Troy Bruner Oral Defense


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A Comparative Study of Levels of Pathological Gambling Among Methamphetamine Abusers and Other Substance Abusers

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Troy Bruner Oral Defense

  1. 1. Oral Defense: A Comparative Study of Levels of Pathological Gambling Among Methamphetamine Abusers and Other Substance Abusers (Troy Bruner, Argosy University, Seattle)
  2. 2. OVERVIEW <ul><li>1. Conceptualization of the Study 2. A Brief Literature Review 3. Research Methodology 4. Data Collection 5. Results 6. Discussion, Conclusions, Implications </li></ul>
  3. 3. Study Conceptualization A brief explanation of background inspiration
  4. 4. Conceptualization of the Study <ul><li>Description of the Research Problem </li></ul><ul><li>Comorbid PG and MA abuse is an understudied subject </li></ul><ul><li>Studies of general substance abusers and PG’s tend not to differentiate MA abusers from other groups of stimulant abusers </li></ul><ul><li>Most studies of substance abusers and PG’s do not include any appreciable number of MA abusers relative to the population sampled </li></ul>
  5. 5. Description of the Research Problem (cont.) <ul><li>Currently, the majority of state-funded CD programs do not assess for PG </li></ul><ul><li>Treatment is difficult to obtain in both the CD and MH systems </li></ul><ul><li>Any research showing SA and PG comorbidities strengthens the argument for dual-diagnosis assessment and treatment </li></ul>
  6. 6. Description of the Problem (cont.) <ul><li>Treating one addiction, but not a subsequent addiction, limits treatment effectiveness </li></ul><ul><li>The economic costs of treating CD and PG are substantial </li></ul>
  7. 7. Comorbidity as an Additional Risk Factor <ul><li>Substance abusers are more likely to have a mental health disorder and vice versa </li></ul><ul><li>Individuals with two or more disorders are more likely to experience homelessness, suicide, incarceration, unemployment, and medical problems </li></ul><ul><li>(Source: Hasin et al., 2006; Quello, Brady & Sonne, 2005; Maxwell, 2005; US Department of Health and Human Services, 2002) </li></ul>
  8. 8. Description of the Problem (cont.) MA abusers experience many problems more severely than other types of substance abusers <ul><li>Co-occurring psychiatric Disorders </li></ul><ul><li>Impulsivity, e.g., risky sexual behavior, aggressiveness, and criminal behavior </li></ul><ul><li>Infectious diseases </li></ul><ul><li>Suicide Completion </li></ul>
  9. 9. MA & PG Comorbidities <ul><li>Psychiatric: most commonly mood disorders with depression being most prevalent followed by bipolar disorder </li></ul><ul><ul><li>The suicide risk for MA ranges from about 20%-40% </li></ul></ul><ul><li>PGs also most commonly experience mood disorders </li></ul><ul><ul><li>Petry’s review of several studies of PG’s showed rates of lifetime suicide attempts ranging from 13%-36.7% for treatment seekers versus 2.3%-11.1% for non-gamblers </li></ul></ul><ul><li>Comorbid suicide rates are unknown </li></ul><ul><li>Alcohol and nicotine are the most common drugs of choice for both groups </li></ul>
  10. 10. Description of the Problem (cont.) MA abusers who are PG’s may be particularly vulnerable due to the chemical properties of MA <ul><li>It delivers a longer lasting high than most stimulants </li></ul><ul><ul><li>Substance abusers who are PG’s tend to gamble while intoxicated </li></ul></ul><ul><li>Unlike straight amphetamine, MA is methylated (more dissolvable and quickly absorbed) </li></ul><ul><li>MA is often augmented by harmful chemicals </li></ul>
  11. 11. Development of Hypothesis <ul><li>The prevalence of PG among MA abusers is unknown and should be studied </li></ul><ul><li>The population studied should include appreciable numbers of MA abusers relative to the total number of subjects </li></ul><ul><li>Preferably, the study should be specific to individuals receiving state-funded treatment </li></ul><ul><li>The study should compare levels of PG among MA abusers with other substance abusers </li></ul>
  12. 12. Formal Hypothesis <ul><li>MA abusers will experience higher levels of PG when compared to a combined group of other substance abusers </li></ul>
  13. 13. Definition of Terms… <ul><li>Methamphetamine abuser </li></ul><ul><li>Substance Abuser </li></ul><ul><li>Pathological Gambler </li></ul><ul><li>Problem (or transitional) gambler </li></ul>
  14. 14. LITERATURE REVIEW <ul><li>Prevalences </li></ul><ul><li>Comorbidities </li></ul><ul><li>Population Characteristics </li></ul><ul><li>Neurobiology </li></ul><ul><li>Treatment Effectiveness </li></ul>
  15. 15. MA Prevalences <ul><li>Global prevalence of annual ATS use is 0.5% (335m) of which 49% (164m) consists of MA consumption (Source: UNDOC, 2004) </li></ul><ul><li>National annual prevalence of 0.6% (1.8m) and lifetime prevalence of 4.9% (14.9m) (Source: SAMHSA, 2006d) </li></ul><ul><li>2003-06 statistics show an increasing annual prevalence of 0.91-1.13% in the State of WA </li></ul><ul><li>Meth treatment admission in the State of WA have doubled since the 1990’s increasing from 4,056 in 1998 to 8,052 in 2004, but have leveled off in subsequent years </li></ul>
  16. 16. PG Prevalences <ul><li>Nationally: (lifetime problem or PG) 1.1%-1.5% (3.3m-4.6m) (Source: Shaffer, Hall & Bilt, 2006) </li></ul><ul><li>State of Washington: (lifetime problem or PG) 5% (past year) 2.5% (Source: Volberg & Moore, 1999). </li></ul><ul><li>Considerations: type of gambling; proximity to casinos; legal versus illegal; internet gambling </li></ul>
  17. 17. Population Characteristics of MA abusers <ul><li>Numerically, most MA abusers are Caucasians </li></ul><ul><li>When weighted for proportional comparisons, Hawaiian Americans experience the highest levels, followed by Native Americans </li></ul><ul><li>Males abuse MA more than females, but marginally </li></ul><ul><li>MA abuse tends to be a more rural than urban phenomenon, but this is changing </li></ul>
  18. 18. Methamphetamine Use in Past Year among Persons Aged 12 or Older, by Race/Ethnicity: 2002, 2003, and 2004 Source: SAMHSA, 2005. For confirmatory research see: Windslow, Voorhees & Pehl, 2007
  19. 19. Source: SAMHSA, 2006a                                                                                                                         
  20. 20. Treatment Data <ul><li>Most referrals for MA treatment come from the criminal justice system </li></ul><ul><ul><li>Treatment tends to be standardized </li></ul></ul><ul><li>Most PG’s in treatment were self-referred </li></ul><ul><ul><li>There is a lack of uniformity in treatment models </li></ul></ul><ul><li>Treatment effectiveness for both groups increases with 12 step involvement </li></ul><ul><li>CBT that stresses accountability and MI has shown some effectiveness for both groups </li></ul>
  21. 21. <ul><li>Source: SAMHSA, 2005 </li></ul>
  22. 22. Neurobiology: PG & MA <ul><li>Both addictive behaviors impact dopamine, serotonin, and norepinephrine nuerotransmitter levels </li></ul><ul><li>“ Gambling can induce effects that closely resemble a psychostimulant drug effect” (Zack & Poulos, 2003) </li></ul><ul><li>Both groups demonstrate frontal lobe impairment </li></ul><ul><li>Both activites stimulate the prefrontal cortex and amygdala </li></ul>
  23. 23. Neurobiology of PG and MA <ul><li>For MA and PG the primary neural pathway is the mesolimbic pathway (reward pathway) </li></ul><ul><li>The primary brain regions for this pathway include the amygdala, ventral tegmenta, nucelus accumben, and hippocampus </li></ul><ul><li>MA is neurologically destructive </li></ul>
  24. 24. Behavioral Genetics & Heritability <ul><li>Genes responsible for serotonic and dopaminergic expression have been linked to MA abuse and PG as well as other addictions </li></ul><ul><li>PG is associated with genes that mediate behavioral inhibition </li></ul><ul><li>There appears to be a genetic, heritable predisposition for PGs </li></ul>
  25. 25. <ul><li>Independently conducted by: Community Detoxification Services </li></ul><ul><li>Location: Spokane, Washington </li></ul><ul><li>Investigator: Troy Bruner </li></ul><ul><li>109 Subjects </li></ul><ul><li>Conducted over a period of 14 weeks </li></ul>Research Overview & Methodology
  26. 26. Description of Instruments: SOGS & MAGS <ul><li>Southern Oaks Gambling Scale </li></ul><ul><ul><li>Screens for lifetime PG </li></ul></ul><ul><ul><li>Asks questions about type of gambling, frequency, and amount spent </li></ul></ul><ul><li>Massachusetts Gambling Scale </li></ul><ul><ul><li>Detects presence of PG within last 12 months </li></ul></ul><ul><ul><li>Two scores. 1 st Emphasizes psychosocial, vocational, legal, and tolerance/withdrawal of PG </li></ul></ul><ul><ul><li>2 nd is based on DSM criteria </li></ul></ul>
  27. 27. Description of Variables <ul><li>IV: Type of substance abuse </li></ul><ul><li>DV: SOGS Score: > 4 = PG </li></ul><ul><li>MAGS 1 Score: > 2 = PG </li></ul><ul><li>MAGS 2 Score: > 4 = PG </li></ul>
  28. 28. Research Design <ul><li>Descriptive-correlational </li></ul><ul><li>Quantitative </li></ul><ul><li>Comparative </li></ul><ul><li>Non-experimental </li></ul>
  29. 29. Data Collection & Population <ul><li>Population characteristics </li></ul><ul><ul><li>Inpatient adults screened for SA </li></ul></ul><ul><ul><li>Confounding variables addressed: MI, intoxication, vulnerability (withdrawal, etc.) </li></ul></ul><ul><ul><li>Purposive sample, N =109 </li></ul></ul>
  30. 30. Results <ul><li>Methamphetamine Abusers as a Percentage of the Sample </li></ul><ul><li> Frequency Percentage </li></ul><ul><li>Meth 32 29.4 </li></ul><ul><li>Non-meth 77 70.6 </li></ul><ul><li>Total 109 100 </li></ul>
  31. 31. Results: Meth vs. Non-Meth (cont.) <ul><li>Instrument Type N Mean </li></ul><ul><li>SOGS Meth 32 5.78 </li></ul><ul><li>Non-Meth 77 2.48 </li></ul><ul><li>MAGS 1 Meth 32 1.0603 </li></ul><ul><li>Non-Meth 77 .0570 </li></ul><ul><li>MAGS 2 Meth 32 2.8125 </li></ul><ul><li>Non-Meth 77 1.1558 </li></ul>
  32. 32. Results: Primary Dx Only <ul><li>Instrument Type N Mean </li></ul><ul><li>SOGS Meth 20 4.70 </li></ul><ul><li>Non-Meth 77 2.48 </li></ul><ul><li>MAGS 1 Meth 20 .4315 </li></ul><ul><li>Non-Meth 77 .0570 </li></ul><ul><li>MAGS 2 Meth 20 2.4250 </li></ul><ul><li>Non-Meth 77 1.1558 </li></ul>
  33. 33. Internal Consistency & Effect Size <ul><li>Crobach’s Alpha shows an acceptable internal consistency for all three instruments </li></ul><ul><li>Cohen’s D showed a moderate effect size </li></ul><ul><li>Responses were subjected to Pearson’s Correlational Coefficient. The majority of items show a linear and consistent relationship </li></ul>
  34. 34. Data Summary <ul><li>The data confirmed the hypothesis </li></ul><ul><li>Per the SOGS results, of 32 MA abusers, 15 (46.9%) met criteria for PG in their lifetimes (versus 77 (24.7%) for non-MA abusers </li></ul><ul><li>MAGS 1 scores showed that 10 (31.25%) of MA abusers met criteria for PG compared to 7 (9%) for other substance abusers </li></ul><ul><li>MAGS 2 revealed that 7 (29.1%) met DSM-IV criteria for PG versus 7 (9.0%) for other SA </li></ul>
  35. 35. Aggregate Summary <ul><li>Of all MA abusers, the instruments showed that 17 (53.1%) have met criteria for PG [SOGS & MAGS combined] </li></ul><ul><li>20 of 77 (25.9%) of the combined group of other substance abusers met past or present criteria for PG </li></ul><ul><li>For all groups combined (n=109) 33% have met criteria for PG </li></ul>
  36. 36. Aggregate Summary (cont.) <ul><li>6 MA abusers had some history of problem gambling without meeting criteria for PG </li></ul><ul><li>19 of the non-Meth group had some history of problem gambling without PG </li></ul><ul><li>Thus we can say that 71.8% of MA abusers have likely been problem or PG’s. </li></ul><ul><li>Of the non-Meth group, 50.6% </li></ul><ul><li>Combined, 62 (56.88%) have some history of problem or PG </li></ul>
  37. 37. Secondary Analysis <ul><li>The MAGS 2 did not appear to correlate with the MAGS 1 as well as the SOGS: </li></ul><ul><li>Every subject who met criteria for problem or PG in MAGS 1 also scored above average on the SOGs </li></ul><ul><li>Of the 37 who met criteria for PG on MAGS 1 or SOGS, only 12 (32.4%) met criteria according to MAGS 2 </li></ul>
  38. 38. Discussion <ul><li>The instruments showed that MA abusers experienced PG at levels higher that other substance abusers. (Petry, 2005 provides a good overview studies). </li></ul><ul><li>Overall, the instruments complimented each other, with some weakness on the MAGS 2 scoring </li></ul>
  39. 39. Discussion (cont.) <ul><li>Regarding gender, males scored higher than females for all DV for both groups </li></ul><ul><li>Overall, both groups experienced much higher levels of PG when compared with the general population </li></ul>
  40. 40. Conclusion <ul><li>The hypothesis was confirmed </li></ul><ul><li>The presence of a problem has been confirmed </li></ul><ul><li>The study implies that MA abusers, like other substance abusers, may benefit from the assessment and treatment of PG </li></ul>
  41. 41. Conclusions (cont.) <ul><li>What are the implication for future research? </li></ul><ul><li>Future studies should seek to confirm or disconfirm the findings in other subject pools </li></ul><ul><li>MA abusers who are PG’s should be studied to determine population characteristics </li></ul><ul><li>Eventually, there may be a need for treatment specific to comorbid PG’s and substance abusers </li></ul>
  42. 42. Questions? Comments? Observations?
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