Washington State University
The need for gambling disorder treatment increases due to the growth of the gaming operations in the United States of America and globally, there is a rise in recognition of clinical investigators together with the creation of awareness among the public to be able to assess gambling symptoms and its harmful consequences on the lives and overall function of gamblers. In this effort to recognize and ameliorate the symptoms of gambling, instruments were created to identify the severity of the gambling symptoms and also any changes that are reflected due to changes from treatment. In empirical research, a variety of tools have been created and used by clinical investigators, and researchers to determine gambling symptoms and treatment effectiveness for gambling. One tool is the Gambling Symptom Assessment Scale (G-SAS; cite). The Gambling Symptom Assessment Scale (G-SAS) is not a diagnostic instrument, but rather it is designed to assess the severity of gambling symptoms and the associated change during treatment.
The Gambling Symptom Assessment Scale includes the Leton Obssessional Inventory (LOI), and the Yale–Brown Obsessive–Compulsive Scale (Y-BOCS). To enhance its efficiency, the G-SAS has integrated the concepts that are used in Leyton Obsession Inventory, (LOI) together with the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). Ideally, LOI gathers information by use of 46 inventory items, which comprise compulsive or obsessive symptoms as well as 23 trait items (Kim, Grant, Potenza, Blanco, & Hollander, 2009).
The Gambling Symptom Assessment Scale yields a score of between zero and four in every 12- item scale. All items require an average symptom that is dependent on the previous seven days with items 1-4 only requiring an average urge. Item 5-7 requires the medium frequency, control of thoughts and most significantly, the amount of time that is associated with gambling. Item 8 requires the total duration in gambling-related behavior while item 9 requires the participation that results in excitement or tension that arises das a result of the gambling act with items 11 and 12 asking for individual problems that arise from gambling such as financial or health issues (Kim, Grant, Potenza, Blanco, & Hollander, 2009). However, its efficiency is handicapped by the fact that the inventory items may not match gambling symptoms of a particular patient and Athus may have low scores even when the patient may be having severe symptoms. Furthermore, the G-SAS items do not show personal traits such as the stress of where to get money to gamble from but rather requires symptoms that relate to the urge, gambling behavior and thoughts domain.. In this paper three articles will be evaluated that focus on the use of the Gambling Symptom Assessment Scale to see how reliable and valid the scale is when assessing gambling symptoms and treatment effectiveness.
The Gambling Symptom Assessment Scale (G-SAS): A Reliability and Validity Study
The article that was extracted Oxford Handbook for Impulse Disorders. Authors Kim, Grant, Potenza, Blanco, & Hollander (2009) evalute the reliability and validity of the Gambling Symptom Assessment Scale by analyzing test-retest nalmefene treatment data from multiple treatment center that presented data which supports the Gambling Symptom Assessment Scale as a reliable and valid instrument to assess gambling symptoms and treatment progress. In this study the method that was used was derived from empirical data and there 207 subjects that randomnly selected from 15 studies, and assigned to a placebo or a nalmefene group. The subjects were recruited through either the newspaper or from medical refferrals for treatment. Part of the selection criterion was that subjects had to be dignosed with Pathological Gambling disorder, could not be expecting, had to have score a minimum of 5 on the d Structured Clinical Interview for Pathological Gambling, scored a minimum of 5 on the South Oaks Gambling Screen (SOGS), and have engaged in gambling behavior at least 2 weeks before participating in the research study. Exclusions to the study were people who were diagnosed to certain Axis I conditions that were relate to substance abuse, bi polar, medical disorder, and for persons who received treatment for their gambling within a 6 month timeframe.
For validity purposes a correlation between the total G-SAS score and the total PG-YBOCS score was obtained. The two tests were categorized as above or not above the median value and cross-classified to reflect the amount of agreement”(Kim, Grant, Potenza, Blanco, & Hollander, 2009 p 78).
The results indicated that the PB-YBOCs instrument had a significantly higher score on the test-retest correlation when compared to the G-SAS. On the other hand, the internal consistency of the G-SAS was greater than the PB-YBOC because of the Cronbach’s alpha visit. It was apparent that both the GSAS and the YBOCS are both valid instruments to measure gambling symptoms. Hence, the G-SAS is a reliable and valid instrument, but a higher internal consistency than the PB-YBOCS, and a lower reliability. The limitations tht were presented in this research study were the G-SAS inability to recognize symptoms of gamblers that lttle to no gabling urges or shw excitement after winning due to their habit. Another limitation in this research is that the G-SAS does not have a scale to account for gamblers that are tryin to use gamblin to escape from other mental health conditions9e.g., depression, lonelines, etc.).
This article is very relevant regarding measuring of gambling symptoms, and therefore, it may be of beneficial for clinicians to use when assessing the symptoms of clients who have been diagnosed with pathologic gambling disorder. However, more descriptive and plain language will be useful in attracting and maintaining the attention of readers who are unclear or not knowledgeable about the clinical, research, and statistical language that was used in this article.
Is control a viable goal in the treatment of pathological gambling?
In Ladouceur, Lachace, and Fournier (2009) study they focused on identifying is controlling gambling for pathoogical gamblers is a realistic and achievable goal. The research questions that were posed by the authors are a follows:Is controlled gambling a reasonable and viable goal for treatment? If so, who will benefit from such an intervention? There was primary hypothesis that researchers presented in the literature and posed as the foundation for the research study. It was hypothesized that the gambling is a viable goal for pathologic gamblers. To determine if the aforementioned hypothesis was accurate authors conducted an exploratory study of past research.
Participants, Research Design, and Procedure
There were a total of 124 participants that that were prescreen and invited to participate in a semi structured intake interview that was administered by qualified clinicians, and based on the following criteria: clients had to be diagnosed with pathologic gambling disorder to be able to actively participate in the study. Participants were also compensated for their participation. They received $5 to cover the cost of parking and/or transportation expenses. In addition, participants were granted $25 gift certificates to grocery establishments or shopping centers each time an assessment was successfully complete. Furthermore, participants had 5 opportunities to be compensated for participation that included the “ pre-treatment, post treatment, and 6- and 12-month follow-ups” (Ladouceur, Lachace, & Fournier, 2009 p 191). The total amount f participants that pased the structured interview were 89. The authors used a clinical protocol research design for al participants. All participants were screen via the telephone to determine their eligibility, administered a pretreatment assessment, and administered the treatment, a post treatment assessment; that was also followed by six and twelve month follow-ups.
Participants were required to sign consent forms before activity participating in the research study. Each participant had 12-scheduled session a week that lasted for a duration of 60 minute each. More sessions could have been schedule if participant required more assistance and interventions. Seven components were implemented into each section base d on motivational interviewing, setting personalized goals, recognizing risk situations, analyzing erroneous belief, the client awareness of erroneous beliefs, gabling simulation, and relapse prevention (Ladouceur, Lachace, & Fournier, 2009). Each of the aforementioned components has a specified number of sessions that the components were the primary focus. All sections begin by revisiting previous section discussions and reviewing previously set goals.
The results of this study 69% of the 89 participants completed the program. It was discovered that 25% of the participant switched to abstinence before terminating their participation from the study. Other results indicated that the participants that terminated their participation in the study had significantly their rates of monetary loss during gambling than those who received treatment for their gambling condition. The “Wilcoxon test repotted the following results: z ¼ 2.04, N ¼ 79, p ¼ 0.042; (2) when asked to report the reasons why they preferred control instead of abstinence, more completers answered that they wished to continue gambling, c2 (1, N ¼ 88) ¼ 6.31, p ¼ 0.012; (3) completers reported that they were less able to resist when opportunities to gamble arose, t (87) ¼ 3.05, p ¼ 0.003; (4) negative consequences of the gambling on family were more important for drop outs than for treatment completers, t(81) ¼ 3.47, p < 0.001. H” (Ladouceur, Lachace, & Fournier, 2009 p 193).
In addition, signficant differences were reported between the pre and post treatmet assesments. (p<0.001), and the twelve month follow-up(p < 0.001). The results for frequency of gambling also yielded significance between post and pre assessments when post hoc tets were applied. Overall offerring controlled gambling as a treatment option fr pthologic gambler. Limitations in the study are limits on the time effect pertainig to the control group. The pre and post test were administeed over a period of time, and a small sample size. This article was very thourough and informative. It provided a substantial amount of background information, descriptors of the various varioables that were evaluated, and was appropriately designed. If I were a readers that as not statistically inclined, I think I would be able to read this article with ease.
Empirical research has examined several methods and instruments that have been used to find adequate treatment options for people diagnosed with pathologic gambling disorder. In Thomas, Merkouris, Browning, Radermacher, Feldman, Enticott, and Jackson (2015) an randomly controlled trial was used to evaluate if cognitive behavioral therapy, behavioral therapy, motivational interviewing, are effective treatments for gambling issues when compared to a non-directive supportive therapy. The number of participants that were included in this study was 297 participants that were recruited from the Victorian, Australia community. Participants ages 18 and over were recruited from colleges, and the community using newspaper ads, referrals from gambling help service, social media (Face book), and Google searches. Participants were randomly assigned to one of the four intervention groups: cognitive behavioral therapy, behavioral therapy, motivational interviewing, or non-directive supportive therapy by using a permuted block design. Other criterion for participants was voluntary participation in the study, the ability to speak English, and readily identified with having a gambling problem.
Participants received 6 individual sessions with a certified mental health professional that was between 45 minutes and 60 minutes each. Sessions took placed in the participant’s assigned psychologist’s office in confidentiality. Results did not yield any statistical differences between the four interventions as treatment options for participants. Limitations to this study were the high drop out rate, assessments were conducted over the telephone, and the use of mixed methods design of qualitative and quantitative data. This study is a prime example of how a mixed methods study can complicate simplistic studies but give more insight of participants at the same time. This study was well written and the language was not too complicated. It was very interesting to read.
Conclusion
Overall the literature that was reviewed pertaining to gambling and the various instruments that have been used evaluate the effectiveness of treatments for pathologic gamblers. Future areas of research that can focus on instruments that assess the differences in the level of symptomatic behavior between participants to yield more accurate results, and insight into the variances in gambler's behavior.. Other additives to the research should consider providing incentives to motivate participants to complete the study.
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References
Kim, S. W., Grant, J. E., Potenza, M. N., Blanco, C., & Hollander, E. (2009). The Gambling Symptom Assessment Scale (G-SAS): A reliability and validity study. Psychiatric Research , 76-84.
Ladouceur, R., Lachace, S., & Fournier, P.-M. (2009). Is control a viable goal in the treatment of pathological gambling? Behaviour Research and Therapy , 189–197.
Thomas, S. A., Merkouris, S. S., Browning, C. J., Radermacher, H., Feldman, S., Enticott, J., et al. (2015). The PROblem Gambling RESearch Study (PROGRESS) research protocol: a pragmatic randomised controlled trial of psychological interventions for problem gambling. BMJ , 1-16.
