Motivational enhancement and self-help treatments for problem gambling.

Two brief treatments for problem gambling were compared with a waiting-list control in a randomized trial. Eighty-four percent of participants (N?=?102) reported a significant reduction in gambling over a 12-month follow-up period. Participants who received a motivational enhancement telephone intervention and a self-help workbook in the mail, but not those who received the workbook only, had better outcomes than participants in a 1-month waiting-list control. Participants who received the motivational interview and workbook showed better outcomes than those receiving the workbook only at 3-and 6-month follow-ups. At the 12-month follow-up, the advantage of the motivational interview and workbook condition was found only for participants with less severe gambling problems. Overall, these results support the effectiveness of a brief telephone and mail-based treatment for problem gambling. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Brief Motivational Treatment for Problem Gambling: A 24-Month Follow-Up.

A 24-month follow-up of a randomized clinical trial of 2 brief treatments for problem gambling (N = 67) revealed an advantage for participants who received a motivational telephone intervention plus a self-help workbook compared with participants who received only the workbook. Although the 2 groups did not differ in the number of participants reporting 6 months of abstinence, the motivational intervention group gambled fewer days, lost less money, and had lower South Oaks Gambling Screen scores. They were more likely to be categorized as improved compared with the self-help workbook only group. Overall, the results support the effectiveness of a brief telephone- and mail-based treatment for problem gamblers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A randomized trial of brief interventions for problem and pathological gamblers.

Limited research exists regarding methods for reducing problem gambling. Problem gamblers (N = 180) were randomly assigned to assessment only control, 10 min of brief advice, 1 session of motivational enhancement therapy (MET), or 1 session of MET plus 3 sessions of cognitive-behavioral therapy. Gambling was assessed at baseline, at 6 weeks, and at a 9-month follow-up. Relative to assessment only, brief advice was the only condition that significantly decreased gambling between baseline and Week 6, and it was associated with clinically significant reductions in gambling at Month 9. Between Week 6 and Month 9, MET plus cognitive-behavioral therapy evidenced significantly reduced gambling on 1 index compared with the control condition. These results suggest the efficacy of a very brief intervention for reduction of gambling among problem and pathological gamblers who are not actively seeking gambling treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Strength of commitment language in motivational interviewing and gambling outcomes.

The purpose of the present study was to examine the mechanisms by which the motivational interview (MI) is an effective treatment for pathological gambling. Forty MIs with pathological gamblers were transcribed and coded for language content and strength of expression. As hypothesized, participants who expressed stronger commitment to change their gambling behavior during the MI exhibited better gambling outcomes over 12 months than did those who expressed weaker commitment or no commitment to change their gambling behavior during the MI. Contrary to expectation, commitment strength in the latter part of the MI was not a stronger predictor of gambling outcome. Expression of desire, ability, need, reasons, and readiness for change were not predictive of outcome. Ability and readiness were associated with commitment. This study has important implications for clinical monitoring of client treatment success and for improving the MI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Increasing Substance Abuse Treatment Compliance for Persons With Traumatic Brain Injury.

This study compared 3 methods of increasing participation in substance abuse treatment for clients with traumatic brain injury. Participants (N = 195) were randomly assigned to 4 conditions: (a) motivational interview, (b) reduction of logistical barriers to attendance, (c) financial incentive, and (d) attention control. Four interviewers conducted structured, brief telephone interventions targeting the timeliness of signing an individualized service plan. Participants assigned to the barrier reduction (74%) and financial incentive (83%) groups were more likely to sign within 30 days compared with the motivational interview (45%) and attention control (45%) groups. Similar results were observed for time to signing, perfect attendance at appointments, and premature termination during the following 6 months. Extent of psychiatric symptoms was the only significant covariate. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive-behavioral therapy for pathological gamblers.

Few studies have evaluated efficacy of psychotherapies for pathological gambling. Pathological gamblers (N = 231) were randomly assigned to (a) referral to Gamblers Anonymous (GA), (b) GA referral plus a cognitive- behavioral (CB) workbook, or (c) GA referral plus 8 sessions of individual CB therapy. Gambling and related problems were assessed at baseline, 1 month later, posttreatment, and at 6- and 12-month follow-ups. CB treatment reduced gambling relative to GA referral alone during the treatment period and resulted in clinically significant improvements, with some effects maintained throughout follow-up ( ps = .05). Individual CB therapy improved some outcomes compared with the CB workbook. Attendance at GA and number of CB therapy sessions or workbook exercises completed were associated with gambling abstinence. These data suggest the efficacy of this CB therapy approach. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Randomized trial of internet-delivered self-help with telephone support for pathological gamblers.

Although effective therapies for pathological gambling exist, their uptake is limited to 10% of the target population. To lower the barriers for help seeking, the authors tested an online alternative in a randomized trial (N = 66). The participants were pathological gamblers not presenting with severe comorbid depression. A wait-list control was compared with an 8-week Internet-based cognitive behavior therapy program with minimal therapist contact via e-mail and weekly telephone calls of less than 15 min. Average time spent on each participant, including phone conversations, e-mail, and administration, was 4 hr. The Internet-based intervention resulted in favorable changes in pathological gambling, anxiety, depression, and quality of life. Composite between-group effect size (Cohen's d) at posttreatment was 0.83. Follow-ups carried out in the treatment group at 6, 18, and 36 months indicated that treatment effects were sustained (ds = 2.58, 1.96, and 1.98). This evidence is in support of Internet-delivered treatment for pathological gamblers. However, it is not clear how effective the treatment is for more severely depressed individuals. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Strike while the iron is hot: Can stepped-care treatments resurrect relapsing smokers?

The efficacies of 2 group counseling step-up treatments for smoking cessation, cognitive-behavioral/skill training therapy (CBT) and motivational interviewing/supportive (MIS) therapy, were compared with brief intervention (BI) treatment in a sample of 677 smokers. Differential efficacy of the 2 step-up treatments was also tested in smokers at low and high risk for relapse (no smoking vs. any smoking during the first postquit week, respectively). All participants received 8 weeks of nicotine patch therapy. BI consisted of 3 brief individual cessation counseling sessions; CBT and MIS participants received BI treatment and 6 group counseling sessions. Neither CBT nor MIS treatment improved long-term abstinence rates relative to BI. Limited support was found for the hypothesis that high-risk smokers would benefit more from MIS than CBT. Other hypotheses were not supported. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treatment of Pathological Gambling: A Critical Review of the Literature.

The legalization and availability of new forms of gambling are increasing in most Western countries. This trend has contributed to the fact that more individuals are developing gambling problems. As a result, there is a need for effective treatments. Although gambling treatment dates several decades, few empirically supported treatments for pathological gambling have been developed. This critical review includes only controlled treatment studies. The primary inclusion criterion was randomization of participants to an experimental group and to at least 1 control group. Eleven studies were identified and evaluated. Key findings showed that cognitive-behavioral studies received the best empirical support. Recommendations to improve gambling treatment research include better validated psychometric measures, inclusion of process measures, better definition of outcomes, and more precise definition of treatments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of A cognitive behavioural therapy program for problem gambling, therapist manual.

Reviews the book, A cognitive behavioural therapy program for problem gambling, therapist manual by Namrata Raylu and Tian Po Oei (2010). This book provides a session by session protocol for outpatient treatment of problem gambling. The protocol was developed for an efficacy study comparing individual and group treatment but has been repackaged for a broader audience. In the research study, both the individual and group participants showed good outcomes in comparison with a waiting list control with no differences between individual and group formats. This work adds to the growing evidence base for cognitive–behavioural and motivational treatments for gambling disorders. The treatment program comprises 10 core and 3 elective sessions. As with many CBT protocols, the first two sessions focus on assessment and psychoeducation. The remaining eight core sessions cover cognitive and behavioural strategies, relaxation, imaginal exposure, problem-solving skills, management of negative emotions, and relapse prevention. The three elective sessions focus on helping clients with assertiveness and dealing with debt, and helping concerned significant others cope with the gambling problems. As is indicated in the Preface, this manual is written for professional health workers with some knowledge of CBT but limited knowledge of problem gambling. The aim of providing the relevant background in gambling disorders is accomplished effectively in two ways. First, the book provides a concise but comprehensive review of the research literature on the etiology, maintenance, and treatment of gambling disorders in the second chapter. Second, a connection is made to the background literature in providing the rationale for specific areas of focus, interventions, and topics for each session. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Association between posttreatment gambling behavior and harm in pathological gamblers.

This study investigated the relationship between posttreatment gambling behavior and harm in a sample of treatment-seeking pathological gamblers. One year after initiating treatment, participants (n = 178) completed the Gambling Timeline Followback (D. C. Hodgins & K. Makarchuk, 2003; J. Weinstock, J. P. Whelan, & A. W. Meyers, 2004) and the South Oaks Gambling Screen (SOGS; H. R. Lesieur & S. B. Blume, 1987), both of which assessed gambling behaviors and problems over the prior 6 months. Based upon self-reports of gambling-related problems on the SOGS, participants were classified as problem free (SOGS scores = 0) or symptomatic gamblers (SOGS scores ≥ 1). Receiver operator characteristic curves evaluated classification by gambling behaviors for individuals classified in these 2 groups. Behavioral indicators for problem-free gambling were gambling no more than once per month, gambling for no more than 1.5 hr per month, and spending no more than 1.9% of monthly income on gambling. Alternative behavioral indicators were examined along a continuum of harm (SOGS cut-points of 1-5). These results provide preliminary data regarding intensity of gambling behavior associated with problem-free to probable pathological gambling in gamblers who presented for treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive changes in pathological gamblers following a 28-day inpatient program.

A cognitive explanation for pathological gambling (PG) posits that problem gambling behaviors are maintained by irrational beliefs and attitudes about gambling. However, it has never been shown that beliefs and attitudes about gambling are affected by treatment. This exploratory study examined the effect of a 28-day inpatient treatment program on beliefs and attitudes in pathological gamblers (PGs). The participants were 66 consecutive admissions to a Veterans Affairs inpatient program for PG. Participants completed a self-report measure of gambling-specific attitudes and beliefs at admission and again before discharge. Discharge scores indicated significant change (p ?     

Cognitive and behavioral treatment of pathological gambling: A controlled study.

This study evaluated the efficacy of a cognitive-behavioral treatment package for pathological gambling. Twenty-nine men who met criteria for pathological gambling in accordance with the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., revised; DSM-III-R; American Psychiatric Association, 1987) were randomly assigned to treatment or wait-list control. The treatment included 4 components: (a) cognitive correction of erroneous perceptions about gambling, (b) problem-solving training, (c) social skills training, and (d) relapse prevention. The dependent variables were the South Oaks Gambling Screen, perception of control, frequency of gambling, perceived self-efficacy, desire to gamble, and number of DSM-III-R criteria met by participants. Posttest results indicated highly significant changes in the treatment group on all outcome measures, and analysis of data from 6- and 12-month follow-ups revealed maintenance of therapeutic gains. Recommendations for clinical interventions are discussed and focus on the cognitive correction of erroneous perceptions of gambling. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Trusting problem gamblers: Reliability and validity of self-reported gambling behavior.

The retest reliability and validity of self-reported gambling behavior were assessed in 2 samples of problem gamblers. Days gambled and money spent gambling over a 6-month timeframe were reliable over a 2- to 3-week retest period using the timeline follow-back interview procedure (N=35; intraclass correlation coefficients [ICCs] ranged from .61 to .98). Gamblers did, however, report significantly more gambling at the 2nd interview. Agreement with collaterals was fair to good overall (ICCs ranged from .46 to .65) with no clear pattern of either over- or underreporting by gamblers. Spouses did not show greater agreement with gamblers compared with nonspouses, and greater agreement was not found for collaterals who were more versus less confident in their reports. The results are generally supportive of the use of self-reported gambling in studies of problem gamblers, assessed face to face and by telephone, although suggestions for further research are provided. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

How treatments for pathological gambling can be informed by treatments for substance use disorders.

Substance use disorders and pathological gambling share similarities in terms of diagnostic criteria, epidemiology, and clinical course. However, relatively few studies have evaluated the efficacy of treatments for gambling disorders. As interest in pathological gambling grows, adaptation of effective treatments from the field of substance abuse may advance the study of treatment for pathological gambling. This article reviews the similarities and differences between pathological gambling and substance use disorders. It describes psychotherapeutic and pharmacological treatments for substance use disorders and their translation to pathological gambling. Future research should consider investigating the onset and course of pathological gambling within the context of other psychiatric disorders, biological abnormalities associated with gambling, and combined effects of psychotherapy and pharmacotherapy in the treatment of this disorder. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Familial influences on gambling behavior: an analysis of 3359 twin pairs

BACKGROUND: Pathological gambling is becoming an increasing problem in the United States as the number of legalized gambling establishments grows. To examine vulnerability to pathological gambling, we estimated the familial contributions (i.e. inherited factors and/or experiences shared by twin siblings during childhood) to DSM-III-R pathological gambling symptoms and disorder. METHODS: Data were obtained from a telephone interview performed in 1991-92 utilizing the Diagnostic Interview Schedule Version III-Revised. Interviews were administered to 6718 members of the nationally distributed Vietnam Era Twin Registry of male-male monozygotic and dizygotic twin pairs who served in the military during the Vietnam era. RESULTS: Inherited factors explain between 35% (95% CI: 28%, 42%) and 54% (95% CI: 39%, 67%) of the liability for the five individual symptoms of pathological gambling behavior that could be estimated statistically. In addition, familial factors explain 56% (95% CI: 36%, 71%) of the report of three or more symptoms of pathological gambling and 62% (95% CI: 40%, 79%) of the diagnosis of pathological gambling disorder (four or more symptoms). CONCLUSIONS: Familial factors have an important influence on risk for pathological gambling behavior. The increasing access to legalized gambling is likely to result in a higher prevalence of pathological gambling behavior among individuals who are more vulnerable because of familial factors.     

Development and psychometric evaluation of the gambling treatment outcome monitoring system (GAMTOMS).

This article describes the development and initial reliability and validity estimates of the Gambling Treatment Outcome Monitoring System (GAMTOMS), a multi-instrument and multidimensional outcome assessment battery designed to measure gambling treatment outcomes. Reliability methods included both internal consistency of scales and a 1-week test-retest temporal stability procedure. Validity was examined with procedures to estimate content, convergent, discriminant, predictive, and construct validity. Data were collected from 2 separate studies, 1 on the questionnaire version and 1 on the interview version. The questionnaire study included 46 female and 41 male gambling treatment clients and 22 female and 2 male nonclinical participants. The interview study included 88 female and 62 male gambling treatment clients and 16 female and 9 male nonclinical participants. The GAMTOMS was found to yield satisfactory estimates of internal consistency, and 1-week test-retest reliability and was also found to demonstrate satisfactory content, convergent, discriminant, predictive, and construct validity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Brief Treatments for Cannabis Dependence: Findings From a Randomized Multisite Trial.

This study evaluated the efficacy of 2 brief interventions for cannabis-dependent adults. A multisite randomized controlled trial compared cannabis use outcomes across 3 study conditions: (a) 2 sessions of motivational enhancement therapy (MET); (b) 9 sessions of multicomponent therapy that included MET, cognitive-behavioral therapy, and case management; and (c) a delayed treatment control (DTC) condition. Participants were 450 adult marijuana smokers with a Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) diagnosis of cannabis dependence. Assessments were conducted at baseline, and at 4, 9, and 15 months postrandomization. The 9-session treatment reduced marijuana smoking and associated consequences significantly more than the 2-session treatment, which also reduced marijuana use relative to the DTC condition. Most differences between treatments were maintained over the follow-up period. Discussion focuses on the relative efficacy of these brief treatments and the clinical significance of the observed changes in marijuana use. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Randomized controlled trial of motivational enhancement therapy with nontreatment-seeking adolescent cannabis users: A further test of the teen marijuana check-up.

Cannabis use adversely affects adolescents and interventions that are attractive to adolescents are needed. This trial compared the effects of a brief motivational intervention for cannabis use with a brief educational feedback control and a no-assessment control. Participants were randomized into one of three treatment conditions: Motivational Enhancement Therapy (MET), Educational Feedback Control (EFC), or Delayed Feedback Control (DFC). Those who were assigned to MET and EFC were administered a computerized baseline assessment immediately following randomization and completed assessments at the 3- and 12-month follow-up periods. Participants in the DFC condition were not assessed until the 3-month follow-up. Following the completion of treatment sessions, all participants were offered up to four optional individual treatment sessions aimed at cessation of cannabis use. The research was conducted in high schools in Seattle, Washington. The participant s included 310 self-referred adolescents who smoked cannabis regularly. The main outcome measures included days of cannabis use, associated negative consequences, and engagement in additional treatment. At the 3-month follow-up, participants in both the MET and EFC conditions reported significantly fewer days of cannabis use and negative consequences compared to those in the DFC. The frequency of cannabis use was less in MET relative to EFC at 3 months, but it did not translate to differences in negative consequences. Reductions in use and problems were sustained at 12 months, but there were no differences between MET and EFC interventions. Engagement in additional treatment was minimal and did not differ by condition. Brief interventions can attract adolescent cannabis users and have positive impacts on them, but the mechanisms of the effects are yet to be identified. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Predictors of engaging in problem gambling treatment: Data from the West Virginia Problem Gamblers Help Network.

Gambling help-lines are an essential access point, or frontline resource, for treatment seeking. This study investigated treatment engagement after calling a gambling help-line. From 2000–2007 over 2,900 unique callers were offered an in-person assessment appointment. Logistic regression analyses assessed predictors of (a) accepting the referral to the in-person assessment appointment and (b) attending the in-person assessment appointment. Over 76% of callers accepted the referral and 55% of all callers attended the in-person assessment appointment. This treatment engagement rate is higher than typically found for other help-lines. Demographic factors and clinical factors such as gender, severity of gambling problems, amount of gambling debt, and coercion by legal and social networks predicted engagement in treatment. Programmatic factors such as offering an appointment within 72 hr also aided treatment engagement. Results suggest gambling help-lines can be a convenient and confidential way for many individuals with gambling problems to access gambling-specific treatment. Alternative services such as telephone counseling may be beneficial for those who do not engage in treatment. (PsycINFO Database Record (c) 2011 APA, all rights reserved)