Optimal public policy for government-operated gambling [open access policy paper]

Abstract: This paper presents a framework for formulating the optimal public policy for government-operated gambling. The goal of public policy with respect to government-operated gambling is typically stated as ‘‘harm minimization.’’ This claim masks the possible trade-off between an increase in social harm (H) and the government’s incremental net revenue (R) from increased gambling activity. Using a graphical approach, we depict first the feasible combinations of H and R, and then identify the combinations that could be classified as efficient, thereby allowing the minimum social harm for any given level of the government’s incremental net revenue from gambling. We indicate how the optimal combination of H and R could be identified and realized in both the short and long run. We then utilize the body of research on gambling and its effects to qualify what this trade-off operates
in the real world. Access policy paper

Citation: Irwin Lipnowski & Austin McWhirter. (2018). Journal of Gambling Issues, 40. 


Treatment for Disordered Gambling: Current Evidence and Recommendations (open access article)

Littman-Sharp, N. (2017). Gambling Research Exchange Ontario. Retrieved from http://www.greo.ca/Modules/EvidenceCentre/files/Littman-Sharp_(2017)_Treatment_for_Disordered_Gambling.pdf

Disordered gambling treatment programming has developed rapidly in the last 20-25 years in response to the need engendered by the proliferation of legal casinos. Research on treatment effectiveness has also expanded. One of the most important elements of good clinical practice is an up to date understanding of evidence-based practices. Research can inform practitioners of new modalities, and of refinements on current modalities. It can indicate training needs, and identify cost-effective methods of treatment that make best use of available resources. Treatment research also acts as an important reminder of the need to measure clients’ progress and outcomes, and to adjust services to maximize their success.

The disordered gambling field benefits greatly from a robust exchange between clinical work and research. This paper will provide an overview of the current state of knowledge on disordered gambling treatment, and identify its gaps and limitations, particularly from the point of view of treatment providers. Researchers have evaluated a number of approaches to disordered gambling treatment. These include cognitive behavioural therapy, motivational interviewing, brief interventions, self-help, mindfulness meditation, family interventions, pharmacotherapy, online interventions, treatments specialized for women, and mutual aid. There are also studies comparing modalities, or combining them – an approach that is perhaps closer to what occurs in the real world. Access full article

Gamble Much? How to Figure out if You’ve Got a Problem: Get inside the mind of the compulsive gambler [Full text]

Susan Krauss Whitbourne Ph.D.. 

Psychology Today

Abstract: Almost everyone has gambled at some point in life, but as many as 3.5% may have a form of gambling disorder. Psychology’s understanding of gambling disorder continues to evolve. Up until recently, people who we might call compulsive gamblers were regarded as having a disorder of “impulse control.” Psychiatry’s diagnostic manual, the DSM-IV-TR (link is external), placed compulsive gambling, called “pathological gambling,” in the section of disorders that also included kleptomania, pyromania, and trichotillomania (compulsive hair-pulling). In their revamping of all psychological disorders, in light of new conceptualizations, DSM-5 places “gambling disorder” in a new category of “Non-Substance-Related-Disorders.” Rather than being more similar to people with compulsive behaviors, then, people with gambling disorder now are viewed as more similar to people who have a substance disorder.

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A Functional Analytic Approach to Understanding Disordered Gambling [Subscription access only]

Mark R. Dixon, Alyssa N. Wilson, Jordan Belisle, James B. Schreiber. 

The Psychological Record

Abstract: The Gambling Functional Assessment (GFA) hypothesized four possible maintaining functions of gambling behavior, including social attention, escape from aversive events, access to tangible items, and sensory stimulation. In the years following the GFA’s release, research teams have argued for a revised model of the GFA to account for just two possible functions maintaining gambling behavior (positive and negative reinforcement). In the current study, we examined the extent to which a four-factor gambling functional assessment was possible, sustaining a conceptual and theoretical orientation consistent with a functional behavioral account of gambling. Three hundred and sixty-five recreational and disordered gamblers completed a demographic survey, the South Oaks Gambling Screen (SOGS), and the GFA. An exploratory factor analysis was first conducted to determine GFA functional items that loaded onto a common factor, and a confirmatory factor analysis was conducted to determine if a four-factor model, consistent with the functional categories of the GFA, provided a good fit for the obtained data. Outcomes supported the model, suggesting that a four-factor functional account of gambling behavior can be obtained. Differing results obtained by separate research teams, however, suggest that more precise research may be needed in the development and analysis of functional instruments for use with gamblers.

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Cite this article as: Dixon, M.R., Wilson, A.N., Belisle, J. et al. Psychol Rec (2018). https://doi.org/10.1007/s40732-018-0279-y


The Economic Burden of Pathological Gambling and Co-occurring Mental Health and Substance Use Disorders

By Rodriguez-Monguio, R., Brand, E., & Volberg, R.

Abstract: Objectives: Disordered gambling often co-occurs with psychiatric and substance use disorders. The study aim was to assess the healthcare costs of pathological gambling (PG) and co-occurring mental health and substance use disorders by payer. This is the first-of-its-kind economic analysis of addictive behaviors and mental health disorders.
Methods: Study data were derived from the Massachusetts All-Payer Claims Data-a representative health claims database-for the period 2009 to 2013. The study analytical sample contained all medical and pharmaceutical claims for commercially insured Massachusetts residents who were aged >=18 years, had health insurance coverage, had a diagnosis of PG, and sought care in the Commonwealth. Healthcare cost components included outpatient, inpatient, emergency room visits, and prescription drugs. Bootstrap analysis was performed to account for skewed distribution of cost data. All costs were adjusted to constant dollars.
Results: The study sample included 599 patients over the study period. The most prevalent principal diagnoses were disorders of impulse control (50%), episodic mood disorders (31%), anxiety disorders (14%), and psychoactive substance (9%). The mean annual total expenditures on health care per patient with diagnosis of pathological gambling were $7993 +/- $11,847 (bias-corrected 95% confidence interval) in 2009, $10,054 +/- $14,555 in 2010, $9093 +/- $13,422 in 2011, and $9523 +/- $14,505 in 2012. Pharmaceutical expenditures represented 16% to 22% of total healthcare expenditures. In the study period, prescription drug co-pays represented approximately 16% of the pharmaceutical expenditures.
Conclusions: Psychiatric comorbidity and substance use disorders, and nondependent abuse of drugs are highly prevalent among pathological gamblers. These disorders pose an economic burden to patients and healthcare payers.
(C) 2017 American Society of Addiction Medicine

Rodriguez-Monguio, R., Brand, E., & Volberg, R. (2017). The Economic Burden of Pathological Gambling and Co-occurring Mental Health and Substance Use Disorders. Journal of Addiction Medicine, Publish Ahead of Print. https://doi.org/10.1097/ADM.0000000000000363


Latest Developments in Treatment for Disordered Gambling: Review and Critical Evaluation of Outcome Studies – Open Access

Yakovenko, I., & Hodgins, D. C.

Purpose of review: Over the last decade, treatments for disordered gambling have developed rapidly. The goal of this paper is to review and to critically evaluate the literature published on the treatment of disordered gambling in the past 3 years. Important findings are emphasized and accompanied by the authors’ personal observations on controversial results or hypotheses of interest. Recent findings: Cognitive-behavioral interventions have been evaluated in treatment of Hong Kong Chinese individuals as well as in combination with mindfulness-based approaches. Personalized-feedback interventions have received increased attention, with brief treatments demonstrating overall efficacy. Pharmacological treatments continue to receive only limited support. On the other hand, web-based treatments appear to show promise. Summary: Cognitive-behavioral and brief treatments remain the most empirically supported approaches, but new inventive combinations of treatments such as web-based therapies are emerging. Future research could benefit from diversification of types of treatments evaluated as well as an examination of what is considered “evidence-based.”

Yakovenko, I., & Hodgins, D. C. (2016). Latest Developments in Treatment for Disordered Gambling: Review and Critical Evaluation of Outcome Studies. Current Addiction Reports, 1–8. http://doi.org/10.1007/s40429-016-0110-2

A qualitative analysis of the effects of a comorbid disordered gambling diagnosis with schizophrenia

Little research has examined the association between disordered gambling and psychosis. In addition, clinicians treating schizophrenia or schizoaffective disorders rarely screen for or treat comorbid gambling problems due to diagnostic overshadowing. Thus, the effects of disordered gambling on symptoms of schizophrenia and vice versa remain largely unexplored and unidentified in research and clinical practice. The goal of the present study was to explore qualitatively the reciprocal associations between schizophrenia/schizoaffective disorder and disordered gambling through content and functional analyses from the perspective of the affected individual. Eight participants who met DSM-IV criteria for schizophrenia or schizoaffective disorder and disordered gambling participated in a qualitative interview examining key antecedents associated with their gambling, as well as perceived functional consequences of gambling…

Source: Yakovenko, I., Clark, C. M., Hodgins, D. C., & Goghari, V. M. (n.d.). A qualitative analysis of the effects of a comorbid disordered gambling diagnosis with schizophrenia. Schizophrenia Research. http://doi.org/10.1016/j.schres.2015.12.008