NCRG Updates: Seed Grant Application Deadline Is May 2, 2011

The application deadline for the NCRG’sSeed Grantsis quickly approaching – May 2, 2011. Make sure you download theannouncementandapplication formto apply today!

The Seed Grants program provides up to $25,000 to support small research projects that can be completed in one year. Seed Grant projects can include pilot and feasibility studies, secondary analysis of existing data, small, self-contained research projects and development of research methodology or new research technology. The Seed Grant is one of five types of the NCRG grants designed to increase the number of researchers in the field and encourage new investigators to explore gambling disorders research. The NCRG will award more than $700,000 in grant funding in 2011 – nearly twice the amount funded in 2010.

The NCRG expects to award three Seed Grants in 2011, so make sure to complete your applications and apply by May 2! For more information on the application process, please see the Seed Grantannouncementand download anapplication form.You can also find examples of previously funded studies on ourFunded Project Grantspage.

Questions or comments? You can leave them in the Comments section below or contact Christine Reilly, Senior Research Director, atcreilly@ncrg.org.

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NCRG-funded Screen For Gambling Disorders Now Available To The Public

Have you ever been screened for a health problem? The answer is probably yes if you’ve ever been questioned by your doctor about symptoms or responded to a telephone survey about health. There are numerous screening instruments used by clinicians to determine if a client has a gambling problem, and some often appear in general population surveys to research the prevalence of the disorder. The Division of Addictions at Cambridge Health Alliance, a teaching affiliate of Harvard Medical School, recently released the Brief Biosocial Gambling Screen (BBGS) to help people decide on their own whether to seek a formal evaluation of their gambling behavior. Development of the screen was funded by the NCRG.

The Division on Addictions at Cambridge Health Alliance launched the BBGS on itswebsite. This 3-item survey is based on the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria for pathological gambling. The BBGS asks:

o During the past 12 months, have you become restless, irritable or anxious when trying to stop/cut down on gambling?

o During the past 12 months, have you tried to keep your family or friends from knowing how much you gambled?

o During the past 12 months, did you have such financial trouble as a result of your gambling that you had to get help with living expenses from family, friends or welfare?

A “yes” answer to any of the questions means the person is at risk for developing a gambling problem. A confidential, personalized message is provided to help guide the person to consider seeking further evaluation.

The development of the BBGS is described in the scientific paper, “Optimizing DSM-IV-TR Classification Accuracy: A Brief Biosocial Screen for Detecting Current Gambling Disorders Among Gamblers in the General Household Population,” published in theCanadian Journal of Psychiatrylast year (Gebauer et al., 2010). The authors derived the three questions from the results of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) a survey of 43,093 households which has yielded the largest sample of pathological gamblers. Their objective was to develop a screening instrument that would correctly identify the largest proportion of current pathological gamblers and exclude non-pathological gamblers (i.e., reduce the number of false positives). Another consideration was the length of the screen. A concise survey is easy to use in a clinical setting or for a self-assessment and can be easily incorporated into a general survey.

Out of the 10 possible criteria listed in the DSM-IV , the authors’ analysis found that the top three criteria for identifying pathological gambling patterns and avoiding false positives were withdrawal, lying about one’s gambling and borrowing money to gamble. The resulting BBGS questions focus on these criteria. A copy of this paper is available for download from the Division on Addictionswebsite.

What do you think about the BBGS and other gambling screens? Please let us know in the Comments section below. The NCRG always welcomes your feedback.

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Feelings And Situations That Precede Gambling Relapse

Why do so many people relapse when they are trying to stop gambling? It has been estimated that 50 to 75 percent of gamblers resume gambling after attempting to quit (N. M. Petry et al., 2006), but what are the thoughts, feelings and situations that precede these events? Researchers who study alcohol and drug abuse – disorders with similarly high rates of relapse – have developed a questionnaire designed to answer these questions for their audiences. A recent study published in the journalExperimental and Clinical Psychopharmacologyattempts to validate this same type of questionnaire for people with gambling disorders (Nancy M Petry, Rash, & Blanco, 2010). The new study attempts to extend and validate Petry’s previous work adapting the Inventory of Drinking Situations for gambling situations (called the Inventory of Gambling Situations, IGS).

The researchers gave the IGS to 283 people seeking treatment for alcohol and drug abuse who were also identified as problem or pathological gamblers. The IGS asked respondents how likely they were to gamble, on a 1 to 4 scale, in response to each of 47 different situations. The situations described the following types of scenarios:

– Emotional situations: “When other people treated me unfairly”

– Physical conditions: “When I would have trouble sleeping”

– Thought cues:“When I would start thinking about all the money I owe”

The researchers used statistical analysis to group similar questions together and to find out how much of the variance in gambling behavior was explained by each group of questions. The first group contained questions about negative emotions (e.g. “When I felt tense or nervous”) and explained 24.6 percent of the variation. The second group contained questions about positive emotions (e.g. “When I would be relaxed and wanted to have a good time”) and explained 15.2 percent of the variance in gambling behavior. The third group contained questions about gambling cues (e.g. “When I would see an advertisement about gambling”), and explained 9.5 percent of the variance. The final group contained questions about social situations (e.g. “When I was with friends and they were gambling”), and explained 8.3 percent of the variance.

All together, the IGS accounted for 57.6 percent of the variance in gambling behaviors found in the sample. This kind of information can be used by therapists to help clients identify what feelings and situations can lead to relapse. It is also possible that gamblers who are having problems, but have not yet progressed to a clinical gambling disorder, may be able to avoid more serious gambling problems by being aware of the feelings and situations that can trigger gambling behavior.

More information about the article is available on the website of the journalExperimental and Clinical Psychopharmacology. Do you have thoughts or questions about prevention and treatment of gambling disorders? Tell us in the Comments section below.

References

Petry, N. M., Ammerman, Y., Bohl, J., Doersch, A., Gay, H., Kadden, R., Molina, C., et al. (2006). Cognitive-behavioral therapy for pathological gamblers.Journal of Consulting and Clinical Psychology,74(3), 555-67. doi:2006-08433-015 [pii] 10.1037/0022-006X.74.3.555

Petry, N. M., Rash, C. J., & Blanco, C. (2010). The Inventory of Gambling Situations in problem and pathological gamblers seeking alcohol and drug abuse treatment.Experimental and Clinical Psychopharmacology,18(6), 530-538. doi:10.1037/a0021718

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New Edition Of The Wager Looks At Dopamine, Excitement Levels And Disordered Gambling

The relationship between the brain chemical dopamine and disordered gambling has been well-established over the past several years (we discussed this relationship in the context of Parkinson’s Disease inthe July 2010Issues and Insights). Dopamine is associated with the reward system of the brain, which affects feelings of enjoyment and behavior reinforcement. It and other brain chemicals are, by their very nature, difficult to observe and thus difficult to translate into preventive applications. To bridge the gap between brain chemistry and disordered behavior, researchers can link the two with quantifiable emotions like excitement. The most recent edition ofThe WAGER(Worldwide Addiction Gambling Education Report) reviews a study that looks at those factors as they relate to pathological gambling.

The 2010 study, featured inThe WAGER – Vol. 16(3), examined the amount of dopamine released in the brain, excitement levels and gambling task performance in samples of people with pathological gambling (PG) and healthy controls (HC) (Linnet, Møller, Peterson, Gjedde, & Doudet, 2011). Researchers monitored the dopamine levels of 18 PGs and 16 HCs at baseline and while they completed a gambling task. The participants also reported their feelings of excitement during the task. The researchers found that PGs whose brains released more dopamine reported higher levels of excitement. Additionally, differences in dopamine release from non-gambling to gambling conditions were significantly correlated with changes in excitement level. The authors suggest that dopamine release may be doubly problematic, by reinforcing gambling behaviors and also promoting risky decision-making.

These findings further previous research which suggests that feelings of excitement while gambling reinforce unhealthy behaviors for some people with PG. This subset of people with PG crave feelings of excitement more than recreational gamblers or other people with PG, and may find gambling especially rewarding because of this (Vachon & Bagby, 2009).

For the full review or to access online reviews of research on other addictive disorders, visitThe BASIS (Brief Addiction Science Information Source).
As always, we welcome thoughts and questions in the comments section below.

References

Linnet, J., Møller, A., Peterson, E., Gjedde, A., & Doudet, D. (2011). Dopamine release in ventral striatum during Iowa Gambling Task performance is associated with increased excitement levels in pathological gambling.Addiction,106(2), 383-390. doi:10.1111/j.1360-0443.2010.03126.x

Vachon, D. D., & Bagby, R. M. (2009). Pathological gambling subtypes.Psychological Assessment,21(4), 608-615. doi:10.1037/a0016846

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New Study Examines The Causes And Correlates Of Gambling In Children

Why do some children start gambling at a young age while others do not? Theorists have suggested that the answer to this question is some combination of individual traits and environmental factors, both nature and nurture, but it is not yet understood which traits and factors have more of an influence on behavior. To address this question, researchers must examine the same children over a length of time (in what is called a longitudinal study) in order to see what traits in a younger child predict gambling behavior as the child ages. A recent study of Canadian children published in the journalPsychology of Addictive Behaviorstook just this approach (Vitaro & Wanner, 2011). The researchers gathered information about 1,125 children and their families between the ages of six and eight, and then measured their gambling behavior at the age of 10. The findings suggest that preventing gambling in children will require a multifaceted approach that addresses all of the potential risk factors involved.

The researchers measured several variables in the children, including their teacher’s impressions of child sensitivity to reward and punishment, parent gambling behavior and demographic factors. Low sensitivity to punishment, which is controlled in the brain by serotonin levels in what is called the behavioral inhibition system (BIS), is manifested in low inhibition and lack of regard for consequences. High sensitivity to reward, which is controlled in the brain by dopamine levels in what is called the behavioral activation system (BAS), is demonstrated in impulsive behavior. These two systems are biologically distinct from each other and vary from person to person.

The researchers were especially interested in how the BIS and BAS interacted with each other, and with the gambling behavior of the parents, to affect gambling in children. One hypothesis is that the systems affect each other. For example, a child who is very sensitive to rewards might be more likely to gamble, but if that same child were also very sensitive to punishment the aversion to punishment might override the desire for rewards and keep him/her from gambling. Another hypothesis is that the systems do not interact at all, and each exerts a separate impact on the individual child.

The researchers’ findings support the second hypothesis. Both BIS and BAS, as well as parental gambling, independently affected whether or not children gambled at the age of 10. That is, the children who were more likely to gamble at age 10 had teachers who thought they were more sensitive to rewards, less sensitive to punishment, or whose parents gambled. However, whether parents suffered from disordered gambling was not a factor. This may be because young children are not aware of their parent’s gambling problems, or because too few family members had gambling problems to achieve statistical significance in this study. While this study lays the groundwork for discussions of what causes youth gambling, more research is needed to further unravel the relationship between genetics, environment and childhood gambling.

More information on the article is available on the website of the journalPsychology of Addictive Behaviors. Do you have thoughts or questions about gamblingamong young children? Tell us in the Comments section below.

References

Vitaro, F., & Wanner, B. (2011). Predicting early gambling in children.Psychology of Addictive Behaviors. doi:10.1037/a0021109

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Study Examines The Best Way To Screen College Students For Gambling Disorders

Measuring addictive behaviors accurately is very difficult. Among the many complications are recruiting subjects, relying on their memory and self-report and quantifying the difference between pathological actions and actions that are merely unusual or uncommon. (Jerome Wakefield, Ph.D.,discussed this topic in detailat the NCRG conference 2010.) One particularly difficult aspect of studying addiction is the diagnostic screening instrument (when scored, the instrument shows whether or not a person should be diagnosed with a particular disorder). Diagnostic screens of all kinds pose the problem of advancement versus consistency: It is always possible to make a newer and better instrument, but a new instrument means that studies conducted with the older one cannot be directly compared to studies conducted with the new instrument. This tension dictates that new instruments must be shown as better along several lines to make them worth implementing. Two researchers at the forefront of this discussion for gambling disorders are Erica Fortune and Adam Goodie, Ph.D., at the University of Georgia. Fortune and Goodie recently published a study, partly funded by a grant from the NCRG to Dr. Goodie, that compares the performance of two diagnostic screens in a population of college students (Fortune & Goodie, 2010).

The researchers compared two gambling screens, the South Oaks Gambling Screen (SOGS) (Lesieur & Blume, 1987) and the Diagnostic Interview for Gambling Severity-S (DIGS-S) (Winters & Stinchfield, 1996). The SOGS was published in 1987 and is the most-used screening instrument for gambling disorders. (Ina recent blogreviewing the 10 most cited gambling research papers of all time, the SOGS paper was number one). The DIGS-S is a more recent screen with questions that mirror the diagnostic criteria for pathological gambling in the American Psychiatric Association’sDiagnostic and Statistical Manual of Mental Disorders(American Psychiatric Association, 1994). The DIGS-S was derived from the original Diagnostic Interview for Gambling Severity (DIGS) that was designed for clinicians to diagnose patients in clinical settings.

To test the two instruments, the researchers recruited 72 undergraduate students who self-identified as frequent gamblers. The participants were given both instruments three times over the course of two months. This allowed the participants’ scores on each screen to be compared to each other and to their previous score on the same scale (a common method for validating diagnostic instruments). The results showed that while both screens performed well, the DIGS-S was more reliable over the three administrations than the SOGS. Coupling this finding with the ease with which the DIGS-S is given to college students via computer, the DIGS-S appears to be a valid alternative to the SOGS for studying disordered gambling in college populations.

More information on the article is available on the website of theJournal of Gambling Studies. Do you have thoughts or questions about problem gambling research or diagnosing gambling problems? Are you a college student and are looking for more information? Please visitwww.CollegeGambling.orgor start a conversation in the Comments section below.

References

American Psychiatric Association. (1994).DSM-IV: Diagnostic and Statistical Manual of Mental Disorders. Washington, DC: American Psychiatric Association.

Fortune, E. E., & Goodie, A. S. (2010). Comparing the utility of a modified Diagnostic Interview for Gambling Severity (DIGS) with the South Oaks Gambling Screen (SOGS) as a research screen in college students.Journal of Gambling Studies / Co-Sponsored by the National Council on Problem Gambling and Institute for the Study of Gambling and Commercial Gaming,26(4), 639-644. doi:10.1007/s10899-010-9189-x

Lesieur, H. R., & Blume, S. B. (1987). The South Oaks Gambling Screen (SOGS): A new instrument for the identification of pathological gamblers.American Journal of Psychiatry,144(9), 1184-8.

Winters, K. C., & Stinchfield, R. D. (1996).Diagnostic Interview for Gambling severtiy (DIGS). Minneapolis: University of Minnesota Medical School.

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Take The Interactive Quiz On Collegegambling.org

What do college basketball and college gambling have in common? Now is a good time to learn about both.Click hereto take the National Center for Responsible Gaming’s (NCRG) newinteractive quizto learn some fun facts about the NCAA tournament at the same time you increase your knowledge about responsible gaming and the risks of gambling disorders. The animated interactive quiz was created to help promote and celebrate the launch of the NCRG’s new resource,www.collegegambling.org. Please let us know what you think about the site, its information and the interactive quiz in the Comments below.

You can also listen to the informational media call about CollegeGambling.org from the launch this week. Click below to hear from: Glenn Christenson, Chairman of the NCRG Board of Directors; Christine Reilly, Senior Research Director for the NCRG; and Patricia Ketcham, Ph.D., CHES, chair of the CollegeGambling.org Advisory Committee. To learn more about Dr. Ketcham’s thoughts about CollegeGambling.org, you canclick hereto read the NCRG’s interview.

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NCRG Insider: Interview With Patricia Ketcham, Ph.d., Ches, About Collegegambling.org

The National Center for Responsible Gaming launchedwww.CollegeGambling.orgthis week as part of its ongoing efforts to develop tools to help higher education institutions address gambling disorders and responsible gaming on campus. The first site of its kind, CollegeGambling.org is a comprehensive resource to help current and prospective students, campus administrators, campus health professionals and parents address gambling and gambling-related harms on campus. The site is a valuable resource for those interested in learning more about college gambling, including information about responsible gaming for students of legal age to gamble and resources for those who may encounter problems. As a part of this launch, the NCRG sat down with Patricia Ketcham, Ph.D., CHES, chair of the CollegeGambling.org Advisory Committee, to learn her perspective on the new site.

NCRG:How did the vision for the CollegeGambling.org resource come about?

PK:It all started with the Task Force on College Gambling. The NCRG and the Division on Addictions at the Cambridge Health Alliance (a teaching affiliate of Harvard Medical School) began the Task Force in 2008 to examine research findings and real-world experiences in student health and university policy issues to develop science-based campus gambling policies.

At that time, the Task Force worked to combine scientific research findings and real-world university experiences to develop science-based recommendations about gambling that would help higher education institutions. We published those recommendations in 2009 in a report titledA Call to Action;Addressing College Gambling: Recommendations for Science-Based Policies and Programs.When completing that report, we realized that universities didn’t have access to tools ready for them to discuss gambling issues with their students. We first wanted to expand the resources to a unique niche – college administrators, students and their parents. Thus, the foundation for CollegeGambling.org was created.

NCRG:What was your role in development of CollegeGambling.org?

PK:The entire Task Force provided content and feedback for the site from our 2009 report and the scientific research findings on student health. We also included other information we gathered from our experiences at our various universities. We watched as CollegeGambling.org began to take shape and offered suggestions along the way. We wanted to make sure that it gave help current and prospective students, campus administrators, campus health professionals and parents the help they really need.

NCRG:What is most exciting for you about the launch of CollegeGambling.org?

PK:For me, there are two aspects of this website that I’m very excited about. First, it is another step toward making sure that more campus administrators and health professionals are aware of the issues. In many cases, gambling problems were not on the radar for many university administrators in their campus policy issues. Currently in the United States, only 22 percent of colleges and universities have formal policies on gambling. Students who admit to having a problem sometimes find a lack of support on campus. An important piece of this resource is to simply heighten the issue on a campus level.

Second, CollegeGambling.org is the first site of its kind for students and their parents. It is a comprehensive resource for those who want to learn more about college gambling, especially discussing what responsible gaming looks like for students who can legally gamble and sharing information with those who want to know more about resources to help those who may have gambling problems. It also opens up conversations between students and parents that may not have happened before.

NCRG:What do you see in the future of CollegeGambling.org?

PK:As the body of literature continues to expand about this subject area, the website will be charged with keeping pace with progress and movement on these issues. We are hopeful that many will refer to it as a key resource in their campus communities, and will continue to find up-to-date information on CollegeGambling.org as it is available.

________

Patricia Ketcham, Ph.D., CHES is the Associate Director of Health Promotion, Student Health Services at Oregon State University. With more than 20 years experience in college health, she is also a member of the Task Force on College Gambling Policies and the chair of the CollegeGambling.org Advisory Committee.

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NCRG Launches Collegegambling.org

Today,the National Center for Responsible Gaming (NCRG) launchedwww.CollegeGambling.org, a new resource to help colleges and universities address gambling and gambling-related harms on campus. View thepress releaseannouncing the launch.

The first site of its kind,CollegeGambling.org brings together the latest research and best practices in responsible gaming and the field of addiction awareness and prevention in order to provide a substantive and versatile resource that will help schools and their students address this important issue in the way that best fits each school’s needs. School administrators are encouraged to use theCollege Policy Toolkitincluding on the site, and campus health professionals can easily locate and distribute theCollegeGambling.org materialsin their health centers.

Research finds that 75 percent of college students gambled during the past year (whether legally or illegally, on campus or off). While the vast majority of those old enough to legally gamble can do so responsibly, the most recent research estimates that 6 percent of college students in the U.S. have a serious gambling problem that can result in psychological difficulties, unmanageable debt and failing grades. For those who are not of legal age to gamble, there is no safe level of gambling.

CollegeGambling.org is a comprehensive resource for students, campus administrators, campus health professionals and parents. In addition to providing those who are concerned about a gambling problem with resources to find help, the website includes separate sections for each of these audiences and content is tailored to address the needs, questions and concerns of these groups.

The site also offers free collateral materials, such as brochures about college gambling and responsible gambling, fact sheets, posters, and stickers, which can help raise awareness about gambling and gambling disorders on campus.

The development of CollegeGambling.org was guided by an advisory committee of leading scientists, clinicians and student life experts. The NCRG has relied on theAdvisory Committeeto help ensure the materials created for the site are firmly grounded in the highest-quality research on these issues and will be effective for the intended audiences.

CollegeGambling.org builds on the recommendations of theTask Force on College Gambling Policies, which provide schools with a roadmap for reducing gambling among students and enabling those who are struggling with addiction to participate more fully in college life. View the Task Force’s“Call to Action”report.

What do you think of CollegeGambling.org? We would love your feedback in the comments below!

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Are Gambling Problems More Common Than Drinking Problems In Adults?

Stories about a recent study on gambling and alcohol use across the lifespan have begun popping up around the Internet with contradictory titles like“Gambling Problems Are More Common Than Drinking Problems, According To First-Of-Its-Kind Study”and“Are Gambling Problems More Common than Drinking Problems? Maybe Not”. The study, published in theJournal of Gambling Studies,is from the Research Institute on Addictions at the University at Buffalo, N.Y.(Welte, Barnes, Tidwell, & Hoffman, 2010). The study is primarily about patterns of gambling behavior across the lifespan compared to patterns of alcohol use and other potentially problematic behaviors, but the researchers also report findings that compare gambling and alcohol problems in the general population. These differences have caused some confusion on the issue.

The researchers state that “after age 21 problem gambling is considerably more common than alcohol dependence” (Welte et al., 2010, p. 57). At first, this statement seems to be at odds with previously published research. It is generally accepted that the rate of alcohol dependence is about double that of pathological gambling (Keyes, Geier, Grant, & Hasin, 2009; Stucki & Rihs-Middel, 2007).

However, a look at the definitions the researchers use explains the apparent discrepancy. The “problem gambling” they refer to is defined as anyone who endorses three or more items on the Diagnostic Interview Schedule (DIS) for the DSM-IV,the handbook for psychiatric disorder in the United States (American Psychiatric Association, 1994). This is a standard way to define problem gambling, a less severe form of the disorder, with pathological gambling being defined as endorsing “five or more criteria,” as the researchers state in the methods section of the paper (Welte et al., 2010, p. 53). The researchers found this broadest definition of problem and pathological gambling to be between 3 and 5 percent for people ages 22 to 60. This is in line with previous research on the subject.

The confusion comes from comparing this broadest definition of disordered gambling with a narrow definition of alcohol disorders. Like gambling disorders, alcohol use disorders are categorized by severity. Alcohol abuse is the less severe disorder while alcohol dependence is the most severe, and the two together are called alcohol use disorders. One of the largest studies of alcohol use disorders is the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) (Hasin, Stinson, Ogburn, & Grant, 2007). The NESARC is a nationally representative survey consisting of face-to-face interviews with more than 43,000 Americans. The NESARC found that people ages 30 to 44 suffered from alcohol abuse at 6 percent and alcohol dependence at 3.8 percent, for a total alcohol use disorder rate of 9.7 percent. When the rate of 9.7 percent is compared with the combined rate of problem and pathological gambling in the Welte et al. study, about 4.5 percent, we find that alcohol use disorders are about double gambling disorders. Note that Welte et al. divided their age groups differently, so this analysis combines the 31-40 and 41-50 groups.

The researchers at the University of Buffalo did not discuss the discrepancies in definitions in their study. However, their larger discussion of alcohol use and gambling across the lifespan is an interesting one that certainly deserves more in-depth study.

More information about the University of Buffalo study is available on theJournal of Gambling Studieswebsite. As always, we welcome your thoughts and questions in the Comments section below.

References

American Psychiatric Association. (1994).DSM-IV: Diagnostic and Statistical Manual of Mental Disorders. Washington, DC: American Psychiatric Association.

Hasin, D. S., Stinson, F. S., Ogburn, E., & Grant, B. F. (2007). Prevalence, correlates, disability, and comorbidity of DSM-IV alcohol abuse and dependence in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions.Archives of General Psychiatry,64(7), 830-842. doi:10.1001/archpsyc.64.7.830

Keyes, K. M., Geier, T., Grant, B. F., & Hasin, D. S. (2009). Influence of a drinking quantity and frequency measure on the prevalence and demographic correlates of DSM-IV alcohol dependence.Alcoholism, Clinical and Experimental Research,33(5), 761-771. doi:10.1111/j.1530-0277.2009.00894.x

Stucki, S., & Rihs-Middel, M. (2007). Prevalence of Adult Problem and Pathological Gambling between 2000 and 2005: An Update.Journal of Gambling Studies / Co-Sponsored by the National Council on Problem Gambling and Institute for the Study of Gambling and Commercial Gaming. doi:10.1007/s10899-006-9031-7

Welte, J. W., Barnes, G. M., Tidwell, M. O., & Hoffman, J. H. (2010). Gambling and Problem Gambling Across the Lifespan.Journal of Gambling Studies / Co-Sponsored by the National Council on Problem Gambling and Institute for the Study of Gambling and Commercial Gaming. doi:10.1007/s10899-010-9195-z

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