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Part two of the series recapping Dr. Howard Shaffer’s keynote address at the 25^thNational Conference on Problem Gambling in Boston, Mass. To read part one of the Gambling Disorders 360° series,click here.

After laying the foundation for his presentation by outlining the theoretical revolutions that have defined our understanding of gambling disorders, Dr. Howard Shaffer then proposed that the next revolution in understanding gambling disorders will come from the way online gambling behavior can now be studied. Until recently, information about people’s gambling behavior has come almost exclusively from self-report (asking a person questions about their past gambling behaviors). Self-report is considered to be acceptably accurate by the scientific community, but it relies on recollections of individuals that may be influenced by a variety of factors such as desire to please interviewers or to downplay losses. For years these problems with self-reported data have presented a challenge to researchers studying gambling disorders. However, Dr. Shaffer suggested that new innovations in research methods will decrease the role of self-report and allow researchers to look directly at the gambling behavior of online gamblers.

To examine gambling behavior directly, researchers need to have access to all of the games played, bets made, wins and losses and other behaviors of those who gamble. In the online environment, those actions and more are being automatically stored by the online casino operator, as was the case in Dr. Shaffer’s study. Dr. Shaffer and his colleagues at the Division on Addictions partnered with European online casino operatorbwin(owned by bwin.party digital entertainment plc)and were given access to a record of the actual gambling activities of more than 40,000 people over a six-year period. (We have discussed this partnership in more detail in previous blog posts, including theSeptember 2010 edition of Issues & Insights).

This partnership has allowed the researchers to focus their efforts on groups that they would not otherwise be able to study, such as people who have closed their accounts because they have said they personally feel that they have “gambling problems”. This group consists of only 215 people out of the 47,000 who used the website during this period (LaBrie & H. J. Shaffer, 2011). The ability see the actual behaviors of this desired population (even when they make up only 1 out of every 218 users, as in this case) is, according to Dr. Shaffer, a revolution in gambling disorder research.

Dr. Shaffer suggested that access to data on the actual behaviors of gamblers creates the opportunity for several potential breakthroughs. For example, it may someday be possible for online casinos to use betting patterns to identify gamblers who are at risk for developing gambling problems before the problems manifest. (We discussed this possibilityin an interviewwith Division on Addictions researcher Dr. Sarah Nelson last year.)

It may also be possible to give firm answers to long standing questions, like “Are people who play certain games more likely to develop problems than others?” by examining the actual betting behavior of groups of gamblers. Only time will tell whether the research being done by groups like the Division on Addictions will be the next great leap forward in gambling disorder research, or just another small step towards some future revolution that is not yet kown.

What do you think the next revolution in gambling disorder research will be? Let us know in the comments section below!

References

LaBrie, R., & Shaffer, H. J. (2011). Identifying behavioral markers of disordered Internet sports gambling.Addiction Research & Theory,19(1), 56 – 65.

Shaffer, H. (2011, July 1).Scientific Revolutions: Understanding Gambling Disorders. Presented at the National Conference on Problem Gambling, Park Plaza Hotel, Boston MA.

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The NCRG will be pulling into Boston, Mass. later today to begin the fifth annual Road Tour. Each year, the NCRG Road Tour travels to a new city to share information about the latest research on gambling disorders and make key stakeholders aware of the science-based programs and resources the NCRG has to offer. These meetings are great opportunities to form new partnerships and educate others on the most up-to-date information about gambling disorders and responsible gaming. Make sure you follow the NCRG onTwitterandFacebookfor the latest update on Road Tour activities! We are also posting articles here on Gambling Disorders 360˚ later in the week to recap the meetings and workshops.

We are honored to have four distinguished guests joining us for the NCRG Road Tour this year:

– AlanFeldman,NCRG board member and senior vice president of public affairs for MGM Resorts International

– Dr. Lisa Najavits, Ph.D.,professor of psychiatry at Boston University School of Medicine

– Christine Reilly,senior research director for the NCRG

– Ken Winters, Ph.D.,director of the Center for Adolescent Substance Abuse and Research, University of Minnesota and member of the NCRG Scientific Advisory Board

They will be speaking at these various events:

– Treatment Provider Workshop:The NCRG and the Massachusetts Council on Compulsive Gambling will co-host a workshop for treatment providers entitled, “Post-traumatic Stress Disorder and Problem Gambling,” led by Lisa Najavits, Ph.D., professor of psychiatry at Boston University School of Medicine. Dr. Najavits will present information on her program “Seeking Safety,” an evidence-based treatment for Post-traumatic Stress Disorder (PTSD) and substance use disorders, and her research on problem gambling in PTSD populations.

– College Gambling Roundtable:The NCRG and the Massachusetts Council on Compulsive Gambling will co-host a discussion with representatives from area colleges and universities to share resources and best practices to address gambling and gambling-related harms on college campuses. Alan Feldman, Christine Reilly, senior research director for the NCRG, and Jim Wuelfing, CPP-R, NRPP, prevention director for the Massachusetts Council, will lead the discussion, which will include an overview of the NCRG’s new CollegeGambling.org website.

– Stakeholder Breakfast on Building Partnerships to Promote Responsible Gaming:The NCRG will host a breakfast for legislative, industry, health care and non-profit stakeholders to learn about the work of the NCRG and receive an in-depth briefing on how communities can effectively work together to address gambling disorders and encourage responsible gaming. Alan Feldman, Christine Reilly and Dr. Ken Winters will discuss the important role of research in developing effective programs.

– Grants Workshop:The NCRG will host a luncheon workshop for research investigators to learn more about the NCRG’s research funding opportunities. Christine Reilly and Dr. Lisa Najavits will discuss the NCRG’s grant-review process, the key ingredients of a proposal competitive for funding by the NCRG and opportunities to receive NCRG funding for research on gambling disorders.

Make sure you follow the NCRG on Twitter, Facebook and Gambling Disorders 360 to hear all of the updates from Boston, Mass. For members of the media, please contact Amy Martin at 202-552-2689 oramartin@ncrg.orgto schedule interviews with participants. Questions or comments? Please leave them in the comments section below.

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Are you excited to learn from leading experts on gambling disorders and responsible gaming and discuss how technology plays a role in gambling behavior? Online registration is now open for the 12^thannual NCRG Conference on Gambling and Addiction. Participants can register by September 12 for the early bird registration rate of $295, now available to all attendees. To register,click hereor visit the NCRG Conference website atwww.ncrg.org/conference.

The NCRG Conference on Gambling and Addiction is packed with informational plenary session topics, ranging from discussions about how the latest technology alters the way our minds develop to best practices in implementing effective responsible gaming programs in the online gaming environment. To download the full conference brochure with the agenda, registration form and continuing education information,click here. Top speakers include:

– Dr. Robert Ladouceur, Connie Jones and Dr. Lia Nower will take the mystery out of slot machines by explaining the research that addresses whether electronic gaming machines are inherently “addictive.”

– Dr. Gary Small will discuss his newest book,iBrain, and how technology continues to change the way young minds develop, function and interpret information – and what strategies and tools are needed to enhance our technological, social and empathic abilities.

– Dr. Sara Kiesler will discuss her research on how health information available on the Internet is affecting people’s well-being.

– Dr. Kathleen M. Carroll will report on studies analyzing the effectiveness of computer-assisted versions of cognitive-behavioral therapy with drug dependent individuals.

Register today to take advantage of these exciting sessions and more. Also make sure to check back to the growing list of continuing education providers who will be distributing up to 13 credit hours for the NCRG Conference on Gambling and Addiction. You can view the full list here.

What NCRG Conference session are you most looking forward to attending? Let us know in the comments below!

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The NCRG is excited to add two new certifications to theNCRG Conference on Gambling and Addiction’s growing list of certifying agencies for continuing education credits! The American Academy of Health Care Providers in the Addictive Disorders (Academy) has approved continuing education credit for Certified Addiction Specialists (CAS) (Approval No. 11-1466). Also the State of Nevada Board of Examiners for Social Workers (approval # A-511-11) approved the NCRG Conference’s 13 credit hours. We are happy to have them on board. These associations join the seven other accrediting organizations to provide NCRG Conference attendees with continuing education credits.

To view the entire list of continuing education opportunities, visit ourNCRG Conference CEU webpage. You can also download the entireNCRG Conference brochureto see the exciting list of speakers and pre-conference workshops.

Questions or comments? Please let us know in the comments below!

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What affects the prevalence of gambling disorders in a given area? Is it access to gambling activities in general, access to a specific type of gambling activity, demographic characteristics, local norms, the presence of an underlying addictive syndrome, or some combination of these factors and others? These questions have been asked for many years and have inspired much debate in both political and academic circles. Studying a question like this requires competent and willing researchers, but also a favorable situation for research.

Unlike clinical trials, people cannot be randomly assigned to live within a certain distance of a casino, to prefer a particular gambling activity, or to have some particular demographic trait. This limitation can be overcome by taking advantage of “natural experiments,” times when some variable in a community changes and researchers can isolate the effect that variable has on the prevalence of gambling disorders in the community.

One such natural experiment will take place in Maryland over the next several years with the legalization of slot machines. The results of the first study measuring baseline disordered gambling in the state has just been released to the public, and further studies will be completed over the next several years to assess the effect (if any) of the addition of slot machines to existing gambling opportunities (Shinogle, Norris, et al., 2011).

The researchers conducted a telephone study of approximately 5,500 residents of Maryland and administered a variety of survey instruments, including 17 questions about lifetime gambling problems from the National Opinion Research Center DSM-IV Screen for Gambling Problems (NODS) (Gerstein, Murphy, et al., 1999). The NODS can be used to diagnose lifetime or past year gambling disorders, or both. A lifetime symptom is one that a person has experienced at any point in their life, as in “Have you ever gambled as a way to escape from personal problems?” The researchers found that 1.5 percent of respondents qualified for lifetime pathological gambling (having experienced 5 or more symptoms in their lifetime), and another 1.9 percent qualified for lifetime problem gambling (having experienced 3 or 4 symptoms in their lifetime). Lifetime prevalence for any individual or age group is always equal to or higher than past year prevalence.

The baseline prevalence rates found in this study are comparable to those found in similar studies, including a study of Maryland by one of the same researchers from 1989 (R A Volberg & Steadman, 1989). The 1989 and 2010 studies both found a prevalence rate for pathological gambling at 1.5 percent. The 1989 study had problem gambling at 2.4 percent while the 2010 study found it at 1.9 percent. These rates are in line with the rates found in large national surveys such as the 1999 meta-analysis of the United States and Canada (1.6 percent lifetime pathological gambling) (H. J. Shaffer, Hall, & Vander Bilt, 1999), and the 2008 National Comorbidity Survey Replication (0.6 percent lifetime pathological gambling) (Kessler et al., 2008).

The ultimate question this study is aimed at answering is what will be the impact, if any, of the expansion of gaming by adding slot machines to Maryland’s racetracks. There are two competing schools of thought that the Maryland experiment will inform. The first is the “exposure” theory that assumes the more exposure people have to gambling activities, the higher the rates of problem and pathological gambling. This theory has begun to give way to a newer “adaptation theory”. Adaptation theory suggests that “after the novelty of initial exposure, people gradually adapt to the risks and hazards associated with potential objects of addiction” (H. J. Shaffer, 2005, p. 1227). Adaptation theory sees the rise in gambling problems that had been previously viewed as evidence of the exposure theory as a temporary “bump” that will decrease as the community adapts to the stimulus. We discussed one example of this pattern of bump and decline in gambling among Minnesota youth in aFebruary Gambling Disorders 360˚ blog post.

The researchers conducting the current study suggest that the rates of problem gambling may rise “three- or four-fold,” though it is not clear from the study where this prediction comes from (Judith Shinogle, Norris, et al., 2011, p. 9). The paper makes reference to three studies that found an increase from .8 to 1.3 percent (H. J. Shaffer et al., 1999), a doubling (D. Gerstein, Murphy, et al., 1999), and a 90% increase in gambling problems (Welte, Wieczorek, Barnes, Tidwell, & Hoffman, 2004), for an average increase of about 80%, well below the 200-300% increase predicted by the authors.

Only time will tell if new gambling opportunities will impact gambling problems in a state that already has access to local racetracks, a lottery and casinos in bordering states. We look forward to the results from Maryland’s natural experiment and what they tell us about exposure and adaptation.

The full study isavailable for downloadon the University of Maryland Baltimore County’s website (the link goes directly to the study PDF). Do you have thoughts or questions about this research? Let us know in the comments section below!

References

Gerstein, D., Murphy, S., Toce, M., Hoffmann, J., Palmer, A., Johnson, R., Larison, C., et al. (1999).Gambling Impact and Behavior Study: Report to the National Gambling Impact Study Commission. Chicago: National Opinion Research Center.

Kessler, R. C., Hwang, I., LaBrie, R., Petukhova, M., Sampson, N. A., Winters, K. C., & Shaffer, H. J. (2008). DSM-IV pathological gambling in the National Comorbidity Survey Replication.Psychol Med,38(9), 1351-60. doi:S0033291708002900 [pii] 10.1017/S0033291708002900

Shaffer, H. J. (2005). From disabling to enabling the public interest: natural transitions from gambling exposure to adaptation and self-regulation.Addiction,100(9), 1227-30; discussion 1235. doi:ADD1200 [pii] 10.1111/j.1360-0443.2005.01200.x

Shaffer, H. J., Hall, M. N., & Vander Bilt, J. (1999). Estimating the prevalence of disordered gambling behavior in the United States and Canada: a research synthesis.American Journal of Public Health,89(9), 1369-76.

Shinogle, J., Norris, D. F., Park, D., Volberg, Rachel A., Haynes, D., & Stokan, E. (2011).Gambling Prevalence in Maryland: A Baseline Analysis(p. 55). Baltimore, MD: Maryland Institute for Policy Analysis & Research.

Volberg, R A, & Steadman, H. J. (1989). Prevalence estimates of pathological gambling in New Jersey and Maryland.The American Journal of Psychiatry,146(12), 1618-1619.

Welte, J. W., Wieczorek, W. F., Barnes, G. M., Tidwell, M.-C., & Hoffman, J. H. (2004). The relationship of ecological and geographic factors to gambling behavior and pathology.Journal of Gambling Studies / Co-Sponsored by the National Council on Problem Gambling and Institute for the Study of Gambling and Commercial Gaming,20(4), 405-423. doi:10.1007/s10899-004-4582-y

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