Gender-related differences in the characteristics of problem gamblers using a gambling helpline

Problem gambling and homelessness: results from an epidemiologic study

The purpose of this study was to investigate the prevalence of gambling disorder and comorbid psychiatric disorders in a homeless population and identify features related to potential subtypes. At baseline, participants were administered a structured interview including socio-demographic sections of the National Comorbidity Study (NCS) interview; seven diagnostic sections of the Diagnostic Interview Schedule (DIS); the alcohol and drug abuse sections of the Composite International Diagnostic Interview-Substance Abuse Module (CIDI-SAM); and the Homeless Supplement to the DIS. At nine months post-baseline assessment, participants were administered additional NCS family history questions and the South Oaks Gambling Screen (SOGS). Participants were an epidemiologic sample of 275 predominately African-American homeless individuals, grouped as lifetime non-gamblers (n = 60), recreational gamblers (n = 152), and problem gamblers (n = 63), recruited on the street and through homeless shelters. Results indicate that lifetime rates of sub-clinical problem (46.2%) and disordered (12.0%) gambling were significantly higher than in the general population. Problem gamblers were more likely than non-problem gamblers to meet diagnostic criteria for antisocial personality disorder, post-traumatic stress disorder, bipolar disorder, and any psychiatric disorder, and more likely than non-gamblers to use illicit drugs or meet criteria for abuse/dependence for nicotine, alcohol, or any substance. This study provides evidence that problem gambling is a significant public health issue among the African-American homeless population. Homeless services should include assessment for problem gambling along with psychiatric disorders and referrals to resources and treatment programs. Future studies should explore the relationship of the onset and course of problem gambling and other psychiatric disorders with homelessness as well as racial differences in gambling patterns and problem severity over time.

Does gender moderate the subjective measurement and structural paths in behavioural and cognitive aspects of gambling disorder in treatment-seeking adults?

INTRODUCTION

Gender differences have been observed in the pathogenesis of gambling disorder and gambling related urge and cognitions are predictive of relapse to problem gambling. A better understanding of these mechanisms concurrently may help in the development of more directed therapies.

METHODS

We evaluated gender effects on behavioural and cognitive paths to gambling disorder from self-report data. Participants (N=454) were treatment-seeking problem gamblers on first presentation to a gambling therapy service between January 2012 and December 2014. We firstly investigated if aspects of gambling related urge, cognitions (interpretive bias and gambling expectancies) and gambling severity were more central to men than women. Subsequently, a full structural equation model tested if gender moderated behavioural and cognitive paths to gambling severity.

RESULTS

Men (n=280, mean age=37.4years, SD=11.4) were significantly younger than women (n=174, mean age=48.7years, SD=12.9) (p<0.001). There was no gender difference in conceptualising latent constructs of problem gambling severity, gambling related urge, interpretive bias and gambling expectancies. The paths for urge to gambling severity and interpretive bias to gambling severity were stronger for men than women and statistically significant (p<0.001 and p=0.004, respectively) whilst insignificant for women (p=0.164 and p=0.149, respectively). Structural paths for gambling expectancies to gambling severity were insignificant for both men and women.

CONCLUSION

This study detected an important signal in terms of theoretical mechanisms to explaining gambling disorder and gender differences. It has implications for treatment development including relapse prevention.

The Dark Side of Authenticity: Feeling "Real" While Gambling Interacts with Enhancement Motives to Predict Problematic Gambling Behavior

Engaging in activities that make people feel authentic or real is typically associated with a host of positive psychological and physiological outcomes (i.e., being authentic serves to increase well-being). In the current study, we tested the idea that authenticity might have a dark side among people engaged in an addictive or risky behavior (gambling). To test this possibility, we assessed gamblers (N = 61) who were betting on the National Hockey League playoff games at a sports bar. As predicted, people who felt authentic when gambling reported behavior associated with problem gambling (high frequency of betting) as well as problematic play (a big monetary loss and a big monetary win). Moreover, such behavior and gambling outcomes were particularly high among people who were motivated to gamble for the purpose of enhancement. The interaction of feeling authentic when betting and gambling for purposes of enhancing positive emotions proved especially troublesome for problematic forms of play. Implications of authenticity as a potential vulnerability factor for sports betting and other types of gambling are discussed.

Psychological Characteristics of Problem Gamblers With and Without Mood Disorder

OBJECTIVE

Problem and pathological gamblers are significantly more likely to experience mood disorders, compared with the general population. Our study examined the relation of psychological characteristics (personality, trait impulsiveness, and gambling motives) to current co-occurring mood disorder (major depression and dysthymia) status among problem and pathological gamblers.

METHOD

Problem and pathological gamblers (N = 150) underwent a clinical interview to assess current co-occurring mood disorders; participants completed measures of problem gambling severity, personality, impulsiveness, and gambling motives.

RESULTS

Problem and pathological gamblers with a current co-occurring mood disorder were more likely to be female, older, and to report higher lifetime and past-year gambling severity. A co-occurring mood disorder was associated with higher personality scores for alienation and stress reaction, lower scores for well-being, social closeness, and control, as well as higher impulsiveness scores for urgency and lack of premeditation, and lower sensation seeking scores. Participants with a co-occurring mood disorder also reported higher coping motives for gambling. Multivariate logistic regression analyses demonstrated that personality factors (lower social closeness and higher alienation) contributed to the greatest likelihood of being diagnosed with a co-occurring mood disorder.

CONCLUSIONS

Mood disorders frequently co-occur with problem and pathological gambling, and they are associated with greater gambling severity. These findings highlight that interpersonal facets of personality contribute substantially to co-occurring mood disorder status. Implications for treatment will be discussed.

Gender differences in the associations of gambling activities and suicidal behaviors with problem gambling in a nationally representative French sample

INTRODUCTION

The objectives of the present study are to describe gender differences in factors associated with moderate risk and problem gambling.

METHOD

Data were extracted from the 2010 Health Barometer, a large survey on a representative sample of the general population aged 15-85 years living in France (n=27,653), carried out by the National Institute for Health Promotion and Health Education. Data were collected between October 2009 and July 2010. A computer-assisted telephone interview system was used.

RESULTS

The findings indicate that men are three times more likely to experience problems with gambling. Men and women have different patterns of gambling activities. Men were more involved with Rapido, internet gambling, sports and racetrack betting, poker, and casino tables, whereas women gambled more often on scratch games. Both men and women engaging in immediate reward games were significantly more likely to experience difficulties with gambling. This association, however, was stronger in women. Furthermore, suicidal ideation and behaviors were more likely to be associated with gambling problems in women as compared to men.

CONCLUSIONS

The study underscores the importance of considering gender-related differences in the study of gambling behaviors.

Gambling behaviors and attitudes in adolescent high-school students: Relationships with problem-gambling severity and smoking status

BACKGROUND AND AIMS

Smoking is associated with more severe/extensive gambling in adults. The purpose of this study was to examine relationships between smoking and gambling in adolescents.

METHODS

Analyses utilized survey data from 1591 Connecticut high-school students. Adolescents were classified by gambling (Low-Risk Gambling [LRG], At Risk/Problem Gambling [ARPG]) and smoking (current smoker, non-smoker). The main effects of smoking and the smoking-by-gambling interactions were examined for gambling behaviors (e.g., type, location), and gambling attitudes. Data were analyzed using chi-square and logistic regression; the latter controlled for gender, race/ethnicity, grade, and family structure.

RESULTS

For APRG adolescents, smoking was associated with greater online, school, and casino gambling; gambling due to anxiety and pressure; greater time spent gambling; early gambling onset; perceived parental approval of gambling; and decreased importance of measures to prevent teen gambling. For LRG adolescents, smoking was associated with non-strategic gambling (e.g., lottery gambling); school gambling; gambling in response to anxiety; gambling for financial reasons; greater time spent gambling; and decreased importance of measures to prevent teen gambling. Stronger relationships were found between smoking and casino gambling, gambling due to pressure, earlier onset of gambling, and parental perceptions of gambling for ARPG versus LRG adolescents.

DISCUSSION

Smoking is associated with more extensive gambling for both low- and high-risk adolescent gamblers.

CONCLUSION

Smoking may be a marker of more severe gambling behaviors in adolescents and important to consider in gambling prevention and intervention efforts with youth.

National Helpline for Problem Gambling: A Profile of Its Users' Characteristics

Gambling has seen a significant increase in Italy in the last 10 years and has rapidly become a public health issue, and for these reasons the first National Helpline for Problem Gambling (GR-Helpline) has been established. The aims of this study are to describe the GR-Helpline users' characteristics and to compare the prevalence rates of the users with those of moderate-risk/problematic gamblers obtained from the national survey (IPSAD 2010-2011). Statistical analysis was performed on data obtained from the counselling sessions (phone/e-mail/chat) carried out on 5,805 users (57.5% gamblers; 42.5% families/friends). This confirms that the problems related to gambling concern not only the gamblers but also their families and friends. Significant differences were found between gamblers and families/friends involving gender (74% of gamblers were male; 76.9% of families/friends were female), as well as age-classes and geographical area. Female gamblers had a higher mean age (47.3 versus 40.2 years) and preferred nonstrategy-based games. Prevalence rates of GR-Helpline users and of moderate risk/problematic gamblers were correlated (Rho = 0.58; p = 0.0113). The results highlight the fact that remote access to counselling can be an effective means of promoting treatment for problem gamblers who do not otherwise appeal directly for services.

Comparative analysis of distinct phenotypes in gambling disorder based on gambling preferences

BACKGROUND

Studies examining gambling preferences have identified the importance of the type of gambling practiced on distinct individual profiles. The objectives were to compare clinical, psychopathological and personality variables between two different groups of individuals with a gambling disorder (strategic and non-strategic gamblers) and to evaluate the statistical prediction capacity of these preferences with respect to the severity of the disorder.

METHOD

A total sample of 2010 treatment-seeking patients with a gambling disorder participated in this stand-alone study. All were recruited from a single Pathological Gambling Unit in Spain (1709 strategic and 301 non-strategic gamblers). The design of the study was cross-sectional and data were collected at the start of treatment. Data was analysed using logistic regression for binary outcomes and analysis of variance (ANOVA) for quantitative responses.

RESULTS

There were significant differences in several socio-demographic and clinical variables, as well as in personality traits (novelty seeking and cooperativeness). Multiple regression analysis showed harm avoidance and self-directedness were the main predictors of gambling severity and psychopathology, while age at assessment and age of onset of gambling behaviour were predictive of gambling severity. Strategic gambling (as opposed to non-strategic) was significantly associated with clinical outcomes, but the effect size of the relationships was small.

CONCLUSIONS

It is possible to identify distinct phenotypes depending on the preference of gambling. While these phenotypes differ in relation to the severity of the gambling disorder, psychopathology and personality traits, they can be useful from a clinical and therapeutic perspective in enabling risk factors to be identified and prevention programs targeting specific individual profiles to be developed.

Anger in pathological gambling: clinical, psychopathological, and personality correlates

The aim of this study was to explore the association between pathological gambling (PG) and anger by assessing whether psychopathology and personality are related to PG and to evaluate gender differences. The sample comprised 71 PGs and 37 healthy controls. Anger, psychopathology and personality were assessed with the STAXI-2, SCL-90-R and TCI-R respectively. Gender did not affect anger expression after stratifying by diagnostic condition (p > .05). Among PG patients, anger, psychopathology and personality measures were correlated with good effect-size (r > .30). Scores in the Anger Temperament (B = 0.21, p = .038) and Anger External-Expression (B = 0.27, p = .029) scales were positively associated with PG severity scores. Anger expression in PG should be considered in future treatment programs.

Lifetime of Prevalence and Risk Factors of Problem and Pathologic Gambling in North Cyprus

In this article, the results of the national survey of adult gambling behavior in North Cyprus (NC) in 2012 are presented. The aim of this study is to investigate the characteristics of adults' participation in gambling, and to determine the prevalence of 'problem and pathological gambling' in NC. The population of this study was formed from all the people living permanently in NC, speaking Turkish, and within the age group 18-65. Household interviews were conducted with 966 people. To obtain data, a 30 item questionnaire prepared by the researchers and a Turkish version of the Revised South Oaks Gambling Screen were used. Prevalence rates are compared with the results of the study conducted in 2007 using the same methodology and survey form. The lifetime prevalence of participating at least once in any of the 17 gambling activities investigated in the survey was 66.4 %. 3.5 % of the respondents scored as lifetime probable pathological gamblers and 9.2 % as probable problem gamblers. Risk factors for becoming probable problem and pathological gamblers include being male, being in the 19-28 age group, having a high education level, having a job and being born in Cyprus. This study shows that the prevalence of problem gambling is high in NC and increasing gradually. NC has socio-cultural features such as a history of colonization, socioeconomic problems and high unemployment, similar to other high prevalence gambling regions, which is suggestive of the importance of socio-cultural factors on gambling behavior.

Age of pathological gambling onset: clinical and treatment-related features

OBJECTIVES

This study examined differences in the clinical and treatment-related features of pathological gambling (PG) on the basis of the age of PG onset among pathological gamblers who sought treatment.

METHODS

A total of 702 male outpatients with a primary diagnosis of PG and who were treated in a clinical practice were assessed by retrospective chart review. We selected the age of 25 years and younger as the threshold for "group 1." We then stratified the participants into 4 groups on the basis of the age of PG onset in 10-year intervals. Analysis of covariance with a covariant of age and the Pearson χ test were used for analyses.

RESULTS

We found that the earlier-onset gamblers were less likely to be escape type (P < 0.05), used significantly more Internet-based gambling (P < 0.001), and were less likely to engage in nonstrategic gambling (P < 0.05) than the later-onset gamblers. In addition, the earlier-onset gamblers took anticraving medication, such as naltrexone, significantly more often (P < 0.05), and sought treatment significantly more slowly after the onset of PG than the later-onset group (P < 0.01). Regarding adherence to treatment, however, there was no significant difference among the 4 groups on the basis of the age of PG onset.

CONCLUSIONS

The age of PG onset is associated with several important clinical and treatment features. More studies are needed to advance prevention and treatment strategies for each age group.

Social strain, couple dynamics and gender differences in gambling problems: evidence from Chinese married couples

Knowledge of the influence of couple dynamics on gender differences in gambling behavior remains meager. Building on general strain theory from the sociology of deviance and stress crossover theory from social psychology, we argue that the strain encountered by one partner in a social setting may affect his or her spouse. For instance, the wife of a man under more social strain may experience more strain in turn and thus be at a higher risk of developing disordered gambling than the wife of a man under less social strain. Using community survey data of 1620 Chinese married couples, we performed multilevel dyad analyses to address social strain and couple dynamics, in addition to their roles as predictors of gambling behavior in both spouses. This was a community survey of Hong Kong and therefore was not representative of China. Based on the DSM-IV screen, the rates of probable problem gambling and pathological gambling among male partners (12.8% vs. 2.5%) were twice those among female partners (5.2% vs. 0.3%). We also found that the social strain experienced by a male partner significantly predicted both his and his wife's likelihood of developing gambling problems. Although a female partner's exposure to social strain was a significant correlate of her gambling problem, it had no significant association with her husband's gambling behavior. These results suggest that the cross-spouse transference of social strain may be a gendered process.

Telescoping and gender differences in the time course of disordered gambling: evidence from a general population sample

BACKGROUND AND AIM

The course of disordered gambling in women has been described as 'telescoped' compared with that in men, with a later age at initiation of gambling but shorter times from initiation to disorder. This study examined the evidence, for the first time, for such a telescoping effect in a general population rather than a treatment-seeking sample.

METHOD

Participants in a large community-based Australian twin cohort (2001 men, 2662 women) were assessed by structured diagnostic telephone interviews in which they reported the ages at which they had attained various gambling milestones and additional information to be used as covariates (the types of gambling in which they had participated and history of symptoms of alcohol dependence, major depression, and adult antisocial behavior). Cox proportional hazards regression models were used to examine differences between men and women in the time from gambling initiation to the first disordered gambling symptom and a diagnosis of disordered gambling.

RESULTS

Men had a higher hazards than women for the time to the first disordered gambling symptom [hazard ratio (HR) = 3.13, P < 0.0001] and to a diagnosis of disordered gambling (HR = 2.53, P < 0.0001). These differences persisted after controlling for covariates. Earlier age of initiation was the most potent predictor of progression to the first symptom.

CONCLUSIONS

When assessed at the general population level, female gamblers do not appear to show a telescoped disordered gambling trajectory compared with male gamblers.

Male and female pathological gamblers: bet in a different way and show different mental disorders

Although in the last years several studies comparing male and female pathological gamblers have been published, most of them have been carried out using only samples of males. The aim of this study was to investigate gender differences in a sample of subjects diagnosed with pathological gambling (PG) attending three specialized outpatient units. Retrospective study was carried out of 96 patients (49% female and 51% male), comparing the main socio-demographic, clinical, and behavioral data. Most subjects (94%) met the criteria for pathological gambling. No significant differences between sexes were found in the severity of gambling behavior or the socio-demographic variables studied. Whereas slot machines were the main type of game for most subjects, a higher percentage of women were addicted to bingo (χ2 (1, 4) = 5.19, p = .029 Cohen's d = 0.48) and had more than one type of game as a secondary addiction χ2 (1, 4) = 7.63, p = .006; Cohen's d = 0.59) . Women started gambling at a later age than men (t (94) = 2.95, p = .004; Cohen's d = 0.60), but developed a pattern of addiction faster ( t (94) = 2.95, p = .004; Cohen's d = -0.61) . Women also had higher comorbidity with other psychiatric disorders (χ2 (1) = 7.28, p = .007; Cohen's d = 0.57), specifically with affective (χ2 (1) = 11.31, p = .001; Cohen's d = 0.73) and personality disorders (χ2 (1) = 4.71, p = .030; Cohen's d = 0.45). Our results indicate the existence of differences between women and men in the pattern of gambling behavior and in psychiatric comorbidity. These aspects should be considered in the design of treatment programs for pathological gamblers.

Jeu problématique en France : une première enquête nationale

Avant l’enquête nationale sur les jeux de hasard et d’argent (JHA) de 2010, la France ne disposait pas de mesure de la prévalence du jeu et du jeu problématique dans la population. Objectif : Cette étude présente un premier portrait des JHA en France, décrivant le profil sociodémographique des joueurs courants, les pratiques de jeu des joueurs dits assidus, c’est-à-dire de joueurs qui jouent fréquemment et qui dépensent beaucoup, ainsi que les associations entre les problèmes de jeu et l’usage de substances psychoactives. Méthodologie : Un module sur les pratiques de JHA fut introduit dans l’enquête nationale Baromètre santé. Lors d’une entrevue téléphonique, les participants répondaient à des questions au sujet de la fréquence à laquelle ils jouent et au sujet de la quantité d’argent qu’ils dépensent au jeu. On a mesuré la gravité des problèmes de jeu en utilisant l’indice canadien de jeu excessif (ICJE) et des mesures sur la consommation de substances psychoactives. Participants : L’enquête générale a été menée en 2010 auprès d’un échantillon représentatif de 25 034 répondants âgés de 18 à 75 ans. Résultats : Les résultats révèlent que près de 12 % de la population générale est constituée de joueurs assidus qui ont joué 52 fois ou plus ou qui ont misé 500 euros ou plus au cours des 12 derniers mois. La proportion de joueurs excessifs parmi les joueurs assidus est estimée à 3,7 % et celle des joueurs à risque modéré à 7,1 %. Ces joueurs problématiques sont plus souvent des hommes issus de milieux socioéconomiques modestes. L’enquête met en évidence une relation significative entre les pratiques de jeu les plus à risque et la consommation problématique d’alcool, de tabac ou de cannabis. Conclusion : L’inclusion d’un ensemble élargi de conduites de jeux de hasard et d’argent à d’autres pratiques de santé assurera une meilleure compréhension des facteurs de risques et de vulnérabilité au jeu problématique.

Sex differences in addictive disorders

Gender-dependent differences in the rate of initiation and frequency of misuse of addicting drugs have been widely described. Yet, men and women also differ in their propensity to become addicted to other rewarding stimuli (e.g., sex, food) or activities (e.g., gambling, exercising). The goal of the present review is to summarize current evidence for gender differences not only in drug addiction, but also in other forms of addictive behaviours. Thus, we first reviewed studies showing gender-dependent differences in drug addiction, food addiction, compulsive sexual activity, pathological gambling, Internet addiction and physical exercise addiction. Potential risk factors and underlying brain mechanisms are also examined, with particular emphasis given to the role of sex hormones in modulating addictive behaviours. Investigations on factors allowing the pursuit of non-drug rewards to become pathological in men and women are crucial for designing gender-appropriate treatments of both substance and non-substance addictions.

Strategic and non-strategic problem gamblers differ on decision-making under risk and ambiguity

AIMS

To analyse problem gamblers' decision-making under conditions of risk and ambiguity, investigate underlying psychological factors associated with their choice behaviour and examine whether decision-making differed in strategic (e.g., sports betting) and non-strategic (e.g., electronic gaming machine) problem gamblers.

DESIGN

Cross-sectional study.

SETTING

Out-patient treatment centres and university testing facilities in Victoria, Australia.

PARTICIPANTS

Thirty-nine problem gamblers and 41 age, gender and estimated IQ-matched controls.

MEASUREMENTS

Decision-making tasks included the Iowa Gambling Task (IGT) and a loss aversion task. The Prospect Valence Learning (PVL) model was used to provide an explanation of cognitive, motivational and response style factors involved in IGT performance.

FINDINGS

Overall, problem gamblers performed more poorly than controls on both the IGT (P = 0.04) and the loss aversion task (P = 0.01), and their IGT decisions were associated with heightened attention to gains (P = 0.003) and less consistency (P = 0.002). Strategic problem gamblers did not differ from matched controls on either decision-making task, but non-strategic problem gamblers performed worse on both the IGT (P = 0.006) and the loss aversion task (P = 0.02). Furthermore, we found differences in the PVL model parameters underlying strategic and non-strategic problem gamblers' choices on the IGT.

CONCLUSIONS

Problem gamblers demonstrated poor decision-making under conditions of risk and ambiguity. Strategic (e.g. sports betting, poker) and non-strategic (e.g. electronic gaming machines) problem gamblers differed in decision-making and the underlying psychological processes associated with their decisions.

Obsessive-compulsive aspects and pathological gambling in an Italian sample

INTRODUCTION

Gambling behaviour appears as repetitive and difficult to resist and seems to be aimed at neutralizing or reducing negative feelings such as anxiety and tension, confirming its similarities with the obsessive-compulsive spectrum. Aims. Estimating the prevalence of gambling behaviour in an Italian sample and assessing the effects of sociodemographic variables and the correlations between gambling behaviour and obsessive-compulsive features.

METHODS

A sample of 300 Italian subjects was evaluated based on gambling behaviours and obsessive-compulsive attitudes. The assessment was carried out in small centers in Italy, mainly in coffee and tobacco shops, where slot machines are located, using the South Oaks Gambling Screen (SOGS) and the MOCQ-R, a reduced form of Maudsley Obsessional-Compulsive Questionnaire.

RESULTS

A negative correlation between SOGS and MOPQ-R, with reference to the control and cleaning subscales, was evidenced in the majority of the examined subjects. Both evaluating instruments showed reliability and a good discriminative capacity.

CONCLUSIONS

Our study evidenced that the sample of gamblers we analysed did not belong to the obsessive-compulsive disorders area, supporting the validity of the model proposed by DSM-5 for the classification of PG. These data confirm the importance of investing in treatments similar to those used for substance use disorders.

Treatment of Gambling Disorders

Preclinical and clinical research implicate several neurotransmitter systems in the pathophysiology of gambling disorder (GD). In particular, neurobiological research suggests alterations in serotonergic, dopaminergic, glutamatergic and opioidergic functioning. The relative efficacy of medications targeting these systems remains a topic of ongoing research, and there is currently no Food and Drug Administration (FDA) approved medication with an indication for GD. Considering co-occurring disorders may be particularly important when devising a treatment plan for GD: extant data suggest that the opioid antagonist naltrexone may by the most effective form of current pharmacotherapy for GD, particularly for individuals with a co-occurring substance-use disorder (SUD) or with a family history of alcoholism. In contrast, lithium or other mood stabilizers may be most effective for GD for patients presenting with a co-occurring bipolar-spectrum disorder (BSD). Further, serotonin reuptake inhibitors (SRIs) may be efficacious in reducing GD symptoms for individuals also presenting with a (non-BSD) mood or anxiety disorder. Finally, elevated rates of GD (and other Impulse Control Disorders; ICDs) have been noted among individuals with Parkinson's Disease (PD), and clinicians should assess for vulnerability to GD when considering treatment options for PD. Reducing levodopa or dopamine agonist (DA) dosages may partially reduce GD symptoms among patients with co-occurring PD. For GD patients not willing to consider drug treatment, n-acetyl cysteine or behavioral therapies may be effective. Ongoing research into the effectiveness of combined behavioral and pharmacotherapies is being conducted; thus combined treatments should also be considered.

Prevalence of suicide attempts in pathological gamblers in a nationwide Austrian treatment sample

BACKGROUND

For pathological gambling (PG), a 12-month prevalence rate of up to 0.66% has been reported. Multiple financial, occupational and relationship problems and losses, humiliation of the person and the environment are possible side effects and may lead to hopelessness, suicidal ideation and suicidal behavior. Suicide attempt rates among pathological gamblers of between 4% and 40% and suicidal ideation of between 12% and 92% have been reported.

AIM

This study aims at assessing the prevalence of suicide attempts in PG and at elucidating differences between the patients with and without suicide attempt history (SAH) in a large nationwide Austrian sample.

METHODS

Between 2002 and 2011, the Austrian Society for the Research of Non-Substance Related Addiction collected 862 questionnaires of pathological gamblers undergoing outpatient and inpatient treatment for PG in Austria.

RESULTS

(a) Of all pathological gamblers, 9.7% had an SAH. (b) The SAH group suffered significantly more from a comorbid disorder and was more often in previous inpatient treatments. (c) The SAH patients had a longer time of an abstinence period in their PG career.

DISCUSSION

One in 10 pathological gamblers has an SAH, demonstrating the relevance of suicidality in this population. Significant differences for several parameters were found for PG with and without SAH. However, a regression analysis only explained 15% of the variance. This suggests that suicidality must be considered in pathological gamblers in general.

An empirical study of gender differences in online gambling

Gambling has typically been considered a predominately male activity. However, recent prevalence surveys have shown greater numbers of females are now gambling. Much of the gambling literature suggests online gamblers are more likely to be male, and that problem gamblers are more likely to be male. Males and females are also likely to be gambling for different reasons and have a preference for different gambling activities. Little is known about the pattern of play among female online gamblers. The aim of this survey was to develop a better profile of female online gamblers and to examine any gender differences between males and females in terms of how and why they gamble online, their frequency of online gambling, patterns of play, as well as attitudes to online gambling. The survey was posted on 32 international online gambling websites and was completed by 975 online gamblers (including 175 female online gamblers). Chi-square tests of association were conducted to examine the association between gender and a range of variables. The results showed that females had been gambling online for a shorter duration of time than males, had much shorter online gambling sessions, different motivations for gambling online (i.e., to practice for free, to spend less money and out of boredom), and experienced online gambling differently to males, with increased feelings of guilt and shame for gambling online. This suggests there is still a stigma around gambling particularly evident among females in this study. The findings indicate that clinicians and treatment providers need to be aware of these potential gender differences in online gambling to develop appropriately tailored interventions.

Personality factors associated with problem gambling behavior in university students

This study investigated sex differences and personality factors associated with gambling behavior in a non-clinical sample of young men and women. The participants were 212 university students (62 men and 150 women) and their mean age was 18.7 years. The South Oaks Gambling Screen (SOGS) was used to assess problem gambling behavior and the NEO Five-Factor Inventory Form S (College Age) was used to assess personality traits. The results indicated that men were more likely to endorse indicators of gambling problems than were women, with sex differences in different endorsed gambling activities. Of the five personality factors investigated, low Openness to experience and low Agreeableness were most strongly associated with higher scores on the SOGS, indicative of potentially problematic gambling behavior. Further analysis illustrated that for men in particular, low Openness to experience was a key personality factor in relation to higher SOGS scores.

Gender differences in the relationship between gambling problems and the incidence of substance-use disorders in a nationally representative population sample

BACKGROUND

Cross-sectional studies have demonstrated gender-related differences in the associations between problem-gambling severity and substance-use disorders; however, these associations have not been examined longitudinally. We aimed to examine the prospective associations between problem-gambling severity and incident substance-use disorders in women versus men.

METHODS

Analyses were conducted using Wave-1 and Wave-2 NESARC data focusing on psychiatric diagnoses from 34,006 non-institutionalized US adults. Inclusionary criteria for pathological gambling were used to categorize Wave-1 participants as at-risk/problem gambling (ARPG) and non-ARPG (i.e. non-gambling/low-frequency gambling/low-risk gambling). Dependent variables included the three-year incidence of any substance-use disorder, alcohol-use disorders, nicotine dependence, drug-use disorders, prescription drug-use disorders, and illicit drug-use disorders.

RESULTS

Significant gender-by-ARPG status interactions were observed with respect to the three-year incidence of nicotine dependence and prescription drug-use disorders, and approached significance with respect to incident alcohol-use disorders. ARPG (relative to non-ARPG) was positively associated with nicotine dependence among women (OR=2.00; 95% CI=1.24-3.00). ARPG was negatively associated with incident prescription drug-use disorders among men (OR=0.30; 95% CI=0.10-0.88)). Finally, ARPG was positively associated with incident alcohol-use disorders among men (OR=2.20; 95% CI=1.39-3.48).

CONCLUSIONS

Gambling problems were associated with an increased 3-year incidence of nicotine dependence in women and alcohol dependence in men. These findings highlight the importance of considering gender in prevention and treatment initiatives for adults who are experiencing gambling problems. Moreover, the specific factors underlying the differential progressions of specific substance-use disorders in women and men with ARPG warrant identification.

Games and gambling involvement among casino patrons

A growing literature is addressing the nature of the relationships among gambling activity, gambling involvement, and gambling-related problems. This research suggests that among the general population, compared to playing any specific game, gambling involvement is a better predictor of gambling-related problems. To date, researchers have not examined these relationships among casino patrons, a population that differs from the general population in a variety of important ways. A survey of 1160 casino patrons at two Las Vegas resort casinos allowed us to determine relationships between the games that patrons played during the 12 months before their casino visit, the games that patrons played during their casino visit, and patrons' self-perceived history of gambling-related problems. Results indicate that playing specific gambling games onsite predicted (i.e., statistically significant odds ratios ranging from .5 to 4.51) self-perceived gambling-related problems. However, after controlling for involvement, operationally defined as the number of games played during the current casino visit and self-reported gambling frequency during the past 12 months, the relationships between games and gambling-related problems disappeared or were attenuated (i.e., odds ratios no longer statistically significant). These results extend the burgeoning literature related to gambling involvement and its relationship to gambling-related problems.

Neurobiology of gambling behaviors

For many, gambling is a recreational activity that is performed periodically without ill effects, but for some, gambling may interfere with life functioning. A diagnostic entity, pathological gambling (PG), is currently used to define a condition marked by excessive and problematic gambling. In this review, the current status of understanding of the neurobiologies of gambling and PG is described. Multiple neurotransmitter systems (norepinephrine, serotonin, dopamine, opioid and glutamate) and brain regions (ventral striatum, ventromedial prefrontal cortex, insula, among others) have been implicated in gambling and PG. Considerations for future directions in gambling research, with a view towards translating neurobiological advances into more effective prevention and treatment strategies, are discussed.

Pathological gamblers are more vulnerable to the illusion of control in a standard associative learning task

An illusion of control is said to occur when a person believes that he or she controls an outcome that is uncontrollable. Pathological gambling has often been related to an illusion of control, but the assessment of the illusion has generally used introspective methods in domain-specific (i.e., gambling) situations. The illusion of control of pathological gamblers, however, could be a more general problem, affecting other aspects of their daily life. Thus, we tested them using a standard associative learning task which is known to produce illusions of control in most people under certain conditions. The results showed that the illusion was significantly stronger in pathological gamblers than in a control undiagnosed sample. This suggests (1) that the experimental tasks used in basic associative learning research could be used to detect illusions of control in gamblers in a more indirect way, as compared to introspective and domain-specific questionnaires; and (2), that in addition to gambling-specific problems, pathological gamblers may have a higher-than-normal illusion of control in their daily life.

An analysis of problem gambling among the Finnish working-age population: a population survey

Background

Gambling problems currently affect approximately 100 000 Finns. In order to prevent and reduce gambling-related harms it is crucial for the Finnish public health authorities to gain a stronger understanding of the association between gambling problems and related socio-demographic factors, other commonly co-occurring dependencies (e.g. alcohol and nicotine) and the type of games gambled. In this article the prevalence of problem gambling in Finland and the socio-demographic profiles of problem gamblers are studied.

Method

An annual postal survey entitled Health Behaviour and Health among the Finnish Adult Population AVTK was sent to a random sample of Finnish adults (N=5000) aged between 15 and 64. The sample was derived from the Finnish Population Register. The survey was mailed to the participants in April 2010. Gender differences in socio-demographic variables and Problem Gambling Severity Index PGSI were assessed. A multinomial regression model was created in order to explore the association between socio-demographic factors and the severity of gambling.

Results

A total of 2826 individuals (1243 males and 1583 females) replied to the survey. Of the respondents, 1.1% (2.1% of males, 0.3% of females) were identified as problem gamblers. Those who were of younger age, gender, had less than twelve years of education, consumed alcohol at risk level and smoked had higher odds of having low or moderate levels of gambling problems. Whereas, unemployment and smoking predicted significantly for problem gambling. Females gambled Lotto and slot machines less frequently than males and had more low level gambling problems. Males gambled more with a higher frequency and had a more severe level of gambling problems. Females were more attracted to scratch card gambling and daily Keno lotteries compared to males. In comparison, males gambled more on internet poker sites than females. Overall, a high frequency of gambling in Lotto, daily lotteries, slot machines, horse race betting and internet gambling was significantly associated with a more severe level of problem gambling.

Conclusion

Gambling problems affect tens of thousands of individuals annually, therefore certain vulnerabilities should be noted. Comorbid dependencies, smoking in particular, ought to be screened for and recognised in the public health sector. Regulating the availability of slot machine gambling and enforcement of the age limit should be acknowledged. In establishing new gambling venues, prevalence rates in those particular areas should be actively monitored.

A targeted review of the neurobiology and genetics of behavioural addictions: an emerging area of research

This review summarizes neurobiological and genetic findings in behavioural addictions, draws parallels with findings pertaining to substance use disorders, and offers suggestions for future research. Articles concerning brain function, neurotransmitter activity, and family history and (or) genetic findings for behavioural addictions involving gambling, Internet use, video game playing, shopping, kleptomania, and sexual activity were reviewed. Behavioural addictions involve dysfunction in several brain regions, particularly the frontal cortex and striatum. Findings from imaging studies incorporating cognitive tasks have arguably been more consistent than cue-induction studies. Early results suggest white and grey matter differences. Neurochemical findings suggest roles for dopaminergic and serotonergic systems, but results from clinical trials seem more equivocal. While limited, family history and genetic data support heritability for pathological gambling and that people with behavioural addictions are more likely to have a close family member with some form of psychopathology. Parallels exist between neurobiological and genetic and family history findings in substance and nonsubstance addictions, suggesting that compulsive engagement in these behaviours may constitute addictions. To date, findings are limited, particularly for shopping, kleptomania, and sexual behaviour. Genetic understandings are at an early stage. Future research directions are offered.

An examination of participation in online gambling activities and the relationship with problem gambling

Background and aims Online gambling participation is increasing rapidly, with relatively little research about the possible effects of different gambling activities on problem gambling behaviour. The aim of this exploratory study was to examine the participation in online gambling activities and the relationship with problem gambling among an international sample of online gamblers. Methods An online gambling survey was posted on 32 international gambling websites and resulted in 1,119 respondents over a four-month period. Results Poker was the most popular gambling activity online. A number of online activities were associated with problem gambling, including: roulette, poker, horse race betting, sports betting, spread betting and fruit (slot) machines. Not surprisingly, those that gambled on these activities regularly (except poker) were more likely to be a problem gambler, however, what is interesting is that the reverse is true for poker players; those that gambled regularly on poker were less likely to be a problem gambler compared to the non-regular poker players. The majority of the players also gambled offline, but there was no relationship between problem gambling and whether or not a person also gambled offline. Discussion Problem gambling is associated more with certain online gambling activities than others, and those gambling on two or more activities online were more likely to be a problem gambler. Conclusion This paper can help explain the impact different online gambling activities may have on gambling behaviour. Consideration needs to be given to the gambling activity when developing and implementing treatment programmes.

Biological contributions to addictions in adolescents and adults: prevention, treatment, and policy implications

PURPOSE

Despite significant advances in our understanding of the biological bases of addictions, these disorders continue to represent a huge public health burden that is associated with substantial personal suffering. Efforts to target addictions require consideration of how the improved biological understanding of addictions may lead to improved prevention, treatment, and policy initiatives.

METHOD

In this article, we provide a narrative review of current biological models for addictions with a goal of placing existing data and theories within a translational and developmental framework targeting the advancement of prevention, treatment, and policy strategies.

RESULTS

Data regarding individual differences, intermediary phenotypes, and main and interactive influences of genetic and environmental contributions in the setting of developmental trajectories that may be influenced by addictive drugs or behavior indicate complex underpinnings of addictions.

CONCLUSIONS

Consideration and further elucidation of the biological etiologies of addictions hold significant potential for making important gains and reducing the public health impact of addictions.

Illicit drug use and problem gambling

Problem gambling, substance use disorders, and their cooccurrence are serious public health concerns. We conducted a comprehensive review of the literature to understand the present state of the evidence on these coaddictions. Our main focus was illicit drug use rather than misuse of legal substances. The review covers issues related to gambling as a hidden problem in the illicit drug use community; prevalence, problem gambling, and substance use disorders as kindred afflictions; problem gambling as an addiction similar to illicit drug use; risk factors and problems associated with comorbidity, and gender issues. We end with some suggestions for future research.

Characteristics of Treatment Seeking Finnish Pathological Gamblers: Baseline Data from a Treatment Study

This article describes the socio-demographic characteristics and gambling behavior of 39 pathological gamblers who participated in our treatment study in 2009. The inclusion criteria of the study were: score of five or more on both the South Oaks Gambling Screen (SOGS) and a pathological gambling screen based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). The first 39 patients meeting the inclusion criterion were recruited into the study. The average age of the subjects was 39 years, and 80 % were males. The lag-time between active gambling (at least three times per week) and the onset of a pathological gambling problem was short: within 2 years of active gambling, 62 % of the subjects reported having become pathological gamblers. Our results also indicated certain gender-specific differences in the age at initiation and in the severity of the gambling problem.

Telescoping phenomenon in pathological gambling: association with gender and comorbidities

The course of pathological gambling (PG) in women has been described as having a later age of initiation but a shorter time to problematic gambling ("telescoped"). This study examined evidence for telescoping and its relationship with comorbidities. Seventy-one treatment-seeking individuals with PG underwent a diagnostic interview to examine gambling behaviors, age at initiation of gambling, and time from initiation to meeting criteria for PG. The women had a higher mean age at gambling initiation compared with that of the men (mean [SD] age, 31.3 [13.0] years, compared with 22.4 [7.9] years; p = 0.0003) and a significantly shorter time from initiation of gambling to meeting the criteria for PG (8.33 [8.7] years compared with 11.97 [9.1] years; p = 0.0476) after controlling for demographic and clinical variables. This study presents evidence for a gender-specific course of PG unrelated to psychiatric comorbidities and suggests a need for greater clinical focus on the gender differences of gambling behavior.

Beyond description: Understanding gender differences in problem gambling

Background and aims Though women make up roughly one third of all problem gamblers, research has typically focused on male problem gamblers. Recent research has started to shift its attention toward the importance of gender. However, studies rarely attempt to understand gender differences in problem gambling or subject these differences to thorough multivariate analyses. To address some of the gaps in our knowledge of gender differences, we examine whether patterns of gambling behavior and psychological factors mediate the relationship between gender and problem gambling. Methods We use logistic multiple regression to analyze two large Canadian datasets - the 2005 Ontario Prevalence Survey and the 2007 Canadian Community Health Survey. Results Variables found to mediate the relationship between gender and problem gambling are the type(s) of game(s) played (in the 2005 Ontario Prevalence Survey) and the number of games played (in the 2007 Canadian Community Health Survey). Conclusions Men are more likely to be problem gamblers than women, and this gender difference is understandable in terms of differences in patterns of gambling behavior. We conclude that men experience problems because they play riskier games and women experience problems because they prefer chance-based games, which are associated with significantly higher odds of problem gambling. We specify the three main ways that women's reasons for gambling - to escape or for empowerment - translate into chance-based games.

Gender-related clinical and neurocognitive differences in individuals seeking treatment for pathological gambling

OBJECTIVES

Understanding variations in disease presentation in men and women is clinically important as differences may reflect biological and sociocultural factors and have implications for selecting appropriate prevention and treatment strategies. The aim of this study was to investigate clinical and cognitive differences in treatment-seeking people with pathological gambling as a function of gender.

MATERIALS AND METHODS

501 adult subjects (n = 274 [54.7%] females) with DSM-IV pathological gambling presenting for various clinical research trials over a 9-year period were assessed in terms of sociodemographics and clinical characteristics. A subset (n = 77) had also undertaken neuropsychological assessment with the Stop-signal and set-shift tasks.

RESULTS

PG in females was associated with significantly worse disease severity, elevated mood and anxiety scores, and history of affective disorders, later age of study presentation, later age of disease onset, and elevated risk of having a first-degree relative with gambling or alcohol problems. These findings were of small effect size (0.20-0.35). Additionally, PG in females was associated with proportionately more non-strategic gambling with medium effect size (0.61). In contrast, PG in males was associated with a significantly greater lifetime history of an alcohol use disorder and any substance use disorder (small effect sizes 0.22-0.38); and slower motoric reaction times (medium effect size, 0.50). Response inhibition and cognitive flexibility were similar between the groups.

CONCLUSIONS

These data suggest that important differences exist in the features of pathological gambling in women and men. Findings are of considerable relevance to clinicians and in terms of targeted treatments.