Joël Tremblay

Problem Gambling and Families: A Systematic Review

Problem gambling is an important public health issue affecting many spheres of the gambling individuals life, including mental health, finances, and family. The family is a topic that has been given little attention in problem gambling research. After a comprehensive search of the literature, this review identified and analyzed 30 empirical studies conducted between 1998 and 2013 examining the effects of problem gambling on families, the impact of family involvement in problem gambling treatment, or both. The literature shows that (a) problem gambling has several adverse effects on individuals, families, and family functioning, and (b) family involvement in problem gambling treatment is linked with better treatment outcomes and improved individual and family functioning. Implications for research and clinical practice are discussed.

Understanding treatment impact on drug-addicted offenders.

This study examines variables that could predict treatment perseverance and impact for offenders (N = 124) admitted to one of five rehabilitation centers for alcoholics/drug addicts representing different regions of the province of Quebec. Information was collected on time spent in treatment, alcohol/drug use–related problems, motivation to change, criminal profile, subjects perception of judicial pressure, subjective assessment of importance/probability of judicial consequences tied to treatment dropout or substance use, quality of the therapeutic relationship, assessment of client commitment to treatment, and social support. Results indicate that judicial pressure only have impact on retention into treatment for those who are not already sentenced but this “forced” retention is not linked with positive results. The studys limitations are noted.

Relationships Between Drugs and Delinquency in Adolescence: Influence of Gender and Victimization Experiences

A total of 726 youths presenting a severe addiction were evaluated at the time of their request for services in an addiction rehabilitation center. Results show that the more delinquent youths have a more severe profile of substance use, thus confirming the strong association between psychoactive substance (PAS) use severity and delinquency. Girls being treated for addiction present a more severe profile of substance use than boys treated. No interaction effect was found between gender and level of delinquency. It also appears important that the history of sexual abuse be considered as one of the variables associated with the severity of PAS use.

Associations of substance use patterns with attempted suicide among persons who inject drugs: Can distinct use patterns play a role?

BACKGROUND While the elevated risk of suicide attempt among persons who inject drugs (PWID) is well documented, whether use of different substances is associated with varying degrees of risk remains unclear. We sought to examine the associations between substance use patterns and attempted suicide in a prospective cohort of PWID in Montreal, Canada. METHODS Between 2004 and 2011, participants completed an interviewer-administered questionnaire eliciting information on socio-demographics, substance use patterns, related behaviors, and mental health markers. Generalized estimating equations were used to model the relationship between self-reported use of six common substances (cocaine, amphetamine, opioids, sedative-hypnotics, cannabis and alcohol), associated patterns of use (chronic, occasional and none), and a recent (past six-month) suicide attempt. RESULTS At baseline, of 1240 participants (median age: 39.1, 83.7% male), 71 (5.7%) reported a recent suicide attempt. Among 5621 observations collected during follow-up, 221 attempts were reported by 143 (11.5%) participants. In multivariate analyses adjusting for socio-demographics and psychosocial stressors, among primary drugs of abuse, chronic [adjusted odds ratio (AOR): 1.97] and occasional (AOR: 1.92) cocaine use, and chronic amphetamine use (AOR: 1.96) were independently associated with attempted suicide. Among co-used substances, chronic sedative-hypnotic use was independently associated with an attempt (AOR: 2.29). No statistically significant association was found for the remaining substances. CONCLUSION Among PWID at high risk of attempted suicide, stimulant users appear to constitute a particularly vulnerable sub-group. While the mechanisms underlying these associations remain to be elucidated, findings suggest that stimulant-using PWID should constitute a prime focus of suicide prevention efforts.

Gender Difference in Internet Use and Internet Problems among Quebec High School Students

Objectives: There are presently no data available concerning Internet addiction (IA) problems among adolescents in Canada and the province of Quebec. The goal of this study is thus to document and compare the influence of gender on Internet use and addiction. Method: The study data were collected from a larger research project on gambling among adolescents. Activities conducted online (applications used and time spent) as well as answers to the Internet Addiction Test (IAT) were collected from 3938 adolescents from grades 9 to 11. The two most often employed cut-off points for the IAT in the literature were documented: (40-69 and 70+) and (50+). Results: Boys spent significantly more time on the Internet than did girls. A greater proportion of the girls made intense use of social networks, whereas a greater proportion of the boys made intense use of massively multiplayer online role-playing games, online games, and adult sites. The proportion of adolescents with a potential IA problem varied according to the cut-off employed. When the cut-off was set at 70+, 1.3% of the adolescents were considered to have an IA, while 41.7% were seen to be at risk. At a 50+ cut-off, 18% of the adolescents were considered to have a problem. There was no significant difference between the genders concerning the proportion of adolescents considered to be at risk or presenting IA problems. Finally, analysis of the percentile ranks would seem to show that a cut-off of 50+ better describes the category of young people at risk. Conclusions: The results of this study make it possible to document Internet use and IA in a large number of Quebec adolescents.

Licit and illicit substance use among people who inject drugs and the association with subsequent suicidal attempt

AIM To estimate associations between recent licit and illicit substance use and subsequent suicide attempt among people who inject drugs (PWID). DESIGN Secondary analysis of longitudinal data from a prospective cohort study of PWID followed bi-annually between 2004 and 2011. SETTING Montréal, Canada. PARTICIPANTS Seven hundred and ninety-seven PWID who reported injection drug use in the previous 6 months, contributing to a total of 4460 study visits. The median number of visits per participant was five (interquartile range: 3-8). MEASUREMENTS An interviewer-administered questionnaire eliciting information on socio-demographic factors, detailed information on substance use patterns and related behaviours, mental health markers and suicide attempt. The primary exposure variables examined were past-month use of alcohol [heavy (≥ 60 drinks); moderate (one to 59 drinks); none], sedative-hypnotics, cannabis, cocaine, amphetamine and opioids [regular (≥ 4 days); occasional (1-3 days); none]. The outcome was a binary measure of suicide attempt assessed in reference to the previous 6 months. FINDINGS In multivariate analyses, a positive association was found among licit substances between heavy alcohol consumption [adjusted odds ratio (AOR) = 2.05; 95% confidence interval (CI) = 1.12-3.75], regular use of sedative-hypnotics (AOR = 1.89; 95% CI = 1.21-2.95) and subsequent attempted suicide. Among illicit substances, occasional use of cannabis (AOR = 1.84; 95% CI = 1.09-3.13) had a positive association with subsequent suicide attempt. No statistically significant association was found for the remaining substances. CONCLUSION Among people who inject drugs, use of alcohol, sedative-hypnotics and cannabis, but not cocaine, amphetamine or opioids, appears to be associated with an increased likelihood of later attempted suicide.

Transition from playing with simulated gambling games to gambling with real money: a longitudinal study in adolescence

Abstract Digital technology advances have supported an expansion of gambling activities, which is notable via the advent of simulated gambling games. Simulated gambling reproduces ‘real’ gambling activities, which enables the users to gamble without investing money. According to research evidence, a certain number of adolescents are playing with these games, but until now little has been known about how they could facilitate the migration to gambling with real money. Using a longitudinal design with a one-year interval period, the goal of this study was to assess the potential transition between playing with simulated gambling and the initiation to gambling with real money. The final sample was constituted of 1220 adolescents (age range = 14 to 18 y.o.) who had never played with real money at the first measurement time. At the second measurement time, 28.8% of the participants had gambled for the first time with real money. Logistic regressions revealed that the predictive association between simulated gambling and gambling with real money only holds for adolescents who transitioned from simulated poker to poker with real money. These findings highlight the need for regulation and monitoring on Internet gambling poker sites, as well as further research to assess the mechanisms at work.

Typologies of Individuals Attending an Addiction Rehabilitation Center Based on Diagnosis of Mental Disorders.

OBJECTIVES This study aimed to: (1) identify clusters based on the diagnostic status of mental disorders among individuals with problematic substance use treated in an addiction rehabilitation center (ARC), and (2) characterize these clusters according to socio-demographic variables, neighborhood characteristics, and health service utilization. METHODS Data were compiled for 4526 individuals with problematic substance use who received services from an ARC in 2004. The data were compiled by merging four databases: the ARC data registry, the Quebec Health Insurance Board database, the Quebec provincial database for hospitalizations, and the Quebec National Institute of Public Health database. A two-step cluster analysis was performed to generate distinct groups based on diagnostic categories of mental disorders. Complementary comparative analyses were conducted to test differences among the clusters. RESULTS Three clusters were identified. The first cluster consisted of individuals who did not receive any diagnosis of a mental disorder, including substance use disorders (SUDs), and who were low users of health services. The second cluster was composed of individuals who received a diagnosis of mental disorder, but not of SUD, and who primarily used mental health services. The third cluster included individuals who had a dual diagnosis (co-occurring SUD and mental disorder), and who were high users of acute care services. CONCLUSIONS This study highlights the heterogeneity of individuals with problematic substance use treated in an ARC. Treatment will be more effective, overall, if tailored to the varying needs of individuals with problematic substance use. Recommendations of the study geared toward improving the effectiveness of care for this population include systematic diagnostic screening for SUDs by physicians, developing strong primary care for individuals with problematic substance use, and ensuring a continuing care model for individuals with a dual diagnosis.

Problem gambling among adolescents: toward a social and interactionist reading

There are two aspects that distinguish the approaches used to conceptualize problem gambling in adolescence. The first aspect concerns the type of variables involved in conceptualizing the phenomenon: most approaches integrate variables of an individual nature in their modelling and give little consideration to social type variables. The second aspect concerns the distinction between determinism and interactionism: many of the approaches seem to follow a determinist line of thinking and few consider people as social actors in interaction with their environment. Consequently, this article aims to conceptually prepare the ground for later studies that will adopt a more sociological and interactionist approach. To do so, the theoretical perspectives that are most commonly used in conceptualizing the phenomenon will be analysed by way of the two above aspects. A new analysis perspective will then be presented, namely the general theory of rationality (GTR) by Raymond Boudon. The GTR proposes a theoretical reversal to other approaches by focusing on social actors and variables of a social nature rather than on a persons psychology. In this sense, the theory adopts a viewpoint that has not been greatly employed in the analysis of adolescent problem gambling.

Efficacy of extensive intervention models for substance use disorders: A systematic review

ISSUES Despite a growing trend towards considering addiction as a chronic disease, the development of intervention models addressing the chronicity of substance use disorder is relatively new, and no literature review on this topic is available. The aim of this systematic review is to evaluate the efficacy of intervention models designed within the perspective of addiction as a chronic disease and those tailored to persons with substance use disorder who revolve in and out of treatment. APPROACH Electronic databases were searched to identify articles published between 2000 and 2015 reporting an empirical study of an intervention model with data on its effectiveness. Study selection, data extraction and quality appraisal were performed independently by two reviewers. KEY FINDINGS The selection process yielded 16 studies meeting all the inclusion criteria. The intervention models were classified into four groups according to the duration, frequency and components of the interventions. In general, the models showed potential therapeutic effects. The outcomes tended to be positive immediately after the end of the treatment. However, months after, the benefits obtained during treatment did not persist. IMPLICATIONS AND CONCLUSION The review highlights that models designed specifically for persons with multiple treatment re-entries are scarce, but promising. Further research is needed to determine the best match between the clinical profile of persons with substance use disorder and a models components, intensity and duration. [Simoneau H, Kamgang E, Tremblay J, Bertrand K, Brochu S, FleuryM-J. Efficacy of extensive interventionmodels for substance use disorders: A systematic review. Drug Alcohol Rev 2017;00:000-000].