The treatment of gambling disorder: A comprehensive (socio-psychological-neurobiological) explanation and therapy model?


Available online working paper made available via the Social Science Open Access Repository.


Summary: In this theoretical work, we present the clinical picture of pathological gambling, an etiological explanatory model and resulting therapeutic implications. Social, psychological and physiological factors are included. The “addiction model” also distinguishes between factors relevant to the onset and continuation of disturbed gambling behavior. Multifactorial causes must be postulated in the “entry phase” of the behavior. During the actual “addiction phase“, the self-perpetuating disturbed gambling behavior is characterized by a strong mental dependence and a nearly autonomously triggered addiction behavior (loss of control) associated with structural changes in the deeper brain areas of the „reward system“. There is an “irresistible urge” to continue gambling, upheld not least by a dominance of gambling behavior in the reward system and the accompanying dysfunction of this area of the brain.

At the beginning of therapy, the focus lies on the addictive behavior itself. The symptoms that developed last are the ones that are first incorporated into the therapy consideration, whereby the therapeutic goals are to be set in a certain order: (a) Motivation, withdrawal symptoms after the patient stopped gambling, (b) insight into the disease (do not deny further) and its acceptance, (c) consolidation of the abstinence through a treatment of the causes of disease development. Dependence means not having sufficient alternatives. The reconstruction of the reward system and the development of a wide range of varied alternatives are an important prerequisite for avoiding relapse and achieving a balanced and satisfied way of life. Eliminating the dominance of gambling in the reward system and strongly anchoring the desired potently rewardable alternatives in behavior is associated with significant psychological and physiological resistance. The adrenaline rush of gambling is not easily compensated and cannot be replaced with lukewarm water or realistic thinking. Problems of implementing desired behavioral changes have not yet been sufficiently taken into account and there is a lack of necessary research. Are there any obligatory treatment factors? Full article

Reference: Bachmann, M., Bachmann, A.A., & Frensemeier, S. (2019). The treatment of gambling disorder: A comprehensive (socio-psychological-neurobiological) explanation and therapy model? Retrieved from https://nbn-resolving.org/urn:nbn:de:0168- ssoar-61824-8

Advertisements

Consumer perspectives of a multi-venue gambling self-exclusion program: A qualitative process analysis


Available online – from the Journal of Gambling Studies


Abstract: Self-exclusion is an important harm minimization strategy implemented by gambling operators to restrict a problem gambler’s access to gambling opportunities. Aspects of self-exclusion, including low uptake and non-compliance, limit the effectiveness of programs. Research that considers the consumer perspective is needed to enhance the perceived utility of self-exclusion in the target audience. Twenty interviews were conducted with current (n = 13) and former (n = 7) participants of a multi-venue self-exclusion program for land-based gaming machine venues in New South Wales, Australia. Participants were asked open-ended questions about their experiences and opinions of the program, including its strengths and weaknesses, and suggested improvements for future consumers. Overall, participants found self-exclusion beneficial. However, several shortcomings of the program were expressed, including lack of available public information and overly complicated registration processes. Participants lacked confidence in venues’ willingness and ability to identify non-compliant gamblers and highlighted the need for vastly improved detection systems. The quality of interactions with venue staff in relation to self-exclusion were mixed; counsellor support, however, was perceived as important from beginning to end of a self-exclusion period. Results suggest that gambling operators should increase marketing efforts to promote the availability and benefits of self-exclusion. Investigation of strategies to streamline registration processes and to augment detection systems with new technologies was supported. Venue staff may benefit from training in appropriate self-exclusion facilitation procedures. Gambling operators should aim to foster strong links between self-exclusion programs and professional gambling counselling services. Access full article

Reference: Pickering, D., Nong, Z., Gainsbury, S.M. & Blaszczynski, A. (2019). Consumer perspectives of a multi-venue gambling self-exclusion program: A qualitative process analysis. Journal of Gambling Studies, 41.

Perceptions of problem gambling among methadone maintenance treatment clients and counsellors [open access article]

Abstract: Problem gambling is highly prevalent and rarely treated among clients who attend methadone maintenance treatment programs (MMTPs). Compared with those of the general population, rates of gambling disorder have been found to be elevated among individuals receiving methadone maintenance treatment. Our study aims were to (a) develop a clearer understanding of the gambling experience of clients and counsellors at a methadone clinic and (b) gain insight into the current treatment options and obstacles to treatment in the clinic. Semi-structured interviews focusing on gambling issues were conducted with 8 clients and 8 counsellors at an MMTP located in an urban area. Participants were asked questions to gain an understanding about their perspectives on, treatment options for, and treatment barriers to problem gambling in the clinic. Data were coded by 4 investigators by using a constant comparison, open coding approach. The findings revealed important differences between clients and counsellors: Opinions differed on the definition of problem gambling, obstacles to treatment, and optimal treatment settings. Clients and counsellors also agreed on some elements, including the negative impact that problem gambling can have on recovery from substance use. This examination of responses of counsellors and client feedback provides a useful mechanism to better understand problem gambling in MMTPs. In addition, the findings have important clinical implications, including a need for more effective screening and treatment in MMTPs and to provide substance use counsellors with training related to problem gambling. Access full article

Megan E. Wall, Cassandra R. Durand, Hana Machover, Rachel Arnold, Haley A. Miles-McLean, Wendy Potts, Loreen Rugle, Christopher Welsh, Seth Himelhoch. (2018). Journal of Gambling Issues.

 

Gambling disorder in adolescents: what do we know about this social problem and its consequences? [open access article]

Abstract: Gambling disorder (GD) is a psychiatric condition and it is characterized by a maladaptive pattern of gambling behavior that persists despite negative consequences in major areas of life functioning. In Italy, CNR (National Research Council) underlined how over 17 million, 42.8% of the population aged 15–64 have a gambling behavior. Among them, there are over one million students, aged 15–19, equal to 44.2% of Italian students; the number of minors in Italy with GD in 2017 was 580,000, equal to 33.6%. Access full article

Pietro Ferrara, Giulia Franceschini and Giovanni Corsello. (2018). Italian Journal of Pediatrics, 44:146. https://doi.org/10.1186/s13052-018-0592-8

Information technology usage as a moderator between disordered gambling, internet gaming addiction, and illusory control [subscription access article]

Abstract: This study tested the hypothesis as to whether the mode and time of information technology use—such as using various electronic and computing devices for gambling and collecting information related to gambling—can positively predict disordered gambling, with the effects of Internet gaming addiction and illusory control being taken into account.

A questionnaire set was administered to 677 Hong Kong secondary school students to assess their maladaptive gambling behavior, Internet gaming addiction, illusory control, and the habit of information technology use, such as the amount of time spent on watching television, browsing the Internet, and playing online gambling and non-gambling games. The results suggest that utilizing computing and electronic devices for gambling-related activities is positively indicative of disordered gambling, making use of information technology for work or study being a buffering factor.

Utilizing information technology for non-gambling activities—such as the durations of playing non-gambling games and making non-gambling purchases online—is not related to disordered gambling, albeit their positive correlations with Internet gaming addiction. Likewise, Internet gaming addiction has no association with using information technology devices for any gambling-related activities, except its very small correlation with playing online gambling games.

In addition, tablet computers may provide a convenient means for gambling activities and tend to be used by problem gamblers. It is recommended that intervention strategies targeted at secondary school students should address not only the amount of use but also the way they use information technology devices. Article details and access conditions

Yu, Calvin Kai-Ching & Fu, Wai. (2018). International Journal of Mental Health and Addiction. https://doi.org/10.1007/s11469-018-0033-3

Gambling-related cognitive distortions mediate the relationship between depression and disordered gambling severity [subscription access article]

Abstract: Background and objectives
Symptoms of depression are highly prevalent among individuals with gambling disorder, and severity of depression is associated with severity of gambling problem. Yet, little is known about the psychological mechanisms by which symptoms of depression lead to greater gambling severity. In this study, we tested whether cognitive distortions represent one such mechanism, as cognitive distortions are key characteristics in both depression and gambling disorder and have been shown to be associated with gambling severity.

Highlights
• Depression symptoms predict cognitive distortions and gambling severity
• Controlling for depression, cognitive distortions predict greater gambling severity
• Cognitive distortions mediate the effect of depression on gambling severity

Article details and access conditions

Magdalen G. Schluter, Hyoun S. Kim, Julia C. Poole, David C. Hodgins, Daniel S. McGrath, Keith S. Dobson, Hermano Taveres. (2019). Gambling-related cognitive distortions mediate the relationship between depression and disordered gambling severity. Addictive Behaviors, 90, 318-323. https://doi.org/10.1016/j.addbeh.2018.11.038.

Gambling disorder, increased mortality, suicidality, and associated comorbidity: A longitudinal nationwide register study [open access article]

Background and aims: Gambling disorder (GD) appears to be an independent risk factor for suicide, and all-cause mortality has been sparsely studied in patients with GD. This study aims to explore mortality and suicide rates in individuals with GD compared to the general population as well as explore risk factors associated with all-cause mortality and suicide mortality. Access full article

Anna Karlsson and Anders Håkansson; Faculty of Medicine, Department of Clinical Sciences Lund, Psychiatry, Lund University, Lund, Sweden; Clinical Research Unit, Malmö Addiction Center, Region Skåne, Sweden. Journal of Behavioral Addictions.
DOI: 10.1556/2006.7.2018.112