Withdrawal and Tolerance Phenomenon in Problem Gambling

The phenomenological similarities between gambling and substance dependence have led to the conceptualization of pathological gambling as an addictive disorder. Tolerance and withdrawal are important features of both disorders, suggesting commonalities in the neurobiological processes associated with neuroadaptational underpinnings. However, there are few empirical studies supporting the presence of tolerance and withdrawal reported in the gambling literature. Moreover, there are no studies comparing the equivalence of tolerance and withdrawal between gambling and alcohol dependence. This study compared tolerance and withdrawal features in samples of gamblers, alcoholics and gamblers who also met criteria for alcohol dependence. In contrast to the addiction model, findings indicate that, while a majority of participants increased bet size, the motivation to do so was not for excitement or to maintain arousal levels as indicated by the DSM-IV-TR but because of cognitive factors related to winning. Results supported the notion that pathological gamblers experienced similar levels of withdrawal symptom severity as alcohol-dependent participants. Further research is needed to evaluate whether those symptoms result from the inability to gamble or from the loss of an avoidant stress coping strategy.     

Cue Reactivity in Active Pathological,Abstinent Pathological,and Regular Gamblers

Twenty-one treatment-seeking pathological gamblers, 21 pathological gamblers in recovery, and 21 recreational gamblers watched two video-taped exciting gambling scenarios and an exciting roller-coaster control scenario while their arousal (heart rate and subjective excitement) and urge to gamble were being measured. The gamblers did not differ significantly in cue-elicited heart rate elevations or excitement. However, the active pathological gamblers reported significantly greater urges to gamble across all cues compared to the abstinent pathological gamblers and, with marginal significance (p = 0.06), also compared to the social gamblers. Further exploration of these findings revealed that active pathological gamblers experience urges to gamble in response to exciting situations, whether or not they are gambling related, whereas abstinent and social gamblers only report urges to an exciting gambling-related cue. This suggests that for pathological gamblers excitement itself, irrespective of its source, may become a conditioned stimulus capable of triggering gambling behavior. Implications for treatment and future research are discussed.     

The role of subjective mood states in the maintenance of fruit machine gambling behaviour

Explanations involving the etiology of pathological gambling have tended to emphasize psychosocial factors. However, the possibility that psychobiological factors are important should not be ruled out. Two currently researched psychobiological approaches to gambling involve the role of (i) arousal and (ii) depression. A study analyzing the subjective mood variables of 60 gamblers (44 males and 16 females; mean age 23.4 years) using self report measures was carried out in an attempt to identify which mood states are critical to gambling maintenance. Results indicated that regular and pathological gamblers experienced more depressive moods before playing and that regular and pathological gamblers experienced significantly more excitement during gambling than non regular gamblers. These results are discussed in relation to contemporary literature regarding the roles of arousal and depression in the maintenance of gambling behaviour.The author would like to thank the UK Economic and Social Research Council for funding this research through a research studentship. The author would also like to thank Henry Lesieur and the anonymous reviewers for their constructive advice and criticism in the revisions of this paper.     

Psychophysiological and Subjective Arousal during Gambling in Pathological and Non-pathological Video Lottery Gamblers

Two groups of video lottery gamblers (pathological N =30, and non-pathological N =34) were compared while they participated in gambling and gambling related tasks using subjective ratings of excitement, electromyographic activity (EMG), skin conductance level (SCL) and heart rate (HR). Although the groups experienced similar levels of increased physiological response the pathological gamblers reported greater levels of subjective excitement. It was concluded that the pathological and non-pathological gamblers might perceive their responses to gambling and gambling related situations differently.     

Internet Gambling Among High School Students in Hong Kong

The study investigated Internet gambling involvement and pathological gambling among Hong Kong adolescents aged 12–19 years. The diagnostic and statistical manual (4th edition) multiple response format for juveniles (DSM-IV-MR-J) (Fisher in J Gambl Stud 16:253–273, 2000) was filled by 1,004 students (597 boys, 407 girls) recruited by random selection of classes. The response rate was 86.6 %. Results indicate that more respondents participated in land-based gambling than Internet gambling (63.5 vs. 3.5 %) but online gamblers are 1.5 and 3.2 times more likely to develop pathological and at-risk gambling than non-Internet gamblers. Using the DSM-IV-MR-J criteria, 5.7 and 22.9 % of the Internet gamblers could be classified as at-risk gamblers and pathological gamblers, respectively. Majority (94.3 %) wagered online at home, and 91.4 % made their first bet before 18 years. Many perceived Internet gambling as a trendy (71.4 %) and safe entertainment (54.3 %). Problematic Internet gambling was significantly associated with the male gender, school grades, online gambling frequency, amount wagered and a gambling family environment. Survey results have implications for gambling research and preventive programs.     

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.     

Psychophysiological and subjective responses of a community sample of video lottery gamblers in gambling venues and laboratory situations

Physiological and subjective arousal in lounge and laboratory conditions were explored using heart rate (HR), skin conductance (SCL) and subjective ratings for a community sample (N=30) of video lottery terminal gamblers (14 non-pathological gamblers [NPG] and 16 probable pathological gamblers [PPG]). For all participants, mean heart rates and ratings of subjective arousal were higher in the lounge situation, while SCL did not differ between locations. SCL increased over baseline when gambling in both situations. HR initially increased over baseline in the lounge situation only, but by the end of gambling HR increased in both situations. HR, SCL and subjective reports were moderately correlated between venues. No correlations were found between subjective and physiological measures of arousal.     

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.     

Some applications of reversal theory to the explanation of gambling and gambling addictions

Reversal theory (Apter, 1982) provides a conceptual framework for the study of homeostatic psychological systems with multiple points of stability. This theory is applied to the explanation of normal and pathological gambling with special attention given to Apter's distinction between Telic (goal oriented) and Paratelic (playful) States. The entry of an individual to an episode of gambling is interpreted as a means of achieving a reversal or switch from one metamotivational state to another and so affecting the hedonic tone of the experience of arousal. The action during an episode of gambling is interpreted as a series of rapid switches from Telic to Paratelic States. Exit from the gambling situation is interpreted as resulting from a reversal from Paratelic to Telic metamotivational states. Scores of regular gamblers on the Telic Dominance Scale are related to their scores on the Sensation Seeking Scale, The interrelationship of arousal and reversals is used to advance an explanation both of some of the rewards of normal gambling and of the continued persistence of pathological gamblers in the face of punishing losses.Part of this paper was presented by R. I. F. Brown, and G. Anderson under the title Gambling, Sensation Seeking and Reversal Theory at the Second International Symposium on Reversal Theory, University of Cardiff Wales, September 1983.     

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.     

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.     

A Latent Class Analysis of Gambling Activity Patterns in a Canadian University Sample of Emerging Adults: Socio-demographic,Motivational, and Mental Health Correlates

This analysis of gambling habits of Canadian university students (ages 18–25) dovetails two recent developments in the field of gambling studies. First, the popularity of latent class analysis to identify heterogeneous classes of gambling patterns in different populations; second, the validation of the Gambling Motives Questionnaire (with financial motives) among university students—specifically to understand both how and why emerging adults gamble. Our results support a four-class model of gambling activity patterns, consisting of female-preponderant casual and chance-based gambling groups, and male-preponderant skill-based and extensive gambling groups. Each class shows a specific combination of motives, underscoring the necessity for nuanced responses to problem gambling among emerging adults. More specifically, gambling for the skill-based group appears primarily to be a source of thrill and a way to cope; for the chance-based group, gambling appears but one symptom of a set of wider issues involving depression, anxiety, substance use, and low self-esteem; while extensive gamblers seem to seek excitement, sociality, and coping, in that order. Only the chance-based group was significantly more likely than casual gamblers to be motivated by financial reasons. Situating our analysis in the literature, we suggest that interventions for the predominantly male subtypes should address gambling directly (e.g. re-focusing excitement seeking into other activities, instilling more productive coping mechanisms) while interventions for predominantly female subtypes should address low self-esteem in conjunction with depression, substance abuse, and problematic levels of gambling. We conclude future research should focus on links between self-esteem, depression, substance abuse, and financial motives for gambling among female emerging adults.     

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.     

Co-morbidity of gambling and Internet use among Internet and land-based gamblers: classic and network approaches

This study investigated co-morbidity of problem gambling and problematic Internet use (PIU) among adolescent Internet and land-based gamblers, with the classic approach using sum-scores of symptoms and a promising new method, namely the network perspective. This perspective allows testing for how multiple disorders are associated, showing symptoms overlap and centralities. We used cross-sectional data from two population-based samples of adolescents aged 17 years in France (n = 2,240) and Switzerland (n = 944). Measures included Internet gambling, problem gambling and PIU. The classic approach showed that Internet gambling was associated with increased levels of disordered gambling and PIU, but that correlations between disorders were weak (R² min = 3.2%, R² max = 17.6%). The network perspective showed that the co-morbid network of Internet gamblers was more connected in comparison with land-based gamblers. Problem gambling and PIU appeared as separate disorders, but their relationship was increased among Internet gamblers in comparison with land-based gamblers. The network perspective appeared as a promising avenue for a better understanding of addictive disorders, but it should not replace the classic approach, which showed increased levels of addictive behaviours among Internet gamblers.     

Impulsivity and Stress Response in Pathological Gamblers During the Trier Social Stress Test

Gambling has been associated with increased sympathetic nervous system output and stimulation of the hypothalamic–pituitary–adrenal axis. However it is unclear how these systems are affected in pathological gambling. This study aimed to investigate the effect of the Trier Social Stress Test (TSST) on cortisol and on cardiac interbeat intervals in relation to impulsivity, in a sample of male pathological gamblers compared to healthy controls. In addition, we investigated the correlation between the TSST, duration of the disorder and impulsivity. A total of 35 pathological gamblers and 30 healthy controls, ranging from 19 to 58 years old and all male, participated in this study. Stress response was measured during and after the TSST by salivary cortisol and cardiac interbeat intervals; impulsivity was assessed with the Barratt Impulsiveness Scale (BIS-11). Exposure to the TSST produced a significant increase in salivary cortisol and interbeat intervals in both groups, without differences between groups. We found a negative correlation between baseline cortisol and duration of pathological gambling indicating that the longer the duration of the disorder the lower the baseline cortisol levels. Additionally, we found a main effect of impulsivity across groups on interbeat interval during the TSST, indicating an association between impulsivity and the intensity of the neurovegetative stress response during the TSST. Involvement of the hypothalamic–pituitary–adrenal axis in pathological gambling was confirmed together with evidence of a correlation between length of the disorder and diminished baseline cortisol levels. Impulsivity emerged as a personality trait expressed by pathological gamblers; however the neurovegetative response to the TSST, although associated with impulsivity, appeared to be independent of the presence of pathological gambling.     

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.     

The prevalence of pathological gambling in Galicia (Spain)

Since 1977, when gambling was legalized in Spain, the amount of money spent on it has increased each year. Expenditures on gambling are now more than 3 billion pesetas per year. This paper provides the results of a study on the prevalence of pathological gambling in the Galicia region of northwest Spain, with a representative random sample (N=1,615) from the seven largest cities of Galicia. The prevalence of pathological gambling was 1.7% utilising the DSM-III-R diagnostic criteria. An additional 1.6% were problem gamblers, 0.6% excessive social gamblers and 1% exexcessive gamblers. The results suggest that slot machines are the most addictive form of gambling. Pathological gamblers are homogeneously distributed in the population with the exception that males and upper income family membership are overrepresented. Alcohol and cigarette consumption were higher among pathological gamblers than in the general population.This research was funded by the Service of Mental Health and Drug Abuse of the Health Authority of Galicia (SERGAS, Consellería de Sanidade). The author is grateful to M. José Fuentes, M. Carmen Carro, M. Angeles González, M. Carmen Lorenzo, Ana Pérez, Ana Sáinz, and Beatriz Torres for her help in collecting the data. I also thank Iain Brown for his helpful comments and English revision of this article. Paper presented at the Society for the Study of Gambling, London, November 1991.     

A Preliminary Investigation of Abstinence and Controlled Gambling as Self-Selected Goals of Treatment for Female Pathological Gambling

The current study aimed to provide a preliminary evaluation of the differential efficacy of a cognitive-behavioural treatment program for female pathological gamblers delivered with the goals of abstinence or controlled gambling. The findings were based on the comparison of pathological gamblers selecting abstinence and pathological gamblers selecting controlled gambling on measures of gambling behaviour and psychological functioning. The findings revealed that pathological gamblers selecting controlled gambling displayed comparable levels of improvement to those displayed by gamblers selecting abstinence. Using a treatment completer approach, 89% of the gamblers selecting abstinence compared with 82% selecting controlled gambling no longer satisfied the diagnostic criteria for pathological gambling by the completion of the 6-month follow-up period. Although further scientific demonstration is required, the findings of this study provide preliminary support for the practice of offering controlled gambling as an alternative goal in the treatment of pathological gambling.     

Real Limits in the Virtual World: Self-Limiting Behavior of Internet Gamblers

The recent expansion of Internet gambling has stimulated debate, policy, and research on this relatively new phenomenon and its potential consequences. The current study focuses on bettors experiencing problems by sampling Internet gamblers who imposed limits on the amount they were allowed to deposit to a betting site. We analyzed the betting transactions over 18 months of all gamblers who subscribed to an online betting site in February, 2005 (N = 47,134), 567 of whom utilized the site’s self-limit feature. Self-limiting gamblers played a wider variety of games and placed more bets than others prior to imposing limits. After imposing limits, self-limiters reduced their activity, but did not reduce the amount they wagered per bet. Time spent gambling, not just money spent, appears to be an important indicator of gambling problems. Self-limit programs appear to be promising options for Internet gamblers at-risk for gambling problems.

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.