Pathological gambling. A comprehensive review

Investigation of Gambling Behavior, Self-Confidence and Psychological Resilience Levels of University Students

The aim of this study is to examine the relationship between gambling behavior, self-confidence, and psychological resilience levels among university students. Additionally, the study aims to investigate the relationship between gambling behavior and socio-demographic variables. This descriptive and cross-sectional study was conducted between April and June 2023. The research employed a questionnaire, the Brief Psychological Resilience Scale, the South Oaks Gambling Screen (SOGS), and the Self-Confidence Scale. The study was carried out online, reaching 229 students through Google Forms. According to the SOGS scores, 4.8% of the students are at risk of gambling addiction. Male students have statistically significantly higher SOGS scores than female students. The SOGS score is significantly higher in working students, smokers, and alcohol drinkers (p < 0.05). No statistically significant relationship was found between the students' SOGS scores and the self- confidence scale (p = 0.637) and the brief resilience scale (p = 0.675). It is thought that training should be given to risky groups in order to prevent gambling behavior. In addition, it is thought that supporting university students to be active in different arts and sports fields may have a positive effect on preventing and reducing addictions.

Appetitively motivated tasks in the IntelliCage reveal a higher motivational cost of spatial learning in male than female mice

The IntelliCage (IC) permits the assessment of the behavior and learning abilities of mice in a social home cage context. To overcome water deprivation as an aversive driver of learning, we developed protocols in which spatial learning is motivated appetitively by the preference of mice for sweetened over plain water. While plain water is available at all times, only correct task responses give access to sweetened water rewards. Under these conditions, C57BL/6J mice successfully mastered a corner preference task with the reversal and also learned a more difficult time-place task with reversal. However, the rate of responding to sweetened water decreased strongly with increasing task difficulty, indicating that learning challenges and reduced success in obtaining rewards decreased the motivation of the animals to seek sweetened water. While C57BL/6J mice of both sexes showed similar initial taste preferences and learned similarly well in simple learning tasks, the rate of responding to sweetened water and performance dropped more rapidly in male than in female mice in response to increasing learning challenges. Taken together, our data indicate that male mice can have a disadvantage relative to females in mastering difficult, appetitively motivated learning tasks, likely due to sex differences in value-based decision-making.

Sports Gambling Intention Comparison Between Males and Females in the United States

The focus of this research is to understand the sports gambling intentions of Gen Z (those born between 1997 and 2012) that can potentially lead to problematic gambling behavior. Rooted in the theory of planned behavior, the study delves into the roles of attitude, subjective norms, and perceived behavior control in shaping these intentions. A cross-sectional study of 513 Gen Z's in the United States was conducted. The partial least square structural equation modeling was used to analyze the relationship and compare the differences between males and females with multigroup analysis. The results indicate that attitude and perceived behavior control have a significant impact on this intention, while subjective norms do not exert substantial influence. Notably, gender differences are observed, with males showing a stronger association with perceived behavior control and females with attitude. The model effectively accounts for significant variations in sports gambling intention, highlighting a higher inclination among females as compared to males. This study provides a new perspective for analyzing disparities in sports gambling intention between genders and delves into the underlying motivations that can potentially contribute to the development of problematic gambling disorders. Given the significant societal impact and the adverse effects that gambling disorders have on those affected, it is imperative to conduct research aimed at understanding the reasons behind Gen Z's engagement in gambling. The findings can then be harnessed to inform the development of preventive programs aimed at curbing problematic gambling behaviors.

Prevalence of Problem Gambling: A Meta-analysis of Recent Empirical Research (2016-2022)

Gambling is widely considered a socially acceptable form of recreation. However, for a small minority of individuals, it can become both addictive and problematic with severe adverse consequences. The aim of this systematic review and meta-analysis is to provide an overview of prevalence studies published between 2016 and the first quarter of 2022 and an updated estimate of problem gambling in the general adult population. A systematic review and a meta-analysis were carried out using academic databases, Internet, and governmental websites. Following this search and utilizing exclusion criteria, 23 studies on adult gambling prevalence were identified, distinguishing between moderate risk/at risk gambling and problem/pathological gambling. This study found a prevalence of moderate risk/at risk gambling to be 2.43% and of problem/pathological gambling to be 1.29% in the adult population. As difficult as it may be to compare studies due to different methodological procedures, cutoffs, and time frames, the present meta-analysis highlights the variations of prevalence across different countries, giving due consideration to the differences between levels of risk and severity. This work intends to provide a starting point for policymakers and academics to fill the gaps on gambling research-more specifically in some countries where the lack of research in this field is evident-and to study the effectiveness of policies implemented to mitigate gambling harm.

The interface of gambling and cultural practices: a Tongan male perspective in Aotearoa | New Zealand

Introduction

For over 30 years, Pacific people have been identified as more at risk of developing problem gambling behaviors than the general population. That observation has not changed despite the increase in treatment service providers, Pacific gambling literature and problem-gambling literature, which are primarily quantitative-based. This article explores the interface of gambling and cultural practices from a Tongan male perspective to consider whether status advancement and rank contribute to the problem-gambling statistics and the qualitative reasons why Tongan peoples engage in gambling activities.

Methods

A phenomenological approach using the talanoa research method was employed to carry out this study. A total of 46 Tongan males participated in this study. Interpretative Phenomenological Analysis was employed to interpret the data. The ethical approval reference number 16/452 for this research was granted by the Auckland University of Technology Ethics Committee (AUTEC).

Results

Participants noted the concept of fatongia as a motivating factor for Tongans to engage in gambling activities, which, in turn, elevates family and village status and rank.

Discussion

Strategies and recommendations around raising cultural awareness with treatment providers are critical to understanding Tongan gambling in New Zealand.

Goal-directed and habitual decision making under stress in gambling disorder: An fMRI study

The development of addictive behaviors has been suggested to be related to a transition from goal-directed to habitual decision making. Stress is a factor known to prompt habitual behavior and to increase the risk for addiction and relapse. In the current study, we therefore used functional MRI to investigate the balance between goal-directed 'model-based' and habitual 'model-free' control systems and whether acute stress would differentially shift this balance in gambling disorder (GD) patients compared to healthy controls (HCs). Using a within-subject design, 22 patients with GD and 20 HCs underwent stress induction or a control condition before performing a multistep decision-making task during fMRI. Salivary cortisol levels showed that the stress induction was successful. Contrary to our hypothesis, GD patients did not show impaired goal-directed 'model-based' decision making, which remained similar to HCs after stress induction. Bayes factors provided three times more evidence against a difference between the groups or a group-by-stress interaction on the balance between model-based and model-free decision making. Similarly, no differences were found between groups and conditions on the neural estimates of model-based or model-free decision making. These results challenge the notion that GD is related to an increased reliance on habitual (or decreased goal-directed) control, even during stress.

Culturally and Linguistically Diverse Gamblers of East Asian Descent in Australia: A Comprehensive Review of Current Evidence

As a country with one of the highest per capita gambling losses per year in the world, and an evolving multicultural profile, Australia has become an important setting in which to examine the harms and benefits related to gambling. The Australian population includes people from East Asian cultural backgrounds who are a key demographic of interest for gambling operators planning to grow revenue. However, Australian gambling research has concentrated primarily on those belonging to the dominant cultural group. Most of the previous and limited number of studies to examine gambling among culturally and linguistically diverse (CALD) residents have focused on people of Chinese descent, and much of the literature is now becoming relatively old. This review examines the current evidence around cultural variations in gambling prevalence, motivations, beliefs, behaviours, and help service utilisation, focusing on gamblers with an East Asian cultural background. Numerous domains in which gambling motivations and behaviours vary across cultural groups are identified, and methodological considerations related to ethnographic gambling research are discussed. This review found that while barriers and predictors to help-seeking for CALD gamblers have been studied extensively, contemporary evidence of help service utilisation and effectiveness in Australia is lacking. Further research providing an accurate assessment of the impacts of gambling for CALD gamblers is needed to ensure that harm minimisation resources are effective for those most vulnerable to harm.

Suicidal Behaviour Among Nigerian Undergraduates: Associations with Gambling Disorder and Emotional Dysregulation

Background: There is a high prevalence of suicidal behavior among Nigerian youths. However, the connections between suicidal behavior and precipitating factors, such as gambling disorder and emotional dysregulation (ED) in this population, are not well researched. Objectives: The present study examined the associations between gambling disorder, ED, and suicidal behavior in Nigerian university undergraduate students. Methods: This study was carried out during October 2020 - April 2021 on 1338 undergraduates with a mean ± SD age of 19.84 ± 3.22 years selected using random and purposive sampling for the universities and participants respectively. Participants responded to the Attitudes Towards Gambling Scale, Difficulties in Emotion Regulation Scale, and Redeemer's University Suicidality Scale. Descriptive statistics (simple percentages) and inferential statistics (Pearson’s correlation and regression analysis) were used for data analysis. Results: The Pearson's correlation revealed that suicidal behaviour had significant positive correlations with the nonacceptance of emotional responses or distress (r = 0.22, P = 0), difficulties engaging in goal-directed behaviours (r = 0.21, P = 0), difficulties in impulse control (r = 0.27, P = 0), the lack of emotional awareness (r = 0.14, P = 0), limited access to emotional regulation strategies (r = 0.33, P = 0), the lack of emotional clarity (r = 0.32, P = 0), and difficulties in emotional regulation (r = 0.4, P = 0). Problematic gambling (PG) independently predicted suicidal behavior, while PG and ED dimensions jointly predicted suicidal behavior. The ED dimensions contributed 15% incrementally to the prediction of suicidal behavior and beyond the 2% variance accounted for PG in undergraduates. Conclusions: Our results showed positive links between PG, ED, and suicidal behavior among Nigerian undergraduates. It suggests that the combination of PG and ED increases the severity of suicidal behavior among students.

Problem gambling and anxiety disorders in the general swedish population - a case control study

Co-occurring psychiatric comorbidity is high among problem gamblers, and anxiety disorders has repeatedly been linked to problem gambling. Less conclusive, however, is the association between problem gambling and specific anxiety disorders. The aim of this study is to examine the association between problem gambling and specific anxiety disorders in subgroups of gender, age and socio-economic status (SES) in the general Swedish population. A case-control design was employed - nested in the Swedish longitudinal gambling study cohort. All anxiety disorders studied - Panic Disorder, Social Phobia, Generalized Anxiety Disorder (GAD) and Post-Traumatic Stress Disorder (PTSD), were significantly associated with problem gambling, however the pattern differed across subgroups. Social Phobia was the anxiety disorder most commonly associated with problem gambling across subgroups. The strongest associations between problem gambling and various anxiety disorders were found in participants under the age of 25, among females, and in the group with middle SES. In those groups three of the four anxiety disorders studied were significantly associated with problem gambling, with different patterns. Quite remarkably, participants under the age of 25 had three times higher risk of having had GAD compared to their controls. Efforts to prevent an escalation of either gambling or anxiety could target the presented vulnerable groups specifically.

A meta-analysis of problem gambling risk factors in the general adult population

BACKGROUND AND AIMS

Few meta-analyses have been conducted to pool the most constant risk factors for problem gambling. The present meta-analysis summarizes effect sizes of the most frequently assessed problem gambling risk factors, ranks them according to effect size strength and identifies any differences in effects across genders.

METHOD

A random-effects meta-analysis was conducted on jurisdiction-wide gambling prevalence surveys on the general adult population published until March 2019. One hundred and four studies were eligible for meta-analysis. The number of participants varied depending on the risk factor analyzed, and ranged from 5327 to 273 946 (52% female). Weighted mean odds ratios were calculated for 57 risk factors (socio-demographic, psychosocial, gambling activity and substance use correlates), allowing them to be ranked from largest to smallest with regard to their association with problem gambling.

RESULTS

The highest odds ratio (OR) was for internet gambling [OR = 7.59, 95% confidence interval (CI) = 5.24, 10.99, P < 0.000] and the lowest was for employment status (OR = 1.03, 95% CI = 0.87, 1.22, P = 0.718). The largest effect sizes were generally in the gambling activity category and the smallest were in the socio-demographic category. No differences were found across genders for age-associated risk.

CONCLUSIONS

A meta-analysis of 104 studies of gambling prevalence indicated that the most frequently assessed problem gambling risk factors with the highest effect sizes are associated with continuous-play format gambling products.

Moderating Effect of Impulsivity on the Association Between Entrapment and Problem Gambling

Impulsivity as measure by delay discounting and entrapment have been known to influence gambling, but their individual and joint influence on problem gambling among Soccer gamblers are not yet understood. We examine the direct and moderation influences of entrapment and delay discounting on problem gambling among 174 Soccer gamblers in Nigeria. Data were obtained by means of self-report questionnaires of entrapment, delay discounting and problem gambling. Results from Hayes PROCESS moderated regression showed that delay discounting moderated the association between entrapment and problem gambling such that the association between entrapment and problem gambling was strong when delay discounting was high and diminished when delay discounting was low. Our findings provide insight into the conditional effect of delay discounting on the entrapment-problem gambling association.

Social Capital and Gambling: Evidence from Australia

The prevalence of problem gambling in many countries necessitates research that examines factors influencing excessive and addictive consumption. We consider how social capital impacts gambling participation for a large representative sample of the Australian population. Specifically, we examine the association between social capital and gambling addiction using data from the Household, Income and Labour Dynamics in Australia survey. We address the endogeneity of social capital by instrumenting for social capital using an urban/rural reversed measure of ethnic diversity. Our main findings suggest that higher levels of social capital are associated with lower gambling risks measured by the Problem Gambling Severity Index. This general finding is robust to alternative ways of measuring social capital and gambling, and alternative estimation approaches. We also find that the effect of social capital is stronger in the case of problem gamblers compared to gamblers in other risk categories.

A Multi-Method Investigation of Normative and Pathological Personality Across the Spectrum of Gambling Involvement

Pathological Gambling (PG) has been linked to both specific personality traits and personality disorders (PDs). However, previous studies have used a wide variety of research designs that preclude clear conclusions about the personality features that distinguish adults with PG from other groups. The current investigation seeks to advance this research by using a sample including adults who do not gamble, who gamble socially, and who exhibit PG, using self-report, informant-report, and interview-rated measures of personality traits and disorders. A total of 245 adults completed measures of gambling behaviour and problems, as well as normative and pathological personality over two assessment visits. A multivariate ANCOVA was conducted to investigate differences between groups. Analyses supported numerous group differences including differences between all groups on the Neuroticism facet of Impulsivity, and between non-gambling/socially gambling and PG groups on the Conscientiousness facet of Self-Discipline. Adults with PG exhibited more symptoms of Borderline, Paranoid, Schizotypal, Avoidant, and Dependent PDs than adults who gamble socially or not at all. The current investigation provides a comprehensive survey of personality across a wide range of gambling involvement, using a multi-method approach. Our findings help to clarify the most pertinent personality risk factors for PG.

The role of cultural worldviews in predicating gambling risk perception and behavior in a Chinese sample

OBJECTIVES

We investigated the relationships between cultural worldviews, gambling risk perception, and gambling behavior with a sample of tourists in Macao.

METHODS

Participants were enrolled at famous landmarks and casinos in Macao, China. Data were collected using several instruments to assess an individual's cultural worldviews, gambling risk perceptions, and gambling intentions.

RESULTS

We found that the three-dimensional solution was valid for the Chinese version of the gambling expectancy scale. Correlational and mediational analyses revealed that the relationship between an individualistic worldview and gambling intention was fully mediated by gambling risk perception. Respondents with an egalitarian worldview perceived greater risk associated with gambling than those with other worldviews.

CONCLUSION

These findings demonstrated the important influence of cultural variables on perceived risk and behavior in gambling. Moreover, understanding gamblers' worldviews could be beneficial for problem gambling interventions. Future research directions and the limitations of the findings were discussed.

Changes of Gambling Patterns during COVID-19 in Sweden, and Potential for Preventive Policy Changes. A Second Look Nine Months into the Pandemic

Gambling has been suggested as one of the potential mental health consequences of the COVID-19 pandemic. In earlier self-report studies, increased gambling has been reported by a limited proportion of respondents characterized with a high degree of problem gambling. The present study, carried out with the same methodology and in the same geographical setting, around seven months later in the pandemic, aimed to repeat and to extend the understanding of potential gambling changes in the population during COVID-19. An anonymous sample of web panel members was assessed, altogether 2029 individuals (52% women, 10% moderate-risk or problem gamblers). Results indicated that 6% reported increased gambling, and 4% reported decreased gambling during the pandemic. Having increased gambling was associated with more severe gambling problems (OR 2.78, 95% confidence interval 2.27–3.40), increased alcohol consumption (OR 2.92, 1.71–4.98), and psychological distress (OR 3.38, 1.83–6.23). In the group reporting increased gambling during COVID-19, moderate-risk/problem gambling was very common (62%). Recent governmental policy interventions in the area were known to a minority (30%) of respondents, but awareness of the regulations was markedly more common in individuals with at least moderate-risk gambling (56%) and in self-excluders (78%). Reporting of any perceived influence from policy changes was low (3%), and divided between those reporting an increasing and decreasing effect, respectively. Increased gambling may be a consequence of COVID-19-related changes in everyday lives of individuals with problematic gambling patterns. Thus, a vulnerable group demonstrates higher rates of gambling migration and psychosocial problems, and may require particular attention in screening and treatment contexts, and further scientific evaluations.

Pathological Gambling, Gambling Disorder, and Problem Gambling Among the Chinese Ethnic Population Living in Western Countries: Is Culture a Sufficient Explanation for the Reported Excess Rates?

A significant gap remains in the understanding of the psychosocial and cultural factors and processes in the development and maintenance of pathological gambling, gambling disorder, and problem gambling among the Chinese ethnic population living in the Western countries. This narrative reviews papers on gambling and pathological gambling among the Chinese ethnic group in Western countries to provide a deeper understanding of the cultural and psychosocial factors and processes that lead to the development and maintenance of pathological gambling, gambling disorder, and problem gambling. The factors leading to development of problem gambling, which also carry distinctive cultural differences, include acculturation process among Chinese migrants to western countries, their social learning patterns in gambling, the patterns and motivation seen in Chinese gamblers, their gambling-related cognitive bias and distortions as well as barriers to their help-seeking behaviours. The collectivistic oriental culture may explain for intrafamilial development of gambling behaviour and this strong male authority in the traditional Chinese family set-up also reinforces this influence. The Chinese culture is associated with increased risk-taking behaviour. Superstitious thinking is more prevalent in the Chinese culture and this can be manifested in individuals' perceptions of fate and luck. Future research projects studying pathological gambling and ethnic minorities in the UK should seek greater understanding and improved management of this condition in a small but highly relevant population.

Gambling Behaviour: Prevalence, Risk Factors and Relation with Acculturation in 2007-2018 North Cyprus Adult Household Surveys

In this study, the prevalence of gambling behaviors among the North Cyprus (NC) in 2018 is compared with the data of 2007, 2012, 2014 and the relationship between acculturation and problem and pathological gambling (PPG) is examined. The population of the study consists of Turkish-speaking individuals between 18 and 65 years of age living in NC. 799 people were consequently selected according to gender, age and geographical region with a multi-stage stratified (randomized) quota. For the collection of the data, a demographic questionnaire, the Turkish version of the Revised South Oaks Gambling Screen (SOGS) and cultural attitude scale (CAS) were used. The prevalence data were compared with the research done by the same researchers in 2007 (n = 1012), 2012 (n = 996) and 2014 (n = 958) which were conducted by same method and questionnaire. The vast majority of participants (70.6%) participated in one or more of the 17 types of gambling activities at least once during their lifetime. Pathologic gambling doubled and rose to 4.5% in 2007-2018 periods. Being male, age range of 18-29, single, living alone and marry less than 5 years are the risk factors for PPG. Separation and integration attitude were related with PPG among Cyprus-born individuals. The study shows that gambling behavior is widespread in the NC and pathologic gambling is increasingly rapidly. High rates of gambling addiction, should be assessed in its own social structure for each community and it should be taken into consideration that acculturation is an effective factor in increasing PPG.

Predicting future harm from gambling over a five-year period in a general population sample: a survival analysis

BACKGROUND

There is little longitudinal evidence on the cumulative risk of harm from gambling associated with excess spending and frequency of play. The present study sought to assess the risk of gambling problems over a five-year period in adults who exceed previously derived low-risk gambling limits compared to those who remain within the limits after controlling for other modifiable risk factors.

METHODS

Participants were adults (N = 4212) drawn from two independent Canadian longitudinal cohort studies who reported gambling in the past year and were free of problem gambling at time 1. Multivariate Cox regression was employed to assess the impact over time of gambling above low-risk gambling thresholds (frequency ≥ 8 times per month; expenditure ≥75CAD per month; percent of household income spent on gambling ≥1.7%) on developing moderate harm and problem gambling. Covariates included presence of a DSM5 addiction or mental health disorder at time 1, irrational gambling beliefs, number of stressful life events in past 12 months, number of game types played each year, and playing electronic gaming machines or casino games.

RESULTS

In both samples, exceeding the low-risk gambling limits at time 1 significantly increased the risk of moderate harm (defined as ≥2 consequences on the Problem Gambling Severity Index [PGSI]) within 5 years after controlling for other modifiable risk factors. Other significant predictors of harm were presence of a mental disorder at time 1, cognitive distortions about gambling, stressful life events, and playing electronic gaming machines or casino games. In one sample, the five-year cumulative survival rate for moderate harm among individuals who stayed below all the low-risk limits was 95% compared to 83% among gamblers who exceeded all limits. Each additional low-risk limit exceeded increased the cumulative probability of harm by 30%. Similar results were found in models when the outcome was problem gambling.

CONCLUSIONS

Level of gambling involvement represents a highly modifiable risk factor for later harm. Staying below empirically derived safe gambling thresholds reduces the risk of harm over time.

Setting Limits: Gambling, Science and Public Policy-summary of results

The gambling industry has grown into a global business in the 21st century. This has created the need for a new emphasis on problem prevention. This article highlights the core themes of the book Setting Limits: Gambling, Science and Public Policy, taking a broad view of the consequences of gambling for society as a burden on health, well-being and equality. The book covers the extent of gambling and gambling-related problems in different societies and presents a critical review of research on industry practices, policy objectives and preventive approaches, including services to people suffering from gambling and its consequences. It discusses the developments in game characteristics and gambling environments and provides evidence on how regulation can affect those. Effective measures to minimize gambling harm exist and many are well supported by scientific evidence. They include restrictions on general availability as well as selective measures to prevent gamblers from overspending. The revenue generated from gambling for the industry, governments, and providers of public services funded from gambling returns presents an obstacle to developing policies to implement harm-reduction measures. A public interest approach must weigh these interests against the suffering and losses of the victims of gambling.

Why Some Sports Bettors Think Gambling Addiction Prevented Them from Becoming Winners? A Qualitative Approach to Understanding the Role of Knowledge in Sports Betting Products

Sports betting products rely upon a balance between their knowledge and chance based structural characteristics. The emphasis by bookmakers on mastering the knowledge-based elements to become winners poses significant challenges for those seeking help for gambling disorder. Bettors find difficulties in integrating their preconceptions about the role of knowledge and skills in winning, into the new cognitive restructuring fostered by cognitive-behavioural therapy. Using a grounded theory approach, this study collected data from 43 Spanish sports bettors undergoing treatment for gambling disorder. The results suggest sports bettors neutralize some gambling-related cognitive distortions during CBT but retain others. Sports bettors try to eliminate them but encounter external validation to retain them, as well as internal incongruences to integrate them into a coherent understanding of how gambling works. The results are discussed with the aim of providing practical guidance as to how skill versus chance related persistent cognitions can be addressed in CBT.

Contribution of sex on the underlying mechanism of the gambling disorder severity

Significant increasing prevalences have been observed in gambling disorder (GD) in the last decades. This study analyzed the underlying mechanisms of the gambling severity with path analysis (implemented through Structural Equation Modeling, SEM), and assessed the potential moderator effect of the patients’ sex. A sample of n = 512 treatment-seeking patients was assessed for sociodemographics and clinical state previously to the treatment. Results obtained in two separate SEM (for men and women) revealed differences in the direct effects and the mediational links. Among the male subsample, higher GD severity was directly related to the higher cognitive bias and the younger age of onset of the problematic gambling, while impulsivity levels and age of onset achieved an indirect effect on the disordered gambling mediated by the cognitive bias. Among females, GD severity was directly increased by younger age of onset, higher cognitive bias and lower self-directedness, while lower socioeconomic positions, and higher levels in harm avoidance achieved an indirect effect on the gambling severity mediated also by the distortions related to the gambling activity. These results provide new empirical evidence for a better understanding of the GD etiology, suggesting that the underlying complex links mediating the GD severity are strongly related to the patients’ sex. The results can also contribute to design more effectiveness and precise therapy programs of patient-centered care.

Screening of problem gambling among a homeless population in Warsaw

Background:

While homelessness and problem gambling are both recognised as social and public health concerns and the prevalence of addictive disorders among homeless populations tends to be high. These questions have been studied predominantly independently.

Aim:

The aim of the study was to explore the co-occurrence of the two phenomena among the homeless population using shelters and night shelters in Warsaw, and, more specifically, to provide information about the forms and frequency of gambling in this homeless population.

Method:

Homeless persons (N = 690) were interviewed in rehabilitation-shelters (n = 17) and night-shelters (n = 2) in Warsaw from November 2015 until January 2016. The core component of the questionnaire was a screening test (Problem Gambling Severity Index). In addition, data regarding the intensity of gambling and various types of games or settings were collected.

Results:

The prevalence of problem gambling in this population of homeless people was 11.3%, whereas the prevalence of problem gambling in the general population in Poland is much lower (0.7%). Similarly to the general population, the most prevalent gambling games in the homeless population were lotteries; however, homeless people gambled in lotteries almost three times more often compared to the general population.

Conclusions:

This is the first study examining the prevalence of problem gambling in the homeless population in Poland. The findings of the study suggest that problem gambling among the homeless is a significant social and public health concern. High rates of problem gambling in the homeless population show the need to identify and monitor this problem in shelters and consequently to provide easier access to gambling treatment or prevention programmes.

Proximal and Distal Risk Factors for Gambling Problems Specifically Associated with Electronic Gaming Machines

Electronic gaming machines (EGMs) are widely used and the gambling product most commonly associated with harmful gambling. Understanding factors that increase the risk of problematic EGM play is therefore important. Previous studies into risk factors for EGM gambling have used measures of problem gambling based on an individual's total gambling activity, which therefore do not distinguish harmful gambling specifically associated with EGMs. This study used an EGM-specific measure (PGSI-EGM) to achieve its aim of identifying risk factors specifically associated with problematic EGM play. By removing nuisance effects from other gambling forms that higher-risk gamblers typically engage in, this approach provides a more accurate assessment of the determinants of EGM-related problems. An online survey was completed by 1932 at-least monthly EGM players in Australia. It measured demographics, EGM gambling behaviour, motivations, gambling urges, gambling fallacies, trait self-control, alcohol misuse, and the PGSI-EGM. A penalised regression model identified the most important proximal predictors of higher-risk EGM gambling as: higher gambling urges, higher levels of erroneous cognitions, playing EGMs more frequently, higher session expenditure, longer sessions, usually playing EGMs alone, and playing EGMs in more venues. Lower trait self control was the strongest distal determinant. Higher-risk EGM players tended to be younger, male, more educated, never married, to have higher (although still modest) incomes, and be more likely to have alcohol problems. These findings can inform interventions such as treatment, consumer education and venue interventions.

Coping Strategies, Creativity, Social Self-Efficacy, and Hypercompetitiveness in Gambling Behaviors: A Study on Male Adolescent Regular Gamblers

The purpose of this research was to explore the cognitive and personality characteristics of male adolescent gamblers. Participants were 273 teenage males (M = 18.04, SD = 2.10) attending betting centers in Sicily, who completed self-report questionnaires on gambling, creativity, perceived social self-efficacy, hypercompetitiveness, and coping strategies. Pathological gamblers reported higher levels of avoidant coping strategies than occasional gamblers. They also scored higher on hypercompetitiveness than both occasional and problem gamblers. Further, problem gamblers scored higher than occasional gamblers on the complexity domain of creative personality. Finally, poor perceived social self-efficacy, higher levels of avoidant coping, and hypercompetitiveness predicted pathological gambling. Theoretical, psycho-educational, and clinical implications are discussed.

Gambling in adolescence: a narrative review of the last 20 years

BACKGROUND

Gambling has increasingly become a problem in adolescence over the last 20 years. Previous research has failed to identify exactly the level of involvement of adolescents in gambling, yet a relevant presence of addictive behaviors was noticed.

OBJECTIVE

This narrative review highlights the implications of adolescent gambling, taking into consideration the main risk and protection factors aimed at limiting gambling activity, as well as the main links with the impulse-control disorder, addiction, and behavioral addiction.

METHODS

The review process was conducted through Medline, Scopus, Web of Science and Google Scholar search engines. The considered keywords were "Gambling" AND "Adolescence," "Behavioral addiction," AND "Adolescence." The articles related to gambling and adolescence in the last 20 years were included in compliance with inclusion and exclusion criteria, to perform a consistent analysis of the phenomenon and the related maintenance factors.

RESULTS

Starting from 1067 articles, 107 were selected to denote the main thematic areas involved in the gambling problem. The online search was completed on December 13, 2019.

CONCLUSIONS

The narrative review of literature can facilitate the analysis of gambling problems in adolescence, as the main studies in the last 20 years showed the complexity of the problem, the links between addiction, and the most effective methods of prevention and treatment.

A research plan to define Canada's first low-risk gambling guidelines

From a public health perspective, gambling shares many of the same characteristics as alcohol. Notably, excessive gambling is associated with many physical and emotional health harms, including depression, suicidal ideation, substance use and addiction and greater utilization of health care resources. Gambling also demonstrates a similar 'dose-response' relationship as alcohol-the more one gambles, the greater the likelihood of harm. Using the same collaborative, evidence-informed approach that produced Canada's Low-Risk Alcohol Drinking and Lower Risk Cannabis Use Guidelines, a research team is leading the development of the first national Low-Risk Gambling Guidelines (LRGGs) that will include quantitative thresholds for safe gambling. This paper describes the research methodology and the decision-making process for the project. The guidelines will be derived through secondary analyses of several large population datasets from Canada and other countries, including both cross-sectional and longitudinal data on over 50 000 adults. A scientific committee will pool the results and put forward recommendations for LRGGs to a nationally representative, multi-agency advisory committee for endorsement. To our knowledge, this is the first systematic attempt to generate a workable set of LRGGs from population data. Once validated, the guidelines inform public health policy and prevention initiatives and will be disseminated to addiction professionals, policy makers, regulators, communication experts and the gambling industry. The availability of the LRGGs will help the general public make well-informed decisions about their gambling activities and reduce the harms associated with gambling.

Problem Gambling in Greece: Prevalence and Risk Factors During the Financial Crisis

In Greece no study has ever been conducted on the prevalence of problem gambling. Therefore, a cross-sectional survey was carried out amid the recession aiming to (1) estimate past year prevalence of problem gambling, (2) explore socio-economic and demographic differences among gamblers and non gamblers, (3) explore socio-economic and demographic differences among gamblers who started gambling prior and during the downturn and (4) identify its risk factors with a special interest in the influence of the recession. To this end, data emanating from a telephone and patron survey were combined. A random and representative sample of 3.404 people participated in the telephone survey and 2.400 in the patron survey. The interview schedule was the same in both studies. The presence of problem gambling was assessed with the Canadian Problem Gambling Index. Information on participants' socio-economic and demographic characteristics as well as their ways of dealing financially with the crisis were collected. Findings indicated that 2.4% of respondents met criteria for problem gambling. Male gender, minority status, living with family of origin, low educational level and low to zero income were found to constitute the risk factors of the disorder. Moreover, having started gambling during the recession increased the odds of suffering from problem gambling; however this finding was gender-specific. Thus, people end up in problem gambling through various pathways, with these trajectories being different for men and women. Any intervention should address the complexity of the issue and be tailored by gender.

The joint role of impulsivity and distorted cognitions in recreational and problem gambling: A cluster analytic approach

BACKGROUND AND AIMS

The Pathways Model (Blaszczynski & Nower, 2002) posits that problem gambling is a heterogeneous disorder with distinct subgroups (behaviorally conditioned gamblers, emotionally vulnerable gamblers, and antisocial-impulsivist gamblers). Impulsivity traits and gambling-related cognitions are recognized as two key psychological factors in the onset and maintenance of problem gambling. To date, these constructs have been explored separately, and their joint role in determining problem gambling subtypes has received little attention. The goal of our study was to identify subgroups of gamblers based on impulsivity traits and gambling-related cognitions, and to determine whether this approach is consistent with the Pathways model.

METHODS

Gamblers from the community (N = 709) and treatment-seeking pathological gamblers (N = 122) completed questionnaires measuring gambling habits, disordered gambling symptoms, gambling-related cognitions, and impulsivity traits.

RESULTS

Cluster analyses revealed that three clusters globally aligned with the pathways proposed by Blaszczynski & Nower (2002). Two other clusters emerged: (1) impulsive gamblers without cognitive-related cognitions; and (2) gamblers without impulsivity or gambling-related cognitions. Gamblers with both heightened impulsive traits and gambling-related cognitions had more severe problem gambling symptoms.

CONCLUSION

We successfully identified, based on an a priori theoretical framework, different subtypes of gamblers that varied in terms of problem gambling symptoms and clinical status. The diversity of the cluster profiles supports the development of personalized prevention strategies and psychological interventions.

Problem Gambling and Psychiatric Comorbidity-Risk and Temporal Sequencing Among Women and Men: Results from the Swelogs Case-Control Study

It is well known that many problem gamblers also suffer from other psychiatric conditions. However, knowledge regarding the temporal sequencing of the conditions is lacking, as well as insight in possible gender specific patterns. The aim of this study was to examine the risk for psychiatric comorbidity among problem gamblers compared to non-problem gamblers in the general Swedish population, as well as the age of onset and the temporal sequencing of problem gambling and the comorbid psychiatric conditions among lifetime problem gamblers. A case–control study nested in the Swelogs cohort was used. For both the female and the male problem gamblers, the risk for having had a lifetime psychiatric condition was double or more than double compared to the controls. Having experienced anxiety or depression before gambling onset, constituted a risk for developing problem gambling for the women but not for the men. Further, the female cases initiated gambling after their first period of anxiety, depression and problems with substances, and problem gambling was the last condition to evolve. Opposite this, the male cases initiated gambling before any condition evolved, and depression and suicidal events emerged after problem gambling onset. There were large differences in mean age of onset between the female cases and their controls, this was not the case for the males. Gender specific patterns in the association between problem gambling and psychiatric comorbidity, as well as in the development of problem gambling needs to be considered in treatment planning as well as by the industry in their advertising.

Gambling and the Role of Resilience in an International Online Sample of Current and Ex-serving Military Personnel as Compared to the General Population

Compared to the general population, military personnel are particularly vulnerable to developing gambling problems. The present study examined the presentation of gambling-including gambling frequency, personal thoughts on reducing gambling and recommendations from others to reduce gambling-across these populations. Additionally, the study measured the association between gambling and various psychosocial risk and protective factors-including psychological distress, suicidal ideation, external encouragement to reduce substance use, days out of role, personal wellbeing, resilience, social support and intimate bonds. Data was extracted from the Global Health & Wellbeing Survey, an online self-report survey conducted in Australia, Canada, New Zealand, the United Kingdom and the United States. Of the 10,765 eligible respondents, 394 were military veterans and 337 were active military personnel. Consistent with previous research, a higher proportion of gambling behaviours were observed in both current and ex-serving military samples, compared to the general population. To varying degrees, significant associations were found between the different gambling items and all psychosocial risk and protective factors in the general population sample. However, the military sample yielded only one significant association between gambling frequency and the protective factor 'resilience'. A post hoc stepwise linear regression analysis demonstrated the possible mediating role resilience plays between gambling frequency and other psychosocial risk (psychological distress, and suicidal thoughts and behaviour) and protective factors (personal wellbeing) for the military sample. Given the findings, it is recommended that routine screening tools identifying problem gambling are used within the military, and subsequent resilience focused interventions are offered to at risk personnel.

The paradoxical relationship between emotion regulation and gambling-related cognitive biases

Background

Gambling behavior presents substantial individual variability regarding its severity, manifestations, and psychological correlates. Specifically, differences in emotion regulation, impulsivity, and cognitive distortions have been identified as crucial to describe individual profiles with implications for the prevention, prognosis, and treatment of gambling disorder (GD).

Aims and method

The aim of the present study was to investigate the associations of gambling-related cognitions (measured according to the GRCS model) with impulsivity (UPPS-P model) and emotion regulation (CERQ model), in a sample of 246 gamblers with different levels of gambling involvement, using mixed-effects modelling to isolate theoretically relevant associations while controlling for the potentially confounding effects of sociodemographic and clinical covariates.

Results

Affective/motivational dimensions of UPPS-P impulsivity positive urgency and sensation seeking, on the one hand, and CERQ emotion regulation strategies reappraisal, rumination and blaming others, on the other, independently and significantly predicted distorted gambling-related cognitions.

Conclusions

These results (a) reinforce the ones of previous studies stressing the relevance of emotional and motivational processes in the emergence of gambling-related cognitive distortions; and (b) replicate the seemingly paradoxical finding that gamblers use emotion regulation strategies customarily considered as adaptive (i.e. reappraisal) to strengthen and justify their biased beliefs about gambling outcomes and controllability.

Decision-Making Styles, Negative Affectivity, and Cognitive Distortions in Adolescent Gambling

Evidences from the extant literature suggest that problem gamblers show higher cognitive distortions and reported experiencing higher levels of negative affective states than recreational gamblers. Furthermore, several studies reported that the more the gambling severity, the poorer the performance in behavioral tasks assessing affective decision-making. Although gambling research on decision-making has mostly focused on the functional or dysfunctional outcomes of the decisional process, no study examined the role of decision-making styles in gambling disorder. This study aimed to first investigate the interplay among negative affectivity, cognitive distortions, and decision-making styles in adolescent problem gambling. Four hundred and twenty-five adolescents, aged between 14 and 19 years, completed the South Oaks Gambling Screen Revised for Adolescents to assess problem gambling, the Depression Anxiety and Stress Scales-21 to measure negative affective states, and the Gambling Related Cognitions Scale as a measure of cognitive distortions about gambling, and the General Decision-Making Style tapping habitual patterns which individuals use in decision-making. Data were submitted to correlational analysis, univariate and mixed-model ANOVAs, and hierarchical regression analysis. Regression analysis indicated that, along with gender, interpretative bias and inability to stop gambling, depression, and spontaneous decision-making style significantly predicted gambling severity. These results extend further previous studies on the role of misconceptions about gambling, and negative affective states in adolescent gambling, and, interestingly, first demonstrate that also maladaptive decision-making styles may represent a risk factor for gambling disorder.

Pharmacological Treatments for Disordered Gambling: A Meta-analysis

Disordered gambling is a public health concern associated with detrimental consequences for affected individuals and social costs. Currently, opioid antagonists are considered the first-line treatments to reduce symptoms of uncontrolled gambling. Only recently, glutamatergic agents and combined pharmacological and psychological treatments have been examined appearing promising options for the management of gambling disorder. A multilevel literature search yielded 34 studies including open-label and placebo-controlled trials totaling 1340 participants to provide a comprehensive evaluation of the short- and long-term efficacies of pharmacological and combined treatments. Pharmacological treatments were associated with large and medium pre-post reductions in global severity, frequency, and financial loss (Hedges’s g: 1.35, 1.22, 0.80, respectively). The controlled effect sizes for the outcome variables were significantly smaller (Hedges’s g: 0.41, 0.11, 0.22), but robust for the reduction of global severity at short-term. In general, medication classes yielded comparable effect sizes independent of predictors of treatment outcome. Of the placebo controlled studies, results showed that opioid antagonists and mood stabilizers, particularly the glutamatergic agent topiramate combined with a cognitive intervention and lithium for gamblers with bipolar disorders demonstrated promising results. However, more rigorously designed, large-scale randomized controlled trials with extended placebo lead-in periods are necessary. Moreover, future studies need to monitor concurrent psychosocial treatments, the type of comorbidity, use equivalent measurement tools, include outcome variables according to the Banff, Alberta Consensus, and provide follow-up data in order to broaden the knowledge about the efficacy of pharmacological treatments for this disabling condition.

Gambling habits, gambling norms, and problem gambling in foreign born and native populations in Denmark - A general population survey

Background

Being foreign born, i.e. not born in the reception country or belonging to an ethnic minority, has been described as a risk factor of problem gambling, although research so far has been inconclusive. Also, there is limited knowledge about whether this association is caused by differing gambling norms. The present study aimed to study whether foreign origin is associated with problem gambling, when controlling for several potential risk factors, gambling frequency and beliefs about peer gambling, i.e. gambling norms.

Methods

Cross-sectional web survey including 1970 adult individuals from the general population in Denmark (50% female), in April 2018. Binary analyses and hierarchical logistic regression with respect to associations between foreign origin, relevant co-factors and problem gambling.

Results

Problem gambling was more common in individuals with foreign origin (15 vs 10%, p = 0.01). In logistic regression, problem gambling was associated with male sex, gambling frequency, foreign origin, psychological distress, smoking, and number of gambling types used. Beliefs about peer gambling did not differ with respect to foreign origin, but were associated with problem gambling until one's own gambling frequency was entered into the model.

Conclusions

When controlling for a number of relevant risk factors, foreign origin still appears to predict problem gambling. Gambling patterns or gambling norms are unlikely to be the sole explanation of the increased prevalence. The findings have implications for preventive work in the foreign born population, and gambling norms may be targeted in screening for at-risk gamblers.

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In the population, problem gambling was more common in first or second generation immigrants.

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The association with problem gambling was not explained by increased gambling norms in the immigrant population instead demonstrated lower beliefs about peer gambling.

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Instead, immigrants demonstrated lower beliefs about peer gambling

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Beliefs about peer gambling were associated with own's problem gambling risk

Rats' optimal choice behavior in a gambling-like task

Among the different procedures that model gambling behavior in non-human animals, the "suboptimal choice procedure" has been extensively employed for analyzing the impact of environmental cues on choice behavior. It has been repeatedly demonstrated that pigeons prefer an alternative that infrequently presents a stimulus that signals a larger amount of reinforcement, than another alternative that always presents a stimulus associated with a smaller amount of reinforcement, even though the net rate of reinforcement is lower in the former. In the present study, we tested rats in the magnitude version of the suboptimal choice procedure. Eight rats were given a choice between two alternatives: a) one in which a stimulus predicting the delivery of ten pellets was presented with probability (p) = 0.2 and a stimulus predicting zero pellets was presented with p = 0.8, and b) one in which either of two stimuli predicted the delivery of three pellets with p = 1.0. Contrary to the consistent and robust suboptimal behavior of pigeons, rats preferred the optimal alternative. This effect occurred despite the high index of discrimination of the stimuli associated with the different outcomes shown by the rats. The relevance of this result to the development of animal models of gambling behavior is discussed.

Correlation between precontemplation and alpha activity in gambling disorder

PURPOSE

Gambling disorder is a psychiatric condition characterized by persistent and recurrent maladaptive gambling. In the present study, we evaluated the characteristics of resting-state electroencephalogram (EEG) recordings in patients with gambling disorder. In addition, we explored the association between the EEG characteristics of the patients and the stages of change in a transtheoretical model.

METHODS

All participants were men who visited a gambling disorder clinic in Seoul, Korea. At the assessment, questionnaires, including the Readiness to Change Questionnaire (RCQ), were administered and resting-state EEGs were carried out. Participants were grouped based on Ward's method for cluster analysis. Independent sample t-tests were used to evaluate group differences. To assess the relationship between the clinical data and the EEG recordings, we used Pearson's partial correlation analysis.

RESULTS

Overall, 63 male participants were enrolled. Cluster analysis of the alpha activity revealed two clusters. No significant differences were observed in the demographic or clinical data between the two groups except for the Beck Depression Inventory (BDI). We found that the precontemplation score of the RCQ was positively correlated with the z-score of the relative alpha power in almost all cortical regions.

CONCLUSION

This study suggests that EEG parameters, particularly alpha activity, could inform us about the subtypes or stages of change in gambling disorder. Alpha power is the predominant EEG rhythm in a relaxed, alert person; thus, alpha power serves as an index of relaxation. We expect that the level of alpha activity could be utilized as an additional parameter to help clinicians assess and treat patients with gambling disorder.

Psychological Vulnerability and Problem Gambling: The Mediational Role of Cognitive Distortions

Despite numerous studies demonstrating the influence of cognitive distortions on gambling problem severity, empirical data regarding the role of psychological vulnerability on the latter is limited. Hence, this study assesses the mediating effect of cognitive distortions between psychological vulnerability (personality and mood), and gambling problem severity. It also verifies whether the relationships between these variables differs according to the preferred gambling activity. The sample is composed of 272 male gamblers [191 poker players; 81 video lottery terminal (VLT) players] aged between 18 and 82 years (M = 35.2). Bootstrap analysis results revealed that cognitive distortions mediate the effect of narcissism on gambling problem severity for both groups. The level of depression for VLT players significantly predicted gambling problem severity, both directly and indirectly via the mediating effect of cognitive distortions. Mediation analyses also indicated that narcissism had an indirect impact on problem gambling through cognitive distortions for both groups. These findings suggest that certain vulnerabilities related to personality and mood may influence cognitive distortion intensity and gambling problem severity. In addition, psychological vulnerabilities could differ based on preferred gambling activity. These results may be useful for prevention policies, identifying high risk gamblers and planning psychological interventions.

Negative Mood States or Dysfunctional Cognitions: Their Independent and Interactional Effects in Influencing Severity of Gambling Among Chinese Problem Gamblers in Hong Kong

Gambling-related cognitions and negative psychological states have been proposed as major factors in the initiation and maintenance of problem gambling (PG). While there are a substantial number of studies supporting the role of cognitive dysfunctions in the initiation and maintenance of PG, very few empirical studies have explored the specific role of negative psychological states in influencing PG behaviours. In addition, very few studies have examined the interaction effects of cognitive dysfunctions and negative psychological states in exerting influence on PG behaviours. Therefore, the present study aims to examine the main and interaction effects of gambling-related cognitions and psychological states on the gambling severity among a group of problem gamblers in Hong Kong. A cross-sectional research design was adopted. A purposive sample of 177 problem gamblers who sought treatment from a social service organization in Hong Kong completed a battery of standardised questionnaires. While gambling-related cognitions were found to exert significant effects on gambling severity, negative psychological states (i.e. stress) significantly moderated the relationship between gambling cognitions and gambling severity. In essence, those participants who reported a higher level of stress had more stable and serious gambling problems than those who reported a lower level of stress irrespective of the level of gambling-related cognitions. The findings of the moderating role of negative emotions in the relationship between cognitive distortions and severity of gambling provide insight towards developing an integrated intervention model which includes both cognitive-behavioural and emotion regulation strategies in helping people with PG.

Effectiveness of a Self Help Cognitive Behavioural Treatment Program for Problem Gamblers: A Randomised Controlled Trial

The study aimed to strengthen the scarce literature on self-help treatments for Problem Gambling (PG) by comparing the effectiveness of a Self-Help Cognitive Behavioral Treatment (SHCBT) program (n = 23) with a 6-week Waitlist condition (n = 32) in problem gamblers. Participants were community volunteers with gambling problems and were randomly allocated to the Waitlist and treatment conditions. Results showed significant improvements at post-treatment in gambling behaviors including frequency of gambling, average amount gambled per day and PG symptoms as well as a number of gambling correlates including psychological states (e.g., depression, anxiety and stress), gambling cognitions, gambling urges, gambling related self-efficacy, satisfaction with life, and quality of life among those who completed the SHCBT program, when compared with the waitlist condition. The effect size (partial η ²) ranged from .25 to .57 for all assessed outcomes that showed significant improvement from pre- to post-treatment. It was concluded that a self-help CBT program can be beneficial for treating community problem gamblers.

Suicidality among gambling helpline callers: A consideration of the role of financial stress and conflict

BACKGROUND AND OBJECTIVES

High rates of suicidal ideation and attempts secondary to gambling are well established among those with gambling disorders. The present study explores potential risk factors for suicidal ideation and/attempt among a sample of help-line callers.

METHODS

Participants (N = 202) completed measures assessing demographics; gambling behavior; and financial, family/social, employment, substance use, and legal difficulties related to gambling. Bivariate analyses, logistic regression, and mediation analyses were used to explore relationship between predictors and risk of suicidal ideation and attempt.

RESULTS

Female gender, gambling severity (including engagement in illegal behaviors), a history of mental health problems, financial problems, and conflict related to gambling were associated with current suicidality in this sample. Mediation analyses revealed that financial problems were associated with increased familial conflict, which was in turn associated with increased suicidality.

CONCLUSIONS

Family and social conflict may be one important way in which financial problems confer risk for suicidality among problem gamblers. These results align with findings from the substance use disorder (SUD) literature and highlight one potential factor that may merit further assessment and/or intervention.

SCIENTIFIC SIGNIFICANCE

Researchers and clinicians may want to consider the overall level of conflict a patient is experiencing when assessing suicide risk among individuals with gambling problems. Professionals may also want to consider the suitability of interventions to address conflict within the context of gambling treatment. (Am J Addict 2018;27:531-537).