Birth cohort and sex differences in the age of gambling initiation in the United States: evidence from the National Comorbidity Survey Replication

Women and gambling disorder: Assessing dropouts and relapses in cognitive behavioral group therapy

BACKGROUND

Gender-specific literature focused on gambling disorder (GD) is scarce, and women with GD have been understudied. Therefore, the aim of this study was to estimate the short-term effectiveness in women with GD (n = 214) of a group standardized cognitive-behavioral therapy (CBT) and to identify the most relevant predictors of the primary therapy outcomes (dropout and relapse).

METHODS

The manualized CBT consisted of 16 weekly outpatient group sessions. Women were provided with resources to obtain a better understanding of the GD, to improve self-control and to manage risk situations.

RESULTS

The dropout risk was higher for women with lower GD severity and higher psychopathological distress. Among other factors, lower education levels were a significant predictor of the relapse risk and and the frequency of relapses was higher for divorced women with a preference for non-strategic gambling and with substances consumption.

CONCLUSIONS

Our findings evidence women-specific predictors of the primary therapy outcomes. The results highlight the need to design psychological interventions that address dropout and relapse risk factors in women.

Retrospective and prospective assessments of gambling-related behaviors across the female menstrual cycle

BACKGROUND AND AIMS

Despite increases in female gambling, little research investigates female-specific factors affecting gambling behavior (GB). Although research suggests that some addictive behaviors may fluctuate across menstrual cycle phase (MCP), gambling requires further investigation. In two studies, we examined associations between MCP and three risky GBs: time spent gambling, money spent gambling, and the probability of consuming alcohol while gambling. Associations between MCP and negative affect were also examined in Study 2. We predicted that, consistent with self-medication theory, increases in negative affect (Study 2) and risky GBs (Studies 1 and 2) would occur premenstrually/menstrually relative to other phases.

METHODS

Data were obtained from 33 female gamblers using a retrospective timeline followback procedure (Study 1) and from 20 female gamblers using a prospective 32-day, daily diary method (Study 2). In Study 2, salivary progesterone levels verified self-reported MCP validity.

RESULTS

Findings revealed significant, but somewhat inconsistent, MCP effects on GBs across studies. The self-medication hypothesis was partially supported. Increases relative to another MCP(s) were found for alcohol consumption while gambling premenstrually, time spent gambling menstrually/premenstrually, money spent gambling menstrually, and negative affect premenstrually. Unexpectedly, findings more consistently indicated that GBs increased during ovulation, suggestive of enhanced reward sensitivity. Progesterone assays validated self-reported MCP (Study 2).

DISCUSSION AND CONCLUSIONS

The results suggest a role of ovarian hormones on negative affect and GBs in females. This research could lead to the identification of female-specific factors affecting gambling and the development of more effective interventions for females with, or at risk for, problematic gambling.

Gender differences in mental health and substance use disorders and related healthcare services utilization

BACKGROUND AND OBJECTIVES

Pathological gambling often co-occurs with other psychiatric disorders. Gender differences in treatment-seeking behaviors among patients with pathological gambling diagnosis remain poorly understood. This study assessed gender differences in healthcare services utilization in patients seeking treatment for pathological gambling, substance use, and mental health co-occurring conditions.

METHODS

Study data were derived from a representative sample of the Massachusetts All Payers Claims Database for the period 2009-2013. Descriptive analyses were performed by gender using group t-tests and Pearson's chi-square tests. Bootstrap analysis was used to account for skewed distribution of healthcare services utilization data. Multiple linear regressions were used to evaluate the association between healthcare services utilization and gender while controlling for patient's age, county, and ICD-9-CM diagnosis codes.

RESULTS

Over two-thirds of the patients were males. Moreover, two in five patients seeking treatment had pathological gambling as principal or primary diagnosis. Females had a significantly greater number of three or more co-occurring psychiatric conditions than males. Having a diagnosis of episodic mood disorder, neurotic disorder, or adjustment reaction significantly increased the utilization of healthcare services for both genders. Females had a greater utilization of healthcare services than males for the same psychiatric diagnosis.

DISCUSSION AND CONCLUSIONS

Healthcare services utilization significantly varies by gender and type of mental health and substance use diagnosis. There are significant differences by gender in the utilization of healthcare services for the same psychiatric disorders.

SCIENTIFIC SIGNIFICANCE

There is a need to address gender differences in psychiatric conditions and their related healthcare needs. (Am J Addict 2019;28:9-15).

Has the Genetic Contribution to the Propensity to Gamble Increased? Evidence From National Twin Studies Conducted in 1962 and 2002

Social changes, such as the expansion of legal forms of gambling, can influence not only the prevalence of gambling, but can also shape the relative importance of genetic and environmental contributions to individual differences in the propensity to gamble. In the present study, I examined differences in the prevalence and in the relative contribution of genetic and environmental factors to gambling involvement in the United States in 1962 versus 2002. The data came from two sources: (1) a survey of 839 17-year-old same-sex twin pairs from the National Merit Scholarship Qualifying Test twin study, and (2) an interview of 477 18- to 26-year-old same-sex twin pairs from Wave III of the National Longitudinal Study of Adolescent to Adult Health. Similar measures of gambling participation were included in the two studies. Evidence for a genotype-by-time interaction was evaluated by testing whether the contribution of genetic influences was greater in the more recently born cohort of twins. Despite the major changes in the gambling landscape over the intervening 40 years, there was no evidence for such an interaction. The contribution of genetic factors and environmental factors did not significantly differ and there was no evidence for genetic influences at either time point. Instead, the variation in the propensity to gamble was explained nearly equally by common and unique environmental factors. Explanations for this surprising finding are discussed.

Quelle est l’influence du genre dans la recherche de soins chez les joueurs?

Cette étude vise à décrire l’influence du genre sur les différentes étapes amenant un joueur ayant des problèmes de jeu à prendre la décision de rechercher de l’aide. Le modèle de recherche d’aide de Goldsmith, Jackson et Hough (1988) a été utilisé pour conceptualiser les étapes de prise de décision menant à consulter des services d’aide pour un problème de jeu de hasard et d’argent. Au total, 83 participants, dont 45 femmes et 38 hommes adultes, y ont pris part. Les résultats indiquent que, comparativement aux hommes, les femmes sont plus nombreuses à habiter en couple, ont plus souvent de faibles revenus et subviennent moins fréquemment seules à leurs besoins, rapportent des conduites de jeu plus conséquentes, souffrent davantage de troubles anxieux au cours de leur vie et, enfin, consultent surtout des services non spécialisés. Au cours des 12 derniers mois, les femmes avaient consulté plus souvent les services médicaux de première ligne et avaient eu moins fréquemment recours aux services spécialisés que les hommes.The aim of this study was to describe the influence of gender on the various stages of the decision-making process that bring problem gamblers to seek help. The authors used the help-seeking model developed by Goldsmith, Jackson and Hough (1988) to conceptualize the different stages of the process that leads to consulting support services for a gambling problem. A total of 83 participants (45 females and 38 males) took part in the study. Results show that women are more likely to have a partner and to earn a lower income; they provide for their own needs less frequently than men; report more consistent gaming behaviours; are more prone to anxiety disorder during their lifetime; and consult primarily non-specialized services. In the previous 12 months, they had accessed front-line services more often and specialized services less frequently than men.

Psychosoziale Risikoindikatoren regelmäßiger und riskanter Glücksspielnutzung im Jugendalter

Mit der vorliegenden Studie werden die regelmäßige, riskante und problematische Glücksspielnutzung sowie psychosoziale Risikoindikatoren des Glücksspielkonsums im Jugendalter untersucht. Datengrundlage bildet eine für Niedersachsen repräsentative Dunkelfeldbefragung mit 11 003 Neuntklässlern. Zur Klassifikation wurde der Glücksspiel-Screen DSM-IV-MR-J eingesetzt. Auf Basis theoretisch abgeleiteter Risikoindikatoren aus den Bereichen Soziodemographie, Person, Freizeit-, Problemverhalten, Familie, Peers und Schule/Nachbarschaft wurden binär logistische Mehrebenen-Regressionsanalysen zur Vorhersage regelmäßiger und riskanter Glücksspielnutzung durchgeführt. Die Ergebnisse zeigen, dass das Glücksspielverhalten bei Jugendlichen von kommerziellen Angeboten dominiert wird. 3.5 % der Jugendlichen weisen eine regelmäßige, 1.1 % eine riskante und 0.3 % eine problematische Glücksspielnutzung auf. Jungen sind in allen glücksspielaffinen Gruppen deutlich stärker vertreten. Bedeutsame Prädiktorvariablen für regelmäßige und riskante Glücksspielnutzung sind neben dem Geschlecht und dem Migrationshintergrund, eine erhöhte Gewaltakzeptanz und eine Sportvereinsmitgliedschaft. Alkohol- und Drogenkonsum sowie insbesondere der Freundeskreis prädizieren ein regelmäßiges Glücksspielverhalten, während Gewalttäterschaft sowie Variablen aus dem Bereich Schule/Nachbarschaft ein riskantes Glücksspielverhalten vorhersagen.

Telescoping and gender differences in the time course of disordered gambling: evidence from a general population sample

BACKGROUND AND AIM

The course of disordered gambling in women has been described as 'telescoped' compared with that in men, with a later age at initiation of gambling but shorter times from initiation to disorder. This study examined the evidence, for the first time, for such a telescoping effect in a general population rather than a treatment-seeking sample.

METHOD

Participants in a large community-based Australian twin cohort (2001 men, 2662 women) were assessed by structured diagnostic telephone interviews in which they reported the ages at which they had attained various gambling milestones and additional information to be used as covariates (the types of gambling in which they had participated and history of symptoms of alcohol dependence, major depression, and adult antisocial behavior). Cox proportional hazards regression models were used to examine differences between men and women in the time from gambling initiation to the first disordered gambling symptom and a diagnosis of disordered gambling.

RESULTS

Men had a higher hazards than women for the time to the first disordered gambling symptom [hazard ratio (HR) = 3.13, P < 0.0001] and to a diagnosis of disordered gambling (HR = 2.53, P < 0.0001). These differences persisted after controlling for covariates. Earlier age of initiation was the most potent predictor of progression to the first symptom.

CONCLUSIONS

When assessed at the general population level, female gamblers do not appear to show a telescoped disordered gambling trajectory compared with male gamblers.

Glücksspielbezogene Probleme unter Jugendlichen

Kommerzielle Glücksspielangebote und selbstorganisierte Spiele um Geld repräsentieren integrale Bestandteile der Lebenswirklichkeit vieler Heranwachsender. In diesem Zusammenhang machen internationale wie nationale Befunde in konsistenter Weise darauf aufmerksam, dass in der Entwicklungsphase des Jugendalters ein erhöhtes Risiko besteht, glücksspielbezogene Probleme zu entwickeln. Allerdings mangelt es an testtheoretisch abgesicherten, jugendgerechten Verfahren zur Bestimmung eines problematischen Spielverhaltens. Daher muss letztendlich offen bleiben, ob diese Form jugendlichen Problemverhaltens überhaupt angemessen und zielgerichtet erfasst wird, oder ob es sich hierbei (zumindest partiell) um einen Messartefakt handelt. Ein Ziel zukünftiger Forschungen ist es folglich, ein Screening-Instrument zu entwickeln und zu validieren.