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Gambling Disorder: Challenges in Diagnosis, Etiology and Treatment

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Mental Health".

Deadline for manuscript submissions: closed (31 August 2021) | Viewed by 36539

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Special Issue Editors

Prof. Dr. Anders Håkansson

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Guest Editor

Faculty of Medicine, Department of Clinical Sciences Lund, Psychiatry, Lund University, S-22100 Lund, Sweden
Interests: gambling disorder; problem gaming; behavioral addiction; gaming disorder; sports psychology; comorbidity; suicide; eating disorder; substance use disorder

Dr. Susana Jiménez-Murcia

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Assistant Guest Editor

Pathological Gambling Unit, Department of Psychiatry, Bellvitge University Hospital-IDIBELL, 08907 Barcelona, Spain
Interests: behavioral addictions; gambling disorder; gaming disorder; buying-shopping disorder; sex addiction; food addiction; interventions based on new technologies
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Special Issue Information

Dear Colleagues,

Gambling disorder is a well-recognized behavioral addictive disorder which affects a substantial number of patients, their families, and society in many settings worldwide. This disorder is receiving increasing attention from researchers and clinicians, but several challenges remain with respect to treatment evidence, as well as treatment-seeking opportunities and challenges in the clinical treatment and diagnosis of gambling disorder and its comorbidities. Specifically, treatment-seeking is low in many settings, and in the treatment provided, short-term and long-term follow-up studies are relatively few. Additionally, the gambling patterns worldwide are changing, which may present new challenges to clinicians and to prevention and treatment interventions. This includes, for example, the large increase in online gambling, but may also include new groups of gambling disorder patients. More research is needed in order to better understand different etiologies of gambling disorder and how these may translate into clinical challenges, and more studies are needed in the treatment methods, patient outcomes, and specific challenges in diagnostic and therapeutic work in specific sub-groups of gambling disorder patients.

Prof. Dr. Anders Håkansson
Dr. Susana Jiménez-Murcia
Guest Editors

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Keywords

gambling disorder
treatment
comorbidity
clinical
etiology
diagnostics

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Published Papers (9 papers)

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20 pages, 2741 KiB

Open AccessArticle

Prevalence of Suicidal Behavior and Associated Clinical Correlates in Patients with Behavioral Addictions

by Eduardo Valenciano-Mendoza, Fernando Fernández-Aranda, Roser Granero, Mónica Gómez-Peña, Laura Moragas, Bernat Mora-Maltas, Anders Håkansson, José M. Menchón and Susana Jiménez-Murcia

Int. J. Environ. Res. Public Health 2021, 18(21), 11085; https://doi.org/10.3390/ijerph182111085 - 21 Oct 2021

Cited by 9 | Viewed by 2929

Abstract

Addictive disorders are characterized by severe consequences, including suicidal events, but most studies investigating the association between addiction and suicidal risk have focused on substance use disorders and gambling disorder at the expense of the rest of behavioral addictions. This study examined the prevalence and the associated clinical correlates of suicidal ideation and suicide attempts in a sample of patients with a diagnosis of behavioral addiction. The total sample consisted of 4404 individuals: 4103 of these patients with gambling disorder, 99 with gaming disorder, 44 with sex addiction, and 158 with buying–shopping disorder. All of them were assessed consecutively at a specialized hospital unit for the treatment of behavioral addictions. Participants attended two clinical interviews and completed self-reported questionnaires to explore clinical features of behavioral addictions, personality traits, psychopathological symptomatology, suicidal behavior, and sociodemographic variables. The highest prevalence of suicidal ideation was found in patients with gambling disorder (22.9%), followed by buying–shopping disorder (18.4%), sex addiction (18.2%), and gaming disorder (6.1%). The highest prevalence of suicide attempts was registered for sex addiction (9.1%), followed by buying–shopping disorder (7.6%), gambling disorder (6.7%), and gaming disorder (3.0%). Female gender and unemployment constituted two relevant sociodemographic factors associated with suicidal risk in gambling disorder, gaming disorder, and buying–shopping disorder. Lack of family support appeared as a relevant risk factor, except for gaming disorder. These results pointed out that suicide is a prevalent behavior in behavioral addictions, and clinicians and researchers need to pay particular attention to the specificities of each behavioral addiction when assessing suicidal risk. Full article

(This article belongs to the Special Issue Gambling Disorder: Challenges in Diagnosis, Etiology and Treatment)

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13 pages, 408 KiB

Open AccessArticle

Impulsivity, Emotion Regulation, Cognitive Distortions and Attentional Bias in a Spanish Sample of Gambling Disorder Patients: Comparison between Online and Land-Based Gambling

by Marta Sancho, Céline Bonnaire, Silvia Costa, Gemma Casalé-Salayet, Javier Vera-Igual, Rita Cristina Rodríguez, Santiago Duran-Sindreu and Joan Trujols

Int. J. Environ. Res. Public Health 2021, 18(9), 4869; https://doi.org/10.3390/ijerph18094869 - 3 May 2021

Cited by 4 | Viewed by 2831

Abstract

Several risk factors have been related to the onset and maintenance of gambling disorder (GD). The aim of this study was to explore the differences in emotion dysregulation, impulsivity, cognitive distortions, and attentional bias between online and land-based gamblers. The sample consisted of 88 treatment-seeking patients from the Behavioral Addictions Unit at the Hospital de la Santa Creu i Sant Pau, Barcelona (Spain). Patients were divided into two groups by considering their main type of gambling, i.e., online (n = 26) and land-based gambling (n = 62). Online gamblers were younger, more often employed, with a higher educational level than land-based gamblers. Regarding the rest of the variables, statistically significant differences were only found in Positive Urgency, one of the UPPS-P subscales, in which the land-based gambling group scored higher than the online gambling group. In this exploratory study, individuals with online and land-based GD phenotypes did not differ either in difficulties in emotion regulation or in attentional and cognitive biases. However, land-based GD patients showed a higher tendency to succumb to strong impulses under the influence of positive emotions. These preliminary findings warrant the need to continue investigating GD phenotypes in larger patient samples. Full article

(This article belongs to the Special Issue Gambling Disorder: Challenges in Diagnosis, Etiology and Treatment)

12 pages, 706 KiB

Open AccessArticle

Further Exploration of the Psychometric Properties of GamTest: A Rasch Analysis

by David Forsström, Alexander Rozental, Anders Kottorp, Philip Lindner, Markus Jansson-Fröjmark and Hugo Hesser

Int. J. Environ. Res. Public Health 2021, 18(9), 4824; https://doi.org/10.3390/ijerph18094824 - 30 Apr 2021

Cited by 1 | Viewed by 2732

Abstract

GamTest is a self-rating scale of negative consequences of gambling, included in the popular responsible gambling tool Playscan as part of an overall risk assessment and feedback feature. Two previous psychometric evaluations of this instrument yielded contradictory results: in an online high-gambling population, a five-factor model was supported and the instrument had overall good psychometric properties, but in a low-gambling population, the same factor structure was not supported. Because GamTest is used with both low- and high-gambling populations, more psychometric research is needed to fully understand how the instrument works. The current study examined, for the first time, psychometric performance among a sample of low-gambling respondents using a Rasch analysis. Results indicated that the instrument could be improved by decreasing the scale-steps and removing several problematic items demonstrating misfit. Furthermore, the findings indicated that some items functioned differently depending on gender, and that a shortened, improved nine-item version could not differentiate between different levels of risk. Our findings suggest that the instrument would arguably benefit from being adapted for use in a low-gambling population. Full article

(This article belongs to the Special Issue Gambling Disorder: Challenges in Diagnosis, Etiology and Treatment)

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19 pages, 932 KiB

Open AccessArticle

Social Ecological Model of Problem Gambling: A Cross-National Survey Study of Young People in the United States, South Korea, Spain, and Finland

by Atte Oksanen, Anu Sirola, Iina Savolainen, Aki Koivula, Markus Kaakinen, Ilkka Vuorinen, Izabela Zych and Hye-Jin Paek

Int. J. Environ. Res. Public Health 2021, 18(6), 3220; https://doi.org/10.3390/ijerph18063220 - 20 Mar 2021

Cited by 22 | Viewed by 7656

Abstract

Problem gambling among young people is an emerging trend globally. The online environment in particular offers various possibilities for gambling engagement. This is the first cross-national survey study using the social ecological model to analyze problem gambling, especially in the online context. The study aimed to analyze how different social ecological spheres explain problem gambling. Participants were young people aged 15–25 in the United States (n = 1212), South Korea (n = 1192), Spain (n = 1212), and Finland (n = 1200). The South Oaks Gambling Screen (SOGS) instrument measured problem gambling. The regression models analyzed problem gambling with measures of intrapersonal, interpersonal, organizational, and societal spheres. Spanish participants had the highest SOGS score for problem gambling. In all countries, the variations in problem gambling were best explained by the organizational sphere measures (26%) when compared to the intrapersonal (11%), interpersonal (5%), and societal (3%) spheres. In the full model, the organizational sphere measures had strong associations with problem gambling. These included consumer debt, online gambling community participation, online casino participation, and exposure to online pop-up advertisements. Problem gambling was also associated with conformity to group norms in the interpersonal sphere, and male gender and impulsivity in the intrapersonal sphere. Cross-national results were similar in different countries. Within the final model, gambling community participation had the strongest association with problem gambling (β = 0.23, p < 0.001). The online context plays a major role in problem gambling behavior. The social ecological model is a useful tool for tackling problem gambling and developing preventative measures. Full article

(This article belongs to the Special Issue Gambling Disorder: Challenges in Diagnosis, Etiology and Treatment)

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15 pages, 946 KiB

Open AccessArticle

Longitudinal Changes in Gambling, Buying and Materialism in Adolescents: A Population-Based Study

by Ana Estévez, Paula Jauregui, Janire Momeñe, Laura Macia, Hibai López-González, Iciar Iruarrizaga, Conchi Riquelme-Ortiz, Roser Granero, Fernando Fernández-Aranda, Cristina Vintró-Alcaraz, Gemma Mestre-Bach, Lucero Munguía, Neus Solé-Morata and Susana Jiménez-Murcia

Int. J. Environ. Res. Public Health 2021, 18(6), 2811; https://doi.org/10.3390/ijerph18062811 - 10 Mar 2021

Cited by 11 | Viewed by 2944

Abstract

Gambling disorder, gambling-related cognitive biases, compulsive buying, and materialistic values lead to impaired functioning in important areas of life. The aims of the present longitudinal study are (1) to evaluate the change produced after one year in those mentioned variables and (2) to examine the gender role in these changes and to analyze the mediational mechanisms among the variables of the study. The sample was composed of 182 adolescents (103 females and 79 males) from secondary education Spanish institutions who completed self-administered questionnaires. Structural equation modeling has been used to explore associations between the different variables. Our results show significant decreases in compulsive buying, materialism, and cognitive biases related to gambling after one year. Gambling disorder severity was directly related to cognitive distortions of gambling and being a man. Compulsive buying was associated with older age and the female gender. Materialism was associated with compulsive buying and the male gender. In conclusion, gambling disorder, gambling-related cognitive biases, compulsive buying, and materialistic values change over time in different ways, according to gender. The understanding of gambling disorder and compulsive buying in adolescents could potentially lead to early prevention and treatment programs for the specific needs of gender and age. Full article

(This article belongs to the Special Issue Gambling Disorder: Challenges in Diagnosis, Etiology and Treatment)

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18 pages, 375 KiB

Open AccessArticle

Changes of Gambling Patterns during COVID-19 in Sweden, and Potential for Preventive Policy Changes. A Second Look Nine Months into the Pandemic

by Anders Håkansson and Carolina Widinghoff

Int. J. Environ. Res. Public Health 2021, 18(5), 2342; https://doi.org/10.3390/ijerph18052342 - 27 Feb 2021

Cited by 27 | Viewed by 3725

Abstract

Gambling has been suggested as one of the potential mental health consequences of the COVID-19 pandemic. In earlier self-report studies, increased gambling has been reported by a limited proportion of respondents characterized with a high degree of problem gambling. The present study, carried out with the same methodology and in the same geographical setting, around seven months later in the pandemic, aimed to repeat and to extend the understanding of potential gambling changes in the population during COVID-19. An anonymous sample of web panel members was assessed, altogether 2029 individuals (52% women, 10% moderate-risk or problem gamblers). Results indicated that 6% reported increased gambling, and 4% reported decreased gambling during the pandemic. Having increased gambling was associated with more severe gambling problems (OR 2.78, 95% confidence interval 2.27–3.40), increased alcohol consumption (OR 2.92, 1.71–4.98), and psychological distress (OR 3.38, 1.83–6.23). In the group reporting increased gambling during COVID-19, moderate-risk/problem gambling was very common (62%). Recent governmental policy interventions in the area were known to a minority (30%) of respondents, but awareness of the regulations was markedly more common in individuals with at least moderate-risk gambling (56%) and in self-excluders (78%). Reporting of any perceived influence from policy changes was low (3%), and divided between those reporting an increasing and decreasing effect, respectively. Increased gambling may be a consequence of COVID-19-related changes in everyday lives of individuals with problematic gambling patterns. Thus, a vulnerable group demonstrates higher rates of gambling migration and psychosocial problems, and may require particular attention in screening and treatment contexts, and further scientific evaluations. Full article

(This article belongs to the Special Issue Gambling Disorder: Challenges in Diagnosis, Etiology and Treatment)

18 pages, 728 KiB

Open AccessArticle

Online Relationships and Social Media Interaction in Youth Problem Gambling: A Four-Country Study

by Iina Savolainen, Markus Kaakinen, Anu Sirola, Aki Koivula, Heli Hagfors, Izabela Zych, Hye-Jin Paek and Atte Oksanen

Int. J. Environ. Res. Public Health 2020, 17(21), 8133; https://doi.org/10.3390/ijerph17218133 - 3 Nov 2020

Cited by 12 | Viewed by 5762

Abstract

The objective of this study was to examine if belonging to online communities and social media identity bubbles predict youth problem gambling. An online survey was administered to 15–25-year-old participants in the United States (N = 1212), South Korea (N = 1192), Spain (N = 1212), and Finland (N = 1200). The survey measured two dimensions of online behavior: perceived sense of belonging to an online community and involvement in social media identity bubbles. Belonging to an online community was examined with a single item and involvement in social media identity bubbles was measured with the six-item Identity Bubble Reinforcement Scale. The South Oaks Gambling Screen was used to assess problem gambling. Statistical analyses utilized linear regression modeling. According to the analyses, strong sense of belonging to an online community was associated with higher problem gambling, but the association was observed mainly among those young individuals who were also involved in social media identity bubbles. For those youths who did not indicate identity bubble involvement, online relationships appeared to function as those offline. Some differences across the four countries were observed but overall, the results indicate that social media identity bubbles could partly explain the harmful influence that some online relations have on youth behavior. Full article

(This article belongs to the Special Issue Gambling Disorder: Challenges in Diagnosis, Etiology and Treatment)

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14 pages, 5754 KiB

Open AccessArticle

The Spanish Version of the Internet Gaming Disorder Scale-Short Form (IGDS9-SF): Further Examination Using Item Response Theory

by Laura Maldonado-Murciano, Halley M. Pontes, Mark D. Griffiths, Maite Barrios, Juana Gómez-Benito and Georgina Guilera

Int. J. Environ. Res. Public Health 2020, 17(19), 7111; https://doi.org/10.3390/ijerph17197111 - 28 Sep 2020

Cited by 9 | Viewed by 4179

Abstract

Internet gaming disorder (IGD) has been recognized by the American Psychiatric Association (APA) as a tentative disorder in the latest (fifth) revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). However, psychometric evaluation of the nine IGD criteria remains necessary to further enhance its assessment. Therefore, the objective of this study was to evaluate the psychometric properties of the Spanish version of the Internet Gaming Disorder Scale-Short Form (IGDS9-SF). The internal structure, internal consistency, temporal stability, and relationships with other variables were assessed. Furthermore, a polytomous item response theory (IRT) approach was used to evaluate the performance of each item and the test as a whole. A sample of 388 online gamers (53.61% women, mean age 25.45 years, standard deviation (SD) = 9.62) was recruited for this study. Similar to previous research, the results supported a one-factor structure for the IGDS9-SF, adequate internal consistency and temporal stability of scores, goodness of fit of the items to the graded response model (GRM), and more precise scores at high trait levels to assess IGD in Spanish populations. These findings corroborate the suitability of the Spanish IGDS9-SF for clinical assessment and research within Spanish-speaking populations. Full article

(This article belongs to the Special Issue Gambling Disorder: Challenges in Diagnosis, Etiology and Treatment)

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12 pages, 326 KiB

Open AccessStudy Protocol

Responsible Gambling Telephone Intervention to High-Risk Gamblers by a State-Owned Gambling Operator in Sweden: Study Protocol for a Study on Effectiveness, User Satisfaction, and Acceptability

by Anders Håkansson, Katja Franklin, Maria Dahlström and Axel Lyckberg

Int. J. Environ. Res. Public Health 2020, 17(23), 9069; https://doi.org/10.3390/ijerph17239069 - 4 Dec 2020

Cited by 3 | Viewed by 2583

Abstract

Gambling disorder is associated with severe financial, social, and psychological consequences, but treatment-seeking rates have been described to be low. Apart from formal treatment, motivational interventions in nontreatment-seeking high-risk gamblers have been shown to be promising. However, little is known about the effectiveness and acceptability of such motivational interventions carried out by a gambling operator as part of the company’s responsible gambling policies. Early experiences of such interventions are limited by the risk that gambling in individuals reached with the intervention may continue with a different gambling operator. The present study aims to evaluate effectiveness and user acceptability of a responsible gambling intervention continuously carried out by the Swedish state-owned gambling operator Svenska Spel Sport & Casino. This intervention for high-risk gamblers, identified either through substantial monetary losses or through a voluntary self-test by the gambler, includes a motivational telephone intervention aiming to encourage the gambler to set deposit limits, practice self-exclusion, or seek help. This protocol paper describes the two-tailed evaluation of this intervention: (1) A retrospective, register-based study of the effectiveness of the motivational intervention on gambling expenditures, deposit limits, and self-exclusions in comparison to control individuals not reached by the intervention, including all clients reached or attempted to be reached during September 2019–April 2020 (total n = 3626), as well as a one-to-one matched comparison of clients reached (n = 1404) and not reached; and (2) a prospective web survey study in individuals reached by the same ongoing telephone intervention practice from November 2020 (target n = 200), measuring clients’ attitudes to the intervention, perceived effects of the intervention on gambling, and their self-reported gambling on all operators after the intervention. Full article

(This article belongs to the Special Issue Gambling Disorder: Challenges in Diagnosis, Etiology and Treatment)

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