Division on Addictions

Did you know that only about 15 percent of disordered gamblers in the US seek treatment or attend self-help groups (Slutske, 2006)? However, nearly half of lifetime disordered gamblers received treatment for some other mental or substance problem (Kessler et al., 2008). According to the National Comorbidity Survey Replication, increased screening for emerging gambling problems in clients already in treatment might be an opportunity to prevent full-blown gambling disorders (Kessler et al., 2008).

Part two of the series recapping Dr. Howard Shaffer’s keynote address at the 25^th National Conference on Problem Gambling in Boston, Mass. To read part one of the Gambling Disorders 360° series, click here.

After laying the foundation for his presentation by outlining the theoretical revolutions that have defined our understanding of gambling disorders, Dr. Howard Shaffer then proposed that the next revolution in understanding gambling disorders will come from the way online gambling behavior can now be studied. Until recently, information about people’s gambling behavior has come almost exclusively from self-report (asking a person questions about their past gambling behaviors). Self-report is considered to be acceptably accurate by the scientific community, but it relies on recollections of individuals that may be influenced by a variety of factors such as desire to please interviewers or to downplay losses. For years these problems with self-reported data have presented a challenge to researchers studying gambling disorders. However, Dr. Shaffer suggested that new innovations in research methods will decrease the role of self-report and allow researchers to look directly at the gambling behavior of online gamblers.

The people who work in casinos and other gaming venues are an important and under-researched group in the pathological gambling literature. Gaming employees constitute a unique group not only because they interact daily with customers in casinos, but because they are slightly more vulnerable to gambling disorders than the general population (Shaffer, Vander Bilt, & Hall, 1999). Because of these and other factors, most states and casino operators in the U.S. require gaming employees to go through training on the specifics of disordered gambling and responsible gaming.  However, there has been very little published research done on the effectiveness of employee training programs used by casinos. In fact, the first study of an employee training program by a U.S. research team was recently published in the Journal of Gambling Studies (Laplante, Gray, Labrie, Kleschinsky, & Shaffer, 2011). 

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.

The relationship between the brain chemical dopamine and disordered gambling has been well-established over the past several years (we discussed this relationship in the context of Parkinson's Disease in the July 2010 Issues and Insights). Dopamine is associated with the reward system of the brain, which affects feelings of enjoyment and behavior reinforcement. It and other brain chemicals are, by their very nature, difficult to observe and thus difficult to translate into preventive applications. To bridge the gap between brain chemistry and disordered behavior, researchers can link the two with quantifiable emotions like excitement. The most recent edition of The WAGER (Worldwide Addiction Gambling Education Report) reviews a study that looks at those factors as they relate to pathological gambling.  

Scientists have proposed an understanding of pathological gambling (PG) as an expression of an underlying addiction syndrome (Shaffer et al., 2004). A syndrome, by definition, is expected to have generally predictable signs and symptoms, though they will vary and may not always be present. Are there definable “types” of people with PG? The most recent edition of The WAGER (Worldwide Addiction Gambling Education Report) reviews a study focused on this issue.

Scientists have identified many commonalities between people with gambling problems and those with substance use disorders. Are there similarities in brain function? A recent edition of The WAGER (Worldwide Addiction Gambling Education Report) reviews a study focused on this issue.

The “Room for Debate” section of The New York Times recently posed the question, “Should Internet gambling be legalized?” Several respondents identified an increase in gambling addiction as the probable outcome if Congress lifts the current ban on online gambling in the United States. The belief that the easy access and social isolation of Internet gambling make it an especially risky behavior has become conventional wisdom.

The WAGER (Worldwide Addiction Gambling Education Report) is a great resource for keeping up with new research on gambling and gambling disorders. This online science review is published by the Division on Addictions at Cambridge Health Alliance, a teaching affiliate of Harvard Medical School.