Treatment Goal Selection for Female Pathological Gambling: A Comparison of Abstinence and Controlled Gambling

The current study was an exploratory investigation of the selection of controlled gambling as a goal of treatment for female pathological gambling. Specifically, it aimed to explore: 1) the popularity of controlled gambling as a goal of treatment; 2) the reasons pathological gamblers select abstinence and controlled gambling as goals of treatment; and 3) the characteristics of pathological gamblers attracted to abstinence and controlled gambling. The sample comprised 85 female pathological gamblers attending a cognitive-behavioural treatment program for pathological gambling. The selection of controlled gambling by one-third (34%) of the sample suggests that, at least in the Australian context, controlled gambling is a relatively popular goal of treatment for female pathological gamblers. In this study, the only differences between treatment-seeking female pathological gamblers selecting abstinence and controlled gambling were that those selecting controlled gambling were older and were less likely to endorse the belief that problematic gambling is a disease or affliction that can only be overcome by lifelong abstinence. Further research investigating the characteristics of pathological gamblers associated with controlled gambling as both a goal and outcome of treatment is required in order to ensure that treatment-seeking pathological gamblers can make an informed decision regarding their goal selection.     

Pathological Gamblers: Inpatients’ versus Outpatients’ Characteristics

Several researchers and clinicians have questioned the advantages and disadvantages of inpatient and outpatient treatment for people suffering from pathological gambling. This study compares the characteristics of pathological gamblers seeking inpatient and outpatient treatment. A total of 233 pathological gamblers (inpatients = 134, outpatients = 99) participated in the study. Results show that inpatients have more severe gambling problems than those receiving outpatient services. Similar results were obtained on most other related variables such as anxiety, depression, alcohol consumption, and comorbidity. These results are discussed in terms of the costs and benefits of these two treatment modalities.     

Treatment of Female Pathological Gambling: The Efficacy of a Cognitive-Behavioural Approach

Given that a substantial proportion of current pathological gamblers are female, it is evident that women are underrepresented in the treatment outcome literature. The current study was designed to redress the limited information on the treatment of female pathological gambling. Although the use of cognitive-behavioural therapy is the most highly recommended approach as ‘best practice’ for the treatment of pathological gambling, no attempt to date has been made to evaluate the efficacy of this approach for female pathological gambling. Nineteen female pathological gamblers with electronic gaming machine problems were treated with a cognitive-behavioural program. While pathological gamblers placed on a waiting list did not show significant improvement on gambling behaviour and psychological functioning measures, the female pathological gamblers showed significant improvement on these measures over the treatment period, and maintained this improvement at the 6-month follow-up evaluation. By the completion of the follow-up period, 89% of participants no longer met diagnostic criteria for pathological gambling. Although further scientific demonstration and replication are required, the outcomes of this study indicate that the therapy that is considered ‘best practice’ in the treatment of pathological gambling is effective for female pathological gambling.     

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.     

Pathological Gambling: Influence of Quality of Life and Psychological Distress on Abstinence After Cognitive-Behavioral Inpatient Treatment

The aim of this study is to understand the influence of psychological distress and quality of life on the maintenance of therapy success during a 1 year follow-up in pathological gamblers after inpatient cognitive-behavioral treatment. In a sample of 281 pathological gamblers (247 men, 34 women) the following measures were taken: psychological distress (beginning and end of treatment, and follow up), quality of life and abstinence from gambling. The results showed that relapsed pathological gamblers suffer of higher psychological distress at discharge and of lower quality of life during follow-up than abstinent gamblers. In a mediator analysis the causal relations between the three variables could be clarified: psychological distress has an impact on abstinence during follow-up, and quality of life can be considered a mediator variable for the relation between psychological distress and abstinence from pathological gambling.     

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.     

Pre/Early Adolescent Onset of Gambling and Psychosocial Problems in Treatment-Seeking Pathological Gamblers

This study examined the association between pre- or early-adolescent onset of gambling and severity of gambling and psychosocial problems in treatment-seeking adult pathological gamblers. A total of 236 pathological gamblers entering outpatient treatment completed the South Oaks Gambling Screen (SOGS) and the Addiction Severity Index (ASI). Using a quartile split procedure, gamblers who began gambling during their pre- or early-adolescent years (mean age of 10.5 years; 1st quartile) were compared to gamblers who began gambling later in life (mean age of 23.0 years; 2nd to 4th quartiles). Compared to later onset gamblers, pre/early adolescent onset gamblers reported increased severity of psychiatric, family/social, and substance abuse problems on the ASI. They were more likely to report cognitive problems (trouble understanding, concentrating, or remembering), suicidal ideation, and a history of inpatient psychiatric treatment, and were less likely to be satisfied with their current living situation. Pre/early adolescent onset gamblers also reported earlier age of initiation of drinking, and were more likely to have received treatment for an alcohol use disorder, and to have used cannabis and cocaine in their lifetimes. Taken together, these data suggest that pre/early adolescent-onset of gambling may be a risk factor for later-life psychiatric, family/social, and substance abuse problems in treatment-seeking pathological gamblers.     

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.     

Accurately depicting pathological gamblers: Policy and treatment implications

This paper describes results from a 3-year study of pathological gambling in the general population. Two distinct groups of pathological gamblers, based on income, were distinguished in the general population. These two groups varied considerably on several dimensions, including their demographic characteristics, gambling involvement and problematic gambling-related behaviors. These results contradict widely-accepted beliefs about the characteristics and behaviors of pathological gamblers and suggest that efforts in outreach, education and program development must be expanded to include types of pathological gamblers beyond those currently in treatment.This work was funded by Research Grant MH44295 from the Violence & Traumatic Stress Research Branch of the National Institute of Mental Health.     

Updates of the Prevalence of Problem Gambling in Romanian Teenagers

The aim of this study was to find out what is the prevalence of pathological in Romanian teenagers. We questioned one thousand thirty-two teenagers in Cluj-Napoca and Harghita counties. Participants completed a questionnaire with 40 items including gamblers anonymous twenty questions. The sample included teenagers aged 11–19 years; 65.57% were male and 34.43% were female. The subjects were divided into three groups: non-gambling/recreational gambling or occasional gambling (0–1 positive answers —Level 1)—753 subjects (72.96%) [316 females and 437 males]; problem gambling (2–6 points—Level 2)—243 subjects (23.54%) [43 females and 200 males]; pathological gambling (above 7 points—Level 3)—36 subjects (3.48%) [3 females and 33 males]. The mean age of pathological gamblers was 16.48 years. Gender differences were as expected, males engaging in pathological gambling (91.66% from pathological gamblers) more than females did (8.33% from pathological gamblers). Data revealed that the most encountered games practiced weekly were sport bets and slot machines in the case of 36.11% of the pathological gamblers; lotto, internet casino and pool bets each with 25%, followed by roulette and black-jack with 22.22%.From those who reported practicing gambling at a pathological level 66.66% engaged in alcohol consumption, 13.88% illicit drug use and 19.44% licit drugs. Just 16.66% smoke cigarettes. Data revealed higher rates of prevalence in Romanian teenagers than in other Central and Eastern European countries. A prevalence study at a national level should be designed.     

Health Outcomes in Individuals with Problem and Pathological Gambling: An Analysis of the 2014 North Carolina Behavioral Risk Factor Survey System (BRFSS)

Problem and pathological gambling refers to subclinical and clinical levels of maladaptive gambling, respectively, and is associated with specific sociodemographic characteristics as well as a number of poor health outcomes. We examined such demographic, physical health, mental health, and health-related behaviors in a sample of 7045 low-risk gamblers and 244 problem/pathological gamblers. Participants completed the 2014 North Carolina Behavioral Risk Factor Surveillance System telephone survey. Using the National Opinion Research Center’s Diagnostic Screen for Gambling Disorders-CLiP, participants were categorized as either “problem/pathological gamblers” or “low-risk gamblers.” Problem/pathological gamblers were younger, more likely to be male, of ethnic minority status, unmarried, and of lower education than low-risk gamblers. No physical health variables differentiated the groups but problem/pathological gamblers reported experiencing significantly more adverse childhood experiences and engaging in significantly more tobacco and alcohol use compared to low-risk gamblers. Moreover, gender moderated relationships between gambling group and several of the alcohol use variables such that male problem/pathological gamblers exhibited greater alcohol use behavior than male low-risk gamblers but no such relationship was present in females. Overall, this study expands the current knowledgebase on disordered gambling and highlights the need to assess disordered gambling in public health samples. Clinical implications are discussed.     

The role of natural recovery in alcoholism and pathological gambling

While most pathological gamblers, like most alcohol abusers, recover on their own, it seems likely that they are at greater risk for relapse than those who have been through successful treatment. Accordingly, a substantial increase in treatment resources for pathological gamblers, along with greater efforts to establish the effectiveness of these treatments, ought to receive national priority. If the data on alcohol-abusing self-changers are generalizable to self-changing pathological gamblers, the prognosis for gamblers who stop gambling all together is better than for those who aspire to controlled or nonproblem gambling. While pathological gamblers with comorbid substance abuse are more difficult to treat than those without it, the impact of comorbid substance abuse on the decision by pathological gamblers to change has not yet been explored, although it should be. Similarly, the impact of other Axis I pathology on pathological gambling self-change, especially depression and anxiety, should be thoroughly explored. The most pressing problem in this field appears to be definitional. As a consequence, until consensus is reached on a reliable, valid, and useful classification scheme for pathological gambling, both research and clinical efforts will continue to suffer.     

Professional and Pathological Gamblers: Similarities and Differences

Although much recent research has focused on the gambling practices and psychosocial functioning of pathological gamblers, few investigations have examined the characteristics of professional gamblers. The current project sought to address this gap in the literature by conducting a quantitative comparison of professional and pathological gamblers. Pathological gamblers were recruited and balanced with professional gamblers on demographic variables and preferred gambling activity. A total of 22 professional gamblers and 13 pathological gamblers completed an extensive self-report battery including instruments assessing demographics, gambling behaviors and problems, other psychiatric disorders, current psychosocial functioning, recent stressful events, personality characteristics, and intelligence. Pathological and professional gamblers reported similar rates of gambling frequency and intensity and types of games played. Pathological gamblers endorsed poor psychosocial functioning, whereas professional gamblers reported a rate of psychiatric distress within a normative range. Pathological gamblers also reported lower gambling self-efficacy, greater impulsivity, and more past-year DSM-IV Axis I disorders than professional gamblers. The results of the present study shed light on the unique circumstances of professional gamblers, as well as underscore important differences between such individuals and pathological gamblers that could prove fruitful in future research and intervention and prevention efforts.     

Controlled Gambling for Pathological Gamblers

Despite its high prevalence, pathological gambling often remains untreated. It is estimated that only 10% of the pathological gamblers identified in prevalence studies will enter treatment. Within this small proportion, a high percentage will drop out. Despite the facts that some researchers argue against abstinence as the unique treatment goal and that regaining control appears to be possible for some pathological gamblers, abstinence has been the only treatment goal in most problem gambling interventions thus far. This paper examines the avenue of controlled gambling embedded in a harm reduction context as a viable solution for some pathological gamblers.     

Psychological characteristics of volunteers in studies on gambling

Advertisements were published in local newspapers asking for volunteers to participate in a study on gambling. A battery of eleven questionnaires was mailed to the subjects assessing pathological gambling behavior, sociodemographic characteristics, motivation to gamble, erroneous perceptions about gambling, superstitious beliefs, depressive symptoms, social anxiety and avoidance, alcohol and drug abuse, problem-solving skills, and marital satisfaction. Subjects received $10 when they returned the questionnaires fully completed. Response rate was over 95%. Surprisingly, 29% of the respondents met the criterion for probable pathological gambling (score of 5 or more on the SOGS) and a further 16% were identified as potential pathological gamblers (scores of 3 or 4). The potential and probable pathological gamblers showed significant differences on motivational and cognitive variables related to gambling compared to those subjects who showed no signs of pathological gambling. The probable pathological gamblers reported significantly more signs of poor psychosocial functioning than the other two groups, including depressive symptoms, poor problem orientation, drug and alcohol abuse, and interpersonal conflict. The practical and theoretical implications of these results are discussed.     

Psychopathology in pathological gamblers seeking treatment

High rates of psychiatric symptoms have been reported in pathological gamblers. This study of psychiatric comorbidity in pathological gamblers is the first to use structured psychiatric interviews assessing DSM-III-R Axis I and II disorders. The Structured Clinical Interview for DSM III-R (SCID-P, SCID-II) was administered to 40 (25 male, 15 male) pathological gamblers seeking outpatient treatment in Minnesota for gambling, and 64 (41 male, 23 female) controls. High lifetime rates of Axis I (92%) but not Axis II (25%) psychopathology were found in pathological gamblers as compared to controls. No differences between male and female gamblers were found in rates of affective, substance use or personality disorders. Females had higher rates of anxiety disorders and histories of physical/sexual abuse. Possible associations between psychiatric disorders and pathological gambling are discussed along with gambler typologies and implications for future research.The authors wish to gratefully acknowledge the assistance of: Gary Christenson, M.D., Carol Peterson, Ph.D., William Meller, M.D., Thomas Mackenzie, M.D.     

Gender Differences in Characteristics of Chinese Treatment-Seeking Problem Gamblers

A total of 952 (841 men and 111 women) Chinese treatment-seeking problem gamblers completed self-report assessment forms. Female in contrast to male gamblers were more likely to be older, married, less educated, and without employment. Female gamblers also started gambling at an older age, had a shorter gambling history, preferred casino and mahjong gambling, and reported more somatic complaints and suicidal thoughts. Male and female gamblers accumulated similar amount of gambling debt and reported an average of 12 gambling-related problems on the Chinese version of the South Oaks Gambling Screen [Lesieur and Blume (Am J Psychiatry 144:1184–1188, 1987)]. Both groups were similarly troubled by their indebtedness, inability to control gambling, and gambling-related interpersonal problems. However, female gamblers had fewer means to pay their gambling debt. Given that significant gender-related differences were observed in Chinese problem gamblers, prevention and treatment services should attend to specific needs of male and female gamblers.     

Pathological gambling: A comparison of gambling at German-style slot machines and “Classical” gambling

German-style slot machines and related legal issues are described. On the basis of a survey on 437 members of self-help groups (Gamblers Anonymous) in Germany, slot machine gamblers were compared with casino gamblers on such variables as sociodemographic data, gambling behaviour, financial expenditure, emotional experience while gambling, symptoms of pathological gambling, psychosocial consequences and gambling related delinquency. The casino gamblers' gambling behaviour is financially more extensive. There were similarities regarding the emotional intensity of the gambling experience. However the casino gamblers show more pronounced symptoms of pathological gambling and the psychosocial consequences of their gambling behaviour are more severe. In spite of these differences, the data show that for young people slot machines can be as stimulating and therefore as dangerous as casino gambling. The young slot machine gambler runs a similar risk of acquiring a pathological gambling habit as the casino gambler.I would like to thank Dr. Gerhard Meyer for his support and his comments on the first draft of this article which is based on data from a research project led by him.     

Criminal Behavior Associated with Pathological Gambling

The influence of addictive gambling behavior on criminal behavior was examined in this study. A sample of pathological gamblers from in- and outpatient treatment centers and self-help groups (n = 300) and a sample of high and low frequency gamblers from the general population and army (n = 274) completed a comprehensive questionnaire which assessed social attachment, personality, pathological gambling and criminal behavior variables. The causal analysis of a Lisrel Model leads to the following results: addictive gambling behavior is an important criminogenic factor. This predisposing factor alone cannot sufficiently explain criminal behavior associated with pathological gambling. Personality variables also directly influence the intensity of criminal behavior. Social attachment variables have only an indirect effect. As far as property offenses are concerned, it was found that the direct causal effect of addiction behavior is greater than that of personality.     

Family,marital, and occupational satisfaction for recovering pathological gamblers

This paper describes the efforts of a private gambling treatment program to conduct a retrospective study of pathological gamblers treated in a publicly supported residential program. The Johns Hopkins Center for Pathological Gambling treated approximately 100 pathological gamblers nationwide from 1979 to 1983 in its residential component. Twenty-six gamblers were assessed regarding their recovery status with specific focus on family, marital status and occupational satisfaction. It was hypothesized that the more satisfied patients would display lower frequencies of gambling and that gambling frequency was dependent upon the level of satisfaction. Thirty-one percent of these gamblers reported abstinence. Regression analyses indicated that the recovery of pathological gamblers as measured by frequency of gambling is significantly influenced by job satisfaction, and moderately influenced by marital status and family life satisfaction. Consequently, these factors should be addressed by mental health professionals in research and treatment of pathological gambling.