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The Development of a Diagnostic Assessment -
The GAM
Abstract
The team of investigators at Washington
University School of Medicine (WUSM) has a long history of developing
structured diagnostic instruments and training clinicians and
non-clinicians in the use of these instruments in treatment settings and
in research. The Gambling Assessment Module -IV (GAM) has been under
initial development by our research team since 1997. Its initial
development is Phase I of a three-phase research program.
The GAM follows the conventions of the CIDI- Substance Abuse Module (CIDI-SAM;
Cottler, et al., 1989; Cottler & Compton, 1993) and provides more detailed
information about gambling history and behaviors. Our team has
successfully cross-classified psychiatric and substance use disorders in
these widely used assessments for over 20 years. In fact, we published the
first and only prevalence study of pathological gambling among an
epidemiologically derived sample of household residents in the U.S.
(Cunningham-Williams, et al 1998.)
To further develop the GAM, clinician experts, and problem and social
gamblers over the age of 14 were recruited from a variety of diverse
settings. Subjects participated in: 1) focus groups (10 groups; n=46) over
a 6-month period and 2) pre-test interviews (n=108 over a 6-month period)
conducted over the telephone and in-person to test the paper-pen version
of the GAM. We are currently computerizing the assessment (C-GAM). These
sessions were all designed to assess the GAM for clarity, ease of
administration, length, ordering of items, logic of skip patterns, and
face validity. The GAM establishes diagnoses for individuals across all
versions of pathological gambling criteria (i.e., cross-classification
using DSM-III, III-R, & IV and ICD-10) No other assessment has ever been
developed to accomplish nomenclature cross-classification for pathological
gambling. In addition to diagnostic information, the GAM elicits other
important gambling information such as the amount, frequency, and type of
gambling activity, onset, recency, and duration of symptoms, amount
wagered per gambling activity, illicit and underage gambling, help-seeking
for gambling problems, and information on the social networks and various
venues for gambling activity.
SPECIFIC AIMS:
(1) To develop a diagnostic psychiatric interview that could be
used by trained lay interviewers to computer generate a diagnosis of
pathological gambling (according to DSM-III, III-R, & IV and ICD-10) and
to provide additional detail about problem gambling;
(2) To establish 1-week test-retest reliability estimates of the
C-GAM and to assess its reliability in males vs. females, underage (15-20
year olds) vs. legal age gamblers (21 and older), African- Americans vs.
Caucasians, urban vs. suburban residents, and persons with co-morbid
psychiatric and substance abuse problems vs. persons without such
problems;
(3) To pre-test the GAM to determine its length, ease of
administration, item clarity, and level of respondent interest and burden
and establish its feasibility as both a telephone and personal interview;
(4) To develop computer algorithms for the scoring of DSM-III,
III-R, & IV and ICD-10 pathological gambling criteria for items in the
GAM;
(5) To computerize the paper-pen version of the GAM;
(6) To provide the first step in a later (PHASE II) test of the
psychometric properties of the GAM and provide a foundation for the next
step (PHASE III) - a longitudinal epidemiological study of risk and
protective factors for problem and pathological gambling using the GAM.
The development and testing of the CATI version of the GAM (C-GAM) for use
in the project currently underway with a diverse sample (n=300) 15-70 year
olds with and without comorbid psychiatric and substance use disorders.
GAM Information
Supplement
(includes a list of publications and presentations in Adobe Acrobat
format)
GAM Final Report
(Final report to the National Center for Responsible gaming. Microsoft
Word format)
For more information about the GAM Project
Contact:
Samantha Books, B.A.,
GAM Research Coordinator
314-286-2274 or
bookssj@epi.wustl.edu
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