disordered gambling: a psychological perspectivewalkerd.people.cofc.edu/360/presentation cofc march...

DISORDERED GAMBLING: A

PSYCHOLOGICAL PERSPECTIVE

Renée A. St-Pierre

Ph.D. Candidate

Psychologist

OUTLINE

Disordered gambling What is it? What is it NOT?

How do we measure it?

How prevalent is it?

Comorbidities

Development and maintenance of disordered gambling

Treatment of disordered gambling

DISORDERED GAMBLING

DISORDERED GAMBLING:

MEDIA PORTRAYALS


WHAT IT IS? WHAT IT IS NOT?

Is there any truth behind these

depictions?

Popular media often portrays disordered gamblers as “driven by an irresistible compulsion [to gamble]” and are “unable to stop”

(Schaler, 1999)

Disease or medical model:

Conceptualizes it as a “dependence on the ‘action’ of gambling, in many ways similar to dependence on a mood-changing drug”

Gambling is assumed to be “reliably and repeatedly harmful to the individual and/or others”

Gambling “MUST be outside conscious control”

(Blume, 1987, p. 241-243)



DSM-5 defines Gambling Disorder as a behavioural addiction

Essential features:

Persistent and recurrent problematic gambling behaviour

Leads to “clinically significant” impairment or distress

(APA, 2013)



DSM-5 criteria (≥4 items endorsed):

Needs to gamble with increasing amounts of money in order to achieve the desired excitement

Has made repeated unsuccessful efforts to control, cut back, or stop gambling

Is often preoccupied with gambling (e.g., thinking of ways to get money with which to gamble)

After losing money gambling, often returns another day to get even (“chasing” one’s losses)

(APA, 2013)



Many criticisms raised about the medical or disease model conceptualization of disordered gambling

One issue raised is whether excessive gambling behaviour really is dichotomous (non-disordered vs. disordered)?



Consider two cases:

Jenny

Alex

Do you think these two gamblers differ from one another? If so, how do they differ?



JENNY

Jenny is a 34-year-old stay-at-home mother of two young boys, Tyler 4, and Joshua, 1. Before her son Tyler was born, Jenny would spend $5 dollars a week to play the State lottery, and an additional $10 dollars at the church’s Bingo night. However, soon after his birth, Jenny was no longer able to get out to the Bingo tournaments as much. Nevertheless, she found a fun alternative: an internet Casino site that allowed her to play roulette for money. She loved the idea of playing online because she could do it whenever her sons were asleep, and it could help her escape from the monotony of housework and mothering responsibilities.

At first, Jenny would spend an average of 20 dollars a week playing internet roulette, but within six months, she was spending approximately 100 dollars a week, and playing an average of 1.5 hours per day. Her husband has since noticed that some of her usual housework is being neglected on occasion, and that the amount of money she needs for groceries isn’t always equivalent to the quantity of food purchased. Upon questioning from her husband, Jenny admitted that she uses some of the grocery money to play Keno, but that it isn’t more than 25 dollars a week.

ALEX

Alex is an 19-year-old student, attending vocational training school to become an electrician. He also works part-time at his father’s electrical company while attending school. When he first began going to the casino to play blackjack (his game of choice), he would spend an average of $50 - $100, depending on his success, and play for one to three hours once a month. However, in his last few visits to the casino, Alex has been on a “losing streak”, and borrowing small amounts of money from friends (≈$25/friend) in order to “get back on track”. What’s more, he has been going to the casino almost every night, spending sometimes over 3 hours at the blackjack tables. Although he is unhappy about his recent losses, he believes that he’ll be able to get back to his usual playing habits just as soon as he wins back the money, which is just around the corner in his eyes.

Current evidence suggests that gambling behaviour (and problems) may instead exist on a continuum

(Strong & Kahler, 2007; Toce-Gerstein, Gerstein, & Volberg, 2003)

Considerable movement in and out of more severe and less severe forms of gambling

(Slutske, Jackson, & Sher, 2003; Winters, Stichfield, Botzet, & Slutske, 2005)

Some gamblers described as “episodic” (Griffiths, 2006; Nower & Blaszczynski, 2003



Problem/

At-Risk/

In-Transition

Gambler

Disordered

gambler

Continuum of Gambling Behaviour

Frequency

Duration

Expenditure

Frequency

Duration

Expenditure

No risk – Low risk Moderate risk High risk

No

gambling

Recreational

gambling

Experimentation



DSM-5 remains the primary tool to diagnose Gambling Disorder in the U.S.

However, there exists several diagnostic screens used to detect potential problematic gambling behaviour

DISORDERED GAMBLING: HOW

DO WE MEASURE IT?

Commonly used diagnostic screens:

South Oaks Gambling Screen (SOGS; , Lesieur & Blume, 1987)

Canadian Problem Gambling Index (CPGI; Ferris & Wynne, 2001)

National Opinion Research Center DSM-IV Screen for Gambling Problems

(NODS; Gerstein et al., 1999)

Massachusetts Gambling Screen (MAGS; Shaffer, Labrie, Scanlan, & Cummings, 1994)

Lie/Bet Questionnaire (Johnson et al., 1997)


DO WE MEASURE IT?

Problems with diagnostics screens:

They are self-report

Subject to a high false positive rate

Different instruments have different cut-off points

Developed based on previous DSM criteria of “pathological gambling”

(Lorains, Cowlishaw, & Thomas, 2011)


DO WE MEASURE IT?

Most people that gamble do so as an occasional recreational activity and do so in a responsible manner (i.e., set and maintain limits)

However, a small but meaningful proportion of individuals gamble excessively and experience serious problems

(St-Pierre, Temcheff, Gupta, Derevensky, & Paskus, 2014)


PREVALENT IS IT?

Based on existing research, prevalence of disordered gambling:

0.15–3.5% (M = 1.6%) for adults (Stucki & Rihs-Middel, 2007)

5.37–10.41% (M = 7.89%) for college students

(Blinn-Pike, Worthy, & Jonkman, 2007)

0.3–10% for adolescents (Volberg, Gupta, Griffiths, Ólason, & Delfabbro, 2010)


PREVALENT IS IT?

Rarely does disordered gambling present itself in isolation

Shown to be comorbid with:

Substance use disorders (e.g., alcohol or drug abuse/dependence, nicotine dependence)

Mood disorders (e.g., depression)

Anxiety disorders (e.g., phobia)

Impulse-control disorders (e.g., ADHD, CD)

(Kessler et al., 2008; Lorains et al., 2011)


COMORBIDITIES

Comorbid disorders tend to develop before the onset of disordered gambling (except substance use disorders)

WHY?

Gambling can be used as a coping strategy or as a means for escaping

High degree of impulsivity associated with gambling

(Kessler et al., 2008; )


COMORBIDITIES

For most disordered gamblers, gambling results in consistent and important financial losses

Despite these significant losses, problem gamblers continue to gamble

WHY?

DEVELOPMENT AND MAINTENANCE OF

DISORDERED GAMBLING

Decisions to continue or cease gambling are influenced by irrational thoughts, inaccurate interpretations, and/or errors in judgment


DISORDERED GAMBLING

My odds of winning now must be...

The cognitive model of gambling (Walker, 1992) is a psychological theory of gambling that focuses on cognitive processes to explain continued involvement in gambling


DISORDERED GAMBLING

Basic tenets of the cognitive model:

i. Gamblers use rules to make quick decisions under conditions of uncertainty (e.g., current situation is representative of previous situations based on similarity)

ii. Over-reliance on these rules eventually leads to an unpredictable negative outcome (loss)

iii. Objective information about loss is misperceived or disregarded

iv. Decision to continue to play becomes open to cognitive distortions


DISORDERED GAMBLING

Cognitive distortions can be divided into three interconnected categories.

Probability

Fallacies

Illusions of

Control

Biased Memories or Evaluations of Outcome


DISORDERED GAMBLING

Probability fallacies involve the tendency to link mutually exclusive events

Past experience in chance situations are believed to dictate present odds of winning

Erroneous because odds of winning are largely independent of past experiences

Product of misunderstanding or inability to apply the notion of randomness

“Each event must appear a proportionate number of times”


DISORDERED GAMBLING

Example:

LOSS + LOSS + LOSS + LOSS + LOSS

TRY 6? _________________ WIN


DISORDERED GAMBLING

Illusions of control are inflated expectations that personal ability is instrumental in determining successful outcomes

Erroneous because no behaviour can be exercised to influence the outcome of games of chance

Influenced by active involvement and “near miss” outcomes

Active involvement provides gambler with concrete examples of actions entailing a favourable outcome

Near miss (failure approaching success) more likely to be interpreted as examples of control over the outcome


DISORDERED GAMBLING

Biased memories or evaluations of outcome are attributions used to explain away or adjust negative outcomes

Failures ascribed to external factors beyond personal control

Erroneous because it distorts the impact of and reason behind a loss

Allows the gambler to continue to believe in his or her ability to “beat the system”


DISORDERED GAMBLING

What kind of cognitive distortion do you think this is an example of?

ACTIVITY

“Ooh, I bet on

Black 13 but it

landed on Red

36 right beside

it. Black 13 has

got to come

soon…”

What kind of cognitive distortion do you think this is an example of?

ACTIVITY

“I needed an

ace to win

that hand. I

guess it just

didn’t come

up because it

wasn’t my

lucky night”

Pharmacologic treatments

Antidepressants (e.g., fluvoxamine, paroxetine)

Opioid antagonists (e.g., naltrexone)

Psychological treatments

Cognitive-behavioural therapy

TREATMENT OF DISORDERED

GAMBLING

QUESTIONS?

disordered gambling: a psychological perspectivewalkerd.people.cofc.edu/360/presentation cofc march...

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