The Brief Addiction Science Information Source (BASIS)

The WAGER, Vol. 14(5) - What’s in a game? Are certain types of gambling more likely to lead to disordered gambling?

At present, research findings are mixed about the impact of specific forms of gambling on gambling-related problems. Using limited samples, some studies have found an association between specific gambling activity and disordered gambling (e.g., Wood & Griffiths, 1998), often implicating gambling machines as especially “addictive” because of their high rate of gambling opportunities. Treatment seekers often report disproportionate rates of play on specific games. However, treatment seekers are not representative of others with similar problems. Therefore, it is not surprising that some researchers (e.g., National Research Council, 1999; Welte, Barnes, Wieczorek, Tidwell, & Parker, 2004) have found that the number of gambling activities is more predictive of problem gambling.  This week’s WAGER reviews a study that examines the relationship between specific forms of gambling and gambling-related problems among a nationally representative sample of U.S. youths (Welte, Barnes, Tidwell, & Hoffman, 2009).

Methods

• Participants were U.S. youths (ages 14-21) selected via random digit dialing of household telephone numbers who completed the National Survey of Youth and Gambling (N = 2,274).
• Interviews assessed past year gambling behavior and gambling-related problems.
  •  Investigators used a researcher-developed survey to assess participant involvement in 15 gambling activities or settings.
  • Investigators evaluated gambling-related problems using the South Oaks Gambling Screen Revised for Adolescents (SOGS-RA).

Results

• Sixty-eight percent of study participants (N=1,535) reported gambling during the previous twelve months; the highest percentage of these gamblers reported engaging in card games (33%), office pools and charitable gambling  (30%), and the lottery (29%).
• Table 1 summarizes the risks for gambling-related problems and gambling versatility (i.e., mean number of types of gambling in which respondents engaged) for each gambling activity/setting.
  • Overall, higher levels of gambling versatility were associated with more gambling-related problems.
• Researchers performed incidence risk ratio analyses to investigate the impacts of engaging in particular forms of gambling while controlling for all other types of gambling behavior.
  • After controlling for involvement in other games/settings, card games, games of skill, gambling at casinos, and ‘other’ gambling were associated with an increased risk of gambling-related problems.  
  • Other gambling types, including Internet gambling, were not associated with increased risk when controlling for involvement in other gambling activities.

Table 1.  Prevalence of Any Gambling Symptoms and Gambling Versatility on All Forms of Gambling for Gamblers Who Played Each Form of Gambling, U.S. Youth and Gambling Survey (Adapted from Welte et al., 2009)

  

Limitations

• Self-report of gambling activity involvement and potential problem gambling behavior can be associated with recall and reporting bias.
• Data was collected using random digit dialing of household phones, which only occasionally included cell phones.  This strategy generally limits the study sample to youths with a landline home telephone. This group might not be representative of the youth population segment.
• Study questions did not distinguish gambling settings from specific forms of gambling (e.g., questions were asked about casino gambling and about gambling machines not in a casino but not about gambling machines in casinos).

Conclusion
The findings from this study do not support the idea that the most rapid forms of gambling, such as gambling machines, are the most problematic type of game. The finding that gamblers who had higher gambling versatility (i.e., experience with more types of gambling) were more likely to experience gambling problems is, however, consistent with previous research (e.g., National Research Council, 1999; Welte et al., 2004) showing that overall gambling involvement is a more useful predictor of gambling-related problems than participation in specific gambling types.  A high correlation between a specific type of gambling (e.g., Internet gambling) and problem gambling does not reflect a causal influence; this association might mean that devotees of that type of gambling also engage in a lot of other gambling. Youth gambling prevention and harm reduction programs might benefit by incorporating the findings of this study into their practices.  Specifically, by focusing less on particular types of gambling and focusing more on the potential risks of high levels of gambling engagement, such programs might better prevent or reduce the harms associated with youth problem gambling behavior.

-Erica Marshall

What do you think?  Please use the comment link below to provide feedback on this article.

References
National Research Council. (1999). Pathological gambling: A critical review. Washington D.C.: National Academy Press.

Welte, J., Barnes, G., Tidwell, M., & Hoffman, J. (2009). The association of form of gambling with problem gambling among American youth. Psychology of Addictive Behaviors, 23(1), 105-112.

Welte, J., Barnes, G., Wieczorek, W., Tidwell, M., & Parker, J. (2004). Risk factors for pathological gambling. Addictive Behaviors, 29(2), 323-335.

Wood, R. T., & Griffiths, M. D. (1998). The acquisition, development and maintenance of lottery and scratchcard gambling in adolescence. Journal of Adolescence, 21(3), 265-273.

 

The WAGER, Vol. 14(4) - Pay Attention: Does Persistent ADHD Lead to Gambling Problems in Young Adults?

A number of studies (Carlton & Manowitz, 1992; Carlton et al., 1987; Rugle & Melamed, 1993) have shown an association between symptoms of Attention Deficit Hyperactivity Disorder (ADHD) in childhood and pathological gambling behavior during adulthood.  The majority of these studies have retrospective designs, and examine past ADHD symptoms after the development of pathological gambling behavior. These study designs are susceptible to considerable recall bias and leave the causal relationship between ADHD and problem gambling unclear. This week’s WAGER reviews a prospective study (Breyer et al., 2009), which attempts to illuminate the relationship between persistent ADHD and gambling behaviors from childhood through young adulthood .

Methods
The study sample included participants involved with a childhood longitudinal ADHD study (i.e., the Minnesota Competence Enhancement Program).

• At baseline (ages 7-11):
  • N (ADHD) = 318; N (Control) = 144
•  At follow-up (ages 18- 24):
  • N (ADHD) = 142, a 45% follow-up (FU) rate; N (Control) = 93, a 65% FU rate. 
• Significantly fewer ADHD cases than controls participated in the follow-up assessment (X² = 11.7, p = 0.008)
• Investigators assessed childhood ADHD status using the Revised Parent Version of the Diagnostic Interview for Children and Adolescents; at follow-up they assessed ADHD status using the Adolescent Diagnostic Interview.
• At follow-up, researchers identified two subgroups of ADHD cases, ADHD “persisters” (i.e., those with a diagnoses both at baseline and follow-up; N = 47) and ADHD “desisters” (i.e., those with a diagnoses at baseline but not at follow-up; N = 95).
• Researchers used the South Oaks Gambling Screen – Revised for Adolescents (SOGS-RA) to assess gambling behavior at follow-up.
  • Investigators categorized participants with scores of 0-1 as “social gamblers” and those with scores of 2+ as “possible problem gamblers” (PPGs).
• Researchers performed ANOVAs and Chi-square analyses to examine relationships between ADHD status and gambling outcome variables.

Results

• There were no significant subgroup differences in gambling participation or frequency between persisters, desisters, and controls.  
• Persisters had significantly higher rates of PPG. 
  • A significantly higher percentage of persisters (19.1%) met the criteria for PPG than desisters (5.3%) and controls (5.4%; X² (4) = 10.05; p < 0.05). See Graph 1.

Figure 1.  Gambling participation and problem severity by ADHD status
               (Adapted from Breyer et al, 2009)

Limitations

• Gambling behavior and ADHD status were assessed via self report.
• Sample was predominantly Caucasian (95%).
• Significant differential loss to follow-up between ADHD cases and controls between baseline and reassessment.
• Study did not examine ADHD co-occurring disorders, particularly externalizing disorders (e.g., those that effect impulsivity and self-control), which might confound the relationship between gambling behavior and ADHD.

Conclusion
Despite the limitations of this study, this research provides important longitudinal evidence about the relationship between persistent ADHD and disordered gambling. Among study participants, those with persistent ADHD have a higher prevalence of PPG during young adulthood; however, a causal relationship between ADHD and gambling problems remains uncertain.  We cannot conclude a causal relationship because the factors contributing to ADHD or the characteristics of persistent ADHD (i.e., potential mediators and moderators) might also increase vulnerability to PPG.  Further, the low occurrence of PPG makes it difficult to evaluate these potential mediators and moderators.  Future research will need to address the limitations of this study (e.g., larger, more ethnically/racially diverse sample, assessment of ADHD co-occurring disorders) to fully understand the causal relationship between persistent ADHD and disordered gambling behaviors.

- Erica Marshall
What do you think?  Please use the comment link below to provide feedback on this article.

References

Breyer, J. L., Botzet, A. M., Winters, K. C., Stinchfield, R. D., August, G., & Realmuto, G. (2009). Young Adult Gambling Behaviors and their Relationship with the Persistence of ADHD. Journal of Gambling Studies.

Carlton, P. L., & Manowitz, P. (1992). Behavioral restraint and symptoms of attention deficit disorder in alcoholics and pathological gamblers. Neuropsychology, 25, 44-48.

Carlton, P. L., Manowitz, P., McBride, H., Nora, R., Swartzburg, M., & Goldstein, L. (1987). Attention deficit disorder and pathological gambling. The Journal of Clinical Psychiatry, 48(12), 487-488.

Rugle, L., & Melamed, L. (1993). Neuropsychological assessment of attention problems in pathological gamblers. The Journal of Nervous and Mental Disease, 181(2), 107-112.

The WAGER, Vol. 14(3) - The early bird is even earlier: predicting gambling behavior in kindergarten

Youth gambling is a potential precursor and a possible indication of pathological gambling later in life (Pagani, Derevensky, & Japel, 2009; Proimos, DuRant, Pierce, & Goodman, 1998). In a prospective longitudinal study, Pagani et al. (2009) examine the correlation between early childhood (i.e., kindergarten) impulsive behavior and youth (i.e., sixth grade) gambling activities.

Methods

• Researchers recruited the children and parents from the kindergarten cohort from the Montreal Longitudinal Preschool Study
  • The authors followed 377 children exclusively selected from intact families
  • The final sample (n= 163) included children with complete youth and parental gambling involvement information from both kindergarten and sixth grade
• Youth Gambling was the dependent variable
  • Assessed via self-report by telephone interview
  • Measured via a 5-item scale to determine past year youth gambling involvement
  • How many times have you done the following: cards; bingo; bought lottery (instant or sports); played video games for money; placed bets at sports venues
  • Scoring: 0 (never) to 3 (once per week or more)
• Early Impulsive Behavior was the independent variable
  • Assessed via completion of the Social Behavior Questionnaire (assessment of children’s behavioral adjustment and current psychosocial adjustment) by children’s kindergarten teacher
  • Impulsivity was measured in a 9-item subscale (α=.91) (combination of inattentiveness, distractibility, hyperactive factors)
  • Scoring: reverse scoring of 1 (often or very true) to 3 (never or not true) followed by summation
• Researchers used two models to measure the correlation
  • The simple model used impulsivity alone
  • The controlled model combined impulsivity with the following covariates:
  • Gender: there are gender differences for ADHD and gambling
  • Maternal education: can represent other unmeasured parental characteristics and explains the home environment and its effect on youth behavior
  • Family dysfunction: correlated with ADHD and gambling
  • Parental gambling: if present it can easily be an example to children
  • Emotional distress (e.g., depression symptoms): ADHD and depression, and gambling and depression can coexist together

Results

• Early childhood impulsivity is significantly correlated to youth gambling
  • According to both models, a 1-unit increase in teacher-reported early childhood impulsivity associated with a corresponding 25% increase in later self-reported youth gambling activities (see Table 1)
• When controlling for impulsivity, others variables (i.e., maternal education, family dysfunction, parental gambling, emotionally distressed behavior (e.g., depression symptoms)) are not significant.

Table 1. Prediction of Youth Gambling Behavior by Early Childhood Impulsivity (from Pagani et al., 2009)

*Click image to enlarge, or adjust your browser's zoom setting.
a For the simple model, R2=0.06; for the fully controlled model, R2=0.16
b The CIs, based on unstandardized βs, are derived for the fully controlled model

Limitations

• Self-report of gambling activity (by parents and children at six-year follow-up)
• Proxy report of early childhood impulsivity by kindergarten teachers
• Study did not include clinical diagnoses of ADHD (or other disorders associated with gambling problems)
• Low follow-up rate (i.e., 48%)

Conclusion
Youth gambling is a public health issue. Youth gambling can also be a precursor to later pathological gambling (Pagani et al., 2009; Proimos et al., 1998). Youth gambling is a dangerous activity because it can lead to (1) situations that young adolescents might not have the experience or maturity to handle and (2) gambling related problems later in life. The study of kindergarten behavior could potentially lead to an over analysis of simple childhood activities (i.e., instead of appreciating a child’s exuberance, parents will start to fear the advent of compulsive gambling). However this study’s findings, that excessive childhood impulsivity has a possible correlation to youth gambling, are promising because these results might lead to better early prevention methods. Despite its limitations, Pagani et al.’s work provided important longitudinal evidence; it will be interesting to see if the suggested correlation between impulsivity and gambling will continue to manifest itself as the participants grow older.

- Ingrid Maurice

What do you think? Please use the comment link below to provide feeback on this article.

References
Pagani, L. S., Derevensky, J. L., & Japel, C. (2009). Predicting gambling behavior in sixth grade from kindergarten impulsivity: a tale of developmental continuity. Arch Pediatr Adolesc Med, 163(3), 238-243.
Proimos, J., DuRant, R. H., Pierce, J. D., & Goodman, E. (1998). Gambling and other risk behaviors among 8th- to 12th-grade students. Pediatrics, 102(2), 1-6.

The WAGER, Vol. 14(3) - Lottery Revenue Increases during Government Check Week: Coincidence?

“Wake up, wake up, wake up it's the 1st of the month
To get up, get up, get up, so cash your checks and get up”
    --Bone Thugs-n-Harmony, “1st of tha [sic] Month,” from the album E 99 Eternal

The timing of government checks, such as social security, coincides with check recipients’ increase in consumption of essential goods and services.  But receiving government checks also coincides with an increase in recipient spending on non-essential goods and services, such as entertainment expenditures (Stephens, 2003).  This week’s WAGER reviews a study, which examined whether the timing of government subsidy distribution corresponds with an increase in lottery revenues, and which type of game revenue tends to increase the most.

Methods

• Weinbach & Paul (2008) used lottery sales data from four years in seven states for different types of games (data from LaFleur, 1993; 1994; 1995; & 1996).
  • Pick 3 games were less expensive to play, and had small yet frequent payouts. 
  • Pick 5 games were more expensive to play, and had large yet infrequent payouts.
• In each state, government transfers of funds for three programs (i.e., disability, social security, and Aid to Families with Dependent Children) occurred during the first week of the month.
• The authors used multiple regression analyses to examine if there was a relationship between lottery revenue and weeks in which the government distributed these checks.

Results

• Table 1 shows that in all 7 states, lottery revenues increased significantly during the first week of the month for Pick 3 games.
• Table 1 also shows that in 6 of 7 states, lottery revenues did not correspondingly increase for Pick 5 games.

Table 1. Pick 3 and Pick 5 revenue change during the 1st week of the month (Adapted from Weinbach et al., 2008).

*p value <.05
**p value <.01

Limitations

• Data was available for both Pick 3 and Pick 5 games in only seven states, so the number of states available for comparison is limited.
• This study examined large consumer trends; therefore it cannot distinguish recipients of government payments from other consumers.
  • For instance, some employers also could distribute paychecks during the first week of the month.  If so, the increase in Pick 3 revenues during the first week of the month might be attributed to both government and employer check distribution. 
  • However, there were no lottery revenue increases during the middle of the month, another common time for employers to distribute checks.  Therefore we can assume that first week of the month lottery revenue increases are partially due to government check distribution.

Conclusion
Weinbach and Paul (2008) found an increase in Pick 3 lottery expenditures during the first week of the month; this result is consistent with the finding that government check distribution occurs in tandem with increased spending on essential and non-essential goods and services (Stephens, 2003).  However, the authors did not observe such an increase in Pick 5 expenditures.  Taken together, these findings indicate that among individuals on a fixed interval reinforcement schedule (such as those receiving government subsidies), games with more frequent, less prolific payouts (e.g., Pick 3 games) more strongly reinforce the purchase of subsequent tickets than games with less frequent, more prolific payouts (e.g., Pick 5 games).

What do you think? Comments can be addressed to Leslie Bosworth.

References

LaFleur, T. (1993). LaFleur's 1993 World Lottery Almanac. Boyds, Maryland: TLF Publications, Inc.

LaFleur, T. (1994). LaFleur's 1994 World Lottery Almanac. Boyds, Maryland: TLF Publications, Inc.

LaFleur, T. (1995). LaFleur's 1995 World Lottery Almanac. Boyds, Maryland: TLF Publications, Inc.

LaFleur, T. (1996). LaFleur's 1996 World Lottery Almanac. Boyds, Maryland: TLF Publications, Inc.

Stephens, M. (2003). 3rd of the month: Do social security recipients smooth consumption between checks? American Economic Review, 93(1), 406-422.

Weinbach, A. P., & Paul, R. J. (2008). Running the Numbers on Lotteries and the Poor: An Empirical Analysis of Transfer Payment Distribution and Subsequent Lottery Sales. Atlantic Economic Journal, 36, 333-344.

The WAGER, Vol. 14(2) - Can Treatment be Short and Sweet? A Comparison of Brief Interventions for Problem and Pathological Gamblers

Disordered gamblers do not typically seek treatment (Slutske, 2006). Therefore, it is important to test brief interventions because these strategies might attract more treatment-seeking gamblers than more extensive treatment. Previous WAGERs (see WAGER 13(5) and 11(9)) have reviewed some of these interventions. This week the WAGER reviews a study examining the efficacy of three types of brief interventions for disordered gamblers (Petry, Weinstock, Ledgerwood, & Morasco, 2008).

Methods:

• Participants (N=180) were recruited using advertisements posted at numerous medical clinics and were eligible for this study if they endorsed > 3 South Oaks Gambling Screen (SOGS: Lesieur & Blume, 1987) items and wagered at least $100.00 on gambling on at least four occasions within the past two months.
• Participants were randomly assigned to one of four treatment groups:
  • Assessment Only Control: a baseline for comparison. 
  • Brief Advice: 10 minute meeting with a therapist to discuss gambling problems, risks, and ways to avoid risk situations.  
  • Motivational Enhancement Therapy (MET): 50 minute therapist session including personalized feedback about gambling’s influence on goals and values and a plan to change that influence.
  • MET plus Cognitive-Behavioral Therapy (CBT): MET session and 3 CBT sessions in which therapists determined gambling triggers and strategies for coping with triggers.  
• At baseline, 6 weeks, and 9 months, participants reported past month gambling expenditures and were assessed using the SOGS.
• At each follow-up, participants were classified into one of the following groups based on their SOGS scores and past month gambling expenditure:
  • Recovered and Improved (e.g., < 3 SOGS items and/or > 30% decrease in dollars wagered). 
  • Unchanged (e.g., > 3 SOGS items and < 30% reduction in dollars wagered). 

Results:

• Retention across assessments ranged from 83.7-87.5%.
• All groups, including the control group, experienced decreases in gambling.
• At 9 months, the only significant difference between pairs of groups was between the best performing group, Brief Advice, and the worst, Assessment Only Control; there were no significant differences among the other groups (See Figure 1).

Figure 1: Percentage of Participants Classified as Improved and Recovered based on Gambling Expenditure and SOGS Score at 6 Weeks and 9 Months (adapted from Petry et al., 2008).
 

*Recovered and Improved defined as < 3 SOGS items and/or > 30% decrease in dollars wagered. MET- Motivational Enhancement Therapy. CBT- Cognitive-Behavioral Therapy.
Please click on image for a clearer picture, or adjust your browser's zoom settings.

Limitations:

• This study used self report.
• Recruitment advertisements were located mostly in inner-city clinics making these results difficult to generalize for all populations.

This study indicates that brief interventions can have a positive impact on gambling problems. Surprisingly, the most successful brief intervention was the most brief (e.g., the Brief Advice group). More research about the efficacy and impact of brief interventions for disordered gambling is needed. Brief advice interventions have an advantage over the others because they are cost-efficient and require less investment of therapists’ time.

What do you think?  Comments can be addressed to Tasha Chandler.

References:

Lesieur, H. R., & Blume, S. B. (1987). The South Oaks Gambling Screen (SOGS): A new instrument for the identification of pathological gamblers. American Journal of Psychiatry, 144(9), 1184-1188.

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.

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.

The WAGER Vol. 14 (1) – Scratching the Surface of Comorbidity: Understanding the Relationships between Substance Use Problems, Gambling Problems, and Other Mental Disorders

Past research focusing on the co-occurrence of disordered gambling and other mental health disorders has left no doubt that significant overlap exists between disordered gambling and substance use, mood, and anxiety disorders (Crockford & el-Guebaly, 1998; Kessler et al., 2008; Petry, Stinson, & Grant, 2005). However, research has yet to uncover how disordered gambling interacts with substance use disorders and other mental disorders. This week the WAGER reviews a large Canadian study that investigates that interaction (Rush, Bassani, Urbanoski, & Castel, 2008).

Methods

• Canadian nationally representative survey employing face-to-face interviews (n = 36,885)

• Measures included the Problem Gambling Severity Index (PGSI: Ferris & Wynne, 2001) to measure past-year gambling problem severity (i.e., non-gambler/non-problem gambler [no endorsed problems], low risk gambler [1-2], and moderate risk/problem gambler [3+]), and the Composite International Diagnostic Interview (CIDI: Kessler & Ustun, 2004) to assess a subset of Axis I mental disorders (i.e., substance use disorders, major depressive disorder, mania, panic disorder, social phobia, and agoraphobia).

• For analysis, substance use disorders were collapsed across alcohol and drug use disorders to create four past-year categories: abstainers, non-problem users, problem users, and dependent users. Other mental disorders were collapsed into a single variable indicating presence or absence of any lifetime disorder.

Results

• The presence of lifetime mental disorders other than substance use disorders increased the prevalence of past-year moderate/problem gambling from 1.7% to 2.9%.

• The more severe the past-year substance use disorder, the higher the prevalence of past-year moderate/problem gambling – from 1.0-1.4% among abstainers to 9.1-9.6% among those with substance dependence.

• The relationship between past-year substance use disorders and past-year gambling problems was not affected significantly by the lifetime presence or absence of other mental disorders. See Figure 1.

Figure 1. Differences in Prevalence Rates of Moderate/Problem Gambling among Participants with and without Substance Use Disorders and Other Mental Disorders (adapted from Rush et al., 2008)

(Click image for clearer, enlarged picture)
* p < .05 – prevalence rate significantly different from that in the general population
Note: No difference between prevalence rates is reflected by a score of 1 in the Figure. An increased prevalence rate for a given group is reflected by a score above 1 and a decreased prevalence rate is reflected by a score below 1. Analyses controlled for age, gender, education, and region. MD = mental disorder; SU = substance use, not problematic; SUP = substance use problem, not dependence; SD = substance dependence.

Limitations

• The survey did not assess all Axis I disorders and the study collapsed these disorders into a single lifetime category.

• The study did not separately assess the impact of alcohol use and drug use disorders.

• The study was cross-sectional; conclusions about the etiology of these disorders and their causal relationships require longitudinal study.

Conclusion
Past year gambling problems appear to be more robustly associated with past-year substance use disorders than with lifetime presence of other mental disorders, and that association between gambling problems and substance use disorders appears unaffected by the lifetime presence of other mental disorders. This suggests that etiologically, gambling problems and substance use disorders are more closely related than gambling problems and other disorders; these other disorders might relate to problem gambling through their associations with substance use disorders or might predispose individuals to gambling problems and substance use disorders (see Kessler et al., 2008). Longitudinal research is needed to test this suggestion.

For more WAGER articles about comorbidity, please see:

The WAGER, Vol. 13(2) - Chickens, Eggs, and Psychiatric Comorbidity Among PGs

The WAGER Vol. 10(12) - Disordered Gambling and Psychiatric Comorbidity

What do you think? Comments can be addressed to Sarah Nelson.

References

Crockford, D. N., & el-Guebaly, N. (1998). Psychiatric comorbidity in pathological gambling: A critical review. Canadian Journal of Psychiatry, 43(1), 43-50.

Ferris, J., & Wynne, H. (2001). The Canadian Problem Gambling Index: Final Report. Ottawa, ON, Canada: Canadian Centre on Substance Abuse.

Kessler, R. C., Hwang, I., LaBrie, R. A., Petukhova, M., Sampson, N. A., Winters, K. C., et al. (2008). DSM-IV pathological gambling in the National Comorbidity Survey Replication. Psychological Medicine 38(9), 1351-1360.

Kessler, R. C., & Ustun, T. B. (2004). The World Mental Health (WMH) Survey Initiative version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). International Journal of Methods in Psychiatric Research, 13(2), 93-121.

Petry, N. M., Stinson, F. S., & Grant, B. F. (2005). Comorbidity of DSM-IV pathological gambling and other psychiatric disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry, 66(5), 564-574.

Rush, B. R., Bassani, D. G., Urbanoski, K. A., & Castel, S. (2008). Influence of co-occurring mental and substance use disorders on the prevalence of problem gambling in Canada. Addiction, 103, 1847-1856.

WAGER 13(10) – The Prevalence of Disordered Gambling Among U.S. Adolescents and Young Adults

Youth gambling has been a subject of great concern, especially given the increased access to gambling in recent years.  Previous studies examining the prevalence of gambling problems among U.S. youths have produced inconsistent results (e.g., some rates higher than and some lower than adult rates) depending on the screening questionnaire, the definition of gambling problems, and the sample. This week the WAGER reviews a study by Welte, Barnes, Tidwell, and Hoffman (2008), which examines the prevalence of disordered gambling among a nationally representative sample of U.S. youths.

Method

• Conducted a random-digit-dial telephone interview between August 2005 and January 2007 with a nationally representative sample.
• Interviewed 2,274 U.S. residents aged 14-21.
• Measured gambling problems by using the South Oaks Gambling Screen – Revised for Adolescents (SOGS-RA, using cut point 4+ as problem gambling) and the Diagnostic and Statistical Manual of Mental Disorders IV/Diagnostic Interview Schedule (DSM-IV DIS, using cut point 3+ as problem gambling).
• Assessed demographic variables, such as age, gender, race, religion, marital status, employment status, living status, and socioeconomic status.

Results

• 68% of the respondents had gambled during the past year. 2.1% met SOGS-RA criteria and 2.2% met DSM-IV criteria for experiencing a gambling disorder. This prevalence of problem gambling is lower than the prevalence in adults (5.5% from SOGS) in a similar national U.S. adult survey  (Welte, Barnes, Wieczorek, Tidwell, & Parker, 2001).  
• Males had a significantly higher disordered gambling rate than females.
• Gambling problems were less likely among respondents who were younger, of Asian ethnicity, had lower socioeconomic status, or were Mormon.
• Higher rates of problem gambling were significantly associated with the transition into adulthood (i.e., working full time, living independently, and not being a student).

Table 1. Past year gambling problems (as measured by SOGS-RA) among a nationally representative sample of U.S youths (n=2,274) (adapted from Welte et al. 2008)

(Click the image to enlarge it.)

Limitations

• Participants self-reported gambling behavior; thus there is potential for self-report bias and/or recall bias.
• The completion rate for the telephone survey was unreported.
• The cut-points used for the SOGS-RA and DSM-IV DIS were arbitrary and inconsistent. If the DSM-IV cut point of 5+ for disordered gambling were applied, the corresponding prevalence of gambling disorder would be 1.3% and 0.4% for SOGS-RA and DSM-IV DIS, respectively. 

Conclusion
The rate of problem gambling observed among this sample is similar to the rate observed among Canadian youth, that is 2.2% from the Canadian Problem Gambling Index (i.e., 2.2% using the Canadian Problem Gambling Index: Huang & Boyer, 2007). The significant relationship between demographic factors and problem gambling, especially factors related to life transition to adulthood, found in this study helps to identify more vulnerable subgroups among youth gamblers and provides important baseline data for future gambling studies.

What do you think? Comments can be addressed to Evelyn Chao.

References

Huang, J. H., & Boyer, R. (2007). Epidemiology of youth gambling problems in Canada: a national prevalence study. Can J Psychiatry, 52(10), 657-665.

Welte, J. W., Barnes, G. M., Tidwell, M. C., & Hoffman, J. H. (2008). The prevalence of problem gambling among U.S. adolescents and young adults: Results from a national survey. Journal of Gambling Studies, 24(2), 119-133.

Welte, J. W., Barnes, G. M., Wieczorek, W. F., Tidwell, M.-C., & Parker, J. (2001). Alcohol and gambling pathology among U. S. adults: Prevalence, demographic patterns and comorbidity. Journal of Studies on Alcohol, 62(5), 706-712.

 

WAGER 13(9) – Cut Me Off: Self-Limit Programs for Internet Gambling

Self-limit programs (i.e., programs offered by casinos or Internet gambling sites that impose wagering or deposit limits) are intended to reduce gambling-related harms.  This week the WAGER examines the Internet sports gambling behavior of people using the self-limit program of a prominent Internet gambling site (Nelson, LaPlante, Peller, Schumann, LaBrie, & Shaffer, 2008). 

Methods

• 567 Internet gamblers who elected to self-limit their gambling deposits (SLs) compared to 46,567 other subscribers to the same betting site (non-SLs)
• Measures of actual Internet sports gambling during an 18 month period: % of days on which a bet was placed; # of bets per day; average bet size; amount wagered; net gambling loss; and % lost (i.e., net loss/amount wagered).

Results

• SLs bet on more days, placed more bets per day, and were more likely to play online games in addition to sports betting than non-SLs.
• After setting self-limits, 10.6% of SLs ceased all betting.
• SLs who continued to bet after setting limits significantly reduced bets per day and total wagered (see Figure 1).

Table 1. Gambling behaviors of self-limiters before and after imposing limits

Adapted from Nelson et al. (in press).

Limitations

• Participants might have gambled on other sites.
• The impact of self-limiting on sports betting might not generalize to other online betting activities, such as poker or casino games.

Conclusion
This study provides preliminary evidence that self-limiting programs are a promising option for Internet gamblers interested in controlling their gambling and also calls attention to the importance of involvement with gambling activity (i.e., days spent betting and bets per day), not just money at risk in distinguishing people with potential gambling problems. 

What do you think?  Comments can be addressed to Ryan J. Martin.  

References
Nelson, S. E., LaPlante, D. A., Peller, A. J., Schumann, A., LaBrie, R. A., & Shaffer, H. J. (in press). Real limits in the virtual world: Self-limiting behavior of Internet gamblers. Journal of Gambling Studies, epub ahead of print.

The WAGER Vol. 13(8): Exposure to casinos and gambling problems: New data, old question

If exposure to gambling contributes to the development of addiction, then more exposure should correspond to higher rates of gambling problems (Shaffer et al., 2004).  This week we examine a study of highly exposed people – those living near a casino – to determine whether their rates of gambling are different from those living farther from a casino (Sevigny, Ladouceur, Jacques, & Cantinotti, 2008).

Participants:

Random sample of 4,922 people drawn from an area within 100km of a Montreal casino.

Methods:

Household telephone survey (Ladouceur, Jacques, Chevalier, Sevigny, & Hamel, 2005)

Measures:

• Driving distance from casino (participants were divided into 5 groups: those who lived 0-20km, 20-40km, 40-60km, 60-80km, and 80-100km away from a casino)
• Casino visits in the past year
• Gambling problems as measured by the South Oaks Gambling Screen (SOGS; Lesieur & Blume, 1987)
• Self reported income

Figure 1: Casino participation, prevalence of pathological gambling, and income in last 12 months by distance to nearest casino (adapted from Sevigny et al., 2008).

Results:

People who lived closest to the casino were:

• Just as likely to be pathological gamblers as the rest of the sample,
• More likely than those living furthest away to have visited the casino during the past year, and
• No more likely than those living furthest away to have lower incomes.

Limitations:

• Proximity to a casino might not be a comprehensive measure of exposure because the casino represents only one gambling venue; other gambling opportunities, such as lotteries, are distributed throughout all regions. 
• Proximity to a casino is arbitrarily set at discrete (20km) intervals; this might not represent distance accurately (a continuous measure).
• Self report methodology

Conclusion:

The relationship between exposure and gambling problems is complex, involving the influence of other variables.  For example, individual or regional vulnerability could moderate the relationship between exposure and gambling disorders. Future studies could measure interactions between exposure variables and vulnerability variables (e.g., local crime levels and gambling policies, individual mental health and family gambling practices), and the interactions’ effects on the exposure-related development of gambling problems.

For more WAGER articles about exposure, please see:

The WAGER Vol. 9(16) - Regional Index of Gambling Exposure – An Acid Test

The WAGER Vol. 10(10) - Risky Business: Youth Gambling

The WAGER Vol. 10(1) - Addiction as Syndrome

What do you think?  Comments can be addressed to Leslie Bosworth

References

Ladouceur, R., Jacques, C., Chevalier, S., Sevigny, S., & Hamel, D. (2005). Prevalence of pathological gambling in Quebec in 2002. Canadian Journal of Psychiatry, 50(8), 181–186.

Lesieur, H. R., & Blume, S. (1987). The South Oaks Gambling Screen: A new instrument for the identification of pathological gamblers. American Journal of Psychiatry, 144, 1184-1188.

Sevigny, S., Ladouceur, R., Jacques, C., & Cantinotti, M. (2008). Links between casino proximity and gambling participation, expenditure, and pathology. Psychology of Addictive Behaviors, 22(2), 295-301.

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 manifestations, common etiology. Harvard Review of Psychiatry, 12(6), 367-374.

The Wager Vol. 13(7) - Binges and bets: Links between drinking problems and gambling problems

Few studies have examined the impact of drinking behavior among individuals experiencing gambling problems.  This week, the WAGER reviews a study by French, Maclean, and Ettner (2008), which examined the relationship between alcohol use and abuse and gambling-related problems among a large, representative sample of U.S. citizens. 

Methods:

• Data from the National Epidemiological Survey on Alcohol and Related Conditions (NESARC) using a sub-sample of participants who experienced 1 or more gambling-related problem(s) during the past year (N=1,203). 
• Measures included number of gambling-related problems experienced by participants during the past year, alcohol use frequency, drinking to intoxication, and alcohol abuse or dependence.
• Probit regression analyses assessed the relationship between the number of gambling problems and drinking behaviors/problems.

Results:

• Weekly or more frequent drinking was not significantly associated with number of gambling problems. 
• Individuals who drank to intoxication and those who met alcohol abuse or dependence criteria had significantly higher (p < .001) numbers of gambling problems, even when models controlled for potential confounding variables. See Figure 1.

Figure 1: Number of gambling-related problems with regard to various drinking behaviors among a sample of participants who have experienced gambling problems in the past year (adapted from French et al., 2008).

Limitations:

• Cross-sectional studies do not measure the temporal or causal relationship among variables of interest. 
• Potential self-report bias and/or recall bias.

Conclusion/Discussion:

French et al. (2008) found no association between gambling problems and frequent consumption of alcohol. They did, however, find a significant positive relationship between problematic drinking behavior patterns (i.e., drinking to intoxication and meeting criteria for alcohol abuse or dependence) and the number of gambling problems.  Thus, participants who drank alcohol to diagnostic level were more likely to have more problems related to their gambling behavior. This finding is consistent with models (e.g. Shaffer LaPlante, LaBrie, Kidman, Donato, & Stanton, 2004) that propose a broader characterization of addiction as including both substance-related and behavioral manifestations (See Wager 10(1)).

What do you think?  Comments can be addressed to Ryan J. Martin.

French, M., Maclean, J., & Ettner, S. (2008). Drinkers and bettors: investigating the complementarity of alcohol consumption and problem gambling. Drug and Alcohol Dependence, 96, 155-164.

Shaffer, H., LaPlante, D., LaBrie, R., Kidman, R., Donato, A., & Stanton, M. (2004). Toward a syndrome model of addiction: multiple expressions, common etiology. Harvard Review of Psychiatry, 12, 367-374.