A Longitudinal Investigation of Lower-Risk Gambling Limits in the Canadian National Study.

Recent years have seen increased attention given to identifying and describing the levels of gambling participation that confer a risk of harm in order to generate public health advice regarding lower-risk gambling. However, most of the existing literature has failed to explicitly assess these limits in a prospective manner. The purpose of this study is to employ a methodology consistent with prior investigations to evaluate the level of gambling participation associated with an increased risk of future gambling-related harm. Using data from the Alberta Gambling Research Institute's National Project Online Panel Survey, risk ratios and Receiver Operating Characteristic (ROC) analyses were used to determine the relative risk of gambling-related harm associated with participating in a greater number of gambling formats, gambling more days per month, and spending a greater proportion of income gambling. Prospective lower-risk limits were largely consistent with those identified in previous cross-sectional analyses (e.g., no more than two gambling formats, no more than once a week), with the exception that higher limits were found for the percent of household income spent gambling (3.4-6.4% vs. 1%). We advise that future research on lower-risk gambling limits consider the use of more granular assessment instruments and prospective methods to more closely evaluate the association between gambling participation and gambling harm.

Trends of repeated emergency department visits among adolescents and young adults for substance use: A repeated cross-sectional study.

Emergency Department (ED) visits for substance-related concerns among young people have been increasing in recent years. Understanding the factors related to repeated ED visits (two or more ED visits per year) for substance use concerns among young people is critical to developing a more efficient mental healthcare system that does not overburden ED and that provides efficient care for substance use patients. This study examined trends of substance use-related ED visits and factors related to repeated ED visits (two or more ED visits per year, in comparison to one ED visit per year) among adolescents and young adults (aged 13 to 25 years) in the province of Ontario, Canada. Binary logistic regression models were conducted to examine associations between hospital-related factors (hospital size, urbanicity, triage level, ED wait time) and visit status (2+ vs 1 ED visit/year), controlling for patient characteristics (age/sex). A population-based, repeated cross-sectional data over a 10-year period (2008, 2013, and 2018) was used. The proportion of substance use-related repeated ED visits significantly and consistently increased in the year 2013 and 2018 compared to 2008 (2008 = 12.52%, 2013 = 19.47%, 2018 = 20.19%). Young adult, male, medium-sized hospital, urban location, wait times longer than 6 hours, and symptom severity was associated with increased numbers of repeated ED visits. Furthermore, polysubstance use, opioid use, cocaine use, and stimulant use were strongly associated with repeated ED visits compared with the use of substances such as cannabis, alcohol and sedatives. Current findings suggest that repeated ED visits for substance use concerns could be reduced by policies that reinforce evenly distributed mental health and addiction treatment services across the provinces in rural areas and small hospitals. These services should put special efforts into developing specific (e.g., withdrawal/treatment) programming for substance-related repeated ED patients. The services should target young people using multiple psychoactive substances, stimulants and cocaine.

In search of lower risk gambling levels using behavioral data from a gambling monopolist.

Background and aims: Lower-risk recommendations for avoiding gambling harm have been developed as a primary prevention measure, using self-reported prevalence survey data. The aim of this study was to conduct similar analyses using gambling company player data. Methods: The sample (N = 35,753) were Norsk Tipping website customers. Gambling indicators were frequency, expenditure, duration, number of gambling formats and wager. Harm indicators (financial. social, emotional, harms in two or more areas) were derived from the GamTest self-assessment instrument. Receiver operating characteristics (ROC) curves were performed separately for each of the five gambling indicators for each of the four harm indicators. Results: ROC areas under the curve were between 0.55 and 0.68. Suggested monthly lower-risk limits were less than 8.7 days, expenditure less than 54 €, duration less than 72-83 min, number of gambling formats less than 3 and wager less than 118-140€. Most risk curves showed a rather stable harm level up to a certain point, from which the increase in harm was fairly linear. Discussion: The suggested lower-risk limits in the present study are higher than limits based on prevalence studies. There was a significant number of gamblers (5-10%) experiencing harm at gambling levels well below the suggested cut-offs and the risk increase at certain consumption levels. Conclusions: Risk of harm occurs at all levels of gambling involvement within the specific gambling commercial environment assessed in an increasingly available gambling market where most people gamble in multiple commercial environments, minimizing harm is important for all customers.

Messenger effects in COVID-19 communication: Does the level of government matter?

Public efforts to limit the spread of the coronavirus rely on motivating people to cooperate with the government. We test the effectiveness of different governmental messengers to encourage preventive health actions. We administered a survey experiment among a sample (n = 1,545) of respondents across the United States, presenting them with the same social media message, but experimentally varying the government sender (i.e., Federal, State, County, a combination of Federal + County, and a control condition) to test whether local relevance influences messaging efficacy. We find that in an information saturated environment the messenger does not matter. There is, however, variation in treatment response by partisanship, education, income, and the degree to which respondents are affected by the pandemic. While the main effect of the level of government on intended behavior is null, public health organizations are universally perceived as more trustworthy, relevant, and competent than anonymous messengers.

Attributable fractions for substance use in relation to crime.

AIMS: Building upon an existing methodology and conceptual framework for estimating the association between the use of substances and crime, we calculated attributable fractions that estimate the proportion of crimes explained by alcohol and six other categories of psychoactive substances. DESIGN: Cross-sectional surveys. SETTING: Canadian federal correctional institutions. PARTICIPANTS: Canadian men (n = 27 803) and women (n = 1335) offenders who began serving a custodial sentence in a Canadian federal correctional institution between 2006 and 2016. MEASUREMENTS: Offenders completed the computerized assessment of substance abuse, a self-report tool designed to assess (1) whether the offence for which they were convicted would have occurred had they not been intoxicated from alcohol or another substance, (2) whether they committed the offence to support their alcohol or other substance use and (3) whether they were dependent on alcohol (alcohol dependence scale) or another substance (drug abuse screening test). Offences were grouped into four mutually exclusive categories: violent crimes, non-violent crimes, impaired driving and substance-defined crimes. This study focused on violent and non-violent crime categories. Substances assessed were: alcohol, cannabis, opioids, other central nervous system (CNS) depressants, cocaine, other CNS stimulants and other substances. FINDINGS: According to offender self-report, 42% of all violent and non-violent crime would probably not have occurred if the perpetrator had not been under the influence of, or seeking, alcohol or other substances. Between 2006 and 2016, 20% of violent crimes and 7% of non-violent crimes in Canada were considered attributable to alcohol. In contrast, all other psychoactive substance categories combined were associated with 26% of all violent crime and 25% of non-violent crime during the same time-frame. CONCLUSIONS: Attributable fraction analyses show that more than 42% of Canadian crime resulting in a custodial sentence between 2006 and 2016 would probably not have occurred if the perpetrator had not been under the influence of or seeking alcohol or other drugs. Attributable fractions for alcohol and substance-related crime are a potentially useful resource for estimating the impact of alcohol and other substances on crime.

Gambling Self-Control Strategies: A Qualitative Analysis.

There is limited research exploring the perceptions of people who gamble on the self-control strategies used to limit their gambling. This qualitative study examines self-control strategies used to limit money spent gambling, frequency of gambling, and time spent gambling. A total of 56 people who gamble (27 males and 29 females) participated in nine focus groups and five individual interviews in Montreal, Calgary, and Toronto (Canada). Self-control strategies used to limit their gambling expenditure were more common than frequency or time limiting strategies. Strategies to limit expenditure included: restricting access to money; keeping track of money allocated to gambling activities; and avoiding certain types of gambling activities. Various contextual factors were identified to influence those strategies, including social influences; winning or losing; using substances. Findings from this study emphasize the importance of communicating clear gambling limits to people who gamble, as well as the value of developing individual self-control strategies to limit frequency, time and money spent gambling.

Psychotic disorder and cannabis use: Canadian hospitalization trends, 2006-2015. / Troubles psychotiques et consommation de cannabis : évolution des hospitalisations au Canada, 2006-2015.

INTRODUCTION: Given the recent and impending changes to the legal status of nonmedical cannabis use in Canada, understanding the effects of cannabis use on the health care system is important for evaluating the impact of policy change. The aim of this study was to examine pre-legalization trends in hospitalizations for mental and behavioural disorders due to the use of cannabis, according to demographics factors and clinical conditions. METHODS: We assessed the total number of inpatient hospitalizations for psychiatric conditions with a primary diagnosis of a mental or behavioural disorder due to cannabis use (ICD-10-CA code F12) from the Hospital Mental Health Database for ten years spanning 2006 to 2015, inclusive. We included hospitalizations from all provinces and territories except Quebec. Rates (per 100 000 persons) and relative proportions of hospitalizations by clinical condition, age group, sex and year are reported. RESULTS: Between 2006 and 2015, the rate of cannabis-related hospitalizations in Canada doubled. Of special note, however, is that hospitalizations during this time period for those with the clinical condition code "mental and behavioural disorders due to use of cannabinoids, psychotic disorder" (F12.5) tripled, accounting for almost half (48%) of all cannabis-related hospitalizations in 2015. CONCLUSION: Further research is required to investigate the reasons for the increase in hospitalizations for cannabis-related psychotic disorder. The introduction of high-potency cannabinoid products and synthetic cannabinoids into the illicit market are considered as possible factors.

Detecting a signal in the noise: monitoring the global spread of novel psychoactive substances using media and other open-source information.

OBJECTIVE: To determine the feasibility and utility of using media reports and other open-source information collected by the Global Public Health Intelligence Network (GPHIN), an event-based surveillance system operated by the Public Health Agency of Canada, to rapidly detect clusters of adverse drug events associated with 'novel psychoactive substances' (NPS) at the international level. METHODS AND RESULTS: Researchers searched English media reports collected by the GPHIN between 1997 and 2013 for references to synthetic cannabinoids. They screened the resulting reports for relevance and content (i.e., reports of morbidity and arrest), plotted and compared with other available indicators (e.g., US poison control center exposures). The pattern of results from the analysis of GPHIN reports resembled the pattern seen from the other indicators. CONCLUSIONS: The results of this study indicate that using media and other open-source information can help monitor the presence, usage, local policy, law enforcement responses, and spread of NPS in a rapid effective way. Further, modifying GPHIN to actively track NPS would be relatively inexpensive to implement and would be highly complementary to current national and international monitoring efforts.

Effectiveness of brief interventions as part of the Screening, Brief Intervention and Referral to Treatment (SBIRT) model for reducing the nonmedical use of psychoactive substances: a systematic review.

BACKGROUND: The purpose of this systematic review is to assess the effectiveness of brief interventions (BIs) as part of the Screening, Brief Intervention, and Referral to Treatment (SBIRT) model for reducing the nonmedical use of psychoactive substances. METHODS: Bibliographic databases (including MEDLINE, Embase, The Cochrane Library, CINAHL, and PsycINFO to April 2012) and gray literature sources were searched. We included randomized controlled trials that opportunistically screened adolescents or adults and then provided a one-to-one, verbal BI to those at risk of substance-use harm. Of interest was the nonmedical use of psychoactive substances (for example, drugs prohibited by international law), excluding alcohol, nicotine, and caffeine. Interventions comprised four or fewer sessions and were compared with no/delayed intervention or provision of information only. Studies were assessed for bias using the Cochrane risk of bias tool. Results were synthesized narratively. Evidence was interpreted according to the GRADE framework. RESULTS: We identified 8,836 records. Of these, five studies met our inclusion criteria. Two studies compared BI with no BI, and three studies compared BI with information only. Studies varied in characteristics such as substances targeted, screening procedures, and BI administered. Outcomes were mostly reported by a single study, leading to limited or uncertain confidence in effect estimates. CONCLUSIONS: Insufficient evidence exists as to whether BIs, as part of SBIRT, are effective or ineffective for reducing the use of, or harms associated with nonmedical use of, psychoactive substances when these interventions are administered to nontreatment-seeking, screen-detected populations. Updating this review with emerging evidence will be important. TRIAL REGISTRATION: CRD42012002414.

Effectiveness of brief interventions as part of the screening, brief intervention and referral to treatment (SBIRT) model for reducing the non-medical use of psychoactive substances: a systematic review protocol.

BACKGROUND: There is a significant public health burden associated with substance use in Canada. The early detection and/or treatment of risky substance use has the potential to dramatically improve outcomes for those who experience harms from the non-medical use of psychoactive substances, particularly adolescents whose brains are still undergoing development. The Screening, Brief Intervention, and Referral to Treatment model is a comprehensive, integrated approach for the delivery of early intervention and treatment services for individuals experiencing substance use-related harms, as well as those who are at risk of experiencing such harm. METHODS: This article describes the protocol for a systematic review of the effectiveness of brief interventions as part of the Screening, Brief Intervention, and Referral to Treatment model for reducing the non-medical use of psychoactive substances. Studies will be selected in which brief interventions target non-medical psychoactive substance use (excluding alcohol, nicotine, or caffeine) among those 12 years and older who are opportunistically screened and deemed at risk of harms related to psychoactive substance use. We will include one-on-one verbal interventions and exclude non-verbal brief interventions (for example, the provision of information such as a pamphlet or online interventions) and group interventions. Primary, secondary and adverse outcomes of interest are prespecified. Randomized controlled trials will be included; non-randomized controlled trials, controlled before-after studies and interrupted time series designs will be considered in the absence of randomized controlled trials. We will search several bibliographic databases (for example, MEDLINE, EMBASE, CINAHL, PsycINFO, CORK) and search sources for grey literature. We will meta-analyze studies where possible. We will conduct subgroup analyses, if possible, according to drug class and intervention setting. DISCUSSION: This review will provide evidence on the effectiveness of brief interventions as part of the Screening, Brief Intervention, and Referral to Treatment protocol aimed at the non-medical use of psychoactive substances and may provide guidance as to where future research might be most beneficial.

The Canadian Problem Gambling Index: an evaluation of the scale and its accompanying profiler software in a clinical setting.

Across two studies we assessed the clinical utility of the Canadian Problem Gambling Index (CPGI). In Study 1, the scored items on the CPGI significantly correlated with those of the South Oaks Gambling Screen (SOGS), yet their shared variance was low. Importantly, clinician evaluation of the client's level of pathology was more strongly associated with that revealed by the CPGI than the SOGS. In terms of utility, clinicians found the non-scored items on the CPGI more useful in treatment than those included with the SOGS. In Study 2, the effectiveness of the CPGI profiler (CPGI-P) software, which graphically depicts problematic gambling-relevant attitudes and behaviours, was assessed. Although clients had difficulties using the CPGI-P interface, they overwhelmingly indicated that the output prompted action to address their gambling. The clinicians were less enthusiastic as they felt the output did not help clients truly understand their gambling problems. Such sentiments were reiterated by the clinicians at a 6 months follow-up. The use of the SOGS and possible adoption of the CPGI (as well as the CPGI-P) in a clinical setting are discussed.

The Gambling Craving Scale: Psychometric validation and behavioral outcomes.

Although craving is an important feature of problem gambling, there is a paucity of research investigating craving to gamble. A major stumbling block for craving research in gambling has been the lack of a methodologically sound, multidimensional measure of gambling-related craving. This article reports the development of the Gambling Craving Scale (GACS). In Study 1 (N = 220), a factor analysis revealed the emergence of a 9-item scale with 3 factors: Anticipation, Desire, and Relief. An important finding was that the GACS predicted problem gambling severity, depression, and positive and negative affect. In Study 2 (N = 145), the factor structure of the GACS was confirmed using a community sample of gamblers. In Study 3 (N = 46), GACS scores significantly predicted persistence at play on a virtual slot machine in the face of continued loss. Specifically, the more participants craved to gamble, the longer they engaged in play. The implications of craving for the development and maintenance of problem gambling severity are discussed.

The desire to gamble: the influence of outcomes on the priming effects of a gambling episode.

The influence of gambling outcomes on the efficacy of a short gambling episode to prime motivation to continue gambling was determined in two experiments in which desire to gamble was evaluated while participants played a slot machine located in a virtual reality casino. In experiment 1, 38 high-risk [>3 Problem Gambling Severity Index (PGSI)] [Ferris and Wynne (The Canadian problem gambling index: final report, 2001)] and 36 non-problem gamblers (0 PGSI) either won or lost a modest amount. Among high-risk gamblers, winning resulted in a greater increase in the desire to continue gambling than did losing. In experiment 2, 39 high-risk, 33 low-risk (0 < PGSI < 3), and 31 non-problem gamblers experienced either a single large win or a series of small wins (equivalent monetary gain). Participants were permitted to continue playing as long as they wanted (all subsequent spins being losses) thus permitting evaluation of persistence (resistance to extinction). Throughout, desire to gamble was assessed using a single item measure. High-risk gamblers who experienced a large win reported significantly greater desire to gamble upon voluntary cessation than those who experienced a series of small wins. It seems that the priming effects of a short gambling episode are contingent on the pattern of outcomes experienced by the gambler. The data were related to motivational factors associated with gambling, gambling persistence, and chasing losses.

Cortisol rise following awakening among problem gamblers: dissociation from comorbid symptoms of depression and impulsivity.

Gambling pathology has been associated with elevated levels of distress, depression and impulsivity. The present investigation assessed whether these behavioral features would be evident among problem gamblers as they are among pathological gamblers. As well, given that gambling has been associated with increased life stress, as an objective index of ongoing distress, elevations of morning cortisol levels were assessed in problem and pathological gamblers relative to recreational gamblers, and their relations to depressive symptoms and impulsivity were assessed. Recreational, problem, and pathological gamblers (N = 140) completed the Beck Depression Inventory and the Barratt Impulsiveness Scale-11, and provided saliva samples at awakening, 30 min, 3.5 h, and 5.5 h afterward. Consistent with the view that problem and pathological gambling are associated with elevated life stressors, the rise of morning cortisol from awakening to 30 min following awakening was greater than in recreational gamblers. Heightened impulsivity was evident among both problem and pathological gamblers, whereas depressive symptoms were only evident among pathological gamblers. In neither instance were these psychological indices related to the morning cortisol rise. Indeed, increased depressive symptoms were not evident among problem gamblers, despite the fact that elevated morning cortisol levels were evident. The elevated morning cortisol rise may be secondary to gambling problems or distress related to gambling problems. Furthermore, the sustained morning cortisol elevations may be indicative of allostatic overload, and could potentially be a harbinger for potential health risks among problematic gamblers.

Self-perceptions of dispositional luck: relationship to DSM gambling symptoms, subjective enjoyment of gambling and treatment readiness.

In the present study, we examined whether having a gambling disorder is related to: (a) the personality trait of perceived personal luck and (b) subjective enjoyment associated with placing bets. We also examined whether the presence or absence of disordered gambling and wagering enjoyment are related to probability of treatment entry. In 2001, we surveyed 82 young adults at the University of Windsor who gambled, but were not in treatment. They completed measures assessing symptoms of pathological gambling (American Psychiatric Association [APA], 1994), dispositional luck (Steenbergh, Meyers, May, and Whelan, 2002), enjoyment of gambling (Ben-Tovim, Esterman, Tolchard, and Battersby, 2001), and attitudes toward treatment (adapted from Fisher and Turner, 1970). Results showed elevated perceptions of personal luck, enjoyment of gambling, and more negative attitudes toward seeking treatment among those who exhibited sub-clinical levels of disordered gambling (n = 41) compared to recreational gamblers (n = 41). Other results showed that, after controlling for the effects of personal luck, the strength of the positive relationship between level of disordered gambling and subjective pleasure of wagering was diminished. Removing the effects of personal luck also weakened the positive association between having a gambling problem and having a negative attitude toward seeking treatment. In light of these results, we suggest cognitive interventions that seek to prevent and treat problematic wagering in early stage gamblers might be efficacious to the extent to which they can modify these young people's belief that they are charmed by high levels of dispositional luck.