Associations Between Self-Reported Reasons for Abstinence, Durations of Abstinence, and Continued Abstinence from Gambling Over a 6-Month Period

In numerous countries, a large majority of the population gambles each year. Understanding the reasons that motivate individuals to abstain from gambling can help inform researchers’ conceptualization of this relatively uncommon decision. I designed this investigation to assess and compare the importance of 13 reasons for abstaining from gambling reported by individuals who were abstinent from gambling for at least 6-months and to identify those motivations associated with continued abstinence during a 6-month follow-up period. To meet these objectives, I conducted two studies. First, I recruited a sample of n=509 adults via Amazon’s Mechanical Turk (MTurk) who had abstained for at least six months and examined the cross-sectional associations between the importance of reasons for abstinence reported by participants and their durations of abstinence. I also conducted an exploratory factor analysis, which revealed that importance rankings for 9 of the 13 reasons loaded onto subscales of reasons. The survey results indicated that financial concerns and knowledge that the odds are against them were the most commonly reported reasons for abstention. In addition, lifelong abstainers tended to rank reasons reflecting sociocultural values as more important than did non-lifelong abstainers. Next, I conducted a second study in which I analyzed importance rankings of the same 13 reasons that had been previously collected as part of an ongoing longitudinal survey. I also collected 6-month follow-up data from those participants. Confirmatory factor analysis indicated that the importance rankings from Study 2 demonstrated good fit with the subscales from Study 1, Robust CFI = 0.990, Robust RMSEA = 0.053, 95% CI for RMSEA = 0.047 to 0.059, SRMR = 0.042. Similar to Study 1, participants in Study 2 ranked fear of losing money and knowledge that the odds are against them as the most important reasons for abstaining. In addition, lifelong abstainers in Study 2 also ranked reasons reflecting sociocultural values as more important than did non-lifelong abstainers. Longitudinal findings demonstrated variability between Time 1 and Time 2 in both the importance rankings and durations of abstinence reported by participants. Nevertheless, participants who ranked sociocultural values as a more important at baseline were more likely to remain abstinent during the six-month follow-up period. This association became non-significant when baseline duration of abstinence was included as an independent variable, and that may have resulted from collinearity between rankings of this subscale and lengths of abstinence at baseline. The results of these two studies suggest that financial concerns and knowledge that the odds are against them are the two most important factors motivating non-gamblers to abstain. However, these reasons do not appear to predict continued abstinence over time, whereas reasons reflecting sociocultural values appear to be longitudinally associated with future abstinence. These findings have implications for both the prevention and treatment of problem gambling. Family-based prevention programs for gambling may help children to avoid gambling in the future by creating sociocultural motivations for abstinence. In addition, linking abstinence-based goals to clients’ religious beliefs, moral values, and the family environments in which they were raised may help clients in recovery from gambling disorder to achieve and maintain abstinence

A hidden crisis: Overdose bereavement, substance use, and subsequent mental health symptoms

Bereavement following an opioid overdose death (OOD) is a particularly disturbing circumstance of sudden, unexpected loss. Despite epidemic proportions, little is known about grief in the wake of an OOD. We surveyed N=158 individuals grieving an OOD, supporting someone actively using opioids, or grieving while supporting similar others, to better understand the mental health impacts of these experiences. Study participants completed assessments of depression, anxiety, posttraumatic stress disorder (PTSD), substance use disorder (SUD), and prolonged grief disorder (PGD). Regression models examined associations between learning of a loved one’s opioid use, the OOD of a child, the OOD of a contemporary, increases in substance use following the event, and current mental health symptoms. Post-hoc path modeling evaluated mediated relationships between losing a child or contemporary to OOD and current mental health symptoms. Losing a child to OOD was associated with increased overall substance use (OR=4.10) during the following year and increased current symptoms of PGD (=0.46). Increasing substance use following the event was significantly associated with greater current symptoms of PGD (=0.24), PTSD (=0.28), SUD (=0.29), and depression (=0.27). Indirect effects mediated by increased substance use after the event were observed between both types of bereavement and current symptoms of depression, PTSD, and SUD. Substance use post-loss appears to contribute to adverse outcomes and future research should address ways to reduce substance use and promote adaptive coping in OOD bereavement

North American experience with Low protein diet for Non-dialysis-dependent chronic kidney disease

Whereas in many parts of the world a low protein diet (LPD, 0.6-0.8 g/kg/day) is routinely prescribed for the management of patients with non-dialysis-dependent chronic kidney disease (CKD), this practice is infrequent in North America. The historical underpinnings related to LPD in the USA including the non-conclusive results of the Modification of Diet in Renal Disease Study may have played a role. Overall trends to initiate dialysis earlier in the course of CKD in the US allowed less time for LPD prescription. The usual dietary intake in the US includes high dietary protein content, which is in sharp contradistinction to that of a LPD. The fear of engendering or worsening protein-energy wasting may be an important handicap as suggested by a pilot survey of US nephrologists; nevertheless, there is also potential interest and enthusiasm in gaining further insight regarding LPD’s utility in both research and in practice. Racial/ethnic disparities in the US and patients’ adherence are additional challenges. Adherence should be monitored by well-trained dietitians by means of both dietary assessment techniques and 24-h urine collections to estimate dietary protein intake using urinary urea nitrogen (UUN). While keto-analogues are not currently available in the USA, there are other oral nutritional supplements for the provision of high-biologic-value proteins along with dietary energy intake of 30–35 Cal/kg/day available. Different treatment strategies related to dietary intake may help circumvent the protein- energy wasting apprehension and offer novel conservative approaches for CKD management in North America. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12882-016-0304-9) contains supplementary material, which is available to authorized users