PATHOLOGICAL GAMBLING: BASIC, CLINICAL AND SERVICES RESEARCH

Release Date:  September 16, 1998

PA NUMBER:  PA-98-106

P.T.

National Institute of Mental Health
National Institute on Alcohol Abuse and Alcoholism
National Institute on Drug Abuse

Letter of Intent Receipt Date:  October 19
Application Receipt Date:  November 16

PURPOSE

The three participating institutes of the National Institutes of Health (NIH)
wish to encourage investigator-initiated research relevant to their programs that
will advance basic, clinical and services research concerning pathological
gambling, as well as enable more effective clinical assessment, prevention and
treatment.  This program announcement encourages research that builds on extant
research findings concerning pathological gambling and research that expands the
breadth and depth of scientific knowledge through increased involvement of
various disciplines, e.g., epidemiology; genetics; neuroscience; developmental
psychopathology; and behavioral, cognitive, and social science. Multidisciplinary
research is especially encouraged. Major questions include: factors that
predispose for pathological gambling and that distinguish types of pathological
gamblers; models for explaining pathological gambling, e.g., social learning,
addiction, impulse dyscontrol; developmental pathways and course; gender, age,
and socio-cultural factors; mechanisms involved in onset, continuation, and
cessation; efficacious clinical interventions for the prevention of onset, for
treatment, and for prevention and management of relapse; effectiveness of
interventions in general use; and effects of the organization and financing of
services.

HEALTHY PEOPLE 2000

The Public Health Service (PHS) is committed to achieving the health promotion
and disease prevention objectives of "Healthy People 2000," a PHS-led national
activity for setting priority areas.  This PA, Pathological Gambling þ Basic,
Clinical and Services Research, is related to priority areas of mental health and
mental disorders, drug abuse and addiction, and alcohol abuse and alcoholism.
Potential applicants may obtain a copy of "Healthy People 2000" (Full Report:
Stock No. 017-001-00474-0 or Summary Report: Stock No. 017-001-00473-1) through
the Superintendent of Documents, Government Printing Office, Washington, DC
20402-9325 (telephone 202-512-1800).

ELIGIBILITY REQUIREMENTS

Applications may be submitted by foreign and domestic, for-profit and non-profit
organizations, public and private, such as universities, colleges, hospitals,
laboratories, units of State and local governments, and eligible agencies of the
Federal government.  Racial/ethnic minority individuals, women, and persons with
disabilities are encouraged to apply as Principal Investigators.

MECHANISM OF SUPPORT

Research Project Grant (R01) applications may be submitted in response to this
program announcement.  R01 applications may request up to five years of support. 
Responsibility for the planning, direction, and execution of the proposed project
will be solely the responsibility of the applicant.

RESEARCH OBJECTIVES

Summary

For many persons, gambling is an interesting and enjoyable activity, with no or
minimal adverse effects on their finances, work, or relationships with family
members and others.  However, for some persons, gambling becomes seriously
maladaptive and results in major financial losses, interferes with work, and
disrupts relationships with family and others.  This type of maladaptive behavior
is sometimes referred to as pathological gambling.  What explains such "out of
control", dysfunctional and injurious behavior?

Is pathological gambling behavior primarily a reflection of another disorder
(e.g., depression) or a non-pharmacological addiction, a result of social-
cognitive factors (e.g., faulty cognitions and reinforcement schedules), or a
reflection of other factors?  What are the predisposing factors?  Are there
different types of pathological gamblers for which different models are required
to explain their gambling?  Once such gambling occurs, what is its life course
and what factors influence that course?  To what extent, and in what ways, is
alcohol and drug use concurrent with pathological gambling? In these cases, is
the pathological gambling and substance abuse a reflection of common or different
factors, and what are the nature and interactive effects of pathological gambling
and substance abuse?  How prevalent is pathological gambling? How is it defined?
What are the reliability and validity of various definitions?

What strategies are most effective for preventing pathological gambling?  For
pathological gamblers, what treatments are effective for this behavior and for
co-occurring disorders and problems, e.g., the risk of suicide?  What treatment
models are effective for preventing and managing relapse and related problems?

What is the effectiveness of treatments delivered in clinical and community
settings?

Applications are encouraged that build on extant research findings concerning
pathological gambling, and also that involve a number of disciplines and methods
in order to produce broad and deep scientific knowledge.

The extant research concerning pathological gambling suggests a number of
possibilities for research. For example, several pharmacological and psychosocial
interventions have shown promise in preliminary studies.  Development of rigorous
efficacy studies, with participants of diverse backgrounds, assessment of
intervention effects on mediators or mechanisms presumed to underlie pathological
gambling, and extended and comprehensive follow up, could contribute both to
better informed clinical practice and basic scientific understanding of factors
that account for pathological gambling.

Multiple disciplines have potentially important contributions to make to a
comprehensive understanding of pathological gambling.  For example, brain imaging
enables new views of the involvement of the brain in various disorders and
addictions. How is the brain involved in the development and course of
pathological gambling? How is this involvement similar to the nature of the
involvement of the brain in disorders of addiction, compulsive behavior, and
impulse dyscontrol?

In addition, alcohol and other drug abuse is often co-current with pathological
gambling and may be related in a number of ways. These two pathological behaviors
may be related to a common underlying etiological process or the comorbidity may
relate in a reinforcing fashion. The study of the relationship, similarities and
differences of these behaviors may not only give important information about
comorbid patterns but may also help illuminate the nature of the pathologies as
distinct patterns of behavior.

Other research possibilities are indicated below.  These are not prescriptive or
exclusive; the goal of this announcement is to encourage investigator-initiated
research that, by its creativity and scientific merit, will most efficiently and
effectively advance basic, clinical and services research concerning pathological
gambling.

Suggested Research topics:

Basic, epidemiological and life course research:

o Animal studies of potentially relevant models, processes and behaviors, e.g.,
addiction, impulsivity, reinforcement schedules.

o Identification of factors that influence the accuracy of self reports and
informant reports in surveys and clinical assessments about the nature, extent
and consequences of gambling episodes, and the use of these findings to develop
procedures to obtain maximally accurate information.

o Family studies of the disorders and dysfunctional behaviors of pathological
gamblers.

o Family genetic and neuroimaging studies of pathological gamblers.

o Determination of factors (genetic, developmental, neuroscience, cognitive,
sociocultural, stable personality characteristics, etc.) associated with the
initiation and course of gambling and its escalation or cessation across gender,
age, SES, culture and ethnicity.

o Studies of the effects of public policies and the availability of gambling
opportunities on the onset and course of individual pathological gambling
behavior (e.g., the effects of legalization of casinos and the availability and
conditions of service of alcohol).

o Investigations of patterns of comorbidity of drug and alcohol abuse and
pathological gambling.

o Investigations of pathological gambling as a non-pharmacological model of
addictive/compulsive behaviors.

o Comparison of pathological gambling with disorders that may involve similar
factors and mechanisms, e.g., addictions, compulsions, and impulse dyscontrol. 

o The role of pre-existing disorders, dysfunctional behaviors and disease in the
development and course of pathological gambling.

o Factors associated with the emergence of comorbid disorders among pathological
gamblers.

o The life course of pathological gamblers and the factors associated with
variation in gambling and other measures of functioning.

Clinical research:

o  Testing and refinement of the DSM definition of pathological gambling to
achieve a construct of high reliability and validity.

o Empirical determination of different types of pathological gamblers, e.g., by
type of gambling, comorbid disorders, distinguishing neuroscience and cognitive
factors.

o Identification of biological, neuroscience, cognitive, affective, sociocultural
and environmental mechanisms that contribute to treatment responsivity or
resistance.

o Development of science-based and theory-driven pharmacological and psychosocial
interventions to prevent or treat pathological gambling, and to prevent and
manage relapse and associated disorders and problems, including mood disorders,
impulsivity, and alcohol and drug abuse.

o Determination of the mechanisms of action in interventions.

o Rigorous efficacy trials of interventions to prevent either the onset and 
relapse, as well as to treat pathological gambling.

o Research on the effective sequencing of interventions, including interventions
for comorbid disorders and problems.

o Development of procedures to enhance entrance into, continuation and active
engagement in prevention, treatment, and in relapse prevention and management.

Services research:

o Factors that contribute to, and militate against, help-seeking behaviors among
pathological gamblers.

o Examination of the settings in which pathological gamblers receive treatment,
and the effectiveness of the service systems in identifying and treating
pathological gambling, particularly when it occurs with other comorbid mental and
substance abuse conditions.

o Analysis of the effects of variations in the organization and financing of care
on the access to and type of treatment programs that pathological gamblers enter
and on the nature and extent of treatment.

o Evaluation of the effectiveness of generally used treatments for pathological
gamblers such as Gamblers Anonymous.

o Evaluation of health-related costs and benefits of legalized gambling in a
jurisdiction (e.g., health-related costs such as changes in rates of psychiatric
service utilization, suicide and self-inflicted injuries, social costs such as
divorce and families in poverty; additional jobs and increased family income).

INCLUSION OF WOMEN AND MINORITIES IN RESEARCH INVOLVING HUMAN SUBJECTS

It is the policy of the NIH that women and members of minority groups and their
subpopulations must be included in all NIH supported biomedical and behavioral
research projects involving human subjects, unless a clear and compelling
rationale and justification is provided that inclusion is inappropriate with
respect to the health of the subjects or the purpose of the research.  This
policy results from the NIH Revitalization Act of 1993 (Section 492B of Public
Law 103-43).

All investigators proposing research involving human subjects should read the
"NIH Guidelines For Inclusion of Women and Minorities as Subjects in Clinical
Research," which have been published in the Federal Register of March 28, 1994
(FR 59 14508-14513) and in the NIH Guide for Grants and Contracts, Vol. 23, No.
11, March 18, 1994.

Investigators also may obtain copies of the policy from the program staff listed
under INQUIRIES.  Program staff may also provide additional relevant information
concerning the policy.

NIH POLICY AND GUIDELINES ON THE INCLUSION OF CHILDREN AS PARTICIPANTS IN
RESEARCH INVOLVING HUMAN SUBJECTS

It is the policy of NIH that children (i.e., individuals under the age of 21)
must be included in all human subjects research, conducted or supported by the
NIH, unless there are scientific and ethical reasons not to include them.  This
policy applies to all initial (Type 1) applications submitted for receipt dates
after October 1, 1998. 

All investigators proposing research involving human subjects should read the
"NIH Policy and Guidelines on the Inclusion of Children as Participants in
Research Involving Human Subjects" that was published in the NIH Guide for Grants
and Contracts, March 6, 1998, and is available at the following URL address:
http://www.nih.gov/grants/guide/notice-files/not98-024.html

LETTER OF INTENT

Prospective applicants are asked to submit, by October 19, a letter of intent
that includes a descriptive title of the proposed research, the name, mail and
Email address, and the telephone number of the Principal Investigator, the
identities of other key personnel and participating institutions, and the number
and title of this program announcement.  Such letters are requested only for the
purpose of facilitating technical assistance and review by providing an
indication of the number and scope of applications likely to be received. 
Although a letter of intent is not required, is not binding, and does not enter
into the review of a subsequent application, the information that it contains
allows NIH staff to estimate the potential review workload and avoid conflict of
interest in the review.

The letter of intent is to be sent to:

James Breiling, Ph.D.
Division of Mental Disorders, Behavior and AIDS Research
National Institute of Mental Health
5600 Fishers Lane, Room 18C-14
Rockville, MD  20857-0001
Telephone:  (301) 443-3527
FAX:  (301) 443-4611
Email:  jbreilin@nih.gov

APPLICATION PROCEDURES

Applications are to be submitted on the grant application form PHS 398 (rev.
5/95).  Application kits are available at most institutional offices of sponsored
research and may be obtained from the Division of Extramural Outreach and
Information Resources, National Institutes of Health, 6701 Rockledge Drive, MSC
7910, Bethesda, MD 20892-7910, telephone (301) 435-0714; fax: (301) 480-0525
Email: GrantsInfo@NIH.GOV.  The title and number of the program announcement must
be typed in Section 2 on the face page of the application.

The completed original application and five legible copies must be sent or
delivered to:

CENTER FOR SCIENTIFIC REVIEW
NATIONAL INSTITUTES OF HEALTH
6701 ROCKLEDGE DRIVE, ROOM 1040 - MSC 7710
BETHESDA, MD  20892-7710
BETHESDA, MD  20817 (for express/courier service)

Applications will be accepted in response the this PA on November 16 of each
year.

REVIEW CONSIDERATIONS

Applications will be assigned on the basis of established PHS referral
guidelines.  An appropriate peer review group convened in accordance with the
standard NIH peer review procedures will evaluate applications that are complete
for scientific and technical merit.  As part of the initial merit review, all
applications will receive a written critique and may undergo a process in which
only those applications deemed to have the highest scientific merit, generally
the top half of applications under review, will be discussed, assigned a priority
score, and receive a second level review by the appropriate national advisory
council or board.

Review Criteria

The goals of NIH-supported research are to advance our understanding of
biological systems, improve the control of disease, and enhance health.  In the
written comments reviewers will be asked to discuss the following aspects of the
application in order to judge the likelihood that the proposed research will have
a substantial impact on the pursuit of these goals.  Each of these criteria will
be addressed and considered in assigning the overall score, weighting them as
appropriate for each application.  Note that the application does not need to be
strong in all categories to be judged likely to have major scientific impact and
thus deserve a high priority score.  For example, an investigator may propose to
carry out important work that by its nature is not innovative but is essential
to move a field forward.

(1) Significance.  Does this study address an important problem? If the aims of
the application are achieved, how will scientific knowledge be advanced? What
will be the effect of these studies on the concepts or methods that drive this
field? 

(2) Approach.  Are the conceptual framework, design, methods, and analyses
adequately developed, well integrated, and appropriate to the aims of the
project? Does the applicant acknowledge potential problem areas and consider
alternative tactics? 

(3) Innovation.  Does the project employ novel concepts, approaches or method?
Are the aims original and innovative? Does the project challenge existing
paradigms or develop new methodologies or technologies? 

(4) Investigator.  Is the investigator appropriately trained and well suited to
carry out this work? Is the work proposed appropriate to the experience level of
the principal investigator and other researchers (if any)?

(5) Environment.  Does the scientific environment in which the work will be done
contribute to the probability of success? Do the proposed experiments take
advantage of unique features of the scientific environment or employ useful
collaborative arrangements? Is there evidence of institutional support? 

The initial review group will also examine the provisions for the protection of
human and animal subjects, the safety of the research environment, and
conformance with the NIH Guidelines for the Inclusion of Women, Children and
Adolescents and Minorities as Subjects in Clinical Research.

AWARD CRITERIA

Applications will compete for available funds with all other approved
applications.  The following will be considered in making funding decisions:
Quality of the proposed project as determined by peer review, availability of
funds, and program priority.

INQUIRIES

Inquiries are encouraged.  The opportunity to clarify any issues or questions
from potential applicants is welcome.

Direct inquiries regarding scientific and programmatic issues to:

James Breiling, Ph.D.
Division of Mental Disorders, Behavioral Research and AIDS
National Institute of Mental Health
5600 Fishers Lane, Room 18C-14
Rockville, MD  20857-0001
Telephone:  (301) 443-3527
FAX:  (301) 443-1611
Email:  jbreilin@nih.gov

Darryl Bertolucci, M.A.
Epidemiology Branch
National Institute on Alcohol Abuse and Alcoholism
6000 Executive Boulevard, Suite 514, MSC 7003
Bethesda, MD  20892-7003
Telephone:  (301) 443-4898
FAX:  (301) 443-8614
Email:  db46e@nih.gov

Meyer D. Glantz, Ph.D.
Division of Epidemiology and Prevention Research
National Institute on Drug Abuse
5600 Fishers Lane, Room 9A-53
Rockville, MD  20857
Telephone:  (301) 443-2974
FAX:  (301) 443-2636
Email:  mg115g@nih.gov

Direct inquiries regarding fiscal matters to:

Diana S. Trunnell
Grants Management Branch
National Institute of Mental Health
5600 Fishers Lane, Room 7C-08
Rockville, MD  20857-0001
Telephone:  (301) 443-2805
FAX:  (301) 443-6885
Email:   Diana_Trunnell@nih.gov

Edward Ellis
Grants Management Branch
National Institute of Alcohol Abuse and Alcoholism
6000 Executive Boulevard, Suite 504, MSC 7003
Bethesda, MD  20892-7003
Telephone:  (301) 443-4706
FAX:  (301) 443-3891
Email:  eellis@willco.niaaa.nih.gov

Gary Fleming, J.D., M.A.
Grants Management Branch
National Institute on Drug Abuse
5600 Fishers Lane, Room 8A-54
Rockville, MD  20857
Telephone:  (301) 443-6710
FAX:  (301) 594-6847
Email:  gf6s@nih.gov

AUTHORITY AND REGULATIONS

This program is described in the Catalog of Federal Domestic Assistance Nos.
93.242, 93.273, and 93.279.  Awards are made under authorization of the Public
Health Service Act, Title IV, Part A (Public Law 78-410, as amended by Public Law
99-158, 42 USC 241 and 285) and administered under PHS grants policies and
Federal Regulations 42 CFR 52 and 45 CFR Part 74.  This program is not subject
to the intergovernmental review requirements of Executive Order 12372 or Health
Systems Agency review.  Awards will be administered under PHS grants policy as
stated in the Public Health Service Grants Policy Statement (April 1, 1994).

PHS strongly encourages all grant and contract recipients to provide a smoke-free
workplace and promote the nonuse of all tobacco products.  In addition, Public
Law 103-227, the Pro-Children Act of 1994, prohibits smoking in certain
facilities (or in some cases, any portion of a facility) in which regular or
routine education, library, day care, health care or early childhood development
services are provided to children.  This is consistent with the PHS mission to
protect and advance the physical and mental health of the American people.


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