A Longitudinal Empirical Investigation of the Pathways Model of Problem Gambling

The pathways model of problem gambling suggests the existence of three developmental pathways to problem gambling, each differentiated by a set of predisposing biopsychosocial characteristics: behaviorally conditioned (BC), emotionally vulnerable (EV), and biologically vulnerable (BV) gamblers. This study examined the empirical validity of the Pathways Model among adolescents followed up to early adulthood. A prospective-longitudinal design was used, thus overcoming limitations of past studies that used concurrent or retrospective designs. Two samples were used: (1) a population sample of French-speaking adolescents (N = 1033) living in low socio-economic status (SES) neighborhoods from the Greater Region of Montreal (Quebec, Canada), and (2) a population sample of adolescents (N = 3017), representative of French-speaking students in Quebec. Only participants with at-risk or problem gambling by mid-adolescence or early adulthood were included in the main analysis (n = 180). Latent Profile Analyses were conducted to identify the optimal number of profiles, in accordance with participants’ scores on a set of variables prescribed by the Pathways Model and measured during early adolescence: depression, anxiety, impulsivity, hyperactivity, antisocial/aggressive behavior, and drug problems. A four-profile model fit the data best. Three profiles differed from each other in ways consistent with the Pathways Model (i.e., BC, EV, and BV gamblers). A fourth profile emerged, resembling a combination of EV and BV gamblers. Four profiles of at-risk and problem gamblers were identified. Three of these profiles closely resemble those suggested by the Pathways Model.     

Topiramate Combined with Cognitive Restructuring for the Treatment of Gambling Disorder: A Two-Center,Randomized, Double-Blind Clinical Trial

Gambling disorder (GD) is a prevalent condition for which no pharmacological treatment has yet been approved, although there is evidence that topiramate can reduce impulsivity in GD and craving in various addictive behaviors. The goal of this study was to investigate the effectiveness of topiramate combined with cognitive restructuring for GD in a two-center, randomized, double-blind clinical trial. Participants were individuals seeking outpatient treatment for GD (n = 30), treated with either topiramate or placebo combined with a brief cognitive intervention, over a 12-week period, the dose of topiramate being tapered up during the first 8 weeks. The main outcome measures were gambling craving, behavior, and cognitive distortions; impulsivity; depression and social adjustment. Topiramate proved superior to placebo in reducing gambling craving (P = 0.017); time and money spent gambling (P = 0.007 and P = 0.047, respectively); cognitive distortions related to gambling (P = 0.003); and social adjustment (P = 0.040). We found no significant effects on impulsivity or depression. These findings are in contrast with data from a previous clinical trial with topiramate for GD. In the current study, we found that topiramate affects features specifically related to gambling addiction and had no significant effect on associated phenomena such as impulsiveness and depression. We believe that this response could be due to synergistic interaction between topiramate and the cognitive intervention.     

Gambling Motives in a Representative Swedish Sample of Risk Gamblers

Motives for gambling have been shown to be associated with gambling involvement, and hence important in the understanding of the etiology of problem gambling. The aim of this study was to describe differences in gambling motives in different subgroups of lifetime risk gamblers, categorized by: age, gender, alcohol- and drug habits and type of game preferred, when considering the level of risk gambling. A random Swedish sample (n = 19,530) was screened for risk gambling, using the Lie/Bet questionnaire. The study sample (n = 257) consisted of the respondents screening positive on Lie/Bet and completing a postal questionnaire about gambling and motives for gambling (measured with the NODS-PERC and the RGQ respectively). When considering the level of risk gambling, motives for gambling were not associated with gender, whereas younger persons gambled for the challenge more often than did older participants. Card/Casino and Sport gamblers played to a greater extent for social and challenge reasons then did Lotto/Bingo-gamblers. EGM-gamblers played more for coping reasons than did Lotto/Bingo gamblers. However, this association turned non-significant when considering the level of risk gambling. Moderate risk gamblers played for the challenge and coping reasons to a greater extent than low risk gamblers motives for gambling differ across subgroups of preferred game and between gamblers with low and moderate risk. The level of risk gambling is intertwined with motives for gambling and should be considered when examining gambling reasons.     

Gender Differences in Self-Conscious Emotions and Motivation to Quit Gambling

Considerable gender differences have been previously noted in the prevalence, etiology, and clinical features of problem gambling. While differences in affective states between men and women in particular, may explain differential experiences in the process of gambling, the role of affect in motivations for quitting gambling and recovery has not been thoroughly explored. The aim of this study was to examine gender differences within a sample of problem gamblers motivated to quit with or without formal treatment, and further, to explore the interactions between gender, shame and guilt-proneness, and autonomous versus controlled reasons for change. Motivation for change and self-conscious emotional traits were analyzed for 207 adult problem gamblers with an interest in quitting or reducing their gambling (96.6 % not receiving treatment). Overall, gender differences were not observed in clinical and demographic characteristics. However, women exhibited greater shame [F(1,204) = 12.11, p = 0.001] and guilt proneness [F(1,204) = 14.16, p < 0.001] compared to men, whereas men scored higher on trait detachment [F(1,204) = 7.08, p = 0.008]. Controlling for demographic and clinical characteristics, general linear models revealed that autonomous motivation for change was associated with higher guilt-proneness, greater problem gambling severity, and the preparation stage of change; whereas controlled forms of motivation were significantly associated with higher shame-proneness and greater problem gambling severity. No gender effects were observed for either motivation for change. These findings suggest that the process of change can be different for shame-prone and guilt-prone problem gamblers, which may impact behavioral outcomes.     

Cue-Reactive Altered State of Consciousness Mediates the Relationship Between Problem-Gambling Severity and Cue-Reactive Urge in Poker-Machine Gamblers

In order to enhance our understanding of the nature of poker-machine problem-gambling, a community sample of 37 poker-machine gamblers (M _age = 32 years, M _PGSI = 5; PGSI = Problem Gambling Severity Index) were assessed for urge to gamble (responses on a visual analogue scale) and altered state of consciousness (assessed by the Altered State of Awareness dimension of the Phenomenology of Consciousness Inventory) at baseline, after a neutral cue, and after a gambling cue. It was found that (a) problem-gambling severity (PGSI score) predicted increase in urge (from neutral cue to gambling cue, controlling for baseline; sr ² = .19, p = .006) and increase in altered state of consciousness (from neutral cue to gambling cue, controlling for baseline; sr ² = .57, p < .001), and (b) increase in altered state of consciousness (from neutral cue to gambling cue) mediated the relationship between problem-gambling severity and increase in urge (from neutral cue to gambling cue; κ² = .40, 99 % CI [.08, .71]). These findings suggest that cue-reactive altered state of consciousness is an important component of cue-reactive urge in poker-machine problem-gamblers.     

Gambling,Risk-Taking,and Antisocial Behavior: A Replication Study Supporting the Generality of Deviance

Research suggests that high frequency gambling is a component of the “generality of deviance”, which describes the observation that various forms of risky and antisocial behavior tend to co-occur among individuals. Furthermore, risky and antisocial behaviors have been associated with such personality traits as low self-control, and impulsivity, and sensation-seeking. We conducted a replication (and extension) of two previous studies examining whether high frequency gambling is part of the generality of deviance using a large and diverse community sample (n = 328). This study was conducted as a response to calls for more replication studies in the behavioral and psychological sciences (recent systematic efforts suggest that a significant proportion of psychology studies do not replicate). The results of the present study largely replicate those previously found, and in many cases, we observed stronger associations among measures of gambling, risk-taking, and antisocial behavior in this diverse sample. Together, this study provides evidence for the generality of deviance inclusive of gambling (and, some evidence for the replicability of research relating to gambling and individual differences).     

Marital Status and Problem Gambling Among Australian Older Adults: The Mediating Role of Loneliness

Problem gambling rates in older adults have risen dramatically in recent years and require further investigation. Limited available research has suggested that social needs may motivate gambling and hence problem gambling in older adults. Un-partnered older adults may be at greater risk of problem gambling than those with a partner. The current study explored whether loneliness mediated the marital status–problem gambling relationship, and whether gender moderated the mediation model. It was hypothesised that the relationship between being un-partnered and higher levels of loneliness would be stronger for older men than older women. A community sample of Australian men (n = 92) and women (n = 91) gamblers aged from 60 to 90 years (M = 69.75, SD = 7.28) completed the UCLA Loneliness Scale and the Problem Gambling Severity Index. The results supported the moderated mediation model, with loneliness mediating the relationship between marital status and problem gambling for older men but not for older women. It appears that felt loneliness is an important predictor of problem gambling in older adults, and that meeting the social and emotional needs of un-partnered men is important.     

Effectiveness of a Self Help Cognitive Behavioural Treatment Program for Problem Gamblers: A Randomised Controlled Trial

The study aimed to strengthen the scarce literature on self-help treatments for Problem Gambling (PG) by comparing the effectiveness of a Self-Help Cognitive Behavioral Treatment (SHCBT) program (n = 23) with a 6-week Waitlist condition (n = 32) in problem gamblers. Participants were community volunteers with gambling problems and were randomly allocated to the Waitlist and treatment conditions. Results showed significant improvements at post-treatment in gambling behaviors including frequency of gambling, average amount gambled per day and PG symptoms as well as a number of gambling correlates including psychological states (e.g., depression, anxiety and stress), gambling cognitions, gambling urges, gambling related self-efficacy, satisfaction with life, and quality of life among those who completed the SHCBT program, when compared with the waitlist condition. The effect size (partial η ²) ranged from .25 to .57 for all assessed outcomes that showed significant improvement from pre- to post-treatment. It was concluded that a self-help CBT program can be beneficial for treating community problem gamblers.     

Differences in the Gambling Behavior of Online and Non-online Student Gamblers in a Controlled Laboratory Environment

Although research suggests that approximately 1 in 4 college students report having gambled online, few laboratory-based studies have been conducted enlisting online student gamblers. Moreover, it is unclear the extent to which differences in gambling behavior exist between online and non-online student gamblers. The current study examined if online gamblers would play more hands, commit more errors, and wager more credits than non-online student gamblers in a controlled, laboratory environment. Online (n = 19) and non-online (n = 26) student gamblers played video poker in three separate sessions and the number of hands played, errors committed, and credits wagered were recorded. Results showed that online student gamblers played more hands and committed more errors playing video poker than non-online student gamblers. The results from the current study extend previous research by suggesting that online gamblers engage in potentially more deleterious gambling behavior (e.g., playing more hands and committing more errors) than non-online gamblers. Additional research is needed to examine differences in the gambling behavior of online and non-online gamblers in a controlled, laboratory environment.     

Impact of a Casino Opening on Gambling Behaviors of People Engaged in Methadone Maintenance

This study examined gambling behavior in the context of a newly opening casino, comparing disordered gamblers to non-disordered gamblers, in a population of individuals involved in methadone maintenance treatment. Disordered gamblers (N = 50) and non-disordered gamblers (N = 50) were surveyed before and after the opening of a new casino on gambling behaviors, substance use, and psychological symptoms. No statistically significant changes in gambling behaviors were observed for disordered gamblers or non-disordered gamblers across time points; however, non-disordered gamblers demonstrated non-significant increases in horse and dog race betting, electronic games, and casino table games. As expected, disordered gamblers were found to spend significantly more money on electronic games and casino table games (p < 0.05) and demonstrated higher rates of drug use and impulsivity than non-disordered gamblers. The introduction of a new casino did not appear to have a major impact on gambling behaviors of individuals attending methadone maintenance treatment, though the non-significant increases in gambling among non-disordered gamblers may indicate that this population is preferentially impacted by the opening of a new casino. Future investigation into the longer term effects of opening a new casino on this population may be warranted.     

Association of Problem Gambling with Type of Gambling Among Italian General Population

The origin of gambling disorders is uncertain; however, research has shown a tendency to focus on specific types of games as a potential important risk factor. The principal aim of this study is to examine the relationships between types of gambling practices and gambling disorder. The data were extracted from IPSAD-Italia^® 2010–2011 (Italian Population Survey on Alcohol and other Drugs), a survey among the Italian general population which collects socio-cultural information, information about the use of drugs, legal substances and gambling habits. In order to identify the “problem gambler” we used the Problem Gambling Severity Index. Three groups are considered in this analysis: no-risk gamblers, low-risk gamblers, moderate-risk/problem gamblers. Type of gambling practice was considered among two types of gambler: one-game players and multi-games players. 1.9 % of multi-game players were considered problem gamblers, only 0.6 % of one-game players were problem gamblers (p < 0.001). The percentage of players who were low and moderate-risk gamblers was approximately double among multi-game players, with 14.4 % low-risk and 5.8 % moderate-risk; compared with 7.7 % low-risk and 2.5 % moderate risk among one-game players. Results of ordinal logistic regression analysis confirmed that higher level of gambling severity was associated with multi-game players (OR = 2.23, p < 0.0001). Video-poker/slot-machines show the highest association with gambling severity among both one-game players and multi-game players, with scores of OR equal to 4.3 and 4.5 respectively. These findings suggest a popular perception of risk associated with this type of gambling for the development of gambling problems.     

Efficacy of a Self-Help Treatment for At-Risk and Pathological Gamblers

Available evidence suggests that self-help treatments may reduce problem gambling severity but inconsistencies of results across clinical trials leave the extent of their benefits unclear. Moreover, no self-help treatment has yet been validated within a French Canadian setting. The current study therefore assesses the efficacy of a French language self-help treatment including three motivational telephone interviews spread over an 11-week period and a cognitive-behavioral self-help workbook. At-risk and pathological gamblers were randomly assigned to the treatment group (n = 31) or the waiting list (n = 31). Relative to the waiting list, the treatment group showed a statistically significant reduction in the number of DSM-5 gambling disorder criteria met, gambling habits, and gambling consequences at Week 11. Perceived self-efficacy and life satisfaction also significantly improved after 11 weeks for the treatment group, but not for the waiting list group. At Week 11, 13% of participants had dropped out of the study. All significant changes reported for the treatment group were maintained throughout 1, 6 and 12-month follow-ups. Results support the efficacy of the self-help treatment to reduce problem gambling severity, gambling behaviour and to improve overall functioning among a sample of French Canadian problem gamblers over short, medium and long term. Findings from this study lend support to the appropriateness of self-help treatments for problem gamblers and help clarify inconsistencies found in the literature. The low dropout rate is discussed with respect to the advantages of the self-help format. Clinical and methodological implications of the results are put forth.     

The Gambling Preferences and Behaviors of a Community Sample of Australian Regular Video Game Players

Research has noted many similarities between video gaming and gambling activities. It has been suggested that video game players may also be attracted to gambling, although there is limited research on this possibility. The present study examined concurrent video gaming and gambling habits in a sample of regular video game players in Australia (N = 485, 84 % male, M _age = 25.8). Gambling involvement was found to be a generally unpopular activity among regular video game players. No significant association between frequency of video game play and frequency of gambling was found. Although significant correlations between gaming ‘addiction’ scores and gambling frequency were identified, age was the only significant predictor of gambling when controlling for all remaining variables. These findings are critically discussed in the context of past research, and future research directions concerning the link between video gaming and gambling are proposed.     

Twelve-Month Prevalence of DSM-5 Gambling Disorder and Associated Gambling Behaviors Among Those Receiving Methadone Maintenance

This study sought to: (1) determine the prevalence of gambling disorder using the Diagnostic and Statistical Manual of Mental Disorders Version 5 (DSM-5; American Psychiatric Association in Diagnostic and statistical manual of mental disorders, American Psychiatric Publishing, Arlington, 2013) criteria; (2) identify the frequency and amount of money spent on gambling behaviors; and (3) determine demographic and treatment related predictors associated with gambling disorder in a substance using population. People receiving methadone maintenance treatment (N = 185) in an urban medical center consented to participate in the study. We used DSM-5 criteria to assess the 12-month prevalence of gambling disorder. Questions adapted from a previously developed measure were used to identify, describe and quantify the frequency of use and amount of money spent on gambling behaviors. Most participants were African-American (71.4 %), male (54.1 %), unmarried (76.8 %), unemployed (88.1 %) and had an income of <$20,000 (88.5 %). On average, participants were receiving 81.0 mg of methadone (SD: 22.8) daily. Nearly half (46.2 %) of participants met DSM-5 criteria for gambling disorder. Compared to those without gambling disorder, those with gambling disorder did not differ significantly with respect to demographic characteristics nor methadone dose. However, those with gambling disorder had been in methadone maintenance treatment for significantly less time. Those with gambling disorder were significantly more likely to report engaging in a variety of gambling behaviors. Given that the 12-month prevalence of DSM-5 defined gambling disorder was nearly 50 % future efforts to screen and treat gambling disorder in the context of methadone maintenance treatment are clearly warranted.     

Where Lies the Harm in Lottery Gambling? A Portrait of Gambling Practices and Associated Problems

Lotteries are one of the most prevalent forms of gambling and generate substantial state revenues. They are also argued to be one of the least harmful forms of gambling. This paper is one of the first to examine exclusive lottery gamblers and compares their gambling patterns and problems as well other associated risky behaviours to those who are not exclusive lottery gamblers. Data were derived from two large surveys conducted with representative adult samples in France (n?=?15,635) and Québec (n?=?23,896). Participants were separated into two groups: exclusive lottery gamblers (ELGs) and non-exclusive lottery gamblers. Using multivariate analysis, study results reveal that ELGs, who represent two thirds of gamblers, generally exhibit less intensive gambling patterns and are less likely to report other risky behaviours. However, harms associated with moderate risk and problem gambling are found to be concentrated in specific subpopulations for both groups, primarily males, older individuals, and those who report lower income and education level. Given widespread participation in lotteries and concentration of harm within specific subgroups, these findings point to the need for prevention efforts despite the lower levels of harm associated with lottery gambling.     

Casino Self- and Forced Excluders’ Gambling Behavior Before and After Exclusion

Casino exclusion programs are intended to prevent or limit gambling-related harm. Although previous research showed that self-exclusion is associated with reduced gambling, it remains unknown whether self- and forced excluded subjects show different patterns of gambling behavior and if exclusion from casino gambling affects all gambling activities. The present study retrospectively investigated (1) the role of voluntariness of exclusion for the first time, and (2) general gambling behavior of excluded individuals before and after exclusion. A total of N = 215 casino excluders (self-excluders: n = 187, forced excluders: n = 28) completed an online survey or a face-to-face interview up to 8 years after enrollment. Self- and forced excluders showed similar rates of abstinence (self-excluders: 19.3%, forced excluders: 28.6%) and reduction (self-excluders: 67.4%, forced excluders: 60.7%), even though forced excluders reported a significantly greater initial gambling intensity compared to self-excluders (e.g., pre-exclusion gambling time; self-excluders: 3.2 days/week, forced excluders: 4.3 days/week). Overall, results indicated that 20.5% of excluders stopped all gambling activities and another 66.5% reduced their gambling. Those who continued gambling significantly reduced this behavior in every segment, except for gambling halls. Findings indicate that self- and forced exclusion are associated with similarly reduced gambling behavior, even in non-excluded segments. However, unchanged gambling in gambling halls emphasizes the importance to implement consistent exclusion programs over all gambling segments.     

Gambling Increases Self-Control Strength in Problem Gamblers

In two studies it is demonstrated that, in the short-term, slot machine gambling increases self-control strength in problem gamblers. In Study 1 (N = 180), participants were randomly assigned to either play slot machines or engage in a control task (word anagrams) for 15 min. Subsequent self-control strength was measured via persistence on an impossible tracing task. Replicating Bergen et al. (J Gambl Stud, doi:10.1007/s10899-011-9274-9, 2011), control condition participants categorized as problem gamblers persisted for less time than did lower gambling risk participants. However, in the slot machine condition, there were no significant differences in persistence amongst participants as a function of their gambling classification. Moreover, problem gambling participants in the slot machine condition persisted at the impossible tracing task longer than did problem gambling participants in the control condition. Study 2 (N = 209) systematically replicated Study 1. All participants initially completed two tasks known to deplete self-control strength and a different control condition (math problems) was used. Study 2 results were highly similar to those of Study 1. The results of the studies have implications for the helping professions. Specifically, helping professionals should be aware that problem gamblers might seek out gambling as a means of increasing self-control strength.     

Problem Gambling Among Urban and Rural Gamblers in Limpopo Province,South Africa: Associations with Hazardous and Harmful Alcohol Use and Psychological Distress

Little is known about the mental health correlates of problem gambling in low- and-middle-income countries such as South Africa and whether these correlates vary by urbanicity. To address this gap, we examined mental health factors associated with problem gambling among gamblers in Limpopo Province, South Africa disaggregated by rural, peri-urban and urban location. A survey of gambling behaviour and mental health was conducted among 900 gamblers. Overall, 28.3 % were at high risk and 38.1 % were at moderate risk for problem gambling. For the entire sample, hazardous/harmful alcohol use was associated with almost twofold increased chance of being at moderate risk (AOR 1.83; 95 % CI 1.08, 3.11) and almost sevenfold greater odds (AOR 6.93; 95 % CI 4.03–11.93) of being at high risk for problem gambling. Psychological distress was associated with being at high risk for problem gambling only (AOR 1.18; 95 % CI 1.14–1.22). After stratifying by urbanicity, hazardous/harmful alcohol use and psychological distress remained associated with high risk gambling across all locations. We found little knowledge of a free gambling helpline and other gambling services—particularly in less urbanised environments [χ² (2), 900 = 40.4; p < 0.001]. These findings highlight the need to increase awareness of free helpline services among gamblers and to ensure gambling services include screening and treatment for common mental disorders.     

Gambling Motives: Do They Explain Cognitive Distortions in Male Poker Gamblers?

Gambling behavior is partly the result of varied motivations leading individuals to participate in gambling activities. Specific motivational profiles are found in gamblers, and gambling motives are closely linked to the development of cognitive distortions. This cross-sectional study aimed to predict cognitive distortions from gambling motives in poker players. The population was recruited in online gambling forums. Participants reported gambling at least once a week. Data included sociodemographic characteristics, the South Oaks Gambling Screen, the Gambling Motives Questionnaire-Financial and the Gambling-Related Cognition Scale. This study was conducted on 259 male poker gamblers (aged 18–69 years, 14.3% probable pathological gamblers). Univariate analyses showed that cognitive distortions were independently predicted by overall gambling motives (34.8%) and problem gambling (22.4%) (p < .05). The multivariate model, including these two variables, explained 39.7% of cognitive distortions (p < .05). The results associated with the literature data highlight that cognitive distortions are a good discriminating factor of gambling problems, showing a close inter-relationship between gambling motives, cognitive distortions and the severity of gambling. These data are consistent with the following theoretical process model: gambling motives lead individuals to practice and repeat the gambling experience, which may lead them to develop cognitive distortions, which in turn favor problem gambling. This study opens up new research perspectives to understand better the mechanisms underlying gambling practice and has clinical implications in terms of prevention and treatment. For example, a coupled motivational and cognitive intervention focused on gambling motives/cognitive distortions could be beneficial for individuals with gambling problems.     

Episodic and Binge Gambling: An Exploration and Preliminary Quantitative Study

The DSM-5 includes provisions for episodic forms of gambling disorder, with such changes aligned with earlier accounts of potential binge gambling behaviours. However, there is little research that indicates the utility of these classifications of episodic or binge gambling, and this study considered their characteristics in a clinical sample. It involved administration of a new binge gambling screening tool, along with routine measures, to n = 214 patients entering a specialist treatment clinic for gambling problems. Results indicated that episodic gambling was common in this clinical context, with 28 and 32% of patients reporting gambling episodes that were (a) regular and alternating, and (b) irregular and intermittent, respectively. These patterns were distinguished by factors including associations with covariates that indicated differences from continuous gamblers. For example, the irregular episodic gamblers, but not the regular pattern, demonstrated lower levels of problem gambling severity and comorbidity. Rates of potential binge gambling, which was defined in terms of additional criteria, were around 4% and numbers were insufficient for comparable analyses. The findings support inclusion of episodic forms of gambling disorder in the DSM-5, but highlight the need for improved recognition and research on heterogeneous forms of episodic gambling.