Diagnosis Of Pathological Gambling Research Articles

The Gambling Habits of University Students in Aragon, Spain: A Cross-Sectional Study.

Gambling has become a routine form of entertainment for many young people. The aim of this study was to describe the gambling behavior that university students are developing in Aragon, Spain, and to analyze whether these habits are more common among students of sports science, on the assumption that they are more likely to have a higher exposure to betting company marketing. A cross-sectional design was applied, with data collected on advertising exposure, gambling habits and experiences, and opinions on the impact of gambling and its regulation from 516 undergraduate students from the University of Zaragoza. The online survey included ad hoc questions and the “Pathological Gambling Short Questionnaire” to screen for potential gambling disorders. Almost half of the sample had bet money at least once in their life (48.1%), and 2.4% screened positive for consideration of a possible diagnosis of pathological gambling. Betting shops (44.2%) were the most common gambling option, and students of sports science showed a higher prevalence of pathological gambling and had greater tendencies to make bets. Gambling is perceived as a normal leisure activity by a significant part of university students. The development of transversal strategies is required to raise awareness towards the potential dangers of gambling.

Gender differences in mental health and substance use disorders and related healthcare services utilization.

Pathological gambling often co-occurs with other psychiatric disorders. Gender differences in treatment-seeking behaviors among patients with pathological gambling diagnosis remain poorly understood. This study assessed gender differences in healthcare services utilization in patients seeking treatment for pathological gambling, substance use, and mental health co-occurring conditions. Study data were derived from a representative sample of the Massachusetts All Payers Claims Database for the period 2009-2013. Descriptive analyses were performed by gender using group t-tests and Pearson's chi-square tests. Bootstrap analysis was used to account for skewed distribution of healthcare services utilization data. Multiple linear regressions were used to evaluate the association between healthcare services utilization and gender while controlling for patient's age, county, and ICD-9-CM diagnosis codes. Over two-thirds of the patients were males. Moreover, two in five patients seeking treatment had pathological gambling as principal or primary diagnosis. Females had a significantly greater number of three or more co-occurring psychiatric conditions than males. Having a diagnosis of episodic mood disorder, neurotic disorder, or adjustment reaction significantly increased the utilization of healthcare services for both genders. Females had a greater utilization of healthcare services than males for the same psychiatric diagnosis. Healthcare services utilization significantly varies by gender and type of mental health and substance use diagnosis. There are significant differences by gender in the utilization of healthcare services for the same psychiatric disorders. There is a need to address gender differences in psychiatric conditions and their related healthcare needs. (Am J Addict 2019;28:9-15).

Who Are the Subjects with Gambling-Related Problems Requiring Treatment? A Study in Northern Italy.

Background: This study analyzes data related to Hospital (HOS), Public Treatment Service Dedicated to Drug Addicts (SERD), or Community Mental Health Center (CMHC) clients with a first diagnosis of Pathological Gambling (PG) in the period 2000/2016 in Northern Italy. The aims were to describe trends and characteristics of pathological gamblers (PGs) and to estimate the prevalence of other diagnoses before or after the diagnosis of PG. Methods: Participants aged over 17 years with an ICD-9 or ICD-10 PG diagnosis were selected. Results: 680 PGs were identified, mean age 47.4 years, 20% female, 13% non-natives, 30% had other mental disorders diagnoses, 9% had alcohol dependence syndrome, and 11% had drug dependence. Most participants with comorbid disorders were diagnosed before PG, with a more elevated prevalence regarding mental disorders. Almost seven years had elapsed on average between the first admission and the diagnosis of PG. Conclusions: The results of this study highlight a growing demand for PG treatment addressed not only to SERD, but also to psychiatric and hospital services, based on the increase in SERD attendance from 2013. Many of them had already been treated for mental health problems before, but their percentage remained costant over time.

The Economic Burden of Pathological Gambling and Co-occurring Mental Health and Substance Use Disorders

Disordered gambling often co-occurs with psychiatric and substance use disorders. The study aim was to assess the healthcare costs of pathological gambling (PG) and co-occurring mental health and substance use disorders by payer. This is the first-of-its-kind economic analysis of addictive behaviors and mental health disorders. Study data were derived from the Massachusetts All-Payer Claims Data-a representative health claims database-for the period 2009 to 2013. The study analytical sample contained all medical and pharmaceutical claims for commercially insured Massachusetts residents who were aged ≥18 years, had health insurance coverage, had a diagnosis of PG, and sought care in the Commonwealth. Healthcare cost components included outpatient, inpatient, emergency room visits, and prescription drugs. Bootstrap analysis was performed to account for skewed distribution of cost data. All costs were adjusted to constant dollars. The study sample included 599 patients over the study period. The most prevalent principal diagnoses were disorders of impulse control (50%), episodic mood disorders (31%), anxiety disorders (14%), and psychoactive substance (9%). The mean annual total expenditures on health care per patient with diagnosis of pathological gambling were $7993 ± $11,847 (bias-corrected 95% confidence interval) in 2009, $10,054 ± $14,555 in 2010, $9093 ± $13,422 in 2011, and $9523 ± $14,505 in 2012. Pharmaceutical expenditures represented 16% to 22% of total healthcare expenditures. In the study period, prescription drug co-pays represented approximately 16% of the pharmaceutical expenditures. Psychiatric comorbidity and substance use disorders, and nondependent abuse of drugs are highly prevalent among pathological gamblers. These disorders pose an economic burden to patients and healthcare payers.

Genome-wide association study of pathological gambling

BackgroundPathological gambling is a behavioural addiction with negative economic, social, and psychological consequences. Identification of contributing genes and pathways may improve understanding of aetiology and facilitate therapy and prevention. Here, we report the first genome-wide association study of pathological gambling. Our aims were to identify pathways involved in pathological gambling, and examine whether there is a genetic overlap between pathological gambling and alcohol dependence. MethodsFour hundred and forty-five individuals with a diagnosis of pathological gambling according to the Diagnostic and Statistical Manual of Mental Disorders were recruited in Germany, and 986 controls were drawn from a German general population sample. A genome-wide association study of pathological gambling comprising single marker, gene-based, and pathway analyses, was performed. Polygenic risk scores were generated using data from a German genome-wide association study of alcohol dependence. ResultsNo genome-wide significant association with pathological gambling was found for single markers or genes. Pathways for Huntington's disease (P-value=6.63×10−3); 5′-adenosine monophosphate-activated protein kinase signalling (P-value=9.57×10−3); and apoptosis (P-value=1.75×10−2) were significant. Polygenic risk score analysis of the alcohol dependence dataset yielded a one-sided nominal significant P-value in subjects with pathological gambling, irrespective of comorbid alcohol dependence status. ConclusionsThe present results accord with previous quantitative formal genetic studies which showed genetic overlap between non-substance- and substance-related addictions. Furthermore, pathway analysis suggests shared pathology between Huntington's disease and pathological gambling. This finding is consistent with previous imaging studies.

Type of gambling as an independent risk factor for suicidal events in pathological gamblers.

Individuals with pathological gambling have an increased risk for suicidal events. Additionally, the prevalence of comorbid psychiatric disorders is high among pathological gamblers. This study analyzes whether the type of gambling is associated with suicidal events in pathological gamblers independently from comorbidity. Participants were recruited in 4 different ways: via random telephone sample from the general population, via individual invitation for study participation in gambling locations, through various media and the distribution of a leaflet in various settings, and via inpatient treatment facilities for pathological gambling. The final sample included 442 participants with a lifetime diagnosis of pathological gambling. A standardized clinical interview was conducted. High financial losses were associated with suicidal events (odds ratio [OR] = 1.94, 95% 95% confidence interval [CI], [1.11, 3.37]), as were mood disorders (OR = 7.70, 95% CI, [4.44, 13.37]) and female gender (OR = 2.52, 95% CI, [1.20, 5.28]). Gambling on electronic gambling machines in gambling halls or bars was associated with increased odds of suicidal events (OR = 2.94, 95% CI, [1.38, 6.24]). Other types of gambling, such as casino games or betting on sports, or the number of DSM-IV criteria for pathological gambling were not associated independently with suicidal events. Our findings suggest that gambling on electronic gambling machines in gambling halls or bars is associated with suicidal events in pathological gamblers independently of comorbidity. This result shows that the type of gambling needs to be considered as a relevant factor in gambling research.

Mapping brain volumetric abnormalities in never-treated pathological gamblers

Several magnetic resonance imaging (MRI) studies to date have investigated brain abnormalities in association with the diagnosis of pathological gambling (PG), but very few of these have specifically searched for brain volume differences between PG patients and healthy volunteers (HV). To investigate brain volume differences between PG patients and HV, 30 male never-treated PG patients (DSM-IV-TR criteria) and 30 closely matched HV without history of psychiatric disorders in the past 2 years underwent structural magnetic resonance imaging with a 1.5-T instrument. Using Freesurfer software, we performed an exploratory whole-brain voxelwise volume comparison between the PG group and the HV group, with false-discovery rate correction for multiple comparisons (p<0.05). Using a more flexible statistical threshold (p<0.01, uncorrected for multiple comparisons), we also measured absolute and regional volumes of several brain structures separately. The voxelwise analysis showed no clusters of significant regional differences between the PG and HV groups. The additional analyses of absolute and regional brain volumes showed increased absolute global gray matter volumes in PG patients relative to the HV group, as well as relatively decreased volumes specifically in the left putamen, right thalamus and right hippocampus (corrected for total gray matter). Our findings indicate that structural brain abnormalities may contribute to the functional changes associated with the symptoms of PG, and they highlight the relevance of the brain reward system to the pathophysiology of this disorder.

A Gamblers Clustering Based on Their Favorite Gambling Activity.

The objective of this study was to identify profiles of gamblers to explain the choice of preferred gambling activity among both problem and non-problem gamblers. 628 non-problem and problem gamblers were assessed with a structured interview including "healthy" (sociodemographic characteristics, gambling habits and personality profile assessed with the Temperament and Character Inventory-125) and "pathological" [diagnosis of pathological gambling, gambling-related cognitions (GRCs) and psychiatric comorbidity] variables. We performed a two-step cluster analysis based solely on "healthy" variables to identify gamblers' profiles which typically reflect the choice of preferred gambling activity. The obtained classes were then described using both "healthy" and "pathological" variables, by comparing each class to the rest of the sample. Clusters were generated. Class 1 (Electronic Gaming Machines gamblers) showed high cooperativeness, a lower level of GRC about strategy and more depressive disorders. Class 2 (games with deferred results gamblers) were high novelty seekers and showed a higher level of GRC about strategy and more addictive disorders. Class 3 (roulette gamblers) were more often high rollers and showed a higher level of GRC about strategy and more manic or hypomanic episodes and more obsessive-compulsive disorders. Class 4 (instant lottery gamblers) showed a lower tendency to suicide attempts. Class 5 (scratch cards gamblers) were high harm avoiders and showed a lower overall level of GRC and more panic attacks and eating disorders. The preference for one particular gambling activity may concern different profiles of gamblers. This study highlights the importance of considering the pair gambler-game rather than one or the other separately, and may provide support for future research on gambling and preventive actions directed toward a particular game.

DSM-5 gambling disorder: Prevalence and characteristics in a substance use disorder sample.

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) replaced the fourth edition's (DSM-IV) diagnosis of Pathological Gambling (PG) with Gambling Disorder (GD). GD differs from PG in that it requires 4 rather than 5 criteria for diagnosis and excludes the "Illegal Acts" criterion. We examined the prevalence of GD and its characteristics and validity in a substance-use disorder (SUD) sample. Participants (N = 6,613) in genetic studies of substance dependence underwent a semistructured psychiatric interview. Individuals who reported ever having gambled $10 at least monthly (n = 1,507) were the focus of the analyses. Approximately one third of acknowledged gamblers (n = 563; 8.5% of the total sample) received PG (DSM-IV) and GD (DSM-5) diagnoses and 678 (10.3% of the total) received only a DSM-5 diagnosis, representing an increase of 20.4% relative to DSM-IV. Although the 3 groups were comparable demographically, the DSM-5-Only group was intermediate between the other 2 groups on the prevalence of comorbid SUDs, the distribution of DSM-IV PG criteria endorsed, and the types of gambling reported. Multinomial logistic regression analysis showed that the DSM-5-Only group was more likely than the No-Diagnosis group and less likely than the Both-Diagnoses group to acknowledge a gambling problem. In conclusion, there was a high prevalence of PG in this SUD sample. Analysis of non-DSM variables suggested that the increased sensitivity of the DSM-5 GD diagnosis successfully identifies a broader set of individuals with clinically significant gambling-related problems. Prospective studies of individuals with GD are needed to validate this finding.

Differences between early-onset pathological gambling and later-onset pathological gambling: data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC).

To examine differences between early-onset versus later-onset pathological gamblers in socio-demographic characteristics, rates of Axis I and II disorders, preferred type of gambling and rates of treatment-seeking in a large nationally representative survey of adults in the United States. Data were collected from face-to-face interviews using the Alcohol Use Disorder and Associated Disabilities Interview Schedule DSM-IV version IV (AUDADIS-IV). SETTING AND MEASUREMENT: The study drew on data from the United States' National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). All individuals with a DSM-IV diagnosis of pathological gambling (PG). To be consistent with prior studies, age of onset of PG was dichotomized as 25 years and younger (early-onset) versus 26 years and older (later-onset). Individuals with early-onset PG were more likely than individuals with later-onset PG to be male [odds ratio (OR) = 2.86; 95% confidence interval (CI) = 1.20, 6.82], never married (OR = 3.51; 95% CI = 1.39, 8.84), to have income below US$70 000 (OR = 0.09; 95% CI = 0.01, 0.61), to belong to younger cohorts (OR = 0.93; 95% CI = 0.89, 0.97) and to have a cluster B personality disorder (OR = 4.11; 95% CI = 1.77, 9.55), but less likely to have a mood disorder (OR = 0.42; 95% CI = 0.19, 0.94). There were no differences between individuals with early- and later-onset PG regarding rates of treatment-seeking (OR = 0.71; 95% CI = 0.20, 2.43) or preferred type of gambling (OR = 2.00; 95% CI = 0.55, 7.3). All results remained significant after adjusting for age, sex and race, except the difference in the prevalence for mood disorders, which was no longer significant. Individuals with early-onset versus later-onset pathological gambling differ in several socio-demographic and clinical characteristics, but not in their preferred types of game. Individuals from more recent cohorts appear to be at significantly increased risk for developing early-onset pathological gambling.

Gambling disorder during dopamine replacement treatment in Parkinson's disease: a comprehensive review.

Gambling Disorder (GD) is characterized by “the failure to resist gambling impulses despite severe personal, family or occupational consequences”. In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), GD replaces the DSM-IV diagnosis of Pathological Gambling (PG). GD estimated prevalence ranges between 0.4% and 3.4% within the adult population and it seems to be more common in patients with Parkinson's disease (PD). In this population, GD recently has become more widely recognized as a possible complication of dopamine agonist (DA) therapy. This association has aroused great interest for the dramatic impact GD has on patients' quality of life. Management of PG in patients with PD could be demanding. It is based on patient and caregiver education, modification of dopamine replacement therapy, and in some cases psychoactive drug administration. In this review article, the authors provide an overview of GD pathogenesis during DA therapy as well as a summary of available treatment options.

Contribution of Illegal Acts to Pathological Gambling Diagnosis: DSM-5 Implications

The purposes of this study were to examine the specific contribution of illegal acts to the diagnostic criteria of pathological gambling, to assess the possibility of differential item functioning across patients’ sex and age, and to explore the existence of different clinical phenotypes based on the presence of illegal acts. The sample consisted of 2,155 patients seeking treatment for pathological gambling at the University Hospital of Bellvitge in Barcelona, Spain. The illegal acts item did not show different item functioning, and younger patients presented higher latent means than middle-aged and older patients, whereas no differences were found across sex. This item also showed the lowest discrimination coefficient; its exclusion would maintain satisfactory internal consistency for the remaining 9 symptoms and was poorly related to psychopathology and the severity of the gambling behavior. The relevance of the illegal acts as a diagnostic criterion appears to be limited, and its elimination from the Diagnostic and Statistical Manual for Mental Disorders, 5th edition, seems justified. However, illegal acts have implications for both the clinical and legal domains and contribute to increase the patients’ impairment.

An Overview of and Rationale for Changes Proposed for Pathological Gambling in DSM-5

The fifth revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is scheduled for publication in 2013. It will include several changes to the diagnosis of pathological gambling: the name of the disorder will be altered, the threshold for diagnosis will decrease, and one criterion will be removed. This paper reviews the rationale for these changes and addresses how they may impact diagnosis and treatment of the disorder, as well as potential for future research in the field.

An empirical evaluation of proposed changes for gambling diagnosis in the DSM‐5

Recommendations related to pathological gambling for the fifth edition of the Diagnostic and statistic manual for mental disorders (DSM) are to eliminate the criterion related to committing illegal acts and reduce the threshold for diagnosis from five to four criteria. This study evaluated the impact of these changes on prevalence rates and classification accuracy. Data were analyzed from five samples, varying in severity of gambling problems. Surveys of randomly selected household residents in the United States (US) (n = 2417), gambling patrons (n = 450), individuals in brief intervention studies (n = 375), patients in community-based gambling treatment programs (n = 149) and participants in randomized intervention studies (n = 319). The national opinion research center DSM-IV screen for gambling problems (NODS) was administered to all participants. Internal consistency and factor structure were evaluated using both 10 and nine criteria. Base rates, hit rates, sensitivity, specificity and overall agreement were compared across classification systems, using DSM-IV classification as the standard. Eliminating the illegal acts criterion did not impact internal consistency and modestly improved variance accounted for in the factor structure. In comparing a classification system using four of 10 criteria versus one using four of nine, the four of nine system yielded equal or slightly better classification accuracy in all comparisons and across all samples. The inclusion of the illegal acts criterion in the proposed DSM-V pathological gambling diagnosis does not appear necessary for diagnosis of pathological gambling and, if it is eliminated, reducing the cut-point to four results in more consistent diagnoses relative to the current classification system.

Prevalence of pathological gambling in treatment-seeking addicted patients: an exploratory study with the South Oaks Gambling Screen

In the current paper, the prevalence of pathological gambling in 112 treatment-seeking patients with substance addiction (81 alcoholics and 31 cocaine dependents) was estimated. The DSM-IV-TR diagnostic criteria for pathological gambling and the Spanish version of the South Oaks Gambling Screen (SOGS) were used. The results showed that 22.3% of substance-addicted patients had a comorbid diagnosis of pathological gambling. Furthermore, an additional 11.6% of the sample had relevant symptoms for problem gambling. In sum, 33.9% of the sample reported clinically significant gambling-related symptoms. From a socio-demographic point of view, all substance-addicted patients with gambling-related symptoms were men. A comparison between substance-addicted patients with and without pathological gambling showed significant differences in alcohol severity (assessed by the EuropASI), psychopathological symptoms (assessed by the SCL-90-R) and personality variables (assessed by the MCMI-II). In all cases, scores were significantly higher in gamblers than in non-gamblers. Finally, the implications of these results for further research and clinical practice are commented upon.

Motivation to change and pathological gambling: Analysis of the relationship with clinical and psychopathological variables

OBJECTIVES. The present study analyses the internal factor structure of the University of Rhode Island Change Assessment (URICA) Scale in pathological gambling (PG). The scale's association with the clinical profile of patients is also evaluated. METHOD. The factor analysis was based on a sample of 531 men with a DSM-IV diagnosis of pathological gambling. The statistical analysis included confirmatory factor analysis and linear correlation. RESULTS. The analyses confirmed the internal structure obtained for the URICA. The internal consistency was satisfactory (Cronbach's alpha between .74 and .85). The association between URICA scores and the socio-demographic and clinical profile of patients ranged between moderate and weak (R coefficients below .30). Lower motivation was present in 28.4% of cases and it was associated with shorter duration of the disorder, lower severity of the PG symptoms, and high psychopathology. Conclusions. The results support the validity and reliability of the URICA in a Spanish clinical population of pathological gamblers.

The relationship of pathological gambling to criminality behavior in a sample of Polish male offenders

SummaryBackgroundSevere problem gambling is most often related to income producing offences such as larceny and embezzlement. In addition, the high rate of relapse to gambling problems and the link between gambling debts and crime have clinical, forensic and penitentiary implications. Considering the data from the literature presented here I decided to form and empirically verify a hypothesis that incarcerated men with a diagnosis of pathological gambling are characterized by psychopathic personality disorders, alcohol problems and criminality.Material/MethodsThe groups of participants encompassed 90 men 26–52 years of age, serving a criminal sentence. All participants had to fulfil the following clinical criteria: a) be interviewed by a psychiatrist and diagnosed with pathological gambling and/or antisocial personality disorders b) obtain a result in the PCL-R test; c) estimate the relationship between gambling problems and crime. Taking into consideration the abovementioned criteria three patient test groups were formed: Group 1, which included those for whom gambling had led to crime; Group 2, where gambling was a part of a criminal lifestyle, and Group 3, in which the mutual relationship between gambling and crime was unclear.ResultsThe participants were diagnosed as pathological gamblers (DSM-IV-TR, ICD-10) and psychopaths (PCL-R). Those tested differed with regard to the intensification of the personality disturbance tested, the co-occurrence of other disturbances, particularly psychoactive addictions, the motivations for taking up gambling, and the type of criminal activity.ConclusionsThe hypothesis was confirmed that incarcerated men with a diagnosis of pathological gambling are characterized by psychopathic personality disorders, alcohol problems and criminality.

Motivação para mudança de comportamento em amostra de jogadores patológicos

OBJETIVO: O objetivo deste trabalho foi conhecer o perfil e avaliar as características de jogadores patológicos que frequentavam clínicas e grupos especializados no tratamento desse problema, quanto à motivação para mudança de comportamento. MÉTODO: Foram avaliados 69 sujeitos com diagnóstico de jogo patológico, segundo critérios diagnósticos do DSM-IV-TR. A amostra foi subdividida em dois grupos, conforme o tipo de tratamento: grupo em tratamento ambulatorial (TA) e grupo de jogadores anônimos (JA). Os instrumentos utilizados foram a University of Rhode Island Change Assessment (URICA), a Régua de Prontidão e a South Oaks Gambling Screen (SOGS). RESULTADOS: A análise dos resultados evidenciou que o grupo TA apresentou escore médio maior do que o do grupo JA tanto no estágio de pré-contemplação quanto no estágio de ação. Comparando os grupos TA e JA com relação ao tempo de abstinência, observou-se que o grupo de JA está associado a um tempo maior de abstinência do que o grupo de ambulatório. CONCLUSÃO: A importância de pesquisar estratégias que favoreçam a compreensão e a adesão aos tratamentos para jogadores patológicos é fundamental. A avaliação da motivação e dos estágios para mudança permite uma direção para o tratamento, auxiliando na elaboração de estratégias terapêuticas.

Comments from the Trenches: Proposed Changes to the DSM-V Classification of Pathological Gambling

The proposed DSM-V changes related to the pathological gambling diagnosis hold far-reaching implications, yet these modifications have been met with little public attention. This letter addresses the three changes proposed including the diagnosis' reclassification alongside other addictive behaviors, the lowering of the pathological gambling threshold to the endorsement of 4 symptoms, and the removal of the "illegal acts" criterion. Support for the initial change is well documented, but there is evidence to suggest that the latter two changes should be reconsidered.

Testing the validity of the Need Inventory (NISS) within a clinical context: The role of pathological gambling

The paper investigates the validity of the Need Inventory for Sensation Seeking (NISS) in comparison to the Sensation Seeking Scale-Form V (SSS-V; Zuckerman, 1994) in pathological gamblers. A sample of 30 inpatients with a primary diagnosis of pathological gambling, and a sample of 30 control subjects, were tested using questionnaires which assess sensation seeking, the severity of pathological gambling, and impulsiveness. Groups differ in terms of impulsivity as well as in terms of sensation seeking, but only when using the NISS. No differences were found with respect to the scores of the SSS-V. The study demonstrates the validity of the NISS (over the SSS-V) within a clinical context.