A Prospective Investigation of Affect, the Desire to Gamble, Gambling Motivations and Gambling Behavior in the Mood Disorders.

Time-sampling methodology was implemented to examine the prospective associations between affect, desire to gamble, and gambling behavior in individuals diagnosed with a mood disorder. Thirty (9 male, 21 female) adults with a lifetime diagnosis of a depressive or bipolar disorder diagnosis who endorsed current gambling and lifetime gambling harm participated in the present study. Participants completed electronic diary entries of their current affective state, desire to gamble, and gambling behavior for 30 consecutive days. Hierarchical linear modelling revealed that affect was not a predictor of gambling behavior. Instead, affect predicted the desire to gamble, with high levels of sadness and arousal independently predicting an increased desire to gamble. Desire to gamble predicted actual gambling behavior. There were no differences across diagnostic groups in terms of gambling motivations at baseline; however, during the 30-day period, participants with bipolar disorder endorsed gambling to cope with negative affect more often than did participants with depressive disorder, whereas those with depressive disorder more often endorsed gambling for social reasons or enhancement of positive affect. The present findings provide evidence that negative affect is not directly related to actual gambling behavior, and suggest that affective states rather impact the desire to gamble.

Motivators for seeking gambling-related treatment among Ontario problem gamblers.

A random digit dialing telephone survey was used to interview 8,467 adults in Ontario, Canada. The NODS-CLiP was used to identify a representative sample of 730 gamblers (54.3% male, mean age 45.3 years) with possible past year gambling problems in order to explore factors that might affect disordered gamblers' motivators for seeking gambling-related help. A final sample of 526 gamblers provided useable data on possible reasons for and barriers to seeking help, awareness of services, self-perception of gambling problems and experience with help-seeking. Financial and relationship issues were the most frequently volunteered motivators. However, over two-thirds of the respondents could not think of a reason for seeking help. Gamblers who had self-admitted or more severe problems, who knew how to get help, who were employed and had more education, and who identified possible barriers to seeking help were more likely to suggest motivators, especially financial ones. More research is recommended on gamblers' trajectory towards recognition of a gambling problem, the process of overcoming specific barriers to treatment, and the role of social advantage (e.g., education and employment), in order to devise educational campaigns that will encourage earlier help-seeking among disordered gamblers.

Beliefs about gambling problems and recovery: results from a general population telephone survey.

Respondents were asked their beliefs about gambling abuse as part of a general population telephone survey. The random digit dialing survey consisted of 8,467 interviews of adults, 18 years and older, from Ontario, Canada (45% male; mean age = 46.2). The predominant conception of gambling abuse was that of an addiction, similar to drug addiction. More than half of respondents reported that treatment was necessary and almost three-quarters of respondents felt that problem gamblers would have to give up gambling completely in order to overcome their gambling problem. Problem gamblers (past or current) were less likely than non- or social gamblers to believe that treatment was needed, and current problem gamblers were least likely to believe that abstinence was required, as compared to all other respondents. Strong agreement with conceptions of gambling abuse as disease or addiction were positively associated with belief that treatment is needed, while strong agreement with conceptions of disease or wrongdoing were positively associated with belief that abstinence is required.

The prevalence and course of pathological gambling in the mood disorders.

The objective of the current investigation was to examine the prevalence of pathological gambling (PG) in a psychiatric sample with a history of mood disorder, and the concurrent and longitudinal association of PG and mood disorder symptoms according to retrospective report. A total of 275 (100 male, 175 female) psychiatric outpatients in Ontario, Canada, with a lifetime diagnosis of a depressive (n = 138) or bipolar disorder (n = 137), completed the Canadian Problem Gambling Index, South Oaks Gambling Screen and Longitudinal Interval Follow-up Evaluation. Correlational and cross-lagged panel analyses evaluated the relation between PG and mood disorder symptom course. The prevalence of PG was elevated within patients with a mood disorder; there was no difference across diagnosis. Concurrent PG and mood disorder symptoms were positively correlated; however, longitudinal analyses revealed no evidence for an association between PG and mood disorder symptoms when symptom stability was taken into account. Despite the elevated prevalence of PG within mood disorders, and the concurrent association between PG and mood disorder symptoms, no direct association was found between these types of pathology. Prospective designs and intervening variables are required to advance understanding of the etiological associations between these disorders.

A randomized, double-blind, placebo-controlled trial of naltrexone in the treatment of concurrent alcohol use disorder and pathological gambling.

The efficacy of naltrexone as a treatment for concurrent alcohol abuse or dependence and pathological gambling was evaluated in a randomized, double-blind, placebo-controlled trial. Fifty-two, mostly male, subjects were recruited from the community and received 11 weeks of medication during which cognitive-behavioral counseling was also provided. No significant group differences were found on any alcohol or gambling variable (ie, frequency, quantity, expenditures) at post-treatment or at the one year follow-up. However, a strong time effect was found suggesting that treatment, in general, was effective. The use of naltrexone to treat concurrent alcohol use and gambling problems was not supported.

Community treatment for problem gambling: sex differences in outcome and process.

This study compared sex differences in related treatment outcomes and processes in a community sample of outpatient problem gambling treatment-seekers. Participants attended approximately seven sessions of cognitive-behavioral treatment. Women were more likely to have a history of psychiatric comorbidity, prefer non-strategic/non-skill forms of gambling, and have a more rapid progression towards a gambling problem than did men. At the 6-month post-treatment follow-up, men were found to have improved to a significantly greater degree on measures of gambling severity and rates of abstinence in comparison to women. Moreover, men rated treatment components to be more helpful, whereas women found specific gambling-related treatment interventions (e.g., identification of high-risk situations, gambling beliefs and attitudes) to be less helpful. Implications for identifying treatment needs of women seeking problem gambling treatment are discussed.

Effectiveness of community-based treatment for problem gambling: a quasi-experimental evaluation of cognitive-behavioral vs. twelve-step therapy.

With the increasing availability of gambling throughout North America, there is interest in developing more effective treatments. This study compares the effectiveness of two brief outpatient treatments for problem gambling: eight sessions of Cognitive-Behavioral Therapy (n = 65) and eight sessions of a twelve-step treatment-oriented approach based on the first five steps of Gamblers Anonymous (n = 61). There were no baseline group differences on gambling-relevant variables. Twelve months post-treatment showed no group differences on key gambling variables (eg, frequency, abstinence rates, money wagered) in an analysis of completers. Participants who attended more sessions and chose an initial abstinent treatment goal appeared to achieve better outcomes.

Interpersonal group psychotherapy for comorbid alcohol dependence and non-psychotic psychiatric disorders.

Alcohol-dependent patients (N = 15) with comorbid non-psychotic psychiatric disorders were treated with Modified Interpersonal Group Therapy (MIGT) for eight weeks, 16 sessions, in a pilot intervention trial. Analysis of the group participants demonstrated that they achieved statistically significant improvements at post-treatment in four of five self-report outcome measures: number of drinking days, number of heavy drinking days, the Brief Symptom Inventory, and the Beck Depression Inventory. Furthermore, the improvements in heavy drinking days and the Brief Symptom Inventory were maintained at two and eight months post-treatment. This study yields preliminary evidence in support of MIGT as a useful treatment approach for an alcohol-dependent population with psychiatric comorbidity.

Minimal treatment approaches for concerned significant others of problem gamblers: a randomized controlled trial.

The goal of this study was to examine the efficacy of minimal treatment interventions for concerned significant others (CSOs) of problem gamblers. One hundred and eighty-six participants (82% females, 56% spouses) were randomly assigned to one of three groups: the first minimal intervention group received a self-help workbook [based on behavioral principles, modified from the Community Reinforcement and Family Therapy (CRAFT) model] and the second minimal intervention group received the workbook plus telephone support. The control condition received a treatment resource information package. Overall, all participants reported significant improvement in personal and relationship functioning and gambling behavior and consequences at the 3- and 6-month follow-up. The data demonstrated differences in favor of the interventions in three areas: days gambling, satisfaction with the program, and number who had their needs met. There was no difference in the number who had entered treatment. It may be that CSOs require more guidance and follow-up support to achieve these goals using the CRAFT procedures and strategies.

A framework for reporting outcomes in problem gambling treatment research: the Banff, Alberta Consensus.

OBJECTIVE: The objective is provide a framework concerning the minimum features of reporting efficacy of treatment in the problem gambling field. Research to date has not used uniform outcome measures and it is, therefore, difficult to compare the relative efficacy of various approaches. Some studies emphasize self-reported behavioural measures such as frequency and intensity of gambling whereas others emphasise change with respect to the criteria used to diagnose problem gambling or use composite measures of symptom severity in multiple domains involving gambling-related thoughts, urges, and behaviours. METHODS: An expert panel consensus. RESULTS: The proposed minimum features of reporting the efficacy of treatment outcome studies are: measures of gambling behaviour - the net expenditure each month, the frequency (in days per month) with which gambling takes place, and the time spent thinking about or engaged in the pursuit of gambling each month; measures of the problems caused by gambling - especially problems in the areas of personal health, relationships, financial, and legal; these measures can be complemented by additional measures of quality of life. measures of the processes of change - whatever mechanisms of change are assumed to occur. CONCLUSIONS: We believe that these guidelines are broad enough to allow clinical research conducted from diverse perspectives to allow valid cross study evaluations of intervention studies. Such conditions will facilitate the development of empirically validated best practice guidelines for use by clinicians in the management of problem gambling.

Overlap of clusters of psychiatric symptoms among clients of a comprehensive addiction treatment service.

This article describes the prevalence and overlap of psychiatric symptoms among 2,784 clients of the outpatient programs at a comprehensive addictions treatment facility. The psychiatric symptoms were assessed by a computer-based questionnaire, and the analysis focused on the overlap of symptom clusters (multimorbidity) and their relation to selected intake variables known to be predictors of treatment outcome. Of all clients, 27.4% scored positive for 1, 18.9% for 2, and 22.3% for 3 or more clusters, the most frequent being depression, anxiety, and history of conduct disorder. Multimorbidity was significantly correlated with female gender, unemployment, less social support, cannabis problems, fewer legal problems, and increased treatment engagement. Clients with more substance use disorders presented more psychiatric symptoms.

Single-session interventions for problem gambling may be as effective as longer treatments: Results of a randomized control trial.

Empirically supported treatments for problem gambling tend to be multimodal combining cognitive, behavior and motivational interventions. Since problem gamblers often prefer briefer treatments it is important that interventions adopt strategies that are optimally effective. In this study, 99 community-recruited problem gamblers (74% male, mean age: 47.5 years) were randomized to one of four treatments: six sessions of cognitive therapy, behavior therapy, and motivational therapy or a single-session intervention. The sample was followed up for 12 months post-treatment. In both the Intent-to-Treat and Completer statistical analyses, no significant group differences on key gambling variables (i.e., frequency, expenditures, severity) were found. All four treatments showed significant improvement as a result of treatment that endured throughout the follow-up period. These results, although preliminary, suggest that very brief, single-session interventions may be as effective as longer treatments.

Cognitive versus behavioral treatment of concurrent alcohol dependence and agoraphobia: a pilot study.

With the growing awareness of the prevalence of anxiety disorders among alcohol abusers there is a need for effective cognitive--behavioral treatments (CBTs). This study is a pilot investigation comparing two treatments for concurrent alcohol dependence and panic disorder with agoraphobia. A 10-session behavioral treatment (BT), consisting of five sessions treating alcohol dependence and five sessions treating panic disorder with agoraphobia, was compared to a 10-session cognitive treatment (CT) that addressed the dysfunctional cognitions mediating the alcohol problem and anxiety symptoms. There were no group differences in frequency or quantity of alcohol consumption or in anxiety symptoms posttreatment or at a 1-year follow-up in a sample of 14 subjects who completed the study. Both groups showed within-group improvements on measures of both alcohol and anxiety symptomatology. Approximately one-third of the subjects made clinically relevant gains on both alcohol and anxiety symptoms. A brief BT for concurrent alcohol dependence and agoraphobia appears encouraging.

A perspective on problem gambling treatment: issues and challenges.

Researchers face several challenges in conducting gambling treatment research. These include the impact of monetary incentives to participate, difficulty in subject recruitment, treatment ambivalence, heterogeneity of gambling behaviors among treatment samples, the role of natural recovery, the impact of intractable financial pressures, and the specification of adequate process and outcome measures. Each challenge is defined and potential resolutions suggested.

Lifetime rates of alcoholism in adults with anxiety, depression, or co-morbid depression/anxiety: a community survey of Ontario.

BACKGROUND: Separate lines of research have demonstrated strong associations linking alcohol misuse with major depression on the one hand, and anxiety disorders on the other. In the current study we examined the possible confounding and/or additive effects of co-morbid depression/anxiety in understanding these relationships. METHODS: A total of 7195 individuals in Ontario, aged 15-64, were interviewed using the CIDI. Based on lifetime diagnoses, we compared rates of alcohol abuse/dependence in four groups consisting of normal controls, individuals with unipolar major depression but no anxiety disorders, individuals with one or more anxiety disorders without depression, and individuals with co-morbid major depression and anxiety. Age of onset of alcoholism in the four study groups was also compared. RESULTS: In both genders, there were significantly higher rates of alcoholism in all three psychiatric groups relative to controls. In females only, there was also a significantly higher rate of alcoholism in the depressed/anxious group than in the pure anxious group. The age of onset of alcoholism was the same across all four study groups. LIMITATIONS: Due to limitations related to sample size, we combined subjects with various anxiety disorders into a single anxiety group and concurrent and sequential co-morbidity were not distinguished. CONCLUSIONS: Both gender effects and depression/anxiety co-morbidity may be important considerations in the design and interpretation of studies on alcohol misuse. This may be particularly relevant when considering the strength of the association between alcoholism and anxiety disorders in women. Depression and anxiety do not appear to influence the age of onset of alcoholism. Furthermore, no single temporal pattern of onset was identified in individuals with all three disorders, suggesting no obvious cause-effect relationship among them.

Treatment of pathological gambling: a critical review of the literature.

The legalization and availability of new forms of gambling are increasing in most Western countries. This trend has contributed to the fact that more individuals are developing gambling problems. As a result, there is a need for effective treatments. Although gambling treatment dates several decades, few empirically supported treatments for pathological gambling have been developed. This critical review includes only controlled treatment studies. The primary inclusion criterion was randomization of participants to an experimental group and to at least 1 control group. Eleven studies were identified and evaluated. Key findings showed that cognitive-behavioral studies received the best empirical support. Recommendations to improve gambling treatment research include better validated psychometric measures, inclusion of process measures, better definition of outcomes, and more precise definition of treatments.

Pathological gambling in treatment-seeking substance abusers.

Accumulating evidence suggests that treatment-seeking substance abusers have high rates of gambling problems. However, relatively little is known about the relation between gambling problems and specific psychoactive substances apart from alcohol and methadone-treated opiate addicts. In this study of 580 individuals admitted to a residential addictions program, 10.5% were found to score in the pathological gambling range on the South Oaks Gambling Screen (SOGS) within the past year. The rate of pathological gambling was much higher for cannabis abusers (24%) than for alcohol (4%), cocaine (11.5%), and opiate abusers (4.8%). Men also reported higher rates of pathological gambling (11.9%) than women (7.5%). Individuals with a pathological gambling problem tended to report family histories of gambling problems as well.

Anxiety and explicit alcohol-related memory in problem drinkers.

Anxiety is associated with increased craving following in vivo cue exposure in alcoholics. Theoretical accounts [Psychol. Rev. 97 (1990) 147.] have proposed that conscious, deliberate cognitive processes underlie increased craving in drinkers who are trying to abstain. The present study tested the hypothesis that anxiety is associated with biases in explicit (i.e., conscious, deliberate) memory that promote recall of alcohol-related concepts in response to negative affective cues. Fifty-two (seven females) outpatient problem drinkers performed a cued recall task that assessed memory for alcohol-related (ALC), negative affective (NEG), and neutral (NEU) target concepts that had been paired with NEG, ALC, and NEU cues during an incidental study phase. Higher anxiety was associated with increased recall of ALC targets paired with NEG cues. State and trait anxiety were intercorrelated, with higher levels coinciding with a higher frequency of drinking in negative mood states. These findings demonstrate a correspondence between anxiety and alcohol-related memory, and suggest that explicit memory biases may contribute to increased subjective responses (e.g., craving, expectancies) to alcohol stimuli in anxious problem drinkers.

Validation and comparison of diagnostic accuracy of four screening tools for mental disorders in people seeking treatment for substance use disorders.

This study aimed to validate and compare performance of four screening tools for mental disorders in a heterogeneous population seeking substance use treatment. A total of 544 clients were recruited prospectively from three treatment centres and completed the screening instruments followed by a reference standard psychiatric interview for research diagnosis. Performance relative to the reference standard was compared across instruments using receiver operator characteristic (ROC) analysis. Screening tools included the GAIN-SS-IDScr; the K6, the Psychiatric Sub-scale of the Addiction Severity Index, and the Psychiatric Diagnostic Screening Questionnaire. All the screening tools performed reasonably well detecting broad groupings of disorders-any past-month disorder, any depressive disorder, anxiety disorder or psychotic disorder, with the GAIN-SS-IDScr being most efficient due to its shorter length. Results strengthen previous validation data for each of the tools investigated and support their use in detecting mental disorders in the substance use treatment population specifically.