To play or not to play: A personal dilemma in pathological gambling

Research has shown that healthy people would rather avoid losses than gamble for even higher gains. On the other hand, research on pathological gamblers (PGs) demonstrates that PGs are more impaired than non-pathological gamblers in choice under risk and uncertainty. Here, we investigate loss aversion by using a rigorous and well-established paradigm from the field of economics, in conjunction with personality traits, by using self-report measures for PGs under clinical treatment. Twenty pathological gamblers, at the earlier and later stages of clinical treatment, were matched to 20 non-gamblers (NG). They played a “flip coin task” by deciding across 256 trials whether to accept or reject a 50–50 bet with a variable amount of gains and losses. They completed questionnaires aimed at assessing impulsivity. Compared to NG, pathological gamblers, specifically those in the later stages of therapy, were more loss averse and accepted a lower number of gambles with a positive expected value, whereas their impulsivity traits were significantly higher. This study shows for the first time that changes in loss aversion, but not in personality traits, are associated with the time course of pathology. These findings can be usefully employed in the fields of both gambling addiction and decision-making.     

Parental bonding in pathological gambling disorder

The purpose of this study was to examine the role of perceived parenting behavior in the childhood of patients with pathological gambling disorder (PGD). Thirty-three outpatient subjects with DSM-IV pathological gambling disorder, and no other current Axis I disorders, completed the Parental Bonding Instrument (PBI), which measures subjects' recollections of parenting on dimensions of care and protection. PBI scores of pathological gamblers were compared to normal controls. Subjects with PGD had significantly lower maternal and paternal care scores than the control subjects (22.6 ± 8.9 vs. 26.9 ± 7.3 on maternal care [p = 0.010], and 17.4 ± 9.6 vs. 23.8 ± 7.6 on paternal care [p = 0.001]). In terms of parental bonding patterns based on a combination of care and protection, the pathological gamblers reported low rates of optimal parenting and high rates of neglectful parenting. These preliminary findings suggest that neglectful parenting appears to be associated with pathological gambling disorder.     

Neurocognitive dysfunction in strategic and non-strategic gamblers

Objective

It has been theorized that there may be subtypes of pathological gambling, particularly in relation to the main type of gambling activities undertaken. Whether or not putative pathological gambling subtypes differ in terms of their clinical and cognitive profiles has received little attention.

Method

Subjects meeting DSM-IV criteria for pathological gambling were grouped into two categories of preferred forms of gambling — strategic (e.g., cards, dice, sports betting, stock market) and non-strategic (e.g., slots, video poker, pull tabs). Groups were compared on clinical characteristics (gambling severity, and time and money spent gambling), psychiatric comorbidity, and neurocognitive tests assessing motor impulsivity and cognitive flexibility.

Results

Seventy-seven subjects were included in this sample (45.5% females; mean age: 42.7 ± 14.9) which consisted of the following groups: strategic (n = 22; 28.6%) and non-strategic (n = 55; 71.4%). Non-strategic gamblers were significantly more likely to be older, female, and divorced. Money spent gambling did not differ significantly between groups although one measure of gambling severity reflected more severe problems for strategic gamblers. Strategic and non-strategic gamblers did not differ in terms of cognitive function; both groups showed impairments in cognitive flexibility and inhibitory control relative to matched healthy volunteers.

Conclusion

These preliminary results suggest that preferred form of gambling may be associated with specific clinical characteristics but are not dissociable in terms of cognitive inflexibility and motor impulsivity.     

Characteristics of Treatment Seeking Problem Gamblers with Adult ADHD

The present study investigates characteristics of treatment seeking problem gamblers with adult ADHD (n = 39) and those without ADHD (n = 87). Patients completed self-report questionnaires about gambling behaviors, impulsivity (UPPS-P), substance abuse (AUDIT/DAST), emotional dysregulation (PHQ-4), illegal activities, and gambling consequences. Each patient received a structured diagnostic interview (MINI) to assess for psychopathology, adult ADHD (ACDS), and gambling disorder (NODS). Results revealed that problem gamblers with adult ADHD encounter unique challenges above those common among problem gamblers including more problems with alcohol/drug abuse and higher levels of impulsivity. Earlier age for first gambling activities, onset of gambling problems, and higher severity of gambling problems was found among gamblers with ADHD. Gamblers with ADHD pawned more items to obtain money for gambling, were more likely to have debt, had significantly higher rates of bankruptcy and domestic violence arising from conflict with family members about their gambling. Interestingly, groups did not differ significantly on their time spent gambling prior to treatment, their win-to-loss ratio, and a number of other gambling-related consequences. These findings are discussed with their clinical ramifications for treatment.

     

Cortisol and heart rate measures during casino gambling in relation to impulsivity

Problematic gambling behavior is thought to be influenced by neurobiological as well as environmental factors. In this study, we investigated the relationship among impulsivity, gambling behavior, the cardiovascular system and the hypothalamic-pituitary-adrenal axis activity in blackjack gamblers. Twenty-nine males were continuously monitored before, during and after a 90-min blackjack session in a casino wagering their own money and during a control condition where subjects played cards for accumulation of points. Heart rate and cortisol levels significantly increased with the onset of gambling and remained elevated throughout the test session compared to the control condition. After median split of impulsivity scores, high impulsivity subjects revealed significantly higher heart rate levels compared to the low impulsivity subgroup. Correlation analyses revealed a positive relationship between impulsivity scores and severity of pathological gambling. Impulsivity may be one important factor mediating gambling behavior and its accompanying autonomic response.     

Impulsivity as a Moderator and Mediator Between Life Stress and Pathological Gambling among Chinese Treatment-Seeking Gamblers

This study examined the role of impulsivity and its interplay with gambling correlates in influencing the severity of pathological gambling in Chinese societies. It also investigated the extent to which impulsivity would moderate and/or mediate the relationship between life stress and pathological gambling in 94 Chinese treatment-seeking gamblers. Results of a hierarchical regression analysis showed that years of gambling, life stress, and impulsivity were significant correlates of pathological gambling. Post-hoc analyses of a significant impulsivity x life stress 2-way interaction effect indicated that life stress was significantly associated with pathological gambling among participants with low impulsivity only, whereas pathological gambling remained high regardless of the stress level among participants with high impulsivity. Bootstrapping results also showed that impulsivity partially mediated the influence of life stress on pathological gambling. Findings have implications for gambling treatment programs.     

Demographic and clinical features of 131 adult pathological gamblers.

BACKGROUND: This study was constructed to detail the demographic and phenomenological features of pathological gamblers. METHOD: One hundred thirty-one subjects with DSM-IV pathological gambling were administered a semistructured interview to elicit demographic data and information on the phenomenology, age at onset, course, associated features, treatment history, and response to treatment of the disorder, followed by the Structured Clinical Interview for DSM-IV. RESULTS: Seventy-eight female (59.5%) and 53 male (40.5%) (mean +/- SD age = 47.7+/-11.0 years) pathological gamblers were studied. The majority of subjects (55.7%) were married. Subjects gambled a mean of 16 hours per week. Slot machines (65%), cards (33%), and blackjack (26%) were the most popular forms of gambling. The mean length of time between first gambling behavior and onset of pathological gambling was 6.3+/-8.9 years. Approximately one half (46%) of the subjects reported that television, radio, and billboard advertisements were a trigger to gamble. Most gamblers had severe financial, social, or legal problems. The majority of the subjects (58%) had at least 1 first-degree relative who also exhibited symptoms of problematic gambling behavior. CONCLUSION: Pathological gambling is a disabling disorder associated with high rates of social and legal difficulties.     

Problem and probable pathological gambling: considerations from a community survey.

OBJECTIVE: To investigate the nature and extent of gambling problems in a region of Canada in which legalized gambling activities were expanded during the 1990s. METHOD: A standardized telephone interview was conducted with a random sample of 738 community-dwelling adults (response rate 74%) in Winnipeg, Manitoba. RESULTS: According to traditional classification criteria, the lifetime prevalence of "probable pathological gambling" was 2.6%. A further 3.0% of the sample met criteria for traditionally defined "problem gambling," and evidence suggests that both types of gamblers share several characteristics. Social or recreational gamblers significantly differed on several variables from individuals who reported gambling problems. CONCLUSIONS: The 2.6% prevalence figure is the highest yet reported in a Canadian epidemiological survey and was obtained in a region that developed a more liberal attitude toward gambling in the 1990s. Further, a continuum of severity was demonstrated by scores on the South Oaks Gambling Screen (SOGS), and a clear and consistent distinction between problem and probable pathological gambling was not apparent. Frequenting casinos and using video poker and slot machines, rather than buying lottery tickets, distinguishes problem or pathological gamblers from recreational gamblers.     

Pathologisches Glücksspiel

Drug craving, the irresistible urge for drug intake, is being discussed as a central construct for the explanation of addictive behaviour and for relapses so far only in substance-related addiction. Based on learning models for the maintenance of addiction, in this study, cue-induced craving and psychological variables that influence craving were investigated in subjects with excessive rewarding behaviour such as pathological gambling. Based on the cue-reactivity paradigm, pathological gamblers and healthy controls were exposed to gambling and other cues. Emotional processing of the gambling cues, cue-induced craving, and the influence on craving of depression, anxiety, and stress-coping strategies were investigated. The results demonstrate disorder-specific processing of cues in pathological gamblers, even after abstinence for more than a year. In addition, craving is influenced by psychological disabilities. Data are discussed with respect to comparable data in studies about substance-related addicts.     

Comparisons between the South Oaks Gambling Screen and a DSM-IV-based interview in a community survey of problem gambling.

OBJECTIVE: To directly compare 2 forms of assessment for determining gambling problems in a community survey, and to examine the characteristics of respondents who endorsed DSM-IV symptoms but who scored below the formal DSM-IV diagnostic cut-off for pathological gambling. METHOD: We interviewed 1489 Winnipeg adults by phone (response rate 70.5%) using th South Oaks Gambling Screen (SOGS), a DSM-IV-based instrument, and several gambling-related variables. RESULTS: The lifetime prevalence of "probable pathological gambling" (according to the SOGS, having a score of > or = 5) was 2.6%. The SOGS items and DSM-IV symptoms were highly correlated (r = 0.80), but a score of 5 or more symptoms for a DSM-IV diagnosis produced lower prevalence figures. Comparisons between recreational gamblers (those with no DSM-IV symptoms), subthreshold pathological gamblers (those with 1 to 4 DSM-IV symptoms), and pathological gamblers (those with > or = 5 DSM-IV symptoms) on series of gambling-related variables (for example, high use of video lottery terminals) revealed that subthreshold individuals significantly differed from recreational gamblers and more closely approximated the characteristics displayed by pathological gamblers. CONCLUSIONS: SOGS items show a high degree of association with the DSM-IV clinical symptoms of pathological gambling, but the DSM-IV cut-off of 5 symptoms is more conservative in defining gambling problems. Results support a continuum view of gambling problems in the community. DSM-IV scores of 3 or 4 represent the higher end of the group officially considered diagnostically "subthreshold" and may be important from both a clinical and public health perspective.     

Health correlates of recreational gambling in older adults

OBJECTIVE: Prior studies have found high rates of alcohol use and abuse/dependence, depression, bankruptcy, and incarceration associated with recreational gambling. Despite growing rates of recreational gambling in older adults, little is known regarding its health correlates in this age group. The objective of this study was to identify health and well-being correlates of past-year recreational gambling in adults age 65 years and older, compared to adults age 18-64 years. METHOD: The Gambling Impact and Behavior Study surveyed by telephone a nationally representative sample of 2,417 adults. Multivariate analyses were used to compare past-year recreational gamblers and nongamblers in the older and younger age groups on measures of alcohol use and abuse/dependence, substance abuse/dependence, depression, mental health treatment, subjective general health, incarceration, and bankruptcy. Additional analyses compared the gambling patterns in older and younger adult past-year recreational gamblers. RESULTS: After the effects of sociodemographic factors were controlled, older adult past-year recreational gamblers were more likely to report past-year alcohol use and better health than were older nongamblers. Multivariate analyses investigating interactions of gambling and age found that higher rates of good to excellent subjective general health in recreational gamblers were mainly attributable to the older age group. Older adult gamblers were more likely than younger adult gamblers to begin gambling after age 18 years, to gamble more frequently, and to report a larger maximum win. CONCLUSIONS: Recreational gambling patterns of older adults differ from those of younger adults. In contrast to findings in younger adults, recreational gambling in older adults is not associated with negative measures of health and well-being.     

Severity of gambling is associated with physical and emotional health in urban primary care patients

OBJECTIVE: The purpose of this study is to assess the prevalence of recreational and disordered gambling, and to identify its association with health functioning, in urban primary care patients. MATERIALS AND METHODS: Data were collected from 574 adults presenting to an urban primary care medical clinic. Participants completed the South Oaks Gambling Screen, Short Form-12 Health Survey, Second Edition and questions assessing demographic characteristics and frequency and intensity of current gambling behaviors. RESULTS: Overall, 10.6% of participants met lifetime criteria for pathological gambling, and an additional 5.1% were classified as problem gamblers. Pathological gamblers and problem gamblers reported more health-related concerns than recreational gamblers and nongamblers on indices of physical and emotional functioning. Contrary to prior research, recreational gambling was not associated with better health. CONCLUSION: These data suggest that disordered gambling is relatively common in primary care settings, and gambling severity is associated with decreased health functioning.     

Mood and Anxiety Disorders Are the Most Prevalent Psychiatric Disorders among Pathological and Recovered Gamblers

Psychiatric disorders among pathological and problem gamblers, especially mood and anxiety, are especially prevalent. Little is known about the rates of psychopathology in active and recovered problem gamblers. The goal of the present study was to compare the rates of lifetime and concurrent psychiatric comorbidity in a sample of problem and recovered gamblers in the community, controlling for severity and duration of the gambling problem. In this study a sample of community-recruited pathological and untreated but recovered gamblers were assessed with a validated structured clinical interview. Consistent with previous research high rates of mood and anxiety disorders, both current and lifetime, were found among current and recovered problem gamblers. Lifetime psychopathology was not a significant predictor of gambling status. The variables that significantly predicted PG or RG were prior history of drug problems and a positive family history for problem gambling.     

Future time perspective in pathological gamblers

The hypothesis that pathological gambling is associated with shortened time horizons was investigated by administering the Zimbardo Time Perspective Inventory (ZTPI) and the Future Time Perspective Inventory (FPTI) to a group of pathological gamblers and two comparison groups, psychiatric day patients and social gamblers. The South Oaks Gambling Screen (SOGS) was used to assess the severity of the participants' gambling. Sixty-six participants were recruited, of which 35 were women. The mean age of participants was 39 years. Results showed significantly shorter time horizons in pathological versus social gamblers but few differences between pathological gamblers and psychiatric patients. These results suggest that shortened time horizons are not a unique feature of addicted populations. The role of psychological distress as a possible explanatory variable is discussed.     

Does sustained-release lithium reduce impulsive gambling and affective instability versus placebo in pathological gamblers with bipolar spectrum disorders?

OBJECTIVE: Selective serotonin reuptake inhibitors may be effective for some patients with pathological gambling, but those with comorbid conditions, such as bipolar spectrum disorders, may relapse during treatment. To the authors' knowledge, this is the first placebo-controlled treatment study in pathological gamblers with bipolar spectrum disorders; it compares sustained-release lithium carbonate to placebo. METHOD: Forty pathological gambling patients with bipolar spectrum disorders entered a 10-week randomized, double-blind, placebo-controlled treatment study of sustained-release lithium carbonate. Outcome measures included gambling severity, mood, anxiety, and impulsivity scales. RESULTS: Pathological gambling patients with bipolar spectrum disorders significantly improved while taking sustained-release lithium carbonate compared to placebo on total pathological gambling scores on the Yale-Brown Obsessive Compulsive Scale, including both thoughts/urges and behavior, as well as on the Clinical Global Impression severity of pathological gambling scale. Affective instability (the Clinician-Administered Rating Scale for Mania score) was also lower in the group treated with sustained-release lithium carbonate compared to placebo. Ten (83%) of 12 completers were rated as responders in the sustained-release lithium group versus five (29%) of 17 in the placebo group. Of note, improvement in gambling severity was significantly correlated with improvement in mania ratings. CONCLUSIONS: Sustained-released lithium may be an effective treatment in reducing both gambling behavior and affective instability in pathological gamblers with bipolar spectrum disorder. This study highlights the need to identify subgroups of pathological gambling patients with bipolar spectrum conditions because this may have important treatment implications.     

Pathological gamblers demonstrate frontal lobe impairment consistent with that of methamphetamine-dependent individuals

Using tests that are frequently administered by neuropsychologists, the authors investigated whether pathological gambling is associated with frontal lobe abnormalities. The sample comprised 10 pathological gamblers, 25 methamphetamine-dependent subjects, and 19 matched comparison subjects. The pathological gamblers and methamphetamine-dependent subjects performed significantly less well than comparison subjects, and the gamblers' test scores were comparable to those of the methamphetamine-dependent participants. The overall magnitude of the effect size was large. These findings demonstrate that the severity of frontal lobe dysfunction in pathological gambling is similar to that observed in methamphetamine-dependent individuals on frequently used clinical measures.     

Self-reported impulsivity and inhibitory control in problem gamblers

Impulsivity is considered a core feature of problem gambling; however, self-reported impulsivity and inhibitory control may reflect disparate constructs. We examined self-reported impulsivity and inhibitory control in 39 treatment-seeking problem gamblers and 41 matched controls using a range of self-report questionnaires and laboratory inhibitory control tasks. We also investigated differences between treatment-seeking problem gamblers who prefer strategic (e.g., sports betting) and nonstrategic (e.g., electronic gaming machines) gambling activities. Treatment-seeking problem gamblers demonstrated elevated self-reported impulsivity, more go errors on the Stop Signal Task, and a lower gap score on the Random Number Generation task than matched controls. However, overall we did not find strong evidence that treatment-seeking problem gamblers are more impulsive on laboratory inhibitory control measures. Furthermore, strategic and nonstrategic problem gamblers did not differ from their respective controls on either self-reported impulsivity questionnaires or laboratory inhibitory control measures. Contrary to expectations, our results suggest that inhibitory dyscontrol may not be a key component for some treatment-seeking problem gamblers.     

Self-reported differences on measures of executive function in a patient sample of pathological gamblers

Patients seeking help for pathological gambling often exhibit features of impulsivity, cognitive rigidity, poor judgment, deficits in emotion regulation, and excessive preoccupation with gambling. Some of these characteristics are also common among patients presenting with neurological pathology associated with executive deficits. Evidence of executive deficits have been confirmed in pathological gamblers using objective neurocognitive tests, however, it remains to be seen if such findings will emerge in self-report measures of executive control. These observations led to the current investigation of differences between a group of pathological gamblers (n = 62) and a comparison group (n = 64) using the Behavior Rating Inventory of Executive Function-Adult Version (BRIEF-A). Significant differences between the groups emerged over all nine subscales of executive functioning with the most dramatic differences on BRIEF-A subscales Inhibit, Plan/Organize, Shift, Emotion Control, Self-Monitor, and Initiate among the pathological gamblers. These results provide evidence that support findings among pathological gamblers using objective neuropsychological measures and suggest that the BRIEF-A may be an appropriate instrument to assess possible problems with executive control in this population.     

The Prevalence,Mental Health and Criminal Characteristics of Potential Problem Gamblers in a Substance Using Treatment Seeking Population

Some recent evidence suggests that problem gambling presents at elevated rates among treatment samples of substance users; if so, there may be significant implications for treatment. This study utilised a retrospective clinical case file review of all clients assessed for entry into a residential substance use service in Australia over a calendar year. Fifty-seven (21.4 %) of the 266 participants were classified as potential problem gamblers. Potential problem gamblers (PPGs) were not associated with increased psychological and social vulnerability; but displayed phenomenology divergent from single substance addiction, indicative of impulsivity. PPGs were more likely to be male, have a personality disorder, and be associated with a broader pattern of criminality, particularly crimes associated with financial gain. These findings challenge the recent re-conceptualisation of problem gambling, suggesting that problem gambling within treatment populations of substance users should be treated as a disorder adjacent to substance addiction, associated with distinct and specific phenomenology.     

Characteristics of Treatment Seeking Finnish Pathological Gamblers: Baseline Data from a Treatment Study

This article describes the socio-demographic characteristics and gambling behavior of 39 pathological gamblers who participated in our treatment study in 2009. The inclusion criteria of the study were: score of five or more on both the South Oaks Gambling Screen (SOGS) and a pathological gambling screen based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). The first 39 patients meeting the inclusion criterion were recruited into the study. The average age of the subjects was 39 years, and 80 % were males. The lag-time between active gambling (at least three times per week) and the onset of a pathological gambling problem was short: within 2 years of active gambling, 62 % of the subjects reported having become pathological gamblers. Our results also indicated certain gender-specific differences in the age at initiation and in the severity of the gambling problem.