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

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 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

How a concerned family member, friend or member of the public can help someone with gambling problems: a Delphi consensus study

BackgroundGambling is an enjoyable recreational pursuit for many people. However, for some it can lead to significant harms. The Delphi expert consensus method was used to develop guidelines for how a concerned family member, friend or member of the public can recognise the signs of gambling problems and support a person to change their gambling.MethodsA systematic review of websites, books and journal articles was conducted to develop a questionnaire containing items about the knowledge, skills and actions needed for supporting a person with gambling problems. These items were rated over three rounds by two international expert panels comprising people with a lived experience of gambling problems and professionals who treat people with gambling problems or research gambling problems.ResultsA total of 66 experts (34 with lived experience and 32 professionals) rated 412 helping statements according to whether they thought the statements should be included in these guidelines. There were 234 helping statements that were endorsed by at least 80 % of members of both of the expert panels. These endorsed statements were used to develop the guidelines.ConclusionTwo groups of experts were able to reach substantial consensus on how someone can recognise the signs of gambling problems and support a person to change.<br /

Functional correlates of clinical phenotype and severity in recurrent SCN2A variants

In SCN2A-related disorders, there is an urgent demand to establish efficient methods for determining the gain- (GoF) or loss-of-function (LoF) character of variants, to identify suitable candidates for precision therapies. Here we classify clinical phenotypes of 179 individuals with 38 recurrent SCN2A variants as early-infantile or later-onset epilepsy, or intellectual disability/autism spectrum disorder (ID/ASD) and assess the functional impact of 13 variants using dynamic action potential clamp (DAPC) and voltage clamp. Results show that 36/38 variants are associated with only one phenotypic group (30 early-infantile, 5 later-onset, 1 ID/ASD). Unexpectedly, we revealed major differences in outcome severity between individuals with the same variant for 40% of early-infantile variants studied. DAPC was superior to voltage clamp in predicting the impact of mutations on neuronal excitability and confirmed GoF produces early-infantile phenotypes and LoF later-onset phenotypes. For one early-infantile variant, the co-expression of the alpha(1) and beta(2) subunits of the Na(v)1.2 channel was needed to unveil functional impact, confirming the prediction of 3D molecular modeling. Neither DAPC nor voltage clamp reliably predicted phenotypic severity of early-infantile variants. Genotype, phenotypic group and DAPC are accurate predictors of the biophysical impact of SCN2A variants, but other approaches are needed to predict severity. A comprehensive biophysical analysis of disease-associated mutations in the voltage-gated sodium channel gene, SCN2A, suggests that dynamic action potential clamp may be a better predictor than voltage clamp of how these mutations alter neuronal excitability, though other approaches are needed to predict severity

Adolescent perspectives about their participation in alcohol intervention research in emergency care: A qualitative exploration using ethical principles as an analytical framework

Aims: To explore adolescents’ experiences of consenting to, and participating in, alcohol intervention trials when attending for emergency care. Methods: In-depth semi-structured interviews with 27 adolescents (16 males; aged 14–17 years (Mage = 15.7)) who had taken part in one of two linked brief alcohol intervention trials based in 10 accident and emergency departments in England. Interviews were transcribed verbatim and subject to thematic analysis Results: Research and intervention methods were generally found to be acceptable though confidentiality was important and parental presence could hinder truthful disclosures regarding alcohol use. Participants discussed the importance of being involved in research that was relevant to them and recognised alcohol consumption as a normative part of adolescence, highlighting the importance of having access to appropriate health information. Beyond this, they recognised the benefits and risks of trial participation for themselves and others with the majority showing a degree of altruism in considering longer term implications for others as well as themselves. Conclusions: Alcohol screening and intervention in emergency care is both acceptable and relevant to adolescents but acceptability is reliant on confidentiality being assured and may be inhibited by parental presence