Patterns of alcohol and substance use among

treatment-seeking problem gamblers

Linshan Gu (Jessica), Grace Wang,Maria Bellringer, Nick Garrett

6th National Addiction Symposium, Auckland, 22 April 2015

Background• High rates of comorbidity have been consistently reported

– Research shows that over 35% of problem gamblers have problem of AOD use

(Hodgin et al., 2005, Stinchfield & Winters, 2011)

• People with problem gambling and substance abuse have improved

not only gambling but also other areas

• However, a concern has been raised in terms of switching one

substance for another during treatment

• There are some uncertainties around the change patterns of AOD

use over the gambling treatment periods

Aim and research question

Aim•To investigate the changing patterns of AOD problems in help-seeking gamblers over time

Research question•Does problem gambling treatment change drug and alcohol behaviour among help-seeking gamblers?

Methods• Participants: help-seeking callers to the Gambling Helpline

• Recruitment: August 2009 to May 2011

• Participants (N=150): over the age of 18 years

• Treatment: Helpline’s standard care including • brief intervention, • suggestions for self-care and/or • referral to face-to-face problem gambling counselling services

• Note that this research is a part of a larger study on gambling treatment outcome (Abbott et al., 2013)

Methods• Measures

- Problem Gambling Severity Index (PGSI) • 0 = non-problem gambling; • 1-2 = low risk; • 3-7 = moderate risk; • 8+ = problem gambling

- Drug Abuse Screening Test (DAST) • 0-2 = non-problem drug use; • 3-10 = moderate to severe level of drug use

- Alcohol Use Disorders Identification Test (AUDIT-C) • social drinkers = drink 2 or more times a week; • heavy drinkers = have 5 or more drinks on a typical day; • binge drinkers = drink six or more drinks on one occasion weekly or almost

daily

ResultsTable 1: Demographics at baseline of the help-seeking gamblers sample

  Help-seeking gamblers  

At Baseline   At 12 months follow up   Retention rate

Variables N (%)   N (%)    

Gender

Male 64 (42.7) 41 (41.8) 64.10%Female 86 (57.3) 57 (58.2) 66.30%

Age Group

18-24 years 21 (14.0) 8 (8.2) 38.10%

25-34 years 37 (24.7) 21 (21.4) 56.80%

35+ years 88 (58.7) 69 (70.4) 78.40%

Ethnicity

European 63 (42.0) 49 (50.0) 77.80%

Non-European 87 (58.0)   49 (50.0)   56.30%

Table 2: Gambling, AOD use measures across two time points

  Help-seeking gamblers

At Baseline   At 12 months follow up

N (%)   N (%)PGSINon-problem gambler 0 (0.0) 5 (3.3)Low risk gambler 1 (0.7) 24 (16.0)Moderate risk gambler 15 (10.0) 27 (18.0)Problem gambler 129 (86.0) 37 (24.7)

Moderate to severe drug useYes 17 (11.3) 2 (2.0)No 123 (82.0) 95 (96.9)

Social drinking

Yes 47 (31.3) 33 (33.7)No 96 (64.0) 65 (66.3)

Heavy drinking

Yes 57 (38.0) 28 (28.6)No 86 (57.3) 70 (71.4)

Binge drinking

Yes 36 (24.0) 9 (9.2)No 107 (71.3)   89 (90.8)

Change patterns- AOD use

Change patterns- AOD use

Discussion• Comorbidity between problem gambling and AOD use are high (11%

for drug use and over 24% for drinking problems)– 2007/2008 New Zealand Alcohol and Drug Survey (Ministry of Health, 2009): 17% for

recreational drug use and 10% for alcohol use– Compared to the general population of NZ, severity of AOD use is greater in

problem gamblers

• Help-seeking gamblers showed improvement in– problem gambling– moderate to severe drug use and – binge drinking

• But did not show significant improvement in – social drinking and – heavy drinking

Discussion• Potential contributing factors for improved treatment outcome

– Attitude: desire to change (Ladd & Petry, 2003)

– Gambling may be a conditioned cue for AOD use (Steward, 2002)

– Help-seeking population

• Factors related to increased heavy drinking and social drinking - Switch addiction

- Social drinking may not have been considered a problem

- Not related to gambling

- Other psychological distress

Strengths and LimitationsStrengths

• Measured problem gambling as well as AOD use

• Followed up at 12 months

Limitations

• Small sample size

• High dropout rates, however, it is common for longitudinal studies

Conclusion and Implications

• AOD use is a common comorbid condition of problem gambling – Therefore should be screened for in routine clinical assessments

• Severity of problem gambling, moderate to severe drug use and binge drinking are likely to be reduced following gambling treatment

• Better outcome may be achieved with the combined gambling and AOD treatment

Acknowledgement

• Funding body: - Ministry of Health

- AUT summer research award

• Gambling and Addictions Research Centre

• Gambling Helpline

• Participants

ReferencesCastren, S., Pankakiski, M., Tamminen, M., Lipsanen, J., Ladouceur, R., & Lahti, T.

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Ministry of Health. (2007). Drug use in New Zealand: analysis of the 2003 New Zealand health behaviours survey - drug use. Wellington: Ministry of Health.

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