The relationship between explicit and implicit learning processes and probable pathological gambling

This paper reports the findings of a study of explicit and implicit learning and gambling with non-problem (n = 107), sub-clinical problem gamblers (n = 13), and probable pathological gamblers (n = 46). Two probability learning tasks modeled after gambling games and an artificial grammar task were used to explore how people learn patterns. In each of the two probability learning tasks, the outcome of the game was biased during the first part (learning phase) of the task. The results showed that many of the participants in the experimental conditions learned the bias and gradually unlearned the bias during the extinction phase of the study. Probable pathological gamblers showed less retention of the bias during two probability tasks and repeated the same errors during the artificial grammar task suggesting that they emphasize explicit learning strategies rather than implicit learning strategies. The results are consistent with the idea that pathological gamblers are more likely to utilize explicit rules than implicit rules.     

Co-morbidity of gambling and Internet use among Internet and land-based gamblers: classic and network approaches

This study investigated co-morbidity of problem gambling and problematic Internet use (PIU) among adolescent Internet and land-based gamblers, with the classic approach using sum-scores of symptoms and a promising new method, namely the network perspective. This perspective allows testing for how multiple disorders are associated, showing symptoms overlap and centralities. We used cross-sectional data from two population-based samples of adolescents aged 17 years in France (n = 2,240) and Switzerland (n = 944). Measures included Internet gambling, problem gambling and PIU. The classic approach showed that Internet gambling was associated with increased levels of disordered gambling and PIU, but that correlations between disorders were weak (R² min = 3.2%, R² max = 17.6%). The network perspective showed that the co-morbid network of Internet gamblers was more connected in comparison with land-based gamblers. Problem gambling and PIU appeared as separate disorders, but their relationship was increased among Internet gamblers in comparison with land-based gamblers. The network perspective appeared as a promising avenue for a better understanding of addictive disorders, but it should not replace the classic approach, which showed increased levels of addictive behaviours among Internet gamblers.     

Predicting gambling behaviour and problems from implicit and explicit positive gambling outcome expectancies in regular gamblers

Outcome expectancies are the positive or negative effects that individuals anticipate may occur from engaging in a given behaviour. Although explicit outcome expectancies have been found to play an important role in gambling, research has yet to assess the role of implicit outcome expectancies in gambling. In two studies, we investigated whether implicit and explicit positive gambling outcome expectancies were independent predictors of gambling behaviour (i.e. amount of time spent and money risked gambling; Study 1) and problem gambling severity (Study 2). In both studies, implicit positive gambling outcome expectancies were assessed by having regular gamblers (N = 58 in Study 1; N = 96 in Study 2) complete a gambling outcome expectancy reaction time (RT) task. A self-report measure of positive gambling outcome expectancies was used to assess participants' explicit positive gambling outcome expectancies. Both the RT task and self-report measure of positive gambling outcome expectancies significantly contributed unique as well as shared variance in the prediction of self-reported gambling behaviour (Study 1) and problem gambling severity (Study 2). Findings from the current research point to the importance of using both direct and indirect assessment modes when examining the role of outcome expectancies in gambling.     

Reduced inhibitory control predicts persistence in laboratory slot machine gambling

Impairments in inhibitory control characterize a range of addictive behaviours including gambling disorder. This study investigated the relationship between a neuropsychological measure of inhibitory control and behaviour on a simulated slot machine that included a measure of gambling persistence, in a non-clinical sample of regular gamblers. Regular gamblers (n = 75) performed a laboratory slot machine task for 30 trials where they could win real money, followed by a persistence phase under extinction (i.e. without wins). Participants also completed a stop-signal task, along with measures of gambling-related cognitions, social desirability, and symptoms of disordered gambling. In hierarchical regression models, reduced inhibitory control was found to predict greater persistence and a higher subjective desire to play again after both wins and near-misses (i.e. unsuccessful outcomes close to the jackpot). These data illustrate the impact of low inhibitory control on relevant behavioural tendencies in a group of regular gamblers. Our results help elucidate a cognitive process that may contribute to problem gambling, with implications for screening and treatment.     

Disordered gamblers with and without ADHD: the role of coping in elevated psychological distress

Attention-deficit/hyperactivity disorder (ADHD) is significantly more prevalent among disordered gamblers than in the general adult population. Despite this, it remains unclear whether co-occurring ADHD is associated with clinically significant differences that call for specialized assessments and treatment planning. The purpose of this article was to explore differences in psychological distress and coping strategies among individuals presenting to an outpatient gambling treatment centre with and without co-occurring adult ADHD. Participants (n = 99) were primarily female (69%) and Caucasian (86%) outpatient treatment-seeking disordered gamblers. At intake, individuals completed self-report measures of coping (Coping Inventory for Stressful Situations – Adult Form), psychological distress (Beck Depression Inventory II) and ADHD (Brown Attention-Deficit Disorder Scales – Adult Form). Results indicated that individuals with ADHD (n = 42) reported significantly more psychological distress and less adaptive coping strategies than those without co-occurring ADHD (n = 57). Mediation analyses showed that an ADHD diagnosis had an indirect effect on psychological distress via the mediator of maladaptive coping. Assessment and treatment should be tailored to address the variety of presentations of gambling disorder. Screening for ADHD at intake may be helpful in creating an individualized treatment plan for disordered gamblers.     

Assessing the effectiveness of a responsible gambling behavioural feedback tool for reducing the gambling expenditure of at-risk players

The current study assessed the utility of a responsible gambling (RG) tool that provides players with behavioural feedback about their gambling. Data was obtained from 779 people (n = 694 male; n = 85 female) who gambled online with Svenska Spel (the Swedish gambling operator) and who opted to receive behavioural feedback via an RG tool (Playscan). Importantly, data was also obtained from a matched sample of 779 players who did not opt to receive behavioural feedback. Feedback took the form of a colour-coded risk rating (Green = no issues, Yellow = at-risk, Red = problematic), which was determined by a proprietary algorithm. Additionally, gambling expenditure data (amounts deposited and wagered) was gathered for the week in which players enrolled to use the RG tool, the subsequent week and 24 weeks later (this data was also gathered for the matched sample). Results showed that Yellow (i.e. at-risk) players who used the tool significantly reduced the amounts of money deposited and wagered compared to players who did not use the tool – an effect observed the week following enrolment as well as 24 weeks later. Thus, informing at-risk players who have opted to receive feedback about their gambling appears to have a positive impact on subsequent expenditures.     

Associations between gambling,substance misuse and recidivism among Canadian offenders: a multifaceted exploration of poor impulse control traits and behaviours

Moderate correlations among gambling, substance use and crime suggest these three behaviours may each be indicators of a single underlying problem trait, such as poor impulse control. We tested whether self-reported traits prospectively predicted future criminal recidivism, when accounting for incarcerated adult offenders' past criminal behaviour, substance use and gambling behaviour. We took a multi-construct approach to measuring components of impulse control, utilizing three questionnaires that assess sensation seeking, poor premeditation, and reward sensitivity. Male participants incarcerated in two federal institutions were invited to complete self-report booklets; participation was self-selected and fully voluntary. Results indicated moderate correlations between measures of trait impulse control, self-reported drug use, and official criminal history (N = 140). Gambling problems prospectively predicted post-release criminal recidivism (n = 83), even when accounting for past criminal behaviour, impulse control traits and substance misuse. Although they represent a small percentage of this sample, results suggest offenders with high gambling problems represent a particularly at-risk group for future crime, who were more than four times likely to reoffend compared to offenders without problem gambling. These results suggest there may be mutual impact of problem behaviours on life outcomes above the contribution of poor impulse control.     

Comorbidity of Alcohol and Gambling Problems in Emerging Adults: A Bifactor Model Conceptualization

Addictive disorders, such as pathological gambling and alcohol use disorders, frequently co-occur at greater than chance levels. Substantive questions stem from this comorbidity regarding the extent to which shared variance between gambling and alcohol use reflects a psychological core of addictive tendencies, and whether this differs as a function of gender. The aims of this study were to differentiate both common and unique variance in alcohol and gambling problems in a bifactor model, examine measurement invariance of this model by gender, and identify substantive correlates of the final bifactor model. Undergraduates (N = 4475) from a large northwestern university completed an online screening questionnaire which included demographics, quantity of money lost and won when gambling, the South Oaks Gambling Screen, the AUDIT, gambling motives, drinking motives, personality, and the Brief Symptom Inventory. Results suggest that the bifactor model fit the data well in the full sample. Although the data suggest configural invariance across gender, factor loadings could not be constrained to be equal between men and women. As such, general and specific factors were examined separately by gender with a more intensive subsample of females and males (n = 264). Correlations with motivational tendencies, personality traits, and mental health symptoms indicated support for the validity of the bifactor model, as well as gender-specific patterns of association. Results suggest informative distinctions between shared and unique attributes related to problematic drinking and gambling.     

Development of an assessment tool to evaluate the risk potential of different gambling types

Based on different characteristics of gambling types, this study aimed to develop an assessment tool to evaluate the risk potential of available and planned gambling types in German-speaking countries. In the first module, 26 experts were interviewed over the course of a Delphi study, and an analysis of those results led to the selection of relevant characteristics and scaling values. Building on the first module, the second module consisted of standardized data collection of nonproblem, problem and pathological gamblers (characteristics: n = 363; scales: n = 356), which served as an empirical validation. Ten characteristics were identified with different weights and differentiated scaling values to evaluate the risk potential, and a psychometric validation indicated that the assessment tool was reliable (α = 0.91; r _ik  = 0.50; r _it  = 0.33–0.80). The correlation measures from data of epidemiological studies (R ² = 0.84) and a treatment survey (p < 0.001) demonstrated that the assessment tool was valid. This assessment tool, which was verified by psychometric validation, can serve the legislation and jurisdiction, the gaming industry and consumers as a future basis for risk evaluation of gambling types.     

Raising the legal gambling age in Finland: problem gambling prevalence rates in different age groups among past-year gamblers pre- and post-implementation

This article reports on the frequency of problem gambling, measured with the Lie/Bet instrument, in different age groups among Finnish past-year gamblers in 2011 (n = 2984) and 2014 (n = 2326). The data highlights the situation before, and three years after, the implementation of a raised minimum age limit for gambling from 15 to 18 years. The difference in problem gambling frequency when comparing all age groups was statistically significant in 2011, but not in 2014. A significantly lower frequency of problem gambling was found among 18–19-year-olds in 2014 (3.4%), compared to 2011 (16.3%). The results regarding problem gambling prevalence among 15–17-year-olds (8.0% in 2011, 0.0% in 2014) are somewhat inconclusive as the number of respondents fulfilling the criteria for problem gambling was zero in 2014, thus affecting the analysis. No statistically significant difference in problem gambling frequency was found among 20–21-year-olds (a group less affected by the policy implementation) – or other older age groups – between the survey years. While the findings should be viewed with caution, they do support recommendations regarding a minimum gambling age of 18 years or higher as an effective harm-minimization measure.     

Self-Generated Motives for Not Gambling Among Young Adult Non-gamblers

Motivational models have been shown to usefully describe reasons for engaging in addictive behaviors including gambling disorder. Although most scales designed to measure motives have been derived statistically, self-generated open-ended responses have also shown utility for identifying unique motives for gambling. While the motivational structure for gambling disorder has been extensively explored, there has been a paucity of research examining motives for choosing not to gamble. This is not the case for other addictive behaviors such as alcohol use where motives for abstaining from drinking have been well defined. The primary goal of this study was to qualitatively explore and identify motives for not gambling in a sample of young adult non-gamblers using open-ended responses. A sample (N = 196) of undergraduate current non-gamblers, defined as no gambling activity over the previous 12 months, completed a series of questionnaires on demographics, gambling behavior, and alcohol consumption. Furthermore, they were asked to provide their top three reasons for not gambling in rank order. The results revealed eight specific motives for why participants chose not to gamble: ‘financial reasons and risk aversion’; ‘disinterest and other priorities’; ‘personal and religious convictions’; ‘addiction concerns’; ‘influence of others’ values’; ‘awareness of the odds’; ‘lack of access, opportunity, or skill’; and ‘emotional distress’. Personal and religious convictions reasons were also related to lifetime non-drinking, suggesting that these motives are associated with decreased addictive behaviors in general. Ultimately, these results may help to inform the design of prevention strategies for gambling disorder.     

Do the DSM-5 diagnostic revisions affect the psychometric properties of the Brief Biosocial Gambling Screen?

Several significant changes in the diagnostic criteria for gambling disorder occurred with the newest revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The changes aim to simplify and streamline the diagnosis without compromising its validity. Yet many of the tools used to screen and diagnose the disorder are based upon the prior fourth edition of the DSM, and it is unclear how they perform with the revised diagnostic criteria. The aim of this study is to examine the psychometric properties of a common pathological gambling screen, the Brief Biosocial Gambling Screen (BBGS; Gebauer, LaBrie, & Shaffer, 2010), in the context of DSM-5 criteria within a help-seeking sample. Gamblers calling a helpline (N = 2750) completed a semi-structured interview assessing DSM-IV past-year pathological gambling criteria with a trained clinician. Sensitivity, specificity, positive predictive value, negative predictive value and differences by sex were examined. The BBGS had high sensitivity as well as positive and negative predictive values. In light of the revisions made to the diagnostic criteria in DSM-5, the BBGS remains a psychometrically supported instrument for gambling disorder.     

Subtyping Non-treatment-seeking Problem Gamblers Using the Pathways Model

This study examined whether distinct subgroups could be identified among a sample of non-treatment-seeking problem and pathological/disordered gamblers (PG) using Blaszczynski and Nower’s (Addiction 97:487–499, 2002) pathways model (N = 150, 50% female). We examined coping motives for gambling, childhood trauma, boredom proneness, risk-taking, impulsivity, attention-deficit/hyperactivity disorder (ADHD), and antisocial personality disorder as defining variables in a hierarchical cluster analysis to identify subgroups. Subgroup differences in gambling, psychiatric, and demographic variables were also assessed to establish concurrent validity. Consistent with the pathways model, our analyses identified three gambling subgroups: (1) behaviorally conditioned (BC), (2) emotionally vulnerable (EV), and (3) antisocial-impulsivist (AI) gamblers. BC gamblers (n = 47) reported the lowest levels of lifetime depression, anxiety, gambling severity, and interest in problem gambling treatment. EV gamblers (n = 53) reported the highest levels of childhood trauma, motivation to gamble to cope with negative emotions, gambling-related suicidal ideation, and family history of gambling problems. AI gamblers (n = 50) reported the highest levels of antisocial personality disorder and ADHD symptoms, as well as higher rates of impulsivity and risk-taking than EV gamblers. The findings provide evidence for the validity of the pathways model as a framework for conceptualizing PG subtypes in a non-treatment-seeking sample, and underscore the importance of tailoring treatment approaches to meet the respective clinical needs of these subtypes.     

How to Maintain High Retention Rates in Long-Term Research on Addiction: A Case Report

High dropout rates threaten the validity of longitudinal studies involving participants suffering from substance use disorder (SUD). The objective of this article is to evaluate strategies to improve retention. The data analysis was based on an ongoing study of long-term recovery of neurocognitive and psychosocial functions. We used traditional strategies to enhance the contact rate. Common factors in psychosocial treatments and biweekly Short Message Service (SMS; text messaging) monitoring were added to further increase the contact rate. The participants (n = 146) were recruited from treatment facilities for SUD. Assessments were measured at 3 months, 6 months, 9 months, and 12 months. This study was successful in retaining a cohort of participants who are typically characterized as having a negative prognosis because of their unstable living arrangements and incomes. Compared to those using GHB, addictive medications, and opiates, the retention rate was the lowest among participants with severe alcohol use disorder (42%).     

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.     

Social Density of Gambling and Its Association with Gambling Problems: An Initial Investigation

The role of social factors in pathological gambling has received relatively little systematic research. The goal of the current study was to examine the relationship between a target individual’s gambling behavior and the gambling behavior among that individual’s parents, siblings and five closest friends. The specific aims were, first, to apply a novel brief assessment to study the social density of factors relating to pathological gambling; second, to replicate previously observed findings involving the social aggregation of alcohol and tobacco use; and third, to examine social density findings among the three domains. Participants were 128 frequent gamblers from the Athens, Georgia area, 79.7 % male with a mean age of 34.2 (SD = 11.7). Participants were assessed using the Diagnostic Interview for Gambling Severity for gambling severity, the Alcohol Use Disorders Identification Test for alcohol abuse, the Fagerstrom Test of Nicotine Dependence for tobacco use, and the novel Brief Social Density of Gambling, Alcohol, and Tobacco Assessment. Significant relationships were observed between participants’ and friends’ activity within all domains: gambling (ps = .001), alcohol use (p < .001) and tobacco use (p < .001). Relationships with friends’ activity across domains were less strong. Distinct patterns of associations with parents and siblings were not observed. Thus, social aggregation was observed across the three domains of potentially addictive behaviors, generally with specificity within domains and with friends, not biological relatives. Methodological considerations and potential applications of these findings are discussed.     

Lottery participation by youth with gambling problems: are lottery tickets a gateway to other gambling venues?

The aim of the present study was to investigate the types of gambling activities youths with gambling problems participate in and whether the lottery is a key gambling venue for these young people. Secondly, we sought to ascertain whether youths with gambling problems display similar gambling behaviour with lottery tickets as those addicted to traditional forms of gambling. Participants were 1,072 young people, 10-18 years of age, in Ontario, Canada. Youths with gambling problems reported having a preference for lottery tickets compared to other forms of gambling. Differences were found for the frequency with which probable pathological gamblers reported going to the store specifically to purchase lottery tickets. Furthermore, probable pathological gamblers reported chasing their losses after having played the lottery more than the other gambling groups. This research demonstrates that youths with gambling problems gamble primarily with lottery products and exhibit similar pathological gambling behaviour (e.g., chasing) as those individuals addicted to other forms of gambling venues. Furthermore, the results suggest that lottery tickets are a potentially addictive activity that introduces youth to the exciting properties of gambling.     

Predictors of help-seeking for gambling disorder from the transtheoretical model perspective

Few gamblers seek treatment despite the severe negative impacts prolonged gambling can have. Research surrounding the predictors of help-seeking for problem gambling is often retrospective in design and inconsistent in findings. This study prospectively investigated whether transtheoretical model (TTM) constructs (readiness to change, ratings of temptations and self-efficacy, decisional balance and processes of change) have utility in predicting help-seeking among disordered gamblers. Community-recruited disordered gamblers (N = 136; 47.06% female; mean age = 44.5 years, SD = 12.8; 80.1% Caucasian) completed three assessments of TTM constructs, help-seeking behaviour, gambling problem severity, and other potential predictors of help-seeking. Informal help-seeking was common (6-month = 71.1%; 12-month = 79.6%); however, formal help-seeking was relatively infrequent (6-month = 22.7%; 12-month = 35.1%). Logistic regression demonstrated that gambling problem severity and the social liberation process of change (i.e. endorsing public awareness of gambling problems or non-gambling role models) consistently predicted formal help-seeking. Helping relationships and counter-conditioning (i.e. engaging in other activities as a replacement for gambling) processes of change uniquely predicted informal help-seeking at 12 months. Individuals most likely to seek formal help have greater problem severity and greater readiness to address problems. Seeking informal help is less predictable but more common.     

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.     

Young Poker Faces

Gambling is an activity that can be performed on-premise (slot machines in casinos, bars and restaurants) or off-premise (scratch cards and lottery tickets). Although the addictive potential may depend on the specific gambling product, early onset increases the likelihood for future pathological gambling. To delay the onset of gambling behavior and to reduce gambling-related problems, many countries have introduced age limits that should decrease the availability of gambling products to underage individuals. In this study we evaluated compliance to the legal age limit, making use of a mystery shopping method. We distinguished between (1) off-premise scratch cards (n = 51); (2) off-premise lottery tickets (n = 49); (3) on-premise slot machines in casinos (n = 88); and (4) on-premise slot machines in the catering industry (n = 100), and we focus on the factors, such as characteristics of the establishment, buyer, and vendor, that may account for possible differences. The 288 visits demonstrate that gambling products are highly available and accessible to under-aged customers; young customers are still able to gamble despite the legal regulations. The compliance rates fluctuate and appear to be related to the specific gambling product in question. Furthermore, age verification activities and certain outlet- and buyer characteristics, as well as characteristics associated with the purchase attempt, may influence compliance.