The role of autonomic arousal in problem gambling

The present study investigated the role of arousal in problem gambling. Three groups of subjects were recruited into the study corresponding to problem gamblers, high and low frequency social gamblers. For the two gambling groups, the preferred form of gambling was poker machine playing. Five different conditions were employed in order to determine under which conditions gambling related cues were related to increased autonomic arousal, as measured by skin conductance level (SCL), heart rate (HR) and frontalis electromyography (EMG). The five conditions were a neutral task, a videotaped poker machine gambling scenario presented with and without distraction, a personally relevant “win” situation and a videotaped horse race. Comparisons between responses for the videotaped poker machine gambling stimuli versus a horse-racing video task demonstrated differences only for the problem gambling group and only for SCL. No differences between these tasks emerged on the HR and EMG indices and no differences were evident for either of the social gambling groups. No changes were observed in any group when subject's cognitions were prevented by asking patients to count the number of wins made during the video play period while watching the same poker machine video. However, when personally relevant situations were presented and compared to a neutral task, differences were observed in all three groups. However, the nature of these differences varied between the groups and the different indices of arousal. For problem gamblers, increases were evident in all three measures. Increases were also observed for the control groups in comparison to the neutral task, but only in HR and SCL and not for EMG. For HR, the increases were equivalent across all three gambling groups. However, for SCL the problem gambling group became significantly more aroused than the control groups, but no differences were observed between the high and low frequency gamblers. Only the problem gambling groups evidenced significant increases in the personally relevant task compared to the neutral task for EMG. Theoretical and clinical implications of these results for the development, maintenance and treatment of problematic levels of gambling are discussed.     

Selective attentional bias to alcohol related stimuli in problem drinkers and non-problem drinkers

Aims. The issues explored in this study were whether a patient group of problem drinkers selectively attend to alcohol-related stimuli and the time course of any interference from alcohol-related stimuli in comparison with two control groups of non-problem drinkers. Design. A 3 × 2 × 2 × 5 factorial design was used. Drinking group (low, high and problem) and word order (alcohol-neutral, neutral-alcohol) were between-participant factors, and word type (alcohol, neutral) and presentation block (1-5) were within participant factors. Participants. Three groups were used, 20 participants from a local community alcohol Service (CAS) and 40 participants (student volunteers) in two control groups. The two control groups were differentiated as scoring high or low on the Alcohol Use Disorders Identification Test (AUDIT). Measurements. A modified computerized Stroop colour naming test was used to measure response latencies. Anxiety was measured using the State-Trait Anxiety Inventory. Findings. The CAS group showed significantly longer reaction times to respond to the colour of alcohol-related words than to neutral category words. Although the interference was smaller for the high AUDIT group it was significant. No significant interference was found in the low AUDIT group. There was no statistical evidence that the interference habituated in the three groups. Conclusions. The present study showed it is possible to use a modified Stroop task as a measure of implicit processing of alcohol stimuli. Despite the fact that all participants were asked to ignore the words, they were unable to do so. Alcohol-related words produced more interference than neutral category words in a group of problem drinkers and a control group of high alcohol drinkers.     

Changes in reaction potentials in neurotic depression

An investigation, comparing the event related potential (ERP) of depressive patients and a control group is presented. The components N100, P200, N200 and P300 have been recorded during the Stroop colour-word-interference test. The task is to name the colour of a colour word presented in a different colour, to read the word of an achromatic colour word and to name the colour of colour strips. The reaction time to name the colour or the word resulted in a general retardation for the patients with neurotic depression in comparison to the control group. The components of the acoustic evoked potentials, recorded after a warning stimulus S1, 4 s before the single Stroop stimuli showed no differences in amplitude or latency. The visual evoked potentials, associated to the Stroop stimuli showed, in case of the neurotic depressive patients an increase of the P300-amplitude. This result is interpreted as an increased cognitive effort of the patients in case of the employed experimental approach.     

Impaired control over gambling in gaming machine and off-course gamblers

Aim To investigate and compare subjectively reported impaired control in two forms of gambling: off‐course Totalizator Agency Board (TAB) horse/dog racing and electronic gaming machines (EGMs). Additionally, gender differences in EGM play were investigated. Design A survey sample of 84 male TAB gamblers and 137 EGM players (73 females and 64 males) was recruited at gambling sites. Setting Hotels and clubs in Adelaide, South Australia, were used as recruiting venues. Interviews were either conducted on site if there was sufficient privacy, or relocated to nearby cafes. Participants The inclusion criteria were gambling at least weekly and being over the age of 18. Female off‐course gamblers were not approached given their scarcity. Measurements A general gambling involvement questionnaire was devised from pilot research. Impaired control was measured using a shortened version of The Scale of Gambling Choices. Findings Impaired control over gambling has a robust factor structure, with little difference between EGM and TAB gamblers. Concurrent validity for the impaired control measure was demonstrated against measures of gambling involvement. Conclusion Impaired control appears to be, in the main, a generic process across these two forms of gambling and for both sexes. Further refinement and application of the concept of impaired control to excessive gambling seems warranted given its strong face, construct and concurrent validity.     

Effects of Disease-Related Cues in Alcoholic Inpatients: Results of a Controlled "Alcohol Stroop" Study

We tested the hypothesis that alcoholics develop a disease-related attentional bias. Therefore, alcohol-related, but task-irrelevant, words should cause a specific perceptual-processing bias. We investigated this by using a special color-naming task. We subjected 40 male alcohol-dependent inpatients and 40 healthy male controls (matched according to age and verbal la) to a modified card version of the Stroop colornaming task that consisted of a neutral and an alcohol word condition ("Alcohol Stroop"). Alcoholic inpatients performed significantly poorer than the control group under the critical experimental condition (color-naming of disease-related words), as compared with the noncritical condition (color-naming of neutral words; p = 0.03). Concerning the possible neuropsychological impairment of the patients, no effects could be found on the reaction time of the "Standard Stroop" using only neutral words (i.e., color-naming of incongruent color words administered without time limitation). The information processing bias on the "Alcohol Stroop" thus qualifies as a cognitive process, which is independent from putative neuropsychological deficits of alcoholic patients and might represent an essential feature of alcoholic psychopathology. The "Alcohol Stroop" contributes to the experimental psychopathology of alcoholism.     

An experimental study of the effect of prior alcohol consumption on a simulated gambling activity

Previous survey research with both clinical populations and random samples of the general population has established that individuals may experience harmful impacts arising from both their gambling and their consumption of alcohol. Experimental study of the interaction of alcohol consumption on gambling is notable for its absence from the literature. Aim. To experimentally study the interaction of alcohol consumption and gambling behaviour. Design. Participants were randomly allocated into two groups-placebo administered and alcohol administered, thus making an independent samples experimental design. Setting. Laboratory. Participants. Forty young, male, regular EGM players, who also regularly consumed alcohol. Measurements. The NEO Personality Inventory; The Scale of Gambling Choices (Revised) (SGC); persistence at gambling while losing, as measured by the number of gambling trials played and amount wagered. Findings. Subjects either received a prior intake of three alcoholic drinks each containing approximately 10 g of pure alcohol (beer or wine) or an equal volume of an equivalent non-alcoholic beverage. The alcohol group persisted for twice as many gaming trials as the placebo group with significantly more players who had consumed alcohol losing all their original cash stake (50% compared with 15% of the placebo group). Conclusions. The consumption of alcohol appeared to eliminate the strong associations found in placebo group between individual difference measures and persistence. The analogue game was accepted by participants as a valid form of gambling. The result showed that relatively small quantities of alcohol have a significant effect on the psychological processes that underpin self-control over gambling. This finding challenges the conceptual research paradigm of studying co-morbidity or dual-addicted clinical populations as the most appropriate method of understanding how two addictive behaviours interact.     

Gender differences, physiological arousal and the role of winning in fruit machine gamblers

Aims . To examine gender differences in changes in physiological arousal as indexed by heart rate during fruit machine gambling while controlling for the confounding effect of movement and as a function of winning and losing, and to examine relationships between sensation-seeking, self-reported arousal during gambling, heart rate during gambling and loss of control of gambling behaviour. Sample, design and measurements . Heart rate and subjective arousal were recorded in a sample of 22 male and 20 female fruit machine players before, during and after the gambling process. At baseline measures were taken of sensation seeking, self-reported arousal during gambling and loss of control of gambling. A simulation of the behaviour used to operate fruit machines was used during baseline measurement. Findings . Significant increases in heart-rate over movement controlled baselines were observed within participants during gambling. However, for the losing group these differences were slight compared to the increases found when participants won during play. Furthermore, winning/losing was the only variable among a range of variables which was a significant predictor of heart-rate increase during play over a baseline control. Additionally HR levels of males and females behaved the same way in relation to the manipulations. Significant correlations between HR during play and the measures of both subjective arousal and sensation seeking were also present. Conclusions . Winning during gambling is essential in order to maintain increased HR levels over baseline after play. Subjective arousal and sensation seeking may be predictors of levels of arousal experienced during play.     

Physiological arousal and sensation-seeking in female fruit machine gamblers

Aims. To examine changes in physiological arousal, as indexed by heart rate, during fruit machine gambling while controlling for the confounding effect of movement and as a function of winning and losing, and to examine relationships between sensation-seeking, self-reported arousal during gambling, heart rate during gambling and frequency of gambling. Sample, design and measurements. Heart rate and subjective arousal were recorded in a sample of 32 female fruit machine players before, during and after the gambling process. At baseline measures were taken of sensation-seeking, self-reported arousal during gambling and frequency of gambling. A simulation of the behaviour used to operate fruit machines was used during baseline measurement. Findings. Significant increases in heart-rate over movement controlled baselines were observed within participants during gambling, but only in those who won during play. No correlations between HR levels and subjective arousal were found. However, striking negative correlations between sensation-seeking and frequency of gambling, and between subjective arousal and frequency were present. Conclusions. Gambling alone is not enough to induce increases in HR levels for female fruit machine gamblers; the experience of winning or the anticipation of that experience is necessary to increase HR levels. In addition sensation-seeking appears to be negatively associated with this kind of gambling behaviour.     

Losses disguised as wins in modern multi‐line video slot machines

Aims Players can wager on multiple lines of modern slot machines. When they spin and fail to gain any credits, the machine goes into a state of relative quiet. By contrast, when they spin and win, these spins are accompanied by reinforcing sights and sounds. Such reinforcement also occurs when the amount won is less than the spin wager. We sought to show that these ‘losses disguised as wins’, or LDWs, would be as arousing as wins, and more arousing than regular losses. Measurement and participants We measured skin conductance response (SCR) amplitudes and heart‐rate changes following wins, LDWs and losses for 40 novices playing a multi‐line slot machine. Findings SCR amplitudes were similar for wins and LDWs—both were significantly larger than for regular losses. Conclusions For novice players, the reinforcing sights and sounds of the slot machine triggered arousal on wins, where the number of credits gained was greater than the spin wager, but also on ‘losses disguised as wins’ where the amount ‘won’ was less than the spin wager. Despite the fact that players lost money on these spins, these outcomes were more arousing than regular losses where no credits were gained. Although these findings involve novice players, the heightened arousal associated with these losses may have implications for the development of problem gambling, as arousal has been viewed as a key reinforcer in gambling behaviour.     

The Dutch instant lottery: prevalence and correlates of at-risk playing

After a long and contentious political debate, the instant lottery was introduced in the Netherlands in 1994. One of the conditions for allowing the introduction was that an evaluation study should be conducted with regard to possible negative side effects of the instant lottery in terms of excessive playing or addiction. This article reports on the main results of this evaluation study. In a random sample of 4497 instant lottery players, at-risk players were differentiated from recreative players on the basis of level of involvement in the instant lottery, impaired control and the experienced negative consequences of playing. Of the sample, 4.1% could be classified as an at-risk player. Actual problems resulting from playing in the instant lottery were experienced by 0.7% of the players. At-risk players and recreative players did not only differ substantially in their playing behaviour, but also with regard to their socio-economic background, playing motivation, participation in other games of chance, and involvement in alcohol use and use of marijuana. To summarize, at-risk players were more likely to come from a poor socio-economic background, to play the instant lottery with a negative playing motivation, to be heavily involved in other forms of gambling, to have used marijuana and to drink alcohol excessively.     

A comparison of treatment-seeking pathological gamblers based on preferred gambling activity

Aims To compare and contrast gamblers with different forms of problematic gambling activities. Design, setting and measurements Pathological gamblers completed the Addiction Severity Index (ASI) and gambling questionnaires when initiating out‐patient treatment. Participants Participants (n = 347) were categorized by their most problematic form of gambling activity: sports, horse/dog‐races, cards, slots and scratch/lottery tickets. Differences in demographics, gambling variables, and ASI composite scores were compared across groups. Findings After controlling for demographic variables, the types of gamblers differed in severity of gambling, alcohol and psychiatric problems. Horse/dog‐race gamblers were generally older, male and less educated; they began gambling regularly at a young age and spent relatively high amounts of money gambling. Sports gamblers were young males and had intermediary gambling problems; they had relatively high rates of current substance use but few psychiatric problems. Card players spent low to moderate amounts of time and money gambling, and they generally reported few alcohol problems and little psychiatric distress. Slot machine players were older and more likely to be female. Slot gamblers began gambling later in life, had high rates of bankruptcy and reported psychiatric difficulties. Scratch/lottery gamblers spent the least amount of money gambling, but they gambled the most frequently and had relatively severe alcohol and psychiatric symptoms. Conclusions Gambling patterns and severity of psychosocial problems vary by form of problematic gambling, and these differences may influence treatment recommendations and outcomes.     

Delay discounting and the alcohol Stroop in heavy drinking adolescents

AIMS: To investigate whether adolescent heavy drinkers exhibit biased cognitive processing of alcohol-related cues and impulsive decision making. DESIGN: A between-subjects design was employed. SETTING: Classrooms in a single sixth-form college in Merseyside, UK. PARTICIPANTS: Ninety adolescent students (mean age 16.83 years), of whom 38% were identified as heavy drinkers and 36% were identified as light drinkers, based on a tertile split of their weekly alcohol consumption. MEASUREMENTS: Participants provided information about alcohol consumption before completing measures of alcohol craving, delay discounting and an "alcohol Stroop" in which they were required to name the colour in which alcohol-related and matched control words were printed. FINDINGS: Compared to light drinkers, heavy drinkers showed more pronounced discounting of delayed hypothetical monetary and alcohol rewards, which is indicative of a more short-term focus in decision making in heavy drinkers. Heavy drinkers were also slower to colour-name alcohol-related words, which indicates an attentional bias for alcohol-related cues. In all participants, measures of delay discounting and attentional bias were correlated moderately with each other, and also with the level of alcohol consumption and with alcohol craving. CONCLUSIONS: In adolescents, heavy alcohol use is associated with biased attentional processing of alcohol-related cues and a shorter-term focus in decision making.     

The anterior cingulate cortex mediates processing selection in the Stroop attentional conflict paradigm.

Regional cerebral blood flow, an index of local neuronal activity, was measured using positron emission tomography (PET) during the performance of the classic Stroop color/word task in eight healthy right-handed subjects. In the first condition of this paradigm, subjects name the color of the words presented on a video monitor. All the words are the color names congruent to the color presented (e.g., the noun "red" displayed in red color). In the second condition, subjects also name the color of the words presented on the monitor. However, during these trials all words are color names incongruent to the color presented (e.g., the noun "red" displayed in green color). The difference in brain activity between these two conditions (i.e., incongruent minus congruent) could reveal brain systems involved in the attentionally mediated resolution of the conflict between the habitual response of reading words vs. the task demands of naming the color of the words--i.e., the Stroop interference effect. The most robust responses occurred in the anterior cingulate cortex. Other responses noted were in the left premotor cortex, left postcentral cortex, left putamen, supplementary motor area, right superior temporal gyrus, and bilateral peristriate cortices. These data provide support for the role of the anterior cingulate cortex in attentional processing through the selection and recruitment of processing centers appropriate for task execution. Furthermore, the extensive distributed network of activated regions suggests that the Stroop interference effect cannot be explained simply in terms of stimulus encoding or response interference.     

The Emotional Stroop as an Emotion Regulation Task

Background/Study Context: The present studies investigate age differences observed when performing the emotional Stroop task considered as an expression of emotion regulation. Previous studies employing this task showed mixed findings regarding age differences, with a lack of evidence for positivity effects. However, moderating factors such as arousal or dispositional (emotion) regulation strategies were mostly not taken into account. Moreover, relations between Stroop effects and emotional reactions were not examined.

Methods: In two studies (Study 1/2: n_young = 26/41; n_old = 19/39), an emotional Stroop task was employed and valence (negative, neutral, positive [Study 2 only]) and arousal of the word stimuli were varied. Additionally, flexible goal adjustment (FGA), positive and negative affect in the last 12 months, and change in momentary affect (Study 2 only) were measured.

Results: Study 1 showed larger emotional Stroop effects (ESE) in older than younger adults with medium arousing negative words. We also found correlations between FGA (positive correlation) as well as negative affect (negative correlation) and the ESE with medium arousing negative words. Study 2 corroborates these findings by exhibiting positive change in momentary affect with larger ESEs for medium arousing negative words in the older age group.

Conclusions: The findings emphasize the importance of including arousal level and dispositional regulation measures (such as FGA) as moderating factors in age differences and within-group differences in emotion regulation. Although we did not find evidence for a positivity effect, processing in the emotional Stroop task was related to positive change in momentary affect and less negative affect in the older age group. Taken together, our experiments demonstrate that the emotional Stroop task is suited as a measure for emotion induction and related emotion regulation mechanisms.     

Measuring treatment outcomes in gambling disorders: a systematic review

Background and Aims

Considerable variation of outcome variables used to measure recovery in the gambling treatment literature has precluded effective cross‐study evaluations and hindered the development of best‐practice treatment methodologies. The aim of this systematic review was to describe current diffuse concepts of recovery in the gambling field by mapping the range of outcomes and measurement strategies used to evaluate treatments, and to identify more commonly accepted indices of recovery.

Methods

A systematic search of six academic databases for studies evaluating treatments (psychological and pharmacological) for gambling disorders with a minimum 6‐month follow‐up. Data from eligible studies were tabulated and analysis conducted using a narrative approach. Guidelines of the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) were adhered to.

Results

Thirty‐four studies were reviewed systematically (RCTs = 17, comparative designs = 17). Sixty‐three different outcome measures were identified: 25 (39.7%) assessed gambling‐specific constructs, 36 (57.1%) assessed non‐gambling specific constructs, and two instruments were used across both categories (3.2%). Self‐report instruments ranged from psychometrically validated to ad‐hoc author‐designed questionnaires. Units of measurement were inconsistent, particularly in the assessment of gambling behaviour. All studies assessed indices of gambling behaviour and/or symptoms of gambling disorder. Almost all studies (n = 30; 88.2%) included secondary measures relating to psychiatric comorbidities, psychological processes linked to treatment approach, or global functioning and wellbeing.

Conclusions

In research on gambling disorders, the incorporation of broader outcome domains that extend beyond disorder‐specific symptoms and behaviours suggests a multi‐dimensional conceptualization of recovery. Development of a single comprehensive scale to measure all aspects of gambling recovery could help to facilitate uniform reporting practices across the field.     

Frequency of gambling problems among parents of pathological, versus nonpathological, casino gamblers using slot machines

Familial and twin studies suggest the implication of a genetic factor in pathological gambling, but mainly assess probands through treatment settings or advertisements. The question raised here is: are parents of casino pathological gamblers using slot machines more affected with pathological gambling than nonpathological gamblers, all interviewed on site at the same casino? Three hundred and fifty‐five casino gamblers on slot machines, which included 96 pathological gamblers, 116 problem gamblers, and 143 nonproblem gamblers, were recruited in situ at the largest casino in the Paris suburbs. We evaluated pathological gambling and two addictive disorders (alcohol dependence and tobacco consumption) in the gamblers and their 690 parents (through the proband). Familial aggregation of pathological gambling was confirmed, with a risk of 3.3 for being a pathological gambler when at least one of the parents has problematic gambling. No familial co‐aggregation of pathological gambling with alcohol or tobacco dependence was observed. Pathological gambling is found in excess in the parents of pathological casino gamblers, in accordance with previous aggregation studies devoted to other types of gambling, and with studies recruiting gamblers in different settings. (Am J Addict 2011;21:86–95)     

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.     

Demographic,psychiatric, and personality correlates of adults seeking treatment for disordered gambling with a comorbid binge/purge type eating disorder

Preliminary evidence suggests that binge/purge type eating disorders and gambling disorder may commonly co‐occur. However, this dual‐diagnosis population remains understudied. The present research examined the prevalence rates and correlates of binge/purge type eating disorders (i.e., bulimia nervosa, binge‐eating disorder, and anorexia nervosa binge/purge type) among adults seeking treatment for their gambling (N = 349). In total, 11.5% of the sample (n = 40) met criteria for a binge/purge type eating disorder, most commonly bulimia nervosa (n = 33). There was a higher preponderance of binge/purge type eating disorders in women. People with a comorbid binge/purge type eating disorder reported more days gambling, gambling‐related cognitive distortions, impulsivity, suicidality, and other current psychiatric comorbidities including addictive behaviours. These findings suggest that binge/purge type eating disorders in people seeking treatment for gambling may be more common than previously believed. Furthermore, the increased psychopathology among people with binge/purge type eating disorder and gambling disorder identify vulnerabilities of this dual‐diagnosed population that may require clinical attention.     

Contemporary issues and future directions for research into pathological gambling

The recent healthy increase in research into all aspects of gambling is noted. The dominant theme accounting for most of this research is the mental disorder model of pathological gambling and measures that have been derived from this conceptualization. It is suggested that an alternative approach focusing on the construct of choice or subjective control over gambling may be a research direction that will ensure that progress is maintained. In this paper a context for the discussion is provided by first identifying briefly fundamental conceptual and methodological issues associated with the mental disorder model. In particular it is argued that the heterogeneity of the diagnosis of pathological gambling makes the research task of assessing truly independent variables extremely difficult. Subsequently an illustrative schema is presented that demonstrates both the potential advantages and some of the complexities associated with the dependent variable of self-control over gambling behaviour. The main advantages are argued to be (a) the focus of research is narrowed to one potential cause of harmful impacts rather than the great diversity of impacts themselves, (b) prospective studies of regular gamblers in real gambling venues may be a key source of insight into the development of pathological gambling and (c) it promotes the development of theoretical links with the mainstream of the discipline of psychology. Despite the conceptual difficulties that may be associated with the variable of self-control, it is suggested that these may be overcome because contemporary research into the addictive behaviours has demonstrated considerable success in the definition and measurement of control and related themes such as craving, restraint and temptation.