Marie Grall-Bronnec

Background and aims: The concept of recovery is gaining increasing relevance in gambling disorder (GD). Rooted in the users' movement, recovery is viewed as a process involving non-medical and subjective dimensions. However, qualitative research on this topic remains limited, and no consensus exists on its definition. This study aimed to develop a theoretical model of recovery, examining stages, dimensions, and conditions shaping recovery trajectories from a holistic, patient-centred perspective. Methods: Semi-structured interviews were conducted with 10 self-defined recovered gamblers and 10 self-defined currently recovering gamblers. Data were analysed using an inductive and comparative approach based on constructivist grounded theory (CGT). Results: A novel nine-stage theoretical model of recovery was developed: (1) Coming to terms with gambling problems; (2) Framing GD as a medical condition; (3) Acknowledging accountability; (4) Deciding to change and making an initial commitment to recovery; (5) Constructing one's recovery goal; (6) Maintaining long-term commitment; (7) Reclaiming autonomy and agency; (8) Rebuilding through recovery; and (9) Post-traumatic growth. The model identifies key dimensions that shape progression and conditions (facilitators and barriers) associated with each stage. Both groups mentioned all stages, though experiences differed depending on recovery status. Shared and group-specific facilitators and barriers were observed across stages. Discussion: Findings show that recovery is a multidimensional process, extending beyond behavioural change to include meaning-making processes and identity renegotiation. Conclusions: Results emphasise the need for a holistic, patient-centred approach. Qualitative research offers insights to inform tailored, recovery-oriented interventions and contribute to a unified, multi-stakeholder definition of recovery.

Background and aims: Gambling disorder (GD) follows a non-linear progression over time. Beyond shifts between disordered and non-disordered gambling statuses, the presence of each DSM-5 diagnostic criteria for GD may fluctuate throughout a gambler's trajectory. This study aimed to identify clusters of gamblers based on the evolution of the nine GD diagnostic criteria over time and to characterize these clusters using clinical variables. Methods: Data were drawn from the JEU cohort (NCT01207674), a multicenter study of adult gamblers with and without GD, featuring a five-year follow-up. Participants completed structured clinical interviews and self-report questionnaires at baseline and annually. The analysis included only individuals who completed at least one follow-up assessment and met at least one GD diagnostic criterion during the study period ( n = 209). A mixture model was applied to estimate the probability of meeting each GD criterion over time. Results: Four distinct clusters emerged, characterized by a gradient of GD severity and specific criterion-based evolutions. Some criteria fluctuated alongside overall GD severity, while others, particularly “loss of control”, persisted even when severity decreased. Additionally, three criteria (“lying”, “jeopardization” and “bailout”) were more likely to be present only in the two most severe clusters. Discussion and conclusions: This study confirms that, beyond the fluctuations of GD states, the presence of individual criteria also varies over time. These findings provide new insights into the dynamic progression of GD and may help tailor therapeutic approaches to better address the specific needs of gamblers at different stages of the disorder.

Background: Short versions of health-related quality of life measures are essential for the development of preference-based measures used to obtain the quality-adjustment weights needed to calculate quality-adjusted life years (QALYs) in health economic evaluations. Using data from the randomized TRAIN study, which compared the efficacy of two cognitive training programs in patients with alcohol use disorder (AUD) recently detoxified at five centers in France from 2019 to 2023 (n=227), we report the development and psychometrics of the AQoLS-Brief, a short version of the initial 34-item Alcohol Quality of Life Scale (AQoLS). Methods: Baseline data on, age, sex, AUD severity, drinking characteristics and consequences of alcohol including the AQoLS were collected. One item per dimension of the AQoLS was chosen following predefined rules. Construct validity of the AQoLS-brief was documented: internal consistency was assessed using Cronbach’s alpha and external validity was assessed with external drinking and non-drinking variables via univariate analyses, a confirmatory factorial analysis (CFA) and a multivariate linear regression. Results: The 7-item AQoLS-Brief demonstrated good internal consistency (Cronbach alpha= 0.80) and very high correlation with the long version AQoLS (rho=0.95). The CFA confirmed the unidimensionality of the AQoLS-Brief. Severity of AUD, as measured by the number of DSM-5 alcohol criteria and the number of heavy drinking days, and the dimension Sadness of the Affective Neuroscience Personality Scales were the heaviest contributors to the AQoLS-Brief score. Conclusions: The AQoLS-Brief is a short version of the AQoLS with good psychometrics, enhancing its use in clinical practice and research, and representing a significant step toward establishing a relevant and specific preference-based measures for calculating QALYs in AUD populations.

Background: In the context of the opioid overdose crisis, understanding the barriers to seeking, attaining and remaining in treatment for patients with opioid use disorder (OUD) is a public health issue. To date, very few studies have assessed the “self-stigma” (i.e., the internalization of negative societal attitudes and stereotypes about oneself, leading to self-judgment) and “perceived stigma” (i.e., the belief that others hold negative attitudes towards oneself due to a particular condition) experienced by patients with OUD receiving opioid agonist treatment (OAT), and none have done so in France. Our study aimed to quantify self-stigma, explore some aspects of perceived stigma, determine the factors associated with greater self-stigma and examine whether the level of self-stigma was related to a delay in seeking care. Methods: The STIGMA study was a monocentric, cross-sectional study. The data were collected in a French hospital addiction medicine department. Participants were outpatients with current or past OUD who were still receiving or had received OAT. A questionnaire assessing sociodemographics; OUD characteristics; perceived stigma; and quantification of self-stigma by the Self-Stigma Scale-Short, was administered. Results: A total of 73 questionnaires were included in the analysis. Nearly two-thirds of the patients had a “moderate to high” level of self-stigma. These patients were significantly younger at OUD onset and were significantly more likely to have at least one dependent child than patients reporting a “very low to low” level of self-stigma. Nearly half of the participants experienced perceived stigma from a healthcare professional regarding their OUD or OAT, and nearly one-third of the participants were refused care from a healthcare professional because of their OUD or OAT. Moreover, a quarter of the sample reported delaying care due to fear of being stigmatized. We did not find a relationship between self-stigma levels and a delay in seeking care. Conclusions: Our study highlights the need to detect stigma and to improve training in addiction medicine.

Online gamblers are more likely to experience gambling problems. The main objective was to compare the frequency of recovery one (middle-term) and two (long-term) years after treatment initiation, according to the gambling medium (Internet vs. land-based gambling). The secondary objectives were (i) to compare online and offline gamblers at inclusion and (ii) to investigate whether the gambling medium was a predictive factor of recovery. Outpatients beginning treatment for a GD (n = 237) were assessed at inclusion (treatment initiation) and after 1 and 2 years. Bivariate analyses were performed to compare online and offline gamblers at inclusion and on the frequency of recovery at one and two years. Two multivariate logistic regressions were then performed to identify factors associated with middle- and long-term recovery. The majority of patients achieved middle (74.2%) and long-term (78.9%) recovery, with no difference between online and offline gamblers. The gambling medium was not a predictive factor of recovery. Patients with a higher perceived self-efficacy (OR = 1.04 [1.01–1.07], p = .046) and having no history of mood disorders (OR = 11.18 [2.53–49.50], p < .001) at inclusion were more likely to achieve middle-term recovery, while long-term recovery was associated with a lower level of sensation seeking (OR = 0.67 [0.48–0.92], p = .015) at treatment initiation. Online gambling did not seem to influence middle- and long-term recovery compared to offline gambling. Enhancement of perceived self-efficacy and treatment of mood disorders, and treatment strategies focused on sensation-seeking may represent helpful care strategies for favouring achievement of middle-term recovery and maintenance of long-term recovery, respectively. ClinicalTrials.gov NCT01248767, date of first registration: November 25, 2010.

Opioid use disorder (OUD) poses a global health challenge, and despite medications for opioid use disorder (MOUD) and psychosocial interventions, relapse remains a significant concern. Comorbid psychiatric disorders, including attention deficit hyperactivity disorder (ADHD), are one of the major factors associated with poor OUD treatment outcome. We aimed to estimate the frequency of probable ADHD (in childhood and in adulthood) in patients with OUD; to assess the factors associated with this comorbidity; and to explore the factors that mediate the relationship between ADHD and OUD treatment outcome. We conducted an observational study using a sample of 229 patients aged 18 years and older who were diagnosed with OUD and had received MOUD for at least six months. Participants were assessed through a structured interview and self-report questionnaires. Multivariate logistic regressions and a mediation analysis were performed. Almost half of the participants reported probable ADHD in childhood, and ADHD persisted into adulthood among two-thirds of the patients. The factors associated with poor OUD treatment outcome included earlier onset of OUD, lower education, and greater impulsivity. There was no direct effect of probable ADHD in childhood on OUD treatment outcome, but there was an indirect effect through negative urgency, the tendency to respond impulsively to negatively connoted emotional experiences. The findings suggest that ADHD symptoms, particularly impulsivity, may contribute to vulnerability in opioid use and play a crucial role in treatment outcomes for this population. Trial registration: ClinicalTrials identifier NCT01847729.

Background and aims: While the concept of recovery is receiving increasing attention in the context of gambling disorder (GD), no consensus has yet been reached regarding its definition. This scoping review aims to map the literature on GD recovery, identify gaps, and provide insights for a more holistic and patient-centred perspective.Methods: A systematic search of three databases was conducted (PubMed, PsycINFO, and ScienceDirect). Based on the method by which the results of these studies were produced, the studies included were sorted into four categories (quantitative, instrument validation, qualitative, and mixed studies) and subsequently examined using conceptual analysis.Results: One hundred thirteen articles were included in this research after the screening process. In the quantitative and instrument validation studies, recovery was defined or operationalized in terms of abstinence, the absence of a GD diagnosis, or mild GD severity, or by reference to treatment outcomes or controlled gambling. A meta-synthesis of the results of the qualitative studies revealed four core features of recovery (insight, empowerment and commitment, wellbeing enhancement, and reconsideration of the issue of relapse).Discussion: Discrepancies in definitions, outcomes, and variables used were evident across studies. Additionally, the quantitative and standardized approaches employed in most studies exhibited severe limitations with regard to defining recovery from the subjective and multidimensional perspectives of people recovering from GD.Conclusions: This lack of definitional clarity emphasizes the necessity for further qualitative research. This research should encompass multiple stakeholder perspectives to develop a working definition promoting recovery from a holistic, patient-centred, and tailored approach.