Relationship between attention-deficit hyperactivity disorder symptoms and problem gambling: A mediation analysis of influential factors among 7,403 individuals from the UK (open access article)

Jacob, L., Haro, J. M., & and Koyanagi, A. (2018). Journal of Behavioral Addictions, 7(3), 781–791. doi: 10.1556/2006.7.2018.72

Background and aims: Our goal was to examine the association between attention-deficit hyperactivity disorder (ADHD) symptoms and gambling problems, and to identify potential mediating factors of this association. Methods: This study used cross-sectional, community-based data from 7,403 people aged ≥16 years who participated in the Adult Psychiatric Morbidity Survey 2007. ADHD symptoms were assessed using the Adult DHD Self-Report Scale (ASRS) Screener. Problem gambling was assessed using a questionnaire based on the 10 DSM-IV diagnostic criteria for pathological gambling. Respondents were classified as having no problem, at-risk, or problem gambling. Logistic regression and mediation analyses were conducted to analyze the association between ADHD symptoms (i.e., ASRS score ≥14) and problem gambling and the role of several variables in this association. Results: The prevalence of at-risk (5.3% vs. 2.4%) and problem gambling (2.4% vs. 0.6%) was higher in individuals with ADHD symptoms than in those without ADHD symptoms. ADHD symptoms were significantly associated with both at-risk (OR = 2.15; 95% CI = 1.22–3.79) and problem gambling (OR = 3.57; 95% CI = 1.53–8.31) when adjusted for age, sex, and ethnicity. Common mental disorders (CMDs; i.e., depression and anxiety disorders) (mediated percentage = 22.4%), borderline personality disorder (BPD) traits (22.1%), stressful life events (13.2%), stress at work or home (12.6%), alcohol dependence (11.8%), and impulsivity (11.2%) were significant mediators in the ADHD–gambling association. Discussion and conclusions: Overall, ADHD symptoms were positively associated with problem gambling. CMDs, BPD traits, and stressful life events were important mediators in this relationship. Access full article


Panels summary: Strengthening collaboration to optimize efforts addressing gambling-related harm in Ontario, 26 January & 2 February, 2018 [open access report]

Waddell K., Moat K. A., Bullock H. (February 2018). Panels summary: Strengthening collaboration to optimize efforts addressing gambling-related harm in Ontario. Hamilton: McMaster Health Forum, 2.

Summary of the panels: Participants across the two panels identified six challenges related to addressing gambling related harms in Ontario: 1) the normalization of gambling and the stigma associated with seeking help for gambling problems inhibits access to supports and services; 2) insufficient restrictions on gambling advertisements and ‘give-aways’ result in skewed messaging that downplays the potential risks associated with gambling; 3) conflict of interest within industry and government, stemming from the conflicting goals of revenue generation and delivery of services, makes addressing gambling-related harms difficult; 4) increasingly blurred lines between gambling and online gaming undermine existing restrictions and prevention; 5) limited availability and accessibility of gambling supports and services, including promotion and prevention services, mean many people who need help aren’t getting it; and 6) lack of availability and sharing of data results in limitations in its use to inform the development of programs and services. Continue to full report

Loot box spending in video games is linked to problem gambling severity [open access article]

Zendle, D., & Cairns, P. (2018). Loot box spending in video games is linked to problem gambling severity. doi:

Abstract: Loot boxes are items in video games that contain randomised contents and can be purchased with real-world money. Similarities between loot boxes and forms of gambling have led to questions about their legal status, and whether they should be regulated as gambling. A large-scale survey of gamers (n=1,174) found evidence for a link (η2 = 0.047) between the amount that gamers spent on loot boxes and the severity of their problem gambling. The more participants spent on loot boxes, the worse their problem gambling was. Previous research has strongly suggested both the size and the direction of link between loot box use and problem gambling. This paper confirms such a link’s existence. These results suggest either that loot boxes act as a gateway to problem gambling, or that individuals with gambling problems are drawn to spend more on loot boxes. In either case, we believe that these results suggest there is good reason to regulate loot boxes. Access full article

Developing a best practices guide for the prevention of problem gambling among older adults [open access article]

Turner, N. E., Wiebe, J., Ferentzy, P., Kauffman, N., Zaheer, S., Quosai, T. S., … Mann, R. E. (2018). Journal of Gambling Issues, (39, September). doi:

Abstract: The purpose of this research and development project was to describe the complete gambling experience and to develop best practices for the prevention of problem gambling among older adults (55 years and over) in Ontario. The challenging task of developing best practices involved integrated research and development, as well as knowledge translation and exchange (KTE) throughout the project. We developed a large, multi-organizational, multidisciplinary research team, as well as prevention and treatment work groups comprising investigators, KTE personnel, knowledge users, and service providers from key stakeholder organizations. Research dealing specifically with older adults is scarce; thus, research from other age groups was also drawn upon for this report. We incorporated a variety of types of evidence, including empirical, theoretical, expert opinion, practice-based, and normative. To obtain feedback ahead of finalizing the best practices, we disseminated preliminary best practices to key informants and other knowledge users and service providers. This feedback was incorporated into the current document. This paper presents the first set of evidence-based best practices for the prevention of problem gambling among older adults, including evidence sources, commentary, and references. We hope that these best practices help enhance prevention programs, services, and practices. In addition, we hope that this study prompts future research that examines areas that are currently insufficiently researched and helps provoke a dialogue that will lead to a broader knowledge base to guide prevention policies and practices directed at this growing segment of the population. Access full article

The crucial role of recovery capital in individuals with a gambling disorder (open access article)

Gavriel-Fried, B. (2018). Journal of Behavioral Addictions, 7(3), 792–799. doi: 10.1556/2006.7.2018.82

Background and aims: The concept of recovery capital (RC) describes the internal and external resources that individuals draw upon to initiate and sustain the processes of addiction recovery. This concept has been primarily applied to individuals recovering from substance addictions. In this study, the RC concept was applied to individuals
with a gambling disorder (GD) to test its associations with the diagnosis and severity of GD and with levels of psychopathology as manifested in depression and anxiety. Methods: A sample of 140 individuals who recovered or did not recover from a GD was drawn from lists of former and currently treated individuals in five gambling treatment centers in Israel. The DSM-5 diagnostic criteria for GD, Assessment of Recovery Capital and Brief Assessment of Recovery Capital Scales adapted to Gambling, Generalized Anxiety Disorder Scale, and the Patient Health Questionnaire 9 which measures depression were used. Results: RC clearly distinguishes between individuals who have recovered from GD and those who have not. A structural equation model showed significant negative associations between RC and GD severity, depression, and generalized anxiety. The associations between GD severity and depression and anxiety were not significant. However, when omitting the path between RC and depression/anxiety, the associations between GD and depression/anxiety became significant. Conclusions: RC plays an important role in GD severity and diagnosis, as well as in psychopathology. This study extends the concept of RC to the area of gambling and contributes to the growing body of studies that have found parallels and common denominators between substance addiction and behavioral addictions. Access full article. Access full article

An analysis of consumer protection for gamblers across different online gambling operators in Ireland: A descriptive study [open access article]

Cooney, C., Columb, D., Costa, J. et al. (2018). International Journal of Mental Health and Addiction. doi:

Abstract: The aim of the present study was to evaluate the responsible gambling tools which are available to online gamblers at Irish online gambling websites. The present study used a similar methodology to a recent study carried out on the world’s most popular websites (Bonello and Griffiths Gaming Law Review and Economics, 21, 278–285, 2017), where 50 of the most advertised online gambling websites were evaluated in relation to their responsible gambling (RG) practices. The present study evaluated 39 gambling websites with either a “.ie” or “.com/ie” domain. Each website was evaluated by checking for a number of RG practices, including presence of a dedicated RG page; age verification; access to gambling account history; the availability of RG tools, such as limit setting facilities and exclusion settings; and links to limit-setting options on the deposit page. Descriptive statistics were then performed on the results from each website. Of the 39 online gambling operators identified, 22 redirected gamblers to a “.com” domain, while 17 operators remained as a “.ie” domain. Thirty-five websites (89.7%) visited had a dedicated RG page. Responsible gambling features were evaluated and demonstrated to be available in an inconsistent manner across online gambling websites. Irish websites were shown to perform poorly in comparison with non-Irish counterparts in the provision of RG tools. The researchers of the present study are not aware of any similar studies conducted to date in Ireland. Access full article

The “Zone”: a qualitative exploratory study of an altered state of awareness in electronic gaming machine problem gambling [subscription access article]

Oakes, J., Pols, R., Lawn, S. et al. (2018). International Journal of Mental Health and Addiction. doi:

Abstract: This paper reports a state of mind described by electronic gaming machine (EGM) problem gamblers (PGs) as the “zone”. Twenty-nine PGs engaged in focus groups and in-depth interviews. Participants described an altered state of awareness: the zone, which was highly desirable providing relief from negative emotions. PGs had difficulty recalling experiences whilst in the zone but described a constriction of attention, awareness and impairment of cognitive functions. During this time, the PG could not think critically, exercise self-observation, realistically appraise the use of money, see the consequences of their actions, exercise the will to cease gambling or learn from harms. Memory was impaired, as was decision-making and the capacity to make rational choices. Understanding the zone may provide insight into treatment where the capacity to learn may be reduced. Further research is needed to determine what proportions of EGM gamblers experience the zone and if this occurs with non-EGM gamblers. Article and access details

Problem gambling and family violence: Findings from a population-representative study (open access article)

Dowling, N., Ewin, C., Youssef, G., Merkouris, S., Suomi, A., Thomas, S., & Jackson, A. (2018). Journal of Behavioral Addictions. doi: 10.1556/2006.7.2018.74

Background and aims: Few studies have investigated the association between problem gambling (PG) and violence extending into the family beyond intimate partners. This study aimed to explore the association between PG and family violence (FV) in a population-representative sample. It was hypothesized that: (a) PG would be positively associated with FV, even after adjusting for sociodemographic variables and comorbidities and (b) these relationships would be significantly exacerbated by substance use and psychological distress. A secondary aim was to explore whether gender moderated these relationships. Methods: Computer-assisted telephone interviews were conducted with a population-representative sample of 4,153 Australian adults.

Results: Moderate-risk (MR)/problem gamblers had a 2.73-fold increase in the odds of experiencing FV victimization (21.3%; 95% CI: 13.1–29.4) relative to nonproblem gamblers (9.4%; 95% CI: 8.5–10.4). They also had a 2.56-fold increase in the odds of experiencing FV perpetration (19.7%; 95% CI: 11.8–27.7) relative to non-problem gamblers (9.0%; 95% CI: 8.0–10.0). Low-risk gamblers also had over a twofold increase in the odds of experiencing FV victimization (20.0%; 95% CI: 14.0–26.0) and perpetration (19.3%; 95% CI: 13.5–25.1). These relationships remained robust for low-risk gamblers, but were attenuated for MR/problem gamblers, after adjustment for substance use and psychological distress. MR/problem gamblers had a greater probability of FV victimization, if they reported hazardous alcohol use; and low-risk gamblers had a greater probability of FV perpetration if they were female. Discussion and conclusion: These findings provide further support for routine screening, highlight the need for prevention and intervention programs, and suggest that reducing alcohol use may be important in these efforts. Access full article

Gambling in two Victorian regional Australian Aboriginal communities [open access presentation]

MacLean, S., Thomas, D., Atkinson, A., Griffin, T., Vaughan, R., Stephens, R., … Whiteside, M. (2018, August). Paper presented at the meeting of the Victorian Responsible Gambling Foundation, Geelong, Australia.

  • Background: In 2017/8 MDAS [Mallee District Aboriginal Services] and GEGAC [Gippsland and East Gippsland Aboriginal CoOperative] commissioned La Trobe to collaborate on two separate studies of gambling and how communities could respond. Together we wrote two reports, one with GEGAC investigating issues for young people and one with MDAS focused on all age groups.
  • In collaboration with MDAS staff we wrote an article on bingo that drew on the MDAS findings (Maltzahn et al, 2018)
  • Today we report on findings across both studies. View presentation online

Understanding the business versus care paradox in gambling venues: a qualitative study of the perspectives from gamblers, venue staff and counsellors [open access article]

Riley, B., Orlowski, S., Smith, D., Baigent, M., Battersby, M., & Lawn, S. (2018). Harm Reduction Journal 15(49). doi

Background: In recent years, greater emphasis has been placed on gambling venues to identify potential problem gamblers, respond appropriately and refer to treatment. In seeking the perspectives of problem gamblers, venue staff and treatment providers, this qualitative study investigates how problem gamblers experience being identified and referred for treatment by venue staff.

Results: ‘Role conflict’ was identified as a considerable source of stress for venue staff who described conflicting priorities in responding to problem gamblers whilst maintaining employer profit margins. Problem gamblers described offers of help from venue staff as hypocritical and disingenuous. Venue staff also described reluctance to make moral judgements through the identification of and engagement with problem gamblers, and gamblers described resentment in being singled out and targeted as a problem gambler. Being approached and offered referral to a counselling service was a rare occurrence among problem gamblers. This corresponded with reports by gambling counsellors.

Conclusions: Role conflict experienced by gambling venue staff and patrons alike inhibits effective referral of potential problem gamblers into treatment. Reducing the need for gambling venue staff to make a perceived moral judgement about the gambling behaviours of specific patrons may improve the reception of responsible gambling information and promote help-seeking. Access full article