Treatment outcomes and predictors of drop out for problem gamblers in South Australia : a cohort study

OBJECTIVES: Recent prevalence studies in Australia, the USA and Canada have estimated 1-2% of the adult population meet the diagnostic criteria for problem or pathological gambling. The Statewide Gambling Therapy Service (SGTS) provides treatment for problem gamblers in key metropolitan and rural regions in South Australia. The aims of this study were two-fold: to analyse the short and mid-term outcomes following treatment provided by SGTS and to identify factors associated with treatment drop-out. METHOD: A cohort of treatment seeking problem gamblers was recruited through SGTS in 2008. Repeated outcome measures included problem gambling screening, gambling related cognitions and urge. Treatment drop-out was defined as participants attending three or less treatment sessions, whilst potential predictors of drop-out included perceived social support , anxiety and sensation-seeking traits. RESULTS: Of 127 problem gamblers who participated in the study, 69 (54%) were males with a mean age of 43.09 years (SD = 12.65 years) and with 65 (52%) reporting a duration of problem gambling greater than 5 years. Follow up time for 50% of participants was greater than 8.9 months and, overall, 41 (32%) participants were classified as treatment drop-outs. Results indicated significant improvement over time on all outcome measures except alcohol use for both treatment completers and drop-outs, although to a lesser extent for the treatment drop-out group. A significant predictor of treatment drop-out was sensation-seeking traits. CONCLUSION: These results will inform future treatment planning and service delivery, and guide research into problem gambling including aspects of treatment drop-out.

Lessons for the development of initiatives to tackle the stigma associated with problem gamling

This research examined the effectiveness of anti-stigma initiatives in the areas of mental health, HIV/AIDS and gambling to understand the different appeal strategies used and to inform future anti-stigma initiatives for problem gambling. The study comprised a literature review of a range of campaigns used to reduce stigma and interviews with experts about the factors that contribute to gambling stigma and potential strategies for responding to them. In reviewing the campaigns, the researchers found most strategies used to reduce stigma tended to be reactive rather than preventative. The gambling campaigns typically focused on personal responsibility. The researchers noted that this may have unintended negative consequences for people experiencing gambling harm, including intensifying stigma and deterring help-seeking. The interviews with experts focused on the causes and consequences of gambling stigma and how to address them through effective anti-stigma initiatives. Interviewees saw stigma exacerbated by community misconceptions about individual responsibility as well as industry and government messages that frame problem gambling as an issue of personal responsibility. They recommended drawing on campaign successes in other areas, such as mental health, and shifting focus from personal responsibility to the multiple factors that contribute to gambling harm, encouraging a more compassionate approach to those who experience it. The foundation’s Grants for Gambling Research program funded this study.

Self-perceived distress and impairment in problem gamblers: a study of pre- to post-treatment measurement invariance

Gambling help services typically evaluate treatment outcomes using self-reported responses and measurements. However, gamblers’ conceptualisations and prioritisations with respect to these measurements may shift over time. Thus, changes in the self-reported responses may not always reflect true change in the individuals. This study investigated for response shift in self-report measures of psychological distress and impairment in 293 help-seeking problem gamblers. We used confirmatory factor analysis to model data structures from pre-treatment to post-treatment. The findings indicated that a response shift had occurred. Two items became less important and one item became more important in measuring psychological distress. Measurement invariance was achieved for the complete set of items for impairment. These findings provide a more in-depth understanding of the nature of self-report outcomes in otherwise routinely collected data.

Cocaine-specific neuroplasticity in the ventral striatum network is linked to delay discounting and drug relapse

AIMS: To contrast functional connectivity on ventral and dorsal striatum networks in cocaine dependence relative to pathological gambling, via a resting-state functional connectivity approach; and to determine the association between cocaine dependence-related neuroadaptations indexed by functional connectivity and impulsivity, compulsivity and drug relapse. DESIGN: Cross-sectional study of 20 individuals with cocaine dependence (CD), 19 individuals with pathological gambling (PG) and 21 healthy controls (HC), and a prospective cohort study of 20 CD followed-up for 12 weeks to measure drug relapse. SETTING AND PARTICIPANTS: CD and PG were recruited through consecutive admissions to a public clinic specialized in substance addiction treatment (Centro Provincial de Drogodependencias) and a public clinic specialized in gambling treatment (AGRAJER), respectively; HC were recruited through community advertisement in the same area in Granada (Spain). MEASUREMENTS: Seed-based functional connectivity in the ventral striatum (ventral caudate and ventral putamen) and dorsal striatum (dorsal caudate and dorsal putamen), the Kirby delay-discounting questionnaire, the reversal-learning task and a dichotomous measure of cocaine relapse indicated with self-report and urine tests. FINDINGS: CD relative to PG exhibit enhanced connectivity between the ventral caudate seed and subgenual anterior cingulate cortex, the ventral putamen seed and dorsomedial pre-frontal cortex and the dorsal putamen seed and insula (P≤0.001, kE=108). Connectivity between the ventral caudate seed and subgenual anterior cingulate cortex is associated with steeper delay discounting (P≤0.001, kE=108) and cocaine relapse (P≤0.005, kE=34). CONCLUSIONS: Cocaine dependence-related neuroadaptations in the ventral striatum of the brain network are associated with increased impulsivity and higher rate of cocaine relapse.

Creating symbolic cultures of consumption: an analysis of the content of sports wagering advertisements in Australia

BACKGROUND: Since 2008, Australia has seen the rapid emergence of marketing for online and mobile sports wagering. Previous research from other areas of public health, such as tobacco and alcohol, has identified the range of appeal strategies these industries used to align their products with culturally valued symbols. However, there is very limited research that has investigated the tactics the sports wagering industry uses within marketing to influence the consumption of its products and services.

METHOD: This study consisted of a mixed method interpretive content analysis of 85 sports wagering advertisements from 11 Australian and multinational wagering companies. Advertisements were identified via internet searches and industry websites. A coding framework was applied to investigate the extent and nature of symbolic appeal strategies within advertisements.

RESULTS: Ten major appeal strategies emerged from this analysis. These included sports fan rituals and behaviours; mateship; gender stereotypes; winning; social status; adventure, thrill and risk; happiness; sexualised imagery; power and control; and patriotism. Symbols relating to sports fan rituals and behaviours, and mateship, were the most common strategies used within the advertisements.

DISCUSSION/CONCLUSIONS: This research suggests that the appeal strategies used by the sports wagering industry are similar to those strategies adopted by other unhealthy commodity industries. With respect to gambling, analysis revealed that strategies are clearly targeted to young male sports fans. Researchers and public health practitioners should seek to better understand the impact of marketing on the normalisation of sports wagering for this audience segment, and implement strategies to prevent gambling harm.

"It's just everywhere!" Children and parents discuss the marketing of sports wagering in Australia

OBJECTIVE: To investigate how children and adults recall the content and promotional channels for sports wagering marketing. METHODS: A mixed methods study of 152 parent/child (8-16 years) dyads was conducted at AFL (Australian Football League), NRL (National Rugby League), and soccer sporting sites in New South Wales and Victoria, Australia. Questions related to the frequency of viewing AFL and NRL matches, sports wagering promotions and perceptions of the normalisation of wagering in sport. Descriptive statistics and thematic analysis were used to analyse data. RESULTS: Children recruited from NRL (n=75, 96.2%) and AFL (n=46, 92.0%) sites were significantly more likely to have recalled having ever seen a promotion for sports wagering as compared to children from Soccer sites (n=18, 75.0%) (p<0.05). Children and adults identified seeing sports wagering promotions in similar environments, most commonly on television, and at stadiums. Three-quarters of children (75.0%) and the majority of adults (90.0%) perceived that sports wagering was becoming a normal part of sport. CONCLUSION AND IMPLICATIONS: This research shows that children engaged in particular sports have high awareness of wagering marketing, particularly as seen on television or at sporting matches. Regulation should comprehensively address the placement, quantity and content of wagering marketing aligned with sport to prevent current and/or future gambling harm.

Meandros psicológicos das dependências – O jogo patológico

Dissertação de Mestrado apresentada ao Instituto Superior de Psicologia Aplicada para obtenção de grau de Mestre na especialidade de Psicologia Clínica.

Self-perceived distress and impairment in problem gamblers : a study of pre- to post-treatment measurement invariance

Gambling help services typically evaluate treatment outcomes using self-reported responses and measurements. However, gamblers’ conceptualisations and prioritisations with respect to these measurements may shift over time. Thus, changes in the self-reported responses may not always reflect true change in the individuals. This study investigated for response shift in self-report measures of psychological distress and impairment in 293 help-seeking problem gamblers. We used confirmatory factor analysis to model data structures from pre-treatment to post-treatment. The findings indicated that a response shift had occurred. Two items became less important and one item became more important in measuring psychological distress. Measurement invariance was achieved for the complete set of items for impairment. These findings provide a more in-depth understanding of the nature of self-report outcomes in otherwise routinely collected data.