Pathological gamblers, with and without substance use disorders, discount delayed rewards at high rates

Pathological gambling is classified as a disorder of impulse control, yet little research has evaluated behavioral indices of impulsivity in gamblers. The rates at which rewards delayed in time are subjectively devalued may be a behavioral marker of impulsivity. This study evaluated delay discounting in 60 pathological gamblers and 26 control participants. Gamblers were divided into those with (n = 21) and without (n = 39) substance use disorders. A hypothetical $1,000 reward was delayed at intervals ranging from 6 hr to 25 years, and immediate rewards varied from $1 to $999. Pathological gamblers discounted delayed rewards at higher rates than control participants, and gamblers with substance use disorders discounted delayed rewards at higher rates than non-substance-abusing gamblers. These data provide further evidence that rapid discounting of delayed rewards may be a feature central to impulse control and addictive disorders, including pathological gambling.     

Measurement and structure of pathological gambling behavior

The serious effects of pathological gambling on both gamblers and their families warrants research on the disorder. This study aimed at identifying components of pathological gambling with the goal of developing methods for early detection and preventive strategies. A factor analysis of behaviors hypothesized to relate to pathological gambling resulted in a multidimensional model of the disorder. Eight factors were identified, including distinct neurotic, psychopathic, and impulsive components, and used in a comparative analysis of 83 admitted compulsive gamblers and 61 nongamblers. Five of the factors differentiated the two groups even when sex, age, and education were controlled. Implications of these findings are discussed.     

Discounting of probabilistic rewards is associated with gambling abstinence in treatment-seeking pathological gamblers

Individuals with addictive disorders, including substance abusers and pathological gamblers, discount or devalue rewards delayed in time more than controls. Theoretically, preference for probabilistic rewards is directly related to gambling, but limited empirical research has examined probabilistic discounting in individuals with pathological gambling. This study evaluated probability and delay discounting in treatment-seeking pathological gamblers and their association with gambling treatment outcomes during and after treatment. At time of treatment entry, 226 pathological gamblers completed probability and delay discounting tasks. They were then randomized to one of three treatment conditions, and gambling behavior was measured throughout treatment and at a 1-year follow-up assessment. After controlling for possibly confounding variables and treatment condition, more shallow probability discounting was associated with greater reductions in amounts wagered during treatment and likelihood of gambling abstinence at the end of treatment and throughout the follow-up period. No associations were noted between delay discounting and gambling treatment outcomes. These data suggest that probability discounting may be an important construct in understanding pathological gambling and its treatment.     

Do patients with OCD and pathological gambling have similar dysfunctional cognitions?

The obsessive-compulsive spectrum disorder (OCSD) theory postulates that a wide range of disorders is closely related to OCD. Current cognitive models ascertain that certain beliefs leading to misinterpretation of the significance of intrusions are important in the etiology and maintenance of OCD. This study examined whether pathological gambling, a disorder belonging to the OC spectrum, is characterized by similar dysfunctional cognitions as OCD. Dysfunctional beliefs of OCD patients were compared to those of patients with pathological gambling, panic disorder and normal controls. These beliefs were measured by the Obsessive-compulsive Beliefs Questionnaire-87 (OBQ-87), which was developed by a group of leading OCD researchers [Behav. Res. Ther. 35 (1997) 667]. It was hypothesized that according to the OCSD theory, pathological gamblers would exhibit similar cognitions to OCD patients, as well as increased levels of OCD symptoms. Analysis showed that OCD patients exhibited higher OBQ-87 scores than both panic patients and normal controls, but equal to pathological gambling patients. Pathological gamblers exhibited, however, no increase in OCD symptoms. These mixed results do not seem to support the OC spectrum theory for pathological gambling, moreover being contradictory to contemporary cognitive OCD models.     

Underlying Cognitions in Gambling Behavior Among University Students1

Differences in underlying cognitions across gambling tasks were examined. The South Oaks Gambling Screen, a measure of pathological gambling, was completed by 60 undergraduate students. They also played computer‐simulated games of roulette, slots, and blackjack in a laboratory setting. The “think‐aloud” procedure was used to reveal subjects' cognitions, which were subsequently categorized into cognitive heuristics. Individuals were classified as social gamblers with and without problems and probable pathological gamblers. Results reveal that certain heuristics, including references to an explanation of their losses, hindsight bias, personification of the dealer/machine, chasing behavior, and past experiences were most frequently endorsed by probable pathological gamblers. Empirical evidence supports that probable pathological gamblers are qualitatively different from social gamblers in their emitted verbalized cognitive heuristics.     

Problem Gambling Features and Gendered Gambling Domains Amongst Regular Gamblers in a Swedish Population-Based Study

This study aimed to investigate, from a gender perspective, how different features of problem gambling present in men and women who gamble regularly in Sweden were distributed in four domains based on gambling type (chance or strategy) and setting (public or domestic). Problem gambling features were based on the nine items in the Problem Gambling Severity Index (PGSI). It was hypothesized that men and women gamble in different domains. Further, it was hypothesized that male gamblers overall experienced more problems with gambling than female gamblers, although in the same domains they would report the same level of problems. A further hypothesis predicted that regular female gamblers would experience more health and social problems and men would experience more financial difficulties. Interviews with a subsample of gamblers (n?=?3191) from a Swedish nationally representative sample (n?=?8179) was used to examine how features of problem gambling correspond with gender and the domains. Only the first hypothesis was fully supported. Men were more likely to participate in forms of gambling requiring strategy in a public setting, and women were more likely to participate in chance-based gambling in a domestic setting. Male and female gamblers had similar levels of problem gambling in the bi-variate analysis, but if controlling for age and gambling in multiple domains, women were more at risk than men. Additionally, men and women presented similar health and economic situations. The differences between male and female gamblers in Sweden have implications for research and prevention.     

Spielsucht – Alkoholabhängigkeit: „Zwei Süchte,eine Behandlung?“

While alcoholism has been undisputedly classified for decades as an addiction in diagnostic manuals like ICD -10 and DSM -IV, the classification of pathological gambling has not been definitively resolved, although alcohol dependence and pathological gambling have many addiction criteria in common. The course of gambling addiction is typically characterized by an initial phase, a critical habituation phase, and a phase of despair. While a gambling addiction may rapidly progress to chronic dependence within a year, the development of chronic alcohol dependence requires many years of misuse. For gambling addicts, external influence plays a considerable role (trigger situation) on the entry into gambling. For the majority of players, the initial contact comes from third parties, while for problem gamblers the social character of an invitation as a maintaining factor has less influence than for alcoholics. There are differences especially in the expression of comorbidities and the consequences of the addiction. For problem gamblers, these are more psychological than social, while secondary disorders are significant for alcoholics.     

Pathological gambling and personality disorders: a pilot-study with the MCMI-II

In this paper, the most frequent personality disorders related to pathological gambling are described. A sample of 50 pathological gamblers, who were assessed with the MCMI-II before treatment, and of 50 normative subjects from general population with the same demographic features (age, sex and socioeconomic level) was selected. According to the results, the 40% of clinical sample (versus the 14% of normative sample) showed at least one personality disorder. The most prevalent one was the Narcissistic (32%), followed by the Antisocial and Passive-Aggressive (16% each one of them). Furthermore, the gamblers with personality disorders presented an average of 2.2 disorders and tended to be more impulsive. Likewise pathological gamblers abused of alcohol, showed a mild anxiety and were not so adapted to everyday life as much as the control group. Finally, implications of this study for clinical practice and future research in this field are commented upon.     

Personality disorders and dimensions in pathological gambling

Comorbid DSM-IV Axis II personality disorders appear to be common in pathological gambling (PG) and may contribute to the chronic problems often associated with the disorder. This study sought to examine the relationship between PG, personality disorders, and impulsivity in a sample of pathological gamblers. Personality assessments included the SCID-II, Eysenck Impulsiveness Questionnaire, Tridimensional Personality Questionnaire, and Barratt Impulsiveness Scale. A total of 77 individuals with DSM-IV PG were included in this study, of which 35 (45.5%) met criteria for at least one personality disorder. Specific aspects of impulsivity were associated with certain personality disorders in PG when grouped by cluster, yet the presence of a personality disorder was not positively correlated with gambling severity. It remains unclear how the presence of a personality disorder and aspects of impulsivity may affect treatment outcome. Further exploration of these disorders and dimensions of personality may encourage a more inclusively global treatment approach.     

Personality disorders and pathological gambling: a review and re-examination of prevalence rates

The current study reviews and reexamines the association between pathological gambling and personality disorders (PDs). To date, the majority of investigations have examined the prevalence of PDs in a single group of treatment-seeking pathological gamblers (PGs); very few of these studies included a comparison group, and even fewer compared PGs to nonpathological gamblers who, in contrast to nongamblers, resemble PGs in their attraction to and engagement in gambling behavior. The current study included a sample composed of nontreatment-seeking pathological gamblers and a comparison group of nonpathological gamblers (NPGs); these participants completed a self-report instrument (SCID-II/PQ) and were administered a structured clinical interview SCID-II) designed to assess PDs. Compared to the SCID-II, the SCIDII/PQ produced significantly higher PD prevalence rate estimates and symptom endorsements. Although the pattern of specific PD prevalence and symptom endorsement varied somewhat across the instruments, PGs consistently displayed significantly higher levels of borderline PD than NPGs; this pattern endured even after controlling for Axis I disorders and overlap among Axis II PDs.     

Contextual control of delay discounting by pathological gamblers

The present study demonstrated the relative impact of gambling and nongambling contexts on the degree of delay discounting by pathological gamblers. We used a delay-discounting task with 20 pathological gamblers in and out of the natural context in which they regularly gambled. For 16 of the 20 participants, it appeared that the difference of context altered the subjective value of delayed rewards, thereby producing relative changes in delay-discounting rates that were generally consistent with a hyperbolic model of intertemporal choice. The current data suggest that empirically derived k values from delay-discounting tasks are context sensitive and are not constant across various settings for the individual. Implications for future transitional research on addictive disorders generally, and gambling specifically, are discussed.     

Pathological gambling and personality disorders: an exploratory study with the IPDE

This article describes the most frequent personality disorders related to pathological gambling. Participants included 50 pathological gamblers assessed with the IPDE, and 50 normative subjects from the general population with the same demographic features (age, sex, and socioeconomic level). Thirty-two percent of the clinical sample (vs. the 8% of the normative sample) showed at least one personality disorder. The most prevalent disorders were Borderline (16%), followed by Antisocial, Paranoid, Narcissistic, and Non-specified (8% each). Gamblers with personality disorders presented an average of 1.5 disorders and they reported higher gambling severity and more severe symptoms of anxiety, depression and alcohol abuse. The implications of this study for clinical practice and research are discussed.     

Traumata, traumatogene Faktoren und pathologisches Glücksspielen

This study compared 100 female pathological gamblers with 100 male pathological gamblers with respect to sociological data, previous trauma and potential traumatogenic factors. All pathological gamblers were inpatients of the German clinic of Muenchwies. The female sample showed later onset of gambling, faster progression into a pathological disorder and higher rates of traumatisation in childhood as well as in adult age (e.g. parental neglect, physical and sexual abuse). Furthermore, significantly higher rates of maternal violence, younger age at the time of parental divorce, higher rates of violence in a partnership and addiction of the partner also differentiated the female sample from the male sample.     

The impact of comorbidity on the management of pathological gambling

A 30-year-old woman with severe pathological gambling and cyclothymia presented to our program with no previous history of pharmacologic or psychotherapeutic treatment. Pathological gambling is an impulse -control disorder not otherwise specified (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) in which comorbidity is common, particularly with substance abuse, obsessive-compulsive disorder and mood disorders. As described in this case, pathological gamblers with bipolar comorbidity may be effectively treated with mood stabilizers such as lithium. After receiving 10 weeks of lithium treatment, the patient showed improvement in both gambling behavior and affective instability. The identification of specific subtypes among patients with pathological gambling may be relevant to the choice of pharmacologic treatment.     

Pathological gambling and suicidality: an analysis of severity and lethality

Pathological gambling represents a major public health issue. Risk factors for suicide such as major depression, substance abuse, marital breakdown, unemployment, financial crises, and legal difficulties are commonly found in populations of pathological gamblers. The objective of this study was to systematically investigate the nature of suicidal behavior among treatment-seeking pathological gamblers and its relationship to gambling characteristics and depression. Indices of suicidality were assessed in a sample of 85 treatment-seeking diagnosed pathological gamblers. High rates of suicidal ideation, suicidal plans, and attempts were found; however, no clear relationship was observed between suicidality and indices of gambling behavior. Depression rather than gambling specific characteristics, marital difficulties, or the presence of illegal behaviors appear to be related to the risk of suicidality.     

Pathological Women Gamblers: Gender-Related Aspects of Control

This study examines the control exhibited by pathological women gamblers over their lives and their surroundings, and how this is governed by their perception of their gender role and socio-cultural expectations of them as women. Seventeen pathological women gamblers (13 of whom were mothers) were recruited from three addiction treatment centers in Israel, and participated in semi-structured interviews. Three central themes emerged during analysis: maintaining control over the gender roles—putting child raising and housekeeping duties first despite their gambling habits; control over the choice of gambling venue—gambling far from their home, or where they knew the owners; and moral control—steering clear of immoral behaviors in spite of their addiction to gambling. Further analysis reveals how pathological women gamblers who are also mothers make rational choices that help them juggle between their gender roles and gambling, to minimize the social costs that might be incurred by their gambling habit. Moreover, presenting the gambling behavior as more moral than theft or prostitution enabled them to normalize their behavior. The study’s findings show how the decisions and choices made by the women in this study are shaped by the socio-cultural context in which they are made.     

Characterization of controlled gamblers and pathological gamblers using the social representation theory

Introduction

In industrialized countries, gambling disorder tends to become a major issue. The use of the social representation theory provides clues for a better understanding of pathological gamblers.

Internet‐based CBT intervention for gamblers in Finland: Experiences from the field

From September 2007 to May 2011 a total of 471 participants (325 males and 146 females) signed up for an 8‐week Internet‐based cognitive behavioral therapy offered for gamblers in Finland. Sixty‐four percent of the participants were pathological gamblers (PGs) (NODS 5> points), 14% were problem gamblers (NODS 3–4 points) and 10% were at risk of gambling problems (NODS 1–2 points). Two hundred and twenty four participants completed the treatment and after the treatment period significant changes were found in the following variables: gambling related problems (NODS), gambling urge, impaired control of gambling, alcohol consumption (AUDIT‐C), social consequences, gambling‐related cognitive erroneous thoughts and depression (MARD‐S). In this sample co‐morbid alcohol consumption was stronger among males. The main finding of this study was that the onset age of gambling was associated with a greater amount of gambling‐related cognitive erroneous thoughts.     

Association of pathological gambling with depression in Scotland

Is most research concerning gambling and depression has been conducted on clinical populations, the present study examined the relationship between gambling and depression across a large sample in Scotland in higher education and the community. A questionnaire-based cluster design involved the distribution of the South Oaks Gambling Screen and the Centre for Epidemiologic Studies Depression Scale mainly to students and staff of higher educational establishments, with small community and gambling samples also included. Thirty-seven colleges and universities across Scotland participated in the research, with a sample of 2259 people aged sixteen years of age or over (M = 28.9 yr., SD = 13.4) being obtained. It was found that past-year probable pathological gamblers had significantly higher depression than problem gamblers, nonproblem gamblers, and nongamblers. However, when probable pathological gamblers who had sought treatment were omitted from the analysis, the nontreatment-seeking probable pathological gambling group no longer had significantly higher depression than the problem gambling group. Female problem and probable pathological gamblers had particularly high depressive symptomatology, suggesting co-morbid depression may be a prominent feature of problematic female gambling.