Teaching Rats To Gamble Responsibly – New Research About Medication To Curb Problematic Gambling Behavior

Dr. Catherine Winstanley

One of the goals of the NCRG research program is to provide initial funding for innovative research studies so that researchers can leverage their findings for larger grants to continue and expand their studies. Researchers from the University of British Columbia have made great strides by continuing the line of study from their NCRG-funded research that began almost seven years ago.

In 2006, the NCRG awarded a new investigator grant to Catherine Winstanley, Ph.D., from the University of British Columbia, to test a new model of gambling behavior in rats, based on the Iowa Gambling Task (IGT).

By administering the IGT and examining how drugs that regulate serotonin and dopamine impacted gambling behavior, Dr. Winstanley and her colleagues were able to simulate real-life decision-making experiences with rats in a laboratory setting. They discovered that the rats could “play the odds” when choosing how to bet while doing the RGT and could regulate their level of play, especially when influenced by neurochemical regulation of serotonin and dopamine (Zeeb, Robbins, & Winstanley, 2009). For more on this study, download thesixth volume ofIncreasing the Odds,the NCRG’s monograph series.

Researchers from the University of British Columbia were recentlyin the news again, this time with further results from the gambling rats. Dr. Winstanley, along with Ph.D. student Paul Cocker, built upon the NCRG-funded study to discover that disordered gambling behavior could be treated with drugs that block dopamine receptors. Research shows that “near misses,” or a moment when the gambler comes very close to winning, can influence an individual with a gambling disorder to continue to gamble. In this study, researchers treated rats with a dopamine receptor-blocking medication that curbed problematic gambling behavior.

We’re proud that NCRG funding played a role in launching this important line of research. Read more about research that the NCRG has supported on ouronline research center.

Reference

Zeeb, F. D., Robbins, T. W., & Winstanley, C. A. (2009). Serotonergic and dopaminergic modulation of gambling behavior as assessed using a novel rat gambling task.Neuropsychopharmacology: Official Publication of the American College of Neuropsychopharmacology,34(10), 2329–2343. doi:10.1038/npp.2009.62

NCRG staffResearch UpdateDr. Catherine WinstanleyIowa Gambling TaskNCRG-funded researchUniversity of British Columbia

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N.j. Offers Self-exclusion For Online Gambling – What Does The Research Say?

Self-exclusion programs are a player-initiated, voluntary form of exclusion that provides gamblers with the opportunity to ban themselves from gambling venues as a tool to reduce or stop excessive gambling.New Jerseyjust announced that its self-exclusion program will be expanded to include gamblers who wager on the Internet. But what is known about the safety and effectiveness of self-exclusion? And, will it work for online gamblers?

Research on self-exclusion programs in land-based casinos in the United States and Canada has shown that this tool can be an effective and safe intervention. One Canadian study reported that self-excluders’ urge to gamble, the number of gambling problem symptoms and the intensity of negative consequences of gambling significantly decreased after six months (Ladouceur, Sylvain, & Gosselin, 2007).

A U.S. study revealed that most gamblers who signed up for a lifetime exclusion ban reduced their gambling and had significantly fewer gambling-related problems at follow up, with the rate of disordered gambling declining from 79 percent at enrollment to 15 percent at follow up (Nelson, Kleschinsky, LaBrie, Kaplan, & Shaffer, 2010). Self-excluders who participated in treatment for gambling problems or self-help groups after enrolling in the program had more positive outcomes than those who did not.

What’s especially intriguing about these findings is that 22 to 55 percent of the self-excluders enrolled in these studies entered casinos undetected, thereby breaching their agreement to stay away from the casino property (Ladouceur, Jacques, Giroux, Ferland, & Leblond, 2000; Ladouceur et al., 2007; Nelson et al., 2010). Yet, many of these self-excluders eventually reduced or eliminated their gambling problems. Researchers have conjectured that “it is possible that the act of self-excluding can reflect a motivation to stop gambling. In other words, those motivated to change their gambling behavior are likely more inclined to sign up for self-exclusion,” (Shaffer & Martin, 2011, p. 501). This could mean that the act of self-excluding is more important for the process of recovery than the threat of legal consequences (e.g., arrest for trespassing) common in the United States.

How do these findings apply to Internet gambling?

Many online gambling companies offer their subscribers’ the opportunity to self-limit their gambling by reducing the amount of money on deposit or closing their accounts altogether. Preliminary studies of these tools have indicated that self-limiters reduced their frequency of play, both the number of days on which they placed bets and the number of bets they placed per betting day (Nelson et al., 2008). Although the amount they wagered per bet did not change significantly, they did reduce the total amount they wagered. According to the authors of this study, these behavioral changes highlight the importance of activity level or involvement—not just money bet or lost—as a risk for gambling problems and as a target for change (Nelson et al., 2008).

For more about these and related studies, download volume 5 of the NCRG’s monograph series, titledEvaluating Self-Exclusion as an Intervention for Disordered Gambling. This compilation summarizes for a public audience the published research on self-exclusion.

References

Ladouceur, R., Jacques, C., Giroux, I., Ferland, F., & Leblond, J. (2000). Analysis of a casino’s self-exclusion program.Journal of Gambling Studies,16(4), 453–460. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/14634308

Ladouceur, R., Sylvain, C., & Gosselin, P. (2007). Self-exclusion program: A longitudinal evaluation study.Journal of Gambling Studies,23(1), 85–94. doi:10.1007/s10899-006-9032-6

National Center for Responsible Gaming (Ed.). (2010).Evaluating Self-Exclusion as an Intervention for Disordered Gambling(Vols. 1-7, Vol. 5). Washington, DC: National Center for Responsible Gaming. Retrieved from http://www.ncrg.org/resources/monographs

Nelson, S. E., Kleschinsky, J. H., LaBrie, R. A., Kaplan, S., & Shaffer, H. J. (2010). One decade of self exclusion: Missouri casino self-excluders four to ten years after enrollment.Journal of Gambling Studies,26(1), 129–144. doi:10.1007/s10899-009-9157-5

Nelson, S. E., LaPlante, D. A., Peller, A. J., Schumann, A., LaBrie, R. A., & Shaffer, H. J. (2008). Real limits in the virtual world: Self-limiting behavior of internet gamblers.Journal of Gambling Studies,24(4), 463 – 477.

Shaffer, H. J., & Martin, R. (2011). Disordered gambling: etiology, trajectory, and clinical considerations.Annual Review of Clinical Psychology,7, 483–510. doi:10.1146/annurev-clinpsy-040510-143928

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Scholarship Recipients Provide Valuable Insights Into Their NCRG Conference Experiences

The14th annual NCRG Conference on Gambling and Addictionwas attended by more than 300 people from around the world. To ensure access to this continuing education opportunity, the NCRG providedscholarshipsto a variety of clinicians, researchers and others. And because we are always interested in improving our program, we asked this year’s scholarship recipients to give us in-depth evaluations of the conference and their experiences.

Here is some of the feedback we received:

  • “One of the most useful workshops was ‘Neural Circuits: The New Frontier of Neuropsychiatric Diagnostic and Therapeutics’ with Dr. Kafui Dzirasa. I particularly enjoyed the explanation on the challenges in understanding the brain and studying the brain & its function.”
  • “The NCRG Scientific Achievement Awards Luncheon was amazing. The food was a 10… Absolutely superb in taste, quantity and amount provided. The awards ceremony provided a scope of where people were attending from and how this is a world-wide line of work. Well done.”
  • “One of the most memorable and eye-opening experiences I had at the conference was attending the open AA/GA meeting. As a researcher working with animal models of disease, it was illuminating to witness the ‘real-life’ version of what I am attempting to study in the lab. It is surprisingly easy to get so focused on brain circuitry, behavioral models, and pharmacological intervention that the translation of our translational research gets lost.”
  • “One of my favorite workshops was “Cause Marketing: Lessons for the Effective Promotion of Responsible Gaming.” I found this workshop to be fun and entertaining, but more importantly, I appreciated how it went through a variety of different marketing techniques that can be used for agencies and programs that provide assistance to people…. My main take-away is that successful marketing is due to a trifecta of: connecting with the intended population, in a way that resonates with them (shock, humor, etc.), and encourages them to think about their behavior, or take steps to act for positive change.”
  • “Building a Partnership: Researching Native American Populations…provided some excellent information on culturally relevant approaches in Indian Country…The best part of the workshop was the…networking with others working in and/or for Indian Country.”
  • “I was very impressed by the presentation…on the four-year exploration of the U.S. Addiction Treatment System. Finally, there is consideration for those who struggle with addiction…The system of treatment is broken and not everyone fits into the rehabilitation structure of yesterday.”

The NCRG also values the constructive criticism offered. One participant suggested the need for livelier presentations and another requested even more clinically-based sessions.

The NCRG is proud to see that the conference serves as a valuable and educational event for all involved in the field—an objective that the organization strives to achieve year-after-year. And we promise to continue this commitment next year!Save the date for the 2014 conference: September 28-30, 2014.

Did you attend the 2013 conference? Share your experiences in the comments section below.

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NCRG Awards Grants To Fund Seven Research Projects In 2013

Earlier this month, theNCRG announcedthat the organization has awarded $751,951 this year to support seven new research projects that will help improve methods of diagnosis, intervention, treatment and prevention of gambling disorders.

Here’s a list of the research projects that received funding from the NCRG:

Travel Grants

  • “Do Pathological Gamblers Suffer from a Distorted Sensitivity to Reward?”– Guillaume Sescousse, Ph.D., of the Donders Institute for Brain, Cognition and Behavior in the Netherlands, was awarded $1,500 to support his participation as a speaker at the 2013 annual conference of the Society for Neuroscience. Dr. Sescousse will present his research on the sensitivity to rewards among disordered gamblers.
  • “The Atypical Antidepressant Mirtazapine Attenuates Gambling-like Behavior in Rodents”– Amanda Persons, Ph.D., of Rush University Medical Center, was awarded $1,500 in 2013 to support her participation in the poster session at the 2013 meeting of the College on Problems of Drug Dependence. Dr. Persons reported on research, funded by the NCRG, revealing that mirtazapine, an atypical antidepressant, reduced risk-taking behavior in rats and, therefore, holds promise as a treatment for gambling disorders.
  • “Gambling and the Onset of Comorbid Mental Disorders: A Longitudinal Study Evaluating Severity and Specific Symptoms” –Iman Parhami, M.D., M.P.H., from the Delaware Division of Substance Abuse and Mental Health was awarded $1,500 to attend the American Academy of Addiction Psychiatry’s annual meeting. Dr. Parhami will give a presentation on a study of two waves of the longitudinal gambling data in the NESARC (National Epidemiological Survey on Alcohol and Related Conditions) survey and a discussion about whether different levels of gambling behavior and gambling-related symptoms were associated with the onset of psychiatric disorders.

Seed Grants

  • “How Skill Affects Gambler Responses to Wins and Losses”– Kyle Siler, Ph.D., of McMaster University, was awarded $27,536.75 to gauge the effects of wins and losses on subsequent play using a large dataset of online poker hands.
  • “An Animal Model of Relapse to Pathological Gambling”– David Kearns, Ph.D., of American University, was awarded $28,750 to address the lack of knowledge about the causes of relapse of a gambling disorder by developing an animal model in which potential precipitators of relapse can be investigated.
  • “The Effects of PTSD on Risky Decision-Making”– Caitlin A. Orsini, Ph.D., of the University of Florida, was awarded $28,750. Because Post-Traumatic Stress Disorder (PTSD) may alter decision-making capabilities, there is increasing interest in the relationship between PTSD and disordered gambling behavior. Dr. Orsini’s study will use a rodent model to determine whether elevated risk-taking is a pre-disposing factor to developing PTSD-like symptoms following trauma.

Early Stage Investigator Grant

  • “Developing a Mouse Model of Pathological Gambling Using an Inducible and Tissue-specific Serotonin 1B Receptor Knock-out”– Katherine Nautiyal, Ph.D., of the Research Foundation for Mental Hygiene, Inc., was awarded $147,706 to develop mouse gambling behavioral models toward the goal of developing pharmacological treatments for gambling disorders.

Large Grants

  • “Social Influences on the Development of Risky Choice”– Scott A. Huettel, Ph.D., of Duke University, was awarded $172,358 to study the emerging perspective that adolescence is associated with increased sensitivity to rewards, which places them particularly at risk for disorders including pathological responses to rewarding outcomes (e.g., gambling disorders).
  • “Neural Correlates of Impulsivity and their Modulation by Dopamine in Problem/Pathological Gambling”– Andrew Kayser, M.D., Ph.D., of Ernest Gallo Clinic and Research Center at the University of California, San Francisco, was awarded $172,500 to evaluate a novel translational (and potentially therapeutic) approach for gambling disorders: inhibitors of the dopamine-degrading enzyme catechol-O-methyltransferase (COMT).
  • “Efficacy of a Brief Motivational Intervention Delivered via Smartphone and Short Messaging Service”– Matthew Martens, Ph.D., of the University of Missouri-Columbia, was awarded $171,350 to expand on his work from a previous NCRG grant. Dr. Martens will test the efficacy of a novel Brief Motivational Intervention (BMI) designed to reduce gambling among college students. This intervention will be delivered via smartphone devices (i.e., cell phones with comprehensive web applications) and short messaging service (SMS) technology.

To read more about this announcement,click here.For more information about the NCRG Grants Program,visit the NCRG website.

Stay connected with the NCRG here, and onFacebookandTwitter, for upcoming announcements on the NCRG’s 2014 funding opportunities.

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NCRG Awards 2013 Outstanding Poster Award At Annual Conference

Last month, the NCRG held the14th annual NCRG Conference on Gambling and Addictionin Las Vegas. One of the NCRG’s favorite events during the conference each year is thePoster Session and Reception, which allows researchers to showcase new findings on gambling disorders and report their empirical research.

The 2013 NCRG Poster Session and Reception featured 30 posters and lead authors who shared their work with other conference attendees and scientists on the poster review committee on Sunday, September 22.

NCRG Chairman Alan Feldman Awards the 2013 NCRG Outstanding Poster Award to Dr. Alyssa Wilson

This year, the NCRG was pleased to award the 2013 Outstanding Poster Award toAlyssa Wilson, Ph.D., of Saint Louis University, and her colleagues for their poster, titled “Exploring Neurological Differences across Gambling Subtypes.” To learn more about Alyssa’s research, listen to the interview below.

[INSERT Audio]

In addition to the Outstanding Poster Award, the NCRG recognized three other poster presenters with honorable mentions. These include:

  • Consensus in Social Norms and Gambling Behavior(Lead Author: Alan Chan, Asian American Center on Disparities Research at the University of California, Davis)
  • Attitudes towards Gambling among Adolescents in Norway(Lead Author: David Hanss, University of Bergen in Norway)
  • Depressive Mood Moderates Urges to Gamble and Brain Insula Activation During Monetary Reward Processing in Disordered Gamblers(Lead Author: Karl Mann, Central Institute of Mental Health (CIMH) and the University of Heidelberg)

Did you attend the Poster Session and Reception? What were some of your favorite posters?

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Register Today For The NCRG’s Free Webinar On Addiction As A Syndrome

Dr. Debi LaPlante
Dr. Sarah Nelson

On Wednesday, Oct. 30 from 2 to 3 p.m., the NCRG will hold the last session in the NCRG’s Webinar Series, titled“Addiction as Syndrome: Implications for Understanding and Treating Gambling Disorders and Other Addictive Disorders.”You can register for this free session online on theNCRG’s webinar webpage.

Recent research on gambling and other behaviors suggests that the existing focus on addictive substances does not adequately capture the origin, nature and processes of addiction. The Harvard Medical School faculty at the Division on Addiction at Cambridge Health Alliance has proposed a new understanding of addiction as a syndrome with multiple expressions, ranging from substance-based disorders to behavioral disorders.

Debi LaPlante, Ph.D.,andSarah Nelson, Ph.D.,will discuss how recent research indicates that the specific objects of addiction play a less central role in the development of addiction than previously thought.

The NCRG Webinar Series sessions are approved for one hour of continuing education by:

  • NAADAC, the Association for Addiction Professionals (provider #737)
  • The California Board of Behavioral Sciences (for MFT and LCSW licensure requirements in California) (Approval #PCE 4619)
  • The National Board for Certified Counselors (provider #6474)

Register todayand join Drs. LaPlante and Nelson for a thought-provoking exploration of this new model of understanding and the implications for clinical practice.

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Dr. Jeffrey Derevensky Named 2013 NCRG Scientific Achievement Award Winner

Monday, the NCRG was honored to present the2013 Scientific Achievement AwardtoJeffrey L. Derevensky, Ph.D.,a professor in the School/Applied Child Psychology and a professor in the department of psychiatry at McGill University in Montreal, during a luncheon today at The Sands Expo and Convention Center at The Venetian in Las Vegas, during the14th annual NCRG Conference on Gambling and Addiction.

Dr. Jeffrey Derevensky and NCRG Chairman Alan Feldman

With more than 150 articles published in peer-reviewed journals, Dr. Derevensky’s research has provided a greater understanding of how to address youth gambling in clinical settings, college gambling, and the development of prevention strategies to help limit youth engagement in gambling and other risky behaviors.

Dr. Derevensky’s leadership of the McGill International Centre for Youth Gambling Problems and High-risk Behaviors, which he co-founded, has played an integral role in understanding and addressing the issue of gambling problems among youth and adolescents. The center has been instrumental not only in researching the various behavioral and clinical implications of youth gambling, but also in developing prevention and treatment strategies that address youth gambling among community leaders and policy makers. Dr. Derevensky’s work at the center has helped to establish international collaborations that ultimately work to investigate youth gambling and translate the research into prevention tools for public use.

An important part of a researcher’s duty is to cultivate the next generation of scientists to continue exploring the field of study. Dr. Derevensky has dedicated a large part of his career to mentoring post-doctoral investigators and helping them to expand their scope of study, especially in of the area of youth gambling. Additionally, he has collaborated with investigators around the world to organize the International Think Tank on Youth Gambling Issues, which brings youth gambling to the forefront of public health issues, and has served as a member of the NCRG Scientific Advisory Board.

On behalf of everyone at the NCRG, congratulations Dr. Derevensky!

NCRG staffConference on Gambling and AddictionDr. Jeffrey DerevenskyNCRG Conference on Gambling and Addictionscientific achievement award

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NCRG Conference: Behind The Screen – Characteristics Of Internet Gamblers Who Trigger Responsible Gaming Interventions

Dr. Heather Gray

On Tuesday, theNCRG Conference on Gambling and Addictionco-located withGlobal Gaming Expo (G2E), the premier trade show and conference event for the gaming entertainment industry, to provide two “NCRG at G2E” sessions. This is the third year that the NCRG Conference co-located with G2E, making it easier for attendees of both events to learn about best practices in responsible gaming.

The first session on this year’s “NCRG at G2E” series examined characteristics of Internet gamblers who trigger responsible gaming interventions and featuredHeather Gray, Ph.D.She is a research associate at theDivision on Addiction, Cambridge Health Alliance, a teaching affiliate of Harvard Medical School and an instructor in psychiatry at Harvard Medical School.

Dr. Gray began the session by providing an overview of the public health view of gambling disorders—the range of gambling problems (from mild to severe) and the range of interventions (i.e., health promotion, harm reduction and treatment).

To help study the need for different interventions for who those gambling online, Dr. Gray and colleagues formed a research collaborative with bwin.party in 2004, in which they examined actual betting behavior of bwin.party subscribers. Their mission was to prevent and reduce Internet gambling-related problems by (1) describing behavioral profiles of those with gambling problems, (2) predicting the development of gambling-related problems, and (3) creating evidence-based intervention strategies to help customers who have gambling problems.

To do this, the Division used the bwin.party customer service and corporate social responsibility departments to identify events that might indicate a need for responsible gambling intervention. They compared the betting records of these players (“RG cases”) against matched controls, and they expected to find that the RG cases might show excessive gambling behavior compared to those who have similar exposure but do not trigger such flags.

They found that they were able to correctly classify 79 percent of subscribers and whether or not to flag them as RG cases. They also found that subscribers who were “flagged” by customer service gambled more intensely than subscribers not flagged (in terms of monetary involvement, time involvement and game involvement).

Dr. Gray noted that there are questions that still need to be answered, including:

  • How did responsible gaming event/response change gambling behavior, if at all?
  • What about the subscribers who triggered responsible gaming events but did not show excessive behavior (and vice versa)?
  • How does the responsible gaming screen compare with other ways of identifying subscribers with potential problems?

Before ending the session, Dr. Gray stated that the Division has created a website, The Transparency Project (www.thetransparencyproject.org), to share the data set and encourage more people to study and upload their own data sets to help move the science forward.

Did you attend the “NCRG at G2E” sessions? What did you find most interesting? What topics should the NCRG consider for next year’s program?

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NCRG Conference: Evaluating Responsible Gaming Strategies – What Regulators Need To Know

Dr. Debi LaPlante presents at the NCRG Conference

Yesterday, the14th annual NCRG Conference on Gambling and Addictionheld an informative session on using a scientific approach to evaluating responsible gambling programs thatDebi LaPlante, Ph.D., an assistant professor of psychiatry at Harvard Medical School and the director of academic affairs at the Division on Addiction, Cambridge Health Alliance, a teaching affiliate of Harvard Medical School.

Dr. LaPlante began the session by explaining that gambling disorders can cause a ripple effect—impacting the individual, his or family, acquaintances and the broader society; therefore, safeguards are often needed for some populations. One way to do this is by through regulating responsible gaming initiatives.

Some of the most common responsible gaming regulations include employee education, resources (e.g., self-exclusion programs, signage and helplines), advertising and marketing restrictions, alcohol services, credit restrictions, loss and stake limitations and mitigation efforts (e.g., treatment funding).

Dr. LaPlante noted that scientific evaluation can help guide regulator programs and provided a flow chart to show how the process works:

  1. Develop and utilize regulation
  2. Build regulation outcome monitoring system
  3. Assess regulation penetration among targets
  4. Analyze and identify best practices activities
  5. Summarize regulation outcomes among targets
  6. Conduct feedback and reporting

These steps form a circular loop. Once the feedback and reporting has been done, the process should begin again.

Dr. LaPlante added that regulations can either decrease or increase gambling-related problems, have no effect on a person’s gambling behavior or influence gambling-related problems indirectly through other factors. One example she provided was baseball’s regulation to stop selling alcohol after the seventh-inning stretch. The intention of this regulation is to limit the amount of alcohol consumed during the game, but often, spectators will purchase several alcoholic beverages before sales conclude (she referred to this as the seventh-inning binge).

Dr. LaPlante stated that regulatory evaluation might be especially important for gambling due to the limited amount of high quality information we have available, adding that what we think we know about gambling is long on anecdote and short on evidence. She provided three different examples and the most recent research on these topics to illustrate this: gambling expansion, Internet gambling and game effects.

After presenting the research, key findings and take-aways from these three examples, Dr. LaPlante posed the question: What do we know about regulations for gambling?

“Not much,” she answered. She added that often, regulations go into play with very little research to support or evaluate them. She also advised that using conventional wisdom to guide regulatory development could send us down the wrong path.

But, she noted that there are ways to know about which regulations work. First, it is important to conduct research that follows gamblers pre-and post-harm minimization effort, as well as test which behaviors and activities of problem gamblers and gambling opportunities influence their problems versus which reflect their problems. This will help inform future harm minimization strategies. She also said that there needs to be less of a reliance on self-reporting and more randomized trials, which coordination with regulators for testing.

However, she said, there are things that science can’t tell us. Sciencecantell us the costs and benefits of a given regulation, how a gambling problem develops and how regulations might intervene in that process. But, sciencecannottell us how much weight to give to individual liberty versus governmental prevention of harm.

She concluded that in an ideal world:

  • We need science to tell us whether regulations and interventions do what we think they do
  • Good intentions do not ensure anticipated benefits or prevented unanticipated harms.
  • Evidence-based regulations will preclude the development of policy based on individual whim and advocate lobbying
  • A science of regulations will ensure that legislation provides targeted influence in the intended direction

While gambling creates opportunities to improve and complicate day-to-day life, the challenges that we face are: (1) to be aware of the changes gambling might create, (2) to navigate the changing opportunities safely and (3) to get ahead of naturally-occurring adaptation, and facilitate the dissolution of novelty effects among those most at-risk.

Did you attend this session? What else did you take away from Dr. LaPlante’s presentation?

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NCRG Conference: Mood Disorders – The Latest Research

Dr. Michael Ostacher

Each year, theNCRG Conference on Gambling and Addictionprovides an opportunity for researchers, clinicians, regulators and other stakeholders to come together, listen to research and programs from leading experts and share their experiences with gambling disorders. One of the benefits of this interaction is that the NCRG staff gets to learn directly from attendees, especially public health officials, about the speakers and topics they might find useful in their work.

One such topic that was overwhelmingly requested was the cluster of disorders previously called “mood disorders” (e.g., major depressive disorder). It turns out that the experiences of gambling treatment providers—of which many have clients with mood disorders in addition to a gambling disorder—are echoed in the published research. TheNational Comorbidity Study-Replication (NCS-R),one of the largest studies of mental health comorbidity in the country, found that more than 55 percent of people with a gambling disorder also had a comorbid mood disorder (Kessler, 2008).

With this, and the feedback of conference attendees in mind, the NCRG invitedMichael Ostacher, M.D., M.P.H., assistant professor of psychiatry and behavioral sciences at the Palo Alto Veterans Affairs Health Care System, to present on the changes in mood disorders made in the fifth edition of theDiagnostic and Statistical Manual of Mental Disorder(DSM-5).

One change that Dr. Ostacher discussed in detail was the updating of bipolar disorder’s “not otherwise specified” (NOS) diagnosis in theDSM-IVto a more specific “specified or unspecified” diagnosis in theDSM-5. Dr. Ostacher outlined several problems with the NOS diagnosis, including its tendency to serve as a catch-all for individuals with bipolar symptoms and a desire to have more specificity in the diagnosis of bipolar disorder. The new diagnosis allows clinicians to either specify a type of bipolar disorder from a list with clear definitional boundaries, or to leave the diagnosis unspecified but with the opportunity to later specify as more information becomes available. Dr. Ostacher suggested that this approach will have several advantages, including the possibility for better drug treatments stemming from the more specific definitions of the disorder.

Another change that Dr. Ostacher discussed was the addition criteria to the definition of a manic episode. In addition to the previous criteria requiring “a distinct period of abnormally and persistently elevated, expansive, or irritable mood,” the new definition also requires an “abnormally and persistently increased activity or energy.” This new “energy” requirement will tighten the diagnosis of manic episodes, with the goal of separating short term changes in mood from true manic episodes.

Did you attend Dr. Ostacher’s presentation? Tell us what you found most intriguing about the session.

References

Kessler, R. C., Hwang, I., LaBrie, R., Petukhova, M., Sampson, N. A., Winters, K. C., & Shaffer, H. J. (2008). DSM-IV pathological gambling in the National Comorbidity Survey Replication.Psychological medicine,38(09), 1351-1360.

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