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Gambling as Work: A Study of German Poker Players. J Gambl Stud 2023:10.1007/s10899-023-10277-0. [PMID: 38135779 DOI: 10.1007/s10899-023-10277-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2023] [Indexed: 12/24/2023]
Abstract
The study addresses the question whether professional gamblers can be considered an occupational group from a sociological perspective. It combines survey data on poker players from the German state North Rhine-Westphalia with sociological theory in order to explain the oxymoron of professional gambling. The descriptive analysis of the survey data is supplemented by ego-centric network data of the poker players to analyze whether hobby and professional players maintain different forms of social relationships. Even when semiprofessionals and professional players are grouped together for the purpose of comparative analysis, they fulfill the criteria of occupational groups according to Salaman's major work on the topic. The study points to the fact that more research on occupational groups outside of the common fields is needed and bridges the gap between the literature on serious leisure and sociological research on professions and professionalization.
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Second Session at the Virtual Poker Table: A Contemporary Study of Actual Online Poker Activity. J Gambl Stud 2023; 39:1295-1317. [PMID: 35882744 PMCID: PMC9325659 DOI: 10.1007/s10899-022-10147-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2022] [Indexed: 12/01/2022]
Abstract
Technological advancements and worldwide television exposure led to a poker boom in the early 2000s, and poker (both live and online) has retained some of that popularity today. The present study examined online poker playing trends based on actual electronic betting records data for 2489 subscribers to a major global internet gambling operator from 2015 to 2017. We found that overall financial involvement (median total overall spend: €439.7) and time commitment (median number of sessions: 43) during the two-year study period were relatively moderate. We identified the top 1% by total overall spend as a subgroup of highly involved players with disproportionately higher financial involvement (median total overall spend: €272,581.4) and time commitment (median number of sessions: 1149). Our results were similar to those reported in LaPlante et al.'s (Comput Hum Behav 25(3):711-717, 2009. https://doi.org/10.1016/j.chb.2008.12.027 ) study of online poker betting records, suggesting that players' levels of involvement are similar to those from ten years ago despite numerous changes to the online poker environment. We also analyzed records of deposits and withdrawals, and we observed similar indicators of moderate gambling behavior within the overall sample (median two-year total amount deposited: €176.4). In contrast to popular beliefs about internet gambling, in our sample, most online poker play was arguably moderate. However, a small percentage of highly involved players play poker at extreme levels and require closer scrutiny.
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Problem Gambling Poker Players: Do They Fit into Blaszczynski and Nower's Pathways Model? J Gambl Stud 2023; 39:249-263. [PMID: 35416621 DOI: 10.1007/s10899-022-10123-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2022] [Indexed: 11/26/2022]
Abstract
Blaszczynski and Nower's (Addiction 97:487-499, 2002) Pathways Model, an integrative model based on problem gamblers' paths and comorbidities, aids in understanding the heterogeneity of problem gamblers' profiles by classifying them into three subgroups. The profiles of problem gamblers may be linked to the type of gambling practiced. Poker is a popular game, primarily due to the involvement of both chance and strategy in its outcome. However, no study has attempted to fit poker players into the Pathways Model. We recruited an online sample of 245 regular poker players (including 146 non-problem gamblers, 83 problem-gambling poker players, and 16 probable pathological gamblers). We assessed multiple variables (impulsivity, sensation seeking, alcohol and tobacco consumption, anxiety, depression, cognitive distortions) from the Pathways Model to determine whether the profiles of poker players fit into one or more gambler subgroups. Cluster analysis showed that poker players had a unique profile with a gambling practice intensity gradient. Compared to non-problem gamblers, problem gamblers displayed significantly higher levels of depression, impulsivity, gambling-related cognitive distortions, and alcohol consumption. Our results suggest that problem-gambling poker players fit into Blaszczynski and Nower's behaviorally conditioned gamblers group. This study opens avenues for both research into and treatment for problem gambling among poker players.
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Once online poker, always online poker? Poker modality trajectories over two years. Addict Behav Rep 2020; 11:100251. [PMID: 32467840 PMCID: PMC7244906 DOI: 10.1016/j.abrep.2020.100251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 01/05/2020] [Accepted: 01/11/2020] [Indexed: 11/10/2022] Open
Abstract
For most players, poker trajectories remained stable over two years (i.e. stable land-based and online poker). Gambling behaviors (number of gambling activities, severity of problems) were the only predictors of poker trajectories. Future research should examine how poker players explain stable and unstable trajectories.
Online poker is considered more at-risk than land-based poker in terms of intense gambling behaviors and gambling problems. The development of many online gambling sites has raised public health concerns about the potential increase in online poker players. Longitudinal studies are useful to better understand the evolution of gambling behaviors; however, very few consider online poker players. Using a prospective design, this study aims to identify online and land-based trajectories over a two-year period and the factors influencing those trajectories. Results are based on data collected at three time-points over the course of a prospective cohort study conducted in Quebec (n = 304). A latent class growth analysis was performed to determine trajectories based on the main poker modality played, either online or land-based poker. Multinomial multivariable logistic regression analyses were conducted to determine the correlates of poker playing trajectories. Over two years, three poker playing trajectories were identified, comprising two stable trajectories [stable land-based (51.5%) and stable online (36.3%)] and an unstable trajectory [unstable online land-based (12.1%)]. The second trajectory included online poker players at baseline who transitioned to land-based poker. Number of gambling activities increased the odds of being in the first trajectory as compared to the others. Severity of gambling problems was a significant predictor of the second “unstable” or the third “stable online” trajectories, but not for the first “stable land-based” poker trajectory. The majority of poker players remained in either the land-based or online trajectories over two years. No poker players transitioned from land-based to online poker.
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"It did not apply to me": poker players' perspectives of prevention messages. Canadian Journal of Public Health 2020; 111:617-626. [PMID: 31933237 DOI: 10.17269/s41997-019-00283-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 12/05/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Despite the risks associated with poker and its unique characteristics when compared with other forms of gambling, little knowledge exists of poker players' perceptions of prevention strategies. The aim of this study was to explore poker players' perceptions and understandings of existing problem gambling prevention strategies. METHODS This exploratory qualitative study is a secondary data analysis of interviews conducted as a part of a sequential mixed-methods research project, with 12 poker players. RESULTS Two main themes emerged from the thematic analysis highlighting a distinction between institutional and personal prevention strategies. When speaking about institutional prevention efforts, players were critical of existing formats, messages, and who these messages were being developed and disseminated by and for. Players believed existing messaging strategies demonstrate an overall lack of awareness concerning the reality of poker. Personal preventive strategies that players themselves put in place to reduce risks included money management, playing for free, maintaining a healthy play-life balance, and managing emotions, to be aware of their relationship with poker, as well as spotting paying opportunities. CONCLUSIONS Given poker players' lack of receptivity to existing prevention messaging, it is essential to consider the unique nature of poker and its players. It is also imperative to explore the potential benefits of collaborating with players when it comes to targeted prevention strategies.
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Connection Between Poker Playing and Problem Gambling with Sociodemographic Factors and Other Gambling Activities. J Gambl Stud 2019; 36:421-433. [PMID: 31828698 DOI: 10.1007/s10899-019-09920-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Many variables predisposing to gambling and problem gambling are already known. Yet, little is still known about the factors associated with poker, which is one of the most popular and the fastest growing areas of gambling, especially among young people. The aim of our study was to identify the relationship of selected sociodemographic factors with playing poker and problematic gambling. The other gambling activities was also included. The results of the regression analysis demonstrated that the following variables were connected with playing poker: place of residence (p < 0.001), mother's education (p = 0.004) and that of father (p = 0.046), material status, both of family of origin and current, and financial independence (p < 0.001). The risk of problem gambling is higher in case of players with low assessment of their own current material status (p = 0.028) and those who are financially dependent (p = 0.046). The risk level of problem gambling is also associated with the poker players' involvement in: slot machine games, sports betting, Totalizator Sportowy (Lotto) games, casino games (for all variables, the significance level is p < 0.001). The acquired data helped us to identify the groups most exposed to playing poker and excessive involvement in the game and may contribute to the development of appropriate prevention programs to protect persons belonging to the risk group.
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Abstract
Tilt is a very common term in online poker players' vocabulary, it describes a state where the player is no longer able to make rational decisions because they are overwhelmed by strong emotions. This study aims to explore the relation existing between the frequency of Tilt episodes, the player's perception of these episodes and excessive gambling in online poker. The sample is composed of 291 adult French-speaking online poker players. All participants completed an online self-assessment questionnaire. The results of the classification analysis showed that the sample could be divided into three groups. The first group, named ''players in control'' included low excessive gambling tendencies with low perceived and measured Tilt frequencies. The two other groups showed high measured tilt levels, with perceived tilt levels that were different from the measured levels. Furthermore, these two groups present a moderate usage risk of developing an excessive gambling tendency in a money-based game of chance. These results show the existence of a relation between the player's capacity to perceive tilt and the online poker player's behavior.
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Abstract
Previous studies on gambling passion have identified that obsessive passion is related to negative consequences, including gambling pathology, whereas harmonious passion is mostly related to positive outcomes both during and after engagement in gambling activity. In the present study, we focused on poker players (N = 311) and investigated the associations between the two types of gambling passion and subjective well-being, while taking into account acquired poker experience. We found that harmonious passion toward poker was associated with higher levels of well-being, whereas the reverse was true for obsessive passion. Poker experience was positively related to harmonious but not obsessive passion, and moderated the relationship between harmonious passion and quality of life. Our findings contribute to extant literature on passion and further solidify its application in a gambling context. Most importantly, our results underline the relevance of accounting for poker experience when studying gambling among poker players.
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Abstract
Recently, the skill involved in playing and mastering video games has led to the professionalization of the activity in the form of 'esports' (electronic sports). The aim of the present paper was to review the main topics of psychological interest about esports and then to examine the similarities of esports to professional and problem gambling. As a result of a systematic literature search, eight studies were identified that had investigated three topics: (1) the process of becoming an esport player, (2) the characteristics of esport players such as mental skills and motivations, and (3) the motivations of esport spectators. These findings draw attention to the new research field of professional video game playing and provides some preliminary insight into the psychology of esports players. The paper also examines the similarities between esport players and professional gamblers (and more specifically poker players). It is suggested that future research should focus on esport players' psychological vulnerability because some studies have begun to investigate the difference between problematic and professional gambling and this might provide insights into whether the playing of esports could also be potentially problematic for some players.
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Psychological Vulnerability and Problem Gambling: The Mediational Role of Cognitive Distortions. J Gambl Stud 2018; 34:807-822. [PMID: 29299737 DOI: 10.1007/s10899-017-9740-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Despite numerous studies demonstrating the influence of cognitive distortions on gambling problem severity, empirical data regarding the role of psychological vulnerability on the latter is limited. Hence, this study assesses the mediating effect of cognitive distortions between psychological vulnerability (personality and mood), and gambling problem severity. It also verifies whether the relationships between these variables differs according to the preferred gambling activity. The sample is composed of 272 male gamblers [191 poker players; 81 video lottery terminal (VLT) players] aged between 18 and 82 years (M = 35.2). Bootstrap analysis results revealed that cognitive distortions mediate the effect of narcissism on gambling problem severity for both groups. The level of depression for VLT players significantly predicted gambling problem severity, both directly and indirectly via the mediating effect of cognitive distortions. Mediation analyses also indicated that narcissism had an indirect impact on problem gambling through cognitive distortions for both groups. These findings suggest that certain vulnerabilities related to personality and mood may influence cognitive distortion intensity and gambling problem severity. In addition, psychological vulnerabilities could differ based on preferred gambling activity. These results may be useful for prevention policies, identifying high risk gamblers and planning psychological interventions.
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Factors associated with social casino gaming among adolescents across game types. BMC Public Health 2018; 18:1167. [PMID: 30305091 PMCID: PMC6180495 DOI: 10.1186/s12889-018-6069-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 09/25/2018] [Indexed: 11/20/2022] Open
Abstract
Background With the proliferation of social casino games (SCGs) online, which offer the opportunity to gamble without monetary gains and losses, comes a growing concern regarding the effects of these unregulated games on public health, particularly among adolescents. However, given the limited research pertaining to SCG use, little is currently known about the manner in which adolescents engage with this new gambling medium. The present study aims to identify the factors that characterize adolescent social casino gamers, and to determine whether these factors differ by SCG type. Moreover, the study examines the extent to which social casino gaming is associated with monetary gambling and problem gambling in this cohort. Method Data were obtained from students in Grades 9 to 12 (n = 10,035) residing in the Canadian provinces of Ontario, Saskatchewan, and Newfoundland and Labrador. Participants completed the Youth Gambling Survey (YGS), which is a supplementary instrument administered alongside the Canadian Student Tobacco, Alcohol and Drugs Survey (CSTADS). Logistic regression was used to assess the factors associated with SCG play. Results Overall, 12.4% of respondents reported having participated in SCGs in the past three months. Compared to adolescents who did not report playing SCGs, SCG players were typically more likely to participate in monetary gambling activities, and were more prevalently classified as problem gamblers of low-to-moderate severity or high severity. Although profiles of SCG players differed across SCG game types, factors significantly associated with the playing of SCGs were gender, weekly spending money, having friends and parents who gamble, and screen time. It was also shown that current smokers were significantly more likely to participate in simulated slots online relative to adolescents who did not play SCGs. Conclusion Significant associations exist between SCG play, monetary gambling, and problem gambling among adolescents. Gambling intervention efforts directed at this population should aim to identify personal and environmental factors associated with social casino gaming, and should be tailored to different types of SCGs.
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Abstract
The concept of passion is relevant to understanding gambling behaviours and gambling problems. Longitudinal studies are useful to better understand the absence and development of gambling problems; however, only one study has specifically considered poker players. Using a longitudinal design, this study aims to determine the influence, 1 year later, of two forms of passion-harmonious and obsessive-on gambling problems in poker players. A total of 116 poker players was recruited from across Quebec, Canada. The outcome variable of interest was participants' category on the Canadian Pathological Gambling Index, and the predictive variable was the Gambling Passion Scale. Multiple logistic regression analyses were conducted to identify independent risk factors of at-risk poker players 1 year later. Obsessive passion at baseline doubled the risk of gambling problems 1 year later (p < 0.01); for harmonious passion, there was no association. Number of gambling activities, drug problems, and impulsivity were also associated with at-risk gambling. This study highlights the links between obsessive passion and at-risk behaviours among poker players. It is therefore important to prevent the development of obsessive passion among poker players.
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Abstract
Gambling behavior is partly the result of varied motivations leading individuals to participate in gambling activities. Specific motivational profiles are found in gamblers, and gambling motives are closely linked to the development of cognitive distortions. This cross-sectional study aimed to predict cognitive distortions from gambling motives in poker players. The population was recruited in online gambling forums. Participants reported gambling at least once a week. Data included sociodemographic characteristics, the South Oaks Gambling Screen, the Gambling Motives Questionnaire-Financial and the Gambling-Related Cognition Scale. This study was conducted on 259 male poker gamblers (aged 18–69 years, 14.3% probable pathological gamblers). Univariate analyses showed that cognitive distortions were independently predicted by overall gambling motives (34.8%) and problem gambling (22.4%) (p < .05). The multivariate model, including these two variables, explained 39.7% of cognitive distortions (p < .05). The results associated with the literature data highlight that cognitive distortions are a good discriminating factor of gambling problems, showing a close inter-relationship between gambling motives, cognitive distortions and the severity of gambling. These data are consistent with the following theoretical process model: gambling motives lead individuals to practice and repeat the gambling experience, which may lead them to develop cognitive distortions, which in turn favor problem gambling. This study opens up new research perspectives to understand better the mechanisms underlying gambling practice and has clinical implications in terms of prevention and treatment. For example, a coupled motivational and cognitive intervention focused on gambling motives/cognitive distortions could be beneficial for individuals with gambling problems.
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Synergistic Information Processing Encrypts Strategic Reasoning in Poker. Cogn Sci 2018; 42:1457-1476. [PMID: 29904937 DOI: 10.1111/cogs.12632] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 04/02/2018] [Accepted: 04/03/2018] [Indexed: 12/01/2022]
Abstract
There is a tendency in decision-making research to treat uncertainty only as a problem to be overcome. But it is also a feature that can be leveraged, particularly in social interaction. Comparing the behavior of profitable and unprofitable poker players, we reveal a strategic use of information processing that keeps decision makers unpredictable. To win at poker, a player must exploit public signals from others. But using public inputs makes it easier for an observer to reconstruct that player's strategy and predict his or her behavior. How should players trade off between exploiting profitable opportunities and remaining unexploitable themselves? Using a recent multivariate approach to information theoretic data analysis and 1.75 million hands of online two-player No-Limit Texas Hold'em, we find that the important difference between winning and losing players is not in the amount of information they process, but how they process it. In particular, winning players are better at integrative information processing-creating new information from the interaction between their cards and their opponents' signals. We argue that integrative information processing does not just produce better decisions, it makes decision-making harder for others to reverse engineer, as an expert poker player's cards act like the private key in public-key cryptography. Poker players encrypt their reasoning with the way they process information. The encryption function of integrative information processing makes it possible for players to exploit others while remaining unexploitable. By recognizing the act of information processing as a strategic behavior in its own right, we offer a detailed account of how experts use endemic uncertainty to conceal their intentions in high-stakes competitive environments, and we highlight new opportunities between cognitive science, information theory, and game theory.
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Abstract
Online gambling has gained popularity in the last decade, leading to an important shift in how consumers engage in gambling and in the factors related to problem gambling and prevention. Indebtedness and loneliness have previously been associated with problem gambling. The current study aimed to characterize online gamblers in relation to indebtedness, loneliness, and several in-game social behaviors. The data set was obtained from 584 Internet gamblers recruited online through gambling websites and forums. Of these gamblers, 372 participants completed all study assessments and were included in the analyses. Questionnaires included those on sociodemographics and social variables (indebtedness, loneliness, in-game social behaviors), as well as the Gambling Motives Questionnaire, Gambling Related Cognitions Scale, Internet Addiction Test, Problem Gambling Severity Index, Short Depression-Happiness Scale, and UPPS-P Impulsive Behavior Scale. Social variables were explored with a latent class model. The clusters obtained were compared for psychological measures and three clusters were found: lonely indebted gamblers (cluster 1: 6.5%), not lonely not indebted gamblers (cluster 2: 75.4%), and not lonely indebted gamblers (cluster 3: 18%). Participants in clusters 1 and 3 (particularly in cluster 1) were at higher risk of problem gambling than were those in cluster 2. The three groups differed on most assessed variables, including the Problem Gambling Severity Index, the Short Depression-Happiness Scale, and the UPPS-P subscales (except the sensation seeking subscore). Results highlight significant between-group differences, suggesting that Internet gamblers are not a homogeneous group. Specific intervention strategies could be implemented for groups at risk.
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Abstract
Poker is a type of gambling that has specific features, including the need to regulate one's emotion to be successful. The aim of the present study is to assess emotion regulation, anxiety and depression in a sample of regular poker players, and to compare the results of problem and non-problem gamblers. 416 regular online poker players completed online questionnaires including sociodemographic data, measures of problem gambling (CPGI), anxiety and depression (HAD scale), and emotion regulation (ERQ). The CPGI was used to divide participants into four groups according to the intensity of their gambling practice (non-problem, low risk, moderate risk and problem gamblers). Anxiety and depression were significantly higher among severe-problem gamblers than among the other groups. Both significantly predicted problem gambling. On the other hand, there was no difference between groups in emotion regulation (cognitive reappraisal and expressive suppression), which was linked neither to problem gambling nor to anxiety and depression (except for cognitive reappraisal, which was significantly correlated to anxiety). Our results underline the links between anxiety, depression and problem gambling among poker players. If emotion regulation is involved in problem gambling among poker players, as strongly suggested by data from the literature, the emotion regulation strategies we assessed (cognitive reappraisal and expressive suppression) may not be those involved. Further studies are thus needed to investigate the involvement of other emotion regulation strategies.
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Six Suggestions for Research on Games in Cognitive Science. Top Cogn Sci 2017; 9:497-509. [PMID: 28452201 DOI: 10.1111/tops.12267] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Accepted: 02/07/2017] [Indexed: 11/29/2022]
Abstract
Games are more varied and occupy more of daily life than ever before. At the same time, the tools available to study game play and players are more powerful than ever, especially massive data sets from online platforms and computational engines that can accurately evaluate human decisions. This essay offers six suggestions for future cognitive science research on games: (1) Don't forget about chess, (2) Look beyond action games and chess, (3) Use (near)-optimal play to understand human play and players, (4) Investigate social phenomena, (5) Raise the standards for studies of games as treatments, (6) Talk to real experts.
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Abstract
Given the evidence for the motivating influence of electronic gaming machines (EGM) jackpots on intensifying player behaviour (Rockloff and Hing in J Gambl Stud 1-7, 2013), there is good reason to explore consumer-protection features. Jackpot Expiry is a potential feature of a mandatory pre-commitment system or player identification system (e.g., loyalty program) whereby the availability of jackpots expires after a fixed interval of play. One hundred and thirty volunteers (males = 56, females = 74) played a laptop-simulated EGM with a starting $20 real-money stake. In the test condition, players were shown a "relevant" message stating that the promised jackpot had expired and could no longer be won by the participant (after the 20th trial). In the irrelevant message condition a similar pop-up message simply said to push the button to continue. Lastly, a control condition had no pop-up message about the jackpot expiring. The results showed that betting speeds (one indicator of gambling intensity) were significantly slowed by the relevant 'expiry' message. Most importantly, all wagers past the 20th trial were programmed as losses. Player receiving the 'expiry' message for a cash jackpot quit with significantly more money remaining on the machine. Therefore, jackpot expiry was effective in limiting player losses, while there was no evidence that jackpot expiry reduced self-rated player enjoyment of the simulated EGM experience.
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Abstract
Use of neuroenhancers has been studied in groups ranging from students to surgeons; however, use of cognitive and performance enhancing medications (CPEMs) to improve performance in poker has remained largely overlooked. To assess the use of CPEMs to improve poker performance, a survey of poker players was conducted. Participants were recruited via Internet poker forums; 198 completed the online survey. Approximately 28 % of respondents used prescription CPEMs, with the most commonly used including: amphetamine/dextroamphetamine (62 %), benzodiazepines (20 %), and methylphenidate (20 %). CPEMs were used in poker to focus (73 %), calm nerves (11 %), and stay awake (11 %). Caffeine (71 %), as well as conventionally counter-intuitive substances like marijuana (35 %) and alcohol (30 %) were also reported to enhance poker performance. Non-users of CPEMs were dissuaded from use due to not knowing where to get them (29 %), apprehension about trying them (26 %), and legal or ethical concerns (16 %). Respondents most frequently acquired CPEMs via friends/fellow poker players (52 %), or prescription from physician (38 %). Additionally, greater use of CPEMs was associated with living outside the United States (p = 0.042), prior use of prescription medications for improving non-poker related performance (p < 0.001), and amateur and semi-professional player status (p = 0.035). Unmonitored use of pharmacologically active agents and their methods of acquisition highlight safety concerns in this cohort of poker players, especially among non-professional players. The current state of guidance from national organizations on CPEM use in healthy individuals could impact prescribing patterns.
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