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

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Abstract

Background and aims

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 < .001) according to short screening tools. Current diagnosis of drug use (OR = 4.31 [CI = 1.98–9.37]), borderline personality (OR = 2.59 [CI = 1.13–5.94]), bipolar affective (OR = 2.01 [CI = 1.07–3.80]), and psychotic (OR = 1.83 [CI = 1.03–3.25]) disorders were significant predictors of problem gambling.

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.

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Most cited references 60

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The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol Use Disorders Identification Test.

K Bush, D R Kivlahan, M McDonell … (1998)

To evaluate the 3 alcohol consumption questions from the Alcohol Use Disorders Identification Test (AUDIT-C) as a brief screening test for heavy drinking and/or active alcohol abuse or dependence. Patients from 3 Veterans Affairs general medical clinics were mailed questionnaires. A random, weighted sample of Health History Questionnaire respondents, who had 5 or more drinks over the past year, were eligible for telephone interviews (N = 447). Heavy drinkers were oversampled 2:1. Patients were excluded if they could not be contacted by telephone, were too ill for interviews, or were female (n = 54). Areas under receiver operating characteristic curves (AUROCs) were used to compare mailed alcohol screening questionnaires (AUDIT-C and full AUDIT) with 3 comparison standards based on telephone interviews: (1) past year heavy drinking (>14 drinks/week or > or =5 drinks/ occasion); (2) active alcohol abuse or dependence according to the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition, criteria; and (3) either. Of 393 eligible patients, 243 (62%) completed AUDIT-C and interviews. For detecting heavy drinking, AUDIT-C had a higher AUROC than the full AUDIT (0.891 vs 0.881; P = .03). Although the full AUDIT performed better than AUDIT-C for detecting active alcohol abuse or dependence (0.811 vs 0.786; P<.001), the 2 questionnaires performed similarly for detecting heavy drinking and/or active abuse or dependence (0.880 vs 0.881). Three questions about alcohol consumption (AUDIT-C) appear to be a practical, valid primary care screening test for heavy drinking and/or active alcohol abuse or dependence.

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Emotion regulation and mental health: recent findings, current challenges, and future directions.

Peggilee Wupperman, Matthias Berking (2012)

In recent years, deficits in emotion regulation have been studied as a putative maintaining factor and promising treatment target in a broad range of mental disorders. This article aims to provide an integrative review of the latest theoretical and empirical developments in this rapidly growing field of research. Deficits in emotion regulation appear to be relevant to the development, maintenance, and treatment of various forms of psychopathology. Increasing evidence demonstrates that deficits in the ability to adaptively cope with challenging emotions are related to depression, borderline personality disorder, substance-use disorders, eating disorders, somatoform disorders, and a variety of other psychopathological symptoms. Unfortunately, studies differ with regard to the conceptualization and assessment of emotion regulation, thus limiting the ability to compare findings across studies. Future research should systematically work to use comparable methods in order to clarify the following: which individuals have; what kinds of emotion regulation difficulties with; which types of emotions; and what interventions are most effective in alleviating these difficulties. Despite some yet to be resolved challenges, the concept of emotion regulation has a broad and significant heuristic value for research in mental health.

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Understanding gambling related harm: a proposed definition, conceptual framework, and taxonomy of harms

Erika Langham, Hannah Thorne, Matthew Browne … (2016)

Background Harm from gambling is known to impact individuals, families, and communities; and these harms are not restricted to people with a gambling disorder. Currently, there is no robust and inclusive internationally agreed upon definition of gambling harm. In addition, the current landscape of gambling policy and research uses inadequate proxy measures of harm, such as problem gambling symptomology, that contribute to a limited understanding of gambling harms. These issues impede efforts to address gambling from a public health perspective. Methods Data regarding harms from gambling was gathered using four separate methodologies, a literature review, focus groups and interviews with professionals involved in the support and treatment of gambling problems, interviews with people who gamble and their affected others, and an analysis of public forum posts for people experiencing problems with gambling and their affected others. The experience of harm related to gambling was examined to generate a conceptual framework. The catalogue of harms experienced were organised as a taxonomy. Results The current paper proposes a definition and conceptual framework of gambling related harm that captures the full breadth of harms that gambling can contribute to; as well as a taxonomy of harms to facilitate the development of more appropriate measures of harm. Conclusions Our aim is to create a dialogue that will lead to a more coherent interpretation of gambling harm across treatment providers, policy makers and researchers.

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Author and article information

Journal

Journal ID (pmc): jba

Journal ID (publisher-id): 2006

Title: Journal of Behavioral Addictions

Abbreviated Title: J Behav Addict

Publisher: Akadémiai Kiadó (Budapest )

ISSN (Print): 2062-5871

ISSN (Electronic): 2063-5303

Publication date (Electronic, epub): 18 December 2017

Publication date (Print, ppub): December 2017

Volume: 6

Issue: 4

Pages: 678-688

Affiliations

[ ¹ ] Turning Point, Eastern Health , Melbourne, VIC, Australia

[ ² ] Eastern Health Clinical School, Monash University , Melbourne, VIC, Australia

[ ³ ] School of Psychology, Deakin University , Geelong, VIC, Australia

[ ⁴ ] Melbourne Graduate School of Education, University of Melbourne , Melbourne, VIC, Australia

[ ⁵ ] Monash Alfred Psychiatry Research Centre, Alfred Health and Monash University Central Clinical School , Melbourne, VIC, Australia

[ ⁶ ] School of Population Health, University of Auckland , Auckland, New Zealand

[ ⁷ ] School of Public Health and Health Sciences, University of Massachusetts Amherst , Amherst, MA, USA

Author notes

[* ]Corresponding author: Victoria Manning; Turning Point, Eastern Health, 110 Church Street, Richmond 3121, VIC, Australia; Phone: +61 3 8413 8413; Fax: +61 3 9416 3420; E-mail: victoriam@ 123456turningpoint.org.au

Article

DOI: 10.1556/2006.6.2017.077

PMC ID: 6034952

PubMed ID: 29254361

SO-VID: e009e456-b03b-4659-8aea-32cdb52bd8b3

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium for non-commercial purposes, provided the original author and source are credited.

History

Date received : 20 July 2017

Date revision received : 29 October 2017

Date accepted : 19 November 2017

Page count

Figures: 0, Tables: 5, Equations: 0, References: 56, Pages: 11

Funding

Funding sources: This research was supported by the Victorian Responsible Gambling Foundation. VM has received funding for research from multiple sources over the past 36 months including the National Health and Medical Research Council (NHMRC), VicHealth, the Victorian Department of Health and Human Services (DHHS), and the Victorian Responsible Gambling Foundation (VRGF). These include government departments or agencies that are primarily funded by government departments (some through hypothecated taxes from gambling revenue). She has not knowingly received direct funding from the gambling industry or any industry-sponsored organization.

NAD has received funding from multiple sources, including government departments or agencies that are funded primarily by government departments (some through hypothecated taxes from gambling revenue). In the previous 36 months, she has received research funding from the VRGF, the Tasmanian Department of Treasury and Finance, Gambling Research Exchange Ontario (GREO), the New South Wales Government Department of Premier and Cabinet, the Hong Kong Research Grants Council, Deakin University, and the Australian Gambling Research Centre. She was previously employed at the Problem Gambling Research and Treatment Centre at the University of Melbourne, which was funded by the VRGF. She has not knowingly received travel support, speaker honoraria, or research funding from the gambling industry or any industry-sponsored organization.

SL is a recipient of a NHMRC Early Career Fellowship. In the past 36 months, he has received funding for research from the Victorian DHHS, Victorian Women’s Benevolent Trust, the VRGF and Janssen-Cilag. He has been an invited speaker for Hospira.

SR does not hold any ongoing position, receive ongoing, or significant funding, and is not engaged in any business or organization that creates a conflict of interest (real, perceived, actual, or potential) with the current research. She has had financial professional dealings with various State and Federal governments directly and indirectly over the past 3 years including research funding from organizations that are funded directly or indirectly from the gambling industry or levies on the gambling industry including the VRGF and GREO. She has also received research funding from the NSW Office of Liquor, Gaming, and Racing, Australian Institute of Family Studies, and Gambling Research Australia. SR is currently the recipient of a Health Research Council grant in New Zealand.

JBBG has no conflict of interest to declare. During the past 36 months, his salary was funded by the NHMRC. RV has no affiliations with the gambling industry. She receives research funding from several government agencies, including the Massachusetts Gaming Commission, and the Canadian Centre on Substance Abuse. She also receives research funding from several academic and non-governmental agencies, including the Center for Gambling Studies at Rutgers University, the Oregon Council on Problem Gambling, and Turning Point in Victoria, Australia.

JK is employed by the Alfred Hospital, Melbourne. She has received research grants from government bodies such as VicHealth and NMHRC as well as Jansen Cilag, Astra Zeneca and Eli Lily pharmaceuticals, and the VRGF.

DIL has received research grants from the NHMRC and has provided consultancy advice to Lundbeck and Indivior, and has received travel support and speaker honoraria from Astra Zeneca, Janssen, Lundbeck, and Servier.

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

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Abstract

Background and aims

Methods

Results

Discussion and conclusions

Related collections

Journal of Behavioral Addictions

Most cited references 60

The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol Use Disorders Identification Test.

Emotion regulation and mental health: recent findings, current challenges, and future directions.

Understanding gambling related harm: a proposed definition, conceptual framework, and taxonomy of harms

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