京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第20567号 / 医博第4252号 / 新制||医||1022(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 古川 壽亮, 教授 髙橋 良輔, 教授 富樫 かおり / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

BACKGROUND: In the U.S., more than two-thirds of college and university students report gambling in the past year. Although most U.S. college students gamble without experiencing clinically significant symptoms, they do experience more problems compared to more mature adult populations. It is estimated that 16.3% of U.S. college students experience clinical or subclinical gambling disorder. Gambling disorder is a serious mental health problem on college campuses with the potential for negative academic, financial, and mental health outcomes. This study is only the second to assess college gambling policies in the U.S. and the first to assess college gambling policies at two time-points. METHODS: To gather gambling policies and supporting web-based materials, I completed extensive searches of websites for 117 U.S. colleges and universities. I assessed each school’s policies and supporting web-based materials using a modified version of Shaffer et al.’s (2005) gambling policy assessment. The policy-coding instrument includes questions about state-level gambling characteristics, school-level characteristics, school gambling policies, and implementation of the Task Force on College Gambling Policy’s 2009 recommendations. RESULTS: A previous assessment of gambling policies among this sample of U.S. colleges and universities found that only 25 had a gambling policy. By the beginning of the 2016-17 academic year, a review of each college and university’s policies revealed that 82 colleges and universities (70.1%) now have a gambling policy, representing a 228% increase. This follow-up assessment further explores college and university gambling policies by reviewing the location and scope of those policies, plus whether certain state or college/university characteristics are associated with having a gambling policy in 2017. CONTRIBUTION: In addition to the study findings, I provide college and university health practitioners with a guide to assess, select, and implement problem gambling policies and programs that are responsive to their campus needs based on SAMHSA’s Strategic Prevention Framework.

Objective: The aims of this systematic review and meta-analysis were to examine the overall prevalence of dropout from psychological treatments for problem gambling and gambling disorder and to examine how study, client, and treatment variables influenced dropout rates. Method: A systematic search was conducted to identify studies of cognitive and/or behavioral therapies and motivational interventions for problem gambling and gambling disorder. Meta-analysis was used to calculate an overall weighted dropout rate. Random effect meta-regressions were used to examine covariates of dropout rates. Mixed-effect subgroup analyses were used to examine moderators of dropout rates. Results: The systematic search identified 24 studies (31 dropout rates) comprising 2,791 participants. Using a random-effects model, the overall weighted dropout rate was 39.1%, 95% CI [33.0%, 45.6%]. Increases in the percentage of married participants were significantly associated with lower dropout rates. Dropout rates were significantly higher when dropout was defined as attending all sessions of a treatment protocol compared to when defined as attending a prespecified number of sessions different from the total in the protocol and when defined as study therapists judging participants to be dropouts. Insufficient reporting of some gambling-related variables and other psychological symptom variables prevented a thorough examination of covariates and moderators. Conclusions: A large proportion of individuals drop out of treatment for problem gambling and gambling disorder. Future research should examine the reasons for dropout across marital statuses and should adopt dropout definitions that consider session-by-session symptom change. (PsycInfo Database Record (c) 2021 APA, all rights reserved) This review suggests that a significant proportion of individuals drop out of psychological treatments for problem gambling and gambling disorder. This review also recommends that the field adopt symptom-based dropout definitions to determine the adequate dosage of psychological treatment for problem gambling and gambling disorder. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

This study focuses on how gambling disorder is a part of the investigation at the social office. Gambling disorder is a part of Socialtjänstlagen. This new law came into effect 1/1-2018. The purpose of this study is to examine how the economic aid, in the social office, works with gambling disorder. The study was made from a qualitative approach and was conducted through semi-structured interviews, the results of which were consequently analyzed by using a theory about social constructionism and social construction. The results indicated that there were some problems in how to ask questions about gaming disorder when meeting with the clients. The study also showed that the investigation are suppose to include the child perspective, but not to which extend this investigation should be made. This study shows the importance of knowledge and understanding in how to help clients with a gambling disorder. The study also shows that social workers might not have enough qualification to investigate gambling disorder among their clients.

京都大学 / 新制・論文博士 / 博士(医学) / 乙第13571号 / 論医博第2297号 / 新制||医||1069(附属図書館) / (主査)教授 川上 浩司, 教授 渡邉 大, 教授 村井 俊哉 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM

Pathological gambling and substance use disorders are highly prevalent and comorbid among veteran populations. These disorders also share genetic influences, although the underlying constructs and magnitude of their influence remain unclear. This project utilized the Hierarchical Taxonomy of Psychopathology (HiTOP) as a framework for modeling the underlying dimensions of psychopathology as latent factors and modeled genetic and environmental influences on substance use disorders and pathological gambling. Study 1 examined the structure of psychopathology for 15 common mental disorders in a sample of Vietnam-era veteran twins from the Harvard Drug Study (nMZ = 3,748 and nDZ = 2,996) to determine the appropriate location for pathological gambling within the HiTOP framework. The best fitting model included internalizing and externalizing spectra and an illicit substance use subfactor. Pathological gambling (loading = .30) loaded onto the externalizing spectrum with legal substance use, conduct disorder, antisocial personality disorder, and a subfactor that subsumed all six illicit substance use disorders. The best fitting model in Study 1 did not support the existence of a ‘p’ factor underlying all psychopathology. In Study 2, genetic and environmental components were modeled for the 15 disorders and 3 latent factors modeled in Study 1. Additive genetics explained from 10% (generalized anxiety disorder, panic disorder) to 49% (nicotine use) of the variance in specific disorders and from 24% (internalizing) to 46% (externalizing) of the variance of latent factors. Only cocaine use and conduct disorder demonstrated significant variance attributable to shared environment, the entirety of which occurred at the disorder-specific level. Only 9% of the genetic variance associated with alcohol use was shared across disorders, whereas 100% of genetic variance in cocaine and hallucinogen use was shared with latent factors. In total, 12% of the variance in risk for pathological gambling was associated with additive genetics, and 13% of that variance was shared via the externalizing spectrum. Findings highlight shared risk among illicit substance use disorders and among other disorders on the externalizing spectrum. These findings suggest externalizing and illicit substance use as transdiagnostic targets for treatments aimed at individuals with comorbid substance use disorders, pathological gambling, and other externalizing disorders.

It is estimated that 2 % of the Swedish population have problems with gambling and / or an addiction. The purpose of this study is to provide insight into life as a gambler to explain the emergence of a gambling addiction but also what negative consequences it can have in everyday life, and to investigate the extent to which treatment can function as a crime prevention measure. The chosen method is a case study where semi-structured interviews were conducted with three informants about their experience of treatment of gambling addiction. The results were analyzed through an inductive thematic analysis where the collected empirical data was allowed to lead to a conclusion. Sampson and Laub's age-graded theory of informal social control was the theoretical framework used to interpret the results. The results showed that three factors form a basis for the emergence of a gambling addiction. Three more factors need to coincide for an individual to find acceptance and thus have a purposeful life. Treatment of gambling addiction can serve as a turning point in a player's life and the conclusion of this study is that it can act as a crime prevention measure. / <p>2022-09-02</p>

Comment notre cerveau traite l’information de la récompense, et comment un tel traitement est influence par des paramètres tels que la probabilité et le risque sont devenues des questions cruciales des neurosciences cognitives. De plus, des recherches récentes suggèrent un effet modulateur d’un certain nombre d’hormones sur le cerveau et sur le comportement, et également qu’un dysfonctionnement du système de récompense pourrait expliquer des comportements addictifs tels que le jeu pathologique. Durant cette thèse, nous avons eu recours à de l’EEG stéréotaxique (SEEG) et à une combinaison d’Imagerie à Résonnance Magnétique fonctionnelle (IRMf) et d’endocrinologie pour réaliser trois études s’intéressant au traitement de la récompense chez des sujets sains, chez des patients souffrant d’épilepsie chez qui des macroélectrodes ont été implantées, et chez des joueurs pathologiques. Ensemble, nos études améliorent la compréhension de nouveaux aspects du traitement de la récompense chez les sujets sains, chez les patients épileptiques, et chez les joueurs pathologiques / How our brain processes reward information and how such processing is influenced by parameters such as reward probability and risk have become key questions in cognitive neuroscience. In addition, recent researches suggest a modulatory effect of a number of hormones on brain and behavior and a dysfunction of the reward system in a number of behavioral addictions, such as gambling disorder. This Ph.D. used intracranial EEG (iEEG) and combined Functional Magnetic Resonance Imaging (fMRI) and endocrinology to perform four studies investigating reward processing in healthy subjects, patients with epilepsy implanted with depth electrodes and individuals with gambling disorder. Together, our series of studies advance our understanding of new aspects concerning reward processing in healthy subjects, patients with epilepsy and individuals with gambling disorder

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Psychological interventions can improve outcomes and reduce symptom severity for individuals with gambling disorder. This chapter provides an overview of current evidence from moderate- to large-scale randomized controlled trials of psychotherapy interventions for the treatment of gambling problems. Interventions include full-length professionally delivered therapies (behavior therapy, cognitive therapy, and cognitive-behavioral therapy), as well as self-directed workbooks and computer-facilitated programs. Motivational interventions, including motivational interviewing, motivational enhancement therapy, and personalized feedback, are also reviewed. This chapter highlights gambling-related treatment outcomes and comparisons between conditions for randomized trials, with an emphasis on treatment dropout. Attrition rates are generally high across all multi-session intervention modalities and formats. Overall, findings suggest that no specific treatment consistently outperforms other active treatments, but cognitive-behavioral therapy does have the most empirical support for the treatment of gambling disorder. In addition, brief motivational interventions are sufficient for some gamblers to change their behavior, particularly those experiencing only a few adverse symptoms from their gambling involvement. Future research efforts will benefit from further refining existing treatments to improve retention, which in turn may enhance effectiveness.