Co-Morbid Alcohol Use and Alcohol Use Disorders within Pathological Gamblers Jeremiah Weinstock, PhD...
-
Upload
holly-gilbert -
Category
Documents
-
view
213 -
download
0
Transcript of Co-Morbid Alcohol Use and Alcohol Use Disorders within Pathological Gamblers Jeremiah Weinstock, PhD...
Co-Morbid Alcohol Use and Alcohol Use Disorders within Pathological
Gamblers
Jeremiah Weinstock, PhDSaint Louis University
Presentation Overview
1. Alcohol use and gambling2. Alcohol use disorders (AUD) and pathological
gambling (PG)3. Alcohol use during treatment 4. Implications
Drinking & Gambling
Some clients will report that they currently:
1. Drink and gamble at the same time.2. Do both, but never at the same time.
Meanwhile, others report only a history of alcohol problems.
Drinking & Gambling
Many gambling environments serve free or reduced cost alcoholic beverages. Why?
1. Alcohol impairs our ability make good decisions.2. Alcohol weakens our ability to recognize the
importance/salience of gambling losses. 3. Individuals frequently wager more than they
intend while intoxicated.
Cronce &Corbin, 2010; Giacoppassi et al., 1998; Nelson et al., 2011
Pathological Gamblers Who Drink
Epidemiological studies find: – Gamblers who drink 3 or more per occasion were
more likely to be problem gamblers– If both disorders are present, severity of both
disorders are closely linked.– Drinking predicts long-term gambling problems in
problem and pathological gamblers.
Abbott et al., 2004; Blankenship et al., 2007; French et al., 2008;
How Much Do They Overlap?
Epidemiological studies estimate: – 28% of pathological gamblers have comorbid
alcohol use disorder.– Lifetime rates are even higher (~50%).
Which came first?PG 1st Alcohol 1st Same Time
Alcohol Abuse
18.7% 70.9% 10.4%
Alcohol Dependence
44.3% 55.7% 0.0%Lorains et al., 2011; Kessler et al., (2008)
Prevalence in Treatment Centers
Comorbidity is rule rather than the exception:– Alcohol use disorders range from 33% to 64% of
treatment seekers.
– Depends upon the setting. • Addiction clinics higher prevalence.• Outpatient clinics slightly lower.
Ibanez et al., 2001; Black & Moyer, 1998; Kausch, 2003
Why Do They Overlap?
Genetics?– Genetic factors account for ~50% - 60% of alcohol
use disorders.– Genetic factors account for ~50% - 60% of
pathological gambling.– Overlap of genetic factors between the two
disorders is about 12% - 20%.– Most overlap revolves around impulsivity and
poor decision making.
Shah et al., 2005; Sherrer et al., 2005
Implications for Treatment
Comorbid AUD & PG – A blessing and a curse: – One study found current AUD at treatment entry
predicted gambling abstinence at 3 month follow-up. Why?
– History of AUD is associated with lower rates of initial abstinence after treatment.
– History of AUD is associated with higher rates of relapse after achieving 6 months of abstinence (37% vs. 17%).
Hodgins et al., 2005, 2010
Symptom Substitution?
If a client stops drinking will his or her gambling get worse?
If a client stops gambling, will his or her drinking get worse?
Empirical question!
Drinking During Treatment?
We examined this very question in a large pathological gambling treatment seeking sample (N = 293).
Drinking assessed via the Timeline Followback.
Slightly more than half (56%) report drinking any alcohol in the 3 months prior to and six months after starting gambling treatment.
Rash, Weinstock, & Petry, 2011
At-Risk Drinking
Almost half of the drinkers (47%) were classified as “At-Risk Drinkers.”
At-Risk Drinkers:– MEN: > 14 drinks/week or > 4 drinks/episode– WOMEN: > 7 drinks/week or > 3 drinks/episode
At-Risk Drinkers were more likely to be:– Male, younger, greater PG severity, and drink 25%
of pre-treatment days with an mean of 5.0 drinks.
During Treatment, Weekly Drinking
Treatment Week -------------------------------------------------->
Other Important Findings
At-Risk Drinkers:– Had lower rates of PG treatment adherence
Reductions in drinking occurred as individuals entered treatment. – Possibly part of a broader health behavior
change.
Implications
Many gamblers seeking treatment will come in with either:– A history of alcohol problems– Currently at-risk drinking
Conceptualize it as an opportunity!– History = experience making significant change– Current drinking = chance to make global health
changes