David C. Hodgins

Motivational enhancement and self-help treatments for problem gambling.

Two brief treatments for problem gambling were compared with a waiting-list control in a randomized trial. Eighty-four percent of participants (N = 102) reported a significant reduction in gambling over a 12-month follow-up period. Participants who received a motivational enhancement telephone intervention and a self-help workbook in the mail, but not those who received the workbook only, had better outcomes than participants in a 1-month waiting-list control. Participants who received the motivational interview and workbook showed better outcomes than those receiving the workbook only at 3- and 6-month follow-ups. At the 12-month follow-up, the advantage of the motivational interview and workbook condition was found only for participants with less severe gambling problems. Overall, these results support the effectiveness of a brief telephone and mail-based treatment for problem gambling.

The Carleton University responsiveness to suggestion scale: normative data and psychometric properties.

A normative sample of 400 subjects was administered the Carleton University Responsiveness to Suggestion Scale (CURSS) in small groups. The Carleton scale yields three suggestibility scores for each subject; objective (CURSS:O) scores reflect overt response to suggestion, subjective (CURSS:S) scores reflect experiential response to suggestion, and objective-involuntariness (CURSS:OI) scores reflect the extent to which objectively “passed” responses were experienced as occurring involuntarily. Guttman scale analyses and factor analyses indicate that each dimension is primarily unidimensional and cumulative. CURSS:O scores had a bell-shaped distribution while CURSS:OI scores were much more strongly skewed toward the low suggestibility end of the distribution. Subjects who “passed” suggestions by objective criteria frequently rated their responses as primarily voluntary rather than involuntary. Implications of these findings for the measurement of hypnotic susceptibility are discussed.

More data on the Addiction Severity Index. Reliability and validity with the mentally ill substance abuser.

The Addiction Severity Index (ASI) is a semistructured interview that collects data from substance abusers in seven problem areas: medical, employment, legal, alcohol, other drug use, family-social functioning, and psychological status. In each area, the clients provide an estimate of the seriousness of the problem and their need for treatment. It has been demonstrated in a number of studies to be reliable, valid, and useful in monitoring treatment changes and in matching substance-abusing clients to treatments. This study investigates the usefulness of the ASI with male and female substance abusers who suffer a concurrent major psychiatric disorder (N = 152). Data on the independence of the problem scales, their internal consistency, interrater reliability, and concurrent validity are presented. It is concluded that: a) the problem areas are independent from each other, underscoring the need for multidimensional assessment; b) interviewer severity ratings provide information in addition to that provided by clients; c) the reliability of the composite scores is generally adequate, with the exception of the legal and family-social scales; and d) further examination of the employment scores is required.

Retrospective and Prospective Reports of Precipitants to Relapse in Pathological Gambling.

A prospective design was used to explore the precipitants of relapse in a naturalistic sample of pathological gamblers (N = 101) who had recently quit gambling. Relapse rates were high; only 8% were entirely free of gambling during the 12-month follow-up. Relapses were highly variable but occurred most frequently in the evening, when the person was alone and thinking about finances. Moods prior to the gambling were as likely to be positive as negative. The most frequently reported attributions, particularly for major relapses, were cognitions about winning and feeling the need to make money, unlike substance abuse relapses that tend to be attributed to negative affect. Some gender differences were found, but the precipitants of shorter and longer relapses did not differ.

Barriers to seeking help for gambling problems: A review of the empirical literature

This literature review summarizes recent empirical research on obstacles preventing problem gamblers from seeking treatment for their gambling problems. Relevant databases and bibliographies were searched for English-language papers and reports published since 1998. The only methodological requirement was that gamblers themselves be asked about reasons for not seeking help. Nineteen studies conducted in five countries were identified. All except one targeted adults. Despite differences in methodology, many of the same barriers to treatment were identified. Most commonly reported barriers were: wish to handle problem by oneself; shame/embarrassment/stigma; unwillingness to admit problem; and issues with treatment itself. The authors of the review argue that unwillingness to admit to the problem may be even more prevalent than is typically indicated by the results of barriers studies. Other frequently reported barriers included lack of knowledge about treatment options and practical issues around attending treatment. More research is needed on barriers to treatment-seeking experienced by subgroups of gamblers defined by culture, ethnicity, gender, age. Open-ended questioning methods can help provide insights into what barrier categories mean to different groups and individuals. Input directly from gamblers can be combined with information from other kinds of studies to devise better ways of reaching problem gamblers, especially those in underserviced populations.

Trusting problem gamblers: reliability and validity of self-reported gambling behavior.

The retest reliability and validity of self-reported gambling behavior were assessed in 2 samples of problem gamblers. Days gambled and money spent gambling over a 6-month timeframe were reliable over a 2- to 3-week retest period using the timeline follow-back interview procedure (N=35; intraclass correlation coefficients [ICCs] ranged from .61 to .98). Gamblers did, however, report significantly more gambling at the 2nd interview. Agreement with collaterals was fair to good overall (ICCs ranged from.46 to.65) with no clear pattern of either over- or underreporting by gamblers. Spouses did not show greater agreement with gamblers compared with nonspouses, and greater agreement was not found for collaterals who were more versus less confident in their reports. The results are generally supportive of the use of self-reported gambling in studies of problem gamblers, assessed face to face and by telephone, although suggestions for further research are provided.

Readiness to stop smoking in schizophrenia.

Objective: To assess the motivation and readiness to change of individuals with schizophrenia prior to developing a smoking cessation program. Method: Smoking history, nicotine dependence, readiness to stop smoking, and interest in a smoking cessation group were assessed in 60 schizophrenia outpatients who smoked. Results: The majority were interested in attending a smoking cessation group and appeared to be appropriately motivated. Conclusions: Smoking cessation groups for a schizophrenia population may be a worthwhile endeavour. Current measures of motivation and readiness to change may be useful to identify those who are most likely to succeed.

Narrowing of Attention and Dissociation in Pathological Video Lottery Gamblers

The phenomena of attention and dissociation were investigated in pathological and occasional video lottery (VLT) gamblers. Twelve problem VLT gamblers [mean age 41.3; 6 male, 6 female; South Oaks Gambling Screen (SOGS; Lesieur & Blume, 1987) scores ≥ 5] were compared to a group of 11 occasional VLT gamblers, (mean age 31.9; 4 male, 7 female; SOGS scores < 5). Pathological gamblers were slower than occasional gamblers in reacting to irrelevant external light stimuli while playing on a demonstration video lottery terminal. They were significantly more likely to report more symptoms of general dissociation as measured by the Dissociative Experiences Scale (Bernstein & Putnam, 1986). The results suggest that pathological gamblers may experience a greater narrowing of attention than occasional gamblers when engaged in VLT play.

The Carleton University Responsiveness to Suggestion Scale: Relationship with other Measures of Hypnotic Susceptibility, Expectancies, and Absorption

The Carleton University Responsiveness to Suggestion Scale (CURSS) yields scores on three suggestibility dimensions. Objective (CURSS:0) scores and subjective (CURSS:S) scores reflect overt and experiential response to suggestion, respectively. Objective-Involuntariness (CURSS:OI) scores indicate the number of objective responses rated as feeling involuntary. Study 1 indicated that all three suggestibility dimensions correlated significantly with the Harvard Group Scale of Hypnotic Susceptibility, and Study 2 showed the three Catleton suggestibility dimensions correlated significantly with Form C of the Stanford Hypnotic Susceptibility Scale. The majority of subjects who obtained high scores on the Stanford:C also scored high on the Carleton suggestibility dimensions. Like the Harvard:A and Stanford:C the three Carleton suggestibility dimensions also correlated significantly with attitude/expectancy measures, absorption, and Fields (1965) “hypnotic experiences” inventory. CURSS:VC (voluntary-cooperation) scores reflect the number of objective responses rated as feeling primarily voluntary rather than involuntary. CURSS:VC scores did not correlate significantly with attitude/expectancy variables, absorption or “hypnotic experiences.” Theoretical implications are discussed.

Treatment Seeking Among Ontario Problem Gamblers: Results of a Population Survey

OBJECTIVE This study examined help seeking for gambling concerns among people with different levels of gambling problems. METHODS Ontario adults who had gambled more than dollars 100 (N=4,217) and who screened positive for a possible gambling problem (N=1,205) were classified according to gambling problem severity and asked about their experiences with gambling treatment. RESULTS Only 6% of gamblers had ever accessed a service, including a self-help group or self-help materials. With self-help materials excluded, only 3% of gamblers (from 1% of those who met only the initial CLiP screening criteria to 53% of those with pathological gambling) had sought treatment for gambling. CONCLUSIONS Few gamblers sought treatment for gambling problems; greater problem severity was associated with greater likelihood of using treatment, with self-help materials used most often. Further research is needed on why treatment seeking is low and on the effectiveness of self-help resources in reaching gamblers with problems in earlier stages.