Five-year follow-up on a sample of gamblers: predictive factors of relapse.

BACKGROUND AND AIMS: Few studies have been conducted on the long-term evolution of gambling disorder (GD). The aim of this study was to identify factors that could predict GD relapse. METHODS: Data were part of a dataset from a large 5-year cohort of gamblers who were assessed at inclusion and each year thereafter. Participants were recruited from an outpatient addiction treatment center, from various gambling places and through the press. For this specific study, inclusion criteria included (i) transitioning from GD to recovery at a follow-up time and (ii) undergoing at least one follow-up visit afterwards. Participants were evaluated using a structured clinical interview and self-report questionnaires assessing sociodemographic, gambling and clinical characteristics. "Relapse" was defined as the presence of GD (according to the DSM-5) at the N+1th visit following the absence of GD at the Nth visit. A Markov model-based approach was employed to examine predictive factors associated with relapse at a subsequent follow-up visit. RESULTS: The sample consisted of 87 participants, aged 47.6 years (sd = 12.6), who were predominantly male (65%). Among the participants, 49 remained in recovery, whereas 38 relapsed. Participants who reported not having experienced at least one month of abstinence and those with a low level of self-directedness at the previous follow-up visit were more likely to relapse. CONCLUSIONS: Our findings suggest the existence of factors that are predictive of relapse in individuals with GD who had previously achieved recovery. These results can inspire the development of measures to promote long-term recovery.

A bias towards natural rewards away from gambling cues in gamblers undergoing active treatment.

BACKGROUND: Disorders of substance and behavioral addiction are believed to be associated with a myopic bias towards the incentive salience of addiction-related cues away from general rewards in the environment. In non-treatment seeking gambling disorder patients, neural activity to anticipation of monetary rewards is enhanced relative to erotic rewards. Here we focus on the balance between anticipation of reward types in active treatment gamblers relative to healthy volunteers. METHODS: Fifty-three (25 gambling disorder males, 28 age-matched male healthy volunteers) were scanned with fMRI performing a Monetary Incentive Delay task with monetary and erotic outcomes. RESULTS: During reward anticipation, gambling disorder was associated with greater left orbitofrontal cortex and ventral striatal activity to erotic relative to monetary reward anticipation compared to healthy volunteers. Lower impulsivity correlated with greater activity in the dorsal striatum and dorsal anterior cingulate cortex to erotic anticipation in gambling disorder subjects. In the outcome phase, gambling disorder subjects showed greater activity in the ventral striatum, ventromedial and dorsolateral prefrontal cortex and anterior cingulate cortex to both reward types relative to healthy volunteers. CONCLUSIONS: These findings contrast directly with previous findings in non-treatment seeking gambling disorder. Our observations highlight the role of treatment state in active treatment gambling disorder, emphasizing a potential influence of treatment status, gambling abstinence or cognitive behavioral therapy on increasing the salience of general rewards beyond that of gambling-related cues. These findings support a potential therapeutic role for targeting the salience of non-gambling related rewards and potential biomarkers for treatment efficacy.

The rise of online sports betting, its fallout, and the onset of a new profile in gambling disorder: young people.

HYPOTHESIS: Since 2015 the gambling trend may have changed among young people between 18 and 30 years old. METHODOLOGY: Range of document review techniques obtained by therapeutic data regarding the personal development of each person in rehabilitation to analyze 13 different variables. FINDINGS: Due to the new regulations legalizing online gambling in Spain, and the constant increase in its advertising, a shift could have taken place in the gamblers' profile: a preference for online sports betting and placing other bets using devices connected to the Internet, such as smartphones, laptops, tablets, and similar technologies. Gamblers who use online media to place their bets also incur debts over the Internet. We find a possible proliferation of online betting services, that could imply an increase of social, psychological, and family relationship problems affecting young gamblers, which may constitute a new profile of gambling disorder.

Training gamblers to re-think their gambling choices: How contextual analytical thinking may be useful in promoting safer gambling.

BACKGROUND AND AIMS: Harmful gambling has been associated with the endorsement of fallacious cognitions that promote excessive consumption. These types of beliefs stem from intuitively derived assumptions about gambling that are fostered by fast-thinking and a lack of objective, critical thought. The current paper details an experiment designed to test whether a four-week online intervention to strengthen contextual analytical thinking in gamblers is effective in changing gamblers cognitions and encouraging safer gambling consumption. METHODS: Ninety-four regular gamblers who reported experiencing gambling-related harm were randomly allocated to either an experimental (n = 46) or control condition (n = 48), including 45 males, ranging from 19 to 65 years of age (M = 36.61; SD = 9.76). Following baseline measurement of gambling beliefs and prior week gambling consumption, participants in the experimental condition were required to complete an adaption of the Gamblers Fallacy Questionnaire designed to promote analytical thinking by educating participants on common judgement errors specific to gambling once a week for four weeks. Post-intervention measures of beliefs and gambling consumption were captured in week five. RESULTS: The experimental condition reported significantly fewer erroneous cognitions, greater endorsement of protective cognitions, and reduced time spent gambling post-intervention compared to baseline. The control group also reported a reduction in cognitions relating to predicting and controlling gambling outcomes. CONCLUSION: Cognitive interventions that encourage gamblers to challenge gambling beliefs by reflecting on gambling involvement and promoting critical thinking may be an effective tool for reducing the time people invest in gambling activities.

Mapping and conceptualizing recovery capital of recovered gamblers.

Recovery capital (RC) is an emerging conceptual framework in the addiction field that pinpoints the internal and external (i.e., human, community, cultural, social, financial) resources individuals can draw on throughout the recovery process. The concept of RC was developed and applied primarily to individuals who have recovered from substance addiction. The aim of this study was to extend the RC conceptual framework to gambling disorder (GD)-which is classified in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013) as a behavioral addiction-and to identify and conceptualize RC resources implemented by individuals who have recovered from GD. Ninety-one individuals who reported a lifetime history of DSM-5 GD but who had not exceeded the DSM-5 GD threshold criteria in the previous year, were interviewed about the factors that helped them throughout their recovery. Directed content analyses identified 12 main RC resources that were classified under 4 RC domains: human capital (subjective well-being, self-efficacy, self-control skills, proactive coping skills, socioemotional skills, reconstruction skills), community capital (prorecovery environment, professional therapeutic milieu), social capital (recovering gamblers' peer group, friends without a GD, family), and financial capital (prorecovery financial state). These findings are the first step toward formulating a comprehensive conceptual model of RC applicable to GD. This study extends the RC and the gambling literature by presenting a holistic view of recovery from GD in many facets of life, and underscores the importance of observing strengths and resources in treating people with GD. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Predictors of Dropout in Disordered Gamblers in UK Residential Treatment.

Within the cohort of individuals who seek treatment for disordered gambling, over half fail to complete treatment. The current study sought to identify predictors of treatment dropout in a sample of gamblers attending a residential treatment facility for disordered gamblers in the UK and to report differences in voluntary and enforced dropout. Data on 658 gamblers seeking residential treatment with the Gordon Moody Association (GMA) was analysed, collected between 2000 and 2015. Measurements included demographic data, self-reported gambling behavior, (including the Problem Gambling Severity Index), mental and physical health status, and a risk assessment. Binary logistic regression models were used to examine predictors of treatment termination. Results confirm a high percentage of treatment dropout among disordered gamblers (51.3%). Significant predictors of treatment dropout included older age of the client, higher levels of education, higher levels of debt, online gambling, gambling on poker, shorter duration of treatment, higher depression, experience of previous treatment programmes and medication, and adverse childhood experiences. Within non-completers, significant predictors of enforced dropout included lifetime homelessness, less debt, sports gambling, depression and lifetime smoking. Those who were on a longer treatment programme and had previously received gambling treatment or support were less likely to be asked to leave. Clinicians working in inpatient support need to be aware of the increased psychopathogical and psychosocial problems in those who are at risk of termination and make attempts to retain them in treatment and increase patient compliance.

Gambling-Related Cognitive Distortions in Residential Treatment for Gambling Disorder.

Gambling-related cognitive distortions are associated with gambling disorder severity, but few studies have provided an in-depth examination of the interrelationship between cognitive distortions, gambling severity, psychiatric comorbidity and treatment outcomes. The present study sought to identify factors associated with elevated cognitive distortions among problem gamblers entering residential treatment, examine changes in cognitive distortions through treatment, and explore the association between cognitive distortions and treatment outcomes. Pre- and post-treatment data were extracted from the charts of 125 individuals who participated in a 21-day residential treatment program for gambling disorder. Assessments included measures of demographics, gambling disorder severity, psychiatric symptoms and gambling-related cognitive distortions. Several significant associations were found between baseline cognitive distortions and psychiatric symptoms. Cognitive distortions decreased significantly from pre- to post-treatment. Pre- to post-treatment changes on several cognitive distortion scales were positively associated with greater baseline psychiatric symptomology. Treatment drop-out was associated with higher scores on measures reflecting greater impulsivity/addiction and greater perceived predictive control. Gambling-related cognitive distortions represent an important mechanism of gambling disorder and its treatment and provide a target for the development and refinement of treatment for gambling disorder.

Recovery Capital and Symptom Improvement in Gambling Disorder: Correlations with Spirituality and Stressful Life Events in Younger but Not Older Adults.

Although age-related differences have been reported in gambling disorder, prior studies have not examined how age may influence recovery in gambling disorder. Recovery may be influenced by positive factors (e.g., spirituality and recovery capital) and negative factors (e.g., depression, anxiety, and stressful life events). The current study examined associations between these positive and negative factors and gambling disorder DSM-5 symptom improvement in younger and older adults. Younger (less than 55 years of age; n = 86) and older (55 years or older; n = 54) adults, with lifetime gambling disorder treated currently or within the past 5 years in five treatment centers in Israel were assessed using structured scales on past-year and lifetime DSM-5 gambling disorder, intrinsic spirituality, recovery capital, anxiety, depression and stressful life-events. Among younger adults, recovery capital and intrinsic spirituality were associated with gambling disorder symptom improvement. Among older adults, only recovery capital was associated with gambling disorder symptom improvement. Correlations between recovery capital and spirituality (z = 2.34, p = 0.02) and recovery capital and stressful life events (z = 2.29, p = 0.02) were stronger in younger than in older adults. Recovery capital is an important resource that should be considered across older and younger adults with gambling disorder. Spirituality and stressful life events may operate differently across age groups in gambling disorder. Future studies should investigate whether the findings may extend to other groups and the extent to which promoting recovery capital should be integrated into treatments for gambling disorder.

Impulsivity and cognitive distortions in different clinical phenotypes of gambling disorder: Profiles and longitudinal prediction of treatment outcomes.

BACKGROUND: Impulsivity and cognitive distortions are hallmarks of gambling disorder (GD) but it remains unclear how they contribute to clinical phenotypes. This study aimed to (1) compare impulsive traits and gambling-related distortions in strategic versus non-strategic gamblers and online versus offline gamblers; (2) examine the longitudinal association between impulsivity/cognitive distortions and treatment retention and relapse. METHODS: Participants seeking treatment for GD (n = 245) were assessed for gambling modality (clinical interview), impulsive traits (Urgency, Premeditation, Perseverance and Sensation Seeking [UPPS] scale) and cognitive distortions (Gambling Related Cognitions Scale) at treatment onset, and for retention and relapse (as indicated by the clinical team) at the end of treatment. Treatment consisted of 12-week standardized cognitive behavioral therapy, conducted in a public specialized clinic within a general public hospital. RESULTS: Strategic gamblers had higher lack of perseverance and gambling-related expectancies and illusion of control than non-strategic gamblers, and online gamblers had generally higher distortions but similar impulsivity to offline gamblers. Lack of perseverance predicted treatment dropout, whereas negative urgency and distortions of inability to stop gambling and interpretative bias predicted number of relapses during treatment. CONCLUSIONS: Individuals with online and strategic GD phenotypes have heightened gambling related biases associated with premature treatment cessation and relapse. Findings suggest that these GD phenotypes may need tailored treatment approaches to reduce specific distortions and impulsive facets.

Nuevas perspectivas en afrontamiento e intervención clínica en el trastorno por juego de azar basada en terapias de tercera generación / New perspectives on coping and clinical intervention in gambling disorder based on third-wave generation therapies

El trastorno por juego de azar (TJA) es un trastorno adictivo que se ha asociado con procesos cognitivos y emocionales que incluyen estilos de afrontamiento desadaptativos. Este artículo tiene como objetivo analizar y revisar diferentes enfoques dentro del afrontamiento, como la regulación emocional, la metacognición o la evitación experiencial, que se centran en la experiencia subjetiva cognitiva y emocional. Asimismo, se incluyen modelos de intervención basados en estos enfoques, como la terapia metacognitiva, la terapia cognitiva basada en mindfulness o la terapia de aceptación y compromiso, y las evidencias científicas disponibles actualmente en relación al trastorno por juego de azar. La comprensión de estos procesos en relación a la conducta de juego es importante para la aplicación de intervenciones y tratamientos basados en terapias de tercera generación, que ponen el foco en la forma de relacionarse con las experiencias internas, y que podrían ser de utilidad para la intervención clínica

Gambling disorder is an addictive disorder that has been related with cognitive and emotional processes that include maladaptive coping styles. This article aims to review different perspectives on gambling and coping, such as emotion regulation, metacognition, and experiential avoidance, which focus on subjective cognitive and emotional experience. Moreover, intervention models based on these approaches are included, such as metacognitive therapy, mindfulness-based cognitive therapy, or acceptance and commitment therapy, as well as current empirical evidence avalaible about the application of these therapies in gambling disorder. Understanding these processes in gambling is important for applying treatments based on third-wave therapies, which highlight the importance of the relationship with inner experiences, and may be useful for clinical intervention

Similar roles for recovery capital but not stress in women and men recovering from gambling disorder.

BACKGROUND: Understanding gender-related differences is important in recovery processes. Previous studies have investigated gender-related differences in factors associated with gambling disorder (GD), but none to date have considered both positive and negative resources related to recovery. Using a recovery capital (RC) framework that considers multiple resources available during recovery, this study examined gender-related similarities and differences in associations between positive resources (RC, spirituality) and negative experiences and states (stressful life events, depression, and anxiety) and GD symptom improvement. METHOD: One hundred and forty individuals with lifetime GD (101 men) were assessed using DSM-5 diagnostic criteria for GD (past-year and lifetime prior to past-year), the Brief Assessment of RC, the Intrinsic Spirituality Scale, the Stressful Life-events Scale, the Generalized Anxiety Disorder Scale, and the Patient Health Questionnaire 9 for depression. Multiple linear regression and Bayesian statistical analyses were conducted. RESULTS: RC was positively and significantly associated with GD symptom improvement in women and men. Stressful life events were negatively associated with GD symptom improvement only in men. CONCLUSIONS: RC is an important positive resource for men and women recovering from GD and should be considered in treating both women and men. Understanding specific RC factors across gender groups and stressors, particularly in men, may aid in developing improved interventions for GD.

Impulsivity and problem awareness predict therapy compliance and dropout from treatment for gambling disorder. / Impulsividad y conciencia del problema predicen la adherencia terapéutica y el abandono del tratamiento en el trastorno por juego de azar.

This study investigates the predictive value of impulsivity traits (as measured by the UPPS-P impulsive behaviour scale) and relevant covariates (sociodemographics, gambling severity, dysphoric mood, other potentially addictive behaviours, and non-verbal intelligence) with regard to treatment dropout and level of adherence to therapy guidelines and instructions in patients with gambling disorder. Sixty-six patients seeking treatment for gambling disorder, and recruited to participate in a larger protocol (G-Brain), were initially assessed in impulsivity traits and relevant covariates in the first six months after admission. Of these, 24 patients dropped out (DO) and 42 patients remained in therapy (NDO) during the subsequent 6-month follow-up period. A multivariate analysis of impulsivity subscales suggested prospective differences between DO and NDO, with affect-driven dimensions (positive and negative urgency) seemingly driving these differences. Among these, only positive urgency independently predicted a slight increase in the drop-out probability. In the NDO group, a higher degree of adherence to therapy was independently predicted by lower sensation-seeking scores and stronger awareness of gambling-related problems. Results suggest the presence of affect-driven impulsivity traits as dropout predictors in patients with gambling disorder. Awareness of gambling-related problems and lower sensation-seeking enhanced compliance with therapeutic guidelines and instructions.

Este estudio investiga el valor predictivo de la impulsividad como rasgo (evaluada con la escala de conducta impulsiva UPPS-P) y de covariados relevantes (variables sociodemográficas, severidad del juego de azar, estado de ánimo disfórico, otras conductas adictivas e inteligencia no verbal), con respecto al abandono del tratamiento y los niveles de cumplimiento de las prescripciones terapéuticas en pacientes con trastorno por juego de azar. Sesenta y seis pacientes con este trastorno, participantes del proyecto G-Brain, fueron evaluados inicialmente en impulsividad rasgo y en los covariados mencionados. Dicha evaluación se realizó durante los seis primeros meses desde el inicio de su tratamiento. En el seguimiento realizado a los 6 meses, 24 pacientes habían abandonado (grupo ABD) y 42 continuaban el tratamiento (grupo NABD). Los análisis multivariados con las subescalas de impulsividad mostraron diferencias prospectivas entre ambos grupos. Aparentemente, estas diferencias son atribuibles a las dimensiones afectivas de impulsividad (urgencias positiva y negativa). Entre ambas dimensiones, solo la urgencia positiva fue un predictor independiente de un ligero incremento en la probabilidad de abandono. Dentro del grupo NABD, un mayor grado de adherencia terapéutica vino predicho, de manera independiente, tanto por una baja búsqueda de sensaciones como por una mayor conciencia de los problemas vinculados al juego. Estos resultados sugieren que los rasgos de impulsividad de origen afectivo son predictores de abandono del tratamiento en pacientes con trastorno por juego. La conciencia de problemas asociados al juego de azar y una baja búsqueda de sensaciones predisponen a una mayor adherencia a las prescripciones terapéuticas.

Impulsividad y conciencia del problema predicen la adherencia terapéutica y el abandono del tratamiento en el trastorno por juego de azar / Impulsivity and problem awareness predict therapy compliance and dropout from treatment for gambling disorder

Este estudio investiga el valor predictivo de la impulsividad como rasgo (evaluada con la escala de conducta impulsiva UPPS-P) y de covariados relevantes (variables sociodemográficas, severidad del juego de azar, estado de ánimo disfórico, otras conductas adictivas e inteligencia no verbal), con respecto al abandono del tratamiento y los niveles de cumplimiento de las prescripciones terapéuticas en pacientes con trastorno por juego de azar. Sesenta y seis pacientes con este trastorno, participantes del proyecto G-Brain, fueron evaluados inicialmente en impulsividad rasgo y en los covariados mencionados. Dicha evaluación se realizó durante los seis primeros meses desde el inicio de su tratamiento. En el seguimiento realizado a los 6 meses, 24 pacientes habían abandonado (grupo ABD) y 42 continuaban el tratamiento (grupo NABD). Los análisis multivariados con las subescalas de impulsividad mostraron diferencias prospectivas entre ambos grupos. Aparentemente, estas diferencias son atribuibles a las dimensiones afectivas de impulsividad (urgencias positiva y negativa). Entre ambas dimensiones, solo la urgencia positiva fue un predictor independiente de un ligero incremento en la probabilidad de abandono. Dentro del grupo NABD, un mayor grado de adherencia terapéutica vino predicho, de manera independiente, tanto por una baja búsqueda de sensaciones como por una mayor conciencia de los problemas vinculados al juego. Estos resultados sugieren que los rasgos de impulsividad de origen afectivo son predictores de abandono del tratamiento en pacientes con trastorno por juego. La conciencia de problemas asociados al juego de azar y una baja búsqueda de sensaciones predisponen a una mayor adherencia a las prescripciones terapéuticas

This study investigates the predictive value of impulsivity traits (as measured by the UPPS-P impulsive behaviour scale) and relevant covariates (sociodemographics, gambling severity, dysphoric mood, other potentially addictive behaviours, and non-verbal intelligence) with regard to treatment dropout and level of adherence to therapy guidelines and instructions in patients with gambling disorder. Sixtysix patients seeking treatment for gambling disorder, and recruited to participate in a larger protocol (G-Brain), were initially assessed in impulsivity traits and relevant covariates in the first six months after admission. 24 patients dropped out (DO) and 42 patients remained in therapy (NDO) during the subsequent 6-month follow-up period. A multivariate analysis of impulsivity subscales suggested prospective differences between DO and NDO, with affect-driven dimensions (positive and negative urgency) seemingly driving these differences. Among these, only positive urgency independently predicted a slight increase in the drop-out probability. In the NDO group, a higher degree of adherence to therapy was independently predicted by lower sensation-seeking scores and stronger awareness of gambling-related problems. Results suggest the presence of affect-driven impulsivity traits as dropout predictors in patients with gambling disorder. Awareness of gambling-related problems and lower sensation-seeking enhanced compliance with therapeutic guidelines and instructions

Prevalence of Pathological Gambling among Alcohol Addicts in Outpatient Treatment in the City of Zagreb: a Cross-Sectional Study.

BACKGROUND: Various types of addictions often co-occur, particularly substance and behavioral ones, which affects the clinical course of mental health disorders as well as the efficacy of therapy and rehabilitation efforts. The present study aims to explore gambling activities and possible gambling addiction among alcoholics in an outpatient treatment in the city of Zagreb. SUBJECTS AND METHODS: Gambling activities were assessed in 140 members of alcohol addiction clubs in the City of Zagreb (Croatia). Participants were undergoing treatment after being diagnosed by their psychiatrist with alcohol dependence syndrome based on ICD-10 criteria. Intensity of gambling-related problems was measured using the South Oaks Gambling Screen (SOGS), while intensity of alcohol addiction was assessed using DSM-5 diagnostic criteria for alcohol use disorder. All instruments were self-report forms and were completed using pen and paper in a group context during outpatient treatment. RESULTS: Pathological gambling was more prevalent in this clinical subsample than in general populations analysed in other studies. Alcohol addicts showing problematic or pathological gambling behaviors tended to play more highly addictive games (sports betting, slot machines, roulette). However, intensity of gambling-related problems did not correlate significantly with the intensity of alcohol addiction. CONCLUSION: These results confirm studies from other countries showing higher prevalence of problematic and pathological gambling among alcohol addicts than in the general population. Gambling behavior in our sample more often involved games with greater addictive potential. These findings suggest that alcohol addicts should be systematically screened for problematic and pathological gambling, which may improve therapeutic efficacy and rehabilitation, as well as reduce relapse in addictive behavior in general.

Betting on Life: Associations Between Significant Life Events and Gambling Trajectories Among Gamblers with the Intent to Quit.

Considerable evidence has suggested that problem gambling may be transitory and episodic, with gamblers routinely moving in and out of clinical thresholds. Findings in qualitative and quantitative studies have converged on identifying preliminary evidence for the role of life events as motivators and contributing factors for gambling changes over time. The aim of this study was to conduct an exploratory analysis of the relationship between life events, their respective experience as positive or negative, and gambling trajectories among problem gamblers intending to quit. Life event occurrence and ratings as positive or negative, and changes in gambling severity were analyzed over a 12-month period for 204 adult problem gamblers intending to reduce or quit their gambling. Overall, mixed effects models revealed several relationships between life events and both the magnitude and direction of gambling change over time. In particular, gamblers who experienced a greater number of positive events or specific events such as legal events, the adoption/loss of a child, or negative changes to their social relationships, finances, work environments or social/health activities were more likely to exhibit greater gambling reductions over time. Conversely, gamblers who experienced a greater number of negative events, such as family bereavement, the dissolution of a marriage, or negative changes to their residence exhibited smaller gambling reductions or increases in gambling severity. Possible mechanisms which may explain the findings and the importance of examining the subjective experience of life events are discussed. Recommendations for future studies examining associations between life events and gambling trajectories are provided.

Gambling problems among patients in primary care: a cross-sectional study of general practices.

BACKGROUND: Primary care is an important context for addressing health-related behaviours, and may provide a setting for identification of gambling problems. AIM: To indicate the extent of gambling problems among patients attending general practices, and explore settings or patient groups that experience heightened vulnerability. DESIGN AND SETTING: Cross-sectional study of patients attending 11 general practices in Bristol, South West England. METHOD: Adult patients (n = 1058) were recruited from waiting rooms of practices that were sampled on the basis of population characteristics. Patients completed anonymous questionnaires comprising measures of mental health problems (for example, depression) and addictive behaviours (for example, risky alcohol use). The Problem Gambling Severity Index (PGSI) measured gambling problems, along with a single-item measure of gambling problems among family members. Estimates of extent and variability according to practice and patient characteristics were produced. RESULTS: There were 0.9% of all patients exhibiting problem gambling (PGSI ≥5), and 4.3% reporting problems that were low to moderate in severity (PGSI 1-4). Around 7% of patients reported gambling problems among family members. Further analyses indicated that rates of any gambling problems (PGSI ≥1) were higher among males and young adults, and more tentatively, within a student healthcare setting. They were also elevated among patients exhibiting drug use, risky alcohol use, and depression. CONCLUSION: There is need for improved understanding of the burden of, and responses to, patients with gambling problems in general practices, and new strategies to increase identification to facilitate improved care and early intervention.

Reliability and Validity of the Work and Social Adjustment Scale in Treatment-Seeking Problem Gamblers.

BACKGROUND: Problem gambling is a growing concern as governments become more reliant on gambling revenue particularly from increases in gambling casinos. It is widely reported that problem gamblers experience both high levels of comorbid mental health issues and subsequent disability that comes with such. To date, there have been few measures tested with problem gamblers that are a good measure of this disability. The Work and Social Adjustment Scale (WSAS) is a five-item measure of disability, which is used widely in a number of clinical settings including gambling. METHOD: The reliability and validity of the WSAS were examined in 171 outpatient problem gamblers who presented to a cognitive behavior therapy service in Adelaide, Australia. Subjects were assessed by trained cognitive behavior therapists and offered individual outpatient, group, or inpatient treatment. All subjects signed consent for their clinical data to be used and completed a battery of outcome measures at assessment, discharge, and 1-, 3-, and 6-month follow-up. RESULTS: The internal consistency of the WSAS was excellent among problem gamblers. A principal component analysis generated a single factor of disability. The WSAS has good concurrent validity with measures of gambling and comorbid anxiety and depression. The WSAS also shows promise as a measure of improvement in a clinical service. CONCLUSION: The WSAS has excellent reliability and sound validity among a treatment-seeking problem gambling population. Understanding disability related to gambling may offer insights into the long-term success of gamblers completing treatment. This instrument needs further refinement in a more rigorous experimental setting.

Gambling with Rose-Tinted Glasses on: Use of Emotion-Regulation Strategies Correlates with Dysfunctional Cognitions in Gambling Disorder Patients.

Background and aims Existing research shows that gambling disorder patients (GDPs) process gambling outcomes abnormally when compared against healthy controls (HCs). These anomalies present the form of exaggerated or distorted beliefs regarding the expected utility of outcomes and one's ability to predict or control gains and losses, as well as retrospective reinterpretations of what caused them. This study explores the possibility that the emotional regulation strategies GDPs use to cope with aversive events are linked to these cognitions. Methods 41 GDPs and 45 HCs, matched in sociodemographic variables, were assessed in gambling severity, emotion-regulation strategies (cognitive emotion-regulation questionnaire, CERQ), and gambling-related cognitions (gambling-related cognitions scale, GRCS). Results GDPs showed higher scores in all gambling-related cognition dimensions. Regarding emotion regulation, GDPs were observed to use self-blame and catastrophizing, but also positive refocusing, more often than controls. Additionally, in GDPs, putatively adaptive CERQ strategies shared a significant portion of variance with South Oaks gambling screen severity and GRCS beliefs. Shared variability was mostly attributable to the roles of refocusing on planning and putting into perspective at positively predicting severity and the interpretative bias (GDPs propensity to reframe losses in a more benign way), respectively. Discussion and conclusions Results show links between emotion-regulation strategies and problematic gambling-related behaviors and cognitions. The pattern of those links supports the idea that GDPs use emotion-regulation strategies, customarily regarded as adaptive, to cope with negative emotions, so that the motivational and cognitive processing of gambling outcomes becomes less effective in shaping gambling-related behavior.

A randomized controlled trial of brief interventions for problem gambling in substance abuse treatment patients.

OBJECTIVE: This study evaluated the efficacy of brief gambling treatments in patients attending substance abuse treatment clinics. METHOD: Substance abuse treatment patients with gambling problems (N = 217) were randomly assigned to a 10- to 15-min brief psychoeducation gambling intervention; a 10- to 15-min brief advice intervention addressing gambling norms, risk factors, and methods to prevent additional problems; or 4 50-min sessions of motivational enhancement therapy plus cognitive behavior therapy for reducing gambling (MET + CBT). Gambling and related problems were assessed at baseline and throughout 24 months. RESULTS: In the sample as a whole, days and dollars wagered and gambling problems decreased markedly from baseline through Month 5; thereafter, reductions in dollars wagered and gambling problems continued to decrease modestly but significantly, and days gambled remained constant. Brief advice significantly reduced days gambled between baseline and Month 5 relative to brief psychoeducation. The MET + CBT condition engendered no benefit beyond brief advice in terms of days gambled but did lead to more precipitous reductions in dollars gambled and problems experienced in the initial 5 months, and greater clinically significant improvements in gambling in both the short and long term. MET + CBT also resulted in initial decreases in self-reported alcohol use and problems but did not differentially impact self-reported illicit drug use or submission of positive samples. CONCLUSIONS: Gambling problems tend to dissipate over time regardless of the intervention applied, but offering MET + CBT was more efficacious in decreasing gambling than providing a brief single session intervention. (PsycINFO Database Record