The Division on Addiction - Cambridge Health Alliance

Risky behaviors, such as alcohol and drug consumption, gambling, and violent or criminal activity, are a public health problem for youth across the United States (Eaton et al., 2010). Native American youth, especially, continue to be at elevated risk for some such harmful behaviors (Friese, Grube, Seninger, Paschall, & Moore, 2011), and little is known about their engagement in other behaviors (e.g., gambling). Consequently, it is important to continue to examine risky behavior among Native American youth. Likewise, it is equally important to pay as much attention to protective factors against risky behavior. Working with Native American tribes to gain information about risky behavior and protective factors will enable the development of programs that address these issues and maximize wellness. To gain information about areas of strength and those that require improvement, the proposed project will partner with The Healing Lodge of the Seven Nations (HL), a residential youth chemical dependency center that serves the Inland Tribal Consortium (ITC), to engage tribal youth in a mutually-developed brief risk and resilience assessment during planned community events. We have secured an agreement with HL and representatives from the four ITC tribes (the Colville Confederated Tribes, Umitilla Tribe, Kootenai Tribe, and the Kalispel Tribe) that will host youth community events during 2014. The assessment includes central risk behaviors (e.g., gambling, alcohol use, violence) and resilience factors (e.g., Native American enculturation and family connectedness) that have well-validated reliable brief assessments available.

New Grant from The Tung Wah Group of Hospitals

"Clinical Research & Training Collaboration between the Tung Wah Group of Hospitals Integrated Center on Addiction Prevention and Treatment and the Division on Addiction, Cambridge Health Alliance, a Harvard Medical School teaching hospital," PI: Howard Shaffer, Ph.D., C.A.S.

The purpose of this project is to guide a multi-year evidence-based clinical research and training program located at the Integrated Center on Addiction Prevention and Treatment (ICAPT) in Hong Kong. We intend this program of activities to lead to enhanced treatment outcomes and provide the architecture for establishing ongoing clinical studies, including prospective longitudinal designs and randomized clinical trials. This architecture will provide the setting for future research activities at ICAPT as well as both clinical and research training. To this end, we will establish a training and development program that includes ethics, clinical, and research activities; this program will feature a “train the trainers” approach to multiply training experience effects. In addition to web based clinical and research training, selected Tung Wah staff will participate in the annual Harvard Medical School Continuing Medical Education live course in Addiction Medicine, offered by the Division on Addiction, and partake in the Division’s Continuing Medical Education Distance Learning courses, administered by Harvard Medical School.

New Grant from OJJDP with the Cambridge Police Department

"Safety Net Collaborative Outcome Evaluation"

Katerina Belkin, B.A., Sarah Nelson, Ph.D., and Howard Shaffer, Ph.D., C.A.S.

The Cambridge Police Department (CPD) has set up a Safety Net Collaborative to promote mental health and limit youth involvement in the juvenile justice system through coordinated services for Cambridge youth and their families. Safety Net's diversion program targets first-time juvenile offenders and focuses on connecting them to the necessary services and programs to prevent recidivism. The Cambridge Department of Human Service Program assists the CPD in connecting kids in the program to five youth centers located throughout the city. Cambridge Health Alliance (CHA) provides phone and in-person consultation, training, evaluation and treatment services as well as outreach with officers to schools and families. Diverted youth can seek treatment at CHA, or in other behavioral health settings. At its five-year juncture, the initiative needs clear measures of positive outcomes and a more specific plan for data collection and analysis. The Division on Addiction will work with the CPD's Community Relations Division to identify measurable predictor and outcome variables to look at whether involvement in the Safety Net program is linked to positive outcomes.

Division Staff Present New Research at the Harvard Psychiatry Research Day Poster Session and Mysell Lecture and the Cambridge Health Alliance Academic Poster Session

Research staff from the Division on Addiction present posters at the Harvard Psychiatry Research Day Poster Session and Mysell Lecture and the Cambridge Health Alliance Academic Poster Session.

Harvard Psychiatry Research Day Poster Session and Mysell Lecture - March 19, 2014

The Cambridge Health Alliance Academic Poster Session - April 9, 2014

Please click on the below links to view the posters.

New Grant from ABMRF: The Foundation for Alcohol Research

"The effect of tailoring a testimonial message on excessive drinking by personal relevance on implicit and explicit narrative persuasion," Co-PIs: Julia Braverman, Ph.D., and John Kleschinsky, M.P.H.

Research suggests that narrative persuasion (i.e., telling vivid stories to promote attitude change) might be an effective public health promotion technique. However, it is unclear whether making a narrative story more personally relevant increases its persuasiveness. This research program explores this possibility for excessive alcohol consumption. It is well known that alcohol abuse impairs various domains of life, e.g., health, social relationships, and career. The importance of these domains varies from person to person. Hence, some people are typically more concerned about their social relationships, whereas others pay more attention to their career, or health. We examine the effect of matching the message content to what individuals find most personally relevant with two experiments. For the first experiment, we will ask participants randomly assigned to read personally relevant, or not, stories about alcohol. We will determine whether matching personal relevance along three domains (relationships, career, or health) positively affects individuals’ psychological immersion into the story, alcohol related attitudes, and self-reported drinking. For the second experiment, we will use a priming technique to make a specific domain temporarily more salient (i.e., “activated”) to an individual. This will allow us to investigate if induced relevance to self can yield similarly positive alcohol-related health outcomes.

New Grants from NCRG

"A benchmark study for monitoring exposure to new gambling," PI: Sarah Nelson, Ph.D.

The Commonwealth of Massachusetts is nearing an historic change to its legal gambling landscape. The expansion of legal gambling opportunities to include large resort style casinos presents a unique opportunity to learn about the short- and long-term ramifications of such expansion on public health. Because this period represents a natural experiment within Massachusetts, there is a limited window of opportunity to collect accurate baseline data. To determine how new gambling opportunities impact the public's gambling-related health, it is imperative to establish baseline estimates of gambling-related behaviors and health prior to the opening of new gambling venues and then track the changes in these individuals' health and behavior across time. This pilot project will survey the Massachusetts arm of an existing nationally representative online panel about their current gambling behaviors, problems, and attitudes, as well as other leisure behaviors, spending habits, substance use, and mental health to establish a benchmark for a future long-term longitudinal investigation of the effect of gambling expansion on public health.

The final report for this study is now available on our Library and Archives page.

"Expanding the study of actual Internet gambling behavior: Exposure and adaptation with a newly opened market," PI: Heather Gray, Ph.D.

In this work, the Division on Addiction will partner with researchers from Reykjavik University and the University of Iceland to conduct an analysis of actual Internet gambling records from a regional Internet gaming provider. We will use these records to conduct an epidemiological description of gamblers and gambling behavior; to describe the gambling behavior of most active gamblers; to describe the gambling behavior of gamblers identified as "high risk;" and to describe gamblers' adaptation to new gambling opportunities. Results from these studies will provide a more complete description of how people gamble online.

New Multi-Year Grant with The Century Council to Reduce Repeat DUI by Developing a Computerized Assessment and Referral System (CARS)

New research has identified that repeat DUI offenders often suffer from a number of psychiatric disorders (e.g., Shaffer et al., 2007), suggesting that untreated mental health issues contribute to the persisting rate of DUI. To combat this pressing public health problem and to build a foundation for expanded treatment, the Division of Addiction, with support from The Century Council, has begun work to develop and test a computerized clinical report generator tool, the Computerized Assessment and Referral System (CARS), for use in DUI intervention and treatment settings. CARS will package a powerful mental health assessment tool, the Composite International Diagnostic Interview (CIDI: Kessler & Ustun, 2004) with a user-friendly interface, increased flexibility, and immediate personalized output, to create a tool that can be used easily by DUI facility staff to screen DUI offenders and target interventions to address comorbid mental health issues. Dr. Ronald Kessler, Professor of Health Care Policy at Harvard Medical School, co-director of the World Health Organization’s World Mental Health Surveys, and an original developer of the CIDI, and his team are collaborating with the Division on the development of CARS.

Shaffer, H. J., Nelson, S. E., LaPlante, D. A., LaBrie, R. A., Albanese, M., & Caro, G. (2007). The epidemiology of psychiatric disorders among repeat DUI offenders accepting a treatment sentencing option. Journal of Consulting and Clinical Psychology, 75(5), 795-804.

Kessler, R. C., & Ustun, T. B. (2004). The World Mental Health (WMH) Survey Initiative version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). International Journal of Methods in Psychiatric Research, 13(2), 93-121.

For the original press release, click here.

Our Annual Addiction Medicine CME Course is in October!

ADDICTION MEDICINE:

A Case-based Approach to the Integrated Treatment of Addictive Disorders and Other Mental and Medical Conditions

Revere Hotel Boston Common

200 Stuart Street, Boston, MA, 02116

AGENDA

Friday, October 10, 2014

7:15 AM REGISTRATION

7:50 AM
Introduction to the Course

John R. Knight, MD

8:00 AM
Keynote Address – A Drug Policy for the 21st Century

This lecture is not designated for AMA PRA Category 1 Credit™ or any other credit this course offers.
Michael Botticelli

9:00 AM The Expanding Role of Primary Physicians in the Treatment of Addiction Patrick G. O'Connor, MD, MPH, FACP

10:00 AM BREAK

10:15 AM The Syndrome Model of Addiction: Implications for Treatment Howard J. Shaffer, PhD, CAS

11:15 AM Treatment of Co-morbid Substance Use and Mood Disorders Dominic A. Ciraulo, MD

12:15 PM LUNCH BREAK

1:15 PM Co-occurring Conditions and Ways for Non-specialists to Provide Coordinated Care for Gambling and Other Mental Health Issues Victor Ortiz, MSW, LADC I, CADC II

2:15 PM Neurobiology of Addiction
Bertha K. Madras, MD

3:15 PM BREAK

3:30 PM Understanding and Managing Co-occurring ADHD and Substance Use Disorders Timothy E. Wilens, MD

4:30 PM Taking CHARGE: Preparing Addiction Specialists and Other Healthcare Providers for Expanded Gambling Opportunities
Mark J. Albanese, MD, and

Debi A. LaPlante, PhD

5:15 PM ADJOURN

Saturday, October 11, 2014

7:45 AM CONTINENTAL BREAKFAST

8:15 AM Screening and Brief Intervention for Adolescent Substance Abuse Traci L. Brooks, MD

9:15 AM Screening and Brief Intervention of Gambling Disorder amongst Youth Jeffrey L. Derevensky, PhD

10:15 AM BREAK

10:30 AM Neurobiology & Pharmacological Treatment of Gambling Disorder Marc N. Potenza, PhD, MD

11:30 AM Integration of Pharmacological Addiction Treatment within Primary Care Jeffrey Samet, MD, MA, MPH

12:30 PM LUNCH BREAK

1:30 PM Psychological Treatment for Parents during the Perinatal Period: Working with Pregnancy and the Post-partum to Treat Families Impacted by Addiction Amy R. Sommer, LICSW

2:30 PM Treating Multiple Expressions of Addiction among Veterans John A. Renner, Jr., MD, CAS

3:30 PM BREAK

3:45 PM Office-based Opioid Treatment for Addiction and Chronic Pain Daniel P. Alford, MD, MPH, FACP, FASAM

4:45 PM ADJOURN

Click here for more information about the course!

Cambridge Health Alliance Readiness for Gambling Expansion (CHARGE)

Cambridge Health Alliance is getting ready for gambling expansion in Massachusetts. The CHARGE Initiative is an education, information, and awareness effort that will help people dealing with gambling disorder. Read more about CHARGE here.

New Online CME Course

Disordered Gambling in Your Practice: Information and Resources for Dealing with Disordered Gambling

Course Directors: Heather M. Gray, Ph.D., Debi A. LaPlante, Ph.D., and Howard Shaffer, Ph.D., C.A.S.

The Division is proud to announce the launch of our latest online CME course, Disordered Gambling in Your Practice: Information and Resources for Dealing with Disordered Gambling. The course is dedicated to increasing providers’ understanding of disordered gambling and its importance to their practice. To learn more about the course, or to register, please click here.

Recruitment Opportunities for Studies

Click here for more information about a smoking cessation study, as well as studies for veterans.

Alcohol, marijuana. and tobacco use trajectories from age 12 to 24 years: Demographic correlates and young adult substance use problems

We examined substance use trajectories from early adolescence to young adulthood among a diverse sample of 998 youth. Distinct trajectories emerged for alcohol, marijuana, and tobacco use. Findings confirmed that adolescents with early- and rapid-onset trajectories of any type of substance are particularly vulnerable to the development of problematic substance use in early adulthood. However, analyses also identified an escalating high school onset trajectory for alcohol and for marijuana use that was equally prognostic of problem use in adulthood. Moreover, tobacco use in early adolescence was associated with developing high-risk marijuana and alcohol use patterns. These findings suggest that prevention and intervention efforts need to address multiple pathways to substance use problems. Click here to visit the Library & Archives page.

Does Pareto rule Internet gambling? Problems among the "Vital Few" & "Trivial Many"

Using records of Internet gambling subscribers (n = 1,384), this study tested the Pareto principle: about 20% of customers, “the vital few,” are responsible for about 80% of the activity, while 80%, “the trivial many,” are responsible for the remaining 20%. Participants completed the Brief Biosocial Gambling Screen (BBGS) and had a history of betting on sports and/or online casino games during the twelve months before completing the screen. Using various measures, the vital few Internet gamblers ranged between 4.6% and 17.8% of the subscribers – smaller than the Pareto principle would suggest. Between 38% and 67% of the vital few and between 24% and 35% of the trivial many screened positive for gambling-related problems. This research suggests that the concepts of the “vital few” and the “trivial many” apply to Internet gambling. Click here to visit the Library & Archives page.

Gambling involvement: Considering frequency of play and the moderating effects of gender and age

Research indicates that specific types of gambling, such as electronic gaming machines, are associated with increased odds of experiencing gambling problems. Recent findings suggest that to advance our understanding of gambling-related problems scientists need to focus less on a simple association (e.g., specific gambling type) and more on complex models that include the extent of gambling involvement. The objective of this study is to advance this area of investigation by establishing the generalizability of the involvement effect to the general population of Canada, as well as to examine two potential moderating factors: gender and age. Secondary data analysis of the nationally representative Canadian Community Health Survey (CCHS) cycle 1.2 (data collected during 2002, response rate = 77 %, n=18,913) using logistic regression models were conducted. All types of gambling were associated with problem gambling. However, when adjusting for gambling involvement (i.e., the number of games played during the past year), these specific game relationships were either eliminated or attenuated. Significant relationships remained for instant win lottery tickets, bingo, card and/or board games, electronic gaming machines outside of casinos, electronic gaming machines inside casinos, other casino gambling, horse racing, sports lotteries, and games of skill. For many types of gambling, the nature of the relationships seemed to be a function of the frequency of engagement with specific games. Gender and age did not moderate these findings. These findings indicate that focusing on a narrow direct cause (e.g., game type) for gambling problems needs to shift towards a more complex model that also includes the level of gambling involvement. Click here to visit the Library & Archives page.

Associations between National Gambling Policies and Disordered Gambling Prevalence Rates within Europe

Policymakers and other interested stakeholders currently are seeking information about the comparative effectiveness of different regulatory approaches to minimizing gambling-related harm. This study responds to this research gap by exploring associations between gambling policies and disordered gambling prevalence rates. We gathered information about gambling policies for thirty European jurisdictions and past-year prevalence rates for disordered gambling for twelve of these jurisdictions. We present policy trends and prevalence rates and then describe the level of association between policy and prevalence. We observe one statistically significant association between policy and prevalence: rates of sub-clinical (i.e., Level 2) disordered gambling were higher within environments that mandated less strict regulation of advertising for online gambling. Finally, we discuss the implications of our research in the context of the current process regarding the pan-European regulation of gambling. Our findings do not offer evidence for certain assumptions made in the past by the European judiciary. Click here to visit the Library & Archives page.

Recently Published:

Braverman, J., LaPlante, D. A, Nelson, S. E, & Shaffer, H. J. (2013). Using cross-game behavioral markers for early identification of high-risk Internet gamblers. Psychology of Addictive Behaviors, 27(3), 868-877. doi: 10.1037/a0032818 (Password Protected)

Gray, H. M., Jonsson, G. K., LaPlante, D. A., & Shaffer, H. J. (In Press). Expanding the study of Internet gambling behavior: Trends within the Icelandic lottery and sportsbetting platform. Journal of Gambling Studies, Online First. doi: 10.1007/s10899-013-9427-0 (Password Protected)

LaPlante, D. A. (2013). Responsible drinking for women: A Harvard Medical School guide. Retrieved from http://www.amazon.com/Responsible-Drinking-Harvard-Medical-ebook/dp/B00EV8XU36/ref=sr_1_1?s=digital-text&ie=UTF8&qid=1378397095&sr=1-1&keywords=responsible+drinking+for+women. (eBook Available for Purchase Online)

LaPlante, D. A., Nelson, S. E., & Gray, H. M. (2013). Breadth and depth involvement: Understanding Internet gambling involvement and its relationship to gambling problems. Psychology of Addictive Behaviors, Online First. doi: 10.1037/a0033810 (Password Protected)

Schuman-Olivier, Z., Hoeppner, B. B., Weiss, R. D., Borodovsky, J., Shaffer, H. J., & Albanese, M. J. (In Press). Benzodiazepine use during buprenorphine treatment for opioid dependence: Clinical and safety outcomes. Drug and Alcohol Dependence. doi: 10.1016/j.drugalcdep.2013.04.006 (Password Protected)

Shaffer, Howard J, & LaPlante, Debi A. (2013). Considering a critique of pathological gambling prevalence research. Addiction Research and Theory, 21(1), 12-14. doi: 10.3109/16066359.2012.715223 (Password Protected)

Spectrum Gaming Group. (2013, October 28). Gambling Impact Study. Retrieved from http://www.leg.state.fl.us/GamingStudy/docs/FGIS_Spectrum_28Oct2013.pdf.
Spectrum Gaming Group released a comprehensive report about the impact of expanded gambling for the State of Florida. The Division on Addiction contributed to this report, specifically providing an assessment of likely social costs associated with expanded gambling.