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.     

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.     

Experimental Analysis of the Game in Pathological Gamblers: Effect of the Immediacy of the Reward in Slot Machines

Slot machines are the most “addictive” games because (a) the disorder (pathological gambling) appears more rapidly in these games than with any other; (b) most patients who seek professional help are mainly addicted to electronic gambling, and (c) even though it is not the more frequent game, most of all the money spent on legal games of chance (at least in Spain) goes to slot machines. Structural characteristics of slot machines induce to gamble because electronic games show the main parameters of operant conditioning, mainly the immediacy of the reinforcement. Ten pathological gamblers played slot machine in two conditions: immediate and delayed reinforcement. The results corroborate the importance of the immediacy of the reinforcement in gambling, because when the result appears immediately (after 2 s), more games are played than when the result is delayed only 10 s. Critical issues in problem gambling prevention and public health are discussed.     

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

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

Quality of Web-based Information on Pathological Gambling

The present study aims to evaluate the quality of web-based information on gambling and to investigate potential content quality indicators. The following key words: gambling, pathological gambling, excessive gambling, gambling problem and gambling addiction were entered into two popular search engines: Google and Yahoo. Websites were assessed with a standardized proforma designed to rate sites on the basis of “accountability”, “presentation”, “interactivity”, “readability” and “content quality”. “Health on the Net” (HON) quality label, and DISCERN scale scores aiding people without content expertise to assess quality of written health publication were used to verify their efficiency as quality indicators. Of the 200 links identified, 75 websites were included. The results of the study indicate low scores on each of the measures. A composite global score appeared as a good content quality indicator. While gambling-related education websites for patients are common, their global quality is poor. There is a need for useful evidence-based information about gambling on the web. As the phenomenon has greatly increased, it could be relevant for Internet sites to improve their content by using global score as a quality indicator.     

Individual outpatient treatment of pathological gambling

Recovery from pathological gambling is viewed as a process whereby the pathological gambler chooses to lose an addiction to gambling and maintains that choice while mourning the loss of the gambling. The self-induced and self-escalating addictive crisis leading up to that choice is explored, as is the crisis caused by the loss of the gambling itself. It is proposed that gambling provides the gambler with action, a method of dealing with stress aand avoiding unpleasant affect, and a variety of social, psychological, and existential benefits. The loss of gambling is seen as a complicated and significant one which elicits grief responses similar to those seen in response to other types of major loss. It is proposed that in the individual outpatient treatment of pathological gamblers, the therapist helps the recovering gambler to accept the loss of the gambling and learn to live a rewarding life without it. Four phases of treatment are suggested which correspond to stages of grieving and accepting the loss of the gambling.     

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.     

Gambling and Problem Gambling among Recently Sentenced Male Prisoners in Four New Zealand Prisons

Recently sentenced inmates in four New Zealand male prisons (N = 357) were interviewed to assess their gambling involvement, problem gambling and criminal offending. Frequent participation in and high expenditure on continuous forms of gambling prior to imprisonment were reported. Nineteen percent said they had been in prison for a gambling-related offence and most of this offending was property-related and non-violent. On the basis of their SOGS-R scores, 21% were lifetime probable pathological gamblers and 16% were probable pathological gamblers during the six months prior to imprisonment. Of the “current” problem gamblers, 51% reported gambling-related offending and 35% had been imprisoned for a crime of this type. Gambling-related offending increased with problem gambling severity. However, only five percent of problem gamblers said their early offending was gambling-related. The large majority reported other types of offending at this time. Few men had sought or received help for gambling problems prior to imprisonment or during their present incarceration. This highlights the potential for assessment and treatment programs in prison to reduce recidivism and adverse effects of problem gambling and gambling-related offending.     

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

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

Twelve-Step Facilitated Versus Mapping-Enhanced Cognitive-Behavioral Therapy for Pathological Gambling: A Controlled Study

This study examined the efficacy of two group treatments for pathological gambling, a node-link mapping-enhanced cognitive-behavioral group therapy (CBGT-mapping) and twelve-step facilitated (TSF) group treatment. Forty-nine participants meeting criteria for pathological gambling were recruited from local newspaper advertisements. These participants were randomly assigned to one of three conditions: TSF (n = 11), CBGT-mapping (n = 18), and Wait-List control (n = 9); 11 refused treatment prior to randomization. Outcome measures included number of DSM-IV criteria met, perception of control/self-efficacy, desire to gamble, and frequency of gambling episodes. Analyses revealed a significant treatment group × time interaction (η2_partial = .39). Specifically, the group treatments resulted in significant improvements in the dependent measures, while the Wait-List group remained relatively stable. Overall, CBGT-mapping and TSF had no significant differences on any outcome measure at follow-up assessments. Analysis of post-treatment and 6-month follow-up reveal a significant improvement in gambling outcomes (i.e., fewer DSM-IV criteria met, greater self-efficacy, and fewer gambling episodes (η2_partial = .35), with treatment gains maintained at 6 months. These results are consistent with previous research for group treatment for pathological gambling and provide support for the utility of TSF and a mapping-based CBT therapy as viable intervention for pathological gambling.     

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.     

Urge to Gamble in a Simulated Gambling Environment

Cue reactivity, while increasingly recognized as a central feature of drug and alcohol addiction, is not well studied in gambling. We evaluated the urge to gamble in a simulated casino environment among frequent gamblers who alternated between cycles in which they observed others playing ten hands of Blackjack (first, third and fifth cycle) and cycles in which they played ten hands of Blackjack themselves (second and fourth cycle). The played cycles served as a manipulation for the observed cycles in terms of “priming” (having previously gambled in the environment vs. not) and “anticipation” (expecting more opportunities to gamble in the environment vs. not) and, thus, allowed these conditions: observed cycle 1 = anticipation (+) and prime (−); observed cycle 2 = anticipation (+) and prime (+); and observed cycle 3 = anticipation (−) and prime (+). Subjects’ urge to gamble was greater in the gambling environment than in a neutral setting and both positive anticipation and positive priming increased cue reactivity within the gambling environment. The frequency of gambling outside of the study did not affect cue reactivity. However, a preference for Blackjack (vs. other types of gambling) and observing winning (vs. losing) hands were both associated with stronger cue reactivity in the study. These findings contribute to our understanding of pathological gambling.     

Comparing the Utility of a Modified Diagnostic Interview for Gambling Severity (DIGS) with the South Oaks Gambling Screen (SOGS) as a Research Screen in College Students

The South Oaks Gambling Screen (SOGS) is compared in reliability to a modified version of the Diagnostic Interview for Gambling Severity (DIGS-S) for use as a pathological gambling (PG) screen in college students. Seventy-two undergraduates (83.3% male, mean age of 18.8) from the University of Georgia completed the measures, completing a longitudinal design with 3 sessions over a 2-month time period. The DIGS-S and the SOGS demonstrated good internal consistency over the 3 sessions, with Cronbach’s Alphas ranging from 0.73 to 0.89, as well as strong concurrent validity, with correlations of .50 to .80 (Ps < .001) between the 2 measures across the 3 sessions. Both Cronbach’s alpha and test–retest reliability were higher with the DIGS-S than the SOGS. Given this, and given that the DIGS directly measures symptoms of pathological gambling, future research could benefit from the use of the DIGS-S as a PG screening tool in a college-aged sample.     

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 Relationship among Negative Affect,Distress Tolerance,and Length of Gambling Abstinence Attempt

The present study tested the theory that negative affect and one’s ability to tolerate distress is associated with failure to quit gambling during an abstinence attempt. Specifically, 16 current pathological gamblers who had at least one sustained period of gambling abstinence lasting a minimum of 3 months (i.e., delayed relapsers) and 16 current pathological gamblers who had never remained abstinent for a period longer than 2 weeks (i.e., immediate relapsers), were assessed for baseline levels of negative affect and stress reactivity, as well as faced with a psychological (mental arithmetic) and physical (breath holding) stressor. Compared to the delayed relapsers, the immediate relapsers displayed higher levels of negative affect and stress reactivity. Immediate relapsers also were less likely to persist on the psychological stressor, suggesting that one’s ability to tolerate the initial discomfort of an abstinence attempt may play an important role in gambling treatment outcome. The current project was completed in partial completion of the degree of Master of Arts in Psychology by the first author under the direction of the second author.     

Neurodevelopment,impulsivity, and adolescent gambling

The prevalence of problem and pathological gambling in adolescence and young adulthood has been found to be two- to fourfold higher than in adulthood. Given that these high rates might predict future increases across all age groups, it is important to explore the causes of the elevated rates of problem and pathological gambling among youths. This article reviews evidence for a neurobiological basis for adolescent vulnerability to problem and pathological gambling behaviors. We propose that a common trait motif of impulsivity might underlie phenomenology of pathological gambling, commonly comorbid psychiatric disorders, and related aspects of adolescent behavior. Recent advances in understanding the brain mechanisms involved in motivation, reward, and decision-making allow a discussion of neural circuitry underlying impulsivity. Emerging data indicate that important neurodevelopmental events during adolescence occur in brain regions associated with motivation and impulsive behavior. We hypothesize that immaturity of frontal cortical and subcortical monoaminergic systems during normal neurodevelopment underlies adolescent impulsivity as a transitional trait-behavior. While these neurodevelopmental processes may confer advantage by promoting a learning drive for optimal adaptation to adult roles, they may also confer an increased vulnerability to addictive behaviors such as problem and pathological gambling. An exploration of the developmental changes in neural circuitry involved in impulse control has significant implications for understanding adolescent behaviors and treating problem and pathological gambling among youths.     

Updates of the Prevalence of Problem Gambling in Romanian Teenagers

The aim of this study was to find out what is the prevalence of pathological in Romanian teenagers. We questioned one thousand thirty-two teenagers in Cluj-Napoca and Harghita counties. Participants completed a questionnaire with 40 items including gamblers anonymous twenty questions. The sample included teenagers aged 11–19 years; 65.57% were male and 34.43% were female. The subjects were divided into three groups: non-gambling/recreational gambling or occasional gambling (0–1 positive answers —Level 1)—753 subjects (72.96%) [316 females and 437 males]; problem gambling (2–6 points—Level 2)—243 subjects (23.54%) [43 females and 200 males]; pathological gambling (above 7 points—Level 3)—36 subjects (3.48%) [3 females and 33 males]. The mean age of pathological gamblers was 16.48 years. Gender differences were as expected, males engaging in pathological gambling (91.66% from pathological gamblers) more than females did (8.33% from pathological gamblers). Data revealed that the most encountered games practiced weekly were sport bets and slot machines in the case of 36.11% of the pathological gamblers; lotto, internet casino and pool bets each with 25%, followed by roulette and black-jack with 22.22%.From those who reported practicing gambling at a pathological level 66.66% engaged in alcohol consumption, 13.88% illicit drug use and 19.44% licit drugs. Just 16.66% smoke cigarettes. Data revealed higher rates of prevalence in Romanian teenagers than in other Central and Eastern European countries. A prevalence study at a national level should be designed.     

Pathological Gambling in Estonia: Relationships with Personality,Self-Esteem,Emotional States and Cognitive Ability

Due to changes in gambling accessibility during the last decade gambling has become more widespread in Estonia and the prevalence of pathological gambling has sharply increased. The present study attempts to identify psychological characteristics of Estonian pathological gamblers. It has been shown that a wide range of social, economic, and individual factors (e.g. personality traits and emotional states) predict the likelihood of becoming a pathological gambler. In the present study, pathological gamblers’ (N = 33) personality traits, self-esteem, self-reported emotional states and cognitive ability were compared to the respective characteristics in a non-gambling control group (N = 42) matched for age, gender and educational level. It was found that compared to controls, pathological gamblers had higher scores on Neuroticism (especially on its immoderation facet) and lower scores on Conscientiousness (especially on its dutifulness and cautiousness facets) and on self-esteem scale. They reported more negative emotional states during the previous month (especially depression and anxiety). Finally, pathological gamblers had lower general cognitive ability. In a logistic regression model, the likelihood of being a pathological gambler was best predicted by high immoderation score and low cognitive ability.