Risk Factors and PrevalenceLaura J. Lamb Atchley, PhD, LPC, LADC/MH, ICGC-II

Assistant ProfessorSoutheastern Oklahoma State University

Basic information: gambling and gambling disorderLifetime prevalence rates of gambling disorder in general

populationRisk groups in the general populationResearch on prevalence rates of gambling disorder in

addiction counselorsPredictors of gambling disorder in addiction counselorsSelf-assessment of gambling disorderSteps to mitigate risk of developing a gambling problemSelf-care plan to mitigate your risk of developing a gambling

problem

Any betting or wagering, for self or others, whether for money or not, no matter how slight or insignificant, where the outcome is uncertain or depends upon chance or “skill” constitutes gambling (Gamblers Anonymous International Service Office, 2019).

• Bingo• Card and domino games• Pool, golf, shuffleboard• Lottery and scratch tickets• Casino games (slots, video

poker, table games)• Horse or dog racing• Sports betting• Fantasy & daily fantasy sports• Stock market and day trading• Internet gambling

The American Gaming Association (2019) estimated:

Nearly 90% of US population view gambling as an acceptable form of entertainment.The US casino industry: $261 billion enterprise that supports 1.8

million jobs nationwide.Gaming revenue in 2018 increased 3.5% over 2017 to the highest ever

annual total at $41.7 billion.

Kessler et al. (2008): 78.4% of Americans have gambled in their lifetime.

• Welte et al. (2015): 76.9% of Americans have gambled in past year.

Fun

Exciting

Escape

Socialization

Enhanced self-esteem

For most, it is a harmless activity

For others, it becomes a compulsion that causes financial, relationship, employment, and legal problems.

First mentioned in the medical literature in the early 1880s (Harvard Medical School, 2010).

First theory of gambling disorder: Freud (Custer & Milt, 1985). Related compulsive gambling to compulsive masturbation and unconscious guilt from the Oedipus complex (Freud, 1928/1961). Freud: First to say that gambling was an addiction (Rosenthal, 1987).

But until 2013 it was classified as an impulse control disorder (APA, 2000).

Preoccupation – planning next venture

Tolerance – gambling with increasing amounts of money to get the same level of excitement

Withdrawal – restlessness, irritability when stopping

Escape – relieving stress and or depressed mood

Lying – concealing the extent of gambling to others

Chasing losses – after losing money, returning to “get their money back”

Loss of Control – Unsuccessful efforts to control behavior

Risked significant relationship –personal, job, educational or career opportunity

Bailout – reliance on others to provide money

Persistent and recurrent problematic gambling behavior leading to clinically significant impairment or distress, as indicated by four or more of the following:

(Gambling is not better accounted for by a manic episode)

Younger ages

Male gender

Single or divorced marital status

Minority ethnicity

Those with lower socioeconomic status

Those with mental health disorders

Those with substance use disorders including alcohol, illicit drugs, and nicotine

Problem gamblers account for approximately 1/3 of the industry’s revenue (Oei & Gordon, 2008).

Very few national prevalence studies

Results vary significantly based on methodology (Williams, Volberg, and Stevens, 2012).

Assessment instrument (SOGS, DSM, PPGM)Cut scores used to designate problemTimeframe used (lifetime, past year, past week)Survey method (in person, self-administered paper, or self-administered onlineHow the survey is described (gambling survey, recreational activities survey, etc.)

Kessler et al. (2008): Lifetime Level 2: 2.3%Lifetime Level 3: 0.6%

Gerstein et al. (1999): Lifetime Level 2: 1.3%Lifetime Level 3: 0.8%

Shaffer et al. (1999): Lifetime Level 2: 3.85%Lifetime Level 3: 1.6%

Two studies of addiction counselors have found higher lifetime prevalence of gambling disorder than general population

Weinstock et al. (2006)

Lamb Atchley (2018)

Similar findings in both studies

Weinstock et al. (2006)

Self administered survey at a regional workshop for addiction counselors (N = 328). Instruments used: SOGS (cut scores: 0-2 no problem, 3-4 problem, 5+

pathological)Short Form-12v2 Health Survey (Summary scales:

physical health and mental health. Subscales: physical functioning, role-physical, bodily pain, general health, vitality, social functioning, role-emotional, and mental health.

Weinstock et al. (2006)

Examined lifetime and past two month prevalenceExplored association between gambling, mental, and physical

health. Findings:Majority of sample (81.7%) were non-problem gamblers

(SOGS = 0-2). Level 2, problem gamblers (SOGS = 3-4) 6.4% of sample Level 3, pathological gamblers (SOGS = 5+) 11.9% of

sample Level 2 and 3 gamblers were more likely to be male and

African American than non-problem gamblers

Weinstock et al. (2006)Findings continued:

Level 3 gamblers were more likely to be older and less educated than non-problem gamblersPoorer physical health, limiting bodily pain, and more

limits in performing physical activities due to health problems was associated with pathological gambling.Mental health was not associated with pathological

gamblingResearchers noted that findings aligned with studies on

individuals with a history of substance use disorders but that factor was not specifically evaluated

Lamb Atchley (2018)

Self administered online survey of addiction counselors (N = 210). Instruments used: SOGS (cut scores: 0-2 no problem, 3-4 problem, 5+

pathological)Self-report questionnaire regarding demographics and

substance use disorder treatment historyRegulatory Mode Questionnaire

Regulatory Mode Theory (Kruglanski et al., 2000) Theory of motivation and self-regulation

Assessment Mode (cognitive) - an individual’s tendency to evaluate options in order to make the right decision in pursuit of a goal. “Do the right thing.” Locomotion Mode (action) – an individual’s tendency to

take action toward a goal. “Just do it!”

Operate independently and vary according to temperament and socialization.

Both are needed for optimum functioning.

Lamb Atchley (2018)Examined lifetime prevalenceExplored extent to which demographic factors, history of

substance use disorder treatment, and regulatory modes predict gambling disorderFindings:Majority of sample (76.15%) were non-problem gamblers

(SOGS = 0). Level 1, non-problem gamblers (SOGS = 1-2) 15.14% of

sample Level 2, problem gamblers (SOGS = 3-4) 2.29% of sample Level 3, pathological gamblers (SOGS = 5+) 6.42% of sample

Lamb Atchley (2018)

Significant predictors of gambling disorder:

History of substance use disorder treatment (consistent with general population research)Female gender (inconsistent with Weinstock et al., 2006

and general population research)Cohabitating marital status Separated/divorced African Americans

Lamb Atchley (2018)

Significant predictors of gambling disorder (continued):

Male/Other Gender X Assessment ScoreFor males, for every 1 point increase in Assessment

Score, mean SOGS score expected to be 4.577 times higher for men as compared to women

No Treatment History X Assessment ScoreFor those with no SUD treatment history, for every 1

point increase in Assessment Score, mean SOGS score expected to be 3.449 times higher as compared to those who have been treated for SUD

Higher lifetime prevalence rates of Level 2 (problem gambling) and Level 3 (pathological gambling) than general population studies.

Higher lifetime prevalence rates of Level 3 (pathological gambling) than Level 2 (problem gambling) unlike general population studies.

These findings suggest that addiction counselors have an increased vulnerability to more severe gambling disorder and that the disorder might escalate faster in addiction counselors than the general population.

All research studies have limitations. Limitations in these studies included:

Small sample sizes

Regional samples – may not be representative of addiction counselor population as a whole

Regions represented could be areas in which there are more gambling opportunities and prevalence rates are higher

Replication is needed to confirm and expand the findings.

Just as it is important to know our risks of health conditions such as diabetes, heart disease, or cancer, it is important to know our risk of developing gambling disorder.

Be honest with yourself about your risk.

Take action to protect yourself.

Brief Bio-Social Gambling Screen (Gebauer, LaBrie, & Shaffer, 2010)

1. In the past 12 months, have you become restless, irritable, or anxious when trying to cut down or stop gambling?

2. In the past 12 months, have you tried to keep your family or friends from knowing how much you gambled?

3. In the past 12 months, have you had such financial trouble that you had to get help from family or friends?

One or more yes answers indicates a likely gambling disorder.

Acknowledge your demographics and history.

Assessment scale (Kruglanski et al., 2000)(See Handout)

What other risk factors apply to you? (family history, age, etc.).

Don’t think of gambling as a way to make money.Always gamble with money that you can afford to lose.Never chase losses.Set a money limit.Don’t gamble when you are depressed or upset.Do not gamble when using alcohol or other drugs.Balance gambling with other activities.

Play sports

Attend sporting events

Go to concerts

Travel (day trips or longer)

Go to spa, nail salon, etc.

Go to amusement, theme, or water parks

Visit outdoor places (parks, lakes, forests, etc.)

Go shopping

Do art, painting, crafts,

Do gardening

Eat out

Read

Visit family or friends

Have family or friends over

Do learning activities

Volunteer

Go to museums

Go to festivals

Explore your city or town

Play board or outdoor games

Cook out

American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Association.

American Gaming Association (2019). State of the states: The AGA survey of casino entertainment. Washington: AGA.

Custer, R. & Milt, H. (1985). When luck runs out: Help for compulsive gamblers and their families. New York, NY: Facts on File, Inc.

Freud, S. (1961). Dostoevsky and parricide. In J. Strachey (Ed. & Trans.), The standard edition of the complete psychological works of Sigmund Freud (Vol. 21, 1927-1931, pp. 173- 196). London, England: The Hogarth Press and The Institute of Psycho-Analysis. Retrieved from https://www.sas.upenn.edu/~cavitch/pdf-library/Freud_Dostoevsky_Parricide.pdf (Original work published in 1928).

Gamblers Anonymous International Service Office (2019). Definition of gambling. Downloaded from http://www.gamblersanonymous.org/ga/content/questions-answers-about-gamblers-anonymous

Gebauer, L., LaBrie, R., & Shaffer, H. J. (2010). Optimizing DSM-IV-TR classification accuracy: a brief biosocial screen for detecting current gambling disorders among gamblers in the general household population. Canadian Journal of Psychiatry(2), 82-90.

Gerstein, D., Murphy, S., Toce, M., Hoffman, J., Palmer, A., Chuchro, L., . . . Hill, M. A. (1999). Gambling impact and behavior study: Report to the National Gambling Impact Study Commission. Chicago, IL: National Opinion Research Center. http://www.norc.org/pdfs/publications/gibsfinalreportapril1999.pdf

Harvard Medical School (2010). Pathological gambling. Harvard Mental Health Letter, 27(2), 1- 3. https://www.health.harvard.edu/newsletter_article/pathological-gambling

Kessler, R. C., Hwang, I., LaBrie, R., Petukhova, M., Sampson, N. A., Winters, K. C., & Shaffer, H. J. (2008). The prevalence and correlates of DSM-IV pathological gambling in the national comorbidity survey replication. Psychological Medicine, 38(9), 1351-1360. doi:10.1017/S0033291708002900

Kruglanski, A. W., Thompson, E. P., Higgins, E. T., Atash, M. N., Pierro, A., Shah, J. Y., & Spiegel, S. (2000). To do the right thing! or to just do it! Locomotion and assessment as distinct self-regulatory imperatives. Journal of Personality and Social Psychology, 79, 793-815. doi:10.1037/0022-3514.79.5.793

Lamb Atchley, L. J. (2018). Regulatory modes and gambling in addiction counselors: A multiple regression study. Retrieved from ProQuest, LLC. (ProQuest No. 10747219).

National Council on Problem Gambling (NCPG, 2016). National Survey of Problem Gambling Services. Retrieved from https://www.ncpgambling.org/programs-resources/programs/2016-survey-problem-gambling-services/

Oei, T.P.S. & Gordon, L.M. 2008. Psychosocial factors related to gambling abstinence and relapse in members of Gamblers Anonymous. Journal of Gambling Studies 24 (1): 91–105.

Petry, N. M. (2005). Pathological gambling: Etiology, comorbidity, and treatment. Washington, DC: American Psychological Association.

Rosenthal, R. J. (1987). The psychodynamics of pathological gambling: A review of the literature. In T. Galski (Ed.), The handbook of pathological gambling. Springfield, MO: Charles C. Thomas.

Shaffer, H. J., Hall, M. N., & Vander Bilt, J. (1999). Estimating the prevalence of disordered gambling behavior in the United States and Canada: A research synthesis. American Journal of Public Health, 89(9), 1369-1376. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1508762/pdf/amjph00009-0065.pdf

Weinstock, J., Armentano, C., & Petry, N. M. (2006). Prevalence and health correlates of gambling problems in substance abuse counselors. The American Journal on Addictions, 15, 144-149. doi:10.1080/10550490500528449

Welte, J. W., Barnes, G. M., Tidwell, M.-C. O., Hoffman, J. H., & Wieczorek, W. F. (2015). Gambling and problem gambling in the United States: Changes between 1999 and 2013. Journal of Gambling Studies, 31(3), 695-715. doi:10.1007/s10899-014-9471-4

Welte, J. W., Barnes, G. M., Wieczorek, W. F., Tidwell, M-C. O., & Parker, J. C. (2002). Gambling participation in the U.S. – Results from a national survey. Journal of Gambling Studies, 18(4), 313-337. doi:10.1023/A:1021019915591

Williams, R. J., Volberg, R. A., & Stevens, R. M. (2012). The population prevalence of problem gambling: Methodological influences, standardized rates, jurisdictional differences, and worldwide trends. Ontario, Canada: Ontario Problem Gambling Research Centre.