Today's review is part of our month-long Special Series on Theories of Addiction. During this Special Series, The BASIS features recent publications that investigate the application of theories and models to addiction science.
There are many reasons why one individual might be able to gamble in a controlled, recreational manner their whole life while another individual is exposed to gambling one time and goes on to develop gambling disorder. Risk factors that tend to differentiate problem gamblers from recreational gamblers include mental health disorders, age, gender, influence of family or friends and certain personality characteristics. This week, The WAGER reviews the most current research on the Pathways Model of problem gambling, originally proposed by Blaszczynski and Nower in 2002, to describe different progressions to problem gambling based on unique biological, psychological and ecological variables.
What was the research question?
Can the development of gambling disorder be explained by the Pathways Model that categorizes problem gamblers into 3 distinct subgroups based on different predisposing characteristics?
What did the researchers do?
When they created the Pathways Model, Blaszczynski and Nower drew on past research looking at the biological, psychological and gambling opportunity characteristics of individuals with gambling disorder to create a model to explain the development of gambling disorder. The model identifies three possible pathways through which individuals begin to experience problems with gambling: Behaviourally Conditioned Problem Gamblers, Emotionally Vulnerable Problem Gamblers and Antisocial Impulsivist Problem Gamblers.
Behaviourally Conditioned Problem Gamblers
According to the Pathways Model, Behaviourally Conditioned Problem Gamblers initially begin gambling for social or entertainment reasons. However, they continue to gamble due to behavioral conditioning (i.e., learning to associate gambling activities with positive emotions or escape from negative emotions) or false cognitions, such as believing that they are more likely to win money than lose money from gambling, associated with gambling. These gamblers tend to have the least severe gambling problems but they still engage in chasing and can experience depression and anxiety as a result of gambling losses. Individuals in this subtype generally respond well to treatment, even relatively brief treatment.
Emotionally Vulnerable Pathological Gamblers
Emotionally Vulnerable Problem Gamblers have pre-existing emotional vulnerabilities that make them more likely to develop gambling problems. Vulnerabilities can include negative life events, anxiety, depression, and poor coping or problem solving skills. These experiences and characteristics can make an individual more likely to gamble to escape their emotions. It is therefore important that treatment for these gamblers targets the underlying emotional issues that led them to gamble in the first place.
‘Antisocial Impulsivist’ Problem Gamblers
Like the Emotionally Vulnerable Problem Gamblers, Antisocial Impulsivist Problem Gamblers have pre-existing biological and/or psychosocial characteristics that make them more likely to develop gambling problems. These characteristics include impulsivity, symptoms of antisocial personality disorder, and attentional problems. These gamblers begin gambling earlier than others and tend to exhibit other behavioral problems unrelated to their gambling such as poor interpersonal relationships, substance misuse, suicidality, and criminal activity. Antisocialist Impulsivist gamblers and might have a harder time complying and finding success with treatment.
The Pathways Model
Across all three subtypes, the pathway to problem gambling begins with availability and access to gambling. As the Figure shows, these pathways then diverge in the behaviors, triggers, and motivations the lead these individuals to continue gambling and develop problems (e.g., gambling to cope with emotions for Emotionally Vulnerable Problem Gamblers, vs. gambling excessively because of impulse control issues for Antisocial Impulsivist Problem Gamblers).
Since the original paper, many different researchers have tested Blaszczynski and Nower’s model. In 2010, Milosevic and Ledgerwood reviewed the existing literature on classification of problem gamblers to assess whether the findings match the classifications in the Pathways Model. Seven years later, Moon et al. conducted a cross-sectional analysis that examined a group of non-treatment seeking problem gamblers to see if the three subtypes in the pathways model would emerge. Two longitudinal studies assessed the timing of the characteristics of each subtype and problem gambling, one during adolescence and--just last year--one during adulthood.
What did they find?
Milosevic and Ledgerwood found evidence for three distinct subtypes of gamblers and that closely resembled the types Blaszczynski and Nower described in the Pathways Model. Similarly, Moon et al. found that the three gambling subtypes of the Pathways Model were the best way to group the gamblers in their sample of non-treatment seeking individuals, and the recent longitudinal study of adults, which assessed adults for risk factors before gambling problems had begun, revealed the same three subgroups. In the sample of adolescents, the same profiles emerged; however, 5% of the adolescent sample fit better in a fourth, additional subtype. This subtype was a combination of the Antisocial Impulsivist and Emotionally Vulnerable subtypes. Previous research has also found this subtype emerges in adolescent gamblers, suggesting it may be a subtype specific to this age group.
Figure. An overview of the Pathways Model of Pathological Gambling (Blaszczynski & Nower 2002) for each of the three subtypes of gamblers. Figure adapted from Blaszczynski & Nower (2002). Click image to enlarge.
Why do these findings matter?
Since multiple studies have been able to replicate the finding of these three problem gambling subtypes, this lends support to this conceptualization of the proposed pathways from gambling access and availability to problem gambling. In fact, identifying and clustering the variables that predispose an individual to develop Gambling Disorder has allowed Nower and Blaszczynski to develop and validate the Gambling Pathways Questionnaire (GPQ). Clinicians can use this questionnaire to help assess what might be the underlying causes of their patients’ gambling problems. This can help treatment providers tailor their treatment to each patient’s specific needs and allow them to address the root of the gambling problem.
Every study has limitations. What are the limitations of this study?
It is not possible for every individual with gambling disorder to fit neatly into one of these three subtypes, as demonstrated by findings of a fourth subtype of problem gambling in adolescents. In addition, not many studies have been able to get longitudinal data on gamblers, which would provide a more accurate assessment of which factors are present before gambling problems begin and which are a consequence of those problems.
For more information:
Do you think you or someone you know has a gambling problem? Visit the National Council on Problem Gambling for screening tools and resources. For additional resources, including gambling and self-help tools, please feel free to visit The BASIS Addiction Resources page.
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-- Alessandra Grossman