Subtyping pathological gamblers based on impulsivity, depression, and anxiety.

This study examined putative subtypes of pathological gamblers (PGs) based on the Pathways model, and it also evaluated whether the subtypes would benefit differentially from treatment. Treatment-seeking PGs (N = 229) were categorized into Pathways subtypes based on scores from questionnaires assessing anxiety, depression, and impulsivity. The Addiction Severity Index—Gambling assessed severity of gambling problems at baseline, posttreatment, and 12-month follow-up. Compared with behaviorally conditioned (BC) gamblers, emotionally vulnerable (EV) gamblers had higher psychiatric and gambling severity, and were more likely to have a parent with a psychiatric history. Antisocial impulsive (AI) gamblers also had elevated gambling and psychiatric severity relative to BC gamblers. They were more likely to have antisocial personality disorder and had the highest legal and family/social severity scores. They were also most likely to have a history of substance abuse treatment, history of inpatient psychiatric treatment, and a parent with a substance use or gambling problem. AI and EV gamblers experienced greater gambling severity throughout treatment than BC gamblers, but all three subtypes demonstrated similar patterns of treatment response. Thus, the three Pathways subtypes differ on some baseline characteristics, but subtyping did not predict treatment outcomes beyond a simple association with problem gambling severity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cross-lagged links among gambling, substance use, and delinquency from midadolescence to young adulthood: Additive and moderating effects of common risk factors.

The authors examined cross-lagged links among gambling, substance use, theft, and violence from midadolescence to young adulthood and whether behavioral disinhibition, deviant peers, and parental supervision as common risk factors explain or moderate those links. In 2 community samples, male Caucasians were assessed for gambling participation and problems with the South Oaks Gambling Screen—Revised for Adolescents (K. C. Winters, R. Stinchfield, & J. Fulkerson, 1993) at age 16 years and the South Oaks Gambling Screen (H. R. Lesieur & S. B. Blume, 1987) at age 23. Other problem behaviors were also assessed both times. Risk factors were measured at age 16. Adolescent substance use was related to subsequent theft and violence but not gambling. Gambling problems were linked to subsequent gambling participation. For adolescents with deviant peers, gambling problems were linked to subsequent theft; this was not the case for adolescents without deviant peers. Only for individuals high on disinhibition did stability of gambling problems resemble moderate stabilities of other problem behaviors. Each risk factor was related to each problem behavior (exception: parenting unrelated to gambling). These risk factors partly explained the cross-lagged links among behaviors and thus may be useful targets of prevention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pathological gamblers, with and without substance abuse disorders, discount delayed rewards at high rates.

Pathological gambling is classified as a disorder of impulse control, yet little research has evaluated behavioral indices of impulsivity in gamblers. The rates at which rewards delayed in time are subjectively devalued may be a behavioral marker of impulsivity. This study evaluated delay discounting in 60 pathological gamblers and 26 control participants. Gamblers were divided into those with (n?=?21) and without (n?=?39) substance use disorders. A hypothetical $1,000 reward was delayed at intervals ranging from 6 hr to 25 years, and immediate rewards varied from $1 to $999. Pathological gamblers discounted delayed rewards at higher rates than control participants, and gamblers with substance use disorders discounted delayed rewards at higher rates than non-substance-abusing gamblers. These data provide further evidence that rapid discounting of delayed rewards may be a feature central to impulse control and addictive disorders, including pathological gambling. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparison of pathological gamblers with and without substance abuse treatment histories.

This study evaluated the prevalence and correlates of substance abuse histories in 341 consecutive admissions to gambling treatment programs. After controlling for gender, income, and site, gamblers with substance abuse treatment histories (SATH; 31%) had more severe problems than gamblers with no substance abuse treatment histories (NSATH) on the Gambling, Alcohol, Drug, Psychiatric, and Employment scales of the Addiction Severity Index. The SATH group had more years of gambling problems and gambled more days in the month prior to initiating gambling treatment. The SATH gamblers were also more likely to be receiving treatment for mental health problems and reported greater lifetime psychiatric distress than NSATH gamblers. These data suggest that pathological gamblers with substance abuse treatment histories may present more persistent and severe gambling dysfunction and psychiatric problems than those without such histories. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Concordance between the SOGS-RA and the DSM-IV criteria for pathological gambling among youth.

This study assessed the possible differences in the classification of adolescent gamblers when using the South Oaks Gambling Screen-Revised for Adolescents (SOGS-RA; K. C. Winters, R. D. Stinchfield, & J. Fulkerson, 1993) versus a clinical interview that was based on Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994) criteria for pathological gambling. A total of 631 adolescents ages 15-17 years participated in the two phases of the study. Results revealed that of the 93 adolescents who had been screened as problem gamblers according to the SOGS-RA, only 7 could be clinically confirmed as pathological gamblers according to the criteria used at present to define pathological gambling. The need to clarify the construct of pathological gambling among youth is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Relationship of Impulsivity, Sensation Seeking, Coping, and Substance Use in Youth Gamblers.

This study examines the relationship of impulsivity, sensation seeking, coping, and substance use to disordered gambling in a sample of 1,339 youth (637 males and 702 females), 17-21 years old. Results indicate that males with serious gambling problems were more likely than their peers to abuse substances and to use avoidant stress-coping strategies, such as seeking emotional outlets, distracting themselves with other activities, and using humor. In contrast, female disordered gamblers were less likely to engage in active coping and planning strategies. Overall, substance use, coping through distraction, and impulsivity proved the most predictive of disordered gambling for males, and intensity seeking and impulsivity proved most predictive for females. Implications for prevention, intervention, and education are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prevalence, course, and predictors of multiple problem behaviors among gay and bisexual male adolescents.

Multiple problem behaviors, stress, and personal resources were assessed over 2 yrs among 136 mainly Black and Hispanic gay and bisexual male adolescents (aged 14–19 yrs). Whereas sexual risk acts, substance abuse, conduct problems, and emotional distress were common, the risk acts did not form a multiple problem behavior cluster, compared with previous findings with heterosexual youths. Problem behaviors were stable over time: Only 20–30% of the youths changed their pattern of problem behaviors over 2 yrs. For each individual, the pattern of change in one behavior problem was not related to patterns of change in other problem behaviors over 2 yrs. At baseline, personal resources were associated with less alcohol use and emotional distress, and stress was associated with delinquent behaviors. The pattern of results was similar whether youths labeled themselves as gay or bisexual, suggesting that problem behaviors among mainly Black and Hispanic gay and bisexual youths may follow different developmental pathways than among heterosexual youths. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Association between posttreatment gambling behavior and harm in pathological gamblers.

This study investigated the relationship between posttreatment gambling behavior and harm in a sample of treatment-seeking pathological gamblers. One year after initiating treatment, participants (n = 178) completed the Gambling Timeline Followback (D. C. Hodgins & K. Makarchuk, 2003; J. Weinstock, J. P. Whelan, & A. W. Meyers, 2004) and the South Oaks Gambling Screen (SOGS; H. R. Lesieur & S. B. Blume, 1987), both of which assessed gambling behaviors and problems over the prior 6 months. Based upon self-reports of gambling-related problems on the SOGS, participants were classified as problem free (SOGS scores = 0) or symptomatic gamblers (SOGS scores ≥ 1). Receiver operator characteristic curves evaluated classification by gambling behaviors for individuals classified in these 2 groups. Behavioral indicators for problem-free gambling were gambling no more than once per month, gambling for no more than 1.5 hr per month, and spending no more than 1.9% of monthly income on gambling. Alternative behavioral indicators were examined along a continuum of harm (SOGS cut-points of 1-5). These results provide preliminary data regarding intensity of gambling behavior associated with problem-free to probable pathological gambling in gamblers who presented for treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Disordered gambling among university-based medical and dental patients: A focus on Internet gambling.

The authors evaluated gambling behaviors, including Internet gambling, among patients seeking free or reduced-cost dental or health care. Three hundred eighty-nine patients at university health clinics completed a questionnaire that included the South Oaks Gambling Screen (SOGS; H. R. Lesieur & S. Blume, 1987). All respondents had gambled in their lifetimes, with 70% gambling in the past 2 months. On the basis of SOGS scores, 10.6% were problem gamblers, and 15.4% were pathological gamblers. The most common forms of gambling were lottery, slot machines, and scratch tickets. Internet gambling was reported by 8.1% of participants. Compared to non-Internet gamblers, Internet gamblers were more likely to be younger, non-Caucasian, and have higher SOGS scores. This study is among the first to evaluate the prevalence of Internet gambling and suggests that people who gamble on the Internet are likely to have a gambling problem. Results also illuminate the need to screen patients seeking health care services for gambling problems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Use of a neonatal blood pressure cuff to monitor blood pressure in the adult finger--comparison with a standard adult arm cuff

This study examined the comorbidity of substance use disorders and other psychiatric disorders in adolescent populations. The study population was comprised of 100 consecutive admissions, ages 13 to 17, to an acute care adolescent psychiatric inpatient unit for substance use disorders. Patients were assessed using the Personal Experience Screening Questionnaire (PESQ) and the substance-use disorder portion of the Structured Clinical Interview for DSM III-R (SCID-R). Thirty-three (33%) patients were identified as having a substance abuse or dependence diagnosis. There was no significant difference in the age between substance users and nonsubstance users. There were significantly more whites in the substance-using group. Sixty percent of all adolescents interviewed had histories of sexual or physical trauma, with trauma being significantly more common in the substance-using group. There were no significant differences in the number or type of other Axis I or Axis II diagnoses between the two groups. While substance users and nonsubstance users had no significant difference in the number of past psychiatric hospitalizations, nonsubstance users had significantly more past medical hospitalizations. These results indicate that high rates of comorbid substance abuse and psychiatric disorders exist in adolescents, and more in-depth study of comorbidity among adolescents is warranted.     

Self-Reported Gambling-Related Suicidality Among Gambling Helpline Callers.

Problem gamblers often attribute suicidal ideation or attempts to their gambling. Logistic regression analyses were applied to data from problem gamblers (N = 986) calling a helpline. Problem gamblers reporting gambling-related suicidality (n = 252; 25.6%) were more likely than those denying it (n = 734; 74.4%) to acknowledge family, financial, legal, and mental and substance-related problems. Of problem gamblers acknowledging gambling-related suicidality, those reporting gambling-related suicide attempts (n = 53; 21.5%) were more likely than those denying them (n = 193; 78.5%) to acknowledge gambling-related illegal behaviors, mental health and substance abuse treatment, and family histories of alcohol problems, and were less likely to report prior gambling treatment. The findings suggest that increased gambling severity is associated with gambling-related suicidality. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Trusting problem gamblers: Reliability and validity of self-reported gambling behavior.

The retest reliability and validity of self-reported gambling behavior were assessed in 2 samples of problem gamblers. Days gambled and money spent gambling over a 6-month timeframe were reliable over a 2- to 3-week retest period using the timeline follow-back interview procedure (N=35; intraclass correlation coefficients [ICCs] ranged from .61 to .98). Gamblers did, however, report significantly more gambling at the 2nd interview. Agreement with collaterals was fair to good overall (ICCs ranged from .46 to .65) with no clear pattern of either over- or underreporting by gamblers. Spouses did not show greater agreement with gamblers compared with nonspouses, and greater agreement was not found for collaterals who were more versus less confident in their reports. The results are generally supportive of the use of self-reported gambling in studies of problem gamblers, assessed face to face and by telephone, although suggestions for further research are provided. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Narrowed focus and dissociative experiences in a community sample of experienced video lottery gamblers.

Problem (20 Ss) and occasional (22 Ss) video lottery terminal (VLT) gamblers were compared on speed of reaction to irrelevant light stimuli on a nongambling baseline measure and while playing on a VLT, on feelings of dissociation when gambling, and on general dissociative experiences. Measures included the Dissociative Experiences Scale (DES), the Brief Symptom Inventory, and the Dissociative Experiences Scale. The groups did not differ on DES scores. Problem gamblers reported more dissociative-like experiences when gambling than occasional gamblers. For the problem gamblers only the speed of response to irrelevant light stimuli when playing on the VLT was dependent on the order of task presentation. These findings suggest problem VLT gamblers focus intensely on VLT play but are capable of changing their focus if the task requires it. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Impulsivity, life stress, refusal efficacy, and problem gambling among Chinese: Testing the diathesis-stress-coping model.

This study extended the diathesis-stress-coping model (Lazarus & Folkman, 1984) to understand problem gambling in Chinese societies. We examined core model components of impulsivity trait (diathesis), life stress, and gambling refusal efficacy (coping efficacy) with 942 Chinese college students and 153 Chinese gamblers. Results showed that the three core model components exerted main effects on problem gambling for both samples. Among college students, refusal efficacy interacted with impulsivity to influence problem gambling in male and female students, and interacted with life stress in male students only. In particular, more severe problem gambling was associated with higher impulsivity in low- but not high-efficacy students, and with higher stress in low- but not high-efficacy male students. Among gamblers, impulsivity interacted with life stress to influence problem gambling. In the high stress condition, high- relative to low-impulsivity gamblers reported more severe problem gambling, but this pattern was not found in the low-stress condition. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Psychiatric Comorbidity and Substance Use Treatment Outcomes of Adolescents.

Treatment outcomes of 126 adolescents (13-18 years old) with comorbid substance use disorders (SUDs) and Axis I psychiatric disorders (mood, anxiety, conduct, and attention-deficit/hyperactivity disorders) were compared to 81 SUD adolescents with no additional Axis I disorder. Participants completed structured interviews and symptom measures while participating in an adolescent treatment program and at 6 months following treatment. Results indicated that comorbid youth received more treatment during the outcome period; despite this, more comorbid SUD-Axis I disordered adolescents used substances following treatment than SUD-only youth, even after controlling for socioeconomic status and ethnicity. Among comorbid youth, internalizing disordered adolescents were less likely to use substances during the follow-up period, and externalizing disordered youth returned to substance use most rapidly after discharge from treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Gambling cognition and subjective well-being as mediators between perceived stress and problem gambling: A cross-cultural study on White and Chinese problem gamblers.

This study aimed to delineate various pathways whereby cognitive and emotional vulnerabilities triggered by stress would lead to disruptive gambling. A multiple mediation framework was proposed to specify that gambling cognition and subjective well-being would mediate the influence of perceived stress on problem gambling. The cross-cultural validity of the proposed framework was examined with 132 White gamblers in Australia and 154 Chinese gamblers in China. They completed psychological scales on perceived stress, gambling expectancy bias, gambling refusal efficacy, negative affect, life satisfaction, and problem gambling. Compared to Chinese gamblers, White gamblers reported higher levels of perceived stress, gambling expectancy bias, and problem gambling as well as more pervasive negative affect and lower levels of life satisfaction. Results showed that the proposed multiple mediation framework fit the data better than two alternative plausible models. Life satisfaction and gambling refusal efficacy were two consistent mediators across White and Chinese gamblers. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Taking chances: problem gamblers and mental health disorders--results from the St. Louis Epidemiologic Catchment Area Study

OBJECTIVES: This study determined prevalence estimates of problem gambling and relationships to other psychiatric and substance use disorders. METHODS: In 1981, the Diagnostic Interview Schedule was used to collect epidemiological information on problem gambling and other disorders from 3004 adults in St. Louis, Mo. RESULTS: The lifetime prevalence of pathological gambling was 0.9%; 46% of those surveyed gambled recreationally. Problem gamblers (those reporting at least one gambling-related problem) were 9.2% of the sample and were predominately White (69%), male (78.2%), and young than nongamblers. They were at increased risk for several psychiatric diagnoses, especially for antisocial personality disorder, alcoholism, and tobacco dependence. CONCLUSIONS: Clinicians treating alcoholism and tobacco dependence may need to screen for problem gambling. Additional research in the context of increased gambling opportunities is needed.     

Use of warning messages to modify gambling beliefs and behavior in a laboratory investigation.

This laboratory study assessed the effectiveness of warning messages intended to aid in the control of gambling. Participants were 120 undergraduate students from an urban state university who reported previous gambling activity. They were recruited to play a computerized roulette game with imaginary money. Money left at the end of play was exchanged for raffle tickets for a prize drawing. Participants were randomly assigned to 1 of 2 conditions. In the warning-message condition, participants received an educational component discussing common irrational beliefs expressed by gamblers and, while playing roulette, viewed brief messages that addressed irrational gambling beliefs. In the control condition, participants received an educational component on the history of roulette but no warning messages. Participants in the warning-message condition reported significantly fewer irrational beliefs and demonstrated less risky gambling behavior than those in the control condition. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Beliefs about control over gambling among young people, and their relation to problem gambling.

The aim of this study was to assess the association between beliefs about 2 types of control—(a) illusion of control and (b) internal locus of control—and gambling frequency–problem gambling among young people age 14 to 25 years (435 males, 577 females, and 5 unreported gender). A revised version of the South Oaks Gambling Screen and measures of gambling frequency and gambling beliefs were administered. Results indicated that irrational control beliefs were strongly associated with problem gambling. Young problem gamblers were more likely to believe that they needed money and that gambling would provide it. In addition, young problem gamblers had more faith in their ability to manipulate chance and "beat the system." Regression models with illusion of control and internal control over gambling significantly predicted gambling frequency and problem gambling. (PsycINFO Database Record (c) 2010 APA, all rights reserved)