Grant et al. (2008)

Question 1

What do endorphins bind to?

What does this allow?

Answer 1

Endorphins bind to opioid receptors, inhibit GABA and allow dopamine to increase.

Question 2

What do opioid antagonists do?

Answer 2

Block opioid receptors and reduce euphoria.

Question 3

What does a lack of reinforcement (euphoria) lead to?

Answer 3

The extinction of compulsive behaviours.

Question 4

Aim & hypothesis

Answer 4

To investigate opiate antagonists as a treatment for gambling disorder.

Opiate antagonists are more effective in reducing gambling disorder in people with a family history of alcoholism, strong urges and euphoric response to alcohol compared to people who do not fit into these categories.

Question 5

Method

Answer 5

Experiment/randomised control trials, independent measures, double-blind.

Question 6

Participants

Answer 6

• 284 pathological gamblers.
• Had all gambled in the past 2 weeks.
• Outpatients from 15 psychiatric centres.
• Equal no. of males/females
• From the USA.

Question 7

What conditions were ppts assigned to?

Answer 7

Low, moderate or high dose of nalmefene, naltrexone or placebo.

Question 8

What technique was used to assign ppts to their condition?

Answer 8

Random allocation.

Question 9

How many trials took place?

What style were they?

How long did they last?

Answer 9

2 double-blind placebo clinical trials which lasted either 16 or 18 weeks.

Question 10

How did Grant measure the severity of ppts’ gambling?

Answer 10

Yale-Brown obsessive compulsive scale modified for pathological gambling (PG-YBOCS).

Question 11

Yale-Brown Obsessive Compulsive Scale Modified for Pathological Gambling (PG-YBOCS)

Answer 11

A clinician-administered scale to assess gambling severity by assessing symptoms over the previous 7 days, in terms of both gambling urges/thoughts and gambling behaviour.

Question 12

Apart from using the PG-YBOCS, how was data gained from ppts?

What was the data about?

Answer 12

Semi-structured interviews were used to gather family history, particularly relating to first-degree relatives with alcoholism.

Question 13

When were the measures taken?

Answer 13

After the 16-18 week long trials.

Question 14

What 3 factors were associated with positive treatment outcomes?

Answer 14

• Family history of alcoholism
• Stronger baseline urges
• Aged (reduced placebo effect in older ppts)

Question 15

What was a treatment response operationalised as?

Answer 15

At least a 35% reduction in PG-YBOCS total score, for at least 1 month following treatment.

Question 16

Conclusions

Answer 16

Opiate antagonists have the greatest effect for gamblers who have a family history of alcoholism.

The stronger the urges, the higher the probability that these drugs will be effective.

Efficacy in younger gamblers may be due to placebo effects.

Question 17

Strengths

Answer 17

• Double-blind = eliminated ppt/researcher bias and increased validity.
• Quantitative data = objective measurement of symptoms through standardised Y-BOCS.
• Informed consent = before the placebo trial, ppts were informed of the process.
• Generalisable = ppts were diverse in age/ethnicity.
• RWA = showed the effectiveness of opiate antagonists in treating gamblers, this can help impact treatment in the future.

Question 18

Criticisms

Answer 18

Unethical = ppts believed they might be receiving the real drug (deception), but did not get treatment which is a risk to their health.
Self-report = ppts may not have accurate knowledge regarding family history of alcoholism.
No follow-up = long-term efficacy is unknown, family history might predict short-term improvement only.