Gambling Problems to Increase Worldwide, Experts Warn

Megan Brooks

May 20, 2011

May 20, 2011 — With the burgeoning availability of gambling opportunities, the prevalence of gambling disorders, including pathological gambling and problem gambling, is likely to increase, new research suggests.

"Gambling disorders cause significant impairment," first study author David Hodgins, PhD, psychology professor at University of Calgary, Alberta, Canada, told Medscape Medical News. It's important to note that treatment for gambling disorders "works and is available in many jurisdictions. Many countries have gambling helplines that provide treatment options for individuals."

He also noted that because gambling problems are often accompanied by other problems and disorders, "numerous professionals, including physicians, mental health therapists, substance abuse counselors, and financial counselors, are well positioned to screen and refer. We also have validated, easy to use, screening questions."

The seminar is published online May 19 in The Lancet.

Dr. David Hodgins

In the article, Dr. Hodgins and 2 coauthors review prevalence of gambling disorders, as well as causes and associated features, screening and diagnosis, and treatment approaches.

For most people, they point out, gambling is a merely an enjoyable social activity. It's only a "small group of people [who] become too seriously involved in terms of time invested and money wagered, and they continue to gamble despite substantial and negative personal, social, family, and financial effects," the study authors note.

Gambling disorders have garnered increased attention from clinicians and researchers during the past 3 decades as gambling opportunities have expanded. Internet gambling, for example, now provides around-the-clock home access to several types of gambling activities to an increasing number of people around the world.

The prevalence of gambling disorders varies widely across the globe. For example, rates of problem gambling range from 0.2% in Norway to 5.3% in Hong Kong. In the United States, rates of pathological gambling range from 0.4% to 1.1% of adults, with an additional 1% to 2% identified as problem gamblers.

Increasing evidence implicates multiple neurotransmitter systems, including dopaminergic, serotonergic, and noradrenergic, in the pathophysiology of gambling disorders. Genetic factors are also thought to play a part, with evidence from twin studies suggesting some level of shared risk between identical twins. Environmental factors are also clearly involved, including accessibility to gambling and growing up with a parent with a gambling addiction.

Simple Screening Tools Available

A variety of effective and easy-to-use screening and assessment tools are available when a gambling disorder is suspected, the study authors say. The most well known is the South Oaks Gambling Screen, or SOGS, which can be administered by either interview or self-report format.

A "briefer" screening tool is the 9-item Problem Gambling Index. It assesses low-risk, moderate-risk and problem gambling within the past 12 months and is increasingly used in prevalence surveys around the world, the study authors note.

Briefer still is the 3-item NODS-CLiP tool, which addresses problems of loss of control, lying, and preoccupation (CLiP) and has shown "excellent" sensitivity and specificity for gambling problems in US community samples, the study authors note. It asks the following:

  • Have you ever tried to stop, cut down, or control your gambling?

  • Have you ever lied to family members, friends, or others about how much you gamble and how much money you lost on gambling?

  • Have there ever been periods lasting 2 weeks or longer when you spent a lot of time thinking about your gambling experiences or planning out future gambling ventures or bets?

Positive responses to any 1 item indicate a likely problem or pathological gambling and the need for further assessment.

Comorbidity Common

Research during the past 2 decades has identified a certain general demographic group at risk for gambling problems. They are young males of nonwhite ethnic origin and low socioeconomic status who are divorced or separated.

But it may depend on the type of gambling, Dr. Hodgins and colleagues say. For example, sports gamblers tend to be young men with high rates of addiction comorbidity, whereas slot machine gamblers tend to be older women with higher rates of psychiatric comorbidity and later onset of gambling.

Comorbidity is common in people with gambling disorders. For example, pathological gamblers have about a 4-fold increased risk for alcohol abuse and mood disorders and a 5- to 6-fold increased risk for drug abuse, the study authors note.

"How concurrent disorders should be addressed in gambling treatment is not well understood and has not been empirically studied,” they point out.

Shame and Denial

Mainly due to shame, denial, and a desire to handle the problem themselves, only about 1 in 10 problem gamblers seeks treatment, Dr. Hodgins and colleagues report. Efforts, they say, are needed to get more people into treatment, such as public awareness and antistigma campaigns.

"Several distinct treatment approaches have been favorably evaluated, such as cognitive behavioral and brief treatment models and pharmacological interventions," the researchers note. "Although promising, family therapy and support from Gamblers Anonymous are less well empirically supported."

Although "substantial progress" has been made in identifying and treating gambling disorders, "this evolution warrants, and is likely to encourage, more innovative research into gambling disorders and its translation into clinical progress," they conclude.

Dr. Hodgins receives research funding from the Alberta Gaming Research Institute, the Ontario Problem Gambling Research Institute, the New Zealand Ministry of Health, and the Nova Scotia Research Foundation. The original article contains a complete list of author disclosures.

Lancet. Published online May 19, 2011. Abstract


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