Nancy M. Petry

Substance abuse, pathological gambling, and impulsiveness

This study evaluated behavioral and self-report indices of impulsiveness in pathological gambling substance abusers (n=27), non-pathological gambling substance abusers (n=63), and non-pathological gambling/non-substance abusing controls (n=21). The Bechara card task measured preferences for decks of cards that ranged in magnitude and probability of delayed and immediate rewards and punishers. The Stanford Time Perception Inventory (STPI) assessed orientation to the future, the Zuckerman Sensation Seeking Scale evaluated sensation seeking, and the Eysenck and Barratt scales measured impulsivity. A Principal Components analysis revealed that these personality measures comprised three distinct measures of impulsivity: impulse control, novelty seeking and time orientation. Linear contrast analyses revealed that substance abuse and pathological gambling resulted in additive effects on the impulse control and time orientation factors, but not on the novelty-seeking scale. Performance on the card task did not correlate with any of the three factors derived from the personality scale scores, but the presence of both substance abuse and pathological gambling had an additive effect on preferences for decks containing greater immediate gains but resulting in large punishers and overall net losses. These results provide further evidence of an association among substance abuse, pathological gambling, and impulsivity.

Overweight and Obesity Are Associated With Psychiatric Disorders: Results From the National Epidemiologic Survey on Alcohol and Related Conditions

Objective: This study evaluated associations between body mass index (BMI) and psychiatric disorders. Methods: Data from 41,654 respondents in the National Epidemiologic Survey on Alcohol and Related Conditions were analyzed. Results: After controlling for demographics, the continuous variable of BMI was significantly associated with most mood, anxiety, and personality disorders. When persons were classified into BMI categories of underweight, normal weight, overweight, obese, and extremely obese, both obese categories had significantly increased odds of any mood, anxiety, and alcohol use disorder, as well as any personality disorder, with odds ratios (ORs) ranging from 1.21 to 2.08. Specific Diagnostic and Statistical Manual of Mental Disorders-revision IV mood and personality disorders associated with obesity included major depression, dysthmia, and manic episode (ORs, 1.45–2.70) and antisocial, avoidant, schizoid, paranoid, and obsessive-compulsive personality disorders (ORs, 1.31–2.55). Compared with normal weight individuals, being moderately overweight was significantly associated with anxiety and some substance use disorders, but not mood or personality disorders. Specific anxiety disorders that occurred at significantly higher rates among all categories of persons exceeding normal weight were generalized anxiety, panic without agoraphobia, and specific phobia (ORs, 1.23–2.60). Being underweight was significantly related to only a few disorders; it was positively related to specific phobia (OR, 1.31) and manic episode (OR, 1.83), and negatively associated with social phobia (OR, 0.60), panic disorder with agoraphobia (OR, 0.40), and avoidant personality disorder (OR, 0.59). Conclusion: These data provide a systematic and comprehensive assessment of the association between body weight and psychiatric conditions. Interventions addressing weight loss may benefit from integrating treatment for psychiatric disorders. NIAAA = National Institute on Alcohol Abuse and Alcoholism; NESARC = National Epidemiologic Survey on Alcohol and Related Conditions; AUDADIS = Alcohol Use Disorder and Associated Disabilities Interview Schedule; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders- Fourth Edition; BMI = body mass index; OR = odds ratio; CI = confidence intervals.

Pathological gambling severity is associated with impulsivity in a delay discounting procedure

Research and clinical expertise indicates that impulsivity is an underlying feature of pathological gambling. This study examined the extent to which impulsive behavior, defined by the rate of discounting delayed monetary rewards, varies with pathological gambling severity, assessed by the South Oaks Gambling Screen (SOGS). Sixty-two pathological gamblers completed a delay discounting task, the SOGS, the Eysenck impulsivity scale, the Addiction Severity Index (ASI), and questions about gambling and substance use at intake to outpatient treatment for pathological gambling. In the delay discounting task, participants chose between a large delayed reward (US

DSM-5 Criteria for Substance Use Disorders: Recommendations and Rationale

1000) and smaller more immediate rewards (US

Give them prizes, and they will come: contingency management for treatment of alcohol dependence.

1-

Excessive discounting of delayed rewards in substance abusers with gambling problems

999) across a range of delays (6h to 25 years). The rate at which the delayed reward was discounted (k value) was derived for each participant and linear regression was used to identify the variables that predicted k values. Age, gender, years of education, substance abuse treatment history, and cigarette smoking history failed to significantly predict k values. Scores on the Eysenck impulsivity scale and the SOGS both accounted for a significant proportion of the variance in k values. The predictive value of the SOGS was 1.4 times that of the Eysenck scale. These results indicate that of the measures tested, gambling severity was the best single predictor of impulsive behavior in a delay discounting task in this sample of pathological gamblers.

A comprehensive guide to the application of contingency management procedures in clinical settings

Since DSM-IV was published in 1994, its approach to substance use disorders has come under scrutiny. Strengths were identified (notably, reliability and validity of dependence), but concerns have also arisen. The DSM-5 Substance-Related Disorders Work Group considered these issues and recommended revisions for DSM-5. General concerns included whether to retain the division into two main disorders (dependence and abuse), whether substance use disorder criteria should be added or removed, and whether an appropriate substance use disorder severity indicator could be identified. Specific issues included possible addition of withdrawal syndromes for several substances, alignment of nicotine criteria with those for other substances, addition of biomarkers, and inclusion of nonsubstance, behavioral addictions.This article presents the major issues and evidence considered by the work group, which included literature reviews and extensive new data analyses. The work group recommendations for DSM-5 revisions included combining abuse and dependence criteria into a single substance use disorder based on consistent findings from over 200,000 study participants, dropping legal problems and adding craving as criteria, adding cannabis and caffeine withdrawal syndromes, aligning tobacco use disorder criteria with other substance use disorders, and moving gambling disorders to the chapter formerly reserved for substance-related disorders. The proposed changes overcome many problems, while further studies will be needed to address issues for which less data were available.

An international consensus for assessing internet gaming disorder using the new DSM‐5 approach

This study evaluated the efficacy of a contingency management (CM) procedure that provided opportunities to win prizes as reinforcers. At intake to outpatient treatment, 42 alcohol-dependent veterans were randomly assigned to receive standard treatment or standard treatment plus CM, in which they earned the chance to win prizes for submitting negative Breathalyzer samples and completing steps toward treatment goals. Eighty-four percent of the CM participants were retained in treatment for an 8-week period compared with 22% of the standard treatment participants (p < .001). By the end of the treatment period, 69% of those receiving CM were still abstinent, but 61% of those receiving standard treatment had used alcohol (p < .05). These results support the efficacy of this CM procedure. Participants earned an average of

Cognitive-Behavioral Therapy for Pathological Gamblers

200 in prizes. This CM procedure may be suitable for use in standard treatment settings because prizes can be solicited from the community.

Low-cost contingency management for treating cocaine- and opioid-abusing methadone patients.

This study evaluated delay discounting functions of substance abusing problem gamblers, substance abusing non-problem gamblers, and non-problem gambling/non-substance abusing controls. Subjects chose between hypothetical monetary amounts available after various delays or immediately. In one condition, a USUS