Research Update

What affects the prevalence of gambling disorders in a given area? Is it access to gambling activities in general, access to a specific type of gambling activity, demographic characteristics, local norms, the presence of an underlying addictive syndrome, or some combination of these factors and others? These questions have been asked for many years and have inspired much debate in both political and academic circles. Studying a question like this requires competent and willing researchers, but also a favorable situation for research.

Unlike clinical trials, people cannot be randomly assigned to live within a certain distance of a casino, to prefer a particular gambling activity, or to have some particular demographic trait. This limitation can be overcome by taking advantage of “natural experiments,” times when some variable in a community changes and researchers can isolate the effect that variable has on the prevalence of gambling disorders in the community.

One such natural experiment will take place in Maryland over the next several years with the legalization of slot machines. The results of the first study measuring baseline disordered gambling in the state has just been released to the public, and further studies will be completed over the next several years to assess the effect (if any) of the addition of slot machines to existing gambling opportunities (Shinogle, Norris, et al., 2011).              

Toll-free help lines have been a common first line of intervention for addictive disorders for many years with successful statewide tobacco help lines leading the way. While there has been research on gambling help lines since the 1990s, to our knowledge there has not been a study tracking help-line callers from their initial call to attendance at a counseling session – until now. With the percentage of people with a gambling disorder who seek treatment from a counselor, psychologist or self-help group such as Gamblers Anonymous at only between 7 and 12 percent (Slutske, 2006), the ability of a help line to promote attendance at a counseling session is vitally important. A new study published in Psychology of Addictive Behaviors provides data on the matriculation of people with gambling disorders from calling the help line to attending a counseling session and suggests potential best practices for increasing the number of callers seeking treatment (Weinstock et al., 2011).

To understand pathological gambling (PG) one must understand the disorders that co-occur with PG. A 2005 study of more than 43,000 representative Americans found that people with PG often have other mental health disorders at the same time (called comorbid disorders). Examples of these include alcohol use disorders (73 percent), drug use disorders (38 percent), mood disorders (49 percent), anxiety disorders (41 percent) and personality disorders (60 percent) (N. M. Petry, Stinson, & Grant, 2005). While it is reasonable to hypothesize that genetic and environmental factors are both responsible for these co-occurrences, more research is necessary to learn how the two variables work together. One study that addresses these questions was recently published in the Journal of Affective Disorders (Giddens, Xian, Scherrer, Eisen, & Potenza, 2011). The study used data from 7,869 male twins to examine the relationship between PG and two anxiety disorders, generalized anxiety disorder (GAD) and panic disorder (PD).     

The American Psychiatric Association (APA) has proposed new criteria for a diagnosis of pathological gambling (PG) in the next edition of the Diagnostic and Statistical Manual of Mental Disorders, slated for publication in 2013.  As reported in Issues and Insights and discussed at the 2010 NCRG Conference on Gambling and Addiction, the proposed revisions included moving PG from the impulse control category into a new classification, “addiction and related disorders.” It also proposes dropping illegal acts from the 10 criteria and possibly reducing the number of criteria needed for a diagnosis from five to four. A new review article by Howard J. Shaffer and Ryan Martin in the 2011 Annual Review of Clinical Psychology (Shaffer & Martin, 2011) provides a critical review of these recommendations.

Have you ever been screened for a health problem? The answer is probably yes if you’ve ever been questioned by your doctor about symptoms or responded to a telephone survey about health. There are numerous screening instruments used by clinicians to determine if a client has a gambling problem, and some often appear in general population surveys to research the prevalence of the disorder. The Division of Addictions at Cambridge Health Alliance, a teaching affiliate of Harvard Medical School, recently released the Brief Biosocial Gambling Screen (BBGS) to help people decide on their own whether to seek a formal evaluation of their gambling behavior.  Development of the screen was funded by the NCRG.

Why do so many people relapse when they are trying to stop gambling? It has been estimated that 50 to 75 percent of gamblers resume gambling after attempting to quit (N. M. Petry et al., 2006), but what are the thoughts, feelings and situations that precede these events? Researchers who study alcohol and drug abuse – disorders with similarly high rates of relapse –  have developed a questionnaire designed to answer these questions for their audiences. A recent study published in the journal Experimental and Clinical Psychopharmacology attempts to validate this same type of questionnaire for people with gambling disorders (Nancy M Petry, Rash, & Blanco, 2010). The new study attempts to extend and validate Petry’s previous work adapting the Inventory of Drinking Situations for gambling situations (called the Inventory of Gambling Situations, IGS).

Why do some children start gambling at a young age while others do not? Theorists have suggested that the answer to this question is some combination of individual traits and environmental factors, both nature and nurture, but it is not yet understood which traits and factors have more of an influence on behavior. To address this question, researchers must examine the same children over a length of time (in what is called a longitudinal study) in order to see what traits in a younger child predict gambling behavior as the child ages. A recent study of Canadian children published in the journal Psychology of Addictive Behaviors took just this approach (Vitaro & Wanner, 2011). The researchers gathered information about 1,125 children and their families between the ages of six and eight, and then measured their gambling behavior at the age of 10. The findings suggest that preventing gambling in children will require a multifaceted approach that addresses all of the potential risk factors involved.

Measuring addictive behaviors accurately is very difficult. Among the many complications are recruiting subjects, relying on their memory and self-report and quantifying the difference between pathological actions and actions that are merely unusual or uncommon. (Jerome Wakefield, Ph.D., discussed this topic in detail at the NCRG conference 2010.) One particularly difficult aspect of studying addiction is the diagnostic screening instrument (when scored, the instrument shows whether or not a person should be diagnosed with a particular disorder). Diagnostic screens of all kinds pose the problem of advancement versus consistency: It is always possible to make a newer and better instrument, but a new instrument means that studies conducted with the older one cannot be directly compared to studies conducted with the new instrument. This tension dictates that new instruments must be shown as better along several lines to make them worth implementing. Two researchers at the forefront of this discussion for gambling disorders are Erica Fortune and Adam Goodie, Ph.D., at the University of Georgia. Fortune and Goodie recently published a study, partly funded by a grant from the NCRG to Dr. Goodie, that compares the performance of two diagnostic screens in a population of college students (Fortune & Goodie, 2010).   

How much college students gamble, and to what extent they suffer from gambling disorders, is an area of great concern in the United States. It is well established that college students suffer from high rates of alcohol and other substance use disorders, and do so in larger numbers than demographically similar non-college students. It is also commonly known that alcohol misuse and gambling disorders are similar in many ways; both cause craving and withdrawal symptoms, have similar neurological characteristics and follow similar clinical courses. This fact raises questions about whether gambling disorders may be found in larger numbers in college populations than in non-college populations with similar demographics. To answer this question, researchers at the Research Institute on Addictions at the University at Buffalo, N.Y., analyzed data from 1,000 representative respondents ages 18-21. Their findings were published in the Journal of American College Health (Barnes, Welte, Hoffman, & Tidwell, 2010).

The Task Force on College Gambling Policies issued a report in 2009 recommending that student health professionals screen for gambling problems among students engaged in risky behaviors. Since the release of this report, new research has been published that provides evidence that a single question can open up information about risky behaviors.