Predictors of help-seeking for gambling disorder from the transtheoretical model perspective

Few gamblers seek treatment despite the severe negative impacts prolonged gambling can have. Research surrounding the predictors of help-seeking for problem gambling is often retrospective in design and inconsistent in findings. This study prospectively investigated whether transtheoretical model (TTM) constructs (readiness to change, ratings of temptations and self-efficacy, decisional balance and processes of change) have utility in predicting help-seeking among disordered gamblers. Community-recruited disordered gamblers (N = 136; 47.06% female; mean age = 44.5 years, SD = 12.8; 80.1% Caucasian) completed three assessments of TTM constructs, help-seeking behaviour, gambling problem severity, and other potential predictors of help-seeking. Informal help-seeking was common (6-month = 71.1%; 12-month = 79.6%); however, formal help-seeking was relatively infrequent (6-month = 22.7%; 12-month = 35.1%). Logistic regression demonstrated that gambling problem severity and the social liberation process of change (i.e. endorsing public awareness of gambling problems or non-gambling role models) consistently predicted formal help-seeking. Helping relationships and counter-conditioning (i.e. engaging in other activities as a replacement for gambling) processes of change uniquely predicted informal help-seeking at 12 months. Individuals most likely to seek formal help have greater problem severity and greater readiness to address problems. Seeking informal help is less predictable but more common.     

Impulsivity and predictive control are associated with suboptimal action-selection and action-value learning in regular gamblers

Heightened impulsivity and cognitive biases are risk factors for gambling problems. However, little is known about precisely how these factors increase the risks of gambling-related harm in vulnerable individuals. Here, we modelled the behaviour of 87 community-recruited regular, but not clinically problematic, gamblers during a binary-choice reinforcement-learning game, to characterize the relationships between impulsivity, cognitive biases and the capacity to make optimal action selections and learn about action-values. Impulsive gamblers showed diminished use of an optimal (Bayesian-derived) probability estimate when selecting between candidate actions, and showed slower learning rates and enhanced non-linear probability weighting while learning action values. Critically, gamblers who believed that it is possible to predict winning outcomes (as ‘predictive control’) failed to use the game's reinforcement history to guide their action selections. Extensive evidence attests to the ease with which gamblers can erroneously perceive structure in the reinforcement history of games when there is none. Our findings demonstrate that the generic and specific risk factors of impulsivity and cognitive biases can interfere with the capacity of some gamblers to utilize structure when it is available in the reinforcement history of games, potentially increasing their risks of sustaining gambling-related harms.     

Behaviour change strategies for problem gambling: an analysis of online posts

Reducing or quitting problematic gambling often requires implementing a variety of behaviour change strategies, but there is limited evidence regarding the breadth of specific strategies that gamblers use to control or limit gambling behaviours. This study aimed to identify the range of change strategies reported by gamblers in a naturalistic setting (i.e. two online forums for problem gambling). A total of 2937 change strategies were extracted from online posts (N = 1370). Content analysis identified 27 discrete change strategies that were pre-decisional (i.e. barriers – behavioural and psychological, decisional balance, realization – behaviour and cognitions, set reasons to change, seek knowledge and information, self-assessment), pre-actional (i.e. action planning, commitment, goal setting), actional (i.e. alternative activity, behavioural substitution, avoidance – abstinence, environment and financial, consumption control, maintain readiness, reinforcement, urge management, cognitive restructuring, seek inspiration, self-monitoring and spiritual) and multi-phased (i.e. external support, social support and well-being). This study suggests the breadth and depth of change strategies are far more complex than previously reported. Future research with a broader population needs to determine which change strategies are most effective for those experiencing different levels of gambling problems.     

The Self-Regulation of Gambling

Despite the prevalence of gambling world-wide, relatively few individuals become problem gamblers. Additionally many problem gamblers recover without professional assistance. The current study aim was to examine how individuals self-manage their gambling through (a) assessing frequency of use of a range of self-regulation strategies (b) examining how these strategies cluster and (c) exploring relationships between strategies, gambling frequency, amount spent and problem gambling severity. A sample of 303 gamblers was recruited, over-sampling for problem gamblers as assessed by the Problem Gambling Severity Index (PGSI) of the Canadian Problem Gambling Index (mean age 26.4 years, SD = 10.1 years; 119 males, 184 females; 238 social gamblers, 63 problem gamblers, 2 unclassified). They rated extent of usage of 27 gambling self-management techniques and completed the PGSI and other gambling measures. Factor analysis of items produced five factors, named Cognitive Approaches, Direct Action, Social Experience, Avoidance and Limit Setting. The relationships between these factors and key gambling variables were consistent with hypotheses that problem gamblers trying to reduce their gambling would be more likely to use the strategies than other gambler groups. The potential for developing the factors into a Gambling Self-regulation Measure was explored.     

Patterns of Autonomic Arousal in Imaginal Situations of Winning and Losing in Problem Gambling

AIMS: To examine changes in skin conductance level (SCL), for problem gamblers in response to personally relevant imaginal tasks, representing winning or losing. SETTING, DESIGN, PARTICIPANTS AND MEASUREMENTS: SCL and subjective arousal were compared for problem poker machine gamblers (n = 13) and a control group (n = 20). Participants were asked to describe a situation in which they had (a) won and (b) lost during a period of gambling. Before and during the task, recordings of SCL were taken. FINDINGS: There were significant differences between responses of problem and social gamblers. A significant interaction indicated that social gamblers became more aroused in reaction to winning than losing, whereas problem gamblers became equally aroused in response to both tasks. CONCLUSIONS: The results suggest that it may be responses to losing, rather than winning that are paramount to the development and maintenance of problem gambling.     

Clustering Finnish Gambler Profiles Based on the Money and Time Consumed in Gambling Activities

Gambling involves consumption of gamblers’ money and time. Gamblers are a heterogeneous group, and in addition to grouping gamblers based on personality factors, it is also important to find different gambler profiles with respect to their gambling behavior. Using the nationally representative survey ‘Finnish Gambling 2011’ (N = 4484), this article studies the subtypes of Finnish gamblers based on the frequency of gambling and the amounts of money and time used in different gambling forms. Cluster analysis reveals six profiles of gamblers, from infrequent gamblers to omnivorous gamblers. In the further analysis of the clusters, it was found that the highest problem gambling prevalence was in the groups of sport betting + electronic gaming machine gamblers and omnivorous gamblers, which were also both dominated by men. Certain gambling consumption patterns and risk factors for problem gambling are related to both socio-demographic backgrounds of the gamblers as well as the structural and situational characteristics of the games. The results have implications for the prevention of problem gambling, as some consumption patterns may be connected with the probability of developing gambling problems.     

Use of a Short Gambling Screen with an Arrestee Population: A Feasibility Study

Problem gamblers have been disproportionally found among prisoners. This study sought to (1) demonstrate if a short screening instrument (Lie/Bet Questionnaire) can expeditiously identify problem gamblers during the initial Criminal Justice System stage, and (2) examine the relationships between problem gambling and criminality among arrestees. Surveys were conducted with 959 inmates (from 1,445 approached) at a Central Booking Facility in Tampa, Florida. Among those surveyed, 81% were male with average age of 32.9. Ethnic distribution of those surveyed was Blacks (35.8%), Whites (43.3%), Hispanics (19.3%), Others (2.4%). Sixty-eight percent had completed trade school or less, 20% had some college and 12% were college graduates. Among those reporting gambling the year prior, 32.7% were problem gamblers according to the Lie/Bet. If including those who declined, the percent drops to a considerable 17.4% of the entire sample. Problem gamblers were significantly more likely to be charged with a drug or status crime, as well as being charged with a felony. Feasibility of screening inmates in an intake facility using the Lie/Bet Questionnaire was found. Furthermore, we found a need for gambling screening. Gambling courts should be considered.     

Exercise behavior in older adults: a test of the transtheoretical model

The transtheoretical model (TTM) was developed as a guide for understanding behavior change. Little attention has been given, however, to the appropriateness of the TTM for explaining the adoption of exercise behavior in older adults. The purposes of this study were to determine the reliability of the TTM instruments and validate TTM predictions in 86 community-dwelling older adults (mean age 75.1 +/- 7.0 years, 87% women) who were participants in a 16-week walking program. TTM construct scales--self-efficacy, decisional balance (pros and cons), and processes of change (behavioral and cognitive)--were generally reliable (all>.78). Behavioral processes of change increased from baseline to follow-up, but pros, cons, and cognitive processes did not change among participants who became regular exercisers. Stage of change did not predict exercise adoption, but baseline self-efficacy predicted walking behavior. These results lend partial support to the TTM in predicting exercise behavior.     

Does the transtheoretical model predict attrition in domestic violence treatment programs?

Attrition in intervention programs for domestically violent men is considered to be a serious and enduring problem. Researchers have found a number of sociodemographic variables that partially explain this phenomenon; however, models based on these variables have a limited predictive power. Scott (2004) argues that a firm theoretical base is needed in future investigations of the problem and suggests the use of the transtheoretical model of behavior change (TTM), which was found to predict dropout with accuracy in other areas of behavioral change. This study investigated the relationship between four TTM constructs (Stages of Change, Decisional Balance, Self-Efficacy, and Processes of Change) and premature termination with a sample of Canadian French-speaking men (N = 302) in five domestic violence treatment programs. Contrary to the initial hypotheses, the TTM constructs did not predict dropout. Discussion investigates how social desirability bias affects results being obtained by current TTM measures and whether more motivation to change at intake necessarily relates to involvement in treatment for longer periods of time.     

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.     

Are Irrational Beliefs and Depressive Mood More Common Among Problem Gamblers than Non-Gamblers? A Survey Study of Swedish Problem Gamblers and Controls

This study tests the hypothesis that problem gamblers are more prone to have irrational beliefs and depressed mood than non-gamblers. Irrational beliefs refer to fallacious opinions about probabilities. Gamblers like to believe that chance games (i.e., roulette and lottery) can be controlled and that the outcome of such games is dependent on the patterns of previous outcomes. The empirical material consists of responses to a survey that 302 individuals have answered. Half of the respondents were deemed to be problem gamblers. The results showed that compared to the controls, the problem gamblers were more inclined to show illusion of control due to their skill and reported more depressive mood. The results are discussed in terms of difficulties to know the “hen and the egg” regarding depressive mood, and in terms of intermittent reinforcement to continue gambling.     

Exploring the relationship between gambling,debt and financial management in Britain

The issue of how and why gamblers end up in debt has received comparatively little attention in the literature. Data from the 2007 Adult Psychiatric Morbidity Survey (APMS) revealed that although problem gamblers were more likely than non-problem gamblers to have forms of financial debt, just under two-thirds of problem gamblers (62%) reported having no debt. Using a qualitative approach, this study aimed to explore the issue from the perspective of gamblers themselves through interviews with 27 purposively sampled gamblers drawn from participants who took part in the APMS and the British Gambling Prevalence Survey 2010. Analysis, using the Framework method, suggested the existence of four kinds of gamblers categorized by their approach to gambling spending and their approach to their general spending: ‘controlled gamblers’, ‘uncontrolled gamblers’, ‘uncontrolled spenders’ and ‘chaotic spenders’. Also proposed on the basis of these data is an ecological model which aims to capture the different levels of personal and environmental factors that influenced people's financial decisions, including cognitive factors, control and compulsion, normative spending, resource and financial management, and the credit environment. The implications for practice are also discussed.     

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.     

Aboriginal card gamblers and non-card gamblers: do they differ?

Many Indigenous populations engage in traditional gambling games, but little is known about their contemporary usage or the characteristics of people who participate. This paper presents the first quantitative study of traditional Indigenous Australian card gambling. The aim of this research was to compare Indigenous Australian card gamblers with non-card gamblers in terms of socio-demographic characteristics, gambling behaviour and motivations, gambling cognitions, gambling consequences, substance use while gambling and problem gambling severity. A gambling survey was conducted at Indigenous festivals, in several communities and online. Within a sample of 1001 gamblers, 414 people had gambled on traditional card games in the previous 12 months. Many card gamblers commenced gambling while young, were highly involved in both cards and commercial gambling and gambled because most of their family and friends also gamble. An important difference revealed here is that card gamblers gamble on more forms of commercial gambling than non-card gamblers. Gambling appears as a deep-seated habit in some participants' lives and although the proportion classified as problem gamblers is high in this sample the card gamblers held more realistic cognitions about chances of winning than did the non-card gamblers.     

Arousal and Gambling Mode Preference: A Review of the Literature

The purpose of this paper is to review the literature examining subjective and physiological arousal associated with an individual’s preferred modes of gambling. Arousal is hypothesised to play a central role in the onset and maintenance of problem gambling. Most studies have failed to differentiate relevant patterns of arousal elicited by stimuli associated with preferred versus non-preferred modes of gambling on the assumption that similar processes motivate all gamblers. At the conceptual level, sub-typing theories of problem gambling propose differences in the motivation to gamble, and the associated role arousal plays in maintaining behaviours. A review of the existing literature reveals preliminary findings that indicate that gamblers respond differentially to preferred compared to non-preferred gambling stimuli, and that gamblers may display greater reactivity in arousal to gambling cues compared to non-gamblers. Understanding differences in such patterns of arousal can be used to inform clinical interventions by effectively targeting the nature and role of arousal associated with preferred modes of gambling, and determining the extent to which non-preferred modes act as secondary reinforces triggering by gambling urges.     

Differences in Cognitive Distortions Between Pathological and Non-Pathological Gamblers with Preferences for Chance or Skill Games

Cognitive distortions have been thought to play an important role in the development and maintenance of pathological gambling. The present study investigated whether severity of gambling problems and gamblers’ preference for chance or skill games were related to two sub-factors of cognitive distortions as measured by the Gamblers Belief Questionnaire: Luck/Perseverance, which reflects an individual’s perception that chance is favorable to him/her, and Illusion of Control, which reflects an individual’s perception that his/her behavior influences chance occurrences. Participants (N = 166) were recruited from a race track (n = 79), off-course betting facilities (n = 50) and from an online treatment program for problem gamblers (n = 49). Gambling severity was measured by the South Oaks Gambling Screen, and 73 were classified as pathological gamblers whereas 93 were classified as non-pathological gamblers. The present study supports previous proposals that cognitive distortions are core processes related to gambling behavior as pathological gamblers reported more cognitive distortions than did non-pathological gamblers. A preference for skill games was also associated with greater Illusion of Control compared to a preference for chance games. For gamblers preferring skill games there were no differences in Luck/Perseverance or Illusion of Control between pathological and non-pathological gamblers.     

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.     

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.     

The Relationship Between Problem Gambling and Attention Deficit Hyperactivity Disorder

Recent studies indicate that treatment-seeking problem gamblers display elevated rates of ADHD and that adolescents who screen positive for ADHD are more likely to engage in gambling, develop gambling problems, and experience a greater severity in gambling problems. This study aimed to (a) compare the prevalence of ADHD in treatment-seeking problem gamblers to the general population; (b) investigate the relationships between ADHD and problem gambling severity, cluster B personality disorders, motor impulsivity, alcohol use, substance use, gender, and age; and (c) investigate the degree to which these factors moderate the relationship between ADHD and problem gambling severity. Participants included 214 adults (154 males, 58 females, 2 unspecified) who sought treatment for their gambling problems at a specialist gambling agency in Melbourne, Australia. Almost one-quarter (24.9 %) of treatment-seeking problem gamblers screened positively for ADHD, which was significantly higher than the 14 % prevalence in a community sample. ADHD was significantly positively correlated with problem gambling severity, motor impulsivity, and cluster B personality disorders, but was not associated with alcohol and substance use, gender or age. None of the factors significantly moderated the relationship between ADHD and problem gambling severity. These findings suggest that a considerable proportion of treatment-seeking problem gamblers report ADHD and that their clinical profile is complicated by the presence of high impulsivity and cluster B personality disorders. They highlight the need for specialist gambling agencies to develop screening, assessment, and management protocols for co-occurring ADHD to enhance the effectiveness of treatment.