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)     

Cigarette smoking is associated with increased severity of gambling problems in treatment-seeking gamblers

Aims Cigarette smoking and gambling often co‐occur, but very little is known about smoking or its correlates in disordered gamblers. This study compared gambling and psychosocial problems in treatment‐seeking gamblers who smoke versus those who do not. Methods At intake to gambling treatment programs, gamblers completed the addiction severity index (ASI) and gambling questionnaires. Subjects were categorized into non‐daily smokers (n = 107) and daily smokers (n = 210). Differences in demographics, gambling variables and ASI composite scores were compared between the groups. Results The daily smokers were more likely to have a history of treatment for a substance use disorder than the non‐daily smokers. After controlling for substance abuse treatment histories, gender and age, the daily smokers demonstrated more severe gambling, family/social and psychiatric problems. Compared to non‐daily smokers, the daily smokers gambled on more days and spent more money gambling; they also ‘craved’ gambling more and had lower perceived control over their gambling. The daily smokers were more likely to be taking psychiatric medications, and they experienced psychiatric symptoms, especially anxiety symptoms, on a greater number of days than non‐daily smokers. Implications Results from this study suggest that about two‐thirds of treatment‐seeking gamblers are current daily cigarette smokers, and smoking status is associated with more severe gambling and psychiatric symptoms. These results warrant further investigation of smoking in gamblers and whether smoking adversely affects the course of treatment or outcomes among gamblers.     

Natural and treatment-assisted recovery from gambling problems: a comparison of resolved and active gamblers

Aim. An exploratory study was conducted to understand the process of recovery from gambling problems. Design. Media recruitment was used to identify a resolved ( n = 43) and a comparison group of active pathological gamblers (n = 63). Participants. Participants showed evidence of significant problems related to gambling as well as high rates of co-morbid mood and substance use disorders. The median length of resolution was 14 months with a range of 6 weeks to 20 years. Findings. Resolved gamblers reported a variety of reasons for quitting gambling, related mainly to emotional and financial factors. They did not experience a greater number of precipitating life events compared with active gamblers but did report an increase in positive and a decrease in negative life events in the year after resolution. Both resolved and active gamblers who had relatively more severe problems were more likely to have had treatment or self-help involvement, whereas those with less severe problems, if resolved, were "naturally recovered". Conclusions. The results support the need for a continuum of treatment options for problem gamblers and provide helpful information about recovery processes.     

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.     

Pathological Gamblers, Heroin Addicts and Controls Compared on the E.P.Q.'Addiction Scale'

A 32 item Addiction Scale derived from the Eysenck Personality Questionnaire was administered to 60 pathological gamblers, 25 male and 26 female heroin addicts and 27 male and 25 female controls. The purpose of the study was to replicate Gossop and Eysenck's (1980) finding that the scale differentiated drug addicts from controls and to test the hypothesis that pathological gambling is an addictive disorder and that pathological gamblers would show a profile similar to substance addicts. Gossop and Eysenck's findings were replicated. Results also supported the present hypothesis. Male addicts and gamblers had significantly higher Addiction, Neuroticism and Psychoticism scale scores than controls. Female addicts scored significantly higher on the Addiction and Psychoticism scales than their female counterparts. As items composing the scale load on anxiety and depression it was concluded that any similarities between pathological gamblers and substance addicts may reflect a general factor of affective disturbance. The role of excitement and arousal as the addictive agent in pathological gambling is discussed.     

Antisocial personality disorder is associated with increased severity of gambling, medical, drug and psychiatric problems among treatment-seeking pathological gamblers

AIMS: To evaluate systematically whether pathological gamblers with antisocial personality disorder (ASPD) experience increased severity of gambling, medical, psychiatric, substance use and psychosocial problems compared to pathological gamblers without ASPD. PARTICIPANTS, DESIGN AND MEASUREMENTS: Pathological gamblers (n = 237) entering an out-patient treatment study for pathological gambling completed the ASPD section of the Structured Clinical Interview for Diagnostic and Statistical Manual version IV (DSM-IV) Personality Disorders, California Psychological Inventory-Socialization Scale, Addiction Severity Index (ASI), Brief Symptom Inventory (BSI) and gambling questionnaires. SETTING: Pathological gambling research clinic. FINDINGS: Thirty-nine (16.5%) pathological gamblers met DSM-IV diagnostic criteria for ASPD. Compared to pathological gamblers without ASPD, pathological gamblers with ASPD were younger, more likely to be male and divorced/separated, and had fewer years of education. They also began gambling earlier in life, reported increased severity of gambling, medical and drug problems, and scored higher on the paranoid ideation, somatization and phobic anxiety subscales of the BSI. Further, logistic regression identified male gender, history of illicit drug use and severity of gambling and medical problems as independent predictors of ASPD. CONCLUSIONS: These results underscore the importance of assessing a wide range of behaviors and personality indices, including ASPD, among treatment-seeking pathological gamblers.     

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.     

Gender differences in mental health characteristics and gambling among African-American adolescent gamblers

This study explores gender differences in lifetime and recent substance use/internalizing behavior, childhood externalizing behavior, and gambling preferences among African-American youth gamblers. Data are from a prospective study of a community sample of 452 urban African-American youths who began at entry into first grade and were followed for ten years. Gambling was associated with high teacher ratings of childhood externalizing behaviors among males and with high parent ratings of childhood impulsivity and hyperactivity among both genders. Internalizing behavior was associated with female gambling. No male-female differences in substance use/lifetime conduct disorder among gamblers were noted. Gambling preferences/frequency differed across genders.     

Characteristics of Pathological Gamblers with a Problem Gambling Parent

This analysis compares the characteristics of adult pathological gamblers with and without a problem gambling parent. A sample of 517 individuals with current DSM‐TV pathological gambling was categorized based on presence of a parental problem gambler. Groups were compared on clinical characteristics, gambling severity, gambling‐related problems, and psychiatric comorbidity. Although the groups were similar on most measures, pathological gamblers with at least one problem gambling parent were more likely to have a father with an alcohol abuse/dependence problem; have financial and legal problems; and report daily nicotine use. Females with a problem gambling parent had significantly earlier onset of gambling behavior, were significantly more likely to have a father with an alcohol use disorder, and were significantly more likely to have financial problems secondary to gambling than females without a problem gambling parent. Males with a problem gambling parent were significantly more likely to have a father with an alcohol use disorder and have legal problems secondary to gambling compared to males without a problem gambling parent. Treatment approaches may need to be tailored for specific problems secondary to gambling and gender issues based on the history of having a problem gambling parent.     

Social Support is Associated with Gambling Treatment Outcomes in Pathological Gamblers

Poor social support is a contributory factor in development of addictive disorders, but it has rarely been evaluated in pathological gamblers. This study examined social support in pathological gamblers and its relationship with treatment outcomes. Low baseline social support was associated with increased severity of gambling, family, and psychiatric problems and poorer post‐treatment outcomes. Further, social support assessed post‐treatment was significantly related to severity of gambling problems at the 12‐month follow‐up. These findings demonstrate that social support plays an important role in moderating outcomes, and enhancing social support may be an important aspect of effective gambling treatments.     

A hierarchy of gambling disorders in the community

Aims To help refine the definition and diagnosis of gambling disorders, we investigated the distribution among US gamblers of the 10 DSM‐IV criteria for Pathological Gambling. Design We drew data from two stratified random surveys (n = 2417, n= 530) of gambling behavior and consequences among community‐based samples of US adults. A fully structured questionnaire, administered by trained lay interviewers, screened for the life‐time prevalence of problem and Pathological Gambling. Per DSM‐IV definitions, anyone meeting five or more of 10 itemized criteria was considered a pathological gambler. We analyzed these criteria among all gamblers who met one or more criteria (n = 399). Findings Most gamblers who met only one or two criteria reported ‘chasing their losses’. At subclinical levels (three to four criteria), gamblers also reported elevated rates of gambling‐related fantasy: lying, gambling to escape and preoccupation. Pathological gamblers with five to seven criteria reported marked elevations of loss of control, withdrawal symptoms and tolerance (internalizing dimensions of dependence); risking their social relationships and needing to be bailed out financially (externalizing dimensions). Most of the highest‐level pathological gamblers (eight to 10 criteria) reported committing illegal acts to support gambling. Conclusion Dependence in a biobehavioral sense appears to be a hallmark of Pathological Gambling, but it marks only one threshold in a qualitative hierarchy of disorders beginning with a common subclinical behavior, ‘chasing’. Epidemiological assessments and future DSM revisions might consider explicit recognition of a problem gambling disorder, identifying people presenting some cognitive symptoms of Pathological Gambling but not clear signs of dependence. Pathological gamblers in turn appear to have two distinct levels of severity.     

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.     

Gambling and substance use disorders: current status and future directions

This paper briefly reviews the clinical presentation of pathological gambling and presents data related to the co-occurrence of pathological gambling and substance use disorders. Both epidemiological and treatment data are reviewed. The putative physiological substrates underlying pathological gambling are described, along with the limited genetics data. Types of treatments applied to gamblers are described, including data on efficacy and overlap of issues that relate to both gambling and substance use disorders. Finally, areas for future research are suggested to advance our understanding of pathological gambling and its relationship to substance use disorders.     

Characteristics of tobacco-smoking problem gamblers calling a gambling helpline

Few studies have examined the smoking behaviors of problem gamblers. A high proportion of problem gamblers calling a gambling helpline reported daily tobacco smoking (43.1%). Problem gamblers reporting daily tobacco smoking more frequently acknowledged depression and suicidality secondary to gambling, gambling-related arrests, alcohol and drug use problems, mental health treatment, and problems with casino slot machine gambling. The findings substantiate the relationship in problem gamblers between tobacco smoking and psychiatric symptomatology, particularly other substance use problems. The high proportion of callers reporting daily tobacco smoking highlights the need for enhanced smoking cessation efforts in problem gamblers.     

Gambling problems in substance abusers are associated with increased sexual risk behaviors

Objectives. This study evaluated the association between gambling problems and HIV risk behaviors in substance abusers. Participants and setting. One hundred and thirty-four substance abusers were recruited from advertisements placed in newspapers and at social service agencies. Intervention. Gambling problems were assessed using the South Oaks Gambling Screen (SOGS). The Addiction Severity Index evaluated drug and psychosocial problems, and the HIV Risk Behavior Scale assessed risk behaviors. Findings. Based on SOGS scores, 24% (n = 31) of substance abusers evidenced probable pathological gambling. Problem gambling substance abusers were more likely to be male than non-problem gamblers, but no other differences in demographic characteristics or drug use variables were noted. Compared to non-problem gamblers, problem gamblers reported more sex partners and less frequent use of condoms with casual and paid sex partners. Stepwise logistic regression confirmed the association between severity of gambling problems and more risky sexual behaviors; higher SOGS scores predicted having more than 50 sex partners, exchanging sex for drugs/money, and engaging in anal intercourse (p < 0.05). Participants with gambling problems were also less knowledgeable about HIV transmission. Conclusions. These data suggest that gambling problems may be a risk factor for contracting HIV. Increased efforts are needed to screen for and treat gambling problems among substance abusers.     

Longitudinal Perspective: Adverse Childhood Events,Substance Use,and Labor Force Participation Among Homeless Adults

Objectives: We examined the long‐term effects of adverse childhood events on adulthood substance use, social service utilization, and subsequent labor force participation. Methods: A county‐wide probability sample of 397 homeless adults was interviewed three times in a 15‐month period. By using a path model, literature‐based relationships between adverse childhood events and labor force participation with the mediating effects of adulthood substance use and service use were tested. Results: Adverse childhood events were precursors to adulthood alcohol and drug use. Consistent substance use was negatively associated with long‐term labor force participation and with social service utilization among homeless adults. Adverse events at childhood, however, were positively associated with service use. Conclusions: Adverse childhood events may contribute to negative adulthood consequences, including consistent substance use and reduced labor force participation. Agencies that are involved in halting the abuse or neglect also should participate in more preventive interventions. Job‐related assistance is particularly important to facilitate employment and labor force participation among homeless adults.     

Do coping skills mediate the relationship between cognitive–behavioral therapy and reductions in gambling in pathological gamblers?

AIMS: Cognitive-behavioral therapy (CBT) is useful for treating substance abusers, and recent data suggest it is also efficacious for pathological gamblers. CBT is purported to exert its beneficial effects by altering coping skills, but data supporting coping changes as the mechanism of action are mixed. This study examined whether coping skills acquisition mediated the effects of CBT on decreasing gambling in pathological gamblers. DESIGN: Participants were assigned randomly to CBT plus referral to Gamblers Anonymous (GA) or to GA referral alone. Setting Out-patient clinic. PARTICIPANTS: A total of 127 pathological gamblers. MEASUREMENTS: Participants completed the Coping Strategies Scale (CSS) before treatment and 2 months later; indices of gambling behavior and problems were administered pretreatment and at months 2 and 12. FINDINGS: Overall, CSS scores increased for participants in both conditions, but those receiving CBT evidenced larger increases than those in the GA condition (P < 0.05), and they also reduced gambling more substantially between pretreatment and month 2. Changes in CSS scores mediated the relationship between treatment assignment and gambling outcomes from pretreatment to month 2, but little evidence of mediation occurred for the long-term follow-ups. CONCLUSIONS: CBT's beneficial effects in decreasing gambling may be related partly to changes in coping responses, and improvements in coping are associated with long-term changes in gambling. However, relationships between coping skills and gambling behavior are fairly strong, regardless of treatment received.     

Examining the predictive validity of low-risk gambling limits with longitudinal data

Aims To assess the impact of gambling above the low‐risk gambling limits developed by Currie et al. (2006) on future harm. To identify demographic, behavioural, clinical and environmental factors that predict the shift from low‐ to high‐risk gambling habits over time. Design Longitudinal cohort study of gambling habits in community‐dwelling adults. Setting Alberta, Canada. Participants A total of 809 adult gamblers who completed the time 1 and time 2 assessments separated by a 14‐month interval. Measurements Low‐risk gambling limits were defined as gambling no more than three times per month, spending no more than CAN$1000 per year on gambling and spending less than 1% of gross income on gambling. Gambling habits, harm from gambling and gambler characteristics were assessed by the Canadian Problem Gambling Index. Ancillary measures of substance abuse, gambling environment, major depression, impulsivity and personality traits assessed the influence of other risk factors on the escalation of gambling intensity. Findings Gamblers classified as low risk at time 1 and shifted into high‐risk gambling by time 2 were two to three times more likely to experience harm compared to gamblers who remained low risk at both assessments. Factors associated with the shift from low‐ to high‐risk gambling behaviour from time 1 to time 2 included male gender, tobacco use, older age, having less education, having friends who gamble and playing electronic gaming machines. Conclusions An increase in the intensity of gambling behaviour is associated with greater likelihood of future gambling related harm in adults.     

Pathological Gambling Among Youthful Multiple Substance Abusers in a Therapeutic Community

Patients in a therapeutic community were questioned about their gambling behavior in order to find out what percentage of them were pathological gamblers. The South Oaks Gambling Screen (the SOGS) was used to screen the clients for gambling-related problems. Out of 100 residents tested, 14 were diagnosed as pathological gamblers and an additional 14 showed signs of problematic gambling. Seventeen percent listing alcohol as one their three favorite drugs, 18% listing cocaine, 13% preferring marihuana, 11% preferring hallucinogens, 29% choosing heroin, 10% choosing PCP, and none choosing tranquilizers or sedatives showed signs of pathological gambling. Males were more likely to be classified as pathological gamblers than females. Residents aged 19 years and over were four times as likely to show signs of pathological gambling than those 18years and under. SOGS was also significantly associated with parental gambling (50% of the children of pathological gamblers were pathological gamblers themselves) and occupational status. The implications for study and treatment of these individuals are made in terms of the study of addictions.     

Alcoholism, Drug Abuse, and Gambling

Patients in an alcoholism and drug dependency treatment facility were questioned about their gambling behavior in order to find out what percentage of them were abusing alcohol and/or drugs and gambling. In order to do this, a pathological gambling signs index was constructed according to a modification of DSM III criteria and validated using independent procedures. Out of 458 patients interviewed, 40 (9%) were diagnosed as pathological gamblers and an additional 47 (10%) showed signs of problematic gambling. These patients showed clear signs of emotional, financial, family and occupational disruption, and illegal behavior in connection with their gambling which compound the disruption induced by alcohol and/or drugs. Five per cent of the patients abusing only alcohol, 12% of those with alcohol and another drug in combination, and 18% of those with other drug abuse problems without an alcohol component showed clear signs of pathological gambling; 11 1/2% of males and 2% of females were classified as pathological gamblers. The index was also significantly associated with parental gambling (38% of the children of pathological gamblers were pathological gamblers themselves). Gambling by siblings, alcoholism in the father (but not in the mother), gambling prior to age 20, greater amounts of gambling for more money, and "chasing losses in order to get even" were also positively correlated with the index. The implications for study and treatment of these individuals are discussed in terms of the study of addictions.