Risk and protective factors in problem gambling: an examination of psychological resilience

Psychological resilience – successful adaptation when faced with adversity – is a product of the balance of risk and protective factors relevant to an outcome. This study examined if protective factors (perceived resilience; mindfulness; grit; self-efficacy) explained variance in problem gambling tendencies (assessed with the Problem Gambling Severity Index) beyond the HEXACO personality traits (honesty-humility, emotionality, extraversion, agreeableness, conscientiousness, openness to experience) and risk factors for problem gambling (gender; age; socio-economic status; high frequency gambling behaviour; harsh unpredictable childhood environments; sensation-seeking; impulsivity; self-control; stress). This study used a crowdsourced community sample (n = 469) recruited from Amazon Mechanical Turk. Bivariate analyses showed that risk factors and some HEXACO traits (especially honesty-humility) were associated with problem gambling issues. Among protective factors, only trait mindfulness showed a bivariate association with problem gambling issues. Somewhat surprisingly, regression analyses revealed that protective factors did not explain variance in problem gambling beyond HEXACO traits and risk factors. However, in exploratory analyses, mindfulness and self-efficacy – both modifiable protective factors – moderated the relationship between high-frequency gambling (a key proximate antecedent of problem gambling) and problem gambling tendencies. These results suggest mindfulness and self-efficacy may serve as ‘buffers’ against the development of problem gambling issues and may be promising targets for clinical interventions.     

Trait Mindfulness,Problem-Gambling Severity,Altered State of Awareness and Urge to Gamble in Poker-Machine Gamblers

In Australia, poker-machine gamblers represent a disproportionate number of problem gamblers. To cultivate a greater understanding of the psychological mechanisms involved in poker-machine gambling, a repeated measures cue-reactivity protocol was administered. A community sample of 38 poker-machine gamblers was assessed for problem-gambling severity and trait mindfulness. Participants were also assessed regarding altered state of awareness (ASA) and urge to gamble at baseline, following a neutral cue, and following a gambling cue. Results indicated that: (a) urge to gamble significantly increased from neutral cue to gambling cue, while controlling for baseline urge; (b) cue-reactive ASA did not significantly mediate the relationship between problem-gambling severity and cue-reactive urge (from neutral cue to gambling cue); (c) trait mindfulness was significantly negatively associated with both problem-gambling severity and cue-reactive urge (i.e., from neutral cue to gambling cue, while controlling for baseline urge); and (d) trait mindfulness did not significantly moderate the effect of problem-gambling severity on cue-reactive urge (from neutral cue to gambling cue). This is the first study to demonstrate a negative association between trait mindfulness and cue-reactive urge to gamble in a population of poker-machine gamblers. Thus, this association merits further evaluation both in relation to poker-machine gambling and other gambling modalities.     

Passion for poker and the relationship with gambling problems: a cross-sectional study

Previous research has shown that poker players spend significant time, large amounts of money and have a high prevalence of gambling problems. While some studies have examined the association between gambling behaviours and passion, none have explored this association specifically among poker players. This study aims to examine the relationships between two types of passion (i.e. harmonious and obsessive) and severity of gambling problems among poker players. A sample of 159 poker players was recruited from across Quebec, Canada. The outcome variable of interest was participants’ scores on the Canadian Pathological Gambling Index and the predictive variable was the Gambling Passion Scale. Multiple logistic regression analyses were conducted to identify independent risk factors of at-risk poker players. Severity of gambling problems is positively associated with obsessive passion (p < .05). However, harmonious passion is not associated with gambling problems. These results align with previous findings obtained for other gambling activities. Thus, passion could be considered a useful tool when approaching players to talk about risk-taking.     

The Relationship Between Problem Gambling and Attention Deficit Hyperactivity Disorder

Recent studies indicate that treatment-seeking problem gamblers display elevated rates of ADHD and that adolescents who screen positive for ADHD are more likely to engage in gambling, develop gambling problems, and experience a greater severity in gambling problems. This study aimed to (a) compare the prevalence of ADHD in treatment-seeking problem gamblers to the general population; (b) investigate the relationships between ADHD and problem gambling severity, cluster B personality disorders, motor impulsivity, alcohol use, substance use, gender, and age; and (c) investigate the degree to which these factors moderate the relationship between ADHD and problem gambling severity. Participants included 214 adults (154 males, 58 females, 2 unspecified) who sought treatment for their gambling problems at a specialist gambling agency in Melbourne, Australia. Almost one-quarter (24.9 %) of treatment-seeking problem gamblers screened positively for ADHD, which was significantly higher than the 14 % prevalence in a community sample. ADHD was significantly positively correlated with problem gambling severity, motor impulsivity, and cluster B personality disorders, but was not associated with alcohol and substance use, gender or age. None of the factors significantly moderated the relationship between ADHD and problem gambling severity. These findings suggest that a considerable proportion of treatment-seeking problem gamblers report ADHD and that their clinical profile is complicated by the presence of high impulsivity and cluster B personality disorders. They highlight the need for specialist gambling agencies to develop screening, assessment, and management protocols for co-occurring ADHD to enhance the effectiveness of treatment.     

Mindfulness in Patients With Gambling Disorders

This study explored facets of mindfulness between patients diagnosed with a gambling disorder (n = 26) and a community sample of non-gambling-disordered individuals (n = 33). Multivariate statistics comparing group differences showed the gambling-disordered patients exhibited significantly lower levels of mindfulness, emotional regulation, stress coping, and impulse control compared to the non-gambling-disordered group. Overall, gambling severity was negatively associated with higher levels of mindfulness and positively linked to indices of emotional dysregulation, stress proneness, and impulsivity. Correlations between mindfulness and emotional dysregulation and impulsivity were much stronger than those between mindfulness and the severity of disordered gambling behaviors as measured by the National Opinion Research Center DSM Screen for Gambling Problems (NODS). These findings are discussed in the context of possible implications for future directions in exploring mindfulness-based interventions as a plausible intervention among those with gambling disorders.     

The Relationship Between Anxiety, Smoking, and Gambling in Electronic Gaming Machine Players

Given higher reported rates of smoking in populations under treatment for problem gambling, in a sample of 81 Electronic Gaming Machine players, this study considered whether: 1) there were relationships between tobacco dependency and problem gambling, and 2) a common mechanism such as negative affect was involved. The untreated sample comprised eighty-one Electronic Gaming Machine players that completed the South Oaks Gambling Screen, the Tobacco Dependence Scale and the State-Trait Anxiety Inventory. There was a relationship between smoking status and scores on the South Oaks Gambling Screen, and negative affect contributed to both gambling problems and tobacco dependence. It was suggested that gambling problems and tobacco dependence have similar characteristics. The data has implications for treatment and anti-smoking legislation in gaming venues.     

Problem gambling,anxiety and poverty: an examination of the relationship between poor mental health and gambling problems across socio-economic status

Socio-economic status has been shown to be significantly related to both problem gambling and mental health problems. Additionally, forms of psychopathology such as mood and anxiety disorders have been shown to correlate with problem gambling across a variety of settings. However, relatively little research has been conducted examining whether the connection between mood and anxiety disorders and problem gambling is consistent across different levels of socio-economic status. This study examines gambling-related problems among a representative sample of Canadian adults using the 2008 Canadian Community Health Survey (N = 28,271). Generalized linear modelling is used to analyze the data. A moderation effect is found that shows the relationship between anxiety disorders and problem gambling severity varies significantly across socio-economic status. This study shows that social setting has an important influence on the assumed relationship between psychopathology and gambling problems that is downplayed in current problem gambling research. A discussion of the need for greater inclusion of socio-economic context when making assumptions about the connections between problem gambling and psychiatric disorders is made in light of the responsibilities of gambling providers and regulators.     

Predicting Gambling Problems from Gambling Outcome Expectancies in College Student-Athletes

While previous research has suggested the potential importance of gambling outcome expectancies in determining gambling behaviour among adolescents, the predictive ability of gambling outcome expectancies has not yet been clearly delineated for college-aged youth. The current study aims to explore the relationships between gender and outcome expectancies in the prediction of gambling severity among college student-athletes. Data from the National Collegiate Athletic Association (NCAA) study assessing gambling behaviours and problems among U.S. college student-athletes were utilized. Complete data was available for 7,517 student-athletes. As expected, male college student-athletes reported more gambling participation as well as greater gambling problems than their female counterparts. Findings showed positive relationships between the outcome expectancies of financial gain, and negative emotional impacts and gambling problems. That is, those who endorsed more items on the outcome expectancy scales for financial gain and negative emotional impacts also tended to endorse more gambling-related problems. Findings also showed a negative relationship between outcome expectancies of fun and enjoyment, and gambling problems over and above the variance accounted for by gender. Those with gambling problems were less likely to have the expectation that gambling would be fun than those without gambling problems. Despite NCAA efforts to curb gambling activity, the results suggest that college student-athletes are at risk for over-involvement in gambling. Therefore, it is important to explore gambling outcome expectancies within this group since the motivations and reasons for gambling might be able to inform treatment initiatives.     

Adolescent gambling and problem gambling: examination of an extended theory of planned behaviour

Adolescent problem gambling is acknowledged as a public health concern. To better understand adolescent gambling and problem gambling behaviour, the present study investigated the relationships between psychological correlates of gambling frequency and problem gambling using an extended theory of planned behaviour (TPB; i.e. intentions, attitudes, subjective norms, perceptions of behavioural control) that includes negative anticipated emotions as a factor associated with gambling intentions. Four hundred and nineteen high school students were surveyed in the Montreal (Canada) region. The findings generally support the applicability of an extended TPB model for explaining gambling behaviour frequency and gambling problems among adolescents. The results reveal that negative anticipated emotions, attitudes and perceptions of behavioural control influence gambling intentions. The results further reveal that intentions and attitudes have a direct relationship with gambling frequency, while intentions and perceptions of behavioural control are directly related to problem gambling behaviours. These findings suggest that adolescent problem gambling prevention and intervention efforts should consider targeting negative anticipated emotions and other TPB components in order to postpone initiation to gambling (a risk factor for problem gambling) and to promote gambling decision-making.     

Investigating Possible Effects of Ethnicity and Age on Gambling as an Escape

Previous research has shown that there are a number of risk factors for disordered and problem gambling, including an individual’s ethnicity and age. Endorsing gambling as an escape has also been shown to contribute to and maintain disordered gambling. The present study examined potential interactions between ethnicity and age as they relate to disordered gambling, as well as if ethnicity and age would be predictors of endorsing gambling as an escape. Three hundred fifteen adults from the United States completed measures relating to gambling. Participants were grouped into ethnic categories of Caucasian and non-Caucasian, and age groups of 18–25, 26–35, 36–55, and 56 years old and above. Non-Caucasians reported more gambling problems than Caucasians. A significant interaction was found between ethnicity and age for 36–55 year olds. Overall, participants were more likely to gamble for positive than negative reinforcement. However, only gambling as an escape was a significant predictor of disordered gambling. Implications and limitations are discussed with the thought that these results are informative to practitioners treating disordered gambling.     

The temporal relationship between gambling related beliefs and gambling behaviour: a prospective study using the theory of planned behaviour

The Theory of Planned Behaviour (TPB) has been successfully employed to investigate the role of gambling-related beliefs in the maintenance of gambling behaviour. However, there is a lack of research that examines the temporal relationships between the TPB predictor variables and gambling behaviour. Thus, the current study examines the utility of expectancies, normative beliefs, perceived behaviour control and gambling intentions in predicting gambling frequency, as assessed 12 months later. In addition, these gambling-related beliefs were reassessed at the 12-month follow-up survey to examine their stability and relationships with gambling behaviour. A total of 805 Australian adults, recruited via an online research panel, completed the baseline and follow-up online survey. Consistent with expectations, gambling-related beliefs explained gambling intentions and intentions predicted Wave 2 gambling frequency, after controlling Wave 1 gambling frequency. In relation to the stability of gambling-related beliefs, the Wave 2 measures explained additional variance in the Wave 2 gambling behaviour, although the type of beliefs associated with Wave 2 gambling frequency and problem gambling severity differed. These findings provide support for the notion that the perceived benefits of gambling and beliefs in skill are important areas to target in preventative and problem gambling initiatives.     

Forms of gambling,gambling involvement and problem gambling: evidence from a Swedish population survey

The purpose of this study was to explore the association between problem gambling (PG) and participation in different forms of gambling in order to elucidate relationships between PG, gambling involvement and gambling intensity. Using data from the first wave of the Swedish Longitudinal Gambling Study (Swelogs) (n = 4,991), the study tested four hypotheses, namely that (1) some forms of gambling are more closely associated with PG than other forms; (2) high gambling involvement is associated with PG; (3) gambling involvement is positively associated with the intensity of gambling; and (4) the relationship between gambling involvement and PG is influenced by the specific forms of gambling in which individuals participate. All four hypotheses were supported. More specifically, the study found that while many PGs regularly participate in multiple forms of gambling, half of PGs participate regularly in only one or two forms of gambling. The study concluded that some forms of gambling are more closely associated with problem gambling than other forms, and that gambling policy and regulation, as well as the development of responsible gambling initiatives, should focus on these forms.     

Anxiety,Depression and Emotion Regulation Among Regular Online Poker Players

Poker is a type of gambling that has specific features, including the need to regulate one’s emotion to be successful. The aim of the present study is to assess emotion regulation, anxiety and depression in a sample of regular poker players, and to compare the results of problem and non-problem gamblers. 416 regular online poker players completed online questionnaires including sociodemographic data, measures of problem gambling (CPGI), anxiety and depression (HAD scale), and emotion regulation (ERQ). The CPGI was used to divide participants into four groups according to the intensity of their gambling practice (non-problem, low risk, moderate risk and problem gamblers). Anxiety and depression were significantly higher among severe-problem gamblers than among the other groups. Both significantly predicted problem gambling. On the other hand, there was no difference between groups in emotion regulation (cognitive reappraisal and expressive suppression), which was linked neither to problem gambling nor to anxiety and depression (except for cognitive reappraisal, which was significantly correlated to anxiety). Our results underline the links between anxiety, depression and problem gambling among poker players. If emotion regulation is involved in problem gambling among poker players, as strongly suggested by data from the literature, the emotion regulation strategies we assessed (cognitive reappraisal and expressive suppression) may not be those involved. Further studies are thus needed to investigate the involvement of other emotion regulation strategies.     

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.     

Self-stigma coping and treatment-seeking in problem gambling

Stigma has been explored as a cause of reduced and delayed treatment-seeking for problem gambling, a population in which only 1 in 10 seek treatment. The present study examined the effect of perceived public stigma and self-stigma on affect and behavioural coping efforts. Path analysis was used to examine self-stigma in 155 individuals with gambling problems. The majority of participants met criteria for a gambling disorder (93.5%), were current gamblers (69%) and had never sought treatment (54.2%). The data fit the proposed path model well; self-stigma was associated with reduced self-esteem and increased shame. Shame predicted use of secrecy and withdrawal coping. Endorsement of negative stereotypes of ‘problem gamblers’ was associated with decreased treatment-seeking while greater self-stigma predicted increased treatment-seeking. Additional predictors of increased treatment-seeking included greater gambling problem severity, more positive attitudes towards treatment, male sex and higher income. Self-stigma increased rather than decreased treatment-seeking in this analysis. Efforts to increase treatment-seeking could target women, those with lower income and those with less severe gambling problems.     

Risk Factors for Problem Gambling in California: Demographics,Comorbidities and Gambling Participation

While population surveys have been carried out in numerous jurisdictions internationally, little has been done to assess the relative strength of different risk factors that may contribute to the development of problem gambling. This is an important preparatory step for future research on the etiology of problem gambling. Using data from the 2006 California Problem Gambling Prevalence Survey, a telephone survey of adult California residents that used the NODS to assess respondents for gambling problems, binary logistic regression analysis was used to identify demographic characteristics, health-related behaviors, and gambling participation variables that statistically predicted the odds of being a problem or pathological gambler. In a separate approach, linear regression analysis was used to assess the impact of changes in these variables on the severity of the disorder. In both of the final models, the greatest statistical predictor of problem gambling status was past year Internet gambling. Furthermore, the unique finding of a significant interaction between physical or mental disability, Internet gambling, and problem gambling highlights the importance of exploring the interactions between different forms of gambling, the experience of mental and physical health issues, and the development of problem gambling using a longitudinal lens.     

Treating Problem Gambling Samples with Cognitive Behavioural Therapy and Mindfulness-Based Interventions: A Clinical Trial

The problem gambling (PG) intervention literature is characterised by a variety of psychological treatments and approaches, with varying levels of evidence (PGRTC in Guideline for screening, assessment and treatment in problem and pathological gambling. Monash University, Melbourne, 2011). A recent PG systematic review (Maynard et al. in Res Soc Work Pract, 2015. doi: 10.1177/1049731515606977) and the success of mindfulness-based interventions to effectively treat disorders commonly comorbid with PG suggested mindfulness-based interventions may be effective for treating PG. The current study tested the effectiveness of three interventions to treat PGs: 1. case formulation driven Cognitive Behaviour Therapy (CBT); 2. manualised CBT; and 3. mindfulness-based treatment. All three interventions tested returned large effect size improvements in PG behaviour after seven sessions (Cohen’s d range 1.46–2.01), at post-treatment and at 3 and 6-month follow-up. All of the interventions were rated as acceptable by participants at post-treatment. This study suggests that the mindfulness-based and TAU interventions used in the current study appear to be effective at reducing PG behavior and associated distress and they also appear to generalise to improvements in other measures such as quality of life-mental functioning and certain mindfulness facets more effectively than the manualised form of CBT utilised used here. Secondly, a brief mindfulness intervention delivered after psycho-education and a brief CBT intervention may be a useful supplement to traditional CBT treatments by addressing transdiagnostic processes such as rumination and thought suppression. Thirdly, CBT interventions continue to report effectiveness in reducing PG behaviour and associated distress consistent with the prevailing literature and clinical direction.     

On a Roll: The Process of Initiation and Cessation of Problem Gambling Among Adolescents

As gambling becomes more accessible and acceptable in society, problems associated with gambling and gaming have begun to affect ever increasing numbers of adolescents. Although restricted from most forms of gambling by law, many adolescents are finding a path into problem gambling. Some are becoming compulsive gamblers early in their gambling career, facing a future filled with consequences and problems. Understanding the pathway or process by which these adolescents become engaged in gambling behavior and how they can extricate themselves from this addictive behavior can enhance the efficiency and effectiveness of our interventions. This article offers a perspective on the initiation and cessation of compulsive gambling using the basic elements of the process of intentional behavior change outlined in the Stages of Change from the Transtheoretical Model. The process of initiation of a problematic behavior is similar to the process of modification or cessation of a problematic behavior in terms of these stages of change. With adolescents it is important to distinguish between the process of initiation, which has implications for prevention of gambling problems, and the process of cessation, which often necessitates the assistance of treatment. Creating interventions that parallel the process of change offers the potential for personalizing and potentiating efforts to reduce the prevalence and consequences associated with compulsive or pathological and problem gambling. Application of this model to gambling behavior offers a heuristic that is intriguing and requires substantiation through rigorous research.     

Self-Directed Gambling Changes: Trajectory of Problem Gambling Severity in Absence of Treatment

Most problem gamblers do not seek formal treatment, recovering on their own through cognitive re-appraisal or self-help strategies. Although barriers to treatment have been extensively studied, there is a paucity of research on self-directed changes in problem gambling and very few studies have examined these changes prospectively. The aim of this study was to examine the trajectory of gambling severity and behavior change over an 18-month period, among a sample of non-treatment seeking/attending problem gamblers recruited from the community (N?=?204) interested in quitting or reducing gambling. Separate mixed effects models revealed that in absence of formal treatment, significant reductions in gambling severity, frequency, and amount gambled could be observed over the course of a 6 to 9-month period and that changes experienced within the first 12 months were maintained for an extended 6 months. Problem gambling severity at baseline was significantly associated with changes in severity over time, such that participants with more severe gambling problems demonstrated greater reductions in their gambling severity over time. A total of 11.1% of participants gambled within a low-risk threshold at 18 months, although 28.7% of the sample reported consecutive gambling severity scores below problem levels for the duration of 1 year or longer. The findings suggest that among problem gamblers motivated to quit or reduce their gambling, significant self-directed changes in gambling severity can occur over a relatively short time. Additional prospective studies are needed to document the role of specific self-help tools or thought processes in exacting gambling changes.     

Loss of Control as a Discriminating Factor Between Different Latent Classes of Disordered Gambling Severity

Analyses of disordered gambling assessment data have indicated that commonly used screens appear to measure latent categories. This stands in contrast to the oft-held assumption that problem gambling is at the extreme of a continuum. To explore this further, we report a series of latent class analyses of a number of prevalent problem gambling assessments (PGSI, SOGS, DSM-IV Pathological Gambling based assessments) in nationally representative British surveys between 1999 and 2012, analysing data from nearly fifty thousand individuals. The analyses converged on a three class model in which the classes differed by problem gambling severity. This identified an initial class of gamblers showing minimal problems, a additional class predominantly endorsing indicators of preoccupation and loss chasing, and a third endorsing a range of disordered gambling criteria. However, there was considerable evidence to suggest that classes of intermediate and high severity disordered gamblers differed systematically in their responses to items related to loss of control, and not simply on the most ‘difficult’ items. It appeared that these differences were similar between assessments. An important exception to this was one set of DSM-IV criteria based analyses using a specific cutoff, which was also used in an analysis that identified an increase in UK problem gambling prevalence between 2007 and 2010. The results suggest that disordered gambling has a mixed latent structure, and that present assessments of problem gambling appear to converge on a broadly similar construct.