Gambling disorder in the UK : key research priorities and the urgent need for independent research funding
- Bowden-Jones, Henrietta, Hook, Roxanne, Grant, Jon, Ioannidis, Konstantinos, Corazza, Ornella, Fineberg, Naomi, Singer, Bryan, Roberts, Amanda, Bethlehem, Richard, Dymond, Simon, Romero-Garcia, Rafa, Robbins, Trevor, Cortese, Samuele, Thomas, Shane, Sahakian, Barbara, Dowling, Nicki, Chamberlain, Samuel
- Authors: Bowden-Jones, Henrietta , Hook, Roxanne , Grant, Jon , Ioannidis, Konstantinos , Corazza, Ornella , Fineberg, Naomi , Singer, Bryan , Roberts, Amanda , Bethlehem, Richard , Dymond, Simon , Romero-Garcia, Rafa , Robbins, Trevor , Cortese, Samuele , Thomas, Shane , Sahakian, Barbara , Dowling, Nicki , Chamberlain, Samuel
- Date: 2022
- Type: Text , Journal article , Review
- Relation: The Lancet Psychiatry Vol. 9, no. 4 (2022), p. 321-329
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- Description: Gambling in the modern era is pervasive owing to the variety of gambling opportunities available, including those that use technology (eg, online applications on smartphones). Although many people gamble recreationally without undue negative effects, a sizeable subset of individuals develop disordered gambling, which is associated with marked functional impairment including other mental health problems, relationship problems, bankruptcy, suicidality, and criminality. The National UK Research Network for Behavioural Addictions (NUK-BA) was established to promote understanding of, research into, and treatments for behavioural addictions including gambling disorder, which is the only formally recognised behavioural addiction. In this Health Policy paper, we outline the status of research and treatment for disordered gambling in the UK (including funding issues) and key research that should be conducted to establish the magnitude of the problem, vulnerability and resilience factors, the underlying neurobiology, long-term consequences, and treatment opportunities. In particular, we emphasise the need to: (1) conduct independent longitudinal research into the prevalence of disordered gambling (including gambling disorder and at-risk gambling), and gambling harms, including in vulnerable and minoritised groups; (2) select and refine the most suitable pragmatic measurement tools; (3) identify predictors (eg, vulnerability and resilience markers) of disordered gambling in people who gamble recreationally, including in vulnerable and minoritised groups; (4) conduct randomised controlled trials on psychological interventions and pharmacotherapy for gambling disorder; (5) improve understanding of the neurobiological basis of gambling disorder, including impulsivity and compulsivity, genetics, and biomarkers; and (6) develop clinical guidelines based on the best contemporary research evidence to guide effective clinical interventions. We also highlight the need to consider what can be learnt from approaches towards mitigating gambling-related harm in other countries. © 2022 Elsevier Ltd
- Authors: Bowden-Jones, Henrietta , Hook, Roxanne , Grant, Jon , Ioannidis, Konstantinos , Corazza, Ornella , Fineberg, Naomi , Singer, Bryan , Roberts, Amanda , Bethlehem, Richard , Dymond, Simon , Romero-Garcia, Rafa , Robbins, Trevor , Cortese, Samuele , Thomas, Shane , Sahakian, Barbara , Dowling, Nicki , Chamberlain, Samuel
- Date: 2022
- Type: Text , Journal article , Review
- Relation: The Lancet Psychiatry Vol. 9, no. 4 (2022), p. 321-329
- Full Text:
- Reviewed:
- Description: Gambling in the modern era is pervasive owing to the variety of gambling opportunities available, including those that use technology (eg, online applications on smartphones). Although many people gamble recreationally without undue negative effects, a sizeable subset of individuals develop disordered gambling, which is associated with marked functional impairment including other mental health problems, relationship problems, bankruptcy, suicidality, and criminality. The National UK Research Network for Behavioural Addictions (NUK-BA) was established to promote understanding of, research into, and treatments for behavioural addictions including gambling disorder, which is the only formally recognised behavioural addiction. In this Health Policy paper, we outline the status of research and treatment for disordered gambling in the UK (including funding issues) and key research that should be conducted to establish the magnitude of the problem, vulnerability and resilience factors, the underlying neurobiology, long-term consequences, and treatment opportunities. In particular, we emphasise the need to: (1) conduct independent longitudinal research into the prevalence of disordered gambling (including gambling disorder and at-risk gambling), and gambling harms, including in vulnerable and minoritised groups; (2) select and refine the most suitable pragmatic measurement tools; (3) identify predictors (eg, vulnerability and resilience markers) of disordered gambling in people who gamble recreationally, including in vulnerable and minoritised groups; (4) conduct randomised controlled trials on psychological interventions and pharmacotherapy for gambling disorder; (5) improve understanding of the neurobiological basis of gambling disorder, including impulsivity and compulsivity, genetics, and biomarkers; and (6) develop clinical guidelines based on the best contemporary research evidence to guide effective clinical interventions. We also highlight the need to consider what can be learnt from approaches towards mitigating gambling-related harm in other countries. © 2022 Elsevier Ltd
Pharmacological interventions for the treatment of disordered and problem gambling
- Dowling, Nicki, Merkouris, Stephanie, Lubman, Dan, Thomas, Shane, Bowden-Jones, Henrietta, Cowlishaw, Sean
- Authors: Dowling, Nicki , Merkouris, Stephanie , Lubman, Dan , Thomas, Shane , Bowden-Jones, Henrietta , Cowlishaw, Sean
- Date: 2022
- Type: Text , Journal article
- Relation: Cochrane Database of Systematic Reviews Vol. 2022, no. 9 (2022), p.
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- Description: Background: Pharmacological interventions for disordered and problem gambling have been employed in clinical practice. Despite the availability of several reviews of the efficacy of pharmacological interventions for disordered or problem gambling, few have employed systematic search strategies or compared different categories of pharmacological interventions. Systematic reviews of high-quality evidence are therefore essential to provide guidance regarding the efficacy of different pharmacological interventions for disordered or problem gambling. Objectives: The primary aims of the review were to: (1) examine the efficacy of major categories of pharmacological-only interventions (antidepressants, opioid antagonists, mood stabilisers, atypical antipsychotics) for disordered or problem gambling, relative to placebo control conditions; and (2) examine the efficacy of these major categories relative to each other. Search methods: We searched the Cochrane Common Mental Disorders Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE, Embase, and PsycINFO (all years to 11 January 2022). Selection criteria: We included randomised trials evaluating a pharmacological intervention for the treatment of disordered or problem gambling. Eligible control conditions included placebo control groups or comparisons with another category of pharmacological intervention. Data collection and analysis: We used standard methodological procedures, including systematic extraction of included study characteristics and results and risk of bias assessment. Our primary outcome was reduction in gambling symptom severity. Our secondary outcomes were reduction in gambling expenditure, gambling frequency, time spent gambling, depressive symptoms, anxiety symptoms, and functional impairment; and responder status. We evaluated treatment effects for continuous and dichotomous outcomes using standardised mean difference (SMD) and risk ratios (RR), respectively, employing random-effects meta-analyses. A minimum of two independent treatment effects were required for a meta-analysis to be conducted (with only meta-analytic findings reported in this abstract). Main results: We included 17 studies in the review (n = 1193 randomised) that reported outcome data scheduled for end of treatment. Length of treatment ranged from 7 to 96 weeks. Antidepressants: Six studies (n = 268) evaluated antidepressants, with very low to low certainty evidence suggesting that antidepressants were no more effective than placebo at post-treatment: gambling symptom severity (SMD
Transforming global approaches to chronic disease prevention and management across the lifespan : integrating genomics, behavior change, and digital health solutions
- Thomas, Shane, Browning, Collette, Charchar, Fadi, Klein, Britt, Ory, Marcia, Bowden-Jones, Henrietta, Chamberlain, Samuel
- Authors: Thomas, Shane , Browning, Collette , Charchar, Fadi , Klein, Britt , Ory, Marcia , Bowden-Jones, Henrietta , Chamberlain, Samuel
- Date: 2023
- Type: Text , Journal article
- Relation: Frontiers in Public Health Vol. 11, no. (2023), p.
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- Description: Chronic illnesses are a major threat to global population health through the lifespan into older age. Despite world-wide public health goals, there has been a steady increase in chronic and non-communicable diseases (e.g., cancer, cardiovascular and metabolic disorders) and strong growth in mental health disorders. In 2010, 67% of deaths worldwide were due to chronic diseases and this increased to 74% in 2019, with accelerated growth in the COVID-19 era and its aftermath. Aging and wellbeing across the lifespan are positively impacted by the presence of effective prevention and management of chronic illness that can enhance population health. This paper provides a short overview of the journey to this current situation followed by discussion of how we may better address what the World Health Organization has termed the “tsunami of chronic diseases.” In this paper we advocate for the development, validation, and subsequent deployment of integrated: 1. Polygenic and multifactorial risk prediction tools to screen for those at future risk of chronic disease and those with undiagnosed chronic disease. 2. Advanced preventive, behavior change and chronic disease management to maximize population health and wellbeing. 3. Digital health systems to support greater efficiencies in population-scale health prevention and intervention programs. It is argued that each of these actions individually has an emerging evidence base. However, there has been limited research to date concerning the combined population-level health effects of their integration. We outline the conceptual framework within which we are planning and currently conducting studies to investigate the effects of their integration. Copyright © 2023 Thomas, Browning, Charchar, Klein, Ory, Bowden-Jones and Chamberlain.
- Authors: Thomas, Shane , Browning, Collette , Charchar, Fadi , Klein, Britt , Ory, Marcia , Bowden-Jones, Henrietta , Chamberlain, Samuel
- Date: 2023
- Type: Text , Journal article
- Relation: Frontiers in Public Health Vol. 11, no. (2023), p.
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- Description: Chronic illnesses are a major threat to global population health through the lifespan into older age. Despite world-wide public health goals, there has been a steady increase in chronic and non-communicable diseases (e.g., cancer, cardiovascular and metabolic disorders) and strong growth in mental health disorders. In 2010, 67% of deaths worldwide were due to chronic diseases and this increased to 74% in 2019, with accelerated growth in the COVID-19 era and its aftermath. Aging and wellbeing across the lifespan are positively impacted by the presence of effective prevention and management of chronic illness that can enhance population health. This paper provides a short overview of the journey to this current situation followed by discussion of how we may better address what the World Health Organization has termed the “tsunami of chronic diseases.” In this paper we advocate for the development, validation, and subsequent deployment of integrated: 1. Polygenic and multifactorial risk prediction tools to screen for those at future risk of chronic disease and those with undiagnosed chronic disease. 2. Advanced preventive, behavior change and chronic disease management to maximize population health and wellbeing. 3. Digital health systems to support greater efficiencies in population-scale health prevention and intervention programs. It is argued that each of these actions individually has an emerging evidence base. However, there has been limited research to date concerning the combined population-level health effects of their integration. We outline the conceptual framework within which we are planning and currently conducting studies to investigate the effects of their integration. Copyright © 2023 Thomas, Browning, Charchar, Klein, Ory, Bowden-Jones and Chamberlain.
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