A Comparison of Online Versus Offline Gambling Harm in Portuguese Pathological Gamblers: An Empirical Study

The Profiles of People who Do not Engage in Positive Play while Gambling

BACKGROUND

Positive Play describes non-problematic gambling behaviour. The term avoids the ambiguity of the term 'Responsible Gambling', and the negative connotations associated with 'Problem Gambling'. This purpose of the paper was to identify demographic groups who score consistently low on the positive play in order to determine where interventions are most needed.

METHODS

The study is a secondary analysis of general population data, collected online by AskingCanadians on behalf of Ontario Lottery and Gaming that examined data on positive play and harm reduction related to gambling. The paper included the analysis of survey data from players who reported engaging in one of the four target gambling activities (N = 3701): Lotteries (n = 1832), casinos (n = 1272), online (n = 300), and charity bingo (n = 297).

RESULTS

People who scored low on all four of the Positive Play scales were more likely to be young, male, single, have a low or middle range income, have at least some university education, and to have been born outside of Canada. In addition, people who scored low on Positive Play scale were more likely to play online games or charity games compared to lotteries. These findings were mostly consistent across game types however due to the small sample sizes for online gamblers and charitable gamblers, some effects did not reach significance.

DISCUSSION

Awareness efforts for Positive Play should be directed at younger players, males, and recent immigrants. In addition, more effort in encouraging Positive Play needs to be directed at online gamblers and bingo gamblers.

"It would Never have Happened Without the Pandemic": Understanding the Lived Experience of Individuals who Increased Their Online Gambling Participation

The gambling landscape was profoundly impacted by the COVID-19 pandemic, leading to an increase in online gambling participation. This growth raises concerns about the potential harms associated with online gambling. This qualitative study aims to understand the lived experiences of gamblers whose participation in online gambling increased due to the pandemic. Thematic content analysis was undertaken based on semi-structured interviews conducted with 58 people who reported an increase in their online gambling participation due to the pandemic. Findings are presented according to the three main themes that emerged from the analyses: (1) whether increases in gambling participation during the pandemic were short-term or sustained, (2) characteristics of the gambling environment and operators' practices that shaped this increase, and (3) the role of gambling in the daily lives of gamblers who reported an increase in their gambling participation during the pandemic. Exploration of the lived experiences of gamblers reporting an increase of their online gambling practices during the pandemic raises important issues regarding online gambling environment and gambling operator's practices.

A Study on Gambling Behavior in Türkiye: Perceptions, Attitudes, Thoughts, and Behaviors Toward Gambling

Background

The aim of this quantitative study conducted with 5008 individuals aged 15 and above in 12 provinces across Turkey was to determine the prevalence and significant variables of gambling behavior in our country and to examine the gambling behaviors, perceptions, thoughts, and attitudes of this population towards gambling. The goal is to generate concrete, original, culturally sensitive, feasible, and effective recommendations for preventive and risk-reducing policies. It is the first and only comprehensive investigation into gambling behavior in Turkey, offering guidance in this field.

Methods

In this study, which was conducted with an epidemiological cross-sectional design, a stratified random sampling technique was employed, and data were collected using computer-assisted faceto-face interviews. Individuals to be surveyed in households were randomly selected using the Kish method.

Results

Three hundred forty-one participants (6.81%) reported having gambled at least once (GALO) in their lifetime, while the remaining participants stated they had never gambled (NG). Among the GALO group, 100 individuals (29.33%) reported regular participation in gambling activities during the data collection period. The most commonly played types of gambling were sports betting (55.4%), national lottery (42.2%), numeric lottery (34.6%), and bingo (30.8%). The ages of first-time gambling ranged from 6 to 41. Tobacco, alcohol, and substance use were significantly more common in the GALO group compared to the NG group (P < .001).

Conclusion

Understanding the prevalence of gambling behavior and underlying motivations is crucial for creating awareness and implementing effective preventive measures. We must determine its prevalence, examine societal attitudes, highlight its presence, and prioritize solution-oriented strategies.

Impact of Gambling on the Internet on Middle-Term and Long-Term Recovery from Gambling Disorder: A 2-Year Longitudinal Study

Online gamblers are more likely to experience gambling problems. The main objective was to compare the frequency of recovery one (middle-term) and two (long-term) years after treatment initiation, according to the gambling medium (Internet vs. land-based gambling). The secondary objectives were (i) to compare online and offline gamblers at inclusion and (ii) to investigate whether the gambling medium was a predictive factor of recovery. Outpatients beginning treatment for a GD (n = 237) were assessed at inclusion (treatment initiation) and after 1 and 2 years. Bivariate analyses were performed to compare online and offline gamblers at inclusion and on the frequency of recovery at one and two years. Two multivariate logistic regressions were then performed to identify factors associated with middle- and long-term recovery. The majority of patients achieved middle (74.2%) and long-term (78.9%) recovery, with no difference between online and offline gamblers. The gambling medium was not a predictive factor of recovery. Patients with a higher perceived self-efficacy (OR = 1.04 [1.01-1.07], p = .046) and having no history of mood disorders (OR = 11.18 [2.53-49.50], p < .001) at inclusion were more likely to achieve middle-term recovery, while long-term recovery was associated with a lower level of sensation seeking (OR = 0.67 [0.48-0.92], p = .015) at treatment initiation. Online gambling did not seem to influence middle- and long-term recovery compared to offline gambling. Enhancement of perceived self-efficacy and treatment of mood disorders, and treatment strategies focused on sensation-seeking may represent helpful care strategies for favouring achievement of middle-term recovery and maintenance of long-term recovery, respectively. ClinicalTrials.gov NCT01248767, date of first registration: November 25, 2010.

A Double-Edged-Sword Effect of Overplacement: Social Comparison Bias Predicts Gambling Motivations and Behaviors in Chinese Casino Gamblers

Overconfidence, a widely observed cognitive bias, has been linked to increased gambling motivations and behaviors. However, previous studies have largely overlooked overconfidence under a social comparison context, known as overplacement, i.e., the tendency of individuals to believe that they are better than their similar peers. In the present study, we tested the effect of overplacement on gambling motivations and behaviors though a Pilot Survey of Chinese college students (N = 129) and a Field Survey of Chinese Macao casino gamblers (N = 733). Our results revealed a double-edged sword effect of overplacement: Serving as a risk factor, evaluating one self's earning ability as higher than others was linked to more gambling motivations (β = 0.18, p = .005) and frequency (β = 0.18, p = .004); Serving as a protective factor, evaluating oneself as happier than others was linked to less gambling motivations (β = - 0.32, p < .001) and problem behaviors (β = - 0.26, p < .001). These findings expand the relationship between overconfidence and gambling from a cognitive bias perspective to a social comparison perspective. Our study not only revealed a typical profile of gambling motivations and behaviors among different demographic groups in Chinese casino gamblers, but also highlighted the importance of considering social factors in the study of the psychological mechanisms of gambling.

Online Gambling: A Systematic Review of Risk and Protective Factors in the Adult Population

In recent decades, internet gambling has seen strong growth and diffusion due to intrinsic characteristics that make it particularly attractive to players (accessibility, anonymity, variety of games). This paper aims to present the current state of knowledge of the risk and protective factors of online gambling. A literature search conducted in the PubMed, PsychInfo, and Scopus databases found 42 articles, which were included in the review. Methodological aspects and risk and protective factors were analysed cross-sectionally. The results concerning risk and protective factors were distinguished by the level of analysis: individual, relational, and contextual. Two types of comparisons were considered: online vs. offline gamblers and online nonproblematic vs. problematic gamblers. The results of the two comparisons were juxtaposed to analyse their consistency and the different associations with factors. In general, the review showed that risk factors and variables at the individual level are investigated to a greater extent, while protective factors at the relational and contextual level need more in-depth study in future research. More specifically, this review found that even if online and offline gamblers shared most risk and protective factors, there are variables that they would not have in common. These factors could be important to consider in preventive interventions aimed at online gamblers and online problematic gamblers.

Situational features of smartphone betting are linked to sports betting harm: An ecological momentary assessment study

Background and aims

Smartphones extend the situational characteristics of sports betting beyond those available with land-based and computer platforms. This study examined 1) the role of situational features and betting platforms in harmful betting behaviours and short-term betting harm, and 2) whether people with more gambling problems have preferred situational features, engage more in harmful betting behaviours, and experience more severe short-term betting harm.

Methods

An ecological momentary assessment analysed 1,378 betting sessions on sports, esports or daily fantasy sports, reported by 267 respondents (18-29 years; 50.9% male) over 10 weeks.

Results

Factor analysis revealed five situational features of betting sessions: 1) quick, easy access from home, 2) ability to bet anywhere anytime, 3) privacy while betting, 4) greater access to promotions and betting options, and 5) ability to use electronic financial transactions. Regression models underpinned the analyses. Greater short-term betting harm was significantly associated with the ability to bet anywhere anytime, privacy when betting, and greater access to promotions and betting options. Betting sessions when these features were prioritised were more likely to involve impulsive betting, use of betting inducements, and betting with more operators. Respondents with more gambling problems were more likely to prioritise privacy and the ability to bet anywhere anytime; and to bet on in-game events, use promotional inducements, bet with more operators, and report greater betting harm.

Discussion and conclusions

Certain situational features of sports betting are empirically associated with engagement and subsequent harm. Only smartphone betting combines all three features associated with betting harm.

Is there such a thing as gambling dual disorder? Preliminary evidence and clinical profiles

Patients with gambling disorder (GD) frequently present other mental disorders, such as substance use disorder (SUDs), attention deficit/hyperactivity disorder (ADHD), mood disorders, and impulse-control disorders. We propose that GD should not be conceptualized as a single nosological entity, but rather as a gambling dual disorder (GDD). This study aims to provide further evidence of the co-occurrence of GD and other mental disorders in routine clinical practice and to identify different clinical profiles of severity. This descriptive, cross-sectional, and observational study included 116 patients with GD who were undergoing treatment in a specialized center. The MULTICAGE-CAD 4 and South Oaks gambling screen questionnaires confirmed the presence of GD in 97.4% and 100% of the patients, respectively. Other addictive behaviors such as compulsive spending, Internet, video games, or SUD (59.5%, 27.6%, 11.2%, and 13.8%, respectively) were also identified. The most used substances were tobacco (42.2%) and alcohol (5.2%). Half of the patients suffered from ADHD, 30.2% showed moderate or severe depression, and 17.2% suffered from a social anxiety problem. The majority (76.7%) also presented a phenotype with high impulsiveness. The cluster analysis identified two different clinical profiles of severity in patients with GDD. One profile showed higher severity of other mental disorders (ADHD, depression, anxiety, SUD, or insomnia), impulsivity, general psychopathological burden, and disability. In conclusion, our study provides further evidence on the co-occurrence of GD and other mental disorders supporting the GDD existence, shows impulsiveness as a vulnerability factor for GD, and identifies two clinical severity profiles.

The Impact of Personalized Feedback Interventions by a Gambling Operator on Subsequent Gambling Expenditure in a Sample of Dutch Online Gamblers

Player protection has become an important area for the gambling industry over the past decade. A number of gambling regulators now require gambling operators to interact with customers if they suspect they are gambling in a problematic way. The present study provided insight on the impact of personalized feedback interventions (PFIs) on subsequent gambling behavior among a Dutch sample of real-world gamblers. Nederlandse Loterij (the national Dutch Lottery operator) provided access to a secondary dataset comprising tracking data from online casino and sports betting gamblers (N = 2,576) who were contacted either by e-mail or telephone between November 2021 and March 2022 if they showed signs of problematic gambling as identified using behavioral tracking software. Compared to matched controls (n = 369,961 gamblers), Dutch gamblers who received a PFI (via e-mail [n = 1876] or a telephone call [n = 700]) from the gambling operator had a significant reduction in amount of money deposited, amount of money wagered, number of monetary deposits, and time spent gambling in the 30 days after being contacted. Gambling frequency as measured by the number of gambling days did not change significantly after a PFI. Telephone calls did not lead to a significant larger reduction with respect to the aforementioned behavioral metrics. High-intensity players reduced their gambling behavior as frequently as low-intensity players, which means that the intervention’s success was independent of gambling intensity. The impact on subsequent gambling was the same across age groups and gender. The results of the present study are of use to many different stakeholder groups including researchers in the gambling studies field and the gambling industry as well as regulators and policymakers who can recommend or enforce that gambling operators utilize responsible gambling tools such as using PFIs to those who may be displaying problematic gambling behaviors as a way of minimizing harm and protecting gamblers.

Neural cue-reactivity in pathological gambling as evidence for behavioral addiction: a systematic review

Increasing incidence of problem gambling has led to prioritizing the problem from the point of view of public health. Additionally, gambling disorder has been recently classified as a behavioral addiction, with implications for both its diagnosis and treatment. However, the shared neural substrate of addictions, to substances and behavioral, is still discussed. Thus, this systematic review aims to provide up-to-date knowledge from the past five years (2017-2022) concerning the neural correlates of gambling related stimuli (cue-reactivity) on the basis of a previous review (Brevers et al., Cognitive, Affective and Behavioral Neuroscience 18:718-729, 2019). A total of five studies were included in the review. Activation of brain areas related to memory, reward and executive functions could be the underlying mechanism of this behavioral addiction. Specifically, nucleus accumbens and striatum (ventral and dorsal), parahippocampal regions, the right amygdala and several prefrontal cortex regions have systematically been found more active in those subjects exposed to gambling-related cues. Also, the insula could play a pivotal role connecting these three systems in a highly integrated neural network with several implications for reward processing modulation, associative learning and top-down attentional regulation to improve saliency of addiction-related cues. These results are consistent with previous findings on other substance addictions, such as alcohol, tobacco, marijuana or cocaine. The study of neural reactivity to stimuli related to addiction could be useful as a biomarker of the severity of the disorder, the efficacy of the treatment, the risk of relapse, in addition to being an objective criterion to measure the effectiveness of prevention campaigns.

Gambling-related suicides and suicidality: A systematic review of qualitative evidence

The relationship between gambling and suicides or suicidality has received much research attention in recent years. Review studies have already mapped the quantitative occurrence of suicide attempts, suicides, and self-harm among gamblers, and found a positive association. Related comorbidities and conditions have also been charted in previous reviews. However, there is still a gap in knowledge regarding the actual processes that connect gambling and suicidal behavior. To understand these processes, the current paper conducts a systematic review of qualitative evidence on gambling-related suicides and suicidality. The aim was to identify the role of gambling as well as of confounding factors in suicidality, and what kind of support suicidal individuals have received or would need. We searched for relevant literature in seven scientific databases. We included all studies that presented empirical qualitative evidence on gambling-related suicide, suicidality and/or self-harm (N = 20). The results show two main processes that connect gambling and suicidal behavior: indebtedness and shame. At the same time, suicide is a multifactorial phenomenon, and related to other confounding factors. These include psychiatric conditions, personality traits, and life conditions. In many cases, these appear to emerge as a consequence of gambling. Treatment for suicidality has been effective in some cases, but indebtedness and shame may also function as barriers to help-seeking. We conclude that effective prevention is needed by adapting a more comprehensive public health approach and population-level interventions.

Emerging Gambling Problems and Suggested Interventions: A Systematic Review of Empirical Research

The goal of the present systematic review is to identify emerging gambling problems and the harm minimization strategies proposed to address them. Our interdisciplinary research team conducted this systematic literature review in 5 nations between which there is significant gambling research exchange. A keyword search of the Scopus and Web of Science databases followed by filtering using inclusion criteria identified 1292 empirical gambling studies from peer-reviewed journals. The data obtained from the articles were analyzed using the content analysis technique. We then used a unique approach to identify relationships between harm minimization strategies and gambling problems. The findings reveal that the most frequently reported gambling problems are related to young gamblers, online gambling, electronic gaming machines, and children and adolescents (underage gamblers). Harm minimization strategies to address these included creating educational and awareness programs, further restrictions on gambling advertising, developing an intervention mechanism for online gambling, and remote gambling-related help (i.e., online counseling, online treatment).

Do Online Gambling Products Require Traditional Therapy for Gambling Disorder to Change? Evidence from Focus Group Interviews with Mental Health Professionals Treating Online Gamblers

Online gambling has significantly altered the situational and structural characteristics of gambling products, to the extent that online gamblers might be substantially different from traditional offline gamblers. A growing body of literature has identified the evolving features of online gambling and the individuals who engage in it. However, beyond understanding the individual characteristics of this subgroup, relatively less effort has been made to examine whether existing cognitive-behavioural therapy (CBT) approaches are still entirely relevant for online problem gamblers, or whether changes are needed to adapt according to gambling mode of access. To understand what kind of challenges online gambling poses to mental health professionals dealing with disordered gamblers, four focus groups comprising 28 Spanish participants were carried out. All the treatment providers had ongoing experience with online gamblers undergoing treatment, and included clinical psychologists, mental health social workers, and a medical doctor. The data were examined using thematic analysis. The analysis identified five main themes that characterised online gamblers: (1) being of younger age, (2) lack of conflicts at home and at work/educational centre, rarely presenting violent or aggressive behaviour, (3) gambling disorder only being identified by overdue debt, (4) co-occurring conditions with technology-related abuse rather than other substance-related addictions, and (5) skill-based gambling. The study highlights mental health workers' perceived insecurities about how to best treat online gamblers, and discusses the specific characteristics that CBT for gambling disorder might need to incorporate to adjust for this particular group of gamblers.

Parental Acceptance/Rejection Perceptions and Attachment Styles of Men With Online Gambling Disorder

Online gambling disorder has recently emerged as a significant public health issue. Family dynamics play an important role in the development of online gambling disorder. In this research, the aimed to compare the parental acceptance/rejection and attachment styles of individuals with online gambling disorder with a healthy control group. Also, the relationship between parental acceptance/rejection and attachment styles was examined in individuals with online gambling disorder. The study group consisted of 53 male patients with online gambling disorder and 57 healthy controls. The individuals with online gambling disorder perceived more rejection from mothers but especially from fathers than the individuals in the control group. Paternal hostility/aggression and indifference/neglect are determinants of online gambling behavior. The individuals with online gambling disorder had lower levels of secure attachment and higher levels of dismissive and fearful attachment than the individuals in the control group. Both secure attachment style and dismissive attachment style are thought to be determinants of gambling behavior. Mother-father rejection and insecure attachment are important in terms of creating risk for online gambling. Assessment of the effects of maternal and especially paternal rejection in online gambling disorder will be beneficial within the scope of preventive mental health.

Problematic online gambling among adolescents: A systematic review about prevalence and related measurement issues

BACKGROUND AND AIMS

Despite its illegality among adolescents, online gambling is a common practice, which puts their mental health and well-being at serious risk. This systematic review summarises international scientific literature from the last 20 years on problematic online gambling among adolescents (11-21 years old) to determine its prevalence and to analyse related measurement issues.

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed and a protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO, IC: CRD42020162932). Five academic databases were consulted, which resulted in an initial sample of 658 papers.

RESULTS

Sixteen studies met the inclusion criteria for this review. All studies were cross-sectional and targeted students from elementary school, secondary school or university. Most followed a convenience sampling procedure. The primary measurement instruments used were the DSM-IV-MR-J and SOGS-RA. Between 0.77% and 57.5% of adolescents present some degree of problematic online gambling (problem, pathological or disordered) depending on the instruments used, the study samples and the timeframe analysed. Between 0.89% and 1% of adolescents exhibited an online gambling disorder.

DISCUSSION AND CONCLUSION

There is a great heterogeneity in the methodology of the reviewed studies (samples, measurement instruments, cut-off points and criteria applied). The limited number of studies and the limited generalizability of their results suggest the need for further research and for development of specific instruments to assess different levels of problematic online gambling in representative samples of adolescents based on clinical 'gold standard' criteria and more accurate cut-off points.

Consumer Profile Segmentation in Online Lottery Gambling Utilizing Behavioral Tracking Data from the Portuguese National Lottery

The present study is the first to examine account-based tracking data of Portuguese online lottery players comprising the gambling activity of all active players over a one-year period (N = 154,585). The main research goal was the identification of groups or segments of players by their engagement levels (high, neutral, low) and to assess preferences in product category with the use of CHAID (Chi-Square Automatic Interaction Detection) segmentation models, based on expenditure and sociodemographic variables. Findings showed that (1) age was found to be the most influential differentiating variable in player segmentation and had a positive correlation with expenditures and wagers, (2) gender was the second most influential variable (males represented 78.7% of players), (3) education the third most influential variable and had a negative correlation with expenditure, and (4) region was the least relevant variable. The models generated several players segments that engaged in different games. Older males (54–64 years; ≥ 65 years) were the most engaged overall. Younger males (18–34 years) were the least engaged but showed preferences for lotto as did females (35–49 years). Lower educated males and older males (49 years+) with a high school education were the most engaged in instant lottery games. These findings show that Portuguese lottery players can be grouped into several segments with distinct demographic characteristics and corresponding engagement levels. These findings help support more effective marketing segmentation and will help in the targeting of responsible gambling approaches.

The Prevalence and Clinical and Sociodemographic Factors of Problem Online Gambling: A Systematic Review

The emergence and spread of new technologies have allowed for the introduction of new forms of gambling. Problem online gambling has specific characteristics, and its prevalence may differ from traditional forms of gambling. This paper systematically reviews studies that include data relevant to problem online gambling and to the sociodemographic and comorbidity variables related to it. A systematic literature search was conducted from Medline database. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, preliminary search resulted in 427 articles, from which 20 were included in this systematic review based on pre-determined criteria. The reported prevalence of problem online gambling varied widely across the different studies. This heterogeneity is due to large variations in settings, instruments, and definitions of problem online gambling, which rules out a meta-analytic approach to the results. The sources of variability in the prevalence, the sociodemographic and comorbidity factors, and the implications for future research are discussed.

Managing Problematic Usage of the Internet and Related Disorders in an Era of Diagnostic Transition: An Updated Review

INTRODUCTION

Problematic Usage of the Internet (PUI) refers to a broad and likely heterogeneous group of Internet-related conditions associated with behavioural disturbances and functional impairment.

METHODS

Within PUI several conditions have been reported, including Gaming Disorder, Shopping Addiction, Cyberchondria, Gambling Disorder, Cyberpornography Addiction and Cyberbullying. While increasing reports in the field try to define the epidemiologic and clinical boundaries of these conditions, the rapid and continuous evolution of Internet related behaviours as well as their problematic/pathological expressions are often difficult to diagnose, assess, approach with treatment interventions and follow-up.

RESULTS

In addition, some of the PUI-related conditions show characteristics of addiction to the Internet as a preferential tool to engage in specific behaviours, while some others exclusively manifest on the Internet, making it necessary to find distinct assessment and treatment pathways.

CONCLUSION

The inclusion of Internet Gaming Disorder in Section III by the DSM-5 and the recognition of Gaming Disorder by the ICD-11 opened the way for a systematic clinical investigation of this and other PUI-related conditions, particularly in terms of preventive and therapeutic strategies. The present article is aimed at offering an updated clinical overview on the main expressions of PUI, focussing on the latest acquisitions in this evolving field.

Impulsivity, Emotion Regulation, Cognitive Distortions and Attentional Bias in a Spanish Sample of Gambling Disorder Patients: Comparison between Online and Land-Based Gambling

Several risk factors have been related to the onset and maintenance of gambling disorder (GD). The aim of this study was to explore the differences in emotion dysregulation, impulsivity, cognitive distortions, and attentional bias between online and land-based gamblers. The sample consisted of 88 treatment-seeking patients from the Behavioral Addictions Unit at the Hospital de la Santa Creu i Sant Pau, Barcelona (Spain). Patients were divided into two groups by considering their main type of gambling, i.e., online (n = 26) and land-based gambling (n = 62). Online gamblers were younger, more often employed, with a higher educational level than land-based gamblers. Regarding the rest of the variables, statistically significant differences were only found in Positive Urgency, one of the UPPS-P subscales, in which the land-based gambling group scored higher than the online gambling group. In this exploratory study, individuals with online and land-based GD phenotypes did not differ either in difficulties in emotion regulation or in attentional and cognitive biases. However, land-based GD patients showed a higher tendency to succumb to strong impulses under the influence of positive emotions. These preliminary findings warrant the need to continue investigating GD phenotypes in larger patient samples.

Psychopathogical status and personality correlates of problem gambling severity in sports bettors undergoing treatment for gambling disorder

BACKGROUND AND AIMS

Sports betting has been barely explored independently from other gambling behaviors. Little evidence is available regarding the factors affecting its severity in a clinical sample. The current study explores new determinants for sports betting severity in Spain by the inclusion of psychopathological distress and personality factors.

METHODS

A sample of 352 Spanish sports bettors undergoing treatment for gambling disorder was recruited. Multiple regression models were used to evaluate the effects of sociodemographic variables, the age of onset of gambling behavior, the global psychopathological distress (SCL-90R GSI) and the personality profile (TCI-R) on sports betting severity and their influence over frequency (bets per episode) and debts due to gambling.

RESULTS

We found that older age, higher psychopathological distress, lower self-directedness level, and higher novelty seeking level were predictors of gambling severity in Spanish sports bettors. The highest betting frequency was found in men, with the lowest education levels but the highest social status, the highest psychopathological distress, reward dependence score, and self-transcendence trait and the lowest persistence score. Debts were also associated to higher score in cooperativeness as well as older age.

DISCUSSION AND CONCLUSIONS

Our findings call for further exploration of factors affecting sports betting severity regarded as a separate gambling entity subtype, as some of the traditional factors typically found in gamblers do not apply to sports bettors or apply inversely in our country. Consequently, sports bettors might deserve specific clinical approaches to tackle the singularities of their gambling behavior.

Is there a health inequality in gambling related harms? A systematic review

Background

Here we present a systematic review of the existing research into gambling harms, in order to determine whether there are differences in the presentation of these across demographic groups such as age, gender, culture, and socioeconomic status, or gambling behaviour categories such as risk severity and participation frequency.

Primary and secondary outcome measures

Inclusion criteria were: 1) focus on gambling harms; 2) focus on harms to the gambler rather than affected others; 3) discussion of specific listed harms and not just harms in general terms. Exclusion criteria were: 1) research of non-human subjects; 2) not written in English; 3) not an empirical study; 4) not available as a full article.

Methods

We conducted a systematic search using the Web of Science and Scopus databases in August 2020. Assessment of quality took place using Standard Quality Assessment Criteria.

Results

A total of 59 studies published between 1994 and 2020 met the inclusion criteria. These were categorised into thematic groups for comparison and discussion. There were replicated differences found in groups defined by age, socioeconomic status, education level, ethnicity and culture, risk severity, and gambling behaviours.

Conclusion

Harms appear to be dependent on specific social, demographic and environmental conditions that suggests there is a health inequality in gambling related harms. Further investigation is required to develop standardised measurement tools and to understand confounding variables and co-morbidities. With a robust understanding of harms distribution in the population, Primary Care Workers will be better equipped to identify those who are at risk, or who are showing signs of Gambling Disorder, and to target prevention and intervention programmes appropriately.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10337-3.

Impulsivity, Lack of Premeditation, and Debts in Online Gambling Disorder

Background and Objectives: Gambling disorder (GD) is a recurrent and persistent problematic gambling behavior that impairs multiple areas of an individual's life. GD can persist through two modes: online or offline. This study aims to compare sociodemographic, clinical, and psychological characteristics between treatment-seeking online and offline gamblers and analyze the effect of the gambling mode (online or offline) on anxiety, depression, impulsivity, and debts. Methods: Seventy-nine treatment-seeking gamblers (96.2% males), who were simultaneously receiving treatment at a specialized Pathological Gambling and Behavioral Addictions Unit, participated in this study. The sample was divided into two subsamples: online (n = 29, 100% males) and offline (n = 50, 94% males); the characteristics of these two groups were compared and analyzed using Chi-Square test (χ²), t-Test or Mann-Whitney U-test (p < 0.05). Multiple linear regression analyses were performed to determine the effects of gambling mode on significant variables (lack of premeditation and debts). Results: The online sample with a mean age of 29.4 years mainly chose to engage in sports betting (45%, p < 0.05) and showed a higher lack of premeditation levels (25.8 points, p < 0.05) than the offline sample. In addition, the online sample was younger with respect to their onset to gambling (20.2 years, p < 0.05) and the beginning of their gambling problems (25 years, p < 0.05) compared to the offline sample. Online gambling increased the levels of lack of premeditation by an average of 5.43 points compared to offline gambling (p < 0.05). Accumulated debts of the online sample were lower (€11,000) than those of the offline sample (€12,000). However, the interaction between age and gambling mode revealed that online gamblers increased their debt amounts with age at an average increase of €2,726.33 per year compared to offline gamblers (p < 0.05). No significant influence of gambling mode was found on GD severity, anxiety, and depression levels. Conclusions: Gambling mode has a significant relationship with lack of premeditation-a component of impulsivity-and accumulation of debts in treatment-seeking people with GD; however, no relationship was found with the rest of the variables analyzed. Future research with larger samples is needed to confirm these findings.

Current Addiction in Youth: Online Sports Betting

Background: Gambling landscape has changed in recent years with the emergence of online gambling (OG). Greater accessibility and availability of this betting modality can increase the risk of developing a gambling disorder (GD). Online sports betting (OSB) is currently the most common type of OG, but little is known about the clinical characteristics of OSB compared to slot-machine (SM) gamblers, the most common offline gambling disorder. Methods: This was a prospective study conducted between October 2005 and September 2019, and included outpatients diagnosed with GD seen in a Pathological Gambling and Behavioral Addictions referral unit. Only patients with OSB and SM disorders were included. The main objective was to assess the clinical profile of OSB compared to SM gamblers, and to define clinical predictors for developing OSB gambling disorder. Logistic regression was performed to determine the effects of variables on the likelihood of this disorder. Results: Among 1,186 patients attended in our Unit during the study period, 873 patients were included; 32 (3.7%) were OSB gamblers and 841 (96.3%) were SM gamblers. Overall, mean age was 45 ± 13 years and 94.3% were men. Compared to SM patients, OSB patients were younger (34.9 ± 9.5 vs. 45.3 ±13), more frequently single (43.8 vs. 20.6%) and had a university education level (43.8 vs. 4.5%); they were also more frequently non-smokers (18.7 vs. 66.7%) and had fewer psychiatric comorbidities (12.5 vs. 29.4%) than SM gamblers. GD duration before treatment initiation was shorter in OSB patients than in SM gamblers, most of them (81.3 vs. 42.4%) with ≤ 5 years of GD duration. OSB gamblers showed significant differences in weekly gambling expenditure, spending higher amounts than SM patients. Younger age (OR: 0.919; 95% CI: 0.874-0.966), university education level (OR: 10.658; 95% CI: 3.330-34.119), weekly expenditure >100€ (OR: 5.811; 95% CI:1.544-21.869), and being a non-smoker (OR:13.248; 95% CI:4.332-40.517) were associated with an increased likelihood of OSB gambling behavior. Conclusions: We identified different profiles for OSB and SM gamblers. Younger age, university education level, higher weekly expenditure, and non-smoking habit were associated with OSB compared to SM disorders. Prevention strategies should help young people become aware of the severe risks of OSB.

A Cross-Cultural Study of Weekly Sports Bettors in Australia and Spain

Betting on sport is one of the fastest developing forms of gambling internationally. Sports betting is attracting considerable scholarly, media, and regulatory attention due to the cultural salience of sport, and the rising public health concerns about the rapid proliferation and penetration of betting products in everyday life. Despite its global expansion, little is known regarding the comparative impact sports betting is having in different territories. This study aims to examine a sample of Australian (n = 738) and Spanish (n = 361) weekly sports bettors to assess their similarities and differences concerning sociodemographic characteristics, channels (i.e., online vs. offline) and devices used, in-play betting, and problem gambling severity. The findings showed high problem gambling scores among sports bettors in both countries, and consistent similarities in the association between problem gambling, in-play betting, and offline betting. Also, clear trends were observed between problem gambling, higher educational level, and female sport betting, particularly in the Australian sample. These results suggest a common pattern of risk factors for problematic sports betting and can help to inform worldwide regulatory efforts to tackle harmful sports betting-specific features such as in-play betting.

Impulsivity and cognitive distortions in different clinical phenotypes of gambling disorder: Profiles and longitudinal prediction of treatment outcomes

BACKGROUND

Impulsivity and cognitive distortions are hallmarks of gambling disorder (GD) but it remains unclear how they contribute to clinical phenotypes. This study aimed to (1) compare impulsive traits and gambling-related distortions in strategic versus non-strategic gamblers and online versus offline gamblers; (2) examine the longitudinal association between impulsivity/cognitive distortions and treatment retention and relapse.

METHODS

Participants seeking treatment for GD (n = 245) were assessed for gambling modality (clinical interview), impulsive traits (Urgency, Premeditation, Perseverance and Sensation Seeking [UPPS] scale) and cognitive distortions (Gambling Related Cognitions Scale) at treatment onset, and for retention and relapse (as indicated by the clinical team) at the end of treatment. Treatment consisted of 12-week standardized cognitive behavioral therapy, conducted in a public specialized clinic within a general public hospital.

RESULTS

Strategic gamblers had higher lack of perseverance and gambling-related expectancies and illusion of control than non-strategic gamblers, and online gamblers had generally higher distortions but similar impulsivity to offline gamblers. Lack of perseverance predicted treatment dropout, whereas negative urgency and distortions of inability to stop gambling and interpretative bias predicted number of relapses during treatment.

CONCLUSIONS

Individuals with online and strategic GD phenotypes have heightened gambling related biases associated with premature treatment cessation and relapse. Findings suggest that these GD phenotypes may need tailored treatment approaches to reduce specific distortions and impulsive facets.