Targeting problem gambling relapse risk factors: Lack of social connectedness and leisure substitution [open-access thesis]

This research added an innovative, critical component to the current problem gambling treatment approaches available in Australia. It targeted a susceptible and significant group of people who experience gambling-related harm but find it difficult to stop gambling and not to start again. Relapse in problem gambling and treatment dropout is common, with a rate of up to 70% being generally accepted.
To date, gambling interventions specifically targeting risk factors for relapse have not been the focus of many studies. The author of this thesis, who has lived experience with problem gambling, designed a structured group program targeting two identified risk factors for gambling relapse: 1) lack of social connectedness, and 2) lack of leisure substitution. Between 2009 and 2016, four versions of this program were trialled. All program participants were supported by a group of volunteers, most of whom had lived experience with problem gambling and were participants in previous program versions. Four versions of the program were evaluated using a multi-method approach. Quantitative data were collected using validated psychosocial measures. Journaled observation by the author, anecdotal evidence and journaled participants quotes were documented by the author in various project reports and are used in this thesis to support the qualitative findings.
The results of the quantitative data revealed significant improvement for participants in the areas of social connectedness, self-efficacy, and mental health. Importantly, the results also indicated that the program supported the goals of either abstinence from, or control over, gambling behaviour for program completers. It is concluded that this innovative program helped to reconnect people to activities other than gambling and to a supportive community and, in so doing, effectively achieved the research objectives.
An extra qualitative study ‘Volunteer study’ was conducted to explore if the aspect of ‘volunteering’ made a positive contribution to sustain behavioural changes that were achieved by previous program participation. This exploratory study utilised 14 in-depth semi-structured interviews with current volunteers of the trialled relapse-focused programs from studies 1-4. This part of the research indicated that volunteering for any of the peer support relapse focused programs provided significant benefits to an individual’s recovery from problem gambling. The sample was a small convenience sample, so it is not possible to generalise the findings but offers an opportunity to further explore the importance of volunteering in recovery. Link to the article

Citation: Byrne, G.H. (2019). Targeting Problem Gambling Relapse Risk Factors: Lack of Social Connectedness and Leisure Substitution (PhD Thesis, Victoria University). Retrieved from

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

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.

Recovery, relapse, or else? Treatment outcomes in gambling disorder from a multicenter follow-up study

K.W. Müller, K. Wölfling, U. Dickenhorst, M.E. Beutel, J. Medenwaldt, A. Koch.

Purpose: Gambling disorder is associated with various adverse effects. While data on the immediate effectiveness of treatment programs are available, follow-up studies examining long-term effects are scarce and factors contributing to a stable therapy outcome versus relapse are under-researched.

Materials and methods: Patients (n = 270) finishing inpatient treatment for gambling disorder regularly participated in a prospective multicenter follow-up study (pre-treatment, post-treatment, 12-month follow-up). Criteria for gambling disorder, psychopathology, functional impairment were defined as endpoints. Changes in personality were defined as an additional parameter.

Results: At follow-up, three groups were identified: subjects maintaining full abstinence (41.6%), patients still meeting criteria for gambling disorder (29.2%), and subjects still participating in gambling without meeting the diagnostic criteria for gambling disorder (29.2%). Every group had improvements in functional impairment, abstinent subjects showed the lowest psychopathology. Significant decreases in neuroticism and increases in both extraversion and conscientiousness were found among abstinent subjects but not in patients still meeting criteria for gambling disorder.

Discussion: One year after treatment, a considerable percentage of patients kept on gambling but not all of them were classified with gambling disorder leading to the question if abstinence is a necessary goal for every patient.

Conclusions: The changes of personality in abstinent patients indicate that after surmounting gambling disorder a subsequent maturing of personality might be a protective factor against relapse.

Müller, K. W., Wölfling, K., Dickenhorst, U., Beutel, M. E., Medenwaldt, J., & Koch, A. (n.d.). Recovery, relapse, or else? Treatment outcomes in gambling disorder from a multicenter follow-up study. European Psychiatry.