Connecting Science and Practice: The Impact of Gambling Research on Clinicians

Transcription

1 Connecting Science and Practice: The Impact of Gambling Research on Clinicians Presented at the 2006 Midwest Conference on Problem Gambling and Substance Abuse. August 17, 2006 Kansas City, MO Anne Helene Skinstad, PhD Martin Goransson, MPH Department of Community and Behavior Health The University of Iowa College of Public Health

2 Connecting Science and Practice Institute of Medicine Report (IOM): Bridging the Gap between Research and Practice (1998) From Bench to Trench (Rawson, 2003). Goals of the IOM report: Reduce the barrier between research and practice Reduce the time between an innovation and adoption of the innovation into practice Increase communication between researchers and practitioners: From Trench to Bench

3 Connecting Science and Practice A number of programs were initiated after the IOM report. Examples include: Substance Abuse and Mental Health Service Administration (SAMHSA): Practice -Improvement Collaborative National Institute on Drug Abuse (NIDA): Clinical Trials Network: Problem gambling: Not yet a research home

4 Connecting Science and Practice Development of a plan for connecting Science to Practice requires clarity in a number of areas, including: Research in assessment and treatment of problem gambling Reno model Knowledge about the workforce Characteristics Training needs Technology transfer of empirically supported innovations Where does technology transfer fit into the RENO model? Summary

5 RESEARCH ON ASSESSMENT AND TREATMENT OF PROBLEM GAMBLING

6 The Reno Model [3] Two Key Barriers to Advancing Responsible Gambling Lack of Conceptual Clarity Absence of Consensus

7 Lack of Conceptual Clarity [3] Multitude of Terms and Definitions Problem Gambler At-risk Gambler Compulsive Gambler Probable Pathological Gambler Pathological Gambler

8 Lack of Conceptual Clarity [3] The South Oaks Gambling Screen (SOGS) [4] Most widely used instrument in treatment studies Not a diagnostic instrument The lack of uniformity hinders effective knowledge transfer

9 Lack of Conceptual Clarity [3] Multitude of Treatment outcome measures Over 30 different outcome measures used in the clinical trials and treatment outcome literature [5] Measures and definitions of effectiveness Abstinence Pre-Post statistical difference Clinically significant differences [6] [6]

10 Best Practices

11 Clearly: Maybe [7] Best Practice implementation urgent to ensure efficacious treatment and start the process It is detrimental to treatment to limit treatment options at this point, lacking more clinical data

12 Cognitive Interventions [8,9] Strongest Empirical Support Cognitive Correction Chance and Randomness clarification Problem Solving Social Skills

13 Medical Treatment [10,11,24] Encouraging Evidence SSRI s Nalmefene, Naltrexone Mood Stabilizers Remaining Problems Placebo response Co-occurrence (what is being treated) Longevity

14 Brief Interventions and Self Help Brief intervention with college students [12] Built on MI and CBT principles High recruitment, completion, and follow-up rates Self help manuals [13] Promising results with 84% of participants reporting reduced gambling behavior at 12 months Gambler s Anonymous in combination with professional treatment [14] Most commonly used treatment method Number of GA meetings attended significantly and independently associated with gambling abstinence

15 WORKFORCE ISSUES

16 Workforce Issues More research on the gambling treatment workforce needed to improve outcomes and quality of services [21,22] 181 psychologists employed by the Veterans Administration surveyed in Over 60% had not received any training on assessment or treatment of gambling disorders during their graduate training, internship or post-graduate training. Almost half of the respondents had never attended or had the opportunity to attend a continuing education seminar or workshop on pathological or problem gambling %psychologists receive training [23].

17 Workforce Issues Opportunity for researchers and providers to collaborate Opportunity for clinicians to improve practices Opportunity for researchers to access populations and conduct community based clinical research Investing in and understanding the gambling treatment workforce benefits research and treatment outcomes Now is the time to start collaborating as more and more research is coming out and gambling is our understanding of gambling is improving fast.

18 A Survey of the Pathological Gambling Treatment Workforce: Who They Are and How Better We Can Help Them 18 month grant awarded by the Institute for Research on Pathological Gambling and Related Disorders First national gambling treatment workforce survey in the U.S. (or elsewhere). Project start: August, Anticipated date of completion: December, 2007.

19 Project aims Specific Aim #1: Develop, pretest, and validate an instrument to measure the characteristics, attitudes, and training needs of the problem gambling workforce. Specific Aim #2: Administer the validated instrument to a purposive sample of gambling and substance abuse treatment providers in seven ATTC regions (a minimum of 12 states) that cover the major geographic regions of the US. Specific Aim #3: Convene an expert panel consisting of ATTC directors and internationally recognized gambling researchers to amass a set of recommendations to enable the development of an evidence-based curriculum firmly based on our findings.

20 Bringing Research Findings to the Workforce [15,16] Scientific advances are under- utilized by the addictions field Gambling presents opportunities and challenges in this regard New field with ability to influence practice Early gambling research hard to sell compared to other addictions

21 Characteristics of the Workforce What do we know about the characteristics of the workforce Educational background Age Knowledge about basic counseling skills Knowledge about assessment and planning an assessment strategies Knowledge about empirically supported therapeutic strategies Gender

22 Additional Workforce Working situations Community based substance abuse treatment centers Inpatient treatment centers Outpatient treatment centers Community-based mental health centers Inpatient mental health units Independent private practices Front line health care practices

23 Other Workforce Issues Supervision issues Administrative supervision Clinical supervision

24 STRATEGIES FOR TECHNOLOGY TRANSFER CONNECTING SCIENCE AND PRACTICE

25 The ATTC Network: Serving the Field since 1993 [1] The Addiction Technology Transfer center center is dedicated to identifying and advancing opportunities for improving addiction treatment Our mission is to unify science, education, and services to transform the lives of individuals and families affected by alcohol and other drug addiction Funded by the Substance Abuse and Mental Health Services Administration (SAMHSA)

26 The ATTC Network Areas of Emphasis Enhancing cultural-appropriate assessment and treatment strategies for substance abuse Dissemination substance abuse assessment and treatment tools Building a stronger and better workforce Advancing knowledge adoption Forging partnerships in order to facilitate adoption

27 Prarielands ATTC (PATTC) [2] Iowa, Minnesota, Nebraska, North Dakota, and South Dakota PATTC heads the ATTC Network gambling initiative Lead Agent for the Annual Midwest Conference on Problem Gambling and Substance Abuse

28 What does Technology Transfer mean? Technology Transfer is producer-oriented Diffusion is user- oriented Rogers 2004 (19)

29 Technology Transfer (Cont.) Technology Transfer is more than a behavior change process. Both cognition and behavior must be impacted. Brown (2000) (18)

30 Technology Transfer Cycle [16] N.A. Roget, University of Nevada, Reno P.K. Horvatich, Virginia Commonwealth University A.H. Skinstad, University of Iowa S.A. Storti, Brown University 2004

31 Knowledge Dissemination Target groups: General public Professionals working in the casinos EMERGE: Executive, Management, & Employee Responsible Gaming Education

32 Knowledge Dissemination (Cont.) Professional communities Pre-service Counseling profession Psychologists Social workers and others Health care professionals: physicians, nurses, physician assistants and others Post-service dissemination

33 Active Ingredients of Technology Transfer (TT) Roget (2002) (20) conducted a review of the technology transfer literature and found nine common themes regarding the processes of technology transfer

34 Adoption of New Innovations In order to facilitate adoption of new innovations, nine ingredients of Technology Transfer need to be included in the effort.

35 The Nine Ingredients of Technology Transfer Influence & Involve Opinion Leaders Ensure & Accessibility Suitability Provide Multiple Exposures Increase Personal Contact with Innovation Provide Positive Rewards Utilize Regeneration Strategies Enhance Ownership Include Bottom-up Perspectives Deal with Resistance

36 Provide Multiple Exposures [16] Expose adopters to the new technology in various modes Workshops Conferences Online education CD-ROM materials

37 Increase Personal Contact with Innovation [16] Onsite technical consulting with innovator Toll-free telephone consulting

38 Positive Rewards (Incentives) [16] The single most poorly understood element of the research-practice formula is the need for treatment programs to be adequately compensated for their participation in research- practice activities [17 p. 776). Time is money Space, supplies, and phones cost money New treatments create expenses [17]

39 Enhance Ownership [16] Clinical guides/manuals Literature reviews and meeting with other users of the technology Provide credible evidence that the technology is working

40 Include Bottom-up Perspectives [16] Front line staff are members of the change team Find ways to integrate research findings into everyday clinical experience What works for whom and where? How to maximize adoption? Be creative and follow up.

41 Deal with Resistance [15,16] Change is stressful Emphasize payoffs of change Include everyone, change cannot be successfully imposed Roll with resistance and realize that some resistance is legitimate and needs to be addressed

42 Summary

43 Summary The field of assessment and treatment of problem gambling presents unique opportunities New area of research New area for dissemination and adoption Adopt strategies for effective dissemination and adoption from other fields Build consensus on what technologies to disseminate Decide on use of dissemination or adoption strategies

44 Summary Support more research on problem gambling Age and gender difference Cultural differences Support more research on issues important for workforce development Support research on training needs Support curriculum infusion in: Pre-service education of health care professionals Continuing education of health care professionals Evaluate our educational efforts

45 Thank you Special Thank You to Nancy Roget, MS. from the Mountain West ATTC for her important contributions to this presentation Thank You also to Candace Peters, MA. and Jane Li, MS., both from the Prairielands ATTC for their contributions to this presentation

46 References 1. National Addiction Technology Transfer (2005) Retrieved from 2. Prarielands Addiction Technology Transfer (2005) Retrieved from 3. Blaszczynski, A., Ladouceur, R., & Shaffer, H. J. (2004). A Science-Based Framework for Responsible Gambling: The Reno Model. Journal of Gambling Studies, 3 (20), Lesieur, H. R., & Blume, S. B. (1987). The South Oaks Gambling Screen (SOGS): A New Instrument for the Identification of Pathological Gamblers. American Journal of Psychiatry, 144, Pallesen, S., Mitsem, M., Kvale, G., Johansen, B-H., & Molde, H. (2005). Outcome of Psychological Treatments of Pathological Gambling: A Review and Meta- Analysis. Addiction, 100, Stinchfield, R., & Winters, K. C. (2001). Outcome of Minnesota s Gambling Treatment Programs. Journal of Gambling Studies, 3 (17), Shaffer, H. J., LaBrie, R. A., LaPlante, D. A., Kidman, R. C., & Nelson, S. E. (n.d.) The Iowa Gambling Treatment Program: Evaluation Services Project: Follow- Up Study Final Report. Retrieved November 9, 2005 from 8. Toneatto, T., & Ladouceur, R. (2003). Treatment of Pathological Gamblers: A Critical Review of the Literature. Psychology of Addictive Behaviors, 4 (17), Petry, N. M., & Armentano, C. (1999). Prevalence, Assessment, and Treatment of Pathological Gambling: A review. Psychiatric Services, 8 (50), Hollander, E., Sood, E., Pallanti, S., Baldini-Rossi, N., & Baker, B. (2005). Pharmacological Treatments of Pathological Gambling. Journal of Gambling Studies, 1 (21) Department Potenza, of Community M. N. (2005). & Behavior Advancing Health Treatment Strategies Prairielands for Addiction Pathological Technology Gambling. Transfer Journal of Gambling Studies, 1 (21),

47 References 1. Takushi, R. Y., Neighbors, C., Larimer, M. E., Lostutter, T. W., Cronce, J. M., & Marlatt, G. A. (2004). Indicated Prevention of Problem Gambling Among College Students. Journal of Gambling Studies, 1 (20), Hodgins, D. C., Currie, S. R., & el-guebaly, N. (2001). Motivational Enhancement and Self-Help Treatment for Problem Gambling. Journal of Consulting and Clinical Psychology. 69, Petry, N. M. (2005). Gamblers Anonymous and Cognitive Behavioral Therapies for Pathological Gamblers. Journal of Gambling Studies, 1 (21) National Addiction Technology. (2004). The Change Book. Retrieved November 10, 2005 from Book_2nd_Edition.pdf 5. Roget, N. A., Horvatich, P. K., Skinstad, H. A., & Storti, S. A. (2004). The Active Ingredients of Technology Transfer: Activities and Strategies to Promote the Adoption of Evidence Based practices. Poster session presented at the annual meeting of the College on Problems of Drug Dependence, San Juan, Puerto Rico. 6. Rawson, R. A., & Branch, C. (2002). Connecting Substance Abuse Treatment and Research: Let s Make a Deal. The Journal of Drug Issues, 22, Brown, B.S. (2000). From research to practice. The bridge is out and the water is rising. Advances in Medical Sociology, 7, Rogers, E.M. (2004). A prospective and retrospective look at the diffusion model. Journal of Health Communication, 9, Roget, N.A. (2002). Nine active ingredients for technology transfer. Paper presented at the meeting of the Addiction Technology Transfer Directors Meeting,, Washington, D.C.

48 References 1. Problem Gambling Foundation of New Zealand. (2003). Problem Gambling Workforce Development. Retrieved April 10, 2006, from % 20Gambling%20Workforce%20Development%20Manual.pdf 2. Clark, H. W. (2005, August). Pathological Gambling and Substance Abuse.. Keynote address delivered at the Midwest Conference on Problem Gambling and Substance Abuse. Kansas City, MO. 3. Derbing, C. E., Mello, A., Penk, W., Krebs, C., Van Ormer, A. E., Peterson, R. L., & Federman, E. J. (2001). Clinical care of gambling disorders: training, experience, and competence among VHA psychologists. Journal of Gambling Studies, 17(2), Grant, J. E., Potenza, M. N., Hollander, E., Cunningham-Williams, R., Nurminen, T., Smits, G., & Kallio, A. (2006). Multicenter investigation of the opiod antagonist Nalmefene in the treatment of pathological gambling. American Journal of Psychiatry, (2)163, ,