Alcohol Consumption and Self-Control of Gambling Behaviour

Suicidal Behaviors and Associated Factors Among Individuals with Gambling Disorders: A Meta-Analysis

The risk for suicidal behaviors including suicide ideations and attempts among individuals with gambling disorder (IWGDs) is high compared to the general population. Little is known about the interplay of mood disorders, alcohol use disorders, and suicidal behaviors among IWGDs. The study aimed to determine the prevalence, sociodemographic characteristics, risky behaviors, mental health disorders, and alcohol use disorders associated with suicide behaviors among IWGDs. Studies published between January 1 1995 and September 1 2022 were obtained from following databases: PubMed, Scopus, Web of Science and Cochrane Library databases. PECOS (population, exposures, comparison, outcome, and study design) criteria were used for selecting studies. The Newcastle-Ottawa Scale (NOS) was used for assessing risk of bias and rated each study in terms of exposure, outcome, and comparability. After initial assessment of 10,243 papers, a total of 39 studies met the eligibility criteria. Among IWGDs, the findings indicated a life-time pooled prevalence rate of 31% for suicide ideations (95% CI, 23-39%), 17% for suicide plans (95% CI, 0-34%), and 16% for suicide attempts (95% CI, 12-20%). Generally, suicide ideations among IWGDs were associated with having any financial debt and having chronic physical illnesses, as well as experiencing depression, mood disorders, and alcohol use disorders. Suicide attempts among IWGDs were associated with being older and having a childhood history of sexual abuse, as well as experiencing depression, mood disorders and alcohol use disorders. Interventions can help to facilitate seeking support among IWGDs by de-stigmatizing mental health disorders as well as improving the quality of care presented to individuals with psychiatric conditions.

Interactive Effects of Problem-Gambling Severity, Gender and Alcohol Consumption on Electronic Gaming Machine Behaviour

While comorbidity of problematic alcohol and gambling use is well established, much less is known about the way in which alcohol consumption while gambling interacts with problem-gambling severity and other individual differences. We hypothesised three factors that would interact with alcohol consumption while gambling on electronic gaming machines (EGMs) to influence four behavioural gambling measures: preferred number of lines bet, average duration of play, average spend per session and preferred electronic gaming machine denomination. The latter is a measure of gambler’s preference for the monetary denomination in which EGM bets are placed (e.g. 1 cent, 2 cents, 5 cents, 10 cents, 20 cents, $1), with higher denomination EGMs being higher risk since bets can be placed in larger amounts and money can be lost more rapidly. The three hypothesised interacting factors were problem-gambling severity, presence/absence of alcohol use disorder and biological gender. A total of 1557 male and female participants completed a questionnaire, measuring their problem-gambling status, problem alcohol status, consumption of alcohol at the gambling venue, preferred EGM denomination, preferred number of lines bet, average duration of play and average spend per session. We found the anticipated gender-differential spending effect with males spending more than females, but we also found a surprising reverse differential spending effect for problem gamblers such that females spent more than males. We also found that alcohol consumption while gambling was generally associated with a preference for higher denomination machines and that those players without alcohol problems who drank at the venue preferred to bet on more lines, suggesting a double-max strategy amongst gamblers who drank at the venue. Finally, for non-problem and low-risk gamblers, concurrent alcohol consumption was related to preference for higher denomination EGMs in female players, but not for male players. These findings are discussed in the context of the physiological and psychological effects of alcohol.

Polysubstance Use Is Positively Associated with Gaming Disorder Symptom Severity: A Latent Class Analytical Study

INTRODUCTION

The link between gaming disorder (GD) and substance use amongst adolescents is not clear. Some studies reported positive associations, whereas others suggested that alcohol and illicit drug use are not related to GD severity.

OBJECTIVES

The present study aimed to identify empirically based latent classes of alcohol and illicit drug use amongst adolescents and explore their associations with GD symptom severity and whether endorsement of specific criteria of GD is linked to the membership of latent classes of alcohol and illicit drug use.

METHODS

Data of the national sample of Hungarian adolescents from the Health Behaviour in School-aged Children survey (N = 2,768; females: 52.08%; mean age: 16.73 years) were analysed. Measures for frequency of alcohol and illicit drug use, gaming, GD symptom severity, and life satisfaction were included in the analyses.

RESULTS

Latent class analysis discriminated 4 subgroups of alcohol and illicit drug use: polysubstance users, high-risk alcohol users, moderate alcohol users, and infrequent substance users. Polysubstance users presented significantly higher levels of GD symptom severity and higher odds for endorsement of criteria of "giving up other activities" and "negative consequences."

CONCLUSIONS

Positive associations were shown between higher GD severity and the polysubstance using class. The roles of criteria of "giving up other activities" and "negative consequences" were highlighted in more severe substance use patterns. However, GD severity and criteria did not differ as a function of the level of alcohol use. These findings may imply common roots of GD and illicit drug use in adolescents.

Adult Gambling Problems and Histories of Mental Health and Substance Use: Findings from a Prospective Multi-Wave Australian Cohort Study

Little is known about the cumulative effect of adolescent and young adult mental health difficulties and substance use problems on gambling behaviour in adulthood. We use data from one of Australia's longest running studies of social and emotional development to examine the extent to which: (1) mental health symptoms (depressive and anxiety symptoms) and substance use (weekly binge drinking, tobacco, and cannabis use) from adolescence (13-18 years) into young adulthood (19-28 years) predict gambling problems in adulthood (31-32 years); and (2) risk relationships differ by sex. Analyses were based on responses from 1365 adolescent and young adult participants, spanning seven waves of data collection (1998-2014). Persistent adolescent to young adult binge drinking, tobacco use and cannabis use predicted gambling at age 31-32 years (OR = 2.30-3.42). Binge drinking and tobacco use in young adulthood also predicted gambling at age 31-32 years (OR = 2.04-2.54). Prior mental health symptoms were not associated with gambling and no risk relationships differed by sex. Findings suggest that gambling problems in adulthood may be related to the earlier development of other addictive behaviours, and that interventions targeting substance use from adolescence to young adulthood may confer additional gains in preventing later gambling behaviours.

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.

Australia's Gambling Epidemic: The Role of Neighbourhood Ethnic Diversity

Gambling is a popular leisure activity but also a significant public health issue in Australia. The severity of gambling in Australia is characterised by unprecedented gambling expenditures and losses representing the highest gambling rates in the world, which has led to renewed interests in understanding the factors influencing gambling behaviours. We contribute to the debate on the determinants of gambling by providing the first study that examines the impact of ethnic diversity on gambling. Using data from the Household, Income and Labour Dynamics in Australia survey, we find that ethnic diversity is positively associated with gambling. This result is robust to alternative estimation approaches, alternative ways of measuring ethnic diversity and irrespective of whether gambling is measured using the Problem Gambling Severity Index, gambling expenditures or number of gambling activities. Our results also suggest stronger effects of ethnic diversity for problem gamblers compared to gamblers in other risk categories. These results support the need for policies that promote social capital in diverse communities to reduce the risks of social isolation, which is an important motivator of gambling behaviour.

The Relationship Between In-Play Betting and Gambling Problems in an Australian Context of Prohibited Online In-Play Betting

Internationally, Internet gambling is increasingly permitted under regulated licensing conditions; however, the specific products that are legal varies between jurisdictions. Online sports and race wagering are now legal in many jurisdictions, but in-play betting (also referred to as "live action" or "in-the-run" betting) is often restricted. In-play betting enables bets to be placed on an event after it has commenced. Prohibitionist policies often cite the potential for this type of betting to increase risk of gambling problems. This study aimed to identify which online bettors are most likely to engage in in-play betting, and to investigate the relationship between in-play betting and gambling problems. Online survey responses were collected from 501 Australian past-month online sports bettors in the context of in-play betting only being available on offshore gambling sites or via telephone betting. Thirty-four percent of participants had placed a bet in-play in the past month. Participants placing in-play bets differed from those who had not in terms of education, employment status, ethnicity, age, and gambling involvement. Those who bet in-play had higher problem gambling severity scores than those who did not bet in-play. Problem gambling severity significantly predicting in-play betting, holding other variables constant. Findings are consistent with previous research indicating that the relationship between in-play gambling and problems holds across jurisdictions which have prohibited and legalized in-play betting. The findings suggest that in-play betting should warrant specific regulatory attention and interventions to minimize gambling harms among individuals that engage with this activity.

The use of naltrexone in pathological and problem gambling: A UK case series

BACKGROUND AND AIMS

To investigate the potential indications and adverse effects of using the opioid antagonist naltrexone to treat problem gamblers.

CASE PRESENTATION

The files of the 1,192 patients who were referred to the National Problem Gambling Clinic between January 2015 and June 2016 were audited. Seventeen patients were considered appropriate for treatment with naltrexone, having attended and failed to respond to psychological therapies at the clinic. Fourteen patients were placed on a regimen of 50 mg/day naltrexone.

DISCUSSION

Of the 14 patients who were treated with naltrexone, there were 10 for whom sufficient follow-up existed to analyze the treatment efficacy and side effects of naltrexone. Patients showed significant decreases in their craving to gamble and the majority (60%) were able to abstain completely from gambling in the treatment period, with a further 20% reducing their gambling to almost nothing. The reported side effects from the naltrexone included: loss of appetite, gastrointestinal pain, headaches, sedation, dizziness, and vivid dreams. Two patients with concurrent alcohol-use disorder relapsed during the treatment. One patient relapsed after the treatment period.

CONCLUSIONS

The study showed significant outcomes in reducing gambling cravings for the sample set. Given the design of the study as a case series, there was no control group, and a number of patients were on other psychotropic medications. We recommend care when prescribing to those suffering from concurrent alcohol-use disorder.

Online interventions for problem gamblers with and without co-occurring problem drinking: study protocol of a randomized controlled trial

Background

The current randomized controlled trial seeks to evaluate whether providing access to an Internet intervention for problem drinking in addition to an Internet intervention for problem gambling is beneficial for participants with gambling problems who do or do not have co-occurring problem drinking.

Methods

Potential participants will be recruited online via a comprehensive advertisement strategy, if they meet the criteria for problem gambling. As part of the baseline measures, problem drinking will also be assessed. Eligible participants (N = 280) who agree to partake in the study and to be followed up for 6 months will be randomized into one of two versions of an Internet intervention for gamblers: an intervention that targets only gambling issues (G-only) and one that combines a gambling intervention with an intervention for problem drinking (G + A). For problem gamblers who exhibit co-occurring problem drinking, it is predicted that participants who are provided access to the G + A intervention will demonstrate a significantly greater level of reduction in gambling outcomes at 6 months compared to those provided access to the G-only intervention.

Discussion

This trial will expand upon the current research on Internet interventions for addictions and inform the development of treatments for those with co-occurring problem drinking and gambling.

Trial Registration

ClinicalTrials.gov, NCT03323606. Registered on 24 October 2017.

Electronic supplementary material

The online version of this article (10.1186/s13063-018-2672-x) contains supplementary material, which is available to authorized users.

Independent Versus Co-occurring Substance Use in Relation to Gambling Outcomes in Older Adolescents and Young Adults

PURPOSE

Gambling is prevalent among college students and can be associated with significant negative consequences. Students who report gambling also tend to report use of alcohol and cannabis, but little research has explored the associated risks of using these substances in relation to gambling episodes. This study explored associations between the independent and co-occurring use of alcohol and cannabis before/during gambling episodes and gambling outcomes.

METHODS

Students (n = 1,834) completed an online survey that included measures of gambling frequency, amount lost, negative gambling consequences, gambling problem severity, and substance use.

RESULTS

As hypothesized, individuals who reported using either alcohol or cannabis alone or both substances before/while gambling endorsed greater gambling quantity, frequency, negative consequences, and problem severity than individuals who used alcohol and cannabis in general but denied use of either substance before/while gambling. Use of both substances compared to use of alcohol alone was associated with greater gambling quantity, frequency, and negative consequences, although these groups did not differ on gambling problem severity. Cannabis use alone was no different on any outcome than use of both substances, and alcohol use alone was no different than cannabis use alone on any outcome.

CONCLUSIONS

Use of cannabis alone before/while gambling may confer the same level of risk for negative gambling outcomes as use of both cannabis and alcohol. Prevention efforts may, therefore, benefit from targeting cannabis use in relation to gambling. Additional investigation is needed in light of recent and upcoming state legislation on the legalization of cannabis.

A dangerous cocktail: Alcohol consumption increases suicidal ideations among problem gamblers in the general population

The current research examined whether alcohol consumption exacerbates suicidal ideations among gamblers in the general population. While prior research suggests problem gambling severity and excessive alcohol consumption are unique predictors of suicidal behaviors, the extant literature as almost exclusively focused on gamblers in treatment. This represents a significant gap in the literature as less than 10% of gamblers seek treatment. Furthermore, gamblers in treatment are not representative of gamblers in the general population, precluding a simple generalization of research findings. We address this gap using data obtained from the Canadian Community Health Survey (Cycle 4.1)--a cross-sectional national survey that assesses health-related information among the Canadian population. To this end, we conducted a moderation analysis with problem gambling severity as the independent variable, weekly alcohol consumption as the moderator variable and suicidal ideations (in the past 12 months) as the dependent variable. The results found that alcohol consumption alone did not reliably predict suicidal ideation among gamblers who did not gamble problematically. However, as predicted, the odds of suicidal ideation were greatest among problem gamblers who frequently consumed alcohol. Thus, it may behoove policy makers to re-visit the availability of alcohol in gambling venues. Moreover, responsible gambling-oriented education initiatives may be advanced by informing gamblers about the increased risk of suicidal ideations when problematic gambling is combined with frequent alcohol consumption.

People with gambling disorder and risky alcohol habits benefit more from motivational interviewing than from cognitive behavioral group therapy

Background. Effective psychological treatment, including cognitive behavioral therapy and motivational interviewing (MI), is available for people with problematic gambling behaviors. To advance the development of treatment for gambling disorder, it is critical to further investigate how comorbidity impacts different types of treatments. The purpose of this study was to investigate whether screening for risky alcohol habits can provide guidance on whether people with gambling disorder should be recommended cognitive behavioral group therapy (CBGT) or MI. Methods. The present study is a secondary analysis of a previous randomized controlled trial that compared the effects of CBGT, MI and a waitlist control group in the treatment of disordered gambling. Assessment and treatment was conducted at an outpatient dependency clinic in Stockholm, Sweden, where 53 trial participants with gambling disorder began treatment. A modified version of the National Opinion Research Centre DSM-IV Screen for gambling problems was used to assess gambling disorder. The Alcohol Use Disorders Identification Test (AUDIT) was used to screen for risky alcohol habits. Results. The interaction between treatment and alcohol habits was significant and suggests that patients with gambling disorder and risky alcohol habits were better helped by MI, while those without risky alcohol habits were better helped by CBGT. Conclusions. The results support a screening procedure including the AUDIT prior to starting treatment for gambling disorder because the result of the screening can provide guidance in the choice of treatment. Patients with gambling disorder and risky alcohol habits are likely to be best helped if they are referred to MI, while those without risky alcohol habits are likely to be best helped if they are referred to CBGT.

Pathological gambling and the loss of willpower: a neurocognitive perspective

The purpose of this review is to gain more insight on the neurocognitive processes involved in the maintenance of pathological gambling. Firstly, we describe structural factors of gambling games that could promote the repetition of gambling experiences to such an extent that some individuals may become unable to control their gambling habits. Secondly, we review findings of neurocognitive studies on pathological gambling. As a whole, poor ability to resist gambling is a product of an imbalance between any one or a combination of three key neural systems: (1) an hyperactive 'impulsive' system, which is fast, automatic, and unconscious and promotes automatic and habitual actions; (2) a hypoactive 'reflective' system, which is slow and deliberative, forecasting the future consequences of a behavior, inhibitory control, and self-awareness; and (3) the interoceptive system, translating bottom-up somatic signals into a subjective state of craving, which in turn potentiates the activity of the impulsive system, and/or weakens or hijacks the goal-driven cognitive resources needed for the normal operation of the reflective system. Based on this theoretical background, we focus on certain clinical interventions that could reduce the risks of both gambling addiction and relapse.

Low trait self-control in problem gamblers: evidence from self-report and behavioral measures

Problems with self-control are seen as a key cause of problem gambling behavior. Yet, self-control is rarely studied directly in gambling studies. We demonstrated that self-report and behavioral measures (derived from the strength model of self-control) show lower trait self-control in problem gamblers. In Study 1, a sample of 2,208 undergraduate students from the University of Guelph, Canada (73% female, mean age = 19 years, SD = 4) completed a self-report measure of self-control strength. In Study 2, a sample of 296 University of Guelph students and staff (58% female, mean age = 19 years, SD = 2) completed multiple behavioral measures of self-control strength. Both studies demonstrated that, compared to lower-risk gamblers, higher-risk gamblers have relative trait self-control deficits.

A Scoping Study of the Structural and Situational Characteristics of Internet Gambling

Internet gambling has risen greatly in recent years, yet there has been very little published research concerning the particular structural and situational characteristics of internet gambling and how these may impact on gambling behaviour and problem gambling. This study develops a comprehensive list of all the structural and situational characteristics of internet gambling and identifies those which may be more problematic for internet gambling compared with offline gambling. A scoping study was undertaken to gather evidence from a wide range of sources, including a Delphi review process among a panel of eight experts to reach consensus on the assessment rating given to each characteristic. Results show that internet gambling has a number of unique structural and situational characteristics compared to offline gambling and it would appear that a number of characteristics may be more problematic for internet gamblers compared to offline equivalents.

Gambling increases self-control strength in problem gamblers

In two studies it is demonstrated that, in the short-term, slot machine gambling increases self-control strength in problem gamblers. In Study 1 (N = 180), participants were randomly assigned to either play slot machines or engage in a control task (word anagrams) for 15 min. Subsequent self-control strength was measured via persistence on an impossible tracing task. Replicating Bergen et al. (J Gambl Stud, doi:10.1007/s10899-011-9274-9, 2011), control condition participants categorized as problem gamblers persisted for less time than did lower gambling risk participants. However, in the slot machine condition, there were no significant differences in persistence amongst participants as a function of their gambling classification. Moreover, problem gambling participants in the slot machine condition persisted at the impossible tracing task longer than did problem gambling participants in the control condition. Study 2 (N = 209) systematically replicated Study 1. All participants initially completed two tasks known to deplete self-control strength and a different control condition (math problems) was used. Study 2 results were highly similar to those of Study 1. The results of the studies have implications for the helping professions. Specifically, helping professionals should be aware that problem gamblers might seek out gambling as a means of increasing self-control strength.

The relationship between alcohol consumption, gambling behaviour and problem gambling during a single visit to a gambling venue

INTRODUCTION AND AIMS

Despite the well-documented comorbidity between disordered alcohol use and problem gambling, little is known about the co-occurrence of drinking and gambling in gambling venues. This paper appears to be the first to investigate the association between drinking and gambling behaviour among a large sample of gamblers during a specific, non-laboratory gambling episode.

DESIGN AND METHODS

We conducted a mail survey of all available households in the Northern Territory of Australia, including questions on drinking and gambling behaviour on the last visit to a gambling venue. We estimate the effect of moderate (1-4 standard drinks) and risky (>4 standard drinks) alcohol consumption on gambling participation and gambling duration for both problem and non-problem gamblers using regression analysis of 7044 survey responses.

RESULTS

The probability of participating in electronic gaming machine (EGM) gambling decreased with alcohol consumption for non-problem gamblers, while the probability of participating in TAB (Totalisator Agency Board, off-course totalisator) gambling increased with risky alcohol consumption for all gamblers. Alcohol consumption was not associated with EGM gambling participation for problem gamblers. Moderate alcohol consumption was negatively associated with EGM gambling duration, with a stronger effect observed for problem gamblers.

DISCUSSION AND CONCLUSIONS

Moderate alcohol consumption is inversely correlated with both the duration of play and probability of participation for EGM gambling. Current laboratory studies do not predict the drinking-gambling behaviour of the general population in non-laboratory settings. Future research on alcohol and gambling co-occurrence must explicitly consider the drinking and gambling environment in order to produce policy-relevant findings.

Playing video games while using or feeling the effects of substances: associations with substance use problems

This study tested the hypothesis that playing video games while using or feeling the effects of a substance—referred to herein as “concurrent use”—is related to substance use problems after controlling for substance use frequency, video gaming as an enthusiastic hobby, and demographic factors. Data were drawn from a nationally representative online survey of adult video gamers conducted by Knowledge Networks, valid n = 2,885. Problem video game playing behavior was operationalized using Tejeiro Salguero and Bersabé Morán’s 2002 problem video game play (PVP) measure, and measures for substance use problems were taken from the National Survey of Drug Use and Health (NSDUH). Separate structural equation modeling analyses were conducted for users of caffeine, tobacco, alcohol, and marijuana. In all four models, concurrent use was directly associated with substance use problems, but not with PVP. Video gaming as an enthusiastic hobby was associated with substance use problems via two indirect paths: through PVP for all substances, and through concurrent use for caffeine, tobacco, and alcohol only. Results illustrate the potential for “drug interaction” between self-reinforcing behaviors and addictive substances, with implications for the development of problem use.

Drinking patterns of pathological gamblers before, during, and after gambling treatment

Despite the high co-occurrence of alcohol consumption and gambling, few studies have investigated alcohol use changes during gambling treatment. Using latent growth modeling, we examined weekly alcohol use trajectories of treatment-seeking pathological gamblers across 36 weeks, allowing rates of change to differ across the 12-week pretreatment, during-treatment and posttreatment periods. For these secondary data analyses, we retained drinking gamblers (N = 163) from a combined sample of two randomized clinical trials for the treatment of pathological gambling. Results indicated a decrease in alcohol use corresponding with treatment entry and maintenance of less drinking during treatment and posttreatment. Despite these decreases in alcohol use overall, 31% (50 of 163) of participants exhibited risky drinking during the treatment or posttreatment periods. Gender, age, at-risk drinking (at any point in the 36-week interval), baseline gambling severity, treatment condition, and gambling during treatment predicted latent alcohol use growth factors. Although entry into gambling treatment was temporally associated with reductions in alcohol use in this retrospective analysis, a substantial portion of the sample exhibited at-risk drinking after treatment entry, suggesting that interventions targeting reductions in alcohol use may be useful for this population.

Reliability, validity, and psychometric development of the pornography consumption inventory in a sample of hypersexual men

This article reports the psychometric evaluation of the Pornography Consumption Inventory (PCI), which was developed to assess motivations for pornography use among hypersexual men. Initial factor structure and item analysis were conducted in a sample of men (N = 105) seeking to reduce their pornography consumption (Study 1), yielding a 4-factor solution. In a second sample of treatment-seeking hypersexual men (N = 107), the authors further investigated the properties of the PCI using confirmatory factor analytic procedures, reliability indices, and explored PCI associations with several other constructs to establish convergent and discriminant validity. These studies demonstrate psychometric evidence for the PCI items that measure tendencies of hypersexual men to use pornography (a) for sexual pleasure; (b) to escape, cope, or avoid uncomfortable emotional experiences or stress; (c) to satisfy sexual curiosity; and (d) to satisfy desires for excitement, novelty, and variety.

The association of at-risk, problem, and pathological gambling with substance use, depression, and arrest history

We examined at-risk, problem, or pathological gambling co-occurrence with frequency of past-year alcohol, tobacco, and marijuana use; depressive symptoms; and arrest history. Data included the responses of over 3,000 individuals who participated in a 2006 telephone survey designed to understand the extent of at-risk, problem, and pathological gambling; comorbidity levels with substance use; mental health; and social problems among Southwestern U.S. residents. Data were analyzed with multinomial and bivariate logistic regression. Respondents at risk for problem gambling were more likely to use alcohol, tobacco, and marijuana than those respondents not at risk. Pathological gamblers were no more or less likely to consume alcohol or tobacco than were non-gamblers or those not at risk. A dose-response relationship existed between degree of gambling problems and depressive symptoms and arrest history. Interventions for at-risk or problem gamblers need to include substance use treatment, and the phenomenon of low levels of substance use among pathological gamblers needs further exploration.

Effects of alcohol and initial gambling outcomes on within-session gambling behavior

Concurrent drinking and gambling is prevalent among young adults and may increase negative consequences associated with each behavior. The effects of alcohol, initial gambling outcomes, gambling-related cognitions, and impulsivity on gambling behavior were evaluated. Initial gambling outcomes, gambling-related cognitions, and impulsivity were also assessed as potential moderators of the relation between alcohol and gambling behavior. Participants (N = 130) were randomly assigned to receive active placebo or alcohol (0.84 g/kg and 0.76 g/kg for men and women, respectively) and were invited to wager on a simulated slot machine programmed to produce 1 of 3 initial outcomes (win, breakeven, or loss) before beginning a progressive loss schedule. Alcohol consumption was associated with larger average bets and more rapid loss of all available funds, though no evidence was found for predicted main effects and interactions for gambling persistence. The effect of impulsivity was moderated by beverage condition, such that higher levels of impulsivity were associated with larger average bets for participants in the placebo but not the alcohol group. Results have direct implications for individual-focused and public-health interventions.

Drinkers and bettors: investigating the complementarity of alcohol consumption and problem gambling

Regulated gambling is a multi-billion dollar industry in the United States with greater than 100% increases in revenue over the past decade. Along with this rise in gambling popularity and gaming options comes an increased risk of addiction and the associated social costs. This paper focuses on the effect of alcohol use on gambling-related problems. Variables correlated with both alcohol use and gambling may be difficult to observe, and the inability to include these items in empirical models may bias coefficient estimates. After addressing the endogeneity of alcohol use when appropriate, we find strong evidence that problematic gambling and alcohol consumption are complementary activities.

Parameters for safer gambling behavior: examining the empirical research

There have been claims that new gambling technology is hazardous to player health, and that technological interventions can alleviate gambling-related harm. In this paper, we systematically review the empirical research about the nexus between gambling and technology to evaluate the veracity of these claims. We use a public health perspective (i.e., the Epidemiologic Triangle) to organize and present study results (i.e., agent, host, and environment). This review intends to offer insight about emerging technology and identify areas that indicate a need for additional research. Forty-seven studies met our inclusion and exclusion criteria; a review of this body of work shows that attempts to develop and implement safety features for new gambling technology are promising, but methodologically are rudimentary and limited in scope. Increased attention to the dynamic interaction among host, agent, and environment factors hold potential to advance the field. In addition, improved study methods (e.g., longitudinal analyses of actual betting behavior), and collaboration among policymakers, manufacturers, and researchers can increase understanding of how new gambling technology affects the public health and stimulate new strategies for implementing effective public health interventions.

Alcohol use and prior substance abuse treatment in relation to gambling problem severity and gambling treatment outcome

Recent research has made it clear that problematic gambling is often accompanied by problematic alcohol use. Unfortunately, little is known about the nature of this association, especially as it relates to gambling treatment outcome. The purpose of this study is to explore the effect of current alcohol use level and previous substance abuse treatment on the symptoms of a large cohort of pathological gamblers as well as on their response to treatment for pathological gambling. The sample included 464 men and 301 women recruited at six gambling treatment programs in Minnesota. Gambling treatment patients were assessed on a number of gambling problem severity and related clinical variables using the Gambling Treatment Outcome Monitoring System (GAMTOMS). Patients with frequent alcohol use had greater gambling involvement at baseline than infrequent alcohol users. Patients with a previous history of substance abuse treatment had more severe psychosocial problems, ostensibly resulting from their gambling behavior, than patients without past substance abuse treatment. A MANOVA with repeated measures showed that neither pretreatment alcohol use, nor past substance abuse treatment exerted significant effects on gambling treatment outcome. While the level of pretreatment alcohol use and a history of substance abuse treatment are markers for greater gambling problem severity, treatment outcome for pathological gambling was not adversely impacted by these variables.

Measuring self-efficacy in gambling: the Gambling Refusal Self-Efficacy Questionnaire

This paper reports on the development and psychometric properties of a Gambling Refusal Self-Efficacy Questionnaire (GRSEQ). Two hundred and ninety-seven gamblers from both normal and clinical populations completed an initial set of 31-items of which 26 were selected for inclusion in the final version of the GRSEQ. A series of factor analyses showed four clear factors accounting for 84% of the variance. These factors can be summarised as situations and thoughts associated with gambling, the influence of drugs on gambling, positive emotions associated with gambling and negative emotions associated with gambling. The GRSEQ total score and factors scores showed high internal consistency (Cronbach's alpha ranging from 0.92 to 0.98). Participants experiencing problems with gambling scored significantly lower on the GRSEQ, and discriminant analyses showed that the scale is able to correctly classify the non-problem (i.e., community and student samples) and problem gamblers (i.e., clinical sample). Furthermore, the GRSEQ showed significant negative relationships with other gambling-related variables (gambling urge and gambling-related cognitions) and negative mood states (depression, anxiety and stress) and was shown to be sensitive to change in treatment of pathological gambling. The results suggest that the GRSEQ is a useful measure of gambling refusal self-efficacy that is suitable for assessment of gamblers from both normal and clinical populations.

Excitement-seeking gambling in a nationally representative sample of recreational gamblers

Excitement-seeking and related constructs have been associated with heavier gambling and negative health measures in problem and/or pathological gamblers. Most adults gamble recreationally and an understanding of the relationship between excitement-seeking as a motivation for gambling amongst subsyndromal gamblers has significant public health implications. Logistic regression analyses were used to examine a national sample of past-year recreational gamblers (N = 1,476) to identify characteristics distinguishing gamblers acknowledging gambling for excitement ("Excitement-seeking Gamblers" or EGs) and gamblers denying gambling for excitement ("Non-excitement-seeking Gamblers" or NEGs). EGs were more likely than NEGs to report alcohol use and abuse/dependence, any substance abuse/dependence, incarceration, large gambling wins and losses, more frequent and varied gambling, and symptoms of pathological gambling (i.e., at-risk gambling). Together, these findings indicate that EGs are more likely than NEGs to demonstrate problems in multiple areas characterized by impaired impulse control.

Gender differences among recreational gamblers: association with the frequency of alcohol use

This study examines the interactive effects of alcohol use and gender on health and gambling attitudes and behaviors in recreational gamblers. The Gambling Impact and Behavior Study (D. Gerstein et al., 1999) surveyed by telephone 2,417 adults targeted to be representative of the U.S. adult population. The authors compared male and female recreational gamblers (n = 1,471) who were stratified by frequency of alcohol use on measures of health and gambling. Significant Gender x Alcohol Use group interactions were observed such that moderate-to-high frequency alcohol consumption correlated with heavier gambling in men than in women, whereas such an association did not exist among abstinent or low frequency drinkers. There were few gender differences in the correlations between alcohol consumption and health. Future research should consider gender-related influences when examining alcohol use and gambling behaviors.

Problem gambling in Australian PTSD treatment-seeking veterans

This study explored gambling among Australian veterans entering posttraumatic stress treatment programs (n = 153). Twenty-eight percent reached the South Oaks Gambling Screen (SOGS) criteria for probable problem gambling, as did 17% on the DSM-IV gambling scale (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition; American Psychiatric Association, 1994). Almost all problem gamblers reported gambling to escape problems in other areas of their lives. The strongest independent predictor of problem gambling was gambling weekly or more often on electronic gaming machines. There was no significant relationship between problem gambling, posttraumatic stress disorder (PTSD), anxiety, depression, or alcohol use. The study identified an entrenched gambling culture among PTSD treatment-seeking veterans, finding these veterans indulge in many different forms of gambling and that these forms are mediated by situational factors that provide both casual and formal gambling opportunities.

Contingent Gambling-Drinking Patterns and Problem Drinking Severity Moderate Implicit Gambling-Alcohol Associations in Problem Gamblers

Although problem gambling and problem drinking often co-occur, the processes underlying this association are not well understood. This study investigated the effects of contingent gambling-drinking patterns and problem drinking severity on implicit gambling-alcohol associations. Participants were 144 (34 female) problem gamblers. The South Oaks Gambling Screen (SOGS) measured severity of problem gambling. The Brief Michigan Alcohol Screening Test (BMAST) measured severity of problem drinking. The Implicit Association Test (Greenwald, McGhee, & Schwartz, 1998, Journal of Personality and Social Psychology, 74, 1464-1480) measured gambling-alcohol associations. Participants who reported drinking when they won displayed faster response time (i.e., priming) on trials where alcohol words were paired with gambling win (e.g., jackpot) vs. gambling loss (e.g., forfeit) words. The tendency to drink in response to losses did not influence the priming effect of win cues or moderate the effects of Win-Drinking Pattern on priming. Severity of problem drinking on the BMAST also correlated positively the priming effects of win cues. These findings indicate that a tendency to drink in response to gambling wins and more severe alcohol problems each coincide with stronger associations between gambling win and alcohol concepts in memory. Such associations can promote drinking and its attendant effects (e.g., poor decision-making) in problem gamblers, and thus, may contribute to co-morbid gambling and alcohol use disorders.

Simultaneous drinking and gambling: a risk factor for pathological gambling

The aim of the current study was to determine the effect of simultaneous drinking and gambling on negative consequences from gambling. Data was analyzed from a national telephone survey of 2631 US residents aged 18 or older. Males were more likely than females to drink while gambling. Simultaneous drinking and gambling was more closely associated with video keno, pull tabs, dice (not in a casino) and casino gambling than with other types of gambling. Those who drank while gambling were more likely to be problem gamblers, even when holding constant frequency of gambling, size of the average win or loss, and average alcohol consumption. Those gamblers who are drinkers, but did not drink while gambling, had a prevalence of problem gambling of close to zero. They had a lower prevalence of problem gambling than gamblers who didn't drink alcohol at all in the past year, and a much lower prevalence than those who drank while gambling. These results were interpreted to mean that simultaneous drinking and gambling is an indicator of a more reckless gambler. The results did not support the theory that gambling while under the influence of alcohol causes more risky gambling behavior.

Definition and measurement of chasing in off-course betting and gaming machine play

The attempt to recover gambling losses by continuing to gamble ('chasing') has featured prominently in accounts of excessive gambling. This research represents the first attempt to operationalize and measure chasing in terms of its cognitive (behavioral intention), emotive (urges) and behavioral components, and to investigate the role of chasing in relation to impaired control over gambling. Two survey samples of 84 male off-course (betting shop) race gamblers (mean age 41, SD = 15) and 137 gaming machine players (73 females, mean age 48, SD = 15 and 64 males, mean age 43, SD = 16) were recruited at gambling venues. Respondents completed a structured questionnaire that investigated retrospective report of chasing and an impaired control scale ("The Scale of Gambling Choices"). It was found that the various components of chasing formed a composite measure with high internal reliability that was strongly related to indicators of excessive gambling (e.g. time spent gambling, expenditure as a proportion of income) and to impaired control scores. Reacting to large wins by further betting was almost as strongly related to impaired control as was persistence after losing. Those who returned later to chase had significantly higher impaired control scores than those who only chased within a session. Alcohol-related chasing was associated with impaired control over gambling. Chasing of losses and impaired control appear to be generic processes in evidence across both forms of gambling and gender (most format and sex differences were of minor significance).

Amphetamine primes motivation to gamble and gambling-related semantic networks in problem gamblers

Previous research suggests that gambling can induce effects that closely resemble a psychostimulant drug effect. Modest doses of addictive drugs can prime motivation for drugs with similar properties. Together, these findings imply that a dose of a psychostimulant drug could prime motivation to gamble in problem gamblers. This study assessed priming effects of oral D-amphetamine (AMPH) (30 mg) in a within-subject, counter-balanced, placebo-controlled design in problem gamblers (n=10), comorbid gamblerdrinkers (n=6), problem drinkers (n=8), and healthy controls (n=12). Modified visual analog scales assessed addictive motivation and subjective effects. A modified rapid reading task assessed pharmacological activation of words from motivationally relevant and irrelevant semantic domains (Gambling, Alcohol, Positive Affect, Negative Affect, Neutral). AMPH increased self-reported motivation for gambling in problem gamblers. Severity of problem gambling predicted positive subjective effects of AMPH and motivation to gamble under the drug. There was little evidence that AMPH directly primed motivation for alcohol in problem drinkers. On the reading task, AMPH produced undifferentiated improvement in reading speed to all word classes in Nongamblers. By contrast, in the two problem gambler groups, AMPH improved reading speed to Gambling words while profoundly slowing reading speed to motivationally irrelevant Neutral words. The latter finding was interpreted as directly congruent with models, which contend that priming of addictive motivation involves a linked suppression of motivationally irrelevant stimuli. This study provides experimental evidence that psychostimulant-like neurochemical activation is an important component of gambling addiction.

Treatment issues pertaining to pathological gamblers with a comorbid disorder

Evidence of an increased risk for various psychiatric disorders among pathological gamblers far exceeds our understanding of the impact that this psychiatric comorbidity has on the outcome of treatment for pathological gambling. One major source of the problem is that treatment efficacy and effectiveness studies for pathological gambling typically have not addressed comorbidity's impact on outcome. This paper discusses epidemiological, clinical, health service delivery, and research issues pertaining to the intersection of pathological gambling treatment outcome and comorbid psychiatric disorders. It is argued that this topic suffers from major knowledge gaps in terms of the nature of comorbidity of pathological gambling and other psychiatric disorders and the role of client characteristics on treatment outcome for pathological gambling. Research priorities are identified.

A comparison of treatment-seeking pathological gamblers based on preferred gambling activity

AIMS

To compare and contrast gamblers with different forms of problematic gambling activities. DESIGN, SETTING AND MEASUREMENTS: Pathological gamblers completed the Addiction Severity Index (ASI) and gambling questionnaires when initiating out-patient treatment.

PARTICIPANTS

Participants (n = 347) were categorized by their most problematic form of gambling activity: sports, horse/dog-races, cards, slots and scratch/lottery tickets. Differences in demographics, gambling variables, and ASI composite scores were compared across groups.

FINDINGS

After controlling for demographic variables, the types of gamblers differed in severity of gambling, alcohol and psychiatric problems. Horse/dog-race gamblers were generally older, male and less educated; they began gambling regularly at a young age and spent relatively high amounts of money gambling. Sports gamblers were young males and had intermediary gambling problems; they had relatively high rates of current substance use but few psychiatric problems. Card players spent low to moderate amounts of time and money gambling, and they generally reported few alcohol problems and little psychiatric distress. Slot machine players were older and more likely to be female. Slot gamblers began gambling later in life, had high rates of bankruptcy and reported psychiatric difficulties. Scratch/lottery gamblers spent the least amount of money gambling, but they gambled the most frequently and had relatively severe alcohol and psychiatric symptoms.

CONCLUSIONS

Gambling patterns and severity of psychosocial problems vary by form of problematic gambling, and these differences may influence treatment recommendations and outcomes.

Pathological gambling. A comprehensive review

Due to recent changes of gambling laws, accessibility to gambling has become more widespread and thus, there has also been an increase in the prevalence of pathological gambling (PG). The wide range of social, economic, and psychological problems associated with PG are well known. There is a need for better understanding of PG and this review attempts to do so. Literature searches using the Medline and PsycINFO databases were used. Critical examining of the literature showed that familial/genetic, sociological, and individual factors (e.g., an individual's personality, biochemistry, psychological states, and cognitions) are implicated in the development and maintenance of PG, yet at present, the evidences are not solid. Similarly, there have been a lot of theories for PG but again, none of them are solid enough to provide a clear understanding of PG. Recent psychological-based theories seem to provide some solid ground for further research. We highlight four areas for future consideration for research. (1) Most studies have generalized findings from one form of gambling to another. It is suggested that it is now not tenable to consider gambling as a single phenomenon that can explain all forms of gambling. (2) Almost all of the studies in the gambling literature are Western-based and the results are often generalized to other ethnic and cultural groups. There is now an urgent need to close this gap. (3) Future studies need to address methodological problems in the current gambling/PG literature. (4) Almost all of the gambling literature has focused on the issue of why people start gambling. It is suggested that looking at variables as to why people stop gambling in a single episode may be a more fruitful area of research then why people start gambling. This is because what motivates one to continue gambling, despite losses in a session and across sessions, is a characteristic that distinguishes nonproblem gamblers from problem gamblers and pathological gamblers (PGs).

Pathological gambling and comorbid substance use

OBJECTIVE

The objective of this study was to determine the rates of substance use problems in a sample of diagnosed pathological gamblers seeking treatment in a university teaching hospital cognitive behavioural outpatient clinic.

METHODS

A semistructured interview schedule and the composite international diagnostic interview (CIDI-auto) were administered to assess substance dependence in a sample of 75 poker-machine gamblers meeting DSM-IV and South Oaks gambling screen (SOGS) criteria for pathological gambling. Both the self-reported rates and the proportion meeting criteria for a psychiatric disorder were determined.

RESULTS

The rates for substance use disorder within a sample of treatment-seeking pathological gamblers is higher as compared to general population figures. Gender differences were found with more current alcohol-abuse problems reported among male than female participants. Non-alcohol-related substance abuse was relatively lower than rates reported by other studies in the literature.

CONCLUSIONS

Substance abuse is a common comorbid condition of pathological gambling and therefore should be screened for in routine clinical assessments. Failure to identify and treat comorbid substance-use disorders in gamblers may lead to higher relapse rates.

A reformulated cognitive-behavioral model of problem gambling. A biopsychosocial perspective

With most Western countries expanding the availability of gambling facilities in recent decades, considerable research interest has developed in those people who develop problematic levels of gambling. In the recent decade, a large body of research has been conducted into the determinants of gambling behavior in an attempt to understand this complex social and psychological problem. Research has varied in its nature from investigating underlying biological, psychological, or social factors that are hypothesized to contribute to gambling behavior. Evidence now exists that biological, psychological, and social factors are all relevant to the development of problematic levels of gambling. However, the theoretical explanation for gambling has lagged behind the advances in empirical work in recent years. The purpose of the current paper is to provide a review of the major research findings in the area of gambling and propose a biopsychosocial model that integrates diverse areas of research. The model described is empirically derived, and it is hoped it will stimulate future research work that investigates not only individual factors and their relationship to gambling, but also the interactions between different variables.