Measuring gambling participation

There are many parallels between research on gambling and research on alcohol use, but a striking difference is the emphasis in the former area on problem gambling rather than the use of participation measures. We outline five topics that are underdeveloped as a consequence: (i) gambling participation and future problems; (ii) moderate gambling; (iii) separate measurement of exposures and harms; (iv) predictors of participation; and (v) natural history of participation. Challenges to the future development of gambling participation measures are discussed by reference to comparable difficulties in the field of alcohol use and some examples are given as to how progress could be made. Further development of measures will necessarily occur in the context of broader scientific aims. Some recent studies are highlighted that provide hope of gains in this area. We urge further progress to yield conceptually and operationally distinct indices of exposures and harms.     

Influence of co‐occurring mental and substance use disorders on the prevalence of problem gambling in Canada

Context/background Research has shown that problem gambling (PG) is associated with substance use disorders (SUD) and also with other mental disorders (MD). Nevertheless, evidence about the relative contribution of each type of disorder for the risk of gambling in the population is very limited. Objective Study the association of SUD, alone and in combination with MD, with the prevalence and severity of PG. Design Cross‐sectional national survey (Canadian Community Health Survey—Mental Health and Well‐Being) data collected through a multi‐stage stratified cluster design. Setting Population‐based household survey. Participants This analysis includes data on 36 885 participants (99.7% of the survey sample). Main outcome measures The prevalence and severity of PG were measured using the Canadian Problem Gambling Index. Prevalence of MD (mood and anxiety disorders) and SUD were defined according to the World Mental Health Survey Initiative Composite International Diagnostic Interview, following definitions of the DSM‐IV. Results Compared to the population, higher prevalence rates of PG are observed when the severity of SUD is higher, but are not impacted by the co‐occurrence of MD. For individuals with low risk and moderate risk/problem gambling, the prevalence rate difference (prevalence rate in the subgroup minus prevalence rate in the population) observed among substance dependents was reduced when MD co‐occurred (from a prevalence rate difference of 2.5; 99% confidence interval 1.6–3.8 to 1.6; 99% confidence interval 1.2–2.2 for low risk gamblers and from 3.7; 99% confidence interval 1.6–5.5 to 2.9; 99% confidence interval 2.0–4.3 for moderate risk/problem gamblers). Estimates were not statistically different. Conclusions Prevalence of all levels of PG increased with SUD severity, but the pattern did not appear to be affected by MD co‐occurrence. Results suggest particular attention be given to SUD in treatment‐seeking clients with co‐occurring disorders.     

A pathways model of problem and pathological gambling

At the moment, there is no single conceptual theoretical model of gambling that adequately accounts for the multiple biological, psychological and ecological variables contributing to the development of pathological gambling. Advances in this area are hampered by imprecise definitions of pathological gambling, failure to distinguish between gambling problems and problem gamblers and a tendency to assume that pathological gamblers form one, homogeneous population with similar psychological principles applying equally to all members of the class. The purpose of this paper is to advance a pathways model that integrates the complex array of biological, personality, developmental, cognitive, learning theory and ecological determinants of problem and pathological gambling. It is proposed that three distinct subgroups of gamblers manifesting impaired control over their behaviour can be identified. These groups include (a) behaviourally conditioned problem gamblers, (b) emotionally vulnerable problem gamblers and (c) antisocial, impulsivist problem gamblers. The implications for clinical management are discussed.