Pathological Gambling and Alcohol Use Disor.ppt

1、Copyright Alcohol Medical Scholars Program,1,Pathological Gambling and Alcohol Use Disorders,Timothy W. Fong MD UCLA Gambling Studies Program Alcohol Medical Scholars Program 2005-2007,Copyright Alcohol Medical Scholars Program,2,Introduction,Lifetime risk Pathological gambling (PG) 2% Alcohol use d

2、isorders (AUD) 13% PG + AUD Often co-occur Worse outcomes,Copyright Alcohol Medical Scholars Program,3,This lecture will cover,Pathological Gambling (PG) Alcohol Use Disorders (AUD),Diagnostic criteria Epidemiology Consequences Screening Risk factors Treatment,Copyright Alcohol Medical Scholars Prog

3、ram,4,PathologicalGambling,Copyright Alcohol Medical Scholars Program,5,Gambling in the United States,85% of Americans gamble Available in 48 states Gambling revenue: $72 billion/year Increasing cultural acceptance 80% parents not opposed (),Copyright Alcohol Medical Scholars P

4、rogram,6,Social Gambling,Similar in meaning to social drinking 85% of gamblers No negative impacts,Copyright Alcohol Medical Scholars Program,7,Pathological Gambling,Maladaptive use impairment,Copyright Alcohol Medical Scholars Program,8,Copyright Alcohol Medical Scholars Program,9,Consequences ofPa

5、thological Gambling,Copyright Alcohol Medical Scholars Program,10,Screening Tools,South Oaks Gambling Screen Lie/Bet Questionnaire “Have you lied about your gambling?” “Have you ever increased bets to get same sense of action?” No objective tests,Copyright Alcohol Medical Scholars Program,11,Risk Fa

6、ctors,Genetic 60% risk Psychological Impulsive Social Increased access Heavy gambling peers,Copyright Alcohol Medical Scholars Program,12,Treatment:Social Assistance,Self-exclusion programs Self-bar entrance into casinos Financial counseling Gamblers Anonymous 1500 chapters Similar to Alcoholics Ano

7、nymous 8% abstinent at 12 months,Copyright Alcohol Medical Scholars Program,13,Psychosocial Treatment,Cognitive behavioral therapy Addresses cognitive distortions 40% stopped gambling Long-term data needed Helplines 24-hour crisis interventions No data on effectiveness Widely available,Copyright Alc

8、ohol Medical Scholars Program,14,Treatment:Pharmacotherapy,Preliminary evidence Naltrexone Selective Serotonin Reuptake Inhbitiors (SSRIs) Valproic Acid Lithium,Copyright Alcohol Medical Scholars Program,15,Alcohol Use Disorders,Copyright Alcohol Medical Scholars Program,16,Alcohol Use in the United

9、 States,63% drank over last 12 months Alcohol beverage industry: 2005 $6 billion gross revenue Alcohol use disorders Abuse Dependence,Copyright Alcohol Medical Scholars Program,17,Alcohol Dependence,Maladaptive use impairment 3 over 12 months Tolerance Withdrawal Larger amts than intended Cant decre

10、ase use Excessive time Decreased activities Use despite problems,(American Psychiatric Association, 1994),Copyright Alcohol Medical Scholars Program,18,Epidemiology of AUD,Lifetime prevalence Males 15% Females 8% 15 million meet criteria Economic burden: $155 billion,Copyright Alcohol Medical Schola

11、rs Program,19,Consequences,Medical Cardiovascular: hypertension Gastrointestinal: fatty liver Neurological: peripheral neuropathy Work lateness, performance, injury Family 80% spousal violence,Copyright Alcohol Medical Scholars Program,20,Screening,Alcohol Use Disorders Identification Test Michigan

12、Alcohol Screening Test Lab tests GGT35 MCV91.5 CDT20,Copyright Alcohol Medical Scholars Program,21,Risk Factors,Gender males females Genetics 60% risk Co-occurring psychiatric disorders 45% lifetime prevalence Heavy drinking peers,Copyright Alcohol Medical Scholars Program,22,Social Assistance,12-st

13、ep, Alcoholics Anonymous 75,000 groups in US Peer support and fellowship SMART Recovery (Self-Management and Recovery Training) Self-reliance, personal responsibility,Copyright Alcohol Medical Scholars Program,23,Psychosocial Treatment,Cognitive-Behavioral Therapy Identify motivations and triggers L

14、onger in treatment, better outcome Relapse Prevention Identify risky situations Develop alternative behaviors,Copyright Alcohol Medical Scholars Program,24,Treatment: Pharmacotherapy,Disulfiram Efficacy: equivocal Naltrexone Efficacy: drinks, # drinking days Acamprosate Efficacy: tx completion and t

15、ime to first drink,Copyright Alcohol Medical Scholars Program,25,Pathological Gambling & Alcohol Use Disorders,Copyright Alcohol Medical Scholars Program,26,PG and AUD,More difficult to treat and retain 2x rate of dropout Lower compliance rates Other comorbidities likely More likely to relapse,Copyr

16、ight Alcohol Medical Scholars Program,27,Epidemiology,PG: rates of AUD (40%) severity of PG = risk for AUD AUD: rates of PG (10%) Lack of screening PG or AUD can occur first,Copyright Alcohol Medical Scholars Program,28,Differences: PG and AUD,No objective tests No intoxicated states No physical signs and symptoms Financial impact PG may win or lose large amount at one time,Copyright Alcohol Medical Scholars Program,29,Treatment Considerations,More data needed Must treat both disorders Get coll