Numerical Reasoning Ability and Irrational Beliefs in Problem Gambling

Numerous studies have shown that pathological gamblers are particularly prone to various cognitive biases that may explain why they continue to gamble despite having occurred substantial losses. A common explanation advanced to account for this finding is that pathological gamblers may have poorer numerical or statistical knowledge than other people. Addressing these deficits is therefore seen as one possible way in which to assist pathological gamblers or prevent the development of problematic behaviour within the broader community. The aim of this study was test this assumption by assessing the numerical reasoning skills, objective gambling knowledge and tendency towards biased reasoning in a sample of 90 regular poker-machine gamblers (pathological and non-pathological) and a non-gambling comparison group (n = 45). Analyses based on both group comparisons and regression analyses controlling for differences in educational attainment showed that pathological gamblers scored significantly higher on the cognitive biases measure than other gamblers. However, this difference could not be attributed to poorer knowledge of gambling odds or limited numerical ability among pathological gamblers. The findings suggest that educating pathological gamblers with greater knowledge about the odds of gambling is unlikely to be an effective harm minimisation strategy.     

Pharmacological treatments of pathological gambling

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

Description and pre-post evaluation of a telephone and Internet based treatment programme for pathological gambling in Norway: a pilot study

Although the effectiveness of treatments for pathological gamblers is gaining support, only 10% of pathological gamblers seek treatment. Providing treatment via the Internet may lower the thresholds for treatment seeking. A new telephone and Internet based treatment programme for pathological gamblers is presented in this article, along with a pre-post evaluation of the programme. The participants (N = 112) were problem gamblers who were either self-referred or referred by their general practitioner. Data from post-treatment and 3-month follow-up are evaluated. The results suggest that using Internet and telephone-assisted treatment interventions can significantly reduce symptoms of pathological gambling (measured by the South Oaks Gambling Screen – Revised). The intervention was also associated with improvement on cognitive distortions, measured by the Gamblers Belief Questionnaire, and general psychological distress and psychopathology as measured by the Symptom Checklist-90-Revised. Although Internet-based treatment programmes have been suggested to have advantages compared to traditional face-to-face therapy, research in this area is scarce. This pilot study contributes to the growing literature in this area, and provides tentative support for the effectiveness of Internet based treatment interventions for pathological gamblers.     

Does your older adult client have a gambling problem?

Pathological gambling is becoming an increasing problem in today's culture, particularly because opportunities and inducements to gamble abound. This article describes symptoms, consequences, and comorbidities experienced by pathological gamblers. Gambling pathology is often invisible because pathological gamblers seldom disclose gambling problems to their primary care provider. Thus, nurses will benefit from knowledge of the physical and emotional signs of the disorder. A two-question assessment tool, the Lie/Bet Questionnaire, is useful in helping nurses identify pathological gamblers. Interventions and treatment options, including group therapy and environmental modification, are also discussed. As always, education concerning problems and consequences of pathological gambling is a first step. Because research has indicated that visits to casinos by older adults have doubled since 1975, the authors use an example of an older adult to clarify the issues. Although the article's content is applicable to clients across the life span, it has particular significance for older adults.     

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.     

Alterations in the Emotional Regulation Process in Gambling Addiction: The Role of Anger and Alexithymia

This study aims at the assessment of alexithymia and anger levels in 100 treatment-seeking pathological gamblers compared with controls, who were matched for age, gender and education. Furthermore a positive correlation between alexithymia, anger and severity of gambling disorder and a relationship between gambling behaviour and anger after controlling for alexithymia, are investigated. Finally the role that gender plays in anger in pathological gamblers was also evaluated. Psychological assessment includes the South Oaks Gambling Screen, State-Trait Anger Expression Inventory-2 and the twenty-item Toronto Alexithymia Scale. Statistical analysis of the results shows a higher level of anger in pathological gamblers than in controls, together with alterations in emotional processing. Severity of gambling behaviour positively correlates with alexithymia scores, state-anger and trait-anger. Moreover, a significant contribution of anger in predicting gambling behaviour was suggested after controlling for alexithymia. In conclusion, anger and alexithymia must be regarded as relevant components of the assessment of pathological gamblers, in order to select the best therapeutical strategies to prevent self-defeating behaviours and to reduce drop-out from treatments.     

A Shorter and Multidimensional Version of the Gambling Attitudes and Beliefs Survey (GABS-23)

The Gambling Attitudes and Beliefs Survey (GABS) is a questionnaire which explores gambling-related dysfunctional beliefs in an unidimensional way. The present research aims to investigate the dimensionality of the scale. 343 undergraduate student gamblers and 75 pathological gamblers seeking treatment completed the GABS and the south oaks gambling screen. Exploratory and confirmatory factor analyses revealed that the original one-factor structure of the GABS did not fit the data effectively. We then proposed a shorter version of the GABS (GABS-23) with a new five-factor structure, which fitted with the data more efficiently. The comparisons between students (problem vs. non-problem gamblers) and pathological gamblers seeking treatment indicated that the GABS-23 can discriminate between problem and non-problem gamblers as efficiently as the original GABS. To ensure the validity and the stability of the new structure of the GABS-23, analyses were replicated in an independent sample that consisted of 628 gamblers (256 non problem gamblers, 169 problem gamblers who are not treatment-seeking and 203 problem gamblers seeking treatment). Analyses showed satisfactory results, and the multidimensional structure of the GABS-23 was then confirmed. The GABS-23 seems to be a valid and useful assessment tool for screening gambling-related beliefs, emotions and attitudes among problem and non-problem gamblers. Moreover, it presents the advantage of being shorter than the original GABS, and of screening irrational beliefs and attitudes about gambling in a multidimensional way. The five-factor model of the GABS-23 is discussed based on the theory of locus of control.     

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.     

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.     

Obsessive-Compulsive Features in Pathological Lottery and Scratch-Ticket Gamblers

The results of this study support the notion that pathological gamblers drawn from the community would score higher on all three scores from the YBOCS than light gamblers. Consistent with hypotheses, pathological gamblers (lottery and scratch ticket) reported more obsessions, compulsions, and avoidance behavior than the light gamblers, and also reported having more urges to engage in injurious behaviors to themselves and others. These findings provide evidence that pathological gambling falls in a spectrum or family of disorders which have obsessive-compulsive disorder at its core. These findings support McElroy, Hudson, Philips, et al.'s (1993) suggestions of similarities between OCD and Impulse Control Disorders, and extend Blaszczynski (1999) findings of overlap between pathological gamblers and OCD in a treatment population. Heavy gamblers also reported significantly more hoarding symptoms and compulsive buying than light gamblers. More research in this area may show further evidence of a spectrum of disorders with obsessive compulsive disorder at its core, and show further links between impulse control disorders (such as pathological gambling) and OCD.     

After the Ban of Slot Machines in Norway: A New Group of Treatment-Seeking Pathological Gamblers?

Changes in demographical and clinical features of treatment-seeking pathological gamblers, and their gambling preferences before and after the ban of slot machines in Norway from 1 July 2007. Is there an emergence of a new group of gamblers seeking treatment after the ban? The participants were 99 patients, 16 women and 83 men, with the mean age of 35 years. All were referred to the Bergen Clinics Foundation, Norway, for treatment of gambling addiction in the period October 2006 to October 2009. A comprehensive assessment package was applied, focusing on demographical characteristics, the severity of pathological gambling, mental health and substance use disorder. After the ban the mean age was significantly lower, and significantly more were highly educated, in regular employment, and married. Internet gambling and a sport betting game called Odds were the most common options, and gambling problems had become more severe with greater depth due to gambling, bad conscious, heavy alcohol consumption, and more suicidal thoughts and attempts. After the ban of slot machines, the characteristics of treatment-seeking gamblers have been changed, and with great implications for treatment strategies.     

Group psychotherapy with pathological gamblers

This paper reviews some of the group therapy techniques utilized in the authors' work with pathological gamblers. These conceptual tools ranged from rational-emotive psychotherapy to Zen philosophy which provided a background and foundation for working with pathological gamblers. Many therapeutic and antitherapeutic beliefs and behaviors of gamblers are discussed including narcissism, manipulative behavior, and rejection of Gamblers Anonymous. Each technique, behavior or belief discussed is explained in terms of how each affects the group process and how each is managed in group therapy.This paper represents a discourse on the group treatment of pathological gamblers primarily from the experiences of Julian Ingersoll Taber, Ph.D. who was the coordinator of the Gambling Treatment Program at the Cleveland Veterans Administration Medical Center for seven years. Dr. Taber is currently Chief of the Addictive Disorders Treatment Program at the Veterans Administration Medical Center in Reno, Nevada. Martin Paul Chaplin, Ph.D., who is specializing in the treatment of addiction, assisted in the theoretical and editorial aspects of this article. He worked under the aegis of Dr. Taber as an intern at the Gambling Treatment Program and currently has a position at Community Mental Health Services of Medina in Ohio.     

The Role of Perceived Control and Overconfidence in Pathological Gambling

Two studies sought to determine whether perceived control has different effects on confidence assessment and betting decisions among pathological and problem gamblers than among non-problem gamblers. In Study 1, 200 college students who were frequent gamblers (80 female and 120 male, median age 20) completed the South Oaks Gambling Screen (SOGS) and then engaged in a task in which they answered questions, assessed confidence in each answer, and considered bets on their answers that were fair if they were well-calibrated, but unfavorable if they were overconfident. Probable pathological and problem gamblers earned significantly fewer points than non-problem gamblers. This was due to greater overconfidence among pathological and problem gamblers, which led to systematically less favorable bets. In Study 2, using 384 participants (105 female and 279 male, median age 20), control was independently manipulated and bets were constructed to make point value independent of overconfidence. Problem and pathological gamblers showed both greater overconfidence and greater bet acceptance. They were less affected by control in their betting decisions than non-problem gamblers, but more affected in the slope of their betting function. It is concluded that pathological and problem gamblers process information about confidence and control differently from non-problem gamblers.     

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.     

A comparison: The treatment of wives of alcoholics with the treatment of wives of pathological gamblers

This study was conducted to determine how treatment approaches would differ for two reference groups — wives of alcoholics and wives of pathological gamblers. Data from thirty-nine wives from each reference group were collected over a period of sixteen months. The results indicate that the wives of the pathological gamblers had to deal with specific issues which did not surface in the treatment of wives of the alcoholics. Some of the wives of the pathological gamblers received threatening phone calls from creditors, had to re-pay loans for which they co-signed, had to commence handling the family budget, and had to deal with their own withdrawal from his gambling. They also found trust very slow in coming, realized they would be under great financial straits for an extended period of time, and found a shortage of self-help groups and qualified professionals within a reasonable distance of their home. Finally they found loneliness a very realistic issue in early abstinence because he was spending so much of his time outside the home attending G.A. meetings, aftercare and working two, and sometimes three jobs, in order to repay his gambling debts.     

Cue Reactivity in Active Pathological,Abstinent Pathological,and Regular Gamblers

Twenty-one treatment-seeking pathological gamblers, 21 pathological gamblers in recovery, and 21 recreational gamblers watched two video-taped exciting gambling scenarios and an exciting roller-coaster control scenario while their arousal (heart rate and subjective excitement) and urge to gamble were being measured. The gamblers did not differ significantly in cue-elicited heart rate elevations or excitement. However, the active pathological gamblers reported significantly greater urges to gamble across all cues compared to the abstinent pathological gamblers and, with marginal significance (p = 0.06), also compared to the social gamblers. Further exploration of these findings revealed that active pathological gamblers experience urges to gamble in response to exciting situations, whether or not they are gambling related, whereas abstinent and social gamblers only report urges to an exciting gambling-related cue. This suggests that for pathological gamblers excitement itself, irrespective of its source, may become a conditioned stimulus capable of triggering gambling behavior. Implications for treatment and future research are discussed.     

On Being Attracted to the Possibility of a Win: Reward Sensitivity (via Gambling Motives) Undermines Treatment Seeking Among Pathological Gamblers

Unfortunately, only a small percent of pathological gamblers seek the professional help they need. In the current study, we test the idea that individual differences in reward sensitivity should predict whether a pathological gambler has sought treatment—the odds of treatment seeking should decrease as reward sensitivity increases. This hypothesis rests on the proposition that reward sensitive pathological gamblers should find treatment seeking aversive because doing so would remove a route to reward. We also tested those motivations to gamble that are positively reinforcing (social affliction and self-enhancement) as a possible mechanism by which reward sensitivity undermines treatment seeking—we did not anticipate negatively reinforcing motivations (e.g., coping) to be a mechanistic variable. Ninety-two pathological gamblers completed a large-scale survey that contained the variables of interest. As predicted, pathological gamblers were less likely to have sought treatment as reward sensitivity increased. Moreover, this relationship was mediated by social affiliation motivations to gamble, but not self-enhancement or coping motives. Reward sensitive gamblers did not wish to seek treatment to the extent that they were motivated to gamble for the social interactions it provides—seeking treatment would cut this avenue of affiliation with others. In light of these results, we suggest health care professionals take reward sensitivity into account when trying to promote treatment seeking, to say nothing of the social affiliation motives that underlie the reward sensitivity-treatment seeking link.     

In Search of Executive Impairment in Pathological Gambling: A Neuropsychological Study on Non-treatment Seeking Gamblers

Pathological gambling is characterized by a persisting maladaptive and recurrent behavior with severe social and psychological consequences. There is evidence of strong comorbidity with psychiatric manifestations as well as cognitive mainly involving executive functions. This study aimed to investigate impairment in executive functions and working memory, and personality traits in a sample of Greek gamblers. Twenty-four men involved in various gambling activities were recruited from ecological settings as probable pathological gamblers. They were assessed with a comprehensive neuropsychological battery involving several executive tasks, the Zuckerman–Kuhlman Personality Questionnaire, the Hospital Anxiety Depression Scale, and the Difficulties in Emotion Regulation Scale. An age- and education-level matched group of 21 men without history of habitual gambling served as controls. As a group, gamblers displayed significantly lower scores on indices of inhibition, decision making and self-reported emotional awareness, and scored higher on impulsivity/sensation seeking personality traits. Notably, gamblers scored similarly or significantly higher on measures of verbal and visuospatial working memory, cognitive flexibility, processing speed, verbal fluency, and sustained attention. Overall, we argue that gamblers do present with specific cognitive deficits, but there is no evidence for a generalized executive impairment, and further stress the importance of investigating cognitive, personality, and psychiatric aspects of gambling on the basis of an ecologically valid sampling.     

Gambling and Problem Gambling Among Recently Sentenced Women in New Zealand Prisons

Ninety-four recently sentenced women prisoners were interviewed to assess aspects of their gambling involvement, problem gambling and relationships between gambling and criminal offending. A third of the women, on the basis of their SOGS-R scores, were assessed as lifetime probable pathological gamblers and just under a quarter were assessed as probable pathological gamblers during the 6 months prior to imprisonment. For women prisoners, a preference for non-casino gaming machines and housie were predictive of problem gambling. Relative to non-problem gamblers, problem gamblers experienced higher rates of childhood conduct disorder and current non-psychotic mental disorder. Just over a quarter of prisoners and a half of the problem gamblers had committed a crime to obtain money to gamble. Few women said their early offending or convictions related to gambling. It was concluded that most women were “criminals first and problem gamblers second” rather than people whose offending careers commenced as a consequence of problem gambling. However, the extent of problem gambling-related offending among the women prisoners highlights the potential for comprehensive assessment and treatment programs in prison to reduce recidivism and other adverse impacts of problem gambling and gambling-related offending.