2014/2015

Couples therapy remains a less explored and underutilized method in addressing gambling
addiction. Congruence Couple Therapy (CCT) as a systemic, integrative four-dimensional model targeting the couple unit as the pivotal unit in addiction intervention is the focus of this research. This major grant supported the implementation, analysis and publications of a CCT randomized controlled trial compared to an individual approach conducted in collaboration with two Addiction and Mental Health Services sites in Alberta Health Services. Results of the trial (Lee et al., 2023), along with CCT’s mechanisms of change (Lee, Ofori & Isik, 2024) were published in a leading family therapy journal, Family Process. Longitudinal analysis of baseline, post-treatment (5 months) and follow-up (8 months) data revealed significantly advantageous outcomes for CCT compared to TAU in alcohol use, gambling, depression, emotion dysregulation, and couple distress with moderate to large effect sizes. Conversely, TAU did not demonstrate significant symptom reduction across any of the clinical measures. Client satisfaction was significantly higher for CCT, with participants reporting a transformed understanding of their addiction, trauma, and relationship issues addressed in the CCT intervention. CCT counsellors’ feedback collected from focus group data at three time points indicated their strong endorsement of the intervention’s acceptability and effectiveness.

Couple counselling has not been a routine option in most addiction and mental health services. As a result of this trial and its publications, two AHS Addiction and Mental Health treatment sites have incorporated CCT as a core routine service in their addiction and mental health services. Our team of counsellors in Addiction Services Edmonton, the PI and the Congruence Couple Therapy model together were recognized as a Distinguished Initiative in the Patient Experience Award by the Health Quality Council of Alberta in 2023. 

Hôtel-Dieu Grace Healthcare (Windsor, Ontario) Centre for Problem Gambling and Digital Dependency in Psychiatry has trained their problem gambling counsellors in CCT. Currently, their Research Services is applying for a grant to study the counsellor, leadership and patient feedback on the routine incorporation of CCT into their Gambling and Digital Dependency Services. 

Under the leadership of Dr. Bonnie Lee, the University of Lethbridge has secured government approval and accreditation to launch a Graduate Certificate Program in Couple and Family Counselling Studies (online, one year, four courses). The inaugural cohort was accepted for the 2023-2024 academic year. The Canadian Counselling and Psychotherapy Association (CCPA) approved the program’s first course on the foundational theories and concepts in family therapy as an elective for their certification requirement. The courses in the program are currently under review by the accreditation committee of the Canadian Association for Couple and Family Therapy (CACFT) for meeting the requirements for registration. Congruence Couple Therapy and its philosophy, concepts and skills are integrated into. The Graduate Certificate program alongside other couple and family therapy models. The education outcomes of this program is to augment the capacity of addiction counsellors and mental health therapists for
working with couples and families within a systemic framework, and ultimately to improve services in addictions and mental health counselling. 

In February 2024, Dr. Lee was invited by the First Nations Addictions Rehabilitation Foundation in Saskatchewan to develop a problem gambling training program for their First Nations Addictions Counsellors. She developed with a series of online session and a three-day in-person sessions on problem and online gambling with a three-day training in Congruence Couple Therapy (CCT). The workshop received top ratings and feedback from indigenous problem gambling counsellors. It was also very well received by counsellors who work indigenous gamblers, substance users and their families in the province’s residential treatment programs. 

Other invitations in 2023 included a 2-hour pre-conference workshop at the International Centre for Responsible Gaming, Las Vegas (Oct. 8-9, 2023), two four-hour workshops at the Evergreen Council for Problem Gambling Conference, Seattle (May 1-4, 2023), two-hour webinar for Illinois Council on Problem Gambling, online (August 14, 2023), 1-hour presentation on the Digital Symposium of the National Council on Gambling Addiction and Responsible Gambling (June 15, 2023).

Lee, B.K., Shi, Y. Ofori Dei, S.M., Miftari, N. (2023). Characteristics of seekers of couple therapy for alcohol use or gambling disorder. The Canadian Journal of Addiction 14(2), 32-39. https://doi.org/10.1097/CXA.0000000000000174

Lee, B. K., Ofori Dei, S. M., Brown, M., Awosoga, A., Shi, Y., & Greenshaw, A. (2022). Congruence Couple Therapy for alcohol use and gambling disorders with comorbidities (Part I): Outcomes from a randomized controlled trial. Family Process. https://doi.org/10.1111/famp.12813

Lee, B. K., & Ofori Dei, S. M. (2022). Congruence Couple Therapy for alcohol use and gambling disorders with comorbidities (Part II): Targeted areas and mechanisms of change. Family Process, 1-23. https://doi.org/10.1111/famp.12816

Lee B. K., Ofori Dei S. M. (2022). Changes in work status, couple adjustment, and recovery capital: Secondary analysis of data from a Congruence Couple Therapy randomized controlled trial. Substance Abuse Research and Treatment, 16. https://doi.org/10.1177/11782218221088875

Lee, B. K., & Merali, N. K. (2022). Employment stress and couple adjustment among clients with disorders of gambling and alcohol use: Themes of transfers in Congruence Couple Therapy. Substance Abuse: Research and Treatment, 16, 1-12. https://doi.org/10.1177/11782218221080773 

Shi, Y. (2021). Couples’ perspectives in Congruence Couple Therapy and Treatment as Usual: a service-user engagement study. University of Lethbridge, Canada: Master’s Thesis. https://opus.uleth.ca/handle/10133/5857

Lee, B.K. (2023). Congruence Couple Therapy for Problem Gambling. 24th International Conference for Responsible Gambling, Oct. 8-9, Las Vegas, Nevada.

Lee, B.K. & Ofori, S.M. (2021) Concurrent treatment for gambling and alcohol use disorders and their comorbidities: Mechanisms of Change with Congruence Couple Therapy. Invited conference presentation, Alberta Gambling Research Institute Conference 2021: Gambling in Canada: Current Research & Future Directions (online), April 27-29, 2021.

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].

Zentner, C. (2023, January 16). New Model of Couple Therapy Helps with Addictions. UNews and News Release.

Pulido-Guzman, A (2023). Innovative Couples Therapy Model Developed at U of L. Lethbridge Herald January 21, 2023.

Lee, B.K. (2017). (Co-Producer, Co-Script Writer) with Harper-Brown, R. Five Couples Communication Postures. Lethbridge, AB: Department of New Media.

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).

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.

Sanders, J., Williams, R., & Damgaard, M. (2016). OR-93: Prevalence and characteristics of Video Game play and problematic levels of play in Canadian adults. Journal of Behavioral Addictions, 5(S1), 38. https://doi.org/10.1556/JBA.5.2016.Suppl.1

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.

Last year we developed a protocol of the control arm. We submitted our ethics amendment to the University of Calgary. However, because the University of Lethbridge lost its human ethics review board the university made an agreement with the University of Alberta to review all human ethics applications. The primary investigator requested that the University of Calgary continue to review the study, but this was denied. Consequently, the primary investigator was required to close the University of Calgary study and open a new application of the original study with the University of Alberta. The review process took some time but eventually the University of Alberta accepted the original study. However, because the original study included the use of Alberta Health Services (AHS) facilities and medical procedures, AHS wanted a new review of the original study. Unfortunately, the study physician has now retired, and we no longer have the same connections with the Opioid Dependency Program who housed our clinical intervention. Consequently, we were unable to meet the requests of AHS, so the primary investigator decided to close the study with the University of Alberta and open a new non-intervention study (i.e., the control arm) with the University of Alberta that did not require review by AHS. During this time, we focused on analyzing our data from the treatment arm of the original study and developing our theoretical understanding of opioid antagonists on gambling urge. Two papers have been developed and are under review.

The primary investigator and the study coordinator (Dr. Catherine Laskowski) have presented the findings (oral and poster presentations) from the treatment arm of the Naltrexone-Imaging study to International Conferences in Canada (Alberta Gambling Research Institute), the United Kingdom (Current Advances in Gambling Research), Australia (National Association for Gambling Studies), and hospitals (Grand Rounds, Foothills Hospital, Alberta; Grand Rounds, Roswell Park, Buffalo, United States of America; Claresholm Centre for Mental Health and Addiction, Alberta), and to local symposia (Campus Alberta Neuroscience Symposium, University of Calgary; Community University Research Exchange, University of Lethbridge; Psychology Department Colloquium, University of Lethbridge).One academic paper has been published and two others are under review.

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 
 

Laskowski, C., Christensen, D. R., Lim, R., Goodyear, B., Pittman, D., Crockford, D., Hodgins, D., & Hodgson, T. (2023). Naltrexone as a Treatment for Gambling Disorder: An Examination of Neural Activation, Gambling Urges, and Gambling Behaviour. Poster Presentation. Alberta Gambling Research Institute, Banff, Canada.

Laskowski, C., Christensen, D. R., Lim, R., Goodyear, B., Pittman, D., Crockford, D., Hodgins, D., & Hodgson, T. (2022). Naltrexone as a Treatment for Gambling Disorder: An Examination of Neural Activation, Gambling Urges, and Gambling Behaviour, Alberta Gambling Research Institute, Banff, Canada.

Christensen, D. R., Lim, R., Goodyear, B., Pittman, D., Crockford, D., Hodgins, D., & Hodgson, T. (2022). Naltrexone as a Treatment for Gambling Disorder: An Examination of Neural Activation, Gambling Urges, and Gambling Behaviour, Current Advances in Gambling Research Conference, Cardiff, Wales, UK.

Christensen, D. R. (2019). Naltrexone as a Treatment for Gambling Disorder: An Examination of Neural Activation, Gambling Urges, and Gambling Behaviour, National Association for Gambling Studies, Hobart, Australia.

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.

Green, K (2017, November 10). Encouraging results in problem gambling study. CTV Calgary.

Woodrow, B (2017, February 5). Naltrexone as a treatment for gambling disorder. CTV Toronto.

Green, K (2017, February 2). University of Lethbridge drug study attempts to alleviate problem gambling. CTV Calgary.

See sections below.

• 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.

Aidelbaum, R., Hodgins, D. C., & Goghari, V. M. (2023). A Family Study of Executive Function in Gambling Disorder. International Journal of Mental Health and Addiction. https://doi.org/10.1007/s11469-022-00963-2

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.