This is a very misleading title. The researchers only looked at the players' behaviors, not "what's in the games". Of course if you only look at the players and not the games, such as specific game characteristics that may increase risks, you'll conclude it's all about the players, not the games. This is common sense that the researchers seem to lack. These conclusions are ethically irresponsible in the absence of looking at game specific characteristics that potentially increase risk. Advising that prevention should not focus on specific games that obviously have their own specific risk factors, is also ethically irresponsible and minimizes potentially hazardous game characteristics that research and prevention should be focused. Seems like the researchers hold an undeclared bias that all games and gambling are benign, which is blinding them from looking at the obvious. The gaming experience affects behaviors.
R.H.
Dear R.H.,
Thank you for writing to the BASIS and for your interest in the WAGER 14(5), What’s in a game? Are certain types of gambling more likely to lead to disordered gambling? You have raised several concerns about our review of the Welte, Barnes, Tidwell & Hoffman article ( 2009); these include concerns about the methods Welte et al. employed and the potential bias associated with the original article and how we reported it in the WAGER. Charges of ethical irresponsibility are significant and we take such an indictment very seriously. Consequently, in this response, we will address each of these matters.
Your first concern is with the title of this WAGER. BASIS titles are intended to both catch the eye of the reader and identify the research aims of the study under review. We are sorry to learn that you thought this particular title missed its mark. You also raise concerns about our suggestion that adolescent gambling prevention programs shift their focus to overall gambling versatility and focus less exclusively on specific types of gambling. We based our suggestion to shift the focus of prevention programs because the findings of this particular study support this assertion. However, this WAGER did not suggest abandoning game-specific interventions; we simply suggested that prevention and harm reduction programs might benefit adolescents by expanding their scope to include this research-identified correlate of problem gambling behavior.
Your overarching concern with the study methodology was that the authors’ did not include an assessment of the characteristics of specific gambling activities. You contend that such characteristics might make participants of certain gambling activities more susceptible to gambling problems than participants of other gambling activities. In the absence of evidence, your position has been widely shared. Contrary to your claim, Welte et al. did examine one such game characteristic (e.g., speed of play) and found that it did not influence gambling patterns. The aim of Welte et al.’s study was not to assess such characteristics in general; rather, this research group assessed a specific game feature. They also examined the extent of gambling involvement to evaluate whether participation in particular gambling activities were associated with problem gambling behavior. Although we support more research to examine other characteristics of games and to determine whether these are associated with gambling-related problems, there is some evidence available that bears on this matter.
Your correspondence suggests that certain gambling activities are more dangerous than others. This is a legitimate hypothesis. However, the current and an emerging body of new research fail to provide support for this position. For instance, popular convention holds that electronic gambling machines are “more addictive” than other gambling activities; yet, a comprehensive review (Dowling, Smith, & Thomas, 2005) of the existing evidence concerning gambling behavior and electronic gambling machines casts doubt on this presumption by showing this claim is not supported by empirical evidence. The Welte et al. study adds to this body of evidence. We also have new research that provides support for the Welte et al. finding. In the face of this growing body of evidence, it would be biased and irresponsible to suggest that certain gambling activities are more dangerous than others.
In contrast to your contention that characteristics of games lead to gambling problems, recent empirical research indicates that overall gambling involvement and the diversity of games played might be more predictive of problem gambling behavior than engagement in specific gambling types. As we noted in the WAGER, researchers have found a connection between the number of gambling activities engaged in and problem gambling behavior (e.g., National Research Council, 1999; Welte, Barnes, Wieczorek, Tidwell, & Parker, 2004). Regardless of game features and player characteristics, it is important to note that the development of problem gambling behavior is neither exclusively the result of gambler behavior nor the characteristics of gambling activities. Rather, interactions between players and games are essential. Games do not cause problem gambling; they provide the theater of opportunity for gambling problems to emerge. You have raised a valid criticism of the field by noting that we need more research to clarify this matter further.
Finally, you charge that Dr. Welte and his colleagues, as well as the BASIS staff, operate with “an undeclared bias that all games and gambling are benign.” Although this study found that gambling involvement and diversity were predictive of gambling problems, neither Welte et al. nor us have suggested that either games or gambling is benign. Indeed, gambling is a risk taking activity. In fact, Welte et al. did mention that card games, games of skill, gambling at casinos, and ‘other’ gambling were associated with an increased risk of gambling-related problems. This statement directly disputes your charge that the authors consider all gambling activities as “benign.”
Rigorous, scientifically sound research should reach objective conclusions based on the available evidence regardless of any personal feelings held by the investigator(s) about the subject under investigation. To meaningfully advance a scientific understanding, research must operate free of personal or political agenda and be willing to accept findings that differ from conventional wisdom or popular thought. That is, we must be willing to revise our positions when the evidence supports such a change. Dr. Welte and his colleagues conducted a methodologically sound, empirical study; we find no evidence of bias in their work. Further, the BASIS staff strives to report the current research as objectively as possible. Our goal is to report studies that advance our understanding of addiction by providing scientific evidence, regardless of whether these findings are consistent with currently held assumptions – either our own or the field at-large.
For more, please see Dr. Welte’s recent editorial for the BASIS where he describes his work in this area.
Again, thank you for your interest in the BASIS and for your comments. We always appreciate feedback, questions, and comments from readers.
--The BASIS Staff
References
Dowling, N., Smith, D., & Thomas, T. (2005). Electronic gaming machines: are they the 'crack-cocaine' of gambling? Addiction, 100(1), 33-45.
National Research Council. (1999). Pathological gambling: A critical review. Washington D.C.: National Academy Press.
Welte, J. W., Barnes, G. M., Tidwell, M. C., & Hoffman, J. H. (2009). The association of form of gambling with problem gambling among American youth. Psychology of Addictive Behaviors, 23(1), 105-112.
Welte, J. W., Barnes, G. M., Wieczorek, W. F., Tidwell, M. C., & Parker, J. C. (2004). Risk factors for pathological gambling. Addictive Behaviors, 29(2), 323-335.
Hi Tasha. Just read your research article on affectiveness of different treatment/intervention modalities.
Frankly, being a recovering compulsive gambler, I didn't get much out of this study. The limitations that you recognize, minimize what I think you were hoping to get out of this.
First your criteria for the problem gambler is not very restrictive. Four times at a casino in two months! So called "normal" people would qualify for that. The "SOGS" test is iffy at best.
Secondly, a compulsive or pathological gambler is not going to be honest in that short a period of time with a counselor. Even when hitting "rock bottom" they will still believe the lies they've told themselves.
Thirdly, what incentive was there to participate in this survey? From my experience, if you are a pathological gambler you are not going to do anything that will threaten your only method of survival unless you've hit rock bottom. Yes, you think you can move the bottom up, but until the gambler gets the issues resolved, they are just white knuckling it.
And fourthly, it's not about MONEY !! When will the health care providers get this?! A reduction in expenditures at a casino is NOT addressing the problem, it's only allowing it to continue. Would you allow an alcoholic or drug user to only have a pint vs a quart? Would you ask them to change their drug of choice?
I am just amazed at how research and some counselors approach this obsessive compulsive disorder. Would you say a "cutter" or a "head banger" showed significant improvement by reducing either the size of the cut or the frequency of bangs? Abstinence is the only real measurement that actually represents improvement and even that is questionable unless measured throughout one's life.
Sorry to sound so "negative", usually I spend my time looking for the positives. In this case, I appreciate anyone willing to try and do something, no matter the outcome.
Sincerely,
Randy Ringaman, a recovering compulsive gambler
Dear Randy,
Thank you for writing to the BASIS and for your interest in the WAGER 14(2), Can Treatment be Short and Sweet? A Comparison of Brief Interventions for Problem and Pathological Gamblers. You raised four primary points concerning our review of the Petry, Weinstock, Ledgerwood, & Morasco (2008) study.
Your first comment raised concern about the specific study inclusion criteria (i.e., endorsing 3 or more SOGS items and wagering at least $100.00 on at least four occasions within the past two months). The level of wagering combined with meeting 3 or more SOGS criteria qualified gamblers for the study. Like you, many scientists have expressed a variety of concerns about the accuracy of interpretation of SOGS scores because of the ever-changing definition of problem and pathological gamblers, but researchers have reviewed the literature and confirmed the validity of interpretations based on scores obtained with the original and recent versions of the SOGS (Gambino & Lesieur, 2006; Stinchfield, 2002). However, there also is a body of research suggesting that the SOGS overestimates the extent of problem gambling (Battersby, Thomas, Tolchard, & Esterman, 2002; Gerstein et al., 1999; Walker & Dickerson, 1996).
Second, you suggest that disordered gamblers might not have been honest about their gambling behaviors when responding to therapists’ questions. This is a well-known and legitimate concern; in our review, we recognized self-report as a study limitation.
Third, you question the use of incentives. In accordance with obtaining Institutional Review Board (IRB) approval, the incentives or rewards offered to participate in a study cannot constitute undue inducement or coercion (U.S.Department of Health & Human Services, 2008). Therefore, the incentives to participate in this study were very minimal: $20 in gift certificates for completing the baseline evaluation, and $15 for each follow-up.
This WAGER noted that many disordered gamblers do not seek treatment (Slutske, 2006). However, this observation does not mean that they will have to hit rock bottom before seeking help. In fact, research indicates that many disordered gamblers recover naturally: they are able to recover without receiving formal treatment (Shaffer, 2007; Slutske, 2006; Slutske, Jackson, & Sher, 2003). For instance, Petry et al. observed this phenomenon. They noted that participants in the assessment only control group experienced a decrease in gambling expenditures and had lower SOGS scores at follow-up despite not receiving any of the offered treatments (e.g., brief advice, motivational enhancement therapy and cognitive-behavioral therapy).
Fourth, you expressed concern that recovery from gambling cannot be measured only by the amount of money wagered. This is a very important and often overlooked point. Times spent thinking about gambling or emotional distress due to avoiding gambling are important components of gambling problems. It is important to note that the researchers who conducted this study did not use dollars wagered as a sole means of determining the participants’ recovery status (i.e., recovered, improved, or unchanged). The investigators also used participants’ SOGS scores at follow-up. Nevertheless, it is reasonable to consider a decrease in gambling expenditure as a significant improvement in one dimension of problem gambling. Abstinence is certainly one way to measure improvement or recovery from disordered gambling, but we do not agree that it is the only way to measure improvement. For some people controlled gambling appears to be possible after recovery from disordered gambling. This view and the evidence for it are not unique to gambling; harm reduction approaches to treatment have been utilized for alcohol and drug problems (Marlatt & Witkiewitz, 2002).
Again, thank you for your interest in the BASIS and for your comments. We always appreciate reader feedback, questions, and comments.
--The BASIS Staff
References Cited
Battersby, M. W., Thomas, L. J., Tolchard, B., & Esterman, A. (2002). The South Oaks Gambling Screen: A review with reference to Australian use. Journal of Gambling Studies, 18(3), 257-271.
Department of Health & Human Services, U. S. (2008, November 13, 2008). Office for Human Research Protections (OHRP)- OHRP informed consent frequently asked questions. Retrieved February 24, 2009, from http://www.hhs.gov/ohrp/informconsfaq.html.
Gambino, B., & Lesieur, H. (2006). The South Oaks Gambling Screen (SOGS): A rebuttal to critics. Journal of Gambling Issues, 17.
Gerstein, D., Murphy, S., Toce, M., Hoffmann, J., Palmer, A., Johnson, R., et al. (1999). Gambling impact and behavior study: Report to the National Gambling Impact Study Commission. Chicago: National Opinion Research Center.
Marlatt, G. A., & Witkiewitz, K. (2002). Harm reduction approaches to alcohol use: health promotion, prevention, and treatment. Addictive Behaviours, 27(6), 867-886.
Petry, N. M., Weinstock, J., Ledgerwood, D. M., & Morasco, B. (2008). A randomized trial of brief interventions for problem and pathological gamblers. Journal of Consulting and Clinical Psychology, 76(2), 318-328.
Shaffer, H. J. (2007). Considering the unimaginable: challenges to accepting self-change or natural recovery from addiction (Foreword). In H. Klingemann & L. Carter-Sobell (Eds.), Promoting Self-Change from Addictive Behaviors: Practical Implications for Policy, Prevention, and Treatment (second ed., pp. ix-xiii). New York: Springer.
Slutske, W. S. (2006). Natural recovery and treatment-seeking in pathological gambling: Results of two U.S. national surveys. American Journal of Psychiatry, 163(2), 297-302.
Slutske, W. S., Jackson, K. M., & Sher, K. J. (2003). The natural history of problem gambling from age 18 to 29. Journal of Abnormal Psychology, 112(2), 263-274.
Stinchfield, R. (2002). Reliability, validity, and classification accuracy of the South Oaks Gambling Screen (SOGS). Addictive Behaviors, 27, 1-19.
Walker, M. B., & Dickerson, M. G. (1996). The prevalence of problem and pathological gambling: A critical analysis. Journal of Gambling Studies, 12(2), 233-249.
Dear Ingrid,
Your research shows that people who commit DUIs in 'dry' counties represent a more serious class of offender. Gambling research shows that in states where electronic gambling machines (EGM's) are only permitted in one or two large casinos, gamblers tend to gamble for longer periods of time in a single session, spend more per gambling session but gamble less often that people living in states where EGM's are permitted in many venues scattered throughout urban centres.
The theory behind this phenomenon is that sparely located casinos are expensive to get to, but once the gamblers visit the casino, they are determined to gamble for as long as possible (thereby spending all the money they can access) because they are unlikely to return for some time.
Applying this phenomenon to your findings, would not drinkers forced to drive long distances to "enjoy" the benefits of venues serving alcohol also be motivated to drink to excess knowing they aren't likely to be able to drink again for some time?
Your findings that DUI offenders in dry counties were more likely to be male and underage, and more likely to have multiple DUI offenses does not surprise me at all. It is well established in psychological and sociological research that teenage males are more likely to take risks (drinking and driving is certainly risky behavior) and less likely to accurately predict the risk of getting caught or the risk of being harmed as a consequence of their behavior than any other demographic group. They are also the demographic group less likely to be able to afford cab fees to and from a drinking establishment (this would be especially true of young males who own motor vehicles) and most likely to be living in the home (where alcohol fueled parties would be frowned upon).
Your finding that DUI offenders in dry counties are more likely to have multiple DUI offenses, more likely to meet alcohol abuse and dependence criteria, and less likely to comply with treatment plans, than offenders in wet counties also does not surprise me. Young males are much more likely to rebel against rules of society and to refuse to follow the "advice" of authorities when caught out.
It would be most interesting to know the age at which frequent DUI offending drops significantly (I would predict it would drop significantly after the age of 25 in dry counties but would not drop as significantly in wet counties). This would indicate whether or not multiple DUI offenses, meeting alcohol abuse and dependence criteria and compliance/non-compliance with treatment plans, actually has a significant impact on changing drinking behavior.
Further study on the age at which frequent DUI offending drops significantly might also reveal
• Whether serial offending continues to differ in one, some or all regions as serial offenders age,
• Whether change occurs 'naturally' as serial offenders "grow up" regardless of where they live, and
• Whether or not meeting alcohol abuse and dependence criteria in one's youth accurately predicts long term alcohol abuse and dependence.
All in all, an interesting piece of research.
Sue
Ms. Pinkerton,
Thank you for your continued interest in the BASIS! Just to clarify, the research we reviewed in the DRAM was conducted by Webster and colleagues, not by anyone at the Division on Addictions. The comparison you draw between these data and gambling findings is intriguing. Based on your interests we think that the following articles may provide you with more information. There are a few other studies about DUI offender characteristics and some of them reference age and gender, on their own, combined with each other, and/or combined with other possible risk factors and variables.
In addition, a citation of the reviewed article is listed below.
We here at the BASIS wish you the best and thank you for your continued support of our publication.
Sincerely,
-The BASIS Staff
DRAM Article: Webster, J. M., Pimentel, J. H., & Clark, D. B. (2008). Characteristics of DUI offenders convicted in wet, dry, and moist counties. Accid Anal Prev, 40(3), 976-982.
Other articles:
Shaffer, H. J., Nelson, S. E., LaPlante, D. A., LaBrie, R. A., Albanese, M., & Caro, G. (2007). The epidemiology of psychiatric disorders among repeat DUI offenders accepting a treatment sentencing option. Journal of Consulting and Clinical Psychology, 75(5), 795-804.
LaPlante, D. A., Nelson, S. E., Odegaard, S. S., LaBrie, R. A., & Shaffer, H. J. (2008). Substance and psychiatric disorders among men and women repeat driving under the influence offenders who accept a treatment-sentencing option. Journal of Studies on Alcohol and Drugs, 69(2), 209-217.
Webster J.M., Pimentel J.H., Harp K.L., Clark D.B., Staton-Tindall M. (2009). Substance abuse problem severity among rural and urban female DUI offenders. Am J Drug Alcohol Abuse, 35(1), 24-27.
Wells-Parker E, Anderson BJ, McMillen DL, Landrum JW. (1989). Interactions among DUI offender characteristics and traditional intervention modalities: a long-term recidivism follow-up. Br J Addict, 84(4), 381-90.
Brown TG, Gianoulakis C, Tremblay J, Nadeau L, Dongier M, Ng Ying Kin NM, Seraganian P, Ouimet MC. (2005) Salivary cortisol: a predictor of convictions for driving under the influence of alcohol? Alcohol Alcohol, 40(5), 474-81
Schell TL, Chan KS, Morral AR. (2006). Predicting DUI recidivism: Personality, attitudinal, and behavioral risk factors. Drug Alcohol Depend, 82(1), 33-40.
Ingrid,
I would be very interested in seeing if information referring to county of residence was available. It seems logical that most arrests would be in wet counties since alcohol is not available in dry ones. However, place of residence could give us a better understanding of the effectiveness of specific responsible consumption programs. How can I get this info or similar data?
Sincerely
Alfredo G. Phillips
Mr. Phillips,
Thank you for your interest in the BASIS! The article we reviewed did not provide information on county of residence. However a full citation is listed below and you could contact the corresponding author of the study, J. Matthew Webster to see if that information is available. We here at the BASIS wish you the best of luck and thank you for your support.
Sincerely,
-The BASIS Staff
DRAM Article: Webster, J. M., Pimentel, J. H., & Clark, D. B. (2008). Characteristics of DUI offenders convicted in wet, dry, and moist counties. Accid Anal Prev, 40(3), 976-982.
Other relevant articles:
Webster J.M., Pimentel J.H., Harp K.L., Clark D.B., Staton-Tindall M. (2009). Substance abuse problem severity among rural and urban female DUI offenders. Am J Drug Alcohol Abuse, 35(1), 24-27.
Socie E.M., Wagner S.A., Hopkins RS. (1994). The relative effectiveness of sanctions applied to first-time drunken driving offenders. Am J Prev Med, 10(2), 85-90.
Prevalence of Problem Gambling
A paper in the December issue of the Archives of General Psychiatry, “Mental Health of College Students and Their Non-College-attending Peers” (Carlos Blanco, et al.) has been in the news because of the notable prevalence of substance abuse (around 25%) and personality disorders (approaching 20%) among young adults (age 19-25) in the U.S. that this epidemiological survey found. The face to face interviews of more than 5,000 youth also included other assessments, including of pathological gambling (PG). The prevalence and confidence interval for PG among college students (n-2188) was 0.35 (.14-.88), i.e., about one-third of one percent, and among Not in College (n=2904) youth was 0.23 (.10-.55), i.e., less than one-quarter of one percent.
-James B
Gambling Laws
I think Franks and Paul [see Op-Ed/Editorials: Gambling and the Law®: An Attempt To Gut The UIGEA] are right, although maybe for slightly different reasons than whether government has the right to intervene. I just don't think it helps, and actually believe it just creates an even more dangerous and costly side business, the criminally minded always find a way to profit from another's misery or addiction. Although it seems that great strides have been made in understanding the basis for addiction, maybe even the biological advantages (with addiction being the unintended side of effect of having plenty! or insufficient outlets for competition, aggression, hunting - I don't know, whatever), most people seem uninformed and under the impression addictions are "moral" issues. The first thing I tell my clients when they talk about "mind over matter, will power or I will quit when I am ready" is that those statements are garbage.
We don't openly talk, discuss or teach children about addictions early on, either in our homes or our schools. We treat the issue of addiction as we do sex, which has achieved us almost 7 billion people, world domination (destruction), poverty, torture, injustice…..I think Ned Rollo (wrote Life w/o a Crutch) talked about natural needs and unnatural solutions. Fortunately, of all my bad habits, that one did not get its hooks into me. But maybe we should be researching and teaching early on regarding the "needs" and how to feed them before they find an addiction trough. Work on prevention, redirection and harm reduction.
-Kathy R
Comment from timada42:
As far as I know Khun Sa [see Addiction & the Humanities Vol 3(10) - Supply & Demand: Looking at addiction through drug trafficking] maintained for years that he was a freedom fighter for the Shan, one of many ethnic minorities who for decades have battled the central government of Myanmar. I don’t know if it’s true, but knowing that the US government offered once a $2-million reward for his arrest proves he had a lot of power over the drug dealing.
Usually I just bite my tongue when I read articles from the BASIS - WAGER, but this article makes a leap of faith in the wrong direction, in my opinion. Problem gambling is NOT about money. Those who sign up for "self-limiting" programs are already in serious trouble and this activity is only one more add-on to their litany of "attempts to control" their gambling. Do you really think that someone who has attempted to control their gambling before, will stop or limit their gambling by signing a "self-limiting program?" I believe that your study limitations are highly probable given what I've seen, heard and experienced during my twenty two years of dealing with problem gambling.
In my opinion, a self-limiting program is nothing more than evidence that the non-problem gambler, the general public and addiction researchers do not understand the true nature of the illness. It relieves the gambling establishments of guilt in exclaiming that they have in fact provided something for the problem gambler, although ineffective. It is not difficult to identify a problem gambler while in action whether it be on the internet or at a casino. I've observed problem gamblers excluding themselves from one gambling venue/site only to either violate their exclusion at the risk of arrest or go to another site. In my opinion it's about escape only once the addiction switch is turned on inside their head. There is no life without gambling for them until they are willing to seek help, which for them is like taking away the one thing that they think sustains them in this world. It is truly a frightening experience if they haven't already opted for prison or suicide.
Thanks for letting me vent on this topic.
Randy R. (a recovering problem gambler)
Dear Randy,
Thank you for writing to the BASIS and for your interest in the WAGER 13(9) – Cut Me Off: Self-Limit Programs for Internet Gambling. The BASIS staff is cognizant that self-limit and/or self-exclusion programs have limitations and will not be helpful for every person with a gambling problem; however, evidence has shown that they have been helpful in better controlling gambling for some people (Ladouceur, Sylvain, & Gosselin, 2007; Nelson et al., 2008; Tremblay, Boutin, & Ladouceur, 2008). Further, some researchers suggest that self-exclusion is a gateway to treatment for gambling problems (Blaszczynski, Ladouceur, & Nower, 2007). Because self-limit and self-exclusion programs are helpful to some, it is important that such programs continue to be implemented, evaluated, and refined to better serve those individuals looking for assistance to help them control their gambling.
Your concerns about the limitations of self-limit programs are valid. As we mentioned in the WAGER 13(9), self-limiters in this study might have gambled on other sites. In the case of self-exclusion, self-excluders might indeed gamble at other venues. In addition, consistent with your observations, another issue that diminishes the impact of self-exclusion programs is lackluster detection (Ladouceur et al., 2007).
Your statement that gambling problems are not necessarily about money also is valid. In fact, the WAGER in question mentioned this concern. The WAGER noted that in this particular study the behavior of self-limiters was excessive in terms of time, not necessarily money.
Concerning the ease of identifying problem gamblers, we do not agree that this is a simple endeavor. Identifying problem gambling is difficult because problematic behavior is contingent on the context of the gambling and the individual’s intent. The same gambling behavior, amount of money spent, or amount of time spent gambling can have very different meanings and/or outcomes for different people.
Again, thank you for your interest in the BASIS and for your comments. We always appreciate feedback, questions, and comments from readers.
--The BASIS Staff
References
Blaszczynski, A., Ladouceur, R., & Nower, L. (2007). Self-exclusion: A proposed gateway to treatment model. International Gambling Studies, 7(1), 59-71.
Ladouceur, R., Sylvain, C., & Gosselin, P. (2007). Self-exclusion program: A longitudinal evaluation study. Journal of Gambling Studies, 23, 85-94.
Tremblay, N., Boutin, C., & Ladouceur, R. (2008). Improved self-exclusion program: preliminary results. Journal of Gambling Studies, 24(4), 505-518.
Wondering how these figures might compare with those who self ban from casinos?
Melvin
Dear Melvin,
Thank you for writing to The BASIS and for your interest in the WAGER 13(9) - Cut Me Off: Self-Limit Programs for Internet Gambling. When you mention “those who self-ban from casinos,” the BASIS staff assumes you are referring to self-excluders (i.e., individuals who voluntarily ban themselves from gaming facilities). There is no research of which we are aware comparing self-excluders and self-limiters.
The scientific literature has not addressed whether self-limiters are more likely to be problem gamblers compared to those who do not self-limit. However, research does indicate that self-excluders are significantly more likely to have experienced gambling problems than their non-excluding counterparts (Ladouceur, Jacques, Giroux, Ferland, & Leblond, 2000; Ladouceur, Sylvain, & Gosselin, 2007). Fortunately, self-exclusion appears to offer one strategy to reduce one’s gambling and associated negative consequences. For instance, one study that examined the impact of a self-exclusion program over a two-year period found that participants in the program indicated a lower urge to gamble and a higher perception of control (Ladouceur et al., 2007). In addition, participants in the program reported that negative consequences as a result of their gambling were significantly less intense for daily activities, social life, work, and mood.
One difference between self-limit and self-exclusion programs is that these strategies attempt to reduce gambling-related harm in different ways. Policy makers offer self-limit programs to help control the extent of gambling; self-exclusion programs exist to prevent gambling (i.e., a harm reduction approach vs. an abstinence approach). Thus, it would be interesting to investigate the differences between people who sign up for each type of program. Until both are offered in a single location and data are available for both programs, this type of comparison will be difficult.
It also is difficult to obtain the actual gambling behavior of casino self-excluders so that scientists can compare them to self-limiters. A strength of the Nelson et al. (2008) study was the authors’ ability to analyze the actual transactions of a large number of Internet gamblers (47,000+) for a long period of time (i.e., 18 months). Such reliable data does not exist for land-based casino gamblers. Consequently, a study among self-excluders would be dependent on less valid self-reports of gambling behavior. Collecting such information daily from casino gamblers over a long time period is costly and cumbersome. Further, self-excluders who gamble are violating their agreements with the casino at the risk of being fined and possibly imprisoned. It is likely that self-excluders who are violating their agreements would not be forthcoming about the extent of their violations.
Again, thank you for your interest in the BASIS and for your comments. We always appreciate feedback, questions, and comments from readers.
--The BASIS Staff
References
Ladouceur, R., Jacques, C., Giroux, I., Ferland, F., & Leblond, J. (2000). Analysis of a casino's self-exclusion program. Journal of Gambling Studies, 16(4), 453-460.
Ladouceur, R., Sylvain, C., & Gosselin, P. (2007). Self-exclusion program: A longitudinal evaluation study. Journal of Gambling Studies, 23, 85-94.
Comment from "james77" regarding Addiction and the Humanities, 4(7) - Cultural Anthropology Guiding Addiction Research
I can really relate to this article as I'm a Native American who has struggled with alcoholism for a very long time. Treatment for me has been more beneficial when conducted with other people who share the same culture as me. Although I am only one person, this study really hits home with me and my struggles and explains many things to me.
Dr Bosworth,
The article on cultural sensitivity & alcohol research [Addiction and the Humanities 4(7)- Cultural Anthropology Guiding Addiction Research] was of interest to me partly because I have some sympathy with Dr Beatrice Medicine's attempt to stand up for her own culture in the face of a more dominant one. There are obvious differences that have developed historically between US & UK views & theoretical models of alcohol use, misuse & addiction but one powerful way North American therapeutic hegemony exerts its influence is via celebrity culture of rehab memoirs which can colour the way problem drinking is discussed, creating needless distractions.
However, the aspect of this article that surprised me most was that drinking was acceptable at all in Native cultures. I had assumed, wrongly it turns out, that Native Americans would reject alcohol, in principal at least, as a means by which Europeans tried to contain their culture.
Regards,
Richard Lee, CPN
Options CSMS ~ Alcohol Team
West Sussex
United Kingdom
The article on living close to casino with no real effect is simply not true. Most of my criminal cases as a result of gambling addiction came about when casino play became more available by being close to client.
Melvin
Dear Melvin:
Thank you for your interest and response to: Exposure to casinos and gambling problems: New data, old question (The WAGER, 13(8)). In your correspondence, you wrote that you noticed that more criminal cases related to gambling occurred when casino play became more accessible; therefore, the findings of Sevigny’s study were false.
Sevigny, Ladouceur, Jacques, & Cantinotti’s 2008 study reports trends – that is, what is true for most people. They aggregated data from many individuals and report about the trends across the individuals included in the sample. For any given individual, the trend they report might not apply. Their study tells us whether, in general, there is a systematic relationship between exposure and gambling problems that exceeds chance. Therefore, the report lacks information about each individual’s experience. On the other hand, your evidence base is case oriented. Ultimately, cases are anecdotal evidence and do not necessarily represent the population.
Thus, there is a divide between clinicians’ experience with individuals and scientists’ experience with groups. The well-known Berkson’s bias (1946) is but one example of this divide. One way research in this area can bridge this divide is to identify for whom casino exposure results in problems and why.
Another consideration in clarifying the relationship between casino exposure and gambling problems is the length of time your criminal cases were exposed to casino games versus how long participants in the Sevigny et al. study were exposed. Your letter implies gambling problems arose soon after the introduction of casino games; Sevigny et al.’s participants were exposed to a casino for ten years before they were surveyed. We have reported previously that people appear to adapt to the presence of the casino (LaPlante, D.A. & Shaffer, H. J. (2007). Understanding the influence of gambling opportunities: Expanding exposure models to include adaptation. American Journal of Orthopsychiatry, 77, 616-623). Gambling-related problems that might be similar to those of your clients tend to happen most when the casino gambling opportunity is new. As the novelty effect wears off, however, people adapt and fewer have gambling related problems.
Identifying these complex issues and the broad research base associated with addictive behaviors is one of the main reasons why we write the BASIS and encourage feedback from readers.
Again thank you for your interest in the BASIS and for your comments. We always appreciate feedback, questions, and comments from readers.
-The BASIS Staff
References
LaPlante, D.A. & Shaffer, H. J. (2007). Understanding the influence of gambling opportunities: Expanding exposure models to include adaptation. American Journal of Orthopsychiatry, 77, 616-623.
Berkson’s bias is detailed in Berkson, J. (1946). Limitations of the application of fourfold table analysis to hospital data. Biometrics, 2, 47-53.
Hello Leslie,
I just read the DRAM article “Relapse After an Organ Transplant” and had to share an incident from about ten years ago: I was trout fishing in the back country in Northeast Iowa (yes, Iowa has back country and trout streams!) when I blew a tire on a gravel road next to a farm field. While I got to work changing the tire, a farmer pulled up in his combine, got off the equipment with a cooler and asked if I needed help. I declined the help, but he stayed to chat and pulled a beer out of his cooler. He asked if I cared for a beer also and I declined. He shared that he was just out of Mayo after a liver transplant and said it was “sooo good to be able to drink again!” He chugged the beer and then opened a second beer. I asked if he wasn’t worried about ruining this liver also, and he responded that since the last liver lasted 45 years, he expected this liver to last another 45 years! I remember wondering if the medical staff Mayo had educated him about the danger of drinking again, particularly so soon after the transplant. Probably he had been using selective listening.
I always enjoy reading the BASIS articles and often forward them on to our gambling and substance abuse treatment contractors.
Best wishes,
Bob K
Dear Prof Kleschinsky,
I found the most recent version of The Dram even more helpful than usual as I am at the end of an assessment of the training GPs in a small part of the south of England need in order to offer alcohol screening & brief intervention. As my recommendations are going to include encouraging greater use of on-line resources I shall make reference to the current Dram in support of it.
Although not, strictly speaking, an observation on this piece of research, one of the ideas that causes a good deal of dissent among health & social care professionals, both medical & non-medical, is the category of hazardous or excessive (or risky) drinking, especially in the context of the Single Alcohol Screening Question. Many find the idea that drinking in excess of 60g of alcohol (= just over 3 imperial pints, or about 1.75 litres, of Guinness) more than once in 3 months could be the starting point for exploring a possible alcohol use disorder highly amusing; this being the right amount to get a typical English Friday or Saturday evening started.
Although It's probably a bit late now & while acknowledging a statistical increase in risk among people consistently drinking more than 20 or 30g of ethyl alcohol/day, I sometimes think the current terminology can impede rather than increase alcohol awareness & wish there was a better way of describing drinking that falls between low-risk & harmful.
Cheers,
R.L.
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:
Again, thanks you for your interest and for writing to the BASIS
--BASIS Staff
References
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.
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
