Pharmacological treatments of pathological gambling

Medication treatment studies have demonstrated short-term efficacy of various SRIs, opioid antagonists, and mood stabilizers in sub-samples of adult treatment seeking pathological gamblers. Pathological gambling is frequently comorbid with bipolar spectrum disorders, substance abuse/dependence, and attention-deficit/hyperactivity disorder (ADHD), and comorbidity may influence treatment response in pathological gambling. This review focuses on recent research examining the treatment of pathological gambling and highlights methodological challenges for future studies.     

Women,Therapy and Dependency

A microsociological longitudinal study of 120 middle class Melbourne women who were having psychotherapy or counselling was conducted over a five year period. The relative effectiveness of four dominant kinds of psychotherapy was assessed, together with outcomes for types of individuals. The therapies were medical chemotherapy (with psychotherapeutic drugs prescribed by general practitioners), social casework counselling, human relations training and church pastoral counselling. Personal accounts of the women revealed their main concerns were to change their personal identities, and the economic, psychological and emotional aspects of dependency on significant others. After five years, only a small proportion of the total showed positive changes as represented by movement towards independence and autonomy. More than twice as many experienced a serious deterioration of circumstances and increased dependency on others, on therapists and drugs. None of the psychotherapies had much positive outcome. However the clients who felt most helped by the therapies became professional therapists themselves — a finding which suggests the perpetuation of ineffectual systems.     

Minding the Gap: Positivism, Psychology, and the Politics of Qualitative Methods

This article explores the politics and practices of qualitative research, in particular by interrogating the "gap" between qualitative and quantitative approaches to research. Two main claims are elaborated: first, that despite being recommended on grounds of ethical superiority (such as of nonmanipulation and instrumentality), qualitative research is not immune from such problems and may indeed harbor its own practices of exploitation; second, and correspondingly, that the moral high ground associated with qualitative research arises from the ways it is used rather than from any intrinsic features of the methodology. The argument is made that it is important to maintain this distinction in order to counter the tendency toward methodological fetishism so prevalent in scientistic (i.e., aspiring to "natural" scientific status) disciplines such as psychology. After framing these issues with some comments on the current popularity of qualitative methods, the article illustrates these claims by exploring 5 key ways that the positivist agenda of the discovery and control of a natural world can return in qualitative research, especially when this is mistakenly evaluated according to criteria formulated for quantitative analyses. The article concludes with a consideration of the epistemological and political status of attempts either to bridge or exacerbate the gap between qualitative and quantitative approaches.     

Using Resilience to Reconceptualise Child Protection Workforce Capacity

Abstract

Current approaches to managing and supporting staff and addressing turnover in child protection predominantly rely on deficit-based models that focus on limitations, shortcomings, and psychopathology. This article explores an alternative approach, drawing on models of resilience, which is an emerging field linked to trauma and adversity. To date, the concept of resilience has seen limited application to staff and employment issues. In child protection, staff typically face a range of adverse and traumatic experiences that have flow-on implications, creating difficulties for staff recruitment and retention and reduced service quality. This article commences with discussion of the multifactorial influences of the troubled state of contemporary child protection systems on staffing problems. Links between these and difficulties with the predominant deficit models are then considered. The article concludes with a discussion of the relevance and utility of resilience models in developing alternative approaches to child protection staffing issues.     

Changing cultural stigma: A pilot study of LGBT and mental illness organizations

This study examines how an LGBT advocacy organization and a mental illness advocacy organization influence cultural byproducts that result in stereotypes. Burke's (1989) redemption ritual is adapted as a framework for conceptualizing the process that occurs when an advocacy organization expresses discontent with a cultural producer's byproducts.     

Assessing University Students’ Self-efficacy to Employ Alcohol-Related Harm Reduction Strategies

Abstract

Objective: Develop and evaluate key psychometric properties of a self-report questionnaire specifically designed to assess student drinkers’ self-confidence to employ a variety of strategies intended to reduce unhealthy consequences of high-risk drinking. Methods: Four hundred ninety-eight participants rated their confidence (from “not at all confident” to “completely confident”) to employ 17 harm reduction strategies when drinking. Results: Factor analysis and internal consistency reliability analyses indicated that the 17 items constitute a single scale with good test–retest reliability. Consistent with other research examining previous use of such strategies, women in our sample reported significantly higher harm reduction self-efficacy than did men. Harm reduction self-efficacy was also associated with reported number of high-risk drinking episodes in the previous 2 weeks. Conclusion: This brief and easily administered questionnaire holds promise as a clinical tool to identify individuals with low harm reduction self-efficacy and as an outcome measure for health promotion and educational interventions.     

Social Density of Gambling and Its Association with Gambling Problems: An Initial Investigation

The role of social factors in pathological gambling has received relatively little systematic research. The goal of the current study was to examine the relationship between a target individual’s gambling behavior and the gambling behavior among that individual’s parents, siblings and five closest friends. The specific aims were, first, to apply a novel brief assessment to study the social density of factors relating to pathological gambling; second, to replicate previously observed findings involving the social aggregation of alcohol and tobacco use; and third, to examine social density findings among the three domains. Participants were 128 frequent gamblers from the Athens, Georgia area, 79.7 % male with a mean age of 34.2 (SD = 11.7). Participants were assessed using the Diagnostic Interview for Gambling Severity for gambling severity, the Alcohol Use Disorders Identification Test for alcohol abuse, the Fagerstrom Test of Nicotine Dependence for tobacco use, and the novel Brief Social Density of Gambling, Alcohol, and Tobacco Assessment. Significant relationships were observed between participants’ and friends’ activity within all domains: gambling (ps = .001), alcohol use (p < .001) and tobacco use (p < .001). Relationships with friends’ activity across domains were less strong. Distinct patterns of associations with parents and siblings were not observed. Thus, social aggregation was observed across the three domains of potentially addictive behaviors, generally with specificity within domains and with friends, not biological relatives. Methodological considerations and potential applications of these findings are discussed.     

A Bioethics Approach to Social Work Practice With Transgender Clients

Increased advocacy for the informed consent model of transgender health care specifies that patients should be in control of access to receiving medical interventions such as hormone therapy or surgery. However, in practice, mental health clinicians, including clinical social workers, are increasingly called upon by medical providers to serve as gatekeepers for these processes. It is frequently the role of social workers to assess transgender clients’ baseline mental health and their understanding of the consequences of treatment, and to forward recommendations to medical providers regarding the readiness of patients to transition. Therefore, social workers assisting transgender clients must be aware of the ethical standards that are particularly pertinent to their work with this marginalized and oppressed population. They must also be prepared to address unique ethical dilemmas that may be especially challenging to resolve. In this article we apply the most commonly utilized bioethical framework known as Principlism to describe the ethical standards and values that are particularly important to consider when working with transgender clients, namely autonomy; beneficence; nonmaleficence; and social justice. Because clinical social workers are frequently in the position of balancing client self-determination with their role as gatekeepers, a framework for resolving resulting ethical dilemmas is described (I CARE) and applied to three case examples.     

Partner aggression severity as a risk marker for male and female violence recidivism

Pretreatment aggression severity was examined as a risk marker for recidivism in the treatment of partner aggression. Intact married couples experiencing husband-to-wife partner aggression were recruited from the community and participated in either conjoint group treatment or gender-specific group treatment. Elevated levels of husband and wife physical aggression and wife psychological aggression before treatment predicted the continuation and severity of physical aggression by both spouses during treatment and in the following year, with no significant differences across treatment formats. These results indicate that high levels of psychological and physical aggression signify a poor prognosis for both conjoint and gender-specific group treatment programs, suggesting the need for interventions of greater intensity, duration, and/or focus for individuals highest in psychological and physical aggression.