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Biomedical subjects

Nady el-Guebaly

Publications and source records attributed to Nady el-Guebaly.

At least 19 recordsLinked to original sources
PubMed2007

Does providing extended relapse prevention bibliotherapy to problem gamblers improve outcome?

Relapse rates among pathological gamblers are high with as many as 75% of gamblers returning to gambling shortly after a serious attempt to quit. The present study focused on providing a low cost, easy to access relapse prevention program to such individuals. Based on information collected in our ongoing study of the process of relapse, a series of relapse prevention booklets were developed and evaluated. Individuals who had recently quit gambling (N = 169) were recruited (through media announcements) and randomly assigned to a single mailing condition in which they received one booklet summarizing all of the relapse prevention information or a repeated mailing condition in which they received the summary booklet plus 7 additional booklets mailed to them at regular intervals over the course of a year period. Gambling involvement over the course of the 12-month follow-up period, confirmed by family or friends, was compared between the two groups. Results indicated that participants receiving the repeated mailings were more likely to meet their goal, but they did not differ from participants receiving the single mailing in frequency of gambling or extent of gambling losses. The results of this project suggest that providing extended relapse prevention bibliotherapy to problem gamblers does not improve outcome. However, providing the overview booklet may be a low cost, easy to access alternative for individuals who have quit gambling.

Adult↗
PubMed2006

Epidemiological associations between gambling behavior, substance use & mood and anxiety disorders.

OBJECTIVE: To compare gambling behaviors in a random sample of community residents with and without mental disorders identified by the Composite International Diagnostic Interview (CIDI). METHOD: A large national community survey conducted by Statistics Canada included questions about problems arising from gambling activities as per the Canadian Problem Gambling Index (CPGI). We compared respondents within three gambling severity categories (non-problem, low severity and moderate/high severity gambling) across three diagnostic groupings (mood/anxiety disorders, substance dependence/harmful alcohol use, no selected psychiatric disorder). RESULTS: Of the 14,934 respondents age 18-64 years who engaged in at least one type of gambling activity in the previous 12 months, 5.8% fell in the low severity gambling category while 2.9% fell in the moderate/high severity category. Females accounted for 51.7% of the sample. The risk of moderate/high severity gambling was 1.7 times higher in persons with mood or anxiety disorder compared to persons with no selected disorder. For persons with substance dependence or harmful alcohol use, the risk of moderate/high severity gambling was 2.9 times higher. Persons with both mood/anxiety and substance/alcohol disorders were five times more likely to be moderate/high severity gamblers. The odds ratio for females was 0.6 and for those with less than post-secondary education it was 1.52. Differences in age and personal income were not significant. CONCLUSIONS: Individuals in the community suffering from mood/anxiety disorders and substance dependence/harmful alcohol, and especially those with both, experience a higher risk for gambling problems. The treatment of these comorbidities should be integrated into any problem gambling treatment program.

Adult↗
PubMed2006

A framework for reporting outcomes in problem gambling treatment research: the Banff, Alberta Consensus.

OBJECTIVE: The objective is provide a framework concerning the minimum features of reporting efficacy of treatment in the problem gambling field. Research to date has not used uniform outcome measures and it is, therefore, difficult to compare the relative efficacy of various approaches. Some studies emphasize self-reported behavioural measures such as frequency and intensity of gambling whereas others emphasise change with respect to the criteria used to diagnose problem gambling or use composite measures of symptom severity in multiple domains involving gambling-related thoughts, urges, and behaviours. METHODS: An expert panel consensus. RESULTS: The proposed minimum features of reporting the efficacy of treatment outcome studies are: measures of gambling behaviour - the net expenditure each month, the frequency (in days per month) with which gambling takes place, and the time spent thinking about or engaged in the pursuit of gambling each month; measures of the problems caused by gambling - especially problems in the areas of personal health, relationships, financial, and legal; these measures can be complemented by additional measures of quality of life. measures of the processes of change - whatever mechanisms of change are assumed to occur. CONCLUSIONS: We believe that these guidelines are broad enough to allow clinical research conducted from diverse perspectives to allow valid cross study evaluations of intervention studies. Such conditions will facilitate the development of empirically validated best practice guidelines for use by clinicians in the management of problem gambling.

Behavior, Addictive↗
PubMed2006

Risk of harm among gamblers in the general population as a function of level of participation in gambling activities.

AIMS: To examine the relationship between gambling behaviours and risk of gambling-related harm in a nationally representative population sample. DESIGN: Risk curves of gambling frequency and expenditure (total amount and percentage of income) were plotted against harm from gambling. SETTING: Data derived from 19, 012 individuals participating in the Canadian Community Health Survey-Mental Health and Well-being cycle, a comprehensive interview-based survey conducted by Statistics Canada in 2002. MEASUREMENT: Gambling behaviours and related harms were assessed with the Canadian Problem Gambling Index. FINDINGS: Risk curves indicated the chances of experiencing gambling-related harm increased steadily the more often one gambles and the more money one invests in gambling. Receiver operating characteristic analysis identified the optimal limits for low-risk participation as gambling no more than two to three times per month, spending no more than 501-1,000 CAN dollars per year on gambling and investing no more than 1% of gross family income on gambling activities. Logistic regression modelling confirmed a significant increase in the risk of gambling-related harm (odds ratios ranging from 2.0 to 7.7) when these limits were exceeded. CONCLUSIONS: Risk curves are a promising methodology for examining the relationship between gambling participation and risk of harm. The development of low-risk gambling limits based on risk curve analysis appears to be feasible.

Adolescent↗
PubMed2006

Genetics and alcoholism: how close are we to potential clinical applications?

Rapid advancement of genetic knowledge has provided a wealth of data demonstrating a significant contribution of genes to the development of alcoholism but has suggested little in the way of clinical applicability. Twin and adoption studies suggest that 50% to 60% of the development of alcoholism is due to heritable factors, and linkage and association studies have identified chromosomal regions and individual genes that likely contribute to the development of this condition. Most of these genes are related to neurotransmitter systems and to alcohol metabolizing enzymes. We briefly review the evidence for this before discussing intermediate phenotypes of alcoholism under genetic control, pharmacogenetic aspects of alcoholism treatment, and the possibility of future clinical applications based on these areas.

Adoption↗
PubMed2006

Personality changes in women recovering from substance-related dependence.

The present study explored the potential for change in personality in women in recovery. Dimensions of the Temperament and Character Model and the five-factor model of personality were examined at baseline and at follow-up after treatment for addiction. Within both models of personality, the factors which have been found to be the best predictors of the presence of a personality disorder (Self-Directedness within the Temperament and Character Model; Neuroticism within the five-factor model) showed significant change at follow-up which suggests the flexibility of personality and the potential for change of personality disorders within women seeking treatment for addiction.

Adolescent↗
PubMed2005

Cue-induced brain activity in pathological gamblers.

BACKGROUND: Previous studies using functional magnetic resonance imaging (fMRI) have identified differential brain activity in healthy subjects performing gambling tasks and in pathological gambling (PG) subjects when exposed to motivational and emotional predecessors for gambling as well as during gambling or response inhibition tasks. The goal of the present study was to determine if PG subjects exhibit differential brain activity when exposed to visual gambling cues. METHODS: Ten male DSM-IV-TR PG subjects and 10 matched healthy control subjects underwent fMRI during visual presentations of gambling-related video alternating with video of nature scenes. RESULTS: Pathological gambling subjects and control subjects exhibited overlap in areas of brain activity in response to the visual gambling cues; however, compared with control subjects, PG subjects exhibited significantly greater activity in the right dorsolateral prefrontal cortex (DLPFC), including the inferior and medial frontal gyri, the right parahippocampal gyrus, and left occipital cortex, including the fusiform gyrus. Pathological gambling subjects also reported a significant increase in mean craving for gambling after the study. Post hoc analyses revealed a dissociation in visual processing stream (dorsal vs. ventral) activation by subject group and cue type. CONCLUSIONS: These findings may represent a component of cue-induced craving for gambling or conditioned behavior that could underlie pathological gambling.

Adult↗
PubMed2005

Comparison of craving between pathological gamblers and alcoholics.

BACKGROUND: Craving is a central phenomenon in addiction. Temperament factors are also important for pathologic gambling and other addictions. The aim of this study was to compare craving between pathologic gamblers (PG) and alcohol-dependent subjects (ADS), correlating craving with personality. METHODS: Forty-nine PG and 101 ADS willing to start treatment were recruited. A trained psychiatrist diagnosed them according to DSM-IV criteria. To be included in this study, subjects had to be abstinent for at least five days and no longer than 21 days. Alcoholics should have no significant physical withdrawal symptoms by the time of craving assessment. Subjects with current comorbidity with other addictions were excluded, except nicotine. ADS rated craving for alcohol and PG rated craving for gambling on the same questions, respectively. Both answered a semistructured interview, the Temperament and Character Inventory and the Beck Scales for anxiety and depression. RESULTS: Pathologic gamblers scored higher than ADS on craving measures (p<0.001) and novelty seeking (p=0.01). ADS scored higher in harm avoidance (p=0.01). Alcohol craving correlated positively with anxiety and novelty seeking and negatively with length of abstinence and persistence. Gambling craving correlated positively with depression and negatively with length of abstinence and reward dependence CONCLUSIONS: Pathologic gamblers experienced stronger cravings than did ADS. This may be a disturbing experience for PG and a potential cause for relapse. The higher scores on novelty seeking concur with previous studies that associate PG and impulsivity. ADS higher scores on harm avoidance suggest anxiety vulnerability. The positive relation between alcohol craving, anxiety, and harm avoidance suggests that ADS rely on alcohol to deal with a proclivity to negative emotions. The positive relation of gambling craving to depression and negative relation to reward dependence suggests that individuals who have a lesser susceptibility to experience positive emotions are the ones who most miss gambling when abstaining.

Adult↗
PubMed2005

Comorbid depression among untreated illicit opiate users: results from a multisite Canadian study.

OBJECTIVES: This study aimed to describe patterns of major depression (MDD) in a cohort of untreated illicit opiate users recruited from 5 Canadian urban centres, identify sociodemographic characteristics of opiate users that predict MDD, and determine whether opiate users suffering from depression exhibit different drug use patterns than do participants without depression. METHOD: Baseline data were collected from 679 untreated opiate users in Vancouver, Edmonton, Toronto, Montreal, and Quebec City. Using the Composite International Diagnostic Interview Short Form for Major Depression, we assessed sociodemographics, drug use, health status, health service use, and depression. We examined depression rates across study sites; logistic regression analyses predicted MDD from demographic information and city. Chi-square analyses were used to compare injection drug use and cocaine or crack use among participants with and without depression. RESULTS: Almost one-half (49.3%) of the sample met the cut-off score for MDD. Being female, white, and living outside Vancouver independently predicted MDD. Opiate users suffering from depression were more likely than users without depression to share injection equipment and paraphernalia and were also more likely to use cocaine (Ps < 0.05). CONCLUSIONS: Comorbid depression is common among untreated opiate users across Canada; targeted interventions are needed for this population.

Adult↗
PubMed2004

Determinants of overdose incidents among illicit opioid users in 5 Canadian cities.

BACKGROUND: Drug overdose is a major cause of death and illness among illicit drug users. Previous research has indicated that most illicit drug users experience nonfatal overdoses and has suggested a variety of factors that are associated with risk of overdose. In this study, we examined the occurrence of and the factors associated with nonfatal overdoses within a Canadian sample of illicit opioid users not enrolled in treatment at the time of study recruitment. METHODS: Interviewers used a standard questionnaire to collect data on sociodemographic characteristics, drug use, health and health care, experience in the criminal justice system and treatment for drug problems; they also performed standard assessments for mental health and infectious disease. The association between overdose and sociodemographic and drug-use factors was examined with chi(2) and t test analyses; marginally significant variables were examined with logistic regression to determine independent effects. RESULTS: A total of 679 subjects were interviewed; 651 provided answers sufficient for this analysis. One hundred and twelve (17.2%) of the 651 respondents reported an overdose episode in the previous 6 months. In the logistic regression analysis (after adjustment for sociodemographic factors), homelessness, noninjection use of hydromorphone in the past 30 days and involvement in drug treatment in the past 12 months were predictors of overdose (p < 0.05). INTERPRETATION: Overdose poses a considerable health risk for illicit opioid users. We found that a diverse set of factors was associated with overdose episodes. Prevention efforts will likely be more effective if they can be directed to specific causal factors.

Adult↗
PubMed2004

Retrospective and prospective reports of precipitants to relapse in pathological gambling.

A prospective design was used to explore the precipitants of relapse in a naturalistic sample of pathological gamblers (N = 101) who had recently quit gambling. Relapse rates were high; only 8% were entirely free of gambling during the 12-month follow-up. Relapses were highly variable but occurred most frequently in the evening, when the person was alone and thinking about finances. Moods prior to the gambling were as likely to be positive as negative. The most frequently reported attributions, particularly for major relapses, were cognitions about winning and feeling the need to make money, unlike substance abuse relapses that tend to be attributed to negative affect. Some gender differences were found, but the precipitants of shorter and longer relapses did not differ.

Adult↗
PubMed2004

Brief motivational treatment for problem gambling: a 24-month follow-up.

A 24-month follow-up of a randomized clinical trial of 2 brief treatments for problem gambling (N = 67) revealed an advantage for participants who received a motivational telephone intervention plus a self-help workbook compared with participants who received only the workbook. Although the 2 groups did not differ in the number of participants reporting 6 months of abstinence, the motivational intervention group gambled fewer days, lost less money, and had lower South Oaks Gambling Screen scores. They were more likely to be categorized as improved compared with the self-help workbook only group. Overall, the results support the effectiveness of a brief telephone- and mail-based treatment for problem gamblers.

Canada↗
PubMed2004

The practice research network: benefits and limitations.

The 5-year experience of the Canadian Psychiatric Association's practice research network (PRN) in providing a window on physician practices in typical clinical settings is reviewed. The strengths of the PRN reside in the active participation of clinicians in self-monitoring as well as in the instrument adaptability and flexibility in addressing current issues of national relevance, including identification of educational needs. The PRN limitations are in the fact that the responders in general have limited research experience and the instrument can provide broad-based answers only. The creation of a national PRN is however an effective strategy in narrowing the gap between practice and research.

Journal Article↗
PubMed2004

Concurrent substance-related disorders and mental illness: the North American experience.

Ingredients of the evolving North American experience in addressing the management of patients with concurrent substance-related disorders and mental illness are presented. This experience as well as select data from Europe and Australia indicate a growing empirically-based consensus to provide an integrated approach to the care of these patients. It also highlights the necessity to conduct local surveys of needs and resources and adapt the published clinical experience to the local system of care, resources and culture.

Journal Article↗
PubMed2003

Relationship between craving and personality in treatment-seeking women with substance-related disorders.

BACKGROUND: Individual differences may impact susceptibility to addiction. The impact of personality features on drug craving, however, has not been studied, particularly in women. METHODS: Ninety-five treatment-seeking women with substance dependence, abstinent for at least 5 and no more than 21 days, were investigated regarding the correlation between personality factors and craving. Personality was assessed using the Temperament and Character Inventory (TCI), the NEO Personality Inventory Revised (NEO-PI-R), and the Barratt Impulsiveness Scale version 11 (BIS-11). Cravings were assessed through the Pennsylvania Craving Scale (PCS), and the Craving Questionnaire (CQ). Anxiety and depressive symptomatology were also recorded. RESULTS: Craving scores were positively correlated with depression and negatively correlated with number of days abstinent from substance use. Also, craving scores were positively associated with the novelty-seeking factor from the TCI and the total score on the BIS-11, and negatively associated with the conscientiousness and agreeableness facets of the NEO-PI-R. CONCLUSION: Findings suggest that personality features, particularly impulsiveness, can be important predictors of craving in women, which has important implications for treatment planning.

Behavior, Addictive↗