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What is a gambling disorder and how can it be treated? To answer those questions, the National Center for Responsible Gaming (NCRG) released the seventh volume ofIncreasing the Odds: A Series Dedicated to Understanding Gambling Disorder.Because some clinicians may not screen for gambling disorders in their patient assessments, this edition ofIncreasing the Oddscan serve as an essential training guide necessary for any clinician to recognize, understand and treat gambling disorders.

The NCRG’s monograph series provides easy-to-understand summaries of seminal peer-reviewed research on gambling disorders, as well as implications for future research and prevention efforts. This edition –“What Clinicians Need to Know About Gambling Disorders”– gives health care providers easy access the most significant research findings on the following topics:

• Chapter 1:A foundational understanding of gambling disorders is critical to assessment and treatment of the disorder by clinicians. Nathan Smith focuses on the reasons why some people develop a gambling problem and covers neurobiological vulnerabilities, family history, lifestyle and co-occurring disorders.
• Chapter 2:Even though youth are generally not of legal age to gamble, research has estimated that nearly 70 percent of Americans aged 14 to 21 have gambled in the past year.6 Ken C. Winters, Ph.D., and Randy Stinchfield, Ph.D., L.P., offer the latest findings on youth gambling.
• Chapter 3:Dr. Stinchfield offers a critical review of the available instruments for identifying and diagnosing a gambling disorder.
• Chapter 4:Jon E. Grant, M.D., J.D., M.P.H., and Brian Odlaug, M.P.H., present the latest on treatment outcomes using psychosocial interventions. They examine the various types of treatment methods that have been deemed as most effective with gambling disorders and other addictions.
• Chapter 5:Marc N. Potenza, M.D., Ph.D., explains the emerging research on drug treatments for gambling disorders.

To supplement this edition ofIncreasing the Odds, the NCRG also made many of thebrief screens and assessment instrumentsavailable as free downloads on the NCRG’s website.

Download a free copy of “What Clinicians Need to Know about Gambling Disorders” and the assessment tools on theNCRG’s monograph page. There you can also find the first six volumes of the series, which address topics such as gambling and the brain, youth and gambling, the various aspects of gambling addiction recovery, gambling and public health and self-exclusion programs. Each volume of theIncreasing the Oddsseries is available as a free download.

Tell us what you think about the latest edition of the NCRG’s monograph series in the comments section below.

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What if you could examine a group of seven-year-olds and predict which of them were more likely to someday develop a gambling disorder? A recent study in the journalAddictionattempts to do just that by analyzing the association between impulsive behavior at age seven and the development of problem gambling by adulthood. The authors found that, compared to their non-impulsive counterparts, children who exhibited impulsive behaviors at age seven were 3.09 times more likely to report problem gambling behavior in later years. Read on for more details about this investigation, the first to predict gambling problems over a 30-year span.

Previous studies have suggested that manifestations of impulsivity appear to be a key personality characteristic among adult problem gamblers. However, the value of these past investigations were limited, in part, because they depended on adult study participants’ ability to accurately recall past events. In contrast, this study tested the subjects for impulsivity at age seven, thus avoiding recall bias.

The participants in this study were children selected from the Boston, Mass., and Providence, R.I., cohorts of the Collaborative Perinatal Project (CPP). The CPP was a multicenter study of prenatal and perinatal antecedents of childhood mental, neurological and physical abilities. The participants’ development was assessed at various times up to age seven. Behavioral functioning was assessed by psychologists on a structured profile completed as part of a two-hour battery of cognitive, sensory and motor tests.

To investigate problem gambling prevalence over time, a segment of the participants from the study were sent the South Oaks Gambling Screen (SOGS) assessment as adults. This yielded 958 participants. Impulsive behaviors were substantially more common among the group with measures of lifetime problem gambling (i.e., the group that exhibited impulsive behaviors at seven years) and probable pathological gambling than those without a history of gambling problems. This finding provides evidence that the influence of early behavior problems on the development of lifetime pathological gambling is specific to measures of childhood impulsivity.

What do you think about this study? Let us know in the comments section below.

References

Shenassa, E. D., Paradis, A. D., Dolan, S. L., Wilhelm, C. S., & Buka, S. L. (In Press). Childhood impulsive behavior and problem gambling by adulthood: A 30-year prospective community-based study.Addiction.

NCRG staffResearch Updateyouth gambling

To understand how many people in a given area have a gambling problem, we must first understand how gambling disorders are defined and measured. We addressed some of the foundational questions of definition and measurement in the NCRG’s‘Gambling Disorders Explained’ post earlier this year. Now that the definitions have been outlined, we will examine two common methods used to discuss diseases in a population: prevalence and incidence.

When you hear or read that about 1 percent of American adults are diagnosed with pathological gambling, you are hearing a prevalence statistic. Prevalence is a snapshot of the number of people in a population who have a particular disorder at a particular moment in time, and it is most often expressed as a percentage. For example, there were 19.7 million Americans with diabetes in 2009, which constituted a prevalence rate of 6.2 percent (Centers for Disease Control and Prevention, 2011). That is, for every 100 Americans, approximately six had diabetes in 2009. Prevalence data is very common, and when a newspaper or magazine discusses a disease in a population, the author is almost always referring to prevalence data.

Incidence refers to the number of new cases of a disease in a population in a given time period. Continuing with the diabetes example, there were 1,812,000 new cases of diabetes reported in the U.S. in 2009 (Centers for Disease Control and Prevention, 2011), and the incidence rate was 0.88 percent. (Incidence rate is often expressed as incidence per thousand, in this case it would be 8.8 new cases per 1000 Americans.) Incidence rate is best used to track the rate at which new cases of a disease are being reported. For example, the incidence rate for diabetes was 3.5 new cases per thousand in 1980 and was 8.8 new cases per thousand in 2009.

Not only do incidence and prevalence rates measure different variables, but they also are affected differently by changing circumstances. For example, the rate of recovery from a disease affects the prevalence of the disease but not the incidence. Hypothetically, if an instant cure for diabetes was discovered tomorrow, the prevalence of the disease would fall to zero percent and the incidence rate would be unchanged from its previous level. Alternately, if some hypothetical new product caused an instant week-long bout of diabetes for everyone in the U.S., incidence rates would spike to 100 percent while prevalence rates would stay stable.

At present, there are no peer-reviewed studies that examine the incidence rate of gambling disorders to our knowledge. This may be because studies of incidence tend to be expensive and difficult to conduct because they require following a population over the course of time. A quality study of incidence rates for gambling disorders would go a long way to answering fundamental questions about the development of gambling disorders in a population.

Do you have questions or comments about the concepts discussed in this blog? Is there another aspect of research on gambling disorders that you would like to have explained in a Gambling Disorders 360˚ post? Please submit your suggestions in the comments section below.

References

Centers for Disease Control and Prevention. (2011). Diabetes Data and Trends. Retrieved August 23, 2011, from http://apps.nccd.cdc.gov/DDTSTRS/default.aspx

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Researchers have debated whether or not casino games, such as poker or sports betting, should be considered games of skill or games of chance. What qualifies a game to be labeled a “game of skill” by researchers? This is the subject being examined by 2012 NCRG Outstanding Poster Award Winner Dr. Gerhard Meyer and his colleagues at the University of Bremen in Germany in the poster titled “Is Poker a Game of Skill or Chance? A Quasi-Experimental Study.”

Dr. Meyer’s experiment was designed to determine if poker is more a game of luck or skill. To do this, he recruited poker players who were either inexperienced or experts and had them play simulated games of poker while receiving weak, moderate or strong hands.

After receiving his award, the NCRG blog team interviewed Dr. Meyer about his winning project and his experience at the 13th annual NCRG Conference on Gambling and Addiction. Listen to the audio interview below for more on Dr. Meyer’s work.

Have a question or comment about Dr. Meyer’s research? Leave it in the comments below or discuss it with the NCRG on Twitter(@theNCRG) and Facebook (www.facebook.com/thencrg)

NCRG staffConference on Gambling and Addiction

Once again, the NCRG Conference on Gambling and Addiction continued its partnership with Global Gaming Expo (G2E) by offering the ‘NCRG at G2E’ track of sessions on October 2. For the second year, the NCRG Conference co-located with G2E, making it easier for attendees of both events to learn about best practices in responsible gaming. The first session on this year’s NCRG at G2E series took a close look howtreatment providers report on their use of funds and how government and the private sector evaluates the impact of these services.

First, Mark Vander Linden, M.S.W., executive officer of the Office of Gambling Treatment and Prevention at the Iowa Department of Public Health and president of the Association of Problem Gambling Service Administrators, provided an overview of funding nationally and in Iowa. Vander Linden stated that with the exception of the Substance Abuse and Mental Health Services Administration (SAMHSA), there has been a lack of federal funding on problem gambling treatment and prevention efforts. In the absence of such federal efforts, individual state efforts have emerge that are often divergent from one another in terms of funding levels and resources offered.

Vander Linden referenced a 2010 national survey of publicly funded problem gambling services. This survey was completed by 46 states and found that a total of $58.4 million was spent on problem gambling services through state-dedicated public funds. Less than half of those funds were directed to treatment services. He also noted highlighted the difference in funding between treatment for gamblingdisorders and substance use disorders. Vander Linden explained that while substance use disorders are about eight times more prevalent than gambling disorders, public funding for substance abuse treatment is about 674 times greater than public funding for problem gambling treatment ($16.17 billion versus $24.0 million).

In Iowa, gaming revenue is $330 million. Of this, $3.1 million is allocated toward problem gambling efforts. Vander Linden noted that these funds go to counseling, primary prevention and education, secondary prevention, helpline referral and education, marketing, training and professional development and evaluation, with treatment and prevention being the priority. One key component, Vander Linden noted, is to spend a portion of the funds to closely examine the effectiveness of these problem gambling resources.

Next, Maureen Greeley, executive director of the Evergreen Council on Problem Gambling (ECPG) in Washington state, discussed problem gambling funding in her area, noting that it is a goal of her organization to ensure they are providing consistent, high-quality services with the limited funding they receive. Greeley stated that the ECPG receives 0 .013 percent of gambling revenue as funding for problem gambling treatment and education services, and this comes from state, tribal and private sources.

Finally, Peter Cohen, director of regulatory affairs for The Agenda Group and former executive commissioner and CEO of the Victorian Commission for Gambling Regulation, provided an international perspective of problem gambling funding from his experience in Australia. According to Cohen, the Victorian Responsible Gambling Foundation was recently established as an independent government agency to fund research on gambling disorders, conduct community education initiatives and provide services, such as a gambling help line. While this is considered an independent agency, Cohen noted that since it gets its funding from the government, it has a responsibility to implement government policy.

The agency was awarded $150 million over four years ($37 million per year) to fund programs that fulfill the organization’s mission. He explained that the Responsible Gambling Foundation will continue to receive support as long as people keep gambling, but at some point, they will have to determine if they are getting their “bang for the buck” with this funding.
When evaluating the effectiveness of the treatment programs, Cohen raised the questions: Is it better when the number of people in treatment programs increases or decreases?

What is your opinion? Does an increase or decrease in the number of people in treatment programs show that problem gambling programs are more effective? Please leave your thoughts in the comments section below.

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