RESUMEN
BACKGROUND: Emergency department (ED) patients comprise a high-risk population for alcohol misuse and sexual risk for HIV. In order to design future interventions to increase HIV screening uptake, we examined the interrelationship among alcohol misuse, sexual risk for HIV and HIV screening uptake among these patients. METHODS: A random sample of 18-64-year-old English- or Spanish-speaking patients at two EDs during July-August 2009 completed a self-administered questionnaire about their alcohol use using the Alcohol Use Questionnaire, the Alcohol Use Disorders Identification Test (AUDIT), and the HIV Sexual Risk Questionnaire. Study participants were offered a rapid HIV test after completing the questionnaires. Binging (≥ five drinks/occasion for men, ≥ four drinks for women) was assessed and sex-specific alcohol misuse severity levels (low-risk, harmful, hazardous, dependence) were calculated using AUDIT scores. Analyses were limited to participants who had sexual intercourse in the past 12 months. Multivariable logistic regression was used to assess the associations between HIV screening uptake and (1) alcohol misuse, (2) sexual risk for HIV, and (3) the intersection of HIV sexual risk and alcohol misuse. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were estimated. All models were adjusted for patient demographic characteristics and separate models for men and women were constructed. RESULTS: Of 524 participants (55.0% female), 58.4% identified as white, non-Hispanic, and 72% reported previous HIV testing. Approximately 75% of participants reported drinking alcohol within the past 30 days and 74.5% of men and 59.6% of women reported binge drinking. A relationship was found between reported sexual risk for HIV and alcohol use among men (AOR 3.31 [CI 1.51-7.24]) and women (AOR 2.78 [CI 1.48-5.23]). Women who reported binge drinking were more likely to have higher reported sexual risk for HIV (AOR 2.55 [CI 1.40-4.64]) compared to women who do not report binge drinking. HIV screening uptake was not higher among those with greater alcohol misuse and sexual risk among men or women. CONCLUSIONS: The apparent disconnection between HIV screening uptake and alcohol misuse and sexual risk for HIV among ED patients in this study is concerning. Brief interventions emphasizing these associations should be evaluated to reduce alcohol misuse and sexual risk and increase the uptake of ED HIV screening.
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Consumo Excesivo de Bebidas Alcohólicas/epidemiología , Infecciones por VIH/diagnóstico , Hospitales Urbanos/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Sexo Inseguro/estadística & datos numéricos , Adulto , Estudios Transversales , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Infecciones por VIH/transmisión , Humanos , Masculino , Persona de Mediana Edad , Rhode Island/epidemiología , Medición de Riesgo , Encuestas y Cuestionarios , Adulto JovenRESUMEN
OBJECTIVE: To evaluate the prevalence and correlates of problem and pathological gambling in older adults. METHODS: Adults (n = 343) aged 60 years and older attending senior centers, bingo sites and other community activities completed a screening form containing the South Oaks Gambling Screen and the Short Form-12 Health Survey, to evaluate physical and mental health. RESULTS: Overall, 6.4% of the respondents were classified as problem gamblers and an additional 3.8% as pathological gamblers. Problem and pathological gamblers evidenced significantly greater physical and mental health problems than non-problem gamblers. CONCLUSIONS: These data suggest that about 10 percent of active older adults experience gambling problems, which are associated with poor physical and mental health.
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Juego de Azar , Estado de Salud , Salud Mental , Anciano , Femenino , Financiación Personal , Juego de Azar/psicología , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Encuestas y CuestionariosRESUMEN
OBJECTIVE: A number of regional prevalence studies suggest that disordered gambling is a clinically significant problem among older adults. However, little research has evaluated whether older adults with a gambling disorder experience increased health, psychiatric, substance use, and social problems as compared with older adults without a gambling disorder. METHODS: A group of 48 older-adult disordered gamblers and 48 older adult non/infrequent gamblers, matched by age, sex, race, and recruitment site, completed the Addiction Severity Index (ASI), Brief Symptom Inventory (BSI), and Short Form-36 Health Survey (SF-36). Multivariate general-linear models evaluated between-group differences on these indices. RESULTS: Compared with non/infrequent gamblers, disordered gamblers reported increased severity of medical, family/social, psychiatric, and alcohol problems on the ASI. They also scored higher on depression, anxiety, paranoid ideation, and psychoticism subscales of the BSI, and lower on vitality, physical functioning, role-physical, general health, and social functioning subscales of the SF-36. CONCLUSIONS: These results suggest that older adults with a gambling disorder experience increased severity of health and psychosocial problems, compared with older adult non/infrequent gamblers matched by age, sex, race, and recruitment site.
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Trastornos Disruptivos, del Control de Impulso y de la Conducta/epidemiología , Juego de Azar/psicología , Estado de Salud , Anciano , Demografía , Femenino , Encuestas Epidemiológicas , Humanos , Masculino , Trastornos Mentales/epidemiología , Persona de Mediana Edad , Encuestas y CuestionariosRESUMEN
Rapid expansion of legalized gambling has been associated with increased rates of gambling disorders among adults and adolescents worldwide. Epidemiologic studies suggest that, in North America, up to 6% of adults and 20% of adolescents have a gambling problem. Despite increasing prevalence rates of gambling disorders, little research is available on how to treat such disorders in adolescents. Much of what is known about how to treat adolescent problem and pathological gambling comes from research on psychosocial and psychopharmacologic treatments for adult pathological gambling. Risk factors for adolescent gambling disorders include male gender, alcohol and drug use, deviant peers, family history of gambling, and impulsive behavior. While several risk factors characterize disordered gambling among adolescents, the extent to which these characteristics are related remains to be determined. In terms of screening for adolescent problem and pathological gambling, several instruments designed to reflect the Diagnostic and Statistical Manual of Mental Disorders diagnostic criteria for pathological gambling are available. Psychosocial approaches used to treat adult pathological gambling include Gamblers Anonymous, cognitive-behavioral therapy (CBT), and motivational enhancement therapy (MET). Among adolescents, CBT as well as an eclectic therapy have been helpful in reducing problematic gambling behavior. In terms of pharmacotherapy, three classes of psychotropic drugs have been used to treat adult pathological gambling - serotonin reuptake inhibitors, opioid antagonists, and mood stabilizers. While some of these pharmacotherapies have been efficacious in treating adult pathological gambling, additional double-blind, placebo-controlled studies are needed to determine the long-term effectiveness of these treatments. No known study has evaluated the use of psychopharmacologic agents in treating adolescent pathological gambling. Possible reasons for the lack of research on treatment for adolescent gambling disorders include lack of motivation to pursue treatment, feelings of self-control, and negative perception of therapy. Referrals from parents, teachers, and peers of adolescents, as well as community outreach programs, may be useful in successfully deriving a treatment population. Clinicians are advised to be sensitive to behavioral risk factors and to screen for disordered gambling in high risk adolescents. A combination of CBT and MET, as well as medication for any comorbid psychiatric condition, is recommended.
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Juego de Azar , Adolescente , Factores de Edad , Antimaníacos/uso terapéutico , Terapia Cognitivo-Conductual , Trastornos Disruptivos, del Control de Impulso y de la Conducta/diagnóstico , Trastornos Disruptivos, del Control de Impulso y de la Conducta/epidemiología , Trastornos Disruptivos, del Control de Impulso y de la Conducta/terapia , Juego de Azar/psicología , Humanos , Antagonistas de Narcóticos/uso terapéutico , América del Norte/epidemiología , Factores de Riesgo , Inhibidores Selectivos de la Recaptación de Serotonina/uso terapéuticoRESUMEN
Few studies have evaluated rates of gambling participation and problems in older adults. This study recruited 492 adults aged 65 years and older from bingo sites (n = 132) and senior centers (n = 360). Compared to those recruited from senior centers, participants recruited at bingo events had higher South Oaks Gambling Screen (SOGS) scores and greater gambling frequency and expenditures. Lifetime rates of combined problem and pathological gambling were 12.9% in the bingo sample and 9.7% in the senior center sample (10.6% overall). Compared to non-problem gamblers, problem and pathological gamblers were more likely to be younger (73 versus 76 years) and male (52% versus 27%). Overall, 39.1% reported gambling at least twice per month over the past year, and 33.7% wagered dollars 50 or more over the prior 2 months. This study suggests that subsets of active older adults have high rates of gambling participation and problems.
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Trastornos Disruptivos, del Control de Impulso y de la Conducta/epidemiología , Juego de Azar/psicología , Factores de Edad , Anciano , Demografía , Femenino , Humanos , Masculino , Encuestas y CuestionariosRESUMEN
This study evaluated the prevalence and correlates of substance abuse histories in 341 consecutive admissions to gambling treatment programs. After controlling for gender, income, and site, gamblers with substance abuse treatment histories (SATH; 31%) had more severe problems than gamblers with no substance abuse treatment histories (NSATH) on the Gambling, Alcohol, Drug, Psychiatric, and Employment scales of the Addiction Severity Index. The SATH group had more years of gambling problems and gambled more days in the month prior to initiating gambling treatment. The SATH gamblers were also more likely to be receiving treatment for mental health problems and reported greater lifetime psychiatric distress than NSATH gamblers. These data suggest that pathological gamblers with substance abuse treatment histories may present more persistent and severe gambling dysfunction and psychiatric problems than those without such histories.
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Juego de Azar/psicología , Trastornos Relacionados con Sustancias/psicología , Adulto , Alcoholismo/psicología , Empleo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Escalas de Valoración PsiquiátricaRESUMEN
Antisocial personality disorder (ASP) is common in substance abusers and may be associated with increased severity of psychosocial problems and risk of HIV infection. This study compared 174 treatment-seeking cocaine abusers with and without ASP on Addiction Severity Index (ASI) scores and the HIV risk behavior scale. Patients with ASP comprised 35% of the sample. These patients evidenced more severe problems than non-ASP patients on alcohol, legal, and psychiatric indices of the ASI. Patients with ASP also reported greater participation in lifetime sexual risk behaviors, including number of casual sexual partners, inconsistent condom use, and frequency of anal sex. This study suggests the importance of screening for ASP when patients initiate treatment. Specific and more intensive treatment may be necessary to improve outcomes in this patient population.
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Trastorno de Personalidad Antisocial/psicología , Trastornos Relacionados con Cocaína/psicología , Infecciones por VIH/transmisión , Aceptación de la Atención de Salud/psicología , Asunción de Riesgos , Adulto , Análisis de Varianza , Trastorno de Personalidad Antisocial/diagnóstico , Trastornos Relacionados con Cocaína/terapia , Femenino , Humanos , Masculino , Conducta SexualRESUMEN
This study investigated gender differences among treatment-seeking pathological gamblers. During treatment intake, 115 pathological gamblers completed the Addiction Severity Index (ASI; A. T. McLellan et al., 1985), including a section on gambling severity, as well as the South Oaks Gambling Screen (H. R. Lesieur & S. B. Blume, 1987). When age and income were controlled, gender differences emerged in ASI gambling, alcohol, and legal scores. Men initiated gambling, began gambling regularly, tried to stop gambling, and first entered gambling treatment at a younger age than women. Women were more likely to be living with someone with a gambling or drinking problem but themselves had fewer alcohol and legal problems. Results suggest that gender differences exist in the initiation of gambling dysfunction and its psychosocial correlates. Understanding these differences may assist in developing treatments that address differential needs of male and female pathological gamblers.
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Juego de Azar/psicología , Adulto , Consumo de Bebidas Alcohólicas/psicología , Empleo , Etnicidad , Femenino , Humanos , Masculino , Matrimonio , Persona de Mediana Edad , Aceptación de la Atención de Salud , Escalas de Valoración Psiquiátrica , Caracteres SexualesRESUMEN
The authors evaluated gambling behaviors, including Internet gambling, among patients seeking free or reduced-cost dental or health care. Three hundred eighty-nine patients at university health clinics completed a questionnaire that included the South Oaks Gambling Screen (SOGS; H. R. Lesieur & S. Blume, 1987). All respondents had gambled in their lifetimes, with 70% gambling in the past 2 months. On the basis of SOGS scores, 10.6% were problem gamblers, and 15.4% were pathological gamblers. The most common forms of gambling were lottery, slot machines, and scratch tickets. Internet gambling was reported by 8.1% of participants. Compared to non-Internet gamblers, Internet gamblers were more likely to be younger, non-Caucasian, and have higher SOGS scores. This study is among the first to evaluate the prevalence of Internet gambling and suggests that people who gamble on the Internet are likely to have a gambling problem. Results also illuminate the need to screen patients seeking health care services for gambling problems.