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.     

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.     

The Role of Metacognition in Pathological Gambling: A Mediation Model

Pathological gambling involves multitudinous costs related to financial, legal, and public health care aspects, as well as to specific psychological disorders. Despite the overall evidence suggesting that comorbid disorders represent a risk factor for pathological gambling, there is scant evidence on the appropriate treatments for gamblers with such disorders. In this context, metacognitive therapy is an interesting approach because it considers psychological disorders as a result of the activation of perseverative cognitive processes and attentional strategies in response to inner events. Several studies report that metacognition is associated with different psychological problems. This study investigated the relationship among comorbid disorders, metacognition, and pathological gambling. 69 pathological gamblers at the first hospital admission and 58 controls drawn from general population (matched for age, gender, education) completed a battery of self report instruments: Symptom Checklist-90-R, Metacognition Questionnaire 30, South Oaks Gambling Scale. Compared to controls, pathological gamblers showed higher level of comorbid symptomatology and metacognition. Correlation analyses showed that: comorbid symptomatology and metacognition were positively and significantly correlated with pathological gambling; metacognition was positively and significantly associated with comorbid symptomatology. Mediation analysis indicated that dysfunctional metacognitive strategies could have an indirect effect on pathological gambling mediated by concurrent psychological disorders. These findings provide some implications for gambling treatment programs: pathological gamblers should be screened for psychiatric disorders, and metacognitive therapy could be considered a correct treatment of pathological gamblers. Metacognitive therapy might lead to the reduction of the pathological gambling by the diminishing of the concurrent psychological disorders.     

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.     

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.     

Adaptive and Maladaptive Coping Strategies in Adult Pathological Gamblers and Their Mediating Role with Anxious-Depressive Symptomatology

Coping plays a central role in the appearance and persistence of pathological gambling. Anxious and depressive symptomatology also influence pathological gambling and are related to coping. This study aimed to analyze pathological gamblers’ coping strategies and styles, as well as associated anxious and depressive symptomatology. The study sample included 167 male pathological gamblers (mean age = 39.29 years) and 107 non-gamblers (mean age = 33.43 years). Measures of gambling, coping, and anxious and depressive symptomatology were used. Results showed that pathological gamblers’ scored higher in all the maladaptive coping strategies, problem- and emotion-focused disengagement, and disengagement subscales. These subscales also correlated with pathological gambling, and anxious and depressive symptomatology. Pathological gamblers also scored higher in emotional expression and emotion-focused engagement, with no differences in the rest of the adaptive coping strategies. Coping was also found to predict pathological gambling and anxious and depressive symptomatology. It was found that coping mediated the relationship between pathological gambling and anxious symptomatology when controlling for the effect of age. Specifically, social withdrawal and disengagement stood out as mediators. These results provide practical information for use in clinical settings with people diagnosed with pathological gambling.     

Gambling Disorder and Affect Regulation: The Role of Alexithymia and Attachment Style

The aim of the present study was to explore the dimensions of alexithymia and attachment styles in a group of disordered gamblers and to evaluate the relationship between alexithymia, attachment styles, and the severity of gambling disorder. Sixty disordered gamblers diagnosed according to the diagnostic and statistical manual-5 filled out the Kurzfragebogen zum Glücksspielverhalten, the 20-Item Toronto Alexithymia Scale, and the Experiences in Close Relationships-Revised. Approximately 70 % of the sample displayed ‘intermediate’ and ‘severe’ gambling severity levels on the Kurzfragebogen zum Glücksspielverhalten, and 77 % showed ‘high’ or ‘borderline’ levels of alexithymia on the Toronto Alexithymia Scale (mean = 56.40). Regarding attachment styles, 70 % of the sample displayed an ‘insecure’ attachment, with a particularly high prevalence of the ‘fearful’ style (26.66 %). A linear regression analysis revealed that only the anxiety dimension of the Experiences in Close Relationships questionnaire predicted the severity of gambling. Our data appear to confirm that gambling disorder is characterised by emotional and relational dysregulation, and that pathological gambling behaviours may serve as external regulators of internal undifferentiated emotional states.     

Temperament and Character in Pathological Gambling

Objective We have studied temperament and character in pathological gambling (PG). Methods Thirty-eight DSM-IV verified pathological gamblers (31 males and 7 females; mean age 35.4 ± 10.4 years) were tested with Cloninger’s Temperament and Character Inventory (TCI). Matched controls were chosen from the normal population. Results Pathological gamblers scored higher on the temperament factors novelty seeking (NS) and harm avoidance (HA). The most pronounced difference was found in the character factor self-directedness (SD). The pathological gamblers differed from controls in cooperativeness and self-transcendence. A personality disorder was found in 29% of the pathological gamblers 84% of whom scored either low on SD and high on impulsivity or had a more dishonest behaviour. Two-thirds of pathological gamblers showed immature character with or without high HA in temperament. The other third showed normal-character extravagant behaviour (86%), high impulsivity (36%) and less responsibility (50%) being the most common personality traits. Conclusion HA and NS might be trait-like characteristics in PG.     

The development of pathological gambling in Sweden

The development and the social, psychological and cultural conditions of pathological gambling reported by 42 interviewed pathological gamblers were compared with data from 63 pathological gamblers identified by case-finding. The two studies gave similar results. Gambling on horse races, roulette and bingo were the only types showing a progressive increase in involvement over time. When gambling heavily 40% of the pathological gamblers regularily experienced a state of altered consciousness. When abstaining from gambling withdrawal-like symptoms were experienced by a third. Fifty-two percent reported at least one family member often gambling. Pathological gambling appears to be a secret behaviour, although there are collective features in its development.     

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.     

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.     

Gambling and Problem Gambling Among Recently Sentenced Women in New Zealand Prisons

Ninety-four recently sentenced women prisoners were interviewed to assess aspects of their gambling involvement, problem gambling and relationships between gambling and criminal offending. A third of the women, on the basis of their SOGS-R scores, were assessed as lifetime probable pathological gamblers and just under a quarter were assessed as probable pathological gamblers during the 6 months prior to imprisonment. For women prisoners, a preference for non-casino gaming machines and housie were predictive of problem gambling. Relative to non-problem gamblers, problem gamblers experienced higher rates of childhood conduct disorder and current non-psychotic mental disorder. Just over a quarter of prisoners and a half of the problem gamblers had committed a crime to obtain money to gamble. Few women said their early offending or convictions related to gambling. It was concluded that most women were “criminals first and problem gamblers second” rather than people whose offending careers commenced as a consequence of problem gambling. However, the extent of problem gambling-related offending among the women prisoners highlights the potential for comprehensive assessment and treatment programs in prison to reduce recidivism and other adverse impacts of problem gambling and gambling-related offending.     

Impulsivity and Stress Response in Pathological Gamblers During the Trier Social Stress Test

Gambling has been associated with increased sympathetic nervous system output and stimulation of the hypothalamic–pituitary–adrenal axis. However it is unclear how these systems are affected in pathological gambling. This study aimed to investigate the effect of the Trier Social Stress Test (TSST) on cortisol and on cardiac interbeat intervals in relation to impulsivity, in a sample of male pathological gamblers compared to healthy controls. In addition, we investigated the correlation between the TSST, duration of the disorder and impulsivity. A total of 35 pathological gamblers and 30 healthy controls, ranging from 19 to 58 years old and all male, participated in this study. Stress response was measured during and after the TSST by salivary cortisol and cardiac interbeat intervals; impulsivity was assessed with the Barratt Impulsiveness Scale (BIS-11). Exposure to the TSST produced a significant increase in salivary cortisol and interbeat intervals in both groups, without differences between groups. We found a negative correlation between baseline cortisol and duration of pathological gambling indicating that the longer the duration of the disorder the lower the baseline cortisol levels. Additionally, we found a main effect of impulsivity across groups on interbeat interval during the TSST, indicating an association between impulsivity and the intensity of the neurovegetative stress response during the TSST. Involvement of the hypothalamic–pituitary–adrenal axis in pathological gambling was confirmed together with evidence of a correlation between length of the disorder and diminished baseline cortisol levels. Impulsivity emerged as a personality trait expressed by pathological gamblers; however the neurovegetative response to the TSST, although associated with impulsivity, appeared to be independent of the presence of pathological gambling.     

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.     

Psychopathology in pathological gamblers seeking treatment

High rates of psychiatric symptoms have been reported in pathological gamblers. This study of psychiatric comorbidity in pathological gamblers is the first to use structured psychiatric interviews assessing DSM-III-R Axis I and II disorders. The Structured Clinical Interview for DSM III-R (SCID-P, SCID-II) was administered to 40 (25 male, 15 male) pathological gamblers seeking outpatient treatment in Minnesota for gambling, and 64 (41 male, 23 female) controls. High lifetime rates of Axis I (92%) but not Axis II (25%) psychopathology were found in pathological gamblers as compared to controls. No differences between male and female gamblers were found in rates of affective, substance use or personality disorders. Females had higher rates of anxiety disorders and histories of physical/sexual abuse. Possible associations between psychiatric disorders and pathological gambling are discussed along with gambler typologies and implications for future research.The authors wish to gratefully acknowledge the assistance of: Gary Christenson, M.D., Carol Peterson, Ph.D., William Meller, M.D., Thomas Mackenzie, M.D.     

Treatment Goal Selection for Female Pathological Gambling: A Comparison of Abstinence and Controlled Gambling

The current study was an exploratory investigation of the selection of controlled gambling as a goal of treatment for female pathological gambling. Specifically, it aimed to explore: 1) the popularity of controlled gambling as a goal of treatment; 2) the reasons pathological gamblers select abstinence and controlled gambling as goals of treatment; and 3) the characteristics of pathological gamblers attracted to abstinence and controlled gambling. The sample comprised 85 female pathological gamblers attending a cognitive-behavioural treatment program for pathological gambling. The selection of controlled gambling by one-third (34%) of the sample suggests that, at least in the Australian context, controlled gambling is a relatively popular goal of treatment for female pathological gamblers. In this study, the only differences between treatment-seeking female pathological gamblers selecting abstinence and controlled gambling were that those selecting controlled gambling were older and were less likely to endorse the belief that problematic gambling is a disease or affliction that can only be overcome by lifelong abstinence. Further research investigating the characteristics of pathological gamblers associated with controlled gambling as both a goal and outcome of treatment is required in order to ensure that treatment-seeking pathological gamblers can make an informed decision regarding their goal selection.     

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.     

Gender Differences in the Presentation of Observable Risk Indicators of Problem Gambling

In many countries where gambling is legalised, there has been a strong public policy focus on the need for strategies to reduce gambling related harm. These have often included policies requiring staff in gambling venues to identify and/or assist people who might be experiencing gambling-related harm. To facilitate this process, researchers have developed visible behavioural indicators that might be used to profile potentially problematic gambling. Few of these studies have, however, examined whether such indicators or ‘warning signs’ might differ between men and women. In this study, we describe the results of an analysis of data drawn from 1185 fortnightly gamblers that included 338 problem gamblers as classified by the Problem Gambling Severity Index. Indicators of problem gambling were similar between males and females with a few key exceptions. Indicators reflecting emotional distress were more commonly reported by females with gambling problems, whereas problem gambling males were more likely to display aggressive behaviour towards gambling devices and others in the venue. Amongst males, signs of emotional distress as well as attempts to conceal their presence in venues from others most strongly differentiated between problem and non-problem gamblers. Amongst females, signs of anger, a decline in grooming and those attempts to access credit were the most distinguishing indicators. These findings have implications for the refinement of identification policies and practices.     

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.     

Living in the Now: Decision-Making and Delay Discounting in Adolescent Gamblers

Several studies examining the relationship of affective decision-making and delay discounting in disordered gambling demonstrated that adult pathological gamblers differ from healthy controls on both reward-related decision tasks. To date no study analyzed the relative contribution of these variables in adolescent gambling. This study was designed to compare affective decision-making and delay discounting in gamblers and nongamblers Italian adolescents, controlling for alcohol consumption. A total of 138 adolescents took part in the research. Two equal-number groups, defined according to the scoring rules for the South Oaks Gambling Screen-Revised for Adolescents, were administered the Iowa Gambling Task (IGT), the Monetary Choice Questionnaire (MCQ), and the Alcohol Use Disorders Identification Test (AUDIT). Zero-order correlations among all variables revealed a moderate negative association between IGT and MCQ scores only in nongamblers group. Results of mixed-model ANOVAs indicated that, compared with nongamblers, adolescent gamblers performed worse on the IGT, showed steeper delay discounting, and scored significantly higher on the AUDIT. Results of logistic regression analysis indicated that IGT, MCQ, and AUDIT scores are all significant predictors of gambling status. This novel finding provides the first evidence of an association among problematic gambling, maladaptive decision-making, and steep delay discounting among adolescents, as already observed in adults.