Targeting problem gambling relapse risk factors: Lack of social connectedness and leisure substitution [open-access thesis]

Abstract
This research added an innovative, critical component to the current problem gambling treatment approaches available in Australia. It targeted a susceptible and significant group of people who experience gambling-related harm but find it difficult to stop gambling and not to start again. Relapse in problem gambling and treatment dropout is common, with a rate of up to 70% being generally accepted.
To date, gambling interventions specifically targeting risk factors for relapse have not been the focus of many studies. The author of this thesis, who has lived experience with problem gambling, designed a structured group program targeting two identified risk factors for gambling relapse: 1) lack of social connectedness, and 2) lack of leisure substitution. Between 2009 and 2016, four versions of this program were trialled. All program participants were supported by a group of volunteers, most of whom had lived experience with problem gambling and were participants in previous program versions. Four versions of the program were evaluated using a multi-method approach. Quantitative data were collected using validated psychosocial measures. Journaled observation by the author, anecdotal evidence and journaled participants quotes were documented by the author in various project reports and are used in this thesis to support the qualitative findings.
The results of the quantitative data revealed significant improvement for participants in the areas of social connectedness, self-efficacy, and mental health. Importantly, the results also indicated that the program supported the goals of either abstinence from, or control over, gambling behaviour for program completers. It is concluded that this innovative program helped to reconnect people to activities other than gambling and to a supportive community and, in so doing, effectively achieved the research objectives.
An extra qualitative study ‘Volunteer study’ was conducted to explore if the aspect of ‘volunteering’ made a positive contribution to sustain behavioural changes that were achieved by previous program participation. This exploratory study utilised 14 in-depth semi-structured interviews with current volunteers of the trialled relapse-focused programs from studies 1-4. This part of the research indicated that volunteering for any of the peer support relapse focused programs provided significant benefits to an individual’s recovery from problem gambling. The sample was a small convenience sample, so it is not possible to generalise the findings but offers an opportunity to further explore the importance of volunteering in recovery. Link to the article

Citation: Byrne, G.H. (2019). Targeting Problem Gambling Relapse Risk Factors: Lack of Social Connectedness and Leisure Substitution (PhD Thesis, Victoria University). Retrieved from http://vuir.vu.edu.au/40035/

Integrating psilocybin and existential-humanistic psychotherapy for pathological gambling treatment: a new perspective [open-access article].

Abstract: In the last years, the debate on the use of psychedelics in psychotherapeutic settings has intensified, attracting a lot of interest and attention from the scholarly community as well as from clinicians and paving the way for new therapeutic paradigms. Besides classical addictions and addictive behaviors, there exist forms of addictions, the so-called new addictions or behavioral addictions, whose characterization is not linked so much to substances but to widespread and socially accepted activities such as games, shopping, internet use, sex, love relationships, work and exercises, physical activities or sports.
Among the various addictions, the gambling disorder is the first form of behavioral addictions officially recognized by the DSM-V, in accordance with a wealth of neurobiological and clinical data showing the activation in patients of the gratification systems (especially dopamine).
Orthos, as intensive residential intervention program envisaging a non-moralistic approach to gambling, can be combined with the administration of psilocybin, a substance characterized by a very low potential for abuse, modulating brain areas and networks affected by addictive behaviors. Therefore, our proposal would be to start treating behavioral addictions combining psilocybin administration with existential-humanistic psychotherapy, like Orthos. Article available online

Reference: Raymondo, S., & Firenzuoli, F. (2019). Integrating psilocybin and existential-humanistic psychotherapy for pathological gambling treatment: a new perspective. Cosmos and History: The Journal of Natural and Social Philosophy, 15(1), 228–236.

Promoting cross-sector collaboration and input into care planning via an integrated problem gambling and mental health service [open-access article].

Abstract: Although problem gambling and mental illnesses are highly comorbid, there are few examples of integrated problem gambling and mental illness services. This has meant that it is unclear whether such services are needed, why they may be used, and how they operate to support clients who are affected by the comorbidity and the clinicians who are providing care. This study reports on data collected via telephone questionnaire-assisted interviews of 20 clients and 19 referrers who had accessed one such Australian integrated problem gambling and mental illness program between July 2014 and June 2016.
Data revealed that clients were often referred in the context of psychiatric or psychosocial crisis, or when clinicians encountered clients who were not making progress and wanted a second opinion about diagnosis and treatment. Improved management of illness symptoms or gambling behaviour was a commonly reported benefit, and a number of clients reported gaining a feeling of reassurance and hope following assessment as a result of a deeper understanding of their issues and available treatment options. Access to dual-specialist expertise on problem gambling and mental illness may therefore enhance treatment planning, management during crises, and cross-sector collaboration to improve access to care and its impact on people who are experiencing comorbidity. Article available online

Reference: McCartney, L.E., Northe, V., Gordon, S., Symons, E., Shields, R., Kennedy, A., & Lee, S.J. (2019). Promoting cross-sector collaboration and input into care planning via an integrated problem gambling and mental health service. Journal of Gambling Issues, 42.

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.

 

Simulations for addicts of gambling [open access article]

Blokland, Piet van. (July, 2018). Paper presented at the Tenth International Conference on Teaching Statistics (ICOTS10), Kyoto, Japan. Retrieved from https://iase-web.org/icots/10/proceedings/pdfs/ICOTS10_C110.pdf

Abstract: Gambling addiction is a serious problem in our societies. The gambling industry is a multi-billion industry with a lot of victims. Treatment for addiction has a high percentage of regression. We think that insight into the statistics involved, will help to strengthen the addicts ability to resist the temptations of gambling. Simulations are an easy way to explain variation and expectation. We describe a series of 3 lessons of 4 hours each about randomness, the gambler’s fallacy, slot machine and roulette to clarify these games in order to give better understanding. Attention is also paid to other aspects of the gambling. We tested these lessons with gamblers and gambling addicts. This approach may also be useful for public education. You can see the simulations at http://www.vustat.eu. Read full article

Participant reflections on gambling treatment services [open access summary of a research project]

Olmstead, C. and Cobb, A. (2018). Participant reflections on gambling treatment services. Undergraduate Student Work. 3. Retrieved from scholarworks.uni.edu/ugswork/3

Background: The Iowa Gambling Treatment Outcomes Monitoring System is an ongoing project implemented by the UNI-CSBR for the purpose of assessing the extent to which state-sponsored problem gambling treatment services are associated with positive outcomes for clients. This study used six-month follow-up questionnaire data from 2013 to 2017 for those Iowans who received gambling treatment services from state licensed providers regarding their perception and opinions of services received while in treatment. Access research summary

Treatment for Disordered Gambling: Current Evidence and Recommendations (open access article)

Littman-Sharp, N. (2017). Gambling Research Exchange Ontario. Retrieved from http://www.greo.ca/Modules/EvidenceCentre/files/Littman-Sharp_(2017)_Treatment_for_Disordered_Gambling.pdf

Introduction
Disordered gambling treatment programming has developed rapidly in the last 20-25 years in response to the need engendered by the proliferation of legal casinos. Research on treatment effectiveness has also expanded. One of the most important elements of good clinical practice is an up to date understanding of evidence-based practices. Research can inform practitioners of new modalities, and of refinements on current modalities. It can indicate training needs, and identify cost-effective methods of treatment that make best use of available resources. Treatment research also acts as an important reminder of the need to measure clients’ progress and outcomes, and to adjust services to maximize their success.

The disordered gambling field benefits greatly from a robust exchange between clinical work and research. This paper will provide an overview of the current state of knowledge on disordered gambling treatment, and identify its gaps and limitations, particularly from the point of view of treatment providers. Researchers have evaluated a number of approaches to disordered gambling treatment. These include cognitive behavioural therapy, motivational interviewing, brief interventions, self-help, mindfulness meditation, family interventions, pharmacotherapy, online interventions, treatments specialized for women, and mutual aid. There are also studies comparing modalities, or combining them – an approach that is perhaps closer to what occurs in the real world. Access full article