Contingency Management in Canadian Addiction Treatment: Provider Attitudes and Use.

OBJECTIVE: Contingency management (CM) is an evidence-based treatment for addictive disorders that is underused in clinical practice. The attitudes of staff are frequently reported as barriers to the uptake and use of evidence-based treatments, including CM. Understanding these barriers is an important step in implementation and could have an impact on an intervention's efficacy. We investigated Canadian addiction treatment providers' (ATPs) beliefs and use of CM. METHOD: Managers of addictions treatment programs across Canada were contacted between March 2019 and February 2021 and asked to forward our survey to interested ATPs (N = 298 respondents; female = 210, male = 80, other = 8) who offered services to help clients reduce substance use in their program(s). RESULTS: Providers in 103 programs across all 10 Canadian provinces participated (26.2% response rate). Most were not familiar with CM and reported largely neutral attitudes toward it. Training-related barriers to CM were the most highly endorsed compared with other barriers. Most ATPs reported a desire for additional training in CM. Some denied wanting additional training because of concerns about CM, which was consistent with previous literature. CONCLUSIONS: Our findings suggest that successful implementation of evidence-based treatments requires consideration of provider-level characteristics including attitudes, knowledge, and concerns about the intervention. Results highlight the importance of integrating training with efforts to address systemic-level barriers to implementation.

Demographic and psychiatric correlates of compulsive sexual behaviors in gambling disorder.

BACKGROUND AND AIMS: Gambling disorder (GD) and compulsive sexual behavior (CSB) may commonly co-occur. Yet, the psychiatric correlates of these co-occurring disorders are an untapped area of empirical scrutiny, limiting our understanding of appropriate treatment modalities for this dual-diagnosed population. This study examined the demographic and clinical correlates of CSB in a sample of treatment-seeking individuals with GD (N = 368) in São Paulo, Brazil. METHODS: Psychiatrists and psychologists conducted semi-structured clinical interviews to identify rates of CSB and other comorbid psychiatric disorders. The Shorter PROMIS Questionnaire was administered to assess additional addictive behaviors. The TCI and BIS-11 were used to assess facets of personality. Demographic and gambling variables were also assessed. RESULTS: Of the total sample, 24 (6.5%) met diagnostic criteria for comorbid CSB (GD + CSB). Compared to those without compulsive sexual behaviors (GD - CSB), individuals with GD + CSB were more likely to be younger and male. No differences in gambling involvement emerged. Individuals with GD + CSB tended to have higher rates of psychiatric disorders (depression, post-traumatic stress disorder, and bulimia nervosa) and engage in more addictive behaviors (problematic alcohol use, drug use, and exercise) compared to GD - CSB. Those with GD + CSB evidenced less self-directedness, cooperativeness, self-transcendence, and greater motor impulsivity. Logistic regression showed that the predictors of GD + CSB, which remained in the final model, were being male, a diagnosis of bulimia, greater gambling severity, and less self-transcendence. DISCUSSION AND CONCLUSION: Given those with GD + CSB evidence greater psychopathology, greater attention should be allocated to this often under studied comorbid condition to ensure adequate treatment opportunities.

Luck, come here! Automatic approach tendencies toward gambling cues in moderate- to high-risk gamblers.

BACKGROUND AND AIMS: Similar to substance addictions, reward-related cognitive motivational processes, such as selective attention and positive memory biases, have been found in disordered gambling. Despite findings that individuals with substance use problems are biased to approach substance-related cues automatically, no study has yet focused on automatic approach tendencies for motivationally salient gambling cues in problem gamblers. We tested if moderate- to high-risk gamblers show a gambling approach bias and whether this bias was related prospectively to gambling behaviour and problems. DESIGN: Cross-sectional assessment study evaluating the concurrent and longitudinal correlates of gambling approach bias in moderate- to high-risk gamblers compared with non-problem gamblers. SETTING: Online study throughout the Netherlands. PARTICIPANTS: Twenty-six non-treatment-seeking moderate- to high-risk gamblers and 26 non-problem gamblers community-recruited via the internet. MEASUREMENTS: Two online assessment sessions 6 months apart, including self-report measures of gambling problems and behaviour (frequency, duration and expenditure) and the gambling approach avoidance task, with stimuli tailored to individual gambling habits. FINDINGS: Relative to non-problem gamblers, moderate- to high-risk gamblers revealed a stronger approach bias towards gambling-related stimuli than neutral stimuli (P = 0.03). Gambling approach bias was correlated positively with past-month gambling expenditure at baseline (P = 0.03) and with monthly frequency of gambling at follow-up (P = 0.02). In multiple hierarchical regressions, baseline gambling approach bias predicted monthly frequency positively (P = 0.03) and total duration of gambling episodes (P = 0.01) 6 months later, but not gambling problems or expenditure. CONCLUSIONS: In the Netherlands, relative to non-problem gamblers, moderate- to high-risk gamblers appear to have a stronger tendency to approach rather than to avoid gambling-related pictures compared with neutral ones. This gambling approach bias is associated concurrently with past-month gambling expenditure and duration of gambling and has been found to predict persistence in gambling behaviour over time.

Distorted Beliefs about Luck and Skill and Their Relation to Gambling Problems and Gambling Behavior in Dutch Gamblers.

Gamblers' cognitive distortions are thought to be an important mechanism involved in the development and maintenance of problem gambling. The Gambling Cognitions Inventory (GCI) evaluates two categories of distortions: beliefs that one is lucky (i.e., "Luck/Chance") and beliefs that one has special gambling-related skills (i.e., "Skill/Attitude"). Prior psychometric evaluations of the GCI demonstrated the utility of both subscales as measures of distortions and their concurrent relations to gambling problems among Canadian gamblers. However, these associations have not yet been studied in gamblers from other cultures nor have relationships between the GCI and indices of gambling behavior been investigated. In addition, the predictive validity of the GCI scales have not been evaluated in studies to date. The present study investigated the validity of the GCI as a measure of cognitive distortions in a sample of 49 Dutch gamblers by examining its concurrent and prospective relationships to both gambling problems (as measured through a standardized nine-item questionnaire assessing gambling-related problems) and behaviors (as measured through two variables: days spent gambling and time spent gambling in minutes) at baseline and over 1-month and 6-month intervals. The GCI subscales were internally consistent at all timepoints, and moderately to strongly inter-correlated at all timepoints. Each subscale correlated with an independent dimension of gambling both concurrently and prospectively: Luck/Chance was related to greater gambling problems and Skill/Attitude was related to greater gambling behavior. Thus, the two GCI subscales, while inter-correlated, appear to be related to different gambling outcomes, at least among Dutch gamblers. Moreover, the first evidence of the predictive validity of the GCI scales was demonstrated over a 1-month and 6-month interval. It is recommended that both types of cognitive distortions be considered in research and clinical practice to fully understand and address individual risk for excessive and problematic gambling.