RESEARCH QUESTION
What is the pattern of alcohol consumption among pathological gamblers over the course of gambling treatment?

PURPOSE
It well-known that gambling and substance use disorders are frequently comorbid, however little research has been done to look at how alcohol consumption might change over the course of gambling treatment. The present study examined alcohol consumption over a 36-week period to understand the drinking patterns among treatment-seeking pathological gamblers.

HYPOTHESIS
The authors predicted that compared to before gambling treatment, drinking behaviour would generally stay the same during treatment or possibly decrease.

PARTICIPANTS
The sample contained 293 individuals who met the DMS-IV criteria for pathological gambling but were not currently in treatment. Out of the 293 individuals, the study focused on the 163 who reported alcohol consumption over the 36-week period of interest, for which 55 participants were classified as at-risk drinkers (14 drinks or more per week for males and 7 for females).

PROCEDURE
Participants first filled out some questionnaires to assess gambling severity and alcohol consumption behaviour. A study therapist then met with each participant and (randomly) recommended one of the four gambling treatment options: (1) Gamblers Anonymous (GA); (2) GA plus a cognitive-behavioural (CBT) based workbook; (3) GA plus eight individual CBT sessions; and (4) GA plus individual CBT sessions and contingency management (participants could earn up to $187 doing non-gambling related social activities. Participants were given 12 weeks to complete the treatment assigned.

MAIN OUTCOME MEASURES
Gambling severity was measured using the South Oaks Gambling Screen (SOGS) and the Addictions Severity Index (ASI). Gambling frequency and intensity was measured using the gambling timeline followback method (G-TLFB) 12 weeks before treatment and 12 weeks after treatment. Alcohol consumption (frequency and quantity) was measured using the same self-reported G-TLFB method for 90 days preceding treatment and again at about 8 and 24 weeks. Only consumption quantity (in standard drinks) was of interest.

KEY RESULTS
The results indicated that the at-risk drinkers showed a significant decrease in average drink/week during gambling treatment compared to before treatment entry. However, alcohol intake increased slightly after treatment for both at-risk and non-risky drinkers (more so for at-risk drinkers). Of the 55 at-risk drinkers, 26 participants reported no at-risk drinking following treatment and 29 continued to show risky drinking patters. Of the 108 non-risky drinkers, 87 continued to report non-risky drinking while 21 reported at-risk drinking behaviour patters following treatment. Thus, while it is encouraging that at-risk drinking was on a decline during treatment for gambling, 50 (of 76) participants still met the criteria for at-risk drinkers during treatment and/or post-treatment. The at-risk drinkers differed from the non-risk drinkers such that they were younger, reported more alcohol-related problems, consumed more alcohol and more intensely, and were less likely to participate in gambling treatment. Lifetime gambling severity and gambling while in treatment were inversely related to alcohol use. That is, less severe gamblers and those who gambled less during treatment showed greater alcohol use than those with more severe gambling problems.

LIMITATIONS
The results cannot generalize to other substances aside from alcohol. The time-course was relatively short and the data cannot speak to changes in alcohol consumption after the 21-week post-treatment period. There was no non-treatment control group. The results are limited to the treatments used (e.g., GA) and may not generalize to other treatment options. The study did not actually diagnose individuals with alcohol disorders. Lastly, the percentage of drinkers and at-risk drinkers might be low compared to other estimates.

CONCLUSIONS
The findings from this study were consistent with others showing a temporary reduction in alcohol use during treatment for pathological gamblers. This reduction in alcohol use could be independent from treatment however, and due to a commitment to change overall health. Even though the majority of participants did not increase alcohol consumption during treatment, there were still a good proportion of participants that maintained at-risk levels of drinking during the time periods studied. Thus, further intervention is still needed.