Addressing Responsible Gaming In Indian Country

Tribal Government Gaming

This spring,Tribal Government Gaming magazinepublished a feature article about the responsible gaming measures already in place at tribal casinos and how some of these operations are expanding their efforts to include science-based technological innovations. The article –“Tribal Responsibility: Addressing Responsible Gaming in Indian Country”– includes a look at how San Manuel Indian Bingo and Casino is using the National Center for Responsible Gaming’s PEER program and EMERGE online employee training program to enhance existing training and “create a whole new level of awareness… about the science behind pathological gambling,” according to Dianna Scina, guest services director.

The article also covers the unique challenges tribal governments and gaming facilities face, including the difficulties involved in using science to inform responsible gaming programs for tribe members due to the lack of research on gambling disorders among tribal populations. Tribal gaming experts Eileen Luna-Firebaugh and Dr. Kate Spilde, who addressed some of these challenges in our January 2010 edition ofIssues & Insights(“Creating Partnerships between American Indian Communities and Researchers”), are quoted in the article, providing their insights about these hurdles and the opportunities they present.

PEER stands for Partnership for Excellence in Education and Responsible Gaming. More information about the PEER program is available on theNCRG’s website.

EMERGE stands for Executive, Management and Employee Responsible Gaming Education.The EMERGE programis a science-based, online training program for gaming industry employees. It is approved by an international, third-party credentialing agency and exceeds the requirements of all current gaming regulations regarding responsible gaming training for employees.

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New Edition Of The Wager Compares Gambling Policies For European Athletes, Ncaa Student Athletes

The WAGER(Worldwide Addiction Gambling Education Report) is a great resource for keeping up with new research on gambling and gambling disorders. This online science review is published by the Division on Addictions at Cambridge Health Alliance, a teaching affiliate of Harvard Medical School.The WAGERis one of a number of publications available through theBrief Addiction Science Information Source (BASIS).

This month’s edition ofTheWAGER–Vol. 14(4)– highlights the newgambling code of conductcreated for European professional athletes and compares it tothe rulesthat deter gambling among NCAA athletes. As always we welcome thoughts and questions in the comments section below.

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May Is Mental Health Month – A Time To Reflect On The Stigma Of Mental Illness And Addiction

Despite scientific advances in understanding mental health problems, the stigma surrounding disorders such as depression, substance-use problems and disordered gambling behavior remains a powerful force in today’s society.Mental Health Americais observing Mental Health Month in May to increase public awareness of mental health issues and reduce the stigma and prejudice toward these problems.

Clinicians and patients report that embarrassment and shame can be especially acute for individuals with gambling problems because of the lack of public awareness about how an activity like gambling can be as powerful as a drug for a vulnerable person.

To help us reflect on this important issue, we have reproduced, with permission from theAmerican Psychological Association(APA), the following interview about mental health awareness and stigma with Katherine C. Nordal, Ph.D., executive director for professional practice at the APA.

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Dr. Nordal is a licensed psychologist experienced in treating adults, children and adolescents and has clinical expertise in the treatment of stress-related disorders. As executive director for the APA’s Practice Directorate, Dr. Nordal manages a variety of activities involving legislative advocacy, legal initiatives, efforts to shape the evolving health care market, and a nationwide public education campaign, including the Mind/Body Health Campaign, to enhance the value of psychology.

Do you think there is still a stigma associated with mental illness?

Awareness of mental health issues has definitely improved in recent decades. When I entered practice more than 30 years ago, individuals in my semi-rural community would often travel 40-50 miles to get treatment because they did not want anyone to know that they were seeing a therapist. Many people were concerned about what others may think if they were open about their mental health. In many ways, we have taken great strides since then as more people talk about mental health publicly and as we see more positive depictions of mental health in popular culture. Yet, for many, stigma remains. A 2008 APA survey found that more than half of Americans saw stigma–and concerns about what other people might think–as barriers that could prevent them from seeking mental health treatment. And while an estimated 50 million Americans experience a mental health disorder in any year, only one in four will receive treatment.

It is important to remember the impact that stigma can have. Because of stigma, people who need treatment may fail to seek it and they may face discrimination and problems at work or school or even encounter harassment or violence. Furthermore, untreated mental health disorders cost businesses millions of dollars in lost productivity, absenteeism and health care costs.

Why does the public often have a different view of mental illness than physical illness?

Traditionally, the medical model has separated mental and physical health. But this fails to take account of the strong links between the mind and body. Research shows that physical health is directly connected to emotional health, and millions of Americans know that suffering from a mental health disorder can be as frightening and debilitating as any major physical health disorder. Poor mental health has implications for physical health – for example, research has shown that people with depression are at greater risk for developing heart disease, and conversely, that people with heart disease are more likely to suffer from depression than others.

Integrated health care – care that treats both the mind and body – is the key to breaking down stigma and providing the best care. Many psychologists already work in primary care settings with physicians and other health care professionals, often serving as members of multidisciplinary treatment teams and taking the lead when a patient has a primary mental health or substance abuse diagnosis.

What can be done to combat stigma and stereotypes about mental illness?

Congress took a huge step in tackling stigma when the Wellstone-Domenici Mental Health Parity and Addiction Equity Act was passed last year. This new law means that insurance policies can no longer discriminate against those with mental health or substance use disorders. We’ve long known that mental health disorders can be as serious as those impacting physical health. The new parity law recognizes this by mandating that coverage must be the same for mental health as for physical health including co-payments, deductibles and in-patient treatment limits.

Events like Mental Health Month also serve to raise awareness and decrease stigma. Mental health disorders impact everyone – by talking about mental health we can dispel stereotypes and raise awareness.

The APA is the largest scientific and professional organization representing psychology in the United States and is the world’s largest association of psychologists.

Have you experienced or observed the stigma surrounding addiction, mood disorders or other mental health problems? Share your stories in the comments section below.

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Naadac Names Institute An Approved Education Provider

The Institute for Research on Gambling Disorders has been awarded “Approved Education Provider” status byNAADAC, the Association for Addiction Professionals. This approval identifies continuing education opportunities offered by the Institute as meeting nationally approved standards of education developed for the addiction counseling field and assures participants that continuing education units (CEUs) provided by the Institute will be accepted toward national credentialing by the NAADAC Certification Commission and by many of the individual state licensing and certification bodies as well.

NAADAC is the largest membership organization for addiction counselors in the world with more than 10,000 members and 43 state affiliates. Credentials (offered through the NAADAC’sNational Certification Commission) include “National Certified Addiction Counselor I/II” and “Master Addiction Counselor,” and require 40 hours of continuing education every two years for renewal.

NAADAC’s rigorous review process for education providers ensures that its members involved in approved continuing education programs “receive a consistent, reliable and quality learning experience that is applicable to their careers and advances their understanding of addiction-related issues.”

The Institute for Research on Gambling Disorders offers several approved educational opportunities for addiction professionals throughout the year, including theNCRG Conference on Gambling and Addiction, scheduled for Nov. 14-16, 2010. The Institute and the NCRG also offer free webinars throughout the year, which can be accessed from anywhere via the Internet. Archived versions of the 2009 webinars – “Youth and College Gambling: New Direction, New Discoveries”and “Treating Pathological Gambling with Motivational Interviewing and CBT: A Webinar for Addiction Professionals” – areavailable for free through the National Center for Responsible Gaming’s website. Announcements about topics for the 2010 webinar series are coming soon.

Have a specific area of interest you’d like to see covered in a webinar or conference session? Let us know in the comments section below.

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Interview With Institute Scientific Advisory Board Chair – Linda B. Cottler, Ph.d., M.p.h.

The following is an excerpt from the story“Cottler Leads Scientific Advisory Board into New Era,”which originally was published in thespring 2010 edition of Responsible Gaming Quarterly.

Dr. Linda B. Cottler

When Dr. Linda B. Cottler was first asked to serve as chair of the Institute for Research on Gambling Disorders’Scientific Advisory Board (SAB), she made one point exceedingly clear – “I didn’t want to do this job unless there was something I could really contribute,” she said. Cottler, a professor of epidemiology in psychiatry at the Washington University School of Medicine, is one of the country’s foremost epidemiological scientists and is widely respected throughout the addictions research community for her contributions to the field.

Less than a year since the Institute’s inception, Cottler and her fellow SAB members already have made a significant impact on the field of research on gambling disorders. In February, guided by the SAB, the Institute announced the restructuring of itsProject Grants program, which will include doubling the number of grants available through that program (see cover story).

By increasing the number of grants available, the SAB is hoping to encourage more researchers to become involved in the field of research on gambling disorders. “The science of addiction shows there are certain synergies between pathological gambling and other addictions, so providing more opportunities for researchers to collaborate and explore these synergies can facilitate interesting new findings and stimulate the growth of the field,” Cottler said. “This new approach provides the same amount of total funding as before, but enables more researchers from diverse backgrounds and areas of expertise to be involved.”

In addition to simply having a greater number of researchers involved in the field, Cottler said the SAB is particularly interested in providing support for junior investigators and encouraging them to conduct studies on gambling disorders.

“In the next 10 years, the research workforce will lose about 30 percent of its active investigators to retirement,” Cottler said. “This is a significant loss, and so it is critical that we focus on helping junior investigators develop an expertise in this area.”

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Cottler explained that the SAB and the Institute also have plans to raise awareness about gambling disorders within the broader addictions community and to encourage various branches of the National Institutes of Health to continue funding gambling research. She noted that an important part of this outreach will be making the connection between gambling disorders and other addictions — such as substance-related disorders – and how research in the gambling sector can help inform broader scientific efforts.

“The NCRG and the Institute have been very important to the field of gambling research, singlehandedly funding the bulk of the research that has helped increase understanding of treatments and assessments and informed the development of science-based tools that can be easily picked up and used by others,” Cottler said. “It is important that we also understand the funding priorities at the federal level so that we can continue to provide seed grant opportunities that can be leveraged into larger federal funding opportunities. This will allow investigators to conduct widescale research in this field and for communities to make further headway in reducing the consequences of gambling disorders.”

Dr. Linda B. Cottler is the chair of the Institute’s Scientific Advisory Board and the 2010recipient of the Marian W. Fischman Lectureship Award from the College on Problems of Drug Dependence in honor of her outstanding contributions in drug abuse research.

For the full article and additional insights from Dr. Cottler, turn to pages 4-5 of thespring 2010 Responsible Gaming Quarterly.

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Researchers Explore How Attitudes, Intentions And Peer Behaviors Influence The Gambling Behavior Of College Students

A recently published study inPsychology of Addictive Behaviorshighlights how gambling behavior among college students can be influenced by their own attitudes and intentions toward gambling, as well as their perceptions of the norms for family and friends regarding gambling.

The 2009report of the Task Force on College Gambling Policiescalled for more research to help colleges and universities develop evidence-based programs to prevent and reduce gambling problems among students. This newly published study, “Using the theory of planned behavior to predict gambling behavior,” offers a promising approach for developing responsible gaming initiatives targeted at this population.

The researchers conducted a classroom-based survey of 785 undergraduate students at a large public university in order to evaluate the usefulness of the theory of planned behavior in understanding past-year gambling and gambling frequency among this population (Martin et al., 2010). The theory of planned behavior (TPB) is a model designed to understand and predict behavior by analyzing the individual’s intentions, attitudes and perceptions of what are normal behaviors and attitudes among friends and family (Ajzen, 1985). The survey assessed the individual’s past year gambling behavior, attitudes towards gambling, intentions to gamble (e.g., “In the next two weeks I intend to spend $20 or more on gambling.”), perception of control over gambling behavior (e.g., “I would be able to control my gambling if I were at a place where other people were gambling.”), perceived attitudes of friends and family towards gambling (e.g., “My family would disapprove of me gambling on the internet.”) and gathered general demographic information.

The researchers tested these factors to determine their influence on gambling behavior, and found that three factors in particular had significant effects. (1) A perception that friends and family were less positive toward gambling resulted in lower intention to gamble. (2) Individual attitudes towards gambling (including belief in luck, winning streaks and positive perceptions of high stakes gamblers) predicted greater intentions to gamble. (3) Individuals who believed that they had more control over their gambling intended to gamble less than those who felt they had less control. All of these factors–the norms of family and friends, the individual’s perception of attitudes and self-control–affected the students’ intentions to gamble. Intentions to gamble, in turn, were significantly related to gambling frequency. This relationship is important because gambling frequency correlates very highly with gambling problems (Kessler et al., 2008).

According to the study, these findings suggest that college-based responsible gambling efforts should consider targeting misperceptions of approval regarding gambling behavior (i.e. subjective norms), personal approval of gambling behavior (i.e. attitudes), and perceived behavioral control to better manage gambling behavior in various situations.

Gambling among college students continues to be a topic of interest throughout the U.S. Just last week, there were stories about college gambling in theWorcester Telegramand theUConn Daily Campus.For more information on college gambling and the Task Force on College Gambling Policies, visit ourYouth and College Programspage. How is gambling being addressed on your campus? Please share your comments and questions with us below.

References

Ajzen, I. (1985). From intentions to actions: A theory of planned behavior. In J. Kuhl & J. Beckman (Eds.),Action-control: From cognition to behavior(pp. 11-39). Heidelberg: Springer.

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.Psychological Medicine, 38(9), 1351-1360.

Martin, R. J., Nelson, S. E., LaPlante, D., Usdan, S., Umstattd, M. R., Perko, M., & Shaffer, H. (2010). Using the theory of planned behavior to predict gambling behavior.Psychology of Addictive Behaviors, 24(1), 89-97.

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Save The Date For The 11th Annual NCRG Conference On Gambling And Addiction

Mark your calendar to attend the 11thannualNCRG Conference on Gambling and Addiction:Redefining Diagnosis, Treatment, Research and Responsible Gaming for the 21stCentury.

WHEN: Nov. 14-16, 2010

WHERE: Mandalay Bay Resort & Casino and Las Vegas Convention Center

This year’s conference will introduce new interactive, workshop-style sessions and take a close look at how new research is redefining how we diagnose, treat, study and prevent gambling disorders. Sessions will examine a variety of compelling issues and topics including the proposed changes to the definition of pathological gambling in theDSM-V, new approaches for studying minority populations, the latest research on online gambling, the implications of new gambling technology on gambling disorders and fresh ideas for implementing responsible gaming policies in new gaming jurisdictions.

The Institute sponsors a poster session at the conference to showcase new empirical research on gambling disorders. To receive the call for posters, send your contact information toinfo@gamblingdisorders.org.

Tthe NCRG conference provides CEUs for clinicians and CLE credit for legal professionals. For more information about registration and the conference program, visit theconference pageof the NCRG website.

We’ll also be keeping you informed about NCRG conference updates here on Gambling Disorders 360° – and don’t forget to connect with the Institute and the NCRG onFacebookfor special registration discounts and conference-related news.

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Testing Responsible Gaming Strategies

Responsible gaming programs are intended to prevent or reduce potential gambling-related harms (Blaszczynski, Ladouceur, & Shaffer, 2004). Examples of such programs range from brochures about disordered gambling to helping gamblers keep track of money wagered through “smart cards.” But are these programs effective? A recently published study by Drs. Lia Nower and Alex Blaszczynski, “Gambling Motivations, Money-Limiting Strategies, and Pre-commitment Preferences of Problem Versus Non-Problem Gamblers,” demonstrates that rigorous scientific research is vital to determining the effectiveness of a responsible gaming strategy. This study also shows that such investigations have to consider the motivations of gamblers who get into trouble and the viability of the program – in this case, the use of smart cards – in real-life gambling situations.

Attempts to identify the specific “addictive” features of electronic gaming machines have yielded largely inconclusive results, suggesting that the interaction between a gambler’s motivation-related thought process and the machine, rather than the machine itself, fuels excessive play (Blaszczynski et al., 2005).

A number of studies have reported that problem gamblers are particularly motivated by the desire to win money (Ladouceur, Sylvain, Boutin, & Doucet, 2002; Neighbors, Lostutter, Cronce, & Larimer, 2002; Park, Griffiths, & Irwing, 2004; Wood, Gupta, Derevensky, & Griffiths, 2004). This is partly due to the misconception that gambling is an income-generating activity rather than a form of entertainment (Walker, 1992). Research has reported that machine players with gambling problems adopt a number of erroneous thought patterns regarding the probability of winning and the nature of randomness, leading to an over-inflated estimate of the likelihood of winning and, in turn, to excessive spending (Gaboury & Ladouceur, 1989; Manoso, Labrador, & Fernandez-Alba, 2004).

Some authors have suggested that requiring patrons to gamble with cards limited to pre-set amounts of money (i.e.,“smart” cards), similar to gift cards, will decrease the impulsive overspending characteristic of problem gamblers (see e.g., Dickerson & O’Connor, 2006). It is unknown, however, whether adopting “pre-session” (i.e., prior to gambling) spending limits will decrease the money spent gambling irrespective of distorted or erroneous thoughts during play. In this study, we explored whether problem gamblers differed from other groups in their motivations to gamble and their willingness to either set or adhere to pre-session spending limits.

A total of 127 electronic gaming machine players in Brisbane, Australia were recruited from the gaming floor at one of four venues and asked to complete a questionnaire. We assessed reasons for gambling, demographics and preferred gambling activities. The questionnaire also measured gamblers’ perspectives on pre-commitment strategies, including: (a) their willingness to gamble with a pre-set amount of money; (b) the perceived effectiveness of pre-commitment on limiting gambling expenditures; (c) potential strategies to compensate for the limitations of pre-commitment; (d) funding preferences; and (e) overall perceptions of money-related harm reduction strategies.

About 71 percent of the participants in the study were men with an average age of 38 years. Women were considerably older, averaging 44 years of age. Participants were grouped according to the Problem Gambling Severity Index of the Canadian Problem Gambling Index (Ferris & Wynne, 2001): non-problem gamblers (48.4 percent), low-risk gamblers (19.7 percent), moderate-risk gamblers (15.7 percent), and problem gamblers (15.7 percent).

Consistent with prior research, we observed a fundamental distinction in the primary motivation for gambling between non-problem and problem gamblers in this study. Although a high proportion of all gambling groups indicated that gambling was fun and enjoyable, a significantly higher proportion of problem gamblers, as compared to non-problem gamblers, reported that playing machines was a way to earn income or to escape problems. In contrast, non-problem gamblers endorsed fun/enjoyment and socialization as the two primary motivations for gambling.

With respect to pre-commitment, problem gamblers expressed much more reluctance than other groups about using smart cards, though they admitted losing track of money while gambling and were rarely aware of whether they were winning or losing. They indicated they would only use a smart card if cards were refillable, or if they were either able to access additional funds as needed or allowed to purchase an additional card if they ran out of funds and wanted to “chase” a loss. These responses suggest that pre-commitment would have little effect on decreasing gambling expenditures among those who are intent on continued gambling, because they will likely find a means of obtaining additional cards or seek out venues where refills or other options were available. Nonetheless, future studies should investigate whether pre-commitment strategies might have a protective effect for non-problem or low-risk gamblers who might otherwise proceed to more serious levels of gambling.

Lia Nower, J.D., Ph.D., is associate professor and director of the Center for Gambling Studies at Rutgers University. Alex Blaszczynski, Ph.D., holds a chair in psychology at the University of Sydney.

References

Blaszczynski, A., Ladouceur, R., & Shaffer, H.J. (2004). A science-based framework for responsible gambling: The Reno model.Journal of Gambling Studies, 20(3), 301-317.

Blaszczynski, A., Sharpe, L., Walker, M., Shannon, K., & Coughlan, M.-J. (2005). Structural characteristics of electronic gaming machines and satisfaction of play among recreational and problem gamblers. International Gambling Studies, 5, 187–198.

Dickerson, M.G., & O’Connor, J. (2006).Gambling is an addictive disorder: Impaired control harm minimisation, treatment and prevention.Cambridge: International Research Monographs in the Addictions.

Ferris, J., & Wynne, H. (2001).The Canadian Problem Gambling Index.Ottawa, ON: Canadian Centre on Substance Abuse.

Gaboury, A., & Ladouceur, R. (1989). Erroneous perceptions and gambling.Journal of Social Behavior and Personality, 4, 411–420.

Ladouceur, R., Sylvain, C., Boutin, C., & Doucet, C. (2002).Understanding and treating pathological gamblers.London: Wiley.

Manoso, V., Labrador, F.J., & Fernandez-Alba, A. (2004). Differences on cognitive distortions during gambling in pathological gamblers and no-gamblers.Psicothema, 16, 576–581.

Neighbors, C., Lostutter, T.W., Cronce, J.M., & Larimer, M.E. (2002). Exploring college student gambling.Motivation, 18, 361–370.

Park, A., Griffiths, M., & Irwing, P. (2004). Personality traits in pathological gambling: Sensation seeking, deferment of gratification and competiveness as risk factor.Addiction Research and Theory, 12, 201–212.

Walker, M.B. (1992).The psychology of gambling.Oxford: Pergamon.

Wood, R.T.A., Gupta, R., Derevensky, J.L., & Griffiths, M. (2004). Video game playing and gambling in adolescents: Common risk factors.Journal of Child and Adolescent Substance Abuse, 14, 77–100.

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Podcast: Understanding And Treating Behavioral Disorders

In December 2009, Dr. Jon Grant of the University of Minnesota Medical School spoke to a human sexuality class about understanding and treating behavioral disorders.This free iTunes podcastof the presentation covers how behavioral addictions, such as pathological gambling, represent significant public health concerns and are associated with high rates of comorbidity with other psychiatric disorders.

According to the podcast description, while research into the biology of these behaviors is still in an early stage, recent advances in the understanding of motivation, reward and addiction have provided substantial insight into the possible pathophysiology of these disorders. Biochemical, functional neuroimaging, genetic studies, and treatment research have all suggested a strong neurobiological link between behavioral addictions and substance use disorders. Given the substantial co-occurrence of these groups of disorders, improved understanding of their relationship has important implications not only for further understanding the neurobiology of both categories of disorders but also for improving prevention and treatment strategies.

Dr. Grantis the principal investigator of theNCRG Center of Excellence in Gambling Research at the University of Minnesota.

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Yale Publishes New Study On Associations Between Gambling, Alcohol And Psychiatric Disorders

A recent study from the Yale Gambling CORE (Center of Research Excellence) published inCNS Spectrumsis shedding new light on the relationship between disordered gambling behavior, alcohol-use disorders and other psychiatric disorders. Research has shown that gambling, alcohol and psychiatric disorders tend to co-occur in the same individual (e.g., Kessler et al., 2008); however, few studies have attempted to tease out the associations between these disorders.

Partially funded by an NCRG Center of Excellence in Gambling Research grant, the Yale study –“Differential Associations Between Problem and Pathological Gambling and Psychiatric Disorders in Individuals With and Without Alcohol Abuse or Dependence”(Brewer et al., 2010) – examined data collected in theNational Epidemiological Survey on Alcohol and Related Conditions(NESARC), which gathered mental health information from a representative sample of 43,093 Americans. It is the largest health survey in the U.S. to provide data on gambling behaviors.

The researchers from Yale were looking for relationships between problem gambling behavior, alcohol use disorders and psychiatric disorders. They found that in individuals who did not have alcohol-use disorders, there was a relationship between increased severity of problem gambling and increased psychiatric disorders. So, those with more psychiatric problems tended to have more gambling problems. Interestingly, there was no similar relationship found among those with alcohol problems. One explanation for this is that people with alcohol-use disorders have higher rates of psychiatric disorders generally, no matter how much they gamble. The researchers’ findings also showed high levels of co-occurrence between disordered gambling and alcohol-use disorders, which confirms the findings of previous studies.

The findings, which suggest significant associations between psychiatric problems and even low-risk gambling patterns, have important implications for the health care community, providing support for instituting a screening process for gambling problems along with other psychopathologies. For more information on the Yale center, visit ourNCRG Centers of Excellence in Gambling Researchpage. You can find more information about Institute Grants (including application instructions and upcoming deadlines) on ourProject Grantspage.

References

Brewer, J.A., Potenza, M.N., &, Desai, R.A. (2010). Differential associations between problem and pathological gambling and psychiatric disorders in individuals with and without alcohol abuse or dependence.CNS Spectrums,15(1), 33-44.

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.Psychological Medicine,38(9), 1351-1360.

NCRG staffResearch Update

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