When Does Premature Treatment Termination Occur? Examining Session-by-Session Dropout Among Clients with Gambling Disorder

By Pfund, R. A., Peter, S. C., Whelan, J. P., & Meyers, A. W.

Abstract: Premature termination challenges the successful outcomes of psychological treatments for gambling disorder. To date, research has primarily identified clients who are at particular risk for dropping out of treatment. A smaller but growing body of literature has investigated when dropout occurs. Typically, those studies have not considered improvement in psychological distress within their operationalizations of dropout and therefore may have misrepresented when dropout occurs. The current study examined when dropout occurs using an operationalization based on the criteria of attaining reliable change in a naturalistic sample of clients with gambling disorder, and the classification rates yielded from that operationalization were compared to the rates from a more common operationalization. Participants (n = 334) were clients meeting diagnostic criteria for gambling disorder at an outpatient private practice who completed a measure of psychological distress at baseline and prior to each subsequent treatment session. A survival analysis was conducted to determine temporal patterns of treatment dropout (i.e., clients who discontinued treatment before realizing reliable changes in psychological distress) and completion (i.e., clients who discontinued treatment after realizing reliable changes in distress) at each treatment session. Forty-nine percent of clients were classified as dropouts, and the majority of those clients did so in the first few sessions. The more common operationalization of dropout classified clients as dropouts when they had improved in their distress and clients as completers when they had not improved in their distress. Discussion centers on the implications of dropout occurring at various stages of treatment and future directions.

Pfund, R. A., Peter, S. C., Whelan, J. P., & Meyers, A. W. (2017). When Does Premature Treatment Termination Occur? Examining Session-by-Session Dropout Among Clients with Gambling Disorder. Journal of Gambling Studies. https://doi.org/10.1007/s10899-017-9733-z

 

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Casino Self- and Forced Excluders’ Gambling Behavior Before and After Exclusion

By Kotter, R., Kräplin, A., & Bühringer, G.

Casino exclusion programs are intended to prevent or limit gambling-related harm. Although previous research showed that self-exclusion is associated with reduced gambling, it remains unknown whether self- and forced excluded subjects show different patterns of gambling behavior and if exclusion from casino gambling affects all gambling activities. The present study retrospectively investigated (1) the role of voluntariness of exclusion for the first time, and (2) general gambling behavior of excluded individuals before and after exclusion. A total of N = 215 casino excluders (self-excluders: n = 187, forced excluders: n = 28) completed an online survey or a face-to-face interview up to 8 years after enrollment. Self- and forced excluders showed similar rates of abstinence (self-excluders: 19.3%, forced excluders: 28.6%) and reduction (self-excluders: 67.4%, forced excluders: 60.7%), even though forced excluders reported a significantly greater initial gambling intensity compared to self-excluders (e.g., pre-exclusion gambling time; self-excluders: 3.2 days/week, forced excluders: 4.3 days/week). Overall, results indicated that 20.5% of excluders stopped all gambling activities and another 66.5% reduced their gambling. Those who continued gambling significantly reduced this behavior in every segment, except for gambling halls. Findings indicate that self- and forced exclusion are associated with similarly reduced gambling behavior, even in non-excluded segments. However, unchanged gambling in gambling halls emphasizes the importance to implement consistent exclusion programs over all gambling segments.

 

Kotter, R., Kräplin, A., & Bühringer, G. (2017). Casino Self- and Forced Excluders’ Gambling Behavior Before and After Exclusion. Journal of Gambling Studies. https://doi.org/10.1007/s10899-017-9732-0

Testing an Incentive-Sensitisation Approach to Understanding Problem Slot-Machine Gambling Using an Online Slot-Machine Simulation

By Davey, B., & Cummins, R.

Abstract: This study aims to test the application of the incentive-sensitisation theory to slot-machine gambling behaviour. The theory posits that for problem gamblers (PGs), gambling strengthens the response of motivational pathways in the mid-brain to gambling cues, eliciting strong wanting, independent of liking. Non-problem gamblers (NPGs) experience weaker changes to motivational pathways so liking and wanting remain associated. Hence, it is predicted that wanting to gamble will be greater than liking for PGs but there will be no difference for NPGs; wanting will be greater for PGs than for NPGs; and, wanting but not liking will predict whether PGs continue gambling, whereas both will predict this for NPGs. During gambling on an online simulated slot-machine, 39 PGs and 87 NPGs rated “liking” and “wanting”. Participants played at least 3 blocks of 10–20 spins, and then had the option of playing up to 4 additional blocks; to continue playing they had to complete an effortful task, so that “number of blocks played” acted as an additional indirect measure of wanting. Results supported hypotheses except on the indirect measure of wanting (the number of blocks played).

Davey, B., & Cummins, R. (2017). Testing an Incentive-Sensitisation Approach to Understanding Problem Slot-Machine Gambling Using an Online Slot-Machine Simulation. Journal of Gambling Studies, 1–12. https://doi.org/10.1007/s10899-017-9718-y

 

Negative Mood States or Dysfunctional Cognitions: Their Independent and Interactional Effects in Influencing Severity of Gambling Among Chinese Problem Gamblers in Hong Kong

By Wong, D. F. K., Zhuang, X. Y., Jackson, A., Dowling, N., & Lo, H. H. M.

Abstract: Gambling-related cognitions and negative psychological states have been proposed as major factors in the initiation and maintenance of problem gambling (PG). While there are a substantial number of studies supporting the role of cognitive dysfunctions in the initiation and maintenance of PG, very few empirical studies have explored the specific role of negative psychological states in influencing PG behaviours. In addition, very few studies have examined the interaction effects of cognitive dysfunctions and negative psychological states in exerting influence on PG behaviours. Therefore, the present study aims to examine the main and interaction effects of gambling-related cognitions and psychological states on the gambling severity among a group of problem gamblers in Hong Kong. A cross-sectional research design was adopted. A purposive sample of 177 problem gamblers who sought treatment from a social service organization in Hong Kong completed a battery of standardised questionnaires. While gambling-related cognitions were found to exert significant effects on gambling severity, negative psychological states (i.e. stress) significantly moderated the relationship between gambling cognitions and gambling severity. In essence, those participants who reported a higher level of stress had more stable and serious gambling problems than those who reported a lower level of stress irrespective of the level of gambling-related cognitions. The findings of the moderating role of negative emotions in the relationship between cognitive distortions and severity of gambling provide insight towards developing an integrated intervention model which includes both cognitive-behavioural and emotion regulation strategies in helping people with PG.

Wong, D. F. K., Zhuang, X. Y., Jackson, A., Dowling, N., & Lo, H. H. M. (2017). Negative Mood States or Dysfunctional Cognitions: Their Independent and Interactional Effects in Influencing Severity of Gambling Among Chinese Problem Gamblers in Hong Kong. Journal of Gambling Studies, 1–15. https://doi.org/10.1007/s10899-017-9714-2

 

Gambling Participation, Expenditure and Risk of Harm in Australia, 1997–1998 and 2010–2011

By Armstrong, A. R., Thomas, A., & Abbott, M.

Abstract: Gambling-related harm results primarily from financial losses. Internationally Australia continues to rank as the largest spending nation per capita on gambling products. This would suggest that Australian gamblers are at disproportionately high risk of harm despite almost two decades of industry scrutiny and regulation, and investment in research, treatment and education programs. However, declines in participation rates, per capita expenditure, household expenditure, national disposable income spent on gambling and problem gambling rates have been cited as evidence that fewer people are gambling, that gamblers are spending less, and that gambling safety in Australia has improved. The current study investigated these propositions using national population and accounts data, and statistics from Australia’s two population-representative gambling surveys conducted in 1997–1998 and 2010–2011. Despite a falling participation rate the study found no real change in the number of people gambling overall, and increasing numbers consuming casino table games, race wagering and sports betting. Further found were increases rather than decreases in average gambler expenditure, overall, and across most products, particularly electronic gaming machines (EGMs). Potentially risky levels of average expenditure were observed in both periods, overall and for race wagering, casino table gaming, and EGMs. Changes in the proportion of income spent on gambling suggest risks declined overall and for race wagering and casino table gaming, but increased for EGMs. Finally, while problem gambling statistics were not comparable between periods, the study found double the number of moderate risk gamblers previously estimated for 2010–2011 amongst the 2 million Australians found to have experienced one or more gambling-related problems. The findings have implications for public health policy and resourcing, and the way in which prevalence and expenditure statistics have been interpreted by researchers, government and industry in Australia and elsewhere.

Armstrong, A. R., Thomas, A., & Abbott, M. (2017). Gambling Participation, Expenditure and Risk of Harm in Australia, 1997–1998 and 2010–2011. Journal of Gambling Studies, 1–20. https://doi.org/10.1007/s10899-017-9708-0

 

On the feasibility of in-venue observations of EGM gamblers and game characteristics

Jason Landon, Katie Palmer du Preez, Maria Bellringer, Max Abbott, and Amanda Roberts.

Detailed observational studies of undisturbed gambler behaviour in venues are rare, especially if the focus is on continuous gambling such as electronic gaming machines (EGMs). EGMs are the main source of harmful gambling in New Zealand and all EGMs in New Zealand now include a mandatory pop-up message feature. The present study reports on 48 hours of in-situ observations of EGM gamblers in casino and non-casino (pub) venues in New Zealand and sought to establish whether relatively detailed observations of EGM features and gambler behaviour in venues were possible. Pop-up messages were the EGM feature focused on given their harm-minimisation potential, and the relative ease with which they can be observed. However, other EGM features were also documented along with descriptive accounts of associated gambler behaviour. The results establish that relatively detailed (quantitative or qualitative) observational data can be collected in venues using smart phones. The data showed pop-up messages were generally attended to but had little observable effect on gambler behaviour in venues. Direct in-situ observation of gamblers can provide ecologically valid information to compliment more common experimental and survey-based approaches. Some suggestions for developing the procedure are discussed.

Episodic and Binge Gambling: An Exploration and Preliminary Quantitative Study (open access)

By S. Cowlishaw, E. Nespoli, J.K. Jebadurai, N. Smith, and H. Bowden-Jones.

The DSM-5 includes provisions for episodic forms of gambling disorder, with such changes aligned with earlier accounts of potential binge gambling behaviours. However, there is little research that indicates the utility of these classifications of episodic or binge gambling, and this study considered their characteristics in a clinical sample. It involved administration of a new binge gambling screening tool, along with routine measures, to n = 214 patients entering a specialist treatment clinic for gambling problems. Results indicated that episodic gambling was common in this clinical context, with 28 and 32% of patients reporting gambling episodes that were (a) regular and alternating, and (b) irregular and intermittent, respectively. These patterns were distinguished by factors including associations with covariates that indicated differences from continuous gamblers. For example, the irregular episodic gamblers, but not the regular pattern, demonstrated lower levels of problem gambling severity and comorbidity. Rates of potential binge gambling, which was defined in terms of additional criteria, were around 4% and numbers were insufficient for comparable analyses. The findings support inclusion of episodic forms of gambling disorder in the DSM-5, but highlight the need for improved recognition and research on heterogeneous forms of episodic gambling.