•One in five daily caffeine consumers exceed the recommended 400 mg daily limit.•85% of respondents report at least one caffeine-related harm in the past year.•20% of respondents met DSM-5 criteria ...for CUD, and 30% for caffeine withdrawal.•Medium and high (vs low) caffeine use tripled the odds of CUD.•Women and smokers may be more prone to CUD and withdrawal than men and non-smokers.
Caffeine Use Disorder (CUD) is not yet formally recognized in the DSM-5, but emerging evidence suggests CUD could impact up to one in five people. The primary aim of this study was to estimate levels of caffeine consumption and its associations with CUD and withdrawal, taking socio-demographic characteristics (age, gender, ethnicity, income) into account. Secondary aims were to measure caffeine-related harm and treatment preferences.
We administered an online cross-sectional survey via Facebook to a convenience sample of 2379 adults in New Zealand. Caffeine consumption was assessed across six products: coffee, tea, energy drinks, cola, alcohol mixed with caffeine, and other products (e.g., caffeine pills, sports supplements).
20% of participants met proposed criteria for CUD, with 30% meeting DSM-5 criteria for caffeine withdrawal. Moderate (200–400 mg per day) and high consumption (>400 mg per day) was associated with a three-fold increase in the odds of CUD and a two-fold increase in the odds of withdrawal. Women and current smokers were at higher risk of CUD and withdrawal even at moderate consumption levels. Nearly 85% of respondents experienced at least one caffeine-related harm in the past 12-months. The number of harms increased with level of caffeine consumption. Nearly 50% indicated a self-help treatment for caffeine reduction would be of interest.
High rates of CUD and caffeine withdrawal amongst moderate caffeine users, women and smokers suggests caffeine consumption guidelines may need refinement. Caffeine-related harm that is not clinically meaningful may still be of concern to individuals and warrants further investigation.
Research investigating rates of help-seeking for problem gambling has traditionally focused on the uptake of face-to-face gambling services alone, despite the World Health Organisation defining ...help-seeking as any action or activity undertaken to improve or resolve emotional, psychological or behavioural problems. The primary aim of this study is to examine the full range of help-seeking options utilised by gamblers, and to determine whether administering a comprehensive list of help options yields higher help-seeking rates than a single item measure. A one-item and expanded 14-item help-seeking Questionnaire (the Help-Seeking Questionnaire; HSQ) were administered to 277 problem gamblers seeking help online. We found the 14-item HSQ yielded a significantly higher level of lifetime professional help-seeking (70%) compared to the one-item measure (22%). When we included self-directed activities, 93% of gamblers reported they had previously attempted at least one activity to reduce their gambling. Current measurement of help-seeking appears to underestimate the range of activities currently undertaken by gamblers to reduce their gambling. Surveys need to include the one-item HSQ (over the past 12 months have you sought professional help or advice (online, by phone, or in person), support from family or friends, or did something by yourself to limit or reduce your gambling?) or the three-item HSQ which measures engagement of face-to-face services (i.e., counselling, advice, groups), distance-based (i.e., anonymous telephone, online) and self-directed (i.e., activities not involving professional oversight) activities separately. The full 14-item screen can be administered when brief screens are positive to ensure accurate measurement of help-seeking.
•One item screens may underestimate the true rate of help-seeking.•Administration of the 14-item HSQ yields a lifetime help-seeking rate of 70%.•Help-seeking screening must include distance and face-to-face and self-directed options.•Gamblers are active in their own recovery and this should be supported.
This systematic review aimed to determine whether the use of specific behaviour change technique (BCT) groups are associated with greater effectiveness for psychosocial interventions delivered to ...family and close friends (FCFs) impacted by addiction. A systematic search of peer-reviewed and grey literature published until August 2021 identified 32 studies in 38 articles. An established BCT taxonomy (93 BCTs clustered into 16 groups) was adapted (inclusion of seven additional BCT groups) and applied to 57 interventions. The meta-analyses indicated that some, but not all, FCF outcomes were improved by the exclusion of BCTs within several groups (Reward and Threat, Scheduled Consequences, Confrontation of the Addicted Person to Engage in Treatment, and Goals and Planning) and inclusion of BCTs within the Restoring a Balanced Lifestyle group. Addicted person outcomes were improved by the inclusion of some BCTs within several groups (Repetition and Substitution, Reward and Threat, Scheduled Consequences, and Restoring a Balanced Lifestyle). Relationship functioning outcomes were improved by the inclusion of BCTs within the Confrontation of the Addicted Person to Engage in Treatment group. Future research involving the development and evaluation of numerous interventions or comprehensive multi-component interventions that can address the various needs of FCFs, without counteracting them, is required.
•First meta-analysis of behaviour change techniques in family/friend interventions.•Excluding operant conditioning-based techniques improved family/friend outcomes.•Including operant conditioning-based techniques improved addicted person outcomes.•Including confrontation-based techniques improved relationship functioning outcomes.•Various techniques may be needed to address multiple family/friend needs.
Non-gambling specialist services, such as primary care, alcohol and other drug use, and mental health services, are well placed to enhance the identification of people with gambling problems and ...offer appropriate generalist first level interventions or referral. Given time and resource demands, many of these clinical services may only have the capacity to administer very short screening instruments. This systematic review was conducted to provide a resource for health service providers and researchers in identifying the most accurate brief (1–5 item) screening instruments to identify problem and at-risk gambling for their specific purposes and populations. A systematic search of peer-reviewed and grey literature from 1990 to 2019 identified 25 articles for inclusion. Meta-analysis revealed five of the 20 available instruments met criteria for satisfactory diagnostic accuracy in detecting both problem and at-risk gambling: Brief Problem Gambling Screen (BPGS-2), NODS-CLiP, Problem Gambling Severity Index-Short Form (PGSI-SF), NODS-PERC, and NODS-CLiP2. Of these, the NODS-CLiP and NODS-PERC have the largest volume of diagnostic data. The Lie/Bet Questionnaire and One-Item Screen are also promising shorter options. Because these conclusions are drawn from a relatively limited evidence base, future studies evaluating the diagnostic accuracy of existing brief instruments across settings, age groups, and timeframes are needed.
•Review is a valuable resource for health service providers and researchers.•Identification of most accurate (1–5 item) problem gambling screening instruments.•Diagnostic accuracy across settings, age groups, and instrument timeframes explored.•Five instruments satisfactorily detected both problem and at-risk gambling.•These are BPGS (2-item), NODS-CLiP, PGSI-Short Form, NODS-PERC, and NODS-CLiP2.
Gambling help websites are an important source of information for gamblers and affected others, but they contain large amounts of information, making it difficult to navigate and access required ...resources. Usability of such websites can be improved through the implementation of chatbots, which are programmed to respond to user requests in natural language. This study aimed to evaluate the impact of a text-based chatbot on the usability, user satisfaction, and experience of the Australian New South Wales GambleAware website; and explore the usability, user satisfaction, and experience of the chatbot itself. A convenience sample of Australian residents were allocated into website with chatbot access (
n
= 32) or website only (
n
= 28). Compared with the website-only group, the website with chatbot access group reported significantly greater ratings of the website’s usability and aspects of user satisfaction, but not user experience, and resulted in higher ease of task completion. Compared with available norms, the chatbot was highly rated on usability, usefulness, information quality, and credibility, with the layout, readability of responses, and look and feel identified as areas for improvement. The usability of the NSW GambleAware website could be enhanced by the integration of a text-based chatbot, with potential applications for similar websites.
Despite high rates of comorbidity between problem gambling and mental health disorders, few studies have examined barriers or facilitators to the implementation of screening for problem gambling in ...mental health services. This exploratory qualitative study identified key themes associated with screening in mental health services. Semi-structured interviews were undertaken with 30 clinicians and managers from 11 mental health services in Victoria, Australia. Major themes and subthemes were identified using qualitative content analysis. Six themes emerged including competing priorities, importance of routine screening, access to appropriate screening tools, resources, patient responsiveness and workforce development. Barriers to screening included a focus on immediate risk as well as gambling being often considered as a longer-term concern. Clinicians perceived problem gambling as a relatively rare condition, but did acknowledge the need for brief screening. Facilitators to screening were changes to system processes, such as identification of an appropriate brief screening instrument, mandating its use as part of routine screening, as well as funded workforce development activities in the identification and management of problem gambling.
Countries with legalized gambling offer a network of government funded face-to-face therapy, but usage of this expertise is on the decline. One way to address this issue is to recruit therapists from ...existing services whereby they provide guidance for the delivery of internet delivered CBT.
To explore the experiences and perceptions of therapists supporting guided online cognitive–behavioural therapy.
Interviewees were a sub-sample of therapists from a randomised trial that investigated the relative efficacy of online guided self-directed versus pure self-directed interventions in Australia.
In-person, semi-structured interviews with seven service providers were completed, and thematic content analysis identified five themes which related to: participant suitability and screening (e.g., motivation, computer literacy and access); program content and modality acceptability (e.g., amount of content, look and feel); participant information and management (e.g., program engagement and progression); email communication (e.g., use of templates, appointments, rapport building), and; ongoing service integration (e.g., infrastructure, confidence in product). Overall experiences and perceptions of therapists were positive, notwithstanding barriers concerning assessment of participant suitability, participant management systems and low participant engagement.
Key themes emphasized the benefits of Internet-based interventions for problem gambling, and suggested several areas for improvement. Results should inform the development of future treatments to enable flexible tailoring of interventions to individuals.
•Guidance for iCBT can be integrated into routine service delivery.•Screening for suitable clients is important to guides.•Guidance as it is typically delivered may be constrictive for highly experienced clinicians.•Ongoing service integration was viewed positively in terms of developing a suite of services.
Research suggests online interventions can have instant impact, however this is yet to be tested with help-seeking adults and in particular those with problem gambling. This study seeks to determine ...the immediate impact of a single session web-based intervention for problem gambling, and to examine whether sessions evaluated positively by clients are associated with greater improvement. The current study involved 229 participants classified as problem gamblers who agreed to participate after accessing Gambling Help Online between November 2010 and February 2012. Almost half were aged under 35 years of age (45 %), male (57 %) as well as first time treatment seekers (62 %). Participants completed measures of readiness to change and distress both prior to and post-counselling. Following the provision of a single-session of counselling, participants completed ratings of the character of the session (i.e., degree of depth and smoothness) post-counselling. A significant increase in confidence to resist and urge to gamble and a significant decrease in distress (moderate effect size; d = .56 and .63 respectively) was observed after receiving online counselling. A hierarchical regression indicated the character of the session was a significant predictor of change in confidence, however only the sub-scale smoothness was a significant predictor of change in distress. This was the case even after controlling for pre-session distress, session word count and client characteristics (gender, age, preferred gambling activity, preferred mode of gambling, gambling severity, and preferred mode of help-seeking). These findings suggest that single session web-based counselling for problem gambling can have immediate benefits, although further research is required to examine the impact on longer-term outcomes.
IntroductionThe prevalence of disordered gambling worldwide has been estimated at 2.3%. Only a small minority of disordered gamblers seek specialist face-to-face treatment, and so a need for ...alternative treatment delivery models that capitalise on advances in communication technology, and use self-directed activity that can complement existing services has been identified. As such, the primary aim of this study is to evaluate an online self-directed cognitive–behavioural programme for disordered gambling (GamblingLess: For Life).Methods and analysisThe study will be a 2-arm, parallel group, pragmatic randomised trial. Participants will be randomly allocated to a pure self-directed (PSD) or guided self-directed (GSD) intervention. Participants in both groups will be asked to work through the 4 modules of the GamblingLess programme over 8 weeks. Participants in the GSD intervention will also receive weekly emails of guidance and support from a gambling counsellor. A total of 200 participants will be recruited. Participants will be eligible if they reside in Australia, are aged 18 years and over, have access to the internet, have adequate knowledge of the English language, are seeking help for their own gambling problems and are willing to take part in the intervention and associated assessments. Assessments will be conducted at preintervention, and at 2, 3 and 12 months from preintervention. The primary outcome is gambling severity, assessed using the Gambling Symptom Assessment Scale. Secondary outcomes include gambling frequency, gambling expenditure, psychological distress, quality of life and additional help-seeking. Qualitative interviews will also be conducted with a subsample of participants and the Guides (counsellors).Ethics and disseminationThe study has been approved by the Deakin University Human Research and Eastern Health Human Research Ethics Committees. Findings will be disseminated via report, peer-reviewed publications and conference presentations.Trial registration numberACTRN12615000864527; results.
IntroductionThe primary purpose of this study is to evaluate the relative effectiveness of 2 of the best developed and most promising forms of therapy for problem gambling, namely face-to-face ...motivational interviewing (MI) combined with a self-instruction booklet (W) and follow-up telephone booster sessions (B; MI+W+B) and face-to-face cognitive–behavioural therapy (CBT).Methods and analysisThis project is a single-blind pragmatic randomised clinical trial of 2 interventions, with and without the addition of relapse-prevention text messages. Trial assessments take place pretreatment, at 3 and 12 months. A total of 300 participants will be recruited through a community treatment agency that provides services across New Zealand and randomised to up to 10 face-to-face sessions of CBT or 1 face-to-face session of MI+W+up to 5 B. Participants will also be randomised to 9 months of postcare text messaging. Eligibility criteria include a self-perception of having a current gambling problem and a willingness to participate in all components of the study (eg, read workbook). The statistical analysis will use an intent-to-treat approach. Primary outcome measures are days spent gambling and amount of money spent per day gambling in the prior month. Secondary outcome measures include problem gambling severity, gambling urges, gambling cognitions, mood, alcohol, drug use, tobacco, psychological distress, quality of life, health status and direct and indirect costs associated with treatment.Ethics and disseminationThe research methods to be used in this study have been approved by the Ministry of Health, Health and Disability Ethics Committees (HDEC) 15/CEN/99. The investigators will provide annual reports to the HDEC and report any adverse events to this committee. Amendments will also be submitted to this committee. The results of this trial will be submitted for publication in peer-reviewed journals and as a report to the funding body. Additionally, the results will be presented at national and international conferences.Trial registration numberACTRN12615000637549.
PDF
