Cue Reactivity in Active Pathological,Abstinent Pathological,and Regular Gamblers

Twenty-one treatment-seeking pathological gamblers, 21 pathological gamblers in recovery, and 21 recreational gamblers watched two video-taped exciting gambling scenarios and an exciting roller-coaster control scenario while their arousal (heart rate and subjective excitement) and urge to gamble were being measured. The gamblers did not differ significantly in cue-elicited heart rate elevations or excitement. However, the active pathological gamblers reported significantly greater urges to gamble across all cues compared to the abstinent pathological gamblers and, with marginal significance (p = 0.06), also compared to the social gamblers. Further exploration of these findings revealed that active pathological gamblers experience urges to gamble in response to exciting situations, whether or not they are gambling related, whereas abstinent and social gamblers only report urges to an exciting gambling-related cue. This suggests that for pathological gamblers excitement itself, irrespective of its source, may become a conditioned stimulus capable of triggering gambling behavior. Implications for treatment and future research are discussed.     

Psychophysiological and subjective responses of a community sample of video lottery gamblers in gambling venues and laboratory situations

Physiological and subjective arousal in lounge and laboratory conditions were explored using heart rate (HR), skin conductance (SCL) and subjective ratings for a community sample (N=30) of video lottery terminal gamblers (14 non-pathological gamblers [NPG] and 16 probable pathological gamblers [PPG]). For all participants, mean heart rates and ratings of subjective arousal were higher in the lounge situation, while SCL did not differ between locations. SCL increased over baseline when gambling in both situations. HR initially increased over baseline in the lounge situation only, but by the end of gambling HR increased in both situations. HR, SCL and subjective reports were moderately correlated between venues. No correlations were found between subjective and physiological measures of arousal.     

Excitement-seeking Gambling in a Nationally Representative Sample of Recreational Gamblers

Excitement-seeking and related constructs have been associated with heavier gambling and negative health measures in problem and/or pathological gamblers. Most adults gamble recreationally and an understanding of the relationship between excitement-seeking as a motivation for gambling amongst subsyndromal gamblers has significant public health implications. Logistic regression analyses were used to examine a national sample of past-year recreational gamblers (N = 1,476) to identify characteristics distinguishing gamblers acknowledging gambling for excitement (“Excitement-seeking Gamblers” or EGs) and gamblers denying gambling for excitement (“Non-excitement-seeking Gamblers” or NEGs). EGs were more likely than NEGs to report alcohol use and abuse/dependence, any substance abuse/dependence, incarceration, large gambling wins and losses, more frequent and varied gambling, and symptoms of pathological gambling (i.e., at-risk gambling). Together, these findings indicate that EGs are more likely than NEGs to demonstrate problems in multiple areas characterized by impaired impulse control.     

Differences in Cognitive Distortions Between Pathological and Non-Pathological Gamblers with Preferences for Chance or Skill Games

Cognitive distortions have been thought to play an important role in the development and maintenance of pathological gambling. The present study investigated whether severity of gambling problems and gamblers’ preference for chance or skill games were related to two sub-factors of cognitive distortions as measured by the Gamblers Belief Questionnaire: Luck/Perseverance, which reflects an individual’s perception that chance is favorable to him/her, and Illusion of Control, which reflects an individual’s perception that his/her behavior influences chance occurrences. Participants (N = 166) were recruited from a race track (n = 79), off-course betting facilities (n = 50) and from an online treatment program for problem gamblers (n = 49). Gambling severity was measured by the South Oaks Gambling Screen, and 73 were classified as pathological gamblers whereas 93 were classified as non-pathological gamblers. The present study supports previous proposals that cognitive distortions are core processes related to gambling behavior as pathological gamblers reported more cognitive distortions than did non-pathological gamblers. A preference for skill games was also associated with greater Illusion of Control compared to a preference for chance games. For gamblers preferring skill games there were no differences in Luck/Perseverance or Illusion of Control between pathological and non-pathological gamblers.     

The role of subjective mood states in the maintenance of fruit machine gambling behaviour

Explanations involving the etiology of pathological gambling have tended to emphasize psychosocial factors. However, the possibility that psychobiological factors are important should not be ruled out. Two currently researched psychobiological approaches to gambling involve the role of (i) arousal and (ii) depression. A study analyzing the subjective mood variables of 60 gamblers (44 males and 16 females; mean age 23.4 years) using self report measures was carried out in an attempt to identify which mood states are critical to gambling maintenance. Results indicated that regular and pathological gamblers experienced more depressive moods before playing and that regular and pathological gamblers experienced significantly more excitement during gambling than non regular gamblers. These results are discussed in relation to contemporary literature regarding the roles of arousal and depression in the maintenance of gambling behaviour.The author would like to thank the UK Economic and Social Research Council for funding this research through a research studentship. The author would also like to thank Henry Lesieur and the anonymous reviewers for their constructive advice and criticism in the revisions of this paper.     

Examining DSM-IV Criteria for Pathological Gambling: Psychometric Properties and Evidence from Cognitive Biases

We examined the DSM-IV criteria for pathological gambling as assessed with the DSM-IV-based Diagnostic Interview for Gambling Severity (DIGS; Winters, Specker, & Stinchfield, 2002). We first analyzed the psychometric properties of the DIGS, and then assessed the extent to which performance on two judgment and decision-making tasks, the Georgia Gambling Task (Goodie, 2003) and the Iowa Gambling Task (Bechara, Damasio, Damasio, & Anderson, 1994), related to higher reports of gambling pathology. In a sample of frequent gamblers, we found strong psychometric support for the DSM-IV conception of pathological gambling as measured by the DIGS, predictive relationships between DIGS scores and all cognitive performance measures, and significant differences in performance measures between individuals with and without pathological gambling. Analyses using suggested revisions to the pathological gambling threshold (Stinchfield, 2003) revealed that individuals meeting four of the DSM-IV criteria aligned significantly more with pathological gamblers than with non-pathological gamblers, supporting the suggested change in the cutoff score from five to four symptoms. Discussion focuses on the validity of the DSM-IV criteria as assessed by the DIGS and the role of cognitive biases in pathological gambling.     

Flow and Dissociation: Examination of Mean Levels, Cross-links, and Links to Emotional Well-Being across Sports and Recreational and Pathological Gambling

To examine whether flow (Csikszentmihalyi (1990). Flow: The psychology of optimal experience. NY: Harper & Row) and dissociation (Jacobs (1986). Journal of Gambling Behavior, 2, 15-31) are experienced across sports and recreational and pathological gambling, we assessed a sample of 511 college students (256 females and 255 males, M age = 19.54) that was comprised of 14 pathological gamblers, 21 non-addicted gamblers, and 476 athletes. The findings showed that both flow and dissociation lay on a continuum of subjective experiences across activity groups. Specifically, pathological gamblers experienced lower levels of flow than athletes, whereas recreational gamblers lay in between the previous groups in this regard. In contrast, pathological gamblers experienced higher mean levels of dissociation than athletes and recreational gamblers who, in turn, were similar in this regard. A LISREL model showed that flow was positively associated with general emotional well-being, whereas dissociation was negatively associated with well-being.     

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.     

Withdrawal and Tolerance Phenomenon in Problem Gambling

The phenomenological similarities between gambling and substance dependence have led to the conceptualization of pathological gambling as an addictive disorder. Tolerance and withdrawal are important features of both disorders, suggesting commonalities in the neurobiological processes associated with neuroadaptational underpinnings. However, there are few empirical studies supporting the presence of tolerance and withdrawal reported in the gambling literature. Moreover, there are no studies comparing the equivalence of tolerance and withdrawal between gambling and alcohol dependence. This study compared tolerance and withdrawal features in samples of gamblers, alcoholics and gamblers who also met criteria for alcohol dependence. In contrast to the addiction model, findings indicate that, while a majority of participants increased bet size, the motivation to do so was not for excitement or to maintain arousal levels as indicated by the DSM-IV-TR but because of cognitive factors related to winning. Results supported the notion that pathological gamblers experienced similar levels of withdrawal symptom severity as alcohol-dependent participants. Further research is needed to evaluate whether those symptoms result from the inability to gamble or from the loss of an avoidant stress coping strategy.     

Numerical Reasoning Ability and Irrational Beliefs in Problem Gambling

Numerous studies have shown that pathological gamblers are particularly prone to various cognitive biases that may explain why they continue to gamble despite having occurred substantial losses. A common explanation advanced to account for this finding is that pathological gamblers may have poorer numerical or statistical knowledge than other people. Addressing these deficits is therefore seen as one possible way in which to assist pathological gamblers or prevent the development of problematic behaviour within the broader community. The aim of this study was test this assumption by assessing the numerical reasoning skills, objective gambling knowledge and tendency towards biased reasoning in a sample of 90 regular poker-machine gamblers (pathological and non-pathological) and a non-gambling comparison group (n = 45). Analyses based on both group comparisons and regression analyses controlling for differences in educational attainment showed that pathological gamblers scored significantly higher on the cognitive biases measure than other gamblers. However, this difference could not be attributed to poorer knowledge of gambling odds or limited numerical ability among pathological gamblers. The findings suggest that educating pathological gamblers with greater knowledge about the odds of gambling is unlikely to be an effective harm minimisation strategy.     

Plasma endorphin levels in pathological gambling

Despite its formal definition as a disorder of impulse control, pathological gambling has come under the generic label of addictive disorders with subjective excitement and physiological arousal as the major motivating factor. Individual differences in autonomic/cortical arousability in interaction with irregular schedules of reinforcement have been postulated to be important determinant factors in the pathogenesis of pathological gambling (Anderson & Brown, 1984). Mood disturbances and cross-addictions are frequently observed in pathological gamblers seeking treatment and the behavior has also been conceptualized as a defense against depression and anxiety. Recently the role of endorphins has been implicated in mood disturbances associated with psychiatric states and in addictive processes; the latter through their euphorogenic or reward-transmitting properties in accordance with operant and classical conditioning principles. The hypothesis that the etiology or maintenance of gambling behavior is related to endorphin activity was investigated in this study. Using radioimmunoassay techniques, baseline B-endorphin plasma levels were measured in a sample of 39 pathological gamblers seeking treatment and 16 male and 19 female non-gambling healthy control subjects. In addition, B-endorphin reactivity to gambling activity was measured in a subgroup of 13 horse-race gamblers.Diagnostic and Statistical Manual III criteria for diagnosis were used. Written consent was obtained. Blood samples were drawn at the same time of day for each subject. The experimental procedure consisted of taking baseline blood samples at 11 a.m. following which subjects were instructed to place a bet sufficient to excite them on a horse-race. A subsequent blood sample was taken at 2 p.m., five minutes after subjects listened to the race broadcast on radio. Heart rate measures and a visual analogue scale rating excitement, tension and urge to gamble were also administered immediately before and after the race broadcast. Results showed that as a group pathological gamblers did not differ from controls on baseline B-endorphin levels. But differentiating gamblers according to type of gambling activity revealed horserace addicts to have significantly lower baseline levels as compared to poker-machine players and controls. This finding provides empirical evidence for the hypothesis that distinct subgroups of gamblers exist and raises the corollary that different etiological factors may characterize each subgroup. That B-endorphin levels did not increase in response to gambling was explained by the failure of the relatively small bet size to generate high arousal.This paper was presented at the Sixth National Conference on Gambling and Risk Taking, held at Atlantic City, New Jersey, December 9 to 12, 1984.     

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.     

A Comparison of Depression and Styles of Coping in Male and Female GA Members and Controls

Depression and maladaptive coping styles are important components of theories of pathological gambling and are frequently foci of treatment with individuals with gambling problems. The present study aimed to improve understanding and treatment of pathological gambling by comparing levels of depression and styles of coping in male and female members of Gamblers Anonymous (GA) to a group of non-pathological gambling controls matched according to gender, age, education, and income. Pathological gambling was measured by the South Oaks Gambling Scale, depression by the Beck Depression Inventory, and coping styles by the Problem-Focused Styles of Coping inventory. Results showed that GA members reported significantly higher levels of depression and more maladaptive styles of coping than controls. Pathological gamblers' greater use of maladaptive coping was evident even when variance attributable to depression was removed, suggesting that their coping deficits may be pervasive. Female subjects reported significantly greater levels of depression and maladaptive coping thantheir male counterparts. Implications for treating depression and coping styles in pathological gamblers are discussed.     

Event frequency,excitement and desire to gamble,among pathological gamblers

In this study we compared gambling behaviour of 15 pathological gamblers (PG) and 15 non-problem gamblers (NPG) on two conditions of a commercially available slot machine. One condition used a commercially available two-second event frequency (games per minute), while the other condition used an experimental three-second event frequency. The payback percentage (wins relative to losses) and reward frequency (wins over number of games played) varied randomly across conditions. The results showed that PG had significantly higher measures than NPG on time spent gambling, excitement level and desire to play again in the two-second condition. In the three-second condition there were no differences in excitement level and desire to play again. The number of PG playing the maximum time (60 minutes) was reduced in the three-second version, and reward frequency contributed to reduction in time spent gambling. The results may have implications for understanding behavioural mechanisms of pathological gambling among slot machine players.     

Health Outcomes in Individuals with Problem and Pathological Gambling: An Analysis of the 2014 North Carolina Behavioral Risk Factor Survey System (BRFSS)

Problem and pathological gambling refers to subclinical and clinical levels of maladaptive gambling, respectively, and is associated with specific sociodemographic characteristics as well as a number of poor health outcomes. We examined such demographic, physical health, mental health, and health-related behaviors in a sample of 7045 low-risk gamblers and 244 problem/pathological gamblers. Participants completed the 2014 North Carolina Behavioral Risk Factor Surveillance System telephone survey. Using the National Opinion Research Center’s Diagnostic Screen for Gambling Disorders-CLiP, participants were categorized as either “problem/pathological gamblers” or “low-risk gamblers.” Problem/pathological gamblers were younger, more likely to be male, of ethnic minority status, unmarried, and of lower education than low-risk gamblers. No physical health variables differentiated the groups but problem/pathological gamblers reported experiencing significantly more adverse childhood experiences and engaging in significantly more tobacco and alcohol use compared to low-risk gamblers. Moreover, gender moderated relationships between gambling group and several of the alcohol use variables such that male problem/pathological gamblers exhibited greater alcohol use behavior than male low-risk gamblers but no such relationship was present in females. Overall, this study expands the current knowledgebase on disordered gambling and highlights the need to assess disordered gambling in public health samples. Clinical implications are discussed.     

A profile of gaming machine players in clubs in Sydney,Australia

New South Wales, Australia, is one of the major markets in the world for machine gaming, with its 1,441 registered clubs holding the dominant share of the state's machines. This study examined machine gambling behavior amongst a random sample of 3,000 club members from six of the largest clubs in Sydney, the capital city of New South Wales. The findings identify their machine gambling preferences and participation levels, isolate significant sociodemographic and other differences between gaming machine and non-gaming machine players, measure the prevalence of probable pathological gambling associated with machine gambling, and identify certain characteristics which differ significantly between probable pathological and non-pathological machine gamblers amongst the respondents.     

Gambling Behavior and Pathology in Relation to Impulsivity, Sensation Seeking, and Risky Behavior in Male College Students

Sensation seeking and impulsivity are two constructs of personality that are generally believed to be associated with risky behavior, including gambling. Despite the fact that pathological gambling is classified as an Impulsive Control Disorder in the DSM-IV, relatively little empirical research has investigated the relationship between gambling and impulsivity. The purpose of this study was to investigate the relationship between sensation seeking, impulsivity, risky behaviors and gambling. One hundred and forty-four male undergraduate university students completed several inventories measuring sensation seeking, impulsivity, gambling, and risky behaviors. Statistical analyses revealed a very high percentage of participants were classified in the pathological gambler range of scores. In addition, a significant difference was found between the relationships of sensation seeking, impulsivity, and risky behaviors with gambling scores in the pathological versus non-pathological groups. Pathological gambler's scores on measures of sensation seeking and impulsivity did not correlate with their degree of gambling pathology. In contrast, the sensation seeking and impulsivity scores of non-pathological gamblers did correlate with their scores of gambling pathology. These results have implications on Jacob's General Theory of Addiction. The findings of this study also suggest that the classification of gambling as an impulse control disorder rather than an addictive disorder needs to be reevaluated.     

Pathological gambling: A comparison of gambling at German-style slot machines and “Classical” gambling

German-style slot machines and related legal issues are described. On the basis of a survey on 437 members of self-help groups (Gamblers Anonymous) in Germany, slot machine gamblers were compared with casino gamblers on such variables as sociodemographic data, gambling behaviour, financial expenditure, emotional experience while gambling, symptoms of pathological gambling, psychosocial consequences and gambling related delinquency. The casino gamblers' gambling behaviour is financially more extensive. There were similarities regarding the emotional intensity of the gambling experience. However the casino gamblers show more pronounced symptoms of pathological gambling and the psychosocial consequences of their gambling behaviour are more severe. In spite of these differences, the data show that for young people slot machines can be as stimulating and therefore as dangerous as casino gambling. The young slot machine gambler runs a similar risk of acquiring a pathological gambling habit as the casino gambler.I would like to thank Dr. Gerhard Meyer for his support and his comments on the first draft of this article which is based on data from a research project led by him.     

Understanding the Relationship Between Subjective Wellbeing and Gambling Behavior

This paper examines the relationship between gambling behavior and subjective wellbeing. It is often asserted that populations consist of different types of gamblers: those for whom gambling is a harmless leisure activity and those (pathological/problem gamblers) for whom the activity has harmful effects. One might, therefore, assume that subjective wellbeing will be negativity associated with an individual’s level of gambling addiction. Alternatively, gamblers may choose to gamble because they derive utility from participating in this activity and so the relationship between happiness and gambling might be positively correlated. In this paper we test this association, empirically, using data from the 2010 British Gambling Prevalence Survey. The statistically significant findings from this analysis support the hypothesis that individual wellbeing falls as gambling disorder increases.     

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.