Wayne Skinner

Problem Gambling and Intimate Partner Violence

This study examined the prevalence and severity of intimate partner violence (IPV) among 248 problem gamblers (43 women, 205 men) recruited from newspaper advertisements. The main outcome measures used were the Canadian Problem Gambling Index, the Conflicts Tactics Scale-2, the State Trait Anger Expression Inventory-2, the drug and alcohol section of the Addiction Severity Index and the substance use section of the Structured Clinical Interview for the DSM-IV. In this sample, 62.9% of participants reported perpetrating and/or being the victims of IPV in the past year, with 25.4% reporting perpetrating severe IPV. The majority of the sample (64.5%) also had clinically significant anger problems, which was associated with an increased risk of being both the perpetrator and victim of IPV. The presence of a lifetime substance use disorder among participants who had clinically significant anger problems further increased the likelihood of both IPV perpetration and victimization. These findings underscore the importance of routinely screening gambling clients for anger and IPV, and the need to develop public policy, prevention and treatment programs to address IPV among problem gamblers. Future research to examine IPV among problem gamblers is recommended.

Minimal Treatment Approaches for Concerned Significant Others of Problem Gamblers: A Randomized Controlled Trial

The goal of this study was to examine the efficacy of minimal treatment interventions for concerned significant others (CSOs) of problem gamblers. One hundred and eighty-six participants (82% females, 56% spouses) were randomly assigned to one of three groups: the first minimal intervention group received a self-help workbook [based on behavioral principles, modified from the Community Reinforcement and Family Therapy (CRAFT) model] and the second minimal intervention group received the workbook plus telephone support. The control condition received a treatment resource information package. Overall, all participants reported significant improvement in personal and relationship functioning and gambling behavior and consequences at the 3- and 6-month follow-up. The data demonstrated differences in favor of the interventions in three areas: days gambling, satisfaction with the program, and number who had their needs met. There was no difference in the number who had entered treatment. It may be that CSOs require more guidance and follow-up support to achieve these goals using the CRAFT procedures and strategies.

Public Awareness of Responsible Gambling and Gambling Behaviours in Ontario

This study reports the findings of a general population telephone survey (N =2500) conducted in Ontario, which was designed to examine behaviour, knowledge and attitudes related to responsible and problem gambling using a combination of closed- and open-ended questions. When asked to identify ‘signs and symptoms of problem gambling’ or to define responsible gambling, most respondents focused on financial issues suggesting that the general population has a very narrow view of the issue of problem gambling. The majority (65.8%) are not aware of any initiatives to reduce problem gambling; however, we found that people who participate in slots and instant lotteries were more likely to report being aware of initiatives to reduce problem gambling. These findings suggest that people do notice the presence of the help-line number on tickets and slot machines. The survey also examined responsible gambling behaviour and biases in beliefs about gambling.

Negotiating the Relationship Between Addiction, Ethics, and Brain Science

Advances in neuroscience are changing how mental health issues such as addiction are understood and addressed as a brain disease. Although a brain disease model legitimizes addiction as a medical condition, it promotes neuro-essentialist thinking and categorical ideas of responsibility and free choice, and undermines the complexity involved in its emergence. We propose a “biopsychosocial systems” model where psychosocial factors complement and interact with neurogenetics. A systems approach addresses the complexity of addiction and approaches free choice and moral responsibility within the biological, lived experience and sociohistorical context of the individual. We examine heroin-assisted treatment as an applied case example within our framework. We conclude with a discussion of the model and its implications for drug policy, research, addiction health care systems and delivery, and treatment of substance use problems.

“Attitude is a Little Thing That Makes a Big Difference”: Reflection Techniques for Addiction Psychiatry Training

ObjectiveThe authors aim to incorporate educational reflection techniques in an addiction psychiatry postgraduate core rotation in order to increase critical self-awareness of attitudes, values, and beliefs related to working with people with substance use and other addictive disorders.MethodsReflection discussion times, reflection journaling, and mandatory end-of-rotation reflection papers were embedded into a core addiction psychiatry postgraduate training block. Qualitative analysis of 28 reflection papers was performed to determine key factors and constructs that impacted on the development of attitudes and professionalism.ResultsA number of constructs emerged that demonstrated the attitudes, beliefs, stereotypes, and stigmas students have regarding addictive disorders. Some constructs also highlighted that students felt much more comfortable dealing with addictive disorders after the training and would treat individuals with these conditions in a more effective manner.ConclusionReflection techniques were endorsed as extremely valuable by students, especially in the development of professional attitudes that will help clinicians effectively engage and provide appropriate care for individuals suffering from addictive disorders. The authors suggest that reflective practices be used more extensively in psychiatric training in order to build and establish reflexive self-awareness as a core professional competence essential to work effectively in clinical practice, especially in the most demanding contexts.

Randomized control trial of an integrated therapy for comorbid anger and gambling

Abstract This study evaluated an integrated treatment for comorbid problem gambling, anger, and substance use. Problem gamblers with comorbid anger problems (N=42), half of whom also had substance use disorders, were randomized to either a 14-week integrated treatment targeting anger and addictions (i.e., both gambling and substance use) or a specialized treatment-as-usual (TAU) for gambling and substance use. Participants were assessed at baseline (Tl), 14 weeks (T2), and 12 weeks follow-up (T3). Relative to the TAU, participants in the integrated anger and addictions treatment reported significantly less gambling at T2 and T3 and less trait anger and substance use at T3. Findings suggest that it is important to screen gambling clients for the presence of comorbid anger and substance use problems and that, when present, these problems need to be addressed concurrently in gambling treatment in order to optimize treatment outcomes.

Journey as Destination A Recovery Model for Families Affected by Concurrent Disorders

We conducted a study offering peer support and education to members of families affected by concurrent disorders (CD). This article is an analysis of the qualitative data from a mixed methods study. Using constructivist grounded theory, we analyzed semistructured interviews with participants, with half attending a 12-week support group and reading weekly workbook assignments, and the others receiving the workbook only and being interviewed 3 months later. We developed a model that describes family journeys into, through, and beyond CD, involving three phases connected by two transitional constructs. Preoccupation with the unresolved CD of an ill family member characterized the journey into and through illness, the first two phases, whereas renewal characterized the passage from illness to journeying on toward recovery. Participants had strong comments about health care providers and the service system, and spoke of the need for self-care, empowerment, support, and inclusion.

Drug testing and mandatory treatment for welfare recipients

Abstract One province in Canada, Ontario, is considering the use of drug tests for welfare recipients. Those with positive tests could be required to receive treatment and abstain from drug use or risk losing their benefits. Several experts from the Centre for Addiction and Mental Health (CAMH) reviewed the scientific strengths and weaknesses of this proposal. Strengths included possible increases in employment and reduced drug use among welfare recipients; however, the group concluded that drug testing of welfare recipients or removal of welfare benefits for people who refuse treatment or relapse is not advisable for several reasons. Drug testing cannot be used to determine substance abuse or dependence, could undermine the client case manager relationship and could be legally challenged as a violation of human rights. Other drawbacks of conditional welfare include possible negative societal consequences (i.e. increased crime and health problems) and disruptions to the treatment population. The whole process is expensive and will likely result in a very marginal increase in employment because drug dependence is not a major barrier to employment.

Gamblers Anonymous as a Recovery Pathway: A Scoping Review.

Given the preponderance of Gamblers Anonymous (GA), there has been relatively little effort to explore the existing evidence base on its effectiveness as a recovery approach for problem gambling. To remedy this gap in the literature we conducted a scoping review of the literature on mutual aid for individuals experiencing problem gambling published between 2002 and 2015. We searched 13 databases and reviewed reference lists and websites of relevant organizations. We reviewed records for eligibility and extracted relevant data from eligible articles. Three reviewers independently assessed the methodological quality of the included studies using the Mixed Methods Appraisal Tool. We identified 17 studies in 25 publications that were eligible for inclusion. Most studies were conducted in the United States, were cross-sectional in design, and involved both male and female adult participants. Results indicate that the evidence for the effectiveness of GA either as a control condition or in conjunction with formal treatment or medication is inconsistent. An emphasis on patience, using the Serenity Prayer as a way to gain acceptance of financial matters and reality, and absolute assertion of identity as a “compulsive gambler” were identified as important aspects of GA’s recovery culture. There is a need for large-scale randomized controlled trials to determine GA’s effectiveness, as well as research exploring the mechanisms through which GA works, barriers to GA as a recovery approach, and the status of women in the fellowship.

GENDER DIFFERENCES IN GAMBLERS ANONYMOUS

Gamblers Anonymous (GA) has earned a reputation in the literature as a fellowship with very few women and as host to a recovery culture that marginalizes women’s needs and concerns. A notable example would be the preponderance of “war stories”—recovery jargon for graphic and often disturbing accounts of one’s life in active addiction—said to alienate many women. However, a 16-month study of GA in the Toronto area has found that this mutual aid organization has changed significantly over the last 10 to 15 years. The number of women in the Toronto area now stands at possibly 20% and rising, war stories no longer predominate, and other changes amenable to women have also taken place. There is good reason to believe that these shifts in GA’s recovery culture have not been limited to Toronto. Still, this was a preliminary study, and these findings call for detailed quantitative verification. *While this article has not been submitted elsewhere, sections from it were based on our final report: Ferentzy, P., Skinner, W., Antze, P. (2004) “Exploring Mutual Aid Pathways to Gambling Problems,” Final Report submitted to the Ontario Problem Gambling Research Centre after a 16-month study of Gamblers Anonymous and Narcotics Anonymous. Funding this study was provided by the Ontario Gambling Research Centre.