Disordered Gambling Prevalence: Methodological Innovations in a General Danish Population Survey

Prevalence of Problem Gambling: A Meta-analysis of Recent Empirical Research (2016-2022)

Gambling is widely considered a socially acceptable form of recreation. However, for a small minority of individuals, it can become both addictive and problematic with severe adverse consequences. The aim of this systematic review and meta-analysis is to provide an overview of prevalence studies published between 2016 and the first quarter of 2022 and an updated estimate of problem gambling in the general adult population. A systematic review and a meta-analysis were carried out using academic databases, Internet, and governmental websites. Following this search and utilizing exclusion criteria, 23 studies on adult gambling prevalence were identified, distinguishing between moderate risk/at risk gambling and problem/pathological gambling. This study found a prevalence of moderate risk/at risk gambling to be 2.43% and of problem/pathological gambling to be 1.29% in the adult population. As difficult as it may be to compare studies due to different methodological procedures, cutoffs, and time frames, the present meta-analysis highlights the variations of prevalence across different countries, giving due consideration to the differences between levels of risk and severity. This work intends to provide a starting point for policymakers and academics to fill the gaps on gambling research-more specifically in some countries where the lack of research in this field is evident-and to study the effectiveness of policies implemented to mitigate gambling harm.

Non-invasive brain stimulation targets and approaches to modulate gambling-related decisions: A systematic review

INTRODUCTION

Despite intense neuroscience research on the neurobiological underpinnings of Gambling Disorder (GD) and gambling-related decision-making, effective treatments targeting these dysfunctions are still lacking. Non Invasive Brain Stimulation (NIBS) techniques, such as transcranial Direct Current Stimulation (tDCS) and Transcranial Magnetic Stimulation (TMS), selectively modulate activity of brain circuits and have the potential to reverse alterations sustaining GD symptoms. Therefore, the aim of this systematic review was to determine the impact of different NIBS interventions on gambling-related decision processes.

METHODS

We conducted a comprehensive and translational search in three online databases (MEDLINE via PubMed, Scopus, Web of Science), in accordance with the PRISMA guidelines. We included studies applying neuromodulation (TMS, tDCS) techniques in GD patients or assessing gambling-related decision-making in healthy subjects. In addition, we explored the potential impact of NIBS in drug-induced GD (e.g., Parkinson's Disease).

RESULTS

Twenty-seven studies have been included. We summarized results to detect the impact of different targets and stimulation/inhibition protocols in terms of gambling-related decision-making. The majority of both tDCS and TMS studies targeted the dorsolateral prefrontal cortex. Although heterogeneous in protocols and parameters, results from tDCS and TMS studies converge in indicating that the stimulation (instead of inhibition) of prefrontal regions could be beneficial to contrast dysfunctional gambling-related decision processes.

CONCLUSION

NIBS interventions show promise to be further tested in controlled clinical settings for the treatment of behavioral addictions. Further studies are also necessary to investigate connectivity changes and laterality issues (unilateral versus bilateral; left versus right) of NIBS application in GD.

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

Background

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

Methods

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

Results

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

Conclusion

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

Experiences of responsible gambling tools among non-problem gamblers: A survey of active customers of an online gambling platform

INTRODUCTION

Responsible gambling (RG) tools, aiming at helping gamblers to avoid gambling-related harms, are common in online gambling platforms. Gambling industry, policy makers, and researchers have warned that RG tools can potentially disturb recreational gamblers, channeling them to less protective operators. No evidence exists to support these concerns, and they can hinder the development of effective RG tools. The current study aimed to investigate the recreational gamblers' experiences of RG tools.

METHODS

A total of 10,200 active customers of an online gambling service were invited to complete an online survey and rate their overall reactions, attitudes, disturbance and irritation towards RG tools, as well as their inclination to abandon a gambling service due to overexposure to RG tools. N = 1223 surveys were completed.

RESULTS

Non-problem gamblers had positive experiences of RG tools. Moderate-risk gamblers had more positive overall reaction and less irritation to previous experiences of RG tools compared to non-problem gamblers. Problem gamblers had least positive attitudes, most disturbance and most irritation towards RG pictures. Non-problem gamblers had lowest rates of having abandoned a service because of perceived overexposure to RG tools (5.2% compared to 25.9% of problem gamblers), with a significant between-group difference (OR [95% CI] = 7.17 [3.61-14.23], p < .001).

CONCLUSIONS

Non-problem gamblers were not particularly disturbed by RG tools and were not at risk of abandoning online gambling services because of overexposure to RG tools. The study found no grounds for limiting the design and implementation of RG tools due to fears of disturbing recreational gamblers.

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

Background

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

Methods

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

Results

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

Conclusions

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

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

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

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Instead, immigrants demonstrated lower beliefs about peer gambling

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

Behavioral responses to surveys about nicotine dependence

Behavioral responses to surveys can significantly affect inferences about population prevalence unless correctly modeled statistically. An important case study is the prevalence of nicotine dependence, a formal psychiatric disorder satisfying clinical criteria. Data from the National Epidemiologic Survey on Alcohol and Related Conditions in the United States are used, along with a flexible semi-nonparametric sample selection model. Corrections for sample selection responses to "gateway" survey questions lead to significantly higher estimates of the prevalence of nicotine dependence among current daily smokers. These corrections also imply even higher levels of the decades-long and lifetime-long persistence of nicotine dependence after the onset of smoking.