17 research outputs found
Prevention approaches to problem gaming: a large-scale qualitative investigation
No full textPrevention and harm minimization approaches to problem gaming have become a matter of growing public health interest, following the recognition of gaming disorder and hazardous gaming in the ICD-11. The present study was the first to gather firsthand accounts of the potential options and challenges for prevention approaches among regular and problematic gamers. An online survey of 992 adult gamers (N = 221 problem gamers) yielded 1987 text responses to open-ended questions. Qualitative analysis of 53,458 words extracted 9 subcategories. Participants believed that some gaming activities were inherently riskier than others, particularly those with ‘predatory’ in-game spending features (microtransactions) that resemble or facilitate electronic gambling. Some participants supported the introduction of in-game features that might facilitate greater self-monitoring and awareness (e.g., education, playing time notifications, limit-setting). Some participants believed that the gaming industry should proactively support and/or fund prevention schemes and share its player data for the purpose of independent health-focused research. These results highlight some of the complexities in developing population-level approaches to problem gaming, and anticipate some of the practical barriers to gaining support from stakeholders, including the industry and the gaming community. Future research should examine the effectiveness and feasibility of voluntary primary prevention measures in real-world settings.Matthew W.R. Stevens, Paul H. Delfabbro, Daniel L. Kin
Prevention strategies to address problematic gaming: an evaluation of strategy support among habitual and problem gamers
No full textPsychosocial problems arising from excessive gaming are a public health issue across the developed world. In its most serious form, problematic gaming is recognized as gaming disorder (GD) in the ICD-11. Research has tended to focus on the value of outpatient treatment for GD, but less attention has been paid to broader prevention strategies to address less serious but nevertheless harmful gaming behaviors. Another gap in this literature has been the lack of involvement of the gaming community as stakeholders to identify feasible prevention approaches. This study investigated: (1) regular and problematic gamers’ level of support for different prevention strategies within primary, secondary, and tertiary approaches; and, (2) whether self-efficacy is associated with greater support for prevention strategies, as predicted by the Health Belief Model. A total of 992 participants completed an online survey that evaluated support for problem gaming prevention strategies and included measures of self-efficacy, gaming involvement, and GD symptoms, psychological distress, and mental health help-seeking behaviors. Participants reported stronger support for primary prevention strategies, including education, screening, and warning labels, than for other prevention approaches. Overall, 61% of participants expressed support for primary prevention as compared to secondary (39%) and tertiary (36%) approaches. There was stronger support for outpatient care (48%) than inpatient services (25%). In-game shutdown features received the lowest support (65% disapproval). Contrary to the Health Belief Model, self-efficacy was not associated with prevention support. Younger, female, and less frequent gamers were more likely to support primary and secondary prevention strategies. These findings suggest that gamers may be more favorable toward prevention measures aligned with informed decision-making, autonomy, and self-directed actions. Gamers may be strongly opposed to modifications to the structure of gaming activities (e.g., shutdown features). Future research should evaluate the efficacy and cost-effectiveness of problem gaming prevention measures in different populations and regions.Matthew W. R. Stevens, Paul H. Delfabbro and Daniel L. Kin
Building workforce capacity to address substance use in primary health care: preliminary results from a mixed-methods pilot program
No full textBackground: Primary health care is critical to the prevention of alcohol, tobacco and other drug-related harms. Scaling-up screening, brief intervention and referral to treatment (SBIRT) within primary health care can reduce the burden of substance-related diseases, and improve downstream healthcare services. Building knowledge, skills and confidence among general practitioners (GPs), particularly in rural, regional and remote areas, to deliver SBIRT is an essential step. Therefore, this study aimed to pilot test a skills-based training program for GPs designed to build capacity for SBIRT delivery. Methods: This pilot study investigated the acceptability of a structured, educational skills-based training program among GPs, as well as its preliminary effectiveness in inducing changes in confidence to deliver SBIRT, and in increasing knowledge about low-risk alcohol guidance. The training package was designed by experts in addiction medicine and public health, and involved a series of online webinars and in-person workshops at four locations across the South Eastern NSW Primary Healthcare Network catchment. Results: A total of 18 GPs registered for the training, with six completing the final webinar. The GPs who completed all sessions demonstrated increases in confidence to deliver SBIRT and alcohol guidance knowledge from baseline. Qualitative feedback found the program acceptable, and GPs were able to successfully implement learnings into practice, and promote to colleagues. Conclusions: The results indicated the potential of this program at a national level, but highlighted the need for a range of additional incentives to encourage uptake and ongoing implementation.Matthew W. R. Stevens, Rowena Ivers, Joanne Telenta, and Robert L. Al
Cognitive-behavioral therapy for internet gaming disorder: a systematic review and meta-analysis
No full textObjective: Although there is sufficient research and clinical evidence to support the inclusion of gaming disorder in the latest revision of the International Classification of Diseases, relatively little is known about the effectiveness of first-line psychological treatment for gaming disorder or internet gaming disorder (IGD) as it is listed in the Diagnostic and Statistical Manual. This systematic review employed meta-analytic techniques to determine the effectiveness of cognitive-behavioural therapy (CBT) for IGD on four key outcomes: IGD symptoms, anxiety, depression, and time spent gaming. Method: A database search identified 12 independent CBT studies. Effect size estimates (Hedges' g) with associated confidence intervals, prediction intervals, and p values for each pre-post treatment outcome, were calculated. Study reporting quality was evaluated in accordance with the Consolidated Standards of Reporting Trials guidelines. Subgroup and moderator analyses were undertaken to investigate potential sources of heterogeneity. Results: CBT demonstrated high efficacy in reducing IGD symptoms (g = 0.92; [0.50, 1.34]) and depression (g = 0.80, [0.21, 1.38]), and showed moderate efficacy in reducing anxiety (g = 0.55, [0.17, 0.93]) at post-test. There was insufficient power to determine whether CBT was capable of reducing time spent gaming. Treatment gains at follow-up were nonsignificant across the four treatment outcomes. Conclusions: The pooled findings suggest that CBT for IGD is an effective short-term intervention for reducing IGD and depressive symptoms. However, the effectiveness of CBT for reducing actual time spent gaming was unclear. Given the limitations of this evidence base, there is a need for more rigorous studies to determine the potential long-term benefits of CBT for IGD. Public Health Significance Statement: Given the rise in treatment demand for internet gaming disorder (IGD) and problematic gaming, it is necessary to determine which treatments are most effective for whom and under which conditions. This review shows that cognitive-behavioural therapy for IGD, which is often considered the first-line therapy, can improve IGD symptoms and comorbid depression. However, treatment gains tend to be short-term and their effect in reducing time spent gaming is unclear. Programs that target problematic gaming may be improved by additional support beyond the standard program of therapy sessions. More funding and resources are needed to support the development of a more rigorous evidence base on IGD and its treatment.Matthew W.R. Stevens, Daniel L. King, Diana Dorstyn, Paul H. Delfabbr
Substance use in the emergency department: Screening for risky drug use, using the ASSIST‐Lite
No full textIntroduction: Substance use is a common contributing factor to emergency department (ED) presentations. While screening, brief intervention, and referral to treatment for alcohol and tobacco is common in ED settings, it is not routinely conducted for illicit substances. This study aimed to deploy the ASSIST-Lite to screen for risky use of alcohol and other drugs in the ED, to identify differences in risk based on between demographic characteristics. Method: All ED attenders, aged 18 years or older, deemed well enough to participate were approached. Recruitment occurred at the Royal Adelaide Hospital ED between May and June 2017. Participants were asked to self-complete the ASSIST-Lite in the ED waiting room. Overall, 632 people were approached, of which 479 (75.8%) agreed to participate. Results: Alcohol (72.2%), tobacco (27.1%) and cannabis (15.2%) were most commonly reported. Eighty-nine participants reported moderate- or high-risk use of two substances, and a further 49 individuals reported moderate- or high-risk use of three or more substances. Across most substances, age, gender and employment status was associated with risky substance use, with higher likelihood of risk reported by males, unemployed and younger participants. Unemployment was also significantly associated with increased risk severity for both moderate and high-risk illicit use. Discussions and Conclusions: The rate of risky illicit and polysubstance use found here highlight the need more focused research in ED settings. The findings also provide support for more routine screening, and early intervention approaches; and suggest the need for active referral pathways through an alcohol and other drug consultation liaison service.Matthew W. R. Stevens, Jennifer Harland, Sam Alfred, Robert L. Al
Screening and early intervention for substance use during pregnancy: A retrospective case note review of antenatal care records
No full textFirst published: 13 August 2024Introduction: Screening for substance use during pregnancy is critical for enhancing maternal health and perinatal outcomes. However, disparities persist in screening and intervention rates within maternity services. This retrospective case note review explored contemporaneous practices around screening and interventions for substance use among pregnant women during routine antenatal care. Methods: A random sample of 100 sets of maternity records were reviewed. Eligible cases included any woman attending initial pregnancy assessments at one of two South Australian metropolitan Hospital-based antenatal clinics, from July 2019–September 2020. Screening rates for past and current alcohol, tobacco and other substance use were identified and compared with data from a subset of a nationally representative survey. Intervention details and referral pathways were also assessed. Results: The final sample of eligible cases (n = 93) demonstrated prioritisation of screening for current use, over past use, across all substances (p < 0.001). Screening was most likely for tobacco and least likely for e-cigarettes (p < 0.001). Significant underreporting of past use compared with the benchmark was identified for all substances (except tobacco, p = 0.224). Interventions typically involved written resources, which were usually declined by clients. Discussion and Conclusions: Despite longstanding recommendations, screening and intervention practices for substance use appear inconsistent. With the recent emergence of vaping, no evidence of updated approaches to identifying e-cigarette consumption in pregnant women was found. Several opportunities for enhancing routine screening and intervention practices within antenatal clinics were identified, and will inform the development of policy directives, targeted training modules, and other resources for health professionals working in these services.Matthew W. R. Stevens, Megan Cooper, Lynette Cusack, Robert L. Ali, Chris Holmwood, Annette L. Brile
ASSIST in Pitjantjatjara: Protocol for a randomised crossover validation study among Aboriginal and Torres Strait Islander Australians
No full textBackground: Substance use significantly contributes to disease burden among Australians, with harms exacerbated among Aboriginal and Torres Strait Islander peoples by colonisation-related factors like stigma and trauma. Addressing this gap requires culturally acceptable, valid and reliable screening tools, available in a familiar language to the participant, to identify and provide support for those at-risk. This protocol describes a study aimed at validating a culturally-adapted screening tool — the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) — into Pitjantjatjara, to detect risk of substance-related harm. Methods: Recruitment will occur at a variety of Aboriginal health and welfare settings across remote, rural and urban South Australia. Eligible participants (aged 18–65) will be briefed and, upon consent, randomly complete the ASSIST app on an iPad and a semi-structured, yarning-style diagnostic interview (see endnote 1) with a health professional and Pitjantjatjara interpreter. The interview will assess for a range of clinically-defined substance use disorders (based on DSM-5-TR and ICD-11 criteria). All participants will be asked to complete the app a second time (between 7 and 28 days) to assess reliability, while a subset of participants at highest-risk will also undergo specialist evaluation from an independent clinician, as a second check for validity. Discussion: Valid and reliable assessment tools are essential for detecting risky and harmful substance use. If valid, this app has the potential to contribute to community-led efforts to bridge the health gap by addressing modifiable health risk factors. Trial registration: ANZCTR: ACTRN12625000413426. Open Science Framework pre-registration: https://doi.org/ 10.17605/OSF.IO/GNZAY. Version control number: Protocol version 1.1, June 23, 2025.Matthew W.R. Stevens, Sue Bertossa, Dominic Barry, Chris Holmwood, KS Kylie Lee, John Marsden, Matt Pedler, Mark Thompson, Scott Wilson, Robert L. Al
Validity, reliability and clinical utility of ASSIST-Y in assessing risk of substance-related harm and dependence in Spanish male adolescents
No full textBackground: Substance use among adolescents is strongly associated with adverse physical, mental health, and social outcomes. Prevention and early intervention can reduce the likelihood of future problems, but requires valid and reliable screening tools capable of assessing risk across a range of substances. This study assessed the validity, reliability, and clinical utility of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST-Y) for adolescents aged 15–17 years. Methods: A sample of adolescent males (N=101), aged 15–17 years, held in a juvenile detention facility on substance-related offences in Barcelona, Spain were eligible. Participants were administered a battery of standardized substance-use screening tools by a clinical psychologist, and underwent a diagnostic interview assessing DSM-IV-TR substance abuse and dependence by an addiction medicine specialist. Scores on the various assessments were compared to establish validity (concurrent with interview, convergent with other measures), reliability, and clinical utility of ASSIST-Y. Results: Majority of participants (n=77) completed assessments. While tobacco was not assessed as part of the interview, concurrent validity in detecting substance abuse was established for all remaining substances. Concurrent validity for detecting dependence was established for alcohol, cannabis, cocaine, stimulants and sedatives. Fewer numbers in higher-risk groups for inhalants, opioids and hallucinogen use limited confirmation of validity for those substances. ASSIST-Y also demonstrated good convergent validity with the other screening tools for all substances, except hallucinogens. Reliability for each subscale was established, except for tobacco (too few items), sedatives, and hallucinogens. Finally, clinical utility indices were significant for most substances (except sedatives and opioids); whilst clinical utility indices were significant for ruling out cases of non-dependence (all substances). Conclusions: As a screening tool, the purpose of ASSIST-Y is designed to help identify adolescents who may be at-risk of substance-related harm. While the instrument was found to be valid and reliable in identifying risky use across a variety of substances, further research is needed to validate the instrument in other population groups, and for other substances. Future research should investigate the effect of the linked brief intervention to reduce risk of harm, especially for non-specialist clinicians.Núria Ibáñez-Martínez, Matthew William Richard Stevens, Núria Civit-Bel, Noemí Moreno-Ferrer, Sandra Lopez-Ferré, Ana Olivares-Casado, Juame Claramunt-Mendoza, Chris Holmwood, and Robert Al
The association between gaming disorder and impulsivity: A systematic review and meta-analysis
No full textImpulsivity, the tendency to act quickly without careful consideration, is a known risk factor and correlate of substance use and addictive disorders, including International Classification of Diseases (ICD)-11 gaming disorder (GD). The aim of this meta-analytic review was to critically evaluate associations between GD symptoms and trait impulsivity and its subtypes.
Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, 33 studies (N = 24,818) met inclusion criteria, including being published between 2019 and 2024 (i.e. to focus on studies in ICD-11 era) and reporting data on problem gaming and trait impulsivity using psychometrically validated tools. Pooled effect sizes were calculated using reported correlations or means and standard deviations. Sources of heterogeneity, such as sample type, age, gender, region, assessment tool and impulsivity subtype, were examined using subgroup and moderator analyses.
The pooled association between GD and impulsivity was r = 0.29 (95% confidence interval [CI] = [0.24, 0.34]). Significant between-study heterogeneity was detected based on study region, with larger correlations in Asian studies compared to European and Western studies. Larger correlations were reported in studies employing the YIAT and IGDS9-SF and in studies employing the Barratt Impulsiveness Scale (BIS)-11 compared to other impulsivity tools.
This meta-analytic review identified a consistent moderate association between trait impulsivity and GD. The result suggests that clinical evaluation and monitoring of GD should consider the influence of impulsivity on risk and recovery. Moreover, assessing specific subtype patterns of impulsivity may inform the implementation of tailored treatment. Future research should examine the relative influence of impulsivity subtypes in the initiation, maintenance and relapse of problematic gaming behaviour
Assessing interactions between the associations of common genetic susceptibility variants, reproductive history and body mass index with breast cancer risk in the breast cancer association consortium: a combined case-control study.
No full textINTRODUCTION: Several common breast cancer genetic susceptibility variants have recently been identified. We aimed to determine how these variants combine with a subset of other known risk factors to influence breast cancer risk in white women of European ancestry using case-control studies participating in the Breast Cancer Association Consortium. METHODS: We evaluated two-way interactions between each of age at menarche, ever having had a live birth, number of live births, age at first birth and body mass index (BMI) and each of 12 single nucleotide polymorphisms (SNPs) (10q26-rs2981582 (FGFR2), 8q24-rs13281615, 11p15-rs3817198 (LSP1), 5q11-rs889312 (MAP3K1), 16q12-rs3803662 (TOX3), 2q35-rs13387042, 5p12-rs10941679 (MRPS30), 17q23-rs6504950 (COX11), 3p24-rs4973768 (SLC4A7), CASP8-rs17468277, TGFB1-rs1982073 and ESR1-rs3020314). Interactions were tested for by fitting logistic regression models including per-allele and linear trend main effects for SNPs and risk factors, respectively, and single-parameter interaction terms for linear departure from independent multiplicative effects. RESULTS: These analyses were applied to data for up to 26,349 invasive breast cancer cases and up to 32,208 controls from 21 case-control studies. No statistical evidence of interaction was observed beyond that expected by chance. Analyses were repeated using data from 11 population-based studies, and results were very similar. CONCLUSIONS: The relative risks for breast cancer associated with the common susceptibility variants identified to date do not appear to vary across women with different reproductive histories or body mass index (BMI). The assumption of multiplicative combined effects for these established genetic and other risk factors in risk prediction models appears justified
