Severity of impairment in dually addicted gamblers

While much information about pathological gamblers has been gathered from clinical observations, few data exist from systematic, objective studies. Furthermore, still less is known about that subset of pathological gamblers who are also chemically dependent and/or substance abusers. Previous studies (e.g., McCormick et al., 1984) report that up to 45% pathological gamblers are substance abusers. The present study hypothesizes that inpatient chemically dependent pathological gamblers will exhibit greater impairment on a variety of life-functioning measures than a comparable group of chemically dependent psychiatric inpatient. Twelve chemically dependent pathological gamblers were matched on the basis of age, sex, alcohol/drug history and occupational status with twelve chemically dependent persons with no pathological gambling history. All study members were inpatients in an addictions program at a private psychiatric hospital. Each patient was administered the Addiction Severity Index (ASI) to assess impairment in seven problem areas: medical, employment/support, alcohol, drug, legal, family/social, and psychological/psychiatric functioning. The following findings emerged: 1) Chemically dependent (CD) gamblers report more chronic medical problems than CD psychiatric patients; 2) CD gamblers report more frequent conflicts with relatives and family members than CD psychiatric patients; 3) CD gamblers report more psychiatric symptoms both in amount and duration; Although not reaching statistical significance, 42% of the CD gamblers had made a previous suicide attempt as compared to 8% of the CD psychiatric patients; 4) CD gamblers and CD psychiatric patients appear comparable with regard to employment functioning and amount of legal problems. The clinical and theoretical implications of these findings are discussed further.     

Inpatient treatment of male pathological gamblers in Germany

Pathological gambling is viewed as a disease of unknown cause which requires treatment. Demographic and psychological traits of fifty-eight male patients are described. A control group of fifty-four patients with other addictions was used to determine the validity of a diagnostic test which aims to differentiate between harmless gambling behavior and addiction to gambling. This test is described along with the stages of pathological gambling and the process of treatment for the disorder. Most of the gamblers are young, often previously convicted of theft, highly indebted, in danger of committing suicide, and susceptible to other addictive substances, especially alcohol. Harmless, critical and chronic stages are described. Regarding in-patient treatment, it has proved to be useful to integrate individual members into groups of alcoholics as they are a therapeutic benefit to these groups. The pragmatic and symptom-oriented therapy proved to be good for gamblers as well. A follow-up with forty-nine patients for one year and twenty-five for two years found 71% abstinent after one year and 62% abstinent after two years of treatment. These results are similar to those obtained with alcoholics.     

A comparison: The treatment of wives of alcoholics with the treatment of wives of pathological gamblers

This study was conducted to determine how treatment approaches would differ for two reference groups — wives of alcoholics and wives of pathological gamblers. Data from thirty-nine wives from each reference group were collected over a period of sixteen months. The results indicate that the wives of the pathological gamblers had to deal with specific issues which did not surface in the treatment of wives of the alcoholics. Some of the wives of the pathological gamblers received threatening phone calls from creditors, had to re-pay loans for which they co-signed, had to commence handling the family budget, and had to deal with their own withdrawal from his gambling. They also found trust very slow in coming, realized they would be under great financial straits for an extended period of time, and found a shortage of self-help groups and qualified professionals within a reasonable distance of their home. Finally they found loneliness a very realistic issue in early abstinence because he was spending so much of his time outside the home attending G.A. meetings, aftercare and working two, and sometimes three jobs, in order to repay his gambling debts.     

Follow-up of male pathological gamblers after treatment: The relationship of intellectual variables to relapse

Male pathological gamblers entering a comprehensive treatment program were followed-up for twelve months after treatment completion. Twelve month follow-up was obtained for 45 of the 66 patients entering treatment. Total abstinence was reported by 55% (n=25) of the patients located for twelve month follow-up. A relationship was found between abstinence at six month follow-up and selected subscales of the Wechsler Adult Intelligence Scale, performance scale. The implications of these findings for sub-typing gamblers are discussed.     

Criminal offenses in gamblers anonymous and hospital treated pathological gamblers

The purpose of this study was to compare the nature and prevalence of gambling and non-gambling related offenses in samples of pathological gamblers seeking behavioural treatment from a hospital-based program and those attending Gamblers Anonymous. A semi-structured interview schedule obtaining demographic data and details of the nature, frequency, and consequent legal action of criminal offenses committed was administered to 152 consecutive hospital treated pathological gamblers, and 154 Gamblers Anonymous attendees who volunteered to participate in the study. Of the total sample, 59% admitted a gambling-related offense, and 23% to a conviction. There was no difference in the proportion of hospital treated and Gamblers Anonymous subjects who offended. The most common gambling-related offenses were larceny, embezzlement and misappropriation. Gamblers committed a median of ten offenses over an average ten year period of pathological gambling with a median value of $ A 300¹ per offense. The median value for each non-gambling-related offense was $ A 130. Except for the significantly older mean age of Gamblers Anonymous subjects, hospital treated gamblers did not differ from Gamblers Anonymous attenders on relevant demographic features or parameters of gambling behaviour. Findings were interpreted to suggest a possible causal link between pathological gambling and the commission of non-violent property offenses.This study was supported by a grant from the Criminology Research Council. The views expressed are the responsibility of the authors and are not necessarily those of the Council. The contribution of Anna Frankova, Research Assistant, is gratefully acknowledged.     

Family,marital, and occupational satisfaction for recovering pathological gamblers

This paper describes the efforts of a private gambling treatment program to conduct a retrospective study of pathological gamblers treated in a publicly supported residential program. The Johns Hopkins Center for Pathological Gambling treated approximately 100 pathological gamblers nationwide from 1979 to 1983 in its residential component. Twenty-six gamblers were assessed regarding their recovery status with specific focus on family, marital status and occupational satisfaction. It was hypothesized that the more satisfied patients would display lower frequencies of gambling and that gambling frequency was dependent upon the level of satisfaction. Thirty-one percent of these gamblers reported abstinence. Regression analyses indicated that the recovery of pathological gamblers as measured by frequency of gambling is significantly influenced by job satisfaction, and moderately influenced by marital status and family life satisfaction. Consequently, these factors should be addressed by mental health professionals in research and treatment of pathological gambling.     

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

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

Personality characteristics of sexual addicts and pathological gamblers

Personality characteristics of three groups were compared: sexual addicts (N=32, 6 females, 26 males, ¯x age=36.37), pathological gamblers (N=32, 13 females, 19 males, ¯x age=46.15), and non-addicts (N=38, 13 females, 25 males, ¯x age=39.65). The sexual addict group was significantly more anxious, depressed, obsessive-compulsive and interpersonally sensitive than the non-addict control group. The sexuai addict group was significantly more depressed than the pathological gambler group. The pathological gambler group was significantly more depressed than the non-addict control group, but was not significantly more anxious, obsessive-compulsive, or interpersonally sensitive. Neither addict group scored higher on levels of sensation-seeking or self-defeating behaviors than did the non-addict control group. The results supported the view that sexual addiction can be explained as a means of coping with anxiety, depression, obsessive-compulsiveness and interpersonal sensitivity whereas pathological gambling may be used as an anti-depressant but there is no significant relationship between that addiction and the other above-mentioned personality characteristics.     

Ego strength and achievement motivation in pathological gamblers

This paper argues that there area priori reasons to extract measures of ego strength and achievement motivation from the psychometric data base routinely collected from inpatient pathological gambers in order to clarify the meaning of these constructs and to evaluate their roles in personality organization. A sample of 57 subjects engaged in an inpatient treatment program for pathological gamblers was studied using Barron's Ego Strength Scale (ES) from the Minnesota Multiphasic Personality Inventory and two measures of achievement motivation from the California Personality Inventory, Achievement via Conformance (Ac) and Achievement via Independence (Ai). Compared to the standardization group norms on these instruments, pathological gamblers are significantly deficient in both ego strength and one type of achievement motivation, Ac. Clinical impressions of gamblers in treatment suggest that narcissistic characteristics are a major problem in treatment and that future research should attempt further detailed studies of ego structure in order to refine treatment objectives.     

Rapid onset of pathological gambling in machine gamblers

A particularly rapid onset of pathological gambling (PG-onset) through the use of gambling machines has been widely alluded to, but this is the first study to empirically examine the phenomenon. This study compared the latency of PG-onset in those who gambled primarily on machines, compared to those who gambled primarily on more traditional forms of gambling at PG-onset. Subjects were 44 adult pathological gamblers (PGs) seeking outpatient treatment in Rhode Island (17 females; mean age = 46.9). Subjects completed questionnaires and a diagnostic interview including a complete history of gambling activities and the course of PG. The latency of PG-onset was defined as the time (in years) elapsed between the age of regular involvement in the primary form of gambling and the age at which DSM-IV criteria were first met. Machine PGs (n = 25) had a significantly shorter latency of onset than did traditional PGs (1.08 years vs. 3.58 years). Females and machine PGs had a significantly older age of onset, but gender was not associated with latency of PG-onset. Lifetime comorbidity of either substance use disorders (SUDS) or depressive disorders (DDS) was also not associated with the latency of PG-onset. The results of the current study suggest that intrapersonal variables such as gender and comorbid disorders do not generally affect the speed with which people develop PG. Rather, the social, environmental, and stimulus features of mechanized gambling are implicated. Prospective longitudinal studies on the onset and course of PG are needed, as well as more basic research on the features of machine gambling that may contribute to rapid onset.     

Accurately depicting pathological gamblers: Policy and treatment implications

This paper describes results from a 3-year study of pathological gambling in the general population. Two distinct groups of pathological gamblers, based on income, were distinguished in the general population. These two groups varied considerably on several dimensions, including their demographic characteristics, gambling involvement and problematic gambling-related behaviors. These results contradict widely-accepted beliefs about the characteristics and behaviors of pathological gamblers and suggest that efforts in outreach, education and program development must be expanded to include types of pathological gamblers beyond those currently in treatment.This work was funded by Research Grant MH44295 from the Violence & Traumatic Stress Research Branch of the National Institute of Mental Health.     

Therapy with male pathological gamblers: Between self help group and group therapy—Report of a developmental process

A therapy project was developed for pathological gambling patients and, within a three year period, more than 60 gamblers were studied and treated. Diagnostic evaluation was made according to DSM-III. In addition to individual and family therapy, we designed a voluntary group setting. In this report, we concentrate first on the development of group work, then on some psychodynamic hypotheses about the personality of the gambler. We also try to show the correspondence between these hypotheses and the group process. Pathological gambling is seen as an attempt at self-healing and a strategy of conflict-solving; the slot machine, as an inanimate object, offers a temporary symbiosis with clear limitations; the gambling will come to a guaranteed end, either when all of the money is lost, or when gaming ends at night. Finally, we list some recommendations for the treatment of gamblers in group therapy.This research was supported by the Ärztliche Psychologische Beratungsstelle für Studierende der Universität Göttingen, Chairman: Prof. E. Sperling, M.D.Since one author (J.H.) worked alone in the first period of the project, passages referring to this period are written in the first person singular.This article is an extension of the special issue on Gambling in Europe edited by Iver Hand, M.D.     

Transference and countertransference reactions in the psychotherapy of pathological gamblers

Traditionally, in psychodynamic forms of treatment, the patient's relationship with the therapist is central to eliciting and exploring the patient's characteristic ways of thinking, feeling and behaving. Research has increasingly demonstrated the significance of the therapeutic relationship to the treatment outcome. Since little has been written about the therapist-patient relationship in the treatment of pathological gambling, we shall describe what we have found to be some of the common and problematic transference and countertransference reactions and interactions. Both positive and negative transferences and countertransferences will be discussed not only as obstacles to successful therapy, but as tools for understanding patients' conflicts, defenses and reasons for gambling.     

The gambling market in the Federal Republic of Germany and the helpseeking of pathological gamblers

The development of the gambling market in the Federal Republic of Germany since the middle of the seventies and data on pathological gamblers seeking help are described. The continuously increasing supply, together with increases in turnover, was followed-with some temporal delay-by an increase in the number of gamblers who sought advice and treatment. Preliminary measures taken by the health authorities as well as some consequences of pathological gambling are discussed.This article is a translation of a German article published in: Deutsche Hauptstelle gegen die Suchtgefahren (1990): Jahrbuch '91 zur Frage der Suchtgefahren. Hamburg: Neuland-Verlag.     

Family environment and length of recovery for married male members of Gamblers Anonymous and female members of GamAnon

Family environments of married male members of Gamblers Anonymous (GA) and married female members of GamAnon were measured with the Family Environment Scale (FES), a measure of 10 characteristics of family life. The total sample of 86 included 50 male GA and 36 female GamAnon members. GA and GamAnon groups did not differ from each other. However, the short-term GA group reported greater dissatisfaction than controls on five personal growth dimensions. The long-term GA group reported less Conflict than controls. Both short-term and long-term GamAnon groups reported less satisfaction than normal controls on personal growth dimensions. A composite measure of social support demonstrated improvement with duration of abstinence for gamblers but not for spouses. Results suggest improvement in family environment for male pathological gamblers with length of gambling abstinence but less improvement for wives.The authors wish to thank Mr. Les Franklin for assistance with data coding.     

The Gambling Cognitions Inventory: scale development and psychometric validation with problem and pathological gamblers

Cognitive distortions are typically identified as an important etiological factor in pathological gambling. The Gambling Cognitions Inventory (GCI) developed by Holub (2003) is examined in this study using a sample of 710 pathological gamblers collected in four Canadian studies. Confirmatory factor analysis did not support the initial 40-item scale and suggested a 33-item scale. The sample was split into two groups to conduct exploratory and confirmatory factor analyses. Scree plots and parallel analysis suggested a two-factor scale. The scale developed by exploratory factor analysis on the first sample was supported by confirmatory factor analysis on the second sample (CFI>0.95; RMSEA < 0.05). The two factors indicated a Skill and Attitude subscale and a Luck and Chance subscale. Analysis conducted within each of the four studies showed good internal reliability for the scale (range of α = 0.91–0.95) and subscales (α = 0.77–0.92). The scale and subscales correlated with gambling severity measures as well as other measures of gambling cognitions including the Gambling Attitudes and Beliefs Scale and the Gambling Beliefs Questionnaire. The results of the study indicate that the GCI is a psychometrically strong scale and may be beneficial in directing cognitive therapy to the most problematic cognitions.     

A comparison of male and female dually arrested domestic violence offenders

This research provides information on dually arrested female defendants in domestic violence cases. The data comes from all heterosexual domestic violence cases resulting in a dual arrest from one large mid-South city during a 28-month period. Information on matched pairs of dually arrested male and female defendants (N = 317) came from multiple sources, including official criminal justice records (arrest reports and local criminal histories) as well as victim/offender interviews with both the arrestee and his/her partner. Comparisons were made between males and females in terms of their demographics, criminal histories, prior history of domestic violence (as both victim and offender), and behavior during the instant offense. Analyses revealed that these couples had ample contact, whether as victim or offender, with the criminal justice system. While there were no significant differences in partners' reports of minor and severe physical abuse, criminal justice date indicated that male arrestees demonstrated a significantly higher overall level of severity of violence than their female counterparts. Additionally, male arrestees had a more serious history of intimate partner and extrafamilial violence as well as other indicators of an antisocial lifestyle in comparison to female arrestees. To the extent that females in our cohort demonstrated less overall criminality and engaged in less severe domestic aggression, the idea of equivalency of violence between male and female arrestees must remain questionable.     

Diagnosis and therapy of male gamblers in a university psychiatric hospital

From 1980 to mid-1990 fifty-one gamblers were evaluated and treated at the psychiatric university hospital of Homburg/Saar in Germany. All were men with a mean age of 33.7 years. Gambling had lasted 5.2 years on average. Most patients were motivated to undergo therapy by members of their family. The majority of them had been in psychotherapeutic treatment before. Thirty-six of the 51 patients had committed punishable acts including fraud and embezzlement and, in 7 cases, robbery. The sample could be divided into three clinical subgroups. The first group consisted of patients with severe psychiatric diseases such as schizophrenia, manic-depressive illness or organic brain disorder. Patients of the second group suffered from serious personality disorders. Those of the third group showed deep-rooted problems in their current relationships.This article is an extension of the special issue on Gambling in Europe edited by Iver Hand, M.D.