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PubMed2005

Conceptual and methodological issues in treatment outcome research.

Few studies have evaluated the comparative efficacy, effectiveness and mode of action of specific treatment interventions, or developed evidence-based best-practice management guidelines for the treatment of problem gambling. While individual and multi-modal programmes demonstrate positive results, systematic well-designed randomised controlled studies incorporating follow-up blind assessments and standardised diagnostic and outcome measures are needed to establish long-term outcomes.

Behavior, Addictive↗
PubMed2006

Treatment of female pathological gambling: the efficacy of a cognitive-behavioural approach.

Given that a substantial proportion of current pathological gamblers are female, it is evident that women are underrepresented in the treatment outcome literature. The current study was designed to redress the limited information on the treatment of female pathological gambling. Although the use of cognitive-behavioural therapy is the most highly recommended approach as 'best practice' for the treatment of pathological gambling, no attempt to date has been made to evaluate the efficacy of this approach for female pathological gambling. Nineteen female pathological gamblers with electronic gaming machine problems were treated with a cognitive-behavioural program. While pathological gamblers placed on a waiting list did not show significant improvement on gambling behaviour and psychological functioning measures, the female pathological gamblers showed significant improvement on these measures over the treatment period, and maintained this improvement at the 6-month follow-up evaluation. By the completion of the follow-up period, 89% of participants no longer met diagnostic criteria for pathological gambling. Although further scientific demonstration and replication are required, the outcomes of this study indicate that the therapy that is considered 'best practice' in the treatment of pathological gambling is effective for female pathological gambling.

Adult↗
PubMed1985

Vasopressin and related peptides: animal and human studies.

In animals, vasopressin and related peptides are present in specific neuronal pathways in the brain and modulate brain processes. It has been suggested that in particular memory processes, including consolidation and retrieval, short and long term memories are facilitated by vasopressin. Evidence has been presented that endogenous vasopressin is involved in these processes. But also other effects of these peptides e.g. an attenuation of acquisition of heroin self-administration have been reported. Vasopressin and related peptides have been administered to humans in a number of studies including volunteers and various patient populations with and without complaints about memory. Beneficial effects on several aspects of memory, learning, attention and concentration have been found, but not in all studies. Patients with severe deficits seem to benefit less from the peptide treatment. This may be related to the amount of brain damage. Beneficial effects of vasopressin treatment have been reported in schizophrenics and heroin addicts. In addition effects on social behavior, energy and mood of certain patients have been noted. The target patient population for vasopressin neuropeptide is thus not yet well defined. With respect to cognitive disorders, sophisticated neuropsychological test procedures, including information-processing tasks, may contribute to define such a patient population. These tasks may also be applied for treatment evaluation. It should however be kept in mind that other interesting influences of vasopressin e.g. on social behavior, mood and addictive behavior, may also appear of clinical significance. Future studies in humans may yield more detailed information in this respect.(ABSTRACT TRUNCATED AT 250 WORDS)

Amnesia↗
PubMed2005

Reductions in and relations between "craving" and drinking in a prospective, open-label trial of ondansetron in adolescents with alcohol dependence.

Recently, we reported that ondansetron (a 5-HT3 antagonist) as an adjunct to cognitive behavioral therapy (CBT) produced significant within-group decreases (improvement) in drinking in adolescents with alcohol dependence. We previously have hypothesized that the mechanism of ondansetron treatment response in adolescents with alcohol dependence should be similar to early onset adult alcoholics, wherein blockade of serotonin-3 receptors may decrease dopamine release and subsequent alcohol consumption and craving. We now suggest that one mechanism by which ondansetron diminishes drinking in adolescents with alcohol dependence is through a reduction in "craving" as measured by the Adolescent Obsessive-Compulsive Drinking Scale (A-OCDS). We conducted an 8-week, prospective, open-label study of ondansetron (4 microg/kg b.i.d.) in 12 adolescents (age 14-20 years) who had alcohol dependence. Results showed that "irresistibility" and total scores as measured by the A-OCDS were correlated significantly with drinking indices (drinks/day, percent days abstinent) at the end of treatment, and that "irresistibility" and total A-OCDS scores decreased significantly by the end of treatment. These preliminary results suggest that the A-OCDS can be useful as an outcome measure in clinical studies of adolescents with alcohol dependence.

Adolescent↗
PubMed2006

A comparison of individual and group cognitive-behavioural treatment for female pathological gambling.

The current study aimed to determine the differential efficacy of a cognitive-behavioural treatment program for female pathological gamblers delivered in individual and group format. Fifty-six female pathological gamblers with electronic gaming machine gambling problems were randomly assigned to the control (waiting list) group or one of the treatment groups (individual or group treatment). Treatment comprised a 12-session program including financial limit setting, alternative activity planning, cognitive correction, problem solving, communication training, relapse prevention, and imaginal desensitisation. Treatment outcome was evaluated with conceptually related measures within the areas of gambling behaviour and psychological functioning. While individual and group treatment formats generally produced comparable outcomes in terms of gambling behaviour and psychological functioning, group treatment failed to produce superior outcomes to the control group in relation to several measures of psychological functioning. Moreover, by the completion of the six-month follow-up, 92% of the gamblers allocated to individual treatment compared with 60% allocated to group treatment no longer satisfied the diagnostic criteria for pathological gambling. These findings suggest that some caution should be employed when delivering cognitive-behavioural treatment in a group format until further research is conducted to establish its efficacy.

Adult↗
PubMed2026

Post-trial 12-month follow-up of TRACE (targeted research on addictive and compulsive eating) randomised controlled trial participants: A brief report.

Few treatment interventions for addictive eating have evaluated long-term effectiveness. This post-trial follow-up study evaluates secondary changes in addictive eating symptoms and quality of life at 12-months in a sample of individuals who participated in the TRACE (Targeted Research for Addictive and Compulsive Eating) RCT. Thirty-three adults out of possible 144 (82% female), median age 53 years, randomised to either the active intervention (five telehealth sessions delivered over 3-months), passive intervention (self-guided workbook) or control group completed an online post-trial survey. Pre- and immediate post-intervention (3-months) outcomes were compared to 12-months post-trial outcomes. Positive effects reported in the short term showed a rebound effect at post-trial follow-up in ∼50% of participants. The findings suggest that longer term support is needed to maintain changes in addictive eating behaviours and improve quality of life. Future research is needed to identify optimal intervention durations and support options for sustained change. Australian New Zealand Clinical Trials Registry (ACTRN12621001079831).

Humans↗
PubMed2003

Group therapy for pathological gamblers: a cognitive approach.

This study evaluated the efficacy of a group cognitive treatment for pathological gambling. Gamblers, meeting DSM-IV criteria for pathological gambling, were randomly assigned to treatment (N=34) or wait-list control (N=24) conditions. Cognitive correction techniques were used first to target gamblers' erroneous perceptions about randomness, and then to address issues of relapse prevention. The dependent measures used were the DSM-IV criteria for pathological gambling, perceived self-efficacy, gamblers' perception of control, desire to gamble, and frequency of gambling. Post-treatment results indicated that 88% of the treated gamblers no longer met the DSM-IV criteria for pathological gambling compared to only 20% in the control group. Similar changes were observed on all outcome measures. Analysis of data from 6-, 12- and 24-month follow-ups revealed maintenance of therapeutic gains. Recommendations for group interventions are discussed, focusing on the cognitive correction of erroneous perceptions toward the notion of randomness.

Adult↗
PubMed2003

Smoked heroin in rhesus monkeys: effects of heroin extinction and fluid availability on measures of heroin seeking.

The purpose of the present study was to evaluate the reinforcing effects of smoked heroin in nonopioid-dependent nonhuman primates when an alternative reinforcer, sweetened fluid, was made available. Four adult male rhesus monkeys lived in three chambers, with heroin self-administration (0, 0.3, and 0.6 mg/kg) specific to one end of the chamber, oral sweetened fluid self-administration specific to the other end chamber, and no commodity available in the middle chamber. The length of time monkeys spent in the drug-associated chamber provided one measure of drug seeking (i.e., location preference). During self-administration sessions, a second-order schedule of reinforcement was used, with responding during the first component maintained by a brief presentation of the stimuli associated with reinforcement. Responding during the second component was maintained by a delivery of the reinforcer, and the associated stimuli. Responding during the first component provided a second measure of drug seeking. Monkeys also had choice trials each day, when they could choose to work for either commodity. Choice behavior provided a third measure of drug seeking. Each experimental day consisted of a smoking session (four smoking trials), a sweetened fluid session (four fluid trials), and a choice session (four choice trials). Monkeys typically completed all four smoking trials each day when either of the active heroin doses was available. They chose both heroin doses over fluid on 3.5 of the four choice trials, and they had a location preference for the heroin chamber. Under baseline conditions, the number of acquisition responses and the number of consumption responses (inhalations) were greater for the high dose of heroin compared to the low dose of heroin. Further, it took longer to extinguish the responding for the high dose of heroin compared to the low dose of heroin when a vehicle was substituted. During heroin extinction, acquisition responding for fluid increased, the number of fluid choices increased, and location preference shifted to the fluid chamber. These data suggest that in nondependent rhesus monkeys, measures of heroin seeking decreased when heroin was not available and seeking behavior shifted to the available alternative commodity.

Animals↗
PubMed2002

Youth tobacco control: reconciling theory and empirical evidence.

Youth smoking is an important target for public policy. The implicit assumption behind targeting youth is that policies that reduce youth smoking initiation will reduce lifetime smoking propensities. This assumption has never been tested empirically. I use data from the National Longitudinal Survey of Youth (NLSY) to follow the smoking pattern of one cohort of teenagers. I examine how smoking rates in youth and young adulthood are affected by the taxes individuals faced at age 14. In panel data analysis, I find that the effects of taxes at age 14 are considerably attenuated by adulthood. I find some evidence suggesting that this result is a consequence of delayed smoking initiation that is correlated with taxes. These results suggest that reducing smoking among teens through tax policy may not be sufficient to substantially reduce smoking in adulthood.

Adolescent↗
PubMed1999

Prevention and harm reduction for chemical dependency: a process perspective.

Clinical psychology is often on the periphery of treatment and prevention efforts to stop substance abuse and dependence. This article describes the current status of prevention research and practice, outlines a process perspective on the initiation and cessation of drug use and abuse, and offers some new ideas about how psychology can and should become involved in the prevention of chemical dependency. Psychologists are faced with the precursors and consequences of chemical dependency on a daily basis. With improved training and increased awareness, and aided by a process perspective, psychology and psychologists can play an important role in preventing the onset of chemical dependency, creating early interventions to stop the process of initiation, and becoming more involved in treatment and harm-reduction efforts. Psychologists have the basic training and the biopsychosocial orientation that could make them effective agents for primary, secondary, and tertiary prevention of chemical dependency.

Attitude to Health↗
PubMed2004

Node-link-mapping-enhanced group treatment for pathological gambling.

Two experiments evaluated a group treatment for pathological gambling that used node-link mapping techniques to enhance treatment effectiveness. In Experiment 1, 13 (8 female) pathological gamblers were randomly assigned to either a mapping group (n=4), a nonmapping group (n=4), or a wait-list control group (n=5). The treatments were conducted by Master's level counselors during 90-min sessions conducted twice per week for 8 weeks. Participants were assessed pre- and post-8 weeks and then 6 months later on Diagnostic and Statistical Manual of Mental Disorders 4th ed. (DSM-IV) pathological gambling criteria, three self-ratings of control of gambling, gambling expenditure, and gambling bout duration. Experiment 2 replicated the mapping (n=9; 8 female) and wait-list (n=10; 8 female) conditions of Experiment 1 and expanded the dependent measures to include assessment of changes in cooccurring depression and anxiety. The node-link-mapping-enhanced group treatment produced improvements in more of the dependent measures of pathological gambling than treatment without maps (Experiment 1) or an equivalent-length waiting period (Experiments 1 and 2). It also produced larger decreases in cooccurring depression and anxiety than an equivalent-length waiting period (Experiment 2). The results are consistent with previous treatment research with substance abusers.

Adult↗
PubMed2002

The effect of compliance-improving interventions on the cognitive-behavioural treatment of pathological gambling.

This exploratory study investigated the effect of interventions designed to improve compliance and reduce dropout rates during the outpatient treatment of pathological gambling at a University-based gambling treatment clinic. Forty subjects (29 males, 11 females, mean age = 37.6) meeting DSM-IV criteria (APA, 1994) for pathological gambling were randomly assigned to either a cognitive-behavioural treatment or a cognitive-behavioural treatment combined with interventions designed to improve treatment compliance. Compliance was indicated by the completion of all treatment sessions. Outcome measures were DSM-IV criteria assessed by structured clinical interview, South Oaks Gambling Screen scores, and percentage of income gambled. Logistic regression analyses identified pretreatment characteristics predicting compliance and outcome. Compliance-improving interventions significantly reduced dropout rates, resulting in superior outcomes at posttreatment compared to the cognitive behavioural treatment alone. At 9-month follow-up, there was no difference in outcome between treatments, although both produced clinically significant change. Comorbid problem drinking, drug use, and problem gambling duration predicted poor compliance. Poor outcome was predicted by comorbid problem drinking. The clinical implications of these results are discussed in light of the exploratory nature of the study and the need for future research to address compliance, outcome, and comorbidity issues.

Adult↗
PubMed2004

Indicated prevention of problem gambling among college students.

This research provides a brief qualitative description of the development of an indicated prevention intervention for college student gamblers. The proposed intervention integrates alcohol prevention strategies with elements of gambling treatment. The intervention combines cognitive-behavioral skills-training and motivational interviewing and includes personalized normative feedback, cognitive correction, discussion of gambling consequences, and relapse prevention techniques. Examples detailing all phases of the intervention are provided from interviews conducted in a pilot of the intervention. Preliminary pilot data suggests the intervention shows promise in reducing high risk gambling among college students.

Adult↗
PubMed1997

The development of a conditioned place preference to morphine: effects of lesions of various CNS sites.

This study examined the neural substrates underlying the development of a conditioned place preference (CPP) to morphine (2 mg/kg x 3 pairings) by testing whether lesions of 7 different neural sites block a morphine-induced CPP. Lesions of the pedunculopontine tegmental nucleus (PPTg), the periaqueductal gray (PAG), or the fornix reduced the preference for a morphine-paired compartment. When they were retested following morphine administration, fornix- or PAG-lesioned animals exhibited a CPP indicating that lesions did not block morphine-induced reward or the ability to associate this effect with salient environmental cues. PPTg-lesioned animals did not express a CPP during state-dependent testing, suggesting that the lesions may attenuate the rewarding effect of the drug. Lesions of the mesolimbic dopamine system, the ventral pallidum, the lateral nucleus of the amygdala, or the caudate putamen had no effect on a morphine-induced CPP.

Animals↗
PubMed2003

Treatment of pathological gambling: a critical review of the literature.

The legalization and availability of new forms of gambling are increasing in most Western countries. This trend has contributed to the fact that more individuals are developing gambling problems. As a result, there is a need for effective treatments. Although gambling treatment dates several decades, few empirically supported treatments for pathological gambling have been developed. This critical review includes only controlled treatment studies. The primary inclusion criterion was randomization of participants to an experimental group and to at least 1 control group. Eleven studies were identified and evaluated. Key findings showed that cognitive-behavioral studies received the best empirical support. Recommendations to improve gambling treatment research include better validated psychometric measures, inclusion of process measures, better definition of outcomes, and more precise definition of treatments.

Behavior, Addictive↗