Implications For Theory and Practice

Transcription

1 Incidence of Childhood Among Pathological Gamblers, Alcoholics and Drug Addicts: Implications For Theory and Practice Durand F. Jacobs, Ph.D., ABPP Clinical Professor of Medicine (Psychiatry) Loma Linda University Medical School, California J Incidence of Childhood Before Age 8 Years Data Source: Jacobs, Abandonment and Protocol Revised, 00 Pages Self-administered Anonymous J- The Data Source: Jacobs, Abandonment, and Protocol SECTION I The Data Source: Jacobs, Abandonment, and Protocol If Negative, Directed To Next Section If Affirmative, Queried About Type of 5 Sections 0 Questions Per Section Each Section Completed Only If Applicable J-8. When, and the setting. The severity, the perpetrator. Occurrence of dissociative reaction. Family members reactions 5. Effects on subject s present life The Data Source: Jacobs, Abandonment, and Protocol The Data Source: Jacobs, Abandonment, and Protocol As a youth, were you ever the victim of loss or abandonment? (That is, before you were 8 years of age, you experienced loss of or abandonment by, one or both of your parents because of death, divorce, separation, flight, hospitalization, or incarceration.) 5 J- As a youth, were you ever the victim of serious neglect? (That is, before you were 8 years of age, parents or adults responsible for your care failed to provide what you consider to be minimally sufficient food, clothing, shelter form rain, cold or heat, necessary medical attention, and protection from harm.) 6 J- Gambling and Substance

2 The Data Source: Jacobs, Abandonment, and Protocol The Data Source: Jacobs, Abandonment, and Protocol As a youth, were you ever the victim of physical abuse? (That is, were you ever hit, bitten, burned, beaten with a belt or other object, kicked or thrown, so that you bled a lot, or suffered pain, broken bones, or long-lasting bruises or welts.) 7 J-5 As a youth, were you ever the victim of emotional abuse? (That is, you were repeatedly made to feel unwanted, worthless, unloved, inferior, and/or you were repeatedly told you were no good, or could do nothing right, and you were made to feel guilty or ashamed.) 8 J-6 The Data Source: Jacobs, Abandonment, and Protocol As a youth, were you ever the victim of sexual abuse? (That is, you were fondled, seduced or forcibly raped by an adult, or you were otherwise led by a person in a position of power or control to participate in, or observe, sexual activities involving genital, oral or masturbatory 9 contacts.) J 7 The Subjects different groups of addicts Recently admitted to residential or outpatient settings Juvenile male and Adult male & Adult First Nations Adult alcoholics and drug addicts N= N=7 N=6 N= 0 J- Results Reporting One or More 88% 75% 7% Adult male & Total N=: N=5 Adult First Nations Total N=7: N= 5 Adult Total N=6: N= Juvenile male and Total N=: N=5 J 9 Incidence of Childhood Before Age 8, As by Adult Pathological Gamblers In A Residential Setting. Total (N=5) (N=0) =57% (N=) =% Median Age=5 years 6% 5% % 6% 0% 7% 87% 7% Refusing to participate or denied maltreatment during childhood (N=9), Median Age 8 yrs. J-9 Gambling and Substance

3 Incidence of Childhood By Patients At A Canadian Recovery Centre : 5% Median Age = yr. Pathol. Gamblers Total (N=7) Percent Reporting Child- Hood 9% 00 56% 7 (N=5) Dissociation During 75% % Three males (median age= years) denied all forms of childhood trauma or refused to participate Based on JNAP scores 7 : 9% Median Age = 0 yr. Types Of 5% 65 8% % 7 Incidence of Childhood Before 8 Yrs of Age, By First Nations Pathological Gamblers. 88% =7% (N=7) =5% Median Age = 7 years 7% 87% 67% 9% Total (N=8) 5% 88% 75% 75% 88% (N=7) Subjects who refused to participate or denied maltreatment during childhood (N= ) Median Age=5 Yrs. J- Incidence of Childhood Before 8 years, By Adult Addicted to Alcohol & Drugs 75% =0% (N=6) =00% Median Age= years Total* (N=) 8% 50% 9% 58% % Incidence of Childhood Before 8 Yrs of Age, By Juveniles Addicted To Alcohol & Drugs. =67% (N=) =% Median Age=6 years 7% TOTAL (N=5) (N=0) 0% % 7% % Subjects who refused to participate or denied maltreatment during childhood (N= ) Median Age=0 Yrs. 5 Subjects who refused to participate or denied maltreatment during childhood (N=7) Median Age=6 Yrs. = 5% = 9% 6 J- Results: Incidence Of : Caucasian Addicts (N=97) 90% 70% 8% 50% 68% 0% 5% 5% 0% 0% 9% 0% 0% 60-9% -5% 7-58% 8-6% -% 7 J 0 Results: Incidence Of : First Nations Pathological Gamblers 87% Total Scores 7% 67% 9% 00% 90% 70% 50% 0% 0% 0% 0% 0% 8 J- Gambling and Substance

4 Frequency Of Experiencing Childhood (N=) Adult Caucasian Pathological Gamblers (N=) Adult First Canadian Pathological Gamblers (N=5) Adult First Nations Pathological Gamblers (N=7) Adult Female Substance rs (N=6) Juvenile Substance rs (N=) Early Childhood s Childhood s 56 9 Most Frequent () () % ( 8 () 87 () 9 () 60 Dissociated While Experiencing 86% Dissociative Reactions Experienced When Indulging Gambling, by Compulsive Gamblers and s (N=) Dissociative Compulsive Normative Sample Reactions Gamblers N= Adults N=68 Adolescents N=8 Trance 79% 5% % Drinking, by Alcoholics and s: (N=) Dissociative Reactions Alcoholics N=0 Normative Sample Adults Adolescents N=68 N=8 Trance 6% 7% 9% Different 79 5 Outside Self 50 8 Blackout 8 Median 6% 6% % J-6 Different Outside Self Blackout 7 5 Median 67% 6% 6% J-7 Eating, by Compulsive Overeaters and s: (N=09) Dissociative Reactions TYPE OF INDULGENCE WHEN GAMBLING WHEN DRINKING WHEN OVEREATING Dissociative reactions reported occasionally to all Pathological the time * Adoles- Alco- Adoles- Over- Adoles- Gamblers Adults cents holics Adults cents eaters Adults cents N= N=68 N=8 N=0 N=68 N=8 N= N=68 N=8 Trance 79% 5% % 6% 7% 9% % 5% 7% Different Outside Self Blackout MEDIAN DISSOCIATIVE SCORE *Reactions reported rarely are not included above 0 J-5 Overeaters N= Normative Sample Adults N=68 Adolescents N=8 Trance % 5% 7% Different Outside Self Blackout MEDIAN 5% 6% 8% J-8 Conclusions Findings support The General Theory of Addictions (Jacobs, 986, 989,00)* Common features across different classes of addicts:. High incidence of early childhood neglect and abuse. High occurrence of dissociative reactions, while experiencing trauma(s). Present adult dissociators were early childhood dissociators, reacting to trauma(s). Higher levels of dissociative reactions among addicts than normals, while indulging 5. Early childhood traumas are a risk factor for later addiction(s) *Jacobs, D.F. (986). Journal of Gambling Behavior, (),5- J- Gambling and Substance

5 Path Analysis Testing Jacobs General Theory of Addiction Physiological Predisposition Excitability High DISSOC. Need To Escape Arousal Predisposition Harter Rads HIGH DSM IV J Group (Gamblers) Drug Use 5 J- Strong support for the applicability of Jacobs General Theory of Addictions for adolescent was obtained. Adolescent problem and were found to have Exhibited evidence of abnormal physiological resting states Showed evidence of greater emotional distress greater levels of dissociation, and higher rates of comorbidity with other addictive behavior More 6 A Path Analysis testing a model adapted from the General Theory of Addictions was found to fit the data, providing impressive validation of the theory. The model tested shows a strong path from both the physiological and emotional predispositions, to a deliberate need to escape, to severity of gambling. Thus, gambling severity was empirically found to be caused by the need to escape, or dissociate, which is fueled by aversive physiological and emotional states. Gambling, therefore, according to the model and Jacobs theory, is a solution, or coping response, albeit a negative one, to aversive life conditions. More 7 Source: Gupta, D. and Deverensky, J.L. (998). An Empirical Examination of Jacobs General Theory of Addictions, Journal of Gambling Studies Vol. (), Recommendations Treatment personnel are urged:. To explore likelihood of childhood trauma. To consider dynamic and cognitive behavioral interventions to mediate stresses engendered by such a history. To acquire training for treating Chronic PTSD in addicts.. To use the Jacobs, Abandonment, and Protocol for additional clinical and research applications 9 J- THANK YOU Durand F. Jacobs, Ph.D., ABPP Clinical Professor of Medicine (Psychiatry) Loma Linda University Medical School, California 0 J- Gambling and Substance 5