Pathological gambling. A comprehensive review

Designing a longitudinal cohort study of gambling in Alberta: rationale, methods, and challenges

Longitudinal research on the determinants of gambling behavior is sparse. This article briefly reviews the previous seventeen longitudinally designed studies, focusing on the methodology for each study. This is followed by a description of our ongoing longitudinal study entitled the Leisure, Lifestyle, and Lifecycle Project (LLLP). Participants for the LLLP were recruited from four locations in Alberta, Canada, including both rural and urban populations. In the LLLP most participants were recruited using random digit dialing (RDD), with 1808 participants from 5 age cohorts at baseline: 13-15, 18-20, 23-25, 43-45, and 63-65. Individuals completed telephone, computer, and face-to-face surveys at baseline, with the data collection occurring between February and October, 2006. At baseline, a wide variety of constructs were measured, including gambling behavior, substance use, psychopathology, intelligence, family environment, and internalizing and externalizing problems. Finally, the conclusions that can be drawn thus far are discussed as well as the plans for three future data collections.

A unified framework for addiction: vulnerabilities in the decision process

The understanding of decision-making systems has come together in recent years to form a unified theory of decision-making in the mammalian brain as arising from multiple, interacting systems (a planning system, a habit system, and a situation-recognition system). This unified decision-making system has multiple potential access points through which it can be driven to make maladaptive choices, particularly choices that entail seeking of certain drugs or behaviors. We identify 10 key vulnerabilities in the system: (1) moving away from homeostasis, (2) changing allostatic set points, (3) euphorigenic "reward-like" signals, (4) overvaluation in the planning system, (5) incorrect search of situation-action-outcome relationships, (6) misclassification of situations, (7) overvaluation in the habit system, (8) a mismatch in the balance of the two decision systems, (9) over-fast discounting processes, and (10) changed learning rates. These vulnerabilities provide a taxonomy of potential problems with decision-making systems. Although each vulnerability can drive an agent to return to the addictive choice, each vulnerability also implies a characteristic symptomology. Different drugs, different behaviors, and different individuals are likely to access different vulnerabilities. This has implications for an individual's susceptibility to addiction and the transition to addiction, for the potential for relapse, and for the potential for treatment.

Reliability, validity, and classification accuracy of a Spanish translation of a measure of DSM-IV diagnostic criteria for pathological gambling

The aim of this study was to measure the reliability, validity, and classification accuracy of a Spanish translation of a measure of DSM-IV diagnostic criteria for Pathological Gambling (PG). Participants were 263 male and 23 female patients seeking treatment for PG and a matched non-psychiatric control sample of 259 men and 24 women. A Spanish translation of a 19-item measure of DSM-IV diagnostic criteria for PG (Stinchfield 2003) was administered along with other validity measures. The DSM-IV diagnostic criteria were found to be internally consistent with a coefficient alpha of .95 in the combined sample. Evidence of satisfactory convergent validity included moderate to high correlations with other measures of problem gambling. Using the standard DSM-IV cut-score of five, the ten criteria were found to yield satisfactory classification accuracy results with a high hit rate (.95), high sensitivity (.92), high specificity (.99), low false positive (.01), and low false negative rate (.08). Lowering the cut score to four resulted in modest improvements in classification accuracy and reduced the false negative rate from .08 to .05. The Spanish translation of a measure of DSM-IV diagnostic criteria for PG demonstrated satisfactory psychometric properties and a cut score of four improved diagnostic precision.

Cerebrospinal fluid amino acids in pathological gamblers and healthy controls

Amino acids, such as valine, isoleucine and leucine compete with tyrosine and tryptophan for transport into the brain and might thus affect the central serotonin and catecholamine patterns. Furthermore, the excitatory amino acids glutamic acid, aspartic acid and glycine are known to act on the N-methyl-D-aspartate receptor, which is part of the reward system. Based on these facts, we have explored the role of cerebrospinal fluid (CSF) amino acids in pathological gambling. Concentrations of amino acids were determined in CSF obtained from one female and 11 pathological male gamblers and 11 healthy male controls. In an ANCOVA with best subset regression, pathological male gamblers had higher CSF levels of the excitatory glutamic and aspartic acids, as well as of phenylalanine, isoleucine, citrulline and glycine. A negative contribution of glycine in interaction with the neuraxis distance might mirror a reduced spinal supply or an altered elimination of glycine in pathological gamblers. A decreasing CSF gradient from the first (0-6 ml) to the third (13-18 ml) CSF fraction was found for glutamic acid, glycine, leucine, isoleucine, lysine, ornithine and glutamine in both pathological gamblers and healthy controls. A decreasing gradient was found, however, for aspartic acid and phenylalanine in pathological male gamblers. The altered pattern of CSF amino acids in pathological gamblers might exert an influence on central monoamines as well as on N-methyl-D-aspartate receptor function.

Gambling among the Chinese: a comprehensive review

Despite being a significant issue, there has been a lack of systematic reviews on gambling and problem gambling (PG) among the Chinese. Thus, this paper attempts to fill this theoretical gap. A literature search of social sciences databases (from 1840 to now) yielded 25 articles with a total sample of 12,848 Chinese community participants and 3397 clinical participants. The major findings were: (1) Social gambling is widespread among Chinese communities as it is a preferred form of entertainment. (2) Prevalence estimates for PG have increased over the years and currently ranged from 2.5% to 4.0%. (3) Chinese problem gamblers consistently have difficulty admitting their issue and seeking professional help for fear of losing respect. (4) Theories, assessments, and interventions developed in the West are currently used to explain and treat PG among the Chinese. There is an urgent need for theory-based interventions specifically tailored for Chinese problem gamblers. (5) Cultural differences exist in patterns of gambling when compared with Western samples; however, evidence is inconsistent. Methodological considerations in this area of research are highlighted and suggestions for further investigation are also included. (6) Much of gambling research has focused on identifying risk factors and at-risk individuals. It is essential to balance this knowledge with a focus on fundamental character strengths, which act as protective factors and motivate one to refrain from gambling.

Replication of low-risk gambling limits using canadian provincial gambling prevalence data

A set of low-risk gambling limits were recently produced using Canadian epidemiological data on the intensity of gambling behavior and related consequences (Currie et al. Addiction 101:570-580, 2006). The empirically derived limits (gambling no more than two to three times per month, spending no more than $501-$100o CAN per year or no more than 1% of gross income spent on gambling) accurately predicted risk of gambling-related harm after controlling for other risk factors. The present study sought to replicate these limits on data collected in three independently conducted Canadian provincial gambling surveys. Dose-response curves and logistic regression analyses were applied to gambling prevalence data collected in surveys conducted in 2001-2002 within the provinces of Alberta, British Columbia, and Ontario (combined sample N = 7,675). A comparable dose-response relationship between gambling intensity and risk of harm was found in each province. The optimal thresholds for defining an upper limit of low-risk gambling were similar across the three provinces despite variations in the availability and organization of legalized gambling opportunities within each region. These results provide additional evidence supporting the validity of the low-risk gambling limits. Quantitative limits could be used to augment existing responsible gambling guidelines.

The Relationship Between Gambling Cognitions, Psychological States, and Gambling

High rates of gambling and problem gambling among the Chinese have been well documented in anecdotal and empirical reports. However, there is a lack of research on the relationship between important gambling correlates (e.g., gambling cognitions and psychological states) and gambling. This study investigated the role of gambling cognitions and psychological states on problem gambling behavior among 501 participants (306 Caucasians and 195 Chinese living in Australia). Participants completed the South Oaks Gambling Screen, the Depression, Anxiety and Stress Scale (DASS), and the Gambling Related Cognitions Scale (GRCS). A significant positive relationship between GRCS and DASS on problem gambling behavior was found for both groups. Further gender disparities in anxiety, stress, and illusion of control were revealed for both ethnicities. Implications of these findings and possible future research are discussed.

An analysis of the accessibility of video lottery terminals: the case of Montréal

Background

Researchers and public health officials in Canada, the United States and Australia have for some time noted broader geographic accessibility to gambling establishments, above all in socioeconomically underprivileged communities. This increase in availability could lead to more and more gambling problems. This article focuses, in an ecological perspective, in particular on a spatial analysis of the geographic accessibility of sites possessing a VLT permit in the Montréal area, i.e. Montréal Island, the South Shore and Laval, from the standpoint of the development of an indicator of the vulnerability (socioeconomic components and demographic components) to gambling of populations at the level of certain neighbourhood units (dissemination areas). With the recent development of geographic information systems (GIS), it is now possible to ascertain accessibility to services much more accurately, for example by taking into account the configuration of the road network.

Results

The findings of our analysis reveal widespread geographic accessibility to sites possessing a VLT permit in the downtown area and in pericentral districts. In some neighbourhood units, a site possessing a VLT permit may be within a three-minute walk. In the region studied overall, average walking time to a VLT site is nine minutes. Access to this type of service on foot is usually limited in the outskirts. However, a number of groups of sites possessing VLT permits are found along certain axial highways. According to local spatial self-correlation analyses, the findings suggest a significant link between walking accessibility to sites possessing VLT permits and the vulnerability of the communities. In a number of neighbourhood units with ready access to VLT's the populations display high vulnerability.

Conclusion

These findings reveal that accessibility to sites possessing a VLT permit is often linked to the vulnerability (socioeconomic and demographic components) of communities. Reliance in our analyses on neighbourhood units with fairly small areas enabled us to emphasize the rectilinear dimension of the spatial distribution of sites possessing VLT permits. This is a significant link that public health officials must consider when elaborating programs to combat pathological gambling.

Psychological treatment dropout among pathological gamblers

Premature dropout from treatments for pathological gambling is potentially of significant importance, if it occurs before substantial progress has been made in addressing the problem. A systematic review of current research on dropout from psychological treatments for pathological gambling identified 12 studies from five countries. Dropout ranged from 14% to 50%, with a median of dropout 26%. Overall, 31% of the participants dropped out of treatment. Few studies distinguish between dropouts at different stages of participation. The evidence on specific variables that predict dropout is limited or inconsistent, and is characterised by a lack of a coherent, gambling-specific model and by methodological problems. Two studies that attempted to apply motivational and compliance-enhancing techniques were found. Both showed promising effects on reduction of dropout and improvement of short-term impact of treatment, but inconsistent results on longer-term outcomes were obtained. The review highlighted a need for more rigorous investigation of the extent of dropout and of variables associated with dropout from pathological gambling treatment programs. Further research on interventions to enhance retention and reduce dropout from psychological treatment is also required.

A test of social cognitive theory reciprocal and sequential effects: hope, superstitious belief and environmental factors among lottery gamblers in Thailand

This study tested social cognitive theory (Bandura, 1986) hypotheses of reciprocal and sequential effects among person, environment variables and behavior. The study examined the impact of hope, superstitious belief and environmental factors on the frequency, amounts of lottery gambling and chasing of particular numbers among Thai lottery gamblers. One hundred and fifty gamblers who visited two temples in Bangkok to search for number clues before buying tickets and 150 gamblers who simply bought lottery tickets from the stalls were recruited for the study. Models were constructed to test the effect of hope, superstitious belief and environmental factors on gambling behavior, and the reciprocal effect of gambling behavior on hope, superstitious belief and environmental factors. Results confirmed the theoretical reciprocal effects. A sequential effect model showing the effects of environmental factors on superstitious belief, hope and gambling behavior was also constructed and hope was found to be the result of superstitious belief. To reduce lottery gambling, the players need to be warned of their distorted hope and the small chance of winning lottery.

Temperament and character in pathological gambling

OBJECTIVE

We have studied temperament and character in pathological gambling (PG).

METHODS

Thirty-eight DSM-IV verified pathological gamblers (31 males and 7 females; mean age 35.4 +/- 10.4 years) were tested with Cloninger's Temperament and Character Inventory (TCI). Matched controls were chosen from the normal population.

RESULTS

Pathological gamblers scored higher on the temperament factors novelty seeking (NS) and harm avoidance (HA). The most pronounced difference was found in the character factor self-directedness (SD). The pathological gamblers differed from controls in cooperativeness and self-transcendence. A personality disorder was found in 29% of the pathological gamblers 84% of whom scored either low on SD and high on impulsivity or had a more dishonest behaviour. Two-thirds of pathological gamblers showed immature character with or without high HA in temperament. The other third showed normal-character extravagant behaviour (86%), high impulsivity (36%) and less responsibility (50%) being the most common personality traits.

CONCLUSION

HA and NS might be trait-like characteristics in PG.

Prevalence estimates of gambling participation and problem gambling among 16-18-year-old students in Iceland: a comparison of the SOGS-RA and DSM-IV-MR-J

The aim of this study was to estimate gambling participation and problem gambling among Icelandic adolescents. Participants were 750 16-18-year-old students, 371 girls and 379 boys. The rate of problem gambling was estimated with the SOGS-RA and DSM-IV-MR-J. Results indicated that 96% of adolescents had gambled in their lifetime, 79% at least once in the preceding year and about 10% gamble at least once a week. A psychometric evaluation of the two screening scales revealed satisfactory reliabilities and factor structures for both scales. The DSM-IV-MR-J identified 2% of the participants as problem gamblers while SOGS-RA identified 2.7%, and problem gambling was more common among boys than girls. It was concluded that problem gambling among adolescents is an area of concern for the Icelandic community that needs to be further investigated.

Divergent validity of measures of cognitive distortions, impulsivity, and time perspective in pathological gambling

The present study assessed the divergent validity of several self-report and objective behavioral measures for assessing pathological gambling using three samples divided by South Oaks Gambling Scale score [Lesieur, & Blume (1987). American Journal of Psychiatry, 144, 1184-1188]: pathological gamblers, potential pathological gamblers, and non-pathological gamblers. Self-report measures included the Gamblers' Beliefs Questionnaire [GBQ; Steenbergh, Meyers, May, & Whelan (2002). Psychology of Addictive Behaviors, 16, 143-149], the Gambling Passion Scale [GPS; Rousseau, Vallerand, Ratelle, Mageau, & Provencher, (2002). Journal of Gambling Studies, 18, 45-66], the Eysenck Impulsivity Questionnaire [EIQ; Eysenck, & Eysenck (1978). Psychological Reports, 43, 1247-1255], and the Stanford Time Perspective Inventory [STPI; Zimbardo, & Boyd (1999). Journal of Personality and Social Psychology, 77, 1271-1288]. Behavioral tasks included the delay discounting task [Madden, Petry, Badger, & Bickel (1997). Experimental & Clinical Psychopharmacology, 5, 256-263] and the Future Time Perspectives [FTP; Wallace (1956). Journal of Abnormal Psychology, 52, 240-245]. The GBQ, GPS, Impulsivity subscale of the EIQ, and DDT all exhibited robust divergent validity, however, neither measure of time perspective discriminated between groups. Applications of these findings to etiological research and clinical contexts are discussed.

Measuring self-efficacy in gambling: the Gambling Refusal Self-Efficacy Questionnaire

This paper reports on the development and psychometric properties of a Gambling Refusal Self-Efficacy Questionnaire (GRSEQ). Two hundred and ninety-seven gamblers from both normal and clinical populations completed an initial set of 31-items of which 26 were selected for inclusion in the final version of the GRSEQ. A series of factor analyses showed four clear factors accounting for 84% of the variance. These factors can be summarised as situations and thoughts associated with gambling, the influence of drugs on gambling, positive emotions associated with gambling and negative emotions associated with gambling. The GRSEQ total score and factors scores showed high internal consistency (Cronbach's alpha ranging from 0.92 to 0.98). Participants experiencing problems with gambling scored significantly lower on the GRSEQ, and discriminant analyses showed that the scale is able to correctly classify the non-problem (i.e., community and student samples) and problem gamblers (i.e., clinical sample). Furthermore, the GRSEQ showed significant negative relationships with other gambling-related variables (gambling urge and gambling-related cognitions) and negative mood states (depression, anxiety and stress) and was shown to be sensitive to change in treatment of pathological gambling. The results suggest that the GRSEQ is a useful measure of gambling refusal self-efficacy that is suitable for assessment of gamblers from both normal and clinical populations.

Psychosocial Factors Related to Gambling Abstinence and Relapse in Members of Gamblers Anonymous

Problem gamblers account for almost one-third of the industry's total revenue with the adverse effects of problem gambling including significant financial loss, legal and occupational difficulties, family problems, psychological distress and suicide. As such, it is important to understand the influential factors in gambling abstinence and relapse, which will assist in the development of relapse prevention methods in therapeutic treatment regimes. This paper reported the role of a set of seven predictors in distinguishing between abstinent and relapsed gamblers among 75 Gambling Anonymous (GA) members (55 males; 20 females; Mean age 45 years) in Southeast Queensland. The measures taken were meeting Attendance and Participation, Social Support, God Belief, Belief in a Higher Power, Working the 12-steps of Recovery, Gambling Urges and Erroneous Cognitions. Discriminant analysis revealed that the variables separating the two groups were significant, suggesting that GA members achieving abstinence could be distinguished from those who relapsed, with Attendance and Participation, and Social Support contributing the greatest influence on member's ability to abstain from gambling. The findings suggested that GA member's involvement in meetings, and support from family and friends had significant impact on their gambling abstinence. In contrast, increased gambling urges and erroneous cognitions increased the chance of relapse.

Reward-Sensitivity, Inhibition of Reward-Seeking, and Dorsolateral Prefrontal Working Memory Function in Problem Gamblers not in Treatment

Given the central role of perseverative chasing in problem gambling, the present study sought to find evidence for three hypothesized components of perseveration in problem gamblers: reward-sensitivity dominance, deficient inhibition of reward-seeking behavior, and working memory deficits. This was the first attempt to examine working memory deficits in problem gamblers using a conditional association task, which is associated with posterior-dorsolateral prefrontal functioning. In a sample that was not in treatment, and representative in terms of comorbidity, problem gamblers performed significantly worse on the conditional association working memory tasks after controlling for general memory function, compared to demographically-matched controls. This is significant because deficits in the dorsolateral prefrontal region have been consistently associated with perseveration, which suggests that problem gamblers' perseverative chasing may be associated with a working memory deficit. Problem gamblers were not significantly higher than at-risk gamblers in terms of reward-sensitivity dominance (measured as a personality trait in terms of extraversion) suggesting that it may not be specifically associated with problem gambling. Sensation-seeking was also not associated with problem gambling in a sample that corrected for the methodological problems of previous studies which examined it. The need for gambling research to focus specifically on the perseverative inability to stop gambling is emphasized, and the present findings of specific working memory deficits in problem gamblers suggest the need for further examination of working memory as a potential risk factor for problem gambling. We propose that subsequent studies examine working memory in terms of the self-regulatory capacity for goal maintenance where attention must specifically be allocated to resist interference.

Selling dreams-causing nightmares?

A review of the literature leads to the conclusion that there are no reliable figures on the impact of gambling advertising on the extent of problem gambling. To measure that impact appears as a very difficult research task. However, we can infer that gambling advertising does add to problem gambling, but with a smaller impact than other influential factors. Thus, alarming claims that gambling advertising substantially increases problem gambling and reassuring statements from gambling companies that advertising merely affects market share and has no impact on the prevalence of problem gambling both appear to be erroneous. Gambling providers are advised to avoid publishing advertising that elaborates on features of gambling known to relate to problem gambling. The controversial nature of gambling advertising is illustrated by the case of Sweden, where advertising and its impact on problem gambling have been hotly debated over the past decade.

Examining DSM-IV criteria for pathological gambling: psychometric properties and evidence from cognitive biases

We examined the DSM-IV criteria for pathological gambling as assessed with the DSM-IV-based Diagnostic Interview for Gambling Severity (DIGS; Winters, Specker, & Stinchfield, 2002). We first analyzed the psychometric properties of the DIGS, and then assessed the extent to which performance on two judgment and decision-making tasks, the Georgia Gambling Task (Goodie, 2003) and the Iowa Gambling Task (Bechara, Damasio, Damasio, & Anderson, 1994), related to higher reports of gambling pathology. In a sample of frequent gamblers, we found strong psychometric support for the DSM-IV conception of pathological gambling as measured by the DIGS, predictive relationships between DIGS scores and all cognitive performance measures, and significant differences in performance measures between individuals with and without pathological gambling. Analyses using suggested revisions to the pathological gambling threshold (Stinchfield, 2003) revealed that individuals meeting four of the DSM-IV criteria aligned significantly more with pathological gamblers than with non-pathological gamblers, supporting the suggested change in the cutoff score from five to four symptoms. Discussion focuses on the validity of the DSM-IV criteria as assessed by the DIGS and the role of cognitive biases in pathological gambling.

Prevalence of adult problem and pathological gambling between 2000 and 2005: an update

BACKGROUND

Excessive gambling is a prominent Public Health problem with high prevalence rates in many countries. Substance abuse and other co-morbidities often constitute a major health hazard for the person which gambles with a loss of material and social resources, as well as being a major concern for his or her significant others. The present study updates and extends prevalence data to include work published between 2000 and 2005 in English and other European languages.

METHODS

In a three-step search and exclusion process, studies with current adult prevalence rates were gathered.

RESULTS

Almost all studies fulfil basic research standards. The weighted mean prevalence rates for excessive gambling (problem and pathological) are 3.0% for the South Oaks Gambling Survey (problem 1.2%; pathological 1.8%), 3.3% for the Canadian Problem Gambling Index (problem 2.4%; pathological 0.8%) and 3.1% for the DSM-IV (problem 1.9%; pathological 1.2%).

CONCLUSION

The prevalence rates are comparable and relatively stable between countries and across survey instruments, and do not differ from earlier reviews. The regular epidemiological monitoring of excessive gambling remains a major Public Health issue although the distinction between pathological and problem gambling is not appropriate for epidemiological research. Further studies are needed with respect to concomitant lifestyle characteristics.

CSF cholecystokinin, γ-aminobutyric acid and neuropeptide Y in pathological gamblers and healthy controls

The sulphated cholecystokinin (CCK) octapeptide (CCK-8S), the CCK tetrapeptide (CCK-4), neuropeptide Y (NPY) and gamma-aminobutyric acid (GABA) were determined in cerebrospinal fluid (CSF) obtained from 11 pathological male gamblers and 11 healthy male controls. Compared with healthy controls, pathological male gamblers displayed higher concentrations of CCK-8S, CCK-4 and GABA (but not NPY). A gradient with decreasing concentrations from the first to the third 6-ml CSF fraction was found for CCK-8S, CCK-4 and NPY, but only in pathological gamblers. Disrupted gradients were found for GABA and for NPY in healthy controls. Given that CCK is a modulator of dopamine in the reward process, the increase in CCK-8S and CCK-4 is not unexpected. The high level of GABA in pathological gamblers is in conformity with a compensatory inhibitory action on noradrenergic neurons. The CSF gradient of CCK-8S and CCK-4 in pathological male gamblers (but not healthy controls) might indicate a difference in diurnal variation. The results obtained are in line with an altered CCK and GABA function in pathological gambling.

Risikofaktoren des problematischen Glücksspielverhaltens

Zusammenfassung. Theoretischer Hintergrund: Pathologisches Glücksspielverhalten nach DSM-IV oder ICD-10 wird als Impulskontrollstörung diagnostiziert. In diesem Artikel wird der Begriff auf problematisches Glücksspielverhalten erweitert. In der Literatur dominieren zwei theoretische Entstehungsmodelle: das “Sucht-“ und das “Neurosemodell“. Fragestellung: Was sind die Korrelate und Risikofaktoren für die Entstehung und Aufrechterhaltung problematischen Glücksspielverhaltens, welche Implikationen gibt es für die Modellannahmen und für die Behandlung. Methode: Auf der Basis einer Literaturanalyse wird ein Überblick über die bislang gesicherten Risikofaktoren gegeben. Ergebnisse: Es gibt eine Fülle von Querschnittsstudien und einige Längsschnittstudien, die Hinweise auf das Vorliegen einiger gesicherter Korrelate und Risikofaktoren geben. Schlussfolgerungen: Die Befunde unterstützen bestimmte Modellannahmen und sollten in der Prävention und Therapie von Personen mit problematischem Glücksspielverhalten berücksichtigt werden.

Convergent validity of measures of cognitive distortions, impulsivity, and time perspective with pathological gambling

The present study investigated the convergent validity of the Gamblers' Beliefs Questionnaire (GBQ), Gambling Passion Scale (GPS), Eysenck Impulsivity Questionnaire (EIQ), and Stanford Time Perception Inventory (STPI) in reference to pathological gambling. The authors recruited 105 undergraduates representing categories of pathological gamblers, potential pathological gamblers, and nonpathological gamblers and administered the measures under neutral conditions. Both subscales of the GBQ and GPS and the Impulsivity subscale of the EIQ exhibited strong convergent validity, whereas the STPI showed weaker correspondence with symptoms of pathological gambling. Applications and limitations of these findings are discussed.

Risk of harm among gamblers in the general population as a function of level of participation in gambling activities

AIMS

To examine the relationship between gambling behaviours and risk of gambling-related harm in a nationally representative population sample.

DESIGN

Risk curves of gambling frequency and expenditure (total amount and percentage of income) were plotted against harm from gambling.

SETTING

Data derived from 19, 012 individuals participating in the Canadian Community Health Survey-Mental Health and Well-being cycle, a comprehensive interview-based survey conducted by Statistics Canada in 2002.

MEASUREMENT

Gambling behaviours and related harms were assessed with the Canadian Problem Gambling Index.

FINDINGS

Risk curves indicated the chances of experiencing gambling-related harm increased steadily the more often one gambles and the more money one invests in gambling. Receiver operating characteristic analysis identified the optimal limits for low-risk participation as gambling no more than two to three times per month, spending no more than 501-1,000 CAN dollars per year on gambling and investing no more than 1% of gross family income on gambling activities. Logistic regression modelling confirmed a significant increase in the risk of gambling-related harm (odds ratios ranging from 2.0 to 7.7) when these limits were exceeded.

CONCLUSIONS

Risk curves are a promising methodology for examining the relationship between gambling participation and risk of harm. The development of low-risk gambling limits based on risk curve analysis appears to be feasible.

Episodic chasing in pathological gamblers using the Iowa gambling task

"Chasing ones losses" is a key symptom among pathological gamblers (PGs). This study focuses on quantitative differences in episodic chasing (i.e., sequences of disadvantageous decisions within a single gambling session) between PGs and non-pathological gamblers (NPGs). We compared 61 PGs and 39 NPGs on the Iowa Gambling Task (IGT) and the Zuckerman Sensation Seeking Scale (SSS). The PGs showed significantly more chasing and had significantly poorer decision-making strategies than NPGs, particularly among males (F = 4.52, p < 0.05). Random players were significantly less sensation seeking than advantageous and disadvantageous (i.e., chasing) players, but there was no interaction with group or gender. The results suggest that quantifiable within-session gambling behavior holds important implications for detecting underlying vulnerabilities to gambling pathology.

Screening for Internet Addiction: An Empirical Study on Cut-off Points for the Chen Internet Addiction Scale

The aim of this study was to establish the optimal cut-off points of the Chen Internet Addiction Scale (CIAS), to screen for and diagnose Internet addiction among adolescents in the community by using the well-established diagnostic criteria of Internet addiction. This survey of 454 adolescents used screening (57/58) and diagnostic (63/64) cut-off points of the CIAS, a self-reported instrument, based on the results of systematic diagnostic interviews by psychiatrists. The area under the curve of the receiver operating characteristic curve revealed that CIAS has good diagnostic accuracy (89.6%). The screening cut-off point had high sensitivity (85.6%) and the diagnostic cut-off point had the highest diagnostic accuracy, classifying 87.6% of participants correctly. Accordingly, the screening point of the CIAS could provide a screening function in two-stage diagnosis, and the diagnostic point could serve as a diagnostic criterion in one-stage massive epidemiologic research.

[Pathological gambling. An empirical study of the desire for addictive substances]

Drug craving, the irresistible urge for drug intake, is being discussed as a central construct for the explanation of addictive behaviour and for relapses so far only in substance-related addiction. Based on learning models for the maintenance of addiction, in this study, cue-induced craving and psychological variables that influence craving were investigated in subjects with excessive rewarding behaviour such as pathological gambling. Based on the cue-reactivity paradigm, pathological gamblers and healthy controls were exposed to gambling and other cues. Emotional processing of the gambling cues, cue-induced craving, and the influence on craving of depression, anxiety, and stress-coping strategies were investigated. The results demonstrate disorder-specific processing of cues in pathological gamblers, even after abstinence for more than a year. In addition, craving is influenced by psychological disabilities. Data are discussed with respect to comparable data in studies about substance-related addicts.

Comparison of Craving Between Pathological Gamblers and Alcoholics

BACKGROUND

Craving is a central phenomenon in addiction. Temperament factors are also important for pathologic gambling and other addictions. The aim of this study was to compare craving between pathologic gamblers (PG) and alcohol-dependent subjects (ADS), correlating craving with personality.

METHODS

Forty-nine PG and 101 ADS willing to start treatment were recruited. A trained psychiatrist diagnosed them according to DSM-IV criteria. To be included in this study, subjects had to be abstinent for at least five days and no longer than 21 days. Alcoholics should have no significant physical withdrawal symptoms by the time of craving assessment. Subjects with current comorbidity with other addictions were excluded, except nicotine. ADS rated craving for alcohol and PG rated craving for gambling on the same questions, respectively. Both answered a semistructured interview, the Temperament and Character Inventory and the Beck Scales for anxiety and depression.

RESULTS

Pathologic gamblers scored higher than ADS on craving measures (p<0.001) and novelty seeking (p=0.01). ADS scored higher in harm avoidance (p=0.01). Alcohol craving correlated positively with anxiety and novelty seeking and negatively with length of abstinence and persistence. Gambling craving correlated positively with depression and negatively with length of abstinence and reward dependence

CONCLUSIONS

Pathologic gamblers experienced stronger cravings than did ADS. This may be a disturbing experience for PG and a potential cause for relapse. The higher scores on novelty seeking concur with previous studies that associate PG and impulsivity. ADS higher scores on harm avoidance suggest anxiety vulnerability. The positive relation between alcohol craving, anxiety, and harm avoidance suggests that ADS rely on alcohol to deal with a proclivity to negative emotions. The positive relation of gambling craving to depression and negative relation to reward dependence suggests that individuals who have a lesser susceptibility to experience positive emotions are the ones who most miss gambling when abstaining.

Freqüência de jogo patológico entre farmacodependentes em tratamento

OBJETIVO: Investigar a freqüência de jogo patológico entre dependentes de álcool e/ou outras drogas que procuraram tratamento em serviço especializado. MÉTODOS: Foram entrevistados 74 pacientes de três serviços especializados em tratamento de farmacodependência. Para diagnóstico de jogo patológico foi utilizada a escala SOGS (South Oaks Gambling Screen). O diagnóstico de dependência de álcool e de outras drogas foi estabelecido a partir dos critérios do DSM-IV e da escala SADD (Short Alcohol Dependence Data). Foram aplicadas as versões brasileiras das escalas SRQ (Self Report Questionnaire) para detecção de sintomas de psiquiátricos e CES-D (Center for Epidemiological Studies Depression Scale) para sintomas depressivos. As médias da pontuação obtida nessas escalas foram comparadas pelo teste t de Student. RESULTADOS: Todos os sujeitos preencheram critério para farmacodependência, sendo que 61,6% preencheram critérios para dependência de álcool 60,3% para cocaína/crack, e 34,2% para maconha. Segundo a escala SOGS, a maioria dos farmacodependentes (70,3%) foi classificada como jogador social, 10,8% como "jogador problema" e 18,9% como jogador patológico. Confirmou-se a presença de sintomas psiquiátricos e depressão na amostra. Pacientes jogadores patológicos apresentaram mais sintomas depressivos que pacientes não jogadores patológicos. CONCLUSÕES: Foi encontrada alta freqüência de jogo patológico entre os farmacodependentes entrevistados. Os resultados mostram a importância da investigação de jogo patológico em pacientes farmacodependentes e inclusão de estratégias para o tratamento desse transtorno nos programas de tratamento.

The gambling urge scale: development, confirmatory factor validation, and psychometric properties

The urge to gamble is a physiological, psychological, or emotional motivational state, often associated with continued gambling. The authors developed and validated the 6-item Gambling Urge Questionnaire (GUS), which was based on the 8-item Alcohol Urge Questionnaire (M. J. Bohn, D. D. Krahn, & B. A. Staehler, 1995), using 968 community-based participants. Exploratory factor analysis using half of the sample indicated a 1-factor solution that accounted for 55.18% of the total variance. This was confirmed using confirmatory factor analysis with the other half of the sample. The GUS had a Cronbach's alpha coefficient of.81. Concurrent, predictive, and criterion-related validity of the GUS were good, suggesting that the GUS is a valid and reliable instrument for assessing gambling urges among nonclinical gamblers.

Assessing and treating problem gambling: empirical status and promising trends

OBJECTIVE

Ways to clinically assess and treat problem gambling evolve as our knowledge about this disorder increases. This paper summarizes current knowledge about treating problem gambling and describes developments in the assessment, psychology, and biology of problem gambling that may be important for treatment.

METHODS

We reviewed recent published literature reporting advances in the assessment, psychology, and biology of problem gambling. We retained for review only controlled clinical trials in which subjects were randomized to either psychological or pharmacologic treatment.

RESULTS

Although several gambling treatments were found to be efficacious, support for any specific treatment modality is still limited. Cognitive-behavioural treatments were most effective. Although diagnostic assessment has improved, there are still very few measures of gambling-related variables. The contribution to gambling of sex, concurrent psychiatric disorders, cognitive distortions, and impulsivity has been described. Evidence implicating decision-making areas of the cortex and disturbances in serotonin and dopamine functioning has been reviewed. Available evidence for a genetic contribution to problem gambling is weak.

CONCLUSIONS

Improvements in the methodology of gambling-treatment research were discussed to advance the clinical approach to this disorder. Developments in the area of assessment, psychology, and biology of gambling should inform clinical approaches to a greater degree than they currently do. We identified the need to study different types of gambling separately, rather than combining them, as an important goal.

The Gambling Related Cognitions Scale (GRCS): development, confirmatory factor validation and psychometric properties

AIMS

The aims of this study are to develop and validate a measure to screen for a range of gambling-related cognitions (GRC) in gamblers.

DESIGN AND PARTICIPANTS

A total of 968 volunteers were recruited from a community-based population. They were divided randomly into two groups. Principal axis factoring with varimax rotation was performed on group one and confirmatory factor analysis (CFA) was used on group two to confirm the best-fitted solution.

MEASUREMENTS

The Gambling Related Cognition Scale (GRCS) was developed for this study and the South Oaks Gambling Screen (SOGS), the Motivation Towards Gambling Scale (MTGS) and the Depression Anxiety Stress Scale (DASS-21) were used for validation.

FINDINGS

Exploratory factor analysis performed using half the sample indicated five factors, which included interpretative control/bias (GRCS-IB), illusion of control (GRCS-IC), predictive control (GRCS-PC), gambling-related expectancies (GRCS-GE) and a perceived inability to stop gambling (GRCS-IS). These accounted for 70% of the total variance. Using the other half of the sample, CFA confirmed that the five-factor solution fitted the data most effectively. Cronbach's alpha coefficients for the factors ranged from 0.77 to 0.91, and 0.93 for the overall scale.

CONCLUSIONS

This paper demonstrated that the 23-item GRCS has good psychometric properties and thus is a useful instrument for identifying GRC among non-clinical gamblers. It provides the first step towards devising/adapting similar tools for problem gamblers as well as developing more specialized instruments to assess particular domains of GRC.