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.     

A review of two measures of pathological gambling in the United States

This paper addresses a debate that has emerged in the field of pathological gambling research. This debate concerns measurement of the prevalence of pathological gambling in the general population. Two instruments have been used to measure prevalence in the United States, the South Oaks Gambling Screen and the Cumulative Clinical Signs Method. These instruments are described and several problems with the statistical properties of the Cumulative Clinical Signs Method are discussed. The authors conclude with a call for continued research in the area of prevalence studies of pathological gambling.This research was partly funded by the Antisocial and Violent Behavior Branch of the National Institute of Mental Health (MH-44295).The authors would like to acknowledge the contribution of Henry J. Steadman, Ph.D. to the initial formulation of the ideas presented here.     

Advances in the pharmacological treatment of pathological gambling

In the present paper we discuss the current status of drug treatment for pathological gambling and the scientific rationales underlying the various pharmacological approaches. Specifically, we summarize the treatment study results of serotonin reuptake inhibitors, mood stabilizers, opioid antagonists, and atypical antipsychotics in pathological gambling. We also discuss dosage strategies, the duration of treatment, issues surrounding medication compliance, and approaches to treatment-refractory pathological gambling, such as pharmacological and behavioral augmentation.     

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.     

Self-efficacy in pathological gambling treatment outcome: development of a gambling abstinence self-efficacy scale (GASS)

A 21-item measure of gambling abstinence self-efficacy (GASS) was developed. A principal component analysis of 101 pathological gamblers supported the use of a total score that showed good internal (α=.93) and retest reliability (ICC (n=35)=.86) as well as four subscales: 1) winning/external situations (6 items, α=.91); 2) negative emotions (9 items, α=.87); 3) positive mood/testing/urges (3 items, α=.70); 4) social factors (3 items, α=.81). The total and subscales showed moderate relationships with single item ratings of confidence to abstain from gambling and weak or non-significance relationships with demographic and gambling-related variables. The total score and three of the subscales showed evidence of predictive validity for gamblers not currently involved with treatment. Higher self-efficacy was related to fewer days of gambling over a 12-month period. These results provide preliminary support for the reliability and validity of the GASS.     

A psychodynamic approach to the treatment of pathological gambling: Part I. Achieving abstinence

A psychodynamic approach emphasizes the meaning and consequences of one's behavior. After a brief review of the literature, the authors present the first of a two-part model for psychodynamic psychotherapy with pathological gamblers. In this first phase, the immediate goal is abstinence, and five strategies for obtaining it are discussed. These consist of 1.) breaking through the denial 2.) confronting omnipotent defenses 3.) interrupting the chasing cycle 4.) identifying reasons for gambling, and 5.) motivating the patient to become an active participant in treatment. An argument is made for integrating a traditional psychodynamic approach with an addictions model.     

The prevalence rates of pathological gambling: A look at methods

Planning the gambling environment requires protection of the public's health, safety and welfare. Whereas most public gaming provisions and statutes address the public's fears of organized crime as well as some welfare needs, rarely do they safeguard the public's health regarding the spread of the mental disease known as pathological gambling. Measurement of the prevalence and incidence of this disease would enable policy planners to evaluate both the state's responsibility for an epidemic and the adequacy of publicly funded treatment programs. The purpose of this paper is to examine the methods which underlie three different estimates of the prevalence rate of pathological gambling and to critique them in the light of sound epidemiological procedure. In 1975, the Institute for Social Research (ISR) of the University of Michigan conducted a national survey and a survey of the state of Nevada on behalf of the U.S. Commission on a National Policy Toward Gambling. Using discriminant function analysis coupled with subjective inspection of cases in the at-risk pool, the researchers estimated rates of probable and potential pathological gamblers. In 1984 and 1985, this author surveyed residents in the Delaware Valley and the state of Ohio using the cumulative clinical signs method which also posited rates of probable and potential pathological gamblers. In 1986, researchers at the Office of Mental Health for the State of New York employed a formal screening device to survey residents and proposed a rate of probable pathological gamblers and a rate of problem — although not pathological — gamblers. All three approaches produced different estimates. The utility of prevalence and incidence rate research in this field is threatened by a lack of consensus about the proper epidemiological procedure to be employed in arriving at these estimates. There is also confusion about the distinction between a probable and a potential pathological gambler. The planning purpose, method, validity and reliability of prevalence rate research about pathological gambling are addressed in this paper.     

The prevalence of problem and pathological gambling: A critical analysis

Prevalence of pathological gambling refers to the percentage of cases of pathological gambling occurring in the community at a given time. Prevalence studies conducted in different principalities throughout the world are reviewed, and it is found that none of them conforms to this definition of prevalence. The major error in all but the most recent surveys conducted is identified as the use of questions which ask whether gambling-related problems have ever occurred rather than whether they are currently occurring. This error will lead to an over-estimation of the prevalence of pathological gambling in society. The second major error identified in nearly all studies involves the accuracy of the screens being used to assess whether or not an individual is a pathological gambler. Concerns about the efficiency of the South Oaks Gambling Screen have not yet been satisfactorily resolved. None-the-less, the widespread use of the South Oaks Gambling Screen has made a valuable contribution to international comparisons of prevalence studies. Future work that explores the emerging relationship between levels of personal expenditure on gambling, types of gambling product and gambling-related problems are recommended.     

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.     

Rates of pathological gambling in publicly funded outpatient substance abuse treatment

Rates of problem or probable pathological gambling were assessed in substance abusers seeking outpatient treatment in a publicly funded outpatient substance abuse treatment program. The South Oaks Gambling Screen (SOGS) was administered to 467 consecutive admissions at three different sites. Problem gamblers comprised 6.2 percent of the total (n=29), and 4.5 percent scored as probable pathological gamblers (n=21). These rates are two and one-half times greater than would be expected according to a recent state survey using the SOGS. Implications for assessment and treatment of problem gambling are discussed.The author expresses his appreciation to John Ramsay and the staff of Epoch Counseling Center for data collection; to Les Franklin for computational analysis; and Dr. Rachel Volberg for providing supplemental data from her Maryland State Gambling Survey.     

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.     

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.     

The effect of compliance-improving interventions on the cognitive-behavioural treatment of pathological gambling

This exploratory study investigated the effect of interventions designed to improve compliance and reduce dropout rates during the outpatient treatment of pathological gambling at a University-based gambling treatment clinic. Forty subjects (29 males, 11 females, mean age = 37.6) meeting DSM-IV criteria (APA, 1994) for pathological gambling were randomly assigned to either a cognitive-behavioural treatment or a cognitive-behavioural treatment combined with interventions designed to improve treatment compliance. Compliance was indicated by the completion of all treatment sessions. Outcome measures were DSM-IV criteria assessed by structured clinical interview, South Oaks Gambling Screen scores, and percentage of income gambled. Logistic regression analyses identified pretreatment characteristics predicting compliance and outcome. Compliance-improving interventions significantly reduced dropout rates, resulting in superior outcomes at posttreatment compared to the cognitive behavioural treatment alone. At 9-month follow-up, there was no difference in outcome between treatments, although both produced clinically significant change. Comorbid problem drinking, drug use, and problem gambling duration predicted poor compliance. Poor outcome was predicted by comorbid problem drinking. The clinical implications of these results are discussed in light of the exploratory nature of the study and the need for future research to address compliance, outcome, and comorbidity issues.     

Narrative analysis in aging studies: A typology for consideration

This article seeks to expand our understanding on narrative and the analysis of stories researchers invite and collect in the domain of aging studies. To do so, we first offer an understanding of what narrative inquiry can be by laying out a theoretical basis for this kind of research, and making a case for the relevance of narrative as an alternative methodology. Painting with broad strokes, narrative analysis as a method is then considered before a typology of different ways in which stories can be analyzed is introduced. Illuminated by the typology are two contrasting standpoints toward narrative analysis—storyteller and story analyst—and three specific methods—structural, performative, and autoethnograpic creative analytic practices—that each standpoint might use to analyse the whats and hows of storytelling. The article closes by suggesting that in order to assist us to understand the complexities of aging researchers might consider using a variety of analyses.     

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.     

Caregiver AOD use, case substantiation, and AOD treatment: studies based on two southwestern counties

This article includes two separate studies: the first explores the impact of caregiver AOD use on CPS case substantiation; the second compares CPS-involved and CPS-noninvolved females in AOD treatment systems. Results suggest that cases with indications of AOD use are more likely to be substantiated than cases without; and increasing numbers of children and younger maternal ages are risk factors for CPS involvement among AOD-using women. Related findings are also presented, followed by implications for practice and research.     

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.