Prevalence of psychiatric co-morbidity in treatment-seeking problem gamblers: A systematic review and meta-analysis

Gambling in COVID-19 Lockdown in the UK: Depression, Stress, and Anxiety

To combat the spread of COVID-19, the UK Government implemented a range of "lockdown" measures. Lockdown has necessarily changed the gambling habits of gamblers in the UK, and the impact of these measures on the mental health of gamblers is unknown. To understand the impact of lockdown on gamblers, in April 2020, after ~6 weeks of lockdown, participants (N = 1,028, 72% female) completed an online questionnaire. Gambling engagement data was collected for pre-lockdown via the Brief Problem Gambling Screen (BPGS) allowing participants to be classified as Non-Gamblers (NG), Non-Problem Gamblers (NPG) or Potential Problem Gamblers (PPG). The Depression, Stress, and Anxiety Scale (DASS21) was used to measure depression, stress, and anxiety scores both pre- and during-lockdown. Results indicate that depression, stress and anxiety has increased across the whole sample. Participants classified in the PPG group reported higher scores on each sub scale at both baseline and during lockdown. Increases were observed on each DASS21 subscale, for each gambler group, however despite variable significance and effect sizes, the magnitude of increases did not differ between groups. Lockdown has had a significant impact on mental health of participants; whilst depression stress and anxiety remain highest in potential problem gamblers, pre-lockdown gambler status did not affect changes in DASS21 scores.

Risk, compensatory, and protective factors in problem gambling: The role of positive mental health characteristics

There is a limited evidence base from which to draw conclusions about compensatory and protective factors for problem gambling. The aim of this study was to explore the potential for positive mental health characteristics (general coping, emotional support, spirituality, interpersonal skills, personal growth and autonomy, and global affect) to play a compensatory role and protective role in problem gambling in a convenience sample of 499 Australian university students. Hazardous alcohol use, past-year substance use, gambling-related cognitions (interpretive bias, illusion of control, predictive control, gambling-related expectancies, and perceived inability to stop gambling), gambling high-risk situations (negative and positive reinforcement situations), and gambling motives (money, positive feelings, regulate internal state, and challenge) positively predicted problem gambling severity. None of the positive mental health characteristics negatively predicted problem gambling severity, suggesting that these factors did not play a compensatory role. However, emotional support, personal growth and autonomy, and global affect buffered the influence of gambling motives and high-risk situations, suggesting that these factors played a protective role. In contrast, spirituality displayed a direct positive predictive relationship with problem gambling severity, suggesting that it served to act as a risk factor in this sample. The identification of these modifiable risk and protective factors has implications for the development of effective prevention and intervention initiatives. Further longitudinal research employing population-representative samples is required to replicate these results and investigate relationship-, community-, and societal-level risk, compensatory and protective factors associated with the development of problem gambling.

Gambling Disorder Symptoms, Suicidal Ideation, and Suicide Attempts

OBJECTIVE

Gambling disorder (GD) patients have a higher suicide risk compared to the general population. The present study investigates the suicide-related risk factors of GD patients by analyzing GD diagnosis-related symptoms and suicide-related behaviors of subjects.

METHODS

This study investigated which symptoms among GD diagnosis criteria are related to suicide risk in 142 patients diagnosed with GD. To analyze the relationship between GD symptoms and suicidal ideation and suicide attempt, the odds ratio (OR) was determined through multivariate logistic regression.

RESULTS

The number of symptoms was significantly higher in the subjects who had suicidal ideation group and attempt group. In the cases of past suicide attempts, responses to withdrawal and escape questions were significantly higher; in the cases of ongoing suicidal ideation, responses to negative consequences and bailout questions were significantly higher. When depression was corrected, the 'bailout' item was, indicating that 'bailout' increased suicidal ideation (OR=4.937, 95% CI=1.009-24.164). In the suicide attempt group, 'relieve' item may increase suicide attempt (OR=6.978, 95% CI=1.300-35.562).

CONCLUSION

Past suicide attempts in GD patients correlated with withdrawal symptoms, and financial problem correlated with suicidal ideation. This suggests that evaluating suicide risk is important when evaluating GD patients, and evaluation of financial problems is important for GD patients with suicide risks.

Problem Gambling Associated With Aripiprazole in First-Episode Psychosis Patients: A Series of 6 Case Reports

BACKGROUND

Aripiprazole (ARI), an antipsychotic drug used to treat various mental health disorders, has recently been associated with the emergence of problem gambling (PBG). However, few cases have been reported in the schizophrenia-related psychotic disorders population, and even fewer provided sufficient details to systematically assess the causality of the association.

METHODS

This article describes 6 cases with first-episode psychosis in whom PBG emerged while on ARI. Detailed information was gathered from clinical staff and patients' families to systematically assess the causal link between ARI and the emergence of PBG using the Naranjo and Liverpool Adverse Drug Reaction scales.

FINDINGS

Five of these cases were previously diagnosed with a substance use disorder and/or cluster B personality traits. Five had received a more potent dopaminergic antagonist treatment before being switched to ARI. Two of them had presented PBG before being diagnosed with a psychotic disorder. The level of certainty about the causal role of ARI varied from possible to certain, and in 4 cases, the 2 scales yielded different ratings.

IMPLICATIONS

Although these cases suggest that ARI may be associated with the emergence of PBG in the early course of schizophrenia-related psychotic disorders, they cannot prove the causality or the strength of this association. They provide the impetus to perform adequately powered and well-controlled prospective studies to draw more definite conclusion about the causality of this association and, in the meantime, further emphasize the need to carefully assess PBG in this population.

Gambling problems among military personnel after deployment

Military and veteran populations may exhibit heightened vulnerability to gambling problems; however, there is scant relevant evidence outside the US, and few studies of transition periods, including return from operational deployment. The aim of this study was thus to highlight the extent, risk-factors, and implications of gambling problems among current members of the Australian Defence Force (ADF) following deployment to the Middle East Area of Operations (MEAO). It involved analyses of data from n = 1324 ADF personnel who deployed between 2010 and 2012, and completed surveys within four months of returning to Australia. The Problem Gambling Severity Index (PGSI) identified Problem Gambling (PG: PGSI ≥5) and At-Risk Gambling (ARG: PGSI 1-4), alongside measures of Depression (PHQ-9), Posttraumatic Stress Disorder (PCL-C), alcohol use problems (AUDIT), distress (K10), and post-deployment stressors. Analyses indicated that 7.7% of personnel reported at least some gambling problems post-deployment, including 2.0% that were distinguished by PG, and 5.7% indicating ARG. These figures were comparable to conditions including probable depression and alcohol dependence, while levels of any gambling problems were high relative to harmful drinking. Higher levels were observed among personnel who were aged 18-24, reported 0-4 years of military service, served in the Army, and comprised Non-Commissioned Officers/Other Ranks. There were strong associations with gambling problems and various indicators of mental health and wellbeing, and self-reported post-deployment difficulties. The findings indicate that gambling problems are salient concerns for some Australian military personnel post-deployment, and highlight the need for increased recognition and responses to these problems.

A Composite Measure of Gambling Exposure: Availability, Accessibility or Both?

Measures of availability and accessibility are often used separately or interchangeably to assess gambling exposure. This study examined the advantages of assessing gambling exposure using availability, accessibility, and a composite measure. Logistic and poisson regression analyses were used to determine the relative importance of these measures in predicting problem gambling using data from the 2008 and 2009 Social and Economic Impacts of Gambling in Alberta (SEIGA) surveys. The composite measure of gambling exposure predicted both the risk and severity of problem gambling better than the availability or accessibility measures alone. These results demonstrate that individual differences in problem gambling are better predicted by a composite measure of exposure.

Developing and testing the effectiveness of a novel online integrated treatment for problem gambling and tobacco smoking: a protocol for an open-label randomized controlled trial

BACKGROUND

Gambling and tobacco smoking are highly comorbid among North American adults. However, there is a paucity of treatment options that are integrated (i.e. targeting both gambling and tobacco smoking simultaneously), accessible, and evidence based.

METHODS

The aim of this two-arm open-label randomized controlled trial is to examine the effectiveness of an online, self-guided integrated treatment for problem gambling and tobacco smoking. A target sample of 214 participants will be recruited and be randomized into either an 8-week integrated or gambling only control condition. Both conditions will consist of seven online modules following cognitive behavioural therapy and motivational interviewing principles. Our three primary outcomes are (1) the number of days gambled, (2) money spent on gambling activities, and (3) time spent in gambling activities. Secondary outcomes include gambling disorder symptoms, cigarette use, and nicotine dependence symptoms. Assessments will be completed at baseline, at completion (i.e. 8 weeks from baseline), and at follow-up (i.e. 24 weeks from baseline). Generalized linear mixed modelling will be used to evaluate our primary and secondary outcomes. We expect that participants receiving online integrated treatment will show larger reductions in gambling relative to those receiving a control gambling only intervention. We further hypothesize that reductions in smoking will mediate these group differences.

DISCUSSION

The rates of problem gambling and tobacco smoking are high in North America; yet, the treatment options for both are limited, with no integrated treatments available. If supported, our pilot study will be a cost-effective and accessible way to improve treatments for co-occurring problem gambling and tobacco use.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03614884 . Registered on August 3, 2019.

A framework for indirect elicitation of the public health impact of gambling problems

Gambling problems are increasingly understood as a health-related condition, with harms from excessive time and money expenditure contributing to significant population morbidity. In many countries, the prevalence of gambling problems is known with some precision. However, the true severity of gambling problems in terms of their impact on health and wellbeing is the subject of ongoing debate. We firstly review recent research that has attempted to estimate harm from gambling, including studies that estimate disability weights using direct elicitation. Limitations of prior approaches are discussed, most notably potential inflation due to non-independent comorbidity with other substance use and mental health conditions, and potential biases in the subjective attribution of morbidity to gambling. An alternative indirect elicitation approach is outlined, and a conceptual framework for its application to gambling is provided. Significant risk factors for propensity to develop gambling problems are enumerated, and relative risks for comorbidities are calculated from recent meta-analyses and reviews. Indirect elicitation provides a promising alternative framework for assessing the causal link between gambling problems and morbidity. This approach requires implementation of propensity score matching to estimate the counterfactual, and demands high quality information of risk factors and comorbid conditions, in order to estimate the unique contribution of gambling problems. Gambling harm is best understood as a decrement to health utility. However, achieving consensus on the severity of gambling problems requires triangulation of results from multiple methodologies. Indirect elicitation with propensity score matching and accounting for comorbidities would provide an important step towards full integration of gambling within a public health paradigm.

Debt stress partly explains the relationship between problem gambling and comorbid mental health problems

RATIONALE

Easy access to consumer credit products, such as credit cards, overdrafts, and personal loans, may facilitate gambling beyond affordable levels, which can result in debt problems. Debt and mental health problems are both potential motivators and core consequences of problem gambling. Debt stress (i.e., worry regarding ability to repay debts) is one potential psychological mechanism underlying the relationship between debt and mental health problems. Few previous studies have investigated debt stress among gamblers.

OBJECTIVE

This cross-sectional study aimed to investigate the mediating effect of debt stress between gambling frequency and mental health and wellbeing.

METHODS & RESULTS

A sample of 309 Australian past-month gamblers (83.8% male; mean age 41.5 years) completed an online survey. There was no evidence for the preregistered association between gambling frequency and debt stress, ruling out a predicted mediating effect for debt stress between gambling frequency and mental health and wellbeing. However, exploratory path analysis showed debt stress has statistically significant mediating effects between problem gambling and psychological distress, depression, wellbeing, and gambling-related family impacts, after controlling for sociodemographic factors and psychiatric history.

CONCLUSIONS & IMPLICATIONS

Debt stress is a robust indicator of financial problems and may indicate underlying problem gambling and mental health issues, making debt stress a useful risk indicator. Clinical services should conduct screening for debt stress and address subjective worry about debts as a standard part of treatment plans as this may help to mitigate some of the impact of gambling and/or financial problems on poor mental health. Health practitioners should develop strong referral networks with gambling and financial counselling services. Government investment in making gambling and financial counselling services freely available and easily accessible is recommended to ensure appropriate support is received via effective care pathways.

High Rollers: Correlates of Problematic Cocaine Use Among a Community Sample of Gamblers

Over half of problem gamblers (PGs; i.e., individuals with an impulse to gamble despite negative consequences) experience a substance use disorder. Explanations for this high rate of comorbidity have included shared clinical and personality factors. While gambling has been associated with substance use disorders in general, relatively few studies have examined the comorbidity of gambling and cocaine use disorders. The current study aimed to address this gap in the literature by comparing the demographic (age, gender, ethnicity, marital status, educational attainment, and employment status), gambling (time and money spent gambling, gambling severity, and motives for gambling), psychological (depression, anxiety, stress, alcohol consumption, nicotine dependency) and personality (trait impulsivity) correlates in a sample of community gamblers with varying degrees of cocaine use; never, recreational, and problematic use as measured by the WHO Alcohol, Smoking and Substance Involvement Screening Test Version 3 (ASSIST-V3.0). Of the 562 participants, 9.3% (N = 51), reported problematic cocaine use. No differences were found between groups for demographic factors. Problematic cocaine users (PCUs) were more likely to be PGs in comparison to recreational users, and never users. They also presented with increased levels of trait impulsivity, depression, anxiety, stress, and alcohol consumption. These results emphasize the need for increased focus on comorbidity and treatment approaches specifically tailored for individuals with PG and PCU.

Feasibility, Acceptance, and Safety of Metacognitive Training for Problem and Pathological Gamblers (Gambling-MCT): A Pilot Study

Approximately 90% of problem and pathological gamblers remain untreated. This treatment gap may be diminished by the implementation of low-threshold treatment programs. As cognitive distortions play a crucial role in the development and maintenance of gambling problems, interventions targeting gambling-related biases may be particularly effective. The aim of the present study was to examine the feasibility, acceptance, and safety of a novel metacognitive training for individuals with gambling problems (Gambling-MCT). Twenty-five participants were included in an uncontrolled pilot trial with two assessment points (intervention). The intervention comprised eight training modules targeting gambling-specific cognitive distortions. At baseline and post assessment, symptom severity, as measured with the PG-YBOCS, and gambling-related cognitive distortions, as measured with the GABS, were assessed. In addition, interim assessments measuring session-specific changes were conducted. Subjective appraisal was examined after each module and also post treatment. On average, participants took part in 4.16 (SD = 2.84) training sessions. Both intent-to-treat and per protocol analyses showed significant improvements on the PG-YBOCS and the GABS (d_z = 0.37–1.37). After Bonferroni correction for multiple testing, linear mixed models for the analysis of session-specific changes showed no deterioration in participants’ mental state after any of the modules. Subjective appraisal of Gambling-MCT was good. The present pilot study provides first evidence for the feasibility, acceptance, and safety of Gambling-MCT. Recruitment of participants remains challenging, emphasizing the importance of overcoming patient-related treatment barriers. Future studies need to investigate the efficacy of Gambling-MCT in randomized controlled trials.

[Problematic gambling and criminal responsibility]

OBJECTIVES

In total, 14% to 30 % of individuals with gambling disorder engage in illegal acts to finance such behavior. This clinical situation could be explained by higher gambling severity, associated substance use disorder, antisocial personality disorder and economic factors (debts, financial problems). The present work focuses, more broadly, on criminal responsibility of problematic gamblers.

METHODS

We will discuss this question through different typical situations that medical experts of criminal responsibility may have to face. We will address each of the following cases: 1) isolated problematic gambling; 2) problematic gambling associated with antisocial personality disorder; 3) problematic gambling associated with a manic episode; 4) problematic gambling associated with substance use disorders; and 5) problematic gambling associated wiht dopamine agonist treatment.

RESULTS

Isolated problematic gambling, (not associated with any psychiatric or addictive disorder): it seems consensual that individuals committing infractions in this case are criminally responsible. However, impeded ability to action control and possible sentence attenuation could be discussed in case of severe gambling disorder. Problematic gambling associated with antisocial personality disorder: if the penal offence reports solely to personality disorder, criminal responsibility would be attributed. However, if illegal or violent acting is directly linked to co-cocurrent delusional symptoms, it could be a cause of criminal non-responsibility. Problematic gambling associated with manic episode: manic episode related offence could lead to negation of criminal responsibility, while a hypomanic episode may provide grounds for sentence reduction. Problematic gambling associated with substance use disorders: in France, addiction is not considered to remove nor to impede a person's ability to understand or control his actions and is excluded from criminal non-responsibility causes. However, substance induced delusional or confusional episodes could abolish a subject's discernment or his ability to control his actions yielding to penal non-responsibility. Problematic gambling associated with dopamine agonist treatment: Criminal responsibility for dopamine agonist induced gambling related illegal acts is still controversial. Nevertheless, people committing an infraction linked to associated dementia or dopamine agonist induced mania should be considered as criminally non-responsible.

CONCLUSIONS

Some clinical dimensions such as craving intensity, compulsivity, disorder's severity, volitional control might be forensic targets to assess criminal responsibility.

Internet-based cognitive behavior therapy for problem gambling in routine care: protocol for a non-randomized pilot and feasibility trial

Background

Problem gambling and gambling disorder are major public health concerns worldwide, and awareness of associated negative consequences is rising. In parallel, treatment demand has increased, and Internet interventions offer a promising alternative for providing evidence-based treatment at scale to a low cost.

Method

We developed a novel Internet-delivered cognitive behavioral treatment for gambling, based on qualitative interviews with treatment-seeking gamblers, behavioral research on gambling behavior, and the pathway model for problem gambling. This research protocol describes a non-randomized pilot and feasibility trial conducted in routine addiction care with adult treatment-seeking patients (max N = 25) with problem gambling. The primary aim is to ensure acceptability and safety, measured by satisfaction, credibility, working alliance, and possible negative effects. Secondary aims are feasibility of study procedures in terms of recruitment and measurement procedures as well as potential effectiveness measured weekly by gambling symptoms as primary outcome and gambling behavior, quality of life, symptoms of depression and anxiety, alcohol, and drug use as secondary outcomes. Potential mediators measured weekly are loss of control, verbal rules, and well-being.

Discussion

This study is innovative in several respects, regarding both treatment development and implementation. The results of the study will guide a future randomized controlled trial, as well as the development of the intervention and intervention implementation within ordinary addiction care.

Trial registration

Clinical trials.gov, NCT ID: NCT03946098. Registered 10 May 2019

A comparison of fraud to fund gambling with fraud for other reasons

In order to compare the characteristics, including diagnosed mental disorder, of people who commit fraud offences to fund gambling with those who committed fraud for other reasons, we examined a complete series of reports prepared for legal proceedings by two of the authors from between January 2002 and June 2019. A total of 160 fraud offenders were located, of whom 48 (30%) reported offending to fund gambling. Females made up 47.5% of the total sample and 43.8% of the gamblers. Of the problem gambling group, 44% had diagnoses of anxiety or depression, 44% had substance use disorder, 17% had bipolar and other psychosis, and 38% reported childhood trauma. There were no significant differences in the frequencies of diagnosis of mental illness or previous criminal convictions compared to the non-gambling group. Two thirds reported only gambling on poker machines. Only 19% of gamblers reported seeking treatment prior to being charged.

An Examination of Clinician Responses to Problem Gambling in Community Mental Health Services

Gambling problems commonly co-occur with other mental health problems. However, screening for problem gambling (PG) rarely takes place within mental health treatment settings. The aim of the current study was to examine the way in which mental health clinicians respond to PG issues. Participants (n = 281) were recruited from a range of mental health services in Victoria, Australia. The majority of clinicians reported that at least some of their caseload was affected by gambling problems. Clinicians displayed moderate levels of knowledge about the reciprocal impact of gambling problems and mental health but had limited knowledge of screening tools to detect PG. Whilst 77% reported that they screened for PG, only 16% did so “often” or “always” and few expressed confidence in their ability to treat PG. However, only 12.5% reported receiving previous training in PG, and those that had, reported higher levels of knowledge about gambling in the context of mental illness, more positive attitudes about responding to gambling issues, and more confidence in detecting/screening for PG. In conclusion, the findings highlight the need to upskill mental health clinicians so they can better identify and manage PG and point towards opportunities for enhanced integrated working with gambling services.

The Conceptual Framework of Harmful Gambling: A revised framework for understanding gambling harm

BACKGROUND AND AIMS

The Conceptual Framework of Harmful Gambling moves beyond a symptoms-based view of harm and addresses a broad set of factors related to the risks and effects of gambling harmfully at the individual, family, and community levels. Coauthored by international research experts and informed by multiple stakeholders, Gambling Research Exchange (GREO) facilitated the framework development in 2013 and retains responsibility for regular updates and mobilization. This review article presents information about the revised version of the Conceptual Framework of Harmful Gambling completed in late 2018.

METHODS

We describe eight interrelated factors depicted in the framework that represent major themes in gambling ranging from the specific (gambling environment, exposure, gambling types, and treatment resources) to the general (cultural, social, psychological, and biological influences). After outlining the framework development and collaborative process, we highlight new topics for the recent update that reflect changes in the gambling landscape and prominent discourses in the scientific community. Some of these topics include social and economic impacts of gambling, and a new model of understanding gambling related harm.

DISCUSSION AND CONCLUSIONS

We address the relevance of the CFHG to the gambling and behavioral addictions research community. Harm-based frameworks have been undertaken in other areas of addiction that can both inform and be informed by a model dedicated to harmful gambling. Further, the framework brings a multi-disciplinary perspective to bear on antecedents and factors that co-occur with harmful gambling.

Chronic traumatic encephalopathy neuropathology might not be inexorably progressive or unique to repetitive neurotrauma

In the 20th century, chronic traumatic encephalopathy (CTE) was conceptualized as a neurological disorder affecting some active and retired boxers who had tremendous exposure to neurotrauma. In recent years, the two research groups in the USA who have led the field have asserted definitively that CTE is a delayed-onset and progressive neurodegenerative disease, with symptoms appearing in midlife or decades after exposure. Between 2005 and 2012 autopsy cases of former boxers and American football players described neuropathology attributed to CTE that was broad and diverse. This pathology, resulting from multiple causes, was aggregated and referred to, in toto, as the pathology ‘characteristic’ of CTE. Preliminary consensus criteria for defining the neuropathology of CTE were forged in 2015 and published in 2016. Most of the macroscopic and microscopic neuropathological findings described as characteristic of CTE, in studies published before 2016, were not included in the new criteria for defining the pathology. In the past few years, there has been steadily emerging evidence that the neuropathology described as unique to CTE may not be unique. CTE pathology has been described in individuals with no known participation in collision or contact sports and no known exposure to repetitive neurotrauma. This pathology has been reported in individuals with substance abuse, temporal lobe epilepsy, amyotrophic lateral sclerosis, multiple system atrophy, and other neurodegenerative diseases. Moreover, throughout history, some clinical cases have been described as not being progressive, and there is now evidence that CTE neuropathology might not be progressive in some individuals. Considering the current state of knowledge, including the absence of a series of validated sensitive and specific biomarkers, CTE pathology might not be inexorably progressive or specific to those who have experienced repetitive neurotrauma.

Role of Gambling in Payback Failure in Consumer Credit-Data from a Large Body of Material Regarding Consumer Loan Recipients in Sweden

Indebtedness is associated with poor health outcomes, and problem gambling may contribute to indebtedness through consumer credits related to gambling expenses. The assessment of consumers’ applications for loans may be an opportunity to detect and prevent further problem gambling. The present study analyzed a number of variables including gambling-related transactions and their association with payback failure in 48,197 loans to 20,750 individuals in Sweden. Sums and frequency of gambling deposits or withdrawals generally did not predict failure to pay back loans. Instead, having a loan defaulted at some time was associated with a baseline pattern describing a theoretical loss-of-control gambling pattern (short-term intense gambling), with a higher ratio of gambling deposits or withdrawals per occasion, and with several instances of gambling in close association with a loan. While several group differences were modest, signs of rapid, short-term and intense gambling, rather than gambling itself, may identify risk of payback failure and risk of indebtedness. Implications for early problem-gambling detection and prevention, such as by gambling operators and financial institutes, are discussed and may promote better public health in relation to gambling indebtedness.

The Effects of Perceived Gambling Availability on Problem Gambling Severity

The aim of this study was to determine the moderating effects of sociodemographic characteristics, substance use, and psychosocial problems on the relationship between perceived gambling availability and problem gambling severity. Bivariate and multivariate regression analyses of the 2008 and 2009 Social and Economic Impacts of Gambling in Alberta surveys found problem gambling severity was 1.25-1.39 times higher for those reporting gambling opportunities were 'too widely available'. Factors such as age, gender, place of residence, and psychosocial problems had significant moderating effects. Our findings indicate that the perception of gambling availability has a statistically significant impact on problem gambling severity.

Problem Gambling in the Fitness World-A General Population Web Survey

The world of sports has a complex association to problem gambling, and the sparse research examining problem gambling in athletes has suggested an increased prevalence and particularly high male predominance. The present study aimed to study frequency and correlates of problem gambling in populations with moderate to high involvement in fitness or physical exercise. This is a self-selective online survey focusing on addictive behaviors in physical exercise distributed by ‘fitness influencers’ on social media and other online fitness forums to their followers. Respondents were included if they reported exercise at least thrice weekly, were above 15 years of age, and provided informed consent (N = 3088). Problem gambling, measured with the Lie/Bet, was studied in association with demographic data, substance use, and mental health variables. The occurrence of lifetime problem gambling was 8 percent (12 percent in men, one percent in women). In logistic regression, problem gambling was associated with male gender, younger age, risky alcohol drinking, obsessive-compulsive disorder, and less frequent exercise habits. In conclusion, in this self-recruited population with moderate to high fitness involvement, problem gambling was moderately elevated. As shown previously in elite athletes, the male predominance was larger than in the general population. The findings strengthen the link between problem gambling and the world of sports.

Gambling disorder and comorbid behavioral addictions: Demographic, clinical, and personality correlates

Gambling disorder (GD) frequently co-occurs with substance use disorders. However, the extent to which GD co-occurs with behavioral addictions (BAs) and the demographic, clinical, and personality correlates of comorbid GD and BA is largely unknown. The aims of the present research were to address this gap among people seeking treatment for GD (N = 458) in São Paulo, Brazil. Structured clinical interviews diagnosed individuals with GD and other psychiatric disorders. The Shorter PROMIS questionnaire was used to identify BAs (work, exercise, food bingeing, sex, and shopping). Questionnaires assessed demographic characteristics, gambling behavior, and personality. Of the total sample, 206 (45.0%) participants met the criteria of having at least one behavioral addiction (GD+BA). The most common comorbid BA was food bingeing (8.1%) with the least common being exercise (3.6%). In a multivariate logistic regression, individuals with GD+BA tended to be younger, and had greater rates of comorbid post-traumatic stress disorder and bulimia nervosa compared to participants who did not present with a comorbid BA. Taken together, individuals with GD+BA present with increased psychopathology. These results may have important implications for the assessment and treatment of individuals with GD and comorbid BAs.

Problem gambling among homeless clinic attenders

OBJECTIVE

To examine the relationship between problem gambling and homelessness.

METHOD

A consecutive sample of attenders at psychiatric clinics at three inner-city homeless hostels over 8.5 years. The demographic characteristics, comorbid conditions, pathway and pattern of homelessness of those identified to have problem gambling were compared with those who did not report problem gambling.

RESULTS

A total of 2388 individuals were seen at the clinics in the 8 years of the study, of whom 289 (12.1%) reported problem gambling, mainly on poker machines. Those with problem gambling were more likely to be male, to have been married, employed for more than a year and to have a diagnosis of mood disorder. They were less likely to have a diagnosis of psychosis. However, the combination of psychosis and problem gambling was associated with the likelihood of having their financial affairs placed under the control of the Public Trustee.

CONCLUSIONS

The findings suggest that earlier attention to problem gambling might reduce the likelihood of becoming homeless, as well as the need for routine enquiry about gambling behaviour, measures to reduce gambling, including expert counselling, restrictions on the availability of addictive forms of gambling and assisting vulnerable individuals with money management.

The Multidimensional Structure of Problem Gambling: An Evaluation of Four Gambling Categorization Instruments from an International Online Survey of Gamblers

To examine the underlying dimensionality and structure of problem gambling using a comprehensive range of problem gambling assessments from an international online survey of gamblers. A total of 12,521 gamblers from 105 countries were recruited through banner advertising placed on a popular online gambling portal to take an online survey. Although participants were recruited online, the majority of the sample (71.6%) gambled only at land-based venues in the past 12 months. A total of 5081 individuals completed all items from the four problem gambling assessments. Participants were allocated to answer one of the four problem gambling assessments and the remaining unique items from the three other problem gambling assessments. The order of assessments were counterbalanced. Two optimal scaling procedures were independently employed to estimate the number of dimensions within the data: exploratory categorical principal component bootstrap analysis and multidimensional scaling. Nonlinear canonical correlation was then used to establish how well each of the four assessment instruments captured the identified dimensions. A final confirmatory principal component analysis was run to understand and characterise the nature of the dimensions that were identified. Both the categorical principal component bootstrap analysis and multidimensional scaling indicated the data was multidimensional, with four dimensions (including a single dominant dimension) providing the best characterisation of the data. The nonlinear canonical correlation analysis found that the Problem and Pathological Gambling Measure and the National Opinion Research Center DSM-IV Screen for Gambling Problems operationalization of the Diagnostic and Statistical Manual of Mental Disorders Four (DSM-IV) criteria best captured these multiple dimensions. Confirmatory principal component analysis suggest a core experience of generic problem gambling symptomology and three other components: "financial problems", "health and relationship issues", and "difficulty controlling gambling". Problem gambling symptomology appears to be multi-dimensional. Certain assessments capture this heterogeneity better than others and thereby provide a more complete and accurate assessment of this construct.

Problem gambling, associations with comorbid health conditions, substance use, and behavioural addictions: Opportunities for pathways to treatment

Background

Problem gambling is a public health issue and its comorbidity with other health conditions may provide an opportunity for screening in healthcare settings; however, a high level of uncertainty and a lack of research in the field remains. The objective of this study is to investigate potential associations between problem gambling and numerous other health conditions, including substance use, mental health problems, and behavioural addictions.

Methods

A cross-sectional web-survey was distributed by a market research company to an online panel of respondents in Sweden, which aimed to be representative of the general population. Chi-squared and Mann-Whitney U tests, followed by logistic regression analysis, were performed to determine associations between screening positive for lifetime problem gambling and potential comorbid conditions and behaviours.

Results

Among 2038 participants, 5.7 percent screened positive for lifetime problem gambling. Significant associations were found between problem gambling and male gender, education level, daily tobacco use, moderate psychological distress, problematic shopping, and problem gaming.

Conclusion

The association between screening for problem gambling and other health conditions, including psychological distress and behavioural addictions such as shopping and gaming, demonstrates the need to screen for problem gambling in the context of other health hazards, such as in different healthcare settings. Further research is required to identify the temporal relationship between these conditions and to investigate underlying etiological mechanisms.

Gambling Despite Nationwide Self-Exclusion-A Survey in Online Gamblers in Sweden

Background: Voluntary self-exclusion is a well-known harm reduction intervention in problem gambling, although primarily in operator-specific or venue-based systems. A nationwide overall self-exclusion system ("Spelpaus") for all licensed gambling was introduced in Sweden in 2019. However, gambling in overseas companies despite national exclusion may be a concern in online gamblers. The present web survey study aimed to study self-reported self-exclusion and gambling despite exclusion in a nationwide multi-operator land-based/online exclusion system. Methods: Web survey in web panel members of a market survey company, carried out in May, 2020 (co-occurring with the COVID-19 pandemic). Past-year online gamblers (n = 997) answered questions about gambling patterns, gambling problems, psychological distress, self-exclusion since "Spelpaus" introduction, and gambling despite self-exclusion. Results: Seven percent reported ever self-excluded at Spelpaus, and this was associated with younger age, female gender, gambling problems, and chance-based games and online poker. In logistic regression, Spelpaus remained strongly associated with past-year online casino gambling, gambling problems, and absence of past-year sports betting. Among those having self-excluded, 38 percent reported gambling despite self-exclusion, most commonly online casino. Conclusions: In online gamblers in a setting with a nationwide self-exclusion system, using this was associated with past-year online casino gambling and gambling problems. Gambling despite self-exclusion appears to be common, and more commonly involves online casino. Stakeholders should aim to increase rates of self-exclusion in high-risk online gamblers, both during and beyond the COVID-19 situation in which the study was carried out. Also, policy makers should use gambling regulation in order to decrease the risk of breaching self-exclusion online, such as through the prohibition of non-registered gambling operators. Further research should focus on in-depth analysis of the reasons for gamblers to enroll or not enroll in multi-operator self-exclusion.

Suicide Attempt in Patients With Gambling Disorder-Associations With Comorbidity Including Substance Use Disorders

Background: Gambling disorder is known to be associated with increased risk of suicidal behavior. However, relatively little is known about how the risk of suicide attempts in gambling disorder is influenced by comorbid alcohol or drug use disorders, as well as other psychiatric conditions. Methods: The present study is a nationwide, diagnostic register study assessing the risk of suicide attempts (including fatal ones) in gambling disorder in Sweden in 2005-2016. Results: In a total of 2,099 individuals (23 percent women) with gambling disorder, 417 individuals had a suicide attempt (including 10 fatal cases of suicide) during the study period. Suicidal behavior was more common in patients with substance use disorders at any time during the study period (50 percent if both alcohol and drug use disorders were present, and 10 percent if none of these were present). In logistic regression, suicidal behavior was significantly associated with female gender (OR 2.13 [1.63-2.78]), mood disorders (OR 2.65 [2.00-3.50]), anxiety disorders (OR 1.78 [1.34-2.35]), and with alcohol (OR 1.95 [1.51-2.51]) or drug use disorders (OR 3.60 [2.76-4.69]), respectively. Conclusions: Suicidal behavior in clinical gambling disorder patients is common, but markedly more common in the presence of substance use and other comorbid disorders.

The Impact of Addictive Behaviors on Adolescents Psychological Well-Being: The Mediating Effect of Perceived Peer Support

Studies exploring excessive Internet use and gambling are rapidly expanding concerns regarding its impact on mental health, especially in young people due to the increased prevalence of Internet and gambling addictions. Research suggests that perceived peer support plays a significant role in adolescents' psychological well-being. However, no empirical study has dealt with the mediating effect of perceived peer support on the relationship between Internet and gambling addictions and psychological well-being. Thus, the present study aimed to examine whether perceived peer support mediates the relation between Internet and gambling addictions and psychological well-being of adolescents. A sample of 347 Iranian adolescents aged 14 to 18 (Mean age 16.14, 50.4% male) who were studying in Kuala Lumpur, Malaysia participated in this study. Subjective Vitality Scale (SVS), Compulsive Internet Use Scale (CIUS), Six-item Social Support Questionnaire (SSQ6), and The South Oaks Gambling Screen (SOGS) were used to collect data. Mediation analyses showed a significant indirect effect of compulsive Internet use and problem gambling on psychological well-being through perceived peer support. The total effects of compulsive Internet use and problem gambling on psychological well-being were negative. This study implies the significance of strengthening the knowledge about the impact of peer relationships among adolescents.

Brief Report: Problem Gambling in International and Domestic University Students

BACKGROUND AND OBJECTIVES

International students comprise an ethnic minority subpopulation who may be at increased risk for the development of gambling problems. This study aimed to explore the psychosocial factors associated with gambling problems in international and domestic university students in Australia.

METHODS

One hundred seventy-three (n = 173) university students (127 domestic, 45 international) completed measures of gambling participation, problem gambling, psychosocial factors (depression, anxiety, perceived social support, loneliness, gambling-related cognitive distortions) and English language difficulties.

RESULTS

Gambling participation, but not problem gambling status, was lower in international than domestic students. Only anxiety and cognitive distortions were associated with problem gambling in domestic students; and only cognitive distortions were associated with problem gambling in international students. International student status failed to moderate the relationships between any psychosocial factor and problem gambling status.

CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE

Future research is required to elucidate problem gambling risk and protective factors in this ethnic minority subgroup, with a view to guide culturally sensitive initiatives. (Am J Addict 2019;00:00-00).

The Reciprocal Association between Problem Gambling and Mental Health Symptoms/Substance Use: Cross-Lagged Path Modelling of Longitudinal Cohort Data

To date, studies have highlighted cross-sectional and unidirectional prospective relationships between problem gambling and mental health symptoms or substance use. The current study aims to: (1) examine the reciprocal relationships between problem gambling and mental health symptoms (depression, generalized anxiety)/substance use variables (hazardous alcohol use, daily tobacco use, and drug use) using cross-lagged path models in a prospective general population cohort sample; and (2) determine whether these associations are moderated by age and gender. This study involved secondary data analysis from 1109 respondents who provided data during Wave 2 or 3 (12-months apart) of the Tasmanian Longitudinal Gambling Study (Australia). Depression (odds ratio (OR) = 2.164) and generalized anxiety (OR = 2.300) at Wave 2 were found to have cross-lagged associations with the subsequent development of any-risk gambling (low-risk, moderate-risk, or problem gambling) at Wave 3. Hazardous alcohol use, daily tobacco use, and drug use at Wave 2 were not associated with the development of any-risk gambling at Wave 3. Any-risk gambling at Wave 2 was not associated with the subsequent development of any mental health symptoms or substance use variables at Wave 3. Age and gender failed to be significant moderators in the associations between any-risk gambling and mental health symptoms or substance use variables. Future longitudinal and event-level research is required to further substantiate these prospective relationships, with a view to developing targeted preventions and interventions.

Adult ADHD Is Associated With Gambling Severity and Psychiatric Comorbidity Among Treatment-Seeking Problem Gamblers

Objective: The aim of this study is as follows: (a) exploring retrospective childhood and adult ADHD symptomatology in treatment-seeking gamblers, (b) providing detailed characteristics of the association between pathological gambling (PG) and ADHD, and (c) identifying risk factors for a history of ADHD. Method: Eighty problem gamblers (20% female) were examined using a standardized interview (PG: Diagnostic and Statistical Manual of Mental Disorders [4th ed.; DSM-IV] criteria, Gambling Attitudes and Beliefs Survey; ADHD: Wender Utah Rating Scale-deutsche Kurzform, Adult ADHD Self-Report Scale; comorbidities: Mini International Neuropsychiatric Interview). Results: Forty-three percentage of patients screened positive for childhood ADHD, and in 11%, ADHD persisted in adulthood. Patients with adult ADHD had more severe gambling problems (p = .009, d = 1.03) and a higher number of psychiatric comorbidities (p < .001, d = 1.62) compared with those without ADHD. Substance abuse/dependence constituted a predictor for having a history of ADHD (odds ratio [OR] = 4.07, p = .025). Conclusion: ADHD-PG comorbidity is linked to factors that worsen the prognosis. Thus, screening for ADHD and verifying persistence in adulthood should be an integral component in the interdisciplinary treatment of problem/pathological gamblers.

Exploring the Relationships Between Problem Gambling and ADHD: A Meta-Analysis

Objective: At present, there are inconsistencies in the literature pertaining to the association between ADHD and problem gambling. This study utilized meta-analytic techniques to clarify the association between symptoms of problem gambling and symptoms of ADHD. Method: Several meta-analyses were conducted using a random effects model. PsycINFO, PubMed, ProQuest Dissertations & Theses, and Google Scholar were searched for relevant studies. Results: The weighted mean correlation between ADHD symptomology and gambling severity was r = .17, 95% confidence interval (CI) = [0.12, 0.22], p < .001. Mean age of the sample was the only moderator to approach significance, with greater age being linked to a stronger relationship between symptoms of ADHD and gambling severity. Conclusion: Clinicians needs to be cognizant of the greater risk of ADHD symptoms when working with problem gamblers and vice versa.

The relationship of loot box purchases to problem video gaming and problem gambling

Loot boxes are virtual items in many video games that let players "gamble" on an item of chance. Loot boxes bring an element of gambling into video games, which might prime video game users to engage in online gambling activities. However, few studies have focused on this emerging issue. The present study investigated the relationships between loot box purchases and both problem video gaming and problem gambling severity. Cross-sectional, self-report data were collected from 618 adult video gamers (M = 27 years of age, SD = 8.9, 63.7% male) via an online survey. Nearly half of the sample (44.2%) spent money on loot box purchases in the past year. Loot box purchasers played video games and gambled online more frequently, reported more extended gaming and online gambling sessions, and endorsed higher levels of problem video gaming and problem gambling severity as well as greater mental distress relative to those who did not buy loot boxes. Results from a series of path analyses revealed that loot box purchasing was directly related to problem video gaming and problem gambling severity as well as indirectly through increased video gaming/online gambling engagement, which in turn is related to elevated psychological distress. The present findings provide insight into the role of loot box purchasing in the transition from recreational engagement in video gaming and online gambling to problem video gaming and/or problem gambling.

Problem gambling and concurrent emotional/behavioral problems among Greek adolescents

Aim:

Problem gambling in adolescents constitutes a major health problem. Very few studies have investigated the relationship of adolescent gambling with emotional/behavioral problems. The aim of this study was to examine the association between adolescent problem gambling and emotional/behavioral problems using data from a school survey in the greater Athens area.

Material and Methods:

The total sample consisted of 2159 high school students (45.4% males and 54.6% females) from a random and representative sample of public and private schools in the greater Athens area. Data were collected in the form of self-reported questionnaires during one school hour. To access problem gambling the Diagnostic and Statistical Manual of Mental Disorders-IV Multiple Response Adapted for Juveniles questionnaire was administered to the study population. The presence of emotional/behavioral problems was assessed via the Strengths and Difficulties Questionnaire. Full data from 2141 participants were analyzed. Eighteen questionnaire with incomplete data were excluded.

Results:

Problem gambling in adolescence is in line with the presence of emotional/behavioral problems. All Strengths and Difficulties Questionnaire subscales were significantly associated with problem gambling. Specifically, emotional symptoms, conduct problems, attention/hyperactivity, and social dysfunction were all significantly and independently associated with adolescent pathologic gambling. The prosocial scale had lower scores in problem gamblers.

Conclusion:

This article aims to highlight and discuss the coexistence of adolescent problem gambling with other symptoms. The significant association of emotional/behavioral problems among adolescents with problem gambling indicates a need to screen for these symptoms and for their subsequent treatment among adolescents with problem gambling.

The therapist experience of internet delivered CBT for problem gambling: Service integration considerations

INTRODUCTION

Countries with legalized gambling offer a network of government funded face-to-face therapy, but usage of this expertise is on the decline. One way to address this issue is to recruit therapists from existing services whereby they provide guidance for the delivery of internet delivered CBT.

OBJECTIVE

To explore the experiences and perceptions of therapists supporting guided online cognitive-behavioural therapy.

METHODS

Interviewees were a sub-sample of therapists from a randomised trial that investigated the relative efficacy of online guided self-directed versus pure self-directed interventions in Australia.

RESULTS

In-person, semi-structured interviews with seven service providers were completed, and thematic content analysis identified five themes which related to: participant suitability and screening (e.g., motivation, computer literacy and access); program content and modality acceptability (e.g., amount of content, look and feel); participant information and management (e.g., program engagement and progression); email communication (e.g., use of templates, appointments, rapport building), and; ongoing service integration (e.g., infrastructure, confidence in product). Overall experiences and perceptions of therapists were positive, notwithstanding barriers concerning assessment of participant suitability, participant management systems and low participant engagement.

CONCLUSIONS

Key themes emphasized the benefits of Internet-based interventions for problem gambling, and suggested several areas for improvement. Results should inform the development of future treatments to enable flexible tailoring of interventions to individuals.

Clinical characteristics of veterans with gambling disorders seeking pain treatment

OBJECTIVES

To examine the relationships between gambling disorder, pain, and suicide attempts among US military veterans using Veterans Health Administration (VHA) pain-related services.

METHODS

Retrospective cohort analysis of 221,817 veterans using pain services was included in the analysis. First, differences in sociodemographic and clinical characteristics (i.e., psychiatric comorbidities and pain-related variables) were analyzed according to gambling disorder. Second, we performed logistic regression analyses to assess the association between gambling disorder and suicide attempts.

RESULTS

Female sex, depressive, alcohol, drug and tobacco use disorders are positively associated with gambling disorders, while severe pain score is negatively associated with gambling disorders. Logistic regression analysis showed that gambling disorder diagnosis was associated suicide attempt in veterans who received a visit for pain in VHA in the past year.

CONCLUSIONS

Our findings suggest that gambling disorder in female veterans and suicide attempts in veterans with gambling disorder should not be underestimated and warrants further consideration. Moreover, the result that veterans with severe pain may be less likely to have a diagnosis of gambling disorder needs to be confirmed.

Decision-Making Styles, Negative Affectivity, and Cognitive Distortions in Adolescent Gambling

Evidences from the extant literature suggest that problem gamblers show higher cognitive distortions and reported experiencing higher levels of negative affective states than recreational gamblers. Furthermore, several studies reported that the more the gambling severity, the poorer the performance in behavioral tasks assessing affective decision-making. Although gambling research on decision-making has mostly focused on the functional or dysfunctional outcomes of the decisional process, no study examined the role of decision-making styles in gambling disorder. This study aimed to first investigate the interplay among negative affectivity, cognitive distortions, and decision-making styles in adolescent problem gambling. Four hundred and twenty-five adolescents, aged between 14 and 19 years, completed the South Oaks Gambling Screen Revised for Adolescents to assess problem gambling, the Depression Anxiety and Stress Scales-21 to measure negative affective states, and the Gambling Related Cognitions Scale as a measure of cognitive distortions about gambling, and the General Decision-Making Style tapping habitual patterns which individuals use in decision-making. Data were submitted to correlational analysis, univariate and mixed-model ANOVAs, and hierarchical regression analysis. Regression analysis indicated that, along with gender, interpretative bias and inability to stop gambling, depression, and spontaneous decision-making style significantly predicted gambling severity. These results extend further previous studies on the role of misconceptions about gambling, and negative affective states in adolescent gambling, and, interestingly, first demonstrate that also maladaptive decision-making styles may represent a risk factor for gambling disorder.

Patterns of Family and Intimate Partner Violence in Problem Gamblers

While the evidence about the statistical co-occurrence of family violence and problem gambling is growing, the mechanism by which the two behaviours are related is less clear. This study sought to clarify the dynamics of the problem behaviours, including the role of gender in victimisation and perpetration of violence in the family. Two-hundred-and-twelve treatment seeking problem gamblers (50.5% females) were recruited for interviews about past year FV and IPV experiences. The interviews included questions about the types of FV and IPV using the HITS tool (Sherin et al. in Fam Med Kans City 30:508-512, 1998). The questions addressed multiple family members, the temporal order of violence and gambling and the perceived associations between the two behaviours. The result show that well over half (60.8%; 95 CI = 54.1-67.2) of the participants reported some form of violence in the past 12 months, with no gender differences in relation to perpetration and victimisation. Bidirectional violence (43.9%; 95 CI = 37.4-50.6) was significantly more common than 'perpetration only' (11.3%; 95 CI = 7.7-16.3) or 'victimisation only' (5.7%; 95 CI = 3.3-9.6). Violence was mostly verbal, although considerable rates of physical violence also featured in the responses. 'Participants' own gambling preceded violence in a majority of the interviews but a small group of IPV victims reported that being a victim had led to their problematic gambling. These results can be used inform prevention, better treatment matching and capacity building in family violence and problem gambling services, where a significant focus should be on situational IPV.

A Systematic Review of Land-Based Self-Exclusion Programs: Demographics, Gambling Behavior, Gambling Problems, Mental Symptoms, and Mental Health

Systematic and quantitative reviews on the effects of land-based self-exclusion are scarce. Therefore, the current review aimed to provide a comprehensive summary of (1) the demographic characteristics of land-based self-excluders and changes after exclusion, including (2) gambling behavior, (3) gambling problems, (4) mental symptoms, and (5) mental health. A systematic database and literature search was performed following PRISMA guidelines. Nineteen naturalistic studies met the eligibility criteria. The quality of all included records was rated via adaption of the Newcastle-Ottawa Scale. Results from higher-quality records were more heavily weighted. Self-excluders were predominantly men in their early or middle forties. Changes after exclusion revealed wide ranges in the rates of abstinence (13-81%), rates of gambling reduction (29-92%), and rates of exclusion breaches (8-59%). The records consistently demonstrated significant changes in pathological gambling from before exclusion (61-95%) to after exclusion (13-26%). Up to 73% of self-excluders exhibited symptoms of anxiety, depression, and substance use disorders at program enrollment. Several aspects of mental health improved after exclusion, e.g., quality of life. Problem and pathological gambling are most prevalent in young men, but self-exclusion was most prominent in middle-aged men. The magnitude of effects widely differed between studies despite overall benefits of self-exclusion, and many individuals continued gambling after exclusion. This shortcoming could be minimized using improved access controls and the extension of exclusion to other gambling segments. High rates of pathological gambling and other mental disorders in self-excluders highlight the need for improved early detection and treatment accessibility.

Comorbidity Patterns Among Patients With Opioid Use Disorder and Problem Gambling: ADHD Status Predicts Class Membership

Objective: Psychiatric comorbidities are highly prevalent among individuals affected by substance use disorders and those with non-substance-related addictive disorders such as gambling disorder. More recently, the frequent co-occurrence of substance use disorders and attention-deficit hyperactivity disorder (ADHD) has received particular attention. The aim of our study was to identify patterns of psychiatric comorbidity and to examine associations between patient group and ADHD status with class membership. Methods: Participants were patients with opioid use disorder enrolled in opioid maintenance treatment (OMT), either recruited from the community (n = 142; M age = 35.8 years; 38.7% female) or prison (n = 133; M age = 35.7 years; 21.8% female), and patients undergoing treatment for problem gambling (PrG; n = 80; M age = 43.1 years; 20% female). To enable direct comparisons, the following instruments were applied: Mini International Neuropsychiatric Interview, Adult ADHD self-report scale, Wender Utah Rating Scale, and European Addiction Severity Index. We used a latent class analysis (LCA) to identify psychiatric comorbidity patterns and a multinomial logistic regression to examine associations between patient group, ADHD status, age, and gender with class membership. Results: The LCA resulted in a three-class solution: (1) a class of individuals with a relatively low probability of current psychiatric comorbidities, except for a high probability of substance use disorders; (2) a class with markedly increased probabilities of current and recurrent psychiatric comorbidities, especially for major depression; and (3) a class with very low probabilities of psychiatric comorbidities, except for moderate probabilities of substance use disorders and antisocial personality disorder. Both OMT patients recruited from the community and those in prison were less likely than PrG patients to be assigned to the most burdened class with respect to psychiatric comorbidity (class 2). Further, both individuals with ADHD in childhood and those with adult ADHD were more likely members of class 2. Conclusions: PrG patients seem to be at an even higher risk for psychiatric comorbidities compared to OMT patients. Raising awareness among practitioners for the high prevalence of psychiatric comorbidities among patients with gambling disorder and individuals with ADHD is crucial to initiate adequate treatment and to improve response.

Problem gambling and associated mental health concerns in elite athletes: a narrative review

Opportunities to participate in gambling have dramatically changed during the past 20 years. Casinos have proliferated as have electronic gambling machines, lotteries, sports betting, and most recently online gambling. Gambling among the general population has moved from being perceived negatively to a socially acceptable pastime. As over 80% of individuals have reported gambling for money during their lifetime, governments recognise that regulating gambling-a multibillion dollar industry-is a significant source of revenue. While the vast majority of individuals engaged in some form of gambling have no or few gambling-related problems, an identifiable proportion of both adolescents and adults experience significant gambling-related problems. Elite athletes have not been immune to the lure of gambling nor its concomitant problems. Prevalence studies suggest higher rates of gambling problems among athletes than the general population. In this narrative review, we examine several risk factors associated with gambling problems among elite athletes and new forms of gambling that may be problematic for this population. Given the potential serious mental health and performance consequences associated with a gambling disorder for athletes, we aim to increase coaches', athletic directors' and health professionals' knowledge concerning the importance of screening and treatment referrals.

Impulsivity and cognitive distortions in different clinical phenotypes of gambling disorder: Profiles and longitudinal prediction of treatment outcomes

BACKGROUND

Impulsivity and cognitive distortions are hallmarks of gambling disorder (GD) but it remains unclear how they contribute to clinical phenotypes. This study aimed to (1) compare impulsive traits and gambling-related distortions in strategic versus non-strategic gamblers and online versus offline gamblers; (2) examine the longitudinal association between impulsivity/cognitive distortions and treatment retention and relapse.

METHODS

Participants seeking treatment for GD (n = 245) were assessed for gambling modality (clinical interview), impulsive traits (Urgency, Premeditation, Perseverance and Sensation Seeking [UPPS] scale) and cognitive distortions (Gambling Related Cognitions Scale) at treatment onset, and for retention and relapse (as indicated by the clinical team) at the end of treatment. Treatment consisted of 12-week standardized cognitive behavioral therapy, conducted in a public specialized clinic within a general public hospital.

RESULTS

Strategic gamblers had higher lack of perseverance and gambling-related expectancies and illusion of control than non-strategic gamblers, and online gamblers had generally higher distortions but similar impulsivity to offline gamblers. Lack of perseverance predicted treatment dropout, whereas negative urgency and distortions of inability to stop gambling and interpretative bias predicted number of relapses during treatment.

CONCLUSIONS

Individuals with online and strategic GD phenotypes have heightened gambling related biases associated with premature treatment cessation and relapse. Findings suggest that these GD phenotypes may need tailored treatment approaches to reduce specific distortions and impulsive facets.

Effects of Gambling Diagnostic Criteria Changes from DSM-IV to DSM-5 on Mental Disorder Comorbidity Across Younger, Middle-Aged, and Older Adults in a Nationally Representative Sample

Changes in Diagnostic and Statistical Manual (DSM) criteria for a gambling disorder from DSM-IV to DSM-5 included a drop in the minimum number of criteria required to qualify for a diagnosis. This threshold reduction resulted in a near doubling of prevalence in non-gambling focused populations. However, the impact of this change on psychiatric comorbidity with gambling is unknown. The current study aimed to: (a) examine whether the diagnostic change affected the severity of those diagnosed with a gambling disorder with respect to mental disorder comorbidity, and (b) determine whether this relationship differed across younger (18-34 years old), middle-aged (35-54 years old), and older (55 years old and over) age groups. This study utilized data from the National Epidemiological Survey for Alcohol and Related Conditions. Results indicated that the prevalence of comorbid mental health/substance use disorders did not significantly change between the DSM-IV pathological gambling group and DSM-5 gambling disorder group in the overall sample. However, among older adults, the DSM-5 gambling disorder were more likely to exhibit any anxiety disorder as well as any comorbid mental health/substance-use disorder compared to the DSM-IV pathological gamblers. No other significant differences were observed in mental health or substance-use disorders within age-specific groupings. Findings suggest that the new, less restrictive DSM-5 criteria for gambling addiction capture older gamblers with more severe clinical presentations in terms of co-occurring mental disorders, contrary to our expectation that the lowered threshold for diagnosis would result in less severe clinical cases.

Behaviour Change Strategies Endorsed by Gamblers Subtyped by Psychological Distress, Risky Alcohol Use, and Impulsivity

Problem gambling is often accompanied by co-morbid psychiatric disorders and maladaptive personality traits. Subtyping gamblers based on these pervasive comorbidities has been attempted so as to aid understanding of the aetiology of problem gambling and inform treatment options. However, there has been less focus on subtyping gamblers with (past or current) or without a history of problem gambling, or on providing more specific treatment or self-help recommendations. The current study sought to subtype current-, past-, and non-problem gamblers using three common comorbidities; psychological distress, risky alcohol use, and impulsivity. Participants' endorsement of helpful behaviour change strategies was also examined by subtype membership. A total of 385 participants were recruited who had a current gambling problem (n = 128; 33%), a past gambling problem (n = 131, 34%) or never had a gambling problem (n = 126, 33%). Hierarchical cluster analysis identified distinct subtypes of current (i.e., low comorbidity, high psychological distress, risky alcohol use and high comorbidity), past (i.e., low comorbidity, high psychological distress and high comorbidity) and non-problem gamblers (i.e., low comorbidity, high psychological distress, risky alcohol use and moderate impulsivity). The most helpful change strategies for current and past gamblers were similar across subtypes (i.e., accept that gambling needs to change, remind yourself of the negative consequences). Non-problem gamblers reported the most helpful strategy as setting financial limits. This study indicated that treatment of psychological distress, risky alcohol use or impulsivity may be important for all gamblers regardless of their level of risk.

The use of self-management strategies for problem gambling: a scoping review

Background

Problem gambling (PG) is a serious public health concern that disproportionately affects people experiencing poverty, homelessness, and multimorbidity including mental health and substance use concerns. Little research has focused on self-help and self-management in gambling recovery, despite evidence that a substantial number of people do not seek formal treatment. This study explored the literature on PG self-management strategies. Self-management was defined as the capacity to manage symptoms, the intervention, health consequences and altered lifestyle that accompanies a chronic health concern.

Methods

We searched 10 databases to identity interdisciplinary articles from the social sciences, allied health professions, nursing and psychology, between 2000 and June 28, 2017. We reviewed records for eligibility and extracted data from relevant articles. Studies were included in the review if they examined PG self-management strategies used by adults (18+) in at least a subset of the sample, and in which PG was confirmed using a validated diagnostic or screening tool.

Results

We conducted a scoping review of studies from 2000 to 2017, identifying 31 articles that met the criteria for full text review from a search strategy that yielded 2662 potential articles. The majority of studies examined self-exclusion (39%), followed by use of workbooks (35%), and money or time limiting strategies (17%). The remaining 8% focused on cognitive, behavioural and coping strategies, stress management, and mindfulness.

Conclusions

Given that a minority of people with gambling concerns seek treatment, that stigma is an enormous barrier to care, and that PG services are scarce and most do not address multimorbidity, it is important to examine the personal self-management of gambling as an alternative to formalized treatment.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-6755-8) contains supplementary material, which is available to authorized users.

Brief interventions for problem gambling: A meta-analysis

Background

Brief interventions have been increasingly investigated to promote early intervention in gambling problems; an accurate estimate of the impact of these interventions is required to justify their widespread implementation. The goal of the current investigation was to evaluate the efficacy of in-person brief interventions for reducing gambling behaviour and/or problems, by quantifying the aggregate effect size associated with these interventions in the published literature to date.

Methods

Randomized controlled trials including the following design features were identified via systematic review: an adult sample experiencing problems associated with gambling; an in-person individual psychosocial intervention of brief duration (≤3 sessions); a control/comparison group; and an outcome related to gambling behaviour and/or problems.

Results

Five records compared brief interventions to assessment only control; using a random effect model, brief interventions were associated with a small but statistically significant reduction in gambling behaviour across short-term follow-up periods versus assessment only control (g = -.19, 95% CI [-.37, -.01]). Aggregate effect sizes for gambling problems and long-term follow-up periods were not statistically significant. Five records compared brief interventions to longer active interventions; there was no significant difference between brief interventions and longer active interventions.

Conclusions

Results supported the efficacy of brief interventions for problem gambling compared to inactive control in the reduction of gambling behaviour; no differences were found across brief versus longer interventions for both gambling behaviour and problems. While these findings must be interpreted in the context of the limited number of studies and small magnitude of the combined effect sizes, the current meta-analysis supports the further investigation of the public health impact of these cost-effective interventions.

Gambling habits, gambling norms, and problem gambling in foreign born and native populations in Denmark - A general population survey

Background

Being foreign born, i.e. not born in the reception country or belonging to an ethnic minority, has been described as a risk factor of problem gambling, although research so far has been inconclusive. Also, there is limited knowledge about whether this association is caused by differing gambling norms. The present study aimed to study whether foreign origin is associated with problem gambling, when controlling for several potential risk factors, gambling frequency and beliefs about peer gambling, i.e. gambling norms.

Methods

Cross-sectional web survey including 1970 adult individuals from the general population in Denmark (50% female), in April 2018. Binary analyses and hierarchical logistic regression with respect to associations between foreign origin, relevant co-factors and problem gambling.

Results

Problem gambling was more common in individuals with foreign origin (15 vs 10%, p = 0.01). In logistic regression, problem gambling was associated with male sex, gambling frequency, foreign origin, psychological distress, smoking, and number of gambling types used. Beliefs about peer gambling did not differ with respect to foreign origin, but were associated with problem gambling until one's own gambling frequency was entered into the model.

Conclusions

When controlling for a number of relevant risk factors, foreign origin still appears to predict problem gambling. Gambling patterns or gambling norms are unlikely to be the sole explanation of the increased prevalence. The findings have implications for preventive work in the foreign born population, and gambling norms may be targeted in screening for at-risk gamblers.

•

In the population, problem gambling was more common in first or second generation immigrants.

•

The association with problem gambling was not explained by increased gambling norms in the immigrant population instead demonstrated lower beliefs about peer gambling.

•

Instead, immigrants demonstrated lower beliefs about peer gambling

•

Beliefs about peer gambling were associated with own's problem gambling risk