Active clinical trials for "Gambling"

Rates of gambling and substance use behaviors are elevated among emerging adults (ages 18-24), and these behaviors are individually and jointly associated with a host of negative consequences. Evidence suggests there is significant overlap between these behaviors as well as comorbidity of associated mental disorders (i.e., pathological gambling and substance abuse/dependence). Prior research suggests that a brief in-person delivered personalized feedback intervention (PFI) may be an effective method of reducing these behaviors and their associated consequences among emerging adults. Thus, the purpose of this study is to determine the relative efficacy of an in-person delivered PFI versus a Web-based PFI in reducing gambling, alcohol and marijuana use behaviors and related-consequences in a sample of emerging adults, as well as explore potential moderators and mediators of intervention efficacy and the longevity of intervention effects (over a period of 18-months).

The quest for an effective medication therapy for problem gambling remains an important priority for the problem gambling treatment research field. While several medications have been evaluated in controlled clinical trials, no medication has been shown to unequivocally reduce gambling behaviour and, to date, no medication has been approved for treating this disorder. Recently, topiramate, indicated for the treatment of seizure disorders, has shown some promise as a medication therapy for problem gambling. In this project, the efficacy of topiramate will be evaluated in a placebo-controlled clinical trial, the first study to do so. The interaction of the effects of the medication and gambling sub-type will be examined to determine whether the efficacy of topiramate is correlated with the specific biopsychosocial history of the gambler.

Despite evidence of high rates of concurrent substance use and anger problems among problem gamblers, until recently there have been no empirically evaluated treatments for these co-morbid problems. A recent study (Korman, Collins, McMain, & Skinner, 2005) found that an emotion and behaviour regulation treatment (EBRT) was more effective than a gambling-only treatment-as-usual in engaging clients in treatment and in reducing gambling, anger, and substance use. This study is a replication of Korman et al's study and will compare an emotion and behaviour regulation treatment (EBRT) for problem gambling, anger and substance use to a manualized cognitive behavioural treatment (CBT) for problem gambling.

The purpose of this study is to determine the effects of a workplace prevention program targeting problematic gambling.

The objective of this prospective observational cohort study is to answer the following clinically important questions: In patients with a pre-operative history of ICBs, what is the likelihood of improvement or deterioration in ICBs post-operatively? What is the risk of developing post-operative de novo ICBs after Subthalamic Nucleus DBS (STN DBS)? Which factors are important in predicting changes in ICBs after STN DBS? What is the impact of ICBs on carer's quality of life QoL and burden?

This study deals with how people decide between rewards of different value. The investigators want to understand how the brain's dopamine system impacts this kind of decision making. The investigators will use a medication, tolcapone, which can temporarily affect the dopamine system.

Online interventions for gambling problems hold a strong potential to help people with gambling concerns. However, there are no trials, to-date, that have been able to demonstrate the effectiveness of such an intervention. The current trial will compare participants provided access to an online gambling intervention to those assigned by chance to a no intervention condition in order to test the efficacy of one such Internet intervention for gambling. Participants will be recruited through Amazon's MTurk crowdsourcing platform. Potential participants identified as problem gamblers who are interested in quitting or reducing their gambling in the next 6 months, or often think about it, based on an initial survey will be invited to complete additional surveys at 6 weeks and 6 months. Those who then agree to be followed up will be randomized to access an online intervention for gambling or a no-intervention website. These participants will then be contacted again at 6 weeks and 6 months to ask about their gambling, and their impressions of the online intervention. The primary hypothesis to be tested is that participants receiving access to the online gambling intervention will report a greater reduction in number of days gambling and in NODS scores at 6-month follow-up than participants in the no intervention control condition.

Background: An imbalance between prefrontal cortex (PFC) and the mesolimbic reward system has been suggested to contribute to GD. GD patients showed increased functional connectivity between regions of the PFC and mesolimbic reward system, as well as reduced connectivity in the area of the PFC. The altered interaction between prefrontal structures and the mesolimbic reward system in GD shares similarity with functional organization reported in Substances Use Disorders (SUDs), suggesting a more general pathophysiology for addictive disorders Objectives: To test if rTMS can reduce craving and playing in Gambling Disorder, and also affect several mood, behavioral and cognitive alterations associated with prolonged Gambling Disorder. Eligibility: Healthy, right-handed adults ages 18-65 who do have Gambling Disorder. Design: This is a non-randomized, open label study. The study includes three phases: 1) a rTMS continued treatment phase; 2) a rTMS follow-up; and 3) a no rTMS follow-up. Prior to participating, participants will be screened with: Questionnaires Cognitive tests Medical history Physical exam After being enrolled, baseline behavioral and imaging data will be collected. In particular, participants will undergo: Questionnaires Cognitive tests During the continued rTMS phase, participants with Gambling Disorder will receive real rTMS. Repetitive TMS will be delivered during 10 outpatient treatment days, over 2 weeks (5 days/week). Following this phase, subjects will have 12 follow-up visits (once/weekly), during which they will receive rTMS, and behavioral assessments will be performed. At the end of the rTMS follow up period, participants will further receive 3 follow up visits (once a month), during which rTMS will not be performed, but behavioral data will be collected. Treatment includes: rTMS: A coil is placed on the head. Brief electrical current passes through the coil. At each visit, participants will receive two rTMS sessions, with a 1hr interval between sessions. At the beginning of each rTMS session, they view gambling-related images for few minutes. Repeat of screening tests and questionnaires

Gambling disorder (GD), currently considered a behavioral addiction, show substantial similarities with substance use disorders (SUDs) in terms of neurobiology and symptomatology. In particular, alterations in prefrontal control circuit may underlie vulnerability to gambling- and drug-related cues and diminished cognitive control over craving, and negative emotions. Repetitive transcranial magnetic stimulation (rTMS) of the dorsolateral prefrontal cortex (DLPFC) could represent a novel approach to remodel these brain circuits. The aim of this study is to evaluate High frequency (HF) rTMS over the left DLPFC as an efficacious treatment for reduction of gambling urges and behavior in a randomized double-blind placebo-controlled design in which 36 GD patients will receive active or sham rTMS for 12 weeks.

Gambling disorder is associated to high impulsivity and excessive risk-taking behaviour. These behavioural characteristics related to addiction are linked to cognitive processes in specific brain areas located in the prefrontal cortex (PFC). With the aim of studying the role of PFC in gambling disorder, the investigators employ transcranial current direct stimulation (tDCS), a noninvasive brain stimulation technique that applies a very weak electrical current to the superficial areas of the brain. The clinical phase of the research consists on studying the effects of tDCS in combination with cognitive behavioural therapy (CBT) in patients that attend the United Kingdom (UK) National Problem Gambling Clinic. The main objective of the project is to investigate whether the combination of tDCS and CBT can help to decrease impulsivity and risk-taking behaviour and therefore improve the treatment for gambling disorder.