Advertisement

Topics

Pilot Randomized Control Trial of an SBIRT Intervention for Gambling Behaviors

2017-09-20 01:53:21 | BioPortfolio

Summary

Disordered gambling, like substance misuse, has been associated with various medical problems and adverse health outcomes. The Maryland Center of Excellence on Problem Gambling, along with experts in the fields of disordered gambling and behavior change, will work with the Maryland State Department of Health and Mental Hygiene's Behavioral Health Administration to develop a problem gambling-specific Screening, Brief Intervention and Referral to Treatment (SBIRT) intervention targeting individuals receiving medical care in general primary care clinics. We will evaluate the feasibility and acceptability of inserting the problem gambling intervention in to preexisting substance use SBIRT services being provided in clinics in the state. In addition, we will establish a clinic prevalence for gambling and finally, conduct a randomized trial using the problem gambling SBIRT intervention to see if it is effective in helping patients reduce their problematic gambling behaviors.

Description

The Substance Abuse and Mental Health Services Administration (SAMHSA) has made health care and health systems integration one of its main priorities to ensure that behavioral health is consistently incorporated within the context of health care delivery systems. However, this initiative has been focused on substance use disorders and mental health disorders that have not included gambling disorder. Disordered gambling (DG) is highly associated with substance use disorders, severe mental illness, depression, domestic violence and suicide7-12. Disordered gambling has also been linked with adverse health conditions and behaviors 1;13;14. Morasco et al. 15, in their analysis of data from the National Epidemiologic Survey of Alcohol and Related Conditions (NESARC), found that persons with DG were more likely to have a range of medical problems including tachycardia, angina, cirrhosis or other liver disease. Even moderate levels of gambling along with more severe levels of DG have been associated with adverse health consequences and unhealthy life style factors. Morasco et al.15 report that at risk gamblers (defined as gambling five or more times in the past 12 months) who they estimate compose 25% of the population, were more likely to have experienced a severe injury in the past year, receive emergency room treatment, have hypertension, be obese, have histories of mood, anxiety, alcohol use and nicotine use disorders. In a more recent study, Black et al.13 found individuals with DG were at higher risk for chronic medical conditions including obesity, heartburn/stomach conditions, headaches, head injury with loss of consciousness, sleep disorders, mood/emotional concerns, and anxiety, tension or stress. Individuals in the DG group also were more likely to have poorer health habits. They were more likely to avoid exercise, to drink alcohol while pregnant, smoke greater than or equal to a pack of cigarettes per day to drink 5 or more servings of caffeine a day and to watch 20 or more hours of television weekly. Subjects meeting DG criteria in this study were also less likely to have regular dental check-ups and more likely to delay medical care for financial reasons. Additionally the DG subjects were more likely to have at least one emergency room visit and at least one hospitalization for mental health reasons in the past year.

Individuals with gambling problems have been found to utilize medical and behavioral health services at higher rates 13;15.

Studies have also reported significant rates of gambling and problem gambling in primary care settings. Pasternak and Fleming14 in a study of 1051 patients in primary care, that 80% had gambled and 6.2% met criteria for problem gambling (score of 3 or more on South Oaks Gambling Screen, SOGS). Additionally they report that gambling disorder was even more prevalent among nonwhites and those from lower socioeconomic groups. In a study of individuals receiving free or reduced-cost dental care, Morasco & Petry16 found rates of problem gambling to be significantly higher than the general population. In their sample, among those receiving disability, 26% met criteria for disordered gambling and among those not receiving disability 14% met criteria based on SOGS scores. Other studies have found prevalence rates of gambling problems of between 3 and 5%17;18 in primary care settings. However, these studies did not include any frequency of gambling items nor an explanation of the range of behaviors meant by "gambling" and have not included the less severe "at risk" gamblers. This study will also address the need to improve the effectiveness of DG screening strategies in actual clinical practice and to effectively identify not just those individuals who are exhibiting multiple symptoms of gambling disorder but those fall into an "at risk" level of gambling that has been associated with multiple poor health outcomes.

A prevalence study conducted in Maryland19 supports the likelihood of significant health issues among those who are identified as at risk, problem or disordered gamblers. This study found that 90% of adults in Maryland had gambled in their lifetimes. Over 21% had gambled at least monthly in the past 12 months which would fit the definition of at risk gambling group that compromised 25% of the subjects in the NESARC study20 who presented increased medical issues and utilization. Those who had ever gambled as well the at risk and problem gambling groups in the Maryland survey also reported higher levels of health risk behaviors (i.e. higher alcohol intake, more frequent drug use, daily smoking) and reported poorer health status. The rates of problem/pathological gambling for all adults was found to be 3.4% and at risk gambling 9%. African Americans(17.3%) were found to have a significantly higher rate of at risk as well as problem and disordered gambling compared to other ethic/racial groups (10.2% white, 11.7% other ethnic/racial combined). The lowest socioeconomic group was also found to have the highest rates of problem/pathological gambling (15%). Therefore, conducting gambling specific screening and brief intervention in these high risk groups within Maryland is strongly indicated.

While the research as sited above clearly indicates that individuals who are experiencing gambling related harms in their lives are likely to experience higher rates of medical and behavioral health problems and utilize health care services, they are not necessarily likely to seek specific help for gambling problems 21;22. Strikingly, Kessler et al21 reported that while nearly half of their large national sample who met criteria for lifetime gambling disorder received treatment for mental health or substance use disorders, none had received any specific treatment for gambling problems. Indeed, it is estimated that only between 1 to 3% of individuals nationwide who meet criteria for gambling disorder access gambling specific treatment services 23.While this is in part due to internal factors in individuals with gambling disorder such as desire to resolve problems on their own, shame, guilt and denial 24;25, there are also provider/institutional factors that are significant. Primary among these is the absence of screening for gambling problems.

Screening, Brief Intervention and Referral to Treatment (SBIRT) is an evidence based, public health approach for delivery of early intervention services in medical and primary care settings for individuals at risk for or experiencing substance use disorders. The most extensive research evidence for the effectiveness of this approach has been with those presenting indicators of alcohol abuse 26-28. Additionally Brief interventions (BI) have been found to be effective for a range of non-alcohol substance abuse issues 29-31. While many studies have demonstrated that brief interventions with disordered gamblers are effective 2-4, these studies have not focused on identifying or providing brief interventions in actual clinical or primary care settings. Research has suggested that there are considerable clinician 32as well as client factors33-36 that contribute to reluctance to address the topic of gambling practice. To our knowledge no study has sought to obtain both client and clinician input into the content and process feasibility of providing screening and intervention for risk for GD in real clinical settings to address clinician and client concerns.

Both research and treatment provider surveys have demonstrated that only a very small percentage of individuals who experience gambling related harms are likely to seek treatment. Furthermore, there is evidence that at risk gamblers who may comprise 20-25% of the adult population are likely to experience increase levels of health related problems and utilize health care services at higher rates than non/low-risk gamblers. However, has been little to no research on how to effectively screen for risk for gambling in health care settings.

Study Design

Conditions

Gambling Disorder

Intervention

SBIRT for Gambing

Location

University of Maryland Medical Center, Midtown Campus
Baltimore
Maryland
United States
21210

Status

Not yet recruiting

Source

University of Maryland

Results (where available)

View Results

Links

Published on BioPortfolio: 2017-09-20T01:53:21-0400

Clinical Trials [533 Associated Clinical Trials listed on BioPortfolio]

Effects of Intranasal Naloxone on Gambling Urges and Craving in Gambling Disorder

Primary objective: *To determine whether treatment with naloxone hydrochloride nasal spray reduces gambling urge symptoms in patients with gambling disorder The secondary objective...

BANCO Study: Behavioral Addictions and Related NeuroCOgnitive Aspects: A Monocentric, Prospective, Controlled, Open-label Study of a Sample of Patients With Gambling Disorder

The prevalence of people suffering from gambling disorder is relatively high, and the impact on this disorder the individual and those around him is considerable. The etiopathogenic model ...

Online Coping Skills Counseling for Problem Gambling and Trauma

This randomized controlled trial examines the efficacy of two behavioral therapies. Seeking Safety, which addresses co-occurring problem gambling (PG) and posttraumatic stress disorder (PT...

Acamprosate in the Treatment of Pathological Gambling

The purpose of this study is to see whether acamprosate (Campral) will curb the desire to gamble in people with pathological gambling disorder.

Memantine Treatment Study of Pathological Gambling

The goal of the proposed study is to evaluate the efficacy and safety of the drug memantine in individuals with pathological gambling (PG). Thirty subjects with DSM-IV PG will receive 10 w...

PubMed Articles [4284 Associated PubMed Articles listed on BioPortfolio]

Decision making measured by the Iowa Gambling Task in alcohol use disorder and gambling disorder: a systematic review and meta-analysis.

Gambling disorder (GD) and alcohol use disorder (AD) have similar features, such as elevated impulsivity and decision-making deficits, which are directly linked to relapse and poor therapeutic outcome...

Gambling-related cognitive distortions predict level of function among US veterans seeking treatment for gambling disorders.

Gambling Disorder (GD) is characterized by recurrent gambling behavior that is associated with significant impairment and distress, high psychiatric comorbidities, and high functional disability. The ...

Gambling Disorder in Veterans: A Review of the Literature and Implications for Future Research.

To review the scientific literature examining gambling behavior in military veterans in order to summarize factors associated with gambling behavior in this population. Database searches were employed...

The intergenerational transmission of problem gambling: The mediating role of offspring gambling expectancies and motives.

The risk for developing a gambling problem is greater among offspring who have a problem gambling parent, yet little research has directly examined the mechanisms by which this transmission of problem...

Predictors of early dropout in treatment for gambling disorder: The role of personality disorders and clinical syndromes.

Several treatment options for gambling disorder (GD) have been tested in recent years; however dropout levels still remain high. This study aims to evaluate whether the presence of psychiatric comorbi...

Medical and Biotech [MESH] Definitions

An activity distinguished primarily by an element of risk in trying to obtain a desired goal, e.g., playing a game of chance for money.

A disorder whose predominant feature is a loss or alteration in physical functioning that suggests a physical disorder but that is actually a direct expression of a psychological conflict or need.

In statistics, a technique for numerically approximating the solution of a mathematical problem by studying the distribution of some random variable, often generated by a computer. The name alludes to the randomness characteristic of the games of chance played at the gambling casinos in Monte Carlo. (From Random House Unabridged Dictionary, 2d ed, 1993)

A personality disorder whose essential feature is a pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood or early adolescence and continues into adulthood. The individual must be at least age 18 and must have a history of some symptoms of CONDUCT DISORDER before age 15. (From DSM-IV, 1994)

A disorder beginning in childhood. It is marked by the presence of markedly abnormal or impaired development in social interaction and communication and a markedly restricted repertoire of activity and interest. Manifestations of the disorder vary greatly depending on the developmental level and chronological age of the individual. (DSM-IV)

More From BioPortfolio on "Pilot Randomized Control Trial of an SBIRT Intervention for Gambling Behaviors"

Advertisement
Quick Search
Advertisement
Advertisement

 

Relevant Topics

Food
Food is any substance consumed to provide nutritional support for the body. It is usually of plant or animal origin, and contains essential nutrients, such as carbohydrates, fats, proteins, vitamins, or minerals. The substance is ingested by an organism ...

Mental Health
Adhd Anorexia Depression Dyslexia Mental Health Psychiatry Schizophrenia Stress Mental health, although not being as obvious as physical health, is very important, causing great unhappiness to those affected, causing add...

Psychiatry
Psychiatry is the study of mental disorders and their diagnosis, management and prevention.  Conditions include schizophrenia, severe depression and panic disorders among others. There are pharmaceutical treatments as well as other therapies to help...


Searches Linking to this Trial