Alcohol use, psychiatric disorders and gambling behaviors: A multi-sample study testing causal relationships via the co-twin control design

Intersection of gambling with smoking and alcohol use in Great Britain: a cross-sectional survey in October 2022

OBJECTIVES

Gambling is associated with cigarette smoking and alcohol consumption. We explored the intersection of gambling across all risk levels of harm with smoking and alcohol use among adults in Great Britain.

DESIGN

A nationally representative cross-sectional survey in October 2022.

SETTING

Great Britain.

PARTICIPANTS

A weighted total of 2398 adults (18+ years).

OUTCOME MEASURES

We examined the prevalence of past-year gambling and, among those reporting gambling, assessed the associations between the outcome of any risk of harm from gambling (scoring >0 on the Problem Gambling Severity Index) and the binary predictor variables of current cigarette smoking and higher risk alcohol consumption (AUDIT-C score≥4). We also explored data on weekly expenditure on gambling with smoking and alcohol use among those categorised at any-risk of harm from gambling.

RESULTS

Overall, 43.6% (95% CI 41.2% to 45.9%) of adults gambled in the past year. Among these, 7.3% (95% CI 5.3% to 9.3%) were classified at any-risk of harm from gambling, 16.0% (95% CI 13.2% to 18.8%) were currently smoking and 40.8% (95% CI 37.2% to 44.4%) were drinking at increasing and higher risk levels. There were no associations between any risk of harm from gambling and current smoking (OR adjusted=0.80, 95% CI 0.35 to 1.66) or drinking at increasing and higher risk levels (OR adjusted=0.94, 95% CI 0.52 to 1.69), respectively. Analyses using Bayes factors indicated that these data were insensitive to distinguish no effect from a range of associations (OR=95% CI 0.5 to 1.9). The mean weekly spend on gambling was £7.69 (95% CI £5.17 to £10.21) overall, £4.80 (95% CI £4.18 to £5.43) among those classified as at no risk and £45.68 (95% CI £12.07 to £79.29) among those at any risk of harm from gambling.

CONCLUSIONS

Pilot data in a population-level survey on smoking and alcohol use yielded similar estimates to other population-level surveys on gambling participation and at-risk gambling. Further data are needed to elucidate the intersections more reliably between gambling, smoking and alcohol use and inform population-level approaches to reduce harm.

Gambling and internet addiction: a pilot study among a Population of Italian Healthcare : Gambling and Internet Addition in a Healthcare Group

AIM

Measuring the phenomenon of gambling and Internet addiction, with analysis of attitudes and psychophysical consequences among nurses working in different care settings.

METHODS

An observational, cross sectional, multicenter study was conducted from April to September 2020. Participants' socio-demographic information, the "Internet Addiction Test" (IAT) scale, and the "South Oaks Gambling Screen" (SOGS) were collected in order to assess the overuse of and whether an individual has a problematic relationship with gambling, respectively.

RESULTS

502 nurses were enrolled in the study. Significant correlations were found (p < .001) between the IAT score and gender, number of years of work experience, job role, educational qualification; and between the SOGS and gender, number of years of work experience, job role and regions of Italy.

CONCLUSIONS

The study highlighted an emerging social problem, and the results may be just the tip of the iceberg. Given the lack of knowledge of these phenomena and a high percentage of people who suffer from them but are afraid to admit it and get help, this study could also be useful in expanding knowledge and allow more professionals to get help and learn about possible treatments and cures for the resolution of these addictions.

Alter Game: A Study Protocol on a Virtual "Serious Game" for Relapse Prevention in Patients With Gambling Disorder

Cognitive behavioral therapy (CBT) is the most successful protocol in gambling disorder (GD) treatment. However, it presents some weaknesses, especially concerning relapse prevention (RP). RP is one of the most important therapeutic steps, aiming at managing cravings and to avoid future relapse increasing perceived self-efficacy. Encouraging results come from the blending of psychotherapy and virtual reality (VR), containing gambling cues. The goal of Alter Game (approved by the Ethical Commission, Prot. No. 69346) is verifying the efficacy of an innovative psychological treatment for GD based on the integration of traditional CBT therapy and an immersive VR cue exposure therapy using a serious virtual game, which is a game designed for purposes other than entertainment. RP in virtual cue-exposure therapy allows pathological gamblers to manage the urge to gamble and to avoid relapse by becoming aware of which internal and external triggers are related to craving. We hypothesize that the integrated intervention will be more effective than simple CBT with regard to self-efficacy, craving, and gambling-related distortions. Four virtual ecological environments were developed, and a virtual app, Exludo, interfaced with a computerized multiparametric acquisition system for biofeedback, was created. A sample of about 60 patients aged between 18 and 65 with GD referring to the Addiction Medicine Unit of Verona (Rossi Hospital) will be recruited. Patients will be randomly assigned to the CBT group (16 CBT sessions) or the CBT + VR group (8 CBT sessions + 8 VR cue-exposure therapy sessions). The MCMI-III, the BIS-11, and the SOGS will be used to evaluate inclusion and exclusion criteria, while the Gambling Related Cognitions Scale and the Multidimensional Gambling Self-Efficacy Scale will be used to verify changes as a function of the treatment. Craving will be evaluated through VAS, and psychophysiological variables will be assessed through biofeedback. A pre-test/post-test experimental design with a 1-month follow-up will be conducted. This study will examine an innovative psychotherapeutic protocol for GD treatment, and it will help in identifying new virtual tools to increase the efficacy of traditional therapeutic approaches that could also be applied to treat other addictions.

Proneness to Alcohol use Disorder or Pathological Gambling as Differentially Determined by Early Parental and Personality Factors

Owing to growing alcoholism and gambling, numerous variables have been the subject of study to better understand the causes of such addictions. This study aims to investigate personality factors, parental styles in upbringing and early exposure to alcoholism integratively to shed light on how such variables generally shape vulnerability for addictive behaviours and alcohol use disorder (AUD) as well as pathological gambling (PG), separately. The sample consisted of 150 for the inpatient groups (78 AUD and 72 PG) and 102 participants for the control group. The inpatient group comprised "pure" AUD (excluding gambling and other significant addictive disorders) and "pure" PG (excluding AUD and other significant addictive disorders). A random forest-trees analysis established a model accurately classifying 79% of participants from the addictive group and found low conscientiousness, an authoritarian father, a less-flexible mother and neuroticism to be predisposed factors for both addictions. Additionally, through structural equation modeling, a satisfying-index model shows higher extroversion and lower openness may be attributed to PG, as well as the father's authoritarian parenting style. The mother's authoritarian or permissive styles may be linked to AUD and the father's alcoholism. The research concludes AUD and PG have similarities in personality as vulnerable factors for addictive behaviours as well as essential differences in personality and early experiences from boundaries set by mothers and fathers and alcoholism in childhood. The results are applicable in preventive programs as well as working with patients and their parents to create more individualized treatment in relation to addiction type.

The structure and subtypes of gambling activities: Genetic, psychiatric and behavioral etiologies of gambling frequency

The multitude of gambling activities has given rise to heterogeneous ways of analyzing these behaviors and may partially underlie the lack of replication in gambling research. The current study used complementary analyses to investigate the structure, typology and etiology of gambling behaviors in a discovery sample of 2,116 twins (54.86% female; M_age = 24.90) and a replication sample of 619 siblings (30.37% female; M_age = 28.00). Our approach was twofold. First, we used confirmatory factor analyses to investigate the structure across the frequency of eight gambling activities. Second, we used factor mixture models to identify gambling frequency subtypes. We assessed associations with gambling frequency as well as conducted genetically informed analyses to estimate the role of genetic and environmental influences. Across samples, a two-factor model fit the data best, with a Common Gambling factor influencing all activities and a separate factor for Skill Gambling. Our study identified four gambling frequency subtypes, which resembled the typology from the Pathways Model. We found distinct demographic, psychiatric, behavioral and genetic risk profiles for the different gambling factors and subtypes with robust associations observed for male sex, risk-taking, sensation seeking, alcohol dependence and problem gambling. Controlling for shared genetic and environmental influences (via co-twin control modeling), we found that sensation seeking directly increased Common Gambling frequency. In sum, we illustrated the utility of multi-dimensional statistical techniques for disentangling the structure and typology from complex multivariate gambling data.

Adolescent Problem Gambling in Rural Ghana: Prevalence and Gender Differentiation

Problem gambling among young people is now a public health challenge in sub-Saharan Africa. However, the behaviour remains understudied, particularly, among rural-dwelling young people in countries within the subregion. We aimed to estimate the 12 months prevalence of problem gambling and to describe the overall and gender differences and commonalities in personal factors and social adversities associated with problem gambling among adolescents in rural Ghana. We conducted a cross-sectional survey involving a random sample of 1101 in-school adolescents aged 10–19 years in a rural district in Eastern Ghana; we used the DSM-IV-Multiple Response-Juvenile (DSM-IV-MR-J) questionnaire to assess problem gambling during the previous 12 months. Personal lifestyle and psychosocial variables were assessed using adopted items from the 2012 WHO–Global School-based Student Health Survey. Overall, three in 10 adolescents (3 in 10 females; 4 in 10 males) in rural Ghana reported problem gambling in the previous 12 months. Female adolescents who experienced problem gambling were more likely to report family-related social adversities, while adolescent male problem gambling was associated with school-related factors and interpersonal factors outside the family context. Regardless of gender, sexual abuse victimisation was associated with three times increase in the odds of experiencing problem gambling. Relative to the prevalence of gambling among adolescents in urban contexts in other countries within sub-Saharan Africa, the estimates of problem gambling among in-school rural adolescents in Ghana are higher. Although further studies are needed to understand the nuances of the behaviour, the evidence of this study underscores the need for general and targeted health promotion, intervention and prevention efforts to mitigate the family, school, and interpersonal social adversities associated with adolescent problem gambling in rural Ghana.

"It Runs in Your Blood": Reflections from Treatment Seeking Gamblers on Their Family History of Gambling

There are considerable gaps in our understanding of the familial transmission of gambling problems. This convergent mixed-methods study aimed to explore the: (1) sources of heterogeneity in the familial (paternal, maternal, and sibling) transmission of gambling problems; (2) degree to which family-of-origin characteristics are associated with family-of-origin problem gambling; and (3) beliefs of gamblers about the nature of the familial transmission of problem gambling. The sample consisted of 97 treatment-seeking gamblers in Australia. One-quarter (25.5%) of participants reported that at least one family member (16.5% father, 7.5% mother, 7.6% siblings) living with them when they were growing up had a gambling problem. Most participants reported that family members with a positive history of problem gambling were biological relatives, lived with them full-time, and experienced long-term difficulties with gambling. Participants with a family history of problem gambling were young (less than 12 years of age) at the onset of parental, but not sibling, problem gambling, were women, and reported difficulties with the same gambling activity as their family member. Participants raised in families with problem gambling were more likely to report parental separation (risk ratio [RR] = 2.32) and divorce (RR = 2.83), and extreme family financial hardship (RR = 1.80), as well as low levels of paternal authoritative parenting than participants raised in non-problem gambling families. Qualitatively, both social learning and genetics were perceived to play a central role in the familial transmission of gambling problems. These findings inform theories of the familial transmission of gambling problems and the design of targeted prevention and intervention strategies.

Toward a unifying theory of dysregulated behaviors

Dysregulated behaviors, defined as active behaviors that have short-term benefits but cause serious recurrent long-term distress or impairment to the individual and/or those around them, include behaviors such as suicidal and nonsuicidal self-injury, aggression, and substance use. These behaviors are common and costly to the individual, their friends and family, and society. Despite similar etiological models and interventions, dysregulated behaviors have largely been studied in isolation from one another. The goals of this paper were to a) define dysregulated behaviors as a coherent class of behaviors, b) review the prevalence and consequences of dysregulated behaviors, c) outline how dysregulated behaviors fit into current models of psychopathology, and d) describe the key questions to be addressed by future research in this area. It is argued that integrating across theories of discrete dysregulated behaviors can help provide aid in the development of etiological models, which in turn can improve prevention and intervention for dysregulated behaviors.

Family history of substance use disorders: Significance for mental health in young adults who gamble

BACKGROUND

Although family history of psychiatric disorders has often been considered potentially useful in understanding clinical presentations in patients, it is less clear what a positive family history means for people who gamble in the general community. We sought to understand the clinical and cognitive impact of having a first-degree relative with a substance use disorder (SUD) in a sample of non-treatment seeking young adults.

METHODS

576 participants (aged 18-29 years) who gambled at least five times in the preceding year undertook clinical and neurocognitive evaluations. Those with a first-degree relative with a SUD were compared to those without on a number of demographic, clinical and cognitive measures. We used Partial Least Squares (PLS) regression to identify which variables (if any) were significantly associated with family history of SUDs, controlling for the influence of other variables on each other.

RESULTS

180 (31.3%) participants had a first-degree family member with a SUD. In terms of clinical variables, family history of SUD was significantly associated with higher rates of substance use (alcohol, nicotine), higher rates of problem gambling, and higher occurrence of mental health disorders. Family history of SUD was also associated with more set-shifting problems (plus higher rates of obsessive-compulsive tendencies), lower quality of decision-making, and more spatial working memory errors.

CONCLUSIONS

These results indicate that gamblers with a first-degree family member with a SUD may have a unique clinical and cognition presentation. Understanding these differences may be relevant to developing more individualized treatment approaches for disordered gambling. Compulsivity may be important as a proxy of vulnerability towards addiction.

Confirmatory factor analysis of adverse childhood experiences (ACEs) among a community-based sample of parents and adolescents

Background

Despite increased understanding of Adverse Childhood Experiences (ACEs), very little advancement has been made in how ACEs are defined and conceptualized. The current objectives were to determine: 1) how well a theoretically-derived ACEs model fit the data, and 2) the association of all ACEs and the ACEs factors with poor self-rated mental and physical health.

Methods

Data were obtained from the Well-Being and Experiences Study, survey data of adolescents aged 14 to 17 years (n = 1002) and their parents (n = 1000) in Manitoba, Canada collected from 2017 to 2018. Statistical methods included confirmatory factor analysis (CFA) and logistic regression models.

Results

The study findings indicated a two-factor solution for both the adolescent and parent sample as follows: a) child maltreatment and peer victimization and b) household challenges factors, provided the best fit to the data. All original and expanded ACEs loaded on one of these two factors and all individual ACEs were associated with either poor self-rated mental health, physical health or both in unadjusted models and with the majority of findings remaining statistically significant in adjusted models (Adjusted Odds Ratios ranged from 1.16–3.25 among parents and 1.12–8.02 among adolescents). Additionally, both factors were associated with poor mental and physical health.

Conclusions

Findings confirm a two-factor structure (i.e., 1) child maltreatment and peer victimization and 2) household challenges) and indicate that the ACEs list should include original ACEs (i.e., physical abuse, sexual abuse, emotional abuse, emotional neglect, physical neglect, exposure to intimate partner violence (IPV), household substance use, household mental health problems, parental separation or divorce, parental problems with police) and expanded ACEs (i.e., spanking, peer victimization, household gambling problems, foster care placement or child protective organization (CPO) contact, poverty, and neighborhood safety).

The effects of alcohol on sequential decision-making biases during gambling

RATIONALE

Gambling and alcohol use are recreational behaviours that share substantial commonalities at a phenomenological, clinical and neurobiological level. Past studies have shown that alcohol can have a disinhibiting effect on gambling behaviour, in terms of bet size and persistence.

OBJECTIVES

This study was conducted in order to characterise how alcohol affects biases in judgment and decision-making that occur during gambling, with a focus on sequential decision-making including the gambler's fallacy.

METHODS

Sequential biases were elicited via a roulette-based gambling task. Using a standard between-groups alcohol challenge procedure, male participants played the roulette task 20 min after receiving an alcoholic (0.8 g/kg; n = 22) or placebo (n = 16) beverage. The task measured colour choice decisions (red/black) and bet size, in response to varying lengths of colour runs and winning/losing feedback streaks.

RESULTS

Across both groups, a number of established sequential biases were observed. On colour choice, there was an effect of run length in line with the gambler's fallacy, which further varied by previous feedback (wins vs losses). Bet size increased with feedback streaks, especially for losing streaks. Compared to placebo, the alcohol group placed higher bets following losses compared to wins.

CONCLUSIONS

Increased bet size after losses following alcohol consumption may reflect increased loss chasing that may amplify gambling harms. Our results do not fit a simple pattern of enhanced gambling distortions or reward sensitivity, but help contextualise the effects of alcohol on gambling to research on decision-making biases.