Accelerating Smoking Relapse Research Using Longitudinal Models of EMA Data, D. McCarthy & S. Shiffman (Co-PIs)

It is estimated that 1-2% of Americans suffer from pathological gambling. Problem and pathological gambling has been associated with significant personal problems including poorer physical and mental health, higher rates of substance abuse, depression, and suicide, and financial hardship; as well as social problems including increases in domestic violence, poor relationships, and poorer mental and physical health of family members. Given the significant personal and societal impact of problem and pathological gambling there is a salient need to develop and disseminate effective treatments for pathological gambling. Mindfulness-based relapse prevention (MBRP) is an aftercare treatment that has been successfully applied to a wide variety of psychological and substance use disorders. The efficacy of MBRP in treating problem gambling was recently tested in a small sample of individuals (n = 6) who were receiving outpatient treatment for gambling problems. Individuals participated in 8 weeks of 90 minute group MBRP sessions and completed assessments prior to starting the group, at mid-treatment (4 weeks), and post-treatment (8 weeks). Participants in the MBRP group had large effect size decreases in gambling symptoms, gambling-related consequences, urges to gamble, and depression symptoms immediately following the treatment. An analysis of other individuals enrolled in the outpatient gambling treatment program during the same time period, who were matched to MBRP participants by gender, income, and problem severity, indicated that the participants in MBRP had better gambling and substance use outcomes than those individuals who did not participate in the MBRP groups. The goal of the proposed study is to conduct a pilot randomized controlled trial to evaluate the efficacy of MBRP in the treatment of problem gambling. Participants (n = 70) will be recruited from two gambling treatment programs in the greater Portland metropolitan area and randomized to receive either MBRP and usual care (n=35) or usual care as typically provided by the gambling treatment programs (n=35). Self-report questionnaires measuring a variety of gambling, substance use, and mental health outcomes, and behavioral tests of impulsivity will be administered prior to starting the MBRP groups, at the midpoint during treatment, one week after completing treatment, and two-months following treatment. It is hypothesized that individuals who receive MBRP will have significantly better gambling and substance use outcomes following treatment, and that better outcomes following MBRP will be mediated by changes in urges to gamble and measures of impulsivity. The overarching purpose of the proposed research is to obtain pilot data that can be used in an application for external funding to conduct a larger randomized controlled trial in gambling treatment programs throughout the entire state of Oregon.