Telescoping and gender differences in the time course of disordered gambling: evidence from a general population sample

Emotional dependence as a predictor of emotional symptoms and substance abuse in individuals with gambling disorder: differential analysis by sex

INTRODUCTION

Emotional dependence, anxious-depressive symptoms and substance use have been associated with gambling disorder (GD). Although anxiety and depression have been predominantly related to female gamblers and substance abuse to male gamblers, the role of emotional dependence in GD is unknown. Moreover, sex differences remain underexplored.

OBJECTIVES

First, to explore possible differences in emotional dependence, anxious-depressive symptoms and substance abuse by group (GD and non-GD) and sex (women vs men). Second, to analyse the predictive role of emotional dependence in alcohol and drug abuse and anxious-depressive symptoms in patients with GD as a function of sex.

METHODS

Instruments to measure gambling (SOGS), emotional dependence (CDE), anxious-depressive symptoms (SCL-90-R) and substance abuse (MULTICAGE CAD-4) were administered to 108 people with GD diagnosis (60 women and 48 men) and 429 without GD (342 women and 87 men).

STUDY DESIGN

The research is an analytical cross-sectional study.

RESULTS

The results showed that the group with GD scored significantly higher than the non-GD group on alcohol abuse, symptoms of depression and anxiety, and emotional dependence, but not on drug abuse. In the group with GD, emotional dependence predicted alcohol and drug abuse in women, and emotional dependence predicted anxiety and depressive symptoms in men.

CONCLUSION

The findings suggest that women with GD who consume alcohol or drugs would benefit from therapies addressing loneliness, borderline expression, attention-seeking and affective expression. Men with GD who report anxious-depressive symptomatology would benefit from therapeutic strategies to deal with separation anxiety and attention-seeking.

Peer and Parental Social Norms as Determinants of Gambling Initiation: A Prospective Study

PURPOSE

Despite the potential consequences of gambling during adolescence, the factors involved in the initiation of this behavior are relatively understudied. Using a longitudinal design, the present study analyzed the contribution of parental and peer norms to adolescent gambling initiation.

METHODS

A sample of 440 adolescent non-gamblers (50.9% males, mean_age = 14.85 [standard deviation = 1.41]) completed a baseline survey and a 1-year follow-up questionnaire. The baseline survey included assessments of perceived descriptive and injunctive norms from parents and peers, perceived parent and peer gambling severity, and susceptibility to peer pressure. A multivariate hierarchical logistic regression model was used to assess the contribution of baseline measures to adolescent gambling initiation at follow-up.

RESULTS

Of the 440 non-gamblers assessed at baseline, 160 (36.4%) reported initiating gambling at follow-up. All the peer factors were prospectively associated with gambling initiation, while only the perceived injunctive norms of parents were associated with initiation. Higher susceptibility to peer pressure, perceived gambling by peers, and peer and parental approval of gambling at baseline were associated with higher odds of adolescent gambling initiation at follow-up. In contrast, the likelihood of gambling initiation among adolescents decreased as the perception of peer gambling severity increased.

DISCUSSION

The identification of parental and peer factors associated with adolescent gambling initiation may provide support for relevant preventative interventions aimed at avoiding or delaying gambling initiation among adolescents. Specifically, to reduce the initiation of gambling, preventative programs should focus on helping adolescents to find strategies for resisting peer influences.

Sex/Gender Differences in the Time-Course for the Development of Substance Use Disorder: A Focus on the Telescoping Effect

Sex/gender effects have been demonstrated for multiple aspects of addiction, with one of the most commonly cited examples being the "telescoping effect" where women meet criteria and/or seek treatment of substance use disorder (SUD) after fewer years of drug use as compared with men. This phenomenon has been reported for multiple drug classes including opioids, psychostimulants, alcohol, and cannabis, as well as nonpharmacological addictions, such as gambling. However, there are some inconsistent reports that show either no difference between men and women or opposite effects and a faster course to addiction in men than women. Thus, the goals of this review are to evaluate evidence for and against the telescoping effect in women and to determine the conditions/populations for which the telescoping effect is most relevant. We also discuss evidence from preclinical studies, which strongly support the validity of the telescoping effect and show that female animals develop addiction-like features (e.g., compulsive drug use, an enhanced motivation for the drug, and enhanced drug-craving/vulnerability to relapse) more readily than male animals. We also discuss biologic factors that may contribute to the telescoping effect, such as ovarian hormones, and its neurobiological basis focusing on the mesolimbic dopamine reward pathway and the corticomesolimbic glutamatergic pathway considering the critical roles these pathways play in the rewarding/reinforcing effects of addictive drugs and SUD. We conclude with future research directions, including intervention strategies to prevent the development of SUD in women. SIGNIFICANCE STATEMENT: One of the most widely cited gender/sex differences in substance use disorder (SUD) is the "telescoping effect," which reflects an accelerated course in women versus men for the development and/or seeking treatment for SUD. This review evaluates evidence for and against a telescoping effect drawing upon data from both clinical and preclinical studies. We also discuss the contribution of biological factors and underlying neurobiological mechanisms and highlight potential targets to prevent the development of SUD in women.

Underlying Mechanisms Involved in Gambling Disorder Severity: A Pathway Analysis Considering Genetic, Psychosocial, and Clinical Variables

Gambling Disorder (GD) has a complex etiology that involves biological and environmental aspects. From a genetic perspective, neurotrophic factors (NTFs) polymorphisms have been associated with the risk of developing GD. The aim of this study was to assess the underlying mechanisms implicated in GD severity by considering the direct and mediational relationship between different variables including genetic, psychological, socio-demographic, and clinical factors. To do so, we used genetic variants that were significantly associated with an increased risk for GD and evaluated its relationship with GD severity through pathway analysis. We found that the interaction between these genetic variants and other different biopsychological features predicted a higher severity of GD. On the one hand, the presence of haplotype block 2, interrelated with haplotype block 3, was linked to a more dysfunctional personality profile and a worse psychopathological state, which, in turn, had a direct link with GD severity. On the other hand, having rs3763614 predicted higher general psychopathology and therefore, higher GD severity. The current study described the presence of complex interactions between biopsychosocial variables previously associated with the etiopathogenesis and severity of GD, while also supporting the involvement of genetic variants from the NTF family.

Gambling: Exploring the Role of Gambling Motives, Attachment and Addictive Behaviours Among Adolescents and Young Women

There is a growing body of research that seeks to understand the aetiology, consequences and risk factors associated with addictive behaviours in youths. However, research examining the specific profile of adolescent females is very limited. Therefore, the objectives of the present study were, firstly, to explore the differences between attachment, gambling motives (social enhancement and coping), positive and negative affect, and addictive behaviours (gambling, drugs, spending, alcohol and video games) in female adolescents with and without risk of gambling problems. Secondly, the relationships between attachment, gambling motives, positive and negative affect and addictive behaviours were analysed in the subsample of female adolescents with problem gambling Thirdly, we examine the predictive role of positive and negative affect, gambling motives, and attachment in the aforementioned addictive behaviours. The sample was composed of 351 adolescents and young women, of which 312 had no risk of gambling and 39 had gambling problems. The results obtained revealed higher scores in drugs, spending, maternal attachment, and all gambling motives in the group of gambling problems. Likewise, analyses showed that the relevance of the predictor variables (attachment, gambling motives, and affect) varied according to the addiction that was taken as a reference point (i.e., gambling, drugs, spending, alcohol and video games).Consequently, the identification of the possible vulnerability factors for each addiction could be useful in the design of prevention and treatment approaches. In addition, the need for integrated and holistic health- and social- care programmes are suggested in terms of sex and age.

Drug-Induced Gambling Disorder: Epidemiology, Neurobiology, and Management

Problematic gambling has been suggested to be a possible consequence of dopaminergic medications used mainly in neurological conditions, i.e. pramipexole and ropinirole, and possibly by one antipsychotic compound, aripiprazole. Patients with Parkinson's disease, restless legs syndrome and other conditions potentially treated with dopamine agonists, as well as patients treated for psychotic disorders, are vulnerable patient groups with theoretically increased risk of developing gambling disorder (GD), for example due to higher rates of mental ill-health in these groups. The aim of the present paper is to review the epidemiological, clinical, and neurobiological evidence of the association between dopaminergic medications and GD, and to describe risk groups and treatment options. The neurobiology of GD involves the reward and reinforcement system, based mainly on mesocorticolimbic dopamine projections, with the nucleus accumbens being a crucial area for developing addictions to substances and behaviors. The addictive properties of gambling can perhaps be explained by the reward uncertainty that activates dopamine signaling in a pathological manner. Since reward-related learning is mediated by dopamine, it can be altered by dopaminergic medications, possibly leading to increased gambling behavior and a decreased impulse control. A causal relationship between the medications and GD seems likely, but the molecular mechanisms behind this association have not been fully described yet. More research is needed in order to fully outline the clinical picture of GD developing in patient groups with dopaminergic medications, and data are needed on the differentiation of risk in different compounds. In addition, very few interventional studies are available on the management of GD induced by dopaminergic medications. While GD overall can be treated, there is need for treatment studies testing the effectiveness of tapering of the medication or other gambling-specific treatment modalities in these patient groups.

Prevalence and comorbidity in a Swedish adolescent community sample - gambling, gaming, substance use, and other psychiatric disorders

BACKGROUND

This study investigates a broad spectrum of psychiatric disorders, substance use disorders, gambling, and internet gaming disorders in Swedish 18-year-old boys and girls with the aim of estimating the prevalence of disorders and comorbidity.

METHODS

We used a two-phase design with screening to detect candidates for clinical interviews. Screening included 949 adolescents (55.6% girls), out of which 758 adolescents (57.0% girls) were selected for interview with at least one of four instruments: M.I.N.I., ADDIS, NODS and IGDS. Of these, 387 (61.2% girls) were interviewed. Gender separated prevalence was estimated on the assumption that those selected but not interviewed had the same distribution as those interviewed based on similar outcomes above screening cut-offs. Comorbidity between types of disorders was estimated on similar assumptions. In addition, comorbidity between dyads of the ten most common specified disorders was calculated based on recorded data without these assumptions.

RESULTS

We estimated that 14.6% met the criteria of a substance use disorder (SUD), mostly concerning alcohol and more frequent in girls than in boys. Those meeting the criteria lifetime of at least one of 16 other psychiatric disorders were 26.7%, more than twice as frequent in girls compared to boys, and with depression being the most common disorder. Gambling and gaming disorders were found almost exclusively in boys, of which 5.8% met the criteria for gambling, and 2.3% for gaming disorders. Of girls with a SUD, 40% also had a psychiatric disorder, while on the other hand more than 28% of girls with a psychiatric disorder also had a SUD. In boys with a SUD, 22% had another psychiatric disorder, while 15% of those with a psychiatric disorder also had a SUD.

CONCLUSIONS

Psychiatric comorbidity is common in SUDs in adolescents, which calls for screening and diagnostic efforts in young patients presenting with symptoms of SUDs. Girls with SUDs are at higher risk of also suffering from psychiatric conditions. Gambling and gaming disorders appear in a substantial minority of adolescents and warrant further study of their comorbidity. Since prevalences and comorbidity were estimated on the assumptions mentioned, some caution in interpreting the results is needed.

Differences in problem and pathological gambling: A narrative review considering sex and gender

Background and aim

A wide range of studies indicates that men and women with Problem (PrG) and Pathological Gambling (PG) differ in several clinical and sociodemographic characteristics. However, evidence for sex differences, such as the telescoping effect, is contradictory, and it is still unclear whether sex differences observed in offline gambling can also be found for online gambling. Furthermore, reviews have so far focused on binary sex differences but neglect gender aspects. In this study, an updated literature survey of sex- and gender-related differences in PrG and PG was conducted.

Methods

We searched PsyInfo, Medline/Pubmed, and the Web of Science databases from 2005 to 2020 for studies investigating sex and gender differences in gambling. A total of 126 papers were included in the literature survey.

Results

We are presenting our findings according to the categories 'prevalence' (offline, online, LGBTQI*), 'sociodemographic factors', 'preferred gambling type', 'gambling motives', 'severity', 'progression of gambling problems', 'use of professional help/motivation for treatment', 'comorbidity', 'trauma', 'violence and criminality/delinquency'. The studies indicate that, despite some robust sex differences (e.g., concerning prevalence rates), results for most areas were mixed or suggest no sex differences (e.g., violence, gambling motives).

Discussion and conclusion

To date, there is a lack of studies assessing gender, and not only sex, warranting further research in this area.

A Normative Feedback Intervention on Gambling Behavior-A Longitudinal Study of Post-Intervention Gambling Practices in At-Risk Gamblers

BACKGROUND

In problem gambling, normative personalized feedback interventions have demonstrated promising effects. Given the widespread increase in online gambling in recent years, internet-delivered normative feedback may serve as a promising intervention. This study aimed to examine whether such an intervention, delivered by a gambling operator and aiming to help problem gamblers decrease their gambling, may in fact be associated with lower gambling practices post-intervention.

METHODS

Online questions on norms and beliefs about one's own and peers' gambling habits, derived from the Gambling Quantity and Perceived Norms Scale, were followed by personalized feedback, delivered online by the Swedish state-owned gambling operator. A total of 1,453 gamblers consented to participate in a pre-post measure of wagering levels.

RESULTS

Wagering decreased significantly post-intervention (28 days) compared to pre-intervention (28 days prior). The decrease was significantly more pronounced in younger and online casino gamblers. In an 84-day follow-up, the decrease remained significant, although less pronounced.

CONCLUSIONS

An online normative intervention delivered by a state-owned gambling operator, addressing norms and beliefs about gambling levels, may lower risky gambling in the short term. Implications and further research needs are discussed.

Clinical differences between men and women in a Swedish treatment-seeking population with gambling disorder

INTRODUCTION

The purpose of this study was to explore clinical differences in Swedish treatment-seeking men and women with gambling disorder (GD). As the prevalence of GD is increasing among women, even though men are still highly overrepresented, the characteristic differences between men and women seeking treatment become increasingly important.

METHOD

A sample of 204 patients with GD (26.5% women and 73.5% men) at an outpatient clinic were diagnosed using the SCI-GD, screened for comorbid diagnoses using the MINI, and further completed a range of self-report questionnaires measuring demographics, GD, alcohol and other drug problems, symptoms of depression and anxiety, and pathways into gambling problems.

RESULTS

Several characteristics differed between treatment-seeking men and women in our sample. Examples of differences between genders included age, onset age, living situation, duration, alcohol and drug problems, comorbidity, and pathways leading to gambling problems.

DISCUSSION

The most evident difference was that women, in addition to GD, showed more symptoms of anxiety and depression than men, while men had a higher degree of substance use problems compared to women. The differences in clinical features between men and women are important to consider in treatment planning and possibly for future gender-based interventions.

Clustering Treatment Outcomes in Women with Gambling Disorder

The rising prevalence of gambling disorder (GD) among women has awakened considerable interest in the study of therapeutic outcomes in females. This study aimed to explore profiles of women seeking treatment for GD based on a set of indicators including sociodemographic features, personality traits, clinical state at baseline, and cognitive behavioral therapy (CBT) outcomes. Two-step clustering, an agglomerative hierarchical classification system, was applied to a sample of n = 163 women of ages ranging from 20 to 73 years-old, consecutively attended to by a clinical unit specialized in the treatment of G. Three mutually exclusive clusters were identified. Cluster C1 (n = 67, 41.1%) included the highest proportion of married, occupationally active patients within the highest social status index. This cluster was characterized by medium GD severity levels, the best psychopathological functioning, and the highest mean in the self-directedness trait. C1 registered 0% dropouts and only 14.9% relapse. Cluster C2 (n = 63; 38.7%) was characterized by the lowest GD severity, medium scores for psychopathological measures and a high risk of dropout during CBT. Cluster C3 (n = 33; 20.2%) registered the highest GD severity, the worst psychopathological state, the lowest self-directedness level and the highest harm-avoidance level, as well as the highest risk of relapse. These results provide new evidence regarding the heterogeneity of women diagnosed with GD and treated with CBT, based on the profile at pre- and post-treatment. Person-centered treatments should include specific strategies aimed at increasing self-esteem, emotional regulation capacities and self-control of GD women.

Women and gambling disorder: Assessing dropouts and relapses in cognitive behavioral group therapy

BACKGROUND

Gender-specific literature focused on gambling disorder (GD) is scarce, and women with GD have been understudied. Therefore, the aim of this study was to estimate the short-term effectiveness in women with GD (n = 214) of a group standardized cognitive-behavioral therapy (CBT) and to identify the most relevant predictors of the primary therapy outcomes (dropout and relapse).

METHODS

The manualized CBT consisted of 16 weekly outpatient group sessions. Women were provided with resources to obtain a better understanding of the GD, to improve self-control and to manage risk situations.

RESULTS

The dropout risk was higher for women with lower GD severity and higher psychopathological distress. Among other factors, lower education levels were a significant predictor of the relapse risk and and the frequency of relapses was higher for divorced women with a preference for non-strategic gambling and with substances consumption.

CONCLUSIONS

Our findings evidence women-specific predictors of the primary therapy outcomes. The results highlight the need to design psychological interventions that address dropout and relapse risk factors in women.

The transition time to gambling disorder: The roles that age, gambling preference and personality traits play

BACKGROUND AND AIMS

Gambling Disorder (GD) is considered a heterogeneous, multidimensional pathology with high personal and social consequences. The transition time (TT) between problematic gaming and pathological gambling, which varies significantly across patients, may predict the disorder's severity. As only limited studies have investigated the factors implicated in the TT, the current study set out to identify its predictors and their relationships with GD severity.

METHODS

Correlation were performed in 725 male GD patients to identify factors associated to TT and GD severity, including: age of onset of gambling behaviors, alcohol/drug use, personality traits and gambling preferences (i.e., strategic, non-strategic, and mixed). Then a regression analysis was performed to identify predictors of TT to GD.

RESULTS

Longer TT correlated with higher GD severity, early age of onset of problematic gambling, substance use and a non-strategic gambling preference. Personality traits including low self-directedness, high novelty seeking, and low cooperativeness were also related with longer TT. The strongest associations with GD severity were substance use, and some of the personality traits (i.e., low self-directedness and cooperativeness, high harm avoidance and self-transcendence). Factors significantly predicting longer transition to GD were older ages, low self-directedness, and non-strategic gambling.

CONCLUSIONS

A clinical profile characterized by a longer TT and more severe GD symptoms pertains to older patients with low self-directedness, and preference for non-strategic gambling. Other relevant factors associated with this profile of patients included early age of onset problematic gambling, substance consumption, high novelty seeking and low cooperativeness.

Moderator effect of sex in the clustering of treatment-seeking patients with gambling problems

BACKGROUND

There are no studies based on a person-centered approach addressing sex-related differences in the characteristics of treatment-seeking patients with gambling disorder (GD). The main objective of the current study is to identify empirical clusters of GD based on several measures of the severity of gambling behavior, and considering the potential role of patient sex as a moderator.

METHODS

An agglomerative hierarchical clustering method was applied to an adult sample of 512 treatment-seeking patients (473 men and 39 women) by using a combination of the Schwarz Bayesian Information Criterion and log-likelihood function.

RESULTS

Three clusters were identified in the subsample of men: cluster M1 (low-mild gambling severity level, 9.1%), cluster M2 (moderate level, 60.9%), and cluster M3 (severe level, 30.0%). In the women subsample, two clusters emerged: cluster W1 (mild-moderate level, 64.1%), and cluster W2 (severe level, 35.9%). The most severe GD profiles were related to being single, multiple gambling preference for nonstrategic plus strategic games, early onset of the gambling activity, higher impulsivity levels, higher dysfunctional scores in the personality traits of harm avoidance, and self-directedness, and higher number of lifespan stressful life events (SLE). Differences between the empirical men and women clusters were found in different sociodemographic and clinical measurements.

CONCLUSIONS

Men and women have distinct profiles regarding gambling severity that can be identified by a clustering approach. The sociodemographic and clinical characterization of each cluster by sex may help to establish specific preventive and treatment interventions.

Problem and non-problem gamblers: a cross-sectional clustering study by gambling characteristics

OBJECTIVES

Gambling characteristics are factors that could influence problem gambling development. The aim of this study was to identify a typology of gamblers to frame risky behaviour based on gambling characteristics (age of initiation/of problem gambling, type of gambling: pure chance/chance with pseudoskills/chance with elements of skill, gambling online/offline, amount wagered monthly) and to investigate clinical factors associated with these different profiles in a large representative sample of gamblers.

DESIGN AND SETTING

The study is a cross-sectional analysis to the baseline data of the french JEU cohort study (study protocol : Challet-Bouju et al, 2014). Recruitment (April 2009 to September 2011) involved clinicians and researchers from seven institutions that offer care for or conduct research on problem gamblers (PG). Participants were recruited in gambling places, and in care centres. Only participants who reported gambling in the previous year between 18 and 65 years old were included.Participants gave their written informed consent, it was approved by the French Research Ethics Committee.

PARTICIPANTS

The participants were 628 gamblers : 256 non-problem gamblers (NPG), 169 problem gamblers without treatment (PGWT) and 203 problem gamblers seeking treatment (PGST).

RESULTS

Six clustering models were tested, the one with three clusters displayed a lower classification error rate (7.92%) and was better suited to clinical interpretation : 'Early Onset and Short Course' (47.5%), 'Early Onset and Long Course' (35%) and 'Late Onset and Short Course' (17.5%). Gambling characteristics differed significantly between the three clusters.

CONCLUSIONS

We defined clusters through the analysis of gambling variables, easy to identify, by psychiatrists or by physicians in primary care. Simple screening concerning these gambling characteristics could be constructed to prevent and to help PG identification. It is important to consider gambling characteristics : policy measures targeting gambling characteristics may reduce the risk of PG or minimise harm from gambling.

TRIAL REGISTRATION NUMBER

NCT01207674 (ClinicalTrials.gov); Results.

Gender-related functional connectivity and craving during gaming and immediate abstinence during a mandatory break: Implications for development and progression of internet gaming disorder

BACKGROUND

Although males more frequently develop Internet gaming disorder (IGD) as compared with females, few studies have examined gender-related neurocognitive differences in IGD. TASK AND DESIGN: fMRI and subjective data were collected from 119 subjects (IGD, male 29, female 25; recreational game use (RGU), male 34, female 31) when they were actively playing games and during a forced mandatory break. Analyses investigating effects of group (IGD, RGU) and gender (male, female) on the functional connectivity (FC) of executive control and reward systems linked to the dorsolateral prefrontal cortex (DLPFC) and striatum, respectively, were performed. Correlations between FC and subjective craving measures were also calculated.

RESULTS

Gaming-group-by-gender interactions were observed. During gaming in males but not in females, the FC between the DLPFC and superior frontal gyrus was relatively decreased, and that between the striatum and thalamus was relatively increased. During the mandatory break, changes in the FC between DLPFC and superior frontal gyrus and the FC between the striatum and thalamus varied by gender with greater RGU-IGD differences observed in females. Significant correlations between FC and self-reported craving were observed.

CONCLUSIONS

During both gaming and a forced mandatory break, brain regions implicated in executive control and reward processing showed changes in FC that varied by gender. Brain regions implicated in executive control showed differential FC in males during gaming, and FC during the forced mandatory break appeared relevant to both genders, and perhaps particularly for females. The findings suggest possible neural mechanisms for why males appear more likely to develop IGD, and why it may be particularly difficult for individuals with IGD to cease gaming.

A national survey of online gambling behaviours

OBJECTIVES

The aim of this study is to look at an Irish population in relation to the online gambling activities people are engaging with, the reasons for gambling online, their attitudes to online gambling and the financial/mental health consequences of online gambling.

METHODS

The outline for this study was adapted from a study by McCormack et al. (2014) in relation to online gambling, with the aim of replicating this study in an Irish population. An online survey consisting of 11 categories related to online gambling was advertised online over a 7-month period. Participants answered on activities gambled online, devices used, duration of time gambling, as well mental health/financial consequences of their gambling.

RESULTS

A total of 208 users participated in the online survey. The most popular gambling activity played was Sports Betting (26.9%) and the most commonly used device was Mobile app (68.6%). The main reason for gambling online was 'To win money' (84.6%), the main reason for ending gambling sessions - 'Had something else to do' (67.3%) and the most prominent emotion experienced - Excitement (60.6%). There were findings related to the severity of gambling addiction (75% - had to borrow or sell to fund gambling) and their attitudes towards online gambling (strongly agreed - 39.9% - The potential dangers of gambling should be advertised).

CONCLUSIONS

Online gamblers in Ireland share similar behavioural profiles to online gamblers in the United Kingdom and worldwide. The majority of participants in this research have been adversely affected from both a mental and financial perspective due to their gambling behaviours.

Clinical neuropsychiatric considerations regarding nonsubstance or behavioral addictions

Over the past several decades, non-substance-use behaviors like gambling, gaming, and sex have received greater consideration as possible foci of addictions. In this article, I will review the recent history and current status of non-substance or behavioral addictions. A main focus will involve gambling and gambling disorder, given that the latter is currently the sole non-substance addictive disorder described in the main text of the current (fifth) edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Internet gaming disorder, currently in the DSM-5 section addressing conditions that may need additional research, will also be considered, as will the concept of Internet addiction. Compulsive sexual behaviors (including problematic pornography use) will be considered, particularly with respect to how behavioral addictions may be considered in the forthcoming 11th edition of the International Classification of Diseases (ICD-11).

Clustering of treatment-seeking women with gambling disorder

BACKGROUND

The prevalence of gambling disorder (GD) in women has increased, but, to date, few studies have explored the features of clinical GD subtypes in female samples.

AIMS

The aim of this study is to identify empirical clusters based on clinical/sociodemographic variables in a sample of treatment-seeking women with GD.

METHODS

Agglomerative hierarchical clustering was applied to a sample of n = 280 patients, using sociodemographic variables, psychopathology, and personality traits as indicators for the grouping procedure.

RESULTS

Three mutually exclusive groups were obtained: (a) Cluster 1 (highly dysfunctional; n = 82, 29.3%) endorsed the highest levels in gambling severity, comorbid psychopathology, novelty seeking, harm avoidance, and self-transcendence, and the lowest scores in self-directedness and cooperativeness; (b) Cluster 2 (dysfunctional; n = 142, 50.7%) achieved medium mean scores in gambling severity and psychopathological symptoms; and (c) Cluster 3 (functional; n = 56, 20.0%) obtained the lowest mean scores in gambling severity and in psychopathology, and a personality profile characterized by low levels in novelty seeking, harm avoidance, and self-transcendence, and the highest levels in self-directedness and cooperativeness.

DISCUSSION AND CONCLUSIONS

This study sheds light on the clinical heterogeneity of women suffering from GD. Identifying the differing features of women with GD is vital to developing prevention programs and personalized treatment protocols for this overlooked population.

Trends in gambling participation and gambling severity among Finnish men and women: cross-sectional population surveys in 2007, 2010 and 2015

OBJECTIVE

The aim of this study is to evaluate trends in past-year gambling participation and gambling severity among Finnish men and women from 2007 to 2015.

DESIGN

Cross-sectional population surveys from years 2007, 2011 and 2015.

SETTING

Data were drawn from the population register and collected using computer-assisted telephone interviews.

PARTICIPANTS

Representative random samples of Finns aged 15-74 were drawn in the study in 2007 (n=5008), 2011 (n=4484) and 2015 (n=4515) with response rates of 58%, 40% and 62%, respectively.

OUTCOME MEASURES

The outcome measures were gambling versatility, type of games, gambling intensity and gambling severity. Significance (p) between time points was determined using χ2 tests. All temporal comparisons between 2007-2011, 2011-2015 and 2007-2015 were performed separately for all respondents aged 15-74 and for women and men.

RESULTS

Gambling participation overall showed a rising trend (6.6 percentage points, 95% CI 4.9 to 8.3) from 2007 to 2015. In 2007-2011 women's gambling participation increased more (7.8 percentage points, 95% CI 5.5 to 10.4) than men's (5.4 percentage points, 95% CI 3.2 to 7.6). The most popular game types since 2007 have been lottery games, scratch cards and electronic gaming machines (EGMs). EGM gambling, on the other hand, has decreased since 2007. Online gambling has increased significantly from 2007 to 2015 in both genders. Men's at-risk gambling decreased from 2007 to 2011, while women's at-risk gambling and problem gambling increased from 2011 to 2015.

CONCLUSIONS

Women's increasing gambling participation is causing gender differences in gambling behaviour to narrow. The article concludes with a discussion of the need for gender-specific interventions aimed at preventing gambling-related harm and ultimately at protecting the most vulnerable groups.

The Telescoping Phenomenon: Origins in Gender Bias and Implications for Contemporary Scientific Inquiry

BACKGROUND

In an article published in International Journal of the Addictions in 1989, Nick Piazza and his coauthors described "telescoping," an accelerated progression through "landmark symptoms" of alcoholism, among a sample of recovering women.

OBJECTIVES

The aim of this critical analysis is to apply a feminist philosophy of science to examine the origins of the framework of telescoping research and its implications for contemporary scientific inquiry.

METHODS

A feminist philosophy of science framework is outlined and applied to key source publications of telescoping literature drawn from international and United States-based peer-reviewed journals published beginning in 1952.

RESULTS

A feminist philosophy of science framework identifies gender bias in telescoping research in three ways. First, gender bias was present in the early conventions that laid the groundwork for telescoping research. Second, a "masculine" framework was present in the methodology guiding telescoping research. Third, gender bias was present in the interpretation of results as evidenced by biased comparative language.

CONCLUSIONS

Telescoping research contributed to early evidence of critical sex and gender differences helping to usher in women's substance abuse research more broadly. However, it also utilized a "masculine" framework that perpetuated gender bias and limited generative, novel research that can arise from women-focused research and practice. A feminist philosophy of science identifies gender bias in telescoping research and provides an alternative, more productive approach for substance abuse researchers and clinicians.

Genetic and environmental origins of gambling behaviors from ages 18 to 25: A longitudinal twin family study

Gambling behaviors tend to increase in prevalence from late adolescence to young adulthood, and the underlying genetic and environmental influences during this period remain largely understudied. We examined the genetic and environmental influences on gambling behaviors contributing to stability and change from ages 18 to 25 in a longitudinal, behavioral genetic mixed-sex twin study design. Participants were enrolled in the Minnesota Twin Family Study. A range of gambling behaviors (maximum frequency, average frequency, money lost, and gambling problems) were assessed at ages 18 and 25. The results of our study support the following conclusions: (a) the genetic and environmental factors impacting a range of gambling behaviors are largely similar in men and women, (b) genetic factors increase in influence from 18 to 25 (21% at age 18 to 57% at age 25), (c) shared environmental factors are influential at age 18, but tend to decrease from ages 18 to 25 (55% at age 18 to 10% at age 25), and (d) nonshared environmental influences are similarly significant and are small to moderate in magnitude at both ages. The findings add to a small yet important research area regarding determinants of youth gambling behaviors and have the potential to inform prevention and intervention efforts. (PsycINFO Database Record

Clinical neuropsychiatric considerations regarding nonsubstance or behavioral addictions

Over the past several decades, non-substance-use behaviors like gambling, gaming, and sex have received greater consideration as possible foci of addictions. In this article, I will review the recent history and current status of non-substance or behavioral addictions. A main focus will involve gambling and gambling disorder, given that the latter is currently the sole non-substance addictive disorder described in the main text of the current (fifth) edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Internet gaming disorder, currently in the DSM-5 section addressing conditions that may need additional research, will also be considered, as will the concept of Internet addiction. Compulsive sexual behaviors (including problematic pornography use) will be considered, particularly with respect to how behavioral addictions may be considered in the forthcoming 11th edition of the International Classification of Diseases (ICD-11).

Local area disadvantage and gambling involvement and disorder: Evidence for gene-environment correlation and interaction

Previous research has demonstrated that local area characteristics (such as disadvantage and gambling outlet density) and genetic risk factors are associated with gambling involvement and disordered gambling. These 2 lines of research were brought together in the present study by examining the extent to which genetic contributions to individual differences in gambling involvement and disorder contributed to being exposed to, and were also accentuated by, local area disadvantage. Participants were members of the national community-based Australian Twin Registry who completed a telephone interview in which the past-year frequency of gambling and symptoms of disordered gambling were assessed. Indicators of local area disadvantage were based on census data matched to the participants' postal codes. Univariate biometric model-fitting revealed that exposure to area disadvantage was partially explained by genetic factors. Bivariate biometric model-fitting was conducted to examine the evidence for gene-environment interaction while accounting for gene-environment correlation. These analyses demonstrated that: (a) a small portion of the genetic propensity to gamble was explained by moving to or remaining in a disadvantaged area, and (b) the remaining genetic and unique environmental variation in the frequency of participating in electronic machine gambling (among men and women) and symptoms of disordered gambling (among women) was greater in more disadvantaged localities. As the gambling industry continues to grow, it will be important to take into account the multiple contexts in which problematic gambling behavior can emerge-from genes to geography-as well as the ways in which such contexts may interact with each other.

Gender Differences in Treatment-Seeking British Pathological Gamblers

Background and aim Gambling is a widespread recreational activity in the UK. A significant percentage of gamblers develop subclinical or clinically relevant problem gambling issues, but only a low percentage of them seek treatment. Although characteristics of pathological gamblers from treatment-seeking population have been examined in some research, only a few studies have explored the differences between females and males. This study aimed to examine the gender-related differences in demographics, gambling measures, and clinical variables in an outpatient sample of pathological gamblers seeking treatment. Methods A total of 1,178 treatment-seeking individuals with gambling disorder were assessed at the National Problem Gambling Clinic in London. Sociodemographic characteristics, clinical variables, and gambling behavior habits were obtained during the assessment evaluation. Of the total sample, 92.5% were males and 7.5% were females. Results Males were more likely to be younger, white, and employed than females. In addition, compared to women, men showed a lower PGSI score, an earlier age of onset of gambling behavior, a higher gambling involvement, and preferred specific forms gambling. Female gamblers were more anxious and depressed, while men were more likely to use alcohol and illicit drugs. Conclusions Our findings support the importance of gender differences in a treatment-seeking population of pathological gamblers both in sociodemographic characteristics, gambling behavior variables, and clinical variables. Males and females might benefit from group-specific treatment.

Compulsive Buying Behavior: Characteristics of Comorbidity with Gambling Disorder

Compulsive buying behavior (CBB) has begun to be recognized as a condition worthy of attention by clinicians and researchers. Studies on the commonalities between CBB and other behavioral addictions such as gambling disorder (GD) exist in the literature, but additional research is needed to assess the frequency and clinical relevance of the comorbidity of CBB and GD. The aim of the study was to estimate the point-prevalence of CBB+GD in a clinical setting. Data corresponded to n = 3221 treatment-seeking patients who met criteria for CBB or GD at a public hospital unit specialized in treating behavioral addictions. Three groups were compared: only-CBB (n = 127), only-GD (n = 3118) and comorbid CBB+GD (n = 24). Prevalence for the co-occurrence of CBB+GD was 0.75%. In the stratum of patients with GD, GD+CBB comorbidity obtained relatively low point prevalence (0.77%), while in the subsample of CBB patients the estimated prevalence of comorbid GD was relatively high (18.9%). CBB+GD comorbidity was characterized by lower prevalence of single patients, higher risk of other behavioral addictions (sex, gaming or internet), older age and age of onset. CBB+GD registered a higher proportion of women compared to only-GD (37.5 vs. 10.0%) but a higher proportion of men compared to only-CBB (62.5 vs. 24.4%). Compared to only-GD patients, the simultaneous presence of CBB+GD was associated with increased psychopathology and dysfunctional levels of harm avoidance. This study provides empirical evidence to better understand CBB, GD and their co-occurrence. Future research should help delineate the processes through which people acquire and develop this comorbidity.

Gambling among European professional athletes. Prevalence and associated factors

In Europe, the prevalence of gambling disorders in the general population ranges from 0.15 to 6.6%. Professional athletes are known for having risk factors for addictive behaviors, such as young age or sensation seeking, though no study has yet tried to evaluate the prevalence of gambling and gambling disorders among this specific population. The goals of this study were to estimate the prevalence of gambling, problematic or not, among European professional athletes and to explore the factors that are associated with gambling practice and gambling problems in professional athletes. A self-completion questionnaire was specifically designed for this study. The questionnaires were distributed by European Union athletes to professional ice hockey, rugby, handball, basketball, football, indoor football, volleyball, and cricket teams in Spain, France, Greece, Ireland, Italy, Sweden, and the United Kingdom. Socio-demographic variables (age, sex, education, marital and parental status, sport, country of birth, and country of practice), variables linked to gambling (gambling habits, screening of gambling problems with the Lie/Bet questionnaire, and gambling related cognitions), and impulsive behavior data (urgency, premeditation, perseverance, and sensation seeking [UPPS]-Short Form questionnaire) were gathered. There were 1,236 questionnaires filled out. The percentage of professional athletes that had gambled at least once during the previous year was 56.6%. The prevalence of problem gambling, current or past, was 8.2%. A certain number of variables were associated with the gambling status. In particular, betting on one's own team (OR = 4.1, CI_95% [1.5-11.5]), betting online (OR = 2.9, CI_95% [1.6-5.4]), gambling regularly (OR = 4.0, CI_95% [2.1-7.6]), and having a high positive urgency score (OR = 1.5, CI_95% [1.3-1.7]) were associated with gambling problems, current or past, among professional athletes. Professional athletes are particularly exposed to both gambling and problem gambling.