NCRG Awarded $380,466 In Research Grants In 2010

The National Center for Responsible Gaming (NCRG) recently announced it awarded $380,466 in project grants in 2010 for five new research projects on topics ranging from a laboratory simulation of Internet gambling to an intervention for college students at risk for developing gambling problems. The recipients of these grants are investigators based at the University of Florida, Duke University, Southern Illinois University, the University of Missouri and the University of Minnesota.

The NCRG grants were selected by independent peer review panels and the Scientific Advisory Board, which guides the NCRG’s grant making. The awards were made in three new categories adopted in 2010: Exploration Grants, Seed Grants and Large Grants.

The following summaries describe the 2010 grant awards:

Exploration Grant

  • Many believe that online wagering is riskier than other forms of gambling; however, there are few studies evaluating problematic gambling on the Internet. Yijun Liu, Ph.D., River Branch Professor and chief of the Division on Global Health at the University of Florida, seeks to fill this void with a project funded by a $5,400 Exploration Grant. The project will develop a virtual Internet gambling website to be used as a simulation in a laboratory experiment involving 12 subjects who meet the criteria for pathological gambling and 12 control group members. Using an fMRI brain scanner, Dr. Liu will seek to understand the neural pathways involved in excessive gambling and discern what is unique about the online gambling experience for people with gambling-related problems.

Seed Grant

  • Gambling is all about making choices, and gambling disorders are characterized by poor judgment and risky decision-making. Scott Huettel, Ph.D., associate professor of psychology and neuroscience at Duke University, was awarded $34,500 to test the hypothesis that whether someone makes a risky or safe choice depends not simply on preferences, but on the strategies they use to acquire and integrate new information. The research team will investigate the information-acquisition process in real time using high-speed, high-resolution tracking of eye movements and tasks that involve incentive-compatible decisions between economic gambles. They will evaluate how factors that contribute to risk-seeking choices alter how people process new information about risks and rewards. Dr. Huettel explained, “By tracking how people move their eyes when they make risky decisions, we will gain a better understanding of how they acquire and integrate information about risks and rewards. In turn, this understanding will provide insight into why environmental cues lead some people to make unwanted risky decisions, while others are unaffected.”
  • Previous brain imaging research has shown that brain activity differs between pathological and non-pathological gamblers when exposed to wins, losses and near-miss outcomes. Mark R. Dixon, Ph.D., professor of rehabilitation at Southern Illinois University, was awarded $34,500 to examine the brain activity of disordered gamblers through an fMRI scanner before and after Acceptance and Commitment Therapy (ACT), an intervention that has shown promise for treating gambling disorders. The investigators will compare the brain scans of the therapy group with the control group to look for evidence of neurobiological changes as a result of ACT. According to Dr. Dixon, “This project will be the first in the published literature to a) document a magnitude effect of near-miss outcomes at the neurobiological level, and b) provide evidence at a neurobiological level of the impact of psychological treatment for pathological gamblers.”

Large Grants

  • Matthew P. Martens, Ph.D., associate professor in the department of educational, school and counseling psychology at the University of Missouri, Columbia, was awarded $172,500 to test a personalized feedback-only intervention that will provide “at-risk” college students with information about their own behavior. This project will determine if college students participating in the personalized feedback condition will report less gambling, fewer dollars gambled and less problem gambling at follow-up than students in both education/advice and assessment-only control conditions. According to Dr. Martens, “Our findings will indicate whether or not a low-cost, personalized feedback-only intervention is effective at reducing gambling-related activities and problems among college students at-risk for problem gambling.”
  • John Nyman, Ph.D., professor of public health at the University of Minnesota, was awarded $136,449 to study the differentiating factors between people who are recreational gamblers with no gambling-related problems and people who are pathological gamblers. Dr. Nyman explained, “There are a number of characteristics that have been associated with disordered gambling, such as race and gender. Our analysis will determine whether and to what extent these are also characteristics of recreational gambling. Isolating the characteristics that are associated with disordered gambling from those also associated with recreational gambling will permit more finely focused and effective interventions of disordered gamblers.” The study will also determine when a recreational gambler becomes a problem gambler. To achieve these objectives, Dr. Nyman’s team will conduct an analysis of two important data sets that include gambling data: the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a nationally representative survey of 43,093 Americans and the Minnesota Twin Family Study.

Christine ReillyIssues & Insights

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New Edition Of The Wager Examines Study Of Personality Subgroups Of Pathological Gamblers

Scientists have proposed an understanding of pathological gambling (PG) as an expression of an underlying addiction syndrome (Shaffer et al., 2004). A syndrome, by definition, is expected to have generally predictable signs and symptoms, though they will vary and may not always be present. Are there definable “types” of people with PG? The most recent edition ofThe WAGER(Worldwide Addiction Gambling Education Report) reviews a study focused on this issue.

This month’s edition ofTheWAGER– Vol. 15(10)reviews a 2010 study published in theCanadian Journal of Psychiatrythat examined the personality variables of 1,171 people seeking treatment for PG in Spain (Alvarez-Moya et al., 2010). The researchers found four subgroups that were composed of people whose personality traits were more similar to each other than to others in the sample. These four groups had varying levels of psychological problems and PG severity with the most disordered meeting the most criteria for PG and the least disordered meeting the fewest PG criteria. For the full review or to access online reviews of research on other addictive disorders, visitThe BASIS (Brief Addiction Science Information Source).

As always, we welcome thoughts and questions in the comments section below.

References

Alvarez-Moya, E. M., Jiménez-Murcia, S., Aymamí, M. N., Gómez-Peña, M., Granero, R., Santamaría, J., Menchón, J. M., et al. (2010). Subtyping study of a pathological gamblers sample.Canadian Journal of Psychiatry. Revue Canadienne De Psychiatrie,55(8), 498-506.

Shaffer, H. J., LaPlante, D. A., LaBrie, R. A., Kidman, R. C., Donato, A. N., & Stanton, M. V. (2004). Toward a syndrome model of addiction: Multiple expressions, common etiology.Harvard Review of Psychiatry,12, 367-374.

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NCRG Awards $380,466 In New Research Grants

The National Center for Responsible Gaming (NCRG) recently announced it awarded $380,466 in project grants in 2010 for five new research projects on topics ranging from a laboratory simulation of Internet gambling to an intervention for college students at risk for developing gambling problems. The recipients of these grants are investigators based at the University of Florida, Duke University, Southern Illinois State University, University of Missouri and University of Minnesota. For more information and to view the press release, go the NCRG’swebsite.

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December Issues &Amp; Insights Examines Motivational Interviewing For Gambling Addiction

Recovering from addiction is all about changing one’s behavior. Anyone who has tried to diet, quit smoking or get off the couch and exercise knows that changing behavior can be very challenging. It is especially true for individuals struggling with an addictive disorder. To assist people with changing their abuse of alcohol and drugs, specialists in addiction have developed motivational interviewing (MI), 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). William R. Miller, Ph.D., Emeritus Distinguished Professor of Psychology and Psychiatry at the University of Mexico, led the development and testing of the original concept.

Research has shown successful outcomes when MI is employed by alcohol and drug counselors. But what about disordered gambling?This month’sIssues & Insightswill focus on the origins of motivational interviewing, its principles and how David Hodgins, Ph.D., professor of psychology at the University of Calgary in Canada, is testing this approach with disordered gamblers.

Miller, W. R., & Rose, G. S. (2009). Toward a theory of motivational interviewing.American Psychologist, 64(6), 527-537.

NCRG staffResearch Update

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The 10 Most Influential Research Papers On Gambling Disorders

One way to measure the success of a research study is to calculate its influence on the field.The Web of Scienceis an online index of peer-reviewed publications that monitors the number of times a particular article is cited in other publications. A count of how many times a paper is referenced can be used as a rough estimation of the impact of a study on the field, although it is not a measure of quality. What are the top 10 most influential research papers on pathological gambling (PG) from 1965 to the present? See the following list.

1. 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), 1184-8.

Times Cited: 659

The SOGS has been the most widely used screening tool for pathological gambling since it was first published in 1987. Screening tools often have very high citation counts because they provide a starting point for research on many diverging aspects of a subject.

2. 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), 1369-76.

Times Cited: 266

This synthesis of findings from 119 other studies was the first in 20 years to provide national estimates of the prevalence of gambling disorders for the U.S. and Canada. The study was funded by the National Center for Responsible Gaming.

3. Petry, N. M., Stinson, F. S., & Grant, B. F. (2005). Comorbidity of DSM-IV pathological gambling and other psychiatric disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions.Journal of Clinical Psychiatry,66(5), 564-74.

Times Cited: 165

The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), the largest prevalence study of psychiatric disorders in the U.S., was one of the first major national health surveys to include questions about gambling. Face-to-face interviews were conducted during 2001 and 2002 with 43,093 U.S. residents aged 18 and older.

4. Dodd, M. L., Klos, K. J., Bower, J. H., Geda, Y. E., Josephs, K. A., & Ahlskog, J. E. (2005). Pathological gambling caused by drugs used to treat Parkinson disease.Archives of Neurology,62(9), 1377-1381.

Times Cited: 154

This exploratory study was one of the first to identify the connection between pathological gambling and a drug used to treat Parkinson’s Disease.

5. Cunningham-Williams, R. M., Cottler, L. B., Compton, W. M., & Spitznagel, E. L. (1998). Taking chances: Problem gamblers and mental health disorders–results from the St. Louis Epidemiologic Catchment Area Study.American Journal of Public Health,88(7), 1093-6.

Times Cited: 150

St. Louis, Mo., was one of five sites to participate in the Epidemiologic Catchment Area Study of mental disorders in the general population in 1981. This survey was among the first to provide substantial evidence for the high rate of co-occurring psychiatric disorders with pathological gambling.

6. McCormick, R. A., Russo, A. M., Ramirez, L. F., & Taber, J. I. (1984). Affective disorders among pathological gamblers seeking treatment.The American Journal of Psychiatry,141(2), 215-218.

Times Cited: 148

This study found a link between PG and affective disorders in a sample of participants in a gambling recovery program at a Virginia hospital.

7. Volberg, R. A. (1994). The prevalence and demographics of pathological gamblers: implications for public health.American Journal of Public Health,84(2), 237-241.

Times Cited: 147

This study of prevalence in five states found a lot of variation in the availability of gambling and prevalence of pathological gambling, while also finding that the demographics of people with PG were similar from state to state.

8. Blum, K., Sheridan, P. J., Wood, R. C., Braverman, E. R., Chen, T. J., & Comings, D. E. (1995). Dopamine D2 receptor gene variants: association and linkage studies in impulsive-addictive-compulsive behaviour.Pharmacogenetics,5(3), 121-141.

Times Cited: 139

This study is regarded as a watershed in the emerging study of the neurobiology of gambling disorders. The authors identified genetic variations in a particular neurotransmitter that is common among several disorders involving impulse control, such as pathological gambling, and coined the name “Reward Deficiency Syndrome” to describe this finding.

9. Sylvain, C., Ladouceur, R., & Boisvert, J. M. (1997). Cognitive and behavioral treatment of pathological gambling: a controlled study.Journal of Consulting and Clinical Psychology,65(5), 727-732.
Times Cited: 133

Cognitive-behavioral therapy (CBT) is one of the few treatments to show evidence of effectiveness for gambling disorders. This study was one of the early research projects to document the efficacy of CBT for pathological gambling.

10. Reuter, J., Raedler, T., Rose, M., Hand, I., Gläscher, J., & Büchel, C. (2005). Pathological gambling is linked to reduced activation of the mesolimbic reward system.Nature Neuroscience,8(2), 147-148.

Times Cited: 128

This study focused on the reward system of those with gambling problems and found similarities in brain chemistry between people with pathological gambling and alcohol/drug use disorders.

*The top 10 studies were identified by searching the Web of Science for the phrase “pathological gambling.” Two studies containing the phrase were excluded because they were not primarily focused on pathological gambling or pathological gamblers.

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New Trends In Research: Motivational Interviewing For Gambling Addiction

Recovering from addiction is all about changing one’s behavior. Anyone who has tried to diet, quit smoking or get off the couch and exercise knows that changing behavior can be very challenging. It is especially true for individuals struggling with an addictive disorder. To assist people with changing their abuse of alcohol and drugs, specialists in addiction have developed motivational interviewing (MI), 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). The development and testing of the original concept was led by William R. Miller, Ph.D., Emeritus Distinguished Professor of Psychology and Psychiatry at the University of Mexico.

Research has shown successful outcomes when MI is employed by alcohol and drug counselors. But what about disordered gambling? This month’sIssues & Insightswill focus on the origins of motivational interviewing, its principles and how David Hodgins, Ph.D., professor of psychology at the University of Calgary in Canada, is testing this approach with disordered gamblers.

The Origins of Motivational Interviewing

The method and research of MI emerged from a series of unexplained outcomes (Miller & Rose, 2009). As with penicillin, the early antidepressants and many other major scientific discoveries, MI was discovered by chance. Its origins illustrate Louis Pasteur’s observation that “chance favors the prepared mind.” In other words, the genius behind accidental discoveries and inventions was that the scientists were prepared and, thus, were able to capitalize on insights derived from mistakes, accidents or coincidence.

In the 1980’s, studies by Dr. Miller yielded a suprising finding: the therapists’ empathy with their clients accounted for successful outcomes in the treatment of alcohol use disorders—regardless of the type of intervention used. Based on these observations, Dr. Miller developed a conceptual framework and clinical guidelines for MI, including a focus on responding to the client’s speech “within a generally empathic person-centered style” and attention to strengthening the client’s own verbalized motivations for change. In contrast to the confrontational style of addiction counseling at the time (a image that persists today in popular culture), the counselor using MI responds empathically to the client’s expression of ambivalence. “Pushing or arguing against resistance seemed particularly counterproductive, in that it evoked further defense of the status quo. A guiding principle of MI was to have the client, rather than the counselor, voice the arguments for change” (Miller & Rose, 2009, p. 2).

Motivational interviewing is guided by five therapeutic guidelines: (a) expression of empathy (acceptance of the individual and recognition that ambivalence about change is normal), (b) development of a discrepancy between the individual’s present behavior and his or her goal and self-image, (c) avoidance of argument and confrontation, (d) rolling with resistance (looking for opportunities to reinforce accurate perceptions versus correcting misperceptions), and (e) support of the self’s ability to change (Miller & Rollnick, 2002).

Since Dr. Miller developed MI, more than 200 clinical trials on this topic have been published. These trials have yielded positive results for an array of health problems that require changes in behavior, such as cardiovascular rehabilitation, diabetes management, dietary change, hypertension, illicit drug use, infection risk reduction and management of chronic mental disorders.

MI for Gambling Problems

We are just now learning about the effectiveness of MI for gambling problems. As with other addictive disorders, individuals with gambling problems struggle with the idea of changing their gambling behavior, even when facing the dire consequences of their excessive gambling. One of Dr. Hodgins’s studies examined the language of problem gamblers in treatment with counselors using MI (Hodgins, Ching, & McEwen, 2009). He and his colleagues hypothesized that participants who expressed stronger commitment to change their gambling behavior during the MI would exhibit better gambling outcomes over 12 months than those who expressed weaker commitment or no commitment to change their gambling behavior during the MI.

The authors explained, “Client speech is the focus of the MI because verbalizing an intention to change and developing a plan to produce change lead to public and personal obligations to modify one’s behavior” (Hodgins, Ching, & McEwen, 2009, p. 122). They measured outcomes by looking at participants’ change in days gambled, dollars lost to gambling, self-confidence in their ability to change their gambling behavior, and success at meeting their treatment goals.

Dr. Hodgins and co-authors reported that the results of their analysis show good support for the initial hypothesis in that the strength of commitment expressed during the MI was predictive of a participant’s gambling outcome over the next year. But what are the practical implications?

Understanding what trends in language are related to positive outcomes allows practitioners to have an accurate perception of the progress of the MI session. Evaluating a client’s likelihood of success on the basis of the MI session allows practitioners to incorporate more or less stringent therapeutic techniques to aid a client in modifying his or her behavior. It also allows the practitioner to modify the interview protocol according to each individual client’s level of resistance and motivation while conducting the MI (Hodgins, Ching, & McEwen, 2009, p.129).

In an interview for this article, Dr. Hodgins further elaborated on the importance of MI for treating gambling problems:

Gambling problems, similar to other addictions, are essentially motivational challenges—individuals are pulled towards something that they are pushing against. There is a good side and a bad side to their gambling- motivational interviewing addresses this head on, helping the person to find the resolve to move ahead (personal communication, November 9, 2010).

MI Training for Clinicians

As Dr. Miller discovered, intensive training of clinicians is the key to the success of MI. Two early studies found that although clinicians perceived themselves to be proficient in MI, tape-recorded work samples before and after training reflected only modest changes in practice and no difference in clients’ in-session response. Extensive continuing education opportunities now exist for clinicians interested in MI. Visithttp://www.motivationalinterview.org/for more information.

The NCRG has provided new MI training programs for health care providers focused on gambling disorders. In 2009, Dr. Hodgins led a live NCRG Webinar, “Treating Pathological Gambling with Motivational Interviewing and CBT: A Webinar for Addiction Professionals.” The archived version is available on theNCRG website.

A new addition to NCRG’s continuing education offerings is a pre-conference workshop on “Motivational Interviewing for Clients with Gambling Problems,” before the start of 2010 NCRG Conference on Gambling and Addiction held on Nov. 14, 2010. For some participants it was the beginning of a long process of learning this approach and for others it contributed a new dimension to their ongoing study of MI.

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In recognition of his pioneering research on MI, brief interventions and relapse, Dr. David Hodgins was namedrecipient of the 2010 NCRG Scientific Achievement Award, presented on Nov. 15 during the NCRG Conference on Gambling and Addiction.

References

Hodgins, D.C., Ching, L.E., & McEwen, J. (2009). Strength of commitment language in Motivational Interviewing and gambling outcomes.Psychology of Addictive Behaviors, 23, 122-130.

Miller, W.R.., & Rollnick, S. (2002).Motivational interviewing: Preparing people for change(2nd ed.). New York: Guilford Press.

Miller, W. R., & Rose, G. S. (2009). Toward a theory of motivational interviewing.American Psychologist, 64(6), 527-537.

Christine ReillyIssues & Insights

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NCRG Conference: Healthstreet – An Innovative Strategy For Involving The Under-served In Research On Gambling &Amp; Other Disorders

Sunday’s third general session at the11th annual NCRG Conference on Gambling and Addictionfocused on an innovative approach to connecting health care providers and researchers with people in under-served communities.

Linda Cottler, Ph.D., professor of of epidemiology at Washington University School of Medicine in St. Louis, presented “HealthStreet: An Innovative Strategy for Involving Under-served Populations in Research on Gambling and Other Disorders.” The HealthStreet program, which began in the 1990s as an HIV treatment program housed in a rundown movie theater, has expanded to collect data on dozens of health measures, while connecting people to health resources and research studies in every corner of St. Louis.

Dr. Cottler described HealthStreet’s innovative methods for connecting people in traditionally marginalized communities to health services to which they might not otherwise have access. The majority of this work is done by HealthStreet’s community health workers, who travel throughout the city to sites like grocery stores, churches and coffee shops to provide health related counseling to people who might not go to a health clinic on their own. By combining this health data with geographical data, the HealthStreet team is able to map health markers throughout the city, allowing researchers and treatment providers to see how illnesses are spread throughout the city and target treatments to the areas where they are most needed.

Dr. Cottler also discussed her team’s process for screening 2,854 community members for participation in health-related studies in areas such as public health, internal medicine and psychiatry. She explained that making clinical trials like these available to a broader audience is a mutually beneficial step forward because researchers can test their treatments on the populations who need them the most, while trial participants get access to cutting-edge therapies which might not be available to them otherwise. Dr. Cottler suggested that the network of community research participants they are building will allow her team and other researchers to more easily study representative community samples and produce effective clinical treatments more quickly and efficiently than was previously possible.

For more information about the HealthStreet program please visit theHealthStreet website.As always we welcome your thoughts and question in the comments section below.

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NCRG Conference: Raising Awareness – Making The Most Of Responsible Gaming Education Weeks

The11thannual NCRG Conference on Gambling and Addictionmoved to the Las Vegas Convention Center yesterday whereGlobal Gaming Expo (G2E), the premier trade show and conference event for the international gaming entertainment industry, is currently taking place. During a session yesterday morning, a panel made up of industry operators and manufactures and a state association representative discussed ways to make the most of responsible gaming awareness weeks.

Holly Wetzel, communications director at theAmerican Gaming Association (AGA), opened the session with an overview the AGA’sResponsible Gaming Education Week (RGEW), which is held each year during the first week of August. RGEW is designed to heighten awareness of responsible gaming and disordered gambling among employees, patrons and the general public. Each year, the AGA creates materials for casinos across the country to help educate their employees and promote RGEW, and individual display promotional materials and provide both employees and customers with copies of important responsible gaming education materials.

The other panel members, Jim Baldacci, deputy chief compliance offer for Penn National Gaming, Inc.; Wes Ehrecke, CAE, president and CEO of the Iowa Gaming Association; Connie Jones, director of responsible gaming for International Game Technology; and Kelly Skindzelewski, public affairs manager for Potawatomi Bingo Casino; discussed creative, fun and cost-effective ways to participate in responsible gaming awareness weeks. Some ideas discussed during the session include:

  • Form committees to develop RGEW programs so the work doesn’t fall to one person
  • Get employees involved – they are the ambassadors to get the responsible gaming message out
  • Create a contest – employees are more likely to get involved if they have a chance at winning a prize
  • Involve a company or property’s general manager
  • Work with state and local governments to getproclamationsthat emphasize a commitment to responsible gaming
  • Distribute press releases about RGEW efforts
  • Engage key stakeholders, including team members, community leaders, patrons, the media and the general public

Jones offered one important piece of advice: ‘Don’t just make gambling fun; keep Responsible Gaming Education Week fun!’

For more information on RGEW, visit theAGA website.

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Interview With Cheryl Currie Of The University Of Alberta, Canada

Clickherefor the NCRG Blog Team interview with Cheryl Currie, a Ph.D. candidate in the School of Public Health at the University of Alberta, Canada, and winner of the NCRG’s 2010 Outstanding Poster award. Cheryl discusses her research and her experience at the NCRG conference.

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Interview With Dr. Sarah Nelson Of Harvard Medical School And The Division On Addictions

Click below for the NCRG Blog Team interview with Sarah Nelson, Ph.D., an associate director for research at the Division on Addictions at Cambridge Health Alliance, a teaching affiliate of Harvard Medical School, and an instructor in psychiatry at Harvard Medical School. Dr. Nelson discusses internet gambling and self-exclusion.

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