Clinical and behavioral evaluation of pathological gambling in Barcelona,Spain

This paper assesses both the clinical characteristics and gambling behavior of 45 pathological gamblers (40 male, 5 female, average age 41) in a psychiatric hospital in Barcelona, Spain. These pathological gamblers tend to have other addictions and psychiatric disorders in addition to their pathological gambling. Suicidal ideation and attempts were one of the most frequent complications with these patients. Slot and fruit machines were found to be the most preferred form of gambling. Loans and crime were frequently used by the gambler to finance his or her gambling. Nevertheless, the gambler is rarely aggessive, and legal problems resulting from serious crimes are the exception. The profile presentes is similar to that found among pathological gamblers in other countries.     

Insurance problems and pathological gambling

A survey of 241 members of Gamblers Anonymous was conducted in order to find out the impact of pathological gambling on the insurance industry and whether Gamblers Anonymous reverses that impact. Fifty-two percent of the respondents cashed in, surrendered, lapsed or had policies revoked for non-payment. Forty-six percent borrowed on or used the cash value of their life insurance policies while gambling. Forty-seven percent admitted to some form of insurance related fraud, embezzlement or arson in connection with their gambling. The cost to the insurance industry was estimated at 66 billion dollars in surrendered policies and 33 billion dollars in fraud. Attendance at Gamblers Anonymous reversed much of this loss as members picked up new policies and engaged in programs of restitution after attendance. A discussion is made of the insurance related activities in terms of the usage of options up to and including suicide. Possible insurance industry responses are presented.     

Genetics of pathological gambling

Pathological gambling (PG) is an impulse control disorder and a model behavioral addiction. Familial factors have been observed in clinical studies of pathological gamblers, and twin studies have demonstrated a genetic influence contributing to the development of PG. Serotonergic, noradrenergic, and dopaminergic dysfunction have been reported as biological factors contributing to the pathophysiology of PG. Molecular genetic techniques have been used to investigate the role of genetic factors in PG. Molecular genetic research has identified specific allele variants of candidate genes corresponding to these neurotransmitter systems to be associated with PG. Associations have been reported between pathological gamblers and allele variants of polymorphisms at dopamine receptor genes, the serotonin transporter gene, and the monoamine-oxidase A gene. Although preliminary data suggest that some of these differences are gender-specific, more research needs to be performed to substantiate gender-specific genetic contributions to the development of pathological gambling. The review of the current findings on genetics of PG suggests that liability to PG is in part mediated by genetic factors. Additional studies are needed to replicate and extend these findings, as well as to better understand the influence of specific allelic variants to differences in biological and behavioral functioning.     

Altering the DSM-III criteria for pathological gambling

Following a critique and revision of the diagnostic criteria for pathological gambling in DSM-III, a field trial of the revised criteria was conducted. Four groups of individuals (762 in all) were surveyed: Gamblers Anonymous members, college students, hospital employees, and outpatients in treatment for pathological gambling. The revised criteria were found to discriminate effectively between pathological gamblers and others. In order to refine the cutoff point, the results on the DSM-III revision were compared to the South Oaks Gambling Screen, a valid, reliable instrument for screening pathological gamblers (Lesieur & Blume, 1987). A cutoff point of four or more items was found to be optimal in diagnosing pathological gamblers.This research was funded by the South Oaks Foundation, Amityville, New York. Special thanks are given Sheila Blume, M.D., Julian I. Taber, Ph.D. and Robert L. Custer, M.D. for their comments on earlier drafts of this paper.     

Antisocial personality disorder and pathological gambling

The prevalence of antisocial personality disorder and its relationship to criminal offenses in pathological gamblers was investigated. A semi-structured interview schedule containing DSM-III criteria for antisocial personality and the California Psychological Inventory Socialisation subscale was administered to a sample of 306 pathological gamblers. Of the total sample, 35% reported no offense. Forty eight percent admitted to the commission of a gambling related offense, 6% to a non-gambling related offense, and 11% to both types of offense. Fifteen percent of subjects met DSM-III diagnostic criteria for antisocial personality disorder. Though these subjects were at greatest risk for committing criminal offenses, offenses were committed independently of DSM-III antisocial personality disorder in the majority of gamblers. It was concluded that features of antisocial personality emerged in response to repeated attempts to conceal excessive gambling and gambling induced financial difficulties.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.     

Gambling and pathological gambling in adolescents

A survey of U.K. secondary school children (aged 11–16 years) was undertaken to enquire into the prevalence of adolescent gambling and pathological gambling on fruit machines, and related behaviours. Sixty-two percent of the children gambled on fruit machines, 17.3% at least weekly and 5.7% pathologically. Pathological fruit machine gambling was correlated with gambling for money on other games, cigarette and alcohol use, video playing, parental gambling, playing alone and an early start (8 years or younger). It was not correlated with age, gender or religion, and only weakly with parental occupation. The implications of the findings for future research and social policy are discussed.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 reviewers of the Journal of Gambling Studies for their helpful comments on an earlier draft of this paper. Special thanks to Professor David Dunkerley for his invaluable support of this project.     

Pharmacological treatments of pathological gambling

Medication treatment studies have demonstrated short-term efficacy of various SRIs, opioid antagonists, and mood stabilizers in sub-samples of adult treatment seeking pathological gamblers. Pathological gambling is frequently comorbid with bipolar spectrum disorders, substance abuse/dependence, and attention-deficit/hyperactivity disorder (ADHD), and comorbidity may influence treatment response in pathological gambling. This review focuses on recent research examining the treatment of pathological gambling and highlights methodological challenges for future studies.     

Crime,antisocial personality and pathological gambling

To investigate the hypothesized causal relationship between pathological gambling and gambling-related illegal behaviors, 77 patients seeking behavioral treatment for excessive gambling and 32 members of Gamblers Anonymous were administered a structured interview schedule. Data on the incidence, nature and extent of both gambling and non-gambling related illegal behaviors was obtained and DSM-III (A.P.A., 1980) criteria for Antisocial personality were used as the measure of sociopathy.Of the sample, 54.1% admitted to a gambling related offense and 21.1% were charged. Results showed that 14.6% met DSM-III criteria for Antisocial Personality, Four subgroups were subsequently identified; gamblers who committed no offense (36.7%), gambling only offenses (40.4%), non-gambling only offenses (9.2%) or both gambling and non-gambling offenses (13.7%). Significantly more subjects from the gambling plus non-gambling related offenses subgroup were classified as antisocial personalities.Of pathological gamblers who committed offenses, two thirds reportedly did so as a direct consequence of gambling induced problems. Subjects reporting gambling-only related offenses showed a significant increase in antisocial features after adolescence suggesting that antisocial features emerge as a secondary phenomenon to pathological gambling behavior patterns.Acknowledgments: This study was made possible by a grant from the Criminology Research Council, Australian Institute of Criminology.     

Cognitive distortions in heavy gambling

A sample of 38 regular and heavy gamblers, recruited through advertisements and not seeking treatment, were asked to describe special strategies, techniques or rituals that they used to increase their chances of winning at gambling in an open-ended interview. The mean South Oaks Gambling Screen Score for the sample was 7.7 with 64% of the sample scoring higher than 4. Their responses reflected multiple means by which the individual believed they were able to control (i.e., active illusory control, passive illusory control), reframe (i.e., interpretive control), or predict (i.e., probability control, predictive control) gambling outcomes. A larger number of cognitive distortions was associated with playing games in which skill was potentially a component (e.g., cards, sports) than in non-skill games (e.g., lotteries) as well as a positive family history of gambling. There were no sex differences. Implications of these findings for the cognitive psychopathology of gambling are discussed.     

The factorial structure of pathological gambling

Pathological gambling has been characterised by DSM-III-R and DSM-IV as a disorder of impulse control with a proportion of gamblers identified as meeting criteria for a co-morbid diagnosis of Antisocial Personality Disorder. To date, empirical evidence in support of the notion that pathological gamblers as a group manifest elevated traits of impulsivity remains equivocal. Principal components analysis was used to investigate relationships between the constructs of impulsivity, psychopathy, DSM-III-R criteria for Antisocial Personality Disorder, psychological distress, criminal offending behavior and a range of other common psychological measures employed with pathological gamblers. The sample comprised 115 pathological gamblers, 80 consecutive gamblers seeking treatment from a general hospital psychiatric inpatient behavior therapy unit, and 35 volunteer Gamblers Anonymous attenders. Four primary factors were determined: psychological distress, sensation seeking, crime and liveliness, and impulsive-antisocial. Results suggest that pathological gambling consists of a number of discrete and reproducible factorial structures. The impulsive antisocial factor was found to be associated with gambling behavior and indices of poor psychosocial functioning.     

Individual outpatient treatment of pathological gambling

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

Impulsivity,compulsivity and pathological gambling: an exploratory study of pathological gambling as an impulsivity-compulsivity spectrum disorder

The current study was conducted to examine pathological gambling as an impulsivity-compulsivity spectrum disorder. University students (N=162) who gambled a minimum of twice monthly completed measures of impulsivity, compulsivity and pathological gambling. Instruments completed included: measures of problem gambling severity (South Oaks Gambling Screen, NORC DSM-IV Screen for Gambling Problems, Canadian Problem Gambling Index, Victorian Gambling Screen), the Padua Inventory, the Barratt Impulsivity Scale and the Tridimensional Personality Questionnaire. Results supported previous research indicating that pathological gamblers had elevated scores on measures of impulsivity and compulsivity, as well as personality factors correlated with these two constructs. Moreover, impulsivity and compulsivity were found to be interrelated as proposed by the impulsivity-compulsivity spectrum model.     

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.     

Epidemiological surveys of pathological gambling: Critique and suggestions for modification

Epidemiological studies of problem and pathological gambling were examined for their accuracy. Fundamental flaws and biases were found in these surveys. These include problems with survey instruments; nonresponses and refusal bias; the exclusion of institutionalized populations; exclusion of other groups; and failure to protect against denial on the part of the respondent when others are present near the telephone. Based on the issues discussed, one can reasonably be expected to assume that most epidemiological surveys seriously underestimate the extent of problem and pathological gambling. Alternative strategies for addressing these issues are discussed. These strategies include the use of field interviews, surveys of institutionalized populations, frequent player surveys and significant other surveys. The value and potential problems of these approaches are also discussed.This is a revision of a paper presented at the 9th International Conference on Risk and Gambling, Las Vegas, Nevada.The author would like to thank Rachel Volberg and Mark Dickerson as well as conference participants for their valuable suggestions on an earlier draft of this paper.     

Cognitive distortions predict future gambling involvement

Disordered gambling is best conceptualized as a continuum of severity. Previous research has demonstrated the utility of studying individuals at all points of this spectrum. The sequence of the development of gambling problems and change in gambling involvement along this continuum of severity is not well understood. The present study examined the interplay between cognitive distortions and gambling involvement in a population sample recruited in Alberta, Canada. Data from 1372 participants over 4 assessment waves (5 years) were used to generate a 2-factor latent structure using gambling fallacies and gambling involvement measurements. Structural equation modelling showed that cognitive distortions more strongly predicted future gambling involvement than the reverse relationship, using the comparative fit index (CFI) and the root mean square error of approximation (RMSEA) to assess the models. In addition, cognitive distortions declined over time, whereas gambling involvement remained stable. The results of the study suggest that focusing primarily on cognitive mechanisms in public health initiatives for gambling disorders may be a more effective strategy than focusing on behavioural solutions.     

Cognitive distortions as a problem gambling risk factor in Internet gambling

The purpose of this study was to examine the role of cognitive distortions in Internet gambling. The primary objectives were to determine whether cognitive distortions predict Internet gambling and investigate whether distorted gambling-related cognitions are associated with problem gambling severity among online gamblers. Three hundred and seventy four undergraduate participants (143 online gamblers, 172 males) completed an online questionnaire looking at demographics, play-related variables (duration, frequency and expenditures of play) and cognitive distortions. Variables were entered into a logistic regression model to predict online gambling. Three variables made independent contributions to predicting Internet gambling: male gender, higher frequency of play, and cognitive distortions. A hierarchical linear regression analysis with Internet gamblers revealed that cognitive distortions accounted for a proportion of the variance in problem gambling severity beyond variance accounted for by demographic variables and level of gambling involvement. Results suggest that cognitive distortions are a risk factor in online gambling.     

The prevalence of pathological gambling in Canada

This paper critically reviews prevalence estimates of problem and pathological gambling in Canada. Populations studied are adults, adolescents and primary school children. The proportions of pathological gamblers found in Canadian studies (ranging from 1.2% to 1.9% for adults) are similar to prevalence rates reported in the United States. Given the apparent link between gambling availability and increases in the prevalence of problem and pathological gambling, it is hoped that provincial and federal authorities in Canada will make investments in research and treatment of pathological gambling in the future.The author wishes to thank Mark Freeston for his helpful comments. Portions of this paper were written while the author had grants from Counseil de Recherche en Sciences Humaines du Canada (410-91-1514) and from Loto-Quebec.     

The development of pathological gambling in Sweden

The development and the social, psychological and cultural conditions of pathological gambling reported by 42 interviewed pathological gamblers were compared with data from 63 pathological gamblers identified by case-finding. The two studies gave similar results. Gambling on horse races, roulette and bingo were the only types showing a progressive increase in involvement over time. When gambling heavily 40% of the pathological gamblers regularily experienced a state of altered consciousness. When abstaining from gambling withdrawal-like symptoms were experienced by a third. Fifty-two percent reported at least one family member often gambling. Pathological gambling appears to be a secret behaviour, although there are collective features in its development.