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Danielle Rossini DibAddiction Therapy 2015Florida, USAAugust 03-08, 2015

A naturalistic study of recovering gamblers: what gets better and when they get better Danielle Rossini-Dib1, Daniel Fuentes2 & Hermano Tavares1.

1 Pro-AMJO Gambling Outpatient Program2 LINEU - Integrated Laboratories of Neuropsychology

Psychiatry Institute of University of So Paulo

@: rossini.danielle@gmail.comPsychiatry Research 227 (2015) 1726Danielle Rossini DibDanielle Rossini Dib2Gambling DisorderTreatable Condition (Rosenthal, 2008)How to define and assess gambling recovery? (Nower and Blaszczynsky,2008).

GD = continued gambling behavior despite the accrual of financial losses and major personal distress DSM 5Banff Consensus: focus on

- Gambling behavior Harm caused by gambling Measures of change in the process (treatment)

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Gambling Disorder RecoveryBanff Consensus: Would be enough?

AND..

Psychiatry ComorbiditiesExecutive Dysfunction Cognitive Distortions & Impulsivityas bias at DM process4Study Question:

Objective:,To measure the treatment outcomes and identify factors that could be associated with clinical GD recovery (negative affectivity, gambling-related cognitive distortions, trait impulsivity, cognitive flexibility, planning, inhibitory control, and decision- making).

This StudyWhat improves as the patient recovers?5Controlled conditions:

Pre-treatment features that could modulate treatment response (i.e.,variations in demographic, gambling, and psychiatric profiles)

Differences in treatment delivery .

Hypothesis:The improvement in GD-related psychopathology would be greater for patients who recovered from GD as opposed to those who did not. This Study6MethodSample: Distribution of patients admitted for treatment at the IPQ (February 2006August 2008)

Final Sample7MethodSample:

Recovered and Non-Recovered post treatment:

Gambling Follow-up Scale (GFS)

- Recovered: >33 (n = 47) - Non-Recovered: 33 (n= 25)

8MethodInstruments

Clinical features

Demographic profile

ADHD symptons (ASRS)

Psychiatry comorbidities and suicide risk assessement (MINI)

Gambling profile, severity and related factors (ASI-G)

Treatment delivered (if CBT or PEG)

Assessment of treatment outcome and related factors

Negative Affect Symptoms (BDI and BAI)

Gambling related cognitive distortions (GBQ)

Trait impulsivity (BIS-11)

Neurocognitive

Classical:

Intelligence (Matrices)

Planning (ROCF)

Mental Flexibility (WCST)

Computerized:

Inhibitory control (Comm. Errors and GoStop Paradigm)

Decision making (IGT)

Assessment: before treatment and 6 months after treatment initiation

9AnalysesTwo parts10AnalysesTwo parts11Results Demographic profile Gambling related factors Age (gambling onset, first problem and fisrt treat) & type of games; ADHD (ASRS) and tobacco Psychiatric Profile Psychotropic medication before and after treatment

Rec = NRec

Table 2T 4Rec NRec12ResultsTable 5: Baseline and endpoint treatment assessments

13ResultsTable 6: Forward logistic regression for gambling recovery, final model (N=34)

14No differences in pre treatment variables beteween Rec and Nrec

DiscussionIt may represent a drawback for the prediction of gambling treatment outcomeThe gambling treatment can offers equal chances of recovery for treatment- seeking gamblers regardless pre treatment conditions.Differences in pre treatment variables between Rec and Nrec

Gambling severity the association faded in subsequent analysis

OR15 By this study, we supose that GBQ, Negative affective and DM predicted treatment response.

Finding differences from the literature: But there are very few outcome prediction studies for GD

Two studies predicts relapses in treatment-seeking gamblers.

DiscussionPersonality features, (high neuroticism, low conscientiousness, and low agreeableness), are related with relapse and treatment dropout after 1 year. (Ramos-Grille e tal, 2013)Inhibitory control and DM are better predictors of relapse 1 year after baseline assessment.(Goudriaan et al.(2008)Family history of alcoholism predicts a positive response to treatment with opiate antagonists. (Grant et al, 2008)

79%16DiscussionWhat gets better when they get better:

Negative affectivity and Gambling cognitive distortions are related:they work as a buffer?

Decision-making: Unrelated with others outcome variables.could be a distinctive feature of disordered gamblers?

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LimitationsThe high losses of the original sample No-shows and dropouts = 36%

Outcome variables did not exhaust all aspects of gambling recovery

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ConclusionsIt might be beneficial to focus the approach in helping patients in dealing with their emotions, to fantasize less, to be more rational about gambling, and to make better decisions, especially when risk is involved. Gambling-related cognitive distortions is central in the treatment tooPsychiatric comorbidities must be assessed and treatedDecision-making, as an impulsivity measure, was strongly related to recovery. 19Special Tanks toAll patients

PRO-AMJO Staff

Institute of Psychiatry of University of So Paulo

CAPES by finance supported (Ms. Rossini)

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@: rossini.danielle@gmail.com21Addiction Therapy 2016 Website: addictiontherapy.conferenceseries.comMeet the eminent gathering once again atAddiction Therapy 2016Miami, USAOctober 06-08, 2016

VariableNon-recoveredN = 25RecoveredN = 47Test[df]a2effect sizep

BaselineMean [SD]EndpointMean [SD]BaselineMean [SD]EndpointMean [SD]

Negative Affectivity46.7 [23.8]44.9 [20.9]44.5 [25.7]24.9 [23.0]F[1,62] = 13.8b0.182