Using the CPGI to Determine Problem Gambling Prevalence in Australia: Measurement Issues

A Systematic Review on Intervention Treatment in Pathological Gambling

Over the last century, there has been a growing interest in researching pathological gambling, particularly in industrialized nations. Historically, gambling was widely perceived as morally questionable, condemned by religious groups. However, contemporary concerns have shifted towards the health repercussions of gambling disorders and broader societal impacts like increased crime and money laundering. Governments, aiming to mitigate social harm, often regulate or directly oversee gambling activities. The global surge in legal gambling has resulted in a substantial rise in its prevalence, popularity, and accessibility in the last two decades. This paper provides a comprehensive overview of global research on interventions for pathological gambling. Through a systematic search on platforms such as EBSCO, PubMed, and Web of Science, 13 relevant records were identified. The revised findings indicate a heightened occurrence of behavioral addictions, linking them to the early onset of gambling issues and their severe consequences. The research emphasizes the active role that clients play in the process of self-directed change and therapy. Therapists recognizing clients as both catalysts for change and potential obstacles can enhance their effectiveness. A common source of resistance arises when clients and therapists are in different stages of the change process, underlining the importance of therapists aligning with clients' readiness for change. Recognizing the urgent need for a better understanding of this problem in adolescents, this study emphasizes the necessity to tailor prevention and treatment plans based on gender and age-specific requirements.

An Empirical Study of the Pathway Model Link Between Cognitive Distortions and Gambling Problems

This research empirically tests the relationship between gambling-related cognitive distortions and the development of gambling problems. In two separate studies using methodologies designed to support non-experimental causal inference, we demonstrate that holding false beliefs about gambling experiences is related to current and future risk of developing problems with gambling. In our first study, we use an instrumental variable estimation strategy on an internet sample (n = 184) and observe a statistically significant relationship between Gamblers' Belief Questionnaire scores and measures of loss chasing, overspending, and gambling problems. These findings were robust to linear and ordinal estimation strategies and multiple model specifications. In our second study, we examine five-year prospective longitudinal data (n = 1,431) to validate our initial findings and test whether irrational thoughts are also related to future problems with gambling. While controlling for current fallacies, we find that past Gambling Fallacies Measure scores are related to present gambling problems across two survey waves. The effect size of each of the past fallacy levels is roughly half of the effect size of present levels, suggesting meaningful impacts. Our findings support the Pathways Model of Problem and Pathological Gambling.

Update on Gambling Disorder

Gambling disorder (GD) is estimated to be experienced by about 0.5% of the adult population in the United States. The etiology of GD is complex and includes genetic and environmental factors. Specific populations appear particularly vulnerable to GD. GD often goes unrecognized and untreated. GD often co-occurs with other conditions, particularly psychiatric disorders. Behavioral interventions are supported in the treatment of GD. No medications have a formal indication for the GD, although clinical trials suggest some may be helpful. Noninvasive neuromodulation is being explored as a possible treatment. Improved identification, prevention, and treatment of GD are warranted.

Is a sense of community belonging associated with problem gambling in Canada?

PURPOSE

Despite the increasing demand for public health measures to prevent problem gambling, few studies have examined the association between community characteristics and problem gambling. The aim of this nationally representative cross-sectional study was to investigate the relationship between a sense of community belonging and problem gambling in Canada. We also examined whether this relationship was modified by sex and marital status.

METHODS

Canadian Community Health Survey (2013-2014) data from 38,968 residents of Quebec, Saskatchewan, Manitoba, and British Columbia were analyzed. Problem gambling was assessed using the Canadian Problem Gambling Index. We estimated the odds ratios (ORs) and 95% confidence intervals (CIs) for problem gambling.

RESULTS

The prevalence of problem gambling was 1.4% (1.9% among males; 0.9% among females). We observed an inverse dose-response relationship between a sense of community belonging and problem gambling. Compared with those with a very strong sense of community belonging, the adjusted ORs for problem gambling were 1.07 (95% CI 0.65-1.76) for a somewhat strong sense, 1.27 (95% CI 0.77-2.11) for a somewhat weak sense, and 2.32 (95% CI 1.34-4.02) for a very weak sense of community belonging. The association was more prominent among females (except for those widowed/divorced/separated), whereas no clear association was found among males, irrespective of marital status.

CONCLUSION

When implementing public health measures to reduce problem gambling, it would be useful to account for possible differential impacts of a sense of community belonging by sex and marital status, which may reflect significant social contexts among residents.

The Effect of Shame and Self-Efficacy on Gambling Behaviour

Previous research has identified the benefits of increasing self-efficacy in problem gamblers, while other research has identified higher levels of shame and dysfunctional coping in problem gamblers. The primary aim of the present study was to examine the relationships between problem gambling behaviour, shame (as both a personality trait and an emotional state), gambling-related self-efficacy, and dysfunctional coping mechanisms. The sample consisted of 235 participants (172 male; mean age = 30.32, SD = 8.57), who completed an online, self-report questionnaire that assessed gambling severity, shame-proneness, post-gambling shame and guilt, and dysfunctional coping. Data were assessed using path analysis models. As hypothesised, more problematic gambling was significantly associated with dysfunctional coping. A pathway mediation model was determined and several mediator variables were found to operate in series, including: shame proneness, post-gambling shame, and gambling-related self-efficacy. This research supports and builds on previous research that has highlighted the detrimental effect of problem gambling and shame on coping mechanisms, and the benefits of gambling-related self-efficacy for subsequent coping. A limitation of the study was that 18.7% of the sample reported scores indicative of probable pathological gambling, while most of the remaining sample were representative of recreational gambling. Implications of this are discussed.

Making EGMs Accountable: Can an Informative and Dynamic Interface Help Players Self-regulate?

Electronic gaming machines (EGMs) are recognised as one of the most harmful gambling forms, because they promote high-speed repetitive gambling and automatically reinvest winnings. These features, amongst others, make it difficult for EGM gamblers to keep track of their play. Tools to assist gamblers exist, but have limited effectiveness because they require user registration and manual activation, leading to low uptake. The present study aimed to evaluate the effect of a more informative interface (including removal of automatic reinvestment of winnings) and pop-up messages on gambling behaviour, and on player experience. A total of 213 Australian participants, recruited through social media, played a simulated online EGM. The experiment was a two (standard vs. informative interface) × two (pop-ups absent vs. present) between-subjects design. The informative interface: promoted keeping track of spins played; increased accurate estimation of amount spent (as did pop-up messages) and time played; and provided game usage figures which acted as cues to quit play. Once the initial deposit (but not winnings) was expended, informative interface users could opt to reinvest their winnings, although many opted to exit at that point. No difference in total spending or dissociation was observed between experimental groups. Informative interface users reported no reduction in enjoyment. Pop-up messages reduced enjoyment with the standard interface, but increased enjoyment when paired with an informative interface. These findings indicate that a more informative interface and pop-up messages may be useful in reducing the harmful nature of EGMs.

Measuring Behavioural Dependence in Gambling: A Case for Removing Harmful Consequences from the Assessment of Problem Gambling Pathology

Behavioural dependence (BD) for gambling has traditionally been subsumed under the concept of 'problems': a hybrid construct that includes both indicators of BD, and adverse consequences (harm) arising from excessive time and money expenditure. Although progress has been made towards specific measurement of harm, dedicated measures of BD do not exist. Theory led us to expect that (1) dependence and harm are measurably distinct constructs, (2) harm mediates the relationship between dependence and wellbeing, and finally, that (3) separate measures should be more effective than a unidimensional problems measure in predicting wellbeing. Candidate BD items from six existing measures of gambling problems were extracted and evaluated with respect to DSM-5 criteria and content overlap, leading to 17 candidate items. This was further reduced to 8 items based on both item content and psychometric criteria, using data from an online panel of 1524 regular gamblers, with demographic characteristics similar to Australian population norms. Participants also completed measures of harm, problems, and subjective wellbeing. All three hypotheses were confirmed. BD was shown to be highly reliable and unidimensional, and measurably distinct from gambling harms. Harm mediated the negative relationship between BD and wellbeing. The harm + BD model yielded better predictions of personal wellbeing that a unidimensional, continuous problems measure-and explained about twice the variance of a simple contrast between problem and non-problem gamblers. We conclude that is psychometrically justified to specifically measure gambling BD, and this may be of particular use in theoretically-driven applications.

On the stability and the progression of gambling problems: longitudinal relations between different problems related to gambling

BACKGROUND AND AIMS

In psychiatric diagnosis, different symptoms of gambling problems are usually aggregated into a single indicator of disorder severity, which has resulted in a knowledge gap on the specific roles of the different issues with which some gamblers struggle. This study estimated the association between baseline symptoms of gambling problems and (i) other symptoms, (ii) the overall severity of gambling problems after 12 months, and the estimated stability rates of various gambling problems after (iii) 12 months and (iv) 5 years. Design and Setting Secondary analysis of data derived from the Swedish Longitudinal Gambling Study (SWELOGS), a prospective representative cohort study conducted between 2008 and 2014 in Sweden.

PARTICIPANTS

A total of 8165 respondents from 16-84 years of age recruited in a stratified random sampling procedure. Among them, 6021 answered the 1-year follow-up survey and 3559 answered the 5-year follow-up survey.

MEASUREMENTS

Nine symptoms related to gambling were assessed using the Problem Gambling Severity Index (excessive gambling, tolerance, chasing, loans, insight, health problems, criticism, financial problems, and guilt).

FINDINGS

Excessive gambling, tolerance, chasing, loans and guilt significantly increased the risk of a range of other symptoms. Chasing and tolerance also tripled the risk of transitioning to more severe gambling problems (OR = 2.9, 95% CI = [1.5-5.5], P = 0.001 and OR = 2.7, 95% CI = [1.6-4.5], P < 0.001, respectively). Stability rates of the different symptoms ranged between 22% (95% CI = [12-31%]) and 42% (95% CI = [35-48%]) after 1 year and 3% (95% CI = [0-10%]) and 19% (95% CI = [7-30%]) after 5 years with chasing being the most stable problem (42% [95% CI = (35-48%)] after 1 year and 17% [95% CI = (6-28%)] after 5 years).

CONCLUSIONS

In psychiatric diagnosis, four symptoms of problem gambling (chasing, tolerance, excessive gambling and guilt) appear to have prognostic validity in assessing gambling-related risk. The symptoms of tolerance and chasing appear to increase the risk of progressing to more severe gambling problems.

Do EGMs have a Stronger Association with Problem Gambling than Racing and Casino Table Games? Evidence from a Decade of Australian Prevalence Studies

Although it is often assumed that electronic gaming machines (EGMs) are associated with the highest level of risk, it has proved difficult to find reliable evidence in support of this proposition. In this paper, we analysed statistics from major Australian community prevalence studies for the period 2011-2020 to investigate whether EGMs (in comparison to racing and casino table games) have a stronger association with problem gambling. All prevalence studies reviewed used telephone sampling and the Problem Gambling Severity Index to assess problem gambling. In this paper, we examine the principal hypothesis using several lines of evidence, including whether problem gamblers are more likely to gamble and gamble regularly on EGMs as opposed to racing and casino games and if the EGM-problem gambling association was maintained after controlling for other forms of participation. Results showed that of all gambling activities, EGMs do appear to have the strongest association with problem gambling. Despite having a disproportionately higher level of participation on racing and casino games as compared with other gamblers, problem gamblers are more likely to report regular or weekly participation in EGM gambling and this may be the reason why this activity emerges most strongly as a predictor of problem gambling in multivariate models. This finding is particularly salient, given the very high prevalence of EGM participation, compared to other risky gambling forms. The findings underscore the importance of survey reporting that presents results in a form that can inform policy relevant research relating to the potential impact of different gambling activities.

Isolating the impact of specific gambling activities and modes on problem gambling and psychological distress in internet gamblers

Background

Gambling disorder is related to high overall gambling engagement; however specific activities and modalities are thought to have stronger relationships with gambling problems. This study aimed to isolate the relationship between specific gambling activities and modalities (Internet and venue/land-based) to gambling disorder and general psychological distress. Past-month Internet gamblers were the focus of this investigation because this modality may be associated with gambling disorders in a unique way that needs to be separated from overall gambling intensity.

Methods

Australians who had gambled online in the prior 30 days (N = 998, 57% male) were recruited through a market research company to complete an online survey measuring self-reported gambling participation, problem gambling severity, and psychological distress.

Results

When controlling for overall gambling frequency, problem gambling was significantly positively associated with the frequency of online and venue-based gambling using electronic gaming machines (EGMs) and venue-based sports betting. Psychological distress was uniquely associated with higher frequency of venue gambling using EGMs, sports betting, and casino card/table games.

Conclusions

This study advances our understanding of how specific gambling activities are associated with disordered gambling and psychological distress in users of Internet gambling services. Our results suggest that among Internet gamblers, online and land-based EGMs are strongly associated with gambling disorder severity. High overall gambling engagement is an important predictor of gambling-related harms, nonetheless, venue-based EGMs, sports betting and casinos warrant specific attention to address gambling-related harms and psychological distress among gamblers.

Evaluating changes in electronic gambling machine policy on user losses in an Australian jurisdiction

Background

Electronic gambling machines (EGMs) are in casinos and community venues (hotels and clubs) in all jurisdictions in Australia, except Western Australia (only in casino). EGMs have a range of features that can affect how people gamble, which can influence losses incurred by users. The Northern Territory Government recently changed two EGM policies – the introduction of note acceptors on EGMs in community venues, and an increase in the cap from 10 to 20 EGMs in hotels and 45 to 55 in clubs. This study evaluates two changes in EGM policy on user losses in community venues, and tracks changes in user losses per adult, EGM gambler, and EGM problem/moderate risk gambler between 2005 and 2015.

Methods

Trends in venue numbers, EGM numbers, user losses and user losses per EGM by venue type and size are presented to determine if EGM policy changes affected user losses. Data from the 2005 and 2015 NT gambling surveys are used to determine EGM user losses per adult, per EGM gambler, and per EGM problem and/or moderate risk gambler, with several assumptions applied.

Results

From 2010 (post smoking ban) to 2013 real user losses were stagnant, but from 2013 to 2017, real user losses in community venues increased 19, 9, 8 and 5% per annum, with increases higher in clubs and hotels with the maximum allowable number of EGMs. Over the same period user losses in the two casinos declined by 13%. Between 2005 and 2015, estimated user losses per EGM problem/moderate risk and problem gambler increased by 5 and 34% respectively.

Conclusions

The analysis demonstrates that reductions in how much money gamblers can insert into an EGM (load-up limit), and/or the abolition of note acceptors, and reductions in the number of EGMs in venues is likely to reduce harm from EGM use. Given the demonstrated inability for Australian jurisdictions to identify and implement effective harm prevention and minimisation interventions, a national approach to gambling regulation in Australia may be desirable. Similarly, national co-ordination of research, particularly on EGMs and online betting is required to better understand changes in gambling policy on related harms.

Spanish validation of the Problem Gambling Severity Index: A confirmatory factor analysis with sports bettors

BACKGROUND AND AIMS

The Problem Gambling Severity Index (PGSI) is one of the most widely used screening tools for problem gambling (PG). However, to date, no empirically validated adaptation of the instrument to Spanish-speaking countries exists.

METHODS

A sample of 659 sports bettors (M_age = 35.1 years, SD = 10.12, 74.2% males) were recruited through an online research panel. A confirmatory factor analysis (CFA) was performed to confirm its construct validity. The participants were administered the Spanish version of the PGSI, along with the adaptation to Spanish of the DSM-IV PG instrument for convergent validity.

RESULTS

The CFA of the Spanish PGSI showed satisfactory construct validity. The internal consistency (α_ordinal = .97) as well as its convergent validity with the DSM-IV scores (r = .77, p < .001) was good.

CONCLUSION

The Spanish adaptation of the PGSI offers satisfactory validity and reliability properties, and is a good psychometric instrument for exploring the social consequences of PG in Spanish-speaking contexts.

A meta-regression analysis of 41 Australian problem gambling prevalence estimates and their relationship to total spending on electronic gaming machines

BACKGROUND

Many jurisdictions regularly conduct surveys to estimate the prevalence of problem gambling in their adult populations. However, the comparison of such estimates is problematic due to methodological variations between studies. Total consumption theory suggests that an association between mean electronic gaming machine (EGM) and casino gambling losses and problem gambling prevalence estimates may exist. If this is the case, then changes in EGM losses may be used as a proxy indicator for changes in problem gambling prevalence. To test for this association this study examines the relationship between aggregated losses on electronic gaming machines (EGMs) and problem gambling prevalence estimates for Australian states and territories between 1994 and 2016.

METHODS

A Bayesian meta-regression analysis of 41 cross-sectional problem gambling prevalence estimates was undertaken using EGM gambling losses, year of survey and methodological variations as predictor variables. General population studies of adults in Australian states and territory published before 1 July 2016 were considered in scope. 41 studies were identified, with a total of 267,367 participants. Problem gambling prevalence, moderate-risk problem gambling prevalence, problem gambling screen, administration mode and frequency threshold were extracted from surveys. Administrative data on EGM and casino gambling loss data were extracted from government reports and expressed as the proportion of household disposable income lost.

RESULTS

Money lost on EGMs is correlated with problem gambling prevalence. An increase of 1% of household disposable income lost on EGMs and in casinos was associated with problem gambling prevalence estimates that were 1.33 times higher [95% credible interval 1.04, 1.71]. There was no clear association between EGM losses and moderate-risk problem gambling prevalence estimates. Moderate-risk problem gambling prevalence estimates were not explained by the models (I ² ≥ 0.97; R ² ≤ 0.01).

CONCLUSIONS

The present study adds to the weight of evidence that EGM losses are associated with the prevalence of problem gambling. No patterns were evident among moderate-risk problem gambling prevalence estimates, suggesting that this measure is either subject to pronounced measurement error or lacks construct validity. The high degree of residual heterogeneity raises questions about the validity of comparing problem gambling prevalence estimates, even after adjusting for methodological variations between studies.

The intergenerational transmission of problem gambling: The mediating role of parental psychopathology

The present study investigated the intergenerational transmission of problem gambling and the potential mediating role of parental psychopathology (problem drinking, drug use problems, and mental health issues). The study comprised 3953 participants (1938 males, 2015 females) recruited from a large-scale Australian community telephone survey of adults retrospectively reporting on parental problem gambling and psychopathology during their childhood. Overall, 4.0% [95%CI 3.0, 5.0] (n=157) of participants reported paternal problem gambling and 1.7% [95%CI 1.0, 2.0] (n=68) reported maternal problem gambling. Compared to their peers, participants reporting paternal problem gambling were 5.1 times more likely to be moderate risk gamblers and 10.7 times more likely to be problem gamblers. Participants reporting maternal problem gambling were 1.7 times more likely to be moderate risk gamblers and 10.6 times more likely to be problem gamblers. The results revealed that the relationships between paternal-and-participant and maternal-and-participant problem gambling were significant, but that only the relationship between paternal-and-participant problem gambling remained statistically significant after controlling for maternal problem gambling and sociodemographic factors. Paternal problem drinking and maternal drug use problems partially mediated the relationship between paternal-and-participant problem gambling, and fully mediated the relationship between maternal-and-participant problem gambling. In contrast, parental mental health issues failed to significantly mediate the transmission of gambling problems by either parent. When parental problem gambling was the mediator, there was full mediation of the effect between parental psychopathology and offspring problem gambling for fathers but not mothers. Overall, the study highlights the vulnerability of children from problem gambling households and suggests that it would be of value to target prevention and intervention efforts towards this cohort.

Prevalence and Correlates of Problem Gambling in a Representative Sample of Norwegian 17-Year-Olds

We report data collected in a representative sample of 17-year-old Norwegians to investigate prevalence rates of non-problem, risk, and problem gambling, as measured by the Problem Gambling Severity Index (PGSI). In addition, we explored the importance of demographic, personality, motivational, social, and health variables explaining variance in adolescent gambling. Prevalence rates of risk and problem gambling were low but similar to those found in previous studies outside of Norway using the PGSI in adolescent samples. With regard to the relative importance of the various covariates, we found that motivational variables (future gambling intentions, attitudes toward gambling, and gambling-related knowledge) distinguished best between those who did not gamble, non-problem gamblers, and risk and problem gamblers. Furthermore, social variables were important covariates of adolescent gambling; significant associations were found for family and friends' approval of gambling, parental monitoring, father's level of education, and having relatives or friends with a history of a gambling disorder. We discuss possible reasons for differences between the covariates with regard to their importance for explaining adolescent gambling and address implications for future research.

Gambling Motives: Application of the Reasons for Gambling Questionnaire in an Australian Population Survey

The Reasons for Gambling Questionnaire (RGQ) consist of 15 items forming five factors: enhancement, social, money, recreation and coping. The RGQ was developed for use in the 2010 British Gambling Prevalence Survey (BGPS) and has now been employed in the second Social and Economic Impact Study (SEIS) of Gambling in Tasmania study conducted in 2011 in Australia. Given differences between Britain and Australia in terms of socio-demographic profiles, gambling cultures and attitudes, gambling access and availability, gambling regulation, and rates and patterns of gambling participation, the aims of this study were to analyse the RGQ data from the SEIS to: (1) determine the most commonly endorsed gambling motives in an Australian jurisdiction, (2) explore the factor structure of the RGQ in an Australian sample, and (3) explore how motives for gambling vary among different Australian population sub-groups. A representative sample of the Tasmanian population who had gambled in the previous 12 months (n = 2,796) were administered the RGQ via computer-assisted telephone interviewing. The five most commonly endorsed reasons for gambling were for fun (62%), followed by the chance of winning big money (52%), it being something to do with friends and family (48%), to be sociable (40%), and excitement (38%). A principal component analysis revealed a five-factor structure that is slightly different from that derived in the BGPS: money, regulate internal state, positive feelings, social, and challenge reasons. Finally, gambling motives varied according to socio-demographic factors, number of gambling activities, problem gambling severity, and participation on different gambling activities. Although some of these findings are consistent with those from the BGPS, there are also some slight differences, suggesting that there may be regional-specific variations in gambling motives.

National estimates of Australian gambling prevalence: f indings from a dual-frame omnibus survey

BACKGROUND, AIMS AND DESIGN

The increase in mobile telephone-only households may be a source of bias for traditional landline gambling prevalence surveys. Aims were to: (1) identify Australian gambling participation and problem gambling prevalence using a dual-frame (50% landline and 50% mobile telephone) computer-assisted telephone interviewing methodology; (2) explore the predictors of sample frame and telephone status; and (3) explore the degree to which sample frame and telephone status moderate the relationships between respondent characteristics and problem gambling.

SETTING AND PARTICIPANTS

A total of 2000 adult respondents residing in Australia were interviewed from March to April 2013.

MEASUREMENTS

Participation in multiple gambling activities and Problem Gambling Severity Index (PGSI).

FINDINGS

Estimates were: gambling participation [63.9%, 95% confidence interval (CI) = 61.4-66.3], problem gambling (0.4%, 95% CI = 0.2-0.8), moderate-risk gambling (1.9%, 95% CI = 1.3-2.6) and low-risk gambling (3.0%, 95% CI = 2.2-4.0). Relative to the landline frame, the mobile frame was more likely to gamble on horse/greyhound races [odds ratio (OR) = 1.4], casino table games (OR = 5.0), sporting events (OR = 2.2), private games (OR = 1.9) and the internet (OR = 6.5); less likely to gamble on lotteries (OR = 0.6); and more likely to gamble on five or more activities (OR = 2.4), display problem gambling (OR = 6.4) and endorse PGSI items (OR = 2.4-6.1). Only casino table gambling (OR = 2.9) and internet gambling (OR = 3.5) independently predicted mobile frame membership. Telephone status (landline frame versus mobile dual users and mobile-only users) displayed similar findings. Finally, sample frame and/or telephone status moderated the relationship between gender, relationship status, health and problem gambling (OR = 2.9-7.6).

CONCLUSION

Given expected future increases in the mobile telephone-only population, best practice in population gambling research should use dual frame sampling methodologies (at least 50% landline and 50% mobile telephone) for telephone interviewing.

Problem Gambling and Intimate Partner Violence: A Systematic Review and Meta-Analysis

This study provides a systematic review of the empirical evidence related to the association between problem gambling and intimate partner violence (IPV). We identified 14 available studies in the systematic search (8 for victimisation only, 4 for perpetration only and 2 for both victimisation and perpetration). Although there were some equivocal findings, we found that most of the available research suggests that there is a significant relationship between problem gambling and being a victim of IPV. There was more consistent evidence that there is a significant relationship between problem gambling and perpetration of IPV. Meta-analyses revealed that over one third of problem gamblers report being victims of physical IPV (38.1%) or perpetrators of physical IPV (36.5%) and that the prevalence of problem gambling in IPV perpetrators is 11.3%. Although the exact nature of the relationships between problem gambling and IPV is yet to be determined, the findings suggest that less than full employment and clinical anger problems are implicated in the relationship between problem gambling and IPV victimization and that younger age, less than full employment, clinical anger problems, impulsivity, and alcohol and substance use are implicated in the relationship between problem gambling and IPV perpetration. The findings highlight the need for treatment services to undertake routine screening and assessment of problem gambling, IPV, alcohol and substance use problems, and mental health issues and provide interventions designed to manage this cluster of comorbid conditions. Further research is also required to investigate the relationship between problem gambling and violence that extends into the family beyond intimate partners.

Consumer Perspectives on Gambling Harm Minimisation Measures in an Australian Jurisdiction

This paper investigates consumer perspectives of implemented and proposed gambling harm minimisation measures taken from a geographically stratified survey of adult residents in Tasmania, Australia. Electronic gaming machine (EGM) gamblers were asked whether current and proposed EGM harm minimisation measures impacted on their actual or anticipated gambling expenditure and enjoyment. Participants were analysed based on their endorsement of Problem Gambling Severity Index criteria (scores 0-27), and categorised as non-problem gamblers (score 0), low-risk gamblers (scores 1-2), and moderate/problem gamblers (scores 3+). Specifically, we wanted to identify harm minimisation policies that resulted in the lowest decreases in enjoyment for non-problem gamblers and the highest decreases in expenditure for moderate/problem gamblers. Regarding current policies, the lowest decrease in enjoyment for non-problem gamblers was the ban on Automatic Teller Machines (ATMs) in EGM venues (0.2 %) while the highest decrease in expenditure for moderate/problem gamblers was the reduction in maximum lines (46.9 %). For the proposed measures, the lowest decrease in enjoyment for non-problem gamblers was visible clocks (1.2 %) while the highest decrease in expenditure for moderate/problem gamblers was reducing cash withdrawals (36.3 %). These results suggest universal EGM harm minimisation measures can differentially target non-problem and moderate/problem gamblers.

Impulsivity, gambling cognitions, and the gambler's fallacy in university students

The present study explored the associations among impulsivity, gambling cognitions, and behavioral adherence to the gambler's fallacy in university students (N = 142). Both impulsivity and gambling cognitions were significant predictors of non-problem and problem gambler categories as defined the Problem Gambling Severity Index. A logistic regression analysis showed that the independent contribution of cognition was statistically significant but that the contribution of impulsivity was not. A behavioral measure of gambling was obtained by asking participants to play an online game of roulette for a maximum of 15 min. Only outside bets were permitted whereby participants were to bet on the color of the winning number. Adherence to the gambler's fallacy was indexed by the likelihood of betting on an alternation in the color of the winning number as the number of consecutive outcomes of the other color increased. Gambling cognitions and gender, but not impulsivity, were associated with adherence to the gambler's fallacy. Tracing the sources of specific influences on gambling behavior may benefit from a framework that distinguishes between "hot" (emotional) and "cold" (non-emotional) mechanisms that promote problem gambling.

Gambling advocacy: lessons from tobacco, alcohol and junk food

OBJECTIVE

To explore the attitudes and opinions of public health experts in gambling and related unhealthy commodity industries towards the tactics used by the gambling industry to prevent reform and the advocacy responses to these tactics.

METHODS

In-depth interviews (30-60 minutes) with a convenience sample of 15 public health experts and stakeholders with a public health approach to gambling (n=10), or other unhealthy commodity industries (food, alcohol, tobacco, n=5).

RESULTS

Participants described the influences of political lobbying and donations on public policy, and industry framing of problem gambling as an issue of personal responsibility. Industry funding of, and influence over, academic research was considered to be one of the most effective industry tactics to resist reform. Participants felt there was a need to build stronger coalitions and collaborations between independent academics, and to improve the utilisation of media to more effectively shift perceptions of gambling harm away from the individual and towards the product.

CONCLUSIONS AND IMPLICATIONS

Gambling industry tactics are similar to the tactics of other unhealthy commodity industries. However, advocacy initiatives to counter these tactics in gambling are less developed than in other areas. The formation of national public health coalitions, as well as a strong evidence base regarding industry tactics, will help to strengthen advocacy initiatives.

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

OBJECTIVE

The aim of this paper was to systematically review and meta-analyse the prevalence of co-morbid psychiatric disorders (DSM-IV Axis I disorders) among treatment-seeking problem gamblers.

METHODS

A systematic search was conducted for peer-reviewed studies that provided prevalence estimates of Axis I psychiatric disorders in individuals seeking psychological or pharmacological treatment for problem gambling (including pathological gambling). Meta-analytic techniques were performed to estimate the weighted mean effect size and heterogeneity across studies.

RESULTS

Results from 36 studies identified high rates of co-morbid current (74.8%, 95% CI 36.5-93.9) and lifetime (75.5%, 95% CI 46.5-91.8) Axis I disorders. There were high rates of current mood disorders (23.1%, 95% CI 14.9-34.0), alcohol use disorders (21.2%, 95% CI 15.6-28.1), anxiety disorders (17.6%, 95% CI 10.8-27.3) and substance (non-alcohol) use disorders (7.0%, 95% CI 1.7-24.9). Specifically, the highest mean prevalence of current psychiatric disorders was for nicotine dependence (56.4%, 95% CI 35.7-75.2) and major depressive disorder (29.9%, 95% CI 20.5-41.3), with smaller estimates for alcohol abuse (18.2%, 95% CI 13.4-24.2), alcohol dependence (15.2%, 95% CI 10.2-22.0), social phobia (14.9%, 95% CI 2.0-59.8), generalised anxiety disorder (14.4%, 95% CI 3.9-40.8), panic disorder (13.7%, 95% CI 6.7-26.0), post-traumatic stress disorder (12.3%, 95% CI 3.4-35.7), cannabis use disorder (11.5%, 95% CI 4.8-25.0), attention-deficit hyperactivity disorder (9.3%, 95% CI 4.1-19.6), adjustment disorder (9.2%, 95% CI 4.8-17.2), bipolar disorder (8.8%, 95% CI 4.4-17.1) and obsessive-compulsive disorder (8.2%, 95% CI 3.4-18.6). There were no consistent patterns according to gambling problem severity, type of treatment facility and study jurisdiction. Although these estimates were robust to the inclusion of studies with non-representative sampling biases, they should be interpreted with caution as they were highly variable across studies.

CONCLUSIONS

The findings highlight the need for gambling treatment services to undertake routine screening and assessment of psychiatric co-morbidity and provide treatment approaches that adequately manage these co-morbid disorders. Further research is required to explore the reasons for the variability observed in the prevalence estimates.

Problem gambling and family violence: prevalence and patterns in treatment-seekers

The primary aim of this study was to explore the prevalence and patterns of family violence in treatment-seeking problem gamblers. Secondary aims were to identify the prevalence of problem gambling in a family violence victimisation treatment sample and to explore the relationship between problem gambling and family violence in other treatment-seeking samples. Clients from 15 Australian treatment services were systematically screened for problem gambling using the Brief Bio-Social Gambling Screen and for family violence using single victimisation and perpetration items adapted from the Hurt-Insulted-Threatened-Screamed (HITS): gambling services (n=463), family violence services (n=95), alcohol and drug services (n=47), mental health services (n=51), and financial counselling services (n=48). The prevalence of family violence in the gambling sample was 33.9% (11.0% victimisation only, 6.9% perpetration only, and 16.0% both victimisation and perpetration). Female gamblers were significantly more likely to report victimisation only (16.5% cf. 7.8%) and both victimisation and perpetration (21.2% cf. 13.0%) than male gamblers. There were no other demographic differences in family violence prevalence estimates. Gamblers most commonly endorsed their parents as both the perpetrators and victims of family violence, followed by current and former partners. The prevalence of problem gambling in the family violence sample was 2.2%. The alcohol and drug (84.0%) and mental health (61.6%) samples reported significantly higher rates of any family violence than the gambling sample, while the financial counselling sample (10.6%) reported significantly higher rates of problem gambling than the family violence sample. The findings of this study support substantial comorbidity between problem gambling and family violence, although this may be accounted for by a high comorbidity with alcohol and drug use problems and other psychiatric disorders. They highlight the need for routine screening, assessment and management of problem gambling and family violence in a range of services.

Blue gum gaming machine: an evaluation of responsible gambling features

Structural characteristics of gaming machines contribute to persistence in play and excessive losses. The purpose of this study was to evaluate the effectiveness of five proposed responsible gaming features: responsible gaming messages; a bank meter quarantining winnings until termination of play; alarm clock facilitating setting time-reminders; demo mode allowing play without money; and a charity donation feature where residual amounts can be donated rather than played to zero credits. A series of ten modified gaming machines were located in five Australian gambling venues. The sample comprised 300 patrons attending the venue and who played the gaming machines. Participants completed a structured interview eliciting gambling and socio-demographic data and information on their perceptions and experience of play on the index machines. Results showed that one-quarter of participants considered that these features would contribute to preventing recreational gamblers from developing problems. Just under half of the participants rated these effects to be at least moderate or significant. The promising results suggest that further refinements to several of these features could represent a modest but effective approach to minimising excessive gambling on gaming machines.

A comparison of university student and community gamblers: Motivations, impulsivity, and gambling cognitions

BACKGROUND AND AIMS

The present study tested whether the associations among motivational, cognitive, and personality correlates of problem gambling severity differed across university student gamblers (n = 123) and gamblers in the general adult community (n = 113).

METHODS

The participants completed a survey that included standardized measures of gambling motivation, gambling related cognitions, and impulsivity. The survey also asked participants to report the forms of gambling in which they engaged to test whether gambling involvement (number of different forms of gambling) was related to problem gambling severity. After completing the survey, participants played roulette online to examine whether betting patterns adhered to the gambler's fallacy.

RESULTS

Gambling involvement was significantly related to problem gambling severity for the community sample but not for the student sample. A logistic regression analysis that tested the involvement, motivation, impulsivity and cognitive correlates showed that money motivation and gambling related cognitions were the only significant independent predictors of gambling severity. Adherence to the gambler's fallacy was stronger for students than for the community sample, and was associated with gambling related cognitions.

DISCUSSION

The motivational, impulsivity and cognitive, and correlates of problem gambling function similarly in university student gamblers and in gamblers from the general adult community. Interventions for both groups should focus on the financial and cognitive supports of problem gambling.

Problem Gambling Features and Gendered Gambling Domains Amongst Regular Gamblers in a Swedish Population-Based Study

This study aimed to investigate, from a gender perspective, how different features of problem gambling present in men and women who gamble regularly in Sweden were distributed in four domains based on gambling type (chance or strategy) and setting (public or domestic). Problem gambling features were based on the nine items in the Problem Gambling Severity Index (PGSI). It was hypothesized that men and women gamble in different domains. Further, it was hypothesized that male gamblers overall experienced more problems with gambling than female gamblers, although in the same domains they would report the same level of problems. A further hypothesis predicted that regular female gamblers would experience more health and social problems and men would experience more financial difficulties. Interviews with a subsample of gamblers (n = 3191) from a Swedish nationally representative sample (n = 8179) was used to examine how features of problem gambling correspond with gender and the domains. Only the first hypothesis was fully supported. Men were more likely to participate in forms of gambling requiring strategy in a public setting, and women were more likely to participate in chance-based gambling in a domestic setting. Male and female gamblers had similar levels of problem gambling in the bi-variate analysis, but if controlling for age and gambling in multiple domains, women were more at risk than men. Additionally, men and women presented similar health and economic situations. The differences between male and female gamblers in Sweden have implications for research and prevention.

A prospective study of adolescent risk and protective factors for problem gambling among young adults

There is a paucity of research examining prospective predictors of problem gambling. The current study utilised a large longitudinal data set (N = 2328) to examine a large range of adolescent risk and protective factors for problem gambling in young adulthood. These risk and protective factors covered the domains of the community, family, school, peer group and individual. Numerous predictors associated with the family, school and peer-individual were statistically significant in analyses adjusted for gender and age. However, in the fully adjusted multivariate analyses, only two predictors were statistically significant. Within this model, gender (female) was associated with a reduced risk of young adult problem gambling, while family rewards for prosocial involvement moderated the risk relationship between adolescent alcohol use and young adult problem gambling. These findings highlight the importance of adolescent alcohol use and family environment as potentially modifiable predictors of young adult problem gambling.

Validation of a one item screen for problem gambling

A valid 1 item screen ("In the past 12 months, have you ever had an issue with your gambling?") is potentially important in both a primary care setting and in research applications where an extended screen is not practical or affordable. Prior research by Thomas et al. (A one item screening tool for problem gambling for use in primary care settings, Unpublished Manuscript, Monash University, 2010) and Thomas et al. (MJA 189(3):135-136, 2008) found that the 1 item screen provided acceptable performance when compared to the 9-item Problem Gambling Severity Index (PGSI, Ferris and Wynne in The Canadian problem gambling Index: Final report, Canadian Centre on Substance Abuse, 2001). The current study sought to replicate these findings in a different geographic area. Data were collected from a telephone survey of 1,292 respondents in Queensland. Results from the phone survey showed a very high proportion of false negatives (79%), indicating that approximately 4/5 of positively identified problem gamblers from the PGSI refused to admit to having any "issues with (their) gambling" in the last 12 months. Further investigation using Rasch analysis (Andrich in Medical Care, 42(1):7-16, 2004) revealed that while the internal construct validity of the PGSI was good, the 1 item screen was ineffective as an indicator of those who are presently at risk for problem gambling. One possible explanation for the discrepancy with past results is that the present study employed the qualifier of "In the past 12 months" to match with the questions on the PGSI, whereas the prior research excluded this timeframe limit. Nevertheless, the current study casts doubt on the ability or willingness of people with severe gambling problems to self-diagnose their behavior as problematic.

Prevalence of comorbid disorders in problem and pathological gambling: systematic review and meta-analysis of population surveys

AIMS

This paper reviews evidence pertaining to the prevalence of common comorbid disorders, including alcohol use disorder, depression, substance use disorders, nicotine dependence, anxiety disorders and antisocial personality disorder, in population-representative samples of problem and pathological gamblers.

METHODS

A systematic search was conducted for peer-reviewed and unpublished articles reported between 1 January 1998 and 20 September 2010. Only studies which examined the prevalence of comorbid conditions in problem and/or pathological gamblers from a general population sample using randomized sampling methods and standardized measurement tools were included. Meta-analysis techniques were then performed to synthesize the included studies and estimate the weighted mean effect size and heterogeneity across studies.

RESULTS

Eleven eligible studies were identified from the literature. Results from across the studies indicated that problem and pathological gamblers had high rates of other comorbid disorders. The highest mean prevalence was for nicotine dependence (60.1%), followed by a substance use disorder (57.5%), any type of mood disorder (37.9%) and any type of anxiety disorder (37.4%). However, there was evidence of moderate heterogeneity across studies, suggesting that rate estimates do not necessarily converge around a single population figure, and that weighted means should be interpreted with caution.

CONCLUSIONS

Problem and pathological gamblers experience high levels of other comorbid mental health disorders and screening for comorbid disorders upon entering treatment for gambling problems is recommended. Further research is required to explore the underlying causes of variability observed in the prevalence estimates.