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.

NCRG staffInterviewscomorbiditydisordered gamblingInstitute grantsNIH

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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.

NCRG staffResearch Updatecollege gamblingHarvard Medical Schoolnew researchTask Force on College Gambling Policiestheory of planned behavior

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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.

NCRG staffConference on Gambling and Addictioncontinuing educationdisordered gamblingNCRG Conferenceresponsible gaming

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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.

NCRG staffIssues & Insightsdisordered gamblingresponsible gaming

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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.

NCRG staffResearch Update

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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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Akron Beacon Journal: NCRG Heads To Cleveland In July To Raise Awareness About Disordered Gambling

Each year, representatives from the National Center for Responsible Gaming (NCRG) and the Institute for Research on Gambling Disorders hit the road to raise awareness about disordered gambling. As reported in theAkron Beacon Journalthis weekend, our representatives will be heading to Cleveland, Ohio for the NCRG’s fourth annual road tour.

These road tours give us the opportunity to ensure the various audiences and individuals who have an interest in gambling disorders and responsible gaming – including regulators, policymakers, researchers, clinicians and gaming industry professionals – have access to the latest information about what’s happening in the field. Our representatives provide an update on the body of peer-reviewed research on gambling disorders, discuss NCRG-funded research projects that have received grants from the Institute and show how the findings from this research are being translated into practical applications for prevention, treatment and responsible gaming education.

If you’re interested in receiving more details about our Ohio trip, e-mailinfo@gamblingdisorders.org, or leave a comment. You can read about last year’s road tour – to Black Hawk and Denver, Colo. – in the fall 2009 issue ofResponsible Gaming Quarterly(PDF link – see cover story).

NCRG staffICRG News

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Institute Grant Deadlines Fast Approaching!

The Institute for Research on Gambling Disordersoffers three types of project grantsto support research on gambling disorders, and important deadlines for two of these categories are fast approaching. We are expecting to award more than $300,000 this year to researchers in all stages of their careers through a competitive grant-making process.

The first deadline is for ourLarge Grants, which provide up to $75,000 per year over a period of 24 months to support discrete, specified research projects. The letter of intent for these grants is due May 1, 2010 and applications are due Sept. 1, 2010. Instructions for the letter of intent and application can be downloaded on theLarge Grants page.

The next impending deadline is for ourExploration Grants, which provide $5,000 over a period of 12 months and are intended to support pilot studies or other small projects. Applications are due June 1, 2010. Download the application instructions (in PDF form) on theExplorations Grants page.

In addition, ourSeed Grants, which provide up to $25,000 over a period of 12 months, are intended for larger pilot studies or small self-contained studies. Applications are due July 1, 2010. Download the application instructions on theSeed Grants page.

For examples of previously funded studies, follow the link to the Funded Project Grants page. Please feel free to discuss or ask questions in the comments section below, or contactChristine Reillydirectly with any specific questions about the application process.

NCRG staffICRG News

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Welcome To Gambling Disorders 360°

Welcome to Gambling Disorders 360°, the Institute for Research on Gambling Disorders’ new blog exploring the latest news, issues and research relating to gambling disorders and responsible gaming.

On Gambling Disorders 360°, you’ll find a broad range of information and resources, including:

  • News and developments relating to research, prevention, treatment and responsible gaming
  • Our monthlyIssues & Insightscolumn, which shares the perspectives of experts in the field
  • Links to helpful resources and articles, such asThe WAGER
  • News from the Institute and theNational Center for Responsible Gaming– including the latest about grants, the NCRG’s annual Conference on Gambling and Addiction and our free webinars
  • Book reviews
  • Interviews with experts in the field
  • And more

Gambling Disorders 360° also will be a forum where researchers, clinicians, regulators, policymakers and industry representatives can come together to share knowledge and best practices, and candidly discuss the field’s most pressing issues.

While you’re here, I encourage you to subscribe to Gambling Disorders 360° via e-mail or RSS (see subscription instructions in the sidebar) to be automatically notified when we have a new post on the blog.

Thank you for stopping by – please feel free to leave a comment with any questions or suggestions you may have. We look forward to hearing your thoughts in the coming weeks and months.

Christine Reilly Executive Director, Institute for Research on Gambling DisordersICRG News

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Redefining Pathological Gambling: New Research Highlights

The American Psychiatric Association currently is in the process of updating theDiagnostic and Statistical Manual of Mental Disordersto its fifth edition (DSM-V). TheDSMis the handbook of mental disorders in the United States, used daily by health care providers, researchers, insurance companies and government agencies. TheDSM-VWork Group that reviewed the diagnosis for pathological gambling has proposed several changes to the diagnostic definition of the disorder. Revisions in diagnostic codes are typically driven by evolving research that transforms our understanding of a disorder, and so this month’sIssues & Insightssummarizes several studies that question the current definition of pathological gambling and, in some cases, might inform the final recommendations for theDSM-V.

From Impulse-Control Disorder to Addiction

Pathological gambling was added to theDSMin 1980. In the current edition of theDSM(DSM-IV), pathological gambling is classified under “Impulse-Control Disorders Not Elsewhere Classified,” along with compulsive stealing (kleptomania), fire starting (pyromania) and hair pulling (trichotillomania) (American Psychiatric Association, 2000). TheDSM-VWork Group has proposed renaming pathological gambling “disordered gambling” and moving it under a new classification titled “Addiction and Related Disorders” (American Psychiatric Association, 2010). This category will replace the current Substance-Related Disorders classification and will include disorders related to alcohol and substance abuse. Disordered gambling will be the sole “behavioral addiction” in this group (Holden, 2010).

The rationale for this change is that the growing body of scientific literature, especially research on the brain’s reward center, has revealed many commonalities between pathological gambling and substance-use disorders, including cravings and highs in response to the gambling, alcohol or drug; the hereditary nature of all of these disorders; and evidence that the same forms of treatment (e.g., 12-step programs, cognitive behavioral therapy) seem to be effective for both gambling and substance-use disorders.

For example, theDSM-VWork Group cited studies showing a high rate of co-occurring substance use disorders with pathological gambling. One of the most definitive is the analysis of the gambling data in the National Comorbidity Survey Replication (NSC-R), a nationally representative sample of 9,282 English-speaking adults. The authors found that almost all participants who had pathological gambling during the course of their lifetime also had another lifetime psychiatric disorder (96.3 percent), and 64.3 percent suffered from three or more disorders. Substance-use disorders were significantly elevated among participants with pathological gambling (Kessler, Hwang, LaBrie, Petukhova, et al., 2008).

The Criterion of “Illegal Acts”

According toDSM-IV, to be diagnosed with pathological gambling, a person needs to have five or more out of10 possible symptoms, such as a preoccupation with gambling; “chasing” one’s losses; lying to loved ones about gambling; and committing “illegal acts, such as forgery, fraud, theft or embezzlement to finance gambling.” TheDSM-VWork Group has proposed eliminating the “illegal acts” criterion because it does not appear to be a decisive symptom for most people with gambling problems (American Psychiatric Association, 2010).

One of the studies cited by theDSM-VWork Group, “Evaluation of the continuum of gambling problems using theDSM-IV,” examined the gambling data from the National Epidemiologic Survey on Alcohol and Related Conditions (commonly known as NESARC) (Strong, & Kahler, 2007). The authors found that the symptom, “Is preoccupied with gambling,” is most useful for identifying individuals with the lowest levels of gambling problem severity, while the illegal acts symptom is most helpful only for identifying those with the highest levels of gambling problem severity. Individuals who commit illegal acts as a result of their gambling already reach the threshold of five or more symptoms and, therefore, this symptom does not improve the precision of the diagnostic code for identifying most individuals with pathological gambling.

Is Pathological Gambling “Persistent and Recurrent”?

TheDSM-IVdescribes pathological gambling as a “persistent and recurrent disorder,” a description that has been challenged by several studies. For example, a review of five studies that followed 1,689 gamblers over the course of two to seven years found that while healthy gambling and non-gambling behavior appears to be relatively stable over time, individuals with gambling problems experience considerable movement in and out of more severe and less severe levels of gambling disorders (LaPlante, Nelson, LaBrie, & Shaffer, 2008). Moreover, the authors observed that rates of recovery from pathological gambling, the most severe level of the disorder, appeared higher than anticipated. Consequently, the authors found no evidence to support the assumptions (1) that individuals cannot recover from disordered gambling, (2) that individuals who have more severe gambling problems are less likely to improve than individuals who have less severe gambling problems, and (3) that individuals who have some gambling problems are more likely to get progressively worse than individuals who do not have gambling problems.

Although theDSM-VWork Group has not proposed altering the “persistent and recurrent” language, ample opportunities remain for consideration of such ideas as theDSM-VDevelopment project moves toward publication in 2013. For a complete discussion of the proposed changes and registration for submitting public comments, visitwww.dsm5.org. The deadline for public comment is April 20, 2010.

Christine Reilly is the executive director of the Institute for Research on Gambling Disorders.

References

American Psychiatric Association. (2000).Diagnostic and statistical manual of mental disorders(4th ed., text revision ed.). Washington, DC: American Psychiatric Association.

American Psychiatric Association. (2010). DSM-V: The Future of Psychiatric Diagnosis. Retrieved March 31, 2010 fromwww.dsm5.org.

Holden, C. (2010). Behavioral Addictions Debut in Proposed DSM-V.Science, 327(5968), 935.

Kessler, R. C., Hwang, I., LaBrie, R., Petukhova, M., Sampson, N. A., Winters, K. C., et al. (2008). DSM-IV pathological gambling in the National Comorbidity Survey Replication.Psychological Medicine,38(9), 1351-1360.

LaPlante, D. A., Nelson, S. E., LaBrie, R. A., & Shaffer, H. J. (2008). Stability and progression of disordered gambling: Lessons from longitudinal studies.Canadian Journal of Psychiatry, 53(1), 52-60.

Strong, D. R., & Kahler, C. W. (2007). Evaluation of the continuum of gambling problems using the DSM-IV.Addiction, 102(5), 713-721.

NCRG staffIssues & Insightsbehavioral addictiondisordered gamblingDSM

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