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.
https://www.icrg.org/wp-content/uploads/2024/03/icrg-logo-157x55-1.jpg00icrg_adminhttps://www.icrg.org/wp-content/uploads/2024/03/icrg-logo-157x55-1.jpgicrg_admin2013-10-18 00:00:002013-10-18 00:00:00Register Today For The NCRG’s Free Webinar On Addiction As A Syndrome
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!
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?
https://www.icrg.org/wp-content/uploads/2024/03/icrg-logo-157x55-1.jpg00icrg_adminhttps://www.icrg.org/wp-content/uploads/2024/03/icrg-logo-157x55-1.jpgicrg_admin2013-09-25 00:00:002013-09-25 00:00:00NCRG Conference: Behind The Screen – Characteristics Of Internet Gamblers Who Trigger Responsible Gaming Interventions
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:
Develop and utilize regulation
Build regulation outcome monitoring system
Assess regulation penetration among targets
Analyze and identify best practices activities
Summarize regulation outcomes among targets
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?
https://www.icrg.org/wp-content/uploads/2024/03/icrg-logo-157x55-1.jpg00icrg_adminhttps://www.icrg.org/wp-content/uploads/2024/03/icrg-logo-157x55-1.jpgicrg_admin2013-09-25 00:00:002013-09-25 00:00:00NCRG Conference: Evaluating Responsible Gaming Strategies – What Regulators Need To Know
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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The session began with a short presentation fromKate Spilde, chair of the Sycuan Institute on Tribal Gaming and associate professor at San Diego State University. Ms. Spilde provided two key resources on building successful research partnerships with tribal communities: the National Congress of American Indians (NCAI) report,“Walk Softly and Listen Carefully,”and the Betty Ford Institute’s “Seme7 (Non-Native) Counselor in a First Nations: A Story of Professional/Personal Growth and Transformation.”
She noted that the tribal gaming industry has brought income and employment benefits to both tribal and non-tribal communities. The economic and social indicators reveal improvements in education attendance and individual/family income, and poverty and unemployment often decreases. However, these good points often mask the long-term problems of tribal gaming and make it more difficult to uncover them.
Ms. Spilde emphasized that research is a key tool of tribal sovereignty, adding that efforts to address longstanding issues, such as health disparities for American Indians and Alaska Natives, have increasingly used research partnerships.
She also noted several tribal community concerns when conducting research in their communities, including:
Research needs vary by community.
An inability for researchers to identify the pressing needs of community members
Recovery needs within tribal communities may not mirror mainstream public policy questions
Non-Natives bring intervention frameworks and tools that may not be appropriate or meaningful to tribal members
Key qualities to look, listen and learn
While it is important for researchers to look, listen and learn, Ms. Spilde also suggested investigators should keep various challenges in mind:
Tribal leaders are community members; many of them also struggle with addiction both personally and within their families.
There is strong political pressure to maintain a positive image of the tribe
Poor understanding among clinicians and researchers of addiction syndrome in Indian Country; are recovering alcoholics more vulnerable to gambling than active ones?
Tribal community-level factors often not included in public health model in Indian Country (i.e. rate of unemployment, presence/absence of community resources/social agencies, lack of recreational outlets)
Difficult to capture impacts of the stress of reservation life, including grief from residential/boarding schools.
Following her presentation, Ms. Spilde also introducedMiriam Jorgenson, Ph.D., research director for the Native Nations Institute for Leadership, Management and Policy at the University of Arizona; research director for the Harvard Project on American Indian Economic Development at Harvard University; and a member of the NCRG’s Scientific Advisory Board.
Dr. Jorgenson started by pointing out that there is far too much research “on” and not enough research “with” or “for” tribal communities. She emphasized that relationships matter, and that is why it is important to conduct researchwiththese communities.
To reiterate point, Dr. Jorgenson shared a quote from the NCAI report:
“Trust takes time. You need to prove—as a researcher or as an outsider—that you can actually function as a positive member of that community; and there’s no way to do that without becoming a part of that community. That takes time.”
Finally, Dr. Jorgenson noted that often, both universities and tribal communities have protocols already in place to help establish and continue the partnership, and if those protocols don’t exist, it is important to establish them prior to facilitating the partnership. She also provided some of the tangible elements of a successful research partnership, including money and resources, in-community partnerships, advocacy for the tribe with funders, products for the community and pro-bono work for the community.
Following Dr. Jorgenson, John Iyott, a counselor with theIndian Health Service, shared some key elements for engaging in successful partnerships. First, he noted that as with any other culture, it is understand the historical trauma that the tribal community has endured before entering into a partnership. He also noted that all tribes are different, and it is important to understand their culture when entering into a partnership.
The session concluded with an engaging question and answer session that left participants interested in connecting with each other for future partnerships and endeavors.
https://www.icrg.org/wp-content/uploads/2024/03/icrg-logo-157x55-1.jpg00icrg_adminhttps://www.icrg.org/wp-content/uploads/2024/03/icrg-logo-157x55-1.jpgicrg_admin2013-09-24 00:00:002013-09-24 00:00:00NCRG Conference: Building A Partnership – Researching Native American Populations
What behaviors are symptoms of a mental disorder? What behaviors are not? And who decides?
In the United States, the most important decision-makers on this subject arguably are the group of scientists who are responsible for updating the preeminent text on the subject of mental disorders,The Diagnostic and Statistical Manual of Mental Disorders (DSM). The fifth edition of this text (DSM-5) was released earlier this year.
Dr. Narrow first discussed changes in the criteria for a gambling disorder in theDSM-5and explained some of the factors theDSM-5Task Force considered when making the changes. In theDSM-IV, individuals had to exhibit five out of 10 symptoms (such as a preoccupation with gambling) of the disorder in a given year to meet the criteria. Perhaps the most controversial change inDSM-5was the deletion of the “has committed illegal acts” criterion, and the subsequent change of cutoff score from five of 10 criteria to four of 9.
Dr. Narrow explained that the illegal acts criterion was found to be very different depending on the region of the country, focus of local law enforcement, and a number of other factors that affect how laws are enforced in the United States and worldwide. This variance in enforcement—and thus in symptom reporting—decreased the reliability and validity of the gambling measure, and several studies found that removing the illegal acts criterion and changing the cut-off score made the diagnoses significantly more accurate.
In addition to this gambling-specific information, Dr. Narrow also outlined some of the changes in the way theDSM-5Task Force defined mental disorders in general, with particular emphasis on two interrelated concepts. The two quotes from theDSM-5below highlight the concepts he discussed (emphasis added by Dr. Narrow on his slides).
‘A mental disorder is a syndrome characterized by clinically significantdisturbance in an individual’s cognition, emotion regulation, or behaviorthat reflects adysfunction in the psychological, biological, or developmental processes underlying mental functioning.’
‘The diagnosis of a mental disorder should have clinical utility: it should help clinicians to determine prognosis, treatment plans, and potential treatment outcomes for their patients. However,the diagnosis of a mental disorder is not equivalent to a need for treatment.’
According to Dr. Narrow,DSM-5mental health disorders must create disturbance and dysfunction in the lives of the individuals that live with them; however, simply having aDSM-5diagnosis does not imply a need for treatment.
One example of this might be caffeine addiction. An individual may experience uncomfortable withdrawal symptoms, but the dysfunction by itself does not imply that the individual needs to “quit” caffeine or seek mental health treatment for their dependence. Allowing for these potentially contradictory points gives theDSM-5more leeway to account for the varied and often complex relationships individuals develop with substances and behaviors.
Did you attend Dr. Narrow’s presentation? Tell us what you found most intriguing about the session.
https://www.icrg.org/wp-content/uploads/2024/03/icrg-logo-157x55-1.jpg00icrg_adminhttps://www.icrg.org/wp-content/uploads/2024/03/icrg-logo-157x55-1.jpgicrg_admin2013-09-24 00:00:002013-09-24 00:00:00NCRG Conference: The Evolving Definition Of Pathological Gambling And Related Disorders
Before the14th annual NCRG Conference on Gambling and Addictionofficially kicked off yesterday, the NCRG held three pre-conference workshops for conference attendees. One workshop featuredShirley Beckett Mikell, NCAC II, CAC II, SAP, director of certification and education, and National Certification Commission for Addiction Professionals (NCC AP) staff liaison forNAADAC, the Association for Addiction Professionals, who spoke about a partnership between the NCRG and her organization to develop a new, evidence-based endorsement for counselors interested in specializing in gambling disorders.
This workshop drew attendees from across the United States—and even from Mexico and Canada—who specialize in many different treatment areas, including mental health, alcohol and drug abuse, family, marriage, substance abuse, addiction and more.
Ms. Mikell began the workshop by providing background on NAADAC and its certification arm, theNCC AP. NCC AP operates as an independent body from all matters involving the association’s alcohol and drug abuse counselor certification and specialty endorsement opportunities at the national and international levels.
After describing NCC AP’s current accreditations and endorsements, Ms. Mikell announced that the organization is partnering with the NCRG to develop a gambling endorsement. Ms. Mikell noted that the gambling endorsement has many benefits, including:
Offers the ability to capitalize on specialized training and education obtained in specialty areas
Allows one who holds a current nationally recognized credential or license identity in a specialty area
Does not cost as much or as long to obtain as a credential
Does not have to be renewed as often as a credential
Identity as a specialist in a specific area of practice
The gambling endorsement will focus on best practices, highlight current theories and approaches, engage experts in the profession and build an educational and training foundation. It will focus on several domain areas, including definitions, the etiology of gambling disorders, population studies, counseling practices and recovery.
Before concluding the session with a question and answer session, Ms. Mikell stated that the gambling endorsement should be ready in 2014.
Are you interested in learning more about this new gambling endorsement? Stay tuned toGambling Disorders 360°for future updates!
We hope you’ll be joining us there, but if you can’t make it, you can still be a part of the conversation and stay updated on everything that’s happening. The NCRG team will be posting updates via Gambling Disorders 360°, Twitter and Facebook. Here’s how you can connect with the NCRG:
Gambling Disorders 360°:Keep up with all the breaking news from the event by subscribing to the NCRG’s blog for daily updates, on-site reporting about the sessions and audio posts from leading researchers and industry representatives.
Twitter:The NCRG’s Twitter account (@theNCRG) will feature conference updates and live-tweeting from events and sessions, including: the conference welcome address, the Scientific Achievement Awards luncheon, “Uncovering the Mystery of the Brain: How Neuroscience Illuminates Addiction and Gambling Disorders,” and “Impact of the Affordable Care Act on the Treatment of Gambling Disorders.” The NCRG’s tweets will include the hashtag #NCRGConference to make it easier for you to find the latest insight from conference sessions. Attendees who would like to tweet what they learn at the NCRG Conference should also use the #NCRGConference hashtag.
Facebook:The NCRG team will also be active on Facebook, posting updates and pictures from the conference. If you are attending the conference and want to share your photos with us, send them to Amy Kugler at akugler@ncrg.org.
Please find us to say hello if you are attending in person. And if you can’t make it, we hope you will join the conversation online!
For more information on the NCRG Conference, visit ourconference page.
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But did you know that the NCRG is offering three pre-conference workshops and a chance to earn up to two additional CE hours before the conference opens Sunday afternoon? This year, the NCRG is offeringthree pre-conference workshopson Sunday, Sept. 22 from 9:30 – 11:30 a.m., and spots are still available! The NCRG pre-conference workshops include:
Using the DSM-5 in Clinical Practice (2 CE hours)
Leader: Jon Grant, J.D., M.D., M.P.H., The University of Chicago
Are you prepared for the changes in the DSM-5? Revisions in the diagnostic codes for gambling and substance use disordersmean that health care providers specializing in addiction need to consider the implications for their clinical practice. Dr. Grant, co-author of the supplemental guidebook forthe DSM-5, will lead an exploration of the clinical issues posed by these changes.(This pre-conference workshop requires an additional fee.)
New Gambling Credential for Counselors through NAADAC (2 CE hours)
Leader: Shirley Beckett Mikell, NCAC II, CAC II, SAP, NAADAC, the Association for Addiction Professionals
NAADAC, the Association for Addiction Professionals, and the NCRG have partnered to develop a new, evidence-based credential for counselors interested in specializing in gambling disorders. Long-time NAADAC education expert and trainer Ms. Mikell will lead workshop participants in a review of the new credential, including the exam questions as well as educational and supervision requirements.
Trends in Research Methodology: A Workshop for Early Stage Investigators
Leaders: Bethany Bray, Ph.D., Penn State University; Clayton Neighbors, Ph.D., University of Houston
In order to produce the most innovative research, scientists need to draw upon collaborations and suggestions from other researchers in the field. Drs. Bray and Neighbors will examine how to efficiently assess an analytic method’s potential for your research. This session will cover how to evaluate what research questions can be addressed by a specific approach and ways to incorporate innovative methods in your grant proposals. Drs. Bray and Neighbors will specifically examine techniques and research questions that are covered by latent class analysis (LCA), causal analysis and a new methodology for analyzing intensive longitudinal data.
Registrationis required for all of the pre-conference workshops, and you can register on-site for the NAADAC and Research Methodology workshops!
If you can’t attend this year’s NCRG Conference, make sure you subscribe toGambling Disorders 360°for recaps from conferences session and interviews with leading experts. You can also follow the action onTwitter(#NCRGConference) orFacebook!
