Igor Yakovenko

The efficacy of motivational interviewing for disordered gambling: Systematic review and meta-analysis

Motivational interviewing is a client-centered therapeutic intervention that aims to resolve ambivalence toward change. We conducted a systematic review and meta-analysis on the efficacy of motivational interviewing, compared to non-motivational interviewing controls, in the treatment of disordered gambling. Electronic databases were searched for randomized controlled trials that evaluated change in gambling behavior using motivational interviewing in adult disordered gamblers. The primary outcomes were the weighted mean difference (WMD) for change in average days gambled per month and average dollars lost per month. The search strategy yielded 447 articles, of which 20 met criteria for full text review. Overall, 8 studies (N=730) fulfilled the inclusion criteria for systematic review and 5 (N=477) were included in the meta-analysis. Motivational interviewing was associated with significant reduction in gambling frequency up to a year after treatment delivery. For gambling expenditure, motivational interviewing yielded significant reductions in dollars spent gambling compared to non-motivational controls at post-treatment only (1-3 months). Overall, the results of this review suggest that motivational interviewing is an efficacious style of therapy for disordered gambling in the short term. Whether treatment effects are maintained over time remains unclear.

Cognitive distortions predict future gambling involvement

Abstract Disordered gambling is best conceptualized as a continuum of severity. Previous research has demonstrated the utility of studying individuals at all points of this spectrum. The sequence of the development of gambling problems and change in gambling involvement along this continuum of severity is not well understood. The present study examined the interplay between cognitive distortions and gambling involvement in a population sample recruited in Alberta, Canada. Data from 1372 participants over 4 assessment waves (5 years) were used to generate a 2-factor latent structure using gambling fallacies and gambling involvement measurements. Structural equation modelling showed that cognitive distortions more strongly predicted future gambling involvement than the reverse relationship, using the comparative fit index (CFI) and the root mean square error of approximation (RMSEA) to assess the models. In addition, cognitive distortions declined over time, whereas gambling involvement remained stable. The results of the study suggest that focusing primarily on cognitive mechanisms in public health initiatives for gambling disorders may be a more effective strategy than focusing on behavioural solutions.

Latest Developments in Treatment for Disordered Gambling: Review and Critical Evaluation of Outcome Studies

Purpose of reviewOver the last decade, treatments for disordered gambling have developed rapidly. The goal of this paper is to review and to critically evaluate the literature published on the treatment of disordered gambling in the past 3 years. Important findings are emphasized and accompanied by the authors’ personal observations on controversial results or hypotheses of interest.Recent findingsCognitive-behavioral interventions have been evaluated in treatment of Hong Kong Chinese individuals as well as in combination with mindfulness-based approaches. Personalized-feedback interventions have received increased attention, with brief treatments demonstrating overall efficacy. Pharmacological treatments continue to receive only limited support. On the other hand, web-based treatments appear to show promise.SummaryCognitive-behavioral and brief treatments remain the most empirically supported approaches, but new inventive combinations of treatments such as web-based therapies are emerging. Future research could benefit from diversification of types of treatments evaluated as well as an examination of what is considered “evidence-based.”

A qualitative analysis of the effects of a comorbid disordered gambling diagnosis with schizophrenia

Little research has examined the association between disordered gambling and psychosis. In addition, clinicians treating schizophrenia or schizoaffective disorders rarely screen for or treat comorbid gambling problems due to diagnostic overshadowing. Thus, the effects of disordered gambling on symptoms of schizophrenia and vice versa remain largely unexplored and unidentified in research and clinical practice. The goal of the present study was to explore qualitatively the reciprocal associations between schizophrenia/schizoaffective disorder and disordered gambling through content and functional analyses from the perspective of the affected individual. Eight participants who met DSM-IV criteria for schizophrenia or schizoaffective disorder and disordered gambling participated in a qualitative interview examining key antecedents associated with their gambling, as well as perceived functional consequences of gambling. Content analysis revealed unique patterns of responses specific to individuals with schizophrenia or schizoaffective disorder that are not typically observed in individuals with disordered gambling alone. Specifically, gambling as filling a need for activity, and gambling as a means of connecting with society/world were the notable reasons for engaging in problematic gambling. Furthermore, some, but not all participants described a direct exacerbation of their psychosis by gambling and a greater involvement in gambling due to their symptoms of schizophrenia.

Treatment of Disordered Gambling

A diverse range of treatments have been adapted for gambling disorders. To date, the results of three meta-analyses have been reported. The most recent one was conducted in 2009 and included 25 outcome studies, conducted between 1980 and 2000, of cognitive-behavioural therapies (CBTs) for gambling disorders (Gooding & Tarrier, 2009). The authors found significant effect sizes for the reduction of various gambling-related behaviours at 3, 6, 12 and 24 months post-treatment. Outcome variables included gambling expenditure, amount of time spent gambling, endorsed cognitive distortions associated with gambling and attitudes towards gambling. Another meta-analysis assessed the efficacy of psychopharmacological treatments for pathological gambling against placebo (Pallesen et al., 2007). Results from 16 included studies showed that compared to placebo, pharmacological interventions were more effective (overall effect size = . 75, p < . 01). Finally, a 2005 meta-analysis was conducted on 22 studies employing a variety of psychosocial treatments for pathological gambling, including CBT, aversion therapy, imaginal desensitisation and Gamblers Anonymous (Pallesen et al., 2005). Favourable results were found compared to no treatment at post-treatment and 17 months follow-up (overall effect size = 2. 01, p < . 01).

A scoping review of co-morbidity in individuals with disordered gambling

Abstract Individuals with disordered gambling often report at least one other lifetime psychiatric diagnosis. Although prevalence rates vary, there is substantial evidence for co-morbidity being the rule rather than the exception. Despite this known association, there has not been a recent comprehensive review of co-morbidity in disordered gambling other than prevalence surveys. The goal of this study was to broadly summarize and review the current literature on the extent, range and nature of disordered gambling co-morbidity. Following an initial search and screening of 6 databases, 251 articles were included in the final synthesis and evaluation. The main findings showed that few studies examine the mechanisms of co-morbidity in gambling beyond prevalence rates; few studies report on temporal sequencing of gambling and co-morbid disorders; there is a lack of treatment evaluation studies designed specifically for dual-diagnosis individuals; there is a need for system-level initiatives to address co-morbidity at the policy level; and the substance use literature may act as a useful model for guiding future gambling research on co-morbidity. The results suggest that despite a reasonable amount of published research on co-morbidity in disordered gambling, most study conclusions relegate to acknowledgements of high co-occurrence between disorders without follow-up.