The personality profile of chronic alcohol dependent patients with comorbid gambling disorder symptoms [open access article]

Abstract
Background and aims: The importance of personality characteristics in the diagnostics and treatment of gambling disorder (GD) and alcohol use disorder (AUD) is often highlighted in scientific literature. This study aimed to test predictions about the associations of temperament and character in chronic AUD patients with comorbid GD symptoms and without them.

Methods: Chronic AUD patients enrolled from an inpatient clinic were divided in two groups based on cluster analysis, AUD patients with (AUD+GD groups: N = 30) and without (AUD groups: N = 68) GD symptoms. Severity of GD symptoms and personality dimensions (Cloninger’s Temperament and Character Inventory Revised, TCI-R) were assessed. Associations of tested variables were analysed with analysis of covariance, one-sample and independent sample t-tests.

Results: GD symptoms proved to be a clustering factor in terms of personality, where AUD+GD groups expressed a more maladaptive personality profile. Compared to Hungarian normative TCI-R scores, both patient groups showed elevated levels of Harm Avoidance and Novelty Seeking with lower scores of Self-directedness, while the AUD+GD group scored lower on Persistence and Cooperation as well. The AUD+GD group reported significantly higher levels of Harm Avoidance, with lower scores of Reward Dependence compared to the AUD group.

Discussion: Comorbid GD symptom severity is an important factor in chronic AUD, where AUD patients with comorbid GD symptoms exhibited more maladaptive personality constellation than singular AUD patients. These emphasize the need of special attention for comorbid GD symptoms in AUD, since treatment recommendations and prognosis for them may also differ. Link to the article

Citation: I. Kovács, I.K. Pribék, I. Demeter, et al., The personality profile of chronic alcohol dependent patients with comorbid gambling disorder symptoms, Comprehensive Psychiatry (2020), https://doi.org/10.1016/j.comppsych.2020.152183

Response trajectories of gambling severity after cognitive behavioral therapy in young-adult pathological gamblers [open access article]

Abstract
Background and aims: The significant increase in the prevalence of gambling disorder (GD) among young adults in recent years has attracted interest in determining therapeutic efficiency in this sector of the population. The aim of this work was to estimate the response trajectories of gambling severity during the six-month follow-up after a cognitive behavioral therapy (CBT) program in young adult patients and to identify the main variables associated with each trajectory.

Methods: The sample included n 5 192 patients, aged 19–35 years old, seeking treatment for GD. Response trajectories were identified through latent class growth analysis.

Results: Three trajectories emerged: T1 (n 5 118, 61.5%), composed of patients with severe GD at pre-treatment and good evolution to recovery; T2 (n 5 62, 32.3%), with patients with moderate-high GD affectation at baseline and good evolution to recovery; and T3 (n 5 12, 6.3%), with participants with severe baseline GD severity and poor evolution after CBT (Abbott, 2019). The highest risk of poor therapeutic outcomes was related to lower social index positions, high emotional distress, high scores in harm avoidance and low scores in self-directedness.

Discussion and conclusions: Differences in the response trajectories at short-term follow-up after CBT reveal heterogeneity in the samples including young and young-adult GD patients. Patients’ phenotype at baseline should be considered when developing efficient, person-centered intervention programs, which should comprise strategies aimed at increasing emotional regulation capacities, self-esteem and self-efficacy, with the aim of avoiding relapses in the medium-long term after therapy. Link to the article

Citation: Granero, R., Valero-Solis, S., Fernández-Aranda, F., Gómez-Peña, M., Moragas, L., Mena-Moreno. & Murcia, S.J. (2020). Response trajectories of gambling severity after cognitive behavioral therapy in young-adult pathological gamblers. Journal of Behavioral Addiction, 9(1), 140-152. Retrieved from https://akjournals.com

Perceived social stigmatisation of gambling disorders and coping with stigma [open access article]

Abstract
Aim: This study concerns perceived social stigmatisation of gambling disorder and its determinants, the self-perceptions of people with gambling disorder (self-stigma) and how they cope with stigma.

Design: In total, 30 interviews with persons with gambling disorder and 60 with professionals were conducted. Selective sampling procedures were employed in the recruitment phase. In the case of professionals, the inclusion criteria were employment in facilities where treatment of gambling disorder is offered, and profession. For people with gambling disorder, the criterion was a diagnosis confirmed by a psychiatrist.

Results: Elements revealed in past research on stigma-creation processes were reflected in respondents’ statements. The type of gambling, the occurrence of negative consequences, the possibility of hiding, personal responsibility, social status and contact with stigmatised populations are perceived determinants of problem gamblers’ stigmatisation. Gambling disorder sufferers experience anxiety associated with the possibility of rejection and a fear related to their condition being revealed to others. Various manifestations of cognitive distancing and hiding were coping mechanisms identified in the study.

Conclusions: People with gambling disorder experience anxiety associated with the possibility of rejection, and they often conceal their disorder, which may hinder their treatment. Therefore the issue of stigma should be addressed in therapy. Link to the article

Citation: Dąbrowska, K. & Wieczorek, Ł. (2020). Perceived social stigmatisation of gambling disorders and coping with stigma. Nordic Studies on Alcohol and Drugs. 1–19.

Stress and gambling [open access article]

Abstract: Gambling is a multi-billion-dollar industry that many people engage with on a regular basis with no adverse effects. For many, gambling is a fun hobby that does not negatively impact their lives. There is, however, a significant minority whose gambling is maladaptive and causes significant adverse consequences, which may lead to personal and financial devastation. Stress and how one responds to stress may be a significant factor in determining who may gamble with impunity versus those who lose control and develop gambling disorder. In this paper, we outline three points at which stress and gambling intersect: 1) gambling to escape stress, 2) gambling as a stressor, and 3) altered stress physiology as a predisposing factor for gambling disorder. Below we describe these intersections and how they may influence the development and maintenance of gambling disorder. Link to the article

Citation: Buchanan, T.W., McMullin, S.D., Baxley, C., & Weinstock, J. (2020). Stress and gambling. Current Opinion in Behavioral Sciences, 31, 8-12. Retrieved from http://www.sciencedirect.com/science/article/pii/S2352154619301032

A systematic review evaluating screening instruments for gambling disorder finds lack of adequate evidence [subscription access article]

Abstract
Objective
To date, no research has systematically evaluated screening instruments for gambling disorder to assess their accuracy and the quality of the research. This systematic review evaluated screening instruments for gambling disorder to inform decision-makers about choices for population-level screening.

Study Design and Setting
On May 22, 2017 and January 4, 2019, we searched PubMed, PsycInfo, EMBASE, and Cochrane for studies that evaluated screening instruments for gambling disorder. Studies were included if (1) the screening instrument was in English, (2) the screening instrument was compared to a reference standard semi-structured interview based on Diagnostic and Statistical Manual of Mental Disorders or International Classification of Diseases diagnoses of gambling disorder, and (3) data were reported on psychometric properties of the instrument.

Results
We identified 31 different screening instruments from 60 studies. Only three instruments from three separate studies were eligible for inclusion in the systematic review.

Conclusion
Few screening instruments for gambling disorder have been validated with sufficient methodological quality to be recommended for use across a large health system. Link to the article

Citation: Otto, J.L., Smolenski, D.J., Garvey Wilson, A.L., Evatt, D.P., Campbell, M.S., Beech, E.H., Workman, D.E., Morgan, R.L., O’Gallagher, K., & Belsher, B.E. (2020). A systematic review evaluating screening instruments for gambling disorder finds lack of adequate evidence. Journal of Clinical Epidemiology, In Press, Journal Pre-proof.

Phenotypes in gambling disorder using sociodemographic and clinical clustering analysis: An unidentified new subtype?

Background: Gambling disorder (GD) is a heterogeneous disorder which has clinical manifestations that vary according to variables in each individual. Considering the importance of the application of specific therapeutic interventions, it is essential to obtain clinical classifications based on differentiated phenotypes for patients diagnosed with GD

Objectives: To identify gambling profiles in a large clinical sample of n = 2,570 patients seeking treatment for GD.

Methods: An agglomerative hierarchical clustering method defining a combination of the Schwarz Bayesian Information Criterion and log-likelihood was used, considering a large set of variables including sociodemographic, gambling, psychopathological, and personality measures as indicators.

Results: Three-mutually-exclusive groups were obtained. Cluster 1 (n = 908 participants, 35.5%), labeled as “high emotional distress,” included the oldest patients with the longest illness duration, the highest GD severity, and the most severe levels of psychopathology. Cluster 2 (n = 1,555, 60.5%), labeled as “mild emotional distress,” included patients with the lowest levels of GD severity and the lowest levels of psychopathology. Cluster 3 (n = 107, 4.2%), labeled as “moderate emotional distress,” included the youngest patients with the shortest illness duration, the highest level of education and moderate levels of psychopathology.

Conclusion: In this study, the general psychopathological state obtained the highest importance for clustering. Link to the article

Citation: Jiménez-Murcia, S., Granero, R., Fernández-Aranda, F., Stinchfield, R., Tremblay, J., Steward, T., Mestre-Bach, G., Lozano-Madrid, M., Mena-Moreno, T., Mallorquí-Bagué, N., Perales, J.C., Navas, J.F., Soriano-Mas, C., Aymamí, N., Gómez-Peña, M., Agüera, Z., del Pino-Gutiérrez, A., Martín-Romera, V., & Menchón, J.M. (2019). Phenotypes in Gambling Disorder Using Sociodemographic and Clinical Clustering Analysis: An Unidentified New Subtype? Frontiers in Psychiatry, 10(173). doi: 10.3389/fpsyt.2019.00173

Similar roles for recovery capital but not stress in women and men recovering from gambling disorder [article]

Background: Understanding gender-related differences is important in recovery processes. Previous studies have investigated gender-related differences in factors associated with gambling disorder (GD), but none to date have considered both positive and negative resources related to recovery. Using a recovery capital (RC) framework that
considers multiple resources available during recovery, this study examined gender-related similarities and differences in associations between positive resources (RC, spirituality) and negative experiences and states (stressful life events, depression, and anxiety) and GD symptom improvement.

Method: One hundred and forty individuals with lifetime GD (101 men) were assessed using DSM-5 diagnostic criteria for GD (past-year and lifetime prior to past-year), the Brief Assessment of RC, the Intrinsic Spirituality Scale, the Stressful Life-events Scale, the Generalized Anxiety Disorder Scale, and the Patient Health Questionnaire 9 for depression. Multiple linear regression and Bayesian statistical analyses were conducted.

Results: RC was positively and significantly associated with GD symptom improvement in women and men. Stressful life events were negatively associated with GD symptom improvement only in men.

Conclusions: RC is an important positive resource for men and women recovering from GD and should be considered in treating both women and men. Understanding specific RC factors across gender groups and stressors, particularly in men, may aid in developing improved interventions for GD. Link to the article

Citation: Gavriel-Fried, B., Moretta, T., & Potenza, M.N. (2019). Similar roles for recovery capital but not stress in women and men recovering from gambling disorder. Journal of Behavioral Addictions 8(4), 770–779.

Stress and gambling

[Introduction]
Gambling is a multi-billion-dollar industry that many people engage with on a regular basis with no adverse effects. For many, gambling is a fun hobby that does not negatively impact their lives. There is, however, a significant minority whose gambling is maladaptive and causes significant adverse consequences, which may lead to personal and financial devastation. Stress and how one responds to stress may be a significant factor in determining who may gamble with impunity versus those who lose control and develop gambling disorder. In this paper, we outline three points at which stress and gambling intersect: 1) gambling to escape stress, 2) gambling as a stressor, and 3) altered stress physiology as a predisposing factor for gambling disorder. Below we describe these intersections and how they may influence the development and maintenance of gambling disorder. Link to the article

Citation: Buchanan, T.W., McMullin, S.D., Baxley, C., & Weinstock, J. (2019). Stress and gambling. Current Opinion in Behavioral Sciences, 31, 8–12.

Gambling-related consumer credit use and debt problems: a brief review [article]

[Introduction]
People experiencing problems with gambling may use consumer credit to cover expenses and/or continue gambling. This may contribute to debt problems and psychological distress, both of which may have pre-existed (and potentially motivated) their gambling. This review found little empirical investigation of patterns of consumer credit use by gamblers, despite borrowing money being a diagnostic criterion for gambling disorder and financial harms being one of the most commonly reported problems. Research suggests that consumer credit use and debt problems increase with problem gambling severity.
Gambling-related debt problems increase the likelihood of experiencing poor psychosocial functioning, including psychological distress, substance use, adverse family impacts, crime, and suicidality. Communities and governments are calling for more socially responsible conduct by financial institutions, which increasingly recognise the potentially harmful impacts of credit provision on the well-being of customers experiencing gambling problems. Policies and interventions are needed relating to consumer credit, debt, and gambling to enhance customers’ financial and psychosocial well-being. Link to the article

Citation: Swanton, T.B., & Gainsbury, S.M. (2019). Gambling-related consumer credit use and debt problems: a brief review. Current Opinion in Behavioral Sciences, 31, 21–31.

The joint role of impulsivity and distorted cognitions in recreational and problem gambling: A cluster analytic approach [open-access article]

Abstract
Background and aims: The Pathways Model (Blaszczynski & Nower, 2002) posits that problem gambling is a heterogeneous disorder with distinct subgroups (behaviorally conditioned gamblers, emotionally vulnerable gamblers, and antisocial-impulsivist gamblers). Impulsivity traits and gambling-related cognitions are re-cognized as two key psychological factors in the onset and maintenance of problem gambling. To date, these constructs have been explored separately, and their joint role in determining problem gambling subtypes has received little attention. The goal of our study was to identify subgroups of gamblers based on impulsivity traits and gambling-related cognitions, and to determine whether this approach is consistent with the Pathways model.

Methods: Gamblers from the community (N= 709) and treatment-seeking pathological gamblers (N= 122)completed questionnaires measuring gambling habits, disordered gambling symptoms, gambling-related cog-nitions, and impulsivity traits.

Results: Cluster analyses revealed that three clusters globally aligned with the pathways proposed by Blaszczynski & Nower (2002). Two other clusters emerged: (1) impulsive gamblers without cognitive-related cognitions; and (2) gamblers without impulsivity or gambling-related cognitions. Gamblers with both heightened impulsive traits and gambling-related cognitions had more severe problem gambling symptoms.

Conclusion: We successfully identified, based on ana prioritheoretical framework, different subtypes of gamblersthat varied in terms of problem gambling symptoms and clinical status. The diversity of the cluster profilessupports the development of personalized prevention strategies and psychological interventions.
Link to the article

Citation: Gaëtan Devos, Luke Clark, Henrietta Bowden-Jones, Marie Grall-Bronnec, Gaëlle Challet-Bouju, Yasser Khazaal, Pierre Maurage, Joël Billieux. (2020). The joint role of impulsivity and distorted cognitions in recreational and problem gambling: A cluster analytic approach. Journal of Affective Disorders, 260, 473-482. https://doi.org/10.1016/j.jad.2019.08.096.