Gamblers seeking treatment: Who does and who doesn't?

Abstract Background and aims As only a minority of pathological gamblers (PGr) presents for treatment, further knowledge about help-seeking behavior is required in order to enhance treatment utilization. The present study investigated factors associated with treatment participation in gamblers in Germany. As subclinical pathological gamblers (SPGr, fulfilling one to four DSM-IV-criteria) are target of early intervention due to high risk of transition to pathological gambling, they were subject of special interest. Methods The study analyzed data from a general population survey (n = 234, SPGr: n = 198, PGr: n = 36) and a treatment study (n = 329, SPGr: n = 22, PGr: n = 307). A two-step weighting procedure was applied to ensure comparability of samples. Investigated factors included socio-demographic variables, gambling behavior, symptoms of pathological gambling and substance use. Results In PGr, regular employment and non-German nationality were positively associated with being in treatment while gambling on the Internet and gaming machines and fulfilling more DSM-IV-criteria lowered the odds. In SPGr, treatment attendance was negatively associated with married status and alcohol consumption and positively associated with older age, higher stakes, more fulfilled DSM-IV criteria and regular smoking. Conclusions In accordance to expectations more severe gambling problems and higher problem awareness and/or external pressure might facilitate treatment entry. There are groups with lower chances of being in treatment: women, ethnic minorities, and SPGr. We propose target group specific offers, use of Internet-based methods as possible adaptions and/or extensions of treatment offers that could enhance treatment attendance

Has gambling changed after major amendments of gambling regulations in Germany? A propensity score analysis

Aims: This study examined changes in general population gambling in the light of two major amendments of the German gambling regulation, the Fifth Amendment of the German Gambling Ordinance (AGO) for commercial amusement machines with prizes (AWP) and the State Treaty on Gambling (STG) for gambling activities subject to the state monopoly. Methods: Applying cross-sectional data from the 2006 and 2009 Epidemiological Survey of Substance Abuse (ESA), propensity-score-matched samples of 7,970 subjects and 3,624 12-month gamblers aged 18–64 years were used for analyses. Logistic regression was employed to examine changes in gambling controlling for possible confounding variables. Results: Overall participation in state gambling activities, participation in lotto as well as TV lottery decreased and gambling on Internet card games increased. No changes were found for any other gambling activity, 12-month prevalence of any gambling and pathological gambling. While weekly gambling declined, overall multiple gambling increased. Effects were similar in the total sample and among current gamblers. Conclusions: Prohibiting specific gambling activities, e.g., Internet gambling, seem to be insufficient approaches to change gambling behavior. Supply reduction might need to be enhanced by changes in game characteristics and implementation of early intervention measures. However, long-term consequences are uncertain and further monitoring is needed

The RESCueH Programme: Testing New Non-Pharmacologic Interventions for Alcohol Use Disorders

Excessive alcohol consumption is one of the most important lifestyle factors affecting the disease burden in the Western world. The results of treatment in daily practice are modest at best. The aim of the RESCueH programme is to develop and evaluate methods, which are as practice-near as possible, and therefore can be implemented quickly and easily in everyday clinical practice. It is the first clinical alcohol programme to be transatlantic in scope, with implementation in treatment centers located in Denmark, Germany and the US. The RESCueH programme comprises 5 randomized controlled trials, and the studies can be expected to result in (1) more patients starting treatment in specialized outpatient clinics, (2) a greater number of elderly patients being treated, (3) increased patient motivation for treatment and thus improved adherence, (4) more patients with stable positive outcomes after treatment and (5) fewer patients relapsing into harmful drinking. The aim of this paper is to discuss the rationale for the RESCueH programme, to present the studies and expected results

No evidence for a reciprocal relationship between daily self-control failures and addictive behavior in a longitudinal study

IntroductionWe all experience occasional self-control failures (SCFs) in our daily lives, where we enact behaviors that stand in conflict with our superordinate or long-term goals. Based on the assumption that SCFs share common underlying mechanisms with addictive disorders, we tested the hypothesis that a generally higher susceptibility to daily SCFs predicts more addictive behavior, or vice versa.MethodsAt baseline, 338 individuals (19–27 years, 59% female) from a community sample participated in multi-component assessments. These included among others (1) a clinical interview on addictive behaviors (quantity of use, frequency of use, DSM-5 criteria; n = 338) and (2) ecological momentary assessment of SCFs (n = 329, 97%). At the 3-year and 6 year follow-up, participation rates for both assessment parts were 71% (n = 240) and 50% (n = 170), respectively.ResultsControlling for age, gender, IQ, and baseline addiction level, random-intercept cross-lagged panel models revealed that participants who reported more SCFs also showed pronounced addictive behavior at the between-person level, but we found no evidence of a predictive relationship at the within-person level over time.DiscussionA higher rate of SCFs is associated with more addictive behavior, while there is no evidence of an intraindividual predictive relationship. Novel hypotheses suggested by additional exploratory results are that (1) only addiction-related SCFs in daily life are early markers of an escalation of use and thus for addictive disorders and that (2) an explicit monitoring of SCFs increases self-reflection and thereby promotes the mobilization of cognitive control in response to goal-desire conflicts

Personality Traits Predict Non-Substance Related and Substance Related Addictive Behaviours

Aims: To examine whether personality traits predict the course of addictive behaviours in general and whether predictive associations differ between non-substance related (NR) and substance related (SR) addictive behaviours. Methodology: We recruited 338 individuals (19–27 y, 59 % female) from a random community sample with NR, SR, or no DSM-5 addictive disorder. Predictors were the Big Five personality traits (NEO-FFI) and reward and punishment sensitivity (BIS/BAS questionnaire). Outcomes were the slopes of addictive behaviours (i. e., quantity, frequency, and number of DSM-5 criteria) over three years. Bayesian multiple regressions were used to analyse the probabilities for each hypothesis. Results: The evidence that higher neuroticism, lower conscientiousness, lower agreeableness, higher extraversion, lower openness, higher reward sensitivity, and lower punishment sensitivity predict increased addictive behaviours over time was, overall, moderate to high (69 % to 99 %) and varied by trait and outcome. Predictive associations were mostly higher for NR compared with SR addictive behaviours. Conclusions: Personality traits predict the course of addictive behaviours, but associations were only about half as large as expected. While some personality traits, such as lower conscientiousness, predict increases in both NR and SR addictive behaviours over time, others, such as lower punishment sensitivity, seem to specifically predict increases in NR addictive behaviours.Zielsetzung: Untersuchung der Vorhersage des Verlaufs von abhängigem Verhalten durch Persönlichkeitsmerkmale und Prüfung, ob sich diese prädiktiven Assoziationen zwischen verhaltensbezogenem (VB) und substanzbezogenem (SB) abhängigen Verhalten unterscheiden. Methodik: Wir rekrutierten 338 Personen (19–27 Jahre, 59 % weiblich) aus einer kommunalen Zufallsstichprobe mit einer VB-, einer SB- oder keiner DSM-5-Abhängigkeit. Prädiktoren waren die „Big Five“-Persönlichkeitsmerkmale (NEO-FFI) und die Belohnungs- und Bestrafungssensitivität (BIS/BAS-Fragebogen). Die Outcomes waren der Verlauf des abhängigen Verhaltens (d. h. Menge und Häufigkeit des Konsums und Anzahl der erfüllten DSM-5-Kriterien) über drei Jahre. Zur Analyse der Wahrscheinlichkeiten für jede Hypothese wurden Bayes‘sche multiple Regressionsanalysen verwendet. Ergebnisse: Die Evidenz, dass höherer Neurotizismus, geringere Gewissenhaftigkeit, geringere Verträglichkeit, höhere Extraversion, geringere Offenheit, höhere Belohnungssensitivität und geringere Bestrafungssensitivität eine Zunahme von Merkmalen abhängigen Verhaltens im Laufe der Zeit vorhersagen, war insgesamt moderat bis hoch (69 % bis 99 %) und variierte je nach Persönlichkeitsmerkmal und Outcome. Die prädiktiven Assoziationen waren meist höher für VB im Vergleich zu SB abhängigen Verhalten. Schlussfolgerungen: Persönlichkeitsmerkmale sagen den Verlauf des abhängigen Verhaltens voraus, allerdings waren die Zusammenhänge nur etwa halb so groß wie erwartet. Während einige Persönlichkeitsmerkmale, wie z. B. eine geringere Gewissenhaftigkeit, im Laufe der Zeit eine Zunahme des VB und des SB abhängigen Verhaltens vorhersagen, scheinen andere, wie z. B. eine geringere Sensibilität für Bestrafung, speziell eine Zunahme des VB abhängigen Verhaltens vorherzusagen

Grundlagen und Forschungsstrategien regionaler Bedarfs- und Allokationsforschung am Beispiel des ASAT-F1-Projektes

Hintergrund und Fragestellung: Weiter steigende Raten des Konsums psychotroper Substanzen und klinisch bedeutsamer Substanzstörungen vor allem bei Jugendlichen und jungen Erwachsenen, veränderte Gebrauchs- und Problemkonstellationen der Konsumentengruppen und die Einführung neuer Therapien und Versorgungsmodelle (Prävention, Frühintervention, Therapie und Rehabilitation) erfordern insbesondere angesichts der begrenzten Finanz- und Versorgungsressourcen neue Bedarfs- und Allokationsmodelle. Diese sollen praxisnah und effizient zu entscheiden helfen wann, bei welchen Rahmenbedingungen, welche Interventionsart und -strategie die individuell erfolgversprechendste ist. Diese Fragen werden in einem Forschungsprojekt des Suchtforschungsverbundes ASAT bearbeitet, das in einer umschriebenen Region mittels schrittweiser, epidemiologisch basierter Bedarfsund Bedürfnisanalysen die Ableitung und Priorisierung von institutionellen und therapeutischen Zuordnungsstrategien untersucht. Methodik: Basierend auf einem prospektiv-epidemiologischen Design wurden (1) bei einer repräsentativen regionalen Bevölkerungsstichprobe (EDSP-Studie) Inzidenzmuster, Spontanverlauf, Risikofaktoren und Konsequenzen des Substanzgebrauchs, -missbrauchs und der -abhängigkeit sowie Inanspruchnahmeverhalten, gedeckter und ungedeckter Bedarf beurteilt. (2) Ergänzt wird diese Erhebung durch eine Gesamterfassung und Evaluation des regionalen Suchthilfesystems. (3) Über statistische Analysen von Verläufen und Suchthilfeangeboten in der Region sollen "natürliche" Allokationsprozesse dargestellt und "outcome"-orientiert bewertet werden. (4) Anhand der dabei sichtbaren Mängel und Defizite können dann zusammen mit den Einrichtungen verbesserte Allokationsrichtlinien für einzelne sowie Gruppen von Patienten abgeleitet werden. Die Ergebnisse sollen in das regionale Suchhilfesystem übertragen werden. Ergebnisse und Diskussion: Erste Ergebnisse des Projekts bestätigen die Möglichkeit, Risikogruppen über spezifische Verlaufsanalysen zu identifizieren (z.B. regelmäßige Cannabiskonsumenten, Mehrfachkonsumenten, mehr weibliche Konsumenten mit einem höherem Abhängigkeitsrisiko). Die Inanspruchnahmemuster deuten in Teilbereichen (Frühintervention) auf ein hohes Ausmaß ungedeckten Bedarfs hin und scheinen neue Allokationsentwürfe zu erfordern. Den Einrichtungsträgern und regional Verantwortlichen der Suchthilfe können nach Auswertung weiterer Daten umfassende Bedarfsabschätzungen und verschiedene alternative Allokationsmodelle basierend auf der Perspektive von KlientInnen/ PatientInnen bereitgestellt werden.Background and Aims: Increasing rates of substance use and substance use disorders especially in adolescents and young adults, changing patterns of use and associated problems and the introduction of new therapies and programs of care (prevention, early intervention, therapy, rehabilitation) require new need and allocation models especially because of restricted financial and care resources. These models should provide a rational basis for the improvement of allocation processes as well as setting priorities in the provision and restructuring of community and patientoriented interventions. In the present paper, we will present a project of the ASAT research network program which aims at a multi-staged, integrated epidemiology-based need and program evaluation in an area to determine institutional and therapeutical allocation processes. Methods: Based on a prospective epidemiological design, (1) prevalence and incidence, risk factors and course of substance use, abuse and dependence are investigated in a representative sample of the community-based EDSP study. Additionally, helpseeking behaviors, met and unmet need are assessed. (2) The investigation is supplemented by a survey of all substance use services in the area. (3) Course of substance use and service provision of substance use services in the area will be analyzed and reviewed to identify natural allocation processes and to determine the outcome. (4) With the knowledge of deficits and unmet need, improved allocation guidelines for specific groups of clients and patients will be developed. The results will be transferred into the regional health care system. Results and discussion: First results show that the identification of new risk groups with the help of course typologies is possible. The patterns of help-seeking point to a high rate of unmet need, especially with regard to the targeted early intervention, and a need of alternative allocation models. After the assessment and the overall data analyses, need evaluations and several alternative allocation models based on the clients'/patients' perspective will be provided

Individual risk factors and prediction of gambling disorder in online sports bettors - the longitudinal RIGAB study

IntroductionWhile research in online sports betting is dominated by studies using objective player tracking data from providers to identify risky gambling behavior, basicresearch has identified various putative individual risk factors assumed to underlie the development of gambling disorder across all types of gambling. This study aims to examine individual risk factors and their longitudinal clinical relevance in online sports bettors.MethodsGerman online sports bettors (N = 607, Mage = 34, 92% male) from a provider based sample took part in an online survey. The study team randomly preselected customers to be invited. N = 325 (53,45%) of the participants also took part in an online follow-up survey one year later. Crosssectional and longitudinal associations of putative risk factors and DSM-5 gambling disorder in online sports bettors were analyzed. These risk factors include alcohol and tobacco use, impulsivity, difficulties in emotion identification, emotion regulation strategies, comorbid mental disorders and stress.ResultsWe found more pronounced impulsivity, difficulties in emotion identification, emotion suppression, comorbid mental disorders and stress were cross-sectionally associated with gambling disorder, and longitudinally predicted gambling disorder in online sports bettors (with the exception of emotion suppression). In an overall model only lack of premeditation and perceived helplessness remained significant as predictors for gambling disorder. Online sports bettors with gambling disorder predominantly showed more pronounced risk factors, which were also confirmed longitudinally as relevant for the maintenance of gambling disorder.DiscussionRisk factors such as impulsivity and stress and appropriate coping mechanisms should consequently be integrated not only into prevention efforts to identify individuals at risk early, but also into intervention efforts to tailor treatment

European Graduate School in Addiction Research: A contribution to the research education of PhD/MD students in Europe

This paper reports on the European Graduate School in Addiction Research (ESADD), which contributes to the scientific education of PhD/MD addiction research students and promotes interdisciplinary cooperation and academic networking in Europe. ESADD is a two-year course, built first from a conceptual analysis of knowledge needs, then iteratively refined based on practical experiences. Its major components are six seminar weeks, homework assignments and an internship in a foreign research group. As part of an internal quality management system, comprehensive evaluations of the programme took into account goals and objectives of the seminar weeks, workloads, study materials, relevance and usefulness of acquired skills, and organisational issues. Assessments of lecturers evaluated their teaching performance and the relevance of their topics. Forty-two out of 45 participants from all over Europe completed one of the three courses carried out between 2008 and 2015. All reported that ESADD provided them with a broad overview of knowledge in the field, and 41 participants were satisfied with the quality of the seminar weeks. ESADD thus seems to be an effective way to educate PhD students from different research disciplines and to provide a comprehensive body of scientific knowledge and competencies on addiction-related research topics. Further ESADD enriches the higher education landscape in addiction education