Recognition and Treatment of Late-Life Addictions in Medical Settings

Addictive disorders among the elderly have emerged as a growing public health concern. As the proportion of the elderly population increases, more and more older adults will either develop addictions as a dysfunctional means of coping with the psychosocial consequences of aging, or will carry their long-standing addictive behaviors with them into later life. Among the most common of these addictions are smoking, excess consumption of alcohol, and gambling. This article briefly reviews these three addictive disorders and examines assessment and treatment options. The current cohort of older adults tends not to seek help for addiction problems in specialty mental health or substance abuse treatment. To improve rates of cessation and abstinence, assessment and intervention should be delivered in general medical settings such as primary care. With the addition of a behavioral health specialist, primary care has the potential to offer improved interventions in a cost-effective and time-efficient manner.     

The Intergenerational Association Between Parents’ Problem Gambling and Impulsivity-Hyperactivity/Inattention Behaviors in Children

Despite the well-established association between problem gambling and ADHD core categories of impulsivity-hyperactivity and inattention, the link between parents’ problem gambling and impulsivity-hyperactivity/inattention (IH/I) behaviors in children has not been investigated. This study investigated the association between parents’ problem gambling and children’s IH/I behaviors while controlling for potential confounding variables. A population-based prospective cohort followed-up from kindergarten to age 30, the Quebec Longitudinal Study of Kindergarten Children (QLSKC), provided data over three generations. Among 1358 participants at age 30, parents with a child aged 1 year or older (N = 468; Mean age = 4.65 years; SD = 2.70) were selected. Generalized Linear Models included measures of grandparents’ and parents’ problem gambling, parents’ IH/I behaviors in childhood, and a host of risk factors and comorbidities to predict IH/I in children. Intergenerational bivariate associations were observed between grandparents’ problem gambling, parents’ IH/I in childhood and problem gambling at age 30, and between parents’ IH/I, problem gambling, and children’s IH/I behaviors. Parents’ problem gambling predicted children’s IH/I behaviors above and beyond the effects of covariates such as family and socioeconomic characteristics, alcohol and drug use, depression symptoms and parents’ gambling involvement. Parents’ IH/I behaviors in childhood also predicted children’s IH/I and had a moderating, enhancing effect on parents’ problem gambling association with their offspring’s IH/I behaviors. Problem gambling is a characteristic of parents’ mental health that is distinctively associated with children’s IH/I behaviors, above and beyond parents’ own history of IH/I and of typically related addictive, psychopathological or socioeconomic risk factors and comorbidities.     

Internet‐based CBT intervention for gamblers in Finland: Experiences from the field

From September 2007 to May 2011 a total of 471 participants (325 males and 146 females) signed up for an 8‐week Internet‐based cognitive behavioral therapy offered for gamblers in Finland. Sixty‐four percent of the participants were pathological gamblers (PGs) (NODS 5> points), 14% were problem gamblers (NODS 3–4 points) and 10% were at risk of gambling problems (NODS 1–2 points). Two hundred and twenty four participants completed the treatment and after the treatment period significant changes were found in the following variables: gambling related problems (NODS), gambling urge, impaired control of gambling, alcohol consumption (AUDIT‐C), social consequences, gambling‐related cognitive erroneous thoughts and depression (MARD‐S). In this sample co‐morbid alcohol consumption was stronger among males. The main finding of this study was that the onset age of gambling was associated with a greater amount of gambling‐related cognitive erroneous thoughts.     

Addictions and the Quest to Control the Object

Most patients come into psychoanalytic treatment engaged in some form of repetitive, destructive behavior that is an externalization or projection of their internal struggles. One form of this object relational acting-out is the addictions, be they to alcohol, gambling, drugs, sex, procrastination, or other variations. The patient's experience is a "must do-can't stop" one that leaves them both desperate and relieved. Patients come to us wanting help in refraining from these addictive patterns. Sometimes, they are attending a 12-step program or are in a day treatment recovery program but need additional assistance in remaining free from their addictive behaviors. Others seek out psychoanalytic treatment while still involved in their addiction, but wish to stop the behavior and build a more positive plan for their lives. This paper examines the deeper object relational issues that lie behind the addictive process. The transference is often colored by acting-out, by sadomasochistic dynamics, by projective identification, and by fantasies of persecution and loss. Case material is used to explore these specific problems as well as the patient's general difficulties with paranoid-schizoid and depressive functioning.     

Characteristics of adolescents at risk for compulsive overeating on a brief screening test

As part of a large survey of addictive behavior in high school students, 43% of a sample of 278 (26% of the males, 57% of the females) scored above the cutoff point set by Overeaters Anonymous on their scale for assessing compulsive overeating. While this at-risk group did not report poorer general adjustment, health, or school achievement than did the students not at risk, they did significantly more often perceive their life quality and relationship with the person closest to them as less positive. The at-risk subsample indicated the defensive effectiveness of overeating in their significantly more frequent report of dissociative experiences while eating, and less severe ratings of insecurity, worrying, and daydreaming. One of the most salient findings was the at-risk students' more frequent report of addictive problems in their parents (overeating, alcohol and drug use, and gambling).     

Disagreeable narcissism mediates an effect of BAS on addictive behaviors

Some forms of personality dysfunction that are associated with substance use and other externalizing behaviors, such as Narcissistic Personality Disorder, are characterized by low five-factor Agreeableness. Low Agreeableness and high Extraversion are both associated with the Behavioral Approach System in the revised Reinforcement Sensitivity Theory of Personality (RST; McNaughton & Corr, 2008). Meta-analyses examining personality predictors of Substance Use Disorders (Kotov et al., 2010) and Pathological Gambling (MacLaren et al., 2011) have implicated low Agreeableness but not Extraversion. In the present study, we sampled undergraduate students (N = 346) to examine relationships between two aspects of grandiose narcissism measured by the Narcissistic Personality Inventory (NPI), approach motivation measured by the BIS/BAS scales, and self-reported addictive behaviors. Disagreeable and Extraverted subscales of the NPI were examined for possible mediation of associations between BAS and addictive behaviors. The more disagreeable aspect of narcissism mediated the effects of BAS on drug use, gambling, sex, and maladaptive intimate relationships. These results suggest that one mechanism through which the Behavioral Approach System may promote addictive behavior among grandiose Narcissists is through its association with their aggressive and antagonistic interpersonal style.     

饮酒对反应抑制的影响及其神经机制

反应抑制是指个体抑制不合适、不安全、或不需要的行为的能力,是重要的执行控制功能,在成瘾行为的作用下易受到损害。目前众多研究发现饮酒行为与个体反应抑制功能的表现关系密切,即便在个体戒断后也有长时间影响,且对饮酒者后代的抑制能力形成破坏,提高了后代出现成瘾行为的风险。随后从脑结构和神经递质两方面探讨饮酒影响反应抑制功能的机制,并整理了近些年基于双重加工模型提出的反应抑制训练及其在临床干预饮酒行为上的作用。未来研究仍有不少问题值得探索,同时考虑遗传和环境因素是相关研究的关键。     

Urgency and negative emotions: Evidence for moderation on negative alcohol consequences

Prior research had shown that impulsivity may enhance the impact of negative emotions on alcohol related problems. However, these studies used broad measures of both negative emotions and impulsivity that may have obscured the effects of more specific constructs of impulsivity or negative emotions. One such construct is urgency, which is defined as the tendency to act impulsively in the face of strong positive emotions (positive urgency) or negative emotions (negative urgency). The present study tested whether urgency moderated the association between separate negative emotions (anger, depression and anxiety) and alcohol related problems. Data were obtained from a large online sample of currently drinking college students attending a large Northwestern university (n = 442). Findings indicated that alcohol related problems were directly associated with anger and both urgency facets. Additionally, positive urgency, but not negative urgency, enhanced the effects of depression, while the buffering effects of positive urgency on the anxiety-consequences association approached significance. These results suggest the importance of emotional context in understanding how dispositions towards rash action may lead to problematic alcohol use.     

Jeux de hasard et d’argent en ligne : quelles spécificités en matière de réduction des risques ?

Initially conceived as an alternative to abstinence-based approaches, the initial goal of harm-reduction was to reduce the health consequences of drug use. Applied to all addictive behaviors (with or without use), it aims to reduce the individual and social problems generated by addiction without condemning the behavior. Harm-minimisation remained very poor in the gambling field. However, the legalization of online gambling in France and their specific characteristics, update the need to develop this field, which is still a new and relatively uncommon part of harm-reduction. The aim of this article is to draw up an inventory of existing knowledge, whether it has been tested empirically or not, in an ecological environment or in a laboratory situation, as regards tools allowing the player to remain in control of his gambling behavior. A reflection on future research and other possible tools is envisaged.     

Blame Without Punishment for Addicts

Philosophia - On the moral model of addiction, addicts are morally responsible and blameworthy for their addictive behaviours. The model is sometimes resisted on the grounds that blaming addicts is...     

Prevalence and correlates of gambling among 16 to 19-year-old adolescents in Norway

There is evidence that young people are at high risk of developing gambling disorders. The prevalence and correlates of gambling among youth therefore merit closer study. During spring 2004, a sample of 1,351 boys and girls (aged 16–19 years) from 151 high-school classes (clusters) participated in an internet survey about gambling. The response rate was 69.8%. The instruments used in the survey were the Hospital Anxiety and Depression Scale, the Alcohol Use Disorders Identification Test and the Massachusetts Adolescent Gambling Screen, in addition to questions about demography. Controlling for the design effect, the estimated prevalence rate was 2.5% for pathological gambling and 1.9% for problem gambling. In all, 7.3% of the boys and 0.6% of the girls fulfilled the criteria for pathological or problem gambling. The results of item analysis of the DSM-IV subscale of MAGS provide support for differential item functioning between boys and girls. A multiple logistic regression analysis revealed that gender (male: OR = 9.09), depression (OR = 9.23), alcohol abuse (OR = 3.62), and dissociation (OR = 1.96) were related to problem and pathological gambling. These results support the view that gambling disorders are best understood as part of an addictive behavior spectrum ( Jacobs, 2000 ).     

The latent structure of decision styles

Responding to calls for theoretical development in research on decision styles, this article focuses on their structural relationships. A two-component model of decision styles is proposed. One component, pertaining to dual process theories of thinking, is concerned with the processes people use to make decisions, and the other is concerned with processes used to regulate decisions (e.g. whether they should be made immediately or delayed). The results of a first study (N = 629) using items from a comprehensive decision style measure (the Decision Styles Questionnaire), support the two-component model. The results of a second study (N = 305), based on an alternative set of style measures, provide support for an extended version of the model. Implications of the theory and research findings for future work on decision styles are discussed.     

Associations of coping and appraisal styles with emotion regulation during preadolescence

We investigated the associations of appraisal and coping styles with emotion regulation in a community sample of preadolescents (N = 196, 9-12 years of age), with appraisal, coping styles, and emotion regulation measured at a single time point. In a previous study, we identified five frustration and four anxiety emotion regulation profiles based on children’s physiological, behavioral, and self-reported reactions to emotion-eliciting tasks. In this study, preadolescents’ self-reported appraisal and coping styles were associated with those emotion regulation profiles. Overall, findings revealed that children who were more effective at regulating their emotions during the emotion-eliciting tasks had higher levels of positive appraisal and active coping when dealing with their own problems. Conversely, children who regulated their emotions less effectively had higher levels of threat appraisal and avoidant coping.     

Spielsucht – Alkoholabhängigkeit: „Zwei Süchte,eine Behandlung?“

While alcoholism has been undisputedly classified for decades as an addiction in diagnostic manuals like ICD -10 and DSM -IV, the classification of pathological gambling has not been definitively resolved, although alcohol dependence and pathological gambling have many addiction criteria in common. The course of gambling addiction is typically characterized by an initial phase, a critical habituation phase, and a phase of despair. While a gambling addiction may rapidly progress to chronic dependence within a year, the development of chronic alcohol dependence requires many years of misuse. For gambling addicts, external influence plays a considerable role (trigger situation) on the entry into gambling. For the majority of players, the initial contact comes from third parties, while for problem gamblers the social character of an invitation as a maintaining factor has less influence than for alcoholics. There are differences especially in the expression of comorbidities and the consequences of the addiction. For problem gamblers, these are more psychological than social, while secondary disorders are significant for alcoholics.     

Gambling Sponsorship and Advertising in British Football: A Critical Account

ABSTRACT

Problem gambling is a growing public health issue in the UK. In this paper, we argue that football plays a problematic role in the promotion and normalisation of gambling. Given that sport broadcasts offer gambling (and alcohol) companies a loophole to avoid the post-watershed guidelines, children and young people are also exposed. By marketing gambling in general and to children in particular, football contributes to an increase in the overall ‘amount’ of gambling in society. In turn, this contributes to an increase in the prevalence of problem gambling (including gambling disorder) and all the associated harms. Furthermore, we argue that a significant amount of gambling profits come from problem gamblers. Therefore, football benefits from, and contributes to, the addictive consumption of gamblers.     

Mutual touch during mother–infant face-to-face still-face interactions: Influences of interaction period and infant birth status

Contact behaviours such as touch, have been shown to be influential channels of nonverbal communication between mothers and infants. While existing research has examined the communicative roles of maternal or infant touch in isolation, mutual touch, whereby touching behaviours occur simultaneously between mothers and their infants, has yet to be examined. The present study was designed to investigate mutual touch during face-to-face interactions between mothers and their 5½-month-old fullterm (n = 40), very low birth weight/preterm (VLBW/preterm; n = 40) infants, and infants at psychosocial risk (n = 41). Objectives were to examine: (1) how the quantitative and qualitative aspects of touch employed by mothers and their infants varied across the normal periods of the still-face (SF) procedure, and (2) how these were associated with risk status. Mutual touch was systematically coded using the mother–infant touch scale. Interactions were found to largely consist of mutual touch and one-sided touch plus movement, highlighting that active touching is pervasive during mother–infant interactions. Consistent with the literature, while the SF period did not negatively affect the amount of mutual touch engaged in for mothers and their fullterm infants and mothers and their infants at psychosocial risk, it did for mothers and their VLBW/preterm infants. Together, results illuminate how both mothers and infants participate in shaping and co-regulating their interactions through the use of touch and underscore the contribution of examining the influence of birth status on mutual touch.     

Risk factors for addictive disorders: a discriminant analysis on 374 addicted and 513 nonpsychiatric participants

Many common risk factors have been described in addictive disorders. Little is known about factors' respective contributions to discrimination of addicted and nonaddicted participants. Two large samples were compared including 513 nonpsychiatric participants and 374 addicted participants meeting the DSM-IV criteria for eating disorders, alcohol, or substance dependence. Twenty-six risk factors were assessed by interview or self-rating scales. A discriminant analysis determined the respective weight of each risk factor. One discriminant function emerged and characterized a depressive dimension. The results suggest that the different risk factors described in addiction could be related to a depressive dimension.     

Discounting of probabilistic rewards is associated with gambling abstinence in treatment-seeking pathological gamblers

Individuals with addictive disorders, including substance abusers and pathological gamblers, discount or devalue rewards delayed in time more than controls. Theoretically, preference for probabilistic rewards is directly related to gambling, but limited empirical research has examined probabilistic discounting in individuals with pathological gambling. This study evaluated probability and delay discounting in treatment-seeking pathological gamblers and their association with gambling treatment outcomes during and after treatment. At time of treatment entry, 226 pathological gamblers completed probability and delay discounting tasks. They were then randomized to one of three treatment conditions, and gambling behavior was measured throughout treatment and at a 1-year follow-up assessment. After controlling for possibly confounding variables and treatment condition, more shallow probability discounting was associated with greater reductions in amounts wagered during treatment and likelihood of gambling abstinence at the end of treatment and throughout the follow-up period. No associations were noted between delay discounting and gambling treatment outcomes. These data suggest that probability discounting may be an important construct in understanding pathological gambling and its treatment.     

Pathological Women Gamblers: Gender-Related Aspects of Control

This study examines the control exhibited by pathological women gamblers over their lives and their surroundings, and how this is governed by their perception of their gender role and socio-cultural expectations of them as women. Seventeen pathological women gamblers (13 of whom were mothers) were recruited from three addiction treatment centers in Israel, and participated in semi-structured interviews. Three central themes emerged during analysis: maintaining control over the gender roles—putting child raising and housekeeping duties first despite their gambling habits; control over the choice of gambling venue—gambling far from their home, or where they knew the owners; and moral control—steering clear of immoral behaviors in spite of their addiction to gambling. Further analysis reveals how pathological women gamblers who are also mothers make rational choices that help them juggle between their gender roles and gambling, to minimize the social costs that might be incurred by their gambling habit. Moreover, presenting the gambling behavior as more moral than theft or prostitution enabled them to normalize their behavior. The study’s findings show how the decisions and choices made by the women in this study are shaped by the socio-cultural context in which they are made.