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

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

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Troy Bruner Oral Defense Troy Bruner Oral Defense Presentation Transcript

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