Ignite Creation Date:
2024-05-06 @ 10:32 AM
Last Modification Date:
2024-10-26 @ 12:31 PM
Study NCT ID:
NCT03287583
Status:
COMPLETED
Last Update Posted:
2024-02-15
First Post:
2017-09-15
Brief Title:
SBIRT Intervention for Gambling Behaviors
Sponsor:
University of Maryland Baltimore
Organization:
University of Maryland Baltimore
Study Overview
Official Title:
Pilot Randomized Control Trial of an SBIRT Intervention for Gambling
Status:
COMPLETED
Status Verified Date:
2024-02
Last Known Status:
None
Delayed Posting:
No
If Stopped, Why?:
Not Stopped
Has Expanded Access:
False
If Expanded Access, NCT#:
N/A
Has Expanded Access, NCT# Status:
N/A
Acronym:
None
Brief Summary:
Disordered gambling like substance misuse has been associated with various medical problems and adverse health outcomes The Maryland Center of Excellence on Problem Gambling along with experts in the fields of disordered gambling and behavior change will work with the Maryland State Department of Health and Mental Hygienes Behavioral Health Administration to develop a problem gambling-specific Screening Brief Intervention and Referral to Treatment SBIRT intervention targeting individuals receiving medical care in general primary care clinics The investigators will evaluate the feasibility and acceptability of inserting the problem gambling intervention in to preexisting substance use SBIRT services being provided in clinics in the state In addition the investigators will establish a clinic prevalence for gambling and finally conduct a randomized trial using the problem gambling SBIRT intervention to see if it is effective in helping patients reduce their problematic gambling behaviors
Detailed Description:
The Substance Abuse and Mental Health Services Administration SAMHSA has made health care and health systems integration one of its main priorities to ensure that behavioral health is consistently incorporated within the context of health care delivery systems However this initiative has been focused on substance use disorders and mental health disorders that have not included gambling disorder Disordered gambling DG is highly associated with substance use disorders severe mental illness depression domestic violence and suicide Disordered gambling has also been linked with adverse health conditions and behaviors Morasco et al in their analysis of data from the National Epidemiologic Survey of Alcohol and Related Conditions NESARC found that persons with DG were more likely to have a range of medical problems including tachycardia angina cirrhosis or other liver disease Even moderate levels of gambling along with more severe levels of DG have been associated with adverse health consequences and unhealthy life style factors Morasco et al report that at risk gamblers defined as gambling five or more times in the past 12 months who they estimate compose 25 of the population were more likely to have experienced a severe injury in the past year receive emergency room treatment have hypertension be obese have histories of mood anxiety alcohol use and nicotine use disorders In a more recent study Black et al found individuals with DG were at higher risk for chronic medical conditions including obesity heartburnstomach conditions headaches head injury with loss of consciousness sleep disorders moodemotional concerns and anxiety tension or stress Individuals in the DG group also were more likely to have poorer health habits They were more likely to avoid exercise to drink alcohol while pregnant smoke greater than or equal to a pack of cigarettes per day to drink or more servings of caffeine a day and to watch or more hours of television weekly Subjects meeting DG criteria in this study were also less likely to have regular dental check-ups and more likely to delay medical care for financial reasons Additionally the DG subjects were more likely to have at least one emergency room visit and at least one hospitalization for mental health reasons in the past year
Individuals with gambling problems have been found to utilize medical and behavioral health services at higher rates
Studies have also reported significant rates of gambling and problem gambling in primary care settings Pasternak and Fleming in a study of patients in primary care that 80 had gambled and 62 met criteria for problem gambling score of 3 or more on South Oaks Gambling Screen SOGS Additionally they report that gambling disorder was even more prevalent among nonwhites and those from lower socioeconomic groups In a study of individuals receiving free or reduced-cost dental care Morasco Petry found rates of problem gambling to be significantly higher than the general population In their sample among those receiving disability 26 met criteria for disordered gambling and among those not receiving disability 14 met criteria based on SOGS scores Other studies have found prevalence rates of gambling problems of between 3 and 5 in primary care settings However these studies did not include any frequency of gambling items nor an explanation of the range of behaviors meant by gambling and have not included the less severe at risk gamblers This study will also address the need to improve the effectiveness of DG screening strategies in actual clinical practice and to effectively identify not just those individuals who are exhibiting multiple symptoms of gambling disorder but those fall into an at risk level of gambling that has been associated with multiple poor health outcomes
A prevalence study conducted in Maryland supports the likelihood of significant health issues among those who are identified as at risk problem or disordered gamblers This study found that 90 of adults in Maryland had gambled in their lifetimes Over 21 had gambled at least monthly in the past 12 months which would fit the definition of at risk gambling group that compromised 25 of the subjects in the NESARC study who presented increased medical issues and utilization Those who had ever gambled as well the at risk and problem gambling groups in the Maryland survey also reported higher levels of health risk behaviors ie higher alcohol intake more frequent drug use daily smoking and reported poorer health status The rates of problempathological gambling for all adults was found to be 34 and at risk gambling 9 African Americans173 were found to have a significantly higher rate of at risk as well as problem and disordered gambling compared to other ethicracial groups 102 white 117 other ethnicracial combined The lowest socioeconomic group was also found to have the highest rates of problempathological gambling 15 Therefore conducting gambling specific screening and brief intervention in these high risk groups within Maryland is strongly indicated
While the research as sited above clearly indicates that individuals who are experiencing gambling related harms in their lives are likely to experience higher rates of medical and behavioral health problems and utilize health care services they are not necessarily likely to seek specific help for gambling problems Strikingly Kessler et al reported that while nearly half of their large national sample who met criteria for lifetime gambling disorder received treatment for mental health or substance use disorders none had received any specific treatment for gambling problems Indeed it is estimated that only between 1 to 3 of individuals nationwide who meet criteria for gambling disorder access gambling specific treatment servicesWhile this is in part due to internal factors in individuals with gambling disorder such as desire to resolve problems on their own shame guilt and denial there are also providerinstitutional factors that are significant Primary among these is the absence of screening for gambling problems
Screening Brief Intervention and Referral to Treatment SBIRT is an evidence based public health approach for delivery of early intervention services in medical and primary care settings for individuals at risk for or experiencing substance use disorders The most extensive research evidence for the effectiveness of this approach has been with those presenting indicators of alcohol abuse Additionally Brief interventions BI have been found to be effective for a range of non-alcohol substance abuse issues While many studies have demonstrated that brief interventions with disordered gamblers are effective these studies have not focused on identifying or providing brief interventions in actual clinical or primary care settings Research has suggested that there are considerable clinician as well as client factors that contribute to reluctance to address the topic of gambling practice To our knowledge no study has sought to obtain both client and clinician input into the content and process feasibility of providing screening and intervention for risk for GD in real clinical settings to address clinician and client concerns
Both research and treatment provider surveys have demonstrated that only a very small percentage of individuals who experience gambling related harms are likely to seek treatment Furthermore there is evidence that at risk gamblers who may comprise 20-25 of the adult population are likely to experience increase levels of health related problems and utilize health care services at higher rates than nonlow-risk gamblers However has been little to no research on how to effectively screen for risk for gambling in health care settings
Individuals with gambling problems have been found to utilize medical and behavioral health services at higher rates
Studies have also reported significant rates of gambling and problem gambling in primary care settings Pasternak and Fleming in a study of patients in primary care that 80 had gambled and 62 met criteria for problem gambling score of 3 or more on South Oaks Gambling Screen SOGS Additionally they report that gambling disorder was even more prevalent among nonwhites and those from lower socioeconomic groups In a study of individuals receiving free or reduced-cost dental care Morasco Petry found rates of problem gambling to be significantly higher than the general population In their sample among those receiving disability 26 met criteria for disordered gambling and among those not receiving disability 14 met criteria based on SOGS scores Other studies have found prevalence rates of gambling problems of between 3 and 5 in primary care settings However these studies did not include any frequency of gambling items nor an explanation of the range of behaviors meant by gambling and have not included the less severe at risk gamblers This study will also address the need to improve the effectiveness of DG screening strategies in actual clinical practice and to effectively identify not just those individuals who are exhibiting multiple symptoms of gambling disorder but those fall into an at risk level of gambling that has been associated with multiple poor health outcomes
A prevalence study conducted in Maryland supports the likelihood of significant health issues among those who are identified as at risk problem or disordered gamblers This study found that 90 of adults in Maryland had gambled in their lifetimes Over 21 had gambled at least monthly in the past 12 months which would fit the definition of at risk gambling group that compromised 25 of the subjects in the NESARC study who presented increased medical issues and utilization Those who had ever gambled as well the at risk and problem gambling groups in the Maryland survey also reported higher levels of health risk behaviors ie higher alcohol intake more frequent drug use daily smoking and reported poorer health status The rates of problempathological gambling for all adults was found to be 34 and at risk gambling 9 African Americans173 were found to have a significantly higher rate of at risk as well as problem and disordered gambling compared to other ethicracial groups 102 white 117 other ethnicracial combined The lowest socioeconomic group was also found to have the highest rates of problempathological gambling 15 Therefore conducting gambling specific screening and brief intervention in these high risk groups within Maryland is strongly indicated
While the research as sited above clearly indicates that individuals who are experiencing gambling related harms in their lives are likely to experience higher rates of medical and behavioral health problems and utilize health care services they are not necessarily likely to seek specific help for gambling problems Strikingly Kessler et al reported that while nearly half of their large national sample who met criteria for lifetime gambling disorder received treatment for mental health or substance use disorders none had received any specific treatment for gambling problems Indeed it is estimated that only between 1 to 3 of individuals nationwide who meet criteria for gambling disorder access gambling specific treatment servicesWhile this is in part due to internal factors in individuals with gambling disorder such as desire to resolve problems on their own shame guilt and denial there are also providerinstitutional factors that are significant Primary among these is the absence of screening for gambling problems
Screening Brief Intervention and Referral to Treatment SBIRT is an evidence based public health approach for delivery of early intervention services in medical and primary care settings for individuals at risk for or experiencing substance use disorders The most extensive research evidence for the effectiveness of this approach has been with those presenting indicators of alcohol abuse Additionally Brief interventions BI have been found to be effective for a range of non-alcohol substance abuse issues While many studies have demonstrated that brief interventions with disordered gamblers are effective these studies have not focused on identifying or providing brief interventions in actual clinical or primary care settings Research has suggested that there are considerable clinician as well as client factors that contribute to reluctance to address the topic of gambling practice To our knowledge no study has sought to obtain both client and clinician input into the content and process feasibility of providing screening and intervention for risk for GD in real clinical settings to address clinician and client concerns
Both research and treatment provider surveys have demonstrated that only a very small percentage of individuals who experience gambling related harms are likely to seek treatment Furthermore there is evidence that at risk gamblers who may comprise 20-25 of the adult population are likely to experience increase levels of health related problems and utilize health care services at higher rates than nonlow-risk gamblers However has been little to no research on how to effectively screen for risk for gambling in health care settings
Study Oversight
Has Oversight DMC:
None
Is a FDA Regulated Drug?:
False
Is a FDA Regulated Device?:
False
Is an Unapproved Device?:
None
Is a PPSD?:
None
Is a US Export?:
None
Is an FDA AA801 Violation?:
None