Web-based counseling for problem gambling: exploring motivations and recommendations

Background:For highly stigmatized disorders, such as problem gambling, Web-based counseling has the potential to&nbsp;address common barriers to treatment, including issues of shame and stigma. Despite the exponential&nbsp;growth in the uptake of immediate synchronous Web-based counseling (ie, provided without&nbsp;appointment), little is known about why people choose this service over other modes of treatment.Objective:The aim of the current study was to determine motivations for choosing and recommending Web-based&nbsp;counseling over telephone or face-to-face services.Methods:The study involved 233 Australian participants who had completed an online counseling session for&nbsp;problem gambling on the Gambling Help Online website between November 2010 and February 2012.&nbsp;Participants were all classified as problem gamblers, with a greater proportion of males (57.4%) and&nbsp;60.4% younger than 40 years of age. Participants completed open-ended questions about their reasons&nbsp;for choosing online counseling over other modes (ie, face-to-face and telephone), as well as reasons for&nbsp;recommending the service to others.Results:A content analysis revealed 4 themes related to confidentiality/anonymity (reported by 27.0%),&nbsp;convenience/accessibility (50.9%), service system access (34.2%), and a preference for the therapeutic&nbsp;medium (26.6%). Few participants reported helpful professional support as a reason for accessing&nbsp;counseling online, but 43.2% of participants stated that this was a reason for recommending the service.Those older than 40 years were more likely than younger people in the sample to use Web-based&nbsp;counseling as an entry point into the service system (&lt;italic&gt;P&lt;/italic&gt;=.045), whereas those engaged in&nbsp;nonstrategic gambling (eg, machine gambling) were more likely to access online counseling as an entry&nbsp;into the service system than those engaged in strategic gambling (ie, cards, sports;&nbsp;&lt;italic&gt;P&lt;/italic&gt;=.01). Participants older than 40 years were more likely to recommend the service&nbsp;because of its potential for confidentiality and anonymity (&lt;italic&gt;P&lt;/italic&gt;=.04), whereas those&nbsp;younger than 40 years were more likely to recommend the service due to it being helpful&nbsp;(&lt;italic&gt;P&lt;/italic&gt;=.02).Conclusions:This study provides important information about why online counseling for gambling is attractive to&nbsp;people with problem gambling, thereby informing the development of targeted online programs,&nbsp;campaigns, and promotional material.</div

Improving gambling survey research using dual-frame sampling of landline and mobile phone numbers

Gambling prevalence studies are typically conducted within a single (landline)&nbsp;telephone sampling frame. This practice continues, despite emerging evidence that significant&nbsp;differences exist between landline and mobile (cell) phone only households. This study&nbsp;utilised a dual-frame (landline and mobile) telephone sampling methodology to cast light on&nbsp;the extent of differences across groups of respondents in respect to demographic, health, and&nbsp;gambling characteristics. A total of 2,014 participants from across Australian states and&nbsp;territories ranging in age from 18 to 96 years participated. Interviews were conducted using&nbsp;computer assisted telephone interviewing technology where 1,012 respondents from the&nbsp;landline sampling frame and 1,002 from the mobile phone sampling frame completed a&nbsp;questionnaire about gambling and other health behaviours. Responses across the landline&nbsp;sampling frame, the mobile phone sampling frame, and the subset of the mobile phone&nbsp;sampling frame that possessed a mobile phone only (MPO) were contrasted. The findings&nbsp;revealed that although respondents in the landline sample (62.7 %) did not significantly&nbsp;differ from respondents in the mobile phone sample (59.2 %) in gambling participation in the&nbsp;previous 12 months, they were significantly more likely to have gambled in the previous&nbsp;12 months than the MPO sample (56.4 %). There were no significant differences in internet&nbsp;gambling participation over the previous 12 months in the landline sample (4.7 %), mobile&nbsp;phone sample (4.7 %) and the MPO sample (5.0 %). However, endorsement of lifetime&nbsp;problem gambling on the NODS-CLiP was significantly higher within the mobile sample&nbsp;(10.7 %) and the MPO sample (14.8 %) than the landline sample (6.6 %). Our research&nbsp;supports previous findings that reliance on a traditional landline telephone sampling&nbsp;approach effectively excludes distinct subgroups of the population from being represented inresearch findings. Consequently, we suggest that research best practice necessitates the use&nbsp;of a dual- rame sampling methodology. Despite inherent logistical and cost issues, this&nbsp;approach &nbsp;needs to become the norm in gambling survey research.</span

The experience of teasing in elective cosmetic surgery patients

The role of teasing as a motivator for patients undertaking elective cosmetic surgery was investigated. Pre-operative data were collected, using a range of standardized tests in addition to open ended questions about their experience of teasing, from 449 patients aged 18 to 70 undergoing elective cosmetic surgery in Australia. Just under half of the sample indicated that they had been teased or bullied about their appearance. Teased patients showed significantly higher levels of anxiety, depression and dysmorphic concern; lower levels of physical attractiveness and appearance satisfaction; and lower levels of satisfaction with discrete aspects of their appearance than nonteased patients. Teasing also contributed to longer periods of considering surgery as an answer to body dissatisfaction concerns, even when controlling for age. Prevention education initiatives on appearance-related teasing should be targeted at school students. This, along with earlier detection of the psychological impacts of weight and appearance-related teasing, fewer people, if offered strategies for coping through counseling, may contemplate surgery as a response to this teasing

Prevalence of psychiatric co-morbidity in treatment-seeking problem gamblers:A systematic review and meta-analysis

Objective: The aim of this paper was to systematically review and meta-analyse the prevalence of co-morbid psychiatric disorders (DSM-IV Axis I disorders) among treatment-seeking problem gamblers. Methods: A systematic search was conducted for peer-reviewed studies that provided prevalence estimates of Axis I psychiatric disorders in individuals seeking psychological or pharmacological treatment for problem gambling (including pathological gambling). Meta-analytic techniques were performed to estimate the weighted mean effect size and heterogeneity across studies. Results: Results from 36 studies identified high rates of co-morbid current (74.8%, 95% CI 36.5–93.9) and lifetime (75.5%, 95% CI 46.5–91.8) Axis I disorders. There were high rates of current mood disorders (23.1%, 95% CI 14.9–34.0), alcohol use disorders (21.2%, 95% CI 15.6–28.1), anxiety disorders (17.6%, 95% CI 10.8–27.3) and substance (non-alcohol) use disorders (7.0%, 95% CI 1.7–24.9). Specifically, the highest mean prevalence of current psychiatric disorders was for nicotine dependence (56.4%, 95% CI 35.7–75.2) and major depressive disorder (29.9%, 95% CI 20.5–41.3), with smaller estimates for alcohol abuse (18.2%, 95% CI 13.4–24.2), alcohol dependence (15.2%, 95% CI 10.2–22.0), social phobia (14.9%, 95% CI 2.0–59.8), generalised anxiety disorder (14.4%, 95% CI 3.9–40.8), panic disorder (13.7%, 95% CI 6.7–26.0), post-traumatic stress disorder (12.3%, 95% CI 3.4–35.7), cannabis use disorder (11.5%, 95% CI 4.8–25.0), attention-deficit hyperactivity disorder (9.3%, 95% CI 4.1–19.6), adjustment disorder (9.2%, 95% CI 4.8–17.2), bipolar disorder (8.8%, 95% CI 4.4–17.1) and obsessive-compulsive disorder (8.2%, 95% CI 3.4–18.6). There were no consistent patterns according to gambling problem severity, type of treatment facility and study jurisdiction. Although these estimates were robust to the inclusion of studies with non-representative sampling biases, they should be interpreted with caution as they were highly variable across studies. Conclusions: The findings highlight the need for gambling treatment services to undertake routine screening and assessment of psychiatric co-morbidity and provide treatment approaches that adequately manage these co-morbid disorders. Further research is required to explore the reasons for the variability observed in the prevalence estimates

Self-reported impulsivity and inhibitory control in problem gamblers

Impulsivity is considered a core feature of problem gambling, however, self-reported impulsivity and inhibitory control may reflect disparate constructs. We examined self-reported impulsivity and inhibitory control in 39 treatment-seeking problem gamblers and 41 matched controls using a range of self-report questionnaires and laboratory inhibitory control tasks. We also investigated differences between treatment-seeking problem gamblers who prefer strategic (e.g., sports-betting) and non-strategic (e.g., electronic gaming machines) gambling activities. Treatment-seeking problem gamblers demonstrated elevated self-reported impulsivity, more go errors on the Stop Signal Task and a lower gap score on the Random Number Generation task than matched controls. However, overall we did not find strong evidence that treatment-seeking problem gamblers are more impulsive on laboratory inhibitory control measures. Furthermore, strategic and non-strategic problem gamblers did not differ from their respective controls on either self-reported impulsivity questionnaires or laboratory inhibitory control measures. Contrary to expectations, our results suggest that inhibitory dyscontrol may not be a key component for some treatment-seeking problem gamblers

Therapist-delivered and self-help interventions for gambling problems: A review of contents

Background and aims To date, no systematic approach to identifying the content and characteristics of psychological interventions used to reduce gambling or problem gambling has been developed. This study aimed to develop a reliable classification system capable of identifying intervention characteristics that could, potentially, account for greater or lesser effectiveness. Methods Intervention descriptions were content analyzed to identify common and differentiating characteristics. A coder manual was developed and applied by three independent coders to identify the presence or absence of defined characteristics in 46 psychological and self-help gambling interventions. Results The final classification taxonomy, entitled Gambling Intervention System of CharacTerization (GIST), included 35 categories of intervention characteristics. These were assigned to four groups: (a) types of change techniques (18 categories; e.g., cognitive restructuring and relapse prevention), (b) participant and study characteristics (6 categories; e.g., recruitment strategy and remuneration policy), and (c) characteristics of the delivery and conduct of interventions (11 categories; e.g., modality of delivery and therapist involvement), and (d) evaluation characteristics (e.g., type of control group). Interrater reliability of identification of defined characteristics was high (κ = 0.80–1.00). Discussion This research provides a tool that allows systematic identification of intervention characteristics, thereby enabling consideration, not only of whether interventions are effective or not, but also of which domain-relevant characteristics account for greater or lesser effectiveness. The taxonomy also facilitates standardized description of intervention content in a field in which many diverse interventions have been evaluated. Conclusion Application of this coding tool has the potential to accelerate the development of more efficient and effective therapist-delivered and self-directed interventions to reduce gambling problems

Problem Gambling and Intimate Partner Violence A Systematic Review and Meta-Analysis

Author version made available in accordance with the publisher's policyThis study provides a systematic review of the empirical evidence related to the association between problem gambling and intimate partner violence (IPV). We identified 14 available studies in the systematic search (six for IPV victimisation and ten for IPV perpetration). Although there were some equivocal findings, we found that most of the available research suggests that there is a significant relationship between problem gambling and being a victim of IPV. There was more consistent evidence that there is a significant relationship between problem gambling and perpetration of IPV. Meta-analyses revealed that over one-third of problem gamblers report being victims of physical IPV (38.1%) or perpetrators of physical IPV (36.5%) and that the prevalence of problem gambling in IPV perpetrators is 11.3%. Although the exact nature of the relationships between problem gambling and IPV is yet to be determined, the findings suggest that less than full employment and clinical anger problems are implicated in the relationship between problem gambling and IPV victimisation and that younger age, less than full employment, clinical anger problems, impulsivity, and alcohol and substance use are implicated in the relationship between problem gambling and IPV perpetration. The findings highlight the need for treatment services to undertake routine screening and assessment of problem gambling, IPV, alcohol and substance use problems, and mental health issues, and provide interventions designed to manage this cluster of comorbid conditions. Further research is also required to investigate the relationship between problem gambling and violence that extends into the family beyond intimate partners

Problem gambling and substance use in patients attending community mental health services

Relatively little is known about co-occurring gambling problems and their overlap with other addictive behaviors among individuals attending mental health services. We aimed to determine rates of gambling and substance use problems in patients accessing mental health services in Victoria, Australia. Methods A total of 837 adult patients were surveyed about their gambling and administered standardized screening tools for problem gambling and harmful tobacco, alcohol, and drug use. Prevalence of gambling problems was estimated and regression models used to determine predictors of problem gambling. Results The gambling participation rate was 41.6% [95% CI = 38.2–44.9]. The Problem Gambling Severity Index identified 19.7% [CI = 17.0–22.4] as “non-problem gamblers,” 7.2% [CI = 5.4–8.9] as “low-risk” gamblers, 8.4% [CI = 6.5–10.2] as “moderate-risk” gamblers, and 6.3% [CI = 4.7–8.0] as “problem gamblers.” One-fifth (21.9%) of the sample and 52.6% of all gamblers were identified as either low-risk, moderate-risk, or problem gamblers (PGs). Patients classified as problem and moderate-risk gamblers had significantly elevated rates of nicotine and illicit drug dependence (p  Discussion and conclusions Patients were less likely to gamble, but eight times as likely to be classified as PG, relative to Victoria’s adult general population. Elevated rates of harmful substance use among moderate-risk and PG suggest overlapping vulnerability to addictive behaviors. These findings suggest mental health services should embed routine screening into clinical practice, and train clinicians in the management of problem gambling