Sex Differences in the Rates of Recovery, Treatment-Seeking, and Natural Recovery in Pathological Gambling: Results From an Australian Community-Based Twin Survey

Beyond Sports Betting Legalization: Comparing Problem Gambling Risk Patterns in Legal and Illegal States

The 2018 Supreme Court decision allowing state-level sports betting legalization in the United States has raised concerns about its impact on problem gambling risk. This study examined whether legal status predicts problem gambling severity scores while adjusting for demographic characteristics. Data were collected in March-April 2022 from sports bettors in states with legal (n = 974) and illegal (n = 307) sports betting, using the Problem Gambling Severity Index to assess risk levels. While legal status did not significantly predict problem gambling risk, demographic factors emerged as crucial predictors. Age and education consistently predicted risk across both regulatory contexts, with younger bettors and those with lower education showing greater vulnerability. However, other demographic patterns varied by context: females demonstrated higher risk in illegal states while no gender differences emerged in legal states, and single status predicted elevated risk only in legal jurisdictions. These findings indicate that sports betting policy considerations should extend beyond the simple decision to legalize or prohibit, to consider context-specific interventions based on demographic vulnerabilities.

A roadmap for transformative translational research on gambling disorder in the UK

The UK has one of the highest rates of recreational gambling in the world. Some vulnerable individuals progressively lose control over gambling and develop at-risk gambling or gambling disorder (GD), characterised by the compulsive pursuit of gambling. GD destroys lives and incurs massive costs to societies, yet only a few treatments are available. Failure to develop a wider range of interventions is in part due to a lack of funding that has slowed progress in the translational research necessary to understand the individual vulnerability to switch from controlled to compulsive gambling. Current preclinical models of GD do not operationalise the key clinical features of the human condition. The so-called "gambling tasks" for non-human mammals almost exclusively assess probabilistic decision-making, which is not real-world gambling. While they have provided insights into the psychological and neural mechanisms involved in the processing of gains and losses, these tasks have failed to capture those underlying real-world gambling and its compulsive manifestation in humans. Here, we highlight the strengths and weaknesses of current gambling-like behaviour tasks and suggest how their translational validity may be improved. We then propose a theoretical framework, the incentive habit theory of GD, which may prove useful for the operationalisation of the biobehavioural mechanisms of GD in preclinical models. We conclude with a list of recommendations for the development of next-generation preclinical models of GD and discuss how modern techniques in animal behavioural experimentation can be deployed in the context of GD preclinical research to bolster the translational pipeline.

Patterns and Challenges in Help-Seeking for Addiction among Men: A Systematic Review

Background/Objectives: Addictive and substance-related disorders represent a substantial public health challenge, marked by rising incidence and prevalence rates. Men and women exhibit different patterns of help-seeking for health and social issues including addictions. This research aimed to analyze the help-seeking process among men with addiction to improve understanding and develop more effective, person-centered treatments. Methods: This systematic review was performed based on the Cochrane Collaboration guidelines and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The protocol of the revision was registered in advance in PROSPERO. Searches were conducted in the PubMed, Scopus, and Web of Science (WOS) databases. Results: Based on the literature search, 16 studies were included in the current systematic review. The analyzed studies included seven on substance-use disorders, three on gambling disorder, two on tobacco-use disorder, two addressing substance-related disorders in general, one on opioid-use disorder, and one focused on marijuana use. Gender differences influenced help-seeking behavior, with women generally exhibiting a higher propensity to seek assistance for addiction-related issues than men. Seeking help for addiction-whether substance use or gambling-can be hindered by several barriers, particularly public stigma and discrimination, which tend to be more pronounced for alcohol and gambling compared to tobacco. Additional barriers in the help-seeking process include negative beliefs and attitudes toward seeking help, often associated with traditional male gender roles. Each substance-use disorder was analyzed in depth to gain a better understanding of the barriers faced by this population. Conclusions: Integrating a gender perspective into the diagnosis, prevention, and treatment of addiction is essential. As addiction patterns vary between men and women, approaches must be tailored accordingly. Recognizing men as a distinct group in research and clinical practice is also crucial for developing more effective and personalized treatments.

A Self-Guided Internet-Based Intervention for the Reduction of Gambling Symptoms: A Randomized Clinical Trial

Importance

Most individuals with problem gambling or gambling disorder remain untreated due to barriers to treatment. Limited research exists on alternative treatments.

Objective

To investigate the efficacy of a self-guided internet-based intervention for individuals with gambling problems and to identify potential outcome moderators.

Design, Setting, and Participants

This single-center randomized clinical trial was conducted from July 13, 2021, to December 31, 2022, at the University Medical Center Hamburg-Eppendorf. Participants were recruited across Germany for 2 assessments (before intervention [t0] and 6 weeks after intervention [t1]). Eligible participants were individuals aged 18 to 75 years with gambling problems, internet access, German proficiency, and willingness to participate in 2 online assessments.

Intervention

The self-guided internet-based intervention was based on cognitive behavioral therapy, metacognitive training, acceptance and commitment therapy, and motivational interviewing.

Main Outcome and Measures

The primary outcome was change in gambling-related thoughts and behavior as measured with the pathological gambling adaption of the Yale-Brown Obsessive-Compulsive Scale. Secondary outcomes were change in depressive symptoms, gambling severity, gambling-specific dysfunctional thoughts, attitudes toward online interventions, treatment expectations, and patient satisfaction.

Results

A total of 243 participants (154 [63.4%] male; mean [SD] age, 34.73 [10.33] years) were randomized to an intervention group (n = 119) that gained access to a self-guided internet-based intervention during 6 weeks or a wait-listed control group (n = 124). Completion at t1 was high (191 [78.6%]). Results showed a significantly greater reduction in gambling-related thoughts and behavior (mean difference, -3.35; 95% CI, -4.79 to -1.91; P < .001; Cohen d = 0.59), depressive symptoms (mean difference, -1.05; 95% CI, -1.87 to -0.22; P = .01; Cohen d = 0.33), and gambling severity (mean difference, -1.46; 95% CI, -2.37 to -0.54; P = .002; Cohen d = 0.40) but not in gambling-specific dysfunctional thoughts (mean difference, -1.62; 95% CI, -3.40 to 0.15; P = .07; Cohen d = 0.23) favoring the intervention group. Individuals in the intervention group who had a positive treatment expectation and more severe gambling-specific dysfunctional thoughts and gambling symptoms benefited more on the primary outcome relative to the control group.

Conclusions and Relevance

In this randomized clinical trial, the effectiveness of a self-guided internet-based intervention for individuals with self-reported problematic gambling behavior was demonstrated when measured 6 weeks after start of the intervention. The study's findings are particularly relevant given the increasing need for accessible and scalable solutions to address problematic gambling.

Trial Registration

bfarm.de Identifier: DRKS00024840.

A nationwide case-control study on cardiovascular and respiratory-related disorders in patients with gambling disorder in Sweden

OBJECTIVES

We aimed to examine potential relationships and gender differences between cardiovascular disease (CVD), diabetes, obesity, respiratory-related disorders, and gambling disorder (GD). We hypothesized that (1) GD patients would be more likely than controls to have CVD, diabetes, obesity, and respiratory-related diseases; and (2) females with GD would be more likely than men with GD to have CVD, diabetes, obesity, and respiratory-related diseases.

STUDY DESIGN

National retrospective case-control study.

METHODS

We used data from the Swedish National Board of Health and Welfare between 2005 and 2019. A total of 10,766 patients were included, and 3592 of them had GD. Every GD patient was matched with two age- and gender-matched controls. Patient data, including the history of medical diagnoses, were extracted. Descriptive statistics, Chi-squared and Fisher's exact tests were used to compare GD patients and controls.

RESULTS

GD patients had a higher prevalence of CVD and respiratory-related disorders than controls. Diabetes rates were 5% for GD patients and 2% for controls; CVD (18% vs 12%); respiratory-related disease (7% vs 4%); and obesity (7% vs 3%). Women with a diagnosis of GD have a higher prevalence of obesity and somatic comorbidities other than diabetes compared to men.

CONCLUSIONS

This is the largest case-control study conducted to date showing GD patients have a higher prevalence of CVD, diabetes, obesity, and respiratory-related disorders than controls. Women with GD appear to be more susceptible than men to CVD, obesity, and respiratory-related disorders; however, this may be partially explained by differences in help-seeking behavior. Thus, our findings highlight the importance of early identification of GD patients who may also have somatic conditions requiring treatment. This can be accomplished by implementing a screening program for GD, CVD, diabetes, obesity, and respiratory-related disorders, and by including healthy lifestyle management strategies.

'We are not the ones to blame'. Gamblers' and providers' appraisal of self-exclusion in Germany

BACKGROUND

Given low utilization by individuals experiencing gambling problems the potential of self-exclusion (SE) might be not fully exploited in Germany. This paper aims to gain insight into different actors' perceptions and reflections on the problems and difficulties in the process of self-exclusion to delineate which specific attitudes hamper a successful implementation of SE.

METHODS

13 individual and four group interviews with individuals experiencing gambling problems and governmental or commercial gambling providers were examined. A Grounded Theory Approach was used to portray the opinions of these different actors on existing regulations of SE and to delineate potentially diverging interests between the distinct groups.

RESULTS

The interviewees agreed on the usefulness of SE and consented that it is important to early recognize individuals experiencing gambling problems. They also considered the present practice insufficient but for different reasons. Individuals experiencing gambling problems and providers particularly disagreed on addressing individuals experiencing gambling problems. While individuals experiencing gambling problems stated that they had hardly ever been approached, providers argued that help offers were mostly rejected. Especially commercial providers also regarded insufficient German language skills and rapid fluctuation of guests as strong barriers to approaching individuals experiencing gambling problems. Interviewees from governmental venues furthermore suspected that commercial providers took addressing individuals experiencing gambling problems less seriously.

CONCLUSION

Our results emphasize the dilemma of conflicting interests in both individuals experiencing gambling problems and providers. Rather than acting against the economic interests of employers, venue staff blame individuals experiencing gambling problems for lack of problem recognition. Conversely, individuals experiencing gambling problems blame the providers for not offering help. To address individuals experiencing gambling problems appropriate staff training is required, and SE regulations need to be controlled by an independent body rather than by the providers themselves.

Global prevalence of help-seeking for problem gambling: A systematic review and meta-analysis

BACKGROUND AND AIMS

Multiple studies have examined barriers and facilitators to help-seeking, but the prevalence of help-seeking for problem gambling (PG) is not well established. We aimed to estimate the international prevalence of help-seeking for PG among the general population and among subgroups of people at risk for PG (i.e. low-risk, moderate-risk and PG).

METHODS

Systematic search of grey literature (through gambling repositories, gambling research institutes and Google) and peer-reviewed literature (through ProQuest, PsycINFO, PubMed and Scopus) for gambling prevalence studies that reported on help-seeking for PG. This review adhered to the Preferred Reporting Items for Systematic Review and Meta-Analyses. Studies used representative sampling methods to determine the prevalence of gambling participation and data collection 2010 onward. Twenty-four studies met the inclusion criteria. The main outcome was population prevalence of help-seeking for PG. Help-seeking was defined as any intentional action to change gambling behaviours, including professional services (inclusive of in-person or distance help), non-professional help (e.g. from family and friends) and self-help. Subgroup analyses were conducted to explain variability in help-seeking prevalence estimates.

RESULTS

Measurement of help-seeking was inconsistent across included studies and, overall, there was high risk of bias. We estimated a general population help-seeking prevalence for PG of 0.23% (95% CI, 0.16-0.33). Prevalence estimates were significantly higher in studies assessing lifetime (0.50%; 95% CI, 0.35-0.71) compared with current help-seeking (0.14%; 95% CI, 0.10-0.20, P < 0.001), but there was no evidence of difference in prevalence estimates by gambling participation, region, type of help-seeking, or year of data collection. Compared with people with low-risk gambling (0.27%; 95% CI, 0.07%-1.04%), prevalence estimates were significantly higher in those with moderate-risk (3.73%; 95% CI, 2.07%-6.63%) and problem gambling (20.63%; 95% CI, 12.89%-31.35%, P < 0.001).

CONCLUSIONS

One in 25 moderate-risk gamblers and 1 in 5 people with problem gambling have sought help for problems related to their gambling.

Recovery capital in action: How is gender understood and employed by men and women recovering from gambling disorder?

Gender is a multidimensional construct that differentiates males and females according to its meanings in different socio-cultural contexts. Recovery capital (RC) describes the internal and external resources individuals employ and/or have access to when overcoming addictions. Negative RC refers to elements that hinder recovery. The literature on gender and RC is baffling since unlike quantitative studies that have found no differences between men and women in the levels of RC, qualitative comparisons indeed underscore differences. This study employed qualitative and quantitative research methods to explore how men and women with gambling disorder (GD) understand and employ gender as a factor in their recovery. Participants with GD (N = 133, 39 women) answered an open-ended question on gender as a component in their recovery. Content analysis revealed that 41.35% of the interviewees did not consider gender as a significant factor in recovery. By contrast, 58.65% viewed gender as important to recovery, indicating four gender-related elements that either enhance and/or hinder recovery: gender stereotypes, gender roles, mixed-gender therapeutic space, and sex in exchange for money for gambling. Chi-square analyses showed no differences between men and women in the distribution of the relevance of gender to recovery. Both groups reported similar perceptions of gender in relation to recovery, and identified similar gender-related specific elements that enhanced or hindered recovery from GD except for exchanging sex for money for gambling. These findings are explained by a combination of macro and micro-level theories that result in a new conceptualization of RC. We coined the term "Recovery Capital in Action" to show how the "RC toolkit" that individuals employ can hinder or enhance their recovery depending on cultural context, and that gender can be both a negative and a positive RC. Mental health professionals should consider the interplay between gender and the socio-cultural contexts during recovery.

Mental illness and socio-economic situation of women and men diagnosed with gambling disorder (GD) in Sweden - nationwide case-control study

The present study aimed to compare men and women with gambling disorder (GD) regarding presence of psychiatric comorbidity and socio-economic vulnerability, and to examine whether these factors appear before or after the gambling disorder. This is a retrospective case-control study, based on registers from The National Board of Health and Welfare and Statistics Sweden. A total of 3592 adults with GD were matched with two controls based on age and gender, including a total of 10776 individuals in the study. The study included psychiatric comorbidity through the presence of relevant diagnostic codes or pharmacological codes, and socio-economic vulnerability data through the presence of unemployment, social welfare payments and sickness/activity/rehabilitation compensation. Time between GD and psychiatric comorbidity/socio-economic vulnerability was calculated by subtracting dates between diagnoses/first incidence of socio-economic vulnerability factor and GD diagnosis. Women with GD were more likely to have a psychiatric comorbidity, compared to men. Overall, women were also more likely to receive their psychiatric diagnosis prior to GD diagnosis, while men were more likely to receive the diagnoses concurrently. Social welfare payments, and sickness support were more common among women, while there was no difference in unemployment between genders. Women were also more likely to receive sickness/activity/rehabilitation compensation prior to GD, than men who were more likely to receive these types of support after GD diagnosis. In conclusion, women appear to be at higher risk of psychiatric comorbidity and socio-economic vulnerability alongside GD. They are in general also more likely to receive have their psychiatric and psycho-social problems identified prior to GD, than men who are more likely to receive diagnoses concurrently.

Natural recovery in trichotillomania

OBJECTIVES

Trichotillomania is characterized by repetitive pulling out of one's hair, leading to distress and/or functional impairment. Long considered a chronic condition if left untreated (albeit with fluctuating intensity), there have been intimations that the disorder may be of limited duration in some people.

METHODS

A sample of 10,169 adults, aged 18-69 years, representative of the general US population, were recruited and screened for current and lifetime trichotillomania. Potential differences in demographic and clinical variables and lifetime comorbidities, between those with natural recovery from trichotillomania, and those with current trichotillomania, were identified using analysis of variance or likelihood-ratio chi-square tests as appropriate. Additional analyses using binary logistic regression were used to control for potential confounding differences between the groups initially identified.

RESULTS

In total, 24.9% of the entire sample of people with lifetime trichotillomania reported that they no longer had symptoms of trichotillomania and had never received therapy or medication treatment for it (i.e. they experienced natural recovery). Those who experienced natural recovery did not differ from those with current trichotillomania in terms of demographic or clinical characteristics, except that they were currently older. Natural recovery was associated with significantly lower rates of related comorbidities: obsessive-compulsive disorder, attention-deficit hyperactivity disorder, panic disorder, skin picking disorder and tic disorder.

DISCUSSION

These findings from the first epidemiology study examining natural recovery in trichotillomania highlight the importance of screening for and treating such comorbidities in patients with trichotillomania, in order to maximize chance of clinical recovery.

Gambling-related harms to concerned significant others: A national Australian prevalence study

Background and aims

Gambling-related harm to concerned significant others (CSOs) is an important public health issue since it reduces CSOs' health and wellbeing in numerous life domains. This study aimed to 1) estimate the first national prevalence of CSOs harmed by gambling in Australia; 2) identify the characteristics of CSOs most at risk of harm from another person's gambling; 3) compare the types and number of harms experienced by CSOs based on their relationship to the person who gambles; and 4) compare the number of harms experienced by CSOs by self-identified gender.

Methods

Based on a national CATI survey weighted to population norms, 11,560 respondents reported whether they had been personally and negatively affected by another person's gambling in the past 12 months; and if so, answered detailed questions about the harms experienced from the person's gambling who had harmed them the most.

Results

Past-year prevalence of gambling-related harm to adult Australian CSOs was (6.0%; 95% CI 5.6%-6.5%). CSOs most commonly reported emotional harms, followed by relationship, financial, health and vocational harms, respectively. Former partners reported the most harm, followed by current partners, other family members and non-family members, respectively. Female CSOs were more likely to report more harm and being harmed by a partner or other family member, and male CSOs from a non-family member.

Discussion and conclusions

The findings provide new insights into the wider societal burden of gambling and inform measures aimed at reducing harm to CSOs from gambling and supporting them to seek help.

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

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

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.

Changes in gambling behaviour and related problems in clients seeking help in outpatient addiction care: Results from a 36-month follow-up study in Bavaria

BACKGROUND AND AIM

Evidence on the course of gambling disorder (GD) in clients seeking help from outpatient addiction care facilities is sparse. To close this knowledge gap, this longitudinal one-armed cohort study portrays the development of GD in help-seeking clients over a 3-year timeframe.

METHODS

We investigated changes in severity of GD as well as in gambling frequency and intensity in 145 gamblers in outpatient treatment in Bavaria using generalized estimation equations (GEEs). To investigate potentially different trajectories between study participants with and without migration background (MB), additional analyses were applied with time*migration interaction. All analyses were adjusted for age, gender, education, electronic gambling machine (EGM) gambling, MB, GD, related help sought before and treatment status.

RESULTS

Within the entire study population, improvements in severity of GD (reduction of 39.2%), gambling intensity (reduction of 75.6%) and gambling frequency (reduction of 77.0%) were observed between baseline and 36 months of follow-up. The declines were most pronounced between baseline and follow-up 1 and stabilized thereafter. Participants with MB improved consistently less than participants without MB.

DISCUSSION AND CONCLUSION

Our study suggests that severity of GD and gambling patterns improve in the context of outpatient treatment. The beneficial results furthermore persist for 36 months after treatment termination. As clients with MB seem to profit less than clients without MB, improvements in outpatient gambling services to the specific needs of this clientele are required.

A randomized controlled trial on a self-guided Internet-based intervention for gambling problems

The majority of individuals with problematic and pathological gambling remain untreated, and treatment barriers are high. Internet-based interventions can help to address existing barriers, and first studies suggest their potential for this target group. Within a randomized controlled trial (N = 150) with two assessment times (baseline and post-intervention), we aimed to investigate the feasibility, acceptance, and effectiveness of a self-guided Internet-based intervention targeted at gambling problems. We expected a significant reduction in gambling symptoms (primary outcome) and depressive symptoms as well gambling-specific dysfunctional thoughts (secondary outcomes) in the intervention group (IG) compared to a wait-list control group with access to treatment-as-usual (control group, CG) after the intervention period of 8 weeks. Results of the complete cases, per protocol, intention-to-treat (ITT), and frequent user analyses showed significant improvements in both groups for primary and secondary outcomes but no significant between-group differences (ITT primary outcome, F(1,147) = .11, p = .739, ηp2 < .001). Moderation analyses indicated that individuals in the IG with higher gambling and depressive symptoms, older age, and comorbid anxiety symptoms showed significant improvement relative to the CG. The intervention was positively evaluated (e.g., 96.5% rated the program as useful). Possible reasons for the nonsignificant between-group differences are discussed. Future studies should include follow-up assessments and larger samples to address limitations of the present study.

Trial Registration ClinicalTrials.gov (NCT03372226), http://clinicaltrials.gov/ct2/show/NCT03372226, date of registration (13/12/2017).

A Change Talk Model for Abstinence Based on Web-Based Anonymous Gambler Chat Meeting Data by Using an Automatic Change Talk Classifier: Development Study

BACKGROUND

Change and sustain talks (negative and positive comments) on gambling have been relevant for determining gamblers' outcomes but they have not been used to clarify the abstinence process in anonymous gambler meetings.

OBJECTIVE

The aim of this study was to develop a change talk model for abstinence based on data extracted from web-based anonymous gambler chat meetings by using an automatic change talk classifier.

METHODS

This study used registry data from the internet. The author accessed web-based anonymous gambler chat meetings in Japan and sampled 1.63 million utterances (two-sentence texts) from 267 abstinent gamblers who have remained abstinent for at least three years and 1625 nonabstinent gamblers. The change talk classifier in this study automatically classified gamblers' utterances into change and sustain talks.

RESULTS

Abstinent gamblers showed higher proportions of change talks and lower probability of sustain talks compared with nonabstinent gamblers. The change talk model for abstinence, involving change and sustain talks, classified abstinent and nonabstinent gamblers through the use of a support vector machine with a radial basis kernel function. The model also indicated individual evaluation scores for abstinence and the ideal proportion of change talks for all participants according to their previous utterances.

CONCLUSIONS

Abstinence likelihood among gamblers can be increased by providing personalized evaluation values and indicating the optimal proportion of change talks. Moreover, this may help to prevent severe mental, social, and financial problems caused by the gambling disorder.

Unguided Chatbot-Delivered Cognitive Behavioural Intervention for Problem Gamblers Through Messaging App: A Randomised Controlled Trial

Internet-delivered intervention may be an acceptable alternative for the more than 90% of problem gamblers who are reluctant to seek face-to-face support. Thus, we aimed to (1) develop a low-dropout unguided intervention named GAMBOT integrated with a messaging app; and (2) investigate its effect. The present study was a randomised, quadruple-blind, controlled trial. We set pre-to-post change in the Problem Gambling Severity Index (PGSI) as the primary outcome and pre-to-post change in the Gambling Symptom Assessment Scale (G-SAS) as a secondary outcome. Daily monitoring, personalised feedback, and private messages based on cognitive behavioural theory were offered to participants in the intervention group through a messaging app for 28 days (GAMBOT). Participants in the control group received biweekly messages only for assessments for 28 days (assessments only). A total of 197 problem gamblers were included in the primary analysis. We failed to demonstrate a significant between-group difference in the primary outcome (PGSI - 1.14, 95% CI - 2.75 to 0.47, p = 0.162) but in the secondary outcome (G-SAS - 3.14, 95% CI - 0.24 to - 6.04, p = 0.03). Only 6.7% of the participants dropped out during follow-up and 77% of the GAMBOT group participants (74/96) continued to participate in the intervention throughout the 28-day period. Integrating intervention into a chatbot feature on a frequently used messaging app shows promise in helping to overcome the high dropout rate of unguided internet-delivered interventions. More effective and sophisticated contents delivered by a chatbot should be sought to engage over 90% of problem gamblers who are reluctant to seek face-to-face support.

The Emerging Adults Gambling Survey: study protocol

The Emerging Adults Gambling Survey is a longitudinal survey of young adults aged 16-24 living in Great Britain. It aims to explore a range of gambling behaviours and harms among young adults and examine how this changes over time. It is part of a broader project funded by Wellcome into the gambling behaviours of young people and its relationship with technological change. Funding is currently available for two waves of data collection: the first collected in June/August 2019 (n=3549) and the second to be collected in June/August 2020. The second wave of data collection will also obtain information about the immediate impact of coronavirus on gambling behaviours. With a sample size of 3549 for Wave 1, this is one of the largest study of gambling behaviours among young adults to be conducted in Great Britain and is a resource for other researchers to draw on. Data will be deposited in the UK Data Archive upon completion of Wave 2 data collection and analysis.  This protocol is intended to support other researchers to use this resource by setting out the study design and methods.

Perceived social stigmatisation of gambling disorders and coping with stigma

Aim:

This study concerns perceived social stigmatisation of gambling disorder and its determinants, the self-perceptions of people with gambling disorder (self-stigma) and how they cope with stigma.

Design:

In total, 30 interviews with persons with gambling disorder and 60 with professionals were conducted. Selective sampling procedures were employed in the recruitment phase. In the case of professionals, the inclusion criteria were employment in facilities where treatment of gambling disorder is offered, and profession. For people with gambling disorder, the criterion was a diagnosis confirmed by a psychiatrist.

Results:

Elements revealed in past research on stigma-creation processes were reflected in respondents’ statements. The type of gambling, the occurrence of negative consequences, the possibility of hiding, personal responsibility, social status and contact with stigmatised populations are perceived determinants of problem gamblers’ stigmatisation. Gambling disorder sufferers experience anxiety associated with the possibility of rejection and a fear related to their condition being revealed to others. Various manifestations of cognitive distancing and hiding were coping mechanisms identified in the study.

Conclusions:

People with gambling disorder experience anxiety associated with the possibility of rejection, and they often conceal their disorder, which may hinder their treatment. Therefore the issue of stigma should be addressed in therapy.

Manaaki - a cognitive behavioral therapy mobile health app to support people experiencing gambling problems: a randomized control trial protocol

Background

The low utilisation of current treatment services by people with gambling problems highlights the need to explore new modalities of delivering treatment interventions. This protocol presents the design of a pragmatic randomized control trial aimed at assessing the effectiveness and acceptability of cognitive behavioral therapy (CBT) delivered via a mobile app for people with self-reported gambling problems.

Methods

An innovative CBT mobile app, based on Deakin University’s GamblingLess online program, has been adapted with end-users (Manaaki). Six intervention modules have been created. These are interwoven with visual themes to represent a journey of recovery and include attributes such as avatars, videos, and animations to support end-user engagement. An audio facility is used throughout the app to cater for different learning styles. Personalizing the app has been accomplished by using greetings in the participant’s language and their name (e.g. Kia ora Tāne) and by creating personalized feedback.

A pragmatic, randomized control two-arm single-blind trial, will be conducted in New Zealand. We aim to recruit 284 individuals. Eligible participants are ≥18 years old, seeking help for their gambling, have access to a smartphone capable of downloading an app, able to understand the English language and are willing to provide follow-up information at scheduled time points. Allocation is 1:1, stratified by ethnicity, gender, and gambling symptom severity based on the Gambling Symptom Assessment Scale (G-SAS). The intervention group will receive the full mobile cognitive behavioural programme and the waitlist group will receive a simple app that counts down the time left before they have access to the full app and the links to the data collection tools. Data collection for both groups are: baseline, 4-, 8-, and 12-weeks post-randomisation. The primary outcome is a change in G-SAS scores. Secondary measures include changes in gambling urges, frequency, expenditure, and readiness to change. Indices of app engagement, utilisation and acceptability will be collected throughout the delivery of the intervention.

Discussion

If effective, this study will contribute to the improvement of health outcomes for people experiencing gambling problems and have great potential to reach population groups who do not readily engage with current treatment services.

Ethics approval

NZ Health and Disability Ethics Committee (Ref: 19/STH/204)

Trial registration

Australian New Zealand Clinical Trial Registry (ANZCTRN 12619001605189) Registered 1 November 2019.

Efficacy of a web-based self-help tool to reduce problem gambling in Switzerland: study protocol of a two-armed randomised controlled trial

INTRODUCTION

The past-year prevalence of problem gambling worldwide averages 2.3%. Switzerland exhibits a slightly lower past-year prevalence rate, of 1.1%, among adults. Only a minority of these adults attend outpatient treatment. Surveyed problem gamblers have explained that they wanted to handle the problem on their own. The option of a web-based self-help programme could potentially reach those users who hesitate to approach treatment centres and help them to reduce or stop their problem gambling. The effectiveness of such web-based interventions has been shown in other countries.

METHODS AND ANALYSIS

This two-armed randomised controlled trial (RCT) will examine the efficacy of a web-based self-help intervention, relative to an active control condition with a self-help manual, at reducing problem gambling. The active intervention programme, spanning 8 weeks, consists of nine modules developed to reduce gambling and attenuate psychopathological comorbidity, including depression, anxiety and stress-related disorder symptoms, relying on motivational interviewing and cognitive behavioural therapy. With a target sample size of 352, questionnaire data will be collected at baseline, and at 8 and 24 weeks after baseline. Primary outcomes will be the number of days one has gambled in the last 30 days. Secondary outcomes will include money and time spent on gambling activities, changes in gambling-related problems (Problem Gambling Severity Index, Gambling Symptom Assessment Scale), use of alcohol and cigarettes, and psychopathological comorbidity. All data analysis will comply with the intention-to-treat principle.

ETHICS AND DISSEMINATION

The RCT will be conducted in accordance with the Declaration of Helsinki; the consort eHealth Guidelines for studies on medical devices; the European Directive on medical devices 93/42/EEC, Swiss Law and Swiss Regulatory Authority requirements. The study was approved by the ethics committee of the Canton of Zurich. Results will be published in a scientific peer-reviewed journal. Participants will be informed via e-mail about study results via a lay-person-friendly summary of trial findings.

TRIAL REGISTRATION NUMBER

Current Controlled Trials registry (ISRCTN16339434).

Similar roles for recovery capital but not stress in women and men recovering from gambling disorder

BACKGROUND

Understanding gender-related differences is important in recovery processes. Previous studies have investigated gender-related differences in factors associated with gambling disorder (GD), but none to date have considered both positive and negative resources related to recovery. Using a recovery capital (RC) framework that considers multiple resources available during recovery, this study examined gender-related similarities and differences in associations between positive resources (RC, spirituality) and negative experiences and states (stressful life events, depression, and anxiety) and GD symptom improvement.

METHOD

One hundred and forty individuals with lifetime GD (101 men) were assessed using DSM-5 diagnostic criteria for GD (past-year and lifetime prior to past-year), the Brief Assessment of RC, the Intrinsic Spirituality Scale, the Stressful Life-events Scale, the Generalized Anxiety Disorder Scale, and the Patient Health Questionnaire 9 for depression. Multiple linear regression and Bayesian statistical analyses were conducted.

RESULTS

RC was positively and significantly associated with GD symptom improvement in women and men. Stressful life events were negatively associated with GD symptom improvement only in men.

CONCLUSIONS

RC is an important positive resource for men and women recovering from GD and should be considered in treating both women and men. Understanding specific RC factors across gender groups and stressors, particularly in men, may aid in developing improved interventions for GD.

Gambling disorder

Gambling disorder is characterized by a persistent, recurrent pattern of gambling that is associated with substantial distress or impairment. The prevalence of gambling disorder has been estimated at 0.5% of the adult population in the United States, with comparable or slightly higher estimates in other countries. The aetiology of gambling disorder is complex, with implicated genetic and environmental factors. Neurobiological studies have implicated cortico-striato-limbic structures and circuits in the pathophysiology of this disorder. Individuals with gambling disorder often go unrecognized and untreated, including within clinical settings. Gambling disorder frequently co-occurs with other conditions, particularly other psychiatric disorders. Behavioural interventions, particularly cognitive-behavioural therapy but also motivational interviewing and Gamblers Anonymous, are supported in the treatment of gambling disorder. No pharmacological therapy has a formal indication for the treatment of gambling disorder, although placebo-controlled trials suggest that some medications, such as opioid-receptor antagonists, may be helpful. Given the associations with poor quality of life and suicide, improved identification, prevention, policy and treatment efforts are needed to help people with gambling disorder.

The use of self-management strategies for problem gambling: a scoping review

BACKGROUND

Problem gambling (PG) is a serious public health concern that disproportionately affects people experiencing poverty, homelessness, and multimorbidity including mental health and substance use concerns. Little research has focused on self-help and self-management in gambling recovery, despite evidence that a substantial number of people do not seek formal treatment. This study explored the literature on PG self-management strategies. Self-management was defined as the capacity to manage symptoms, the intervention, health consequences and altered lifestyle that accompanies a chronic health concern.

METHODS

We searched 10 databases to identity interdisciplinary articles from the social sciences, allied health professions, nursing and psychology, between 2000 and June 28, 2017. We reviewed records for eligibility and extracted data from relevant articles. Studies were included in the review if they examined PG self-management strategies used by adults (18+) in at least a subset of the sample, and in which PG was confirmed using a validated diagnostic or screening tool.

RESULTS

We conducted a scoping review of studies from 2000 to 2017, identifying 31 articles that met the criteria for full text review from a search strategy that yielded 2662 potential articles. The majority of studies examined self-exclusion (39%), followed by use of workbooks (35%), and money or time limiting strategies (17%). The remaining 8% focused on cognitive, behavioural and coping strategies, stress management, and mindfulness.

CONCLUSIONS

Given that a minority of people with gambling concerns seek treatment, that stigma is an enormous barrier to care, and that PG services are scarce and most do not address multimorbidity, it is important to examine the personal self-management of gambling as an alternative to formalized treatment.

Help-seeking behaviour of problem gamblers: a narrative review

Abstract. Background: There is evidence for low rates of help-seeking among problem gamblers. Identifying reasons for and barriers to seeking help is essential for improving help supply and gamblers’ treatment utilisation. The present study examines treatment utilisation of problem or pathological gamblers and reviews the evidence related to motives for and barriers to seeking help. Methods: The databases Medline, PsycInfo, and PubMed were searched for English-, Swedish- and German-language studies published between 2000 and 2017. Furthermore relevant references of included studies were analysed. Results: After exclusion of non-relevant publications 34 journal articles and seven reports covering the prevalence of help-seeking among gamblers or self-reported reasons for/barriers to help-seeking were maintained. The proportion of problem gamblers seeking help was less than 10 % in most studies. Problem severity was found positively associated with treatment attendance. Financial issues, negative emotions and crises were identified as main motives for seeking treatment. Main barriers to seeking treatment were shame, problem denial and lack of treatment availability. The results were similar across the examined studies. Conclusion: Low rates of treatment utilisation by problem gamblers strongly indicate that treatment providers and the society should strive to eliminate structural barriers that hinder gamblers to seek help. To better match problem gamblers´ needs, low-threshold early intervention, increasing knowledge of treatment options and efforts to reduce stigmatisation are important strategies to enhance access to help offers.

Mini-Review: Recovery without treatment in gambling disorder and problematic gambling

Mini-Review: Überwindung von Glücksspielstörung und problematischem Glücksspielen ohne Behandlung

Abstract. Zusammenfassung: Ziel: Eine Reihe von Studien konnte zeigen, dass im Bereich der substanzbezogenen Störungen Remissionen ohne formelle Hilfe weitverbreit sind. Weniger ist dazu im Bereich von Verhaltenssüchten bekannt. Ziel ist eine Übersicht zur Datenlage unbehandelter Remission bei Glücksspielstörungen zur Verfügung zu stellen. Methode: Es wurde eine systematische Recherche in PubMed and Web of Science durchgeführt. Nach Ausschluss von Duplikaten wurden 152 Publikationen hinsichtlich Relevanz und Einschlusskriterien geprüft. Insgesamt konnten 8 Studien für dieses Review genutzt werden. Ergebnisse: Etwa 80 % aller Remittierten – mit höheren Raten bei Männern im Vergleich zu Frauen – nutzen keine formale Hilfe. Remittierte mit Behandlung wiesen eine ausgeprägtere Schwere und mehr negative Konsequenzen auf. Die methodische Qualität der Studien weist deutliche Unterschiede auf und ist auf der einen Seite durch kleine Stichproben, Sample-Selection-Bias und wenig präzisen Erhebungsinstrumenten gekennzeichnet, während die Allgemeinbevölkerungsstudien eine sehr hohe Qualität aufweisen. Schlussfolgerung: Die Ergebnisse zeigen Ähnlichkeiten zu Befunden in Studien zu unbehandelter Remission bei substanzbezogenen Störungen auf. Die geringe Anzahl der gefundenen Studie in dieser systematischen Übersicht weisen auf eine Forschungslücke hin. Dies ist in Anbetracht dessen, dass solche Studien wertvolle Hinweise für die Prävention und Behandlung zur Vermeidung und Überwindung von Glücksspielstörungen ermöglichen, bedauerlich.

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.

The crucial role of recovery capital in individuals with a gambling disorder

BACKGROUND AND AIMS

The concept of recovery capital (RC) describes the internal and external resources that individuals draw upon to initiate and sustain the processes of addiction recovery. This concept has been primarily applied to individuals recovering from substance addictions. In this study, the RC concept was applied to individuals with a gambling disorder (GD) to test its associations with the diagnosis and severity of GD and with levels of psychopathology as manifested in depression and anxiety.

METHODS

A sample of 140 individuals who recovered or did not recover from a GD was drawn from lists of former and currently treated individuals in five gambling treatment centers in Israel. The DSM-5 diagnostic criteria for GD, Assessment of Recovery Capital and Brief Assessment of Recovery Capital Scales adapted to Gambling, Generalized Anxiety Disorder Scale, and the Patient Health Questionnaire 9 which measures depression were used.

RESULTS

RC clearly distinguishes between individuals who have recovered from GD and those who have not. A structural equation model showed significant negative associations between RC and GD severity, depression, and generalized anxiety. The associations between GD severity and depression and anxiety were not significant. However, when omitting the path between RC and depression/anxiety, the associations between GD and depression/anxiety became significant.

CONCLUSIONS

RC plays an important role in GD severity and diagnosis, as well as in psychopathology. This study extends the concept of RC to the area of gambling and contributes to the growing body of studies that have found parallels and common denominators between substance addiction and behavioral addictions.

The Experience of Couples in the Process of Treatment of Pathological Gambling: Couple vs. Individual Therapy

Context: Couple treatment for pathological gambling is an innovative strategy. There are some results supporting its potential effectiveness, but little is known about the subjective experiences of the participants. Objective: The aim of this article is to document the experiences of gamblers and their partners participating in one of two treatments, namely individual or couple. Method: In a study aiming to evaluate the efficacy of the Integrative Couple Treatment for Pathological Gambling (ICT-PG), couples who were entering specialized treatment for the addiction of one member who was a pathological gambler were randomly assigned to individual or ICT-PG. Nine months after their admission to treatment, gamblers and partners (n = 21 couples; n = 13 ICT-PG; n = 8 individual treatment) were interviewed in semi-structured interviews. A sequenced thematization method was used to extract the major themes. Results: This study highlighted five major themes in the therapeutic process noted by the gamblers and their partners mainly after the couple treatment but also partly through the individual therapy. These were: (1) the gamblers' anxiety about having to reveal their gambling problems in couple therapy; (2) the wish to develop a mutually beneficial understanding of gambling and its effects on the partners in the two types of treatments; (3) the transformation of negative attributions through a more effective intra-couple communication fostered by the couple therapy; (4) the partners' contribution to changes in gambling behavior and prevention of relapses, which were both better supported in couple therapy; and (5) the interpersonal nature of gambling and its connections with the couples' relationship. However, gamblers who were in individual treatment were more likely to mention that their partners' involvement was not necessary. Participants likewise made a few recommendations about the conditions underlying the choice of one treatment method or the other. Discussion: Participants reported satisfaction with both treatment models, but their experience was more positive in couple treatment. Complementary benefits emerged from each form of treatment, which points to future treatments involving both types. Future research should explore both the couple processes associated with attempts to stop pathological gambling and the various ways of involving partners in the gamblers' treatment.

Primary and Secondary Diagnoses of Gambling Disorder and Psychiatric Comorbidity in the Swedish Health Care System-A Nationwide Register Study

Background: Psychiatric comorbidity is common in gambling disorder, a condition with low rates of treatment seeking. There is a paucity of documented nationwide data on gambling disorder and its co-occurring psychiatric comorbidities in the health care system. Methods: This is a nationwide register-based study of all patients aged above 18 years who were diagnosed with gambling disorder (corresponding to pathological gambling, code F63.0, in the ICD-10) in Swedish specialized out-patient health care or in-patient care, from 2005 through 2016. All psychiatric disorders co-occurring with the diagnoses were recorded, along with age, gender and the type of medical specialty. Results: A total of 2,099 patients were included (1,784 in out-patient care and 629 patients in in-patient care), among whom 77 percent were men. Treatment uptake during the study period increased significantly in out-patient care, with an increasing uptake of younger individuals, whereas in-patient treatment uptake remained stable. A co-occurring psychiatric diagnosis was registered in 73 percent of patients, more commonly in females (77 vs. 71 percent, p < 0.01). Several diagnostic subgroups were more common in women, with anxiety and affective disorders being the most common subgroups. Prevalence of substance use disorders did not differ with respect to gender. Conclusions: Despite a large gap between probable population prevalence of gambling disorder and the number of treated patients, the number of patients treated in out-patient health care with a gambling disorder diagnosis increased over time, with an increasing treatment uptake in younger individuals. Psychiatric comorbidity is common in gambling disorder patients in the health care system, with a higher prevalence in women.

Self-guided Change: The most common form of long-term, maintained health behavior change

Millions of people change risky, health-related behaviors and maintain those changes. However, they often take years to change, and their unhealthy behaviors may harm themselves and others and constitute a significant cost to society. A review-similar in nature to a scoping review-was done of the literature related to long-term health behavior change in six areas: alcohol, cocaine and heroin misuse, gambling, smoking, and overeating. Based on the limited research available, reasons for change and strategies for changing and for maintaining change were also reviewed. Fifty years of research clearly indicate that as people age, in the case of alcohol, heroin and cocaine misuse, smoking, and gambling, 80-90 percent moderate or stop their unhealthy behaviors. The one exception is overeating; only 20 percent maintain their weight loss. Most of these changes, when they occur, appear to be the result of self-guided change. More ways to accelerate self-guided, health-related behavior change need to be developed and disseminated.

Barriers in Access to the Treatment for People with Gambling Disorders. Are They Different from Those Experienced by People with Alcohol and/or Drug Dependence?

A prevalence of gambling disorders is diversified depending on the region of the world. Almost three quarters of pathological gamblers had never sought a professional treatment as well as an assistance in self-help groups. Reasons why they do not initiate a treatment are complex. The aim of the article is to compare barriers to the treatment for people with gambling disorders found in presented study and barriers to alcohol and drug treatment identified in the available literature. The semi structured interviews were applied and conducted with people with gambling disorders, social workers, therapists employed in the addiction treatment facilities, General Practitioners and psychiatrists. Selection of the respondents was based on purposive sampling. In total, 90 interviews were completed. Respondents identified individual barriers as well as structural ones. Individual barriers include internal resistance and a fear of the treatment. In turn structural barriers apply to the organization of the therapy, infrastructure, personnel, and the therapeutic program. A comparison of barriers experienced by people with gambling disorders and substance use disorders showed that they are largely similar, but people with gambling disorders also experience specific barriers. Empirical studies focused specifically on treatment needs of people experiencing gambling disorders may improve an offer of help for them. More adequate treatment options could contribute to the increasing in the number of people who start the treatment. It can result in improving their quality of life and may have positive impact on public health.

Assisting an Australian Aboriginal and Torres Strait Islander person with gambling problems: a Delphi study

BACKGROUND

Gambling problems appear to be more prevalent in the Australian Aboriginal and Torres Strait Islander population than in the non-Indigenous population. Although gambling harms can be significant, treatment-seeking rates are low. The Delphi expert consensus method was used to develop a set of guidelines on how a family or community member can assist an Aboriginal or Torres Strait Islander person with gambling problems.

METHODS

Building on a previous systematic review of websites, books and journal articles a questionnaire was developed that contained items about the knowledge, skills and actions needed for supporting an Aboriginal or Torres Strait Islander person with gambling problems. These items were rated over three rounds by an expert panel comprising professionals who provide treatment to or conduct research with Aboriginal and Torres Strait Islander people with gambling problems.

RESULTS

A total of 22 experts rated 407 helping statements according to whether they thought the statements should be included in these guidelines. There were 225 helping statements that were endorsed by at least 90% of participants. These endorsed statements were used to develop the guidelines.

CONCLUSION

Experts were able to reach substantial consensus on how someone can recognise the signs of gambling problems and support an Aboriginal or Torres Strait Islander person to change.

Quelle est l’influence du genre dans la recherche de soins chez les joueurs?

Cette étude vise à décrire l’influence du genre sur les différentes étapes amenant un joueur ayant des problèmes de jeu à prendre la décision de rechercher de l’aide. Le modèle de recherche d’aide de Goldsmith, Jackson et Hough (1988) a été utilisé pour conceptualiser les étapes de prise de décision menant à consulter des services d’aide pour un problème de jeu de hasard et d’argent. Au total, 83 participants, dont 45 femmes et 38 hommes adultes, y ont pris part. Les résultats indiquent que, comparativement aux hommes, les femmes sont plus nombreuses à habiter en couple, ont plus souvent de faibles revenus et subviennent moins fréquemment seules à leurs besoins, rapportent des conduites de jeu plus conséquentes, souffrent davantage de troubles anxieux au cours de leur vie et, enfin, consultent surtout des services non spécialisés. Au cours des 12 derniers mois, les femmes avaient consulté plus souvent les services médicaux de première ligne et avaient eu moins fréquemment recours aux services spécialisés que les hommes.The aim of this study was to describe the influence of gender on the various stages of the decision-making process that bring problem gamblers to seek help. The authors used the help-seeking model developed by Goldsmith, Jackson and Hough (1988) to conceptualize the different stages of the process that leads to consulting support services for a gambling problem. A total of 83 participants (45 females and 38 males) took part in the study. Results show that women are more likely to have a partner and to earn a lower income; they provide for their own needs less frequently than men; report more consistent gaming behaviours; are more prone to anxiety disorder during their lifetime; and consult primarily non-specialized services. In the previous 12 months, they had accessed front-line services more often and specialized services less frequently than men.

Barriers in Access to the Treatment for People with Gambling Disorders. Are They Different from Those Experienced by People with Alcohol and/or Drug Dependence?

A prevalence of gambling disorders is diversified depending on the region of the world. Almost three quarters of pathological gamblers had never sought a professional treatment as well as an assistance in self-help groups. Reasons why they do not initiate a treatment are complex. The aim of the article is to compare barriers to the treatment for people with gambling disorders found in presented study and barriers to alcohol and drug treatment identified in the available literature. The semi structured interviews were applied and conducted with people with gambling disorders, social workers, therapists employed in the addiction treatment facilities, General Practitioners and psychiatrists. Selection of the respondents was based on purposive sampling. In total, 90 interviews were completed. Respondents identified individual barriers as well as structural ones. Individual barriers include internal resistance and a fear of the treatment. In turn structural barriers apply to the organization of the therapy, infrastructure, personnel, and the therapeutic program. A comparison of barriers experienced by people with gambling disorders and substance use disorders showed that they are largely similar, but people with gambling disorders also experience specific barriers. Empirical studies focused specifically on treatment needs of people experiencing gambling disorders may improve an offer of help for them. More adequate treatment options could contribute to the increasing in the number of people who start the treatment. It can result in improving their quality of life and may have positive impact on public health.

Recovery Agency and Informal Recovery Pathways from Gambling Problems

This study applied a holistic, strength-based lens to better articulate the impetus for, and processes of, informal recovery from gambling problems. Two research objectives framed the parameters of the study: to explore (a) the process by which gamblers move from recognition of a gambling problem to action for recovery and (b) the experiences, perceptions and contextual factors that shape the features of this process. Narrative telephone interviews were conducted with adult residents of Victoria, Australia. Thirty-two adult participants (22 males and 10 females) were recruited from the general community. All participants were self-identified as recovering or recovered from gambling problems. Participants primarily used informal recovery strategies, rather than professional services or support groups. The impetus for informal recovery was identified broadly as either (a) dissonance between desired and actual self-image and goals, (b) an uncontrollable adverse event, or (c) confrontation and decisive action by others affected by the individual's gambling involvement. The impetus, process and goals of recovery were best described by pathways that were distinguished by agency in recovery: externally directed and self-directed. The application of a strength-based lens helped to illuminate the role of agency in informal recovery. A proposed pathways framework may inform strength-based informal recovery strategies for gamblers and affected others, and therapeutic approaches. The pathways, which have not been articulated in previous gambling recovery literature, generally cohere with pathways articulated in the alcohol and substance recovery literature.

Gender Differences in Self-Conscious Emotions and Motivation to Quit Gambling

Considerable gender differences have been previously noted in the prevalence, etiology, and clinical features of problem gambling. While differences in affective states between men and women in particular, may explain differential experiences in the process of gambling, the role of affect in motivations for quitting gambling and recovery has not been thoroughly explored. The aim of this study was to examine gender differences within a sample of problem gamblers motivated to quit with or without formal treatment, and further, to explore the interactions between gender, shame and guilt-proneness, and autonomous versus controlled reasons for change. Motivation for change and self-conscious emotional traits were analyzed for 207 adult problem gamblers with an interest in quitting or reducing their gambling (96.6 % not receiving treatment). Overall, gender differences were not observed in clinical and demographic characteristics. However, women exhibited greater shame [F(1,204) = 12.11, p = 0.001] and guilt proneness [F(1,204) = 14.16, p < 0.001] compared to men, whereas men scored higher on trait detachment [F(1,204) = 7.08, p = 0.008]. Controlling for demographic and clinical characteristics, general linear models revealed that autonomous motivation for change was associated with higher guilt-proneness, greater problem gambling severity, and the preparation stage of change; whereas controlled forms of motivation were significantly associated with higher shame-proneness and greater problem gambling severity. No gender effects were observed for either motivation for change. These findings suggest that the process of change can be different for shame-prone and guilt-prone problem gamblers, which may impact behavioral outcomes.

Sensation seeking and impulsive traits as personality endophenotypes for antisocial behavior: Evidence from two independent samples

Sensation seeking and impulsivity are personality traits that are correlated with risk for antisocial behavior (ASB). This paper uses two independent samples of twins to (a) test the extent to which sensation seeking and impulsivity statistically mediate genetic influence on ASB, and (b) compare this to genetic influences accounted for by other personality traits. In Sample 1, delinquent behavior, as well as impulsivity, sensation seeking and Big Five personality traits, were measured in adolescent twins from the Texas Twin Project. In Sample 2, adult twins from the Australian Twin Registry responded to questionnaires that assessed individual differences in Eysenck's and Cloninger's personality dimensions, and a structured telephone interview that asked participants to retrospectively report DSM-defined symptoms of conduct disorder. Bivariate quantitative genetic models were used to identify genetic overlap between personality traits and ASB. Across both samples, novelty/sensation seeking and impulsive traits accounted for larger portions of genetic variance in ASB than other personality traits. We discuss whether sensation seeking and impulsive personality are causal endophenotypes for ASB, or merely index genetic liability for ASB.

The Public Stigma of Problem Gambling: Its Nature and Relative Intensity Compared to Other Health Conditions

Problem gambling attracts considerable public stigma, with deleterious effects on mental health and use of healthcare services amongst those affected. However, no research has examined the extent of stigma towards problem gambling within the general population. This study aimed to examine the stigma-related dimensions of problem gambling as perceived by the general public compared to other health conditions, and determine whether the publicly perceived dimensions of problem gambling predict its stigmatisation. A sample of 2000 Australian adults was surveyed, weighted to be representative of the state population by gender, age and location. Based on vignettes, the online survey measured perceived origin, peril, concealability, course and disruptiveness of problem gambling and four other health conditions, and desired social distance from each. Problem gambling was perceived as caused mainly by stressful life circumstances, and highly disruptive, recoverable and noticeable, but not particularly perilous. Respondents stigmatised problem gambling more than sub-clinical distress and recreational gambling, but less than alcohol use disorder and schizophrenia. Predictors of stronger stigma towards problem gambling were perceptions it is caused by bad character, is perilous, non-recoverable, disruptive and noticeable, but not due to stressful life circumstances, genetic/inherited problem, or chemical imbalance in the brain. This new foundational knowledge can advance understanding and reduction of problem gambling stigma through countering inaccurate perceptions that problem gambling is caused by bad character, that people with gambling problems are likely to be violent to other people, and that people cannot recover from problem gambling.

How a concerned family member, friend or member of the public can help someone with gambling problems: a Delphi consensus study

Background

Gambling is an enjoyable recreational pursuit for many people. However, for some it can lead to significant harms. The Delphi expert consensus method was used to develop guidelines for how a concerned family member, friend or member of the public can recognise the signs of gambling problems and support a person to change their gambling.

Methods

A systematic review of websites, books and journal articles was conducted to develop a questionnaire containing items about the knowledge, skills and actions needed for supporting a person with gambling problems. These items were rated over three rounds by two international expert panels comprising people with a lived experience of gambling problems and professionals who treat people with gambling problems or research gambling problems.

Results

A total of 66 experts (34 with lived experience and 32 professionals) rated 412 helping statements according to whether they thought the statements should be included in these guidelines. There were 234 helping statements that were endorsed by at least 80 % of members of both of the expert panels. These endorsed statements were used to develop the guidelines.

Conclusion

Two groups of experts were able to reach substantial consensus on how someone can recognise the signs of gambling problems and support a person to change.

Electronic supplementary material

The online version of this article (doi:10.1186/s40359-016-0110-y) contains supplementary material, which is available to authorized users.

Gender differences in felt stigma and barriers to help-seeking for problem gambling

Background

Men and women differ in their patterns of help-seeking for health and social problems. For people experiencing problem gambling, feelings of stigma may affect if and when they reach out for help. In this study we examine men's and women's perceptions of felt stigma in relation to help-seeking for problematic gambling.

Methods

Using concept mapping, we engaged ten men and eighteen women in group activities. We asked men and women about their perceptions of the pleasurable aspects and negative consequences of gambling; they generated a list of four hundred and sixteen statements. These statements were parsed for duplication and for relevance to the study focal question and reduced to seventy-three statements by the research team. We then asked participants to rate their perceptions of how much felt stigma (negative impact on one's own or family's reputation) interfered with help-seeking for gambling. We analyzed the data using a gender lens.

Findings

Men and women felt that shame associated with gambling-related financial difficulties was detrimental to help-seeking. For men, the addictive qualities of and emotional responses to gambling were perceived as stigma-related barriers to help-seeking. For women, being seduced by the 'bells and whistles' of the gambling venue, their denial of their addiction, their belief in luck and that the casino can be beat, and the shame of being dishonest were perceived as barriers to help-seeking.

Conclusions

Efforts to engage people who face gambling problems need to consider gendered perceptions of what is viewed as stigmatizing.