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TheNational Center for Responsible Gaming(NCRG) presented the first installment of the 2010NCRG Webinar Seriesto more than 100 participants in June. Led by Dr. Marc Potenza, the webinar focused on “Co-Occurring Disorders: How Research is Informing the Identification and Treatment of Pathological Gambling.” Visit the NCRG website for an archived version of the presentation.

Dr. Potenza reviewed studies ranging from brain imaging research to population surveys that show how pathological gambling interacts and co-occurs with other psychological and addictive disorders and suggested possible treatment approaches. For example, researchers continue to confirm the relationship between pathological gambling and substance-use disorders, citing high rates of their co-occurrence in both population studies and in investigations of individuals in treatment. Other disorders that have been observed in individuals with gambling problems include mood disorders such as depression and anxiety, nicotine dependence and schizophrenia.

For health care providers, one of the challenges of co-occurring disorders is how to treat individuals with a gambling disorder and another psychiatric problem. Dr. Potenza offered a “decision tree” to help clinicians deal with the complexities of clients with gambling problems. According to the “decision tree,” a clinician should consider prescribing a mood stabilizer (such as lithium) for a client diagnosed with both disordered gambling and bipolar disorder (a mood disorder characterized by periods of extremely high energy followed by periods of depression). If the patient has a gambling problem but not bipolar disorder, the decision tree would recommend naltrexone, a drug used to treat cravings for alcohol that also has shown promise for treating pathological gambling.

If you missed the live presentation, you can access it and other past sessions free of charge in theWebinar Archivessection of theNCRG website. While you’re on this site, you can sign up for the next webinar, “Regulating Interventions for Disordered Gambling: What New Research Says about the Safety, Effectiveness and Logistics of Self-Exclusion Programs,” featuring Dr. Robert Ladouceur, a leading gambling researcher who has studied self-exclusion programs, and Kevin Mullally, the developer of the first self-exclusion program in the U.S. The free program is scheduled for Aug. 16, 2010, 2 p.m.- 3 p.m., EDT. Participants will be eligible to earn one continuing education credit approved byNAADAC, The Association for Addiction Professionals;The California Foundation for Advancement of Addiction Professionals(CFAAP); and theCalifornia Board of Behavioral Sciences.

As always, we welcome your thoughts and questions, including suggestions for webinar topics, in the comments section below.

NCRG staffContinuing Education Opportunitiescomorbiditycontinuing educationdisordered gamblingNCRG Webinar Seriesnew researchtreatment of pathological gamblingwebinars

The WAGER(Worldwide Addiction Gambling Education Report) is a great resource for keeping up with new research on gambling and gambling disorders. This online science review is published by the Division on Addictions at Cambridge Health Alliance, a teaching affiliate of Harvard Medical School.The WAGERis one of a number of publications available through theBrief Addiction Science Information Source (BASIS).

This month’s edition ofTheWAGER–Vol. 15(5)– explores data from a 2007 British Gambling Prevalence Survey suggesting thathow manydifferent games a gambler plays (gambling involvement) may be a better predictor of disordered gambling thanwhichgames are played. This concept contradicts the conventional wisdom that certain activities, like Internet gambling, are inherently more “addictive” than others. As always, we welcome thoughts and questions in the comments section below.

NCRG staffIn the Newsdisordered gamblingDivision on AddictionsHarvard Medical Schoolnew researchThe WAGER

Inpatient treatment programs have been helping people with substance-use disorders for decades, but only recently have they been used in the treatment of pathological gambling. The Louisiana Center of Recovery (CORE) was one of the first inpatient treatment facilities dedicated to treating disordered gambling. The following is an excerpt from the article,“Louisiana Treatment Center is a Model for State-Funded Programs,”which was originally published in thespring 2010 edition ofResponsible Gaming Quarterly.

In June of 1999, the state of Louisiana’s Office for Addictive Disorders, with support from the Louisiana Association on Compulsive Gambling and the state’s casinos and gaming companies, opened a one-of-a-kind residential treatment center for those suffering from pathological gambling. It was called the Center of Recovery (CORE) and, at that time, was the only state-funded center with a primary focus on treating gambling disorders.

“There was a visionary thinker, Jake Hadley, in the Office for Addictive Disorders, and he felt that pathological gambling was a major public health concern for the citizens of Louisiana,” said CORE executive director Reece Middleton. “He wanted to address the problem in a proactive fashion, and thought those affected would benefit most from a residential treatment facility.”

Eleven years later, CORE is still going strong. Louisiana residents who are interested in seeking treatment at the 21-bed facility can do so free of charge, and non-residents can receive the standard 36-day round of treatment for just $6,000. Middleton says that the low costs are part of CORE’s mission of helping people with a problem and a result of the center’s status as a 501(c)3 organization. In the last 10 years, CORE has received referrals from 30 other states and three foreign countries.

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The residents’ therapeutic process includes group, individual and family therapy, a financial inventory, development of plans for restitution, including gambling debts, involvement in community activities, help with the maintenance of the facility, major life analysis and planned recreational activities. Residents also are strongly advised to become involved in 12-step programs, such as Gamblers Anonymous, Alcoholics Anonymous and other programs, as needed. Middleton noted that CORE provides transportation to 12-step meetings and is disinclined to work with anyone who rejects this aspect of their treatment.

“Gamblers tend to have a lot of energy, so we try to help them channel that energy into positive activities,” Middleton said.

CORE has proven to be successful for most of the patients that complete the treatment regimen. An outcome study performed by Behavioral Analysis Incorporated at Louisiana Tech University found that “treatment at CORE is considered successful, as evidenced by the fact that a majority of the clients that complete treatment are able to maintain abstinence from gambling behavior.”

CORE graduates also report a marked improvement in their overall quality-of-life. When CORE staff surveyed former residents, they found that 70 percent of those who completed treatment had improved family relationships, 79 percent experienced improvements in their financial status and 60 percent saw their relationships with employers improve.

Perhaps the greatest metric for the success of CORE is that it has become a model for other state and tribal-funded residential gambling disorder treatment facilities across the country, including Michigan, Minnesota and Iowa.

For more information about the Louisiana CORE facility, please visitthe CORE websiteand read the full Responsible Gaming Quarterly articleon pages 16-17 of the spring 2010 edition. Do you have thoughts or questions about this article? Please share them in the comments section below.

NCRG staffResearch Updateaddiction counselingdisordered gamblinginpatient treatmentResponsible Gaming Quarterly

The recently proposed changes to the definition of pathological gambling for thenext editionof the American Psychiatric Association’sDiagnostic and Statistical Manual of Mental Disorders (DSM)prompted us to think about the dizzying pace of change within the field over the past 30 years.

In this month’sIssues & Insights, four researchers reflect on the progress of the field by answering the question, “What has been the most significant change in how scientists look at disordered gambling over the past 30 years?” Their conclusions range from the inclusion of pathological gambling in the DSM-III in 1980 to advances in understanding the neurobiology of disordered gambling behavior. All agree that there have been tremendous advances in the field in the past three decades. You can read their full comments in June’sIssues & Insights.

What do you think has been the most significant change in gambling research during the past 30 years? Share your thoughts with us in the comments section below.

Donald W. Black, M.D., Professor of Psychiatry, University of Iowa College of Medicine

The most significant change was the inclusion of pathological gambling (PG) in theDiagnostic and Statistical Manual of Mental Disorders, Third Editionin 1980. While disordered gambling has been around since antiquity, it had not been considered a formal disorder that psychiatrists and other mental health professionals could identify and treat. This set off a paradigm shift away from disordered gambling being considered strictly a social and behavioral phenomenon, to that of it being a neuropsychiatric disorder. Clinicians and researchers now had operational criteria that allowed them to identify homogeneous groups of subjects. This has led to an explosion in the amount of research in PG, bringing with it new ways to conceptualize its pathophysiology, genetics and treatment. Once considered a problem that could only be addressed through a 12-step program, cognitive behavioral therapy was soon applied, followed by medication treatment studies. All these advances have transformed the way PG is thought of by the general public, mental health professionals and researchers.

Adam S. Goodie, Ph.D., Associate Professor and Undergraduate Coordinator, Department of Psychology, University of Georgia

There has been an upsurge in the breadth, depth and maturity of the ways that scientists confront disordered gambling. Thirty years ago, the field was marked by a preponderance of prevalence studies and relatively raw, subjective clinical observations, which revealed a priority simply on establishing that disordered gambling was serious and widespread. (Prevalence studies are an essential piece of the puzzle, but sometimes it seemed the field did little more than count up numbers of people with gambling problems.) Today, research covers all the issues that characterize a serious disorder, and is conducted by individuals as adept with modern research methods as they are with clinical practice. Clinical research is enriched and informed by basic research in fields of social and cognitive psychology, neuroscience, behavioral genetics and others. More than any single research finding, the maturing of the research culture has accelerated our progress in understanding and treating!

Harold Wynne, Ph.D., President, Wynne Resources

The ‘psycho-bio-social’ perspective is frequently cited as the best way to understand behaviour associated with disordered gambling. The order of this term is illustrative of the evolution of research in the field; that is, 30 years ago psychologists started to examine this disorder by looking inside the individual gambler. In the past five to 10 years, neurobiologists and geneticists focused on physiological evidence for answers. More recently, attention has been given to the social milieu wherein the disordered gambler lives day-to-day: the family, peer group, work place, cultural group and community. As gambling is a social activity, this latter focus on behaviour-influencing factors external to the individual is a welcome and significant contribution to understanding disordered gambling.

Anneke Goudriaan, Ph.D., Senior Researcher, Amsterdam Institute for Addiction Research, Academic Medical Center, University of Amsterdam

As I have been in gambling research for almost 10 years now, my perspective relates to this period. I think that the field of gambling research has advanced in several ways: both in the depth and quality of studies, and in broadening research directions. There is now much more attention to pathological gambling and comparing it with other disorders. For example, the efficacy of successful treatment strategies for substance dependence is now being investigated in pathological gambling. Behavioral treatments that have been effective for substance dependence, such as contingency management (i.e., using rewards to encourage positive change), are being studied, and we now know that pharmacological treatments such as nalmefene (a drug used to blunt cravings for alcohol) can be effective for treating pathological gambling. Compared to 10 years ago, there is greater insight into the neurobiology of pathological gambling. We now know that near wins elicit similar reward areas in the brain as actual wins, and that diminished neurocognitive functions influence relapse negatively. I hope that we will be able to implement this new knowledge in developing new interventions and improving treatment strategies.

NCRG staffIssues & Insightsdisordered gamblingDSMresearch challenges