The gambling lifestyle: II. Treatment

Two individuals with records of prior compulsive gambling involvement are profiled in order to illustrate the nature of a gambling lifestyle and describe the process of lifestyle change. The treatment model utilized by therapists proposing a lifestyle interpretation of compulsive gambling behavior is guided by three primary objectives or goals: (1) the cessation of lifestyle activities; (2) the development of skills useful in managing gambling-related conditions, choices, and cognitions; and (3) the implementation of an effective program of follow-up intervention and support. These goals give rise to the three stages of lifestyle intervention — (1) laying a foundation for change, (2) identifying vehicles for change, and (3) establishing a reinforcing nongambling life-style—from which specific change strategies are derived. The implications of this model and the possibility of limited generalizability are discussed.The assertions and opinions contained herein are the private views of the author and should not be construed as official or as reflecting the views of the Federal Bureau of Prisons or United States Department of Justice.     

A Case of Mistaken Identity? A Comparison of Professional and Amateur Problem Gamblers

Professional gamblers are more likely than amateur gamblers to meet criteria for problem gambling but minimal research has examined their gambling behavior and its consequences. This study compared gambling behavior, problem gambling symptoms, related harms, recognition, and help-seeking among problem semi/professional gamblers (PPGs/PSPGs) and problem amateur gamblers (PAGs). Surveys completed by 57 self-identified professional gamblers, 311 semi-professional gamblers and 4226 amateur gamblers were analysed. PPGs/PSPGs were significantly more likely than PAGs to be male, younger, never married, speak a language other than English at home, and have higher psychological distress, compared to PAGs. PPGs/PSPGs were more likely to gamble more frequently on many skills-based forms, but most also participated in several chance-based forms. PPGs’/PSPGs’ most common problematic gambling form was electronic gaming machines and they were more likely to have problems with sports betting than PAGs. Most PPGs/PSPGs reported coming out behind on all gambling forms over the previous year. PPGs/PSPGs were more likely than PAGs to report chasing losses and numerous detrimental financial gambling consequences. This group’s self-identification as PPGs/PSPGs is clearly inaccurate and perhaps a means to avoid stigma, elevate status and support problem denial. PPGs/PSPGs may represent an extreme example of gamblers with erroneous cognitions and beliefs who lack the required discipline and skill to be successful professional gamblers. The findings identify a group of problem gamblers who may benefit from interventions to dispel their mistaken self-identity, and emphasize the need for more rigorous confirmation of professional gambler status in future research.     

Prevalence of Problem Gambling Among Adolescents: A Comparison Across Modes of Access,Gambling Activities,and Levels of Severity

The high availability and accessibility of online gambling have recently caused public concern regarding the potential increase of gambling-related problems among young people. Nonetheless, few studies among adults and none among adolescents have explored specific characteristics of gamblers as a function of gambling venues to date. This study sought to analyze the prevalence of gambling among a sample of adolescents in the last year, as well as sociodemographic and gambling-related characteristics as possible predictors of at-risk and problem gambling. The sample comprised 1313 adolescents aged 14–18 years. Participants were asked to respond to several questions regarding their gambling behavior. Chi square and ANOVA tests were performed in order to explore differences between groups, and a set of multinomial regressions established significant severity predictors. The prevalence of at-risk and problem gambling was 4 and 1.2 %, respectively. Regression analyses showed that having a relative with gambling problems predicted at-risk gambling. Both living with only one parent or not living with parents at all, and the prevalence of Electronic Gambling Machines in the last year were associated with problem gambling. Mixed-mode gambling was a predictor of both at-risk and problem gambling. Our findings extend previous research on gambling among adolescents by exploring gambling behavior according to different modes of access. Although the prevalence of exclusive online gambling among the total sample was low, these results support the need to consider specific subgroups of gamblers and their concrete related features when conducting both indicated prevention and treatment protocols for adolescents.     

Self-perception of Gambling Problems among Adolescents Identified as At-risk or Problem Gamblers

The relative influence of perceived familial addictive behaviors and personal gambling behaviors on adolescents' self-perceptions of gambling problems was examined. Students from five high schools in Connecticut (N = 3,886) were surveyed. Of those between the ages of 14 and 17 who scored two or more on the South Oaks Gambling Screen--Revised for Adolescents (n = 532; 72% male; 43% Caucasian), 14.3% reported having a current or past problem with gambling. Wagering larger amounts in a single day, gambling on a daily basis, and perceived presence of a family member with a gambling problem were associated with increased odds of self-perception of a gambling problem. Thus, adolescents who may be less likely to be identified for prevention efforts (due to lack of engagement in high stakes gambling or the real/perceived absence of a problematic gambler in the home) appear less likely to perceive a gambling problem. To advance prevention and treatment strategies, the apparent discrepancy between adolescents' self-perceptions and objective reports of problem gambling behaviors warrants further investigation.     

Behaviour change strategies for problem gambling: an analysis of online posts

Reducing or quitting problematic gambling often requires implementing a variety of behaviour change strategies, but there is limited evidence regarding the breadth of specific strategies that gamblers use to control or limit gambling behaviours. This study aimed to identify the range of change strategies reported by gamblers in a naturalistic setting (i.e. two online forums for problem gambling). A total of 2937 change strategies were extracted from online posts (N = 1370). Content analysis identified 27 discrete change strategies that were pre-decisional (i.e. barriers – behavioural and psychological, decisional balance, realization – behaviour and cognitions, set reasons to change, seek knowledge and information, self-assessment), pre-actional (i.e. action planning, commitment, goal setting), actional (i.e. alternative activity, behavioural substitution, avoidance – abstinence, environment and financial, consumption control, maintain readiness, reinforcement, urge management, cognitive restructuring, seek inspiration, self-monitoring and spiritual) and multi-phased (i.e. external support, social support and well-being). This study suggests the breadth and depth of change strategies are far more complex than previously reported. Future research with a broader population needs to determine which change strategies are most effective for those experiencing different levels of gambling problems.     

GamTest: Psychometric Evaluation and the Role of Emotions in an Online Self-Test for Gambling Behavior

Recent increases in the number of online gambling sites have made gambling more available, which may contribute to an increase in gambling problems. At the same time, online gambling provides opportunities to introduce measures intended to prevent problem gambling. GamTest is an online test of gambling behavior that provides information that can be used to give players individualized feedback and recommendations for action. The aim of this study is to explore the dimensionality of GamTest and validate it against the Problem Gambling Severity Index (PGSI) and the gambler’s own perceived problems. A recent psychometric approach, exploratory structural equation modeling (ESEM) is used. Well-defined constructs are identified in a two-step procedure fitting a traditional exploratory factor analysis model as well as a so-called bifactor model. Using data collected at four Nordic gambling sites in the autumn of 2009 (n = 10,402), the GamTest ESEM analyses indicate high correspondence with the players’ own understanding of their problems and with the PGSI, a validated measure of problem gambling. We conclude that GamTest captures five dimensions of problematic gambling (i.e., overconsumption of money and time, and monetary, social and emotional negative consequences) with high reliability, and that the bifactor approach, composed of a general factor and specific residual factors, reproduces all these factors except one, the negative consequences emotional factor, which contributes to the dominant part of the general factor. The results underscore the importance of tailoring feedback and support to online gamblers with a particular focus on how to handle emotions in relation to their gambling behavior.     

Predictors of help-seeking for gambling disorder from the transtheoretical model perspective

Few gamblers seek treatment despite the severe negative impacts prolonged gambling can have. Research surrounding the predictors of help-seeking for problem gambling is often retrospective in design and inconsistent in findings. This study prospectively investigated whether transtheoretical model (TTM) constructs (readiness to change, ratings of temptations and self-efficacy, decisional balance and processes of change) have utility in predicting help-seeking among disordered gamblers. Community-recruited disordered gamblers (N = 136; 47.06% female; mean age = 44.5 years, SD = 12.8; 80.1% Caucasian) completed three assessments of TTM constructs, help-seeking behaviour, gambling problem severity, and other potential predictors of help-seeking. Informal help-seeking was common (6-month = 71.1%; 12-month = 79.6%); however, formal help-seeking was relatively infrequent (6-month = 22.7%; 12-month = 35.1%). Logistic regression demonstrated that gambling problem severity and the social liberation process of change (i.e. endorsing public awareness of gambling problems or non-gambling role models) consistently predicted formal help-seeking. Helping relationships and counter-conditioning (i.e. engaging in other activities as a replacement for gambling) processes of change uniquely predicted informal help-seeking at 12 months. Individuals most likely to seek formal help have greater problem severity and greater readiness to address problems. Seeking informal help is less predictable but more common.     

Thoughts and acts of self-harm,and suicidal ideation,in online gamblers

Gambling problems have been linked to suicidal ideation and enhanced risk of suicide attempts. However, we know very little about the factors associated with either thoughts or acts of self-harm amongst people who gamble. A web-based study of 4125 online gamblers (79% males; mean age 35.5 years), analysed using hierarchical multiple regression, revealed that self-reported non-gambling-related self-harm was negatively related to age and marital status, and positively related to problematic alcohol use. Self-reported acts of self-harm both related and unrelated to gambling were associated with drug misuse. Thoughts and acts of gambling-related self-harm were associated with problem gambling, gambling involvement and parental problem gambling. All types of self-harm were associated with mood disorder symptoms, unemployment and certain gambling motivations. When tailoring assessment and interventions for individuals at risk for gambling-related deliberate self-harm, it is important to recognize that contributory factors may include some that differ from those for deliberate self-harm in general, and that there is potential value in evaluating gambling involvement and motivations, and history of parental gambling.     

Prevalence Estimates of Adolescent Gambling: A Comparison of the SOGS-RA, DSM-IV-J, and the GA 20 Questions

Concerns over the rising prevalence of adolescent gambling problems have become more commonplace. A recent meta analysis of studies examining adolescent prevalence rates by Shaffer and Hall (1996) has suggested that between 77–83% of adolescents are engaging in some form of gambling behavior with between 9.9% and 14.2% of youth remaining at risk for a serious gambling problem. Their results further suggest that between 4.4% and 7.4% of adolescents exhibit serious adverse gambling related problems and/or pathological gambling behavior. Comparisons of studies are often difficult due to the use of alternative measures, differing classification schemes, and nomenclature. The present study examined the gambling behaviors of 980 adolescents who were administered three screening measures used with adolescents; the SOGS-RA, DSM-IV-J, and the GA 20 Questions. The DSM-IV-J was found to be the most conservative measure identifying 3.4% of the population as problem/pathological gamblers while the SOGS-GA identified 5.3% and the GA 20 Questions identified 6% of youth as experiencing serious gambling problems. The degree of concordance amongst the measures, gender differences, and classification systems are discussed.     

The Problem with Self-Forgiveness: Forgiving the Self Deters Readiness to Change Among Gamblers

Self-forgiveness is generally understood to be a mechanism that restores and improves the self. In the current study, we examine the possible deleterious consequences of forgiving the self among gamblers-specifically in regard to gamblers' readiness to change their problematic behavior. At a large Canadian university, 110 young adult gamblers' level of gambling pathology was assessed, along with their readiness to change and self-forgiveness for their gambling. Participants were 33 females and 75 males (2 unspecified) with a mean age of 20.33. Results revealed that level of pathology (at risk vs. problem gamblers) significantly predicted increased readiness to change. Self-forgiveness mediated this relationship, such that level of gambling pathology increased readiness to change to the extent that participants were relatively unforgiving of their gambling. Implications for seeking professional assistance as well as treatment and recovery are discussed.     

Internet-Based Interventions for Addictive Behaviours: A Systematic Review

Internet-based interventions have emerged as a new treatment and intervention modality for psychological disorders. Given their features of treatment flexibility, anonymity and confidentiality, this modality may be well suited in the management of addictive behaviours. A systematic literature review of the effectiveness and treatment outcomes of Internet-based interventions for smoking cessation, problematic alcohol use, substance abuse and gambling was performed. Studies were included if they met the following criteria: clients received a structured therapeutic Internet-based intervention for a problematic and addictive behaviour; included more than five clients; effectiveness was based on at least one outcome; outcome variables were measured before and immediately following the interventions; had a follow-up period; and involved at least minimal therapist contact over the course of the program. Sixteen relevant studies were found; nine addressed the effects of Internet-based interventions on smoking cessation, four on gambling, two on alcohol and one on opioid dependence. All studies demonstrated positive treatment outcomes for their respective addictive behaviours. The current review concluded that Internet-based interventions are effective in achieving positive behavioural change through reducing problematic behaviours. This mode of therapy has been found to have the capacity to provide effective and practical services for those who might have remained untreated, subsequently reducing the barriers for help-seekers. This in turn provides imperative information to treatment providers, policy makers, and academic researchers.     

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.     

Impaired Metacognitive Capacities in Individuals with Problem Gambling

Impaired insight into behavior may be one of the clinical characteristics of pathological gambling. In the present study, we tested whether the capacity to evaluate accurately the quality of one’s own decisions during a non-gambling task was impaired in problem gamblers. Twenty-five problem gamblers and 25 matched healthy participants performed an artificial grammar-learning paradigm, in which the quality of choice remains uncertain throughout the task. After each trial of this task, participants had to indicate how confident they were in the grammaticality judgements using a scale ranging from 1 (low confidence) to 7 (high confidence). Results showed that (i), problem gamblers’ performance on the grammaticality test was lower than controls’; (ii) there was a significant correlation between grammaticality judgments and confidence for control participants, which indicates metacognitive insight and the presence of conscious knowledge; (iii) this correlation was not significant in problem gamblers, which suggests a disconnection between performance and confidence in this group. These findings suggest that problem gamblers are impaired in their metacognitive abilities on a non-gambling task, which suggests that compulsive gambling is associated with poor insight as a general factor. Clinical interventions tailored to improve metacognition in gambling could be a fruitful avenue of research in order to prevent pathological gambling.     

Predictors of adverse gambling related consequences among adolescent boys

Although gambling is illegal for minors, adolescents do gamble and even higher proportions of adolescents than adults are at risk to become problem gamblers. Moreover, many adolescents suffer from a wide range of gambling related harms, and this study sought to examine what predicts different adverse consequences of adolescent gambling. Our aim was to test whether various cognitive, motivational and behavioural factors were associated with psychosocial consequences and loss of control, and with interpersonal and financial consequences of gambling, as measured by the Canadian Adolescent Gambling Inventory, the only instrument developed specifically for use on adolescents. The data was collected on a convenience sample of 1330 male Croatian students (Mage = 16.58, SDage = 1.16) from all three types of secondary education in Croatia. Results show that a high proportion of adolescents gamble, and that almost half of them are either at risk or can already be considered problem gamblers. Sport betting, VLT machines and betting on virtual horse races were the most frequent gambling activities for Croatian high-school boys. Hierarchical regression models showed that psychosocial consequences and loss of control can be predicted by higher frequency of gambling, previous experience with winning money and a specific motivation to earn money gambling, to become a better gambler and with having a drive to continue gambling after winning. On the other hand, interpersonal and financial consequences were predicted again by a higher frequency of gambling, the motive to be a better gambler and the drive to continue gambling after winning, but also by specific motivation to relax and feel better. Having more cognitive distortions, specifically having poorer understanding of chance and probabilities and more superstitious beliefs, as well as engagement in general risky and antisocial behaviour also predicted more interpersonal and financial consequences. Findings are discussed in the context of practical implications for prevention programs of adolescent gambling.     

Estimating the prevalence of adolescent gambling disorders: A quantitative synthesis and guide toward standard gambling nomenclature

This article reviews the extant published and unpublished studies that estimate the prevalence of adolescent gambling problems in North America. The nine nonduplicative studies identified by our literature search included data collected from more than 7700 adolescents from five different regions of the United States and Canada. In addition to comparing the conceptual and methodological differences that exist among these studies, this article employed a meta-analytic strategy to synthesize prevalence estimates from the existing studies. This analysis revealed that within a 95 percent confidence interval, between 9.9% and 14.2% of adolescents are at risk of developing or returning to serious gambling problems. Similarly, between 4.4% and 7.4% of adolescents exhibit seriously adverse compulsive or pathological patterns of gambling activity. Finally, the discussion proposes a generic multi-level classification scheme to reconcile the divergent classification methods and data reporting strategies. This new multi-level approach to reporting gambling prevalence will facilitate interstudy comparisons among existing estimates of gambling prevalence and help to provide a general data reporting system for future research.     

Prevalence of Adolescent Problem Gambling: A Systematic Review of Recent Research

Previous research has shown that gambling is a popular activity among adolescents. Following a rapid expansion of legalized gambling opportunities and the emergence of new forms of gambling, many researchers have carried out studies on adolescent gambling and problem gambling. The present paper reviews studies that have been conducted worldwide since 2000, and then presents a more detailed picture of adolescent gambling research in Europe, by providing a country-by country analysis. After an extensive search on academic databases and following an exclusion process, 44 studies were identified. The findings showed that 0.2–12.3 % of youth meet criteria for problem gambling, notwithstanding differences among assessment instruments, cut-offs, and timeframes. However, despite this variability, several demographic characteristics were associated with adolescent gambling involvement and problem gambling. It is concluded that a small but significant minority of adolescents have gambling-related problems. Such findings will hopefully encourage more research into youth gambling to further understand the determinants of this phenomenon.     

Demographic,Behavioural and Normative Risk Factors for Gambling Problems Amongst Sports Bettors

Sports betting is growing exponentially, is heavily marketed and successfully targets young adult males. Associated gambling problems are increasing. Therefore, understanding risk factors for problem gambling amongst sports bettors is an increasingly important area of research to inform the appropriate design and targeting of public health and treatment interventions. This study aimed to identify demographic, behavioural and normative risk factors for gambling problems amongst sports bettors. An online survey of 639 Australian sports bettors using online, telephone and retail betting channels was conducted. Results indicated that vulnerable sports bettors for higher risk gambling are those who are young, male, single, educated, and employed full-time or a full-time student. Risk of problem gambling was also found to increase with greater frequency and expenditure on sports betting, greater diversity of gambling involvement, and with more impulsive responses to betting opportunities, including in-play live action betting. Normative influences from media advertising and from significant others were also associated with greater problem gambling risk. The results of this study can inform a suite of intervention, protection and treatment initiatives targeted especially at young male adults and adolescents that can help to limit the harm from this gambling form.     

Prevalence and Correlates of Gambling Problems Among a Nationally Representative Sample of Brazilian Adolescents

The objectives of the study are: (a) to provide the first prevalence estimates of pathological gambling among Brazilian adolescents using an age-specific instrument in a nationally representative sample; (b) to investigate the extent to which adolescents participate in gambling activities in a developing country; and (c) to correlate different levels of gambling behavior with demographic variables. Multistage cluster sampling selected 3,007 individuals over 14 years of age from Brazilian household population. A total of 661 participants were between 14 and 17 years old. The Lie/Bet Questionnaire and the DSM-IV-MR-J were used for assessing problem and pathological gambling. 2.8% scored positive on the screening questionnaire, while 1.6% were classified as problem and pathological gamblers. Factors associated with problem and pathological gambling were male sex, not currently studying and considering religion as not important. Less than 4 months elapsed between the age of regular gambling involvement and the first gambling problem. Prevalence rates were quite similar from recent studies which used nationally representative samples. The association of problem and pathological gambling with male sex, school drop-out and low religiosity supports the Problem Behavior Theory. The fast progression to problem gambling adds evidence that adolescents may be more vulnerable to the effects of gambling.     

The Dark Side of Authenticity: Feeling “Real” While Gambling Interacts with Enhancement Motives to Predict Problematic Gambling Behavior

Engaging in activities that make people feel authentic or real is typically associated with a host of positive psychological and physiological outcomes (i.e., being authentic serves to increase well-being). In the current study, we tested the idea that authenticity might have a dark side among people engaged in an addictive or risky behavior (gambling). To test this possibility, we assessed gamblers (N = 61) who were betting on the National Hockey League playoff games at a sports bar. As predicted, people who felt authentic when gambling reported behavior associated with problem gambling (high frequency of betting) as well as problematic play (a big monetary loss and a big monetary win). Moreover, such behavior and gambling outcomes were particularly high among people who were motivated to gamble for the purpose of enhancement. The interaction of feeling authentic when betting and gambling for purposes of enhancing positive emotions proved especially troublesome for problematic forms of play. Implications of authenticity as a potential vulnerability factor for sports betting and other types of gambling are discussed.