Defining a threshold of harm from gambling for population health surveillance research

The measurement of harm in the context of non-problem gambling has received little attention from researchers in the field. Using the combined data from six provincial gambling surveys conducted in Canada between 2001 and 2005 (N = 12,285), we compared how different thresholds of defining gambling-related harm impacts prevalence, the relationship with indicators of gambling intensity and the characteristics of non-pathological gamblers who report experiencing below threshold symptoms of problem gambling. Survey items defining harm were drawn from the Problem Gambling Severity Index (PGSI) of the Canadian Problem Gambling Index. Three definitions of harm – reporting one or more problem gambling symptoms, reporting two or more problem gambling symptoms and having a PGSI score ≥ 3 – demonstrated a strong relationship with indicators of gambling intensity, and reliably differentiated low-threshold and zero symptom problem gamblers in terms of gambling characteristics and other risk factors.     

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.     

A Taxometric Analysis of Problem Gambling Data from a South African National Urban Sample

We investigate the question whether problem gambling (PG) in a recent South African sample, as measured by the Problem Gambling Severity Index (PGSI), is dimensional or categorical. We use two taxometric procedures, Mean Above Minus Below A Cut (MAMBAC) and Maxim Covariance (MAXCOV), to investigate the taxonic structure of PG as constructed by the PGSI. Data are from the 2010 South African National Urban Prevalence Study of Gambling Behavior. A representative sample of the urban adult population in South Africa (N = 3,000). Responses are to the 9 item PGSI. MAMBAC provided positive but modest evidence that PG as measured by the PGSI was taxonic. MAXCOV pointed more strongly to the same conclusion. These analyses also provide evidence that a PGSI cutoff score of 10 rather than the standard 8 may be called for. PG as constructed by the PGSI may best be thought of as categorical, but further studies with more theory based measurements are needed to determine whether this holds in a wider range of samples and for other screens. A higher cutoff score may be called for on the PGSI when it is used for research purposes to avoid false positives.     

The Temporal Relationship Between Faulty Gambling Cognitions and Gambling Severity in Young Adults

Disordered gambling in young adults is hypothesized as being related to mistaken gambling-related cognitions. Few studies have examined the temporal order of this relationship using longitudinal data. The purpose of this study is to understand the directionality of the relationship between gambling cognitions and gambling severity in a longitudinal sample of young adults. Young adults (N = 578), initially aged 18–21 years, completed the Manitoba Longitudinal Survey of Young Adults at two time points approximately 2–3 years apart. Measures of beliefs about randomness related to gambling and gambling severity, as measured by the Problem Gambling Severity Index, were utilized. A cross-sectional relationship between gambling severity and gambling-related cognitions was observed with greater gambling severity being associated with increased endorsement of mistaken cognitions. Evidence for a bidirectional longitudinal relationship was observed with faulty gambling cognitions leading to later problematic gambling behaviors and vice versa when examining a total beliefs scale. When examining specific beliefs about randomness, initial gambling group membership predicted later endorsement of certain beliefs about randomness while initial belief ratings did not impact later gambling group membership. The results of this study suggest a bidirectional relationship between gambling severity and erroneous gambling-related cognitions. However, when examining specific beliefs about randomness, evidence was found for problem gambling behaviors leading to erroneous gambling beliefs. These findings suggest that prevention efforts targeting cognitions may not be as effective in impacting those not yet demonstrating disordered gambling behaviors.     

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.     

The Four Es of Problem Gambling: A Psychological Measure of Risk

A focus group of Reno area Gamblers Anonymous members identified four psychological traits contributing to risk for problem gambling, including: Escape, Esteem, Excess and Excitement. A panel of four experts authored 240 Likert-type items to measure these traits. By design, none of the items explicitly referred to gambling activities. Study 1 narrowed the field of useful items by employing a quasi-experimental design which compared the answers of Reno area Gamblers Anonymous members (N = 39) to a control sample (N = 34). Study 2 submitted successful items, plus new items authored with the knowledge gained from Study 1, to validation in a random sample telephone survey across Queensland, Australia (N=2577). The final 40 item Four Es scale (4Es) was reliable (α=.90); predicted gambling problems as measured by the Canadian Problem Gambling Index of Severity (PGSI, Ferris & Wynne (2001). The Canadian Problem Gambling Index: Final Report: Canadian Centre on Substance Abuse); and distinguished problem gamblers from persons with alcohol abuse problems. The new scale can provide a basis for further study in harm minimization, treatment, and theory development.     

Gambling motivation: comparisons across gender and preferred activity

People gamble for emotional, social and monetary reasons. However, it remains unclear whether the relationships between these distinct aspects of gambling motivation and gambling behaviour hold across gender and types of gambling. Thus, the current study compared gambling motivation across different subgroups while taking into account problem gambling severity. A total of 4945 adults were recruited as part of the Northern Territory (Australia) population gambling survey. Of the full sample, 1207 participants (52% female) completed the Gambling Outcomes Expectancies Scale to assess gambling motivation. This subsample comprised those who scored one or more on the PGSI (n = 407) and a random sample of those who gambled at least once a year with a PGSI of zero (n = 800). The findings revealed excitement, escape and monetary expectancies increased in concert with gambling risk for both men and women, although only escape differentiated the low-risk and at-risk gamblers when other expectancies were controlled. In relation to differences across types of gambling, horse races/sports bettors rated excitement but not escape more favourably than lottery players. These findings suggest problem gambling severity should be considered when examining motivation difference by gender and that gambling motivation depends, in part, on preferred activity.     

Clustering Finnish Gambler Profiles Based on the Money and Time Consumed in Gambling Activities

Gambling involves consumption of gamblers’ money and time. Gamblers are a heterogeneous group, and in addition to grouping gamblers based on personality factors, it is also important to find different gambler profiles with respect to their gambling behavior. Using the nationally representative survey ‘Finnish Gambling 2011’ (N = 4484), this article studies the subtypes of Finnish gamblers based on the frequency of gambling and the amounts of money and time used in different gambling forms. Cluster analysis reveals six profiles of gamblers, from infrequent gamblers to omnivorous gamblers. In the further analysis of the clusters, it was found that the highest problem gambling prevalence was in the groups of sport betting + electronic gaming machine gamblers and omnivorous gamblers, which were also both dominated by men. Certain gambling consumption patterns and risk factors for problem gambling are related to both socio-demographic backgrounds of the gamblers as well as the structural and situational characteristics of the games. The results have implications for the prevention of problem gambling, as some consumption patterns may be connected with the probability of developing gambling problems.     

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.     

About the contributors

The paper reports secondary analysis of data from the 2010 British Gambling Prevalence Survey, a household survey of a representative sample of the population aged 16 years and over (N = 7756). Responses to questions about frequency of gambling and average monthly spend on each of 15 forms of gambling, and responses to two different problem gambling screens (DSM-IV and PGSI), were used to derive estimates, for each form of gambling separately, of the percentage of (1) all days play (two estimates), and (2) all spend (four estimates), attributable to problem gamblers. Although these estimates must be treated as approximations only, they demonstrate that problem gamblers make a far greater contribution to total gambling attendances and losses than problem gambling prevalence figures would suggest. There are certain forms of British gambling to which problem gamblers may be contributing as much as 20–30% of all days play and spend, and moderate risk gamblers a possible further 10–20%.     

Personality,Gender, and Family History in the Prediction of College Gambling

The present study examined the degree to which gambling behaviors and gambling-relevant cognitive distortions could be predicted by personality factors, gender, and familial history of substance use and gambling problems in a large sample of college students (N = 581). Results indicate that parental gambling problems and, especially for males, a propensity to experience negative emotions predicted time spent gambling and gambling problems. Negative emotionality, along with parental substance use problems, impulsivity, and being male predicted gambling-related cognitive distortions. The differing pattern for impulsivity with respect to behaviors and beliefs might be explained by the low accessibility of gambling venues for the student population. We compare the present findings with past studies examining gambling behaviors in adult populations.     

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.     

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.     

Validity of the Problem Gambling Severity Index Interpretive Categories

The Problem Gambling Severity Index (PGSI) is a widely used nine item scale for measuring the severity of gambling problems in the general population. Of the four gambler types defined by the PGSI, non-problem, low-risk, moderate-risk and problem gamblers, only the latter category underwent any validity testing during the scale’s development, despite the fact that over 95% of gamblers fall into one of the remaining three categories. Using Canadian population data on over 25,000 gamblers, we conducted a comprehensive validity and reliability analysis of the four PGSI gambler types. The temporal stability of PGSI subtype over a 14-month interval was modest but adequate (intraclass correlation coefficient = 0.63). There was strong evidence for the validity of the non-problem and problem gambler categories however the low-risk and moderate-risk categories showed poor discriminant validity using the existing scoring rules. The validity of these categories was improved with a simple modification to the scoring system.     

Problem Gambling Inside and Out: The Assessment of Community and Institutional Problem Gambling in the Canadian Correctional System

This paper reports on the results of a multi-site survey of gambling behaviour and gambling problems amongst offenders in correctional institutions in Ontario, Canada, conducted between 2008 and 2011. A total of 422 (completion rate 61.5 %) incarcerated offenders (381 male and 41 female) took part in the study including 301 federal offenders and 121 provincial offenders. Based on the Problem Gambling Severity Index of the Canadian Problem Gambling Index (CPGI/PGSI) the prevalence rate of severe problem gambling was 8.9 prior to incarceration and 4.4 % during incarceration. These numbers are substantially higher than rates found among the general public. Thirty-four percent of the sample reported gambling in prison. Half of those who suffered from gambling problems before incarceration continued to have gambling problems during incarceration. People with problems related to slot machines prior to incarceration reported fewer gambling problems during incarceration compared to other problem gamblers.     

The Development of a Multi-dimensional Gambling Accessibility Scale

The aim of the current study was to develop a scale of gambling accessibility that would have theoretical significance to exposure theory and also serve to highlight the accessibility risk factors for problem gambling. Scale items were generated from the Productivity Commission’s (Australia’s Gambling Industries: Report No. 10. AusInfo, Canberra, 1999) recommendations and tested on a group with high exposure to the gambling environment. In total, 533 gaming venue employees (aged 18–70 years; 67% women) completed a questionnaire that included six 13-item scales measuring accessibility across a range of gambling forms (gaming machines, keno, casino table games, lotteries, horse and dog racing, sports betting). Also included in the questionnaire was the Problem Gambling Severity Index (PGSI) along with measures of gambling frequency and expenditure. Principal components analysis indicated that a common three factor structure existed across all forms of gambling and these were labelled social accessibility, physical accessibility and cognitive accessibility. However, convergent validity was not demonstrated with inconsistent correlations between each subscale and measures of gambling behaviour. These results are discussed in light of exposure theory and the further development of a multi-dimensional measure of gambling accessibility.     

Description and pre-post evaluation of a telephone and Internet based treatment programme for pathological gambling in Norway: a pilot study

Although the effectiveness of treatments for pathological gamblers is gaining support, only 10% of pathological gamblers seek treatment. Providing treatment via the Internet may lower the thresholds for treatment seeking. A new telephone and Internet based treatment programme for pathological gamblers is presented in this article, along with a pre-post evaluation of the programme. The participants (N = 112) were problem gamblers who were either self-referred or referred by their general practitioner. Data from post-treatment and 3-month follow-up are evaluated. The results suggest that using Internet and telephone-assisted treatment interventions can significantly reduce symptoms of pathological gambling (measured by the South Oaks Gambling Screen – Revised). The intervention was also associated with improvement on cognitive distortions, measured by the Gamblers Belief Questionnaire, and general psychological distress and psychopathology as measured by the Symptom Checklist-90-Revised. Although Internet-based treatment programmes have been suggested to have advantages compared to traditional face-to-face therapy, research in this area is scarce. This pilot study contributes to the growing literature in this area, and provides tentative support for the effectiveness of Internet based treatment interventions for pathological gamblers.     

Cue-Reactive Rationality,Visual Imagery and Volitional Control Predict Cue-Reactive Urge to Gamble in Poker-Machine Gamblers

Poker-machine gamblers have been demonstrated to report increases in the urge to gamble following exposure to salient gambling cues. However, the processes which contribute to this urge to gamble remain to be understood. The present study aimed to investigate whether changes in the conscious experience of visual imagery, rationality and volitional control (over one’s thoughts, images and attention) predicted changes in the urge to gamble following exposure to a gambling cue. Thirty-one regular poker-machine gamblers who reported at least low levels of problem gambling on the Problem Gambling Severity Index (PGSI), were recruited to complete an online cue-reactivity experiment. Participants completed the PGSI, the visual imagery, rationality and volitional control subscales of the Phenomenology of Consciousness Inventory (PCI), and a visual analogue scale (VAS) assessing urge to gamble. Participants completed the PCI subscales and VAS at baseline, following a neutral video cue and following a gambling video cue. Urge to gamble was found to significantly increase from neutral cue to gambling cue (while controlling for baseline urge) and this increase was predicted by PGSI score. After accounting for the effects of problem-gambling severity, cue-reactive visual imagery, rationality and volitional control significantly improved the prediction of cue-reactive urge to gamble. The small sample size and limited participant characteristic data restricts the generalizability of the findings. Nevertheless, this is the first study to demonstrate that changes in the subjective experience of visual imagery, volitional control and rationality predict changes in the urge to gamble from neutral to gambling cue. The results suggest that visual imagery, rationality and volitional control may play an important role in the experience of the urge to gamble in poker-machine gamblers.     

A retrospective study of attitudes and triggers towards gambling of prisoners before their incarceration in Australia

The purpose of this study is to examine the relationship between attitudes towards gambling, triggers for gambling, and the severity of the gambling problem of convicted offenders before their incarceration. Participants were recruited through transitional managers of prisons. There were 96 referrals, of which 66 participants completed the study. Results showed that there was a significant correlation between the Gambling Attitudes and Beliefs Survey (GABS) and the Inventory of Gambling Situations (IGS) and a significant correlation between the IGS and the EIGHT Gambling Screen. However, no significant correlation was found between the EIGHT Gambling Screen and the GABS. The results indicated that attitudes towards and beliefs about gambling did not directly influence the severity of the participants’ gambling problem. Attitudes and beliefs were more closely linked to their triggers for gambling, and these triggers carried more weight in the severity of their gambling problem. These results suggest that problem gamblers need assistance in dealing with their trigger situations for gambling as well as receiving a therapeutic programme to change their attitudes towards and beliefs about gambling.     

Adolescent Gambling Behavior: A Prevalence Study and Examination of the Correlates Associated with Problem Gambling

Eight-hundred and seventeen adolescent high school students in the Montreal region completed the DSM-IV-J gambling screen along with a questionnaire devised by the authors inquiring about their gambling behavior, including items assessing the types of activities in which they engage, frequency of involvement, reasons for gambling, and their cognitive perceptions of gambling activities. The results indicate that, in general, 80.2% of students reported having gambled during the previous year, with 35.1% gambling a minimum of once per week. Adolescents reported participating in gambling behavior more often than any other addictive behavior, including cigarette smoking, alcohol consumption, and illicit drug use. The mean age of onset of gambling behavior for the sample was 11.5 years. The rate of pathological gambling was 4.7% as measured by the DSM-IV-J. Pathological gamblers were more likely to have parents with gambling problems and to be engaging in illegal activities than non-pathological gamblers. Gender differences were evident, with males engaging in gambling activities more than females. Differences in game preferences were found, with males more attracted to sports lottery tickets and sports pool betting and females more attracted to lottery tickets and bingo. Gambling awareness and prevention issues are addressed.