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The Transparency Project

Sitting at the virtual poker table: A prospective epidemiological study of actual Internet poker gambling behavior

Epidemiological analyses of Internet gambling are necessary to determine the potential for harm. This paper reports the results of the first prospective epidemiological study of actual Internet poker gambling behavior. Among our sample, we identified two subgroups of poker players. Approximately 95% of the sample bought a median of €12 worth of chips at each of two poker sessions per week during a median duration from first to last bet of six months. A smaller subgroup (i.e., 5%) of most involved poker players bought a median of €89 worth of chip at each of 10 sessions per week during a median duration from first to last bet of 18 months. Additional analyses presented in this paper regarding patterns of behavior suggest that the majority of Internet poker players moderated their behavior based on their wins and losses. A minority of most involved players did not show such moderation. These results have important implications for both gambling-and addiction-related research. Click here to visit the Library & Archives page.

St. Francis House Moving Ahead Program (MAP): Phase II report

The St. Francis House Moving Ahead Program (MAP) Phase II Report provides a psychometric evaluation of the instruments used by St. Francis House (the largest day service provide for homeless individuals in New England) to assess MAP participants and evaluate their progress. This is the second report from a project that also evaluated MAP, a work and life skills training program. This Phase II Report also includes recommendations for improving the MAP instruments and developing a system-wide tracking and assessment program. (For more information about these results, please see the Phase I and Phase II Reports.)

As a result of the suggestions and recommendations in this report, the Division on Addictions and St. Francis House are currently collaborating on the Linking, Evaluation, Assessment & Data System (LEAD), a technological solution for conducting comprehensive assessments St. Francis House guests, tracking their use of services and programs, and evaluating the impact of those programs and services. Click here to visit the Library & Archives page.

Virtual harm reduction efforts for Internet gambling: effects of deposit limits on actual Internet sports gambling behavior

In an attempt to reduce harm related to gambling problems, an Internet sports betting service provider, bwin Interactive Entertainment, AG (bwin), imposes limits on the amount of money that users can deposit into their online gambling accounts. We examined the effects of these limits on gambling behavior. Our findings indicate that Internet gamblers who exceed deposit limits constitute a group of bettors willing to take high risks; yet, surprisingly, they appear to do this rather successfully because their percentage of losses is lower than others in the sample. However, some of these gamblers exhibit some poor outcomes. Deposit limits might be necessary harm reduction measures to prevent the loss of extremely large amounts of money and cases of bankruptcy. This paper discusses how these limits might be modified based on its findings. Click here to visit the Library & Archives page.

Population trends in Internet sports gambling

The Internet is a controversial new medium for gambling. This study presents the first longitudinal analysis of online gambling participation and activity among a population of newly subscribed Internet bettors. Our analyses indicate that this population of gamblers adapted to the new subscription service rapidly, as evidenced by quickly developing declines in population participation, number of bets, and size of stakes. Adaptation was not uniformly evident in our population. Among subgroups of heavily involved bettors, adaptation was generally slower or not apparent. Rather than adapt, involved bettors often maintained the high level of betting they escalated to in the days following subscription. This was particularly evident for one type of game: live-action betting. These involved individuals and the effect of live-action play require close scrutiny and ongoing examination. Click here to visit the Library & Archives page.

Parameters for safer gambling behavior: Examining the empirical research

There have been claims that new gambling technology is hazardous to player health, and that technological interventions can alleviate gambling-related harm. In this paper, we systematically review the empirical research about the nexus between gambling and technology to evaluate the veracity of these claims using a public health perspective. A review of forty seven studies showed that attempts to develop and implement safety features for new gambling technology are promising, but methodologically rudimentary and limited in scope. Increased attention to the dynamic interaction among host, agent, and environment factors hold potential to advance the field. Click here to visit the Library & Archives page.

Substance and psychiatric disorders among men and women repeat driving under the influence offenders who accept a treatment-sentencing option

Driving under the influence (DUI) continues to be a serious health public health concern in the United States. Research suggests that the substance use/abuse and psychiatric histories of repeat offenders might contribute to the persistence of this phenomenon. This study examined psychiatric and substance-use histories of male and female DUI repeat offenders in treatment. The authors found that male and female repeat DUI offenders have extensive but different psychiatric and substance-use histories that might play a significant role in DUI recidivism. These differences in psychiatric and substance-use histories among men and women could have important implications for treatment and prevention of DUI. Click here to visit the Library & Archives page.

Stability and progression of disordered gambling: lessons from longitudinal studies

Very few studies have examined the progression of disordered gambling in an individual or the tendency for individuals to stay at one diagnostic level, as opposed to getting better or worse. Nonetheless, conventional wisdom states that disordered gambling is a condition that is both escalating and unmanageable. The objective of this study was to examine these assumptions. In analyses of available longitudinal studies from the peer reviewed literature, LaPlante, et al found no evidence to support the assumption that individuals cannot recover from disordered gambling, no evidence to support the assumption that individuals who have more severe gambling problems are less likely to improve than individuals who have less severe gambling problems, and no evidence to support the assumption that individuals who have some gambling problems are more likely to worsen than individuals who do not have gambling problems. This review demonstrates instability and multidirectional courses in disordered gambling. Click here to visit the Library & Archives page.

Joint research project extended for an additional five years: bwin Interactive Entertainment AG and Harvard Medical School Faculty at the Division on Addictions, Cambridge Health Alliance an affiliate of Harvard Medical School

The Division on Addictions has been working with bwin for the last three years setting new standards for the industry, developing and testing empirically-supported new responsible gaming initiatives, and providing customers with responsible gaming information and tools. This research has just been extended for another five years. The prime research objective is to establish a scientific evidence base that can guide the development of safe, recreational gaming environments and prevent the emergence of gaming-related problems as well as reduce any such problems that already exist.

This project involves using scientific evidence to create the safest possible online gaming environment by implementing the findings of the world's largest longitudinal study. The scientific studies analyzed the data of over 47,000 customers over a 36-month period, making it the largest longitudinal study of its kind worldwide. Because it relies on actual customer data and not self-reported results, the results are not influenced by customer recall or interpretation. The intention is to expand and enhance the responsible gaming activities into a systematic program of responsible gaming tools and applications.

Visit The Transparency Project website to download the "Actual Internet Sports Gambling Activity: February 2005 through September 2005" dataset, which describes the actual aggregated Internet sports gambling behavior of participants during the first eight months of the longitudinal study with bwin.

Indices of Exposure & Vulnerability for Predicting Alcohol-Related Problems

This project's aim is to develop indices of regional and personal exposure and vulnerability that can be used in the longitudinal study of determinants of early alcohol use and alcohol-related problems. We know little about the interaction between exposure and vulnerability and less about the relative influence of risk factors measured within different contexts (e.g., at regional, macro levels and personal, micro levels). The integration of models of risk and vulnerability at macro- and micro- levels can lead to deeper understanding of the interactions between risk factors and more effective treatment and prevention of alcohol-related problems. The research program will a) develop both regional and personal theoretical models that measure exposure to alcohol-using opportunities and vulnerability to early alcohol use and the development of alcohol-related problems; b) test those models and their ability to predict alcohol using behaviors in a longitudinal sample of adolescents; and c) use the findings from those tests to expand and refine the models.

St. Francis House Moving Ahead Program (MAP) Evaluation

The Division on Addictions has partnered with St. Francis House, a service center for people struggling with homelessness in the greater Boston area, to evaluate the instruments used to collect information from participants in its job- and life-skills training program, the Moving Ahead Program (MAP). The current evaluation project includes a descriptive and psychometric analysis of approximately 10 years of data on participants in MAP. Findings from these analyses will inform recommendations for both revising the intake, graduation, and follow-up tools used at MAP, and creating a complete computerized intake and assessment system for St. Francis House and its programs.

The Opioid Addiction and Family Project

The Opioid Addiction and Family Project is a new research study being conducted at Cambridge Health Alliance. The goal of this effort is to find out if adding family counseling to individual counseling and Naltrexone medication leads to better treatment outcomes for people struggling with opioid addiction. This study is funded by the National Institute of Drug Abuse. Patients in the study are randomly assigned to receive either (a) naltrexone plus individual drug counseling without family counseling, or (b) naltrexone plus individual drug counseling with family counseling. Counseling and medication received as part of this study are free of charge. Each patient takes part in the study for 16 months - 4 months of treatment and 12 months follow-up. Study participants are needed. For more information, please visit our webpage at www.challiance.org/research/opioid.shtml or call (617) 591-6055.

Joint research initiative on multiracial identity and health: Harvard Medical School faculty at the Division on Addictions, Cambridge Health Alliance, University of Michigan, and University of Nevada, Las Vegas

The Division on Addictions is a founding member of a multi-university research initiative dedicated to examining the distribution and determinants of important addiction-related health behaviors among multi-racial/ethnic populations. Compared to monoracial majority and monoracial minority individuals, research shows that multiracial individuals are in greater danger of developing a number of risky health behaviors (e.g., underage drinking) and health disorders (e.g., depression) (Choi, et al.,2006; Shih & Sanchez, 2005). Two research projects addressing this issue will commence during the summer of 2007. First, we will collaborate with Dr. Margaret Shih of the University of Michigan on a secondary data analysis of the ADD Health longitudinal dataset to examine addiction-related behavior and social support among multiracial young adults. The Robert Wood Johnson Health and Society Scholars program at University of Michigan will provide support for this study. Second, we will collaborate with Dr. Shih and Dr. Bo Bernhard of the University of Nevada, Las Vegas on a study that will examine addiction-related behavior among multiracial individuals in the rural and urban Southwest. The University of Nevada, Las Vegas President’s Research Award will provide support for this study.

Our Annual Addiction Medicine CME Course is in October!

Click here for more information about the course!

Ryan J. Martin to Receive the National Council on Problem Gambling 2009 Dissertation Award

We would like to congratulate Ryan J. Martin, Ph.D., the inaugural Thomas N. Cummings postdoctoral research fellow at the Division on Addictions and Massachusetts Council on Compulsive Gambling, who will receive the National Council on Problem Gambling (NCPG) 2009 Dissertation Award. The annual award was established by the NCPG in 1999 to acknowledge superior research efforts among young scholars in the field. Dr. Martin’s dissertation, An examination of gambling behavior among college students using the theory of planned behavior, was completed as part of the doctoral program in Health Education and Promotion at the University of Alabama. In addition to receiving the award, Dr. Martin will present his dissertation findings at the 23rd National Conference on Problem Gambling (June 25-27 in Indianapolis, IN).

Dr. Martin’s dissertation examined the role of the theory of planned behavior (TPB; i.e., intentions, subjective norms, perceived behavioral control, and attitudes) in predicting gambling frequency among college student gamblers. Results from his research support the utility of the TPB to explain gambling behavior in this population. Specifically, TPB distal determinants (i.e. friend and family subjective norms, attitudes and perceived behavioral control) predicted gambling frequency and intention to gamble mediated the relationship. In addition, moderation analyses indicated that the TPB was less predictive of frequent gambling among disordered gamblers than those without gambling problems. These findings suggest that college gambling prevention efforts focused toward non-problem gamblers should target misperceptions of approval regarding gambling behavior (i.e., subjective norms), personal approval of gambling behavior (i.e., attitudes), and perceived behavioral control to better manage gambling behavior in various situations. Efforts to reduce gambling among college students experiencing gambling problems might need to consider and explore alternative approaches.

The Thomas N. Cummings Research Fellow is supported by a grant from the National Center for Responsible Gaming and the Massachusetts Council on Compulsive Gambling.

The Transparency Project is Here!

The Transparency Project is the world's first data repository for privately funded research. 

Transparency Project Datasets:

Visit the Transparency Project website to download the “Meta-analytic Prevalence Estimates of Disordered Gambling Behavior in the United States and Canada” codebook and datasets.

This meta-analytic dataset extends the first comprehensive gambling related epidemiological meta-analysis published in the American Journal of Public Health in 1999 by Shaffer et al to update and refine the prevalence estimates of disordered gambling in the United States and Canada. This dataset employs an empirical strategy to synthesize estimates of gambling-related disorders across an array of differing estimation methodologies and population samples. This dataset provides the opportunity to evaluate and integrate the range of assumptions and strategies used by the various scientists who have estimated the prevalence of disordered gambling. This search strategy initially identified 193 prevalence studies and a total of 146 studies were included for analyses in this meta-analysis study.

The “Actual Internet Sports Gambling Activity: February 2005 through September 2005” codebook and datasets are also available for download.

The first available analytic dataset for the Transparency Project comes from the collaborative Internet gambling research project involving the Division on Addictions and bwin Interactive Entertainment, AG (bwin), an Internet betting service provider headquartered in Vienna, Austria. The dataset provides the first prospective longitudinal data reflecting real-time Internet sports betting behavior. It contains information from a large cohort of participants (N=40,499) who opened an account with bwin from February 1, 2005 through February 27, 2005. This dataset also describes the actual aggregated Internet sports gambling behavior of participants during the first 8 months of a longitudinal study that took place from February 1, 2005 through September 30, 2005. Original raw datasets are also available for download. These bwin Internet gambling datasets include the following participant information: demographic information (user ID, country of residence, language, gender, registration date, age at registration) and daily aggregated online betting activity (first active date, last active date, total days active, total stakes, total winnings, total bets).

The Tung Wah Group of Hospitals Visited the Division on Addictions

Delegates from the Tung Wah Group of Hospitals in Hong Kong recently visited the Division on Addictions and other community programs. Their educational trip focused on pathological gambling, psychoactive substance abusers and victims of violence.   We would like to thank our colleagues from the Cambridge Health Alliance Victims of Violence Program; the Cambridge Health Alliance Outpatient Addiction Service; the Massachusetts Council on Compulsive Gambling; the National Center for PTSD, VA Boston; Transition House; the Boston Area Rape Crisis Center and other local community organizations for their help and support hosting delegates from the Tung Wah Group of Hospitals.

Distinguished Contributions

to the Study of Addiction

Timothy O’Farrell, Ph.D., A.B.P.P.

Dr. O’Farrell is Professor of Psychology in the Harvard Medical School Department of Psychiatry at the VA Boston Healthcare System where he directs the Families and Addiction Program and the Counseling for Alcoholics’ Marriages (CALM) Project. His work has examined behavioral couples therapy (BCT), which treats the substance abuse patient together with their spouse or domestic partner to support the patent’s abstinence and improve relationship functioning. Studies show that BCT produces greater abstinence, happier relationships, fewer separations, and greater reductions in social costs, domestic violence, and emotional problems of the couple’s children than typical individual-based treatment. BCT also improves compliance with recovery-related medications, including disulfiram for alcoholism and naltrexone for alcoholism and for opioid addiction.

His latest book Behavioral Couples Therapy for Alcoholism and Drug Abuse is a clinician’s guide to BCT. Virtually all reviews of research on addiction treatment, as well as government panels in the U.S. and the U.K., cite BCT as an empirically supported method that should be used by clinicians treating substance abuse. To learn more about BCT, see BCT clinical guidelines and book on BCT.

Medical Journalist Jeanne Blake Joins McLean Hospital Board

Jeanne Blake is an affiliated faculty member at the Division on Addictions, founder of Words Can Work® and the president of Blake Works. We are pleased to announce that Blake has been named to the board of McLean Hospital, the largest psychiatric facility of Harvard Medical School and an affiliate of Massachusetts General Hospital.
For Immediate Release February 13, 2009 Contact Laura Neves McLean Hospital 617.855.2110

BELMONT, MA—McLean Hospital has announced the appointment of Jeanne Blake, a critically acclaimed medical reporter, author and producer, to its board of trustees.

Blake will use her commitment to educating the public about mental and public health and her experience as a journalist to promote understanding of psychiatric illness.

"There is a greater acceptance of people living with mental illness, but the stigma remains," Blake says. "Too often people are afraid or feel ashamed to ask for help. As a member of the McLean Hospital board, I will use my skills and expertise to help raise awareness about mental illness and how we can encourage more people to seek life transforming and lifesaving medical treatment."

Blake is president and founder of Blake Works Inc. and Family Health Productions. Her Words Can Work® evidence-based media (DVDs, Words Can Work family guides and wordscanwork.com) address the challenges young people face growing up. Her productions including Alcohol: True Stories Hosted by Matt Damon; Depression: True Stories; Drugs: True Stories and Steroids: True Stories Hosted by Curt Schilling serve as a catalyst for potentially lifesaving dialogue among young people and parents. They are incorporated into programs nationally by thousands of healthcare and community organizations, schools, and corporate work/life programs.

Blake's newest product in development is the Words Can Work online corporate employee program to support parents in talking with their kids.

"When young people can talk openly and honestly with a parent or another adult they trust, and really feel listened to, they tend to make better choices," Blake says. "Ultimately these kids grow up more safely and parents can be less stressed and more productive at work and in life."

This fall, Blake partnered with McLean Hospital Chief Medical Officer Joseph Gold, MD, to train Boston Public School mental health personnel. The program, addressing depression and suicide prevention, was so well received that Blake and Dr. Gold are developing additional online training sessions for educators and others who work with youth.

"The feedback was tremendous," Blake says. "One counselor reported that in the week following the training she felt significantly better equipped to meet the needs of a student who was suicidal. This is an example of how we can make a difference in peoples' lives and one of the many reasons I'm committed to McLean Hospital's mission."

From 1984 to 1991, Blake was a medical reporter and anchor at Boston's CBS-TV affiliate where she earned the Robert F. Kennedy Memorial Journalism Award, was recognized by Americans for Democratic Action, and was honored by the Human Rights Campaign for her coverage of health-care issues.

Blake, who lives in New York City and Gloucester, Massachusetts, serves on the American Psychological Association's Task Force on the Sexualization of Girls and is president of the Perfect Storm Foundation in Gloucester.

McLean Hospital is the largest psychiatric facility of Harvard Medical School, an affiliate of Massachusetts General Hospital and a member of Partners HealthCare. For more information about McLean Hospital, visit www.mclean.harvard.edu.
 

New Harvard Medical School Department of Continuing Education Online Course - Addiction in Your Practice: Information and Resources for Dealing with Addictive Behavior

Course Description: Psychiatric comorbidity, such as addictive behavior, is common in a variety of treatment settings, and has far-reaching consequences. Complications from addictive behavior can impede treatment progress, lead to additional problems, and increase the chance of treatment failure. Consequently, there recently has been increased demand on medical care workers who do not specialize in addiction (e.g., nurse practitioners, general practitioners, obstetricians, trauma specialists, etc.) to assess, intervene, and provide referrals for their patients who demonstrate addictive behavior. However, research suggests that many medical care providers lack addiction-related training and resources. The goals of this online course are to improve participants’ understanding of addiction and its influence on medical care. We will discuss the theoretical and clinical aspects of addictive behavior, as well as strategies for dealing with patients who demonstrate addictive behavior.

To learn more about the course, or to register, please click here.