia Scale and Work and Social Adjustment Scale. RESULTS: Three thousand nine hundred and forty-six individuals were assessed, and 3269 attended at least two treatment sessions. Forty percent were males. There was a clinically meaningful reduction (improvement) shown by reliable recovery rates in both depression and anxiety symptoms at post-treatment assessment (68%; 95% CI: 66-70%) with large effect sizes (1.23 for depression and 1.25 for anxiety). Outcomes in PHQ-9 and GAD-7 were not influenced by age or sex, but recovery rates were significantly reduced by relationship status (single or separated). Unemployment reduced PHQ-9 outcomes but not GAD-7 outcomes. CONCLUSION: NewAccess demonstrated positive clinical outcomes in Australia, that compared favourably with international studies with the same methodology.

Mental health and wellbeing of Australian police and emergency services employees.

Answering the Call, the Australian National Police and Emergency Services Mental Health and Wellbeing Study, surveyed 14,868 Australian ambulance, fire and rescue, police, and state emergency service employees. Emergency services personnel had lower rates of mental wellbeing and higher rates of psychological distress and probable PTSD than the general adult population. Overall 30% had low wellbeing, 21% had high and 9% had very high psychological distress, and 10% had probable PTSD. An estimated 5% had suicidal ideation and 2% had a suicide plan in the past 12 months, while 16% binge drink at least weekly. Only one in five of those with very high psychological distress or probable PTSD felt they received adequate support for their condition. These findings highlight the risk of mental health conditions associated with work in the emergency services sector.

Graded Exposure Therapy for Online Mobile Smartphone Sports Betting Addiction: A Case Series Report.

Advances in technology and increased usage of electronic mobile devices over the past decade have changed the way gamblers engage with online gambling. The convenience of mobile electronic devices is understood to be a major contributor to the increase of online gambling, which in turn has been implicated in the growth of sports betting. Emerging evidence suggests several sources of differentiation between mobile and other online gambling, which have important psychological implications. Given the inherent differences, we cannot conclude that evidence for the effectiveness of treatment for non-smartphone problem gambling (PG) automatically translates to online smartphone sports betting PG. The aim of this study, therefore, was to describe the feasibility and preliminary effectiveness of cue exposure therapy (CET) to treat individuals presenting to a community-based PG therapy service with an online smartphone sports betting addiction, using a case series design. Six men (21-42 years old) received up to 10 weekly 60-min manualised CET sessions. Outcome measures were gambling harm, gambling urge, gambling cognitions, psychological distress, and functional impairment. All six participants completed a course of CET averaging 8.33 sessions (SD = 1.75) and reported improvement across each of the outcome measures. Psychological distress scores had reduced to the non-clinical range for all six participants and five participants scored below the cut offs for PG and functional impairment at 1 month follow up. The findings provide preliminary proof of concept evidence for the feasibility and efficacy of CET for online smartphone sports betting addiction.

A Literature Review and Gap Analysis of Emerging Technologies and New Trends in Gambling.

There have been significant changes in the gambling landscape particularly relating to gambling in the digital age. As the gambling landscape changes, regulation of gambling also needs to change. In 2018, the Office of Responsible Gambling in New South Wales, Australia, commissioned a gap analysis to inform their research objectives and priority focus areas. This included an identification of gaps in our understanding of emerging technologies and new trends in gambling. A gap analysis of the peer-reviewed literature published since 2015 was undertaken, identifying 116 articles. The main area of focus was Internet gambling, followed by articles exploring the relationship between video gaming and gambling, the expansion of the sports betting market, Electronic Gambling Machines characteristics and articles exploring new technologies and trends in advertising and inducements. Key gaps related to the need for more research in general, as well as research focusing on subpopulations such as those using different gambling formats, those with varying levels of problem gambling, and vulnerable populations. From a methods perspective, researchers saw the need for longitudinal studies, more qualitative research and improved outcome measures. The development and testing of a public health approach to addressing the harms associated with gambling in these areas is needed.

Mindfulness and Acceptance-Based Group Therapy: An Uncontrolled Pragmatic Pre-Post Pilot Study in a Heterogeneous Population of Female Prisoners.

The rate of females imprisoned worldwide has increased by more than 50% during the last two decades, with recent figures suggesting that, worldwide, the female prison population may still be increasing at a faster rate than males. Despite prevalence rates for psychiatric conditions among female prisoners being significantly higher than males, there is a particular lack of programs specifically designed for women. This preliminary study evaluates the initial effectiveness of a mindfulness and acceptance-based group program in an uncontrolled pragmatic pilot study of a heterogeneous group of incarcerated women with a range of mental health issues. Participants were 59 incarcerated women who engaged in a 10-session group program. Outcome measures comprised the Acceptance and Action Questionnaire-II, Depression Anxiety and Stress Scale, Mindfulness Attention Awareness Scale, and three screening tools derived from the full version of the Patient Health Questionnaire (PHQ-9), to measure depression, binge eating (Patient Health Questionnaire-Binge Eating Disorder [PHQ-ED]), and somatoform disorders (PHQ-15). Results of linear mixed modelling showed improvements in mindfulness and acceptance, and reductions in depression, anxiety, and somatoform symptoms. Furthermore, acceptance and commitment therapy (ACT) was shown to be an acceptable and feasible intervention for female Indigenous Australian prisoners. A mindfulness and acceptance-based group approach appears to be feasible and acceptable in a prison environment for a female prisoners with a range of mental health symptomatology.

Understanding the business versus care paradox in gambling venues: a qualitative study of the perspectives from gamblers, venue staff and counsellors.

BACKGROUND: In recent years, greater emphasis has been placed on gambling venues to identify potential problem gamblers, respond appropriately and refer to treatment. In seeking the perspectives of problem gamblers, venue staff and treatment providers, this qualitative study investigates how problem gamblers experience being identified and referred for treatment by venue staff. METHODS: A semi-structured interview guide focusing on experiences and perceptions of problem gambling identification and referral for treatment in gaming venues was used to conduct 4 focus groups and 9 semi-structured in-depth interviews. Participants comprised 22 problem gamblers, 10 gambling venue staff and 8 problem gambling counsellors. Audio recordings were transcribed verbatim, and an interpretive phenomenological analysis was conducted. RESULTS: 'Role conflict' was identified as a considerable source of stress for venue staff who described conflicting priorities in responding to problem gamblers whilst maintaining employer profit margins. Problem gamblers described offers of help from venue staff as hypocritical and disingenuous. Venue staff also described reluctance to make moral judgements through the identification of and engagement with problem gamblers, and gamblers described resentment in being singled out and targeted as a problem gambler. Being approached and offered referral to a counselling service was a rare occurrence among problem gamblers. This corresponded with reports by gambling counsellors. CONCLUSIONS: Role conflict experienced by gambling venue staff and patrons alike inhibits effective referral of potential problem gamblers into treatment. Reducing the need for gambling venue staff to make a perceived moral judgement about the gambling behaviours of specific patrons may improve the reception of responsible gambling information and promote help-seeking.

How can psychiatrists offer psychotherapeutic leadership in the public sector?

OBJECTIVE: This article reviews the forms that psychotherapeutic leadership can take for psychiatrists attempting to optimise outcomes for individuals receiving treatment in the public mental health sector. It explores a range of roles and functions that psychiatrists can take on as psychotherapy leaders, and how these can be applied in clinical, administrative and research contexts. CONCLUSIONS: Psychiatrists need to play an increasing role in clinical, administrative and academic settings to advance service provision, resource allocation, training and research directed at psychotherapies in the public health sector.

Exposure based therapy for problem gambling in a patient with Alzheimer's dementia.

OBJECTIVES: This case report discusses the response to exposure and response prevention therapy in a patient with problem gambling and comorbid early dementia. It further discusses neurobiology of exposure therapy and its application in patients with mild cognitive impairment. CONCLUSION: Studies show good response to the use of exposure therapy in patients with cognitive impairment and further studies are needed to study the neurobiological changes and response to the therapy in patients with cognitive impairment.

Predictors of relapse in problem gambling: a prospective cohort study.

To explore the variation of predictors of relapse in treatment and support seeking gamblers. A prospective cohort study with 158 treatment and support seeking problem gamblers in South Australia. Key measures were selected using a consensus process with international experts in problem gambling and related addictions. The outcome measures were Victorian Gambling Screen (VGS) and behaviours related to gambling. Potential predictors were gambling related cognitions and urge, emotional disturbance, social support, sensation seeking traits, and levels of work and social functioning. Mean age of participants was 44 years (SD = 12.92 years) and 85 (54 %) were male. Median time for participants enrollment in the study was 8.38 months (IQR = 2.57 months). Patterns of completed measures for points in time included 116 (73.4 %) with at least a 3 month follow-up. Using generalised mixed-effects regression models we found gambling related urge was significantly associated with relapse in problem gambling as measured by VGS (OR 1.29; 95 % CI 1.12-1.49) and gambling behaviours (OR 1.16; 95 % CI 1.06-1.27). Gambling related cognitions were also significantly associated with VGS (OR 1.06; 95 % CI 1.01-1.12). There is consistent association between urge to gamble and relapse in problem gambling but estimates for other potential predictors may have been attenuated because of methodological limitations. This study also highlighted the challenges presented from a cohort study of treatment and support seeking problem gamblers.

Managing patients with dual diagnosis in psychiatric practice.

PURPOSE OF REVIEW: To focus on recent research that may influence clinical practice in relation to patients with dual diagnosis disorders. RECENT FINDINGS: Harmful substance use is a heightened risk with bipolar disorder. Self-medication with substances of abuse for anxiety is linked with greater risk of developing anxiety disorders, particularly social anxiety disorder. Antisocial and schizotypal personality disorders were particularly linked with chronicity in substance use disorders. There are sex differences in responses to psychological approaches for dual disorders involving alcohol. Integrated dual diagnosis treatment for youth is not conclusive but shows promise. Online therapy is viable for adult patients with dual diagnosis. Structured interventions reduce the risk of opioid misuse amongst those with chronic pain, who are identified as at high risk. SUMMARY: We have confirmation that clinicians should be particularly vigilant in monitoring for substance use problems early in anxiety disorders and mood disorders and that certain personality disorders are linked with substance use chronicity. Practitioners can incorporate specific therapy approaches for dual disorders that appear to have advantages over treatment as usual.

The influence of depression and other co-occurring conditions on treatment outcomes for problem gamblers: a cohort study.

OBJECTIVE: To examine the influence of co-occurring conditions on gambling treatment outcomes. DESIGN, SETTING AND PARTICIPANTS: Prospective cohort study of problem gamblers. Participants were recruited from consecutive referrals to a gambling therapy service in 2008. Inclusion criteria were: (i) assessed as a problem gambler based on a screening interview including DSM-IV criteria for pathological gambling, and (ii) suitable for admission to a treatment program. Cognitive-behavioural therapy was based on graded exposure-to-gambling urge. One-to-one treatment was conducted with 1-hour sessions weekly for up to 12 weeks. MAIN OUTCOME MEASURES: Problem gambling screening and co-occurring conditions including depression, anxiety and alcohol use. RESULTS: Of 127 problem gamblers, 69 were males (54%), mean age was 43.09 years, and 65 (51%) reported a duration of problem gambling greater than 5 years. Median time for participants' enrolment in the study was 8.9 months. Results from mixed effects logistic regression analysis indicated that individuals with higher depression levels had a greater likelihood (13% increase in odds [95% CI, 1%-25%]) of problem gambling during treatment and at follow-up. CONCLUSION: Addressing depression may be associated with improved treatment outcomes in problem gambling; conversely, treatment of problem gambling improves affective instability. We therefore recommend a dual approach that treats both depression and problem gambling.

Treatment outcomes and predictors of drop out for problem gamblers in South Australia: a cohort study.

OBJECTIVES: Recent prevalence studies in Australia, the USA and Canada have estimated 1-2% of the adult population meet the diagnostic criteria for problem or pathological gambling. The Statewide Gambling Therapy Service (SGTS) provides treatment for problem gamblers in key metropolitan and rural regions in South Australia. The aims of this study were two-fold: to analyse the short and mid-term outcomes following treatment provided by SGTS and to identify factors associated with treatment drop-out. METHOD: A cohort of treatment seeking problem gamblers was recruited through SGTS in 2008. Repeated outcome measures included problem gambling screening, gambling related cognitions and urge. Treatment drop-out was defined as participants attending three or less treatment sessions, whilst potential predictors of drop-out included perceived social support , anxiety and sensation-seeking traits. RESULTS: Of 127 problem gamblers who participated in the study, 69 (54%) were males with a mean age of 43.09 years (SD = 12.65 years) and with 65 (52%) reporting a duration of problem gambling greater than 5 years. Follow up time for 50% of participants was greater than 8.9 months and, overall, 41 (32%) participants were classified as treatment drop-outs. Results indicated significant improvement over time on all outcome measures except alcohol use for both treatment completers and drop-outs, although to a lesser extent for the treatment drop-out group. A significant predictor of treatment drop-out was sensation-seeking traits. CONCLUSION: These results will inform future treatment planning and service delivery, and guide research into problem gambling including aspects of treatment drop-out.

Putting 'addiction' back into psychiatry: the RANZCP Section of Addiction Psychiatry.

OBJECTIVE: The aim of this paper is to provide an overview of the history and activities of the RANZCP Section of Addiction Psychiatry, as well as its current challenges and opportunities. CONCLUSIONS: From initial exclusion to an active and growing membership, the Section of Addiction Psychiatry continues to ensure that problematic substance use and gambling remain core issues within Australasian psychiatry. In addition to commenting and contributing to ongoing clinical and policy initiatives, the Section has recently introduced an advanced training curriculum and maintains a strong partnership with the relatively new Australasian Chapter of Addiction Medicine. Its active input into education, training, media and policy development within the College guarantees that psychiatry is represented within the addiction field, and that tomorrow's psychiatrists are competent to assess and treat comorbid addiction issues.

Understanding alcohol misuse and comorbid psychiatric disorders.

PURPOSE OF REVIEW: This review examines the relationship between alcohol misuse and comorbid psychiatric disorders, and the treatment of these comorbid disorders. In the past, the literature was dominated by papers describing prevalence, clinical services and comorbidity with schizophrenia. It is now advancing into areas such as the relationship between alcohol misuse and the anxiety disorders, affective disorders and eating disorders, and considering the diagnostic paradigm. Knowledge is also emerging about the influences of genetics and adverse effects over different stages of the life cycle in the development of these disorders. RECENT FINDINGS: Recent studies have examined the relationships between alcohol dependence and psychiatric illness, particularly anxiety and depression, but also subthreshold conditions. Childhood trauma, having parents with substance dependence and genetic factors influence the development of alcohol and comorbid psychiatric disorders. There is a genetic contribution to suicidal behaviour in alcohol-dependent patients. Early diagnosis is important. Alcohol Use Disorders Identification Test scores on admission to psychiatric hospital were found to correlate with suicidal ideation and behaviour. In patients with alcohol use disorders, treatment for depression works better after a period of abstinence. Abstinence alone can help for anxiety disorders. High-intensity services had better outcomes for this comorbid population than less intensive services. SUMMARY: Depression in patients with alcohol use disorders cannot be ignored. Treatment of depression alone will not help the alcohol use problems. All psychiatric inpatients should be screened for alcohol use disorders as part of their risk assessment. Research is focusing more on examining the complexities of these disorders, but there are no specific pharmacotherapies to treat particular comorbid conditions.