The Brief Addiction Science Information Source (BASIS)

The WAGER, Vol. 14(5) - What’s in a game? Are certain types of gambling more likely to lead to disordered gambling?

At present, research findings are mixed about the impact of specific forms of gambling on gambling-related problems. Using limited samples, some studies have found an association between specific gambling activity and disordered gambling (e.g., Wood & Griffiths, 1998), often implicating gambling machines as especially “addictive” because of their high rate of gambling opportunities. Treatment seekers often report disproportionate rates of play on specific games. However, treatment seekers are not representative of others with similar problems. Therefore, it is not surprising that some researchers (e.g., National Research Council, 1999; Welte, Barnes, Wieczorek, Tidwell, & Parker, 2004) have found that the number of gambling activities is more predictive of problem gambling.  This week’s WAGER reviews a study that examines the relationship between specific forms of gambling and gambling-related problems among a nationally representative sample of U.S. youths (Welte, Barnes, Tidwell, & Hoffman, 2009).

Methods

• Participants were U.S. youths (ages 14-21) selected via random digit dialing of household telephone numbers who completed the National Survey of Youth and Gambling (N = 2,274).
• Interviews assessed past year gambling behavior and gambling-related problems.
  •  Investigators used a researcher-developed survey to assess participant involvement in 15 gambling activities or settings.
  • Investigators evaluated gambling-related problems using the South Oaks Gambling Screen Revised for Adolescents (SOGS-RA).

Results

• Sixty-eight percent of study participants (N=1,535) reported gambling during the previous twelve months; the highest percentage of these gamblers reported engaging in card games (33%), office pools and charitable gambling  (30%), and the lottery (29%).
• Table 1 summarizes the risks for gambling-related problems and gambling versatility (i.e., mean number of types of gambling in which respondents engaged) for each gambling activity/setting.
  • Overall, higher levels of gambling versatility were associated with more gambling-related problems.
• Researchers performed incidence risk ratio analyses to investigate the impacts of engaging in particular forms of gambling while controlling for all other types of gambling behavior.
  • After controlling for involvement in other games/settings, card games, games of skill, gambling at casinos, and ‘other’ gambling were associated with an increased risk of gambling-related problems.  
  • Other gambling types, including Internet gambling, were not associated with increased risk when controlling for involvement in other gambling activities.

Table 1.  Prevalence of Any Gambling Symptoms and Gambling Versatility on All Forms of Gambling for Gamblers Who Played Each Form of Gambling, U.S. Youth and Gambling Survey (Adapted from Welte et al., 2009)

  

Limitations

• Self-report of gambling activity involvement and potential problem gambling behavior can be associated with recall and reporting bias.
• Data was collected using random digit dialing of household phones, which only occasionally included cell phones.  This strategy generally limits the study sample to youths with a landline home telephone. This group might not be representative of the youth population segment.
• Study questions did not distinguish gambling settings from specific forms of gambling (e.g., questions were asked about casino gambling and about gambling machines not in a casino but not about gambling machines in casinos).

Conclusion
The findings from this study do not support the idea that the most rapid forms of gambling, such as gambling machines, are the most problematic type of game. The finding that gamblers who had higher gambling versatility (i.e., experience with more types of gambling) were more likely to experience gambling problems is, however, consistent with previous research (e.g., National Research Council, 1999; Welte et al., 2004) showing that overall gambling involvement is a more useful predictor of gambling-related problems than participation in specific gambling types.  A high correlation between a specific type of gambling (e.g., Internet gambling) and problem gambling does not reflect a causal influence; this association might mean that devotees of that type of gambling also engage in a lot of other gambling. Youth gambling prevention and harm reduction programs might benefit by incorporating the findings of this study into their practices.  Specifically, by focusing less on particular types of gambling and focusing more on the potential risks of high levels of gambling engagement, such programs might better prevent or reduce the harms associated with youth problem gambling behavior.

-Erica Marshall

What do you think?  Please use the comment link below to provide feedback on this article.

References
National Research Council. (1999). Pathological gambling: A critical review. Washington D.C.: National Academy Press.

Welte, J., Barnes, G., Tidwell, M., & Hoffman, J. (2009). The association of form of gambling with problem gambling among American youth. Psychology of Addictive Behaviors, 23(1), 105-112.

Welte, J., Barnes, G., Wieczorek, W., Tidwell, M., & Parker, J. (2004). Risk factors for pathological gambling. Addictive Behaviors, 29(2), 323-335.

Wood, R. T., & Griffiths, M. D. (1998). The acquisition, development and maintenance of lottery and scratchcard gambling in adolescence. Journal of Adolescence, 21(3), 265-273.

 

STASH, Vol. 5(5) – Substance use and abuse among lesbian, gay, and bisexual youths: The role of rejection to disclosure

Youths who self-identify as lesbian, gay, or bisexual (LGB) are significantly more likely than other young people to report using alcohol, tobacco, and other drugs (Marshal et al., 2008). Recent research has focused on risk or protective factors that influence substance use among this population. One proposed risk factor is rejection from one’s friends and family members following the disclosure of sexual orientation (i.e., “coming out”). Rejection following disclosure might produce feelings of shame and social isolation, which might contribute to increased substance use. This week’s STASH reviews a recent study of the relationship between reactions to disclosure of sexual orientation and substance use among LGB youths (Rosario, Schrimshaw, & Hunter, 2009)

Participants
•    Participants were an ethnically diverse convenience sample of 156 14-21 year-olds (mean age = 18.3, SD = 1.65) recruited from LGB community-based and college student organizations in New York City.

•    Roughly 66% self-identified as lesbian/gay, 31% identified as bisexual, and 3% identified as “other” (e.g., “confused”).

Procedures
•    Participants completed a 2- to 3-hour structured interview at recruitment (Time 1), with follow-up interviews occurring 6 and 12 months later (Times 2 and 3, respectively).

•    The retention rates were 92% for the 6-month assessment and 90% for the 12-month assessment.

•    Attrition analyses revealed that participants lost to one or more follow-up assessments did not differ at baseline from those interviewed at all three assessments on any demographic factors or Time 1 variables.

•    Participants were paid $30 at each interview.

Primary Measures
•    Participants listed the “important people” to whom they first disclosed their sexual orientation and then indicated whether each person reacted in an accepting, neutral, or rejecting manner. Therefore, there were four disclosure measures:  the total number of people, and the number of people who had an accepting, neutral, or rejecting response.

•    Substance use (quantity and frequency of cigarette, alcohol, and marijuana use) was assessed at Times 1-3 using the Alcohol and Drugs Schedule (see Rosario, Schrimshaw, & Hunter, 2009). The Time 1 assessment measured substance use in the past 3 months; the Times 2 and 3 assessments measured substance use in the past 6 months. Investigators assessed substance abuse using 11 items derived from the Diagnostic Interview Schedule for Children (e.g., “Felt you needed or were dependent on alcohol and/or drugs”). The index of substance abuse was the number of endorsed items. 

Results
•    On average, participants first became aware of their sexual orientation at age 10 and first disclosed their sexual orientation at age 15. The majority (57.1%) first disclosed to a friend. Approximately 30% first disclosed to a family member. The typical participant’s first disclosure happened roughly 3 years before Time 1.

•    Correlations and linear regressions controlling for gender, age, and social desirability revealed that, of the four disclosure measures, only the number of rejecting reactions was directly associated with substance use or abuse. More rejecting reactions predicted greater substance use at Times 1 and 2 (beta’s ranged from 0.13-0.28) and more substance abuse symptoms at Time 2 (beta = 0.44) and Time 3 (beta = 0.20). 

•    Researchers used linear regression to assess whether the number of accepting reactions moderated the relationship between the number of rejecting reactions and substance use. The interaction term (number of accepting reactions x number of rejecting reactions) significantly added to the prediction of four measures of alcohol use. Inspection of the regression slopes revealed that when participants had fewer accepting reactions, alcohol frequency and quantity increased as the number of rejecting reactions increased. However, when participants had a high number of accepting reactions, participants reported a relatively low/moderate level of alcohol use, regardless of the number of rejecting reactions they experienced. Figure 1, adapted from Rosario et al., 2009, shows the interaction between accepting and rejecting reactions predicting frequency of alcohol use at Time 1. The pattern was similar for other alcohol measures.

Limitations
•    The sample was composed of individuals living in an urban environment who were members of LGB organizations. Therefore, this sample might differ from the wider population of LGB youths in some important ways.

•    Participants provided descriptions of their disclosure retrospectively.

•    Participants varied in the length of time between disclosure and Time 1; it is unclear whether this variable influenced the relationship between reactions to disclosure and substance use/abuse.

•    Because these data were correlational, it is premature to conclude that reactions to disclosure causally influenced substance use and abuse.

Conclusions
•    Despite the limitations noted above, these data suggest that one risk factor for substance use and abuse among LGB youths is having more friends, family members, and other people react to disclosure in a rejecting manner.
•    Accepting reactions to disclosure are protective and blunt the impact of rejection on substance use and abuse.

What do you think?  Please use the comment link below to provide feedback on this article.

References
Marshal, M. P., Friedman, M. S., Stall, R., King, K. M., Miles, J., Gold, M. A., et al. (2008). Sexual orientation and adolescent substance use: A meta-analysis and methodological review. Addiction, 103(4), 546-556.

Rosario, M., Schrimshaw, E. W., & Hunter, J. (2009). Disclosure of sexual orientation and subsequent substance use and abuse among lesbian, gay, and bisexual youths: Critical role of disclosure reactions. Psychology of Addictive Behaviors, 23(1), 175-184.

Addiction & the Humanities, Vol. 5(5) – A Possible Resolution: Regulation of Cognitive-Enhancing Drugs

In our past two issues of Addiction and the Humanities, we discussed the debate within the medical and legal communities about whether people should use powerful drugs for cognitive enhancement. This last installment of the series advances the discussion from whether people should use these drugs to a consideration of safety, distribution, and legalization.

Safety
Cognitive-enhancing drugs specifically affect executive function, and anecdotal evidence claims that they also improve focus and memory and reduce the effects of fatigue (Beddington et al., 2008; Morein-Zamir, Turner, & Sahakian, 2007; Turner et al., 2003). Researchers have tested one drug,  Modafinil, in healthy individuals (Turner et al., 2003) but there is little research on the safe use of other cognitive-enhancing drugs among healthy individuals (Lanni et al., 2008). For example, it is unclear what the difference in dosage for increasing focus would be for a healthy person versus a person with ADHD (Turner et al., 2003). Further, some drugs, such as Ritalin, carry the risk of heart problems and dependency (Hibbert, 2007), two issues that would have to be addressed in order to distribute cognitive-enhancing drugs safely and legally. Lastly, like any other drug, there are unsafe black-market versions of cognitive enhancing drugs available to buyers; it is important to alert the public to the dangers of using these unsafe versions that could lead to lethal side effects. 

Distribution
The widespread use of cognitive enhancing drugs for self-improvement also brings up the issue of fairness and equal access (Dekkers & Rikkert, 2007). As more people request to use these drugs, legislators, researchers, and clinicians will have to work together to ensure that groups of people with a greater need will always be given priority access to cognitive enhancing drugs. Furthermore, a discussion about access ought to stimulate discussion about where people should be purchasing cognitive-enhancing drugs (i.e. prescriptions vs. over the counter availability).

Legalization
Although cognitive-enhancing drugs such as Ritalin, Adderall, and Modafinil are legal, there are issues surrounding use, supplier authorization, and possession that will have to be addressed. For example, if cognitive enhancers can only be obtained via prescriptions, then regulations will have to be put in place to determine how much of each substance an individual is allowed to have in their possession. Furthermore, discussion of necessary rules and regulations should encourage discussion about whose responsibility it will be to make these rules (i.e., legislators vs. clinicians)

Conclusion
The use of cognitive enhancing drugs is already fairly common (DeSantis et al., 2008; Greely et al., 2008). In fact, some experts consider these drugs the next logical step in human self-improvement (Greely et al., 2008). However, if we, as a society, are willing to legitimize the use of drugs for cognitive enhancement, then we must also accept the unavoidable changes that they will bring to opportunities for success, academics, and even creativity. In order to manage cognitive-enhancing drug use, there needs to be enough regulation to prevent harm.

- Ingrid Maurice

What do you think? Please use the commen tlink below to provide feedback on this article.

References

Beddington, J., Cooper, C. L., Field, J., Goswami, U., Huppert, F. A., Jenkins, R., et al. (2008). The mental wealth of nations. Nature, 455(7216), 1057-1060.

Dekkers, W., & Rikkert, M. O. (2007). Memory enhancing drugs and Alzheimer's disease: enhancing the self or preventing the loss of it? Med Health Care Philos, 10(2), 141-151.

DeSantis, A. D., Webb, E. M., & Noar, S. M. (2008). Illicit use of prescription ADHD medications on a college campus: a multimethodological approach. J Am Coll Health, 57(3), 315-324.

Greely, H., Sahakian, B., Harris, J., Kessler, R. C., Gazzaniga, M., Campbell, P., et al. (2008). Towards responsible use of cognitive-enhancing drugs by the healthy. Nature, 456(7223), 702-705.

Hibbert, K. (2007, November 8). Ways to make you think better. guardian.co.uk.

Lanni, C., Lenzken, S. C., Pascale, A., Del Vecchio, I., Racchi, M., Pistoia, F., et al. (2008). Cognition enhancers between treating and doping the mind. Pharmacol Res, 57(3), 196-213.

Morein-Zamir, S., Turner, D. C., & Sahakian, B. J. (2007). A review of the effects of modafinil on cognition in schizophrenia. Schizophr Bull, 33(6), 1298-1306.

Turner, D. C., Robbins, T. W., Clark, L., Aron, A. R., Dowson, J., & Sahakian, B. J. (2003). Cognitive enhancing effects of modafinil in healthy volunteers. Psychopharmacology (Berl), 165(3), 260-269.

ASHES, Vol. 5(5) – The Effects of Smoking and Smoking Abstinence on Verbal and Visuospatial Working Memory Capacity

Smoking can cause numerous health problems. However, despite this fact, many people start and continue to smoke cigarettes. Often, smokers argue that smoking actually helps them concentrate and think more clearly. Is it actually so? Working memory is one of the mental systems involved in the thinking process. This week the ASHES reviews a study by Greenstein & Kassel (2009), which examines the effect of smoking on working memory. Working memory is a complex mental system that is involved in performing tasks that require both storage and processing information. How does smoking and smoking abstinence affect working memory capacity? Previous studies examining this question have produced inconsistent results (e.g., showing higher or lower performance for smokers and nonsmokers on different tasks) depending on the task itself. The study under review uses highly reliable, well-validated working memory tasks to examine the effect of smoking and smoking abstinence on verbal and visiospatial working memory capacity.

Methods

• Researchers recruited 49 male middle-aged participants, 26 smokers and 23 nonsmokers.
• All participants completed two experimental sessions (1 week apart).
  • During one session, smokers abstained from smoking for 12 hours or more. During the next session, investigators instructed smokers to smoke as they usually would.  
  • During each session, participants completed two tasks to measure their memory capacity.  
    1. OSPAN – a measure of verbal working memory capacity.
       •  Participants solved a math problem while simultaneously trying to recall a series of letters.   
       • Investigators calculated their performance as a proportion of correct responses multiplied by 100 to get an index that ranged from 0 to 100.   
    2. SSPAN – a measure of spatial working memory capacity. 
    • Participants recalled sequences of red-squared locations while performing a symmetry judgment task (deciding whether the presented figures were symmetrical or asymmetrical along the vertical axis).
• In addition, researchers measured demographic characteristics and cognitive abilities to assure the initial similarities in basic academic skills between smokers and nonsmokers (no differences were found).      

Results

• Investigators removed 15 participants (9 smokers and 6 nonsmokers) from the analyses, because of low performance in math or symmetry tasks (less than 80% accuracy). This ensured that the analyses included only those participants who were attempting to solve both tasks.
• Smokers manifested better OSPAN performance (verbal working memory task) when they were abstinent compared with when they were not abstinent. Also, nonsmokers performed better on this task than did smokers (see Figure 1).
• There were no significant differences between any groups for the SSPN (spatial working memory task) performance.
  

Figure 1. OSPAN (Operation Span Task) performance (* p < .05).

 
Limitations

• Is working memory actually the same as “concentration”? These two concepts are not necessary identical. 
• The study used a limited sample size.
• Participants were males only.

Conclusion

The study claims to test the conventional wisdom that smoking helps concentration. Rather then testing concentration, however, the authors examined the more specific effects of smoking on working memory capacity. The results demonstrate that smoking might cause different effects on different working memory domains. Specifically, (a) smokers’ verbal working memory performance is less effective compared to nonsmokers’, (b) smokers’ verbal working memory capacity is less effective after smoking than during abstinence, and (c) smoking does not affect visiospatial working memory span. These results suggest that smoking actually can impair some of the memory functions necessary for complex tasks (e.g., comprehension, learning, and reasoning). The authors also interpret their results as a demonstration that there is no evidence that smoking helps the ability to concentrate. This particular conclusion, however, seems to contradict the “conventional wisdom” and other scientific results. For example, a recent study (Zabala et al. 2009) showed that smoking facilitated cognitive functioning (including attention and working memory tasks performance) among psychotic patients. The contradiction between these studies might be due to the differences between psychotic and non-psychotic participants. To test this hypothesis and to resolve the contradiction, we need additional studies.

-Julia Braverman

What do you think?  Please use the comment link below to provide feedback on this article.

References

 Greenstein, J., & Kassel, J. (2009). The effects of smoking and smoking abstinence on verbal and visuospatial working memory capacity. Experimental and Clinical Psychopharmacology, 17(2), 78-90.

Zabala, A., Eguiluz, J., Segarra, R., Enjuto, S., Ezcurra, J., Pinto, A., et al. (2009). Cognitive performance and cigarette smoking in first-episode psychosis. European Archives of Psychiatry and Clinical Neuroscience, 259(2), 65-71

The DRAM Vol. 5(5) - One Drug, Two Treatments

Research has shown that alcohol and tobacco dependence are often comorbid disorders (Grant, 1998; McKee, Falba, O'Malley, Sindelar, & O'Connor, 2007). Research also shows that some of the chemical treatments used for smoking cessation may be used to treat alcohol consumption and craving. This week the DRAM reviews a study that tested the effects of varenicline, a new FDA approved treatment for smoking cessation, on alcohol consumption in heavy smokers and drinkers (McKee et al., 2009).

Methods:

• The researchers conducted a double-blind, placebo controlled study examining the effect of varenicline on alcohol self-administration.
• Participants (N=20) were eligible if they were ≥ 21 years old, smoked ≥ 10 cigarettes daily, and drank multiple drinks multiple days per week but were not alcohol dependent.
• Participants took varenicline or a placebo for 7 days prior to completing a 14-hour laboratory session that included two 1-hour alcohol self-administration sessions.
• The researchers measured alcohol craving prior to and during the alcohol self-administration sessions.

Figure 1: Alcohol Craving Before and During Alcohol Self-Administration Sessions (Adapted from McKee et al., 2009).

*VAS is a visual analogue scale, i.e., a continuous scale on which participants mark a point indicating their response

Results:

• Figure 1 shows that alcohol cravings decreased in the varenicline group but increased in the placebo group across time (time x medication, F = 2.57, p < .05).
• Participants who took varenicline consumed significantly fewer drinks than participants who took a placebo during the self-administration periods (varenicline M = 0.5, SD = .40; placebo M = 2.60, SD = .9; p < .05).

Limitations:

• The sample size was small.
• The results might not generalize to all drinking populations because the drug was not tested on people with alcohol dependence or people who did not smoke.
• The effects of this drug were tested in a laboratory, not in actual social drinking situations.

Conclusion:

This study demonstrated that varenicline was able to inhibit alcohol consumption and craving in people who are heavy drinkers and smokers. Varenicline use had minimal adverse effects. Given that the majority of drinkers smoke, varenicline seems like a promising drug to treat people with dual alcohol and tobacco disorders.

-Tasha Chandler

What do you think? Please use the comment link below to provide feedback on this article.

References:

Grant, B. F. (1998). Age at smoking onset and its association with alcohol consumption and DSM-IV alcohol abuse and dependence: Results from the National Longitudinal Alcohol Epidemiologic Survey. Journal of Substance Abuse, 10(1), 59-73.

McKee, S. A., Falba, T., O'Malley, S. S., Sindelar, J., & O'Connor, P. G. (2007). Smoking status as a clinical indicator for alcohol misuse in US adults. Archives of Internal Medicine, 167(7), 716-721.

McKee, S. A., Harrison, E. L., O'Malley, S. S., Krishnan-Sarin, S., Shi, J., Tetrault, J. M., et al. (2009). Varenicline reduces alcohol self-administration in heavy-drinking smokers. Biological Psychiatry (In Press).