Measuring Problem Gambling: Assessment of Three Prevalence Screens

Five-Factor Model and DSM-5 Alternative Model of Personality Disorder Profile Construction: Associations with Cognitive Ability and Clinical Symptoms

Although numerous studies have explored latent profiles using the Five-Factor Model (FFM) of normative personality, no studies have investigated how broad personality traits (i.e., FFM) and pathological personality traits using the alternative model of personality disorder (AMPD) may combine for latent personality profiles. The present study recruited outpatients (N = 201) who completed the Big Five Aspects Scales (BFAS), Personality Inventory for DSM-5 (PID-5), Structured Clinical Interview for DSM-IV (SCID-I/P), gambling and alcohol use measures, and the Weschler Intelligence subtests. When FFM and AMPD measures were combined, latent profile analyses revealed four profiles, Internalizing-Thought disorder, Externalizing, Average-Detached, and Adaptive. Detachment and openness to experience were the most and least essential traits for profile distinction, respectively. No associations between group membership and cognitive ability measures were found. Internalizing-Thought disorder membership was linked with a current mood and anxiety disorder diagnosis. Externalizing profile membership was associated with younger age, problematic gambling, alcohol use, and a current substance use disorder diagnosis. The four FFM-AMPD profiles overlapped with the four FFM-only and three AMPD-only profiles. Overall, the FFM-AMPD profiles appeared to have better convergent and discriminant validity with DSM-relevant psychopathology.

Are problem buying and problem gambling addictive, impulsive, or compulsive in nature? A network analysis and latent dimension analysis study in Italian community-dwelling adults

Prominent scholars suggested that the impulsive-obsessive compulsive continuum may represent a framework to understand both substance and behavioral addictions. However, the characterization of pathological buying (PB) and problem gambling (PG) within the compulsive-impulsive spectrum has not been extensively investigated. To explore the relationships among PB, PG, alcohol and substance abuse, DSM-5 obsessive-compulsive and related disorders, and impulsive dimensions, a sample of 1,005 Italian community-dwelling adult participants (55.5% female), was administered self-reported measures of PB, PG, and other theoretically-relevant constructs. We expected to observe a multidimensional structure in our data; moreover, DSM-5 obsessive compulsive and related disorders were hypothesized to be accounted for by a common dimension. Three dimensions were identified and replicated across two different, non-redundant methods (i.e., exploratory graph analysis and exploratory factor analysis), namely, substance use and gambling, obsessive and compulsive phenomena, and impulsivity dimensions. Specifically, PG seemed to represent a behavioral variant of addiction vulnerability, PB seemed more akin to obsessive-compulsive spectrum disorders, and disinhibition dimension represented the common core of negative urgency, lack of premeditation, lack of perseverance, sensation seeking (SS), and positive urgency. Our findings may be helpful in improving our knowledge on the similarities and differences between PB and PG.

The Evolution of Gambling-Related Harm Measurement: Lessons from the Last Decade

Jurisdictions around the world have a self-declared mandate to reduce gambling-related harm. However, historically, this concept has suffered from poor conceptualisation and operationalisation. However, recent years have seen swift advances in measuring gambling harm, based on the principle of it being a quantifiable decrement to the health and wellbeing of the gambler and those connected to them. This review takes stock of the background and recent developments in harm assessment and summarises recent research that has validated and applied the Short Gambling Harms Screen and related instruments. We recommend that future work builds upon the considerable psychometric evidence accumulated for the feasibility of direct elicitation of harmful consequences. We also advocate for grounding harms measures with respect to scalar changes to public health utility metrics. Such an approach will avoid misleading pseudo-clinical categorisations, provide accurate population-level summaries of where the burden of harm is carried, and serve to integrate gambling research with the broader field of public health.

Relative Deprivation and Hope: Predictors of Risk Behavior

The belief that one is in a worse situation than similar others (Relative Deprivation) has been associated with involvement in a range of maladaptive escape behaviors, including excessive risk taking. Yet not everyone scoring high on measures of relative deprivation makes maladaptive choices. We hypothesized that hope may ameliorate the negative effects of relative deprivation. In two laboratory-based experiments using a novel risk-taking task (N = 101) we show that hope reduces risk-taking behavior in relatively deprived participants. A third study (N = 122) extended the moderating effect of hope on relative deprivation to real-world risk behavior; increased hope was associated with decreased likelihood of loss of control of one's gambling behavior in relatively deprived individuals. Nurturing hope in relatively deprived populations may protect them against maladaptive behaviors with potential applications for harm reduction.

Embedded Gambling Promotion in Football: An Explorative Study of Cue-Exposure and Urge to Gamble

Limited research has evaluated the psychological effect of sports-betting advertising (such as embedded promotion) upon consumers considered 'higher-risk'. Students are often considered a higher-risk group given the numerous gambling-related risk factors associated with their lifestyle. Furthermore, students studying sports-related subjects may possess a bespoke vulnerability to sports-betting risk, due to contextual factors such as (mis)perceptions regarding advantages of sports-related knowledge. The pilot study investigated whether exposure to embedded gambling promotions during televised football, elicits urges to gamble amongst students, and whether the severity of reported gambling varies between those who study sports-related and non-sports subjects. An experimental methodology was employed. Sixty students from the University of South Wales were shown one of three videos: (a) televised football match highlights containing a high density of embedded promotion; (b) amateur football match highlights containing no gambling-related cues or embedded promotion; (c) a neutral control video containing footage of a live concert. Urge to gamble and risk of gambling problems were measured following video exposure. Sports-students reported significantly higher risk of gambling problem scores than non-sports students. Correspondingly, sport-students who were exposed to embedded gambling promotion reported significantly higher urges to gamble compared to all other conditions. This effect was also observed amongst sports-students who were exposed to an amateur match containing no gambling-related material. These findings provide evidence for the cue-induced urge effect of sports-embedded gambling promotion, amongst vulnerable audiences. Public health interventions and harm reduction strategies should look to counteract these pervasive forms of gambling advertising.

Enhancing the utility of the problem gambling severity index in clinical settings: Identifying refined categories within the problem gambling category

BACKGROUND

The Problem Gambling Severity Index (PGSI) was intended for use in epidemiological research with gamblers across the continuum of risk. Its utility within clinical settings, where the majority of clients are problem gamblers, has been brought into question.

AIMS

(1) Identify refined categories for the problem gambling category of the PGSI in help-seeking gamblers; (2) Validate these categories using the Gambling Symptom Assessment Scale (G-SAS); (3) Explore the relationship of these categories with indices of gambling and help-seeking behaviour.

METHODS

Secondary data analysis of help-seeking problem gamblers from the Australian online gambling counselling/support service (Gambling Help Online [GHO]) from October 2012 to December 2015 (n = 5,881) and trial data evaluating an Australian online self-directed program for gambling (GamblingLess; n = 198). Both datasets included the PGSI, gambling frequency and expenditure. The GamblingLess dataset also included the G-SAS and help-seeking behaviour.

RESULTS

A Latent Class Analysis, using GHO data, identified a 2-class solution. Multiple analytical methods identified a cut-off value of ≥ 19 distinguishing this 2-class solution (low problem severity: Median = 16; high problem severity: Median = 23). High problem severity gamblers had increased odds of being categorised in the higher GSAS category, greater gambling expenditure and having sought face-to-face support. The refined categories were not associated with gambling frequency, distance-based or self-directed help-seeking.

CONCLUSION

These findings are consistent with a stepped-care approach, whereby individuals with higher severity may be better suited to more intensive interventions and individuals with lower severity could commence with less intensive interventions and step-up to intensive interventions.

The Multidimensional Structure of Problem Gambling: An Evaluation of Four Gambling Categorization Instruments from an International Online Survey of Gamblers

To examine the underlying dimensionality and structure of problem gambling using a comprehensive range of problem gambling assessments from an international online survey of gamblers. A total of 12,521 gamblers from 105 countries were recruited through banner advertising placed on a popular online gambling portal to take an online survey. Although participants were recruited online, the majority of the sample (71.6%) gambled only at land-based venues in the past 12 months. A total of 5081 individuals completed all items from the four problem gambling assessments. Participants were allocated to answer one of the four problem gambling assessments and the remaining unique items from the three other problem gambling assessments. The order of assessments were counterbalanced. Two optimal scaling procedures were independently employed to estimate the number of dimensions within the data: exploratory categorical principal component bootstrap analysis and multidimensional scaling. Nonlinear canonical correlation was then used to establish how well each of the four assessment instruments captured the identified dimensions. A final confirmatory principal component analysis was run to understand and characterise the nature of the dimensions that were identified. Both the categorical principal component bootstrap analysis and multidimensional scaling indicated the data was multidimensional, with four dimensions (including a single dominant dimension) providing the best characterisation of the data. The nonlinear canonical correlation analysis found that the Problem and Pathological Gambling Measure and the National Opinion Research Center DSM-IV Screen for Gambling Problems operationalization of the Diagnostic and Statistical Manual of Mental Disorders Four (DSM-IV) criteria best captured these multiple dimensions. Confirmatory principal component analysis suggest a core experience of generic problem gambling symptomology and three other components: "financial problems", "health and relationship issues", and "difficulty controlling gambling". Problem gambling symptomology appears to be multi-dimensional. Certain assessments capture this heterogeneity better than others and thereby provide a more complete and accurate assessment of this construct.

Problem Gambling in Greece: Prevalence and Risk Factors During the Financial Crisis

In Greece no study has ever been conducted on the prevalence of problem gambling. Therefore, a cross-sectional survey was carried out amid the recession aiming to (1) estimate past year prevalence of problem gambling, (2) explore socio-economic and demographic differences among gamblers and non gamblers, (3) explore socio-economic and demographic differences among gamblers who started gambling prior and during the downturn and (4) identify its risk factors with a special interest in the influence of the recession. To this end, data emanating from a telephone and patron survey were combined. A random and representative sample of 3.404 people participated in the telephone survey and 2.400 in the patron survey. The interview schedule was the same in both studies. The presence of problem gambling was assessed with the Canadian Problem Gambling Index. Information on participants' socio-economic and demographic characteristics as well as their ways of dealing financially with the crisis were collected. Findings indicated that 2.4% of respondents met criteria for problem gambling. Male gender, minority status, living with family of origin, low educational level and low to zero income were found to constitute the risk factors of the disorder. Moreover, having started gambling during the recession increased the odds of suffering from problem gambling; however this finding was gender-specific. Thus, people end up in problem gambling through various pathways, with these trajectories being different for men and women. Any intervention should address the complexity of the issue and be tailored by gender.

The Relationship Between In-Play Betting and Gambling Problems in an Australian Context of Prohibited Online In-Play Betting

Internationally, Internet gambling is increasingly permitted under regulated licensing conditions; however, the specific products that are legal varies between jurisdictions. Online sports and race wagering are now legal in many jurisdictions, but in-play betting (also referred to as "live action" or "in-the-run" betting) is often restricted. In-play betting enables bets to be placed on an event after it has commenced. Prohibitionist policies often cite the potential for this type of betting to increase risk of gambling problems. This study aimed to identify which online bettors are most likely to engage in in-play betting, and to investigate the relationship between in-play betting and gambling problems. Online survey responses were collected from 501 Australian past-month online sports bettors in the context of in-play betting only being available on offshore gambling sites or via telephone betting. Thirty-four percent of participants had placed a bet in-play in the past month. Participants placing in-play bets differed from those who had not in terms of education, employment status, ethnicity, age, and gambling involvement. Those who bet in-play had higher problem gambling severity scores than those who did not bet in-play. Problem gambling severity significantly predicting in-play betting, holding other variables constant. Findings are consistent with previous research indicating that the relationship between in-play gambling and problems holds across jurisdictions which have prohibited and legalized in-play betting. The findings suggest that in-play betting should warrant specific regulatory attention and interventions to minimize gambling harms among individuals that engage with this activity.

Screening for problem gambling within mental health services: a comparison of the classification accuracy of brief instruments

BACKGROUND AND AIMS

Despite the over-representation of people with gambling problems in mental health populations, there is limited information available to guide the selection of brief screening instruments within mental health services. The primary aim was to compare the classification accuracy of nine brief problem gambling screening instruments (two to five items) with a reference standard among patients accessing mental health services.

DESIGN

The classification accuracy of nine brief screening instruments was compared with multiple cut-off scores on a reference standard.

SETTING

Eight mental health services in Victoria, Australia.

PARTICIPANTS

A total of 837 patients were recruited consecutively between June 2015 and January 2016.

MEASUREMENTS

The brief screening instruments were the Lie/Bet Questionnaire, Brief Problem Gambling Screen (BPGS) (two- to five-item versions), NODS-CLiP, NODS-CLiP2, Brief Biosocial Gambling Screen (BBGS) and NODS-PERC. The Problem Gambling Severity Index (PGSI) was the reference standard.

FINDINGS

The five-item BPGS was the only instrument displaying satisfactory classification accuracy in detecting any level of gambling problem (low-risk, moderate-risk or problem gambling) (sensitivity = 0.803, specificity = 0.982, diagnostic efficiency = 0.943). Several shorter instruments adequately detected both problem and moderate-risk, but not low-risk, gambling: two three-item instruments (NODS-CLiP, three-item BPGS) and two four-item instruments (NODS-PERC, four-item BPGS) (sensitivity = 0.854-0.966, specificity = 0.901-0.954, diagnostic efficiency = 0.908-0.941). The four-item instruments, however, did not provide any considerable advantage over the three-item instruments. Similarly, the very brief (two-item) instruments (Lie/Bet and two-item BPGS) adequately detected problem gambling (sensitivity = 0.811-0.868, specificity = 0.938-0.943, diagnostic efficiency = 0.933-0.934), but not moderate-risk or low-risk gambling.

CONCLUSIONS

The optimal brief screening instrument for mental health services wanting to screen for any level of gambling problem is the five-item Brief Problem Gambling Screen (BPGS). Services wanting to employ a shorter instrument or to screen only for more severe gambling problems (moderate-risk/problem gambling) can employ the NODS-CLiP or the three-item BPGS. Services that are only able to accommodate a very brief instrument can employ the Lie/Bet Questionnaire or the two-item BPGS.

Comparative Test Evaluation: Methods and Challenges

The present paper has three objectives. First, methods for comparing alternative tests for the purpose of replacement of one test with a second presumably superior test are described. Second, problems in the interpretation of the relevance of different diagnostic thresholds (thresholds of positivity) that define who is and who is not a disordered gambler are examined and a potential solution offered in the form of a common quantitative measure of the risk of being a disordered gambler. Third, alternative methodologies are described as potential solutions to the lack of a gold or reference standard in the evaluation of new tests.

Sense of Coherence and Gambling: Exploring the Relationship Between Sense of Coherence, Gambling Behaviour and Gambling-Related Harm

Understanding why some people experience problems with gambling whilst others are able to restrict gambling to recreational levels is still largely unexplained. One potential explanation is through salutogenesis, which is a health promotion approach of understanding factors which move people towards health rather than disease. An important aspect of salutogenesis is sense of coherence. Individuals with stronger sense of coherence perceive their environment as comprehensible, manageable and meaningful. The present study examined the relationship of individuals' sense of coherence on their gambling behaviour and experience of gambling related harm. This exploratory study utilised an archival dataset (n = 1236) from an online, cross sectional survey of people who had experienced negative consequences from gambling. In general, a stronger sense of coherence was related to lower problem gambling severity. When gambling behaviour was controlled for, sense of coherence was significantly related to the experience of individual gambling harms. A strong sense of coherence can be seen as a protective factor against problematic gambling behaviour, and subsequent gambling related harms. These findings support the value of both primary and tertiary prevention strategies that strengthen sense of coherence as a harm minimisation strategy. The present study demonstrates the potential value of, and provides clear direction for, considering sense of coherence in order to understand gambling-related issues.

How does routinely delivered cognitive-behavioural therapy for gambling disorder compare to "gold standard" clinical trial?

Currently, it is unknown whether treatment outcomes derived from randomized controlled trials (RCTs) of cognitive-behavioural therapy (CBT) for problem gamblers still hold when applied to patients seen in routine practice. Thus, data from an RCT of cognitive therapy versus exposure therapy for problem gambling versus patients of a gambling help service were compared. Assessments of problem gambling severity, psychosocial impairment, and alcohol use were undertaken at baseline and post-treatment and evaluated within a counterfactual framework. Findings showed that the contrast between routine CBT for pokies and horse betting had a significant effect, indicative of a 62% lower gambling urge score if routine CBT recipients had all been horse/track betters opposed to gambling with "pokies." However, the majority of contrasts indicated therapeutic outcomes achieved in routine CBT treatments were of equivalent robustness relative to RCT conditions. The present findings infer routine practice treatment outcomes are as efficacious as those generated in RCT contexts.

A Baseline Study of Past-Year Problem Gambling Prevalence Among Ohioans

Historically, the scope of legalized gambling was limited in Ohio, but everything changed when a new constitutional amendment allowed four casinos to open. To better understand the impact of gambling expansion, a household survey was commissioned to determine the baseline estimate of problem gambling behaviours in the state before casinos opened. Participants were selected through multi-stage probability sampling, with over 3,500 respondents completing valid surveys. Nearly 60% of Ohioans gambled in the past year, but the statewide prevalence of problem gambling was relatively low; only 1.4% of persons scored high enough on the Problem Gambling Severity Index to be classified as a potential problem gambler (score >3). Regional estimates of problem gambling were highest for Franklin and Hamilton counties (both 5.0%) and lowest for Lucas and Cuyahoga counties (3.2% and 2.1%, respectively). Exploratory logistic regression modelling found that race, employment, education, family history of problem gambling, and feelings of depression increased the odds of being a problem gambler. Results will inform the discussion about current gambling problems and enable policy makers to design prevention strategies.La présente étude portait sur la relation entre le prix des billets de loterie instantanée (à gratter) et la « récupération des pertes » dans un seul épisode de jeu. Pendant plusieurs mois, chaque fois qu’un billet de loterie instantanée était acheté (N = 1081), les commis de dépanneur consignaient le sexe des joueurs et le prix des billets de loterie instantanée, et indiquaient si le consommateur avait acheté un autre billet avant de quitter les lieux. L’analyse de régression logistique a montré une corrélation importante entre le prix des billets et le rachat (rapport de cotes = 0,842, p < 0,0001), ce qui suggère que la récupération au cours d’un même épisode de jeu est courante pour les billets de loterie instantanée à plus bas prix et que de plus faibles coûts ne réduisent pas nécessairement les risques.

Gambling behavior among Macau college and university students

This survey investigated gambling behavior among Chinese students studying in Macau colleges and universities. It also aimed to examine the relationship between problem gambling, affect states and sensation seeking propensity. A convenience sample of 999 students (370 men, 629 women) filled a self-administered questionnaire consisted of the Problem Gambling Severity Index (PGSI) (Ferris and Wynne in The Canadian problem gambling index: User manual. Canadian Centre on Substance Abuse, Toronto 2001a), the 8-item Brief Sensation Seeking Scale (BSSS-8) (Hoyle et al. Pers Individ Diff 32(3): 401–414, 2002), Bradburn’s Affect Balance Scale (BABS) (Bradburn in The structure of psychological well-being. Aldine, Chicago 1969) and questions on gambling activities. The response rate is 65%. Results indicate 32.3% (n = 323) of the survey participants wagered on mahjong (61.8%), soccer matches (40.2%), Mark Six lottery (37.2%), card games (28.1%), land-based casino gambling (13.1%), slot machines (7.5%) and online casino games (2.0%). The average monthly stake was MOP $411. Seeking entertainment (18.7%), killing time (12.5%) and peer influence (11.1%) were the three main reasons for gambling. Using the PGSI, 3.6 and 5.3% of the students could be identified as moderate-risk and problem gamblers respectively. Men were significantly more vulnerable to gambling problems (X2(1) = 35.00, p < 0.01) than women. Most of the problematic gamblers (76%) made their first bet before 14 years. The PGSI scores are significantly correlated with the BSSS-8 scores (r = 0.23, p < 0.01) but not with the overall ABS scores (r = −0.06, p > 0.05). The study findings inform campus prevention programs and future research.

Loss of Control as a Discriminating Factor Between Different Latent Classes of Disordered Gambling Severity

Analyses of disordered gambling assessment data have indicated that commonly used screens appear to measure latent categories. This stands in contrast to the oft-held assumption that problem gambling is at the extreme of a continuum. To explore this further, we report a series of latent class analyses of a number of prevalent problem gambling assessments (PGSI, SOGS, DSM-IV Pathological Gambling based assessments) in nationally representative British surveys between 1999 and 2012, analysing data from nearly fifty thousand individuals. The analyses converged on a three class model in which the classes differed by problem gambling severity. This identified an initial class of gamblers showing minimal problems, a additional class predominantly endorsing indicators of preoccupation and loss chasing, and a third endorsing a range of disordered gambling criteria. However, there was considerable evidence to suggest that classes of intermediate and high severity disordered gamblers differed systematically in their responses to items related to loss of control, and not simply on the most ‘difficult’ items. It appeared that these differences were similar between assessments. An important exception to this was one set of DSM-IV criteria based analyses using a specific cutoff, which was also used in an analysis that identified an increase in UK problem gambling prevalence between 2007 and 2010. The results suggest that disordered gambling has a mixed latent structure, and that present assessments of problem gambling appear to converge on a broadly similar construct.

Problem Gambling Family Impacts: Development of the Problem Gambling Family Impact Scale

Although family members of problem gamblers frequently present to treatment services, problem gambling family impacts are under-researched. The most commonly endorsed items on a new measure of gambling-related family impacts [Problem Gambling Family Impact Measure (PG-FIM: Problem Gambler version)] by 212 treatment-seeking problem gamblers included trust (62.5 %), anger (61.8 %), depression or sadness (58.7 %), anxiety (57.7 %), distress due to gambling-related absences (56.1 %), reduced quality time (52.4 %), and communication breakdowns (52.4 %). The PG-FIM (Problem Gambler version) was comprised of three factors: (1) financial impacts, (2) increased responsibility impacts, and (3) psychosocial impacts with good psychometric properties. Younger, more impulsive, non-electronic gaming machine (EGM) gamblers who had more severe gambling problems reported more financial impacts; non-EGM gamblers with poorer general health reported more increased responsibility impacts; and more impulsive non-EGM gamblers with more psychological distress and higher gambling severity reported more psychosocial impacts. The findings have implications for the development of interventions for the family members of problem gamblers.

How Anticipated and Experienced Stigma Can Contribute to Self-Stigma: The Case of Problem Gambling

The degree to which anticipated and experienced public stigma contribute to self-stigma remains open to debate, and little research has been conducted into the self-stigma of problem gambling. This study aimed to examine which aspects of anticipated and experienced stigma (if any) predict the anticipated level of public stigma associated with problem gambling and the degree of self-stigma felt by people experiencing problem gambling. An online survey of 177 Australians experiencing problem gambling examined whether aspects of the public characterization of problem gambling, anticipated reactions to problem gamblers, and experiences of devaluation and discrimination predicted anticipated level of public stigma and self-stigma. The study found that self-stigma increases with expectations that the public applies a range of negative stereotypes to people with gambling problems, holds demeaning and discriminatory attitudes toward them, and considers them to lead highly disrupted lives. These variables directly predicted anticipated level of public stigma and indirectly predicted self-stigma. These findings lend weight to conceptualizations of self-stigma as an internalization of actual or anticipated public stigma. They also highlight the need for stigma reduction efforts, particularly those that lower negative stereotyping and prejudicial attitudes, to improve currently low rates of help-seeking amongst people with gambling problems.

Future-oriented mental time travel in individuals with disordered gambling

This study investigated the ability of individuals with disordered gambling to imagine future events. Problem gamblers (n=35) and control participants (n=35) were asked to imagine positive and negative future events for three temporal distances (one week, one year, 5-10years). Then, a variety of phenomenological aspects of their future thoughts (e.g., sensory and contextual details, autonoetic consciousness) were rated. Compared to control subjects, problem gamblers generated fewer positive and negative events across all temporal distances, an impairment that was correlated to verbal fluency scores. Furthermore, problem gamblers rated imagined events as containing fewer sensory and contextual details, and lacking autonoetic consciousness. These findings demonstrate that problem gambling is associated with a reduced future-oriented mental time travel ability and, in particular, with diminished autonoetic consciousness when imagining future events.

Unpacking the public stigma of problem gambling: The process of stigma creation and predictors of social distancing

Background and aims Public stigma diminishes the health of stigmatized populations, so it is critical to understand how and why stigma occurs to inform stigma reduction measures. This study aimed to examine stigmatizing attitudes held toward people experiencing problem gambling, to examine whether specific elements co-occur to create this public stigma, and to model explanatory variables of this public stigma. Methods An online panel of adults from Victoria, Australia (N = 2,000) was surveyed. Measures were based on a vignette for problem gambling and included demographics, gambling behavior, perceived dimensions of problem gambling, stereotyping, social distancing, emotional reactions, and perceived devaluation and discrimination. A hierarchical linear regression was conducted. Results People with gambling problems attracted substantial negative stereotypes, social distancing, emotional reactions, and status loss/discrimination. These elements were associated with desired social distance, as was perceived that problem gambling is caused by bad character, and is perilous, non-recoverable, and disruptive. Level of contact with problem gambling, gambling involvement, and some demographic variables was significantly associated with social distance, but they explained little additional variance. Discussion and conclusions This study contributes to the understanding of how and why people experiencing gambling problems are stigmatized. Results suggest the need to increase public contact with such people, avoid perpetuation of stereotypes in media and public health communications, and reduce devaluing and discriminating attitudes and behaviors.

The cost of virtual wins: An examination of gambling-related risks in youth who spend money on social casino games

Background and aims Social casino games (SCGs) are not technically considered a form of gambling but they do enable players to spend money in a game that is gambling themed or structurally approximate to gambling. It has been theorized that SCGs could be a gateway to gambling activities or otherwise normalize the experience of gambling for young people, particularly when money becomes involved. The aim of this study was to investigate whether adolescents' financial expenditure in SCGs was associated with broader gambling activity, including level of participation, expenditure, and problem gambling symptoms. Methods An online survey was administered to 555 adolescents, including 130 SCG players (78 non-paying and 52 paying users). Results Paying SCG users tended to be employed males who play more frequently and engage in more SCG activities, who report more symptoms of problem gambling and higher psychological distress than non-paying SCG users. Paying SCG users reported more frequent engagement and spending in monetary gambling activities, and two-thirds of SCG payers recalled that their SCG use had preceded involvement in financial gambling. Discussion and conclusions Spending in simulated gambling activities by adolescents may be a risk factor for problem gambling. Although SCGs may currently defy classification as a form of gambling, these activities will likely continue to be scrutinized by regulators for the use of dubious or exploitative payment features offered in a gambling-themed format that is available to persons of all ages.

Effects of Affective and Anxiety Disorders on Outcome in Problem Gamblers Attending Routine Cognitive-Behavioural Treatment in South Australia

This study evaluated the influence of 12-month affective and anxiety disorders on treatment outcomes for adult problem gamblers in routine cognitive-behavioural therapy. A cohort study at a state-wide gambling therapy service in South Australia. Primary outcome measure was rated by participants using victorian gambling screen (VGS) 'harm to self' sub-scale with validated cut score 21+ (score range 0-60) indicative of problem gambling behaviour. Secondary outcome measure was Work and Social Adjustment Scale (WSAS). Independent variable was severity of affective and anxiety disorders based on Kessler 10 scale. We used propensity score adjusted random-effects models to estimate treatment outcomes for sub-populations of individuals from baseline to 12 month follow-up. Between July, 2010 and December, 2012, 380 participants were eligible for inclusion in the final analysis. Mean age was 44.1 (SD = 13.6) years and 211 (56%) were males. At baseline, 353 (92.9%) were diagnosed with a gambling disorder using VGS. For exposure, 175 (46%) had a very high probability of a 12-month affective or anxiety disorder, 103 (27%) in the high range and 102 (27%) in the low to moderate range. For the main analysis, individuals experienced similar clinically significant reductions (improvement) in gambling related outcomes across time (p < 0.001). Individuals with co-varying patterns of problem gambling and 12 month affective and anxiety disorders who present to a gambling help service for treatment in metropolitan South Australia gain similar significant reductions in gambling behaviours from routine cognitive-behavioural therapy in the mid-term.

From Boredom to Dependence: The Medicalisation of the Swedish Gambling Problem

Aims

The aim of this study is to investigate the medicalising of gambling problems by comparing the political discussions on gambling in the Swedish Parliament in the early 1970s and the early 2010s.

Design

Against a theoretical background on medicalising processes in general, and medicalisation of gambling problems in particular, we have analysed discussion protocols and parliamentary bills in the Swedish Parliament from the years 1970–1975 and 2012–2013.

Results

The problem descriptions of the 1970s and 2010s are, in certain respects, strikingly similar, identifying proactive operators such as the gambling companies and highlighting an inadequate legal framework. But where the MPs of the 1970s put some effort into describing the drab society which fed the need for gambling, the elected representatives of the 2010s shortcut to individual dependence.

Conclusions

EU membership and the development of the Internet have made effective control and regulation impossible in the early 2010s and the political handling of the Swedish gambling problem is therefore a clear example of how market liberalisation can pave the way for individualisation, medicalisation and depoliticisation of social problems.

A preliminary adaptation of the Problem Gambling Severity Index for Indigenous Australians: internal reliability and construct validity

OBJECTIVE

This paper describes the process employed to adapt the Problem Gambling Severity Index (PGSI) for use with Indigenous Australian populations.

METHODS

This study comprised a two-stage process: an initial consultation with Indigenous health workers, informing the textual and conceptual adaptation of items, followed by trial of the adjusted instrument with Indigenous community members (n=301).

RESULTS

Internal reliability was demonstrated: Australian Indigenous Problem Gambling Index (AIPGI) Cronbach's alpha α = 0.92 (Original PGSI, α = 0.84). Item-rest correlations confirmed that responses to items were consistent and related to the total score of remaining items. The AIPGI could predict gambling severity based on gambling frequency, when controlling for age and gender (OR=1.28, 95%CI 1.17-1.40).

CONCLUSIONS

The adapted instrument is accessible to a cross-section of Indigenous Australians and has demonstrated properties of reliability and validity. An extended trial is needed to test the application of the instrument to a broader Indigenous audience and to further explore and confirm psychometric properties of the adapted instrument.

IMPLICATIONS

This study introduces a culturally adapted tool for measuring rates of disordered gambling among Indigenous Australians.

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.

Cognitive versus exposure therapy for problem gambling: Randomised controlled trial

BACKGROUND

Problem gambling-specific cognitive therapy (CT) and behavioural (exposure-based) therapy (ET) are two core cognitive-behavioural techniques to treating the disorder, but no studies have directly compared them using a randomised trial.

AIMS

To evaluate differential efficacy of CT and ET for adult problem gamblers at a South Australian gambling therapy service.

METHODS

Two-group randomised, parallel design. Primary outcome was rated by participants using the Victorian Gambling Screen (VGS) at baseline, treatment-end, 1, 3, and 6 month follow-up.

FINDINGS

Of eighty-seven participants who were randomised and started intervention (CT = 44; ET = 43), 51 (59%) completed intervention (CT = 30; ET = 21). Both groups experienced comparable reductions (improvement) in VGS scores at 12 weeks (mean difference -0.18, 95% CI: -4.48-4.11) and 6 month follow-up (mean difference 1.47, 95% CI: -4.46-7.39).

CONCLUSIONS

Cognitive and exposure therapies are both viable and effective treatments for problem gambling. Large-scale trials are needed to compare them individually and combined to enhance retention rates and reduce drop-out.

The relative contribution of metacognitions and attentional control to the severity of gambling in problem gamblers

The present study explored the relationship between metacognitions, attentional control, and the severity of gambling in problem gamblers. One hundred and twenty six problem gamblers completed the Depression Anxiety Stress Scales 21, the Meta-Cognitions Questionnaire 30, the Attentional Control Scale, and the Problem Gambling Severity Index. Results revealed that negative affect, four out of five metacognitions factors (positive beliefs about worry, negative beliefs about thoughts concerning danger and uncontrollability, cognitive confidence and beliefs about the need to control thoughts), and all attentional control factors (focusing, shifting and flexible control of thought) were correlated, in the predicted directions, with the severity of gambling. The same metacognitions were also found to be correlated, in the predicted directions, with attention focusing, however only negative beliefs about thoughts concerning danger and uncontrollability and cognitive confidence were found to be correlated with attention shifting and flexible control of thought. A hierarchical regression analysis showed that beliefs about the need to control thoughts were the only predictor of the severity of gambling controlling for negative affect. Overall these findings support the hypotheses and are consistent with the metacognitive model of psychological dysfunction. The implications of these findings are discussed.

Effects of gambling-related cues on the activation of implicit and explicit gambling outcome expectancies in regular gamblers

The current research examined whether the presentation of gambling-related cues facilitates the activation of gambling outcome expectancies using both reaction time (RT) and self-report modes of assessment. Gambling outcome expectancies were assessed by having regular casino or online gamblers (N = 58) complete an outcome expectancy RT task, as well as a self-report measure of gambling outcome expectancies, both before and after exposure to one of two randomly assigned cue conditions (i.e., casino or control video). Consistent with hypotheses, participants exposed to gambling-related cues (i.e., casino cue video condition) responded faster to positive outcome expectancy words preceded by gambling prime relative to non-gambling prime pictures on the post-cue RT task. Similarly, participants in the casino cue video condition self-reported significantly stronger positive gambling outcome expectancies than those in the control cue video condition following cue exposure. Activation of negative gambling outcome expectancies was not observed on either the RT task or self-report measure. The results indicate that exposure to gambling cues activates both implicit and explicit positive gambling outcome expectancies among regular gamblers.

Professional help-seeking for gambling problems: awareness, barriers and motivators for treatment

Despite the negative consequences associated with gambling, few problem gamblers seek professional help. This study aimed to examine awareness of professional sources of help and help-seeking behaviour amongst regular and problem gamblers. Australian gamblers (N = 730) were recruited from the general population, multicultural gambling venues, and gambling helplines and treatment services. Surveys measured awareness of professional help services, help-seeking behaviour and motivators and barriers to seeking help. Gamblers demonstrated low awareness of professional help services. Problem gamblers born in Australia or who were divorced were more likely to seek help. Problem gamblers who were reluctant to seek help due to a desire solve the problem on their own and feeling ashamed for themselves or their family pride were more likely to have overcome these barriers to seek help. However, significant barriers related to denial of problem severity and concerns about the ability to access low cost services that cater for multicultural populations predicted a lower likelihood of having sought help. Public education should aim to de-mystify the treatment process and educate gamblers about symptoms of problem gambling to reduce shame, stigma, and denial and encourage help-seeking. Ongoing education and promotion of help services is required to increase awareness of the resources available, including targeted promotions to increase awareness of relevant services among specific populations.

Are psychology university student gamblers representative of non-university students and general gamblers? A comparative analysis

Students recruited from psychology undergraduate university populations are commonly used in psychology research, including gambling studies. However, the extent to which the use of this subpopulation produces findings that can be extrapolated to other groups is questionable. The present study was designed to compare results from university-recruited psychology student gamblers to those obtained from a sample of gamblers recruited from the general population that also included students. An online survey measuring gambling behavior and Internet gambling, attitudes and knowledge about gambling and problem gambling severity was posted on websites accessed by gamblers. Participants were recruited from two sources, a psychology undergraduate university population (n = 461) and online websites (n = 4,801). Results showed university-recruited students differed significantly from both adults and students recruited from the general population in respect to demographic variables and gambling behavior. Psychology undergraduate students were younger, more likely to be female, and had lower incomes. When relevant demographic variables were controlled, psychology undergraduate students were found to gamble less frequently, at different times, and to be at lower-risk for gambling-related problems, but had more irrational beliefs and more negative attitudes towards gambling than gamblers recruited from the general population. Results suggest that caution should be used in extrapolating findings from research using university-recruited psychology student gamblers to wide community populations due to differences related to gambling thoughts, attitudes and behaviors.

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.

An assessment of the psychometric properties of Italian version of CPGI

The aim of this study was to adapt to the Italian context a very commonly used international instrument to detect problem gambling, the canadian problem gambling index (CPGI), and assess its psychometric properties. Cross-cultural adaptation of CPGI was performed in several steps and the questionnaire was administered as a survey among Italian general population (n = 5,292). Cronbach's alpha reliability coefficient was 0.87 and can be considered to be highly reliable. Construct validity was assessed first by means of a principal component analysis and then by means of confirmatory factor analysis, showing that only one factor, problem gambling, was extracted from the CPGI questionnaire (an eigenvalues of 4,684 with percentage of variance 52 %). As far as convergent validity is concerned, CPGI was compared with Lie/Bet questionnaire, a two-item screening tool for detecting problem gamblers, and with both depression and stress scales. A short form DSM-IV CIDI questionnaire was used for depression and VRS scale, a rating scale, was used for rapid stress evaluation. A strong convergent validity with these instruments was found and these findings are consistent with past research on problem gambling, where another way to confirm the validity is to determine the extent to which it correlates with other qualities or measures known to be directly related to problem gambling. In sum, despite the lack of a direct comparison with a classic gold-standard such as DSM-IV, the Italian version of CPGI exhibits good psychometric properties and can be used among the Italian general population to identify at-risk problem gamblers.

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

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

Gratitude, hope, mindfulness and personal-growth initiative: buffers or risk factors for problem gambling?

The majority of prevention and intervention research in problem gambling (PG) has focused on identifying negative risk factors. However, not all at-risk individuals go on to develop anticipated disorders and many thrive in spite of them. In healthcare settings, PG and other disorders are typically conceptualized from the biomedical perspective that frame disorders as something negative residing within the individual and reduction in negativity is seen as success. Indeed, this problem-focused conceptualization may be adequate in many cases as reducing PG behaviour is undoubtedly an important outcome, but the focus on negativity alone is too narrow to capture the complexity of human behaviour. Hence, this study attempts to bridge the gap in literature by providing an evaluation of the predictive ability of the positive dispositions on problem gambling severity, gambling-related cognitions, and gambling urges. The positive psychological dispositions examined were curiosity, gratitude, hope, personal growth initiative, and mindfulness. Participants consisted of 801 Taiwanese Chinese students and community individuals (Mean age = 25.36 years). Higher levels of gratitude and hope have been found to predict lower PG, gambling-related cognitions, or gambling urges. Meanwhile, higher mindfulness predicted lower PG, but only among Chinese males. However, lower personal growth initiative predicted lower PG, gambling-related cognitions, and gambling urges. These analyses have small to medium effect sizes with significant predictions. Findings of this study have essential implications in understanding and treating Chinese problem gamblers. These positive dispositions should be addressed by mental health professionals in preventative and treatment programs among Chinese individuals. Further implications and suggestions for future research are discussed.

Validity of the Problem Gambling Severity Index interpretive categories

The Problem Gambling Severity Index (PGSI) is a widely used nine item scale for measuring the severity of gambling problems in the general population. Of the four gambler types defined by the PGSI, non-problem, low-risk, moderate-risk and problem gamblers, only the latter category underwent any validity testing during the scale's development, despite the fact that over 95% of gamblers fall into one of the remaining three categories. Using Canadian population data on over 25,000 gamblers, we conducted a comprehensive validity and reliability analysis of the four PGSI gambler types. The temporal stability of PGSI subtype over a 14-month interval was modest but adequate (intraclass correlation coefficient = 0.63). There was strong evidence for the validity of the non-problem and problem gambler categories however the low-risk and moderate-risk categories showed poor discriminant validity using the existing scoring rules. The validity of these categories was improved with a simple modification to the scoring system.

Complex factors and behaviors in the gambling population of Italy

Gambling has seen significant growth globally, and particularly in Italy: it has rapidly evolved from a simple recreational activity to represent 4% of Italian GDP in 2010.A sample of 4.494 gamblers was drawn from IPSAD-Italia(®)2007-2008 (Italian Population Survey on Alcohol and Drugs) in order to examine different gambling patterns (assessed using the Canadian Problem Gambling Index Short form scale).Separate analysis was performed on young adults, age 15-24 (n = 1,241; male 56.2%), and adults, age 25-64 (n = 3,253; male 53.8%): compared with adults, Italian youth, although they gambled less (35.7% vs. 45.3%), appeared to have higher prevalence of low risk gambling (6.9% vs. 5.8%) and moderate risk or problem gambling (2.3% vs. 2.2%). Males are more likely to be moderate-risk or problem gamblers. Those with only a primary education are more likely to be moderate-risk or problem gamblers (young adults: RRR = 5.22; adults: RRR = 3.23) than those with a university education, just like those youth who use depressants, but only among younger (RRR = 3.38).A fundamental issue, "do not disapprove of gambling", seems to relate to problematic gambling: a specific Italian legislation, the Abruzzi Decree Law, could have influenced the perception that gambling may contribute positively to provide additional funds to the government for social good as well as to add needed jobs. Regardless of such potential social benefits, gambling is a social epidemic and if this association should be confirmed by more focused studies, policy makers should evaluate ways to affect this perception as soon as possible.

Low trait self-control in problem gamblers: evidence from self-report and behavioral measures

Problems with self-control are seen as a key cause of problem gambling behavior. Yet, self-control is rarely studied directly in gambling studies. We demonstrated that self-report and behavioral measures (derived from the strength model of self-control) show lower trait self-control in problem gamblers. In Study 1, a sample of 2,208 undergraduate students from the University of Guelph, Canada (73% female, mean age = 19 years, SD = 4) completed a self-report measure of self-control strength. In Study 2, a sample of 296 University of Guelph students and staff (58% female, mean age = 19 years, SD = 2) completed multiple behavioral measures of self-control strength. Both studies demonstrated that, compared to lower-risk gamblers, higher-risk gamblers have relative trait self-control deficits.