Authors:Sophie Ward, Neil Smith and Henrietta Bowden-Jones
Background and aims
To investigate the potential indications and adverse effects of using the opioid antagonist naltrexone to treat problem gamblers.
The files of the 1,192 patients who were referred to the National Problem Gambling Clinic between January 2015 and June 2016 were audited. Seventeen patients were considered appropriate for treatment with naltrexone, having attended and failed to respond to psychological therapies at the clinic. Fourteen patients were placed on a regimen of 50 mg/day naltrexone.
Of the 14 patients who were treated with naltrexone, there were 10 for whom sufficient follow-up existed to analyze the treatment efficacy and side effects of naltrexone. Patients showed significant decreases in their craving to gamble and the majority (60%) were able to abstain completely from gambling in the treatment period, with a further 20% reducing their gambling to almost nothing. The reported side effects from the naltrexone included: loss of appetite, gastrointestinal pain, headaches, sedation, dizziness, and vivid dreams. Two patients with concurrent alcohol-use disorder relapsed during the treatment. One patient relapsed after the treatment period.
The study showed significant outcomes in reducing gambling cravings for the sample set. Given the design of the study as a case series, there was no control group, and a number of patients were on other psychotropic medications. We recommend care when prescribing to those suffering from concurrent alcohol-use disorder.
Authors:Steve Sharman, Jenny Dreyer, Luke Clark and Henrietta Bowden-Jones
Backgrounds and aims
Problem gambling occurs at higher levels in the homeless than the general population. Past work has not established the extent to which problem gambling is a cause or consequence of homelessness. This study sought to replicate recent observations of elevated rates of problem gambling in a British homeless sample, and extend that finding by characterizing (a) the temporal sequencing of the effect, (b) relationships with drug and alcohol misuse, and (c) awareness and access of treatment services for gambling by the homeless.
We recruited 72 participants from homeless centers in Westminster, London, and used the Problem Gambling Severity Index to assess gambling involvement, as well as DSM-IV criteria for substance and alcohol use disorders. A life-events scale was administered to establish the temporal ordering of problem gambling and homelessness.
Problem gambling was evident in 23.6% of the sample. In participants who endorsed any gambling symptomatology, the majority were categorized as problem gamblers. Within those problem gamblers, 82.4% indicated that gambling preceded their homelessness. Participants displayed high rates of substance (31.9%) and alcohol dependence (23.6%); these were not correlated with PGSI scores. Awareness of treatment for gambling was significantly lower than for substance and alcohol use disorders, and actual access of gambling support was minimal.
Discussion and conclusions
Problem gambling is an under-recognized health issue in the homeless. Our observation that gambling typically precedes homelessness strengthens its role as a causal factor. Despite the elevated prevalence rates, awareness and utilization of gambling support opportunities were low compared with services for substance use disorders.
Authors:Silvia Ronzitti, Emiliano Soldini, Vittorio Lutri, Neil Smith, Massimo Clerici and Henrietta Bowden-Jones
Background and aim
Previous international research emphasized that some forms of gambling are more “addictive” than others. More recently, research has shown that we should shift our attention from the type of gambling activity to the level of involvement in a number of different gambling activities. The aim of our study was to verify whether a higher Problem Gambling Severity Index (PGSI) score was associated with particular gambling activities and evaluate the impact of involvement on gambling behavior.
A total of 736 treatment-seeking individuals with gambling disorder were assessed at the National Problem Gambling Clinic in London. First, the independent two-sample t-test and the Mann–Whitney test were used to verify if the PGSI score changed significantly according to the gambling activity at a bivariate level. Second, we conducted a cluster analysis and finally, we fitted a linear regression model in order to verify if some variables are useful to predict gambling addiction severity.
The PGSI score was significantly higher for lower stakes gaming machine gamblers (1% significance level) and for fixed-odds betting terminal (FOBT) gamblers (5% significance level) at a bivariate level. Moreover, such finding was confirmed by cluster and linear regression analyses.
The results of this study indicated that gambling addiction severity was related to gambling involvement and, for a given level of gambling involvement, gambling addiction severity may vary according to gambling type, with a particularly significant increase for FOBT and gaming machine gambling.
Authors:Joël Billieux, Daniel L. King, Susumu Higuchi, Sophia Achab, Henrietta Bowden-Jones, Wei Hao, Jiang Long, Hae Kook Lee, Marc N. Potenza, John B. Saunders and Vladimir Poznyak
This commentary responds to Aarseth et al.’s (in press) criticisms that the ICD-11 Gaming Disorder proposal would result in “moral panics around the harm of video gaming” and “the treatment of abundant false-positive cases.” The ICD-11 Gaming Disorder avoids potential “overpathologizing” with its explicit reference to functional impairment caused by gaming and therefore improves upon a number of flawed previous approaches to identifying cases with suspected gaming-related harms. We contend that moral panics are more likely to occur and be exacerbated by misinformation and lack of understanding, rather than proceed from having a clear diagnostic system.
Authors:Silvia Ronzitti, Vittorio Lutri, Neil Smith, Massimo Clerici and Henrietta Bowden-Jones
Background and aim
Gambling is a widespread recreational activity in the UK. A significant percentage of gamblers develop subclinical or clinically relevant problem gambling issues, but only a low percentage of them seek treatment. Although characteristics of pathological gamblers from treatment-seeking population have been examined in some research, only a few studies have explored the differences between females and males. This study aimed to examine the gender-related differences in demographics, gambling measures, and clinical variables in an outpatient sample of pathological gamblers seeking treatment.
A total of 1,178 treatment-seeking individuals with gambling disorder were assessed at the National Problem Gambling Clinic in London. Sociodemographic characteristics, clinical variables, and gambling behavior habits were obtained during the assessment evaluation. Of the total sample, 92.5% were males and 7.5% were females.
Males were more likely to be younger, white, and employed than females. In addition, compared to women, men showed a lower PGSI score, an earlier age of onset of gambling behavior, a higher gambling involvement, and preferred specific forms gambling. Female gamblers were more anxious and depressed, while men were more likely to use alcohol and illicit drugs.
Our findings support the importance of gender differences in a treatment-seeking population of pathological gamblers both in sociodemographic characteristics, gambling behavior variables, and clinical variables. Males and females might benefit from group-specific treatment.
Authors:John B. Saunders, Wei Hao, Jiang Long, Daniel L. King, Karl Mann, Mira Fauth-Bühler, Hans-Jürgen Rumpf, Henrietta Bowden-Jones, Afarin Rahimi-Movaghar, Thomas Chung, Elda Chan, Norharlina Bahar, Sophia Achab, Hae Kook Lee, Marc Potenza, Nancy Petry, Daniel Spritzer, Atul Ambekar, Jeffrey Derevensky, Mark D. Griffiths, Halley M. Pontes, Daria Kuss, Susumu Higuchi, Satoko Mihara, Sawitri Assangangkornchai, Manoj Sharma, Ahmad El Kashef, Patrick Ip, Michael Farrell, Emanuele Scafato, Natacha Carragher and Vladimir Poznyak
Online gaming has greatly increased in popularity in recent years, and with this has come a multiplicity of problems due to excessive involvement in gaming. Gaming disorder, both online and offline, has been defined for the first time in the draft of 11th revision of the International Classification of Diseases (ICD-11). National surveys have shown prevalence rates of gaming disorder/addiction of 10%–15% among young people in several Asian countries and of 1%–10% in their counterparts in some Western countries. Several diseases related to excessive gaming are now recognized, and clinics are being established to respond to individual, family, and community concerns, but many cases remain hidden. Gaming disorder shares many features with addictions due to psychoactive substances and with gambling disorder, and functional neuroimaging shows that similar areas of the brain are activated. Governments and health agencies worldwide are seeking for the effects of online gaming to be addressed, and for preventive approaches to be developed. Central to this effort is a need to delineate the nature of the problem, which is the purpose of the definitions in the draft of ICD-11.
Authors:Hans-Jürgen Rumpf, Sophia Achab, Joël Billieux, Henrietta Bowden-Jones, Natacha Carragher, Zsolt Demetrovics, Susumu Higuchi, Daniel L. King, Karl Mann, Marc Potenza, John B. Saunders, Max Abbott, Atul Ambekar, Osman Tolga Aricak, Sawitri Assanangkornchai, Norharlina Bahar, Guilherme Borges, Matthias Brand, Elda Mei-Lo Chan, Thomas Chung, Jeff Derevensky, Ahmad El Kashef, Michael Farrell, Naomi A. Fineberg, Claudia Gandin, Douglas A. Gentile, Mark D. Griffiths, Anna E. Goudriaan, Marie Grall-Bronnec, Wei Hao, David C. Hodgins, Patrick Ip, Orsolya Király, Hae Kook Lee, Daria Kuss, Jeroen S. Lemmens, Jiang Long, Olatz Lopez-Fernandez, Satoko Mihara, Nancy M. Petry, Halley M. Pontes, Afarin Rahimi-Movaghar, Florian Rehbein, Jürgen Rehm, Emanuele Scafato, Manoi Sharma, Daniel Spritzer, Dan J. Stein, Philip Tam, Aviv Weinstein, Hans-Ulrich Wittchen, Klaus Wölfling, Daniele Zullino and Vladimir Poznyak
The proposed introduction of gaming disorder (GD) in the 11th revision of the International Classification of Diseases (ICD-11) developed by the World Health Organization (WHO) has led to a lively debate over the past year. Besides the broad support for the decision in the academic press, a recent publication by van Rooij et al. (2018) repeated the criticism raised against the inclusion of GD in ICD-11 by Aarseth et al. (2017). We argue that this group of researchers fails to recognize the clinical and public health considerations, which support the WHO perspective. It is important to recognize a range of biases that may influence this debate; in particular, the gaming industry may wish to diminish its responsibility by claiming that GD is not a public health problem, a position which maybe supported by arguments from scholars based in media psychology, computer games research, communication science, and related disciplines. However, just as with any other disease or disorder in the ICD-11, the decision whether or not to include GD is based on clinical evidence and public health needs. Therefore, we reiterate our conclusion that including GD reflects the essence of the ICD and will facilitate treatment and prevention for those who need it.