Transcript n - Addiction Conference

Addiction Therapy 2015
Florida, USA
August 03-08, 2015
Danielle Rossini Dib
A naturalistic study of recovering gamblers:
what gets better and when they get better
Danielle Rossini Dib
Danielle Rossini-Dib1, Daniel Fuentes2 & Hermano Tavares1.
– Gambling Outpatient Program
2 LINEU - Integrated Laboratories of Neuropsychology
1 Pro-AMJO
Psychiatry Institute of University of São Paulo
Psychiatry Research 227 (2015) 17–26
@: [email protected]
Gambling Disorder
GD = continued gambling behavior despite the accrual of
financial losses and major personal distress
DSM 5
• Treatable Condition (Rosenthal, 2008)
• How to define and assess gambling recovery? (Nower and Blaszczynsky,2008).
Banff Consensus: focus on
- Gambling behavior
- Harm caused by gambling
- Measures of change in the process (treatment)
Gambling Disorder Recovery
Banff Consensus: Would be enough?
AND…..
Psychiatry Comorbidities
Executive Dysfunction
Cognitive Distortions & Impulsivity
as bias at DM process
This Study
Study Question:
What improves as the patient recovers?
Objective:
,
To measure the treatment outcomes and identify factors that
could be associated with clinical GD recovery
(negative affectivity, gambling-related cognitive distortions, trait impulsivity,
cognitive flexibility, planning, inhibitory control, and decision- making).
This Study
Controlled conditions:
- Pre-treatment features that could modulate treatment
response (i.e.,variations in demographic, gambling, and psychiatric profiles)
- Differences in treatment delivery .
Hypothesis:
The improvement in GD-related psychopathology would be
greater for patients who recovered from GD as opposed to
those who did not.
Method
• Sample: Distribution of patients admitted for treatment at
the IPQ (February 2006–August 2008)
Current sub use disorder
n = 3;
Acute neuropsych disorder
n = 1;
No
n = 29
Withdrawal by
sample exclusion
criteria:
Intel disability + Illiteracy
n = 11 + 2;
Refusal to participate
n = 1;
Initial N =
142
Did not meet all criteria for
DG n = 11.
Included in
the study?
Dropped out of treat
n = 22;
No
n = 41
Yes
n = 113
Completed
treatement?
Yes
N = 72
Did not complete posttreat assessm
n = 19.
Final Sample
Method
• Sample:
Yes
N = 72
Treatment
Treatment of
psychiatry
comorbidities +
4 PEG
Recovered and Non-Recovered
post treatment:
Gambling Follow-up Scale (GFS)
Treatment of
psychiatry
comorbidities +
12 CBT
- Recovered: >33 (n = 47)
- Non-Recovered: ≤ 33 (n= 25)
Method
Instruments
Clinical features
• Demographic profile
• ADHD symptons
(ASRS)
• Psychiatry comorbidities
and suicide risk
assessement (MINI)
• Gambling profile, severity
and related factors (ASI-G)
• Treatment delivered (if
CBT or PEG)
Assessment of
treatment outcome and
related factors
•Negative Affect
Symptoms (BDI and BAI)
•Gambling related
cognitive distortions (GBQ)
•Trait impulsivity (BIS-11)
Neurocognitive
Classical:
•Intelligence (Matrices)
•Planning (ROCF)
•Mental Flexibility (WCST)
Computerized:
•Inhibitory control (Comm.
Errors and GoStop Paradigm)
•Decision making (IGT)
Assessment: before treatment and 6 months after treatment initiation
Analyses
Statistical Analysis part I
Two parts
Pre treatment &
Treatment features
data
Distribution data
analisys
Recovered X
Non-recovered:
Psychotropic
medication
Categorical:
Pearson or Fisher;
Continuous:
t Student or Mann Whitney
McNermar`s test
(begenning and endpoint)
All treatment
outcome variables
ANOVA or non-parametric
repeated measures analysis
(1.if p<0,10; 2.* CBT)
Analyses
Statistical Analysis part II
Two parts
Dependet variable:
Gambling Recovery
Multivariate analisys
Logistic regression
Factor’: p< 0.10
(rec x Nrec)
Factor’’: CBT
(by ANOVA Analysis)
Results
- Demographic profile
- Gambling related factors
- Age (gambling onset, first problem and fisrt treat) & type of games;
- ADHD (ASRS) and tobacco
- Psychiatric Profile
- Psychotropic medication before and after treatment
T4
Table 2
Rec ≠ NRec
Results
Table 5: Baseline and endpoint treatment assessments
Results
Table 6: Forward logistic regression for gambling recovery, final model
(N=34)
Discussion
No differences in pre treatment variables beteween Rec and Nrec
It may represent a drawback for
the prediction of gambling
treatment outcome
The gambling treatment can
offers equal chances of
recovery for treatment- seeking
gamblers regardless pre
treatment conditions.
Differences in pre treatment variables between Rec and Nrec
Gambling severity
analysis
the association faded in subsequent
Discussion
By this study, we supose that GBQ, Negative affective
and DM predicted treatment response.
79
%
Finding differences from the literature: But there are very few outcome prediction studies for GD
Family history of alcoholism predicts a positive response to treatment with opiate
antagonists.
(Grant et al, 2008)
Two studies predicts relapses in treatment-seeking gamblers.
Personality features, (high neuroticism,
low conscientiousness, and low
agreeableness), are related with relapse
and treatment dropout after 1 year.
(Ramos-Grille e tal, 2013)
Inhibitory control and DM are better
predictors of relapse 1 year after
baseline assessment.
(Goudriaan et al.(2008)
Discussion
What gets better when they get better:
• Negative affectivity and Gambling cognitive distortions
are related:
– they work as a buffer?
• Decision-making: Unrelated with others outcome variables.
– could be a distinctive feature of disordered gamblers?
Limitations
 The high losses of the original sample
 No-shows and dropouts = 36%
 Outcome variables did not exhaust all
aspects of gambling recovery
Conclusions
Psychiatric comorbidities must be assessed
and treated
Gambling-related cognitive distortions is
central in the treatment too
Decision-making, as an impulsivity
measure, was strongly related to recovery.
It might be beneficial to focus the approach in helping patients in
dealing with their emotions, to fantasize less, to be more rational
about gambling, and to make better decisions, especially when risk
is involved.
Special Tanks to
All patients
PRO-AMJO Staff
Institute of Psychiatry of University of São Paulo
CAPES – by finance supported (Ms. Rossini)
@: [email protected]
Meet the eminent gathering once again at
Addiction Therapy 2016
Miami, USA
October 06-08, 2016
Addiction Therapy 2016
Website: addictiontherapy.conferenceseries.com