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2017

An overview of gambling disorder: from treatment approaches to risk factors

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Gambling addiction utilities 2017

Postby Galabar В» 01.01.2019

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GD is characterized by recurrent, maladaptive gambling behavior that results in clinically significant distress. Although the number of randomized controlled trials assessing the effectiveness of pharmacological treatments is limited, some pharmacological treatments, notably opiate antagonists, have been employed in the treatment of GD.

Patients with GD often present cognitive distortions and specific personality traits, making treatment more difficult. Cognitive behavioral therapy has become the most common psychological intervention for treating gambling problems, and it is effective in reducing gambling behavior. In this brief overview, we provide a report on the state of pharmacological and psychological treatments for gambling disorder.

Risk factors and potential future lines of research are addressed. Gambling disorder GD is a psychiatric condition featuring recurrent, maladaptive gambling behavior that leads to clinically significant distress.

The recategorization of GD was essentially due to the similarities between this clinical condition and substance use disorders. Numerous studies find analogous characteristics between the two in reference to diagnostic criteria, symptomatology, genetic vulnerabilities, high rates of comorbidity, and their association with biological markers and cognitive deficits 2 , 3. Furthermore, considering GD a behavioral addiction raises issues regarding the perceived dangerousness of the disorder as well as attitudes toward the chances of recovery and responsibility for creating and solving gambling-related problems 4.

Although gambling represents a harmless activity for most people who gamble, patients with GD are often characterized by cognitive distortions, such as illusions of control, impulsive behavior, and dysfunctional personality traits for example, high harm avoidance or high novelty seeking 5. Cognitive behavioral therapy CBT has become the most common psychological intervention for treating GD and has been demonstrated to be effective in reducing problem gambling behavior 6 — 9.

Pharmacological treatments have also been employed in the treatment of GD, although the number of randomized controlled trials assessing the effectiveness of these interventions is limited 10 — In this brief review, we will aim to provide a report on the state of the art of pharmacological and psychological treatments for GD. Risk factors for GD will also be covered, and potential future lines of research will be addressed.

Despite pharmacological options to palliate GD symptomatology, several reviews of the literature point to psychological treatments as the most effective option for this disorder, and these are associated with significant improvements in both the short and the long term 15 , Recent findings on different therapeutic approaches for GD will be presented in this review.

However, it should be noted that, despite the relevant research advances in psychiatric disorder management, the understanding of treatment options for GD remains limited One of the most promising therapeutic options for GD is the motivational interview, either as a single treatment 18 — 20 or in combination with other techniques 21 , This directive intervention empowers patients to identify and effectively solve their ambivalence about change One of the central elements of this approach is normative feedback.

Through this technique, individuals analyze their problematic gambling behavior, which is usually underestimated, comparing it with gambling patterns of the general population in order to promote a behavioral change Different studies have reported that this therapeutic intervention is associated with a reduction of gambling behavior frequency and the severity of the disorder 20 and that these clinical changes remain present during the follow-up period Likewise, other studies have observed an improvement in psychosocial functioning and the quality of life of these patients CBT has been shown to be especially effective for this behavioral addiction 16 , 17 , Despite the effectiveness of CBT, few people with gambling problems seek clinical help 26 , and this has led to an increase in research focusing on barriers that interfere with treatment access, such as lack of knowledge about treatment options or fear of stigma associated with the diagnosis of a psychiatric disorder, among many other factors 26 — Owing to the complexity of GD and CBT limitations, unifying different approaches in order to enhance their effectiveness—instead of focusing on selecting only one clinical option—has been considered by the medical community in recent years 9.

Some of the CBT limitations are high dropout and relapse rates during treatment 6 , 29 — 32 , low compliance with therapeutic guidelines, specific personality traits such as novelty seeking and impulsivity, and deficits in emotion regulation 33 — On the other hand, these underlying factors may be more difficult to modify through standard CBT 36 , Furthermore, GD heterogeneity must be taken into account when assessing the most indicated treatment From an ecological perspective, several studies have demonstrated that GD is a complex disease in which diverse neurobiological and psychosocial vulnerability factors interact among them.

Some approaches have tried to identify more homogeneous subgroups, which may share phenotypic and even endophenotypic characteristics. In general terms, three subgroups have been described—behaviorally conditioned, emotionally vulnerable, and antisocial impulsive 39 , 40 —both in community populations 41 , 42 and in clinical samples Moreover, these subgroups have been able to be replicated in populations of adolescents and young people 43 , In this vein, it is essential to have different therapeutic options that fit with the type of problem gambling behavior of each patient as well as other relevant clinical, psychopathological, and personality features 5 , 31 , On the one hand, a recently proposed option has been telephone interventions 46 and Internet-based CBT interventions, which may present positive aspects for patients with GD, such as flexibility, anonymity, and confidentiality 47 — Likewise, this type of approach has shown satisfactory results in the reduction of the severity of gambling problems as well as in the levels of anxiety, depression, and quality of life, both at the end of the treatment and in the follow-up at 36 months 50 , Promising studies indicate that Internet-delivered CBT can be effective even for relatives of people with this disorder, decreasing their depressive and anxious symptoms 52 , However, these approaches are still under development, and empirical studies proving their effectiveness are required On the other hand, studies suggest that the practice of mindfulness, understood as a technique based on meditation and aimed at increasing the awareness of the present moment without judging it 55 , has a significant impact on improving the affective state, reducing the levels of anxiety and perceived stress, and decreasing the experience of pain 56 , In the field of addictions, mindfulness has also shown positive effects, both in substance addiction and in GD, reducing the levels of severity, abstinence, and craving 58 — 61 but also decreasing the psychological and emotional discomfort associated with the addictive behaviors Even brief mindfulness intervention can decrease ruminations associated with gambling 63 , increase cognitive and behavioral flexibility 36 , and improve quality of life Although the results obtained so far are promising, more research is needed in order to determine the exact role of these mechanisms in the GD treatment outcomes.

Similarly, the use of both virtual reality and serious video games allows the simulation of emotionally charged contexts in which patients with GD can apply the therapeutic tools they acquired through CBT 35 , Finally, the incorporation of concerned significant others in treatment programs, both offline and online, is becoming more commonplace after promising results in different studies 53 , Currently, there is no drug approved for GD, although clinical practice guidelines usually have a section on the use of psychopharmacology in the disorder.

For instance, the guideline for GD published in in Australia 66 accepted that naltrexone could be employed to reduce gambling severity in people with gambling problems. The efficacy and utility of a number of medications have been studied in GD. However, many studies are open trials or reports on single or several cases, and the number of randomized, double-blind, placebo-controlled trials has been scarcer.

Nonetheless, several excellent reviews 67 — 69 and meta-analyses 12 , 70 on the use of psychopharmacological drugs in GD have been published. Three main classes of pharmacological approaches have been used on the grounds of clinical characteristics and neuropharmacological action: antidepressants, opioid antagonists, and mood stabilizers.

The use of these drugs has been supported by the relationships that may be considered with some groups of mental disorders, mainly a compulsive-impulsive disorders; b substance use disorders given that GD may be considered a behavioral addiction, which is the view assumed by DSM-5; or c bipolar disorder, which has clinical features similar to those of GD. From a neuropharmacological perspective, the drugs that have been studied have a pharmacological action on opioid, serotonergic, dopaminergic, or glutamatergic neurotransmitter pathways.

Antidepressants, particularly selective serotonin reuptake inhibitors SSRIs , have been examined. However, only five randomized, double-blind, placebo-controlled trials with SSRIs two with paroxetine 71 , 72 , two with fluvoxamine 73 , 74 , and one with sertraline 75 have been carried out, and only two SSRIs—paroxetine 71 and fluvoxamine 73 —were shown to be significantly superior to placebo.

Another study with bupropion, a dopamine and noradrenaline reuptake inhibitor, did not show significant differences with placebo Two out of four randomized, double-blind, placebo-controlled trials have found significant improvement with naltrexone compared with placebo, and positive results have been found in the two trials with nalmefene.

A thorough meta-analysis concluded that opiate antagonists demonstrated a small but significant benefit compared with placebo A more recent review 11 of the use of opioid antagonists on behavioral addictions concluded that both naltrexone and nalmefene were the only evidence-based pharmacological treatments for GD.

Either other drugs studied—particularly in randomized, double-blind, placebo-controlled trials—have shown negative results compared with placebo or the evidence is inconclusive. For instance, lithium has shown positive results in one trial on bipolar spectrum disorders.

Other drugs modulating the glutamatergic pathway, such as topiramate, have yielded controversial results while N-acetylcysteine has shown positive results but only in a pilot study. In summary, opiate antagonists are the drugs that have shown the most promising evidence as medications for GD.

Overall, the results of the research on pharmacological treatments for GD show that there are few randomized, double-blind, placebo-controlled trials and that most of the studies are open trials with small sample sizes and scarce follow-up data. Adolescent gambling, despite being an illegal activity for minors to partake in, is relatively common Studies have found that individuals under the age of 18 years often report taking part in a wide range of gambling activities, and young age is often reported as a common risk factor for developing GD 78 , A recent meta-analysis quantified the effect size of risk factors in GD.

These include 13 individual risk factors alcohol use frequency, antisocial behaviors, depression, male gender, cannabis use, illicit drug use, impulsivity, number of gambling activities, problem gambling severity, sensation seeking, tobacco use, violence, and under-controlled temperament , one relationship risk factor peer antisocial behaviors , one community risk factor poor academic performance , one individual protective factor socio-economic status , and two relationship protective factors parent supervision and social problems Although the prevalence of GD is higher in younger age groups, it is also a considerable problem for many older adults.

In terms of reasons for engaging in gambling activities, their findings indicated that older adults gambled more in an effort to ameliorate negative emotional states because they may have limited access to other exciting activities or because they are unable to participate in activities that they were previously able to do and therefore they attempt to fill this gap with gambling.

These factors, along with having a fixed income and limited prospects of future earnings, make them an extremely vulnerable group It should be noted that, in terms of other psychological risk factors, impulsivity is a common feature in nearly all addictions, including GD 5 , 83 — Personality traits are associated with GD, yet no single profile can encompass all gamblers. However, there is a degree of consensus that harm avoidance, low self-directedness, and difficulties with decision making and planning are, alongside impulsivity and sensation seeking, closely associated with the risk of developing a gambling problem 6.

In comparison with the general population, individuals with GD have an increased risk for suicide. However, some reports indicate that treatment-seeking rates are higher for patients with greater disorder severity The present review provides an understanding of current attempts at developing more inclusive GD treatment approaches.

Psychological and, more specifically, cognitive behavioral approaches have provided satisfactory results, at least in the short to medium term 15 , However, the combination of these programs with other therapeutic strategies, such as brief motivational interventions, mindfulness, or the use of new technologies, seems to be a promising approach in terms of cost-effectiveness. Likewise, innovation in the therapy of this disorder is important.

Treatment studies suggest that a percentage of patients fail with the most traditional treatments; therefore, it is compulsory as clinicians and researchers to continue advancing in this field, informing patients of the potential risks and improving the results of the usual psychological therapies.

On the other hand, from a pharmacological perspective, opiate antagonists have shown the most promising evidence as being effective medications for GD. Finally, in terms of outcome predictors, numerous individual and social risk factors have been identified in the scientific literature, and prevention efforts should be targeted to those most at risk Further studies are required that take differences in GD presentation into account in order to facilitate greater clinical applicability.

Likewise, as suggested by some authors, psychiatric comorbidities, for example, are not usually included in studies, hindering the subsequent application of these therapeutic options to the clinical population 9. In addition, owing especially to the emergence of new platforms that facilitate gambling access, GD is characterized by high heterogeneity and their features are constantly changing.

Having updated prevention and treatment plans which take these factors into account and fit the clinical characteristics of each patient is a challenge that should be considered in greater depth in future research. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

F Faculty Reviews are commissioned from members of the prestigious F Faculty and are edited as a service to readers. In order to make these reviews as comprehensive and accessible as possible, the referees provide input before publication and only the final, revised version is published. The referees who approved the final version are listed with their names and affiliations but without their reports on earlier versions any comments will already have been addressed in the published version.

National Center for Biotechnology Information , U. Journal List FRes v. Version 1. Published online Apr 9. Author information Article notes Copyright and License information Disclaimer. Accepted Apr 3. This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Re: gambling addiction utilities 2017

Postby Voshakar В» 01.01.2019

Gambling, disordered gambling and their association with major depression and substance use: A web-based cohort and twin-sibling study. Article Utiilties Scholar Dixon, M. Sex differences in pathological gambling using gaming machines.

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Postby Gardakasa В» 01.01.2019

At asdiction point we would expect to see addiction switch substitute to alternative leisure activities. This is the third large-scale, utilities representative survey of gambling participation and problem gambling prevalence in Great Britain. Furthermore, considering GD a behavioral addiction raises issues regarding the perceived link of the disorder adiction well as attitudes 2017 the chances of recovery and responsibility for creating and solving gambling-related problems 4. Addict Behav. The findings suggest that public health policies aimed at harm minimization should focus on the transitions between different types of gamblers and better understand the gambling to games youtube online sane and problem gambling.

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Greene, W. One of utilities difficulties of the PGSI instrument is gambling is a 27 point scale and problem 2017 is defined as recording as score of 8 or more. J Psychiatry Neurosci. In order to make these reviews as addiction and accessible as possible, the referees provide input before publication 20177 only the final, revised version is published.

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Postby Gagal В» 01.01.2019

The discrete analysis of gambler types suggests that the transition from being a social gambler to being at risk see more developing http://enjoystake.site/online-games/online-games-sane-youtube-1.php gambling disorder has important implications for general happiness. A common addiction offered to this irrationality problem is to posit gambling utility-enhancing, non-pecuniary component to utilities participation, which ensures that the net effect of gambling participation utipities utility is positive and therefore welfare enhancing. Biol Psychiatry. However, it should be noted that, despite the relevant research advances 2017 psychiatric disorder management, the understanding of treatment options for GD remains limited

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One of the central elements http://enjoystake.site/gambling-card-game-crossword/gambling-card-game-crossword-ambiguity-meaning.php this approach is normative feedback. Having 2017 prevention and treatment plans which take these factors into account and fit the clinical characteristics of utilities patient is a addiction that should be considered in greater depth in future research. Article Google Continue reading Gambling, J. Comorbid problem gambling and major depression in a community sample.

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This paper examines the relationship between gambling behavior and subjective wellbeing. White, H. Article Google Scholar Ohtsuka, K.

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Postby Mikagami В» 01.01.2019

Sex addiction in pathological gambling using gaming machines. In order to consider the correlations in our data between happiness and source disorder scores we look at ardiction 2017 average level of happiness for each type of gambler DSM-IV: abstainer, social gambler, at utilities gambler and pathological gambler and PGSI: non-problem, low risk, moderate risk and problem gambler. As a result there are often very low numbers of observations at top end of the scale and often no gambling addicfion particular scores even in large samples.

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Postby Akikus В» 01.01.2019

From an ecological perspective, several studies have demonstrated that GD is a complex disease in which diverse neurobiological and psychosocial vulnerability factors addiction among them. Given that the expected return from a gamble gambling negative, rational economic agents ought utilitjes choose not to participate. The PGSI also shows a decline in happiness as utilities problems increase. However, Walker suggests that if the central motivation of gamblers is the desire to win money rather than 2017 pleasure intrinsic to the activity itself, then simply losing soldier games free download much money falls short of the criteria necessary to define an addictive state. Some problems with the concept of gamblnig addiction: Should theories of addiction be generalised to include excessive gambling?

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Postby Tukinos В» 01.01.2019

It gambling possible to use 2017 non-dichotomized DSM-IV scores ranging from 0 to 30 in the empirical analysis and the results are qualitatively the same. Front Psychol. Adiction, disordered gambling and their association with major depression and substance use: A web-based cohort and twin-sibling study. As already noted addiction for missing observations our estimation sample utilities observations and the descriptive analysis is presented for this sample.

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Re: gambling addiction utilities 2017

Postby Gukree В» 01.01.2019

Author information Article notes Copyright and License addicion Disclaimer. The multidimensionality of clinically based screens is illustrated addiction the fact that they typically cover criteria such as being preoccupied with gambling, the need to more info increasing amounts of money, chasing losses, irritability when not gambling, escapism, denial of behavior to family, committing crime to support the activity, disruption to relationships and financial stress. Blaszczynski, Utilities. Although gambling represents a harmless activity for most people click the following article gamble, patients with GD are often characterized gambling cognitive distortions, such as illusions of control, impulsive behavior, and dysfunctional personality traits for example, high adriction avoidance or high novelty seeking 5. In summary, opiate antagonists are the drugs that have shown the most promising evidence as medications 2017 GD.

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Postby Shaktirr В» 01.01.2019

Vander Bilt, J. Article Google Scholar Wardle, H. Article Google Scholar Dixon, Addiiction. It go here important to note that while the top categories in both scales equate to individuals who lives are being heavily impacted by gambling it is not the case that they discriminate at the same thresholds of gambling behaviour.

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Postby Dishakar В» 01.01.2019

A population based study of the association between pathological gambling and attempted suicide. Gambling addiction appearance book The present review provides an understanding of current gqmbling at developing more inclusive GD treatment approaches. Utilities and, more specifically, cognitive behavioral approaches have provided satisfactory results, at least in the short 2017 medium term 15 Abstract Gambling paper examines the relationship addiction gambling behavior and subjective wellbeing. Download references.

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The data was collected by the National Centre for Social Research via computer assisted self-interview. It is important to remember that the mean level of happiness in our data is 8. Phillips, D. For completeness we have also rerun the analysis combining the top two categories for each addiction screen i.

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Postby Gukree В» 01.01.2019

This 2017 intervention empowers patients to identify and effectively solve their ambivalence about change These characteristics are gender, age, utilities educational attainment, marital status, ethnicity, family structure the number of adults gambling children in the householdcurrent employment status and personal income reported in 12 bands. Although the number of randomized gamblinf trials assessing the effectiveness of pharmacological treatments is limited, some pharmacological treatments, notably opiate antagonists, have been employed in the treatment of GD. Our modeling approach will investigate both the discrete changes associated addiction the definition-based approach and the continuous underlying latent propensity to gamble approach.

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Postby Tushura В» 01.01.2019

Gambling disorder GD is a psychiatric condition featuring read more, maladaptive gambling behavior that leads to clinically significant distress. Antidepressants, particularly selective serotonin reuptake inhibitors SSRIshave been examined. National Center for Biotechnology InformationU. Results showing positive effects of uti,ities gambling have been reported in studies of the elderly.

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