Plasma endorphin levels in pathological gambling

Despite its formal definition as a disorder of impulse control, pathological gambling has come under the generic label of addictive disorders with subjective excitement and physiological arousal as the major motivating factor. Individual differences in autonomic/cortical arousability in interaction with irregular schedules of reinforcement have been postulated to be important determinant factors in the pathogenesis of pathological gambling (Anderson & Brown, 1984). Mood disturbances and cross-addictions are frequently observed in pathological gamblers seeking treatment and the behavior has also been conceptualized as a defense against depression and anxiety. Recently the role of endorphins has been implicated in mood disturbances associated with psychiatric states and in addictive processes; the latter through their euphorogenic or reward-transmitting properties in accordance with operant and classical conditioning principles. The hypothesis that the etiology or maintenance of gambling behavior is related to endorphin activity was investigated in this study. Using radioimmunoassay techniques, baseline B-endorphin plasma levels were measured in a sample of 39 pathological gamblers seeking treatment and 16 male and 19 female non-gambling healthy control subjects. In addition, B-endorphin reactivity to gambling activity was measured in a subgroup of 13 horse-race gamblers.Diagnostic and Statistical Manual III criteria for diagnosis were used. Written consent was obtained. Blood samples were drawn at the same time of day for each subject. The experimental procedure consisted of taking baseline blood samples at 11 a.m. following which subjects were instructed to place a bet sufficient to excite them on a horse-race. A subsequent blood sample was taken at 2 p.m., five minutes after subjects listened to the race broadcast on radio. Heart rate measures and a visual analogue scale rating excitement, tension and urge to gamble were also administered immediately before and after the race broadcast. Results showed that as a group pathological gamblers did not differ from controls on baseline B-endorphin levels. But differentiating gamblers according to type of gambling activity revealed horserace addicts to have significantly lower baseline levels as compared to poker-machine players and controls. This finding provides empirical evidence for the hypothesis that distinct subgroups of gamblers exist and raises the corollary that different etiological factors may characterize each subgroup. That B-endorphin levels did not increase in response to gambling was explained by the failure of the relatively small bet size to generate high arousal.This paper was presented at the Sixth National Conference on Gambling and Risk Taking, held at Atlantic City, New Jersey, December 9 to 12, 1984.     

Pathological gamblers in methadone treatment: A comparison between men and women

This article uses data from interviews with 462 individuals enrolled in methadone treatment programs in New York City to compare the gambling and gambling-related drug use and criminal activities of those males (N=72) and females (N=27) found to be pathological gamblers. Both the male and female pathological gamblers were and continue to be actively involved in various forms of gambling. A greater proportion of males had engaged in almost all specific types of gambling, although differences between males and females were not all statistically significant. Males and females were very similar in terms of their patterns of drug and alcohol use and the substances they used when gambling. Males and females shared some reasons but also had separate reasons as to why they used heroin when they gambled. Males especially may participate in a variety of criminal and hustling activities to have the money to be able to gamble or to pay gambling debts. The implications of this research are discussed.This study was supported by grant 1RO3-DA08348, Prevalence of Gambling Problems Among Methadone Patients, from the National Institute on Drug Abuse, awarded to National Development and Research Institutes, Inc. Points of view or opinions in this report do not necessarily represent the official opinions or policies of the United States Government, National Development and Research Institutes, Inc., John Jay College of Criminal Justice/CUNY, Illinois State University, or Abt Associates. The authors wish to thank Leila Cahill and Michelle Silverman for their assistance with this research.     

Perceptions of the Extent of Problem Gambling Within New Casino Communities

Several recent studies using objective measures have found that the rate of pathological gambling in the U.S. is less than 5%. To determine the general population's perception of the prevalence of pathological gambling, a survey was conducted in seven communities where casinos have recently opened. Of the 1631 respondents who provided an estimate, the mean response was that 16% of the community residents were problem gamblers, more than three times the rate found by studies using specific diagnostic criteria. A regression equation found several demographic and attitudinal items are associated with higher prevalence estimates. In addition, the data support a close to home hypothesis that respondents who have relatives who have experienced problems with gambling will tend to perceive higher rates of problem gambling in the community.     

Impulsiveness,Locus of Control,Motivation and Problem Gambling

A questionnaire consisting of demographic items, questions about gambling behavior, the South Oaks Gambling Screen (SOGS), a depression inventory, the Eysenck Impulsiveness Questionnaire, Levensons Internality, Powerful Others and Chance Scales of locus of control and the Gambling Motivation Scale, was completed by a non-random sample of 147 New Zealand university students who gambled for money, median age 24 years. Approximately 17 of the sample was classified as problem gamblers, the rest as non-problem gamblers. Multivariate analysis of variance showed that there were significant differences between problem and non-problem gamblers on gambling frequency, number of activities, parents gambling, depression, impulsiveness and motivation, but not on locus of control. Amotivation (apathy) and motivation towards stimulation correlated with powerful others and chance locus of control, and motivation to impress others with powerful others locus of control. Hierarchical regression analysis showed that: (1) beyond gambling frequency, number of activities and parents gambling, motivation explained a substantial proportion of variance in SOGS scores, with impulsiveness accounting for a lesser amount, and (2) predictors of problem gambling included impulsiveness, amotivation and the motivations for accomplishment and tension release. It was concluded that gambling motivation is a more useful construct than locus of control in explaining problem gambling. Suggestions were made for future research, and aspects of gambling motivation were discussed in terms of a treatment program with groups of problem gamblers.     

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.     

The medical model of pathological gambling: Current shortcomings

Occasional, regular and pathological gambling are distributed in the population as a continuum. Failure to find categorical features of pathological gambling weakens the medical model for this condition, and the implications of this model concerning treatment, both in relation to the possibility of controlled gambling as an acceptable goal, and as to the effectiveness of social manipulations, such as restrictions of gambling outlets. Differences in gambling behavior patterns between pathological and nonpathological gamblers has not been consistently demonstrated and though some support exists for a relationship between addiction to gambling and alcohol, this could be accounted for by other factors than an addiction-prone personality. While findings support a relationship between personality variables and pathological gambling, the concept of a single personality type associated with the behavior seems unlikely. Nevertheless, evidence of physiological differences between pathological gamblers and controls has recently been reported and if established would provide strong support for a medical model, particularly one which allows for an interaction of physiological and sociological factors resulting in dimensional distribution of gambling behaviors.     

Pathological gambling in Montreal's Chinese community: an anthropological perspective

Pathological gambling has been identified as a major issue in Montreals Chinese community. A variety of sources attest to the fact that, though we live in an increasingly heterogeneous society, the services provided to minority communities for preventing and treating pathological gambling are inadequate. An anthropological approach that takes into account cultural characteristics of ones community could lead to better strategies for acknowledgement, definition, diagnosis and treatment of pathological gambling among culturally different communities. Research paths that could help to provide effective treatment and services to specific populations are suggested. An overview of the way the Chinese view gambling, pathological gambling and treatment is presented. The concepts of fate, destiny and luck in Chinese thought, as well as Montreals Chinese community social norms related to gambling are then described. The incorporation of those cultural understandings in future studies and treatment attempts is suggested.     

Behavior Genetic Research on Gambling and Problem Gambling: A Preliminary Meta-Analysis of Available Data

A meta-analysis of family and twin studies on gambling and problem gambling was initiated in an effort to determine the probable role of genetic factors in high risk wagering. Two twin studies and 17 investigations employing the family history or family study method were included in this meta-analysis. A summation of the 19 studies produced a small but significant overall effect size (weighted = .10, unweighted = .13), with both family (weighted = .12, unweighted = .14) and twin (weighted = .06, unweighted = .05) studies achieving significant individual mean effects. Given the paucity of twin data, further analysis was confined to family studies and revealed a stronger familial effect for the sons of problem gambling fathers than for the daughters of problem gambling mothers and for more severe forms of problem gambling than for less severe forms of problem wagering, and was strongest for high severity problem gambling in males. The implications of these results are discussed.     

Video lottery gambling: Effects on pathological gamblers seeking treatment in South Dakota

Fifty-eight pathological gamblers receiving treatment for addictive illness in two South Dakota hospitals were assessed for types of gambling and grouped into three categories; 15 video lottery only (VLO), 36 video lottery mixed (VLM), and 7 not video lottery (NVL). There were 51 male and 7 female respondents, with a mean age of 38.2. We hypothesized that video lottery would be the predominant type of gambling on several dimensions: level of recent activity, most money lost on one occasion, and number of DSM-IV criteria met. Of all gamblers, 87.9% had pathological involvement with video lottery. Video lottery gambling accounted for the highest level of recent activity. In the VLM group, video lottery gambling led to greater single-occasion monetary losses. In addition, significantly more DSM-IV criteria were met in the VLM group for video lottery gambling than for other forms of gambling these subjects had engaged in. Results indicate that video lottery gambling is the predominant type of gambling behavior engaged in by gamblers seeking treatment for addictive illness in South Dakota. We propose that these findings could be associated with the availability and stimulus differences between video lottery and other gambling types.The authors would like to thank Larry Atwood, Chemical Dependency Counselor at Keystone Treatment Center in Canton, S.D., for his assistance with data collection.     

Measuring pathological gambling in children: The case of fruit machines in the U.K.

The alleged incidence of addiction to fruit machine gambling among children in the U.K. has highlighted the need for a measure to define and count pathological gambling in children. The DSM-IV criteria, which are being refined to diagnose pathological gambling in adults, was adapted for use with pre-adult gamblers. The resulting DSM-IV-J criteria were tested using a questionnaire survey on a sample of 467 schoolchildren aged between 11 and 16 years. Those children who were defined as probable pathological gamblers by the DSM-IV-J index were significantly more likely to be involved in behaviours hitherto associated with dependency, than were the control group. DSM-IV-J appears to be a major advance in the discrimination of pathological gambling in children.The author would like to thank the Economic and Social Research Council for funding this work through a Research Studentship Grant. The author would also like to thank Henry Lesieur Ph.D. and Mark Dickerson Ph.D. for their helpful comments in the design stage of this research.     

Reasons for Starting and Continuing Gambling in a Mixed Ethnic Community Sample of Pathological and Non-problem Gamblers

Very few studies have investigated motivational differences between pathological gamblers (PG) and non-problem gamblers (NPG), or between men and women. Motives for starting gambling have not been distinguished from motives for continuing gambling. From a community survey questionnaire listing reasons generated from the population studied, the motives of 103 current PG met the DSM-IV-TR criteria of five or more symptoms within the 12 months to October 2004. NPG assented to less than three symptoms. Generally, PG had significantly stronger motives than NPG and preferred continuous forms of gambling. There were no overall gender differences in motives, but electronic gaming machines and bingo were the primary choices for female PG. Gambling to escape from stress and troubles increased for PG but not for NPG, while gambling for social reasons decreased for both groups. Because of disproportionate numbers of PG and NPG in the Caucasian, Maori, Pacific Island and Asian groups, ethnic differences were not examined. The findings supported some aspects of theories of gambling motivation. Lowering stress for PG, raising community awareness of the risk of gambling to socialize and undertaking longitudinal research in community samples were suggested.     

The Gambling Self-Efficacy Questionnaire: An Initial Psychometric Evaluation

Instruments to assess individuals' self-efficacy for the control of addictive behaviors have been useful for monitoring behavior change, predicting maintenance of treatment gains, and identifying potential relapse situations. The Gambling Self-Efficacy Questionnaire (GSEQ) was developed to assess perceived self-efficacy to control gambling behavior. A demographically diverse sample of 309 adult gamblers completed an initial set of 42 items, of which 16 were selected to form the final version of the GSEQ. The GSEQ showed high internal consistency ( = .96) and good test-retest reliability (r = .86). A factor analysis provided some support for a unitary factor structure. As expected, GSEQ scores were negatively correlated with reports of problematic gambling behavior. Participants experiencing problems related to their gambling behavior scored significantly lower on the GSEQ than those who were not experiencing gambling problems. This psychometric examination of the GSEQ supported its potential utility for treatment planning and outcome evaluation with problem gamblers.     

Subtyping Non-treatment-seeking Problem Gamblers Using the Pathways Model

This study examined whether distinct subgroups could be identified among a sample of non-treatment-seeking problem and pathological/disordered gamblers (PG) using Blaszczynski and Nower’s (Addiction 97:487–499, 2002) pathways model (N = 150, 50% female). We examined coping motives for gambling, childhood trauma, boredom proneness, risk-taking, impulsivity, attention-deficit/hyperactivity disorder (ADHD), and antisocial personality disorder as defining variables in a hierarchical cluster analysis to identify subgroups. Subgroup differences in gambling, psychiatric, and demographic variables were also assessed to establish concurrent validity. Consistent with the pathways model, our analyses identified three gambling subgroups: (1) behaviorally conditioned (BC), (2) emotionally vulnerable (EV), and (3) antisocial-impulsivist (AI) gamblers. BC gamblers (n = 47) reported the lowest levels of lifetime depression, anxiety, gambling severity, and interest in problem gambling treatment. EV gamblers (n = 53) reported the highest levels of childhood trauma, motivation to gamble to cope with negative emotions, gambling-related suicidal ideation, and family history of gambling problems. AI gamblers (n = 50) reported the highest levels of antisocial personality disorder and ADHD symptoms, as well as higher rates of impulsivity and risk-taking than EV gamblers. The findings provide evidence for the validity of the pathways model as a framework for conceptualizing PG subtypes in a non-treatment-seeking sample, and underscore the importance of tailoring treatment approaches to meet the respective clinical needs of these subtypes.     

The Relationship of Ecological and Geographic Factors to Gambling Behavior and Pathology

The current study examined the effect of neighborhood disadvantage and gambling availability on gambling participation and pathology. A national telephone survey included 2631 US adults. Census data was used to characterize the respondents neighborhood, and the distance from the respondents home to gambling facilities was calculated. Logistic and linear regressions were performed to predict gambling participation and pathology. Results showed that the neighborhood disadvantage was positively related to frequency of gambling and problem/pathological gambling. The presence of a casino within 10miles of the respondents home was positively related to problem/pathological gambling. The permissiveness of gambling laws was positively related to any gambling in the past year, as well as frequent gambling. These results were interpreted to mean that the ecology of disadvantaged neighborhoods promotes gambling pathology, and that availability of gambling opportunities promotes gambling participation and pathology.     

Treating Problem Gamblers: Working towards Empirically Supported Treatment

There is an urgent need for mental health professionals to develop effective treatments for pathological gambling. A scientific meeting was held in Quebec City in June 2002 where 13 specialists in the treatment of gamblers pursued the objectives of making the State of the art statement concerning the procedures and the methodology to be used in future treatment outcome studies. This paper introduces this special issue of the Journal of Gambling Studies and identifies some of the key issues that confront clinicians and researchers interested in evidence based treatment for gambling related disorders.     

The relationship between dissociative-like experiences and sensation seeking among social and problem gamblers

The present study examined the relationships between dissociative experiences, sensation seeking scores, and gambling behavior. On the basis of the frequency of their gambling behavior and responses to the Gamblers Anonymous Twenty Questions, subjects were designated as either problem gamblers (N=30) or social gamblers (N=30).Those designated as problem gamblers responded yes to an average of 12.17 questions on the Gamblers Anonymous Twenty Questions as compared to the social gamblers who averaged 1.90 yes responses. Responses on the Twenty Questions correlated strongly with the frequency of gambling behavior and dissociative experiences. Problem gamblers reported a significantly greater number of dissociative experiences than social gamblers (p<.01). Problem gamblers scored significantly higher than social gamblers on the Total Sensation Seeking Scale, and the Boredom Susceptibility, Experience Seeking, and Disinhibition subscales. Clinical implications and recommendations for future research are discussed.     

The Clustering of Psychiatric Disorders in High-Risk Gambling Populations

The aims of this study were to examine the associations between psychiatric disorders and pathological gambling (PG) and the clustering of psychiatric disorders in high risk gambler populations. The sample comprised 140 regular gamblers who were recruited from the general public. A variety of self- report and semi structured questionnaires was administered, including the Mini International Neuropsychiatric Interview, The Personality Diagnostic Questionnaire-4th Edition, NORC DSM-IV Screen for Gambling Problems Self- administered and Problem Gambling Severity Index. Axis I and Axis II psychiatric disorders and personality disturbances were found to be more prevalent amongst pathological gamblers than other gamblers with the strongest differences observed for mood and anxiety-related disorders. Almost two-thirds of pathological gamblers reported both an anxiety or mood disorder in conjunction with another type of disorder. These differences between the gambling groups existed even after controlling for gender. The results highlight the high rates of co-morbidity in pathological gamblers in the community and the extent to which anxiety and mood disorders co-existing with other forms of pathology. These results highlight the significant challenges facing treatment services in the treatment of PG and the extent to which this should be treated as the primary disorder.     

Alcohol Consumption and Self-Control of Gambling Behaviour

This paper reports the results of a preliminary investigation into whether the drinking of alcohol contributes to impaired control of gambling behaviour. The sampling method consisted of a two-phase survey design, collecting data both prospectively within session and retrospectively via a take-home questionnaire. One hundred sixteen people were interviewed while in a gaming venue playing on an electronic gaming machine (egm) of whom 34 men and 11 women also returned take-home surveys. Comparisons of the sample to previous studies suggested that the sample was representative of the population of egm players. Results indicated a consistent theme of alcohol use contributing significantly to impaired control of gambling behaviour, with level of involvement (Corless & Dickerson, 1989) contributing the most significant variance in the independent variables. Limitations of the study are discussed, but the case is argued that this type of process research is essential in better understanding how these two types of popular leisure activities may interact, possibly leading to the previously recorded chronic, excessive alcohol intake and problematic gambling (e.g. McCormick, Russo, Ramirez & Taber, 1984).