Assessing the Need for Higher Levels of Care Among Problem Gambling Outpatients

Most treatment for gambling disorder is provided on an outpatient basis. Only a small number of jurisdictions in North America provide higher levels of gambling treatment, such as residential or intensive outpatient (IOP) care, despite the potential need for these services. Further, there appear to be few guidelines for determining appropriate level of gambling treatment. The aim of the present study was to assess the appropriateness of higher levels of problem gambling care among clients receiving outpatient treatment. Problem gamblers and their therapists independently completed questionnaires that assessed the need and desire for residential and IOP treatment. About 42% of problem gambling outpatients noted that they would be “probably” or “definitely” willing to attend residential treatment, and about half indicated they would be equally likely to attend IOP. Therapists recommended about a third of their clients as appropriate for higher levels of care. For both client and therapist assessments, there was a significant association between desire or recommendation for level of treatment and severity of gambling and co-occurring problems. Further, therapist recommendations for level of care were significantly associated with client willingness to attend higher levels of treatment. Our data reveal the potential need for higher levels of care for problem gambling, as evaluated by clients and their therapists. Policy implications for the funding of residential and IOP treatment are discussed.     

Subtyping Non-treatment-seeking Problem Gamblers Using the Pathways Model

This study examined whether distinct subgroups could be identified among a sample of non-treatment-seeking problem and pathological/disordered gamblers (PG) using Blaszczynski and Nower’s (Addiction 97:487–499, 2002) pathways model (N = 150, 50% female). We examined coping motives for gambling, childhood trauma, boredom proneness, risk-taking, impulsivity, attention-deficit/hyperactivity disorder (ADHD), and antisocial personality disorder as defining variables in a hierarchical cluster analysis to identify subgroups. Subgroup differences in gambling, psychiatric, and demographic variables were also assessed to establish concurrent validity. Consistent with the pathways model, our analyses identified three gambling subgroups: (1) behaviorally conditioned (BC), (2) emotionally vulnerable (EV), and (3) antisocial-impulsivist (AI) gamblers. BC gamblers (n = 47) reported the lowest levels of lifetime depression, anxiety, gambling severity, and interest in problem gambling treatment. EV gamblers (n = 53) reported the highest levels of childhood trauma, motivation to gamble to cope with negative emotions, gambling-related suicidal ideation, and family history of gambling problems. AI gamblers (n = 50) reported the highest levels of antisocial personality disorder and ADHD symptoms, as well as higher rates of impulsivity and risk-taking than EV gamblers. The findings provide evidence for the validity of the pathways model as a framework for conceptualizing PG subtypes in a non-treatment-seeking sample, and underscore the importance of tailoring treatment approaches to meet the respective clinical needs of these subtypes.     

Prevalence of sarcopenia and its association with functional and nutritional status among male residents in a nursing home in Turkey

Introduction The Aging Male Symptoms' (AMS) scale was designed as a health-related quality of life (QoL) scale and standardized as a self-administered scale, first, to assess symptoms of aging (independent from those which are disease-related) between groups of males under different conditions, second, to evaluate the severity of symptoms/QoL over time, and, third, to measure changes pre- and post-androgen replacement therapy. The scale is in widespread use (17 languages currently available) and a recent review of methodological data documented good psychometric characteristics and ability as a clinical utility. This paper describes test characteristics of the AMS (positive and negative predictive values), taking two internationally established and published screening scales for androgen deficiency as the available standard.

Method A sample of 150 German males aged 40–69 years completed the AMS scale and two screening scales for androgen deficiency: the ADAM scale of Morley and colleagues and the screener of Smith and colleagues. The technique of a computer-assisted telephone interview was applied.

Result The comparison of the AMS with the two screening instruments for androgen deficiency showed sufficiently good compatibility despite conceptual differences. The AMS scale sufficiently predicted the results of the two screening instruments. A positive predictive value of 92% and a negative predictive value of 50% were found regarding the ADAM scale. The respective figures regarding Smith's screener were 65% and 49% for positive and negative predictive values, respectively.

Conclusion The AMS scale obviously measures a similar phenomenon as the two established and widely used screeners for androgen deficiency, although it was not developed as a screening instrument.     

Alternative plans for London Dockland: Not force but seduction

Built into the planning of much of dockland has been the belief that physical plans would stimulate adequate new machinery to implement them.

A review of some of these plans suggests that physical plans can sterilize new machinery, by pre-empting decisions which are seen to be integral to the purposes of that new institution.

This article suggests that the next round of dockland planning should concentrate on the organizational and political design to manage change in dockland.

The physical-economic plans can then become an accurate reflection of widely inclusive emplementation institutions.

If brought into being with political astuteness, new government development corporations have the possibility of capturing political constituencies presently omitted from the system. But persuasion and participation must be the major processes, not coercion or exclusion.     

What's an Oscar worth?

This article examines the impact of an Academy Award nomination and award for best picture, best actor/actress, and best supporting actor/actress on a film's (i) market share of theaters, (ii) average revenue per screen, and (iii) its probability of survival. The model is estimated using weekly box-office data for a matched sample of nominated and non-nominated films. The results indicate substantial financial benefits for a nomination and award for best picture and best actor/actress. The structure of rewards is consistent with that found in two-stage, single-elimination tournaments.     

Executive Function in Pathological Gamblers and Healthy Controls

Executive function (EF) deficits may underlie some of the impulse control problems seen in pathological gambling. Pathological gamblers (PGs, n = 45) and controls (n = 45) were compared on several measures of EF (including measures of response inhibition, working memory, cognitive flexibility and perseveration, planning and decision-making), as well as memory and intelligence tests to examine whether PGs evidence EF dysfunction. Compared with controls, PGs exhibited specific deficits on measures of planning and decision-making. PGs also exhibited relative deficits on a measure of perseveration, but this deficit was no longer significant after controlling for group differences in intelligence. These results suggest that PGs may experience deficits on specific components of EF.