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Treatment

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The Treatment of Problem and Pathological Gambling in New Brunswick: Approaches to Establishing Services. Rachel A. Volberg. Gemini Research, December 28, 1992. The study found that 87 percent of the population has participated in gaming. Additionally, problem and probable pathological gamblers were more likely to be men, under the age of 35, unemployed and never married than the general population. They are also less likely to have graduated from high school and more likely to be earning less than $20,000 annually than the general population. The most likely gaming activities for problem and probable pathological gamblers in New Brunswick were card games and video gaming machines. The lifetime prevalence rate for problem and pathological gamblers was 6 percent, while the current rate was 4.5 percent. A two-phase approach to implement services for treatment was recommended in this report. Phase One would establish funding, develop a public educational campaign and establish prevention efforts in schools. It would also provide training in identifying the problem in clients for professionals in health related services. Phase Two would include providing training for treatment providers, establish a certification program for counselors and evaluate the effectiveness of these efforts.

A Two to Nine Year Treatment Follow-up Study of Pathological Gambling. Alex Blaszczynski and Neil McConaghy, in Gambling Behavior and Problem Gambling (1993) eds. William R. Eadington and Judy A. Cornelius. Reno, Nevada: Institute for the Study of Gambling and Commercial Gaming, pages 215-238. This study resurveyed the gambling behavior, financial status, and mental health of 63 pathological gamblers two to nine years following completion of treatment. The paper focuses on a comparsion of those who completely abstained from gambling (29%), those who gambled in a controlled manner (38%), and those who had relapsed into uncontrolled gambling (33%). They find that the abstainers and controlled gamblers "showed comparable improvements in social and financial functioning and decreased ratings of psychopathology compared to those admitting to continued uncontrolled gambling." They conclude that "some gamblers have the ability to return to and maintain controlled gambling over substantial periods with minimal risk for relapse" but caution that "it seems prudent to encourage abstinence as the preferred treatment goal until predictor variables are available which could identify the subjects who are able to maintain controlled gambling following treatment."

Establishing Treatment Services for Pathological Gamblers in Manitoba. Rachel Volberg. Manitoba Lotteries Foundation, June 8, 1993. The prevalence study indicates that 1.3 percent of Manitoba adults are possible pathological gamblers. A two-phase approach to implementing services for treatment was recommended. Phase One would establish funding, organizational responsibility, public education, prevention, diagnostic training and crisis intervention. Phase Two would expand to include treatment training, certification, outpatient treatment, evaluation and ongoing research.

Couples Treatment Issues for Recovering Male Compulsive Gamblers and their Partners. Marvin A. Steinberg. Journal of Gambling Studies 9(2), 153-167, Summer 1993. Steinberg presents a case for the need to include spouses in the treatment program for pathological gamblers and outlines the issues likely to be raised with the spouseâs involvement. Issues include multiple addictions, finances, control and power, anger, sexuality, and emotional intimacy, with intimacy deficit viewed as the most critical.

Treatment of Pathological Gamblers: An Experimental Study. Annie Bujold, Robert Ladouceur, Caroline Sylvain and Jean-Marie Boisvert. Journal of behavior therapy and experimental psychiatry. 25: 275-282. 1994. This paper is of interest for its description of a three-phase treatment program consisting first of a cognitive intervention phase (correction of false beliefs involving gambling), followed by assistance in developing problem solving skills, and finally by relapse prevention. While this program was effective in the three cases described here, the small sample size limits the studyâs value.

Cognitive-Behavioral Treatment for Adolescent Pathological Gamblers. Robert Ladouceur, Jean-Marie Boisvert, Jilda Dumont. Behavior Modification (19:2, 230-242) April 1994. This article presents the results of a cognitive-behavioral treatment regimen for four male pathological gamblers between the ages of 17 and 19. Treatment emphasized correction of erroneous beliefs concerning gambling and randomness, followed by problem-solving training and social skills training. All four subjects reported clinically significant improvement in both their perception of control over gambling and the severity of their problems for six months following treatment.

Cognitive and Behavioral Therapies for Pathological Gambling. Alex Blaszczynski and Derrick Silove. Journal of Gambling Studies (1995), 11(2), pages 195 ö 220. The authors describe and compare several different treatment approaches, including behavioral therapy, cognitive therapy, and imaginal desensitisation. They discuss the results and limitations of outcome studies on each, concluding that substantial numbers ãrespond positively with abstinence or controlled gambling irrespective of whether the treatment is behavioral or multimodal in nature.ä

Treatment Effectiveness of Six State-Supported Compulsive Gambling Treatment Programs in Minnesota. Randy Stinchfield and Ken Winters. Minnesota Department of Human Services, April, 1996. This is the fourth and final report of an ongoing evaluation of the effectiveness of gambling treatment programs. The study focuses on basic research questions like demographic characteristics and clinical history of gamblers as well as clients’ evaluation of the treatment components. 1342 clients were recruited for the study, of which 944 were admitted to treatment. Among the 944 clients admitted to treatment, 658 (70 percent) completed treatment. The study found that the three most preferred gambling activities were cards (37 percent), slot machines (37 percent), and pulltabs (14 percent). The Lottery was rated by less than 1 percent as the game of choice, but was played about as frequently as the most preferred games. The 658 clients completing treatment exhibited significant improvements from pretreatment to post-treatment in gambling frequency, problem severity and in areas of functioning.

Prevalence Studies and the Development of Services for Problem Gamblers and Their Families. Rachel A. Volberg, Mark G. Dickerson, Robert Ladouceur and Max W. Abbott. Journal of Gambling Studies, Vol.12(2), p215-231, Summer 1996. This article summarizes services available in Australia, Canada, New Zealand and the United States for problem gamblers and their families. The services provided have largely been the response of governments to the prevalence studies performed within their jurisdictions.

Problem Gambling in a Federal Prison Population: Results from the South Oaks Gambling Screen. Glenn D. Walters. Journal of Gambling Studies, 13(1), 7-24, Spring 1997. The author administered the South Oaks Gambling Screen (SOGS) to 363 federal prison inmates, finding that 5.2 percent achieved scores of 5 or greater (the traditional criterion for pathological gambling) with another 7.4 percent attaining scores of 3 or 4. Walters also examined spontaneous remission, and found that 44 percent of those with scores of 3 or 4 had ceased problem gambling on their own as had 21 percent of those with scores of 5 or greater.

The Application of Harm Minimization Principles to Gambling and Gaming in Western Democracies. Robert Quinlan. 10th International Conference on Gambling and Risk-Taking, Montreal. Northern Problem Gambling Service, Victoria, Australia. June 1997. The discussion places gambling firmly within the scope of addiction theory and focuses on harm minimization to society through the application of public health initiatives that have been used to combat tobacco, drugs and alcohol.

The Maroondah Assessment Profile for Problem Gambling (G-MAP): A New Direction in Problem Gambling Counseling. Tim Loughnan, Mark Pierce & Anastasia Sagris. 10th International Conference on Gambling and Risk-Taking, Montreal. June 1997. This paper describes the development and use of the Maroondah Assessment Profile for Problem Gambling (G-MAP), for the assessment and treatment of gambling problems. The G-MAP is designed to provide a map of relevant treatment issues to assist in the planning of individualized, cost effective treatment for people with gambling problems. Developed by three psychologists, the G-MAP is currently in a developmental phase and further research on its reliability and validity is underway.

Evaluation of the Minnesota State-Funded Compulsive Gambling Treatment Programs, Final Report. William Rhodes, Jon Norman, Stacia Langenbahn, Patricia Harmon and David Deal. Division of Mental Health, Minnesota Department of Human Services, St. Paul, MN. July 21, 1997. This report, prepared by Abt Associates, Inc., concludes that compulsive gambling and its associated problems decrease with treatment. The evaluation showed that women were more likely than men to enter treatment. Adults with higher education, prior treatment experiences or high South Oaks Gambling Screen (SOGS) scores were also more likely to seek and complete treatment than those with less education, no prior treatment experience or those testing with low SOGS scores.

Cognitive and Behavioral Treatment of Pathological Gambling: A Controlled Study. Caroline Sylvain, Robert Ladouceur, and Jean Marie Boisvert. Journal of Consulting and Clinical Psychology 65:5, 727-732. 1997. This is one of only a few studies comparing those in treatment for pathological gambling to a control group. Twenty-nine adult males meeting the DSM-III-R criteria for pathological gambling were randomly assigned to a treatment program or control group. Those in treatment were given a four-stage ãcognitive-behavioralä package consisting of correcting misconceptions of randomness, problem-solving training, social skills training, and relapse prevention. At the end of treatment, 86 percent were no longer considered pathological gamblers, with most maintaining gains through a 12 month followup. Only one member of the control group showed comparable improvement.

Treatment Approaches for Pathological Gamblers. V.C. L—pez Viets and W. R. Miller. Clinical Psychology Review (1997), 17(7), pages 689-702. A review of the literature on treatment methods, this article describes psychodynamic, behavioral, cognitive, cognitive-behavioral, multimodal, pharmacotherapeutic, and 12-step approaches. The authors take pains to point out the limitations of the outcome research on each of these, but conclude that on the whole, pathological gambling can be treated with successful outcomes.

Pathological Gambling: A Critical Review. Committee on the Social and Economic Impact of Pathological Gambling and Committee on Law and Justice, National Research Council. 1999. National Academy Press: Washington, D.C. This report provides a comprehensive overview of what is known about treatment of pathological gambling. It paints a pessimistic picture of the state of knowledge in this area. "The treatments and interventions for pathological gambling that have been developed and reported in the literature are quite similar to methods of treating other disorders or addictions. Substantial progress has not been made in understanding the treatment of this disorder or the characteristics of those seeking help for it, nor is there research basis for matching clients to treatments. ... Moreover, treatment approaches have not been subjected to rigorous and detailed empirical research. Given the lack of national attention to the treatment of pathological gambling, it is difficult to estimate the scope of intervention services available in the United States."

Adolescents with Gambling Problems: From Research to Treatment. Rina Gupta and Jeffrey L. Derevensky. Journal of Gambling Studies. 16:2/3, 315-342 Summer 2000. This article presents a description of the therapeutic processes and underlying philosophy of the McGill University Youth Gambling Research and Treatment Clinic and illustrates these concepts with a detailed case study.

Double-Blind Naltrexone and Placebo Comparison Study in the Treatment of Pathological Gambling. Suck Won Kim, Jon E. Grant, David E. Adson, and Young Chul Shin. Biological Psychiatry, 2001;49:914-921. This study involved 45 patients, half of whom were administered the drug naltrexone and half of whom were given a placebo. At the end of an 11-week trial, 75 percent of those taking naltrexone were rated as either much or very much improved on both a patient-rated and a clinician-rated Clinical Global Impression scale compared to only 24 percent of those on the placebo. The authors note that while the drug was clearly more effective than the placebo, this and other studies suggest that the placebo effect is significant. (An additional 23 subjects were eliminated from the study after showing a positive placebo response in the first week.) The greatest response to naltrexone was found in those with the highest level of urge symptoms - the drug seemed to both reduce the urge to gamble and the level of pleasure associated with the gambling experience.

Motivational Enhancement and Self-Help Treatments for Problem Gambling. David C. Hodgins, Shawn R. Currie, and Nady el-Guebaly. Journal of Consulting and Clinical Psychology 2001, 69:1, 50-57. This paper explores a program where problem gamblers are given a self-help workbook and a motiviational enhancement telephone interview in lieu of more traditional forms of treatment. The 102 gamblers participating in the trial were divided into three groups: interview and workbook, workbook only, and a "control" group placed on a 1 month waiting list. The researchers found that after 12 months there were few differences between the interview and workbook and workbook only groups, but that the motiviational enhancement call was effective in the short run. Both treatment groups showed more improvement than the control group during the one-month waiting list period. Overall, 89 percent of the interview/workbook group showed significant improvement after 12 months compared to 79 percent of the workbook only group.

The Effect of Compliance-Improving Interventions on the Cognitive-Behavioural Treatment of Pathological Gambling. Simon Milton, Rocco Crino, Caroline Hunt, and Emma Prosser. Journal of Gambling Studies Vol. 18(2), p207-230, Summer 2002. In this study, 40 clients were randomly assigned to either a cognitive-behavioral treatment program alone or the same program combined with various interventions thought to increase treatment compliance. Those receiving the interventions were much more likely to complete the program (65% to 35%), but nine months after the completion of treatment there was no significant difference in the rates of pathological gambling of the two groups. The authors also found that poor treatment outcomes were highly correlated with comorbid problem drinking, while poor treatment compliance was related to comorbid drinking, drug use, and a long history of problem gambling. 

Gambling Decisions: An Early Intervention Program for Problem Gamblers Ellie Robson, Joy Edwards, Garry Smith, and Ian Colman. Journal of Gambling Studies. 18:3 235-256. Fall 2002. The authors describe and assess a treatment program for people with moderate gambling problems. Participants were given a copy of a “client handbook” that included assistance on assessment of gambling behavior, examples of coping strategies, reinforcement of progress, and guidelines for handling relapse. They were also given a choice between two individual sessions with a trained nurse facilitator or six group sessions. Participants could select either abstinence or controlled gambling as a goal. People with severe gambling problems were referred to an abstinence-only program. Seventy-nine clients enrolled in the program, with 60 of those completing four questionnaires administered between enrollment and a year after completion of the program. A year after completion of the program, participants reported significant declines in the number of gambling occasions, time spent gambling, and losses. Problems in seven different life areas were also significantly reduced. These improvements were seen in both those choosing abstinence and those electing controlled gambling as a goal. Seventy-seven percent believed that they had been successful or very successful at controlling their gambling.

Pathological gambling associated with dopamine agonist therapy in Parkinson’s disease. E. Driver-Dunckley, J. Samanta, and M. Stacy. Neurology 61:422-423. August, 2003. The authors reviewed records from 1,884 patients with Parkinson’s disease and found nine records indicating that the patient had developed a gambling problem leading to serious financial loss while undergoing treatment for their disease. All nine were found to have been taking high doses of dopamine agonist drugs, and in seven cases the gambling began within a month of an increase in the dosage. Additionally, seven achieved “sustained resolution” of gambling symptoms following a change in their drug regimen. The remaining two required additional psychiatric intervention.