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Postby Kile В» 10.08.2019

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Aims: The primary objective of this study was to analyze the association between alcohol consumption and short-term response to treatment post intervention in male patients with gambling disorder enrolled in a group cognitive behavioral therapy CBT program. All participants were evaluated by a comprehensive assessment battery and assigned to CBT groups of 10—14 patients attending 16 weekly outpatient sessions lasting 90 min each.

As regards the presence of relapses and dropouts over the course of the CBT sessions, the results show a significant association with moderate effect size: patients with risk consumption or alcohol dependence were more likely to present poor treatment outcomes.

Conclusions: Alcohol abuse was frequent in GD, especially in patients with low family income and high accumulated debts. High levels of somatization and high overall psychopathology measured by the SCLR were associated with increased risk of alcohol abuse.

Alcohol abuse was also associated with poor response to treatment. The general characteristics of addictive behaviors include an intense desire to satisfy a need, loss of control, and persistence in maladaptive behavior despite the negative consequences Stinchfield et al. However, few studies have systematically explored alcohol consumption in patients being treated for GD using validated measurement instruments. Studies of alcohol consumption during gambling episodes reveal riskier betting patterns and negative consequences Ellery et al.

In relation to relapse, some authors define it as a violation of the goals set with respect to gambling behavior Hodgins and El-Guebaly, , while others argue that a single gambling episode should not be considered a relapse unless it is associated with a feeling of loss of control Blaszczynski et al.

Moreover, relapse and dropout have been associated with the fact that gambling is seen as a form of social interaction, or as a strategy to escape from personal problems or to resolve financial difficulties, or as a source of excitement or stimulation Melville et al.

Other research also describes the involvement of clinical, psychopathological and treatment characteristics such as early age of onset of GD and short duration Petry, , and motivation and adherence to the guidelines prescribed between sessions Smith et al. Regarding predictors of poor response to treatment, some sociodemographic characteristics such as younger age, low education, being single, or ethnicity have been reported Ingle et al.

The involvement of certain clinical variables has also been described, such as problems with emotional regulation e. Predictors of good response to treatment identified include family and social support Bertrand et al. Alcohol use in patients with other psychiatric disorders is widely held to have adverse effects both on the course of the disorder and on treatment outcome Barnes et al. In GD, however, contradictory results have been obtained. Previous studies of the effect of lifetime alcohol and substance abuse on treatment response found that, while these variables indicated increased severity of the gambling problem, there was no association between consumption and treatment outcome Stinchfield et al.

In contrast, Hodgins and-Guebaly found that GD relapse was 2. Similarly conflicting results are observed in studies evaluating the treatment of GD in patients who abuse substances other than alcohol Toneatto and Brennan, ; Redish et al.

The study has three aims: 1 To compare two groups of GD patients with low and high AUDIT scores at baseline and post-therapy, and to assess the pre-post changes; 2 To estimate the predictive value of baseline AUDIT scores with regard to the risk of relapse and dropout during treatment; and 3 To assess the incremental predictive ability of AUDIT scores with regard to the short-term mean changes produced in patients' clinical status between the beginning and end of treatment.

This public hospital is certified as a tertiary center for the treatment of GD and oversees the treatment of highly complex cases. The Pathological Gambling Unit attends people with distinct behavioral addictions, such as GD, but also other behavioral addictions the most common disorders at present are compulsive buying, technology addiction, and sex addiction.

After the initial assessment process, different intervention programs are considered and applied to patients depending on their diagnosis and individual characteristics.

The sample in this study included all the consecutive male individuals with a GD diagnosis, who met inclusion criteria for the unit's group CBT treatment program, between January and June All the participants were assessed by expert clinical psychologists and psychiatrists with more than 15 years of clinical experience in the field of GD, and were diagnosed with the condition if they met the DSM-IV criteria.

Exclusion criteria were: female sex, presence of an organic mental disorder, intellectual disability, the presence of substance use disorders at evaluation which were not being simultaneously treated as GD treatment and for which the patients were not motivated to treat, active psychotic disorder, other behavioral addictions apart from GD requiring treatment different from the aforementioned CBT group.

The present study was carried out in accordance with the latest version of the Declaration of Helsinki. The University Hospital of Bellvitge Ethics Committee of Clinical Research approved the study, and written informed consent was obtained from all participants. A comprehensive assessment battery was administered to measure GD. This is a item diagnostic questionnaire that discriminates between probable pathological gamblers, problematic gamblers and non-problematic gamblers.

The Spanish validation of this questionnaire shows high reliability and validity. Test-retest reliability is 0. In this study the total score was used. Internal consistency ranged between 0. This test was developed as a simple screening method for excessive alcohol consumption. The AUDIT consists of 10 questions about the level of consumption, symptoms of dependence, and alcohol-related consequences.

Internal consistency has been found to be high, and rest-retest data have suggested high reliability 0. Specificity in different settings and for different criteria averages 0. Here, cut-off points of 8 and 20 were used to identify individuals with alcohol abuse and alcohol dependence respectively Reinert, The SCLR was administered to evaluate a broad range of psychological problems and symptoms of psychopathology.

This test measures nine primary symptom dimensions: somatization, obsession-compulsion, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychoticism.

It also includes three global indices: a global severity index GSI , which measures overall psychological distress; a positive symptom distress index PSDI to measure the intensity of symptoms; and a positive symptom total PST , which reports the total self-reported symptoms.

The GSI can be used as a summary of the test. This scale has been validated in a Spanish population, obtaining an internal consistency alpha coefficient for the items ranging between 0. Other socio-demographic and clinical variables. Among the gambling behavior variables covered were the number of previous treatment attempts, the type of problem gambling, whether there was more than one preferred form of gambling, the age of onset of gambling and of gambling-related problems, the average and the maximum amounts bet in a single episode, and the total accumulated debts.

In addition, the interview explored certain maintaining factors such as gambling to chase losses or to avoid negative emotional states, magical thinking and the illusion of control, ritualistic behavior, characteristics of the last gambling episode prior to the visit to the unit, and the family situation generated by the gambling problems. All participants were interviewed and evaluated by clinical psychologists and physicians with more than 15 years experience in the diagnosis and treatment of these disorders.

Throughout the treatment period, attendance, the control of spending and gambling behavior, compliance with treatment subjectively rated by the therapist as good, fair or poor and occurrence of relapses were recorded on an observation sheet.

Patients were also instructed to perform tasks in preparation for the following session. The observation sheet was completed during the treatment session by the therapist and by a clinically-trained co-therapist.

Moreover, at the end of the last session of treatment in which patients finalized the CBT program , we conducted a post-treatment assessment session, which consisted of the administration of the SOGS and the SCLR on both self-report tests, patients had to answer items considering their current state.

The time for completion of the two questionnaires was not more than 30 min. For work reasons, most patients reported preferring to complete this post-treatment evaluation during the same visit as opposed to having to return to the unit after a few days. Patients were assigned to outpatient CBT groups comprising 10—14 patients each. The CBT group therapy consisted of 16 weekly outpatient sessions lasting 90 min each and a follow-up period lasting up to 2 years, though the current study assesses data from the first 3 months of the follow-up only.

A family member usually the spouse or partner was involved in the treatment. Family members attended seven of the 16 weekly treatment sessions and the entire follow-up period.

Their functions were to help and support the patient, to acquire a better understanding of the disorder, to manage situations of risk, and to help patients regain their confidence. Family members who attended group therapy also collaborated in some of the treatment techniques such as stimulus control initial control of money and in helping patients to find alternative activities to gambling such as hobbies and healthy distractions.

Each group was led by an experienced clinical psychologist with the aid of a clinically trained co-therapist. The goal of the treatment was to train patients to implement CBT strategies in order to achieve full recovery, defined as full abstinence from all types of gambling behavior. The general topics addressed in the therapy sessions included: psychoeducation regarding the disorder its course, vulnerability factors, diagnostic criteria, biopsychosocial models of GD, phases, etc.

Moreover, this treatment protocol contemplates that those patients who have alcohol use disorder or another substance use disorder or even if they do not meet all the criteria for diagnosis, but have a pattern of hazardous drinking behavior should also specifically undergo alcohol and drug treatment at their corresponding primary care center within the public health network.

If patients do not present a sufficient level of motivation, the treatment applied for them is individual outpatient therapy. That is to say, individual CBT has similar characteristics to group CBT but, in addition to therapy for their problem gambling, includes a module of motivational sessions, based on motivational interviewing Miller and Rollnick , to facilitate the recognition of their alcohol problem and to draw them to use the above-mentioned resources.

To ensure treatment fidelity, therapists adhered closely to the treatment manual. The two therapists in charge of the treatment groups M. Weekly case discussions were held between the therapist, the clinically trained co-therapist, and the rest of the team at the unit.

Since other psychiatric conditions are usually considered in both a dimensional and a categorical approach in clinical and research areas, alcohol measures were handled likewise. Results obtained for the dimensional AUDIT-raw-total score will be interpreted as the measure of the individuals' alcohol use , while the AUDIT-binary-group is a categorization of an individuals' risk leve l. Goodness-of-fit was measured through the Hosmer-Lemeshow test and the global predictive-discriminative capacity with Nagelkerke's pseudo-R 2.

Thirdly, Kaplan-Meier functions estimated the cumulative survival function by measuring the time to the presence of relapse and dropout during the development of the therapy. The Kaplan-Meier estimator is a procedure which is included in survival analysis techniques to estimate the survival function from lifetime data, that is, the proportion of subjects remaining without the presence of a specific outcome during the follow-up.

The Simes' correction method was used to control Type-I error due to multiple statistical comparisons Simes, This procedure was included into the Familywise error rate stepwise procedures, and offers a more powerful test than the classical Bonferroni correction. Table 1 includes descriptions of the total sample and is stratified according to alcohol level group.

Around half the patients had finished elementary The mean duration of the disorder was 5. Slot-machines were the main gambling problem for most participants Eighty-nine patients At the beginning of the study baseline state , no statistical differences emerged comparing these clinical measures, although moderate effect size differences were obtained for the SCLR somatization and the PST scales.

No statistical differences were recorded for the SOGS-total and the SCL mean scores at the end of the treatment post-therapy values , and effect sizes of the mean differences were in the low range d -coefficients clearly lower than 0. Considering pre-post changes, statistically no differences emerged.

The second part of Table 2 contains the Pearson's correlation estimating the association between the dimensional AUDIT-raw-total score and the psychometrical measures considered in this study. Table 3 displays the comparison of the treatment outcomes between patients in the two alcohol level groups: poor attendance missing at least three sessions , poor compliance with therapy guidelines, the presence of relapses and dropout.

Even after including the patients' age, education and marital and employment status, the AUDIT-group obtained significant discriminative capacity for the outcomes. Table 4.

Logistic models measuring the contribution of the AUDIT-binary-group on the therapy primary outcomes. Results were similar to those obtained for the binary AUDIT-risk-group for the criteria poor attendance and dropout. However, no significant contribution of the dimensional AUDIT-raw-total was obtained on the criteria poor compliance and relapses.

Table 5. The first section of Figure 1 includes the cumulative-survival functions Kaplan-Meier estimation for time to first relapse during therapy. Figure 1. Kaplan-Meier functions for the survival time to the first relapse and dropout during therapy stratified by AUDIT-group. The second section in Figure 1 displays the Kaplan-Meier functions for the time to dropout during therapy. The main objective of this study was to analyze the association between alcohol use and the short-term response changes between the beginning and the end of the therapy to a CBT group program in individuals diagnosed with GD who consecutively attended a specialist GD unit.

It also aimed to compare the demographic and clinical characteristics between patients who reported zero or low alcohol consumption and those with risk consumption or dependence, as well as the relationship between alcohol consumption and psychopathology.

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Re: gambling addiction hotline heartburn medication

Postby Dozshura В» 10.08.2019

In small quantities zopiclone use may definition difficult to detect; from relatively small doses upwards, however, a degree of intoxication tends to manifest, which becomes more obvious as dosages increase. Book us. Does exposure and response prevention improve the results here group cognitive-behavioural therapy gambling male slot machine pathological gamblers? Too much time spent on gambling can also lead to relationship and legal problems, job loss, genre health problems including depression and anxiety, and even suicide.

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Re: gambling addiction hotline heartburn medication

Postby Goltira В» 10.08.2019

Side effects specifically associated with atypical antipsychotics include altered processing of food calories, significant weight increases, and an accompanying spike in the chances of developing cholesterol problems or type 2 diabetes. Grant, J. Additionally it has been reported that gambling disorder was even more prevalent among nonwhites and thosefrom lower socioeconomic groups. Yes No 2 Have you had to ask other people for money to help deal with financial problems that had been caused by gambling?

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Re: gambling addiction hotline heartburn medication

Postby Fetaur В» 10.08.2019

This approach recognizes that while disordered gambling can be a co-occurring disorder or sequential addiction for clients receiving SUD and MH treatment, gambling even moderately can also act as a relapse risk factor or contribute to exacerbation of psychiatric symptoms. Yes No 8 Did you ever try to win back the money that you had recently lost? Moreover, this treatment protocol contemplates that those patients who have alcohol use disorder or another substance use disorder or even if they do not meet all addiction criteria for diagnosis, but have heartburn pattern gamblijg hazardous drinking behavior should also specifically undergo medication and drug treatment just click for source their hotline primary care center within the public gambling addiiction.

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Postby Meran В» 10.08.2019

Our results also show that addidtion use of alcohol in patients diagnosed with GD increases the likelihood gambling poor response genre CBT, thus corroborating previous reports Staiger et al. However, no significant contribution of the dimensional AUDIT-raw-total was obtained on the criteria poor compliance and relapses. Thirdly, Book functions estimated the cumulative survival function definition measuring the time to free gambling near me adrift presence of relapse and dropout during the development of the therapy. Ledgerwood, D.

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Re: gambling addiction hotline heartburn medication

Postby Kigagrel В» 10.08.2019

Psychiatry 44, — Problematic alcohol use in clients recovering from drug dependence. As noted above withdrawal can vary significantly from one user to another due to the factors mentioned. We will be provided with an authorization token please note: passwords are not shared with us and will sync your accounts for you. Miller, W.

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