Patterns of alcohol and substance use among treatment-seeking problem gamblers Linshan Gu (Jessica), Grace Wang, Maria Bellringer, Nick Garrett 6 th National Addiction Symposium, Auckland, 22 April 2015

Background High rates of comorbidity have been consistently reported –Research shows that over 35% of problem gamblers have problem of AOD use (Hodgin et al., 2005, Stinchfield & Winters, 2011) People with problem gambling and substance abuse have improved not only gambling but also other areas However, a concern has been raised in terms of switching one substance for another during treatment There are some uncertainties around the change patterns of AOD use over the gambling treatment periods

Aim and research question Aim To investigate the changing patterns of AOD problems in help-seeking gamblers over time Research question Does problem gambling treatment change drug and alcohol behaviour among help-seeking gamblers?

Methods Participants: help-seeking callers to the Gambling Helpline Recruitment: August 2009 to May 2011 Participants (N=150): over the age of 18 years Treatment: Helpline’s standard care including brief intervention, suggestions for self-care and/or referral to face-to-face problem gambling counselling services Note that this research is a part of a larger study on gambling treatment outcome (Abbott et al., 2013)

Methods Measures - Problem Gambling Severity Index (PGSI) 0 = non-problem gambling; 1-2 = low risk; 3-7 = moderate risk; 8+ = problem gambling - Drug Abuse Screening Test (DAST) 0-2 = non-problem drug use; 3-10 = moderate to severe level of drug use - Alcohol Use Disorders Identification Test (AUDIT-C) social drinkers = drink 2 or more times a week; heavy drinkers = have 5 or more drinks on a typical day; binge drinkers = drink six or more drinks on one occasion weekly or almost daily

Results Table 1: Demographics at baseline of the help-seeking gamblers sample Help-seeking gamblers At Baseline At 12 months follow up Retention rate VariablesN (%) Gender Male64 (42.7)41 (41.8)64.10% Female86 (57.3)57 (58.2)66.30% Age Group years21 (14.0)8 (8.2)38.10% years37 (24.7)21 (21.4)56.80% 35+ years88 (58.7)69 (70.4)78.40% Ethnicity European63 (42.0)49 (50.0)77.80% Non-European87 (58.0) 49 (50.0) 56.30%

Table 2: Gambling, AOD use measures across two time points Help-seeking gamblers At Baseline At 12 months follow up N (%) PGSI Non-problem gambler0 (0.0)5 (3.3) Low risk gambler1 (0.7)24 (16.0) Moderate risk gambler15 (10.0)27 (18.0) Problem gambler129 (86.0)37 (24.7) Moderate to severe drug use Yes17 (11.3)2 (2.0) No123 (82.0)95 (96.9) Social drinking Yes47 (31.3)33 (33.7) No96 (64.0)65 (66.3) Heavy drinking Yes57 (38.0)28 (28.6) No86 (57.3)70 (71.4) Binge drinking Yes36 (24.0)9 (9.2) No107 (71.3) 89 (90.8)

Change patterns- AOD use

Discussion Comorbidity between problem gambling and AOD use are high (11% for drug use and over 24% for drinking problems) –2007/2008 New Zealand Alcohol and Drug Survey (Ministry of Health, 2009) : 17% for recreational drug use and 10% for alcohol use –Compared to the general population of NZ, severity of AOD use is greater in problem gamblers Help-seeking gamblers showed improvement in –problem gambling –moderate to severe drug use and –binge drinking But did not show significant improvement in –social drinking and –heavy drinking

Discussion Potential contributing factors for improved treatment outcome – Attitude: desire to change (Ladd & Petry, 2003) – Gambling may be a conditioned cue for AOD use (Steward, 2002) – Help-seeking population Factors related to increased heavy drinking and social drinking - Switch addiction - Social drinking may not have been considered a problem - Not related to gambling - Other psychological distress

Strengths and Limitations Strengths Measured problem gambling as well as AOD use Followed up at 12 months Limitations Small sample size High dropout rates, however, it is common for longitudinal studies

Conclusion and Implications AOD use is a common comorbid condition of problem gambling –Therefore should be screened for in routine clinical assessments Severity of problem gambling, moderate to severe drug use and binge drinking are likely to be reduced following gambling treatment Better outcome may be achieved with the combined gambling and AOD treatment

Acknowledgement Funding body: - Ministry of Health - AUT summer research award Gambling and Addictions Research Centre Gambling Helpline Participants

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