Gambling Disorder vs Alcohol Use Disorder: Comparing Treatment Outcomes with Congruence Couple Therapy
Project Approved 2014-15
Dr. Bonnie K. Lee (Principal Investigator)
Faculty of Health Sciences, University of Lethbridge
This study will compare Gambling Disorder and Alcohol Use Disorder treatment outcomes in a multi-site randomized controlled trial. The experimental treatment will be Congruence Couple Therapy. The control will be primarily treatment-as-usual sites in Alberta’s public mental health and addiction services.
Time Frame: July 1, 2016 to June 30, 2020; extended to December 31, 2021
Couple therapy is under-utilized and under-researched in gambling disorder. This randomized controlled trial was the first to be conducted in Alberta's provincial health system comparing results from a systemic integrated Congruence Couple Therapy (CCT) versus Treatment-as-Usual (TAU) routinely provided by addiction and mental health services. Analysis of the main clinical outcomes of the randomized controlled trial has been completed and prepared for publication. Data were collected at three time points from baseline to post-treatment (5 months) to follow-up (8 months). CCT participants showed significantly greater symptom reduction compared to TAU in alcohol use, gambling, depression, emotion dysregulation, and couple distress with moderate to large effect sizes. CCT group showed larger changes in PTSD compared to TAU but the difference was not significant. No significant symptom reduction was found in TAU on all clinical measures. There was no difference within groups of CCT and of TAU in terms of their treatment effects on gambling and alcohol use disorders. We are now examining the mechanisms of change to help us understand the differences between CCT and TAU results. Clinical outcomes were triangulated with 20 interviews with TAU and CCT participants conducted as an adjunct study funded by a SPOR graduate student award under the supervision of the PI. CCT counsellors' focus group feedback at termination on the intervention's acceptability and effectiveness was also analyzed and included in the main findings.
One major impact was the continued provision of Congruence Couple Therapy at two participating research sites following the conclusion of the study. These sites have since established a waiting list for couple therapy demonstrating the need for its inclusion in the menu of addiction and concurrent treatment services. A virtual knowledge translation PPT presentation "Congruence Couple Therapy: An Integrated Approach in Addiction and Concurrent Disorder Treatment" delivered to the province by Dr. Bonnie Lee and Korielyn Northey, Community Addiction Services Administrator (CASA), a CCT counsellor in the study. Key findings from the study included client and counsellor voices and evaluation. The talk was sponsored by the Knowledge Exchange team of Alberta Health Services Provincial Addiction & Mental Health with a registration of 250 and a waitlist.
Lee, B.K. Employment among Addicted Clients: Skills and Personal Development through Congruence Couple Therapy. Paper presented at 23rd Annual American Association of Behavioral and Social Sciences Conference. February 24–25, 2020, Las Vegas, Nebraska. [Peer-reviewed]
Ofori Dei & Lee, B.K. Reducing Employment-related Stress and Increasing Employment Rate in Addicted Clients Using Congruence Couple Therapy. Poster presented at 23rd Annual American Association of Behavioral and Social Sciences Conference. February 24–25, 2020, Las Vegas, Nebraska. [Peer-reviewed]
Lee, B. K., & Bastardo-Gaelzer, J. Integrating Trauma-informed Relational Work in Addiction Treatment. Poster presentation, Canadian Centre on Substance Use and Addiction, Issues of Substance Conference 2019, Ottawa, November 25-27, 2019. [Peer-reviewed]
Lee, B.K., Shi, Y., & Knighton, R. Couples in Alcohol and Gambling Treatment: Evidence from a Randomized Controlled Trial in the Health System. Paper presented at the Canadian Centre on Substance Use and Addiction Issues of Substance Conference 2019, Ottawa, November 25-27, 2019. [Peer reviewed]
Lee, B. K. Working with Couple Relationship Issues in Addictive Disorders. Workshop presented at the 2019 American Association for Marriage and Family Therapy, Institutes for Advanced Clinical Education, Singapore, July 10-12, 2019. [Peer reviewed]
Lee, B. K. The Centrality of Couple Therapy for Addiction Treatment – Conference Institute (6 hours). Annual American Association for Marriage and Family Therapy Conference, Louisville, Kentucky, November 15-18, 2018.
Lee, B.K. & Greenshaw, A. Family as a Social Determinant of Health Interdisplincary Knowledge Translation Meeting (1-day). Funded by the Campus Alberta Health Outcomes and Public Health Meeting Grants Award, December 19, 2018, Edmonton, Alberta.
Lee, B.K. Couple and Family Therapy for Addiction: Using the Congruence Couple Therapy Model workshop (1.5 days). Invited by the University of Winnipeg, Faculty of Education, Master of Marriage and Family Therapy Program, November 2-3, 2018.
Lee, B.K. & Knighton. Facilitators and Barriers in Conducting a Couple Therapy Randomized Trial in the Health System. Poster presentation at the Canadian Research Initiative in Substance Misuse (CRISM), Prairie Node, 3rd Annual Gathering. Saskatoon, November 1-2, 2018.
Lee, B.K. How Communication Goes Sideways in Families Affected by Problem Gambling (1.5 hr. workshop). Four Directions Conference, sponsored by the Evergreen Council on Problem Gambling, Olympia, Washington, October 2-4, 2018.
Lee, B.K. Connecting the Dots: Couple Communication, Childhood Trauma and Problem Gambling (1.5 hr. workshop). Four Directions Conference, sponsored by the Evergreen Council on Problem Gambling, Olympia, Washington, October 2-4, 2018.
Lee, B. K. Five Reasons to Focus on Couples With Alcohol and Gambling Disorders. Paper presented at the 12th European Conference on Gambling Studies & Policy Issues, Valetta, Malta, September 11-14, 2018.
Lee, B.K. Improving Communication in Couples & Families. South Central Kansas Problem Gambling Task Force. Invited Annual Conference Workshop Presenter (1 day), Wichita, Kansas, April 28, 2018. [KEYNOTE WORKSHOP].
Lee, B. K. Improving Communication in Couples with Problem Gambling. Invited 1.5 hr. workshop presentation at the 2018 Massachusetts Conference on Gambling Problems, 'Gambling – A Spectrum of Public Health Approaches', Norwood, Massachusetts, March 21-22, 2018. [INVITED WORKSHOP].
Lee, B. K. Healing Childhood Trauma and Problem Gambling through Couple Relationship. Invited 1.5 hr. workshop presentation at the 2018 Massachusetts Conference on Gambling Problems, 'Gambling – A Spectrum of Public Health Approaches', Norwood, Massachusetts, March 21-22, 2018. [INVITED WORKSHOP].
Lee, B. K. Improving Communication in Couples and Families. Invited 1-day workshop, Alberta Health Services, Northern Addiction Centre, Grande Prairie, AB, February 23, 2018. [INVITED WORKSHOP].
Lee, B. K. & Knighton, R. Communication Patterns as Diagnostic of Couple Distress in Addictive Disorders. 5th International Conference on Behavioral Addictions. Cologne, Germany, April 23-25, 2018. [RESEARCH PRESENTATION].
Lee, B. K. Engaging the Couple in Addiction Treatment: Why It Matters. Presentation at Covenant Health Research Day, Theme: 'Addiction and Caring for this Vulnerable Population', Grey Nuns Hospital, Edmonton, February 12, 2018. [RESEARCH PRESENTATION].
Lee, B.K., Shi, Y., Gaelzer, J., Awosoga, O., & Christensen, D. Profiles of Alcohol and Gambling Treatment-seeking Couples in a Randomized Trial. University of Lethbridge, Gambling Research Group, Faculty of Health Sciences, October 18, 2017. [RESEARCH PRESENTATION].
Lee, B. K. Congruence Couple Therapy for Addictive Disorders (3 hr. seminar). American Association for Marriage and Family Therapy Annual Conference, Atlanta, Georgia, October 5-8, 2017. [CONFERENCE WORKSHOP].
Lee, B. K. Improving Communication in Problem Gambling Families (3 hr. pre-conference workshop). 31st National Conference on Problem Gambling. Portland Oregon, July 19-22, 2017. [CONFERENCE WORKSHOP].
Lee, B. K. & Knighton, R. Couple Relationship as A Natural Resource for Recovery: Process Evaluation of an Ongoing Congruence Couple Therapy Outcomes Study for Gambling and Alcohol Use Disorders. Poster presentation at the Canadian Research Initiative in Substance Misuse (CRISM), Prairie Node, 2st Annual Gathering. Calgary, AB, November 15-16, 2017. [RESEARCH POSTER].
Lee, B. K., Shi, Y., Gaelzer, J. Awosoga, O., & Christensen, D. Couples seeking Congruence Couple Therapy Treatment for Alcohol and Gambling Problems in a Randomized Trial. Poster presentation at the Canadian Research Initiative in Substance Misuse (CRISM), Prairie Node, 2st Annual Gathering. Calgary, AB, November 15-16, 2017. [RESEARCH POSTER].
Lee, B. K. Training Addiction and Mental Health Counsellors in a Couples Systems Intervention. Poster Presentation, Canadian Research Initiative in Substance Misuse (CRISM), Prairie Node, 1st Annual Gathering. Calgary, AB, June 22-24, 2016. [RESEARCH POSTER].
Lee, B.K. Congruence Couple Therapy Project Update and Quality Improvement KT Meeting. Edmonton Zone Alberta Health Services, Addiction and Mental Health. February 13, 2018. [KNOWLEDGE TRANSLATION].
Lee, B.K. (2017). (Co-Producer, Co-Script Writer) with Harper-Brown, R. Five Couples Communication Postures. Lethbridge, AB: Department of New Media.
Lottery Winners and Bankruptcy Filers
Project Approved 2014-15
Lottery winning is a random event, thus evidence on the behavior of lottery winners provides a clean statistical test of how individuals respond to exogenous income shocks. This project will link the names and post codes of individual lottery winners with other individual level databases on various economic outcomes, in order to examine the impact of lottery winnings of different sizes. For example, we will match these lottery winner names and post codes with the names and post codes of individual bankruptcy filers, in order to test the hypothesis that winning the lottery reduces the chance of personal bankruptcy.
Agarwal, S., Mikhed, V., & Scholnick, B. (2019). Peers’ income and financial distress: Evidence from lottery winners and neighboring bankruptcies. The Review of Financial Studies, 33(1), 433-472. http://dx.doi.org/10.1093/rfs/hhz047
Agarwal, S., Mikhed, V., & Scholnick, B. (2016). Does inequality cause financial distress? Evidence from lottery winners and neighboring bankruptcies (2016-02-11). FRB of Philadelphia Working Paper No. 16-4. Available at SSRN: http://ssrn.com/abstract=2731562
We test the hypothesis that income inequality causes financial distress. To identify the effect of income inequality, we examine lottery prizes of random dollar magnitudes in the context of very small neighborhoods (13 households on average). We find that a C$1,000 increase in the lottery prize causes a 2.4% rise in subsequent bankruptcies among the winners’ close neighbors. We also provide evidence of conspicuous consumption as a mechanism for this causal relationship. The size of lottery prizes increases the value of visible assets (houses, cars, motorcycles), but not invisible assets (cash and pensions), appearing on the balance sheets of neighboring bankruptcy filers.
The paper has been presented at the following conferences or seminars: (1) Alberta School of Business; (2) Federal Reserve Bank of Philadelphia; (3) Boulder Summer Conference on Consumer Financial Decision Making; (4) Frankfurt European Conference on Household Finance; (5) Venice CREDIT Conference on Social Fault Lines and Credit Risk, and; (6) AGRI Conference 2017, Banff, Alberta.
Our work from this project has been featured in the following outlets: Wall Street Journal (US), Washington Post (US), Daily Mail (UK), Globe and Mail (Canada), National Post (Canada), CBC (Canada), Vox (Online), Huffington Post (Online).
Examining the Psychometric Properties of a Test of Video Game Addiction
Project Approved 2014-15
This project will investigate the relationship between problem gambling and problematic video game use among adults in Canada.
Objectives were achieved in examining the reliability and validity of the Behavioural Addiction Measure (BAM) for video games through an online panel. The BAM was determined to have good internal consistency, factorial validity, convergent validity, and criterion validity.
Establishing the psychometric properties of the BAM will allow for analysis of the relationship between gambling and video game use using the Quinte Longitudinal Study (QLS), which collected comprehensive data on 4,121 adults. In addition, the BAM will be used to assess a cross-section of 4,000 adult gamblers and/or video game players, supported by another AGRI grant.
The BAM dataset provided opportunity to assess the prevalence of video game play and problematic video game play in Canada. A small dataset was collected on players of Collectible Card Games (CCG) with an adaptation of the BAM. A manuscript on CCG, problematic use, and psychometric properties of the BAM adaptation is being prepared. CCG share a number of characteristics with gambling and may be the topic of future research.
Sanders, J. L. & Williams, R. (2016). Reliability and validity of the Behavioural Addiction Measure for Video Gaming (BAM-VG). Cyberpsychology, Behavior, and Social Networking, 19(1), 43-48. http://dx.doi.org/10.1089/cyber.2015.0390
Sanders, J. L., Williams, R., & Damgaard, L. M. (submitted). Prevalence and characteristics of video game play and problematic levels of play in Canadian adults.
Neural Mechanisms of Gambling
Project Approved 2014-15
Impulsivity is an important pre-disposing factor leading to disordered gambling. This research studies the relationship between impulsivity and behavioural addiction in a rat model, with special emphasis on the role of the prefrontal cortex.
1. Develop and animal model of gambling based on random-ratio reinforcement.
We ran two large-scale studies (plus several pilot studies) which tested rats on random-ratio (gambling-like) schedules of reinforcement using food pellets. What we found is that random-ratio schedules of reinforcement are highly motivating. However, we largely failed to show that rats given long-term exposure to a random-ratio schedule will develop compulsive, addiction-like behavior (meaning that they'll keep pressing a lever even when it requires many, many presses for reward or when reward is paired with shock). From this we conclude that, at least in rats, compulsive behavior requires some extra ingredient in order to emerge. The results of these studies have been submitted for publication to the Journal of Gambling Studies (currently under review).
2. Is impulsivity in rats predictive of the development of behavioral addiction?
My master's student, Kathleen Ward, ran several studies to examine the relationship between impulsivity and the tendency to develop addiction-like symptoms in rats. We adopted the 5-choice serial reaction time test to measure a form of impulsivity in rats. We ran two pilot studies to validate this measure (i.e., to confirm that it was stable through time). In addition, we ran two experiments where rats were tested in the 5-choice task and our gambling task (described above). In our first study, we tested impulsivity after our gambling task and found, to our surprise, that impulsivity was not related to any aspect of addiction-like behavior, neither response rates nor compulsive tendencies. In our second study, we ran the impulsivity test before the gambling task and found that more impulsive animals actually showed lower motivation on the gambling task, the opposite of what we expected. These findings were presented at the AGRI conference in 2018 and will form the basis of Kathleen Ward's master's thesis, which she will defend this summer (2019).
Given these results, we have decided to shift focus from the 5-choice task to another task which assesses delay discounting, also known in the rat and human literature as "choice impulsivity." This form of impulsivity is distinct from that measured with the 5-choice task and may be more predictive of addiction processes.
3. Test the role of ventral-medial prefrontal cortex in impulsivity and behavioral addiction.
Our original goal was to do lesions to prefrontal cortex and observe the effects on impulsivity and, ultimately, addiction-like behavior in our gambling task. Given the negative findings of a relationship between impulsivity and gambling measures, we decided to shift focus and test the effects of the dopamine agonist Pramipexole on measures of addiction in our gambling task. Pramipexole is sometimes given to Parkinson's patients and has been show to dramatically increase the incidence of behavioral addictions, including gambling. Hence, we wondered whether this drug might tip the scales towards addiction in our rats. We hence used the last installment of our grant money to run 2 pilot studies on the effects of Pramipexole on rats in our gambling paradigm. Among other things, we had to develop a method to administer the drug (we tried oral, injected, and settled on an implanted mini-pump). These studies then formed the basis for our next AGRI grant, under which we have run a full-scale test of the effects of Pramipexole on rats trained on both random- and fixed-ratio reward schedules (see AGRI Major Grant #84: From Motivation to Compulsion: the Neural Bases of Disordered Gambling Explored in a Rodent Model).
These are the major advancements in knowledge:
- We have confirmed and quantified the effect to which random-ratio schedules increase motivation. We have shown this effect on motivation with several different measures. This motivational effect thus constitutes one model of gambling addiction which can be used in future studies.
- We have shown that even 8 weeks of daily exposure to a random-ratio schedule does not induce gambling like-behavior in our rats (contrary to expectations and contrary to results seen with drugs of abuse). We wish we had been able to demonstrate compulsive symptoms, but this is science.
- We have shown that impulsivity in rats, as measured by the 5-choice serial reaction-time task (a common measure of impulsivity in drug studies) is actually inversely related to motivation (another surprising finding).
Laskowski, C. S., Ward, K., Christensen, D. R. & Euston, D. R. (revise and resubmit). Can slot-machine reward schedules induce gambling addiction in rats?
Laskowski, C. S., Williams, R. J., Martens, K. M., Gruber, A. J., Fisher, K. G., & Euston, D. R. (2016). The role of the medial prefrontal cortex in updating reward value and avoiding perseveration. Behavioural Brain Research, 306, 52-63. http://dx.doi.org/10.1016/j.bbr.2016.03.007
Euston, D. R. (2018). Gambling Rats: Motivation but not Compulsion. Talk given at the Alberta Gambling Research Institute's Annual Conference. Banff Centre, Banff, Alberta. April 12-14, 2018.
Morris, L. S., Laskowski, C. S., Dorchak, D. L., Euston, D. R. (2018). Are depressed rats more susceptible to behavioral addiction? Poster and talk presented at the Undergraduate Neuroscience Conference. University of Alberta, Edmonton. August 17-19.
Guyn, C. M., Ward, K. M., Euston, D. R. (2018). How do you find impulsive rats? Factors that influence the measurements of delay discounting. Poster presented at the Undergraduate Neuroscience Conference. University of Alberta, Edmonton. August 17-19.
Laskowski, C. S., Ward, K. M., Dorchak, D. L., Christensen, D. R., Euston, D. R. (2018). Does Chronic Dopamine Agonist Administration Generate Gambling Addiction in Rats? Poster presented at the Alberta Gambling Research Institute Conference - April 12-14, Banff, AB.\
Dorchak, D. L., Ward, K. M., Laskowski, C. S., Christensen, D. R., Euston, D. R. (2018). Are Impulsive Rats More Sensitive to Gambling Reward Schedules? Poster presented at the Alberta Gambling Research Institute Conference - April 12-14, Banff, AB.
Laskowski, C. S., Christensen, D. R., Dorchak, D. L., Fisher, K. G., & Euston, D. R. (2017). Short Term Dopamine D3 Agonist Administration Increases Motivation but Does Not Generate Addiction in Rats. Poster presented at the Meeting of the Minds Conference, Lethbridge, Alberta. March 18, 2017.
Ward, KM, Laskowski, C. S., & Euston, D. R. (2017). Impulsivity of Rats Based on 1-Choice Serial Reaction Time Task. Poster presented at the Meeting of the Minds Conference, Lethbridge, Alberta. March 18, 2017
Laskowski, C. S., Christensen, D. R., Dorchak, D., Fisher, K. G., & Euston, D. R. (2017) Short term dopamine D3 agonist administration increases motivation but does not generate addiction in rats. Talk given at Canadian Spring Conference on Brain and Behaviour, Feb 23-25, Fernie, BC.
Laskowski, C. S., Ward, K. M., Christensen, D. R., Dorchak, D. L., Fisher, K. G., & Euston, D. R. (2017). Short Term Dopamine D3 Agonist Administration Increases Motivation but Does Not Generate Addiction in Rats. Poster presented at the Alberta Gambling Research Institute Conference - April 7-8, Banff, AB
Burchan, M. S., Ward, K. M., Laskowski, C. S., Dorchak, D. L., & Euston, D. R. (2017). Measuring Impulsivity in Rats - Is There a Better Way? Poster presented at the Undergraduate Neuroscience Conference. University of Alberta, Edmonton. August 18-20.
Laskowski, C. S. (2016, April 8). Reward Schedule Variability Generates Addiction-like Behaviours in Rats. Poster presented at the Alberta Gambling Research Institute Conference, Banff, AB.
Laskowski, C. S. (2016, March 12). Unpredictable Rewards Generate Addiction-like Behaviours in Rats Talk given at Meeting of the Minds Conference, University of Lethbridge.
Euston, D. R. (2016, January 6). Decision Making in Rat Prefrontal Cortex. Invited talk given at the University of Alberta for Dept. of Psychology, University of Alberta, Edmonton, Alberta. [Clayton Dickson, Host.]
Euston, D. R. (2015, March). Neural basis of problem gambling. Paper presented at the Community University Research Exchange (CURE) conference, Lethbridge, Alberta.
Euston, D. R. (2015, January). Neural mechanisms of impulsivity and their relationship to the development and persistence of disordered gambling. Paper presented at the University of Lethbridge Gambling Research Group meeting, Lethbridge, Alberta.
Fisher, K. G., & Euston, D. R. (2015, June). Gambling on dopamine: An animal model. Poster presented at the Canadian Undergraduate Neuroscience Conference, Edmonton, Alberta.
Laskowski, C. S. (2016, April). Reward schedule variability generates addiction-like behaviours in rats. Poster presented at the AGRI Conference, Banff, Alberta. (also presented at University of Lethbridge Gambling Research Group meeting in April, 2016).
Laskowski, C. S. (2016, March). Unpredictable rewards generate addiction-like behaviours in rats. Paper presented at Meeting of the Minds Graduate Student Conference, University of Lethbridge, Lethbridge, Alberta.
Project Approved 2014-15
This study examines the effect of regular naltrexone dosing on disordered gamblers. Gamblers will also be scanned pre- and post-treatment where we will investigate the functional changes to tasks designed to engage brain region associated with gambling and addiction. These changes will be correlated with treatment outcomes and urge scores.
Time Frame: February 1, 2016 to December 31, 2019; extended to June 30, 2020; extended to December 31, 2020; extended to to June 30, 2021.
During the reporting period August 1, 2018 to June 30, 2019, 10 new participants were consented to the Naltrexone-Imaging study. Typically, no new participants enroll during the winter months where those currently enrolled complete their treatment and study assessments. As the project is drawing closer to the objective of 44 completers, the research team has begun preparing the two primary manuscripts that investigate the effects of regular naltrexone dosing on clinical outcomes (i.e., gambling abstinence, gambling spend, and gambling urge), and the changes in neurological function to constructs related to gambling; impulsivity, disinhibition, and gambling urge. Office use only: we hope to complete the project once regular access to Alberta Health Services resumes.
The Naltrexone-Imaging study has shown promising results suggesting that regular dosing of an opioid antagonist can mitigate gambling behaviour. We plan to submit to Health Canada an application that Naltrexone is endorsed as the first 'indicated' pharmacological treatment for gambling disorder. This study has also allowed the primary investigator to have regular contact with the clinical lead of the Calgary Opioid Dependency program. This has led to a further collaboration examining the use of buprenorphine transdermal patches to mitigate opioid withdrawal symptoms prior to naloxone maintenance.
Christensen, D. R. (2018). A review of opioid based medications as treatments for gambling disorder: An examination of treatment outcomes, cravings, and individual differences. International Gambling Studies 18(2), 286-309. http://dx.doi.org/10.1080/14459795.2018.1470662
Christensen, D. R. (2018). Naltrexone as a Treatment for Gambling Disorder: An Examination of Neural Activation, Gambling Urges, and Gambling Behaviour*. Grand Rounds, Roswell Park (March 12, 2018), Paper Presentation, Buffalo, New York, United States of America.
Christensen, D. R. (2017). Naltrexone as a Treatment for Gambling Disorder: An Examination of Neural Activation, Gambling Urges, and Gambling Behaviour*. Grand Rounds, Claresholm Mental Health and Addictions Centre, Alberta Health Services, Paper Presentation, Claresholm, Canada.
Christensen, D. R. (2017). Naltrexone as a Treatment for Gambling Disorder: An Examination of Neural Activation, Gambling Urges, and Gambling Behaviour*. Alberta Gambling Research Institute: Just Gambling? Ethical Challenges Pertaining to Gambling Provision, Policy and Research, Paper Presentation, Banff, Canada.
Christensen, D. R. Naltrexone as a Treatment for Disordered Gambling. Campus Alberta Neuroscience Symposium. University of Calgary (October, 2015), Paper Presentation, Lethbridge, Canada
Christensen, D. R. Naltrexone as a Treatment for Disordered Gambling. Community University Research Exchange (CURE). University of Lethbridge (March, 2015), Paper Presentation, Lethbridge, Canada.
Christensen, D. R. Two Novel Treatments for Problematic Gambling: Naltrexone and Contingency Management (February, 2015). Psychology Department Colloquium, University of Lethbridge, Lethbridge, Canada.
Family Study of Executive Functioning Deficits in Gambling Disorder
Project Approved 2014-15
Executive functioning deficits are found in individuals with gambling disorder and are conceptually related to the behavioural symptoms of the disorder. There is also evidence for genetic risk for gambling disorder. We will conduct a family study of individuals with gambling disorder, their siblings, and community controls to assess for genetic (i.e. familial vulnerability) and/or disease-specific effects.
This study is unique as there currently are no family studies of cognition in gambling disorder. By using a family study design, this investigation goes beyond just demonstrating difficulties in the disorder of interest. We will be better able to determine the etiology of the abnormalities. By comparing siblings and individuals with disordered gambling to controls, we will be able to identify likely cognitive deficits associated with genetic (ie., familial) vulnerability for the disorder. Second, by comparing individuals with gambling disorder and siblings, we get a better measure of cognitive dysfunction associated with the disease-process and other associated effects. Third, by investigating siblings who are at greater risk for developing the disorder, but do not have the disorder, we may also get glimpses of compensatory mechanisms that allow for healthy behaviour. All these pieces of information are critical in providing us with a more holistic understanding of how cognition is affected in individuals with gambling disorder. Furthermore, these results can spur future research. Any cognitive markers uncovered can be used for association in large scale genetic analyses or can be used as dependent measures to be associated with candidate single nucleotide polymorphisms. Importantly, similar strategies have been used in medical disorders leading to success in isolating the underlying genes.
This study also has implications for clinical practice and treatment development. If we learn cognition is associated with symptom severity and functioning, we may be able to improve functioning in gambling disorder by targeting cognitive deficits. Cognitive remediation (I.e., training on cognitive tasks) has been used with some success in other psychiatric disorders and may be useful in gambling disorder as well.
- Individuals with gambling disorder have higher rates of alcohol use disorder, substance use disorders, and depressive disorders, compared to relatives and controls.
- Individuals with gambling disorder and relatives engage in lower task-oriented coping when compared to healthy control participants. Conversely, individuals with gambling disorder engage in higher emotion-oriented coping than relatives and healthy controls.
- Problem gamblers experienced significantly more childhood trauma compared to control participants.
- Problem gamblers rate significantly higher in dispositional factors such as detachment, antagonism, and disinhibition than relatives and healthy controls, and rate significantly higher in negative affect and psychoticism than healthy controls.
- No differences in proactive inhibitory control between problem gamblers and healthy controls.
The research represents the continued collaboration between Dr. Goghari's and Dr. Hodgins' laboratories. Dr. Goghari has completed a neuroimaging family study of cognition in schizophrenia. She has also developed executive functioning tasks and has investigated cognitive functions in healthy and psychiatric populations. Dr. Hodgins has studied the psychopathological aspects of gambling and other addictive behaviors. The current study represents a unique collaboration of their skills.
This study has provided students with opportunities to learn how to conduct mood and cognitive assessments and provided opportunities for clinical psychology graduate students to gain experience with conducting clinical (i.e., SCID-5) interviews. Data from this study has supplemented data collection for two students who completed their Master's theses in recent years. Both theses (Sharif-Razi, 2017; Ramakrishnan, 2019) have been published, and one has led to a published, peer-reviewed article (Sharif-Razi, Hodgins, & Goghari, 2019). Additionally, this data has been used to supplement data collection for a published, peer-reviewed article that was written with one of our post-doctoral fellows (Shakeel, Hodgins, & Goghari, 2019). Currently, this dataset is being used to conduct a descriptive sample analysis, as well as a family study comparing probands, relatives, and controls on measures of impulsivity and social cognition.
Shakeel, M. K., Hodgins, D. C., & Goghari, V. M. (2019). A Comparison of self-reported impulsivity in
gambling and bipolar disorder. Journal of Gambling Studies, 35(1), 339-350. https://dx.doi.org/10.1007/s10899-018-9808-5
Sharif-Razi, M., Hodgins, D. C. & Goghari, V. M. (2019). Reactive and proactive control mechanisms of response inhibition in gambling disorder. Psychiatry Research, 272, 114-121. https://doi.org/10.1016/j.psychres.2018.12.049
Ramakrishnan, N. (2019). Measuring the extended phenotype using a dimensional model of personality in gambling and bipolar disorder [Master’s thesis, University of Toronto]. http://hdl.handle.net/1807/98295
Goghari, V.M., Hodgins, D.C. (2019, April). Family study of executive functioning in gambling disorder. Poster presented at the Alberta Gambling Research Institute Conference, Banff, Canada.
Cassetta, B. D., Goghari, V., Kim, H. S., Hodgins, D. C., Tomfohr-Madsen, L. M. (April, 2018). Schizophrenia and Disordered Gambling: The Effects of Working Memory Training. Poster presented at the Alberta Gambling Research Institute, Banff.
Shakeel MK, Lefebvre DC, Hodgins DC, Goghari VM. 2017. Trauma, Stress and Coping in People with Problem Gambling and their Relatives. Poster presented at the Alberta Gambling Research Institute Conference.
Sharif-Razi M, Hodgins DC, Goghari VM, & McGrath DS. 2017. Proactive and reactive mechanisms of response inhibition in gambling disorder. Poster presented at the Canadian Psychological Association (CPA) Annual Conference, Toronto, ON.