ICD grant et al. (2008) Flashcards
(16 cards)
opiates
drugs produced from opium
found in poppies
include morphine
molecules bind to opioid receptors
bc body also has endogenous morphine called endorphins
response to exercise sex eating but also pain and stress
increase pleasure and decrease pain
how opioid receptors work
inhibit release of GABA neurotransmitter
GABA regulates dopamine
so activity increase so pleasure/euphoria
antagonists reduce effects of neurochemicals by occupying receptors but dont activate it
block ability of experiencing euphoria
drugs thus used to treat substance addictions
aim
investigate factors that predict the effectiveness of opiate antagonists in treatment of gambling disorder
hypotheses
opiate antagonists would be more effective if have family history of alcoholism, stronger urges to gamble and euphoria in response to alcohol compared to those without family history, weaker urge, less pronounced response to alcohol
people w less severe gambling urges may experience placebo effect > respond pos to drugs but no diff in improvement if drug or placebo
methodology
combined results of two RCTs
meta-analysis
both RCTs double blind placebo controlled experiments
independent measures
data gathering techniques - structured and semi structured interviews, ques, psychometric tests
sample
284 americans ps
diagnosed w pathological gambling using DSM 5
scored 5 or more on south oaks gambling screen SOGS
48% female
52% male
none preggo or breastfeeding
used reg contraception
207 outpatients from 15 psych centres who participated in a 16 week nalmefene trial
other 77 in 18 week naltrexone trial
all had gambled in past 2 weeks and more than once a week
none had used the drugs b4
procedure
randomly assigned placebo or low med high drug dose
nalfemene 25mg 50mg 100mg
naltrexone 50mg 100mg 150mg
comorbid diagnoses identified via ques
severity of symptoms assessed before and after treatment using modofied vers of YBOCs
decrease of > 35% is pos response
daily functioning, anxiety, depression assessed using ques
family psych history via semi structured interview
^ including alcoholism in first degree relatives
demographics results
avg age of onset 29
avg 11 years 1-40 range between starting gamble and being diagnosed
30% attended gamblers anonymous
19% prev sought help
48% played non strategic games like slots and bingo
16% strategic only like blackjack poker
36% both
24% met criteria for mood disorders
7% anxiety disorders
3% eating disorders
42 tobacco users
results - response to drug and placebo
initially 2 drugs separated but then results similar so analysed same
family history of alcoholism robustly associated w pos response to treatment outcome
stronger baseline urges to gamble score mildly associated w pos treatment response to higher doses of drugs
younger ps more likely to respond pos to placebo
30% less effective for every 10 years in age
conclusions
family history of alcholism and to a lesser extent strength of urges to gamble are associated with a pos response to opiate antagonists as treatment for gambling disorder
methodological strengths
1) double blind placebo controlled, increase validity
2) nalmefene ps recruited from 15 treatemtn centres, mroe representative of tagret pop, generalisability
BUTTT 90% caucasian and from minnesota USA
methodological weaknesses
1) family history self reported in interviews so less valid
2) semi structured interview so not replicable bc diff qs based on ps response
3) no follow up assessment after 16 week and 18 week trials
results may be short term only
relapse is typical
not taking meds is also relapse, likely after trial over and less support available
ethics
drug trials approved by institutional board of the uni of minnesota
informed written consent by all ps
risks explained and given info abt alt treatment
number of placebo pls lower than treatment 1-3
as many ps treated as possible without compromising study’s design
all ps screened so no one at risk of additionial physical or psych harm
> unstable medical conditions or taking meds that could interact bad w the drugs and w psych conditions or suicidality excluded
application to everyday life
help health professionals ask qs that help make more informed decisions about best drugs to offer people with gambling disorders
asking qs abt fam history gain info to informps abt possible pos response to drugs
may work for those without fam history bit may be helpful to use smth else first like antidepress or antipsychotic
idiographic vs nomothetic
nomothetic approach
obj to draw concs about the factors that predict efficacy
info gathered like age gambling ajd tobacco use
ALL DATA QUANTITATIVE
statistical techniques used
probabilities based on avg rather than focusing on unique treatment journeys
idiographic could help provide more detailed understanding of experience of taking meds and impact on individuals and fam members
reductionism vs holism
focus on bio factors reductionist
without additional support people may relapse without meds
behaviour may not feel rewarding but the beliefs underpinning remain same
pairing drugs w psych therapies to focus on stress management and coping skills more comprehensive treatment package
