PSYCHOLOGICAL PERSPECTIVE Rene A. St-Pierre Ph.D. Candidate - - PowerPoint PPT Presentation

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

DISORDERED GAMBLING: MEDIA PORTRAYALS

DISORDERED GAMBLING: 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

• thers”

Gambling “MUST be outside conscious control”

(Blume, 1987, p. 241-243)

DISORDERED GAMBLING: WHAT IT IS? WHAT IT IS NOT?

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)

DISORDERED GAMBLING: WHAT IT IS? WHAT IT IS NOT?

DSM-5 criteria (≥4 items endorsed):

Needs to gamble with increasing amounts of money in

• rder 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)

DISORDERED GAMBLING: WHAT IT IS? WHAT IT IS NOT?

Many criticisms raised about the medical

• r disease model conceptualization of

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

DISORDERED GAMBLING: WHAT IT IS? WHAT IT IS NOT?

Consider two cases:

Jenny Alex

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

DISORDERED GAMBLING: WHAT IT IS? WHAT IT IS NOT?

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

DISORDERED GAMBLING: WHAT IT IS? WHAT IT IS NOT?

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

DISORDERED GAMBLING: WHAT IT IS? WHAT IT IS NOT?

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)

DISORDERED GAMBLING: HOW 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)

DISORDERED GAMBLING: HOW DO WE MEASURE IT?

Most people that gamble do so as an

• ccasional 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)

DISORDERED GAMBLING: HOW PREVALENT IS IT?

Based on existing research, prevalence

• f 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)

DISORDERED GAMBLING: HOW 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)

DISORDERED GAMBLING: 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; )

DISORDERED GAMBLING: 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

DEVELOPMENT AND MAINTENANCE OF DISORDERED GAMBLING

My odds of winning now must be...

The cognitive model of gambling (Walker, 1992) is a psychological theory

• f gambling that focuses on cognitive

processes to explain continued involvement in gambling

DEVELOPMENT AND MAINTENANCE OF 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

DEVELOPMENT AND MAINTENANCE OF DISORDERED GAMBLING

Cognitive distortions can be divided into three interconnected categories.

Probability Fallacies Illusions of Control Biased Memories or Evaluations

• f Outcome

DEVELOPMENT AND MAINTENANCE OF 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”

DEVELOPMENT AND MAINTENANCE OF DISORDERED GAMBLING

Example:

LOSS + LOSS + LOSS + LOSS + LOSS     

TRY 6? _________________

WIN DEVELOPMENT AND MAINTENANCE OF 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”

• utcomes

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

DEVELOPMENT AND MAINTENANCE OF 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” DEVELOPMENT AND MAINTENANCE OF 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?