This study assessed rates and correlates of suicidal ideation and suicide attempts in individuals seeking treatment for pathological gambling. At intake to gambling treatment programs, 342 pathological gamblers completed the Addiction Severity Index and the South Oaks Gambling Screen. Participants were categorized into three groups: no suicidal ideation (N = 175, 51%), suicidal ideation alone (N = 109, 32%), and suicide attempters (N = 58, 17%). After controlling for gender, age, treatment site, and substance abuse treatment histories, differences among the groups emerged in terms of severity of psychiatric, social/family, and gambling problems. Compared with nonsuicidal gamblers, those with suicidal ideation suffered from more psychiatric symptoms, were less satisfied with their living situations, and experienced more days of conflict in the month before entering gambling treatment. Compared with pathological gamblers with no history of suicidal ideation, those with suicidal ideation spent more money gambling in the month before entering treatment, reported greater cravings for gambling, and had higher South Oaks Gambling Screen scores. These data confirm other reports of high rates of suicidality in pathological gamblers and may suggest the need for more intensive and focused treatments in pathological gamblers with suicidality.Pathological gambling is characterized by loss of control over gambling, financial debt, family and social difficulties, legal and employment problems, and psychological distress. A meta-analysis of prevalence surveys (Shaffer et al., 1999) indicates that the lifetime prevalence rate of pathological gambling in the adult population is approximately 1.8%.In epidemiological studies, disordered gambling seems to be associated with depression and suicidality. For example, Cunningham-Williams et al. (1998) and Bland et al. (1993) found that disordered gamblers identified in general population surveys were more likely to meet criteria for affective disorders than respondents with no gambling problems. In a survey of college students, Ladouceur et al. (1994) found that 27% of those identified as pathological gamblers had attempted suicide, compared with 7% of students without gambling problems. Phillips et al. (1997) reviewed mortality data between the years 1969 and 1991 from three major gambling areas. Compared with other metropolitan areas, they found elevated rates of suicide among resident and nonresident visitors in these gambling venues.Studies of treatment-seeking pathological gamblers likewise point to a relationship among gambling, depression, and suicide. In studies that used structured diagnostic instruments in (Linden et al., 1986;McCormick et al., 1984;Taber et al., 1987;Ramirez et al., 1983;Roy et al., 1988) rates of major depression ranged from 32% to 76%. Specker et al. (1996) found that gamblers seeking outpatient treatment had much higher rates of major depression (35% current, 70% lifetime) compared with control subjects (5% current, 23% lifetime).High rates of sui...

Objectives A previous pilot trial evaluating computer-based cognitive behavioral therapy (CBT4CBT) among 77 heterogeneous substance users (alcohol, marijuana, cocaine, opioids) provided preliminary support for its efficacy in the context of a community-based outpatient clinic. Aims of the present trial were to conduct a more definitive trial in a larger, more homogeneous sample. Methods Randomized clinical trial in which 101 cocaine-dependent methadone maintained individuals were randomized to standard methadone maintenance or methadone maintenance with weekly access to CBT4CBT, with 7 modules delivered within an 8 week trial. Results Treatment retention and data availability were high and comparable across the treatment conditions. Participants assigned to the CBT4CBT condition were significantly more likely to attain three or more consecutive weeks of abstinence from cocaine (36 versus 17%, p<.05, OR=.36). The group assigned to CBT4CBT also had better outcomes on most dimensions, including urine specimens negative for all drugs, but these reached statistical significance only for the completer sample (N=69). Follow-up data collected 6 months after treatment termination were available from 93% of the randomized sample; these indicated continued improvement for those assigned to the CBT4CBTgroup, replicating previous findings regarding its durability. Conclusions This trial replicates earlier findings indicating CBT4CBT is an effective adjunct to addiction treatment with durable effects. CBT4CBT is an easily disseminable strategy for broadening the availability of CBT, even in challenging populations such as cocaine-dependent individuals enrolled in methadone maintenance programs. Clinical trials.gov ID number NCT00350610

Objective: This meta-analysis examined 30 randomized controlled trials (32 study sites; 35 study arms) that tested the efficacy of cognitive-behavioral therapy (CBT) for alcohol or other drug use disorders. The study aim was to provide estimates of efficacy against three levels of experimental contrast (i.e., minimal [k = 5]; nonspecific therapy [k = 11]; specific therapy [k = 19]) for consumption frequency and quantity outcomes at early (1 to 6 months [kes = 41]) and late (8+ months [kes = 26]) follow-up time points. When pooled effect sizes were statistically heterogeneous, study-level moderators were examined. Method: The inverse-variance weighted effect size was calculated for each study and pooled under random effects assumptions. Sensitivity analyses included tests of heterogeneity, study influence, and publication bias. Results: CBT in contrast to minimal treatment showed a moderate and significant effect size that was consistent across outcome type and follow-up. When CBT was contrasted with a nonspecific therapy or treatment as usual, treatment effect was statistically significant for consumption frequency and quantity at early, but not late, follow-up. CBT effects in contrast to a specific therapy were consistently nonsignificant across outcomes and follow-up time points. Of 10 pooled effect sizes examined, two showed moderate heterogeneity, but multivariate analyses revealed few systematic predictors of between-study variance. Conclusions: The current meta-analysis shows that CBT is more effective than a no treatment, minimal treatment, or nonspecific control. Consistent with findings on other evidence-based therapies, CBT did not show superior efficacy in contrast to another specific modality.

Background Selection of an appropriate indictor of treatment response in clinical trials is complex, particularly for the various illicit drugs of abuse. Most widely-used indicators have been selected based on expert group recommendation or convention rather than systematic empirical evaluation. Absence of an evidence-based, clinically meaningful index of treatment outcome hinders cross-study evaluations necessary for progress in addiction treatment science. Method Fifteen candidate indicators used in multiple clinical trials as well as some proposed recently are identified and discussed in terms of relative strengths and weaknesses (practicality, cost, verifiability, sensitivity to missing data). Using pooled data from five randomized controlled trials of cocaine dependence (N = 434), the indicators were compared in terms of sensitivity to the effects of treatment and relationship to cocaine use and general functioning during follow-up. Results Commonly used outcome measures (percent negative urine screens; percent days of abstinence) performed relatively well in that they were sensitive to the effects of the therapies evaluated. Others, including complete abstinence and reduction in frequency of use, were less sensitive to effects of specific therapies and were very weakly related to cocaine use or functioning during follow-up. Indicators more strongly related to cocaine use during follow-up were those that reflected achievement of sustained periods of abstinence, particularly at the end of treatment. Conclusions These analyses did not demonstrate overwhelming superiority of any single indicator, but did identify several that performed particularly poorly. Candidates for elimination included retention, complete abstinence, and indicators of reduced frequency of cocaine use.