Melissa J Stewart’s research while affiliated with Dalhousie University and other places

The aim of the present case series was to provide a preliminary assessment of the utility of a motivation-matched treatment for problem gamblers. On the basis of their primary underlying motivations for gambling, 6 problem gamblers received either action-motivated (n = 4) or escape-motivated (n = 2) treatment. Drawing upon a cognitive-behavioural framework, this 6-session motivation-matched treatment was designed to address gamblers’ maladaptive motivations for gambling (i.e., the need or desire for ‘‘escape’’ or ‘‘action’’), as well as the effects of conditioning and maladaptive thinking patterns unique to each gambling motive subtype. Assessments were conducted at pre-treatment, post-treatment, and 3- and 6-month follow-up. Primary outcome measures included gambling behaviour (i.e., gambling frequency, time, and money spent gambling), severity of gambling problems, and gamblingrelated impairment or disability; secondary outcome measures included gamblingrelated craving, gambling abstinence self-efficacy, positively and negatively reinforcing gambling situations, and gambling outcome expectancies. Overall, participants showed pre- to post-treatment improvements on the majority of these measures, with relatively less immediate post-treatment treatment gains observed on measures that assessed positively and negatively reinforcing gambling situations and gambling-related impairment or disability. However, treatment gains at the 3- and 6-month follow-up were shown for most participants on these latter measures as well. Findings suggest promise for this novel treatment approach. The next step in this line of research is to conduct a randomized, controlled trial to compare the efficacy of this motivation-matched treatment for disordered gambling with treatment as usual. © 2016, Centre for Addiction and Mental Health. All rights reserved.

Outcome expectancies are the positive or negative effects that individuals anticipate may occur from engaging in a given behaviour. Although explicit outcome expectancies have been found to play an important role in gambling, research has yet to assess the role of implicit outcome expectancies in gambling. In two studies, we investigated whether implicit and explicit positive gambling outcome expectancies were independent predictors of gambling behaviour (i.e. amount of time spent and money risked gambling; Study 1) and problem gambling severity (Study 2). In both studies, implicit positive gambling outcome expectancies were assessed by having regular gamblers (N ¼ 58 in Study 1; N ¼ 96 in Study 2) complete a gambling outcome expectancy reaction time (RT) task. A self-report measure of positive gambling outcome expectancies was used to assess participants’ explicit positive gambling outcome expectancies. Both the RT task and self-report measure of positive gambling outcome expectancies significantly contributed unique as well as shared variance in the prediction of self-reported gambling behaviour (Study 1) and problem gambling severity (Study 2). Findings from the current research point to the importance of using both direct and indirect assessment modes when examining the role of outcome expectancies in gambling.

Objectives: Problematic cocaine use is highly prevalent and is a significant public health concern. However, few investigations have distinguished between the 2 formulations of cocaine (ie, powder and crack cocaine) when examining the characteristics of cocaine use. Moreover, research has yet to assess the patterns of powder and crack cocaine use among opioid users, a clinical population in which problematic cocaine use is increasingly common. Using a within-subjects design, this study examined whether opioid users reported different patterns and features of powder and crack cocaine use, along with distinct trajectories and consequences of use. Methods: Seventy-three clients enrolled in a low-threshold methadone maintenance treatment were interviewed regarding their lifetime use of powder and crack cocaine. Results: Compared with crack cocaine, initiation and peak use of powder cocaine occurred at a significantly younger age. In relation to recent cocaine use, participants were significantly more likely to report using crack cocaine than using powder cocaine. Differences in routes of administration, polysubstance use, and criminal activity associated with cocaine use were also found between the 2 forms of cocaine. Conclusions: Results suggest that it may not be appropriate to consider powder and crack cocaine as diagnostically and clinically equivalent. As such, researchers may wish to distinguish explicitly between powder and crack cocaine when assessing the characteristics and patterns of cocaine use among substance users and treat these 2 forms of cocaine separately in analyses.

Gambling outcome expectancies refer to the anticipated outcomes that gamblers expect will occur from gambling (i.e., learned memory associations between gambling cues, behavior, and outcomes). Unlike previous approaches to gambling outcome expectancies that have predominantly focused on the valence of outcome expectancies (positive vs. negative), the present study investigated two specific types of positive gambling outcome expectancies: reward and relief gambling outcome expectancies. Specifically, the primary purpose of the current research was to examine whether gambling prime exposure activates different types of positive gambling outcome expectancies in enhancement- versus coping-motivated gamblers. Fifty adult, community-recruited regular gamblers performed a reaction time (RT) task and completed a self-report expectancy scale, both designed to assess reward and relief gambling outcome expectancies. They also completed the Gambling Motives Questionnaire (Stewart and Zack in Addiction 103:1110-1117 2008) to assess their levels of coping and enhancement motives for gambling. As hypothesized, reward gambling outcome expectancies were more strongly activated by gambling prime exposure than relief outcome expectancies on the RT task for gamblers with high enhancement motives. On the self-report expectancy measure, high enhancement-motivated gamblers endorsed stronger reward gambling outcome expectancies than low enhancement-motivated gamblers, and high coping-motivated gamblers endorsed stronger relief gambling outcome expectancies than low coping-motivated gamblers. Results suggest that automatic activation of reward gambling outcome expectancies is particularly strong for high enhancement-motivated gamblers. Possible reasons for the failure to observe an association between coping gambling motives and automatic relief gambling outcome expectancies are discussed.

In the current study, we assessed whether undergraduate electronic gaming machine (EGM) gamblers would be more apt to set a time limit and spend less time gambling when asked to consider setting an explicit time limit prior to their gambling session. To this end, participants (N = 43) were randomly assigned to a time limit pop-up condition or control condition, both of which involved gambling on an EGM in a virtual reality (VR) casino. In the time limit pop-up condition, participants were asked (via pop-up message) to consider setting a time limit on play and entering that limit in an available text box prior to commencing play. In the no time limit pop-up condition, participants engaged in play immediately upon accessing the EGM in the VR casino (i.e. they were not exposed to a time limit pop-up message). As predicted, participants who were explicitly asked to consider setting a time limit on their EGM play were significantly more likely to do so and spent less time gambling than those who were not given such instructions. The results provide preliminary support for the contention that setting a time limit on EGM play is an effective responsible gambling strategy.

The current research examined whether the presentation of gambling-related cues facilitates the activation of gambling outcome expectancies using both reaction time (RT) and self-report modes of assessment. Gambling outcome expectancies were assessed by having regular casino or online gamblers (N = 58) complete an outcome expectancy RT task, as well as a self-report measure of gambling outcome expectancies, both before and after exposure to one of two randomly assigned cue conditions (i.e., casino or control video). Consistent with hypotheses, participants exposed to gambling-related cues (i.e., casino cue video condition) responded faster to positive outcome expectancy words preceded by gambling prime relative to non-gambling prime pictures on the post-cue RT task. Similarly, participants in the casino cue video condition self-reported significantly stronger positive gambling outcome expectancies than those in the control cue video condition following cue exposure. Activation of negative gambling outcome expectancies was not observed on either the RT task or self-report measure. The results indicate that exposure to gambling cues activates both implicit and explicit positive gambling outcome expectancies among regular gamblers.

Although most gamblers set a monetary limit on their play, many exceed this limit-an antecedent of problematic gambling. Responsible gambling tools may assist players to gamble within their means. Historically, however, the impact of such tools has been assessed in isolation. In the current research, two responsible gambling tools that target adherence to a monetary limit were assessed among 72 electronic gaming machine (EGM) players. Participants watched an educational animation explaining how EGMs work (or a neutral video) and then played an EGM in a virtual reality environment. All participants were asked to set a monetary limit on their play, but only half were reminded when that limit was reached. Results showed that both the animation and pop-up limit reminder helped gamblers stay within their preset monetary limit; however, an interaction qualified these main effects. Among participants who did not experience the pop-up reminder, those who watched the animation stayed within their preset monetary limits more than those who did not watch the animation. For those who were reminded of their limit, however, there was no difference in limit adherence between those who watched the animation and those who did not watch the animation. From a responsible gambling perspective, the current study suggests that there is no additive effect of exposure to both responsible gambling tools. Therefore, for minimal disruption in play, a pop-up message reminding gamblers of their preset monetary limit might be preferred over the lengthier educational animation.

A failure to set and adhere to monetary limits has been implicated in the development of problematic gambling. A randomized controlled experiment (N = 59) with 2 conditions (i.e., monetary limit pop-up reminder vs. no monetary limit pop-up reminder) was conducted to assess the value of monetary limit pop-up messages in increasing adherence to self-proclaimed monetary limits. The current research also examined dissociation as a potential mechanism by which gambling symptomatology may undermine adherence to monetary limits. Results revealed that participants who received a monetary limit pop-up reminder were significantly more likely to adhere to monetary limits than participants who did not. As predicted, dissociation mediated the relationship between gambling symptomatology and adherence to monetary limits, but only among those who did not receive a monetary limit pop-up reminder. Importantly, the forced stop in play created by the pop-up message did not heighten craving to continue gambling. The efficacy of monetary limit pop-up messages as a tool to facilitate responsible gambling is discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved).