Similarities and Differences between Individuals Seeking Treatment for Gambling Problems vs. Alcohol and Substance Use Problems in Relation to the Progressive Model of Self-stigma (open access)

By Belle Gavriel-Fried and Tal Rabayov.

Aims: People with gambling as well as substance use problems who are exposed to public stigmatization may internalize and apply it to themselves through a mechanism known as self-stigma. This study implemented the Progressive Model for Self-Stigma which consists four sequential interrelated stages: awareness, agreement, application and harm on three groups of individuals with gambling, alcohol and other substance use problems. It explored whether the two guiding assumptions of this model (each stage is precondition for the following stage which are trickle-down in nature, and correlations between proximal stages should be larger than correlations between more distant stages) would differentiate people with gambling problems from those with alcohol and other substance use problems in terms of their patterns of self-stigma and in terms of the stages in the model.

Method: 37 individuals with gambling problems, 60 with alcohol problems and 51 with drug problems who applied for treatment in rehabilitation centers in Israel in 2015–2016 were recruited. They completed the Self-stigma of Mental Illness Scale-Short Form which was adapted by changing the term “mental health” to gambling, alcohol or drugs, and the DSM-5-diagnostic criteria for gambling, alcohol or drug disorder.

Results: The assumptions of the model were broadly confirmed: a repeated measures ANCOVA revealed that in all three groups there was a difference between first two stages (aware and agree) and the latter stages (apply and harm). In addition, the gambling group differed from the drug use and alcohol groups on the awareness stage: individuals with gambling problems were less likely to be aware of stigma than people with substance use or alcohol problems.

Conclusion: The internalization of stigma among individuals with gambling problems tends to work in a similar way as for those with alcohol or drug problems. The differences between the gambling group and the alcohol and other substance groups at the aware stage may suggest that public stigma with regard to any given addictive disorder may be a function of the type of addiction (substance versus behavioral).

Gavriel-Fried, B., & Rabayov, T. (2017). Similarities and Differences between Individuals Seeking Treatment for Gambling Problems vs. Alcohol and Substance Use Problems in Relation to the Progressive Model of Self-stigma. Frontiers in Psychology, 8.

Risk Factors for Gambling Problems on Online Electronic Gaming Machines, Race Betting and Sports Betting (open access)

By  Nerilee Hing, Alex M. Russell and Matthew Browne

Growth of Internet gambling has fuelled concerns about its contribution to gambling problems. However, most online gamblers also gamble on land-based forms, which may be the source of problems for some. Studies therefore need to identify the problematic mode of gambling (online or offline) to identify those with an online gambling problem. Identifying most problematic form of online gambling (e.g., EGMs, race betting, sports betting) would also enable a more accurate examination of gambling problems attributable to a specific online gambling form. This study pursued this approach, aiming to: (1) determine demographic, behavioral and psychological risk factors for gambling problems on online EGMs, online sports betting and online race betting; (2) compare the characteristics of problematic online gamblers on each of these online forms. An online survey of 4,594 Australian gamblers measured gambling behavior, most problematic mode and form of gambling, gambling attitudes, psychological distress, substance use, help-seeking, demographics and problem gambling status. Problem/moderate risk gamblers nominating an online mode of gambling as their most problematic, and identifying EGMs (n = 98), race betting (n = 291) or sports betting (n = 181) as their most problematic gambling form, were compared to non-problem/low risk gamblers who had gambled online on these forms in the previous 12 months (n = 64, 1145 and 1213 respectively), using bivariate analyses and then logistic regressions. Problem/moderate risk gamblers on each of these online forms were then compared. Risk factors for online EGM gambling were: more frequent play on online EGMs, substance use when gambling, and higher psychological distress. Risk factors for online sports betting were being male, younger, lower income, born outside of Australia, speaking a language other than English, more frequent sports betting, higher psychological distress, and more negative attitudes toward gambling. Risk factors for online race betting comprised being male, younger, speaking a language other than English, more frequent race betting, engaging in more gambling forms, self-reporting as semi-professional/professional gambler, illicit drug use whilst gambling, and more negative attitude toward gambling. These findings can inform improved interventions tailored to the specific characteristics of high risk gamblers on each of these online activities.

Food Addiction in Gambling Disorder: Frequency and Clinical Outcomes

By Susana Jiménez-Murcia, Roser Granero, Ines Wolz, Marta Baño, Gemma Mestre-Bach, Trevor Steward, Zaida Agüera, Anke Hinney, Carlos Diéguez, Felipe F. Casanueva, Ashley N. Gearhardt, Anders Hakansson, José M. Menchón, and Fernando Fernández-Aranda.

Background: The food addiction (FA) model is receiving increasing interest from the scientific community. Available empirical evidence suggests that this condition may play an important role in the development and course of physical and mental health conditions such as obesity, eating disorders, and other addictive behaviors. However, no epidemiological data exist on the comorbidity of FA and gambling disorder (GD), or on the phenotype for the co-occurrence of GD+FA.

Objectives: To determine the frequency of the comorbid condition GD+FA, to assess whether this comorbidity features a unique clinical profile compared to GD without FA, and to generate predictive models for the presence of FA in a GD sample.

Method: Data correspond to N = 458 treatment-seeking patients who met criteria for GD in a hospital unit specialized in behavioral addictions.

Results: Point prevalence for FA diagnosis was 9.2%. A higher ratio of FA was found in women (30.5%) compared to men (6.0%). Lower FA prevalence was associated with older age. Patients with high FA scores were characterized by worse psychological state, and the risk of a FA diagnosis was increased in patients with high scores in the personality traits harm avoidance and self-transcendence, and low scores in cooperativeness (R2 = 0.18).

Conclusion: The co-occurrence of FA in treatment-seeking GD patients is related to poorer emotional and psychological states. GD treatment interventions and related behavioral addictions should consider potential associations with problematic eating behavior and aim to include techniques that aid patients in better managing this behavior.

The Relationship Between Impulsivity And Problem Gambling In Adolescence

Secades-Villa R, Martínez-Loredo V, Grande-Gosende A and Fernández-Hermida JR

Gambling has become one of the most frequently reported addictive behaviors among young people. Understanding risk factors associated with the onset or maintenance of gambling problems in adolescence has implications for its prevention and treatment. The main aim of the present study was to examine the potential relationships between impulsivity and problem gambling in adolescence. Participants were 874 high school students (average age: 15 years old) who were surveyed to provide data on gambling and impulsivity. Self-reported gambling behavior was assessed using the South Oaks Gambling Screen – Revised for Adolescents (SOGS-RA) and impulsivity was measured using the Impulsive Sensation Seeking Questionnaire (ZKPQ), the Barratt Impulsiveness Scale (BIS-11-A), and a delay discounting task. The data were analyzed using both a prospective-longitudinal and a cross-sectional design. In the longitudinal analyses, results showed that the impulsivity subscale of the ZKPQ increased the risk of problem gambling (p =.003). In the cross-sectional analyses, all the impulsivity measures were higher in at-risk/problem gamblers than in non-problem gamblers (p = .04; .03 and .01 respectively). These findings further support the relationship between impulsivity and gambling in adolescence. Moreover, our findings suggest a bidirectional relationship between impulsivity and problem gambling in adolescence. These results have consequences for the development of prevention and treatment programs for adolescents with gambling problems.

Compulsive Buying Behavior: Characteristics of Comorbidity with Gambling Disorder – Open Access

Compulsive buying behavior (CBB) has begun to be recognized as a condition worthy of attention by clinicians and researchers. Studies on the commonalities between CBB and other behavioral addictions such as gambling disorder (GD) exist in the literature, but additional research is needed to assess the frequency and clinical relevance of the comorbidity of CBB and GD. The aim of the study was to estimate the point-prevalence of CBB+GD in a clinical setting. Data corresponded to n = 3221 treatment-seeking patients who met criteria for CBB or GD at a public hospital unit specialized in treating behavioral addictions. Three groups were compared: only-CBB (n = 127), only-GD (n = 3118) and comorbid CBB+GD (n = 24). Prevalence for the co-occurrence of CBB+GD was 0.75%. In the stratum of patients with GD, GD+CBB comorbidity obtained relatively low point prevalence (0.77%), while in the subsample of CBB patients the estimated prevalence of comorbid GD was relatively high (18.9%). CBB+GD comorbidity was characterized by lower prevalence of single patients, higher risk of other behavioral addictions (sex, gaming or internet), older age and age of onset. CBB+GD registered a higher proportion of women compared to only-GD (37.5 vs. 10.0%) but a higher proportion of men compared to only-CBB (62.5 vs. 24.4%). Compared to only-GD patients, the simultaneous presence of CBB+GD was associated with increased psychopathology and dysfunctional levels of harm avoidance. This study provides empirical evidence to better understand CBB, GD and their co-occurrence. Future research should help delineate the processes through which people acquire and develop this comorbidity.

Why are Some Games More Addictive than Others: The Effects of Timing and Payoff on Perseverance in a Slot Machine Game – Open Access

Manipulating different behavioral characteristics of gambling games can potentially affect the extent to which individuals persevere at gambling, and their transition to problematic behaviors. This has potential impact for mobile gambling technologies and responsible gambling interventions. Two laboratory models pertinent to this are the partial reinforcement extinction effect (PREE) and the trial spacing effect. Both of these might speed up or delay the acquisition and extinction of conditioned behavior. We report an experiment that manipulated the rate of reinforcement and inter trial interval (ITI) on a simulated slot machine where participants were given the choice between gambling and skipping on each trial, before perseverative gambling was measured in extinction, followed by measurements of the illusion of control, depression and impulsivity. We hypothesized that longer ITI’s in conjunction with the low rates of reinforcement observed in gambling would lead to greater perseverance. We further hypothesized, given that timing is known to be important in displaying illusory control and potentially in persevering in gambling, that prior exposure to longer intervals might affect illusions of control.

Source: James, R. J. E., O’Malley, C., & Tunney, R. J. (2016). Why are Some Games More Addictive than Others: The Effects of Timing and Payoff on Perseverance in a Slot Machine Game. Frontiers in Psychology, 7.

A Serious Videogame as an Additional Therapy Tool for Training Emotional Regulation and Impulsivity Control in Severe Gambling Disorder

Full text available. 

Background: Gambling disorder (GD) is characterized by a significant lack of self-control and is associated with impulsivity-related personality traits. It is also linked to deficits in emotional regulation and frequently co-occurs with anxiety and depression symptoms. There is also evidence that emotional dysregulation may play a mediatory role between GD and psychopathological symptomatology. Few studies have reported the outcomes of psychological interventions that specifically address these underlying processes.

Objectives: To assess the utility of the Playmancer platform, a serious video game, as an additional therapy tool in a CBT intervention for GD, and to estimate pre-post changes in measures of impulsivity, anger expression and psychopathological symptomatology.

Method: The sample comprised a single group of 16 male treatment-seeking individuals with severe GD diagnosis. Therapy intervention consisted of 16 group weekly CBT sessions and, concurrently, 10 additional weekly sessions of a serious video game. Pre-post treatment scores on South Oaks Gambling Screen (SOGS), Barratt Impulsiveness Scale (BIS-11), I7 Impulsiveness Questionnaire (I7), State-Trait Anger Expression Inventory 2 (STAXI-2), Symptom Checklist-Revised (SCL-90-R), State-Trait Anxiety Inventory (STAI-S-T), and Novelty Seeking from the Temperament and Character Inventory-Revised (TCI-R) were compared.

Source: Tárrega, S., Castro-Carreras, L., Fernández-Aranda, F., Granero, R., Giner-Bartolomé, C., Aymamí, N., … Jiménez-Murcia, S. (2015). A Serious Videogame as an Additional Therapy Tool for Training Emotional Regulation and Impulsivity Control in Severe Gambling Disorder. Frontiers in Psychology, 6.