Treating Adults With Co-occurring Disorders

Many individuals that suffer from gambling issues also have co-occurring psychiatric disorders and limited or no adequate treatment options to address all disorders at once. These co-occurring disorders include anxiety, depression and substance use disorders. Because of this problem, the Ohio Department of Mental Health and Addiction Services created The Ohio Problem Gambling Treatment Model for Adults with Co-Occurring Disorders (Kruse-Diehr et al., 2022), specifically for adults with co-occurring disorders. This manual, aims to fill in the gaps that exist when treating individuals with co-occurring disorders.

Aims

The researchers aimed to create and test the efficacy of a gambling disorder (GD) treatment manual, The Ohio Problem Gambling Treatment Model for Adults with Co-Occurring Disorders (OhPGTM). The main aims of the study were to assess, treat and measure changes in gambling disorder when using the manual and the treatment methods it recommends. This is important for treatment providers because it provides a uniform process to address all co-occurring disorders that are presenting along with a client’s gambling issues. Additionally, the overarching and long-term goal of this study was to address the negative consequences of GD and ultimately reduce its prevalence in Ohio populations.

What did they do?

The Ohio Problem Gambling Treatment Model for Adults with Co-Occurring Disorders (OhPGTM) was developed over a period of five years, drawing from various addiction treatment models including cognitive behavioral treatment, Motivational Interviewing and improvement of life skills. The manual included a 12-week process of modules with each week covering a new topic related to co-occurring disorders and gambling disorder. Participants completed monitoring logs, craving scales, handouts and take home assignments. Each study participant was placed into a group, with each group consisting of between three to 12 participants. Each participant completed a pre-test and post-test assessment to discern the helpfulness of the 12-week process. The scales used to assess the efficacy of the manual included The Gambling Craving Scale (Young & Wohl, 2009); the Problem Gambling Severity Index (Ferris, J., & Wynne, H., 2001), which was used to assess the previous year’s actual GD symptom severity and its effects on both the individual and family members; and The Rosenberg Self-Esteem Scale (Rosenberg, 1965), which was used to assess participant self-esteem.

What did they find?

Over the course of the study, 122 participants completed the program. Participants that completed the course reported a reduction in gambling, but no change in self-esteem or gambling urges. Two-thirds of the sample that completed the program reported a co-occurring mental disorder, and three fourths had a substance use disorder. The researchers concluded that this manual represents a significant improvement in GD treatment for at risk communities. As with many pilot studies, efficacy is not always immediately clear but the authors believe further research can help solidify its usefulness for both treatment providers and the clients that they serve.

Limitations:

The study authors stated that improvements in gambling behaviors cannot be confirmed as a result of the manual itself; participants may have had other factors in their life that affected their gambling actions over the course of the study. The researchers also noted that the study participants were almost predominantly white, which does not provide a representative sample of the population of Ohio.

Further Direction:

The ICRG was lucky enough to talk with Derek Longmeier,Executive Director, Problem Gambling Network of Ohio, who commented on his excitement over this manual:

We’ve found that screening at intake is not the most effective method for identifying those in need of gambling support services and that there is a strong connection between disordered gambling and substance use disorder. We are confident that this program will be a catalyst for identifying and serving individuals with co-occurring disorders. We know that there are many roads to recovery for those with a gambling disorder and we are hopeful that through broad distribution and utilization of the manual throughout Ohio, we can make the process as smooth as possible for both counselors and the clients they serve.

References

Ferris, J., & Wynne, H. (2001).The Canadian Problem Gambling Index(Final Report; p. 59). Canadian Consortium for Gambling Research.

Kruse-Diehr, A., Shamblen, S., & Courser, M. (2022). Longitudinal assessment of a manualized group treatment program for gambling disorder: The Ohio problem gambling treatment model for adults with co-occurring disorders.Journal of Gambling Studies.

Rosenberg, M. (1965). Rosenberg self-esteem scale.APA PsychTests.

Young, M., & Wohl, M. (2009). The Gambling Craving Scale: Psychometric validation and behavioral outcomes.Psychology of Addictive Behaviors,23(4).

ICRG staffResearch UpdateCo-occurring disordersGaming DisorderThe Ohio Problem Gambling Treatment Model

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ICRG Supports Gambling Disorder Screening Day

Brief screens can help people decide whether to seek formal evaluation of their gambling behavior. The 3-item Brief Biosocial Gambling Screen (BBGS) is based on the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria for Gambling Disorder. A “yes” response to any single item indicates potential gambling-related problems and the need for additional evaluation. The ICRG is proud to have played a role in the development of this evidence-based screening tool.

The ICRG is also a proud supporter of Gambling Disorder Screening Day (Screening Day), a one-day event held annually on the second Tuesday of March. Established by the Division on Addiction at Cambridge Health, a teaching hospital of Harvard Medical School, Screening Day has included supporters and screeners from Cambridge Health Alliance, Massachusetts and New England, the United States and around the world. Screening Day has helped identify individuals in those regions who might have Gambling Disorder and should seek further assessment.

The ICRG is participating in Screening Day by distributing for free the BBGS in magnet form—suitable for affixing to your file cabinet—to treatment providers. To request magnets, contact nmancini@icrg.org.

Organizations are encouraged to host a screening event on Screening Day. The Division’s Screening Day Toolkit contains a variety of free online tools and resources, including a printable and customizable Screening Day Flyer, BBGS e-Screener (Brief Biosocial Gambling Screen) and a one-page article What Is Gambling Disorder? The Division encourages organizations and individuals to share these tools and resources to educate staff and patients. To host Screening Day on Tuesday, March 8th, 2022, email info@divisiononaddiction.org.

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ICRG staff Responsible Gaming gambling disorder Division on Addictions

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The Connection Between Gambling Disorder And Suicide In Twins

Past studies have drawn a correlation between gambling disorder and suicidal behaviors but have yet to establish whether this is a direct cause or is influenced by other outside factors such as genetics and environment. Twin studies are important for looking at causal mechanisms of disease as they allow researchers to tease out the effect of genetics and environment. In an attempt to determine whether gambling disorder (GD) is a causal mechanism for suicidal behaviors, Dr. Wendy Slutske, an ICRG Center of Excellence Grant recipient, and colleagues conducted a twin study utilizing members of the Australian Twin Registry.

Aims:

Slutske et al., 2022 focused this study on the relationship between precursors to suicide, such as suicidal thoughts, plans and attempts and gambling disorder. Past studies have failed to either prove or disprove a causal link between the two.Twin studies are important to public health because they allow researchers to look at the comparative influences of genetics and environment on a certain behavior.

What did they do?

The researchers assembled two cohorts from the Australian Twin Registry, which included 2,995 complete twin pairs. Two phases of assessments were conducted that gathered information on suicidal behaviors, psychiatric disorders, gambling disorder, income and education. Gambling disorder was assessed by using the National Opinion Research Center DSM Screen for Gambling Problems (Gerstein et al., 1999). Suicidal behaviors were assessed by utilizing a script asking various questions about past suicidal thoughts, plans and actions. The researchers also screened for other psychiatric disorders, including major depression, alcohol use disorder, cannabis use disorder, nicotine dependence and conduct disorder. Socioeconomic status and education level were self-reported by participants. After ascertaining the above information on the twin pairs, the research team performed multilevel discordant-twin analyses to determine whether there was a causal link between gambling disorder and suicidal thoughts, plans and actions.

What did they find?

This study established a significant association between gambling disorder (GD) and suicide thoughts, plans and attempts for the very first time in the peer-reviewed literature. Despite finding an association between GD and suicide thoughts, plans and attempts, researchers were unable to confirm that the relationship is causal in the sample unless they removed the influence of shared genetics and environmental risk factors between the twins. The males within the sample showed a stronger possibility of having a causal relationship between gambling disorder and suicidal thoughts, ideas and attempts than women. . This potential causal relationship may have been related to financial problems related to GD instead of just gambling disorder itself. As a result, the researchers emphasized that using financial harms data to identify individuals having financial hardships may be the best option for targeting, screening and intervening with individuals before they reach suicidal ideation.

Limitations

The authors reported on the limitations of their current study. They observed that the exclusion of interview questions on other psychiatric disorders such as anxiety, post -traumatic stress disorder and panic order might affect the findings, as these disorders may also affect the presence of suicidal ideation. Next, data collection was retrospective in design, which could lead to some inaccuracies when individuals recall specific past actions, thoughts and traits. Finally, the participant pool represented a narrow age group, (27-43), and included only Australian residents. Therefore, the findings of this study cannot be generalized to other age groups or countries.

Gerstein, D., Murphy, S., Toce, M., Hoffmann, J., Palmer, A., Johnson, R., Larison, C., Chuchro, L., Bard, A., Engelman, L., Hill, M. A., Buie, T., Volberg, R., Harwood, H., Tucker, A., Christiansen, E., Cummings, W., & Sinclair, S. (1999).Gambling Impact and Behavior Study: Report to the National Gambling Impact Study Commission. National Opinion Research Center.

Slutske, W., Davis, C., Lynskey, M., Heath, A., & Martin, N. (2022). An epidemiologic, longitudinal, and discordant-twin study of the association between gambling disorder and suicidal behaviors.Clinical Psychological Science, 1–19. https://doi.org/10.1177/21677026211062599

ICRG staffResearch Updategambling disordersuicideGambling disorder research

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Returning To The Virtual Casino: A Contemporary Study Of Actual Online Casino Gambling

Online casino gambling has been less utilized than its brick and mortar counterparts historically. However, with the expansion of legalized internet gambling, its popularity is expected to increase. The research base for this form of gambling is under-developed. Consequently, the Division of Addiction, Cambridge Health Alliance, a teaching hospital of Harvard Medical School, has set out to fill this void by examining actual internet casino gambling behaviors in the European Union (EU).

Aims:

Edson et al., 2021 aimed to compare actual online casino data from bwin, previously one of the largest online gambling operators in the EU, to a similar study conducted in 2008 by the Division on Addiction (LaBrie et al., 2008), while also adding in a few novel metrics. These new metrics included looking at deposit and withdrawal behaviors of the participants within the sample. The researchers hoped to find out how online casino gambling behaviors may have changed over time, and how more “extreme” gamblers, those found to be in the top 5% of gambling participation in the sample and defined as being overly involved in gambling, differ from the rest of the sample.

Why is this important?

This study is important because it aims to fill in gaps of research on online casino games, such as slot machines, blackjack, and roulette. Although they are historically played less often than the same games in land-based casinos, there is reason to believe that they may gain popularity over the next few years with the continued expansion of legalized online gambling opportunities in the EU. A study by Gainsbury & Wood, 2011, found that increased accessibility to online casino games may be correlated with overall changes in rates of gambling disorder. On the other hand, an investigation by Philander & MacKay, 2014, found that online gambling was not heavily correlated with increased risk of gambling problems. The Division on Addiction’s study, that looks at participants’ data over time, will answer some important questions raised by previous research.

What did they do?

Researchers examined two years of longitudinal data from 4,424 actual online gambling subscribers to bwin. The study was modeled on the the previously mentioned 2008 study. The researchers at the Division of Addiction gathered data on the 4,424 subscribers’ characteristics, gambling activity, deposit activity, and withdrawal activity. Correlation analyses were conducted to assess relationships between gambling, depositing, and withdrawal behaviors. The researchers also conducted analyses of gambling behavior and age, and compared participants who showed more involvement in gambling activities to a typical gambler.

What did they find?

The investigators found that online casino gambling behaviors are very similar to those outlined in the 2008 study (LaBrie et al., 2008). The previous study found that small proportions of the participants (~5%) exhibited more extreme gambling involvement than the rest, and that most online casino players in the sample bet modest amounts. Some gambling behaviors such as net loss, credit card use, and withdrawals distinguished these more “extreme” gamblers from the typical gamblers.

Limitations

The researchers noted that this study was conducted within one online gambling service, and participants within the sample may have gambled with other operators as well during the study period. Additionally, this sample was derived from one single registration cohort and may not be representative of all online casino gamblers. Finally, because the sample was restricted to the EU, the findings are not necessarily applicable to the US.

Edson, T., Tom, M., Louderback, E., Nelson, S., & LaPlante, D. A. (2021). Returning to the virtual casino: A contemporary study of actual online casino gambling.International Gambling Studies.

Gainsbury, S., & Wood, R. (2011). Internet gambling policy in critical comparative perspective: The effectiveness of existing regulatory frameworks.International Gambling Studies,11(3), 309–323.

LaBrie, R. A., Kaplan, S. A., LaPlante, D. A., Nelson, S. E., & Shaffer, H. J. (2008). Inside the virtual casino: A prospective longitudinal study of actual Internet casino gambling.European Journal of Public Health,18(4), 410–416. https://doi.org/10.1093/eurpub/ckn021

Philander, K., & MacKay, T.-L. (2014). Online gambling participation and problem gambling severity: Is there a causal relationship?International Gambling Studies,14(2).

ICRG staffResearch UpdateOnline Gambling

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Annual Golf Classic Raises $104,000 For The ICRG

The 22nd annual AGEM & AGA Golf Classic Presented by JCM Global was a huge success, and thanks to the generous support of sponsors and players, the event raised $104,000 to benefit the first-class research conducted by the International Center for Responsible Gaming (ICRG).

Including this year, the event has now raised more than $2.3 million for the ICRG and its important research into gambling disorder.

“The ICRG is so grateful to JCM Global, AGA, AGEM, and the participating companies for continuing this important source of funding for research on gambling disorder,” said ICRG President Arthur Paikowsky. “Funding for gambling research brings us one step closer to developing effective prevention and treatment for the millions of Americans who suffer from gambling addiction.”

The Golf Classic attracts players and sponsors from across the gaming industry spectrum. Title Sponsors are Association of Gaming Equipment Manufacturers (AGEM) and the American Gaming Association (AGA). Presenting Sponsor is JCM Global (JCM). Media sponsor is GGB Magazine. Other sponsors include Aristocrat Gaming, Caesars Entertainment, Catapult Global, Century Gaming Technologies, Fantalooks, ICE London 2022, IGT, Konami, Patriot Gaming & Electronics, and Scientific Games.

Planning is underway for the 2022 Golf Classic. For more information or to become a sponsor, visitgolf.jcmglobal.comor contactmarketing@jcmglobal.com.

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ICRG staffIn the News

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ICRG Online Poster Session

We, at ICRG, would like to thank everyone that participated in this year’s online poster session. It has been a trying last couple of years, and although we couldn’t see the posters in person, research doesn’t stop and we were able to learn via online presentations.

Additionally, we would like to announce the winners of poster awards for 2021:

Honorable Mention: “Preparing Massachusetts treatment providers for gambling expansion: Initial observations from a statewide needs assessment and capacity building program”- Kira A. Landauer, Amy Flynn, Caitlyn S. Fong, Tamika R. Francis, Ivy Schmalzried, Elizabeth Bice, Amanda Ayers, Debi A. LaPlante, Heather M. Gray Division on Addiction at Cambridge Health Alliance, a teaching hospital of Harvard Medical School

Abstract: Like many places around the world, the Commonwealth of Massachusetts is undergoing a period of gambling expansion. Increased availability of gambling opportunities, both land-based and online, might contribute to an increase in the prevalence of problem gambling and health workforce, who already provide care for common co-occurring conditions including substance use disorders and other mental health conditions, must be prepared to screen for and manage problem gambling among their clientele. To that end, the Massachusetts Department of Public Health Office of Problem Gambling Services partnered with Health Resources in Action and the Division on Addiction at Cambridge Health Alliance to build the capacity of substance use outpatient treatment programs in Massachusetts to address problem gambling and co-occurring substance use and mental health disorders, and to reduce health disparities associated with the delivery of those services in their communities. This poster will review the Massachusetts

Technical Assistance Center for Problem Gambling Treatment’s (MTAC) first year of activity. First, we will review findings from a statewide needs assessment designed to identify treatment providers’ most pressing needs as they relate to integrating problem gambling treatment into their portfolio of services in a way that reduces or eliminates persistent healthcare disparities. Twenty-six programs, each with an average of 1,798 patients, completed a needs assessment survey and a subset completed individual structured interviews. Questions were focused on whether and how programs screen for, assess, and treat problem gambling among their

patients. Programs also answered questions about organizational-level factors that have the potential to impact their problem gambling treatment services, including recruitment and retention of staff, training, collection and use of data, marketing and promotion of services, and organizational culture. Second, we will describe the development of individualized TA plans created in collaboration with outpatient programs and centered on health equity. Finally, more broadly, we will describe challenges, successes, and planned next steps of this collaboration.

Most Outstanding Poster:“Should I stay or should I go: Feeling both optimistic for recovery and nostalgic for gambling heightens ambivalence and likelihood of relapse”- Mackenzie Dowson, Michael J. A. Wohl, Melissa M. Salmon, Isabella R. L. Bossom, Nassim Tabri, Carleton University

Abstract: A growing body of research has demonstrated that nostalgic reverie (i.e., sentimental longing) for the pre-addicted self readies people living with a gambling disorder for change. However, there may be a potential dark side to nostalgia among those in recovery. In this novel research, we recruited a sample of 304 (Male= 172; Female=132) people in recovery from disordered gambling (recruited via CloudResearch) and assessed them on nostalgia for gambling and optimism for a gambling-free future. Specifically, we predicted and found support for the idea that nostalgia for gambling (e.g., reminiscing about emotional and or behavioural aspects of gambling) is associated with greater ambivalence about the recovery process and greater likelihood of having experienced a relapse. We also found support for the idea that although optimism about one’s recovery is negatively associated with ambivalence about the recovery process, those who feel both nostalgic about the past and optimistic about the future report the greatest amount of ambivalence. Results suggest that treatment providers should examine the extent to which their clients nostalgize about gambling and work to undermine such sentiments, particularly among those who express confidence in their recovery process.

ICRG staffConference on Gambling and Addiction

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Learn About New Research On Gambling – Virtual Poster Session

Learn about New Research on Gambling! ICRG Virtual Conference Poster Session on Oct. 4-7, 2021

The International Center for Responsible Gaming is excited to announce its 2021 Virtual Conference Poster Session. Due to the ongoing pandemic, we are unable to host our yearly conference in person, but we will be bringing you the poster session to your computer!

Poster presenters will submit a virtual poster and video submission that will act as a presentation of the poster. Posters and presentations will be judged for merit and awarded accordingly. We are excited to share these posters with you and hope you will join us October 4-7thvirtually to learn more about the new and exciting research in the field of gambling disorder and responsible gaming, including topics ranging from behavioral characteristics of gamblers seeking help, to medicinal treatment of problem gambling behaviors. This year’s presenters include researchers from McGill University, UNLV, and Swansea University to name a few.

We invite you to join the fun and subscribe to the ICRG Poster Session YouTube channel athttps://www.youtube.com/channel/UC-7db3FayYuhR7uxMcPPH0A. Poster videos will go live at 12 PM EST on October 4th.

Please visithttps://www.icrg.org/public-education-and-outreach/ncrg-conference-gambling-and-addiction/poster-sessionfor any updates on the poster session.

ICRG staffConference on Gambling and AddictionResponsible Gaming Research

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The Impact Of Covid-19 On Gambling And Gambling Disorder: Emerging Data

The Covid-19 pandemic and subsequent lockdown has had many effects on society and various industries including the gambling industry. Many commercial gambling establishments were forced to close, while online venues continued to operate. In addition to the varying availability of the different types of gambling, the social and economic impacts of the pandemic may affect an individual’s desire to gamble.

Aim:

(Hodgins & Stevens, 2021) completed a literature review to identify and describe data and findings that examined the effect of Covid-19 on individual gambling and gambling disorder. Researchers completed database searches to identify peer-reviewed articles and other relevant research reports that examine changes in individuals’ gambling behaviors during the pandemic. To be included in the study, articles must have a collection of data on individual gamblers, be published post March 2020, and have Covid effect assessed in English.

What did they find?

Researchers narrowed their literature review to seventeen online self-report surveys. Seven articles were peer reviewed, three were re-prints, and seven were online reports. Eleven of these were cross-sectional, while six were longitudinal in nature. Results showed both an increase and reduction in individual gamblers. An overall reduction in gambling frequency and expenditure was reported in all seventeen articles. Common reasons for gambling less included financial reasons, not wanting to gamble in front of family, someone suggesting they gamble less, no live sports, and cancellation of sporting events.

A handful of studies estimated the increase in gambling. Characteristics of gamblers who reported increased gambling included younger and older age, being male, being female, full-time employment, higher income, anxiety, depression, alcohol consumption, and non-smokers. Reasons for increasing gambling included boredom, need for relaxation, financial pressure, and desire to earn money.A consistent correlate to increased gambling was higher problem gambling severity.

Three studies included in this paper looked at gambling post-lockdown. It was found that 48% of individuals maintained or increased gambling activities. This increase was associated with ethnic background, lower education, non-student status, and smoking.

Limitations

No study is without limitations. This literature review includes only seven peer-reviewed studies, and all are self-report. This self-report methodology is vulnerable to bias as respondents report their own behavior. Additionally, studies are not generalizable to the entire population of the world, as study groups were specific to regions.

Hodgins, D., & Stevens, R. (2021). The impact of COVID-19 on gambling and gambling disorder: Emerging data.Current Opinion in Psychiatry,34(4), 332–343.

ICRG staffResponsible GamingCOVID-19gambling disorder

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Examining Player Engagement With And Attitudes Toward A Gambling Play Management System

Gambling play management systems are preventative tools used to keep patrons within set budget limits. PlayMyWay is the first used within a casino setting with the US, described as “innovative budgeting tool designed to allow customers the ability to monitor the amount of money they spend on electronic gaming machines, and to inform their decision to continue or stop play” (Tom et al., 2017).

Dr. Timothy Edson and fellow researchers set out to examine gambling patrons’ attitudes toward PlayMyWay, the gambling play management system deployed at Plainridge Casino in Massachusetts (Edson et al., 2021).

Aim

Dr. Edson and his team examined patrons’ reported use of PlayMyWay and attitudes toward the system. They surveyed a sample of Marquee Rewards cardholders, which included demographics, questions based on the PlayMyWay system and gambling behaviors. Participants were labeled as “enrolled”, “un-enrolled”, and “never enrolled”. Enrolled and un-enrolled participants were further classified in to one group “ever-enrolled”. Ever-enrolled participants, either currently enrolled or previously enrolled, were asked to report their personal response to notification sent by the system, possible emotions they may have felt upon receiving notifications, and whether they would recommend PlayMyWay to others. Additionally, they were asked to complete a Systems Usability Scale to measure ease of use of the program. Gambling behaviors were also assessed, including how often the patrons’ visited the casino and the results of a Brief Biosocial Gambling Scale (BBGS) (Gebauer et al., 2010) screening to assess any possible gambling issues.

Why is this Important?

Play management systems, such as PlayMyWay have the potential to be a necessary responsible gambling tool within casinos, but there is a dearth of research that examines users’ attitudes towards it. At the time of publication, studies that examined play management systems reported mixed results on efficacy of reducing play time and gambling limits when at the casino. Additionally, the attitudes of users towards these systems remain unknown. This study seeks to fill these gaps in research by assessing user’s attitudes toward PlayMyWay and hopes to use these results to improve the system.

What did they find?

The researchers were able to extract some important findings from their survey, despite a majority of the participants having never used PlayMyWay. They found that users not enrolled despite knowing about the PlayMyWay system, reported that they did not believe they needed the reminders and warnings. Generally, users of the system found it easy to use, but reported that they paid little attention to the notifications and tended to react negatively to them. Finally, users who screened positive on the BBGS were more likely to un-enroll, less likely to report that they needed the notification from the program, and were more likely to respond negatively to notifications than those that tested negative on the BBGS scale.

Limitations

Authors of this study reported low generalizability, as only 1.5% of the survey population participated in this study after being contacted. Additionally, these patrons are only a small sample from one casino and the results should be taken to represent only this one small population and not all casino patrons. Additionally, responses from users are subject to biases caused by falsification of responses, recall bias, faulty memory, and other miscomprehension.

Edson, T., Tom, M. A., & LaPlante, D. (2021). Examining player engagement with and attitudes toward a gambling play management system.Journal of Gambling Studies, Epub: ahead of print. https://doi.org/10.1007/s10899-021-10002-9

Gebauer, L., LaBrie, R., & Shaffer, H. J. (2010). Optimizing DSM-IV-TR classification accuracy: A brief biosocial screen for detecting current gambling disorders among gamblers in the general household population.Canadian Journal of Psychiatry,55(2), 82–90.

Tom, M., Singh, P., Edson, T., LaPlante, D., & Shaffer, H. (2017).Preliminary study of patrons’ use of the PlayMyWay play management System at Plainridge Park Casino: June 8, 2016-January 31, 2017. Division on Addiction, Cambridge Health Alliance.

ICRG staffResponsible GamingGambling Play Managementgambling researchresponsible gaming

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The Efficacy Of Personalized Feedback Interventions Delivered Via Smartphone

Brief motivational interviews,“a widely disseminated clinical approach that uses a directive, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence about changing the addictive behavior” (Miller & Rose, 2009)have been used to reduce gambling-related behaviors, especially when they incorporate personalized feedback. Personalized feedback will typically include pieces of information relating specifically to the issues one is facing, such as difficulties that have occurred due to the problem, and comparisons to social norms. This is used as a catalyst for motivating one to change their behavior.

A new study (McAfee et al., 2020), funded by an ICRG Large Grant, set out to look at whether brief motivational interviews with personalized feedback delivered via smartphone to college students would be helpful in reducing gambling related harms.

Hypotheses

Researchers examined the efficacy of personalized feedback based interventions delivered via smartphone and text message with college-aged gamblers. They wished to test three separate hypotheses within the sample. First, they hypothesized that students that received motivational interviews would report lower gambling norms than the control group that received no motivational interview or text messages. Second, they hypothesized that students that received personalized feedback via text during the trial period (PFB-TXT) would report fewer gambling-related cognitive distortions at the one month follow up, and subsequently less gambling and fewer gambling problems at the six-month follow-up than the study group that received general education information about gambling, rather than personalized feedback (PFB-EDU). Lastly, they hypothesized that students in the PFB-TXT group would report use of gambling protective strategies at the one-month follow-up and subsequently less gambling and problems at the six-month follow up than the PFB-EDU group.

Why is this important?

College students, on average, engage in at-risk gambling at a higher rate than the general population. This is concerning because evidence shows that disordered gambling often co-occurs with other health related problems such as alcohol abuse, drug use, and tobacco use. Previous interventions that incorporate personalized feedback have been effective at reducing gambling problems. Most importantly, addressing cognitive distortions about gambling and offering protective behaviors related to gambling may be useful in treatment of gambling problems in college students.

What did they do?

Researchers completed a clinical trial of college students that had gambled in the last 60 days and successfully scheduled an enrollment meeting to participate in the trial. These students, recruited through email announcements and that met the screening threshold, were assigned randomly to one of three study groups. Eighty students were assigned to the Personalized Feedback plus Text group, 68 students assigned to the personalized feedback, no text message group, and 93 were assigned to the control group, which received no personalized feedback or text messages. All participants completed self-report questionnaires at baseline, one month and six months.

  • Screening was completed using SOGS (Lesieur & Blume, 1987) and BBGS (Gebauer et al., 2010) to screen for at-risk gambling
  • Gambling Frequency was measured by asking participants to indicate days they gambled on a calendar and how much they gambled
  • Gambling Problems were measured using the CPGI nine-item measure (Ferris & Wynne, 2001) developed to assess the degree to which participants experienced any consequences related to gambling
  • Gambling norms were assessed by asking participants how many times they believe a typical student gambles within a month
  • Cognitive distortions were measured using the GRCS gambling related cognitions scale (Raylu & Oei, 2004) to assess cognitions related to gambling.
  • Protective strategies were measured via a gambling protective behavior scale

The PBS-TXT group received 12 targeted text messages with a link to personalized feedback including the number of times they gambled per month compared to other college students and a summary of self-reported negative consequences they associated with their gambling.

The PBS-EDU group received personalized feedback identical to the first group, but instead of targeted information, they received generic educational information in texts.

The control group completed the same assessments as the first two groups but received no feedback or texts.

At the completion of the study, researchers conducted three sets of analyses using the PROCESS program, which tests for indirect, direct, and total effects of an intervention condition.

Results

Researchers found that personalized feedback conditions did not have a direct effect compared to the control condition on variables measured at the six-month follow-up. However, they found a significant effect of gambling norms answers at the one-month follow-up. Additionally, they found no differences between the two different PFB conditions in terms of indirect or direct effects at the six-month follow-up, which suggests personalized feedback did not provide greater efficacy in changing gambling -related outcomes throughout the trial. Although the main hypothesis could not be substantiated within this study, researchers had a few significant findings.

  • Participants in both of the PFB groups reported less perceived gambling among students at one month, which correlated fewer gambling problems at month 6.
  • Participants that received the targeted PFB messages, rather than the generic messages, did not report a significantly greater usage of protective behavioral strategies at one-month follow-up
  • Participants in both of the PFB groups reported that the typical student gambled less than the students in the control group reported

Limitations

Although a clinical trial with a control group, this study was not without limitations. Researchers report that they believe the intervention did not work well with the sample chosen, as many of the student gamblers engaged in gambling outside of traditional establishments and the interventions and messages were written for traditional methods of gambling. Researchers also reported generalizability is low, because the sample group is one set of students at one University. Additionally, assessments utilized retrospective self-report, which is prone to bias.

Ferris, J., & Wynne, H. (2001).The Canadian Problem Gambling Index: User’s Manual. Canadian Centre on Substance Abuse (CCSA).

Gebauer, L., LaBrie, R., & Shaffer, H. J. (2010). Optimizing DSM-IV-TR classification accuracy: A brief biosocial screen for detecting current gambling disorders among gamblers in the general household population.Canadian Journal of Psychiatry,55(2), 82–90.

Lesieur, H. R., & Blume, S. B. (1987). The South Oaks Gambling Screen (SOGS): A new instrument for the identification of pathological gamblers.American Journal of Psychiatry,144(9), 1184–1188.

McAfee, N., Martens, M. P., Herring, T., Takamatsu, S. K., & Foss, J. (2020). The efficacy of personalized feedback interventions delivered via smartphone among at-risk college student gamblers.Journal of Gambling Issues,45, 39–63.

Miller, W., & Rose, G. (2009). Toward a theory of motivational interviewing.American Psychologist,64(4), 527–537.

Raylu, N., & Oei, T. P. S. (2004). The Gambling Related Cognitions Scale (GRCS): Development, confirmatory factor validation and psychometric properties.Addiction,99(6), 757–769. https://doi.org/10.1111/j.1360-0443.2004.00753.x

ICRG staffResearch Updategambling researchcollege gambling

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