Alexithymia and Gambling: A Risk Factor for All Gamblers?

The purpose of this study was to investigate alexithymia (in relation with depression) in three groups of French gamblers (n = 186) recruited in their gambling location: at the racetracks (n = 80 males; mean age 28.1 years), in the slot machine rooms (n = 65; 29 males, 36 females; mean age 34.6 years), and in the traditional gaming rooms (n = 41 males; mean age 36 years). Gambling behavior was measured by the South Oaks Gambling Screen and DSM-IV criteria for pathological gambling, Alexithymia by the Toronto Alexithymia Scale (TAS-20) and depression with the Beck Depression Inventory (BDI-13). For racetracks and slot machine gambling, pathological gamblers differed from non-pathological gamblers, regarding their alexithymia scores. These results remained stable after controlling for depression scores among the racetracks gamblers only. The relationship between alexithymia and depression depends on the type of pathological gambler. These findings are consistent with the idea of identifying clinically distinct subgroups of gamblers.     

The Experience of Gambling and its Role in Problem Gambling

This paper reports on the results of a psychological study conducted in Ontario, Canada, that attempted to answer the question of why some people develop gambling problems while others do not. A group of social gamblers (n = 38), sub-clinical problem gamblers (n = 33) and pathological gamblers (n = 34) completed a battery of questionnaires. Compared to non-problem gamblers, pathological gamblers were more likely to report experiencing big wins early in their gambling career, stressful life events, impulsivity, depression, using escape to cope with stress and a poorer understanding of random events. We grouped these variables into three risk factors: cognitive/experiential, emotional and impulsive and tested the extent to which each risk factor could differentiate non-problem and pathological gamblers. Each risk factor correctly identified about three-quarters of the pathological gamblers. More than half (53%) of the pathological gamblers had elevated scores on all three risk factors. Interestingly, 60% of the sub-clinical cases had elevated scores on only one risk factor. The results are interpreted in terms of a bio-psycho-social model of gambling addiction.     

Co-morbidity of gambling and Internet use among Internet and land-based gamblers: classic and network approaches

This study investigated co-morbidity of problem gambling and problematic Internet use (PIU) among adolescent Internet and land-based gamblers, with the classic approach using sum-scores of symptoms and a promising new method, namely the network perspective. This perspective allows testing for how multiple disorders are associated, showing symptoms overlap and centralities. We used cross-sectional data from two population-based samples of adolescents aged 17 years in France (n = 2,240) and Switzerland (n = 944). Measures included Internet gambling, problem gambling and PIU. The classic approach showed that Internet gambling was associated with increased levels of disordered gambling and PIU, but that correlations between disorders were weak (R² min = 3.2%, R² max = 17.6%). The network perspective showed that the co-morbid network of Internet gamblers was more connected in comparison with land-based gamblers. Problem gambling and PIU appeared as separate disorders, but their relationship was increased among Internet gamblers in comparison with land-based gamblers. The network perspective appeared as a promising avenue for a better understanding of addictive disorders, but it should not replace the classic approach, which showed increased levels of addictive behaviours among Internet gamblers.     

The Social and Psychological Impacts of Gambling in the Cree Communities of Northern Québec

A detailed survey of gambling, addiction and mental health was conducted with randomly selected respondents (n = 506) from four Cree communities of Northern Quebec. The study examined the current patterns of gambling in relation to demographic, social, and psychological factors. Instruments included the Canadian Problem Gambling Index, Addiction Severity Index, Beck Depression Inventory and the computerized Diagnostic Interview Schedule for psychiatric diagnoses. Overall, 69.2 % of the total sample participated in any gambling/gaming activities over the past year; 20.6 % of this group were classified as moderate/high risk gamblers, and 3.2 % were classified in the highest “problem gambling” category. Considering the entire sample, the overall prevalence of problem gambling was 2.2 %. Women were significantly more likely to play bingo (56.6 %) compared to men (35.1 %) and they played more frequently; 20.8 % of women versus 3.8 % of men played once/week or more often. Compared to the no/low risk gamblers, a greater proportion of moderate/high risk gamblers were cigarette smokers (44.8 vs. 56.3 %), they were more likely to meet DSM-IV diagnostic criteria for alcohol dependence (21.2 vs. 46.2 %), and they were more likely to report moderate to severe depressive symptoms in the past month. Risk factors for problem gambling included traumatic life events (physical and emotional abuse), anxiety and depression, as well as drug/alcohol abuse. The high rates of comorbidity between problem gambling, tobacco dependence, substance abuse and other psychological problems demonstrate that gambling among some Cree adults is part of a pattern of high-risk factors for negative long-term health consequences. The results also have implications for treatment, suggesting that interventions for gambling disorders should not focus on gambling alone but rather the constellation of high-risk behaviours that pose a risk to recovery and well-being.     

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.     

Are Psychology University Student Gamblers Representative of Non-university Students and General Gamblers? A Comparative Analysis

Students recruited from psychology undergraduate university populations are commonly used in psychology research, including gambling studies. However, the extent to which the use of this subpopulation produces findings that can be extrapolated to other groups is questionable. The present study was designed to compare results from university-recruited psychology student gamblers to those obtained from a sample of gamblers recruited from the general population that also included students. An online survey measuring gambling behavior and Internet gambling, attitudes and knowledge about gambling and problem gambling severity was posted on websites accessed by gamblers. Participants were recruited from two sources, a psychology undergraduate university population (n = 461) and online websites (n = 4,801). Results showed university-recruited students differed significantly from both adults and students recruited from the general population in respect to demographic variables and gambling behavior. Psychology undergraduate students were younger, more likely to be female, and had lower incomes. When relevant demographic variables were controlled, psychology undergraduate students were found to gamble less frequently, at different times, and to be at lower-risk for gambling-related problems, but had more irrational beliefs and more negative attitudes towards gambling than gamblers recruited from the general population. Results suggest that caution should be used in extrapolating findings from research using university-recruited psychology student gamblers to wide community populations due to differences related to gambling thoughts, attitudes and behaviors.     

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.     

A mixed method approach to developing a multidimensional scale for gambling fallacy in the Korean context

This article offers an understanding of and reduces gaps in the existing literature regarding cognitive distortion (e.g. gambling fallacy) and problem gambling behaviour. The primary objective of this study is to develop a valid gambling fallacy scale for the South Korean population using qualitative and quantitative methods to thoroughly understand the underlying structure of erroneous beliefs towards gambling among recreational and problem gamblers. The study interviewed eight casino supervisors and dealers and conducted online (n = 1419 gamblers) and onsite surveys (n = 400 gamblers) in South Korea. The proposed scale satisfies reliability and numerous types of validity that provide evidence on the three distinctive underlying structures of gambling fallacy (i.e. a system to win, superstitions, and follow and blame) among the Korean population. This study carries substantial theoretical and practical implications that further assure its usability as a platform for developing scales in various cultural settings.     

An Empirical Study of Personality Disorders Among Treatment-Seeking Problem Gamblers

The primary aims of this study were to examine the prevalence of personality disorders in problem gamblers, to explore the relationship between personality disorders and problem gambling severity, and to explore the degree to which the psychological symptoms highlighted in the biosocial developmental model of borderline personality disorder (impulsivity, distress tolerance, substance use, PTSD symptoms, psychological distress and work/social adjustment) are associated with problem gambling. A secondary aim was to explore the strength of the relationships between these symptoms and problem gambling severity in problem gamblers with and without personality disorder pathology. Participants were 168 consecutively admitted problem gamblers seeking treatment from a specialist outpatient gambling service in Australia. The prevalence of personality disorders using the self-report version of the Iowa Personality Disorders Screen was 43.3 %. Cluster B personality disorders, but not Cluster A or C personality disorders, were associated with problem gambling severity. All psychological symptoms, except alcohol and drug use, were significantly higher among participants with personality disorder pathology compared to those without. Finally, psychological distress, and work and social adjustment were significantly associated with problem gambling severity for problem gamblers with personality disorder pathology, while impulsivity, psychological distress, and work and social adjustment were significantly associated with problem gambling severity for those without personality disorder pathology. High rates of comorbid personality disorders, particularly Cluster B disorders, necessitate routine screening in gambling treatment services. More complex psychological profiles may complicate treatment for problem gamblers with comorbid personality disorders. Future research should examine the applicability of the biosocial developmental model to problem gambling in community studies.     

The Role of Metacognition in Pathological Gambling: A Mediation Model

Pathological gambling involves multitudinous costs related to financial, legal, and public health care aspects, as well as to specific psychological disorders. Despite the overall evidence suggesting that comorbid disorders represent a risk factor for pathological gambling, there is scant evidence on the appropriate treatments for gamblers with such disorders. In this context, metacognitive therapy is an interesting approach because it considers psychological disorders as a result of the activation of perseverative cognitive processes and attentional strategies in response to inner events. Several studies report that metacognition is associated with different psychological problems. This study investigated the relationship among comorbid disorders, metacognition, and pathological gambling. 69 pathological gamblers at the first hospital admission and 58 controls drawn from general population (matched for age, gender, education) completed a battery of self report instruments: Symptom Checklist-90-R, Metacognition Questionnaire 30, South Oaks Gambling Scale. Compared to controls, pathological gamblers showed higher level of comorbid symptomatology and metacognition. Correlation analyses showed that: comorbid symptomatology and metacognition were positively and significantly correlated with pathological gambling; metacognition was positively and significantly associated with comorbid symptomatology. Mediation analysis indicated that dysfunctional metacognitive strategies could have an indirect effect on pathological gambling mediated by concurrent psychological disorders. These findings provide some implications for gambling treatment programs: pathological gamblers should be screened for psychiatric disorders, and metacognitive therapy could be considered a correct treatment of pathological gamblers. Metacognitive therapy might lead to the reduction of the pathological gambling by the diminishing of the concurrent psychological disorders.     

Treatment issues pertaining to pathological gamblers with a comorbid disorder

Evidence of an increased risk for various psychiatric disorders among pathological gamblers far exceeds our understanding of the impact that this psychiatric comorbidity has on the outcome of treatment for pathological gambling. One major source of the problem is that treatment efficacy and effectiveness studies for pathological gambling typically have not addressed comorbidity's impact on outcome. This paper discusses epidemiological, clinical, health service delivery, and research issues pertaining to the intersection of pathological gambling treatment outcome and comorbid psychiatric disorders. It is argued that this topic suffers from major knowledge gaps in terms of the nature of comorbidity of pathological gambling and other psychiatric disorders and the role of client characteristics on treatment outcome for pathological gambling. Research priorities are identified.     

Adaptive and Maladaptive Coping Strategies in Adult Pathological Gamblers and Their Mediating Role with Anxious-Depressive Symptomatology

Coping plays a central role in the appearance and persistence of pathological gambling. Anxious and depressive symptomatology also influence pathological gambling and are related to coping. This study aimed to analyze pathological gamblers’ coping strategies and styles, as well as associated anxious and depressive symptomatology. The study sample included 167 male pathological gamblers (mean age = 39.29 years) and 107 non-gamblers (mean age = 33.43 years). Measures of gambling, coping, and anxious and depressive symptomatology were used. Results showed that pathological gamblers’ scored higher in all the maladaptive coping strategies, problem- and emotion-focused disengagement, and disengagement subscales. These subscales also correlated with pathological gambling, and anxious and depressive symptomatology. Pathological gamblers also scored higher in emotional expression and emotion-focused engagement, with no differences in the rest of the adaptive coping strategies. Coping was also found to predict pathological gambling and anxious and depressive symptomatology. It was found that coping mediated the relationship between pathological gambling and anxious symptomatology when controlling for the effect of age. Specifically, social withdrawal and disengagement stood out as mediators. These results provide practical information for use in clinical settings with people diagnosed with pathological gambling.     

Reward Preferences of Pathological Gamblers Under Conditions of Uncertainty: An Experimental Study

Among many personality traits, impulsivity represents one of the most important traits associated with pathological gambling. Empirical research has highlighted the multidimensional nature of impulsivity, which includes different heterogeneous traits and behavioral tendencies. The present study experimentally examined reward preferences of pathological gamblers under conditions of uncertainty using the Balloon Analogue Risk Task (BART). Furthermore it also examined the relationship between impulsivity, time perspective, inability to tolerate delay in gratification, and risk-taking. The present study is the first to simultaneously examine all these variables simultaneously in a sample of pathological gamblers (n = 54) and healthy controls (n = 54) from Italy. All participants participated in the BART and were also administered Italian versions of the South Oaks Gambling Screen, the Barratt Impulsiveness Scale, the Consideration of Future Consequences, and the Monetary Choice Questionnaire. Analyses revealed that compared to HCs, PGs were more risk prone on the BART, and reported elevated levels of impulsivity, steeper discounting rates and a shorter time perspective. All the measures correlated with the gambling severity and strong correlations between the BIS, CFC-14 and BART were observed. Logistic regression analysis demonstrated that impulsivity and risk-taking were strong predictors of pathological gambling.     

The Influence of Substance Dependence and Mood Disorders on Outcome from Pathological Gambling: Five-Year Follow-Up

A prospective study of the role of comorbid substance abuse and dependence and mood disorders in the outcome from pathological gambling. A naturalistic sample of pathological gamblers who had recently quit gambling (N = 101) was followed and data were available for 83% of participants at 3 months, 80% at 12 months, and 52% at 5 years. Those participants with a drug diagnosis during their lifetime were less likely to have a minimum 3 month period of abstinence, and those who had been involved in gambling treatment were more likely to have a minimum 12 months of continuous abstinence. Lifetime gambling problem severity and involvement in gambling treatment were most commonly associated with a shorter time to achieving a period of abstinence of any length. Lifetime history of a mood disorder also predicted a longer time to reach a minimum 3 months of continuous abstinence. Both gambling treatment and an alcohol diagnosis follow up predicted an increase in the odds of experiencing a relapse from a minimum 6 month period of abstinence. Overall, comorbid mental health disorders are predictive of shorter term but not longer term outcome.     

Subtyping Non-treatment-seeking Problem Gamblers Using the Pathways Model

This study examined whether distinct subgroups could be identified among a sample of non-treatment-seeking problem and pathological/disordered gamblers (PG) using Blaszczynski and Nower’s (Addiction 97:487–499, 2002) pathways model (N = 150, 50% female). We examined coping motives for gambling, childhood trauma, boredom proneness, risk-taking, impulsivity, attention-deficit/hyperactivity disorder (ADHD), and antisocial personality disorder as defining variables in a hierarchical cluster analysis to identify subgroups. Subgroup differences in gambling, psychiatric, and demographic variables were also assessed to establish concurrent validity. Consistent with the pathways model, our analyses identified three gambling subgroups: (1) behaviorally conditioned (BC), (2) emotionally vulnerable (EV), and (3) antisocial-impulsivist (AI) gamblers. BC gamblers (n = 47) reported the lowest levels of lifetime depression, anxiety, gambling severity, and interest in problem gambling treatment. EV gamblers (n = 53) reported the highest levels of childhood trauma, motivation to gamble to cope with negative emotions, gambling-related suicidal ideation, and family history of gambling problems. AI gamblers (n = 50) reported the highest levels of antisocial personality disorder and ADHD symptoms, as well as higher rates of impulsivity and risk-taking than EV gamblers. The findings provide evidence for the validity of the pathways model as a framework for conceptualizing PG subtypes in a non-treatment-seeking sample, and underscore the importance of tailoring treatment approaches to meet the respective clinical needs of these subtypes.     

The relationship between explicit and implicit learning processes and probable pathological gambling

This paper reports the findings of a study of explicit and implicit learning and gambling with non-problem (n = 107), sub-clinical problem gamblers (n = 13), and probable pathological gamblers (n = 46). Two probability learning tasks modeled after gambling games and an artificial grammar task were used to explore how people learn patterns. In each of the two probability learning tasks, the outcome of the game was biased during the first part (learning phase) of the task. The results showed that many of the participants in the experimental conditions learned the bias and gradually unlearned the bias during the extinction phase of the study. Probable pathological gamblers showed less retention of the bias during two probability tasks and repeated the same errors during the artificial grammar task suggesting that they emphasize explicit learning strategies rather than implicit learning strategies. The results are consistent with the idea that pathological gamblers are more likely to utilize explicit rules than implicit rules.     

The association between comorbidity and outcome in pathological gambling: a prospective follow-up of recent quitters

A naturalistic sample of pathological gamblers (N = 101) who recently quit gambling was followed prospectively for a year (follow-up rate 80%). Lifetime mood disorders were identified in 61% of participants and 73% and 48% had lifetime alcohol use and drug use disorders, respectively. Current prevalence rates, however, were much lower. Current mood disorders were found for 20% and 7% had a current alcohol disorder and 7% a current drug use disorder. Age of onset for substance use disorders was earlier than gambling disorders but mood disorders were equally likely to predate or follow gambling disorders. Lifetime mood disorder was associated with a longer time to achieve 3 months of stable abstinence. Participants who were currently in treatment or attending Gamblers Anonymous and the small number of participants with current alcohol disorders were also more likely to achieve abstinence earlier. The results underscore the importance of increasing our understanding of the role of comorbid disorders in the recovery process from gambling problems.     

Association of Problem Gambling with Type of Gambling Among Italian General Population

The origin of gambling disorders is uncertain; however, research has shown a tendency to focus on specific types of games as a potential important risk factor. The principal aim of this study is to examine the relationships between types of gambling practices and gambling disorder. The data were extracted from IPSAD-Italia^® 2010–2011 (Italian Population Survey on Alcohol and other Drugs), a survey among the Italian general population which collects socio-cultural information, information about the use of drugs, legal substances and gambling habits. In order to identify the “problem gambler” we used the Problem Gambling Severity Index. Three groups are considered in this analysis: no-risk gamblers, low-risk gamblers, moderate-risk/problem gamblers. Type of gambling practice was considered among two types of gambler: one-game players and multi-games players. 1.9 % of multi-game players were considered problem gamblers, only 0.6 % of one-game players were problem gamblers (p < 0.001). The percentage of players who were low and moderate-risk gamblers was approximately double among multi-game players, with 14.4 % low-risk and 5.8 % moderate-risk; compared with 7.7 % low-risk and 2.5 % moderate risk among one-game players. Results of ordinal logistic regression analysis confirmed that higher level of gambling severity was associated with multi-game players (OR = 2.23, p < 0.0001). Video-poker/slot-machines show the highest association with gambling severity among both one-game players and multi-game players, with scores of OR equal to 4.3 and 4.5 respectively. These findings suggest a popular perception of risk associated with this type of gambling for the development of gambling problems.     

A Communication Perspective on Video Lottery Terminals

Video Lottery Terminals (VLT) are associated with pathological gambling and with most of the requests for help in combating gambling addiction. Embeddedness of a person in his or her social network is among the communicational factors that may help explain this phenomenon. To verify this, we compared ego networks of VLT gamblers, of gamblers of games with low request for help and of VLT gamblers in treatment (n = 90). The networks of regular VLT gamblers are small and dense and offer little social support. Gamblers in treatment also have small networks, but they are less dense, have more components and offer more social support. Networks of gamblers with low requests for assistance are approximately twice the size as those of VLT gamblers, are sparser and offer more companionship. In conclusion, the VLT gambler is not an isolated individual, but rather an individual ‘shut-in’ a small network of tightly knitted relationships.     

Problem Gambling Among Urban and Rural Gamblers in Limpopo Province,South Africa: Associations with Hazardous and Harmful Alcohol Use and Psychological Distress

Little is known about the mental health correlates of problem gambling in low- and-middle-income countries such as South Africa and whether these correlates vary by urbanicity. To address this gap, we examined mental health factors associated with problem gambling among gamblers in Limpopo Province, South Africa disaggregated by rural, peri-urban and urban location. A survey of gambling behaviour and mental health was conducted among 900 gamblers. Overall, 28.3 % were at high risk and 38.1 % were at moderate risk for problem gambling. For the entire sample, hazardous/harmful alcohol use was associated with almost twofold increased chance of being at moderate risk (AOR 1.83; 95 % CI 1.08, 3.11) and almost sevenfold greater odds (AOR 6.93; 95 % CI 4.03–11.93) of being at high risk for problem gambling. Psychological distress was associated with being at high risk for problem gambling only (AOR 1.18; 95 % CI 1.14–1.22). After stratifying by urbanicity, hazardous/harmful alcohol use and psychological distress remained associated with high risk gambling across all locations. We found little knowledge of a free gambling helpline and other gambling services—particularly in less urbanised environments [χ² (2), 900 = 40.4; p < 0.001]. These findings highlight the need to increase awareness of free helpline services among gamblers and to ensure gambling services include screening and treatment for common mental disorders.