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New research on natural recovery from disordered gambling

New research on natural recovery from disordered gambling. Wendy Slutske, Ph.D. Professor of Psychology University of Missouri. Supported in part by NIH grant MH66206. what is natural recovery? how common is natural recovery for disordered gambling?

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New research on natural recovery from disordered gambling

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  1. New research on natural recovery from disordered gambling Wendy Slutske, Ph.D. Professor of Psychology University of Missouri Supported in part by NIH grant MH66206

  2. what is natural recovery? • how common is natural recovery for disordered gambling? • how does this compare to other disorders? • how is natural recovery studied? • results of three epidemiologic studies of natural recovery from disordered gambling • the why, who, and how of natural recovery Plan of talk

  3. natural recovery is a well-traveled road to recovery for disordered gambling

  4. What are we talking about? • natural recovery • untreated recovery • spontaneous recovery • spontaneous remission • natural resolution • self-recovery • self-resolution • self-change • maturing out • when a disorder is “self-limited”

  5. What are we talking about? help line? From Sobell, 2007

  6. What are we talking about? help line? From Sobell, 2007

  7. Gambling helplines • Connecticut 1-800-34 NO BET • California 1-800-GAMBLER • New Jersey 1-800-GAMBLER • West Virginia 1-800-GAMBLER • Florida 1-888-ADMIT IT • Oregon 1-800-MY LIMIT • Missouri 1-888-BETS OFF

  8. What is “recovery”? • not meeting diagnostic criteria anymore? • completely symptom free? (for how long?) • completely abstaining from gambling? • symptom free for the past 12 months, abstinence not required

  9. What is “natural recovery”? “natural recovery” may be a deliberate active intentional process of recovering from problems without formal treatment (that requires recognition that there is a problem) or “natural recovery” truly may happen naturally, without any intention or effort, e.g. problems may be developmentally- or situationally-limited

  10. Problem recognition in pathological gambling DSM-IV PG 14% % ever thought had a “problem” # lifetime DSM-IV PG symptoms = % received formal treatment in NESARC study

  11. Problem recognition?

  12. Excerpts From: My Prison Without Bars by Pete Rose (2004) Outside of baseball and my family, nothing has ever given me the pleasure, relaxation, or excitement that I got from gambling. …I started going to the racetrack with my dad when I was 6 years old and I've been going ever since. I tried to think back to the times when friends and family tried to warn me that my gambling was getting out of control. Why did I ignore their advice? How could I have been so arrogant? I was bothered by the very thought that something might be wrong with me. So I dismissed the thought altogether.

  13. Excerpts From: My Prison Without Bars by Pete Rose (2004) I honestly didn't believe I had a "problem"...definitely not a "sickness." Then my lawyer Reuven Katz gave it to me straight. "If you don't seek help," he said, "I can't continue to represent you as a client."... So as difficult as it was, I went to a psychiatrist... My first instinct was to convince the shrink that I didn't have a problem...I explained that I gambled for excitement...pleasure...and competition… …I saw problem gamblers as degenerates who held no status in life, people who gambled every day until they lost everything. I reminded him that I didn't drink, smoke, or use drugs, and that I sometimes went months at a time without gambling at all. In my mind, I still didn't fit the profile of the typical "problem" gambler.

  14. 1997 attended just one meeting of Gambler’s Anonymous recovered from PG would not count as a “natural recovery” in my research

  15. From: Canadian Medical Association Journal, July 15, 2008

  16. July 2007 February 2008 “Many are addicted. Few are treated. Yet many who are not treated recover.”

  17. How is natural recovery studied? • longitudinal research • course of disordered gambling behavior • cross-sectional survey research • rates of treatment and recovery for disordered gambling behavior • media solicitations of recovered individuals • why, when, and how natural recovery occurs

  18. Conclusions from longitudinal studies of the course of disordered gambling behavior • disordered gambling can be episodic as well as chronic • recovery is not uncommon • the level of disordered gambling within an individual often changes over time • major weakness of the longitudinal studies is that they were small and focused on subclinical problem gambling

  19. What about pathological gambling disorder?

  20. Vietnam Era Twin Registry • national sample of male-male twins concordant for serving in the U.S. military 1965-1975 (the era of the Vietnam war) • 8,169 individuals completed a psychiatric diagnostic interview including symptoms of DSM-III-R PG in 1992 • twins were 34-54 years old at the time of the interview • in 2002 conducted a 10-year follow-up of 2,400 individuals, including: • 94 individuals with DSM-III-R PG disorder • 420 individuals with subclinical problem gambling

  21. 10 year follow-up of disordered gambling in the VET Registry

  22. How is natural recovery studied? • longitudinal research • course of disordered gambling behavior • cross-sectional survey research • rates of treatment and recovery for disordered gambling behavior • media solicitations of recovered individuals • why, when, and how natural recovery occurs

  23. The Epidemiologic Catchment Area Study From Robins & Regier, 1991; Regier et al., 1993

  24. The Epidemiologic Catchment Area Study From Robins & Regier, 1991; Regier et al., 1993

  25. Three cross-sectional epidemiologic studies of pathological gambling disorder • National Epidemiologic Survey of Alcohol and Related Conditions (NESARC) • Gambling Impact and Behavior Study (GIBS) • Australian Twin Gambling Study

  26. National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) • surveyed 43,093 individuals drawn from the civilian, non-institutionalized United States population • structured in-home interviews conducted in 2001-2002 • assessed DSM-IV pathological gambling and comorbid conditions • lifetime prevalence of DSM-IV pathological gambling = 0.42%

  27. The course of pathological gambling in the NESARC study • number of episodes of PG: 1 episode – 62% 2 episodes – 11% 3 or more episodes – 27% • duration of longest episode of PG: mean = 2.4 years range = 1 month to 50 years 1 year or less – 80% 1.5 to 5 years – 12% 9 or more years – 8%

  28. Gambling Impact and Behavior Study • surveyed 2,417 individuals drawn from the civilian, non-institutionalized United States population • conducted as part of a report prepared by the National Gambling Impact Study Commission, authorized by Congress • structured telephone interviews conducted in 1998-1999 • assessed DSM-IV pathological gambling and gambling involvement • lifetime prevalence of DSM-IV pathological gambling = 0.80%

  29. Australian Twin Gambling Study • surveyed 4,764 members of a national Australian Twin Registry • structured telephone diagnostic interviews included DSM and SOGS • twins born between 1964-1971 (age 33-43 years at interview) • lifetime prevalence of DSM-IV pathological gambling = 2.2%

  30. Why Australia? • “Australians have long thought of themselves as a nation of gamblers...The belief that typical Australians would bet on two flies crawling up a wall is part of our folklore” (O’Hara, 1988) • The first state lottery was established in 1916 in Australia (in Queensland) compared to 1963 in the United States (in New Hampshire)

  31. Cross-national comparison of gaming machines Expenditure on gaming machines per adult ($AU) Gaming machines per 10,000 adults Maximum average loss per hour ($AU) From: How Australia Compares, 2004

  32. Lifetime participation in gambling activities

  33. Rates of recovery from pathological gambling

  34. Rates of recovery from pathological gambling * at 10 year follow-up

  35. Rates of treatment for pathological gambling

  36. Rates of treatment for pathological gambling * Restricting NESARC sample to 32-43 year olds

  37. Rates of treatment for other psychiatric disorders in the NESARC From: Dawson et al. (2005); Huang et al. (2006); Hasin et al. (2005); Grant et al. (2005); Grant et al. (2005); Grant et al. (2006); Grant et al. (2005)

  38. Percentage of pathological gambling recoveries that are natural recoveries

  39. Recovery from pathological gambling: treatment versus no treatment

  40. Conclusions from cross-sectional epidemiologic studies of disordered gambling • confirm that recovery from DG is not uncommon and that DG is often episodic • treatment for DG is rare • people suffering from DG are less likely to receive treatment than those suffering from other mental disorders • most recoveries are natural recoveries

  41. natural recovery is a well-traveled road to recovery for many with disordered gambling

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