Addiction: A treatise from 1561.

BACKGROUND AND AIMS: In 1561, physician and philosopher Pascasius Justus Turq published a monograph on the description and treatment of pathological gambling. When the monograph came to the attention of the authors in 2006, there existed no known translation of it in any modern language. In 2014, it was translated and published in French. This paper analyses the monograph's key content elements and its place in the history of the concept of addiction. METHODS: A contextual analysis of the late Italian Renaissance, followed by key excerpts from the text and commentaries on the meaning and significance of the monograph. FINDINGS AND CONCLUSIONS: Pascasius Justus Turq's 1561 monograph on pathological gambling outlines a disease view of gambling, identifies cognitive processes and biological vulnerabilities as aetiological factors, avoids religious or moral judgements and recommends cognitive treatment to change the beliefs and expectancies of gamblers. This study shows that a 'disease formulation' of addiction was enunciated as early as the 16th century, and its contemporary resonance suggests that current clinical features of addictive disorders have existed for centuries.

Gambling disorder-related illegal acts: Regression model of associated factors.

Background and aims Gambling disorder-related illegal acts (GDRIA) are often crucial events for gamblers and/or their entourage. This study was designed to determine the predictive factors of GDRIA. Methods Participants were 372 gamblers reporting at least three DSM-IV-TR (American Psychiatric Association, 2000) criteria. They were assessed on the basis of sociodemographic characteristics, gambling-related characteristics, their personality profile, and psychiatric comorbidities. A multiple logistic regression was performed to identify the relevant predictors of GDRIA and their relative contribution to the prediction of the presence of GDRIA. Results Multivariate analysis revealed a higher South Oaks Gambling Scale score, comorbid addictive disorders, and a lower level of income as GDRIA predictors. Discussion and conclusion An original finding of this study was that the comorbid addictive disorder effect might be mediated by a disinhibiting effect of stimulant substances on GDRIA. Further studies are necessary to replicate these results, especially in a longitudinal design, and to explore specific therapeutic interventions.

Cognitive distortions and ADHD in pathological gambling: A national longitudinal case-control cohort study.

Introduction The primary outcome of our study was to assess the links between the level of cognitive distortions and the severity of gambling disorder. We also aimed at assessing the links between patient gambling trajectories and attention deficit and hyperactivity disorder (ADHD). Materials and methods The study population (n = 628) was comprised of problem and non-problem gamblers of both sexes between 18 and 65 years of age, who reported gambling on at least one occasion during the previous year. Data encompassed socio-demographic characteristics, gambling habits, the South Oaks Gambling Screen, the Gambling Attitudes and Beliefs Survey - 23, the Wender Utah Rating Scale - Child, and the Adult ADHD Self-report Scale. Results The cognitive distortions with the greatest correlation to the severity of gambling disorder were the "Chasing" and "Emotions." These two dimensions were able to distinguish between problem gamblers seeking treatment or not. While age of onset of gambling and length of gambling practice were not associated with the level of distorted cognitions, a period of abstinence of at least 1 month was associated with a lower level of distorted cognitions. The presence of ADHD resulted in a higher level of distorted cognitions. Conclusion Cognitive work is essential to the prevention, and the treatment, of pathological gambling, especially with respect to emotional biases and chasing behavior. The instauration of an abstinence period of at least 1 month under medical supervision could be a promising therapeutic lead for reducing gambling-related erroneous thoughts and for improving care strategies of pathological gamblers.

Harmonizing Screening for Gambling Problems in Epidemiological Surveys - Development of the Rapid Screener for Problem Gambling (RSPG).

Background and aims The aim of this study was to test the screening properties of several combinations of items from gambling scales, in order to harmonize screening of gambling problems in epidemiological surveys. The objective was to propose two brief screening tools (three items or less) for a use in interviews and self-administered questionnaires. Methods We tested the screening properties of combinations of items from several gambling scales, in a sample of 425 gamblers (301 non-problem gamblers and 124 disordered gamblers). Items tested included interview-based items (Pathological Gambling section of the DSM-IV, lifetime history of problem gambling, monthly expenses in gambling, and abstinence of 1 month or more) and self-report items (South Oaks Gambling Screen, Gambling Attitudes, and Beliefs Survey). The gold standard used was the diagnosis of a gambling disorder according to the DSM-5. Results Two versions of the Rapid Screener for Problem Gambling (RSPG) were developed: the RSPG-Interview (RSPG-I), being composed of two interview items (increasing bets and loss of control), and the RSPG-Self-Assessment (RSPG-SA), being composed of three self-report items (chasing, guiltiness, and perceived inability to stop). Discussion and conclusions We recommend using the RSPG-SA/I for screening problem gambling in epidemiological surveys, with the version adapted for each purpose (RSPG-I for interview-based surveys and RSPG-SA for self-administered surveys). This first triage of potential problem gamblers must be supplemented by further assessment, as it may overestimate the proportion of problem gamblers. However, a first triage has the great advantage of saving time and energy in large-scale screening for problem gambling.

Gambling behaviors and psychopathology related to Attention-Deficit/Hyperactivity Disorder (ADHD) in problem and non-problem adult gamblers.

Previous studies showed that Pathological Gambling and Attention Deficit/Hyperactivity Disorder (ADHD) often co-occur. The aim of this study was to examine whether ADHD is associated with specific severity patterns in terms of gambling behavior, psychopathology and personality traits. 599 problem and non-problem-gamblers were recruited in addiction clinics and gambling places in France. Subjects were assessed with the Wender-Utah Rating Scale-Child, the Adult ADHD Self-Report Scale, the Mini International Neuropsychiatric Interview, the Temperament and Character Inventory, the South Oaks Gambling Screen and questionnaires assessing gambling related cognitive distortions and gambling habits. 20.7% (n=124) of gamblers were screened positive for lifetime or current ADHD. Results from the multivariate analysis showed that ADHD was associated with a higher severity of gambling-related problems and with more psychiatric comorbidity. Among problem gamblers, subjects with history of ADHD were also at higher risk for unemployment, psychiatric comorbidity and specific dysfunctional personality traits. This study supports the link between gambling related problems and ADHD in a large sample of problem and non-problem gamblers, including problem-gamblers not seeking treatment. This points out the necessity to consider this disorder in the prevention and in the treatment of pathological gambling.

Gambling transitions among adult gamblers: A multi-state model using a Markovian approach applied to the JEU cohort.

INTRODUCTION: The aim of this paper is to study transitions between two states of gambling in adulthood (problem gambling and non-problem gambling) and to identify factors that might influence these transitions. METHODS: Data for this 2-year long longitudinal study were collected in a French Outpatient Addiction Treatment Center, in gambling establishments and through the press. Both problem gamblers and non-problem gamblers were evaluated using a structured interview and self-report questionnaires. The statistical analysis was carried out using a Markovian approach. RESULTS: The analyzed cohort consisted of 304 gamblers with 519 observed transitions. Participants with no past-year gambling problems (based on the DSM-IV) had a probability of about 90% of also having no past-year gambling problems at the following assessment, whereas the observed percentage of problem gamblers transitioning to non-problem gambling was of 48%. We reported (i) vulnerability factors of transitioning to problem gambling (such as an anxiety disorder or an Attention Deficit Hyperactivity Disorder (ADHD) during the childhood), (ii) protective factors for non-problem gamblers, (iii) recovery factors (such as ongoing treatment and younger age) and (iv) persistence factors of a gambling problem (such as a persistent ADHD). CONCLUSIONS: The status of problem gambler is unstable over time, whereas we found stability among non-problem gamblers. Our findings suggest the existence of vulnerability and protective factors in gambling. These results lead to think about preventive actions and adaptive care, such as cognitive-behavioral therapy or researching gambling problems in people with an anxiety disorder or ADHD.

Towards a Validation of the Three Pathways Model of Pathological Gambling.

With the aim of validating the three pathways hypothesis of pathological gambling (Blaszczynski and Nower in Addiction 97:487-499, 2002) 372 pathological gamblers meeting DSM IV (2000) criteria were assessed via a structured clinical interview as well as being subjected to personality tests and evaluation of their gambling practices. Our results show that it is possible to identify three subgroups corresponding to the three pathways: behaviourally conditioned problem gamblers, emotionally vulnerable problem gamblers and antisocial impulsivist problem gamblers. Our results particularly demonstrate that impulsivist gamblers preferentially choose semi-skilful gambling (horse racing and sports gambling) whereas emotionally vulnerable gamblers are significantly more attracted to games of chance (one-armed bandits, scratch cards, etc.) This led us to propose a functional presentation of the three pathways model which differs somewhat from the Blaszczynski and Nower presentation.

Gambling and gambling-related problems in France.

AIMS: To provide an overview of the gambling landscape and gambling-related problems in France, including the history, legislation, gambling policy and epidemiological data on excessive gambling. METHOD: A literature review, using Medline, PsycInfo and Toxibase/OFDT databases, based on the systematic monitoring of scientific literature since 2008 (including French and international papers). RESULTS: Since 1776 and the creation of the royal lottery, state monopoly has been the main pillar of gambling policy in France. Increases in gambling venues and opportunities, growing evidence of gambling-related problems, pressures from the European Commission and the growth of on-line gambling have led to major changes in this policy: while land-based gambling remains mainly in the form of a state monopoly, on-line gambling was partially liberalized in 2010, and regulation authorities were established. The first epidemiological survey was conducted in 2010. Rates of problematic gambling in France are within the average of other European countries. Treatment has begun to be made available within addiction centres. CONCLUSION: A majority of on-line gamblers in France use legal websites, which was one of the initial goals of liberalization. Recent studies confirm that the prevalence of problem gambling in France is far higher among on-line gamblers than among land-based gamblers; however, this difference cannot be attributed only to greater addictiveness of on-line gambling.

A Gamblers Clustering Based on Their Favorite Gambling Activity.

The objective of this study was to identify profiles of gamblers to explain the choice of preferred gambling activity among both problem and non-problem gamblers. 628 non-problem and problem gamblers were assessed with a structured interview including "healthy" (sociodemographic characteristics, gambling habits and personality profile assessed with the Temperament and Character Inventory-125) and "pathological" [diagnosis of pathological gambling, gambling-related cognitions (GRCs) and psychiatric comorbidity] variables. We performed a two-step cluster analysis based solely on "healthy" variables to identify gamblers' profiles which typically reflect the choice of preferred gambling activity. The obtained classes were then described using both "healthy" and "pathological" variables, by comparing each class to the rest of the sample. Clusters were generated. Class 1 (Electronic Gaming Machines gamblers) showed high cooperativeness, a lower level of GRC about strategy and more depressive disorders. Class 2 (games with deferred results gamblers) were high novelty seekers and showed a higher level of GRC about strategy and more addictive disorders. Class 3 (roulette gamblers) were more often high rollers and showed a higher level of GRC about strategy and more manic or hypomanic episodes and more obsessive-compulsive disorders. Class 4 (instant lottery gamblers) showed a lower tendency to suicide attempts. Class 5 (scratch cards gamblers) were high harm avoiders and showed a lower overall level of GRC and more panic attacks and eating disorders. The preference for one particular gambling activity may concern different profiles of gamblers. This study highlights the importance of considering the pair gambler-game rather than one or the other separately, and may provide support for future research on gambling and preventive actions directed toward a particular game.

Study protocol: the JEU cohort study--transversal multiaxial evaluation and 5-year follow-up of a cohort of French gamblers.

BACKGROUND: There is abundant literature on how to distinguish problem gambling (PG) from social gambling, but there are very few studies of the long-term evolution of gambling practice. As a consequence, the correlates of key state changes in the gambling trajectory are still unknown. The objective of the JEU cohort study is to identify the determinants of key state changes in the gambling practice, such as the emergence of a gambling problem, natural recovery from a gambling problem, resolution of a gambling problem with intermediate care intervention, relapses or care recourse. METHODS/DESIGN: The present study was designed to overcome the limitations of previous cohort study on PG. Indeed, this longitudinal case-control cohort is the first which plans to recruit enough participants from different initial gambling severity levels to observe these rare changes. In particular, we plan to recruit three groups of gamblers: non-problem gamblers, problem gamblers without treatment and problem gamblers seeking treatment.Recruitment takes place in various gambling places, through the press and in care centers. Cohort participants are gamblers of both sexes who reported gambling on at least one occasion in the previous year and who were aged between 18 and 65. They were assessed through a structured clinical interview and self-assessment questionnaires at baseline and then once a year for five years. Data collection comprises sociodemographic characteristics, gambling habits (including gambling trajectory), the PG section of the DSM-IV, the South Oaks Gambling Screen, the Gambling Attitudes and Beliefs Survey - 23, the Mini International Neuropsychiatric Interview, the Wender-Utah Rating Scale-Child, the Adult ADHD Self-report Scale, somatic comorbidities (especially current treatment and Parkinson disease) and the Temperament and Character Inventory - 125. DISCUSSION: The JEU cohort study is the first study which proposes to identify the predictive factors of key state changes in gambling practice. This is the first case-control cohort on gambling which mixes non-problem gamblers, problem gamblers without treatment and problem gamblers seeking treatment in almost equal proportions. This work may help providing a fresh perspective on the etiology of pathological gambling, which may provide support for future research, care and preventive actions. TRIAL REGISTRATION: (ClinicalTrials.gov): NCT01207674.

[The place of cyber addiction in teenagers' addictive behavior]. / La place des cyberaddictions dans les conduites de dépendance des adolescents.

The easy access which modern teenagers have to new technologies favours their excessive use of video games, as they seek to escape potential existential difficulties. This harmful aspect should not mask the creative potential of games for the majority of teenagers. Treatment for young people with a gaming addiction is based on psychotherapy and takes into account the family dimension of the problem. This article presents an interview with Marc Valleur, a psychiatrist and head physician at Marmottan hospital specialising in the care and support of people with addictions.

Factors to improve the management of hepatitis C in drug users: an observational study in an addiction centre.

Barriers to management of HCV in injection drug users are related to patients, health providers, and facilities. In a primary care drug user's addiction centre we studied access to HCV standard of care before and after using an onsite total care concept provided by a multidisciplinary team and noninvasive liver fibrosis evaluation. A total of 586 patients were seen between 2002 and 2004. The majority, 417 patients, were HCV positive and of these patients 337 were tested positive for HCV RNA. In 2002, patients were sent to the hospital. with the Starting of 2003, patients were offered standard of care HCV management in the center by a team of general practitioners, a consultant hepatologist, psychiatrists, nurses, and a health counsellor. Liver fibrosis was assessed by a non invasive method. In 2002, 6 patients had liver fibrosis assessment at hospital facilities, 4 patients were assessed with liver biopsy and 2 patients with Fibrotest-Actitest. 2 patients were treated for HCV at hospital. In 2003 and 2004, 224 patients were assessed with Fibrotest-Actitest on site. Of these, 85 were treated for HCV. SVR was achieved in 43%. We conclude that the combination of an onsite multidisciplinary team with the use of a noninvasive assessment method led to improved management of HCV infection in drug users' primary care facility.