David M. Ledgerwood

Psychological experience of gambling and subtypes of pathological gamblers

Clinical experience and some empirical data suggest that different subtypes of gamblers may exist. This study examined psychometric properties of the Gambling Experience Measure (GEM) to establish support for differing subtypes of gamblers. In total, 149 treatment-seeking pathological gamblers completed the GEM and other instruments. A principal component analysis produced a three-factor solution that included gambling as a way to escape negative emotions (Escape), dissociating (Dissociation), and narcissism/seeking attention (Egotism). Multiple regression analyses revealed that being female and general dissociation was associated with Escape gambling. General dissociation was also related to the Dissociation factor. Male gender and impulsivity were associated with the Egotism factor. These data offer preliminary evidence of the validity and reliability of the GEM in distinguishing subgroups of gamblers.

The subtyping of pathological gambling: a comprehensive review.

Pathological gamblers (PGs) present with various forms of psychopathology, maladaptive personality traits, and gambling motivations. Some suggest that this variability supports classification of PGs into distinct subtypes. Subtyping models are thought to have implications for understanding pathological gambling (PG) etiology and treatment outcomes. This review evaluates the existing literature on the subtyping of PGs based on psychopathology, personality, and/or motivation for gambling. We conclude that three PG subtypes consistently emerge from the empirical literature, and should be the focus of future study. These subtypes closely parallel the three types of gamblers presented in Blaszczynski and Nowers (2002) conceptual pathways model. We suggest that future investigations on PG subtypes build upon the theoretical framework of the pathways model, but also address the limitations of prior studies.

A randomized trial of brief interventions for problem and pathological gamblers.

Limited research exists regarding methods for reducing problem gambling. Problem gamblers (N = 180) were randomly assigned to assessment only control, 10 min of brief advice, 1 session of motivational enhancement therapy (MET), or 1 session of MET plus 3 sessions of cognitive-behavioral therapy. Gambling was assessed at baseline, at 6 weeks, and at a 9-month follow-up. Relative to assessment only, brief advice was the only condition that significantly decreased gambling between baseline and Week 6, and it was associated with clinically significant reductions in gambling at Month 9. Between Week 6 and Month 9, MET plus cognitive-behavioral therapy evidenced significantly reduced gambling on 1 index compared with the control condition. These results suggest the efficacy of a very brief intervention for reduction of gambling among problem and pathological gamblers who are not actively seeking gambling treatment.

Comparison between self-report and hair analysis of illicit drug use in a community sample of middle-aged men

Discrepancies between biological assays and self-report of illicit drug use could undermine epidemiological research findings. Two objectives of the present study are to examine the degree of agreement between self-reported illicit drug use and hair analysis in a community sample of middle-aged men, and to identify factors that may predict discrepancies between self-report and hair testing. Male participants followed since 1972 were interviewed about substance use, and hair samples were analyzed for marijuana, cocaine, opiates, phencyclidine (PCP) and methamphetamine using radioimmunoassay and gas chromatography-mass spectrometry (GC-MS) techniques. Self-report and hair testing generally met good, but not excellent, agreement. Apparent underreporting of recent cocaine use was associated with inpatient hospitalization for the participants most recent quit attempt, younger age, identifying as African American or other, and not having a diagnosis of antisocial personality disorder. The overestimate of marijuana use relative to hair test was associated with frequent use since 1972 and providing an inadequate hair sample. Additional research is needed to identify factors that differentially affect the validity of both hair drug testing and self-report.

Behavioral assessment of impulsivity in pathological gamblers with and without substance use disorder histories versus healthy controls.

Pathological gamblers (PGs) may have high levels of impulsivity, and a correlation between substance use disorders (SUDs) and impulsivity is well established. However, only a handful of studies have attempted to assess impulsivity and other impulse-spectrum traits (e.g., sensation seeking) using a variety of behavioral and self-report measures in PGs and few examined the independent impact of SUDs. We compared 30 PGs without SUD histories, 31 PGs with SUD histories and 40 control participants on self-reported impulsivity, delayed discounting, attention/memory, response inhibition, risk taking, sensation seeking and distress tolerance measures. PGs, regardless of SUD history, discounted delayed rewards at greater rates than controls. PGs also reported acting on the spur of the moment, experienced trouble planning and thinking carefully, and noted greater attention difficulties than controls. PGs with SUD took greater risks on a risk-taking task than did PGs without SUD histories, but the two groups did not differ on any other measures of impulsivity. We conclude that PGs are more impulsive than non-problem gamblers in fairly specific ways, but PGs with and without SUD histories differ on few measures. More research should focus on specific ways in which PGs exhibit impulsivity to better address impulsive behaviors in treatment.

Subtyping Pathological Gamblers Based on Impulsivity, Depression, and Anxiety

This study examined putative subtypes of pathological gamblers (PGs) based on the Pathways model, and it also evaluated whether the subtypes would benefit differentially from treatment. Treatment-seeking PGs (N = 229) were categorized into Pathways subtypes based on scores from questionnaires assessing anxiety, depression, and impulsivity. The Addiction Severity Index-Gambling assessed severity of gambling problems at baseline, posttreatment, and 12-month follow-up. Compared with behaviorally conditioned (BC) gamblers, emotionally vulnerable (EV) gamblers had higher psychiatric and gambling severity, and were more likely to have a parent with a psychiatric history. Antisocial impulsive (AI) gamblers also had elevated gambling and psychiatric severity relative to BC gamblers. They were more likely to have antisocial personality disorder and had the highest legal and family/social severity scores. They were also most likely to have a history of substance abuse treatment, history of inpatient psychiatric treatment, and a parent with a substance use or gambling problem. AI and EV gamblers experienced greater gambling severity throughout treatment than BC gamblers, but all three subtypes demonstrated similar patterns of treatment response. Thus, the three Pathways subtypes differ on some baseline characteristics, but subtyping did not predict treatment outcomes beyond a simple association with problem gambling severity.

Gambling and suicidality in treatment-seeking pathological gamblers

One hundred twenty-five adult participants recruited from gambling treatment centers were included in an examination of gambling-related suicidal ideation and attempt. In this sample, 48% (N = 60) had a history of gambling-related suicidal ideation, and an additional 12% (N = 15) reported at least one gambling-related suicide attempt. Measures of gambling experience, impulsiveness, and dissociation were evaluated across groups. Level of suicidality was associated with greater gambling severity, gambling escape, dissociation and attention seeking, impulsivity, and generalized dissociative experience, but not with other psychological indices such as empathy or venturesomeness. The implications of these findings for the identification and treatment of gamblers at risk for suicide are discussed.

Self-reported gambling-related suicidality among gambling helpline callers.

Problem gamblers often attribute suicidal ideation or attempts to their gambling. Logistic regression analyses were applied to data from problem gamblers (N = 986) calling a helpline. Problem gamblers reporting gambling-related suicidality (n = 252; 25.6%) were more likely than those denying it (n = 734; 74.4%) to acknowledge family, financial, legal, and mental and substance-related problems. Of problem gamblers acknowledging gambling-related suicidality, those reporting gambling-related suicide attempts (n = 53; 21.5%) were more likely than those denying them (n = 193; 78.5%) to acknowledge gambling-related illegal behaviors, mental health and substance abuse treatment, and family histories of alcohol problems, and were less likely to report prior gambling treatment. The findings suggest that increased gambling severity is associated with gambling-related suicidality.

Brief motivational interventions for college student problem gamblers.

AIMS College students experience high rates of problem and pathological gambling, yet little research has investigated methods for reducing gambling in this population. This study sought to examine the efficacy of brief intervention strategies. DESIGN Randomized trial. SETTING College campuses. PARTICIPANTS A total of 117 college student problem and pathological gamblers. INTERVENTIONS Students were assigned randomly to: an assessment-only control, 10 minutes of brief advice, one session of motivational enhancement therapy (MET) or one session of MET, plus three sessions of cognitive-behavioral therapy (CBT). The three interventions were designed to reduce gambling. MEASUREMENTS Gambling was assessed at baseline, week 6 and month 9 using the Addiction Severity Index-gambling (ASI-G) module, which also assesses days and dollars wagered. FINDINGS Compared to the assessment-only condition, those receiving any intervention had significant decreases in ASI-G scores and days and dollars wagered over time. The MET condition decreased significantly ASI-G scores and dollars wagered over time, and increased the odds of a clinically significant reduction in gambling at the 9-month follow-up relative to the assessment-only condition, even after controlling for baseline indices that could impact outcomes. The Brief Advice and MET+CBT conditions had benefits on some, but not all, indices of gambling. None of the interventions differed significantly from one another. Conclusions These results suggest the efficacy of brief interventions for reducing gambling problems in college students.

Impulsivity as a predictor of treatment outcome in substance use disorders: Review and synthesis

ISSUES Impulsivity is a widely studied personality trait and research construct that has been implicated as a risk factor for substance use, including initiating and continuing use. However, relatively few studies have examined impulsivity as a predictor of treatment outcome. Because impulsivity has been operationalised in many different ways, cross-comparisons of empirical studies have been difficult. APPROACH The PubMed database was searched in September 2013. Reference lists of papers retrieved from this search were also manually scanned for additional resources. Studies were included if they presented data that assessed impulsivity as a predictor of treatment outcomes. KEY FINDINGS The body of literature reviewed in this paper suggests that higher pretreatment impulsivity, regardless of how it is measured, usually is associated with poorer treatment outcomes. Recent data indicate that some psychosocial and pharmacological treatments may directly impact impulsivity and thus represent an interesting avenue for further research. CONCLUSIONS Impulsivity appears to be a key predictor of substance use treatment outcomes and warrants more attention in the improvement of treatment outcomes. Suggestions for future research on the role of impulsivity in substance use treatment are provided.