DISORDERED GAMBLING: A PSYCHOLOGICAL PERSPECTIVE Renée A. St-Pierre Ph.D. Candidate Psychologist
OUTLINE Disordered gambling What is it? What is it NOT? How do we measure it? How prevalent is it? Comorbidities Development and maintenance of disordered gambling Treatment of disordered gambling
DISORDERED GAMBLING
DISORDERED GAMBLING: MEDIA PORTRAYALS
DISORDERED GAMBLING: MEDIA PORTRAYALS
DISORDERED GAMBLING: WHAT IT IS? WHAT IT IS NOT? Popular media often portrays disordered gamblers as “driven by an irresistible compulsion [to gamble]” and are “unable to stop” (Schaler, 1999) Is there any truth behind these depictions?
DISORDERED GAMBLING: WHAT IT IS? WHAT IT IS NOT? Disease or medical model: Conceptualizes it as a “dependence on the ‘action’ of gambling, in many ways similar to dependence on a mood- changing drug” Gambling is assumed to be “reliably and repeatedly harmful to the individual and/or others” Gambling “ MUST be outside conscious control” (Blume, 1987, p. 241-243)
DISORDERED GAMBLING: WHAT IT IS? WHAT IT IS NOT? DSM-5 defines Gambling Disorder as a behavioural addiction Essential features: Persistent and recurrent problematic gambling behaviour Leads to “clinically significant” impairment or distress (APA, 2013)
DISORDERED GAMBLING: WHAT IT IS? WHAT IT IS NOT? DSM-5 criteria (≥4 items endorsed): Needs to gamble with increasing amounts of money in order to achieve the desired excitement Has made repeated unsuccessful efforts to control, cut back, or stop gambling Is often preoccupied with gambling (e.g., thinking of ways to get money with which to gamble) After losing money gambling, often returns another day to get even (“chasing” one’s losses) (APA, 2013)
DISORDERED GAMBLING: WHAT IT IS? WHAT IT IS NOT? Many criticisms raised about the medical or disease model conceptualization of disordered gambling One issue raised is whether excessive gambling behaviour really is dichotomous (non-disordered vs. disordered)?
DISORDERED GAMBLING: WHAT IT IS? WHAT IT IS NOT? Consider two cases: Jenny Alex Do you think these two gamblers differ from one another? If so, how do they differ?
JENNY Jenny is a 34-year-old stay-at-home mother of two young boys, Tyler 4, and Joshua, 1. Before her son Tyler was born, Jenny would spend $5 dollars a week to play the State lottery, and an additional $10 dollars at the church’s Bingo night. However, soon after his birth, Jenny was no longer able to get out to the Bingo tournaments as much. Nevertheless, she found a fun alternative: an internet Casino site that allowed her to play roulette for money. She loved the idea of playing online because she could do it whenever her sons were asleep, and it could help her escape from the monotony of housework and mothering responsibilities. At first, Jenny would spend an average of 20 dollars a week playing internet roulette, but within six months, she was spending approximately 100 dollars a week, and playing an average of 1.5 hours per day. Her husband has since noticed that some of her usual housework is being neglected on occasion, and that the amount of money she needs for groceries isn’t always equivalent to the quantity of food purchased. Upon questioning from her husband, Jenny admitted that she uses some of the grocery money to play Keno, but that it isn’t more than 25 dollars a week.
ALEX Alex is an 19-year-old student, attending vocational training school to become an electrician. He also works part- time at his father’s electrical company while attending school. When he first began going to the casino to play blackjack (his game of choice), he would spend an average of $50 - $100, depending on his success, and play for one to three hours once a month. However, in his last few visits to the casino, Alex has been on a “losing streak”, and borrowing small amounts of money from friends (≈$25/friend) in order to “get back on track”. What’s more, he has been going to the casino almost every night, spending sometimes over 3 hours at the blackjack tables. Although he is unhappy about his recent losses, he believes that he’ll be able to get back to his usual playing habits just as soon as he wins back the money, which is just around the corner in his eyes.
DISORDERED GAMBLING: WHAT IT IS? WHAT IT IS NOT? Current evidence suggests that gambling behaviour (and problems) may instead exist on a continuum (Strong & Kahler, 2007; Toce-Gerstein, Gerstein, & Volberg, 2003) Considerable movement in and out of more severe and less severe forms of gambling (Slutske, Jackson, & Sher, 2003; Winters, Stichfield, Botzet, & Slutske, 2005) S ome gamblers described as “episodic” (Griffiths, 2006; Nower & Blaszczynski, 2003
DISORDERED GAMBLING: WHAT IT IS? WHAT IT IS NOT? Continuum of Gambling Behaviour No risk – Low risk Moderate risk High risk Problem/ No Recreational Experimentatio n Disordered gambling gambling At-Risk/ gambler In-Transition Frequency Frequency Gambler Duration Duration Expenditure Expenditure
DISORDERED GAMBLING: HOW DO WE MEASURE IT? DSM-5 remains the primary tool to diagnose Gambling Disorder in the U.S. However, there exists several diagnostic screens used to detect potential problematic gambling behaviour
DISORDERED GAMBLING: HOW DO WE MEASURE IT? Commonly used diagnostic screens: South Oaks Gambling Screen (SOGS; , Lesieur & Blume, 1987) Canadian Problem Gambling Index (CPGI; Ferris & Wynne, 2001) National Opinion Research Center DSM-IV Screen for Gambling Problems (NODS; Gerstein et al., 1999) Massachusetts Gambling Screen (MAGS; Shaffer, Labrie, Scanlan, & Cummings, 1994) Lie/Bet Questionnaire (Johnson et al., 1997)
DISORDERED GAMBLING: HOW DO WE MEASURE IT? Problems with diagnostics screens: They are self-report Subject to a high false positive rate Different instruments have different cut-off points Developed based on previous DSM criteria of “pathological gambling” (Lorains, Cowlishaw, & Thomas, 2011)
DISORDERED GAMBLING: HOW PREVALENT IS IT? Most people that gamble do so as an occasional recreational activity and do so in a responsible manner (i.e., set and maintain limits) However, a small but meaningful proportion of individuals gamble excessively and experience serious problems (St-Pierre, Temcheff, Gupta, Derevensky, & Paskus, 2014)
DISORDERED GAMBLING: HOW PREVALENT IS IT? Based on existing research, prevalence of disordered gambling: 0.15 – 3.5% ( M = 1.6%) for adults (Stucki & Rihs-Middel, 2007) 5.37 – 10.41% ( M = 7.89%) for college students (Blinn-Pike, Worthy, & Jonkman, 2007) 0.3 – 10% for adolescents (Volberg, Gupta, Griffiths, Ólason, & Delfabbro, 2010)
DISORDERED GAMBLING: COMORBIDITIES Rarely does disordered gambling present itself in isolation Shown to be comorbid with: Substance use disorders (e.g., alcohol or drug abuse/dependence, nicotine dependence) Mood disorders (e.g., depression) Anxiety disorders (e.g., phobia) Impulse-control disorders (e.g., ADHD, CD) (Kessler et al., 2008; Lorains et al., 2011)
DISORDERED GAMBLING: COMORBIDITIES Comorbid disorders tend to develop before the onset of disordered gambling (except substance use disorders) WHY? Gambling can be used as a coping strategy or as a means for escaping High degree of impulsivity associated with gambling (Kessler et al., 2008; )
DEVELOPMENT AND MAINTENANCE OF DISORDERED GAMBLING For most disordered gamblers, gambling results in consistent and important financial losses Despite these significant losses, problem gamblers continue to gamble WHY ?
DEVELOPMENT AND MAINTENANCE OF DISORDERED GAMBLING Decisions to continue or cease gambling are influenced by irrational thoughts , inaccurate interpretations , and/or errors in judgment My odds of winning now must be...
DEVELOPMENT AND MAINTENANCE OF DISORDERED GAMBLING The cognitive model of gambling (Walker, 1992) is a psychological theory of gambling that focuses on cognitive processes to explain continued involvement in gambling
DEVELOPMENT AND MAINTENANCE OF DISORDERED GAMBLING Basic tenets of the cognitive model: Gamblers use rules to make quick decisions under i. conditions of uncertainty (e.g., current situation is representative of previous situations based on similarity) ii. Over-reliance on these rules eventually leads to an unpredictable negative outcome (loss) iii. Objective information about loss is misperceived or disregarded iv. Decision to continue to play becomes open to cognitive distortions
DEVELOPMENT AND MAINTENANCE OF DISORDERED GAMBLING Cognitive distortions can be divided into three interconnected categories. Illusions of Probability Control Fallacies Biased Memories or Evaluations of Outcome
DEVELOPMENT AND MAINTENANCE OF DISORDERED GAMBLING Probability fallacies involve the tendency to link mutually exclusive events Past experience in chance situations are believed to dictate present odds of winning Erroneous because odds of winning are largely independent of past experiences Product of misunderstanding or inability to apply the notion of randomness “ Each event must appear a proportionate number of times ”
DEVELOPMENT AND MAINTENANCE OF DISORDERED GAMBLING Example: LOSS + LOSS + LOSS + LOSS + LOSS WIN TRY 6? _________________
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