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Biomedical subjects

Nancy M Petry

Publications and source records attributed to Nancy M Petry.

At least 37 records · Page 2Linked to original sources
PubMed2006

Severity of gambling problems and psychosocial functioning in older adults.

This study examined the relationship between severity of gambling problems and psychosocial functioning in older adults. Twenty-one current pathological gamblers and 10 current problem gamblers over 60 years of age completed the Addiction Severity Index (ASI), Geriatric Depression Scale (GDS), Brief Symptom Inventory (BSI), UCLA Loneliness Scale (UCLA-LS), and Social Provisions Scale (SPS). Compared with problem gamblers, pathological gamblers reported increased severity of gambling and family/social problems on the ASI; scored higher on the GDS, BSI, and UCLA-LS; and scored lower on the SPS. Although they were not seeking treatment at the time of the interview, three fourths of pathological gamblers and 30% of problem gamblers were interested in gambling treatment. These results suggest that severity of gambling problems is associated with increased psychosocial distress in older adults and that a significant proportion of older adults with a gambling disorder may be cognizant of their gambling problem and interested in treatment.

Aged↗
PubMed2006

Contingency management treatments.

Contingency management is highly efficacious in improving outcomes in substance misuse. Whereas a great deal of research has evaluated these interventions empirically, few treatment providers integrate this approach in practice. The rationale for contingency management is described, with a call for expansion of this technique outside the USA.

Behavior Therapy↗
PubMed2005

What do we know about relapse in pathological gambling?

The study of pathological gambling and its treatment is in a nascent stage. To date, no consistent definition of relapse to gambling exists, and only a few empirical studies have evaluated the phenomenon of relapse directly in this patient population. Perspectives on relapse to drug and alcohol use appear relevant to the study of pathological gambling, and relapse to gambling is reviewed within the larger context of addictive disorders. The application of psychological, biological, environmental, and treatment factors are described as they may relate to relapse among pathological gamblers.

Behavior, Addictive↗
PubMed2005

Does contingency management affect motivation to change substance use?

Although substantial evidence favors the efficacy of contingency management (CM) for substance use disorders, few studies have examined the effect of CM on one's motivation to change substance use. One way of conceptualizing motivation to change is by using the stages of change model [Prochaska, J.O., DiClemente, C.C., 1983. Stages and processes of self-change of smoking: toward an integrative model of change. J. Consult. Clin. Psychol. 51, 390-395]. We assessed motivation to change substance use as conceptualized by the stages of change model using the University of Rhode Island Change Assessment (URICA [McConnaughy, E.A., Prochaska, J.O., Velicer, W.F., 1983. Stages of change in psychotherapy: measurement and sample profiles. Psychother. Theor. Res. 20, 368-375]) in 115 patients in community treatment clinics before they were randomized to receive standard treatment or standard treatment plus CM. Motivation was also assessed 3 months later. Patients in both conditions evidenced significant decreases in their motivation scores from pre- to post-treatment. CM neither increased nor decreased motivation relative to the standard treatment condition. Pre-treatment motivation scores were also not related to treatment outcome. Assignment to the CM condition was associated with better treatment outcome as defined by longest duration of abstinence during treatment (LDA). Higher post-treatment motivation was also modestly associated with LDA, but not in all analyses. These findings suggest that CM neither increases nor decreases motivation to change substance use in outpatients receiving treatment at community-based drug-free clinics. Future studies should further examine motivation change in CM treatment using different assessment tools and conceptualizations of motivation, extending these effects to other treatment settings and populations.

Adult↗
PubMed2005

Contingency management treatments that reinforce completion of goal-related activities: participation in family activities and its association with outcomes.

Contingency management (CM) techniques that reinforce completion of nondrug related activities may be efficacious in treating substance dependence. No studies to date have evaluated whether involvement in particular types of activities reduces problems in those domains. One hundred fifty-nine cocaine-abusing adults who had been randomized to a CM intervention were categorized based on whether or not they engaged in three or more family related activities during the 12-week treatment period. Differences between the groups were evaluated with respect to treatment retention, length of continuous abstinence, and changes from baseline to the end of the intervention in ASI-family scores and days of family conflict. Participants who engaged in family activities (N=29) remained in treatment longer, were abstinent for more weeks, and reported greater reduction in family conflict compared to participants who did not engage in family activities (N=130). These data suggest that participants who elect to complete family related activities during CM treatments may evidence improved outcomes and reduced family conflict.

Adult↗
PubMed2005

Effect of prize-based incentives on outcomes in stimulant abusers in outpatient psychosocial treatment programs: a national drug abuse treatment clinical trials network study.

CONTEXT: Contingency management interventions that provide tangible incentives based on objective indicators of drug abstinence are efficacious in improving outcomes in substance abusers, but these treatments have rarely been implemented in community-based settings. OBJECTIVE: To evaluate the efficacy of an abstinence-based contingency management intervention as an addition to usual care in community treatment settings. DESIGN: Random assignment to usual care or usual care plus abstinence-based incentives for 12 weeks. SETTING: Eight community-based outpatient psychosocial drug abuse treatment programs. PARTICIPANTS: A total of 415 cocaine or methamphetamine users beginning outpatient substance abuse treatment. INTERVENTION: All participants received standard care, and those assigned to the abstinence-based incentive condition also earned chances to win prizes for submitting substance-free urine samples; the chances of winning prizes increased with continuous time abstinent. MAIN OUTCOME MEASURES: Retention, counseling attendance, total number of substance-free samples provided, percentage of stimulant- and alcohol-free samples submitted, and longest duration of confirmed stimulant abstinence. RESULTS: Participants assigned to the abstinence-based incentive condition remained in treatment for a mean +/- SD of 8.0 +/- 4.2 weeks and attended a mean +/- SD of 19.2 +/- 16.8 counseling sessions compared with 6.9 +/- 4.4 weeks and 15.7 +/- 14.4 sessions for those assigned to the usual care condition (P<.02 for all). Participants in the abstinence-based incentive condition also submitted significantly more stimulant- and alcohol-free samples (P<.001). The abstinence-based incentive group was significantly more likely to achieve 4, 8, and 12 weeks of continuous abstinence than the control group, with odds ratios of 2.5, 2.7, and 4.5, respectively. However, the percentage of positive samples submitted was low overall and did not differ between conditions. CONCLUSION: The abstinence-based incentive procedure, which provided a mean of 203 dollars in prizes per participant, was efficacious in improving retention and associated abstinence outcomes.

Adult↗
PubMed2005

Problem and pathological gambling are associated with poorer mental and physical health in older adults.

OBJECTIVE: To evaluate the prevalence and correlates of problem and pathological gambling in older adults. METHODS: Adults (n = 343) aged 60 years and older attending senior centers, bingo sites and other community activities completed a screening form containing the South Oaks Gambling Screen and the Short Form-12 Health Survey, to evaluate physical and mental health. RESULTS: Overall, 6.4% of the respondents were classified as problem gamblers and an additional 3.8% as pathological gamblers. Problem and pathological gamblers evidenced significantly greater physical and mental health problems than non-problem gamblers. CONCLUSIONS: These data suggest that about 10 percent of active older adults experience gambling problems, which are associated with poor physical and mental health.

Aged↗
PubMed2005

Gamblers anonymous and cognitive-behavioral therapies for pathological gamblers.

Numerous types of treatments for pathological gambling have been described, but two of the most common are Gamblers Anonymous (GA) and cognitive-behavioral therapy. This paper describes some outcome data associated with the two approaches. It also reviews evidence suggesting that a combined intervention may enhance therapy engagement and reduce relapse rates.

Behavior Therapy↗
PubMed2005

Stages of change in treatment-seeking pathological gamblers.

The transtheoretical model has been applied to many addictive disorders. In this study, psychometrics properties of the University of Rhode Island Change Assessment (URICA) scale were evaluated in 234 pathological gamblers initiating treatment. Four components were identified--reflective of precontemplation, contemplation, action, and maintenance stages--with internal consistency from .74 to .88. Cluster analyses identified 4 patterns of responding, ranging from ambivalent to active change. The 4 clusters differed with respect to baseline gambling variables and treatment engagement and outcomes assessed 2 months later. A continuous measure of readiness to change was also correlated with gambling severity and predictive of reductions in gambling. This study provides initial support for reliability and validity of the URICA in treatment-seeking gamblers, and it suggests that stage of change may have an impact on outcomes.

Cognitive Behavioral Therapy↗
PubMed2005

Prize reinforcement contingency management for cocaine dependence: integration with group therapy in a methadone clinic.

In this study, the authors evaluated a low-cost contingency management (CM) procedure for reducing cocaine use and enhancing group therapy attendance in 77 cocaine-dependent methadone patients. Patients were randomly assigned to 12 weeks of standard treatment or standard treatment with CM, in which patients earned the opportunity to win prizes ranging from $1 to $100 for submitting cocainenegative samples and attending therapy. Patients in the CM condition submitted more cocaine-negative samples and attended more groups than patients in standard treatment. The best predictor of cocaine abstinence at follow-up was duration of abstinence during treatment. On average, patients in the CM condition earned $117 in prizes. Data from this study suggest that some aspects of reinforcement can be implemented in group therapy in community-based clinics.

Adult↗
PubMed2005

Vouchers versus prizes: contingency management treatment of substance abusers in community settings.

Contingency management (CM) interventions usually use vouchers as reinforcers, but a new technique awards chances of winning prizes. This study compares these approaches. In community treatment centers, 142 cocaine- or heroin-dependent outpatients were randomly assigned to standard treatment (ST), ST with vouchers, or ST with prizes for 12 weeks. CM patients remained in treatment longer and achieved greater durations of objectively confirmed abstinence than did ST patients; CM conditions did not differ significantly. Although abstinence at 6- and 9-month follow-ups did not differ by group, the best predictor of abstinence was longest duration of abstinence achieved during treatment. Thus, prize and voucher CM systems are equally efficacious in promoting long durations of abstinence, which in turn are associated with benefits posttreatment.

Adult↗
PubMed2005

Childhood maltreatment in male and female treatment-seeking pathological gamblers.

Little empirical research has evaluated childhood abuse in pathological gamblers. This study describes results of an analysis of childhood maltreatment histories among 149 pathological gamblers being treated at 1 of 7 gambling treatment programs. Measurements included instruments assessing gambling behavior and the Childhood Trauma Questionnaire (CTQ; D. P. Bernstein et al., 1994). Women scored higher than men on the overall CTQ scale and subscales measuring childhood physical neglect, emotional abuse, and sexual abuse. Severity of childhood maltreatment was significantly and independently associated with lower age of onset of gambling and increased severity of gambling problems. This study suggests that childhood maltreatment is prevalent in pathological gamblers, especially female gamblers. These results warrant further investigation of the role of childhood maltreatment in the etiology of pathological gambling and its treatment.

Adolescent↗
PubMed2005

Antisocial personality disorder is associated with increased severity of gambling, medical, drug and psychiatric problems among treatment-seeking pathological gamblers.

AIMS: To evaluate systematically whether pathological gamblers with antisocial personality disorder (ASPD) experience increased severity of gambling, medical, psychiatric, substance use and psychosocial problems compared to pathological gamblers without ASPD. PARTICIPANTS, DESIGN AND MEASUREMENTS: Pathological gamblers (n = 237) entering an out-patient treatment study for pathological gambling completed the ASPD section of the Structured Clinical Interview for Diagnostic and Statistical Manual version IV (DSM-IV) Personality Disorders, California Psychological Inventory-Socialization Scale, Addiction Severity Index (ASI), Brief Symptom Inventory (BSI) and gambling questionnaires. SETTING: Pathological gambling research clinic. FINDINGS: Thirty-nine (16.5%) pathological gamblers met DSM-IV diagnostic criteria for ASPD. Compared to pathological gamblers without ASPD, pathological gamblers with ASPD were younger, more likely to be male and divorced/separated, and had fewer years of education. They also began gambling earlier in life, reported increased severity of gambling, medical and drug problems, and scored higher on the paranoid ideation, somatization and phobic anxiety subscales of the BSI. Further, logistic regression identified male gender, history of illicit drug use and severity of gambling and medical problems as independent predictors of ASPD. CONCLUSIONS: These results underscore the importance of assessing a wide range of behaviors and personality indices, including ASPD, among treatment-seeking pathological gamblers.

Adult↗
PubMed2005

Health and psychosocial correlates of disordered gambling in older adults.

OBJECTIVE: A number of regional prevalence studies suggest that disordered gambling is a clinically significant problem among older adults. However, little research has evaluated whether older adults with a gambling disorder experience increased health, psychiatric, substance use, and social problems as compared with older adults without a gambling disorder. METHODS: A group of 48 older-adult disordered gamblers and 48 older adult non/infrequent gamblers, matched by age, sex, race, and recruitment site, completed the Addiction Severity Index (ASI), Brief Symptom Inventory (BSI), and Short Form-36 Health Survey (SF-36). Multivariate general-linear models evaluated between-group differences on these indices. RESULTS: Compared with non/infrequent gamblers, disordered gamblers reported increased severity of medical, family/social, psychiatric, and alcohol problems on the ASI. They also scored higher on depression, anxiety, paranoid ideation, and psychoticism subscales of the BSI, and lower on vitality, physical functioning, role-physical, general health, and social functioning subscales of the SF-36. CONCLUSIONS: These results suggest that older adults with a gambling disorder experience increased severity of health and psychosocial problems, compared with older adult non/infrequent gamblers matched by age, sex, race, and recruitment site.

Aged↗
PubMed2005

Comorbidity of DSM-IV pathological gambling and other psychiatric disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions.

OBJECTIVE: To present nationally representative data on lifetime prevalence and comorbidity of pathological gambling with other psychiatric disorders and to evaluate sex differences in the strength of the comorbid associations. METHOD: Data were derived from a large national sample of the United States. Some 43,093 household and group quarters residents age 18 years and older participated in the 2001-2002 survey. Prevalence and associations of lifetime pathological gambling and other lifetime psychiatric disorders are presented. The diagnostic interview was the National Institute on Alcohol Abuse and Alcoholism Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV Version. Fifteen symptom items operationalized the 10 pathological gambling criteria. RESULTS: The lifetime prevalence rate of pathological gambling was 0.42%. Almost three quarters (73.2%) of pathological gamblers had an alcohol use disorder, 38.1% had a drug use disorder, 60.4% had nicotine dependence, 49.6% had a mood disorder, 41.3% had an anxiety disorder, and 60.8% had a personality disorder. A large majority of the associations between pathological gambling and substance use, mood, anxiety, and personality disorders were overwhelmingly positive and significant (p < .05), even after controlling for sociodemographic and socioeconomic characteristics. Male sex, black race, divorced/separated/widowed marital status, middle age, and living in the West and Midwest were associated with increased risk for pathological gambling. Further, associations between alcohol dependence, any drug use disorder, drug abuse, nicotine dependence, major depressive episode, and generalized anxiety disorder and pathological gambling were stronger among women than men (p > .05). CONCLUSION: Pathological gambling is highly comorbid with substance use, mood, anxiety, and personality disorders, suggesting that treatment for one condition should involve assessment and possible concomitant treatment for comorbid conditions.

Adolescent↗
PubMed2004

Gambling participation and problems among employees at a university health center.

This study evaluated the frequency and intensity of gambling behaviors among employees at an academic health center. Employees were sent an anonymous questionnaire assessing demographic characteristics, participation in gambling activities, and gambling-related problems. Of the 904 respondents, 96% reported gambling in their lifetimes, with 69% gambling in the past year, 40% in the past two months, and 21% in the past week. The most common forms of gambling were lottery and scratch tickets, slot machines, card playing, sports betting, bingo, and track. Only 1.2% of the sample reported gambling on the internet. Using scores on the South Oaks Gambling Screen, 3.0% of the respondents were classified as Level 2 (or problem) gamblers, and an additional 1.8% were Level 3 (or pathological) gamblers. Compared to Level 1 (non-problem) gamblers, Level 2 and Level 3 gamblers were more likely to be male, single, and employed full-time, and to have lower income and education. About half of the Level 2 and Level 3 gamblers reported interest in an evaluation of their gambling behaviors and treatment interventions. These data suggest the need to screen for gambling problems in health care professionals and to provide gambling-specific treatments.

Adult↗
PubMed2004

Gambling and suicidality in treatment-seeking pathological gamblers.

One hundred twenty-five adult participants recruited from gambling treatment centers were included in an examination of gambling-related suicidal ideation and attempt. In this sample, 48% (N = 60) had a history of gambling-related suicidal ideation, and an additional 12% (N = 15) reported at least one gambling-related suicide attempt. Measures of gambling experience, impulsiveness, and dissociation were evaluated across groups. Level of suicidality was associated with greater gambling severity, gambling escape, dissociation and attention seeking, impulsivity, and generalized dissociative experience, but not with other psychological indices such as empathy or venturesomeness. The implications of these findings for the identification and treatment of gamblers at risk for suicide are discussed.

Adaptation, Psychological↗