Letters to the Editor
Dear Basis,
I am an Irish researcher who is undertaking an analysis of the addictive nature of fixed odds betting terminals which may be introduced here in Ireland.
I was wondering if you had any research already conductive on the addictiveness of such machines within the UK or indeed any country.
I would be grateful if you could contact me if you do have any such material.
Regards and thanks,
Andrea
Dear Andrea,
Thank you for your interest in the BASIS. In your letter, you propose that fixed odds betting terminals and other machines themselves are addictive. Our research at the Division on Addiction does not subscribe to the view that objects or machines have inherently addictive properties. Instead, we view addiction as a relationship between people and objects within a context that influences the nature of that relationship (Shaffer et al., 2004). With this understanding of addiction, we propose that public health initiatives to create parameters for safer gambling need to address the dynamic relationship between gambling machines, player characteristics, and the context of gambling behavior (Peller, LaPlante, & Shaffer, in press). In addition, we argue that scientists, policymakers, and game operators should base public health interventions for safer gambling on sound scientific research rather than speculation or public opinion.
Our longitudinal research about the Internet betting behavior of more than 40,000 subscribers provides one illustration of the effect of new electronic gambling technology on gambling behavior. Findings from this research suggest an overall pattern of moderate Internet gambling behavior among the vast majority of subscribers (e.g., 2.5 fixed odds sports bets of €4, or approximately $6 US each, every fourth day), and that the most involved bettors can limit their betting behavior. Only approximately 1% of the subscribers wagered and lost disproportionately high amounts (LaBrie, LaPlante, Nelson, Schumann, & Shaffer, 2007). This research presents evidence that Internet gambling is not universally “addictive” for even the majority of subscribers. If gambling technology was the necessary and sufficient cause of addiction, then all (at least most) of those exposed to such a gambling experience would develop problems. Since this is not the case, we must conclude that gambling machines at most contribute a very small portion to the causes of gambling disorders.
-The BASIS staff
To access Division on Addiction research please visit the library and archives on the Division on Addictions website http://www.divisiononaddictions.org/html/library.htm
References
LaBrie, R. A., LaPlante, D. A., Nelson, S. E., Schumann, A., & Shaffer, H. J. (2007). Assessing the Playing Field: A Prospective Longitudinal Study of Internet Sports Gambling Behavior. Journal of Gambling Studies, 23(3), 347-363.
Peller, A. J., LaPlante, D. A., & Shaffer, H. J. (in press). Parameters for Safer Gambling Behavior: Examining the Empirical Research. Journal of Gambling Studies.
Shaffer, H. J., LaPlante, D. A., LaBrie, R. A., Kidman, R. C., Donato, A., & Stanton, M. V. (2004). Toward a syndrome model of addiction: Multiple expressions, common etiology. Harvard Review of Psychiatry, 12, 367-374.
Hello,
I had a couple of questions/thoughts about the last two Wagers:
1. "gambling machines" -- does this mean video poker and/or ??
2. In general, I think of problem gamblers as usually attached to one, maybe two types of games. ("I play blackjack, but occasionally will play x". "I'm a poker player.") So, I was surprised at the statement that "More than half of gamblers with problems...played 7 or more games..." . I take this to mean that if the gambler said yes to any of the DSM criteria during their lifetime, the number of games reflected any they had ever played? So, my question is around whether or not there was any indication that the game they played was part of the era of problem gambling (did they play bingo once as a kid, but then 20 years later start playing the dogs daily-- and that would count as two games? Also, there is some thought, probably not researched, that over the lifetime of a gambler, the games may move from more skill/action to more luck/escape games. (I've read the theory, don't know the origin).
3. Lastly, if I read this correctly, cards, sports betting, etc. are up to 20 times more likely to be associated with problem gambling than slots. Am I reading this correctly? I find this quite different than clinical experience (and might be indicative of who seeks treatment, who doesn't). And the recovery rate is even higher. I found this even more surprising.
Thanks for your help, Judy
Dear Judy,
Thank you for questions regarding The WAGER volume 13(3) – Game Preferences of Pathological Gamblers and Odds of Recovery.
“Gambling machines” is a broad phrase encompassing four different terms: “slot machine,” a “fruit machine,” a “poker machine,” and a “video lottery terminal (VLT).”
More than half of problem gamblers (who met 1-4 lifetime criteria) played 7 or more games. This means that they played 7 different games one or more times at any point during their lifetimes.
Although cards and sports betting were about 20 times more likely to be associated with problem gambling than slots, this estimate is imprecise because the sample of problem and pathological gamblers was quite small. This creates large confidence intervals, so we must remember to interpret all findings about pathological and problem gamblers in the study with caution.
Clinical experience and clinical epidemiology indicate that pathological gamblers are more likely to play slot machines than most other games, as evidenced in the Iowa Gambling Study. Again, we must interpret these findings cautiously because because the Iowa study sample represents treatment seekers only. There was no one who received treatment in the Kessler (2008) study. It is likely that that evidence obtained from clinical populations differs from evidence generated by household populations. Throughout their lifetime, disordered gamblers might change their game of choice, and different games might have different risk factors. For current research on this subject, we recommend the following article, which compares actual online betting activities of heavily involved bettors to activities of less involved bettors over a two year period:
LaBrie R.A., Kaplan, S.A., LaPlante, D.A., Nelson, S.E., and Shaffer, H.J. (2008) Inside The Virtual Casino: A Prospective Longitudinal Study Of Actual Internet Casino Gambling, European Journal of Public Health. doi:10.1093/eurpub/ckn02.
This paper is available on our website at http://www.divisiononaddictions.org/html/library.htm.
Again, thank you for your interest and for writing to the BASIS.
--BASIS Staff
The article in this month's wager on problem gambling and other psychiatric comorbidity is interesting.
Is problem gambling perhaps a good indicator of an underlying psychiatric disorder?
Could pathological gambling (PG) be like having a high temperature, i.e., not a cause but a side effect?
Could problem gambling be a side effect which is readily recognised and could therefore be used as an early warning device for detecting psychiatric disorders?
Cheers,
Lynne O
Dear Ms. O:
Thank you for your comment about the WAGER volume 13(2) – Chickens, Eggs, and Psychiatric Comorbidity among PGs.
Based on the current evidence, we think that pathological gambling is a psychiatric disorder, and it seems to be a proxy for the presence of additional psychiatric disorders, among other things. In addition, PG might indicate that those with this diagnosis qualified for other disorders during their lifetime, but not currently.
Comparing PG to a high body temperature (fever) is an interesting analogy that we also have used. The National Comorbidity Study Replication (NCS-R) reveals the sequence of disorders, and shows that other problems typically precede and potentially stimulate gambling problems. The NCS-R, however, is designed so that it can only measure associations. Although we can determine that there is a relationship between PG and other disorders, we only can infer the nature of this relationship and the factors that mediate the association. This means designating psychiatric disorders as a cause for PG or PG as a side effect of a psychiatric disorder is beyond the scope of the NCS-R. This is a subject area that needs and deserves more prospective research.
PG could be a warning device for detecting psychiatric disorders, much as smoking tobacco in the United States is now. The social context of these phenomena is important to consider. Finally, prevention programs look for opportunities to identify the “proxy” that reliably predicts other problems as early in the sequence of events as possible and then tries to change them. If we can make life worth living, fewer people need to attenuate or escape their lives. Of course we still need to permit that some people – the minority – have problems with gambling or other objects of addiction without any preceding psychopathology. However, this group is few in number.
Faculty at the Division on Addictions have promulgated a Syndrome Model of Addiction. Your questions allude to some parts of this model. A complete description of the model might help connect your questions into a more comprehensive understanding of addiction, including pathological gambling as one expression of addiction, and how various expressions of addiction can relate to psychiatric disorders. You can find original syndrome model paper in the following publication:
Shaffer, H. J., LaPlante, D. A., LaBrie, R. A., Kidman, R. C., Donato, A. N., & Stanton, M. V. (2004). Toward a syndrome model of addiction: Multiple expressions, common etiology. Harvard Review of Psychiatry, 12, 367-374.
Some BASIS articles briefly describe and discuss the Syndrome Model. Links to those articles are below:
http://www.basisonline.org/2007/05/addiction_the_h.html
http://www.basisonline.org/2007/02/the_dram_vol_32.html
Thank you again for your questions and feedback,
BASIS Staff
