Un kleptomane, pris d’impulsions irrésistibles, peut-il être responsable pénalement de ses actes ? Voilà la question à l’origine de cette recherche. Les troubles du contrôle des impulsions sont des troubles mentaux caractérisés par l’impossibilité de résister à une impulsion. Comment peut-on concilier ceux-ci avec le droit pénal canadien sachant que la responsabilité criminelle repose sur le postulat voulant que seul un acte volontaire justifie une déclaration de culpabilité ? Afin d’avoir une étude exhaustive sur le sujet, nous avons choisi trois troubles du contrôle des impulsions, soit la kleptomanie, la pyromanie et le jeu pathologique. Cette sélection permet d’étudier à la fois l’imputabilité criminelle et l’imposition d’une sentence en droit pénal canadien. Cette étude propose un retour aux principes fondamentaux de la responsabilité criminelle et l’analyse du droit pénal canadien afin de démontrer que certains troubles du contrôle des impulsions (kleptomanie et pyromanie) entraînent chez le sujet atteint une incapacité criminelle, le rendant non criminellement responsable au sens de l’article 16 du Code criminel. Au surplus, cette recherche porte sur les principes entourant l’imposition d’une sentence en droit pénal canadien et étudie l’impact de ces maladies mentales au point de vue de la peine. Cette analyse démontre que les caractéristiques diagnostiques des troubles du contrôle des impulsions sont utilisées afin d’alourdir la peine imposée aux contrevenants. Nous considérons que celles-ci ne devraient pas être employées comme facteurs aggravants (particulièrement en matière de jeu pathologique), mais devraient plutôt être utilisées afin d’imposer une peine plus appropriée pour remédier à la problématique entraînant la commission des délits. / A kleptomaniac, taken by overpowering impulses, can he be criminally responsible for his actions? That is the question behind this research. The impulse control disorders are mental disorders characterized by the inability to resist an impulse. How can we reconcile this with the Canadian criminal law, knowing that criminal liability based on the assumption that only a voluntary act warrants a conviction? To gain a comprehensive study on the subject, we chose three impulse control disorders, kleptomania, pyromania and pathological gambling. This selection allows us to study both the criminal accountability and the imposition of a sentence in Canadian criminal law. This study proposes a return to fundamental principles of criminal responsibility and the analysis of Canadian criminal law to demonstrate that some impulse control disorders (kleptomania and pyromania) result in the subject reaching a criminal incapacity, making it not criminally responsible within the meaning of article 16 of the Criminal Code. Furthermore, this research focuses on the principles surrounding the imposition of a sentence in Canadian criminal law and explores the impact of mental illness in terms of the sentence. This analysis shows that the diagnostic features of impulse control disorders are used to increase the punishment imposed on offenders. We consider that these characteristic should not be used as aggravating factors (especially in pathological gambling), but should be used to impose a sentence more appropriate to remedy to the problem causing the commission of crimes.

Les récompenses possèdent plusieurs fonctions importantes, liées au plaisir, à la motivation et à l’apprentissage, qui façonnent notre comportement au quotidien. Il est aujourd’hui bien établi que ces fonctions sont prises en charge par un ensemble de régions cérébrales appelé « système de récompense », dont la perturbation peut générer des comportements inadaptés tels que l’addiction. Néanmoins, toutes les récompenses ne sont pas équivalentes, et il n’y a pas lieu de penser que le cerveau répond de façon identique à chacune d’entre elles. Nous avons testé cette hypothèse à l’aide de l’Imagerie par Résonance Magnétique fonctionnelle (IRMf), en adoptant trois angles d’approche différents. Une première expérience s’est concentrée sur la distinction entre récompenses primaires (i.e. ancestrales et concrètes) et secondaires (i.e. évoluées et abstraites), étudiée ici à travers l’exemple des images érotiques et de l’argent. En plus d’un réseau cérébral activé en commun par ces récompenses, nos résultats ont montré une dissociation au sein du cortex orbitofrontal (OFC), recruté spécifiquement dans sa partie postérieure par les récompenses primaires, et spécifiquement dans sa partie antérieure par les récompenses secondaires. Ce résultat soutient l’idée générale d’un gradient de complexité croissante le long de l’axe postéro-antérieur de l’OFC. Dans la deuxième étude, nous avons comparé, au moyen d’une approche méta-analytique quantitative, les activités cérébrales rapportées dans la littérature en réponse à des gains monétaires, des goûts plaisants et des stimuli érotiques visuels. Les résultats obtenus étayent les conclusions de la première étude, et confirment parallèlement l’existence de réponses cérébrales spécifiques à chaque type de récompense. Enfin, dans la troisième étude, nous nous sommes intéressés au jeu pathologique, en formulant l’hypothèse d’un déséquilibre de la sensibilité aux récompenses monétaires versus non-monétaires. Les résultats obtenus confortent cette prédiction, en suggérant principalement une perturbation du traitement des récompenses non-monétaires dans le striatum ventral des joueurs. Dans l’ensemble, ces résultats apportent un éclairage nouveau sur l’architecture fonctionnelle du système de récompense, à la fois chez des individus sains et des individus joueurs pathologiques / Rewards serve several important behavioural functions related to motivation, pleasure and learning. At the cerebral level, reward processing is thought to rely on a well-defined set of brain regions known as the “reward system”, whose disruption has been linked to maladaptive behaviours such as addiction. However, a wide variety of rewards exists, and there is no reason to think that the brain responds equivalently to all of them. In order to test this assumption, we used functional Magnetic Resonance Imaging (fMRI), with three different perspectives. In a first experiment, we investigated the distinction existing between so-called primary (i.e. primitive and concrete) rewards and secondary (i.e. evolved and abstract) rewards, studied here through the examples of erotic pictures and monetary gains. In addition to a common brain network recruited regardless of reward type, our results revealed a functional dissociation within the orbitofrontal cortex (OFC), whose posterior part responded specifically to primary rewards, while its anterior part responded specifically to secondary rewards. Interestingly, this finding supports the idea of a complexity gradient along the postero-anterior axis of the OFC. In a second study, we used a quantitative meta-analytic approach to compare the brain activations reported in the literature in response to monetary gains, pleasant tastes and erotic pictures. The results are in line with the conclusions drawn from the first experiment, and confirm the existence of reward-type-specific responses in the brain. Finally, we conducted a third study focusing on pathological gambling, and aiming to test the hypothesis of an imbalance in the sensitivity to monetary versus non-monetary rewards. The results bring evidence supporting this view, and essentially demonstrate an impaired processing of non-monetary rewards in the ventral striatum of gamblers. Overall, this work sheds new light on the functional architecture of the reward system, both in healthy subjects and pathological gamblers

Jogo Patológico é um transtorno psiquiátrico ao qual se reputa importante participação de fatores de personalidade. Jogo Patológico tem sido associado com dependências de substâncias e especula-se uma relação com Transtorno Obsessivo Compulsivo (TOC). Alguns propõem que seja visto como uma dependência não química, outros recusam esta designação argumentando que o termo dependência deveria ser reservado ao uso abusivo de substâncias psicoativas e que JP estaria mais próximo de transtornos do humor e ansiosos. Jogo patológico já foi classificado como comportamento compulsivo, como dependência e, atualmente, encontra-se entre os 'Transtornos do Controle dos Impulsos Não Classificados em Outro Local' no DSM-IV, e entre os 'Transtornos de Hábitos e Impulsos' na CID-10. A relativa juventude do Jogo Patológico, enquanto categoria diagnóstica operacionalmente definida, talvez explique a imprecisão em sua caracterização fenomenológica e clínica. Os objetivos desta tese foram comparar Jogo Patológico e TOC, quanto às características de curso clínico e comorbidade e comparar jogadores patológicos, portadores de TOC e controles normais quanto a traços de personalidade com enfoque específico em impulsividade e compulsividade. Foram selecionados 40 jogadores patológicos, 40 portadores de TOC e 40 controles normais, pareados por gênero, idade e nível educacional. Os instrumentos utilizados foram o SCAN (Schedules for Clinical Assessment in Neuropsychiatry), para investigação de curso e comorbidade; o Tridimensional Personality Questionnaire; a Barrat Impulsiveness Scale versão 11 e uma versão adaptada da Yale Brown Obsessive Compulsive Scale para investigação de compulsividade. Observou-se que os portadores de TOC apresentaram início mais precoce, curso mais insidioso e menor freqüência de períodos livres de sintomatologia. Jogo Patológico e TOC apresentaram elevada comorbidade com transtornos ansiosos e depressão, porém Jogo Patológico apresentou uma associação significativamente maior com alcoolismo e tabagismo, enquanto TOC apresentou maior freqüência de transtornos somatoformes. Jogadores pontuaram em média significativamente mais que portadores de TOC e controles normais nas medidas de impulsividade. Portadores de TOC pontuaram mais que jogadores e controles normais em compulsividade. Jogadores pontuaram mais que controles normais em compulsividade. Conclui-se que Jogo Patológico e TOC guardam alguma semelhança no tocante à elevada comorbidade com depressão e ansiedade. Contudo, o curso clínico do Jogo Patológico, marcado por exacerbações paroxísticas e períodos de abstinência, além da elevada comorbidade com alcoolismo e tabagismo, reforçam suas semelhanças com as dependências. Em relação à personalidade, o traço mais saliente dos jogadores foi a impulsividade, justificando sua classificação como um transtorno do impulso. / Pathological Gambling (PG) is a psychiatric disorder in which personality features are considered essential for its development. In addition, it has been associated to Substance Dependence and a relationship to Obsessive-Compulsive Disorder (OCD) has been proposed. Some authors conceptualize it as a non-chemical dependence; others refuse this concept, arguing that the term dependence should be used exclusively to the misuse of psychoactive substances, and that PG would be closer to anxiety and affective disorders. PG has been classified as a compulsive behavior, as a dependence, and presently it is classified among the Impulse Control Disorders Not Elsewhere Classified in the DSM-IV, and 'Habit and Impulse disorders' in the ICD-10. PG's relative youth as a diagnostic category may explain the inaccuracy of its phenomenology and clinical characterization. The objectives of this study were: to compare PG and OCD regarding clinical course and psychiatric comorbidity; to compare pathological gamblers, obsessive-compulsive patients, and normal controls regarding personality features, specifically focussing impulsivity and compulsivity. Forty pathological gamblers, 40 obsessive-compulsive patients, and 40 normal control volunteers, matched by gender, age, and educational level were included. They were assessed through the Schedules for Clinical Assessment in Neuropsychiatry for evaluation of course of illness and psychiatric comorbidity; the Tridimensional Personality Questionnaire; the Barratt Impulsiveness Scale version 11, and an adapted version of the Yale Brown Obsessive Compulsive Scale for investigation of compulsivity. It was observed that OCD patients were younger at illness onset, had a more insidious course of the illness, with less frequent symptom free periods. PG and OCD presented high comorbidity with anxiety and depressive disorders, but PG presented a higher association to alcoholism and tobacco dependence as compared to OCD, while OCD presented a higher association to somatoform disorders as compared to PG. Pathological gamblers scored significantly higher than OCD patients and normal controls on impulsivity measures. OCD patients scored higher than pathological gamblers and normal controls on impulsivity. Pathological gambler scored higher than normal controls on compulsivity. It was concluded that PG and OCD have similarities regarding their high comorbidity to depression and anxiety. Nevertheless, PG's clinical course, characterized by recurrent symptomatic periods and symptom free periods, in addition to the high comorbidity with alcoholism and tobacco dependence, reinforces its resemblance to the dependencies. Regarding personality, impulsivity was the most salient feature found among pathological gamblers, thus supporting PG's classification as an impulsive control disorder.

No presente estudo foi feita uma investigação qualitativa sobre o discurso de terapeutas e pacientes jogadores patológicos, envolvidos em psicoterapia de orientação psicodinâmica, para que fossem identificados elementos relevantes à formulação de diretrizes para psicoterapia psicodinâmica de curto prazo (PPCP) para jogadores patológicos. O método qualitativo escolhido para este estudo foi a Análise do Discurso do Sujeito Coletivo (DSC). Os discursos colhidos de terapeutas e pacientes foram analisados em conjunto a fim de mapear como se deu o processo da perspectiva de ambos. Os objetivos do estudo junto aos terapeutas foram: identificar como se deu a transferência, como se manifestou a resistência, identificar etapas ou seqüências de fases apresentadas pelos Jogadores durante o tratamento psicodinâmico de Jogadores Patológicos. Os objetivos do estudo junto aos pacientes foram: identificar como se deu a percepção sobre o terapeuta e sobre a relação paciente-terapeuta, se houve dificuldades específicas do paciente em relação ao tratamento e relacionamento com o terapeuta e se houve fases de tratamento vividas pelos pacientes entre o início e o término da PPCP. Os resultados mostram a importância da transferência para o tratamento, indicações de como manejar a transferência negativa, a qual se mostrou inescapável. Foram identificadas quatro fases pelas quais o processo psicoterapêutico acontece. Foram identificadas defesas e conflitos típicos do jogador patológico e indicações de manejo eficaz das resistências. Foi possível também verificar a percepção e expectativa dos terapeutas e pacientes com relação ao sucesso terapêutico para este tipo de patologia. Foram levantadas hipóteses teóricas e verificada a importância e formas de se trabalhar assuntos da infância e/ou adolescência do paciente. Foram percebidos aspectos relacionados ao final de tratamento e possibilidades de manejo deste principalmente no caso de psicoterapia com tempo limitado. As conclusões deste estudo apontam para a importância do preparo dos terapeutas no sentido de estarem conscientes sobre as defesas, conflitos e resistências típicas e possibilidades de manejo destes. A postura ativa do terapeuta em psicoterapia breve foi discutida e foi percebida a necessidade de um melhor treinamento dos terapeutas a respeito da finalização do processo. Foram colocadas sugestões de avaliação final do paciente a fim de verificar em que etapa do processo este paciente se encontra e se há necessidade de rever o manejo do final do tratamento e quando não for possível prolongar as sessões fazer o encaminhamento para outro terapeuta. Conclui-se que a partir da análise e comparação entre os discursos foram encontradas, até o presente momento, algumas diretrizes importantes no que diz respeito a PPCP de jogadores patológicos. Estes dados poderão ser organizados em um manual para que os terapeutas possam se preparar para o atendimento visando melhores resultados / This research paper presents the qualitative analysis of the discourse of therapists and of patients who are pathological gamblers, throughout psychodynamic orientation therapy in order to identify elements that are relevant to the formulation of guidelines to short term psychodynamic psychotherapy (PPCP) for pathological gamblers. The method employed in this qualitative study was the Discourse of the Collective Subject Analysis (DSC). The discourses of therapists and patients were jointly evaluated so as to analyze the process from the perspective of both sides involved. The purposes of the study with the therapists were: identify how the transference took place, how the resistance was expressed, and which were stages or sequence of steps revealed by gamblers during the psychodynamic treatment. The purposes of the study with the patients were: identify how the patient assessed the therapist and the relationship patient-therapist, identify if the patient had specific difficulties regarding the treatment and the relationship with the therapist, and if there were different stages experienced by the patients between the beginning and the end of the PPCP. The results of the study show the relevance of transference to the treatment, and indications on how to handle negative transference, which ended up being unavoidable. Four stages were identified during the psychotherapeutic treatment. Defenses and typical conflicts of pathologic gamblers as well as signs of efficient handling of resistances were also identified. Besides, it was possible to observe the perception and expectation of therapists and patients with regard to the therapeutic attainment in this type of pathology. Theoretical hypothesis were analyzed. The importance and forms of working through childhood and adolescence issues were verified. Aspects related to the end of the treatment and its administration were analyzed, especially in the event of psychotherapy for a limited period. The inferences brought in by this study point up the importance of the preparation of therapists in the sense that they have to be fully aware of the defenses, conflicts, typical resistances and administration possibilities. The active attitude of a therapist in a brief psychotherapy was considered necessary and it was found that a better training on the administration of the ending of the treatment is very important. This paper suggests alternatives for the final evaluation of the patient in order to verify the stage in which the patient is and if it is necessary to review the handling of the end of treatment. When it is not possible to extend the sessions, it is suggested redirect the patient to other therapist. Finally, from the analysis and comparison of the discourses, it is possible to conclude that there are, so far, important guidelines for the short term psychodynamic psychotherapy of pathologic gamblers. Such relevant data may be compiled in a manual to be used for the preparation of therapists aiming better results

Sociální prostředí jako rizikový faktor pro kurzovém sázení u sportovců léčících se v ambulanci pro gamblery zaměřuje na tři životní období klientů Poradny pro nelátkové závislosti Prevent. Obecně je problematika hazardního hraní v ČR velice aktuální téma. S regulací heren a novou ČR vystupuje do popředí problematika kurzového sázení. V 14 došlo k nárůstu podílu populace, která má zkušenosti s hazardní hrou. Nejvyšší nárůst (Mravčík et al., 2018) Cílem této práce je zmapovat a popsat sociální faktory, které měli přímý vliv na vznik a rozvoj závislosti na kurzovém sázení u sportovců léčících se v ambulantní léčbě. Práce se zaměřuje na tři životní období respondentů. Prvním zkoumaným životním obdobím období počátků sázení a první zkušenosti s hazardem, druhým životním obdobím je přechod z ní do závislosti a třetí ži respondenti rozhodli jít léčit. U všech třech etap života respondentů jsou mapovány a popsány veškeré sociální vlivy a interakce s Práce je založena na metodě kvalitativního výzkumu a vychází z zakotvené teorie a otevřeného kódování. Pro sběr dat byl použit polostrukturovaný rozhovor, který umožnil flexibilitu při samotné formulaci otázek a jejím případném doplnění dalšími otázkami a tím přesnějším získáním potřebných dat. Výzkumu se zúčastnilo celkem šest respondentů, kteří v té době byli...

O jogo patológico é classificado como um transtorno do controle dos impulsos, que envolve a fissura e a impulsividade para jogar, causando prejuízos sociais. Estudos prévios sugeriram que o topiramato poderia ser mais eficaz do que o placebo no tratamento de alguns transtornos relacionados com impulsividade, tais como transtorno de compulsão alimentar periódico, alcoolismo e dependência de cocaína. O principal objetivo deste estudo foi verificar se o topiramato foi superior ao placebo em controlar fissura e reduzir pensamentos e comportamentos relacionados ao jogo. Método: os jogadores patológicos foram aleatoriamente distribuídos em um de dois grupos: o que recebeu topiramato (n=15) e o que recebeu placebo (n=15) por 12 semanas. Durante o estudo, todos os pacientes participaram de quatro sessões psicoeducacionais, baseadas no programa de 12 passos dos jogadores anônimos. A principal variável de desfecho foi a escala G-SAS. As demais variáveis de desfecho foram consideradas secuindárias, sendo as escalas/entrevista: Escala Yale Brown de obsessão e compulsão adaptada para jogo patológico (PG-YBOCS), Timeline Follow-Back (TFB), questionário de crença de jogadores (GBQ), escala de impulsividade de Barratt (BIS-11), escala de impressão clínica global (CGI), escala de adequação social (EAS). Nos resultados, os pacientes que receberam topiramato obtiveram melhora nos escores das escalas: G-SAS, o que implica em redução dos sintomas de fissura e abstinência; PG-YBOCS, que mostrou redução de comportamentos e obsessões relacionados ao jogo; GBQ, que demonstrou redução de crenças supersticiosas e melhora cognitiva e EAS, que mostrou melhora na qualidade de vida. A entrevista TFB mostrou maiores reduções na média de tempo e quantia de dinheiro gasto em jogo no grupo topiramato em relação ao grupo placebo. Conclusão: o uso de topiramato associado a quatro sessões psicoeducacionais foi superior ao uso de placebo associado a quatro sessões psicoeducacionais, na redução de fissura, freqüência, comportamentos, superstições, quantidade de tempo e dinheiro destinados ao jogo, com melhora na qualidade de vida / Pathological gambling is an impulse control disorder that involves craving and impulsivity to gamble and in which gambling thoughts and behaviors may cause social impairment. Previous studies suggested that topiramate could be effective in the treatment of some disorders related to impulsivity, such as binge eating disorder, alcoholism or cocaine addiction. The studys main goal was to verify if topiramate was superior to placebo in controlling craving and reducing thoughts and behaviors related to gambling. Methods: pathological gamblers were randomized to topiramate (n=15) or placebo (n=15) in a 12-week, double-blind placebo controlled trial. During the 12 weeks the patients had four sessions of a program based on the 12 steps of Anonymous Gamblers. The primary outcome measure was the Gambling Symptom Assessment Scale (G-SAS), which evaluates symptoms related to abstinence. As secondary outcome measures it was used the following scales or interviews: Yale Brown Obsessive Compulsive Scale adapted for Pathological Gambling (PG-YBOCS), Timeline Follow-Back Method (TFB), Gamblers Beliefs Questionnaire (GBQ), Barratt Impulsiveness Scale (BIS-11), Clinical Global Impression (CGI), Social Adjustment Scale (SAS). Results: There were statistic robust findings in some of the scales used in this study. The group of patients who took topiramate had improvement in the scores of the G-SAS, which implies reduction in the symptoms of craving and abstinence; PG-YBOCS, which showed reductions in the behaviors and obsessions related to gambling; GBG, which revealed reduction of superstitious thoughts and cognitive improvement, and EAS that showed improvement in the quality of life. TFB showed that the topiramate group had more reductions in the average of time and money spent on gambling than the placebo group. Conclusions: According to the results, topiramate associated with four sessions based in cognitive restructuring were superior to placebo associated with four sessions based in cognitive restructuring in reducing craving, frequency, behaviors and superstitions related to gambling, and amount of time and money used in gambling. Moreover, according to SAS, the group that took topiramate had better improvement in the quality of life than the placebo group

Plusieurs études telles que le NESARC ont démontré la comorbidité chez les joueurs pathologiques dans la population générale et dans des échantillons cliniques. Le jeu pathologique se présente souvent avec des troubles comorbides tels que les toxicomanies, les troubles de l’humeur, les troubles anxieux et les troubles de la personnalité. Cette étude a été réalisée auprès de 40 joueurs pathologiques admis en traitement au Centre Dollard-Cormier, Institut universitaire sur les dépendances à Montréal. Les objectifs étaient d’évaluer : la consommation d’alcool et de drogues, la présence d’une détresse psychologique caractérisée par des symptômes et des syndromes cliniques ainsi que par des troubles de la personnalité et la prévalence du trouble de l’ÉSPT dans l’échantillon. L’ICJE a été utilisé pour évaluer la gravité du jeu. Les autres troubles ont été mesurés à travers l’IGT, l’AUDIT, le MCMI-III, le QÉT et l’ÉMST. Les résultats montrent que 65 % des participants présentent une consommation problématique d’alcool (25 % actuellement, 40 % dans le passé), 27,5 % une consommation problématique de drogues; 52,5 %, un diagnostic probable d’au moins un syndrome clinique (surtout anxiété et dépression), 55 %, un diagnostic probable d’au moins un trouble de la personnalité; 30 %, des symptômes du trouble d’ÉSPT et 17,5 %, un diagnostic probable du trouble. Alors, la comorbidité est présente chez les joueurs pathologiques de l’échantillon. Il est essentiel de l’identifier pour mieux répondre aux besoins particuliers de l’individu et l’aider avec les symptômes qui aggravent le problème de jeu et augmentent le risque de récidive. / Several studies such as the NESARC have demonstrated the comorbidity in pathological gamblers in the general population and in clinical samples. Pathological gambling often occurs with other comorbid disorders, such as addictions, mood disorders, anxiety disorders, and personality disorders. This study was conducted among 40 pathological gamblers admitted in treatment at Centre Dollard-Cormier, Institut universitaire sur les dépendances, in Montreal. The objectives were to assess the use of alcohol and drugs, the presence of psychological distress characterized by clinical symptoms and syndromes as well as by personality disorders, and the prevalence of PTSD in the gamblers of the sample. The CPGI was used to assess the severity of gambling. The other disorders were measured through the ASI, the AUDIT, the MCMI-III, the QÉT and the ÉMST. The results show that 65% of participants had a problem with alcohol (25% currently, 40% in the past), 27.5% presented a problematic drug use, 52.5% had a potential diagnosis of at least one clinical syndrome (mainly anxiety and depression), 55% had a potential diagnosis of at least one personality disorder, 30% presented symptoms of PTSD and 17.5% had a potential diagnosis of PTSD. In conclusion, comorbidity exists in the pathological gamblers of the sample. It is essential to identify it in order to better address the needs of the individual and to help him with the symptoms that worsen the gambling problem and increase the risk of recurrence.

Background & objective Cognitive Behavioural Therapy (CBT) and Motivational Interviewing (MI) have been the treatment of choice for problem or pathological gambling in the field in Western countries, and their efficacy has been supported by a considerable empirical research. Alternative treatments are little known; and such treatments for minority ethnic populations have been scarce. This study adopted Kazdin‘s procedures for assessing the acceptability of treatments (Kazdin, 1980a, 1980b, 1981) to test alternative treatments of problem or pathological gambling as a part of the broadening of treatment choices. This thesis presented 2009 survey results from counselling service providers in New Zealand on the acceptability of alternative treatments to problem or pathological gambling. The thesis, therefore, reports the responses of counsellors to counselling vignette case examples, not the views of actual clients viewing counselling. Methods The survey pack was distributed to counselling service providers in New Zealand. The survey included descriptions of sixteen vignettes of case examples of counselling treatments. Categories of clients in the vignette case examples included two genders (male, female) and three ethnicities (Pakeha, Maori, and Asian). Four counselling treatment conditions were selected from Solution-Focused Brief Counselling (SFBC), SFBC+Multicultural Counselling (SFBC+MC), Cognitive-Behavioural Therapy (CBT), and Motivational Interviewing (MI). CBT and MI were only administered to Pakeha clients for the purpose of comparison of the alternatives. Two measurements were used. The first a modified Problem Gambling Treatment Evaluation Inventory (TEI) was used to measure the acceptability levels of the alternative treatments for problem or pathological gambling. The Cross-Cultural Counselling Inventory-Revised (CCCI-R) was used for measuring the perceived cross-cultural competency of counsellors depicted in the vignette case examples. Findings Counsellors‘ ratings of the vignette case examples revealed the following findings: Measurement 1: Problem Gambling Treatment Evaluation Inventory (TEI). Overall, 1) The survey results of TEI questionnaires showed significant main effects across the four treatment conditions and the three client ethnicities, and there was no difference according to client genders. 1.1) SFBC+MC and SFBC were slightly more acceptable than CBT, and much more acceptable than MI. 1.2) The TEI scores for Pakeha clients were much higher than for Maori clients, and the scores for the Asian clients were in between. 2) There was a significant interaction effect between the four treatments and the three client ethnicities. 2.1) For Maori clients: SFBC+MC was much more acceptable than SFBC; for Pakeha clients: SFBC+MC was the most acceptable, closely followed by SFBC, CBT, then MI; and for Asian clients: SFBC was more acceptable than SFBC+MC. 2.2) SFBC+MC was most acceptable to Maori clients across all treatments and ethnic groups. 2.3) The variation in acceptability ratings for SFBC was larger than for SFBC+MC in Maori and Asian clients, and less variable in Pakeha. 2.4) Maori clients had the largest mean variation between SFBC and SFBC+MC, and Pakeha clients had the smallest mean variation. Measurement 2: Cross-Cultural Counselling Inventory-Revised (CCCI-R). The survey results of the CCCI-R showed significant main effects across the four treatment conditions and the three ethnicities. 1) The counsellors depicted in the vignette case examples under the SFBC+MC treatment condition were rated with the highest mean competence score and least variability across all the treatments and the ethnicities, the MI treatment condition were rated with the lowest mean score, CBT and SFBC were in between. 2) The counsellors described in the vignette case examples were rated more culturally competent with Pakeha clients and Maori clients than with Asian clients in the vignette case examples, the rating levels for both Pakeha and Maori were similar. 3) The Maori client in the vignette case examples had the largest mean gap between SFBC and SFBC+MC, and Pakeha client in the vignette case examples had the smallest mean gap. Clinical implications The tests of the acceptability of alternative treatment for problem or pathological gambling could provide useful information about 1) whether the above alternatives would be recommended or selected by the counselling service providers in their clinical practice, 2) which treatment would be more/less preferred by which ethnic group, 3) whether it would work or be worth the efforts to introduce or promote the above alternatives to the counselling service providers, 4) what needs to be explored for increasing levels of the acceptability of alternative treatment to problem or pathological gambling, 5) adding training in the techniques to counsellors training programme and curricula. The limitation of this study was discussed and future research was suggested.

Un kleptomane, pris d’impulsions irrésistibles, peut-il être responsable pénalement de ses actes ? Voilà la question à l’origine de cette recherche. Les troubles du contrôle des impulsions sont des troubles mentaux caractérisés par l’impossibilité de résister à une impulsion. Comment peut-on concilier ceux-ci avec le droit pénal canadien sachant que la responsabilité criminelle repose sur le postulat voulant que seul un acte volontaire justifie une déclaration de culpabilité ? Afin d’avoir une étude exhaustive sur le sujet, nous avons choisi trois troubles du contrôle des impulsions, soit la kleptomanie, la pyromanie et le jeu pathologique. Cette sélection permet d’étudier à la fois l’imputabilité criminelle et l’imposition d’une sentence en droit pénal canadien. Cette étude propose un retour aux principes fondamentaux de la responsabilité criminelle et l’analyse du droit pénal canadien afin de démontrer que certains troubles du contrôle des impulsions (kleptomanie et pyromanie) entraînent chez le sujet atteint une incapacité criminelle, le rendant non criminellement responsable au sens de l’article 16 du Code criminel. Au surplus, cette recherche porte sur les principes entourant l’imposition d’une sentence en droit pénal canadien et étudie l’impact de ces maladies mentales au point de vue de la peine. Cette analyse démontre que les caractéristiques diagnostiques des troubles du contrôle des impulsions sont utilisées afin d’alourdir la peine imposée aux contrevenants. Nous considérons que celles-ci ne devraient pas être employées comme facteurs aggravants (particulièrement en matière de jeu pathologique), mais devraient plutôt être utilisées afin d’imposer une peine plus appropriée pour remédier à la problématique entraînant la commission des délits. / A kleptomaniac, taken by overpowering impulses, can he be criminally responsible for his actions? That is the question behind this research. The impulse control disorders are mental disorders characterized by the inability to resist an impulse. How can we reconcile this with the Canadian criminal law, knowing that criminal liability based on the assumption that only a voluntary act warrants a conviction? To gain a comprehensive study on the subject, we chose three impulse control disorders, kleptomania, pyromania and pathological gambling. This selection allows us to study both the criminal accountability and the imposition of a sentence in Canadian criminal law. This study proposes a return to fundamental principles of criminal responsibility and the analysis of Canadian criminal law to demonstrate that some impulse control disorders (kleptomania and pyromania) result in the subject reaching a criminal incapacity, making it not criminally responsible within the meaning of article 16 of the Criminal Code. Furthermore, this research focuses on the principles surrounding the imposition of a sentence in Canadian criminal law and explores the impact of mental illness in terms of the sentence. This analysis shows that the diagnostic features of impulse control disorders are used to increase the punishment imposed on offenders. We consider that these characteristic should not be used as aggravating factors (especially in pathological gambling), but should be used to impose a sentence more appropriate to remedy to the problem causing the commission of crimes.

The diploma thesis focuses on fixed-odds betting among male adolescents. In theoretical part, game as a whole life matter is explained, afterwards it aims closer to hazard game, especially fixed-odds betting. Regarding to children, multiple smaller studies, focused on risky behaviour on the internet and gambling, are introduced. Empirical part combines qualitative and quantitative approach. Interviews with betters jointly with the theory creates the base for hypothesises and questionnaire, which was distributed in five schools; three elementary and two high schools. Results of the empirical part are suggesting that adolescent boys have experiences with fixed-odds betting even though they are not of age. Frequently, the reason for betting is being involved in sport and the favourite form is on-line betting.