Transcript Diapositiva 1

Patterns of alcohol and
substance use among
treatment-seeking problem
gamblers
Linshan Gu (Jessica), Grace Wang,
Maria Bellringer, Nick Garrett
6th National Addiction Symposium,
Auckland, 22 April 2015
Background
• High rates of comorbidity have been consistently reported
– Research shows that over 35% of problem gamblers have problem of AOD use
(Hodgin et al., 2005, Stinchfield & Winters, 2011)
• People with problem gambling and substance abuse have improved
not only gambling but also other areas
• However, a concern has been raised in terms of switching one
substance for another during treatment
• There are some uncertainties around the change patterns of AOD
use over the gambling treatment periods
Aim and research question
Aim
•To investigate the changing patterns of AOD problems in
help-seeking gamblers over time
Research question
•Does problem gambling treatment change drug and
alcohol behaviour among help-seeking gamblers?
Methods
• Participants: help-seeking callers to the Gambling Helpline
• Recruitment: August 2009 to May 2011
• Participants (N=150): over the age of 18 years
• Treatment: Helpline’s standard care including
•
•
•
brief intervention,
suggestions for self-care and/or
referral to face-to-face problem gambling counselling services
• Note that this research is a part of a larger study on gambling
treatment outcome (Abbott et al., 2013)
Methods
• Measures
- Problem Gambling Severity Index (PGSI)
•
•
•
•
0 = non-problem gambling;
1-2 = low risk;
3-7 = moderate risk;
8+ = problem gambling
- Drug Abuse Screening Test (DAST)
• 0-2 = non-problem drug use;
• 3-10 = moderate to severe level of drug use
- Alcohol Use Disorders Identification Test (AUDIT-C)
• social drinkers = drink 2 or more times a week;
• heavy drinkers = have 5 or more drinks on a typical day;
• binge drinkers = drink six or more drinks on one occasion weekly or almost
daily
Results
Table 1: Demographics at baseline of the help-seeking gamblers sample
Help-seeking gamblers
At Baseline
At 12 months follow up
N (%)
N (%)
64 (42.7)
86 (57.3)
41 (41.8)
57 (58.2)
64.10%
66.30%
18-24 years
21 (14.0)
8 (8.2)
38.10%
25-34 years
37 (24.7)
21 (21.4)
56.80%
35+ years
88 (58.7)
69 (70.4)
78.40%
European
63 (42.0)
49 (50.0)
77.80%
Non-European
87 (58.0)
49 (50.0)
56.30%
Variables
Gender
Male
Female
Retention rate
Age Group
Ethnicity
Table 2: Gambling, AOD use measures across two time points
Help-seeking gamblers
At Baseline
At 12 months follow up
N (%)
N (%)
PGSI
Non-problem gambler
0 (0.0)
5 (3.3)
Low risk gambler
1 (0.7)
24 (16.0)
Moderate risk gambler
15 (10.0)
27 (18.0)
Problem gambler
129 (86.0)
37 (24.7)
Moderate to severe drug use
Yes
No
17 (11.3)
123 (82.0)
2 (2.0)
95 (96.9)
Social drinking
Yes
No
47 (31.3)
96 (64.0)
33 (33.7)
65 (66.3)
Heavy drinking
Yes
No
57 (38.0)
86 (57.3)
28 (28.6)
70 (71.4)
Binge drinking
Yes
No
36 (24.0)
107 (71.3)
9 (9.2)
89 (90.8)
Change patterns- AOD use
n=83
Moderate to severe drug use
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
n=5
n=2
No
Follow up
Yes
No
Baseline No
Follow up
Yes
Baseline Yes
Binge drinking
100%
n=68
90%
80%
n=17
70%
60%
50%
n=8
40%
30%
20%
n=1
10%
0%
No
Follow up
Baseline No
Yes
No
Follow up
Baseline Yes
Yes
Change patterns- AOD use
Heavy drinking
100%
90%
n=51
80%
70%
n=20
60%
n=16
50%
40%
30%
n=8
20%
10%
0%
No
Follow up
Yes
No
Baseline No
Follow up
Yes
Baseline Yes
Social drinking
100%
n=55
90%
n=26
80%
70%
60%
50%
40%
n=7
30%
20%
n=6
10%
0%
No
Follow up
Baseline No
Yes
No
Follow up
Baseline Yes
Yes
Discussion
• Comorbidity between problem gambling and AOD use are high (11%
for drug use and over 24% for drinking problems)
– 2007/2008 New Zealand Alcohol and Drug Survey (Ministry of Health, 2009): 17% for
recreational drug use and 10% for alcohol use
– Compared to the general population of NZ, severity of AOD use is greater in
problem gamblers
• Help-seeking gamblers showed improvement in
– problem gambling
– moderate to severe drug use and
– binge drinking
• But did not show significant improvement in
– social drinking and
– heavy drinking
Discussion
• Potential contributing factors for improved treatment outcome
– Attitude: desire to change
(Ladd & Petry, 2003)
– Gambling may be a conditioned cue for AOD use (Steward, 2002)
– Help-seeking population
• Factors related to increased heavy drinking and social drinking
- Switch addiction
- Social drinking may not have been considered a problem
- Not related to gambling
- Other psychological distress
Strengths and Limitations
Strengths
•
Measured problem gambling as well as AOD use
•
Followed up at 12 months
Limitations
•
Small sample size
•
High dropout rates, however, it is common for longitudinal studies
Conclusion and Implications
• AOD use is a common comorbid condition of problem
gambling
– Therefore should be screened for in routine clinical assessments
• Severity of problem gambling, moderate to severe drug
use and binge drinking are likely to be reduced following
gambling treatment
• Better outcome may be achieved with the combined
gambling and AOD treatment
Acknowledgement
• Funding body:
- Ministry of Health
- AUT summer research award
• Gambling and Addictions Research Centre
• Gambling Helpline
• Participants
References
Castren, S., Pankakiski, M., Tamminen, M., Lipsanen, J., Ladouceur, R., & Lahti, T. (2013).
Internet-based CBT intervention for gamblers in Finland: experiences from the field.
Scandinavian Journal of Psychology, 54, 230-235. doi: 10.1111/sjop.12034
Lorains, F., Cowlishaw, S., & Thomas, S. (2011). Prevalence of comorbid disorders in
problem and pathological gambling: systematic review and meta-analysis of population
surveys. Addiction, 106(3), 490-498.
Ministry of Health. (2009). Alcohol use in New Zealand: key results of the 2007/8 New
Zealand alcohol and drug use survey. Wellington: Ministry of health.
Ministry of Health. (2007). Drug use in New Zealand: analysis of the 2003 New Zealand
health behaviours survey - drug use. Wellington: Ministry of Health.
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. The Journal of Clinical Psychiatry, 66, 564574. doi: 10.4088/JCP.v66n0504
Rash, C. J., Weinstock, J., & Petry, N. M. (2011). Drinking patterns of pathological
gamblers before, during, and after gambling treatment. Psychology of Addictive
Behaviours, 25(4), 664-674. doi: 10.1037/a0025565