Treatment Utilization of Pathological Gamblers with and without PTSD

This paper represents the first study of treatment utilization among pathological gamblers with and without PTSD. Comorbidity of PG and PTSD is increasingly recognized as an important association, both in its rate and clinical severity. The sample comprised 106 adults from the community (35 with current PG; 36 with current PTSD, and 35 with BOTH). Four areas were addressed: current treatment utilization, lifetime treatment utilization, specific treatments utilized, and satisfaction with treatments. Results indicated that the presence of PTSD was associated with higher treatment utilization (for current utilization, PTSD was higher than PG; and for lifetime, PTSD and PTSD/PG were both higher than PG). Indeed, only a minority of the PG group had ever attended current or lifetime treatment, whereas the majority of PTSD and PTSD/PG had. Yet notably, those with PG who utilized current treatment had no less satisfaction, number of treatment types, nor number of days in treatment than the other two groups. For all three groups, the most common current treatments were individual therapy and psychiatric medications. Study strengths include a rigorously diagnosed sample; an extensive interview-based assessment of treatment utilization, and identification of both current and lifetime utilization. Limitations include the inability to explore change over time or test–retest reliability of responses.     

Suicidal behavior among members of Gamblers Anonymous

A national sample of 500 members of Gamblers Anonymous was surveyed by mail in order to gather information on suicidal history. One hundred sixty two usable surveys were returned representing 32.4% of the original sample. Compulsive gamblers who had a history of suicidal preoccupation began gambling at an earlier age than nonsuicidal gamblers and were more likely to have stolen to support their gambling. They also tended to have addicted relatives and children more than nonsuicidal gamblers did. The data suggest that those gamblers who had been suicidal tend to be more serious gamblers than nonsuicidal respondents.     

Clinical Gender Differences Among Adult Pathological Gamblers Seeking Treatment

This study aimed to examine the gender-related differences in demographics, gambling measures, psychological functioning, and motivation for therapy in an outpatient sample of pathological gamblers seeking treatment. Participants in this multisite study included 103 adult outpatients (51 women and 52 men) meeting current DSM-IV-TR criteria for PG. Logistic regression was used to examine if gender was related together to categorical and continuous independent variables. Female gamblers were older than men and more likely to be divorced or widowed and to have a lower annual income. Women became more dependent on bingo and men on slot machines. Gambling motivation and the course of illness for both sexes were also different. Female gamblers were more anxious and with a poorer self-esteem than male gamblers and more affected by depressive symptoms; in turn, men were more impulsive and higher sensation seekers than women and more affected by drug/alcohol abuse. The 68.6% of female gamblers reported being victims of intimate partner violence. There were no gender differences about the motivation for treatment. Future research should examine gambling behaviors and psychological functioning and suggest treatment approaches to address specific goals according to these gender-related differences.     

Characteristics and Gender Differences Among Self-Excluded Casino Problem Gamblers: Missouri Data

The present study explores gender-related differences in the demographic and gambling-related characteristics of 2670 problem gamblers participating in a state-administered (Missouri) casino self-exclusion program between 2001 and 2003. Female (n=1298, 48.4%) and male (n=1372, 51.1%) participants ranged in age from 21 to 84 years. Gender-related differences were noted among demographic variables, patterns of gambling behavior, reasons for self-exclusion, and involvement in self-help, counseling, and bankruptcy services. Female self-excluders were more likely than males to be older at time of application, African American, and either retired, unemployed or otherwise outside the traditional workforce. In addition, female self-excluders were more likely to report a later age of gambling onset, a shorter period between onset and self-exclusion, a preference for non-strategic forms of gambling and prior bankruptcy. The main predictors for female participation in self-exclusion included a desire to gain control and prevent suicide and referral by a counselor. The desire to save the marriage was a motivating factor for all participants. Findings suggest that the most efficacious treatment strategies with this group will include family systemic therapy and financial management in addition to pharmaco-treatment and culturally-sensitive individual therapy.     

Gambling Increases Self-Control Strength in Problem Gamblers

In two studies it is demonstrated that, in the short-term, slot machine gambling increases self-control strength in problem gamblers. In Study 1 (N = 180), participants were randomly assigned to either play slot machines or engage in a control task (word anagrams) for 15 min. Subsequent self-control strength was measured via persistence on an impossible tracing task. Replicating Bergen et al. (J Gambl Stud, doi:10.1007/s10899-011-9274-9, 2011), control condition participants categorized as problem gamblers persisted for less time than did lower gambling risk participants. However, in the slot machine condition, there were no significant differences in persistence amongst participants as a function of their gambling classification. Moreover, problem gambling participants in the slot machine condition persisted at the impossible tracing task longer than did problem gambling participants in the control condition. Study 2 (N = 209) systematically replicated Study 1. All participants initially completed two tasks known to deplete self-control strength and a different control condition (math problems) was used. Study 2 results were highly similar to those of Study 1. The results of the studies have implications for the helping professions. Specifically, helping professionals should be aware that problem gamblers might seek out gambling as a means of increasing self-control strength.     

Affect-Regulation Expectancies among Gamblers

Factor scores on a gambling expectancy questionnaire (GEQ) were used to subtype 132 university students who gamble regularly (37.9% male; M age = 22.6 years, SD = 6.04) as: Reward Expectancy Gamblers (Reward EGs)—have strong expectations that gambling augments positive mood, Relief Expectancy Gamblers (Relief EGs)—have strong expectations that gambling relieves negative affect, and Non-Expectancy Gamblers (Non-EGs)—have neither strong expectation. Gambling on a high-low card game was compared across subtypes following priming for either “relief” or “reward” affect-regulation expectancies with the Scrambled Sentence Test (SST). The hypothesized Prime type × GEQ subtype interaction was not significant. When a more stringent set of criteria for GEQ subtyping was imposed, the “purified” sub-sample (n = 54) resulted in the hypothesized statistically significant Prime type × GEQ subtype interaction. Relief EGs gambled more after being primed with the construct “relief of negative emotions” compared to after being primed with the construct “augmentation of positive emotion.” Planned orthogonal contrasts showed a significant linear increase in number of bets made across GEQ subtypes when prime type corresponded to GEQ subtype. The results suggest a need for components in gambling treatment programs that address clients’ expectancies that gambling can provide a specific desirable emotional outcome.     

Reduced Risk-Taking After Prior Losses in Pathological Gamblers Under Treatment and Healthy Control Group but not in Problem Gamblers

A group of pathological gamblers and a group of problem gamblers (i.e., gamblers at risk of becoming pathological) were compared to healthy controls on their risk-taking propensity after prior losses. Each participant played both the Balloon Analogue Risk Taking task (BART) and a modified version of the same task, where individuals face five repeated predetermined early losses at the onset of the game. No significant difference in risk-taking was found between groups on the standard BART task, while significant differences emerged when comparing behaviors in the two tasks: both pathological gamblers and controls reduced their risk-taking tendency after prior losses in the modified BART compared to the standard BART, whereas problem gamblers showed no reduction in risk-taking after prior losses. We interpret these results as a sign of a reduced sensitivity to negative feedback in problem gamblers which might contribute to explain their loss-chasing tendency.     

Differences between Poker Players and Non-Poker-Playing Gamblers

Since approximately 2003, the popularity of poker has quickly risen to unprecedented heights. This study examined poker play among university students who gamble on a regular basis. A total of 513 undergraduate students (females = 344, males = 170; mean age = 22.1) who gamble in some form at least two times per month completed an online questionnaire; 62.2 per cent (n = 319) of the respondents reported playing poker for money in the past year. A logistic regression analysis showed that poker players were more likely to be male, younger, have higher scores on an index of alcohol abuse, spend more time gambling and gamble more frequently compared to non-poker players. A second logistic regression showed that online/casino poker players were more likely to be male, have higher scores on an index of problem gambling, spend more time and money gambling, and gamble more often compared to social/non-poker players. These results are discussed in terms of the potential of poker's newfound popularity to lead to an increase in addictive behaviours, particularly among adolescents and young males.     

Barriers to Treatment for Female Problem Gamblers: A UK Perspective

There is a paucity of research in the UK which examines problem gambling and that which does exist is mainly quantitative, focuses on male samples and fails to look at treatment seeking populations or obstacles preventing problem gamblers from seeking treatment. This paper presents findings from part of a larger qualitative study that explored the experience of treatment for female problem gamblers. Data were collected using semi-structured interviews with eight women who had received individual cognitive-behavioural therapy in the National Health Service for their gambling problem. An interpretative phenomenological analysis approach was applied in the research process, identifying three main themes, of which the subtheme ‘Barriers to Treatment’ is examined here. Internal and external barriers to treatment organically emerged in all female participants’ accounts and appear to have an impact on service utilisation. Input directly from gamblers can be combined with findings from other studies to devise better ways of reaching female problem gamblers. A better understanding of barriers to treatment can also provide valuable direction for future research and suggest applications in clinical service provision and treatment planning.     

Impaired Self-Awareness in Pathological Gamblers

Lack of self-awareness of one’s decisions remains an understudied and elusive topic in the addiction literature. The present study aimed at taking a first step towards addressing this difficult subject through the use of a combination of behavioral procedures. Here, we explored the association between a metacognitive process (the ability to reflect and evaluate the awareness of one’s own decision) and poor performance on the Iowa Gambling Task (IGT) in a group of pathological gamblers (PG; n = 30), and in a comparison group (n = 35). This metacognitive process was assessed during the IGT with the post-decision wagering procedure, while a number of potential confounds (i.e., reward/loss sensitivity, dual-tasking) were controlled for. Results showed that: (1) Initial performance enhancement of the control group on IGT occurred without explicit knowledge of the task, thus confirming its implicit character; (2) compared to controls, performance of PG on the IGT failed to increase during the task; (3) taking into account increased reward sensitivity and decreased loss sensitivity as well as poorer dual-tasking in pathological gamblers, PG tended to exhibit a bias in evaluating their own performance on the IGT by maximizing their wagers independently of selecting advantageous decks. Our findings suggest that biased metacognition may affect pathological gamblers, leading to disadvantageous post-decision wagering, which is in turn linked to impaired decision making under ambiguity. Perhaps this deficit reflects the impaired insight and self-awareness that many addicts suffer from, thus providing a novel approach for capturing and measuring this impairment, and for investigating its possible causes.     

Children of Gamblers Anonymous members

One hundred and five children of Gamblers Anonymous (GA) members and pathological gamblers in treatment were surveyed concerning behavioral, psychological, and emotional problems as well as parental use of violence. The results were compared with control groups and Jacobs' study of high school students who reported they were children of compulsive gamblers. Children of known pathological gamblers were less likely to admit to moderate or heavy use of cocaine/crack and less likely to gamble more than they could afford than either Jacobs' children of compulsive gamblers or controls. Children of pure gamblers looked more like Jacobs' controls than the self-reported children of compulsive gamblers he surveyed on several measures. Children of multiple-problem families are more likely than children of pure gamblers to smoke tobacco, get drunk, overeat, sleep worse than most people, have an unhappy present state of mind, and feel more insecure, inferior, or inadequate than most. GA and treatment children as a whole were more likely to say they had an unhappy childhood, and feel a need for success, acceptance, and approval than Jacobs' children of compulsive gamblers or his controls. Using Strauset al.'s conflict tactics scale, children of known pathological gamblers were more subject to parental violence and abuse than nationally normed samples. On most measures, the children of multiple-problem families fared worse than children of pure gamblers. However, there were no differences in the expressions of anger, hurt, sadness, depression, confusion, and other feelings between these groups concerning their parents' gambling. Treatment implications of the findings are discussed.The authors would like to thank Mary Heineman, M.S.W., and Valerie Lorenz, Ph.D., for their comments on an earlier draft of this paper.     

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.     

Personality Disorders Among Pathological Gamblers

The objective of this study was to investigate the prevalence of DSM-III-R diagnostic categories of personality disorders in pathological gamblers and to highlight the possible association between such disorders, psychological distress and selected forms of gambling. The Personality Disorders Questionnaire-Revised and a battery of psychometric measures were administered to a sample of 82 consecutive admissions to a behavioral treatment program for gambling problems at an impulse control disorders research unit in Sydney, Australia. Seventy-three percent of subjects were male. The total sample reported having gambled a mean of 15 years of which, on average, the last 6.4 years were associated with problems. Results indicated that the majority of subjects met diagnostic criteria for at least one Personality Disorder (93%), with an average of 4.6 personality disorders per subject. The majority of gamblers evidenced personality disorders from the Cluster B grouping with particularly high rates of borderline, histrionic, and narcissistic personality disorders which were found to be associated with high levels of impulsivity and affective instability. Antisocial personality disorder and narcissistic personality disorder were both found to be possible mediators of the severity of the problem gambling behaviours.     

Experiences and Perceptions of Problem Gamblers on Cognitive and Exposure Therapies When Taking Part in a Randomised Controlled Trial: A Qualitative Study

In South Australia (SA) problem gambling is mainly a result of the widespread availability of electronic gaming machines. A key treatment provider in SA offers free cognitive and behavioural therapy (CBT) to help-seeking problem gamblers. The CBT program focuses on the treatment of clients’ urge to gamble using exposure therapy (ET) and cognitive therapy (CT) to restructure erroneous gambling beliefs. The aim of this study was to explore treatment specific and non-specific effects for CT alone and ET alone using qualitative interviews. Interviewees were a sub-sample of participants from a randomised trial that investigated the relative efficacy of CT versus ET. Findings revealed that all interviewees gained benefit from their respective therapies and their comments did not appear to favour one therapy over another. Both treatment specific and treatment non-specific effects were well supported as playing a therapeutic role to recovery. Participants’ comments in both therapy groups suggested that symptom reduction was experienced on a gambling related urge–cognition continuum. In addition to symptom improvement from therapy-specific mechanisms, ET participants described a general acquisition of “rational thought” from their program of therapy and CT participants had “taken-over” their gambling urges. The findings also highlighted areas for further improvement including therapy drop-out.     

A Gender-based Examination of Past-year Recreational Gamblers

Background Most adults gamble recreationally yet few studies have systematically investigated for gender-related differences in recreational gamblers.Methods Logistic regression analyses were performed on data from a nationally representative sample of respondents from the 1998 Gambling Impact and Behavior Study. Results Female gamblers versus non-gamblers were more likely to report use of alcohol and drugs. Male gamblers versus non-gamblers were more likely to report alcohol use and abuse/dependence, any substance abuse/dependence, and lifetime incarceration. An analysis of gambling by gender group interaction effects did not identify significant differences in health-related measures. Male as compared with female gamblers reported beginning gambling earlier, experiencing higher past-year maximal losses and wins, and finding favorite and engaging in different types of gambling.Conclusions Despite heavier gambling in male as compared with female recreational gamblers, similar mental health functioning was observed in female and male past-year recreational gamblers. Types of gambling problematic for men and women are reflected in the gambling preferences of recreational gamblers.     

An Examination of Factors Driving Chinese Gamblers’ Fallacy Bias

Gambling is a leisure activity, which is enjoyed by many people around the world. Among these people, Chinese are known for their high propensity to gamble and are highly sought after by many casinos. In this exploratory study, the effect of two types of fallacy bias—positive recency and negative recency—on the betting behavior of Chinese gamblers is investigated. Although the influence of fallacy bias on a betting decision is well documented, little is known about the interaction of the factors that dictate fallacy bias. Drawing from an analysis of 2,645 betting decisions, the results show that Chinese gamblers primarily endorse positive recency, especially when the latest outcome is more frequent. This is contrary to most findings on Western subjects in which negative recency is more common. Current findings have meaningful implications to casino gaming entertainment businesses and public policymakers.     

The Development of an Internet-Based Treatment for Problem Gamblers and Concerned Significant Others: A Pilot Randomized Controlled Trial

Problem gambling creates significant harm for the gambler and for concerned significant others (CSOs). While several studies have investigated the effects of individual cognitive behavioral therapy (CBT) for problem gambling, less is known about the effects of involving CSOs in treatment. Behavioral couples therapy (BCT) has shown promising results when working with substance use disorders by involving both the user and a CSO. This pilot study investigated BCT for problem gambling, as well as the feasibility of performing a larger scale randomized controlled trial. 36 participants, 18 gamblers and 18 CSOs, were randomized to either BCT or individual CBT for the gambler. Both interventions were Internet-delivered self-help interventions with therapist support. Both groups of gamblers improved on all outcome measures, but there were no differences between the groups. The CSOs in the BCT group lowered their scores on anxiety and depression more than the CSOs of those randomized to the individual CBT group did. The implications of the results and the feasibility of the trial are discussed.     

Cognitive Characteristics of Strategic and Non-strategic Gamblers

Participation in strategic and non-strategic games is mostly explained in the literature by gender: men gamble on strategic games, while women gamble on non-strategic games. However, little is known about the underlying cognitive factors that could also distinguish strategic and non-strategic gamblers. We suggest that cognitive style and need for cognition also explain participation in gambling subtypes. From a dual-process perspective, cognitive style is the tendency to reject or accept the fast, automatic answer that comes immediately in response to a problem. Individuals that preferentially reject the automatic response use an analytic style, which suggest processing information in a slow way, with deep treatment. The intuitive style supposes a reliance on fast, automatic answers. The need for cognition provides a motivation to engage in effortful activities. One hundred and forty-nine gamblers (53 strategic and 96 non-strategic) answered the Cognitive Reflection Test, Need For Cognition Scale, and socio-demographic questions. A logistic regression was conducted to evaluate the influence of gender, cognitive style and need for cognition on participation in strategic and non-strategic games. Our results show that a model with both gender and cognitive variables is more accurate than a model with gender alone. Analytic (vs. intuitive) style, high (vs. low) need for cognition and being male (vs. female) are characteristics of strategic gamblers (vs. non-strategic gamblers). This study highlights the importance of considering the cognitive characteristics of strategic and non-strategic gamblers in order to develop preventive campaigns and treatments that fit the best profiles for gamblers.     

Superstitious Beliefs in Gambling Among Problem and Non-Problem Gamblers: Preliminary Data

Superstitious beliefs, defined as a strong conviction based on the erroneous perception of a cause-effect association between two independent events, are considered to play an instrumental role in the maintenance of gambling behaviour. In this preliminary study, responses to eight items assessing superstitious beliefs were compared among 56 electronic gaming machine (EGM) problem gamblers, 22 non-problem EGM and 23 non-EGM non-problem gamblers. Results suggested that problem gamblers endorsed more superstitious beliefs than non-problem gamblers and that such beliefs were correlated with gambling intensity. Further research is required to determine if superstitious beliefs represent a vulnerability factor for the development of problem gambling or emerge as a consequence of involvement in gambling.     

Health Care Providers' Experiences with Problem Gamblers

The purpose of this study was to document health care providers' awareness of problem gambling and frequency of recognition and treatment. An exploratory survey was designed to collect data on awareness and knowledge of problem gambling. A structured questionnaire was completed anonymously by 180 health care providers (nurses, physicians, social workers, and other allied health professionals). Almost all respondents (96%) reported knowledge of problem gambling, and 30% reported asking clients about gambling problems when they presented with stress related symptoms. A third of the respondents reported identifying and treating clients for a gambling problem. The most frequently reported intervention was referral to counseling and other gambling resources. Respondents were generally interested in learning more about gambling problems, particularly those providers who have had a client discuss gambling related concerns. There were no significant differences in findings between provider groups.