Factors Associated with Recent Suicide Attempts in Clients Presenting for Addiction Treatment

Factors associated with recent suicide attempts were examined in clients who sought treatment at an addictions facility between 2001 and 2008. Clients who reported being hospitalized for attempting suicide in the past year (n = 76) were compared to all other clients (n = 5914) on demographic, mental health, substance use, and problem gambling variables. Compared to all other clients, clients who attempted suicide were significantly less educated, and more likely to have major depressive disorder, a bipolar disorder, ADHD, a personality disorder, or a gambling problem. While mental health issues have long been linked with suicide, new research, such as the present study, continues to find associations between gambling and suicide. With the strong relationship between mood disorders and gambling, these findings support continued research into the possible connection between gambling and suicide.     

Differences in Addiction Severity Between Social and Probable Pathological Gamblers Among Substance Abusers in Treatment in Rio de Janeiro

There is a strong association between pathological gambling and substance abuse. The objective of this study is to identify the differences between substance abusers with and without gambling problems. A cross sectional study was conducted interviewing with Addition Severity Index (ASI) and South Oaks Gambling Screen (SOGS), alcohol and drug abusers (N = 147) who sought treatment in specialized treatment facilities. SOGS was used to access and classify individuals into two groups: social gamblers (n = 96) and probable pathological gamblers (n = 32). Scores on ASI provided data about severity on seven areas. Several differences were found between the two groups. Cocaine was the major reason for treatment among drug abusers with gambling problems. This group had more severity problems in the areas of drug use, psychiatric, legal and family-social. Furthermore, they had more suicidal ideas, parents with gambling problems and started to play earlier than the social gamblers group. These results indicate the need to improve the services that provide treatment to alcohol and drug abusers, including routines for screening to early identification and professional education on specific treatment to substance abusers with pathological gambling.     

Factors Associated with the Severity of Gambling Problems in a Community Gambling Treatment Agency

Factors (demographics, gambling behaviors and comorbid problems) that may be related to the severity of gambling problems were investigated among 440 problem gamblers seeking treatment in an Australian outpatient treatment agency. The participants were divided into sub-threshold pathological gamblers (SPGs; N = 104) and pathological gamblers (PGs; N = 336) using Diagnostic Statistical Manual (DSM) IV diagnosis of pathological gambling. SPGs were more likely to be separated/divorced, while PGs were more likely to be single. PGs tended to be younger than SPGs. Participation in lottery games was the only form of gambling that could distinguish between the two severity groups. No significant differences were found in participation in more than one gambling session per week and average amount spent per session on various gambling activities between the two groups. PGs were more likely to report financial, relationship, employment, physical, intrapersonal, other excessive behaviors (e.g., substance problems), leisure (e.g., loneliness, boredom) and legal problems than SPGs. Implications and limitations of these findings are discussed.     

Abstinence Versus Harm Reduction: Considering Follow-up and Aftercare in First Nations Addictions Treatment

Research on alcohol and substance use in First Nations populations frequently describes the nature of the problem, and the severity of the risk factors, but seldom addresses possible interventions and the effectiveness of the treatments that clients do engage in. This paper reviews a participatory evaluation of the 6-week residential ‘Namgis Treatment Centre (NTC) program in Alert Bay, British Columbia. Intake files (n = 218) were reviewed for clients who participated in 17 different 6-week sessions over a period of two and a half years. The assessment included a telephone follow-up survey, developed in conjunction with all of the NTC staff, for clients who had been out of treatment for 3–37 months (n = 91, 52.7% male and 47.3% female participants). In total, 24 clients (26.37%) were abstinent at the time of the interview, and 67 clients (73.6%) had had a relapse on average 155.29 (SD = 167.77) days after completing treatment. Cox regression univariate and bivariate analysis revealed that pre-treatment variables were not associated with time to relapse or what happened after relapse (abstinence again, harm reduction or resuming pre-treatment consumption levels). However, the greater number of supports the client had, the more likely they were to be completely abstinent, and the less supports the client had, the more likely they were to completely relapse. NTC staff and community members were consulted on the implications of the data, and recommendations were shared with NTC policy makers. Based on the findings of this project, it is apparent, that in this context, follow-up and aftercare are critical for effective treatment.     

Randomized control trial of an integrated therapy for comorbid anger and gambling

Abstract

This study evaluated an integrated treatment for comorbid problem gambling, anger, and substance use. Problem gamblers with comorbid anger problems (N=42), half of whom also had substance use disorders, were randomized to either a 14-week integrated treatment targeting anger and addictions (i.e., both gambling and substance use) or a specialized treatment-as-usual (TAU) for gambling and substance use. Participants were assessed at baseline (Tl), 14 weeks (T2), and 12 weeks follow-up (T3). Relative to the TAU, participants in the integrated anger and addictions treatment reported significantly less gambling at T2 and T3 and less trait anger and substance use at T3. Findings suggest that it is important to screen gambling clients for the presence of comorbid anger and substance use problems and that, when present, these problems need to be addressed concurrently in gambling treatment in order to optimize treatment outcomes.     

Individual characteristics of the literally homeless,marginally housed,and impoverished in a US substance abuse treatment-seeking sample

Background  Many researchers and clinicians believe that understanding substance use problems is key to understanding homelessness. This study’s purpose was to test, in a national sample of urban substance abuse treatment seekers, whether (1) income was related to amount of money spent on substances and (2) homeless chronic substance users had more severe psychosocial problems or histories than housed chronic substance users. Method  Questions assessing homelessness were inserted into the Drug Evaluation Network System—a computer-assisted intake interview (including the Addiction Severity Index) implemented in addiction treatment programs across the U.S. Based on these data, clients were divided into four residential groups: literally homeless (n = 654), marginally housed (n = 1138), housed poor (n = 3119), and housed not poor (n = 718). Income, human capital (education level and acquisition of a trade/skill), substance use, mental health, and social support were examined. Results  The literally homeless was not the poorest group, although these clients did spend the most money on substances. All four groups’ incomes were positively related to amount of money spent on drugs, but only the marginally housed’s income was related to money spent on alcohol. The literally homeless had the most severe alcohol, mental health, and social support problems. The literally homeless and marginally housed had similar incomes and human capital and the most severe cocaine problems. In general the housed poor and housed not poor fared better than the literally homeless and marginally housed groups. Discussion  Practitioners should continue to intervene with the homeless and consider working with the marginally housed’s social support systems. Future research should examine the marginally housed as an at-risk group for homelessness.     

Internet Gambling, Health, Smoking and Alcohol Use: Findings from the 2007 British Gambling Prevalence Survey

This study provides analysis of a representative national sample of Internet gamblers. Using participant data from the 2007 British Gambling Prevalence Survey (n = 9003 adults aged 16 years and over), all participants who had gambled online, bet online, and/or who had used a betting exchange in the last 12 months (6% of the total sample) were compared with all other gamblers who had not gambled via the Internet (62% of the sample). Results showed that Internet gambling and non-Internet gambling had a significant association with smoking (nicotine) and drinking (alcohol). Self-reported general health status was not significantly associated with Internet gambling but was significantly associated with offline gambling. Analysis of DSM-IV scores showed that problem gambling prevalence rate was significantly higher among Internet gamblers than non-Internet gamblers (5% versus 0.5%) and that Internet gamblers were significantly more likely to endorse individual DSM-IV items compared to non-Internet gamblers.     

Internet Gambling Behavior in a Sample of Online Gamblers

The present study examined Internet gambling behavior in a sample of online gamblers. Participants (N = 563; 382 male; ages 18–over 65) were recruited from a banner placed in an online newsletter. Questionnaires were completed online and assessed demographic information, game-play patterns (e.g., frequency, duration, wagering), preferred type of play, and problem gambling (using the DSM-IV). In addition, participation in gambling-type games without money was also examined. Seventy-seven percent of respondents reported playing gambling-type games without money and 42% reported gambling on the Internet. Twenty-three percent of participants were identified as problem gamblers. Problem gamblers were significantly more likely than social gamblers to spend more time gambling per session, gamble alone, from school, or with a cell phone, gamble with more money, wager online while consuming alcohol or illicit drugs, and lose more money gambling online. These results hint at a disturbing and difficult relationship between the Internet and individuals with gambling problems.

Opportunity Structure for Gambling and Problem Gambling Among Employees in the Transport Industry

Working conditions for employees in the transport sector might present an opportunity structure for gambling by providing access to gambling during the workday. This study investigates connections between opportunity structure, gambling during the workday, and gambling problems among employees in the transport sector. Data has been collected from three different transport organizations in Norway: bus, truck, and taxi drivers (N = 1033). 6.8% of the sample gambled during working hours and 3.2% of the employees could be characterized as having a gambling problem. We found a positive relationship between opportunities to gamble during working hours and problem gambling, with the odds for problem gambling increasing fourteen-fold if employees gambled during working hours. Gambling during the workday is a major risk factor for gambling problems in this sample.

Distinct Neurochemical Profiles of Spinocerebellar Ataxias 1, 2, 6, and Cerebellar Multiple System Atrophy

Hereditary and sporadic neurodegenerative ataxias are movement disorders that affect the cerebellum. Robust and objective biomarkers are critical for treatment trials of ataxias. In addition, such biomarkers may help discriminate between ataxia subtypes because these diseases display substantial overlap in clinical presentation and conventional MRI. Profiles of 10–13 neurochemical concentrations obtained in vivo by high field proton magnetic resonance spectroscopy (¹H MRS) can potentially provide ataxia-type specific biomarkers. We compared cerebellar and brainstem neurochemical profiles measured at 4 T from 26 patients with spinocerebellar ataxias (SCA1, N = 9; SCA2, N = 7; SCA6, N = 5) or cerebellar multiple system atrophy (MSA-C, N = 5) and 15 age-matched healthy controls. The Scale for the Assessment and Rating of Ataxia (SARA) was used to assess disease severity. The patterns of neurochemical alterations relative to controls differed between ataxia types. Myo-inositol levels in the vermis, myo-inositol, total N-acetylaspartate, total creatine, glutamate, glutamine in the cerebellar hemispheres and myo-inositol, total N-acetylaspartate, glutamate in the pons were significantly different between patient groups (Bonferroni corrected p < 0.05). The best MRS predictors were selected by a tree classification procedure and lead to 89% accurate classification of all subjects while the SARA scores overlapped considerably between patient groups. Therefore, this study demonstrated multiple neurochemical alterations in SCAs and MSA-C relative to controls and the potential for these neurochemical levels to differentiate ataxia types. Studies with higher numbers of patients and other ataxias are warranted to further investigate the clinical utility of neurochemical levels as measured by high-field MRS as ataxia biomarkers.     

Don’t Let an Opportunity Go by: Validation of the EIGHT Gambling Screen

The EIGHT Screen is a brief problem gambling screen originally designed for use by family doctors. Its wider use indicated the need for further validation. A triangulated approach used a range of measures in different settings in both the current study and findings from a number of earlier projects, and reviewed current use. The EIGHT Screen had acceptable correlations with the SOGS (r = 74–90%) and with the NODS-12 months Screen (r = 62.4%). Measurements remained relatively constant amongst a range of cultures, settings, age and gender, while few false positives were produced by the screen. The EIGHT Screen appears to be a valid tool for untrained users to identify Level 2 and 3 problem gambling in a wide range of cultures and settings.     

Childhood Adverse Events and Health Outcomes Among Methamphetamine-Dependent Men and Women

To describe the prevalence of childhood adverse events (CAEs) among methamphetamine-dependent men and women, and assess the relationship of cumulative CAEs to health problems. Data for 236 men and 351 women were analyzed assessing CAEs. Dependent variables included 14 self-reported health problems or psychiatric symptom domains. Mental health was assessed via the Mini-International Neuropsychiatric Interview. Medical conditions were collected using the Health Status Survey. Women reported more cumulative exposure to CAEs than men (28% vs. 13%, p < 0.01). Regressions showed the impact of CAEs on health is strong for both men and women. Yet, women were more likely than men to have 7 out of 14 health problems, independent of their reported abuse (ranging from a positive OR for suicidality = 1.63 to a positive OR for bladder/bowel disease = 6.09). Substance abuse treatment programs should prioritize individual treatment plans and enhance multi-agency collaborations to provide referrals and community networks that offer clients appropriate trauma-based psychiatric and/or medical treatment.

The Prevalence,Mental Health and Criminal Characteristics of Potential Problem Gamblers in a Substance Using Treatment Seeking Population

Some recent evidence suggests that problem gambling presents at elevated rates among treatment samples of substance users; if so, there may be significant implications for treatment. This study utilised a retrospective clinical case file review of all clients assessed for entry into a residential substance use service in Australia over a calendar year. Fifty-seven (21.4 %) of the 266 participants were classified as potential problem gamblers. Potential problem gamblers (PPGs) were not associated with increased psychological and social vulnerability; but displayed phenomenology divergent from single substance addiction, indicative of impulsivity. PPGs were more likely to be male, have a personality disorder, and be associated with a broader pattern of criminality, particularly crimes associated with financial gain. These findings challenge the recent re-conceptualisation of problem gambling, suggesting that problem gambling within treatment populations of substance users should be treated as a disorder adjacent to substance addiction, associated with distinct and specific phenomenology.     

Lagos “Area Boys”, Substance Usage and Potential Risk Factors

The current study explores the rate at which members of Lagos’ “area boys” engage in drug and alcohol use, and determines the predictive roles of parental and neighbourhood characteristics in the gang patterns of psychoactive substance misuse behaviour. The study approached gang members (N = 129) aged from 18 to 38 years (M = 25.83, SD = 4.82) through a snowballing (non probability) sampling method. Adopting a quantitative analytic technique, the results showed cannabis and alcohol as substance of choice with other improvised local drug concoctions being taken by some participants. The role of parental and neighbourhood characteristics as probable risk factors are described. The implications of the findings for rehabilitation service for the gang members are discussed.     

Gambling Trends in the State of New Mexico: 1996–1998

New Mexico experienced a surge in the gaming industry during the mid-1990s with the initiation of a state lottery and other new gaming opportunities, as well as the development of many Indian gaming establishments. This paper explores patterns associated with gambling in two random samples of the adult population (N = 2674) in the entire State of New Mexico in 1996 and 1998. Specifically, the purpose of this paper is to describe the relationship between gambling and such variables as age, gender, and ethnicity. Overall, an increase occurred in the number of people who reported having ever gambled, from 86.4% in 1996 to 92.5% in 1998. From 1996 to 1998, respondents’ reports of their past month gambling showed that certain forms of gambling (e.g., playing cards and betting on animals for money) decreased, while other forms of gambling either remained unchanged or increased in frequency (e.g., sports and investment gambling). The relationship of gender and age to gambling was also examined. Survey results indicated that while males and females reported many similar gambling habits, there are gender differences, particularly with regard to investment gambling. Specifically, females show a greater increase in investment gambling from 1996 to 1998, than do males. Overall results indicate a small positive correlation between age and dollar amount spent on gambling in the past month. In addition, ethnicity and age-specific patterns for certain forms of gambling are described.     

Dual diagnosis in the suburbs: prevalence, need, and in-patient service use

  Background: Previous research has found comorbid severe mental illness and substance misuse (dual diagnosis) to be highly prevalent and to be associated with serious clinical and social problems, and increased service use in inner-city populations. The present study measures the prevalence of dual diagnosis, patterns of substance misuse, and associated in-patient use in a more demographically representative population in a suburban area of South London Method: We identified representative prevalent cases with psychotic illnesses who had been in contact with services in a geographically defined catchment area in Croydon over the previous 6 months. Cases of alcohol or substance misuse and dependence were identified through standardised interviews with patients and keyworkers, and socio- demographic and in-patient psychiatric service use data were also recorded. Results: Sixty-one of the 124 cases identified were randomly selected for interview, of whom 66% responded (N = 40). The prevalence rates of dual diagnosis (DD) observed were 33% (95% CI 18–47%) for any substance misuse, 20% (95% CI 8–32%) for alcohol misuse only, 5% (95% CI −16 to 26%) for drug misuse only, and 8% (95% CI −0.7 to 16%) for both drug and alcohol misuse. A lifetime history of any illicit drug use was observed in 35% of the sample (95% CI 20–50%). Patients who misuse alcohol and drugs were not found to be more likely to have been admitted to hospital in the previous 2 years, with little difference being observed between DD and psychosis-only patients in the mean number of in-patient admissions in this period (mean difference 0.25, 95% CI for difference −1.5 to 2.0). However, the DD patients were found to have spent on average over twice as long in hospital as other psychotic in-patients over the previous 2 years (mean difference 67.3 days, 95% CI for difference −205.9 to 71.2 days). DD patients were also found to have a greater number of unmet areas of need than the psychosis-only patients, which included accommodation, daytime activity, and social life, as well as substance misuse. Conclusions: The prevalence of substance misuse in patients with severe mental disorders in a suburban area is about as high as that for similar patients in inner-city London. While DD patients are not admitted more often than patients with psychosis alone, they have double the length of in-patient stay, which may be attributable to higher levels of unmet need. Accepted: 6 April 2000     

The Relationship Between Post-Traumatic Stress Symptoms and Substance Use Among Adolescents Involved with Child Welfare: Implications for Emerging Adulthood

The purpose of the present study was to examine the role of posttraumatic stress symptoms (PTSS) in predicting substance use and substance-related problems in a sample of older youth and emerging adults involved with child welfare. The sample was drawn from the Maltreatment and Adolescent Pathways (MAP) longitudinal study (Wekerle et al. 2009). Participants were 253 youth and emerging adults (ages 15–20; M = 16.87, SD = 1.04; 61.4% female and 38.6% male) who were involved with child welfare. Multiple regression analyses were conducted to examine the impact of PTSS using subscales from the Trauma Symptom Checklist for Children (TSCC; Briere 1996). Outcome variables were past year alcohol, marijuana and illicit drug use; as well as alcohol and drug problems. Controlling for gender, age, child welfare status and child maltreatment, both dissociation and anger emerged as significant predictors of substance use and related problems. The implications of these findings for older youth and emerging adults exiting the child welfare system are discussed.     

Characteristics of Treatment Seeking Problem Gamblers with Adult ADHD

The present study investigates characteristics of treatment seeking problem gamblers with adult ADHD (n = 39) and those without ADHD (n = 87). Patients completed self-report questionnaires about gambling behaviors, impulsivity (UPPS-P), substance abuse (AUDIT/DAST), emotional dysregulation (PHQ-4), illegal activities, and gambling consequences. Each patient received a structured diagnostic interview (MINI) to assess for psychopathology, adult ADHD (ACDS), and gambling disorder (NODS). Results revealed that problem gamblers with adult ADHD encounter unique challenges above those common among problem gamblers including more problems with alcohol/drug abuse and higher levels of impulsivity. Earlier age for first gambling activities, onset of gambling problems, and higher severity of gambling problems was found among gamblers with ADHD. Gamblers with ADHD pawned more items to obtain money for gambling, were more likely to have debt, had significantly higher rates of bankruptcy and domestic violence arising from conflict with family members about their gambling. Interestingly, groups did not differ significantly on their time spent gambling prior to treatment, their win-to-loss ratio, and a number of other gambling-related consequences. These findings are discussed with their clinical ramifications for treatment.