Towards DSM‐V: considering other withdrawal‐like symptoms of pathological gambling disorder

Despite clinical reports of other withdrawal‐like symptoms, the DSM‐IV considers only restlessness/irritability as a withdrawal‐like criterion comprising pathological gambling disorder (PGD). We explored whether this criterion should be broadened to include other gambling withdrawal‐like symptoms. Community‐recruited adult gamblers (n = 312) participated in telephone interviews about gambling and related behaviors as a part of a larger psychometric study. Frequency and chi‐square analyses described the association of gambling withdrawal‐like symptoms by gambling disorder status. Multinomial forward selection logistic regression obtained a multivariate model describing the simultaneous relationship between these symptoms and gambling disorder status. One‐quarter of the sample experienced the DSM‐IV PGD criterion of restlessness/irritability. However, 41% experienced additional gambling withdrawal‐like symptoms when attempting to quit or control gambling. A model including restlessness/irritability and three additional non‐DSM‐IV withdrawal‐like symptoms (i.e. feelings of anger, guilt, and disappointment) is a stronger model of gambling disorder (χ² = 217.488; df = 8, p < 0.0001; R² = 0.5428; p < 0.0001) than restlessness/irritability alone (χ² = 151.278; df = 2, p < 0.0001; R² = 0.4133). The overlap of gambling withdrawal‐like symptoms with substance use withdrawal (11%) and depressive symptoms (34%) failed to fully account for these associations with gambling disorder status. Future PGD conceptualization and potential criteria revisions for DSM‐V may warrant a broader inclusion of gambling withdrawal‐like symptoms. Copyright © 2009 John Wiley & Sons, Ltd.     

The Risk of Online Gambling: a Study of Gambling Disorder Prevalence Rates in Spain

Since the 1990s, gambling has been considered a public health concern. The characteristics of games and the environments in which gambling is carried out are major causes of gambling disorder. Information and communication technologies (e.g., Internet, mobile phones) have been adapted for gambling, and new forms of online gambling have appeared.

Online gambling is currently legal in many countries worldwide, and it is continuing to expand globally. In Spain, online gambling has been legal since 2012, when the government authorized companies to operate in this space. Many other countries have been through a similar process of legalization and the promotion of online gambling.

In this study, we analyzed the prevalence of gambling disorder in Spain, as well as differences between online and traditional gambling, according to sex and age group. Prevalence indicators of gambling disorder were higher than expected, and this result was especially evident with regard to online gambling.

     

Pathological gambling: review of the recent research trends

The aim of this paper is to reduce a significant gap in the gambling literature in Hungary by presenting existing models and available treatments. Although theoretical models of pathological gambling all have strengths and weaknesses, they do provide valuable insights into the development of pathological gambling. Evidence now exist that psychological, biological and social factors are all relevant in pathological gambling but as yet a comprehensive theoretical model that could adequately account for the complex interaction of the factors has to be developed. Some methodological problems in the area of research are highlighted, and suggestions for future research are included. It is hoped this paper will stimulate future research work in this field and support the work of clinical psychologists.     

Cultural Icons and Marketing of Gambling

A number of different countries and states have or are in the process of developing formal or informal guidelines to govern gambling advertising and marketing of gambling. There is a growing consensus that gambling advertising should not mislead the public, be fair, provide information on the odds of wining and there should be provisions in place to protect vulnerable groups, such as, children. In the development of these guidelines by different countries or states there has been no real consideration of the need to engage with different indigenous and ethnic populations to ensure that they are protected as vulnerable populations. Further there is a need to engage with these populations within countries and across countries to ensure that indigenous and ethnic minority cultural icons, values, religious practices and music are not used without their permission or exploited in the business of promoting and marketing different forms of gambling products. New Zealand’s experience of marketing and advertising of gambling is discussed in this paper. It is outlined the development of casinos in New Zealand and how Maori were actively encouraged to participate in the opening of these establishments and therefore, legitimate their existence as a safe place for Maori, the indigenous population of New Zealand to frequent on a regular basis. Since then other ethnic minority populations have been targeted to engage in different forms of gambling by recognising their significant cultural events, importance of family events and celebrating and promoting the success of important sport role models. Gambling advertising can be direct or subtle, however, little research has focussed on the third person effect associated with gambling advertising. New Zealand has adopted a public health approach to reduce gambling related harm. One of the key strategies introduced to reduce gambling related harm has been the development and implementation of harm minimisation regulations. Research conducted in New Zealand regarding individuals’ attitudes and behaviour to gambling, highlights that Maori have a high recall of gambling advertisements alongside other ethnic populations. The paper suggests that as part of a public health approach to reduce gambling related harm that it is now timely in New Zealand, for consideration to be given as to how much exposure, if any, New Zealanders should be subjected to gambling advertising.

Prevalence, assessment, and treatment of pathological gambling: a review.

OBJECTIVE: Although pathological gambling is an increasing problem, many mental health providers are unfamiliar with its diagnosis and treatment. To improve recognition and treatment of pathological gambling, the authors reviewed the literature on its prevalence, assessment, and treatment. METHODS: Entries in PsycLIT and MEDLINE were examined for the years 1984 to 1998. RESULTS AND DISCUSSION: The prevalence of pathological gambling seems to be increasing with the spread of legalized gambling; casinos are now operating in 27 states. Point and lifetime prevalence rates of pathological gambling are reported to be as high as 1.4 percent and 5.1 percent, respectively. The most commonly used assessment instrument is the DSM-based, 20-item South Oaks Gambling Screen. There is no standard treatment for pathological gambling. Gamblers Anonymous (GA) is the most popular intervention, and about 1,000 chapters exist in the U.S. Studies suggest that only 8 percent of GA attendees achieve a year of abstinence. Combining professional therapy and GA participation may improve retention and abstinence. Marital and family treatments, including participation in Gam-Anon, the spousal component of GA, have not been sufficiently evaluated. The few studies of cognitive-behavioral treatments suggest that this approach, which may include cognitive restructuring, problem solving, social skills training, and relapse prevention, is promising. Carbamazepine, naltrexone, clomipramine, fluvoxamine, and lithium have been used with some effect. Therapists' manuals and self-help manuals are available. Although research evaluating their efficacy is necessary, manuals can provide a start for therapists who encounter patients with gambling problems. Brief motivational interviewing may be a useful strategy for decreasing gambling among heavy gamblers who are ambivalent about entering treatment or who do not desire abstinence.     

Don't Say the ‘P’ Word: Problem Gambling Is More than Harm

An important consequence of adoption of public health approaches in the field of gambling studies has been the increasing emphasis afforded to gambling harm. Reducing or eliminating harm has now become the overt stated mission of many government foundations and funding bodies. A by-product of these developments has been the gradual reduction of references to terms capturing the nature of the primary disorder (problem or pathological gambling or gambling disorder) in preference for what are considered to be more neutral or less ‘stigmatising’ terms (e.g. ‘people with gambling harm’). In this paper, we argue that this conflation of gambling harm with the disorder is misguided. Not only does it fail to acknowledge the validity of the disorder but it is also unjustified by evidence and may have unintended negative consequences for both people affected by gambling and the field more generally. In particular, we focus on the clinical and legal advantages of adherence to an individual-centred, pathology model of gambling disorder.

     

On the Necessity of U‐Shaped Learning

A U‐shaped curve in a cognitive‐developmental trajectory refers to a three‐step process: good performance followed by bad performance followed by good performance once again. U‐shaped curves have been observed in a wide variety of cognitive‐developmental and learning contexts. U‐shaped learning seems to contradict the idea that learning is a monotonic, cumulative process and thus constitutes a challenge for competing theories of cognitive development and learning. U‐shaped behavior in language learning (in particular in learning English past tense) has become a central topic in the Cognitive Science debate about learning models. Antagonist models (e.g., connectionism versus nativism) are often judged on their ability of modeling or accounting for U‐shaped behavior. The prior literature is mostly occupied with explaining how U‐shaped behavior occurs. Instead, we are interested in the necessity of this kind of apparently inefficient strategy. We present and discuss a body of results in the abstract mathematical setting of (extensions of) Gold‐style computational learning theory addressing a mathematically precise version of the following question: Are there learning tasks that require U‐shaped behavior? All notions considered are learning in the limit from positive data. We present results about the necessity of U‐shaped learning in classical models of learning as well as in models with bounds on the memory of the learner. The pattern emerges that, for parameterized, cognitively relevant learning criteria, beyond very few initial parameter values, U‐shapes are necessary for full learning power! We discuss the possible relevance of the above results for the Cognitive Science debate about learning models as well as directions for future research.     

Gambling and Problem Gambling in Canada in 2018: Prevalence and Changes Since 2002

Objective:The purpose of this study was to provide an updated profile of gambling and problem gambling in Canada and to examine how the rates and pattern of participation compare to 2002.Method:An assessment of gambling and problem gambling was included in the 2018 Canadian Community Health Survey and administered to 24,982 individuals aged 15 and older. The present analyses selected for adults (18+).Results:A total of 66.2% of people reported engaging in some type of gambling in 2018, primarily lottery and/or raffle tickets, the only type in which the majority of Canadians participate. There are some significant interprovincial differences, with perhaps the most important one being the higher rate of electronic gambling machine (EGM) participation in Manitoba and Saskatchewan. The overall pattern of gambling in 2018 is very similar to 2002, although participation is generally much lower in 2018, particularly for EGMs and bingo. Only 0.6% of the population were identified as problem gamblers in 2018, with an additional 2.7% being at-risk gamblers. There is no significant interprovincial variation in problem gambling rates. The interprovincial pattern of problem gambling in 2018 is also very similar to what was found in 2002 with the main difference being a 45% decrease in the overall prevalence of problem gambling.Conclusions:Gambling and problem gambling have both decreased in Canada from 2002 to 2018 although the provincial patterns are quite similar between the 2 time periods. Several mechanisms have likely collectively contributed to these declines. Decreases have also been reported in several other Western countries in recent years and have occurred despite the expansion of legal gambling opportunities, suggesting a degree of inoculation or adaptation in large parts of the population.     

Pathological gambling amongst Parkinson's disease and ALS patients in an online community (PatientsLikeMe.com)

Pathological gambling (PG) has been identified in Parkinson's disease (PD), but such gambling behaviors may also occur in amyotrophic lateral sclerosis (ALS). We sought to estimate the prevalence of PG amongst members of a web‐based community, PatientsLikeMe.com. A survey was constructed, consisting of demographic information, the South Oaks Gambling Screen (SOGS), the K‐6 measure of distress, and items related to motivation for gambling. Data were obtained from 236 ALS patients and 208 PD patients. Of the PD patients, 13% were classified as problem gamblers compared with 3% of ALS patients (χ² = 14.005, P ≤ 0.001). PD patients reported thoughts about gambling to be more distressing, harder to resist and more outside their control than ALS patients. Thus, the higher prevalence of compulsive behavior in PD may relate to damaged reward pathways or medication rather than to the effects of living with a chronic progressive neurological disorder per se. © 2009 Movement Disorder Society     

Gambling Awareness for Youth: An Analysis of the “Don’t Gamble Away our Future™” Program

Gambling has become increasingly popular among minors and is easily accessible to them. This is alarming since research has indicated that minors are more susceptible to gambling pathology than adults. Additionally, gambling has devastating effects on minors that gamble as well as their families and communities. The Illinois Institute for Addiction Recovery (IIAR) developed a gambling awareness prevention program called “Don’t Gamble Away our Future _™” to educate minors about gambling and the dangers associated with it. The IIAR started collecting data for the purpose of evaluation in 2005. The purpose of the current study was to evaluate the program’s effectiveness at changing knowledge about gambling and to assess the frequencies of problem and pathological gambling among participants at program implementation (year one). The program was evaluated with a sample of 8,455 Midwestern youth. Findings indicated that 10% of the participants were probable pathological gamblers and that the program was successful at increasing knowledge of gambling and the negative effects it can have, over the short term. Teaching minors about the risks of gambling and the effects it can have is an important preventative measure that can help protect youth from the dangers associated with problem and pathological gambling.     

A Life Well Lived and a Contribution Well Made: Bruce Winick

The Productivity Commission's 2010 report confirmed that gambling is a fundamental aspect of contemporary Australian culture. This is likely to become even more entrenched with the increasingly prominent association between gambling and professional sport. In addition, since the liberalisation of gambling in Australia during the 1990s, governments have become heavily dependent upon gambling revenue. The role of the law as a regulator of the excesses of gambling is complex, both in respect of criminal matters and recourse sought by gamblers against gambling houses where they have lost significant sums of money. The decision of the High Court in Kakavas v Crown Melbourne Limited [2013] HCA 25 confines the potential for gamblers to sue casinos and bookmakers in equity for unconscionably exploiting their vulnerabilities. However, it leaves open a door for such actions to be brought by some categories of persons whose inability to exercise rational judgment in respect of their DSM-5 gambling disorder, or some other form of vulnerability, can be proved to have been known by casinos and bookmakers. This will be relatively rare but such actions remain feasible.     

Traumatic brain injury as an independent risk factor for problem gambling: a matched case-control study

Purpose

To assess whether traumatic brain injury (TBI) increases the risks of subsequent problem gambling.

Methods

We conducted a matched case–control analysis of adults in Ontario, Canada. The study included those who self-reported their gambling activities in the Canadian Community Health Survey 2007–2008. Using Problem Gambling Severity Index, we defined cases as those who were problem gamblers and controls who were recreational gamblers. Cases were matched to controls 1:2 using propensity scores based on demographics, prior mental health, and self-reported behaviours. The main predictor was prior TBI defined as requiring emergency care and identified using ICD-10 codes from administrative health databases. We estimated the likelihood of prior TBI in problem gamblers compared to controls using conditional logistic regression.

Results

Of 30,652 survey participants, 16,002 (53%) reported gambling activity of whom 14,910 (49%) were recreational gamblers and 4% (n = 1092) were problem gamblers. A total of 1469 respondents (5%) had a prior TBI. Propensity score matching yielded 2038 matched pairs with 1019 cases matched to 2037 controls. Case–control analysis showed a significant association between prior TBI and subsequent problem gambling (odds ratio 1.27, 95% confidence interval 1.07–1.51, P = 0.007). The increased risk was mostly apparent in men aged 35 to 64 years who reported alcohol use or smoking. The relative risk of problem gambling in those with two or more TBIs equated to an odds ratio of 2.04 (95% confidence interval 1.05–3.99).

Conclusions

We found that a prior TBI was associated with an increased subsequent risk of problem gambling. Our findings support more awareness, screening, and treating problem gambling risks among TBI patients.

     

Problem Gambling Prevention: Before, During, and After Measures

This paper reviewed the literature on problem gambling prevention measures, and found two problem gambling prevention models: harm reduction and responsible gambling. Problem gambling prevention measures could be classified according to the temporal sequence of before, during and after gambling. Before measures involved attempts to change misconceptions and attitudes toward gambling; they tended to have limited effect on gambling behaviors. During measures required structural changes to gambling machines, and insertion of warning messages; they tended to have mixed results in terms of gambling behaviors. After measures included relapse prevention and self-exclusion; some self-excluded gamblers returned to gambling. Future research should focus on theory, longitudinal studies, internet gambling, and cross-national research. No prevention measure seemed to be more effective than the gamblers’ motivation to control their own gambling behaviors.     

Factors Associated with Recent Suicide Attempts in Clients Presenting for Addiction Treatment

Factors associated with recent suicide attempts were examined in clients who sought treatment at an addictions facility between 2001 and 2008. Clients who reported being hospitalized for attempting suicide in the past year (n = 76) were compared to all other clients (n = 5914) on demographic, mental health, substance use, and problem gambling variables. Compared to all other clients, clients who attempted suicide were significantly less educated, and more likely to have major depressive disorder, a bipolar disorder, ADHD, a personality disorder, or a gambling problem. While mental health issues have long been linked with suicide, new research, such as the present study, continues to find associations between gambling and suicide. With the strong relationship between mood disorders and gambling, these findings support continued research into the possible connection between gambling and suicide.     

Prevalence of pathological gambling in the general population around Paris: preliminary study

Introduction

Pathological gambling is characterized in the DSM IV-TR as one of the disorders of impulse control. Problem gambling is also part of what is considered as behavioural addictions, the criteria of which have been defined by Goodman, with intrusive thoughts about the game, spending more and more to play, unable to control, reduce or stop gambling despite negative consequences, etc.

Aim of the study

There is no epidemiological study in France on the prevalence of pathological gambling. We wanted to study the prevalence of pathological gambling in a sample of 529 persons: 368 gamblers of Pari Mutuel Urbain and La Française des Jeux, and 161 persons in the general population. The study took place between January 2008 and June 2009.

Methods

As instruments, we used: the South Oaks Gambling Scale (SOGS) for screening of pathological gambling and the BIS-10 for impulsiveness’ evaluation, the HAD scale to assess anxiety and depression and the ASRS for the evaluation of attention deficit disorder/hyperactivity disorder (ADHD).

Results

The rate of pathological gambling in the general population is 1.24% (this result is similar to those found in other places, such as in Quebec). In the general population, the rate of play at risk is of 5.59%. Among the population of gamblers, the rate for pathological gambling (JP) amounted to 9.23% and risk gambling to 10.86%. Men are overrepresented in the group of pathological gamblers (88.9%), also with consumption of alcohol and tobacco. Suicide attempts are more important than in the general population, but the difference was statistically significant. Depression and anxiety are particularly high, 40% of gamblers with an anxiety score significantly higher.

Discussion

The results indicate rates close to those of other countries, such as Canada. It would be necessary to establish follow-up studies of populations and patients, as well as specific studies on people who frequent casinos, racetracks and internet gambling. The importance of the phenomenon is obvious, because almost 20% of players have a gambling problem or risk and these people do not consult despite their psychological problems, family, work, debts.     

Gaming-Gambling Convergence: Trends,Emerging Risks,and Legislative Responses

A convergence of gaming and gambling products, services, and platforms is presently drawing considerable policy debate. This convergence may be giving rise to a critical area of consumer vulnerability given the addictive potential of gaming and gambling. While some convergence aspects are gaining research attention, the broader contexts of the phenomenon have not been adequately examined. In light of this, the present study aimed to inform four key enquiry areas pertaining to gaming-gambling convergence—contexts and drivers, definitions and framings, risk and harm, and legislative response. Using a narrative review method, 108 articles from the academic and grey literature were examined and thematically summarised to provide an overview of the convergence phenomenon. Findings indicate convergence in multiple overlapping contexts (gaming elements in gambling, games incorporating gambling elements, gambling on games, free simulated online gambling, and social media games and gambling) driven by technological advances and commercial interests. Findings related to definitions and framing include the industry’s strategic use of the term gaming to reduce negative connotations associated with gambling, and community perceptions of gaming as legitimate and harmless entertainment. Potential risks include transitions from games (without money) to real-money gambling, and problem co-existence. Legislative responses are beginning to emerge with the greatest focus being on loot boxes in games. However, the limited evidence of risk and harm has led to hesitancies in legislative actions to regulate gaming-gambling hybrids in some jurisdictions. Considering that convergence is supported by rapid advances in technology and is taking place largely on the Internet (accessible 24 h), harms for consumers could manifest quickly and spread broadly across societies before their existence and severity are established. Based on the Precautionary Principle, the present evidence base call for harm prevention policies and regulations in addition to changes in the definition of money (including digital currency and microtransaction) in gaming and gambling laws.

     

When Problem Gambling is the Primary Reason for Seeking Addiction Treatment

An existing database was used to compare problem gamblers (N = 138) who presented for treatment of their gambling problem to two other groups: alcohol and/or drug addiction clients who also had a gambling problem (N = 280) or who did not have a gambling problem (N = 2178). Clients with gambling as their primary problem were more likely to be female; employed or retired; more highly educated; married, divorced, or widowed; without legal problems; and older than the other groups. They also had different patterns of recent mental health diagnoses and problematic substance use. The other problem gambling clients were more similar to the substance only clients. These findings indicate that those who present for treatment of problem gambling are a distinct subset of addiction clients who have gambling problems, and emphasize the importance of considering the reasons for seeking treatment, not just the presence of a gambling problem.     

Opportunity Structure for Gambling and Problem Gambling Among Employees in the Transport Industry

Working conditions for employees in the transport sector might present an opportunity structure for gambling by providing access to gambling during the workday. This study investigates connections between opportunity structure, gambling during the workday, and gambling problems among employees in the transport sector. Data has been collected from three different transport organizations in Norway: bus, truck, and taxi drivers (N = 1033). 6.8% of the sample gambled during working hours and 3.2% of the employees could be characterized as having a gambling problem. We found a positive relationship between opportunities to gamble during working hours and problem gambling, with the odds for problem gambling increasing fourteen-fold if employees gambled during working hours. Gambling during the workday is a major risk factor for gambling problems in this sample.

Gambling, Social Disorganisation and Deprivation

The harms associated with the proliferation of gambling opportunities is increasingly being researched and documented as part of a public health approach to reduce gambling related harm in many countries. New Zealand has had a history of gambling for just under 200 years with the behaviour introduced by new settlers to New Zealand and the indigenous population around 1840. This paper proposes that gambling contributes to the social disorganisation and social deprivation of many communities and especially, those which are low income and are the residence of indigenous and ethnic minority populations. New Zealand has adopted a public health approach to addressing gambling related harm and this is supported through legislation. As part of a public health approach to reduce gambling related harm new questions are proposed to challenge those who have power in the licensing and regulation of gambling and the authority as where public health resources should be directed to remove gambling related harm. Maori the indigenous population of New Zealand is the focus this paper, but the questions proposed can be used by different groups in communities where gambling creates harm.

Factors Associated with the Severity of Gambling Problems in a Community Gambling Treatment Agency

Factors (demographics, gambling behaviors and comorbid problems) that may be related to the severity of gambling problems were investigated among 440 problem gamblers seeking treatment in an Australian outpatient treatment agency. The participants were divided into sub-threshold pathological gamblers (SPGs; N = 104) and pathological gamblers (PGs; N = 336) using Diagnostic Statistical Manual (DSM) IV diagnosis of pathological gambling. SPGs were more likely to be separated/divorced, while PGs were more likely to be single. PGs tended to be younger than SPGs. Participation in lottery games was the only form of gambling that could distinguish between the two severity groups. No significant differences were found in participation in more than one gambling session per week and average amount spent per session on various gambling activities between the two groups. PGs were more likely to report financial, relationship, employment, physical, intrapersonal, other excessive behaviors (e.g., substance problems), leisure (e.g., loneliness, boredom) and legal problems than SPGs. Implications and limitations of these findings are discussed.