Pathological Gambling A Critical Review (1999) / Chapter Skim
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4: Research on the Origins of Pathological and Problem Gambling
4: Research on the Origins of Pathological and Problem Gambling
Pages 107-155
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From page 107... ...
This chapter begins by describing considerations for undertaking or evaluating etiological research on pathological gambling, as well as the current state of knowledge regarding the causal pathways of pathological gambling. Risk factors for and correlates of pathological gambling, including psychosocial, environmental, genetic, and biological ones, are discussed and evaluated in terms of commonly accepted criteria for determining the strength of an association.
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From page 108... ...
, research on the more common mental disorders has flourished and has led to a concomitant explosion in research on risk factors (Goodwin and Guze, 1974~. Research on the diagnostic cIassification of pathological gambling has lagged behind, and it has been identified as an area in serious need of etiological research.
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In the study just described, a family history of a psychiatric disorder or a substance abuse problem was identified as a common risk factor for exposure to traumatic events and acquiring PTSD. Unique Risk Factors Equally important to consider in etiological research on pathological and problem gambling is which factors for chronic, long-term gambling are unique to this disorder and not just predictors of excessive deviant behavior of all kinds.
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These effects pertain to how risk factors and outcomes change with age and differ among groups of people (Mok and Hraba, 1991~. Cohort effects pertain to specific events that affect groups of people born during the same time period (Mok and Hraba, 1991~.
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From page 111... ...
, it was found, even after controlling for other variables, that older cohorts are less likely to gamble than younger cohorts (Mok and Hraba, 1991~. Criteria to Determine the Strength of an Association Mindful of the considerations discussed above, and in order to evaluate the research evidence that various risk factors are associated with pathological gambling, the committee adopted a number of general criteria, which are commonly accepted by epidemiologists throughout the world (Hill et al., 1963)
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From page 112... ...
Still, despite the generally deficient state of etiological research on pathological and problem gambling, there does exist some tangible evidence to suggest certain risk factors and associations.) PSYCHOSOCIAL AND ENVIRONMENTAL RISK FACTORS Determining psychosocial and environmental risk factors for pathological and problem gambling is guided by the following question: Is the risk for pathological or problem gambling associated with sociodemographic factors, such as age, gender, ethnicity, and family effects, or is it associated with the availability of gambling to the gambler?
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From page 113... ...
found that pathological gamblers started gambling, on average, at age 10.9 and nonpathological gamblers at age 11.5. Studies of teens indicate that young age of onset of gambling is more than an artifact of reporting bias.
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and 5 Canadian adolescent gambling studies, Jacobs found that in the past 10 years the number of teenagers ages 12 to 17 reporting serious gambling problems has increased from 50 to 66 percent. The age of onset for gambling has dropped so that now, throughout America, the majority of 12-year-olds have already gambled (Jacobs, in press)
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The American Psychiatric Association reports in three editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) that the rate of pathological gambling is twice as high among men than among women (American Psychiatric Association, 1987, 1994, 1980~.
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An earlier multistate analysis found that the only significant difference between probable pathological gamblers from different states is that those from the East Coast states
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But there is still some question as to whether peers have a strong influence on early gambling or other risky adolescent behaviors. At this point, all we can say for sure is that family and peer influences as psychosocial variables are correlates or predictors of gambling behavior.
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Those who perceived that their parents had gambling problems were three times more likely to score as probable pathological gamblers on the South Oaks Gambling Screen. Those who also perceived that their grandparents had gambling problems had a 12-fold increased risk.
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investigated gambling involvement among 3,359 twin pairs using DSM-III-R criteria, assessed via phone interview. Their original evaluation found that inherited factors explained between 35 and 54 percent of the liability for five individual symptoms of pathological gambling behavior.
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Because the impulsive and addictive disorders that are associated with this variant are also related to pathological gambling, research was conducted to determine if a similar relationship might be present with pathological gambling. Based on this premise, genetic research on pathological gambling theorizes that variants in the DRD2 gene, and perhaps other genes, might be associated with biochemical reward and dysfunctioning reinforcement mechanisms that effectively lead pathological gamblers to behave self-destructively.
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From page 121... ...
The Comings laboratory independently collected blood DNA samples from 171 white pathological gamblers recruited from inpatient and outpatient treatment programs, Gamblers Anonymous, and attendees from conferences on problem gambling. Researchers also collected self-reports of gambling behaviors and blood specimens from 102 people in the sample (about 60 percent)
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Moreno and colleagues have reported a blunted prolactin response among a small sample of gamblers, suggestive of serotonin receptor hyposensitivity (Moreno et al., l991~. DeCaria and colleagues found an enhanced prolactin response in pathological gamblers suggestive of seroto
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It should also be noted that there are studies that have failed to support a central role for serotonin. In several studies, the metabolites 5-HT and 5-HIAA in the cerebral spinal fluid of pathological gamblers were unchanged (Roy et al., 1988,1989; Bergh et al., 1997~.
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In summary, a great deal has been learned about the neurobiology factors contributing to drug abuse. Particular attention has been paid to the role of the mesolimbic dopamine pathway in mediating the acute reinforcing effects of most and possibly all drugs of abuse.
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Studies that control for lifetime drug abuse are important, however, since drugs may have a permanent effect on brain circuitry. Because various stimuli may reinforce and maintain stimuJus-seeking behavior, researchers hypothesize that a shared brain mechanism is at work in a variety of activities, including gambling.
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Recently other brain imaging techniques such as positron emission tomography (PET) and magnetic resonance imaging (MRI)
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increases or decreases gambling behavior or (b) modifies the euphoric effects of winning and the dysphoric effects of losing during a gambling session.
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In addition, information about the cooccurrence of psychiatric disorders improves the field's understanding of the neurophysiology, genetics, and risk factors associated with these disorders. The occurrence of one disorder with another in an epidemiological study can indicate that one disorder causes another, that there is a common underlying risk factor associated with both disorders, or that comorbid disorders are not independent but simply two phenotypes of the same underlying illness.
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From page 129... ...
In Chapter 2 we mentioned a partial exclusion for pathological gambling in cases for which the clinician believes the symptoms were better accounted for by a manic episode. Historically, exclusion criteria were designed to ensure that, when studying a given disorder, the group to be studied would be homogeneous to allow for specific and significant findings regarding the risk factors under study.
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Specifically, investigators should state the rate of drug abuse only among drug users and should report a conditional rate among nongamblers, gamblers without problems, and pathological gamblers. Rarely has this been done.
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, researchers, using the South Oaks Gambling Screen among a small sample of 85 patients on an alcohol treatment ward of the Ft. Meade Veterans Administration hospital, found that American Indians compared with whites had a higher rate of probable pathological gambling (22 compared with 7.3 percent)
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Pathological gamblers in some studies did report more depression than nongamblers. Depression scales that measure current depressed mood were commonly used.
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When manic-like mood changes occur in pathological gamblers, they are generally related to winning streaks, and they are usually followed by depressive episodes because of subsequent losses. Periods of depression tend to increase as the disorder progresses.
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For example, McCormick found that 38 percent of Veterans Administration patients hospitalized for gambling were diagnosed with hypomania (McCormick, 1993~. Specker and colleagues found no difference between pathological gamblers and controls for bipolar and dysthymia disorders (Specker et al., 1996~.
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From page 135... ...
In another study, 58 male patients in an inpatient treatment program for pathological gamblers in Germany were compared with a control group of patients with other addictions. The gamblers were found to be younger, previously convicted of theft, highly indebted, susceptible to other addictive substances, especially alcohol, and in danger of committing suicide (Schwarz and Lindner,1992~.
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They also stress the importance of carefully controlled studies to minimize the risk of making conclusions based on unrepresentative samples, such as a conclusion that pathological gambling leads to suicide. These findings do not suggest that pathological gamblers never think about or attempt suicide.
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reported in a sample of 230 male and 118 female prisoners, 30 percent were probable pathological gamblers, and 13 percent stated that gambling was either partially or wholly to blame for their detention. However, a spurious association between pathological gambling and ASPD may exist because substance use disorders, which are highly prevalent in these populations, are also
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(1995) , who found that pathological gamblers compared with controls were more likely to meet criteria for ADHD.
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Bland and colleagues found that gamblers were over three times more likely than nongamblers to meet criteria for alcoho] and drug use disorders, affective disorder, agoraphobia, obsessive-compulsive disorder, and antisocial personality disorder (Bland et al., 1993~.
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Although adolescents can gamble and not become problem or pathological gamblers, certain risk factors, including family member and peer influences, are important for this group. Preliminary evidence suggests that the earlier people begin gambling, the more likely they are to experience problems from gambling.
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Now research is needed that addresses the history of the disorder, and that seeks biological etiologies for these changes. Antisocial personality disorder, substance use disorders, and depression seem to be the most prevalent disorders among pathological gamblers.
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Once the psychometric properties of these tools are firmly established, the field can move expeditiously to identify socioenvironmental, genetic, and family risk factors, as well as the neurobiological and molecular mechanisms that figure in the development of pathological gambling. The committee concludes, from its review and critique of the literature, that the following specific areas are in critical need of immediate research attention: · Longitudinal research that explores the transition from childhood to adolescence through later adulthood, to determine the natural history of pathological gambling, including initiation, progression, remission, and relapse.
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· Research that identifies whether certain games may be gateways to subsequent gambling problems, just as previous research indicates there are gateway drugs that precede the use of hard drugs. · Studies to determine whether factors are risk factors or con sequences of gambling.
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1992 Posttraumatic stress disorder in an urban population of young adults: Risk factors for chronicity. American Journal of Psychiatry 149:671-675.
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Spitznagel, and A Janca 1992 Posttraumatic stress disorder among substance abusers in the general population.
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Derevensky, J.L., and R Gupta 1996 Risk-taking and Gambling Behavior Among Adolescents: An Empirical Examination.
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1990a The acquisition, development, and maintenance of fruit machine gambling in adolescents. fournal of Gambling Studies 6~3~:193-204.
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Journal of Gambling Behavior 4~2~:110118. Indian Gaming and Regulatory Act 1988 Public Law 100-497, October 17,1988,102 Stat.
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Jacobs 1988 The relationship between dissociative-like experiences and sensation seeking among social and problem gamblers. journal of Gambling Behavior 4:197-207.
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Blume 1987 The South Oaks Gambling Screen (SOGS) : A new instrument for the identification of pathological gamblers.
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Rameriz, and J.I Taber 1984 Affective disorders among pathological gamblers seeking treatment. American Journal of Psychiatry 141:215-218.
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Russo, and J.I. Taber 1983 Patterns of substance use in pathological gamblers undergoing treatment.
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Marcotte 1996 Psychopathology in pathological gamblers seeking treatment. Journal of Gambling Studies 12:67-81.
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1994 The prevalence and demographics of pathological gamblers: Implications for public health. American Journal of Public Health 84~2~:237-241.
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1996 Comparative study of problematic gambling behaviors between American Indian and non-Indian adolescents within and near a northern plains reservation. American Indian and Alaska Native Mental Health Research 7~2~:14-26.
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