Problem gambling and internalising symptoms: A longitudinal analysis of common and specific social environmental protective factors.

Comorbidity between problem gambling and internalising disorders (anxiety and depression) has long been recognised. However, it is not clear how these relationships develop, and what factors can foster resilience to both conditions. The current study draws on longitudinal cohort data to investigate: 1) the cross-sectional and longitudinal relationships between problem gambling and internalising symptoms; 2) whether there are common and/or specific social environmental factors protective against both internalising symptoms and problem gambling in young adulthood; and 3) interactive protective factors (i.e., those that moderate the relationship between problem gambling and internalising symptoms).

The relationship between problem gambling and attention deficit hyperactivity disorder

Recent studies indicate that treatment-seeking problem gamblers display elevated rates of ADHD and that adolescents who screen positive for ADHD are more likely to engage in gambling, develop gambling problems, and experience a greater severity in gambling problems. This study aimed to (a) compare the prevalence of ADHD in treatment-seeking problem gamblers to the general population; (b) investigate the relationships between ADHD and problem gambling severity, cluster B personality disorders, motor impulsivity, alcohol use, substance use, gender, and age; and (c) investigate the degree to which these factors moderate the relationship between ADHD and problem gambling severity. Participants included 214 adults (154 males, 58 females, 2 unspecified) who sought treatment for their gambling problems at a specialist gambling agency in Melbourne, Australia. Almost one-quarter (24.9 %) of treatment-seeking problem gamblers screened positively for ADHD, which was significantly higher than the 14 % prevalence in a community sample. ADHD was significantly positively correlated with problem gambling severity, motor impulsivity, and cluster B personality disorders, but was not associated with alcohol and substance use, gender or age. None of the factors significantly moderated the relationship between ADHD and problem gambling severity. These findings suggest that a considerable proportion of treatment-seeking problem gamblers report ADHD and that their clinical profile is complicated by the presence of high impulsivity and cluster B personality disorders. They highlight the need for specialist gambling agencies to develop screening, assessment, and management protocols for co-occurring ADHD to enhance the effectiveness of treatment.

How the causes, consequences and solutions for problem gambling are reported in Australian newspapers: a qualitative content analysis

OBJECTIVE: To inform public health approaches to problem gambling by examining how the news media covers problem gambling, with a particular focus on the causes, consequences and solutions to problem gambling, and the 'actors' and sources who influence media coverage. METHODS: A qualitative content analysis guided by framing theory analysed coverage of problem gambling in Australian newspapers in the period 1 July 2011 to 30 June 2012. RESULTS: Solutions to problem gambling were more frequently discussed than causes and consequences. A focus on the responsibility of individuals was preferred to reporting that focused on broader social, ecological, and industry determinants of problem gambling. Reporting was highly politicised, with politicians frequently quoted and political issues frequently discussed. In contrast, the community sector, health professionals and problem gamblers were rarely quoted. CONCLUSIONS AND IMPLICATIONS: This analysis has revealed the need for a more proactive, coordinated approach to the media by both public health researchers and health groups. The establishment of a gambling-specific coalition to push for evidence-based reform is recommended.

Problem gambling patterns among Australian young adults: associations with prospective risk and protective factors and adult adjustment outcomes

There is instability in the developmental course of problem gambling [PG] over time; however, studies that examine PG at an aggregate level obscure these variations. The current study employed data from a longitudinal study of Australian young adults to investigate: 1) PG patterns (i.e., resistance, persistence, desistence, and new incidence); 2) prospective risk and protective factors for these patterns; and 3) behavioural outcomes associated with these patterns. A sample of 2261 young adults (55.73% female) from Victoria, Australia, who were part of the International Youth Development Study completed a survey in 2010 (T1, age 21) and 2012 (T2, age 23) measuring PG (two items based on established measures), risk and protective factors, and behavioural outcomes. The majority of the sample (91.69%) were resistors (no PG at T1 and T2), 3.62% were new incidence PG cases, 2.63% were desistors (PG at T1 but not T2), and 2.07% reported persistent PG at T1 and T2. Individual civic activism was protective of new incidence PG, while affiliation with antisocial peers and frequent alcohol use increased the risk of persistence. Persistent problem gamblers also experienced the greatest number of poor behavioural outcomes at T2. New incidence was associated with internalising symptoms at T2, while desistance was not associated with any behavioural outcomes. In conclusion, each PG pattern was associated with different predictors and outcomes, highlighting the need to consider variation in the course of young adult PG in order to provide efficacious prevention and intervention approaches, and to protect against relapse.

Role of culture in gambling and problem gambling

There has been a significant gap in the gambling literature regarding the role of culture in gambling and problem gambling (PG). This paper aims to reduce this gap by presenting a systematic review of the cultural variations in gambling and PG as well as a discussion of the role cultural variables can play in the initiation and maintenance of gambling in order to stimulate further research. The review shows that although studies investigating prevalence rates of gambling and PG among different cultures are not plentiful, evidence does suggest certain cultural groups are more vulnerable to begin gambling and to develop PG. Significant factors including familial/genetic, sociological, and individual factors have been found in the Western gambling literature as playing important roles in the development and maintenance of PG. These factors need to be examined now in other cultural groups so we can better understand the etiological processes involved in PG and design culturally sensitive treatments. In addition, variables, such as cultural values and beliefs, the process of acculturation, and the influence of culturally determined help-seeking behaviors need to be also examined in relation to the role they could play in the initiation of and maintenance of gambling. Understanding the contribution of cultural variables will allow us to devise better prevention and treatment options for PG. Methodological problems in this area of research are highlighted, and suggestions for future research are included. (C) 2004 Elsevier Ltd. All rights reserved.

Understanding problem gambling in two ethnic communities in Brisbane, Queensland - A pilot study

This paper aims to present findings from a pilot study on understanding gambling within the Greek and Vietnamese communities in Brisbane, the capital city of Queensland State. It explores gambling behaviour among gamblers and views of workers from their own communities. Rich data were obtained by conducting qualitative semi-structured interviews. Three themes that emerged are the causes of gambling, the impact of gambling, and participants' views on existing delivery of gambling services. It appears that a more culturally appropriate gambling service is necessary to address the needs and problems of gamblers from non-English speaking backgrounds.

A preliminary adaptation of the Problem Gambling Severity Index for Indigenous Australians: internal reliability and construct validity

Objective: This paper describes the process employed to adapt the Problem Gambling Severity Index (PGSI) for use with Indigenous Australian populations.Methods: This study comprised a two-stage process: an initial consultation with Indigenous health workers, informing the textual and conceptual adaptation of items, followed by trial of the adjusted instrument with Indigenous community members (n=301).Results: Internal reliability was demonstrated: Australian Indigenous Problem Gambling Index (AIPGI) Cronbach's alpha α = 0.92 (Original PGSI, α = 0.84). Item-rest correlations confirmed that responses to items were consistent and related to the total score of remaining items. The AIPGI could predict gambling severity based on gambling frequency, when controlling for age and gender (OR=1.28, 95%CI 1.17–1.40).Conclusions: The adapted instrument is accessible to a cross-section of Indigenous Australians and has demonstrated properties of reliability and validity. An extended trial is needed to test the application of the instrument to a broader Indigenous audience and to further explore and confirm psychometric properties of the adapted instrument.Implications: This study introduces a culturally adapted tool for measuring rates of disordered gambling among Indigenous Australians.

The application of an etiological model of personality disorders to problem gambling

Problem gambling is a significant mental health problem that creates a multitude of intrapersonal, interpersonal, and social difficulties. Recent empirical evidence suggests that personality disorders, and in particular borderline personality disorder (BPD), are commonly co-morbid with problem gambling. Despite this finding there has been very little research examining overlapping factors between these two disorders. The aim of this review is to summarise the literature exploring the relationship between problem gambling and personality disorders. The co-morbidity of personality disorders, particularly BPD, is reviewed and the characteristics of problem gamblers with co-morbid personality disordersare explored. An etiological model from the more advanced BPD literature—the biosocial developmental model of BPD—is used to review the similarities between problem gambling and BPD across four domains: early parent–child interactions, emotion regulation, co-morbid psychopathology and negative outcomes. It was concluded that personality disorders, in particular BPD are commonly co-morbid among problem gamblers and the presence of a personality disorder complicates the clinical picture. Furthermore BPD and problem gambling share similarities across the biosocial developmental model of BPD.Therefore clinicians working with problem gamblers should incorporate routine screening for personality disorders and pay careful attention to the therapeutic alliance, client motivations and therapeutic boundaries. Furthermore adjustments to therapy structure, goals and outcomes may be required. Directions for future research include further research into the applicability of the biosocial developmental model of BPD to problemgambling.

Cognitive versus exposure therapy for problem gambling: randomised controlled trial

BACKGROUND: Problem gambling-specific cognitive therapy (CT) and behavioural (exposure-based) therapy (ET) are two core cognitive-behavioural techniques to treating the disorder, but no studies have directly compared them using a randomised trial. AIMS: To evaluate differential efficacy of CT and ET for adult problem gamblers at a South Australian gambling therapy service. METHODS: Two-group randomised, parallel design. Primary outcome was rated by participants using the Victorian Gambling Screen (VGS) at baseline, treatment-end, 1, 3, and 6 month follow-up. FINDINGS: Of eighty-seven participants who were randomised and started intervention (CT = 44; ET = 43), 51 (59%) completed intervention (CT = 30; ET = 21). Both groups experienced comparable reductions (improvement) in VGS scores at 12 weeks (mean difference -0.18, 95% CI: -4.48-4.11) and 6 month follow-up (mean difference 1.47, 95% CI: -4.46-7.39). CONCLUSIONS: Cognitive and exposure therapies are both viable and effective treatments for problem gambling. Large-scale trials are needed to compare them individually and combined to enhance retention rates and reduce drop-out.

Problem gambling, familial violence and alcohol misuse: exploring the triad for treatment-seekers

Research into the co-occurrence of problem gambling, familial violence, and alcohol misuse is limited. While these issues have been considered in combination (i.e.violence and alcohol misuse, problem gambling and alcohol misuse, problem gambling and violence), within Australia, in particular, there has been an absence of exploration of this triad. The current research attempts to fill the gap in the literature, to establish whether there is any difference between problem gamblers with co-occurring violence and problem gamblers who had not experienced violence in terms of their alcohol misuse and gambling behaviours. Interviews were conducted with 81 treatment- seeking problem gamblers to explore how a history of victimization only, perpetration only, victimization and perpetration, or no history of family violence impacted on gambling behaviours (including baseline Victorian Gambling Screen), as well as alcohol misuse. Results indicated that in this treatment-seeking sample there were no significant differences for gambling behaviours or alcohol misuse between problem gamblers with issues of violence and those without. Males demonstrated (on average) a greater tendency toward hazardous drinking or disordered alcohol use. It would be prudent for treatment services to routinely examine problem gamblers’ history of violence and alcohol misuse until research verifies the nature of this triad

A preliminary, qualitative exploration of the influences associated with drop-out from cognitive-behavioural therapy for problem gambling : an Australian perspective

It has been estimated that 80% of Australians engage in some form of gambling, with approximately 115,000 Australians experiencing severe problems (Productivity Commission 2010). Very few people with problem gambling seek help and, of those who do, large numbers drop-out of therapy before completing their program. To gain insights into these problems, participants who had either completed or withdrawn prematurely from an individual CBT-based problem gambling treatment program were interviewed to examine factors predictive of premature withdrawal from therapy as well as people's 'readiness' for change. The results indicated that there might be some early indicators of risk for early withdrawal. These included: gambling for pleasure or social interaction; non-compliance with homework tasks; gambling as a strategy to avoid personal issues or dysphoric mood; high levels of guilt and shame; and a lack of readiness for change. The study further showed that application of the term 'drop-out' to some clients may be an unnecessarily negative label in that a number appear to have been able to reduce their gambling urges even after a short exposure to therapy.

Measuring problem gambling in Indigenous communities : an Australian response to the research dilemmas

This paper examines evidence relating to harmful consequences of gambling in the Australian Indigenous population and highlights the failure of research to date to define problem gambling from Indigenous perspectives or to tailor research processes to accommodate the cultural beliefs and experiences of Indigenous groups. It advocates for the development of a unique set of measures to assess the function of problem gambling aspects, negative impacts, trends, risks and protective factors. This would be informed by more recent qualitative studies into gambling that are specific to Indigenous communities. Additionally, this paper argues the need to adapt and validate a commonly applied assessment tool, such as the Canadian Problem Gambling Index, to monitor prevalence of problem gambling over time. Targeted research into Indigenous people's experiences of gambling will facilitate the development of culturally based responses and interventions into problem gambling.