Frequent Card Playing and Pathological Gambling: The Utility of the Georgia Gambling Task and Iowa Gambling Task for Predicting Pathology

The current investigation examined performance on two laboratory-based gambling tasks, the Georgia Gambling Task (GGT; Goodie, 2003. The effects of control on betting: Paradoxical betting on items of high confidence with low value. Journal of Experimental Psychology: Learning, Memory, and Cognition, 29, 598–610) and the Iowa Gambling Task (IGT; Bechara, Damasio, Damasio, & Anderson, 1994. Insensitivity to future consequences following damage to human prefrontal cortex. Cognition, 50, 7–15), as well as self-reported markers of gambling pathology using the Diagnostic Interview for Gambling Severity (DIGS; Winters, Specker, & Stinchfield, 2002. The downside: Problem and pathological gambling (pp. 143–148). Reno, NV: University of Nevada, Reno) among a sample of undergraduate students who are frequent card players. Two hundred twenty-one participants (55 female and 166 male; mean age 19.21 years) who self-classified as playing cards at least once per month completed these measures. Performance on GGT and IGT systematically related to gambling-related pathology in several ways. Overconfidence and bet acceptance on the GGT, and myopic focus on reward on the IGT, predicted gambling related pathology. GGT and IGT performance correlated with each other, but both contributed independently to predicting gambling pathology. Card playing frequency predicted gambling pathology but not GGT or IGT performance. Discussion focuses on the role of biases of judgment and risky decision making in pathological gambling.     

Gambling Screens: Does Shortening the Time Frame Affect their Psychometric Properties?

Gambling screening tools such as the South Oaks Gambling Screen (SOGS) and a DSM-IV Screen for Gambling Problems (NODS) developed by the National Opinion Research Council have psychometrically validated lifetime and past-year versions. As research questions often dictate shorter time intervals, researchers have adapted the time frames of these instruments to their specific purposes without examining whether changing the time frame affects the psychometric properties. In this study, 3-month versions of SOGS and NODS were administered to a sample of 80 pathological gamblers (59 men, 21 women, mean age 44) seeking treatment at a state-funded facility. The 3-months versions had good internal consistency, good convergent validity with each other, with gambling behaviors assessed via the timeline followback method, and with measures of impulsivity. The 3-month versions also showed good discriminant validity with demographic variables and a measure of verbal IQ. Together the data indicate that shortening the time frame to 3 months does not seem to have adverse effects on the psychometric properties of SOGS and NODS. Thus these adapted versions could profitably be used for shorter time intervals, including as pre/post-treatment and follow-up measures in treatment outcome studies.     

Reliability,Validity, and Cut Scores of the South Oaks Gambling Screen (SOGS) for Chinese

We examined the reliability, validity, and classification accuracy of the South Oaks Gambling Screen (SOGS) when adopted for use in Chinese. The DSM-IV criteria for pathological gambling served as the standard against which the classification accuracy of the SOGS was tested. A total of 283 Chinese adults in the community and 94 Chinese treatment-seeking gamblers were recruited. The internal reliability of the SOGS was satisfactory for the general sample and acceptable for the gambling sample. The SOGS was correlated with the DSM-IV criteria items as well as psychosocial and gambling-related problems. Relative to the DSM-IV criteria, the SOGS tended to overestimate the number of pathological gamblers in both samples. In general, we were relatively confident that individuals were not pathological gamblers if the SOGS scores were between 0 and 4 and were pathological gamblers if the SOGS were between 11 and 20. There was about 50–50 chance of being pathological gamblers if the SOGS scores were between 8 and 10. However, the probability of individuals being pathological gamblers was about 0.30 if the SOGS scores were between 5 and 7. We proposed a SOGS cut score of 8 to screen for probable pathological gambling in Chinese societies.     

Reliability, Validity, and Classification Accuracy of a Spanish Translation of a Measure of DSM-IV Diagnostic Criteria for Pathological Gambling

The aim of this study was to measure the reliability, validity, and classification accuracy of a Spanish translation of a measure of DSM-IV diagnostic criteria for Pathological Gambling (PG). Participants were 263 male and 23 female patients seeking treatment for PG and a matched non-psychiatric control sample of 259 men and 24 women. A Spanish translation of a 19-item measure of DSM-IV diagnostic criteria for PG (Stinchfield 2003) was administered along with other validity measures. The DSM-IV diagnostic criteria were found to be internally consistent with a coefficient alpha of .95 in the combined sample. Evidence of satisfactory convergent validity included moderate to high correlations with other measures of problem gambling. Using the standard DSM-IV cut-score of five, the ten criteria were found to yield satisfactory classification accuracy results with a high hit rate (.95), high sensitivity (.92), high specificity (.99), low false positive (.01), and low false negative rate (.08). Lowering the cut score to four resulted in modest improvements in classification accuracy and reduced the false negative rate from .08 to .05. The Spanish translation of a measure of DSM-IV diagnostic criteria for PG demonstrated satisfactory psychometric properties and a cut score of four improved diagnostic precision.     

Cortisol Rise Following Awakening Among Problem Gamblers: Dissociation from Comorbid Symptoms of Depression and Impulsivity

Gambling pathology has been associated with elevated levels of distress, depression and impulsivity. The present investigation assessed whether these behavioral features would be evident among problem gamblers as they are among pathological gamblers. As well, given that gambling has been associated with increased life stress, as an objective index of ongoing distress, elevations of morning cortisol levels were assessed in problem and pathological gamblers relative to recreational gamblers, and their relations to depressive symptoms and impulsivity were assessed. Recreational, problem, and pathological gamblers (N = 140) completed the Beck Depression Inventory and the Barratt Impulsiveness Scale-11, and provided saliva samples at awakening, 30 min, 3.5 h, and 5.5 h afterward. Consistent with the view that problem and pathological gambling are associated with elevated life stressors, the rise of morning cortisol from awakening to 30 min following awakening was greater than in recreational gamblers. Heightened impulsivity was evident among both problem and pathological gamblers, whereas depressive symptoms were only evident among pathological gamblers. In neither instance were these psychological indices related to the morning cortisol rise. Indeed, increased depressive symptoms were not evident among problem gamblers, despite the fact that elevated morning cortisol levels were evident. The elevated morning cortisol rise may be secondary to gambling problems or distress related to gambling problems. Furthermore, the sustained morning cortisol elevations may be indicative of allostatic overload, and could potentially be a harbinger for potential health risks among problematic gamblers.     

Screening for college problem gambling in Chinese societies: psychometric properties of the Chinese version of the South Oaks Gambling Screen (C-SOGS)

A total of 979 Chinese college students were recruited in order to examine the psychometric properties of the Chinese version of the South Oaks Gambling Screen (C-SOGS). The C-SOGS was internally consistent and correlated with gambling-related problems and negative mental health status. Results of likelihood ratios (LRs) and receiver operating characteristic (ROC) curve supported the C-SOGS as a valid screening instrument for probable pathological gambling. Using the DSM-IV criteria for pathological gambling, the conventional cut score of 5 on the C-SOGS showed satisfactory sensitivity, specificity and false negative rates. This cut score identified 85% of the true positives and 95% of the true negatives. In general, the C-SOGS overestimated the number of pathological gamblers relative to DSM-IV criteria. Future research on Chinese gambling should build on current empirical work on the SOGS to refine the C-SOGS for use with Chinese populations.     

Measuring Self-efficacy in Gambling: The Gambling Refusal Self-Efficacy Questionnaire

This paper reports on the development and psychometric properties of a Gambling Refusal Self-Efficacy Questionnaire (GRSEQ). Two hundred and ninety-seven gamblers from both normal and clinical populations completed an initial set of 31-items of which 26 were selected for inclusion in the final version of the GRSEQ. A series of factor analyses showed four clear factors accounting for 84% of the variance. These factors can be summarised as situations and thoughts associated with gambling, the influence of drugs on gambling, positive emotions associated with gambling and negative emotions associated with gambling. The GRSEQ total score and factors scores showed high internal consistency (Cronbach’s alpha ranging from 0.92 to 0.98). Participants experiencing problems with gambling scored significantly lower on the GRSEQ, and discriminant analyses showed that the scale is able to correctly classify the non-problem (i.e., community and student samples) and problem gamblers (i.e., clinical sample). Furthermore, the GRSEQ showed significant negative relationships with other gambling-related variables (gambling urge and gambling-related cognitions) and negative mood states (depression, anxiety and stress) and was shown to be sensitive to change in treatment of pathological gambling. The results suggest that the GRSEQ is a useful measure of gambling refusal self-efficacy that is suitable for assessment of gamblers from both normal and clinical populations.     

Impulsivity,compulsivity and pathological gambling: an exploratory study of pathological gambling as an impulsivity-compulsivity spectrum disorder

The current study was conducted to examine pathological gambling as an impulsivity-compulsivity spectrum disorder. University students (N=162) who gambled a minimum of twice monthly completed measures of impulsivity, compulsivity and pathological gambling. Instruments completed included: measures of problem gambling severity (South Oaks Gambling Screen, NORC DSM-IV Screen for Gambling Problems, Canadian Problem Gambling Index, Victorian Gambling Screen), the Padua Inventory, the Barratt Impulsivity Scale and the Tridimensional Personality Questionnaire. Results supported previous research indicating that pathological gamblers had elevated scores on measures of impulsivity and compulsivity, as well as personality factors correlated with these two constructs. Moreover, impulsivity and compulsivity were found to be interrelated as proposed by the impulsivity-compulsivity spectrum model.     

A Cognitive Neuroscience Approach to Studying the Role of Overconfidence in Problem Gambling

Research on the neural correlates of decision making in gambling tasks may be informative for understanding problem gambling. The present study explored confidence and overconfidence using magnetoencephalography (MEG) to measure brain activity during a judgment task. Nineteen undergraduates who self-identified as frequent gamblers (average age 19.7 years; 5 females, 14 males) participated in this study. Participants first completed the DIGS (Winters, Specker & Stinchfield, 2002), a measure of gambling pathology. They then engaged in a behavioral task of confidence assessment, wherein they answered two-alternative trivia questions and estimated the probability that each answer was correct. In a subsequent MEG task, they viewed the questions and a target answer, and indicated with a button press whether the target matched the correct answer. Confidence was directly related to activity in the right prefrontal cortex. Matching and mismatching targets were associated with activity in the medial occipital cortex and left supramarginal gyrus, respectively. An interaction of pathology and match/mismatch was observed in the right inferior occipital-temporal junction region, showing more activity following a mismatch in non-problem gamblers, but not in problem gamblers. Implications of the results for understanding of top–down modulation and attentional systems are discussed in relation to gambling behavior.     

The Gambling Cognitions Inventory: scale development and psychometric validation with problem and pathological gamblers

Cognitive distortions are typically identified as an important etiological factor in pathological gambling. The Gambling Cognitions Inventory (GCI) developed by Holub (2003) is examined in this study using a sample of 710 pathological gamblers collected in four Canadian studies. Confirmatory factor analysis did not support the initial 40-item scale and suggested a 33-item scale. The sample was split into two groups to conduct exploratory and confirmatory factor analyses. Scree plots and parallel analysis suggested a two-factor scale. The scale developed by exploratory factor analysis on the first sample was supported by confirmatory factor analysis on the second sample (CFI>0.95; RMSEA < 0.05). The two factors indicated a Skill and Attitude subscale and a Luck and Chance subscale. Analysis conducted within each of the four studies showed good internal reliability for the scale (range of α = 0.91–0.95) and subscales (α = 0.77–0.92). The scale and subscales correlated with gambling severity measures as well as other measures of gambling cognitions including the Gambling Attitudes and Beliefs Scale and the Gambling Beliefs Questionnaire. The results of the study indicate that the GCI is a psychometrically strong scale and may be beneficial in directing cognitive therapy to the most problematic cognitions.     

DSM-IV and the South Oaks Gambling Screen: diagnosing and assessing pathological gambling in Turkey

The main purpose of this study was to investigate the effectiveness of the DSM-IV diagnostic criteria and the South Oaks Gambling Screen (SOGS) in identifying Turkish pathological gamblers. Fifty-nine subjects participated in the study. The subjects were diagnosed as either pathological gamblers or not (comparison group) through the use of the DSM-IV criteria and were given the Turkish version of the SOGS. Four of the ten DSM-IV criteria were found to be problematic in the diagnosis of Turkish pathological gamblers. The data concerning reliability and validity of the Turkish version of the SOGS suggested that the SOGS can be used as a reliable and valid instrument in identifying Turkish pathological gamblers. Most (16 out of 20) of the items of the SOGS appear to work well in discriminating pathological gamblers from the subjects in the comparison group. In the case of the two DSM-IV criteria and the four SOGS items that failed to discriminate, cultural factors seemed to be responsible for the failure.     

Pathological gambling among adolescents: Massachusetts Gambling Screen (MAGS)

This article describes the development of the Massachusetts Gambling Screen (MAGS). The purpose of the MAGS is to provide a brief clinical screening instrument that can (1) yield an index of non-pathological and pathological gambling during a 5 to 10 minute survey or interview and (2) document the first psychometric translation of the proposed DSM-IV pathological gambling criteria into a set of survey or clinical interview questions. The development data for this instrument were obtained from a survey of 856 adolescents who were students in suburban Boston high schools. The results provided evidence that weighted item scores (i.e., discriminant function coefficients) could correctly classify 96% of adolescent gamblers as pathological, in transition or non-pathological when DSM-IV criteria were employed as the conceptual referent. The results also describe the prevalence of a variety of social and emotional problems associated with adolescent gambling. Finally, the discussion examined the normalization and contemporary social context of gaming and the impact of these influences on the measurement and identification of pathological gambling.Thanks are extended to Dr. Thomas Sharkey, Mary Kaddaras, Alan Bryce, David Shaffer, and Reingard Heller for their assistance during the development and implementation of this project.     

Alexithymia and Gambling: A Risk Factor for All Gamblers?

The purpose of this study was to investigate alexithymia (in relation with depression) in three groups of French gamblers (n = 186) recruited in their gambling location: at the racetracks (n = 80 males; mean age 28.1 years), in the slot machine rooms (n = 65; 29 males, 36 females; mean age 34.6 years), and in the traditional gaming rooms (n = 41 males; mean age 36 years). Gambling behavior was measured by the South Oaks Gambling Screen and DSM-IV criteria for pathological gambling, Alexithymia by the Toronto Alexithymia Scale (TAS-20) and depression with the Beck Depression Inventory (BDI-13). For racetracks and slot machine gambling, pathological gamblers differed from non-pathological gamblers, regarding their alexithymia scores. These results remained stable after controlling for depression scores among the racetracks gamblers only. The relationship between alexithymia and depression depends on the type of pathological gambler. These findings are consistent with the idea of identifying clinically distinct subgroups of gamblers.     

Prevalence Rates of Gambling Problems in Montreal,Canada: A Look at Old Adults and the Role of Passion

The purpose of the present research was to determine the prevalence rate of gambling problems in senior citizens (55 years and older). A community-dwelling sample composed of 810 old adults living in the greater Montreal area in the Province of Quebec completed the Revised South Oaks Gambling Screen (SOGS-R). Results revealed that the 12-month prevalence rate was 1.2% for pathological gambling and 1.6% for at-risk gambling. Although, these rates are comparable to those reported elsewhere in Canada and in the US for senior citizens, the at-risk gambling rate was significantly higher than the current one for the general population of the overall Province of Quebec. Finally, a smaller portion of participants also completed two key items from the Gambling Passion Scale (GPS). Results revealed that obsessive passion was higher for pathological gamblers than for at-risk and non-problematic gamblers, while harmonious passion was lower for pathological gamblers than for at-risk and non-problematic gamblers.     

A Preliminary Investigation of Abstinence and Controlled Gambling as Self-Selected Goals of Treatment for Female Pathological Gambling

The current study aimed to provide a preliminary evaluation of the differential efficacy of a cognitive-behavioural treatment program for female pathological gamblers delivered with the goals of abstinence or controlled gambling. The findings were based on the comparison of pathological gamblers selecting abstinence and pathological gamblers selecting controlled gambling on measures of gambling behaviour and psychological functioning. The findings revealed that pathological gamblers selecting controlled gambling displayed comparable levels of improvement to those displayed by gamblers selecting abstinence. Using a treatment completer approach, 89% of the gamblers selecting abstinence compared with 82% selecting controlled gambling no longer satisfied the diagnostic criteria for pathological gambling by the completion of the 6-month follow-up period. Although further scientific demonstration is required, the findings of this study provide preliminary support for the practice of offering controlled gambling as an alternative goal in the treatment of pathological gambling.     

The Self-Regulation of Gambling

Despite the prevalence of gambling world-wide, relatively few individuals become problem gamblers. Additionally many problem gamblers recover without professional assistance. The current study aim was to examine how individuals self-manage their gambling through (a) assessing frequency of use of a range of self-regulation strategies (b) examining how these strategies cluster and (c) exploring relationships between strategies, gambling frequency, amount spent and problem gambling severity. A sample of 303 gamblers was recruited, over-sampling for problem gamblers as assessed by the Problem Gambling Severity Index (PGSI) of the Canadian Problem Gambling Index (mean age 26.4 years, SD = 10.1 years; 119 males, 184 females; 238 social gamblers, 63 problem gamblers, 2 unclassified). They rated extent of usage of 27 gambling self-management techniques and completed the PGSI and other gambling measures. Factor analysis of items produced five factors, named Cognitive Approaches, Direct Action, Social Experience, Avoidance and Limit Setting. The relationships between these factors and key gambling variables were consistent with hypotheses that problem gamblers trying to reduce their gambling would be more likely to use the strategies than other gambler groups. The potential for developing the factors into a Gambling Self-regulation Measure was explored.     

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.     

Altering the DSM-III criteria for pathological gambling

Following a critique and revision of the diagnostic criteria for pathological gambling in DSM-III, a field trial of the revised criteria was conducted. Four groups of individuals (762 in all) were surveyed: Gamblers Anonymous members, college students, hospital employees, and outpatients in treatment for pathological gambling. The revised criteria were found to discriminate effectively between pathological gamblers and others. In order to refine the cutoff point, the results on the DSM-III revision were compared to the South Oaks Gambling Screen, a valid, reliable instrument for screening pathological gamblers (Lesieur & Blume, 1987). A cutoff point of four or more items was found to be optimal in diagnosing pathological gamblers.This research was funded by the South Oaks Foundation, Amityville, New York. Special thanks are given Sheila Blume, M.D., Julian I. Taber, Ph.D. and Robert L. Custer, M.D. for their comments on earlier drafts of this paper.     

Treatment of Female Pathological Gambling: The Efficacy of a Cognitive-Behavioural Approach

Given that a substantial proportion of current pathological gamblers are female, it is evident that women are underrepresented in the treatment outcome literature. The current study was designed to redress the limited information on the treatment of female pathological gambling. Although the use of cognitive-behavioural therapy is the most highly recommended approach as ‘best practice’ for the treatment of pathological gambling, no attempt to date has been made to evaluate the efficacy of this approach for female pathological gambling. Nineteen female pathological gamblers with electronic gaming machine problems were treated with a cognitive-behavioural program. While pathological gamblers placed on a waiting list did not show significant improvement on gambling behaviour and psychological functioning measures, the female pathological gamblers showed significant improvement on these measures over the treatment period, and maintained this improvement at the 6-month follow-up evaluation. By the completion of the follow-up period, 89% of participants no longer met diagnostic criteria for pathological gambling. Although further scientific demonstration and replication are required, the outcomes of this study indicate that the therapy that is considered ‘best practice’ in the treatment of pathological gambling is effective for female pathological gambling.     

Decision-Making,Cognitive Distortions and Alcohol Use in Adolescent Problem and Non-problem Gamblers: An Experimental Study

In the psychological literature, many studies have investigated the neuropsychological and behavioral changes that occur developmentally during adolescence. These studies have consistently observed a deficit in the decision-making ability of children and adolescents. This deficit has been ascribed to incomplete brain development. The same deficit has also been observed in adult problem and pathological gamblers. However, to date, no study has examined decision-making in adolescents with and without gambling problems. Furthermore, no study has ever examined associations between problem gambling, decision-making, cognitive distortions and alcohol use in youth. To address these issues, 104 male adolescents participated in this study. They were equally divided in two groups, problem gamblers and non-problem gamblers, based on South Oaks Gambling Screen Revised for Adolescents scores. All participants performed the Iowa gambling task and completed the Gambling Related Cognitions Scale and the alcohol use disorders identification test. Adolescent problem gamblers displayed impaired decision-making, reported high cognitive distortions, and had more problematic alcohol use compared to non-problem gamblers. Strong correlations between problem gambling, alcohol use, and cognitive distortions were observed. Decision-making correlated with interpretative bias. This study demonstrated that adolescent problem gamblers appear to have the same psychological profile as adult problem gamblers and that gambling involvement can negatively impact on decision-making ability that, in adolescence, is still developing. The correlations between interpretative bias and decision-making suggested that the beliefs in the ability to influence gambling outcomes may facilitate decision-making impairment.