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

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          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.


          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.


          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 47

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          The Severity of Dependence Scale (SDS): psychometric properties of the SDS in English and Australian samples of heroin, cocaine and amphetamine users.

          The Severity of Dependence Scale (SDS) was devised to provide a short, easily administered scale which can be used to measure the degree of dependence experienced by users of different types of drugs. The SDS contains five items, all of which are explicitly concerned with psychological components of dependence. These items are specifically concerned with impaired control over drug taking and with preoccupation and anxieties about drug use. The SDS was given to five samples of drug users in London and Sydney. The samples comprised users of heroin and users of cocaine in London, and users of amphetamines and methadone maintenance patients in Sydney. The SDS satisfies a number of criteria which indicate its suitability as a measure of dependence. All SDS items load significantly with a single factor, and the total SDS score was extremely highly correlated with the single factor score. The SDS score is related to behavioural patterns of drug taking that are, in themselves, indicators of dependence, such as dose, frequency of use, duration of use, daily use and degree of contact with other drug users; it also shows criterion validity in that drug users who have sought treatment at specialist and non-specialist agencies for drug problems have higher SDS scores than non-treatment samples. The psychometric properties of the scale were good in all five samples, despite being applied to primary users of different classes of drug, using different recruitment procedures in different cities in different countries.
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            Measuring the heaviness of smoking: using self-reported time to the first cigarette of the day and number of cigarettes smoked per day.

            Two simple self-report measures have been used to assess the heaviness of smoking, 'number of cigarettes per day' (CPD) and 'time to the first cigarette of the day' (TTF). Little attention, however, has been given to the precise method of scoring this information. Using biochemical indicators of heaviness of smoking (alveolar carbon monoxide and cotinine), we explore the optimum data transformations for regression analysis and categorical analysis. We suggest a four category scoring scheme for both time to the first cigarette of the day (less than or equal to 5, 6-30, 31-60 and 61+ min) and average daily consumption of cigarettes (1-10, 11-20, 21-30, 31+ cigarettes) as the most powerful and practical categorical scoring of these variables. Due to possible ceiling effects on biochemical measures, we suggest using logarithmic transformations of CPD or TTF for regression or correlation analyses.
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              Emotion regulation and mental health: recent findings, current challenges, and future directions.

              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.

                Author and article information

                Journal of Behavioral Addictions
                J Behav Addict
                Akadémiai Kiadó (Budapest )
                18 December 2017
                December 2017
                : 6
                : 4
                : 678-688
                [ 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@
                © 2017 The Author(s)

                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.

                Page count
                Figures: 0, Tables: 5, Equations: 0, References: 56, Pages: 11
                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.
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