Developing a population approach to gambling health issues

The Institute of Public Health in Ireland (IPH) has developed this briefing paper to highlight the health impacts connected to gambling and in particular problem gambling.  This paper was developed to give information to Government Departments who are currently reviewing gambling legislation across the island of Ireland.  It draws attention to the impact problem gambling can have on the individual, family and community health and well-being.

IPH response to Department for Social Development consultation on future regulation of gambling in Northern Ireland

The Department for Social Development (DSD) recently undertook a review of Northern Ireland's gambling law sought views to help strike a balance between developing gambling as a leisure pursuit and minimising its potential negative consequences.  Following the consultation period, DSD aims to produce a balanced package of reforms which will strengthen the regulatory regime while easing some of the current restrictions on industry development.

A Descriptive Study of Gambling Among Emerging Adult Males in French-Speaking Switzerland.

The aims were twofold: to examine the gambling habits of emerging adult males in the French-speaking regions of Switzerland and to what extent these habits predict problem gambling within this population. We also evaluated problem gambling rates and provided data concerning variables such as gambling location, level of information about problem gambling and awareness of treatment centers. 606 Swiss male conscripts, aged 18-22 years, completed a self-report questionnaire. This was administered during their army recruitment day in 2012. Problem gambling was assessed through the Problem Gambling Severity Index (PGSI) (Ferris and Wynne 2001). 78.5% of the respondents were lifetime gamblers, 56.1% were past-year gamblers. Four out of ten past-year gamblers played in private spaces and in back rooms. The PGSI indicated that 10.8% of past-year gamblers presented with moderate gambling problems, whilst 1.4% appeared to be problem gamblers. The majority of respondents had never received information about problem gambling. Moreover, they were unaware of the existence of treatment centers for problem gambling in their region. PGSI scores were significantly predicted by the variety of games played. Problem gambling rates among young men appear to be higher than those of the general Swiss population. This confirms that emerging adult males are a particularly vulnerable population with regards to gambling addiction. The implications of this are considered for youth gambling-prevention programs.

Asumiendo las consecuencias negativas de la adicción al juego

La adicción al juego no sólo se caracteriza por la pérdida de control ante el juego, sino que esta conducta tiende a generar problemas en los diferentes ámbitos de la vida del ludópata. Por ello, este aspecto se recoge en el Manual diagnóstico y estadístico de los trastornos mentales-5 (DSM-V) como uno de los criterios para realizar su valoración diagnóstica. Objetivo: describir y analizar los diferentes elementos que conforman la compleja problemática aparejada a esta adicción y que pueden terminar en situaciones de exclusión social. Método: Se opta por una metodología cualitativa que se ajusta mejor a los intereses del estudio. Como técnica se ha seleccionado la historia de vida, instrumento de evaluación que permite conocer la verdadera magnitud del problema desde el punto de vista de los afectados. Resultados. De manera general, se ha descubierto que ser ludópata tiene muchos más consecuentes que el problema económico evidente. No debemos despreciar las implicaciones de esta conducta a otros niveles: familiar, laboral, legal y social, que pueden considerarse, a medio plazo, como factores mucho más execrables que el del mero gasto económico. Conclusión. Es fácil avistar que los graves problemas que acarrea la adicción al juego son capaces de desmembrar el proyecto vital del ludópata y el de su familia. Todo vale, aunque para ello tenga que jugarse su puesto de trabajo, su casa, su familia, sus amistades, su estatus social y su propia dignidad.

“Adição ao Jogo online”

Esta dissertação visa compreender a adição ao jogo online, através de duas perspetivas complementares que se congregam num estudo de caso. Analisamos o discurso de um jogador predominantemente de Blackjack online adicto a esta prática (F.) em processo de desabituação, e desenvolvemos a mesma metodologia junto da mãe deste, enquanto fonte complementar de informação, através de entrevistas semi-estruturadas. Desta análise emergiram resultados que clarificam os fatores que funcionam como determinantes da adição, que a mantêm bem como elementos indispensáveis para compreender a decisão de paragem do jogo. Nesta dinâmica conjugamos a perspetiva de F e da sua mãe. A metodologia escolhida para análise dos dados de investigação foi a Grounded Analysis Theory, partindo das vozes dos dois participantes e tendo como objetivo a construção de uma narrativa alternativa e assim contribuir para uma melhor análise de compreensão dos dados obtidos. Através de um processo indutivo de produção de conhecimento organizado e obedecendo a uma sequência que busca uma maior complexidade de integração, tem como objetivo final gerar uma teoria sustentada nos dados recolhidos (Fernandes & Maia, 2001). Enquanto metodologia qualitativa permite-nos aceder aos significados múltiplos que emergiram da experiência destes dois participantes. O jogo online sustentado na sua fácil disponibilidade tem como consequência um maior isolamento do jogador, e uma vez que as recompensas financeiras são uma possibilidade alimenta o ciclo do comportamento aditivo. A observância de problemas físicos e psicológicos percebidos como graves, justificaram uma abordagem de tratamento multidisciplinar, envolvendo ajuda farmacológica, psicológica e social. Os estudos existentes sobre o jogo online são ainda muito escassos, justificandose o estudo qualitativo na construção do conhecimento, pela análise mais detalhada dos fatores que podem contribuir para uma melhor compreensão de todas as especificidades presentes, numa perturbação aditiva ao jogo online.

Non-Substance-Related Disorders: Gambling disorder and internet addiction

Behavioral addictions are highly prevalent and have a major individual and societal impact. Moreover, given the availability and increase of potentially addictive activities in our societal development (e.g. internet, gaming, online pornography) an increase in these types of behavioral disorders is very likely. Gambling Disorders are best studied among the non-chemical addictions. However, effective treatment interventions need to be further developed, in particular for Internet Addiction. Most of the available evidence supports behavioral interventions as first line treatment. Specifically for Gambling Disorder, pharmacotherapy can be an useful augmentation.. Psychiatric comorbidities are frequent in patients with behavioral addictions and negatively affect the course of non-substance-related disorders. Concurrent treatment of these comorbid disorders is advised, although there is a clear need of conducting studies evaluating the effectiveness of integrated treatment approaches.

Early life course determinants of young adults' gambling behaviour. An Australian Longitudinal Study

Problem gambling represents a public concern as both a social and health issue. Available evidence shows problem gambling is associated with a range of psychological disorders, criminality, and disruption to families. While gambling itself may represent a pleasurable pursuit for the majority, for a proportion, gambling-related activities may assume many of the characteristics of an addiction and have the capacity to undermine individuals� mental and physical health, social relationships, financial independence, as well as the financial and psychological wellbeing of their families and/or friends. The objectives of this study are based on the need to increase our understanding of gambling behaviour, its antecedents, as well its influence on the health and wellbeing of gamblers and their families. One of the most important and unresolved issues in gambling research is whether the mental health and social/family correlates of gambling precede or follow gambling behaviour. This report focuses on this issue.

Gambling among youths in Switzerland and its association with other addictive behaviours: a population-based study.

OBJECTIVE: To assess the prevalence of problem gambling in a population of youths in Switzerland and to determine its association with other potentially addictive behaviours. METHODS: Cross-sectional survey including 1,102 participants in the first and second year of post-compulsory education, reporting gambling, socio-demographics, internet use and substance use. For three categories of gambling (nongambler; nonproblem gambler and at-risk/problem gambler). socio-demographic and addiction data were compared using a bivariate analysis. All significant variables were included in a multinominal logistic regression using nongamblers as the reference category. RESULTS: The prevalence of gamblers was 37.48% (n = 413), with nonproblem gamblers being 31.94% (n = 352) and at-risk/problem gamblers 5.54% (n = 61). At the bivariate level, severity of gambling increased among adults (over 18 years) and among males, vocational students, participants not living with both parents and youths having a low socio-economic status. Gambling was also associated to the four addictive behaviours studied. At the multivariate level, risk of nonproblem gambling was increased in males, older youths, vocational students, participants of Swiss origin and alcohol misusers. Risk of at-risk/problem gambling was higher for males, older youths, alcohol misusers, participants not living with both parents and problem internet users. CONCLUSIONS: One-third of youths in our sample had gambled in the previous year and gambling is associated with other addictive behaviours. Clinicians should screen their adolescent patients for gambling habits, especially if other addictive behaviours are present. Additionally, gambling should be included in prevention campaigns together with other addictive behaviours.

Dépendances: nouveautés en médecine 2008 [Addiction]

L'actualité 2008 des dépendances est centrée sur l'avancée des neurosciences psychiatriques dans le domaine des addictions mais aussi sur les clarifications nécessaires face à la complexité des comorbidités psychiatriques des addictions, notamment en cas de schizophrénie. Enfin, le praticien trouvera des considérations utiles pour la prescription de traitements de substitution chez des patients VIH en trithérapie. The highlights 2008 in the addiction field are correlated to the progress of psychiatric neurosciences. Clarifications are also necessary towards the psychiatric comorbidities (schizophrenia) with the addictions. Then, useful considerations are given for the prescription of substitution treatment among HIV patients under tritherapy.

Dépendances [Addiction]

This year review emphasizes four aspects coming from addiction psychiatry: 1. Initiation and maintenance of cannabis use. 2. Methadone and heart toxicity. 3. Suicidal behaviour in gambling. 4. Treatment of addictive disorders via internet: present and future perspectives.

Gambling in Spain: update on experience, research and policy

AIMS: To describe the current situation of gambling in Spain, sketching its history and discussing the regulations and legislation currently in force within the framework of the European Union (EU), and to review the epidemiology of gambling in Spain, the self-help groups and professional treatments available, and their potential effectiveness. METHODS: A systematic computerized search was performed in three databases (EMBASE, PubMed and PsychINFO, including articles and chapters) and the reference lists from previous reviews to obtain some of the most relevant studies published up to now on the topic of pathologic gambling in Spain. RESULTS: Similar to other EU countries, Spain has a high prevalence of pathologic gambling, focused on specific culturally bounded types of gambling. Expenditure in online gaming has risen significantly in the last few years, prompting the Spanish government to draft new legislation to regulate gaming. CONCLUSIONS: The gaming industry is expected to be one of the fastest growing sectors in Spain in the coming years owing to the rise of new technologies and the development of online gaming

Neurobiology of pathological gambling. Brain imaging and epidemiological studies

Pathological gambling, a form of behavioral addiction, refers to maladaptive, compulsive gambling behavior severely interfering with an individual’s normal life. The prevalence of pathological gambling has been estimated to be 1–2% in western societies. The reward deficiency hypothesis of addiction assumes that individuals that have, or are prone, to addictions have blunted mesolimbic dopamine reward signaling, which leads to compulsive reward seeking in an attempt to compensate for the malfunctioning brain reward network. In this research project, the effects of gambling were measured using brain [11C] raclopride PET during slot machine gambling and possible brain structural changes associated with pathological gambling using MRI. The subjects included pathological gamblers and healthy volunteers. In addition, impulse control disorders associated with Parkinson’s disease were investigated by using brain [18F]fluorodopa PET and conducting an epidemiological survey. The results demonstrate mesolimbic dopamine release during gambling in both pathological gamblers and healthy volunteers. Striatal dopamine was released irrespective of the gambling outcome, whether the subjects won or not. There was no difference in gambling induced dopamine release between pathological gamblers and control subjects, although the magnitude of the dopamine release correlated with gambling related symptom severity in pathological gamblers. The results also show that pathological gambling is associated with extensive abnormality of brain white matter integrity, as measured with diffusion tensor imaging, similar to substance-addictions. In Parkinson’s disease patients with impulse control disorders, enhanced brain [18F] fluorodopa uptake in the medial orbitofrontal cortex was observed, indicating increased presynaptic monoamine function in this region, which is known to influence signaling in the mesolimbic system and reward processing. Finally, a large epidemiological survey in Finnish Parkinson’s disease patients showed that compulsive behaviors are very common in Parkinson disease and they are strongly associated with depression. These findings demonstrate the role of dopamine in pathological gambling, without support for the concept of reward deficiency syndrome.

Secular Possession: Cinematic Iconography of Addiction

Addiction, and the experience of being addicted, is notoriously difficult to describe verbally and explain rationally. Would multifaceted and multisensory cinematic images work better in making addiction understandable? This study enquires how cinematic expression can render visible the experience of being addicted which is invisible as such. The basic data consists of circa 50 mainly North American and European fiction films from the early 1900s to the early 2000s that deal with addictive disorders as defined in the psychiatric DSM-V classification (substance dependence- and gambling disorders). The study develops an approach for analyzing and interpreting a large volume of digital film data: digital cinematic iconography is a framework to study the multifaceted cinematic images by processing and viewing them in the “digital image-laboratory” of the computer. Images are cut and classified by editing software and algorithmic sorting. The approach draws on early 1900s German art historian Aby Waburg’s image research and media archaeology, that are connected to film studies inspired by the phenomenology of the body and Gilles Deleuze’s film-philosophy. The first main chapter, “Montage”, analyses montage, gestural and postural images, and colors in addiction films. The second main chapter, “Thingness”, focuses on the close-ups of material objects and faces, and their relation to the theme of spirituality in cinema and art history, The study argues that the cinema engages the spectator to "feel" what addiction is through everyday experience and art historical imagery. There is a particular, historically transmitted cinematic iconography of addiction that is profane, material, thing-centered, abject, and repetitive. The experience of being addicted is visualized through montages of images characterized by dark and earthy colors, horizontal compositions and downward- directed movements. This is very profane and secular imagery that, however, circulates image-historical traces of Christian iconography, such as that of being in the grip of an unknown power.

Compulsive features in behavioural addictions: the case of pathological gambling

Aims To describe, in the context of DSM-V, how a focus on addiction and compulsion is emerging in the consideration of pathological gambling (PG). Methods A systematic literature review of evidence for the proposed re-classification of PG as an addiction. Results Findings include: (i) phenomenological models of addiction highlighting a motivational shift from impulsivity to compulsivity associated with a protracted withdrawal syndrome and blurring of the ego-syntonic/ego-dystonic dichotomy; (ii) common neurotransmitter (dopamine, serotonin) contributions to PG and substance use disorders (SUDs); (iii) neuroimaging support for shared neurocircuitries between behavioural and substance addictions and differences between obsessivecompulsive disorder (OCD), impulse control disorders (ICDs) and SUDs; (iv) genetic findings more closely related to endophenotypic constructs such as compulsivity and impulsivity than to psychiatric disorders; (v) psychological measures such as harm avoidance identifying a closer association between SUDs and PG than with OCD; (vi) community and pharmacotherapeutic trials data supporting a closer association between SUDs and PG than with OCD. Adapted behavioural therapies, such as exposure therapy, appear applicable to OCD, PG or SUDs, suggesting some commonalities across disorders. Conclusions PG shares more similarities with SUDs than with OCD. Similar to the investigation of impulsivity, studies of compulsivity hold promising insights concerning the course, differential diagnosis and treatment of PG, SUDs, and OCD.