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| Cognitive-Behavioral Treatments/Pathological GamblingSummaryPrincipal Investigator: Nancy Petry Affiliation: University of Connecticut Health Center Country: USA Abstract: Pathological gambling is serious problem, with significant psychological, financial, and public health consequences. Nevertheless, controlled trials examining the efficacy of therapeutic interventions for pathological gamblers are sparse. Gambler's Anonymous (GA) is the most popular form of treatment, and GA participation may improve outcomes among patients who become actively involved in the fellowship. Results from our first cycle of funding indicate that cognitive-behavioral (CB) treatment in conjunction with GA is more efficacious in reducing gambling than referral to GA alone. However, only about 60% of patients assigned to the CB condition became actively involved in treatment, and only about a third attended GA even once during the 8-weeks of treatment. The purposes of the present study are two-fold. First, we will compare the efficacy of CB treatment to an active control condition to ascertain whether the beneficial effects are related specifically to CB therapy or to more general therapeutic processes. Second, we will evaluate the efficacy of CB therapy to an enhanced CB approach that utilizes contingency management (CM). CM treatments provide tangible rewards for objective behavior changes, and these procedures are highly efficacious in improving retention and reducing substance use in drug abusing patients. We have pilot data from pathological gamblers suggesting that we can enhance engagement in therapy to over 85% utilizing CM techniques, and patients receiving the CB-CM treatment are more likely to complete CB homework exercises and become engaged with GA. This study will assess whether these effects are associated with long-term improved outcomes. In total, 210 pathological gamblers will be randomized to one of three conditions: psychoeducation plus case management (an active control condition), CB therapy, or CB therapy plus CM. Patients in each group will receive 8 individual therapy sessions, and all will be referred to GA. Gambling and psychosocial problems will be assessed from both the patient and a collateral using standardized instruments at pre- and post-treatment, and at 6, 9, 12, 18, and 24-month follow-up evaluations. We expect that CB will improve outcomes relative to psychoeducation, and that CB-CM will reduce gambling to a greater extent than CB alone. We will also assess whether the interventions result in better psychosocial functioning during treatment and follow-up. Patient characteristics that may be associated with outcomes will be evaluated, and a cost-effectiveness evaluation of the interventions also will be conducted. Funding Period: 1999-08-15 - 2009-07-31 more information: NIH RePORT Top Publications
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Cognitive-behavioral therapy for pathological gambling: cultural considerationsMayumi Okuda
New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
Am J Psychiatry 166:1325-30. 2009....
Psychiatric disorders are associated with hospital care utilization in persons with hypertension: results from the National Epidemiologic Survey on alcohol and related conditionsJulie A Wagner
Division of Behavioral Sciences and Community Health, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030, USA
Soc Psychiatry Psychiatr Epidemiol 43:878-88. 2008..However, the contribution of specific psychiatric disorders to healthcare utilization in persons with hypertension is unknown...- Psychometric properties of the inventory of gambling situations with a focus on gender and age differencesLindsay M Weiss
Department of Psychiatry, University of Connecticut Health Center, Farmington, Connecticut 06030 3944, USA
J Nerv Ment Dis 196:321-8. 2008..The IGS may assist in better understanding situations in which pathological gamblers wager, and individual differences with respect to these situations... - Overweight and obesity are associated with psychiatric disorders: results from the National Epidemiologic Survey on Alcohol and Related ConditionsNancy M Petry
Department of Psychiatry, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030 3944, USA
Psychosom Med 70:288-97. 2008..This study evaluated associations between body mass index (BMI) and psychiatric disorders... - A randomized trial of brief interventions for problem and pathological gamblersNancy M Petry
Department of Psychiatry, University of Connecticut Health Center, Farmington, CT 06030 3944, USA
J Consult Clin Psychol 76:318-28. 2008..These results suggest the efficacy of a very brief intervention for reduction of gambling among problem and pathological gamblers who are not actively seeking gambling treatment... - Gender differences in associations between body mass index and DSM-IV mood and anxiety disorders: results from the National Epidemiologic Survey on Alcohol and Related ConditionsDanielle Barry
Department of Psychiatry, University of Connecticut Health Center, Farmington, CT 06030 3944, USA
Ann Epidemiol 18:458-66. 2008..The purpose of this study is to examine gender differences in associations between body mass index (BMI) and affective disorders... 
[Ludomania: cross-cultural examinations of gambling and its treatment]Jeremiah Weinstock
Health Center, University of Connecticut, Farmington, CT 06030 3944, USA
Rev Bras Psiquiatr 30:S3-S10. 2008..Therefore, direct screening for gambling problems is recommended. Increasing education about the disorder, from both the provider and societal perspective, is necessary to reduce the personal and societal consequences of this disorder...- Randomized trial of contingent prizes versus vouchers in cocaine-using methadone patientsNancy M Petry
Department of Psychiatry, University of Connecticut Health Center, Farmington, CT 06030, USA
J Consult Clin Psychol 75:983-91. 2007..Thus, reinforcement with prizes was similar to voucher CM in promoting LDA, which is associated with posttreatment benefits... - Lifetime major depression is associated with coronary heart disease in older adults: results from the National Epidemiologic Survey on Alcohol and Related ConditionsSarah Herbst
Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT, USA
Psychosom Med 69:729-34. 2007..To examine the association between mood and anxiety disorders and coronary heart disease (CHD) in a nationally representative sample of older adults... - Predictors of decision-making on the Iowa Gambling Task: independent effects of lifetime history of substance use disorders and performance on the Trail Making TestDanielle Barry
Department of Psychiatry MC 3944, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030, USA
Brain Cogn 66:243-52. 2008..A lifetime SUD diagnosis was associated with performance on the IGT after controlling for covariates, and Trail Making Test performance was associated with IGT performance in both SUD and control participants... - DSM-IV personality disorders and coronary heart disease in older adults: results from The National Epidemiologic Survey on Alcohol And Related ConditionsRobert H Pietrzak
Department of Psychiatry, University of Connecticut Health Center, Farmington, CT 06030 3944, USA
J Gerontol B Psychol Sci Soc Sci 62:P295-9. 2007..63), and obsessive-compulsive (OR = 1.37) personality disorders increased the odds of having CHD. Personality disorders may increase the risk of CHD in older adults. Putative mechanisms and directions for future research are proposed... - Clinical features and treatment prognosis of pathological gamblers with and without recent gambling-related illegal behaviorDavid M Ledgerwood
Department of Psychiatry, University of Connecticut Health Center, Farmington, CT, USA
J Am Acad Psychiatry Law 35:294-301. 2007.... - Concurrent and predictive validity of the Addiction Severity Index in pathological gamblersNancy M Petry
Department of Psychiatry, University of Connecticut Health Center, Farmington, Connecticut 06030 3944, USA
Am J Addict 16:272-82. 2007..Thus, the ASI may be a useful tool for assessing gambling and psychosocial problems in the growing population of treatment-seeking gamblers... - Ethnic differences in HIV risk behaviors among methadone-maintained women receiving contingency management for cocaine use disordersDanielle Barry
Department of Psychiatry, University of Connecticut Health Center, Farmington, CT 06030, United States
Drug Alcohol Depend 98:144-53. 2008.... - Cocaine abusers with and without alcohol dependence respond equally well to contingency management treatmentsCarla J Rash
Department of Psychiatry, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06033, USA
Exp Clin Psychopharmacol 16:275-81. 2008..Further, alcohol dependent participants are able to offset greater baseline severity in psychosocial functioning and maintain these improvements with CM... - Obesity and its relationship to addictions: is overeating a form of addictive behavior?Danielle Barry
University of Connecticut Health Center, Farmington, Connecticut 06030 3944, USA
Am J Addict 18:439-51. 2009..Although there are important differences between overeating and other addictive behaviors, an addiction model of overeating may effectively inform prevention and treatment of obesity... - Social support is associated with gambling treatment outcomes in pathological gamblersNancy M Petry
University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030 3944, USA
Am J Addict 18:402-8. 2009..These findings demonstrate that social support plays an important role in moderating outcomes, and enhancing social support may be an important aspect of effective gambling treatments... - Pathological gamblers discount probabilistic rewards less steeply than matched controlsGregory J Madden
Department of Applied Behavioral Science, University of Kansas, Lawrence, KS 66045, USA
Exp Clin Psychopharmacol 17:283-90. 2009..The nature of the relation between probability discounting and severity of problem gambling is deserving of further study... - Brief motivational interventions for college student problem gamblersNancy M Petry
University of Connecticut School of Medicine, Calhoun Cardiology Center, MC 3944, 263 Farmington Avenue, Farmington, CT 06030 3944, USA
Addiction 104:1569-78. 2009..College students experience high rates of problem and pathological gambling, yet little research has investigated methods for reducing gambling in this population. This study sought to examine the efficacy of brief intervention strategies... - Behavioral assessment of impulsivity in pathological gamblers with and without substance use disorder histories versus healthy controlsDavid M Ledgerwood
Department of Psychiatry, University of Connecticut Health Center, 263 Farmington Ave, Farmington, CT 06030 3944, USA
Drug Alcohol Depend 105:89-96. 2009..More research should focus on specific ways in which PGs exhibit impulsivity to better address impulsive behaviors in treatment... - Income does not affect response to contingency management treatments among community substance abuse treatment-seekersCarla J Rash
Department of Psychiatry, University of Connecticut Health Center, Farmington, CT 06030 1410, USA
Drug Alcohol Depend 104:249-53. 2009.... - The cost-effectiveness of prize-based and voucher-based contingency management in a population of cocaine- or opioid-dependent outpatientsTodd A Olmstead
University of Connecticut Health Center, Department of Medicine, 263 Farmington Avenue, Farmington, CT 06030 3944, USA
Drug Alcohol Depend 102:108-15. 2009..To evaluate the cost-effectiveness of using prize-based and voucher-based contingency management (CM) as additions to standard treatment for cocaine- or heroin-dependent outpatients in community treatment centers... - Comparable efficacy of contingency management for cocaine dependence among African American, Hispanic, and White methadone maintenance clientsDanielle Barry
Department of Psychiatry, University of Connecticut School of Medicine, USA
Psychol Addict Behav 23:168-74. 2009..CM appears to be an efficacious treatment for cocaine dependence among methadone maintenance clients, regardless of ethnicity. (PsycINFO Database Record (c) 2009 APA, all rights reserved)... - Contingency management is efficacious for cocaine abusers with prior treatment attemptsCarla J Rash
Department of Psychiatry, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030 3944, USA
Exp Clin Psychopharmacol 16:547-54. 2008..The results provide support for CM as an advantageous option for individuals with multiple prior treatment attempts, as well as for substance abuse treatment patients in general... - Serious adverse events in randomized psychosocial treatment studies: safety or arbitrary edicts?Nancy M Petry
Calhoun Cardiology Center, Department of Medicine, University of Connecticut Health Center, USA
J Consult Clin Psychol 76:1076-82. 2008..These data underscore the need to reconsider the rationale behind, and appropriate methods for, monitoring safety during psychosocial therapy trials... - Associations between body mass index and substance use disorders differ by gender: results from the National Epidemiologic Survey on Alcohol and Related ConditionsDanielle Barry
Department of Psychiatry, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, Connecticut 06030, USA
Addict Behav 34:51-60. 2009..Further research is needed to identify reasons for observed gender differences in relationships between BMI and substance use disorders... - Gender differences in associations between stressful life events and body mass indexDanielle Barry
Department of Psychiatry, University of Connecticut Health Center, 263 Farmington Avenue MC 3944, Farmington, CT 06030, USA
Prev Med 47:498-503. 2008..To identify relationships between body mass index (BMI) and stressful life events and to determine whether relationships differ by gender... - Do coping skills mediate the relationship between cognitive-behavioral therapy and reductions in gambling in pathological gamblers?Nancy M Petry
University of Connecticut Health Center, Farmington, CT 06030 3944, USA
Addiction 102:1280-91. 2007..This study examined whether coping skills acquisition mediated the effects of CBT on decreasing gambling in pathological gamblers... - Gambling and substance use disorders: current status and future directionsNancy M Petry
University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030, USA
Am J Addict 16:1-9. 2007..Finally, areas for future research are suggested to advance our understanding of pathological gambling and its relationship to substance use disorders... - What do we get for our money? Cost-effectiveness of adding contingency managementJody Sindelar
Yale School of Public Health and Yale Medical School, CT 06520, USA
Addiction 102:309-16. 2007..To assess the relative cost-effectiveness of lower versus higher cost prize-based contingency management (CM) treatments for cocaine abuse... - Prevalence and health correlates of gambling problems in substance abuse counselorsJeremiah Weinstock
University of Connecticut Health Center, Farmington, Connecticut 06030-3944, USA
Am J Addict 15:144-9. 2006..Poorer physical health was associated with pathological gambling, but mental health was not. These results suggest that substance abuse counselors may benefit from education, prevention, and intervention efforts for disordered gambling... - Severity of gambling is associated with physical and emotional health in urban primary care patientsBenjamin J Morasco
Department of Psychiatry, University of Connecticut Health Center, Farmington, CT 06030, USA
Gen Hosp Psychiatry 28:94-100. 2006..CONCLUSION: These data suggest that disordered gambling is relatively common in primary care settings, and gambling severity is associated with decreased health functioning... - Health correlates of pathological gambling in a methadone maintenance clinicJeremiah Weinstock
Department of Psychiatry, University of Connecticut Health Center, Farmington, CT 06030, USA
Exp Clin Psychopharmacol 14:87-93. 2006..These results extend previous research in other populations that has found that pathological gamblers report poorer mental and physical health than nonpathological gamblers... - Prize-based contingency management does not increase gamblingNancy M Petry
Department of Psychiatry, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030 3944, USA
Drug Alcohol Depend 83:269-73. 2006..No differences in gambling over time were noted between those assigned to the prize CM versus standard care conditions, indicating that this prize CM procedure does not adversely impact gambling behavior among stimulant abusers... - What do we know about relapse in pathological gambling?David M Ledgerwood
Department of Psychiatry, University of Connecticut Health Center, 263 Farmington Ave, Farmington, CT 06030 3944, USA
Clin Psychol Rev 26:216-28. 2006..The application of psychological, biological, environmental, and treatment factors are described as they may relate to relapse among pathological gamblers... - Antisocial personality disorder is associated with increased severity of gambling, medical, drug and psychiatric problems among treatment-seeking pathological gamblersRobert H Pietrzak
Department of Psychiatry, University of Connecticut Health Center, Farmington, CT 06030, USA
Addiction 100:1183-93. 2005..CONCLUSIONS: These results underscore the importance of assessing a wide range of behaviors and personality indices, including ASPD, among treatment-seeking pathological gamblers... - Problem and pathological gambling are associated with poorer mental and physical health in older adultsLauren Erickson
University of Connecticut Health Center, Farmington, CT 06030-3944, USA
Int J Geriatr Psychiatry 20:754-9. 2005..CONCLUSIONS: These data suggest that about 10 percent of active older adults experience gambling problems, which are associated with poor physical and mental health... - Childhood maltreatment in male and female treatment-seeking pathological gamblersNancy M Petry
Department of Psychiatry, University of Connecticut Health Center, Farmington, 06030, USA
Psychol Addict Behav 19:226-9. 2005..These results warrant further investigation of the role of childhood maltreatment in the etiology of pathological gambling and its treatment... - Health and psychosocial correlates of disordered gambling in older adultsRobert H Pietrzak
Dept. of Psychiatry, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030-3944, USA
Am J Geriatr Psychiatry 13:510-9. 2005.... - Comorbidity of DSM-IV pathological gambling and other psychiatric disorders: results from the National Epidemiologic Survey on Alcohol and Related ConditionsNancy M Petry
Department of Psychiatry, University of Connecticut Health Center, Farmington, CT, USA
J Clin Psychiatry 66:564-74. 2005.... - Prize reinforcement contingency management for cocaine dependence: integration with group therapy in a methadone clinicNancy M Petry
Department of Psychiatry, University of Connecticut Health Center, Farmington, CT 06030 3944, USA
J Consult Clin Psychol 73:354-9. 2005..On average, patients in the CM condition earned $117 in prizes. Data from this study suggest that some aspects of reinforcement can be implemented in group therapy in community-based clinics... - Stages of change in treatment-seeking pathological gamblersNancy M Petry
Department of Psychiatry, University of Connecticut Health Center, Farmington, CT 06030 3944, USA
J Consult Clin Psychol 73:312-22. 2005..This study provides initial support for reliability and validity of the URICA in treatment-seeking gamblers, and it suggests that stage of change may have an impact on outcomes... - Internet gambling: an emerging concern in family practice medicine?Nancy M Petry
Department of Psychiatry, University of Connecticut Health Center, Farmington, CT 06030 3944, USA
Fam Pract 23:421-6. 2006..Recent availability and easy accessibility of Internet gambling may be associated with pathological gambling status, and Internet gambling may confer health risks... - Sex differences in subclinical and DSM-IV pathological gambling: results from the National Epidemiologic Survey on Alcohol and Related ConditionsCarlos Blanco
Department of Psychiatry, Columbia University/New York State Psychiatric Institute, New York, NY, USA
Psychol Med 36:943-53. 2006..Results underscore the need to investigate sex differences in the social determinants, neurobiology and treatment response of DSM-IV subclinical and pathological gambling... - Health problems and medical utilization associated with gambling disorders: results from the National Epidemiologic Survey on Alcohol and Related ConditionsBenjamin J Morasco
Department of Psychiatry, University of Connecticut Health Center, Farmington, Connecticut, USA
Psychosom Med 68:976-84. 2006..CONCLUSIONS: A lifetime diagnosis of pathologic gambling is associated with several medical disorders and increased medical utilization, perhaps leading to a burden on healthcare costs in the United States... - Gambling level and psychiatric and medical disorders in older adults: results from the National Epidemiologic Survey on Alcohol and Related ConditionsRobert H Pietrzak
Department of Psychiatry, University of Connecticut Health Center, Farmington, CT 06030 3944, USA
Am J Geriatr Psychiatry 15:301-13. 2007..This study examined the association between gambling level and psychiatric and medical disorders in a nationally representative sample of older adults... - Gambling severity and health functioning in adolescents recruited from urban primary care settingsRobert H Pietrzak
Department of Psychiatry, University of Connecticut Health Center, Farmington, Connecticut 06030-3944, USA
J Adolesc Health 39:764-6. 2006..A total of 11.8% were probable pathological gamblers, and 5.5% were problem gamblers. Probable pathological/problem gambling was associated with poor mental health and perceived social functioning... - Regardless of psychiatric severity the addition of contingency management to standard treatment improves retention and drug use outcomesJeremiah Weinstock
University of Connecticut Health Center, Farmington, CT 06030 3944, USA
Drug Alcohol Depend 87:288-96. 2007..Overall, these findings suggest contingency management is an efficacious and appropriate intervention for substance use disordered individuals across a range of psychiatric problems... - Should the scope of addictive behaviors be broadened to include pathological gambling?Nancy M Petry
University of Connecticut Health Center, Farmington, CT, USA
Addiction 101:152-60. 2006..This paper considers the prospect of reclassifying and broadening the substance use disorders to include non-pharmacological addictions such as pathological gambling... - Psychological experience of gambling and subtypes of pathological gamblersDavid M Ledgerwood
Department of Psychiatry, School of Medicine, University of Connecticut Health Center, 263 Farmington Ave, Farmington, CT 06030 3944, United States
Psychiatry Res 144:17-27. 2006..Male gender and impulsivity were associated with the Egotism factor. These data offer preliminary evidence of the validity and reliability of the GEM in distinguishing subgroups of gamblers... - Contingency management treatments: Reinforcing abstinence versus adherence with goal-related activitiesNancy M Petry
Department of Psychiatry, University of Connecticut Health Center, Storrs, CT 06030 3944, USA
J Consult Clin Psychol 74:592-601. 2006..Abstinence at 6- and 9-month follow-ups did not differ by group, but longest duration of abstinence achieved during treatment was associated with abstinence posttreatment... - Cognitive-behavioral therapy for pathological gamblersNancy M Petry
Department of Psychiatry, University of Connecticut Health Center, Storrs, CT 06030 3944, USA
J Consult Clin Psychol 74:555-67. 2006..Attendance at GA and number of CB therapy sessions or workbook exercises completed were associated with gambling abstinence. These data suggest the efficacy of this CB therapy approach... - Pre/early adolescent onset of gambling and psychosocial problems in treatment-seeking pathological gamblersAlesia N Burge
Department of Psychiatry, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030 3944, USA
J Gambl Stud 22:263-74. 2006..Taken together, these data suggest that pre/early adolescent-onset of gambling may be a risk factor for later-life psychiatric, family/social, and substance abuse problems in treatment-seeking pathological gamblers... - Posttraumatic stress disorder symptoms in treatment-seeking pathological gamblersDavid M Ledgerwood
Department of Psychiatry, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030 3944, USA
J Trauma Stress 19:411-6. 2006..These findings point to a need for more assessment and research about PTSD in PGs... - Severity of gambling problems and psychosocial functioning in older adultsRobert H Pietrzak
Department of Psychiatry, University of Connecticut Health Center, Farmington, Connecticut 06030-3944, USA
J Geriatr Psychiatry Neurol 19:106-13. 2006.... - Gambling problems and health functioning in individuals receiving disabilityBenjamin J Morasco
Portland VA Medical Center, Portland, OR, USA
Disabil Rehabil 28:619-23. 2006..Results suggest that disordered gamblers who receive disability have an increased need for interventions to reduce gambling and associated problems... - Gamblers anonymous and cognitive-behavioral therapies for pathological gamblersNancy M Petry
Department of Psychiatry, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT 06030 3944, USA
J Gambl Stud 21:27-33. 2005..This paper describes some outcome data associated with the two approaches. It also reviews evidence suggesting that a combined intervention may enhance therapy engagement and reduce relapse rates...