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.     

Gambling, Delinquency, and Drug Use During Adolescence: Mutual Influences and Common Risk Factors

The purpose of this study was threefold: (1) to assess the possible mutual influence between gambling, substance use, and delinquency over a two-year period during mid adolescence, (2) to test whether variables that are usually predictive of delinquency and substance use also predict gambling, and (3) to test whether the links between the three problem behaviors could be, at least partially, accounted for by common antecedent factors (impulsivity, parental supervision, and deviant friends) assessed during early adolescence. Seven hundred and seventeen boys participated in the study. Impulsivity, parental supervision, and friends' deviancy were collected when participants were 13 and 14 years of age. Gambling, substance use, and delinquency were collected through self-reports at ages 16 and 17 years. Results showed no influence or modest influence of problem behaviors on each other from age 16 to age 17 years, once current links and auto-correlations were accounted for. Conversely, the cross-sectional links between the three problem behaviors at each age were moderately high. Impulsivity, low parental supervision, and deviant friends were predictively related to each problem. Finally, a significant, although modest, portion of the covariance between the three problem behaviors was accounted for by these three predictors. The present findings contradict previous findings about the influence of gambling on other problem behaviors and support the notion of a general problem behavior syndrome fed by generic risk factors.     

Birth cohort and sex differences in the age of gambling initiation in the United States: evidence from the National Comorbidity Survey Replication

Youth gambling has become a significant public health concern, and it appears that individuals are gambling at younger ages than they did in earlier generations. We tested this question by examining birth cohort differences in the age of onset of gambling in a national epidemiologic survey. Data were drawn from the United States National Comorbidity Survey Replication, a nationally representative general population survey of adults born 1904–84. Individuals were divided into four birth cohorts. The cohorts were compared on their lifetime gambling involvement and age of onset of gambling. Significant birth cohort and sex differences were found in the age of gambling initiation, with more recently born cohorts starting to gamble at progressively earlier ages, and men starting to gamble at younger ages than women. The mean age of onset of gambling for individuals born before 1942 was 32.9 years, and for those born between 1973 and 1984 it was 16.9 years. The overall mean ages of onset of gambling were 20.8 for men and 26.4 for women, but more recently born women appear to be ‘catching up’ with their male counterparts. This decreasing age of gambling initiation may help explain the increasing prevalence of disordered gambling in the United States.     

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.     

School Violence and Adolescent Mental Health in South Africa: Implications for School Health Programs

This study examines the perceptions of high-school adolescents about gang violence in a periurban community near Cape Town and the implications for school health in South Africa. Using the qualitative focus group discussion (FGD) guide, data were collected from 60 high-school adolescents, between 10 and 20 years of age. Trained moderators conducted nine FGDs with small groups of six to eight students. The constant comparative ethnographic method was used to analyze the data. Results indicate that gang violence is very common among high-school adolescents living on the Cape Flat. Gangs, perceived by many as part of the rite of passage among adolescents, are a major threat to the public health, mental well-being, general welfare, happiness, and development of high-school populations on the Cape Flat. Gang activity interlock with many other social problems, including drug and alcohol abuse, school unrest and violence, and the increasing prevalence of sexually transmitted diseases, especially HIV and AIDS. These findings suggest an urgent need for concerted efforts to develop mechanism to protect school pupils from gangs and develop healthier social alternatives to gang-related activites. Ties among government, school, parents, and community education and participation are urgently necessary to implement a school-based approach to adolescent health promotion.     

Smart money

Rick was an ambitious entrepreneur beginning the first of several businesses at age 16. He amassed a fortune by age 35. Between the ages of 42 and 50, his gambling rampage liquidated his assets, he lost his business and license to practice in his field, and he ended up in debt of over $1 million. Today at age 53 he is starting a new career in counseling and working with compulsive gamblers.     

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 Public Stigma of Problem Gambling: Its Nature and Relative Intensity Compared to Other Health Conditions

Problem gambling attracts considerable public stigma, with deleterious effects on mental health and use of healthcare services amongst those affected. However, no research has examined the extent of stigma towards problem gambling within the general population. This study aimed to examine the stigma-related dimensions of problem gambling as perceived by the general public compared to other health conditions, and determine whether the publicly perceived dimensions of problem gambling predict its stigmatisation. A sample of 2000 Australian adults was surveyed, weighted to be representative of the state population by gender, age and location. Based on vignettes, the online survey measured perceived origin, peril, concealability, course and disruptiveness of problem gambling and four other health conditions, and desired social distance from each. Problem gambling was perceived as caused mainly by stressful life circumstances, and highly disruptive, recoverable and noticeable, but not particularly perilous. Respondents stigmatised problem gambling more than sub-clinical distress and recreational gambling, but less than alcohol use disorder and schizophrenia. Predictors of stronger stigma towards problem gambling were perceptions it is caused by bad character, is perilous, non-recoverable, disruptive and noticeable, but not due to stressful life circumstances, genetic/inherited problem, or chemical imbalance in the brain. This new foundational knowledge can advance understanding and reduction of problem gambling stigma through countering inaccurate perceptions that problem gambling is caused by bad character, that people with gambling problems are likely to be violent to other people, and that people cannot recover from problem gambling.     

The ethics of gambling research: an agenda for mature analysis

The purpose of this article is to explore the ethics of both the anti-gambling and pro-gambling groups as they present their research into the gambling phenomenon. The type of ethical thinking that each group uses will be characterized to show how their ethical views have caused their research to be biased. The second part of this article proposes a modest research agenda for future gambling studies. This agenda rests a foundation of a mature ethical thinking.     

Gambling,Drinking and Quality of Life: Evidence from Macao and Australia

The investigation of the interface between psychological constructs, compulsive consumption of alcohol and pathological gambling is an important avenue for development of future initiatives in social marketing or prevention programs. This cross-cultural study attempts to bridge the gap in literature by providing an evaluation of the predictive ability of psychological variables such as gambling urge, gambling-related erroneous cognitions and comorbid alcohol consumption on pathological gambling behaviour and its impact on overall quality of life indicators. Participants consist of 445 Macao and Australian young adults (Mean age = 23 years). Results indicate that probable pathological gamblers as compared with non-gamblers reported significantly lower quality of life in all domains—physical health, psychological well-being, social relationships and environment. Adults who drank more alcohol and have stronger erroneous cognitions evidenced higher pathological gambling behavior. Our research model fits both cohorts and interestingly, erroneous gambling-related cognitions serve as a full mediator for the predictive relationship between gambling urge and pathological gambling in the Macao sample, but serve as a partial mediator in the Australian sample. Targeting erroneous cognitions in future social marketing or preventive campaigns should demonstrate to be an important strategy in reducing the effects of urge to gamble among at-risk individuals. Further implications for the industry, marketing and governmental strategies are discussed.     

Definition and Measurement of Chasing in Off-Course Betting and Gaming Machine Play

The attempt to recover gambling losses by continuing to gamble (chasing) has featured prominently in accounts of excessive gambling. This research represents the first attempt to operationalize and measure chasing in terms of its cognitive (behavioral intention), emotive (urges) and behavioral components, and to investigate the role of chasing in relation to impaired control over gambling. Two survey samples of 84 male off-course (betting shop) race gamblers (mean age 41, SD = 15) and 137 gaming machine players (73 females, mean age 48, SD = 15 and 64 males, mean age 43, SD = 16) were recruited at gambling venues. Respondents completed a structured questionnaire that investigated retrospective report of chasing and an impaired control scale (The Scale of Gambling Choices). It was found that the various components of chasing formed a composite measure with high internal reliability that was strongly related to indicators of excessive gambling (e.g. time spent gambling, expenditure as a proportion of income) and to impaired control scores. Reacting to large wins by further betting was almost as strongly related to impaired control as was persistence after losing. Those who returned later to chase had significantly higher impaired control scores than those who only chased within a session. Alcohol-related chasing was associated with impaired control over gambling. Chasing of losses and impaired control appear to be generic processes in evidence across both forms of gambling and gender (most format and sex differences were of minor significance).     

The treatment model of the guidance center for gamblers and their relatives in Vienna/Austria

Within 8 years, Gamblers Anonymous in Vienna evolved into a guidance center for gamblers and their relatives, with professional aid. It is a non-profit institution and the therapeutic team consists of one psychologist, one social-worker and one psychiatrist. The clients can remain anonymous, but about 90% of them reveal their identity. The treatment model integrating professional therapy and self-help is presented. The reasons we decided to base our work on an addiction model of pathological gambling are explained. All the clients consulting our center in 1990 (N=237) are described according to age, sex, types of gambling, duration of problem gambling, family status, profession, income, debts, and income/debt relationship. Finally, the treatment program of our center is presented.This article is an extension of the special issue on Gambling in Europe edited by Iver Hand, M.D.     

Predictors of Relapse in Problem Gambling: A Prospective Cohort Study

To explore the variation of predictors of relapse in treatment and support seeking gamblers. A prospective cohort study with 158 treatment and support seeking problem gamblers in South Australia. Key measures were selected using a consensus process with international experts in problem gambling and related addictions. The outcome measures were Victorian Gambling Screen (VGS) and behaviours related to gambling. Potential predictors were gambling related cognitions and urge, emotional disturbance, social support, sensation seeking traits, and levels of work and social functioning. Mean age of participants was 44 years (SD = 12.92 years) and 85 (54 %) were male. Median time for participants enrolment in the study was 8.38 months (IQR = 2.57 months). Patterns of completed measures for points in time included 116 (73.4 %) with at least a 3 month follow-up. Using generalised mixed-effects regression models we found gambling related urge was significantly associated with relapse in problem gambling as measured by VGS (OR 1.29; 95 % CI 1.12–1.49) and gambling behaviours (OR 1.16; 95 % CI 1.06–1.27). Gambling related cognitions were also significantly associated with VGS (OR 1.06; 95 % CI 1.01–1.12). There is consistent association between urge to gamble and relapse in problem gambling but estimates for other potential predictors may have been attenuated because of methodological limitations. This study also highlighted the challenges presented from a cohort study of treatment and support seeking problem gamblers.     

Measuring costs from permitted gaming: concepts and categories in evaluating gambling's consequences

This paper addresses the methodology of cost–benefit analysis as applied to policy alternatives regarding legally sanctioned gambling in its various forms. Existing economic studies regarding the social costs of gambling are reviewed and critiqued. Distinctions are made between definitions of social costs that are defined as actions which result in negative changes in aggregate social wealth (the narrow definition), and those which also include internal nonmarket costs that are borne by individual gamblers and their immediate families and acquaintances (the broader definition). This distinction is important because of its bearing on economic policies that are primarily concerned with economic efficiency versus policies that are more paternalistic, which attempt to protect individuals from self-damage or self-destruction by restricting their ranges of choice. Whether societies choose to prohibit or severely restrict permitted gambling, or allocate substantial resources to mitigate its negative side effects, rests largely on which of these perspectives regarding social costs they find more appropriate. Finally, the issue of social protection through restrictions on the availability of gambling to the entire population, versus a strategy tailored toward identifiable problem gamblers, is discussed.     

Gambling in the Netherlands: Developments,participation, and compulsive gambling

An inventory was made of the developments in what the gambling market had to offer and the extent of public participation in games of chance in The Netherlands for the period 1945–1988. Both these aspects show a sharp rise in the post-war years, but the more negative effects of gambling are also becoming clearer. Since the beginning of the 1980's, assistance organizations have received increasing requests for help and advice on gambling problems. Roughly half of those seeking help are younger than 25 years, presenting the compulsive use of slot-machines as their main problem.Acknowledgments: This article is a revision of an article that has been published before in the Dutch journal Tijdschrift voor Alcohol en Drugs en andere psychotrope stoffen. Vol. 14, no 5–6. pp 162–173. The article has been reproduced in English by courtesy of the publisher.     

Correlated factors with filial piety expectations of older Koreans and Korean-Americans

ABSTRACT

Changing filial piety expectations have been examined from the viewpoint of younger generations. However, research on older adults’ perspective of this cultural phenomenon is virtually absent from the empirical literature. In an effort to address the changing family life circumstances of Korean and Korean-American families, this study explores older adults’ filial expectations from their own children and correlated factors associated with the expectation. The cross-sectional survey study with 449 older adults found that the majority of respondents still believe that adult children should assume responsibility for the care of their parents. Several factors such as age, education, income, living arrangements, self-rated health, year of immigration, and social support were significantly correlated with filial expectations among older Korean-Americans. Only satisfaction with social support received from family and friends was significantly related to older Koreans’ expectations. Implications for social work practice are discussed and further research directions are suggested.     

Gambling behaviours and associated familial influences among 9-year old Pacific children in New Zealand

There is a paucity of research investigating child gambling, particularly studies that do not use retrospective designs. The presented findings provide cross-sectional data of the gambling behaviours of 874 9-year old Pacific children from a birth cohort study (recruited from one hospital) investigating health, developmental and social outcomes for Pacific children and their families in New Zealand. Structured interviews were administered to participants (mothers and children), face to face, in their homes (mothers) or school (children). Child gambling behaviours and associations with some maternal behaviours were investigated; five gambling participation questions were included in the child interview. Almost all child respondents (96%) reported having played card games with family or friends and 60% reported participation in housie (bingo), although only 27% reported having bet with money. Associations were noted between child gambling and household deprivation, and effectiveness of parental monitoring. There was no association between children's gambling and mothers' gambling. This is the first research to examine gambling in Pacific children at 9 years of age within a familial context. It will allow exploration of links between parental gambling and child development of gambling behaviours, as well as risk and protective factors for problem gambling at future data collection phases of the study.     

Sexual Behavior Among Young Carers in the Context of a Kenyan Empowerment Program Combining Cash-Transfer,Psychosocial Support,and Entrepreneurship

This study examined associations between sexual initiation, unprotected sex, and having multiple sex partners in the past year with participation in a three-year empowerment program targeting orphan and vulnerable children (OVC). The Kenya-based program combines community-conditioned cash transfer, psychosocial empowerment, health education, and microenterprise development. Program participants (n = 1,060) were interviewed in a cross-sectional design. Analyses used gender-stratified hierarchical logit models to assess program participation and other potential predictors. Significant predictors of increased female sexual activity included less program exposure, higher age, younger age at most recent parental death, fewer years of schooling, higher food consumption, higher psychological resilience, and lower general self-efficacy. Significant predictors of increased male sexual activity included more program exposure, higher age, better food consumption, not having a living father, and literacy. Findings support a nuanced view of current cash transfer programs, where female sexual activity may be reduced through improved financial status but male sexual activity may increase. Targeting of OVC sexual risk behaviors would likely benefit from being tailored according to associations found in this study. Data suggest involving fathers in sexual education, targeting women who lost a parent at a younger age, and providing social support for female OVC may decrease risk of human immunodeficiency virus (HIV) transmission.