Kudos To The Division On Addiction On Its 20th Anniversary!

Dr. Howard Shaffer, director of the Division on Addiction at Cambridge Health Alliance, a Harvard Medical School teaching affiliate, spoke on the subject ofresearch revolutions in gambling disordersat last year’s National Council on Problem Gambling annual conference. Although he was discussing new trends in gambling research, “revolution” is also an apt term to describe the work of Dr. Shaffer and his colleagues at the Division on Addiction, which is celebrating its 20th anniversary this year.

Although gambling research is just one of many areas that the Division on Addiction studies, it is a field in which Dr. Shaffer and associates have been responsible for many “firsts” that have revolutionized the field of gambling research with their seminal studies:

  • The first reliable prevalence estimates for gambling disorders in the U.S. (Kessler et al., 2008; Shaffer, Hall & Vander Bilt, 1999)
  • The first longitudinal study of casino employees’ health risks (Shaffer & Hall, 2002)
  • The first study of Internet gambling based on the actual transactions of online bettors (LaBrie, LaPlante, Nelson et al., 2007)
  • The first studies to conceptualize gambling as a public health issue (Shaffer & Korn, 2002)
  • The first attempt to analyze the effect of adaptation when looking at how communities adapt to new forms of gaming (LaPlante & Shaffer 2007)

This list includes just a few of the pioneering studies undertaken by the Division on Addiction over the past 20 years, and the NCRG is proud to have been a partner in many of these ventures. It reminds us that science is about having the courage to take the road less traveled. We encourage readers to visitwww.divisiononaddictions.organd celebrate the 20thanniversary of the Division on Addiction.

References

Kessler, R. C., Hwang, I., LaBrie, R., Petukhova, M., Sampson, N. A., Winters, K. C., et al. (2008). DSM-IV pathological gambling in the National Comorbidity Survey Replication.Psychological Medicine, 38(9), 1351-1360.

Labrie, R. A., Laplante, D. A., Nelson, S. E., Schumann, A., & Shaffer, H. J. (2007). Assessing the playing field: A prospective longitudinal study of internet sports gambling behavior.Journal of Gambling Studies,23(3):347-62.

LaBrie, R. A., Shaffer, H. J., LaPlante, D. A., & Wechsler, H. (2003). Correlates of college student gambling in the United States.Journal of American College Health, 52(2), 53-62.

LaPlante, D. A., & Shaffer, H. J. (2007). Understanding the influence of gambling opportunities: Expanding exposure models to include adaptation.American Journal of Orthopsychiatry, 77(4), 616-623.

Shaffer, H. J., Donato, A. N., LaBrie, R. A., Kidman, R. C., & LaPlante, D. A. (2005). The epidemiology of college alcohol and gambling policies.Harm Reduction Journal, 2(1), 1.

Shaffer, H. J., & Hall, M. N. (2002). The natural history of gambling and drinking problems among casino employees.Journal of Social Psychology, 142(4), 405-424.

Shaffer, H. J., Hall, M. N., & Vander Bilt, J. (1999). Estimating the prevalence of disordered gambling behavior in the United States and Canada: a research synthesis.American Journal of Public Health, 89(9), 1369-1376.

Shaffer, H. J., & Korn, D. A. (2002). Gambling and related mental disorders: A public health analysis.Annual Review of Public Health, 23, 171-212.

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2012 NCRG Conference Outstanding Poster Award Winner Tests Luck And Skill Of Poker Players

Researchers have debated whether or not casino games, such as poker or sports betting, should be considered games of skill or games of chance. What qualifies a game to be labeled a “game of skill” by researchers? This is the subject being examined by 2012 NCRG Outstanding Poster Award Winner Dr. Gerhard Meyer and his colleagues at the University of Bremen in Germany in the poster titled “Is Poker a Game of Skill or Chance? A Quasi-Experimental Study.”

Dr. Meyer’s experiment was designed to determine if poker is more a game of luck or skill. To do this, he recruited poker players who were either inexperienced or experts and had them play simulated games of poker while receiving weak, moderate or strong hands.

After receiving his award, the NCRG blog team interviewed Dr. Meyer about his winning project and his experience at the 13th annual NCRG Conference on Gambling and Addiction. Listen to the audio interview below for more on Dr. Meyer’s work.

Have a question or comment about Dr. Meyer’s research? Leave it in the comments below or discuss it with the NCRG on Twitter(@theNCRG) and Facebook (www.facebook.com/thencrg)

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The Science Of Recovery With Alexandre Laudet, Ph.d.

Recovery from addiction can be a fluid process, with successful times and relapses. During her talk at the 13thannual NCRG Conference on Gambling and Addiction, Alexandre Laudet, Ph.D., stated that the science of addiction needs to be complemented with the science of recovery. This will help to increase our understanding of the components, patterns paths and predictors of long-term recovery.

Dr. Laudet is a nationally recognized expert in addiction recovery. Her federally funded research over the past 15 years has focused on elucidating what helps people with drug and/or alcohol problems quit drinking or getting high and how they stay in recovery. She leads the Center for the Study of Addictions and Recovery at the National Development and Research Institutes, Inc.

The NCRG blog team had the unique opportunity to interview Dr. Laudet after her plenary session. Listen to the podcast interview below for additional insights from her discussion on the science of recovery.

Have a question or comment about Dr. Laudet’s talk? Leave it in the comments below or discuss it with Dr. Laudet (@alexandrelaudet) and the NCRG (@theNCRG) on Twitter.

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NCRG At G2e: Industry And Government Support Of Treatment Centers – Evaluating Where The Dollars Go

Once again, the NCRG Conference on Gambling and Addiction continued its partnership with Global Gaming Expo (G2E) by offering the ‘NCRG at G2E’ track of sessions on October 2. For the second year, 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 took a close look howtreatment providers report on their use of funds and how government and the private sector evaluates the impact of these services.

First, Mark Vander Linden, M.S.W., executive officer of the Office of Gambling Treatment and Prevention at the Iowa Department of Public Health and president of the Association of Problem Gambling Service Administrators, provided an overview of funding nationally and in Iowa. Vander Linden stated that with the exception of the Substance Abuse and Mental Health Services Administration (SAMHSA), there has been a lack of federal funding on problem gambling treatment and prevention efforts. In the absence of such federal efforts, individual state efforts have emerge that are often divergent from one another in terms of funding levels and resources offered.

Vander Linden referenced a 2010 national survey of publicly funded problem gambling services. This survey was completed by 46 states and found that a total of $58.4 million was spent on problem gambling services through state-dedicated public funds. Less than half of those funds were directed to treatment services. He also noted highlighted the difference in funding between treatment for gamblingdisorders and substance use disorders. Vander Linden explained that while substance use disorders are about eight times more prevalent than gambling disorders, public funding for substance abuse treatment is about 674 times greater than public funding for problem gambling treatment ($16.17 billion versus $24.0 million).

In Iowa, gaming revenue is $330 million. Of this, $3.1 million is allocated toward problem gambling efforts. Vander Linden noted that these funds go to counseling, primary prevention and education, secondary prevention, helpline referral and education, marketing, training and professional development and evaluation, with treatment and prevention being the priority. One key component, Vander Linden noted, is to spend a portion of the funds to closely examine the effectiveness of these problem gambling resources.

Next, Maureen Greeley, executive director of the Evergreen Council on Problem Gambling (ECPG) in Washington state, discussed problem gambling funding in her area, noting that it is a goal of her organization to ensure they are providing consistent, high-quality services with the limited funding they receive. Greeley stated that the ECPG receives 0 .013 percent of gambling revenue as funding for problem gambling treatment and education services, and this comes from state, tribal and private sources.

Finally, Peter Cohen, director of regulatory affairs for The Agenda Group and former executive commissioner and CEO of the Victorian Commission for Gambling Regulation, provided an international perspective of problem gambling funding from his experience in Australia. According to Cohen, the Victorian Responsible Gambling Foundation was recently established as an independent government agency to fund research on gambling disorders, conduct community education initiatives and provide services, such as a gambling help line. While this is considered an independent agency, Cohen noted that since it gets its funding from the government, it has a responsibility to implement government policy.

The agency was awarded $150 million over four years ($37 million per year) to fund programs that fulfill the organization’s mission. He explained that the Responsible Gambling Foundation will continue to receive support as long as people keep gambling, but at some point, they will have to determine if they are getting their “bang for the buck” with this funding.
When evaluating the effectiveness of the treatment programs, Cohen raised the questions: Is it better when the number of people in treatment programs increases or decreases?

What is your opinion? Does an increase or decrease in the number of people in treatment programs show that problem gambling programs are more effective? Please leave your thoughts in the comments section below.

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Dr. Randy Stinchfield Named 2012 Scientific Achievement Award Winner

The NCRG has named Randy Stinchfield, Ph.D., L.P., associate director of the Center for Adolescent Substance Abuse Research in the department of psychiatry at the University of Minnesota Medical School, the recipient of the NCRG 2012 Scientific Achievement Award in recognition of his pioneering contributions to the field of research on rambling disorders. Dr. Stinchfield was honored at an awards luncheon on October 1, 2012 during the13thannual NCRG Conference on Gambling and Addiction. You can watch his acceptance speech below or on theNCRG’s YouTubechannel.

Dr. Stinchfield has conducted some of the earliest and most significant research on youth gambling, including the first youth gambling survey in the U.S. He is the co-author of one of the most widely used instruments for youth gambling assessment around the world, named the South Oaks Gambling Screen Revised for Adolescents (SOGS-RA). In a related track, Dr. Stinchfield has analyzed gambling behavior based on Minnesota Student Survey data administered to nearly all ninth- and 12th-grade public school students in the Minnesota every three years since 1992, which is now the largest database of youth gambling information in existence.

Dr. Stinchfield is a leading researcher in investigating the accuracy of instruments intended to measure and diagnose gambling problems, including the South Oaks Gambling Screen (SOGS) and the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) diagnostic criteria for pathological gambling, the most commonly used assessment instruments for both epidemiological and clinical work. He has calibrated the classification accuracy of both the SOGS andDSM-IV, which has led to a greater understanding of reported prevalence rates using these instruments.

Additionally, he conducted one of the first gambling treatment outcome studies. Aware of the lack of assessments tools to track the effectiveness of treatment, Dr. Stinchfield and his colleagues developed the Gambling Treatment Outcome Monitoring System (GAMTOMS), which has been used to evaluate gambling treatment in Minnesota and across the nation.

Beyond his research, Dr. Stinchfield contributes to the field by serving on the editorial boards of a number of peer-review journals, and serves as a board member of Northstar Alliance for Problem Gambling.

On behalf of the NCRG, the NCRG blog team would like to congratulate Dr. Stinchfield!

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NCRG Conference: Recovery-oriented Systems Of Care – A National Perspective

Dr. Westley Clark, SAMHSA

To understand the big picture of what constitutes a recovery from a gambling disorder, it is best to look at it from both national and local perspectives. The 13th annual NCRG Conference on Gambling and Addiction kicked off Tuesday morning with a presentation from H. Westley Clark, M.D., J.D., M.P.H., director of the Center for Substance Abuse Treatment (CSAT) in the Substance Abuse and Mental Health Services Administration (SAMHSA). SAMHSA’s mission is to reduce the impact of substance abuse and mental illness in America’s communities.

During the session, Dr. Clark explained SAMHSA’s priority of fostering and developing recovery-oriented systems of care (ROSC). ROSC provides a coordinated network of community-based services and supports that is focused on the individual’s needs. It builds on the strengths and resilience of families and communities to achieve abstinence and improved health, wellness and quality of life for those at risk of developing alcohol and drug problems or other addictions. Dr. Clark noted that ROSC is already being successfully integrated into many treatment programs for gambling disorders.

Dr. Clark noted several benefits of ROSC, such that it does the following.

  • ROSC addresses quality of life issues through a holistic approach decreases the risk of relapse and increases the chances for a successful recovery for pathological gamblers.
  • The system Includes recovery support services in conjunction with clinical treatment help to establish a more continuous treatment response.
  • ROSC focuses on reducing the acute and severe relapses that pathological gambling clients often experience.

He noted that implementation of ROSC continues to evolve and the passage of health care reform will allow for additional support of ROSC programs.

A part of a successful ROSC program is to distribute information to the individual in innovative ways. Dr. Clark discussed that providers are beginning to encourage patients to use health apps for assistance in treat conditions and promoting general wellness. These apps offer health-related services for smartphones, tablets or PCs and can be used for self-monitoring or in collaboration with treatment providers.

Examples of these apps are:

  • Overcoming Gambling Addiction by KoolAppz: This is a written education tool with chapters on relevant topics, including gambling addiction, symptoms of a gambling addiction, phases of gambling addiction, who is a gambling addict and how to stop gambling.
  • Gambling Addiction Help: This app includes a set of audios that patients can listen to in times of need to help them control their urges, impulses, emotions and thoughts.

Additionally, Dr. Clark said that SAMHSA has created and is currently testing a smartphone-based recovery tool the Addiction Comprehensive Health Enhancement Support System (A-Chess). This app will feature online peer support groups, clinical counselors, a GPS feature that sends an alert when the user is near an area of previous drug or alcohol activity, real-time video counseling and a “panic button” that will allow users to place an immediate call for help.

Dr. Clark concluded the session by stating that there still is a lot to be done in this area, including: developing the workforce, developing core principles of effective treatment and improve public perception.

What do you think about ROSC programs and SAMHSA placing it as a top priority? Treatment providers, how does that translate to your practice? Please leave your comments in the section below.

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NCRG Conference: Pre-commitment As A Responsible Gaming Strategy – Is The Smart Card That Smart?

Continuing the theme of “Exploring New Trends in Recovery, Research and Responsible Gaming,” Monday’s NCRG Conference sessions took a close look at responsible gaming strategies. The afternoon session let by Robert Ladouceur, Ph.D., professor emeritus of psychology at Laval University, talked about smart cards and examined whether or not they were effective in encouraging responsible play among gamblers.

Dr. Ladouceur began the session by defining responsible gaming as a set of policies and practices designed to prevent and reduce potential harms associated with gambling. Responsible gaming aims to restrict expenditure to affordable limits. More specifically, the objective is to decrease the incidence of problem gambling.

Dr. Ladouceur provided two options to achieve this goal:

  1. Supply reduction:strategies that are intended to achieve social, health and safety benefits by reducing the availability of gambling
  2. Demand reduction:strategies aimed at motivating users to gamble less overall and/or less per occasion

He noted that the main difference between supply reduction and demand reduction is that the former focuses on external control while the latter focuses on internal control. When developing interventions, Dr. Ladouceur stated that the focus should be on internal controls.

One such strategy is pre-commitment (also known as smart cards), which is a system that enables gamblers to set money and time limits on expenditures prior to the commencement of a session of play. This concept was first introduced by Mark Dickerson in Australia, and his studies indicated that most gamblers lose control while they are gambling, and therefore, gamblers should determine the amount of time and money they will allocate before (rather than during) the gambling session.

Some jurisdictions have proposed implementing mandatory pre-commitment systems, but Dr. Ladouceur questioned whether or not there is sufficient evidence to implement a mandatory pre-commitment system to all inhabitants in a given jurisdiction.

He reviewed several studies on pre-commitment and noted that meaningful conclusions cannot be drawn as to whether or not it was effective. He stated that “although the notion of mandatory pre-commitment appears very compelling and possibly useful, its implementation appears to be dictated by a political rather than a scientific agenda.“

For more from the 13th annual NCRG Conference, make sure to stay tuned to Gambling Disorders 360.

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NCRG Conference: What Does It Mean To Be Recovered From A Gambling Disorder?

On the first day of the 13th annual NCRG Conference on Gambling and Addiction, a session of three notable researchers and clinicians took a close look at the issues surrounding treatment and recovery from a gambling disorder.

Lia Nower, Ph.D., J.D., associate professor and director of the Center for Gambling Studies at Rutgers University, began the session by discussing some of the difficulties associated with measuring recovery from pathological gambling. For example, the standard definition of a gambling disorder requires a cluster of symptoms but not a time frame. For example, a person who experiences three symptoms in the same weekend and a person who experiences three symptoms in their life are categorized in the same way. Another issue in defining a gambling disorder is that gambling “consumption” is not as easily classifiable as substances, such as alcohol, that can be standardized by weight or volume. While there are several ways that gambling researchers try to define consumption there is no easily understood standard as with other substance use disorders.

Next, Jody Bechtold, LCSW, NCGC-II, a nationally recognized gambling counselor, discussed recovery from a clinical perspective, noting that for clinicians, it is very hard to answer the question of what it means to be fully recovered. She explained that recovery may look different depending on the severity of the gambling disorder. For some pathological gamblers, complete abstinence from gambling behaviors may be the best way to prevent relapse. However, for problem gamblers, recovery could be defined either as abstinence or controlled gambling, but maybe changing the game or other factors. Counselors should take a multidisciplinary treatment approach with a goal to achieve better than pre-crisis states of well-being. She concluded by offering a definition of recovery: being accountable and responsible in all major life areas on a regular and consistent basis.

Finally, Harold Wynne, Ph.D., head of Wynne Resources, ended the session discussing several screening and diagnostic issues, including:

  • Issue 1: We are not really sure what pathological gambling is: a disease, a social problem or a social disease.
  • Issue 2: If we are not really sure what pathological gambling is, how can we screen for and diagnose the condition?
  • Issue 3: We tend to treat the symptoms and not the “pathological gambling disease.”
  • Issue 4: We tend to define pathological gambling recovery as being free some symptoms.
  • Issue 5: Recovery should be redefined as improvement in the overall health of the individual – not just the absence of pathological gambling symptoms.

What do you think it means to be recovered from a gambling disorder? Share your thoughts in the comments below. For more recap posts from the NCRG Conference, make sure to stay tuned to Gambling Disorders 360˚.

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NCRG Pre-conference Workshop: Acceptance And Commitment Therapy (Act)

Before the official start of the 13thannual NCRG Conference on Gambling and Addiction, Mark Dixon, Ph.D., professor and coordinator for the Behavior Analysis and Therapy Program at Southern Illinois University, and Alyssa Wilson, Ph.D., assistant professor of social work at Saint Louis University, led a two-hour preconference workshop that focused on Acceptance and Commitment Therapy (ACT).

ACT is a unique evidenced-based psychological intervention that uses acceptance and mindfulness strategies together with commitment and behavior change strategies to increase psychological flexibility. It is considered a second generation cognitive behavioral therapy (CBT) model and is based on behavioral principles on the nature of language and cognition.

Dr. Dixon noted that there is a growing body of literature on the effectiveness of ACT, adding that these studies have shown it is more effective than CBT. ACT is an alternate to CBT that focuses on acceptance of thoughts rather than suppression of thoughts.

ACT uses mind and body interventions to help change behavior patterns. The goal of ACT is to increase psychological flexibility by changing how we relate to thoughts and feelings rather than change their content. To do this, ACT focuses on six principles:

  • Contact with the Present Moment:Contact and awareness of the here and now, where the client is in their own thoughts and feelings
  • Acceptance:Willingness to accept everything good, bad and uncomfortable about the situation
  • Diffusion:De-literalizing language (learning to not tie words with emotions)
  • Self as Context:Separating yourself from your thoughts; words do not define a person (i.e. the label “pathological gambler” does not define who you are as a person, but you are a mom/dad, brother/sister, etc.)
  • Values:The goals we set for ourselves and what is most important to each person, along with the understanding that values are different for each indiividual
  • Committed Actions:Focusing on value-based behaviors

During the second half of the workshop, Dr. Wilson showed attendees how they can apply ACT with their patients. She led attendees through several exercises they can use to help their patients realize that pathological gambling does not define them as a person and learn how to make decisions based on their values.

For more information about the 13th Annual NCRG Conference on Gambling and Addiction, please visit theNCRG website, and stay tuned to this blog for updates.

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Connect With The NCRG Online For Conference Updates

The13th annual NCRG Conference on Gambling and Addictionbegins this Sunday, Sept. 30 and runs through Tuesday, Oct. 2 at the Sands Expo and Convention Center at the Venetian Las Vegas.

If you can’t make it to the event, we still want you to be a part of the conversations that are taking place! There are three ways you can stay updated on everything that’s happening at the NCRG Conference:

  1. 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.
  2. 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, “Screening and Brief Intervention: So You Want to Implement an Evidence-Based Practice?” “The Science of Recovery” and “Roundtable on Online Gambling: Regulating Responsible Gaming on the Internet.” For a full list of sessions, you can view theNCRG Conference schedule.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.
  3. Facebook:The NCRG team will also be active on Facebook (www.facebook.com/theNCRG), 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 atakugler@ncrg.org.

The NCRG team is excited for this year’s conference and looks forward to seeing participants who will be attending in person. If you can’t make the NCRG Conference, we hope you will participate online.

For more information on the NCRG Conference, visithttp://www.ncrg.org/public-education-and-outreach/conference.

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