Comorbid psychiatric diagnoses and gaming preferences in US armed forces veterans receiving inpatient treatment for gambling disorder

Armed Forces Veterans are uniquely vulnerable to problem gambling and gambling disorder. Even so, research regarding the full clinical profile of veterans with gambling problems lags. Gambling activities vary widely from each other, but most gambling activities can be understood as either strategic (i.e., involving some measure of skill and decision-making as a part of the gambling practice) or non-strategic (i.e., gambling activities that are entirely based on chance). Prior works have found that gamblers that prefer strategic gambling activities and those that prefer nonstrategic gambling activities often differ from each other in key ways, with the two preferences being linked to varying motivations for gambling, varying cognitions about gambling, and the course of gambling disorder. The present work sought to examine how preferences for strategic vs. nonstrategic gambling might be related to psychiatric comorbidities among U.S. Armed Forces Veterans receiving inpatient treatment for Gambling Disorder. Data from U.S. Armed Forces Veterans (N = 401) receiving residential treatment for GD between the years of 2010-2016 were analyzed. Results demonstrated that gamblers that preferred strategic gambling, as opposed to non-strategic gambling, were more likely to be younger, more likely to be men, less likely to have a nicotine use disorder, and less likely to have PTSD. Such findings suggest that gamblers with PTSD are likely to prefer nonstrategic games and may imply a unique vulnerability to gambling problems related to non-strategic gambling among armed forces veterans.

Do emotion regulation and impulsivity differ according to gambling preferences in clinical samples of gamblers?

BACKGROUND AND AIMS

Emotion regulation (ER) and impulsivity impairments have been reported in patients with gambling disorder (GD). However, both constructs have not been studied in depth jointly in clinical samples. Therefore, the aim of this study was to analyze ER and impulsive tendencies/traits in a sample of n = 321 treatment-seeking individuals with GD by differentiating them according to their gambling preference (n = 100 strategic; n = 221 non-strategic).

METHODS

Our sample was assessed through the DERS (ER), the UPPS-P (impulsivity), and the DSM-5 (GD severity).

RESULTS

The non-strategic group included a higher proportion of women and reported greater ER impairments, and more impulsive traits/tendencies compared to strategic gamblers. GD severity was associated with all DERS subscale (except for awareness) and with urgency dimensions of the UPPS-P.

DISCUSSION AND CONCLUSIONS

Our findings confirm that strategic and non-strategic gamblers differ in their ER processes and impulsive tendencies, showing the first clinical group a more adaptive profile. These results suggest the relevance of assessing these ER and impulsivity in order to tailor better treatment approaches.

Do Online Gambling Products Require Traditional Therapy for Gambling Disorder to Change? Evidence from Focus Group Interviews with Mental Health Professionals Treating Online Gamblers

Online gambling has significantly altered the situational and structural characteristics of gambling products, to the extent that online gamblers might be substantially different from traditional offline gamblers. A growing body of literature has identified the evolving features of online gambling and the individuals who engage in it. However, beyond understanding the individual characteristics of this subgroup, relatively less effort has been made to examine whether existing cognitive-behavioural therapy (CBT) approaches are still entirely relevant for online problem gamblers, or whether changes are needed to adapt according to gambling mode of access. To understand what kind of challenges online gambling poses to mental health professionals dealing with disordered gamblers, four focus groups comprising 28 Spanish participants were carried out. All the treatment providers had ongoing experience with online gamblers undergoing treatment, and included clinical psychologists, mental health social workers, and a medical doctor. The data were examined using thematic analysis. The analysis identified five main themes that characterised online gamblers: (1) being of younger age, (2) lack of conflicts at home and at work/educational centre, rarely presenting violent or aggressive behaviour, (3) gambling disorder only being identified by overdue debt, (4) co-occurring conditions with technology-related abuse rather than other substance-related addictions, and (5) skill-based gambling. The study highlights mental health workers' perceived insecurities about how to best treat online gamblers, and discusses the specific characteristics that CBT for gambling disorder might need to incorporate to adjust for this particular group of gamblers.

An Initial Investigation of Individual Rate-of-Play Preferences and Associations with EGM Gambling Behavior

Electronic gambling machines (EGMs) show a strong association with gambling problems. The high speed of gaming offered by modern EGMs allows playing numerous games in a short span of time, which is thought to contribute to attentional distraction, increased spending and prolonged play. However, the relationship between EGM speeds and potentially risk-related gambling behavior remains unclear. We introduce a novel approach to investigating the role of gaming speed in EGM gambling behavior by examining 'individual rate-of-play' (I-ROP) during simulated EGM gambling. A community sample of male regular gamblers (N = 72) played virtual slot machines in pairs offering sequentially adjusted game speeds towards the estimation of a behaviorally expressed preference speed, or I-ROP. This initial experiment aimed to explore the variability of I-ROPs during simulated EGM gambling, and examine behavior while playing EGMs at speeds relative to their I-ROP. Estimated I-ROPs ranged from less than one half second to over seven seconds and were negatively associated with cognitive ability, but not related to problem gambling severity, impulsiveness, or gambling-related cognitions. Subsequent gambling sessions on EGMs offering individually calibrated faster and slower gaming speeds were associated with greater and reduced risk-related gambling behaviors respectively. I-ROPs represent a potentially informative construct for exploring influences of gaming speed on gambling behavior, and may lend insight into potential risk-related behavior an individual vulnerability with respect to commercially available EGMs that warrants additional research.