Gambling problems among patients in primary care: a cross-sectional study of general practices (full text)

Sean Cowlishaw, Lone Gale, Alison Gregory, Jim McCambridge and David Kessler

Background: Primary care is an important context for addressing health-related behaviours, and may provide a setting for identification of gambling problems. Aim: To indicate the extent of gambling problems among patients attending general practices, and explore settings or patient groups that experience heightened vulnerability. Design and setting: Cross-sectional study of patients attending 11 general practices in Bristol, South West England. Method: Adult patients (n = 1058) were recruited from waiting rooms of practices that were sampled on the basis of population characteristics. Patients completed anonymous questionnaires comprising measures of mental health problems (for example, depression) and addictive behaviours (for example, risky alcohol use). The Problem Gambling Severity Index (PGSI) measured gambling problems, along with a single-item measure of gambling problems among family members. Estimates of extent and variability according to practice and patient characteristics were produced. Results: There were 0.9% of all patients exhibiting problem gambling (PGSI ≥5), and 4.3% reporting problems that were low to moderate in severity (PGSI 1–4). Around 7% of patients reported gambling problems among family members. Further analyses indicated that rates of any gambling problems (PGSI ≥1) were higher among males and young adults, and more tentatively, within a student healthcare setting. They were also elevated among patients exhibiting drug use, risky alcohol use, and depression. Conclusion: There is need for improved understanding of the burden of, and responses to, patients with gambling problems in general practices, and new strategies to increase identification to facilitate improved care and early intervention.

Post-traumatic stress symptoms in pathological gambling: Potential evidence of anti-reward processes (full text)

By Cheryl L. Green, Ramzi W. Nahhas, Arielle A. Scoglio, Igor Elman.

Background: Excessive gambling is considered to be a part of the addiction spectrum. Stress-like emotional states are a key feature both of pathological gambling (PG) and of substance addiction. In substance addiction, stress symptomatology has been attributed in part to “anti-reward” allostatic neuroadaptations, while a potential involvement of anti-reward processes in the course of PG has not yet been investigated. Methods: To that end, individuals with PG (n = 22) and mentally healthy subjects (n = 13) were assessed for trauma exposure and post-traumatic stress symptomatology (PTSS) using the Life Events Checklist and the Civilian Mississippi Scale, respectively. Results: In comparison with healthy subjects, individuals with PG had significantly greater PTSS scores including greater physiological arousal sub-scores. The number of traumatic events and their recency were not significantly different between the groups. In the PG group, greater gambling severity was associated with more PTSS, but neither with traumatic events exposure nor with their recency. Conclusions: Our data replicate prior reports on the role of traumatic stress in the course of PG and extend those findings by suggesting that the link may be derived from the anti-reward-type neuroadaptation rather than from the traumatic stress exposure per se.

An Examination of the Relationship Between Social Casino Gaming and Gambling: The Bad, The Ugly, and The Good (open access)

Michael J.A. Wohl, Melissa M. Salmon, Samantha J. Hollingshead, Hyoun S. Kim.

Social casino games (i.e., free-to-play online gambling-themed games) are now ubiquitous on social network platforms such as Facebook. Their popularity and similarity to gambling games has raised concern that, among other things, social casino games will normalize gambling behaviour, which may contribute to gambling participation and to a rise in the rate of disordered gambling. Herein, we review theory and research that address potentially bad (migration to gambling) and ugly (increased rate of problem gambling) consequences of social casino gaming. We also outline the limits and boundaries of this presupposition. Specifically, we outline contexts in which social casino games may yield positive consequences when played, including the use of such games as a proxy for gambling among disordered gamblers. Drawing on these discussions, we offer a path model for gambling behaviour that places social casino gaming at its core. Although we, like others, present some pessimism regarding the outcome of social casino game play, this paper points to situations and motivations that may yield positive effects.

Electronic Gaming Machine (EGM) Environments: Market Segments and Risk

Matthew Rockloff, Neda Moskovsky, Hannah Thorne, Matthew Browne, Gabrielle Bryden.

This study used a marketing-research paradigm to explore gamblers’ attraction to EGMs based on different elements of the environment. A select set of environmental features was sourced from a prior study (Thorne et al. in J Gambl Issues 2016b), and a discrete choice experiment was conducted through an online survey. Using the same dataset first described by Rockloff et al. (EGM Environments that contribute to excess consumption and harm, 2015), a sample of 245 EGM gamblers were sourced from clubs in Victoria, Australia, and 7516 gamblers from an Australian national online survey-panel. Participants’ choices amongst sets of hypothetical gambling environments allowed for an estimation of the implied individual-level utilities for each feature (e.g., general sounds, location, etc.). K-means clustering on these utilities identified four unique market segments for EGM gambling, representing four different types of consumers. The segments were named according to their dominant features: Social, Value, High Roller and Internet. We found that the environments orientated towards the Social and Value segments were most conducive to attracting players with relatively few gambling problems, while the High Roller and Internet-focused environments had greater appeal for players with problems and vulnerabilities. This study has generated new insights into the kinds of gambling environments that are most consistent with safe play.

Effectiveness of problem gambling interventions in a service setting: a protocol for a pragmatic randomised controlled clinical trial (open access)

M Abbott, M Bellringer, A C Vandal, D C Hodgins M Battersby, S N Rodda.

Introduction The primary purpose of this study is to evaluate the relative effectiveness of 2 of the best developed and most promising forms of therapy for problem gambling, namely face-to-face motivational interviewing (MI) combined with a self-instruction booklet (W) and follow-up telephone booster sessions (B; MI+W+B) and face-to-face cognitive–behavioural therapy (CBT).

Methods and analysis This project is a single-blind pragmatic randomised clinical trial of 2 interventions, with and without the addition of relapse-prevention text messages. Trial assessments take place pretreatment, at 3 and 12 months. A total of 300 participants will be recruited through a community treatment agency that provides services across New Zealand and randomised to up to 10 face-to-face sessions of CBT or 1 face-to-face session of MI+W+up to 5 B. Participants will also be randomised to 9 months of postcare text messaging. Eligibility criteria include a self-perception of having a current gambling problem and a willingness to participate in all components of the study (eg, read workbook). The statistical analysis will use an intent-to-treat approach. Primary outcome measures are days spent gambling and amount of money spent per day gambling in the prior month. Secondary outcome measures include problem gambling severity, gambling urges, gambling cognitions, mood, alcohol, drug use, tobacco, psychological distress, quality of life, health status and direct and indirect costs associated with treatment.

Addressing the Issue of Problem Gambling in the Criminal Justice System: A Series of Case Studies

Nigel E. Turner, Steve McAvoy, Peter Ferentzy, Flora I. Matheson, Chris Myers, Farah Jindani, Nina Littman-Sharp, Jan Malat.

The prevalence rates of problem gambling in the adult correctional population are 5 to 10 times higher than those found in the general population. Yet little has been published about dealing with problem gamblers in correctional settings. We conducted a literature review and interviewed 16 key informants who provide services to clients experiencing problem gambling and/or who have worked in the criminal justice system. Our objective was to gain greater understanding of programming for problem gambling for clients who are involved in the criminal justice system, with a particular focus on Ontario. The published literature on this topic is remarkably sparse. In fact, only two peer-reviewed published studies were identified that formally evaluated a treatment program for problem gambling for clients in these settings. However, we uncovered a small number of programs (10) that had been developed for, and delivered to, this population, including a gambling treatment court in Buffalo, Gamblers Anonymous, outpatient treatment during probation or parole, brief psychoeducational programs, brief therapy, a full intense treatment program, and inpatient treatment after release. We present a series of short case studies of these programs. Although some programs have been delivered within correctional institutions, others have been offered either after release or prior to sentencing. A major issue is the lack of awareness of problem gambling in the criminal justice system among judges, lawyers, wardens, corrections workers, and parole officers. The results are discussed in terms of issues and opportunities for programming for problem gamblers in the criminal justice system.

The Janus-Faced Role of Gambling Flow in Addiction Issues

Rohit H. Trivedi & Thorsten Teichert.

Flow experience has been widely investigated in experiential activities such as sports, the performing arts, gaming, and Internet usage. Most studies focus on the positive aspects of flow experience and its effect on performance. In stark contrast, gambling research focusing on the negative side of addiction lacks an in-depth investigation of gamblers’ (positive) flow encounters. This separation of research lines seems out of place given that recent research indicates connections between flow and addiction. Joining both constructs in a causal-effects model helps one gain a better understanding of their relationship and its contingencies. This article empirically investigates whether and how it is possible to observe a “Janus face” of flow with its various sub-dimensions in online gambling. Empirical data were collected from 500 online gamblers by applying a structured questionnaire with established scales. The data were analyzed with a confirmatory factor analysis and a double-hurdle model to separate casual gamblers who are unsusceptible to any addiction issues from gamblers affected by initiatory addiction issues. The findings indicate that online gambling addiction is negatively influenced by two sub-dimensions of flow experience, namely a sense of control and concentration on the task at hand, whereas it is enhanced by a transformation of time and autotelic experience.