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

Advancing the Pathways Model: Financially Focused Self-concept and Erroneous Beliefs as Core Psychopathologies in Disordered Gambling

In the Pathways Model, there are three distinct etiological subtypes of disordered gambling (Behaviourally Conditioned, Emotionally Vulnerable, and Anti-Social Impulsive Risk-Taker). The Pathways Model also posits that erroneous gambling beliefs are a maintenance factor of disordered gambling across the subtypes. Yet, etiological factors and erroneous beliefs have largely been examined separately when determining disordered gambling subtype. Moreover, there may be heretofore unexamined maintenance factors that span the disordered gambling subtypes. In the current research, we addressed this gap by using latent profile analyses to assess the role both erroneous beliefs and financially focused self-concept (a novel maintenance factor) play in the determination of disordered gambling subtype. In Study 1, community members with gambling problems (n = 215) completed the Gambling Pathways Questionnaire and Financially Focused Self-Concept Scale. In Study 2 (n = 290), participants also completed the Gambling Beliefs Questionnaire. Results from both studies revealed three profiles that coincide with the subtypes in the Pathways Model as providing the best fit to the data. The three profiles were largely distinguished by low, medium, or high scores on the etiological factors, which is consistent with the disordered gambling subtypes being on different parts of the same continuum of psychopathology severity. Financial focus (Studies 1 and 2) and erroneous gambling beliefs (Study 2) were elevated across the three profiles, and both were higher among profiles with more severe psychopathology. Findings support a dimensional understanding of gambling disorder psychopathology and suggest that a financially focused self-concept may be a maintenance factor of disordered gambling.

Problem Gambling Poker Players: Do They Fit into Blaszczynski and Nower's Pathways Model?

Blaszczynski and Nower's (Addiction 97:487-499, 2002) Pathways Model, an integrative model based on problem gamblers' paths and comorbidities, aids in understanding the heterogeneity of problem gamblers' profiles by classifying them into three subgroups. The profiles of problem gamblers may be linked to the type of gambling practiced. Poker is a popular game, primarily due to the involvement of both chance and strategy in its outcome. However, no study has attempted to fit poker players into the Pathways Model. We recruited an online sample of 245 regular poker players (including 146 non-problem gamblers, 83 problem-gambling poker players, and 16 probable pathological gamblers). We assessed multiple variables (impulsivity, sensation seeking, alcohol and tobacco consumption, anxiety, depression, cognitive distortions) from the Pathways Model to determine whether the profiles of poker players fit into one or more gambler subgroups. Cluster analysis showed that poker players had a unique profile with a gambling practice intensity gradient. Compared to non-problem gamblers, problem gamblers displayed significantly higher levels of depression, impulsivity, gambling-related cognitive distortions, and alcohol consumption. Our results suggest that problem-gambling poker players fit into Blaszczynski and Nower's behaviorally conditioned gamblers group. This study opens avenues for both research into and treatment for problem gambling among poker players.

An empirical investigation of the Pathways Model of problem gambling through the conjoint use of self-reports and behavioural tasks

BACKGROUND AND AIMS

Blaszczynski and Nower (2002) conceptualized their Pathways Model by postulating the existence of three subtypes of problem gamblers who share common characteristics, but also present specific ones.

METHODS

This study investigated how the psychological mechanisms postulated in the Pathways Model predict clinical status in a sample that combined treatment-seeking gamblers (n = 59) and non-problematic community gamblers (n = 107). To test the Pathways Model, we computed a hierarchic logistic regression in which variables associated with each postulated pathway were entered sequentially to predict the status of the treatment-seeking gambler. Self-report questionnaires measured gambling-related cognitions, alexithymia, emotional reactivity, emotion regulation strategies and impulsivity. Behavioural tasks measured gambling persistence (slot machine task), decision-making under uncertainty (Iowa Gambling Task) and decision-making under risk (Game of Dice Task).

RESULTS

We showed that specific factors theorized as underlying mechanisms for each pathway predicted the status of clinical gambler. For each pathway, significant predictors included gambling-related cognitive distortions and behaviourally measured gambling persistence (behaviourally conditioned pathway), emotional reactivity and emotion regulation strategies (emotionally vulnerable pathway), and lack of premeditation impulsivity facet (impulsivist-antisocial pathway).

DISCUSSION AND CONCLUSIONS

Our study adds to the body of literature confirming the validity of the Pathways Model and hold important implications in terms of assessment and treatment of problem gambling. In particular, a standardized assessment based on the Pathways Model should promote individualized treatment strategies to allow clinicians to take into account the high heterogeneity that characterizes gambling disorder.

Clarifying gambling subtypes: the revised pathways model of problem gambling

BACKGROUND AND AIMS

The pathways model is a highly cited etiological model of problem gambling. In the past two decades, a number of studies have found support for the model's utility in classifying gambling subtypes. The aims of this paper were to refine empirically the model subtypes and to revise and update the model based on those findings.

DESIGN AND MEASUREMENT

Observational study using data collected from treatment-seeking problem gamblers using the Problem Gambling Severity Index (PGSI) and the Gambling Pathways Questionnaire (GPQ).

SETTING

Treatment clinics in Canada, Australia and the United States.

PARTICIPANTS

A convenience sample of 1168 treatment-seeking problem gamblers, aged 18 years or older.

FINDINGS

Empirically validated risk factors were analyzed using latent class analyses, identifying a three-class solution as the best-fitting model. Those in the largest class (class 1: 44.3%, n = 517) reported the lowest levels of all etiological risk factors. Participants in class 2 (39.5%, n = 461) reported the highest rates of anxiety and depression, both before and after gambling became a problem, as well as childhood maltreatment, and a high level of gambling for stress-coping. Those in class 3 (16.3%, n = 190) reported high levels of impulsivity; risk-taking, including sexual risk-taking; antisocial traits; and coping to provide meaning in life and to alleviate stress.

CONCLUSIONS

The revised pathways model of problem gambling includes three classes of gamblers similar to the three subtypes in the original pathways model, but class 3 in the revised pathways model is distinct from class 2, showing higher levels of risk-taking and antisocial traits and gambling motivated by a desire for meaning/purpose and/or to alleviate stress. Class 2 in the revised pathways model demonstrates high levels of childhood maltreatment as well as gambling for stress-coping.

Clinical differences between men and women in a Swedish treatment-seeking population with gambling disorder

INTRODUCTION

The purpose of this study was to explore clinical differences in Swedish treatment-seeking men and women with gambling disorder (GD). As the prevalence of GD is increasing among women, even though men are still highly overrepresented, the characteristic differences between men and women seeking treatment become increasingly important.

METHOD

A sample of 204 patients with GD (26.5% women and 73.5% men) at an outpatient clinic were diagnosed using the SCI-GD, screened for comorbid diagnoses using the MINI, and further completed a range of self-report questionnaires measuring demographics, GD, alcohol and other drug problems, symptoms of depression and anxiety, and pathways into gambling problems.

RESULTS

Several characteristics differed between treatment-seeking men and women in our sample. Examples of differences between genders included age, onset age, living situation, duration, alcohol and drug problems, comorbidity, and pathways leading to gambling problems.

DISCUSSION

The most evident difference was that women, in addition to GD, showed more symptoms of anxiety and depression than men, while men had a higher degree of substance use problems compared to women. The differences in clinical features between men and women are important to consider in treatment planning and possibly for future gender-based interventions.

Testing the Validity of the Pathways Model: A Latent Class Analysis of Potential Pathological Gambling Subtypes in a Non-Treatment Sample

Latent class analysis (LCA) was used to test the validity of the Pathways Model in 285 subjects with DSM-IV pathological gambling (PG). In addition to identifying three subtypes that roughly correspond with those described in the model (Behaviorally Conditioned, or BC, Emotionally Vulnerable, or EV, Antisocial-Impulsivist, or AI), LCA identified a fourth class, termed the Antisocial Drinker, or AD, characterized by high rates of antisociality, conduct disorder, and alcohol use disorder. BC gamblers comprised 45% of the sample, followed by EV (24%), AD (22%), and AI (9%) gamblers. Women were more likely to be EV gamblers (OR = 1.89) and less likely to be AD gamblers (OR = 0.46). Those who had attempted suicide were more likely to be EV (OR = 3.06) or AI (OR = 3.05) gamblers and less likely to be BC (OR = 0.37) or AD gamblers (OR = 0.50). Greater childhood maltreatment was associated with AD (standardized OR = 1.81) and AI (standardized OR = 1.43) gamblers. Individuals with later PG onset were less likely to be AI gamblers (standardized OR = 0.48). Individuals who preferred slots were more likely to be EV gamblers (OR = 1.83) and less likely to be AD gamblers (OR = 0.33). The BC subtype was associated with better health outcomes, better social functioning, less childhood maltreatment, and less severe PG. The AI subtype was associated with worse health outcomes, worse social functioning, and higher PG severity. The findings provide a better understanding PG heterogeneity that could be relevant to clinical management.

Risky Gambling Behaviors: Associations with Mental Health and a History of Adverse Childhood Experiences (ACEs)

Problem gambling and adverse childhood experiences (ACEs) are highly co-morbid and lead to numerous adverse health outcomes. Research demonstrates that greater levels of well-being protect individuals from experiencing ACE-related harms after a history of childhood adversity; however, this relationship has not been examined in the gambling literature. We hypothesized that individuals who experienced ACEs would engage in more problem gambling behaviors. We also hypothesized that individuals who experienced ACEs and reported flourishing mental health would have lower rates of problem gambling than individuals who experienced ACEs but did not report flourishing mental health. We conducted a secondary data analysis of the adult sample in the Well-Being and Experiences (WE) Study. Examining a parent population, parents and caregivers (N = 1000; M_age = 45.2 years; 86.5% female) of adolescents were interviewed on a variety of measures, including their history of ACEs, their gambling behaviors within the past year, and their mental health and well-being. We used multinomial logistic regression analysis to examine the relationship between 15 ACEs and gambling type (i.e., non-gambler, non-problem gambler, at-risk/problem gambler). We used interaction terms between each ACE and mental health to examine the moderating role of flourishing mental health and well-being. ACEs were associated with at-risk/problem gambling supporting hypothesis 1. Contrary to hypothesis 2, overall, flourishing mental health did not moderate the relationship between ACEs and gambling severity except for one ACE. In this study, we were able to gain a better understanding of how different ACEs each contribute to varying levels of gambling severity.

A Serious Game to Improve Emotion Regulation in Treatment-Seeking Individuals With Gambling Disorder: A Usability Study

Background: Serious games have shown positive results in increasing motivation, adherence to treatment and strengthening the therapeutic alliance in multiple psychiatric disorders. In particular, patients with impulse control disorders and other disorders in which the patient suffers from inhibitory control deficits (e.g., behavioral addictions) have been shown to benefit from serious games. Aim: The aim of this study was to describe the characteristics and to evaluate the usability of a new serious videogame, e-Estesia. This serious videogame was designed to improve emotion regulation in patients with gambling disorder (GD). Preliminary results from a pilot sample are also reported. Method: A pilot sample of 26 patients undergoing treatment for GD was recruited (ranging from 22 to 74 years, mean = 41.2 and SD = 12.9; 80.8% men). Participants used e-Estesia on a tablet, which was connected to a thoracic band that sent heart rate (HR) and heart rate variability (HRV) data to the videogame platform in order to provide biofeedback. The System Usability Scale was completed by patients to determine the usability of e-Estesia. Results and Discussion: e-Estesia performed comparatively well for all the explored groups (i.e., sex, age, and online vs. offline gambling: mean usability score = 83.8, SD = 13.1). Around 84.6% of the patients endorsed that it was easy to use. Female patients with GD presented higher HRV during the use of the serious videogame compared to men.

Gambling Disorder and comorbid PTSD: A systematic review of empirical research

BACKGROUND AND AIMS

Gambling Disorder (GD) and Posttraumatic Stress Disorder (PTSD) are frequently comorbid and often associated with a more severe clinical profile compared to those with either diagnosis alone. Despite recent growing interest in this comorbidity, there has been little effort to synthesize this domain of research and define areas of need for future research.

DESIGN

The present work details a systematic review of empirical studies examining the relationship between PTSD and GD-related factors. This review encompassed 74 studies each examining the overlap between GD and the following domains: PTSD, Trauma, Adverse Childhood Experiences, and Stressful Life Events.

FINDINGS

The included studies yielded 91 independent samples each providing associations between the above-mentioned constructs. The present work found that stress, trauma, and symptom severity of PTSD each influence the severity of both GD and subclinical levels of GD. The severity, type, and time at which trauma occurs in the lifespan all appear to influence the predictive strength of trauma on GD severity. However, PTSD symptoms appear to have a greater impact on GD severity compared to trauma alone.

CONCLUSION

PTSD symptoms result in increased severity of GD, and pathological dissociation plays a particularly important role in exacerbating this relationship. Clinical and etiological implications, as well as direction for future research from these findings, are revealed and discussed.

Is Subtyping of Gamblers Based on the Pathways Model of Problem and Disordered Gambling Valid? A Systematic Review

Gamblers are a heterogenous group in terms of the presence of comorbid psychopathology, maladaptive personality traits, and motivation to gamble. The Pathways Model, the most promising comprehensive framework to explain this heterogeneity, classifies gamblers into three subtypes. The aim of this review was to determine whether or not subtyping of gamblers based on the Pathways Model of problem and disordered gambling is valid. A literature review was conducted using the following online databases: Academic Search Complete, PubMed, Web of Science, and PsychINFO. Studies were selected or excluded based on meeting predetermined criteria. Fourteen studies examining subtyping of gamblers based on the Pathways Model were reviewed and evaluated. Results suggest that in the adult population there are three subtypes of gamblers that largely coincide with the subtypes defined in the Pathways Model. Of these, the emotionally vulnerable subtype is the most problematic and inconsistent. In contrast, for adolescents, at least four gambler subtypes have been identified. The extant literature on subtyping of gamblers suffers from some severe limitations. Further research is required to fully validate the Pathways Model.

Craving for Gambling Predicts Income-Generating Offenses: A Pathways Model of a Japanese Prison Population

The links between gambling and criminal offenses have been frequently reported, but the pathways from gambling to a particular offense have not. Our study applied a pathways model to predict participants' income-generating, drug-related, and violent offenses stemming from their craving for gambling. The participants were 332 male inmates in a Japanese local prison. They answered questionnaires on gambling behavior, alcohol addiction, Internet addiction, impulsivity, and psychopathy. Their official records with information on their current offense, sentence length, number of imprisonments, and length of education were also analyzed. The results show that 38.55% (n = 128) of the participants had a probable gambling disorder, a rate of problem gambling at least four times higher than that among the general Japanese population. Furthermore, their craving for gambling predicted their income-generating offenses, but not their drug-related and violent offenses. Their craving for gambling can thus be linked to their financial issues, rather than their emotional and impulsive issues. The pathways model explained the path not only from addiction/psychopathy to gambling, but also from gambling to committing an income-generating offense.

Gender Differences in Problem Gamblers in an Online Gambling Setting

Background

Problem gambling traditionally is markedly more common in men than in women. However, recent data in online gamblers have indicated at least a comparable risk of problem gambling in women in this sub-group. The present study aimed to compare the characteristics of male and female moderate-risk and problem gamblers in online gamblers in Sweden.

Methods

In a web survey addressing online gamblers (past-year online gambling on 10 or more occasions), women and men with moderate-risk or problem gambling (n=327) were compared with respect to gambling severity, financial consequences, comorbidity, socio-demographic characteristics, and fulfilled screening items.

Results

Female gender was associated with psychological distress, over-indebtedness, higher problem gambling severity and with screening items indicating financial consequences and guilt, with no gender difference for the self-reported need to seek treatment for substance use problems. In the sub-group of problem gamblers, female gender remained associated with psychological distress.

Conclusion

In a setting displaying high rates of online gambling and novel findings of a higher risk of problem gambling in women than previously seen, psychological distress appears to separate female and male problem gamblers. Given the higher level of severity and financial consequence, these findings call for screening and early intervention in female at-risk gamblers.

Conduct problems and depressive symptoms in association with problem gambling and gaming: A systematic review

BACKGROUND AND AIMS

Behavioral addictions such as gambling and gaming disorder are significant public health issues that are of increasing importance to policy makers and health care providers. Problem gambling and gaming behaviors have been identified as being associated with externalizing and internalizing problems, with theoretical models suggesting that both conduct problems and depressive symptoms may be significant risk factors in the development of problem gambling and gaming. As such, the purpose of this systematic review is to provide an overview of research identifying the relationship between conduct problems, depressive symptoms and problem gambling and gaming among adolescents and young adults.

METHODS

Systematic literature searches in accordance with PRISMA guidelines found 71 eligible studies that met the inclusion criteria, 47 for problem gambling, 23 for problem gaming and one for both problem behaviors.

RESULTS

Based on cross-sectional evidence, both problem gambling and gaming are consistently concurrently associated with conduct problems and depressive symptoms. Longitudinal evidence appears to be clearer for conduct problems as a risk factor for problem gambling, and depressive symptoms as a risk factor for problem gaming. However, both risk factors appear to increase the risk for these problem behaviors.

DISCUSSION AND CONCLUSIONS

Results from the literature review suggest that problem gambling and gaming are associated with the presence of conduct problems and depressive symptoms, with the potential of sharing common etiological factors. Additional research is necessary to confirm these longitudinal relationships with an emphasis on investigating the interaction of both early conduct problems and depressive symptoms.

Response trajectories of gambling severity after cognitive behavioral therapy in young-adult pathological gamblers

BACKGROUND AND AIMS

The significant increase in the prevalence of gambling disorder (GD) among young adults in recent years has attracted interest in determining therapeutic efficiency in this sector of the population. The aim of this work was to estimate the response trajectories of gambling severity during the six-month follow-up after a cognitive behavioral therapy (CBT) program in young adult patients and to identify the main variables associated with each trajectory.

METHODS

The sample included n = 192 patients, aged 19-35 years old, seeking treatment for GD. Response trajectories were identified through latent class growth analysis.

RESULTS

Three trajectories emerged: T1 (n = 118, 61.5%), composed of patients with severe GD at pre-treatment and good evolution to recovery; T2 (n = 62, 32.3%), with patients with moderate-high GD affectation at baseline and good evolution to recovery; and T3 (n = 12, 6.3%), with participants with severe baseline GD severity and poor evolution after CBT (Abbott, 2019). The highest risk of poor therapeutic outcomes was related to lower social index positions, high emotional distress, high scores in harm avoidance and low scores in self-directedness.

DISCUSSION AND CONCLUSIONS

Differences in the response trajectories at short-term follow-up after CBT reveal heterogeneity in the samples including young and young-adult GD patients. Patients' phenotype at baseline should be considered when developing efficient, person-centered intervention programs, which should comprise strategies aimed at increasing emotional regulation capacities, self-esteem and self-efficacy, with the aim of avoiding relapses in the medium-long term after therapy.

Problem and non-problem gamblers: a cross-sectional clustering study by gambling characteristics

OBJECTIVES

Gambling characteristics are factors that could influence problem gambling development. The aim of this study was to identify a typology of gamblers to frame risky behaviour based on gambling characteristics (age of initiation/of problem gambling, type of gambling: pure chance/chance with pseudoskills/chance with elements of skill, gambling online/offline, amount wagered monthly) and to investigate clinical factors associated with these different profiles in a large representative sample of gamblers.

DESIGN AND SETTING

The study is a cross-sectional analysis to the baseline data of the french JEU cohort study (study protocol : Challet-Bouju et al, 2014). Recruitment (April 2009 to September 2011) involved clinicians and researchers from seven institutions that offer care for or conduct research on problem gamblers (PG). Participants were recruited in gambling places, and in care centres. Only participants who reported gambling in the previous year between 18 and 65 years old were included.Participants gave their written informed consent, it was approved by the French Research Ethics Committee.

PARTICIPANTS

The participants were 628 gamblers : 256 non-problem gamblers (NPG), 169 problem gamblers without treatment (PGWT) and 203 problem gamblers seeking treatment (PGST).

RESULTS

Six clustering models were tested, the one with three clusters displayed a lower classification error rate (7.92%) and was better suited to clinical interpretation : 'Early Onset and Short Course' (47.5%), 'Early Onset and Long Course' (35%) and 'Late Onset and Short Course' (17.5%). Gambling characteristics differed significantly between the three clusters.

CONCLUSIONS

We defined clusters through the analysis of gambling variables, easy to identify, by psychiatrists or by physicians in primary care. Simple screening concerning these gambling characteristics could be constructed to prevent and to help PG identification. It is important to consider gambling characteristics : policy measures targeting gambling characteristics may reduce the risk of PG or minimise harm from gambling.

TRIAL REGISTRATION NUMBER

NCT01207674 (ClinicalTrials.gov); Results.

The joint role of impulsivity and distorted cognitions in recreational and problem gambling: A cluster analytic approach

BACKGROUND AND AIMS

The Pathways Model (Blaszczynski & Nower, 2002) posits that problem gambling is a heterogeneous disorder with distinct subgroups (behaviorally conditioned gamblers, emotionally vulnerable gamblers, and antisocial-impulsivist gamblers). Impulsivity traits and gambling-related cognitions are recognized as two key psychological factors in the onset and maintenance of problem gambling. To date, these constructs have been explored separately, and their joint role in determining problem gambling subtypes has received little attention. The goal of our study was to identify subgroups of gamblers based on impulsivity traits and gambling-related cognitions, and to determine whether this approach is consistent with the Pathways model.

METHODS

Gamblers from the community (N = 709) and treatment-seeking pathological gamblers (N = 122) completed questionnaires measuring gambling habits, disordered gambling symptoms, gambling-related cognitions, and impulsivity traits.

RESULTS

Cluster analyses revealed that three clusters globally aligned with the pathways proposed by Blaszczynski & Nower (2002). Two other clusters emerged: (1) impulsive gamblers without cognitive-related cognitions; and (2) gamblers without impulsivity or gambling-related cognitions. Gamblers with both heightened impulsive traits and gambling-related cognitions had more severe problem gambling symptoms.

CONCLUSION

We successfully identified, based on an a priori theoretical framework, different subtypes of gamblers that varied in terms of problem gambling symptoms and clinical status. The diversity of the cluster profiles supports the development of personalized prevention strategies and psychological interventions.

Demographic and psychiatric correlates of compulsive sexual behaviors in gambling disorder

BACKGROUND AND AIMS

Gambling disorder (GD) and compulsive sexual behavior (CSB) may commonly co-occur. Yet, the psychiatric correlates of these co-occurring disorders are an untapped area of empirical scrutiny, limiting our understanding of appropriate treatment modalities for this dual-diagnosed population. This study examined the demographic and clinical correlates of CSB in a sample of treatment-seeking individuals with GD (N = 368) in São Paulo, Brazil.

METHODS

Psychiatrists and psychologists conducted semi-structured clinical interviews to identify rates of CSB and other comorbid psychiatric disorders. The Shorter PROMIS Questionnaire was administered to assess additional addictive behaviors. The TCI and BIS-11 were used to assess facets of personality. Demographic and gambling variables were also assessed.

RESULTS

Of the total sample, 24 (6.5%) met diagnostic criteria for comorbid CSB (GD + CSB). Compared to those without compulsive sexual behaviors (GD - CSB), individuals with GD + CSB were more likely to be younger and male. No differences in gambling involvement emerged. Individuals with GD + CSB tended to have higher rates of psychiatric disorders (depression, post-traumatic stress disorder, and bulimia nervosa) and engage in more addictive behaviors (problematic alcohol use, drug use, and exercise) compared to GD - CSB. Those with GD + CSB evidenced less self-directedness, cooperativeness, self-transcendence, and greater motor impulsivity. Logistic regression showed that the predictors of GD + CSB, which remained in the final model, were being male, a diagnosis of bulimia, greater gambling severity, and less self-transcendence.

DISCUSSION AND CONCLUSION

Given those with GD + CSB evidence greater psychopathology, greater attention should be allocated to this often under studied comorbid condition to ensure adequate treatment opportunities.

Clinical and Personality Characteristics of Problem and Pathological Gamblers With and Without Symptoms of Adult ADHD

The study examined the differential clinical and personality characteristics of problem and pathological gamblers (PPGs) with and without clinically significant symptoms of adult attention deficit hyperactive disorder (ADHD). Adults (N = 150, n = 75 women) with PPG were assessed by the SCID-IV, Conners' Adult ADHD Rating Scales, Multidimensional Personality Questionnaire, Gambling Motivation Questionnaire, and the Barratt Impulsiveness Scale. PPGs who reported symptoms of ADHD were more likely to be male, endorse psychiatric comorbidities (i.e., alcohol dependence, anxiety disorders, and antisocial personality disorder), report maladaptive personality traits (i.e., higher negative emotionality and lower positive emotionality), as well as higher impulsivity (attention impulsiveness, motor impulsiveness, and nonplanning impulsiveness). PPGs with symptoms of ADHD reported gambling for social, coping, and enhancement reasons. A multivariate binary logistic regression revealed that sex, higher scores on social reasons for gambling, and lack of premeditation were associated with an increased likelihood of reporting ADHD symptoms. The findings demonstrate important differences of PPGs with symptoms of ADHD and provide information for treatment consideration.

Differences in Emotion Regulation Considering Gender, Age, and Gambling Preferences in a Sample of Gambling Disorder Patients

Introduction: Impairments in emotion regulation are understood to be a transdiagnostic risk factor of suffering from compulsive and addictive behaviors. The aim of this study was to investigate the role of emotion regulation deficits in gambling disorder and to analyze these differences taking gender, age, and gambling activity preferences into account.

METHODS

The sample included n = 484 patients seeking treatment for gambling disorder at a specialized outpatient service. Main outcomes were sociodemographic variables, emotion regulation, and gambling severity.

RESULTS

Differences between sexes were found in non-acceptance of emotions. Older patients obtained higher levels in non-acceptance of emotions, lack of emotion regulation strategies, emotional clarity, and global emotion regulation scores. No differences were found in emotion scores considering gambling preferences (non-strategic versus strategic). Path analysis showed that emotion regulation scores and age had a direct effect on gambling disorder severity, while emotion regulation and gambling preference were not mediational variables in the relationships of gender and age with gambling severity.

CONCLUSIONS

Emotion regulation impairments differ in patients seeking treatment for gambling problems. Early prevention and intervention programs should incorporate the different dimensions of this process, taking into account clinical phenotypes.

Phenotypes in Gambling Disorder Using Sociodemographic and Clinical Clustering Analysis: An Unidentified New Subtype?

Background: Gambling disorder (GD) is a heterogeneous disorder which has clinical manifestations that vary according to variables in each individual. Considering the importance of the application of specific therapeutic interventions, it is essential to obtain clinical classifications based on differentiated phenotypes for patients diagnosed with GD. Objectives: To identify gambling profiles in a large clinical sample of n = 2,570 patients seeking treatment for GD. Methods: An agglomerative hierarchical clustering method defining a combination of the Schwarz Bayesian Information Criterion and log-likelihood was used, considering a large set of variables including sociodemographic, gambling, psychopathological, and personality measures as indicators. Results: Three-mutually-exclusive groups were obtained. Cluster 1 (n = 908 participants, 35.5%), labeled as "high emotional distress," included the oldest patients with the longest illness duration, the highest GD severity, and the most severe levels of psychopathology. Cluster 2 (n = 1,555, 60.5%), labeled as "mild emotional distress," included patients with the lowest levels of GD severity and the lowest levels of psychopathology. Cluster 3 (n = 107, 4.2%), labeled as "moderate emotional distress," included the youngest patients with the shortest illness duration, the highest level of education and moderate levels of psychopathology. Conclusion: In this study, the general psychopathological state obtained the highest importance for clustering.

Spanish adaptation of the Gambling Motives Questionnaire (GMQ): Validation in adult pathological gamblers and relationship with anxious-depressive symptomatology and perceived stress

Gambling has been found to be related to different motives, such as enhancement, social, and behavioral and emotional coping. The most used instrument in this field is the Gambling Motives Questionnaire (GMQ; Stewart & Zack, 2008), which has not been validated in clinical samples. This study aimed to validate a Spanish version of the GMQ in a sample of adult pathological gamblers and to analyze its relationship with pathological gambling, anxiety, depression, and perceived stress. A sample of 164 gamblers was recruited from centers for the treatment of pathological gambling. The three-factor structure (enhancement, social, and coping motives) of the GMQ was validated through exploratory and confirmatory factorial analyses, and its convergent validity was proven. Gambling motives correlated with pathological gambling, anxiety, depression, and perceived stress. Enhancement motives predicted pathological gambling, while controlling for the effect of anxiety, depression, and perceived stress. These results are relevant for clinical evaluation and intervention with adult pathological gamblers.

Cognitive Deficits in Executive Functions and Decision-Making Impairments Cluster Gambling Disorder Sub-types

To identify Gambling Disorder (GD) subtypes, in a population of men seeking treatment for GD, according to specific executive function domains (i.e., cognitive flexibility, inhibition and working memory as well as decision making) which are usually impaired in addictive behaviors. A total of 145 males ranging from 18 to 65 years diagnosed with GD were included in this study. All participants completed: (a) a set of questionnaires to assess psychopathological symptoms, personality and impulsivity traits, and (b) a battery of neuropsychological measures to test different executive functioning domains. Two clusters were identified based on the individual performance on the neuropsychological assessment. Cluster 1 [n = 106; labeled as Low Impaired Executive Function (LIEF)] was composed by patients with poor results in the neuropsychological assessment; cluster 2 patients [n = 46; labeled as High Impaired Executive Function (HIEF)] presented significantly higher deficits on the assessed domains and performed worse than the ones of LIEF cluster. Regarding the characterization of these two clusters, patients in cluster 2 were significantly older, unemployed and registered higher mean age of GD onset than patients in cluster 1. Additionally, patients in cluster 2 also obtained higher psychopathological symptoms, impulsivity (in both positive and negative urgency as well as sensation seeking) and some specific personality traits (higher harm avoidance as well as lower self-directedness and cooperativeness) than patients in cluster 1. The results of this study describe two different GD subtypes based on different cognitive domains (i.e., executive function performance). These two GD subtypes display different impulsivity and personality traits as well as clinical symptoms. The results provide new insight into the etiology and characterization of GD and have the potential to help improving current treatments.

An overview of gambling disorder: from treatment approaches to risk factors

Gambling disorder (GD) has been reclassified recently into the "Substance-Related and Addictive Disorders" category of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), a landmark occurrence for a behavioral addiction. GD is characterized by recurrent, maladaptive gambling behavior that results in clinically significant distress. Although the number of randomized controlled trials assessing the effectiveness of pharmacological treatments is limited, some pharmacological treatments, notably opiate antagonists, have been employed in the treatment of GD. Patients with GD often present cognitive distortions and specific personality traits, making treatment more difficult. Cognitive behavioral therapy has become the most common psychological intervention for treating gambling problems, and it is effective in reducing gambling behavior. In this brief overview, we provide a report on the state of pharmacological and psychological treatments for gambling disorder. Risk factors and potential future lines of research are addressed.

Hypothesizing Las Vegas and Sutherland Springs Mass Shooters Suffer from Reward Deficiency Syndrome: "Born Bad"

The slaughters in Las Vegas and Sutherland Springs demand explanation, in the face of the ineffable. An understanding of the shooters’ motives could restore our trust in our mutually cooperative existence. In this short communication we provide post-hoc rationale of both Stephen Paddock (Las Vegas mass shooting) and Devin Kelley (Southerland Springs mass shooting) and hypothesize that these shooters had genetically induced “Reward Deficiency Syndrome” (RDS) and a hypodopaminergia trait/state. In this particular case we are in pursuit of trying to obtain postmortem samples of mass shooters for subsequent epigenetic and neurogenetic analyses. It is our contention that early genetic identification of RDS and its pathological behaviors including hyper – sexuality, violence, a love for guns, even in children, could be a giant step forward in potentially saving lives.