Translating research into evidence-based practice within the problem gambling field

[This presentation was recorded at the SSA Annual Symposium on Thursday 10 November 2010].

Dr Henrietta Bowden-Jones

Consultant Psychiatrist

MRCPsych, BA (Hons), DOccMed, MD (Imperial).

Dr Henrietta Bowden-Jones is a consultant psychiatrist working in the field of substance misuse.

Within the NHS she is the Lead Consultant for Problem Gambling for Central North West London Mental Health Foundation Trust as well as running an inpatient ward for alcohol and drug detoxifications in central London.

In 2008 she founded the CNWL National Problem Gambling Clinic, the first NHS multidisciplinary treatment centre for problem gamblers which has been inundated by hundreds of referrals since its opening.

The clinic works on an evidence-based approach and is host to high quality research projects.

She is the Royal College of Psychiatrists’ spokesperson on Problem Gambling as well as being an elected member of the Executive Committee Addictions Faculty at the Royal College of Psychiatrists.

Henrietta is a member of the Government’s Responsible Gambling Strategy Board advising on prevention, research, treatment and education and a member of the Board’s Prevention Panel.

Having completed her medical degree and her psychiatric training she spent some years researching the effects of alcohol on the brain. She was awarded an MD for her work, her doctorate thesis with Imperial College is on Ventromedial Prefrontal Cortex Dysfunction in Alcohol dependency.

Dr Henrietta Bowden-Jones is an Honorary Senior Lecturer in the Division of Neurosciences at Imperial College and is the co-recipient of a Medical Research Council grant in the area of decision-making and impulsivity.

She has a group of 12 researchers from Imperial, Cambridge, Oxford and UCL collaborating on different research projects within the National Problem Gambling Clinic.

In her charity work she is a Trustee of Sporting Chance Clinic, a high profile addiction charity which helps top sportsmen and women in the UK in their fight against drugs, alcohol and gambling.

The National Problem Gambling Clinic is part of Central North West London NHS Foundation Trust, it is the first designated, multidisciplinary NHS clinic for Problem Gamblers in the UK.

It was set up by Dr Henrietta Bowden-Jones in 2008 as a direct result of her interest in the field of decision-making following her neuroscience doctorate with Imperial College where gambling tests such as the Iowa Gambling Task were used to assess ventro-medial prefrontal cortex impairment in alcohol dependency as prognostic indicators.

The clinic is based in central London and receives referrals from all over the country, to date, more than 700 pathological gamblers have been referred. The team consists of a consultant psychiatrist, some trainee psychiatrists, psychologists, family therapists and a financial awareness trainer funded by a government scheme to support finances in mental health patients. There is also a newly appointed fundraiser and a team coordinator.

The income for the clinic comes mainly from the Government’s Responsible Gambling Fund but also in smaller amounts from NHS resources, Imperial College grants, report writing earnings, public speaking earnings and an employee assistance programme newly started. A 3 year tender is about to be called and the NPGC will enter the tender in partnership with a non-stat problem gambling charity.

All the research at the clinic is funded solely by academic research grants such as the MRC or by individual university funding grants.

The treatment is manualized, evidence-based and time limited and patients can stay with the clinic for up to 6 months. Over the past three years the treatment has evolved form individual CBT sessions to group sessions for most patients other than the ones with significant co-morbidity issues or language problems. Every patient is offered family therapy and money management.

Every patient undergoes an hour and a half initial assessment when initial data is collected, then again at treatment start a full set of evaluation measures is collected. These include gambling severity screens as well as a modified TOP (G-TOP) and depression and anxiety scales. These are repeated every 3 months and entered into our database.

The first national database for problem gambling has been set up recently at the NPGC with funding from Imperial College, we have data on every one of the 700 referrals and are beginning to get an idea of outcomes as well as of patient profiles.

The clinic has an associated Pathological Gambling Research Hub led by Dr Bowden-Jones and Prof Lingford-Hughes. There are about seven research projects ongoing at any one time using our patients. We operate a waiting list for interested researchers who can email us their requests and wait for one of the ongoing projects to end. Currently we are working with Imperial, Cambridge, Oxford and UCL.

The data presented at this year’s SSA conference is the first to come out of the clinic, we have already started to use the information we have obtained to perfect the structure of the clinical work in a true evidence-based approach.

Our first annual conference will be on Dec 6th 2010 in London.