The prevalence of problem and pathological gambling: A critical analysis

Reduced Risk-Taking After Prior Losses in Pathological Gamblers Under Treatment and Healthy Control Group but not in Problem Gamblers

A group of pathological gamblers and a group of problem gamblers (i.e., gamblers at risk of becoming pathological) were compared to healthy controls on their risk-taking propensity after prior losses. Each participant played both the Balloon Analogue Risk Taking task (BART) and a modified version of the same task, where individuals face five repeated predetermined early losses at the onset of the game. No significant difference in risk-taking was found between groups on the standard BART task, while significant differences emerged when comparing behaviors in the two tasks: both pathological gamblers and controls reduced their risk-taking tendency after prior losses in the modified BART compared to the standard BART, whereas problem gamblers showed no reduction in risk-taking after prior losses. We interpret these results as a sign of a reduced sensitivity to negative feedback in problem gamblers which might contribute to explain their loss-chasing tendency.

Daily Fantasy Football and Self-Reported Problem Behavior in the United States

Traditional, season-long fantasy sport participation has grown considerably since the late 1990s, and in an attempt to capitalize on this growing demand, daily fantasy sports (DFS) providers have created a new game where money changes hands instantly. This change has led some legal commentators and state agencies to believe the game is a form of Internet gambling similar to online poker, blackjack, and sports wagering, and thus, it requires increased regulation or even prohibition. Little is known, however, about the gambling behavior associated with DFS participation. Thus, the purpose of the current study was to examine problem gambling severity in conjunction with DFS participant motives, perceptions, and consumption behavior. Over 500 DFS participants were surveyed, and the results suggest DFS participants behave similarly with participants in other forms of gambling activities. In addition, the findings suggest additional consumer protections may be needed to prevent further problem behavior such as chasing.

Impact of alcohol consumption on clinical aspects of gambling disorder

Similarities between gambling disorder and substance use disorders have been extensively described. To date, however, few studies using large clinical samples have been carried out that reliably assess the relationship between different levels of alcohol consumption and gambling disorders. The present study aimed to assess the impact of baseline alcohol consumption levels on the clinical profile in a large sample of treatment-seeking individuals. Nine hundred and fifty-one consecutive outpatients diagnosed with gambling disorder according to DSM-IV criteria were compared after being included in three alcohol consumption groups (low risk, abuse and risk of dependence) based on their total raw scores on the AUDIT questionnaire. Results showed a high prevalence of risk of alcohol dependence in GD patients who were immigrants, unemployed, and had a low level of education. A positive linear trend was also found between alcohol consumption level and the prevalence of other current and life-time comorbid mental disorders, and for the presence of drug abuse. Statistically significant differences were found between the three alcohol consumption groups in terms of the evolution and severity of the gambling disorder, self-directedness personality trait, and levels of general psychopathology, hostility and paranoid ideation. In conclusion, the results showed an association between increased alcohol consumption and greater dysfunction.

Genetic and Environmental Influences on Gambling: A Meta-Analysis of Twin Studies

Disentangling the genetic and environmental influences of gambling is important for explaining the roots of individual differences in gambling behavior and providing guidance for precaution and intervention, but we are unaware of any comprehensive and systematic quantitative meta-analysis. We systematically identified 18 twin studies on gambling in the meta-analysis. The correlation coefficients within monozygotic (MZ) and dizygotic (DZ) twins, along with the corresponding sample size, were used to calculate the proportion of the total variance accounted for by additive genes (A), dominant genes (D), the shared environment (C), and the non-shared environment plus measurement error (E). We further assessed the moderating effects of gambling assessment (symptom oriented assessment vs. behavior oriented assessment), age, and sex. The whole sample analyses showed moderate additive genetic (a² = 0.50) and non-shared environmental influences (e² = 0.50) on gambling. The magnitude of the genetic influence (a²) was higher for disordered gambling assessed with symptom oriented assessment (53%) than for general gambling assessed with behavior oriented assessment (41%). Additionally, the magnitude of the genetic influence (a²) was higher for adults (53%) than adolescents (42%). Genetic influence (a²) was greater for male (47%) gambling than female (28%) gambling. Shared environment had noticeable effects on female gambling (c² = 14%) but zero effect on male gambling. In conclusion, gambling behavior was moderately heritable and moderately influenced by non-shared environmental factors. Gambling assessment, age, and sex significantly moderated the magnitude of genetic and environmental influences on gambling. Note that the number of studies might serve as a limitation.

Assessment of High School Students’ Understanding of DSM-IV-MR-J Items

The current study examines the understanding of the DSM-IV-MR-J items to assess pathological gambling among adolescents aged 12 to 15, and explores its accuracy. The DSM-IV-MR-J was first administered in the classroom. Participants were assigned to either an experimental or a control group. Participants in the first group were asked to explain the meaning of each DSM-IV-MR-J item during an individual interview. If the item was not properly understood, the investigator corrected the participant’s understanding of the item. The questionnaire was then administered a second time. The control group was only submitted to a test-retest procedure. The results showed that 22% of the items were misunderstood. Changes in diagnostic categories emerged on the second administration for both groups. A 20% and 29.4% decrease in the number of problem/pathological gamblers was observed in the experimental and control group. The implications of these results are discussed in terms of the reliability of the DSM-IV-MR-J as a measure of problem gambling among adolescents.

Gambling participation and policies in Malaysia

Regulatory policies for responsible gambling practices in Asia are constantly evolving as the gambling industry and technological landscape change over time. Malaysia makes an interesting case study for a commentary on gambling participation and policies, as this country has a unique dual justice system with religious and ethnic diversity that may impact on the way in which gambling activities are regulated. This regulatory ecosystem has important consequences on behaviour change, treatment approaches and recovery processes involved in gambling disorder. This commentary will discuss evidence for Malaysian gambling antecedents, public policy and socioeconomic impacts of gambling, possible costs and benefits of gambling legalization, and issues pertinent to regulating gambling activities in Malaysia.

Construct Development for the FocaL Adult Gambling Screen (FLAGS): A Risk Measurement for Gambling Harm and Problem Gambling Associated with Electronic Gambling Machines

This is the first of two papers describing the development of the FocaL Adult Gambling Screen for Electronic Gambling Machine players (FLAGS-EGM). FLAGS-EGM is a measurement approach for identifying gambling risk, a tool that incorporates separate reflective and formative constructs into a single instrument. A set of statements was developed that captured ten constructs associated with gambling risk or which were considered components of problem gambling. Following completion of focus groups with regular slot players, a survey with the reduced set of statements was then administered to a sample of 374 casino slot players in Ontario, Canada. Nine of the proposed constructs passed tests for reliability and validity (Risky Cognitions Beliefs, Risky Cognitions Motives, Preoccupation Desire, Risky Practices Earlier, Risky Practices Later, Impaired Control Continue a Session, Impaired Control Begin a Session, Negative Consequences, and Persistence). A tenth construct (Preoccupation Obsession) requires further development through the addition of improved statements.

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

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

The Role of Cultural Factors in Differentiating Pathological Gamblers

It is recognised that cultural factors play a role in the onset and continuation of several mental health problems. However, there is a significant lack of empirical studies investigating the relationships between cultural factors and gambling behavior. This study assessed whether the subjective cultures through which subjects interpret and enact their experience of the social environment play a major role in increasing (or decreasing) the probability of pathological gambling. Participants, recruited in three different contexts (public health services for the treatment of addiction, casino, undergraduate course) were subjected to the South Oaks Gambling Screen (SOGS) (Lesieur and Blume in Am J Psychiatry 144(9):1184-1188, 1987), in order to identify a group of pathological gamblers-and with the Questionnaire on the Interpretation of the Social Environment (QUISE) (Mossi and Salvatore in Eur J Educ Psychol 4(2):153-169, 2011)-in order to detect their subjective cultures. The study compares pathological group (scoring >5 on SOGS, n = 34) and a healthy control group (scoring <1 on SOGS, n = 35). One-way analysis of variance (ANOVA) was used to compare groups on QUISE scores of subjective culture. Moreover, a logistic regression was applied in order to esteem the capability of the QUISE scores to differentiate between pathological gamblers and control. The results are consistent with the hypothesis that pathological group expresses different subjective cultures compared with no gambler subjects. The theoretical and clinical implications of the results are discussed.

Criterion-related and construct validity of the Problem Gambling Severity Index in a sample of South African gamblers

The Problem Gambling Severity Index, the scored module of the Canadian Problem Gambling Index, is a population-based survey instrument that is becoming the preferred epidemiological tool for estimating the prevalence of disordered gambling. While some validation evidence for the Problem Gambling Severity Index is available, very little is known about its psychometric characteristics in developing countries or in countries the populations of which are not highly Westernised. The aim of this study was to investigate the validity of the Problem Gambling Severity Index with a specific focus on its criterion-related and construct (concurrent) validity in a community sample of gamblers in South Africa ( n = 127). To this end, the Problem Gambling Severity Index was administered alongside the Diagnostic Interview for Gambling Severity and measures known to associate with gambling severity (impulsivity, current debt, social problems, financial loss, race, sex). Results showed that the Problem Gambling Severity Index was predictive of Diagnostic Interview for Gambling Severity diagnosis from both a categorical and dimensional point of view and demonstrated high discrimination accuracy for subjects with problem gambling. Analysis of sensitivity and specificity at different cut-points suggests that a slightly lower Problem Gambling Severity Index score may be used as a screening cut-off for problem gambling among South African gamblers. The Problem Gambling Severity Index also showed significant correlations with the Barratt Impulsiveness Scale, a widely known measure of impulsivity, and with some of the predicted behavioural variables of interest (gambling activities, money lost to gambling, current debt, interpersonal conflict). This article therefore demonstrates initial criterion and concurrent validity for the Problem Gambling Severity Index for use in South African samples.

An examination of the relationship between gambling and antisocial behavior

Problem gambling is significantly more prevalent in forensic populations than in the general population. Although some previous work suggests that gambling and antisocial behavior are related, the extent and nature of this relationship is unclear. Both gambling and antisocial behavior are forms of risk-taking, and may therefore share common determinants. We investigated whether individual differences in personality traits associated with risk-taking, the Big Five personality traits, and antisocial tendencies predicted gambling and antisocial behavior among 180 male students recruited for a study of gambling (35.0% non-problem gamblers, 36.7% low-risk gamblers, 21.7% problem gamblers, and 6.7% pathological gamblers). All forms of gambling and antisocial behavior were significantly correlated. Personality traits associated with risk-acceptance explained a significant portion of the variance in problem gambling, general gambling involvement, and all forms of antisocial behavior. Antisocial tendencies (aggression and psychopathic tendencies) explained a significant portion of additional variance in severe antisocial behavior but not moderate or minor antisocial behavior. When controlling for personality traits associated with risk-acceptance, the relationship between gambling and antisocial behavior was greatly diminished. The results are consistent with the hypothesis that gambling and antisocial behavior are associated because they are, in part, different manifestations of similar personality traits.

Effects on Gambling Behaviour of Developments in Information Technology

The rapid growth and acceptance of online gambling is concerning to academics and clinicians in the field of pathological gambling research. This study proposes a theoretical framework that outlines the effect of technological developments in information technology (IT) on gambling behaviour. The aim of the study is to produce theoretical propositions that can be investigated empirically in future research. Grounded Theory was employed to enable a theoretical framework to conceptualise online gambling behaviour and the utility of IT in gambling behaviour. In total, eight participants were interviewed via semi-structured interviews until theoretical saturation was achieved. The theoretical framework was contrasted against existing problem gambling research. Grounded Theory has indicated that developments in IT have been a catalyst for Elevated Gambling Involvement, in terms of both participation and pre-occupation, and that this phenomenon was produced via the following behavioural constructs: Increased Outcome Control, Reduced Discipline, Expediency and Consumer Value.

Motivation to change and pathological gambling: analysis of the relationship with clinical and psychopathological variables

OBJECTIVES. The present study analyses the internal factor structure of the University of Rhode Island Change Assessment (URICA) Scale in pathological gambling (PG). The scale's association with the clinical profile of patients is also evaluated. METHOD. The factor analysis was based on a sample of 531 men with a DSM-IV diagnosis of pathological gambling. The statistical analysis included confirmatory factor analysis and linear correlation. RESULTS. The analyses confirmed the internal structure obtained for the URICA. The internal consistency was satisfactory (Cronbach's alpha between .74 and .85). The association between URICA scores and the socio-demographic and clinical profile of patients ranged between moderate and weak (R coefficients below .30). Lower motivation was present in 28.4% of cases and it was associated with shorter duration of the disorder, lower severity of the PG symptoms, and high psychopathology. Conclusions. The results support the validity and reliability of the URICA in a Spanish clinical population of pathological gamblers.

Personality, perceived luck and gambling attitudes as predictors of gambling involvement

A quantitative observational study was undertaken to examine the relationship between individual factors and level of gambling involvement, in particular problem gambling (PG). The specific factors under study were personality, perceived luck, and attitudes towards gambling. A sample of university students (N = 185) completed a battery of questionnaires, consisting of the 16PF, Canadian Problem Gambling Index, Belief in Good Luck Scale (BIGL), Gambling Attitudes Scale (GAS), and the Impulsive Non-Conformity subscale (ImpNon) from the Oxford-Liverpool Inventory of Feelings and Experiences. Four groups were formed (Non-PG, Low-Risk, Moderate-Risk, and PG). Personality profiles varied between groups, and there were significant main effects and interaction effects on gender and personality factors. The PG group was higher on impulsivity, and belief in luck, and had more positive attitudes towards gambling. Multiple Regression Analysis and Discriminant Functions Analysis, using variables including some 16PF factors, BIGL and GAS variables, produced models that were highly predictive of gambling severity and gambling membership. In both models, impulsivity was the strongest predictor. These results were discussed in terms of their implications for future research and treatment of PG.

Comorbidity in pathological gambling: clinical variables, personality and treatment response

INTRODUCTION

Pathological gambling shows high comorbidity rates, especially with substance use disorders, although affective, anxiety and other impulse control disorders, as well as personality disorders, are also frequently associated.

OBJECTIVES

To explore comorbidity in pathological gambling with other mental disorders in a consecutive sample of patients attending a unit specialized in pathological gambling, and specifically the relationship between substance-related disorders, on the one hand, and personality and clinical variables in pathological gamblers, on the other.

METHOD

A total of 498 patients with a DSM-IV-TR diagnosis of Pathological Gambling (11.8% women) were assessed with a semi-structured clinical interview and several clinical and personality scales.

RESULTS

Higher comorbidity with affective disorders was found in women (30.5%), while higher comorbidity with substance-related disorders was found in men (11.2%). A positive association was also detected between a history of psychiatric disorders and current comorbidity with substance-use disorders, as well as between alcohol abuse and age. Finally, some personality traits such as low reward dependence (OR=0.964) and high impulsivity (OR=1.02) predicted other substance abuse (not alcohol). High selftranscendence scores predicted both alcohol and other substance abuse (OR=1.06).

CONCLUSIONS

Our results suggest a high prevalence of comorbid disorders in pathologic gambling, mainly with affective and substance-related disorders. The results of the present study, conducted in a broad sample of consecutively admitted pathologic gamblers, may contribute to understanding of this complex disorder and treatment improvement.

The prevalence of problematic gambling behaviour: A Scandinavian comparison

Aims: On the basis of a new large-scale screening for the prevalence of problematic gambling behaviour in Denmark, the aim of the study was: (a) to evaluate the effect of applying different screening tools; and (b) to compare gambling behaviour in Denmark with the prevalence of problematic gambling behaviour in other Scandinavian countries. Methods: The screening tools applied were the internationally validated SOGS-R and NODS. These were used within the same survey, thus allowing for comparison with surveys conducted in other Scandinavian countries where either the one or the other tool has been utilized. Results: The prevalence of at-risk gamblers, problematic gamblers and pathological gamblers was significantly lower in Denmark than in the other Scandinavian countries. This held true for both genders as well as for different age groups in comparisons of Denmark and Norway. Conclusions: There is a considerable variation in the prevalence of problematic gambling between the Scandinavian countries, with Denmark having the smallest number of gamblers with problematic behaviour. The variation might be due to national differences in gambling preferences, access to games, public policies concerning gambling, etc., but investigation of this would require further comparative research.

Inconsistency between concept and measurement: The Canadian Problem Gambling Index (CPGI)

"Problem" and "pathological" gambling represent core concepts that guide gambling research today. However, divergent interpretation of the relation between these terms is continually misguiding the measurement and interpretation of empirical data, and may cumulatively lead to larger-scale problems of conclusion and policy formulation over the next decade. This paper first attempts to unravel the conceptual muddle by outlining the trajectory of the usage of the two terms, from a period where both were dimensionally similar concepts firmly situated in the addiction model to a more recent conception, which takes the view that problem gambling is distinct and properly measured by focusing on the problems that excessive gambling may cause to individuals, families, and communities. We then aim to analyse and criticize the Canadian Problem Gambling Index (CPGI) as a clear example of the confusion of paradigms, an index that defines problem gambling in the newer, problem-centred model, but continues to measure it with items reflecting the older, addiction-centred model. We argue that results obtained using the CPGI, much like those of its predecessors, will not adequately capture the notion of harm that underpins current definitions of problem gambling.

Evaluating the problem gambling severity index

A large, integrated survey data set provided by the Ontario Problem Gambling Centre was used to investigate psychometric properties of the Problem Gambling Severity Index (PGSI). This nine-item self-report instrument was designed to measure a single, problem gambling construct. Unlike its nearest competitor--the South Oaks Gambling Screen (SOGS)--the PGSI was designed specifically for use with a general population rather than in a clinical context. The present analyses demonstrated that the PGSI does assess a single, underlying, factor, but that this is complicated by different, multiple factor structures for respondents with differing levels of problem gambling severity. The PGSI also demonstrated small to moderate correlations with measures of gambling frequency and faulty cognitions. Overall, the PGSI presents a viable alternative to the SOGS for assessing degrees of problem gambling severity in a non-clinical context.

Differences in monthly versus daily evaluations of money spent on gambling and calculation strategies

This study investigated whether reported amounts of money spent on gambling - when calculated retrospectively on a monthly basis - differ from the amounts recorded on a daily basis. Participants were required to retrospectively report monthly gambling expenditure and also complete a "daily gambling expenditure chart" for 4 weeks. Fifty participants responded to a media call for volunteers and completed the data collection. Results indicate that retrospective estimates of a previous month's expenditures tend to be lower than daily self-reported expenditures. Further, results show that an often-used, conventional self-report gambling question tends to over-estimate expenditures in comparison with calculations using a net expenditure strategy. The findings indicate important biases when reporting gambling losses, thus casting doubt on the validity of estimated gambling expenditures. The implications of these results suggest possible inconsistencies in gambling literature based on players' estimates of previous gambling expenditures.

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.

SOGS and CGPI: parallel comparison on a diverse population

The Northern Territory of Australia, one of the most demographically and socially diverse jurisdictions in the country, conducted its first population-based gambling and problem gambling prevalence survey in 2005. Both the South Oaks Gambling Screen (SOGS) and the Canadian Problem Gambling Index (CPGI) were administered to the same sample of respondents. Using data from this survey, the current paper presents a parallel comparison of the respective screens with particular reference to gender, region, and the socio-demographic characteristics of respondents. The respective screens produced significantly different groups of problem gamblers as measured by their association with a range of socio-demographic variables. Specifically, the large number of SOGS items related to money issues may cause selective overrepresentation among low socioeconomic groups, including Indigenous people, who exist in relatively high proportions in the Northern Territory. In addition, there existed substantial gender-based differences within screens. Identified female problem gamblers were associated with household level variables (i.e. employment status, household type and marital status), while males were associated with socio-economic variables including language, education, and income. Further research is required to validate the use of problem gambling screens within the Indigenous population and to understand the role of gender in the experience and categorisation of problem gambling.

A Canadian population level analysis of the roles of irrational gambling cognitions and risky gambling practices as correlates of gambling intensity and pathological gambling

Using population data (N = 11,562) drawn from five Canadian gambling prevalence surveys conducted between 2000 and 2005, the current study investigated the relationship between irrational gambling cognitions and risky gambling practices upon (a) gambling intensity, as measured by percent of income spent on gambling and (b) tolerance, a diagnostic indicator of pathological gambling. First, we found irrational gambling cognitions and risky gambling practices to be positively related. Second, irrational gambling cognitions moderated the relationship between risky gambling practices and gambling intensity. Specifically, people engaging in risky practices, spent less of their income on gambling when they had fewer irrational gambling cognitions compared to those with more irrational cognitions. Third, irrational gambling cognitions moderated the relationship between risky gambling practices and tolerance. Of the people engaging in risky practices, those with no irrational cognitions reported lower levels of tolerance than those with at least one irrational cognition. Interactions with gender are reported and discussed. These findings demonstrate the importance of both gambling cognitions and gambling practices upon the intensity of gambling and pathological gambling.

Gambling screens: does shortening the time frame affect their psychometric properties?

Gambling screening tools such as the South Oaks Gambling Screen (SOGS) and a DSM-IV Screen for Gambling Problems (NODS) developed by the National Opinion Research Council have psychometrically validated lifetime and past-year versions. As research questions often dictate shorter time intervals, researchers have adapted the time frames of these instruments to their specific purposes without examining whether changing the time frame affects the psychometric properties. In this study, 3-month versions of SOGS and NODS were administered to a sample of 80 pathological gamblers (59 men, 21 women, mean age 44) seeking treatment at a state-funded facility. The 3-months versions had good internal consistency, good convergent validity with each other, with gambling behaviors assessed via the timeline followback method, and with measures of impulsivity. The 3-month versions also showed good discriminant validity with demographic variables and a measure of verbal IQ. Together the data indicate that shortening the time frame to 3 months does not seem to have adverse effects on the psychometric properties of SOGS and NODS. Thus these adapted versions could profitably be used for shorter time intervals, including as pre/post-treatment and follow-up measures in treatment outcome studies.

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.

The South Oaks Gambling Screen (SOGS): A rebuttal to critics

A review of the literature reveals strong support for the construct validity of interpretations based on scores obtained with the original and more recent versions and/or variants of the South Oaks Gambling Screen (SOGS). Criticisms of the SOGS are shown to lack merit, to be offset by more important criteria, or to be no longer relevant. The evidence reviewed indicates that the construct of pathological gambling as represented by the SOGS and its variants provides a robust definition and implies that the SOGS meets the important criterion of validity generalization. The construct of chasing and behaviors related to chasing is shown to provide powerful measures by which to discriminate between the presence and absence of pathological gambling. The viability of the SOGS to continue to make important contributions to the understanding of pathological gambling is discussed in terms of the criteria for selecting a research instrument.

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.

Interpreting prevalence estimates of pathological gambling: Implications for policy

Some guidelines for interpreting prevalence estimates for the purpose of establishing the number of pathological gamblers in the community are presented. The analysis is based on the concept of the likelihood ratio, a recommended procedure for validating criteria for defining cases based on test scores. It is shown that the likelihood ratio can be employed with available estimates of prevalence to translate cut-off scores into positive predictive value. Those cut-off scores associated with high positive predictive values provide an empirical measure of confidence that those gamblers who meet or exceed the cut-off criterion are pathological gamblers. A potential limitation of the analysis is the possible specificity of results to the validation studies employed to compute likelihood ratios and to the specific estimates of prevalence used to determine positive predictive value. A recommendation is presented for obtaining study- or community-specific validation evidence.

Prevalence of pathological gambling in Quebec in 2002

OBJECTIVE

To assess gambling behaviours and the problems associated with pathological gambling among the adult population of Quebec in 2002.

METHOD

In Phase 1 of this 2-phase study, a total sample of 8842 adults was assessed. We used the South Oaks Gambling Screen (SOGS), adapted for telephone interview, to assess one-half of the sample; the other one-half was evaluated with the Canadian Problem Gambling Index (CPGI). In the study's second phase, we compared the classifications obtained from these screening instruments with classifications obtained by a psychologist using a semistructured clinical telephone interview.

RESULTS

The results indicate that the prevalence of pathological gambling in 2002 (at which time 0.8% of the adult population were classified as probable pathological gamblers) did not differ from the proportion obtained in 1996 (1.0%), despite the significant decrease in gambling participation in 2002 (81% vs 90% in 1996). The most popular gambling activities were buying lottery tickets (68%), participating in fundraising draws (40%), gambling in casinos (18%), playing cards with family or with friends (10%), playing bingo (9%), and playing video lotteries (8%). The findings obtained from the SOGS and the CPGI revealed that the 2 instruments perform similarly when identifying pathological gambling prevalence. However, the results of the semistructured clinical telephone interviews differed from the results obtained with the screening instruments: 82% of the gamblers initially identified as probable pathological gamblers by the SOGS or the CPGI were not confirmed by a clinical interview.

CONCLUSION

The discrepancy between the results of the screening questionnaires and the clinical evaluation is significant, and this difference needs to be addressed before further cross-sectional or longitudinal studies are conducted.

The road less travelled: moving from distribution to determinants in the study of gambling epidemiology

This article reviews the current status of gambling epidemiology studies and suggests that it is time to move from general population-prevalence research toward the investigation of risk and protective factors that influence the onset of gambling disorders. The study of incidence among vulnerable and resilient populations is a road yet to be taken. In this review, we briefly introduce the history of the field and thoroughly review the epidemiologic research on disordered gambling before providing a critical assessment of the current diagnostic tools. Overall, the extant research shows that disordered gambling is a relatively stable phenomenon throughout the world. Given that certain segments of the population (for example, adolescents and substance users) have elevated prevalence rates, we suggest focusing future prevalence studies on groups with apparently increased vulnerability. Moreover, we suggest that, for the field of gambling studies to progress, researchers need to take the road less travelled and examine more carefully the onset and determinants of disordered gambling. That said, given the problems with the current diagnostic screens, investigators need to refine their theoretical concepts and the epidemiologic tools used to examine them before the field can travel down this new road.

Comparisons between the South Oaks Gambling Screen and a DSM-IV-based interview in a community survey of problem gambling

OBJECTIVE

To directly compare 2 forms of assessment for determining gambling problems in a community survey, and to examine the characteristics of respondents who endorsed DSM-IV symptoms but who scored below the formal DSM-IV diagnostic cut-off for pathological gambling.

METHOD

We interviewed 1489 Winnipeg adults by phone (response rate 70.5%) using th South Oaks Gambling Screen (SOGS), a DSM-IV-based instrument, and several gambling-related variables.

RESULTS

The lifetime prevalence of "probable pathological gambling" (according to the SOGS, having a score of > or = 5) was 2.6%. The SOGS items and DSM-IV symptoms were highly correlated (r = 0.80), but a score of 5 or more symptoms for a DSM-IV diagnosis produced lower prevalence figures. Comparisons between recreational gamblers (those with no DSM-IV symptoms), subthreshold pathological gamblers (those with 1 to 4 DSM-IV symptoms), and pathological gamblers (those with > or = 5 DSM-IV symptoms) on series of gambling-related variables (for example, high use of video lottery terminals) revealed that subthreshold individuals significantly differed from recreational gamblers and more closely approximated the characteristics displayed by pathological gamblers.

CONCLUSIONS

SOGS items show a high degree of association with the DSM-IV clinical symptoms of pathological gambling, but the DSM-IV cut-off of 5 symptoms is more conservative in defining gambling problems. Results support a continuum view of gambling problems in the community. DSM-IV scores of 3 or 4 represent the higher end of the group officially considered diagnostically "subthreshold" and may be important from both a clinical and public health perspective.

Is the SOGS an accurate measure of pathological gambling among children, adolescents and adults?

The South Oaks Gambling Screen (SOGS) is widely used to assess the prevalence of pathological gambling. For a variety of reasons, this instrument may not provide an accurate rate of the prevalence of pathological gambling. In this paper, one source of error in data provided by the SOGS is investigated. It is argued that individuals may not fully understand the meaning of some items, and that clarification of the meaning of misunderstood items may in some cases lead to a changed score on the scale. The present study evaluates respondents' understanding of the SOGS items. The results from three studies are reported, each using a different sample: grade school children, adolescents and adults. It was hypothesised that (1) participants would not understand some items of the SOGS, (2) problem gamblers and probable pathological gamblers would be more inclined to interpret items incorrectly than would non-problem gamblers and, (3) consistent with the first two hypotheses, clarification of items would decrease the number of participants identified as problem gamblers or probable pathological gamblers. The data obtained supported hypotheses 1 and 3. Furthermore, hypothesis 2 was supported for grade school children, but not for adolescents or adults. These results are consistent with recent literature on endorsement and acquiescence phenomena, and have implications for prevalence studies of probable pathological gambling.

Problem gambling among adolescent students in the atlantic provinces of Canada

The objectives of the present study were to determine the prevalence of problem gambling among adolescent students in the Atlantic provinces of Canada, and to determine the role of age and deception about legal age status as potential risk factors for problem gambling. In 1998, a total of 13,549 students in grades 7, 9, 10 and 12 in the public school systems of the four Atlantic provinces completed a self-reported anonymous questionnaire that included the South Oaks Gambling Screen-Revised for Adolescents. About 8.2% and 6.4% of adolescent students met the broad definition of at-risk and problem gambling, respectively. About 3.8% and 2.2% of adolescent students met the narrow definition of at-risk and problem gambling, respectively. The prevalence of problem gambling did not vary according to age. Using a fake identification or lying about one's age was found to be an independent risk factor for problem gambling. Playing video gambling machines was the gambling activity associated with the single greatest independent risk of using a fake identification or lying about one's age. It was concluded that deception about legal age status may be a facilitating factor permitting adolescents to gamble to the point of experiencing problems.

Definition and measurement of chasing in off-course betting and gaming machine play

The attempt to recover gambling losses by continuing to gamble ('chasing') has featured prominently in accounts of excessive gambling. This research represents the first attempt to operationalize and measure chasing in terms of its cognitive (behavioral intention), emotive (urges) and behavioral components, and to investigate the role of chasing in relation to impaired control over gambling. Two survey samples of 84 male off-course (betting shop) race gamblers (mean age 41, SD = 15) and 137 gaming machine players (73 females, mean age 48, SD = 15 and 64 males, mean age 43, SD = 16) were recruited at gambling venues. Respondents completed a structured questionnaire that investigated retrospective report of chasing and an impaired control scale ("The Scale of Gambling Choices"). It was found that the various components of chasing formed a composite measure with high internal reliability that was strongly related to indicators of excessive gambling (e.g. time spent gambling, expenditure as a proportion of income) and to impaired control scores. Reacting to large wins by further betting was almost as strongly related to impaired control as was persistence after losing. Those who returned later to chase had significantly higher impaired control scores than those who only chased within a session. Alcohol-related chasing was associated with impaired control over gambling. Chasing of losses and impaired control appear to be generic processes in evidence across both forms of gambling and gender (most format and sex differences were of minor significance).

Fifteen years of problem gambling prevalence research: What do we know? Where do we go?

This paper charts the rapid growth of problem gambling prevalence research in North America and internationally. Looking beyond the overall prevalence of problem gambling in the general population, the results of these studies support the notion of a link between the expansion of legal gambling opportunities and the prevalence of problem gambling as well as the notion that the characteristics of problem gamblers change in response to changes in the availability of specific types of gambling. The results of these studies also challenge existing concepts and definitions of problem gambling. In the future, it will be important to improve how problem gambling prevalence research is done. Such work is likely to include changes in how we measure gambling problems as well as requiring us to take steps to overcome obstacles in achieving representative samples of the population and obtaining valid and accurate information.

"How much do you spend gambling?" ambiguities in survey questionnaire items

The validity of a survey's findings is dependent upon the clarity and lack of ambiguity contained in each individual item yet minimal attention has been directed to this issue in most prevalence studies. Researchers have shown a tendency to accept the uncritical assumption that respondents interpret seemingly simple and straightforward items such as 'how much do you spend gambling?' in a consistent manner. No attempt is made to confirm the uniformity of responses by clarifying the mathematical formulae used by respondents to derive their answers. The purpose of this paper was to examine the consistency shown by a sample of 181 medical undergraduate subjects in estimating the level of gambling expenditure in a series of five case vignettes describing various scenarios of wins and losses during a session of gambling. Results revealed a wide variation in calculated figures depending upon whether or not subjects interpreted the item to mean net expenditure or turnover. Only two thirds or less of subjects calculated the figure to be the difference between the initial amount risked and the residual at the conclusion of the session. It is suggested that more attention be paid in prevalence and clinical studies to providing subjects with clear instructions on how to calculate expenditure estimates.