A Follow-up Study of Addictions and Co-Occurring Disorders in Older Adults

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DESCRIPTION (provided by applicant): The goal of this application is to conduct a controlled, blind longitudinal follow-up (f/u) of older adults with pathological gambling (PG). This study will be the first of its type and set the standard. Pathological gambling is a formidable public health problem associated with other addictions, depression, domestic abuse, bankruptcy, and suicide. Pathological gambling has been ignored by researchers and is greatly understudied. It is particularly devastating to elders who form a vulnerable subset of persons at risk for PG. This project has important clinical implications because it will significantly advance understanding of PG course and outcome among the elderly, including its relationship with other addictions and co-occurring mental disorders, treatment utilization and response, suicidal behavior, economic harm, and both risk and protective factors. Social networking, relationship loss, retirement, decision-making, and other issues pertinent to elders will be examined as potential modifiers of PG risk. This work will be accomplished through an intensive study of 75 older adults (e.g., >60 years of age) with lifetime PG and two comparison groups: 75 persons <40 years of age with lifetime PG and 75 elder controls (who gamble recreationally or not at all). Subjects with PG will meet DSM-IV criteria and have a South Oaks Gambling Screen (SOGS) score e 5. They will be recruited from 1) an ongoing family study or 2) from the community. Elder controls matched on important characteristics will have a SOGS score d 2. They will be recruited via random-digit dialing through a subcontract to the University of Northern Iowa to obtain an unbiased comparison group. Intake will occur in person and subjects will be re-interviewed by phone at six-month intervals through 48 months. The SCID, SIDP-IV, and other validated scales will be used to assess addictions and co-occurring mental disorders, gambling behavior, functional status, life events, personality, impulsivity, gambling-related cognitions, suicidality, social support, economic loss, and quality of life. Diagnostic reliability will be carefully monitored; new raters will be fully trained. Neurocognitive assessments will be administered at intake. The Longitudinal Interval Follow-up Evaluation (LIFE) will be used to track the trajectories of PG, other addictions and co- occurring disorders, suicidality, and functional status. The investigators will make every reasonable effort to maintain contact with subjects and document reasons for loss to f/u. Persons with PG who drop out will be replaced. The investigators hypothesize that elders with PG will have a higher level of gambling participation, greater percentage of time spent gambling, and fewer periods of abstinence than younger gamblers; that their gambling intensity/severity will vary in response to substance misuse and co-occurring disorders (e.g., major depression), life events (e.g., relationship loss, retirement), social support, proximity to casinos, and treatment; that those with the poorest outcome will have impulsive antisocial behavior, impaired decision making, and few protective factors. This work will push the field forward by leading to a better understanding of the course and trajectory of PG in elders and younger controls, and will inform the field regarding its proper classification and validity of subtyping schemes. This work will contribute to better and more targeted treatment/preventive strategies.