Problem Gambling Awareness Month – March 2022

By: Eliscia Siu-Lin Liang Sinclair, undergraduate student in Psychology at the University of British Columbia

March is Problem Gambling Awareness Month. Problem Gambling Awareness Month aims to increase awareness about problem gambling and educate the public about the availability of prevention, intervention, and rehabilitation services.

Many organizations participate in this campaign, including the National Council in Problem Gambling, gambling companies, health agencies, and more. 

What is gambling?

Gambling generates an enormous amount of revenue in modern societies. Research indicates that approximately 80% of the population across Western countries has endorsed having gambled in their lifetime (Petry, 2002). Gambling is difficult to define, but it can be characterized as a behaviour where something of value (typically monetary) is placed on the uncertain prospects of a larger prize (Williams et al., 2017). It is important to note that not all gambling behaviour warrants a diagnosis for gambling disorder. 

What is a gambling disorder?

In 2013, gambling disorder was officially classified as an addictive disorder in the Diagnostic Statistical Manual (5th edition). Gambling disorder involves “persistent and recurrent problematic gambling leading to clinically significant impairment or distress” (American Psychiatric Association, 2013). Gambling disorder criteria include needing to gamble with increasing amounts to achieve the desired excitement and unsuccessful efforts to control, reduce, or stop gambling.

What was the impact of re-classifying gambling disorder as an addictive disorder?

Classifying gambling disorder as an addiction gave the condition more scientific and medical credibility. It also corroborated research indicating that gambling problems are similar to substance-use problems. Kessler et al. (2008) found that gambling disorder and mood disorders have a comorbidity rate of 55%, and mood disorders tend to precede gambling problems. It is possible that these individuals are using gambling as negative reinforcement to escape or cope with their negative emotions. 

Treating gambling disorder as an addictive disorder rather than an impulse control disorder has impacted clinical research. Some researchers began investigating gambling disorders using methods classically used to study substance-use disorders (Clark et al., 2012)

The change also prompted more research regarding the ‘addictiveness’ of gambling and the psychology behind the game’s structural characteristics. Unlike substances, gambling does not have a chemical that makes people want to keep playing. Some other mechanism is making gambling ‘addictive’. It is already known that playing on a slot machine resembles a form of operant conditioning called variable ratio reinforcement; this type of reinforcement increases the ‘uncertainty’ of the game, which research shows can affect the brain’s dopamine system (Zald et al. 2004). It is important that individuals become aware of gambling features that may fuel the addictive potential of different gambling games. 

Are some people more at-risk for gambling problems than others?

Research indicates that certain individuals may be vulnerable or be predisposed to forming gambling problems. One research study found that, in individuals with symptoms of problem gambling, brain activity in the ventral striatum (a key area of the brain’s reward system) was reduced after winning a card game (Reuter et al. 2005). Blaszczynski and Nower (2002) devised a model encompassing three subgroups of problem gamblers. One subset is the ‘emotionally vulnerable’ individual, who may have faced childhood adversity, chronic stressors, mental disorders, or have poor coping skills. These individuals may use gambling as a way of ‘escape’ or a distraction; as a result, gambling becomes a negative reinforcement. 

How are gambling problems usually measured?

The Problem Gambling Severity Index (PGSI; Ferris & Wynne, 2001) has become the gold-standard measure for gambling problems. The PGSI inquires about gambling involvement in the past 12 months (e.g., “Thinking about the past 12 months, have you bet more than you could afford?). 

What does problem gambling look like in British Columbia?

The 2020 BC Problem Gambling Survey revealed that 85% of British Columbians (aged 19 and older) spent money on at least one gambling activity in the past year. Approximately 17% of gamblers indicated they had had problems with at least one form of gambling in the past year. 

How are the loved ones of people with gambling problems affected? 

Gambling problems have a significant impact on society. Research examining gambling problems in Australia found that a typical problem gambler negatively affects six other individuals (Goodwin et al., 2016). Surprisingly, this research also found that much of the burden of gambling (80%) came from low-risk or mildly affected individuals. This phenomenon, known as the “prevention paradox,” highlights the fact that gambling treatment and prevention efforts need to consider individuals at-risk of gambling problems in addition to individuals with full-fledged gambling problems. 

Treatment methods for gambling disorder

  • Telephone helplines: as individuals begin to become concerned about their gambling, speak to trained counsellors over the phone (Ipsos, 2021)
  • Voluntary Self-Exclusion programs: in British Columbia, individuals can enroll in self-exclusion, which adds them to a register barring them from all casino venues across the province for a certain period of time (Finkenwirth et al., 2021)
  • Gambler’s anonymous: a self-help 12 step program (Schuler et al., 2016)
  • Cognitive-behavioural therapy: a therapy approach applied to several mental disorders emphasizing both cognitive and behavioural portions of gambling disorder (Gooding & Tarrier, 2009)
  • Motivational interviewing: a procedure where a counsellor speaks to a gambler about whether they are ready to change; emphasizes “change talk” (Yakovenko et al., 2015)
  • Residential treatment programs: in-patient facility individuals would live in, specializing in gambling problems (Campbell & Smith, 2003)

What research is the B.R.A.I.N. Lab conducting that involves people with gambling problems?

The B.R.A.I.N. Lab is currently running the Hybrid Response Inhibition study focussing on populations with Gambling Disorder, Bipolar Disorder, and Stimulant-Use Disorder. Response inhibition is the ability to inhibit an action once initiated. It is a form of impulsivity and cognitive control. Controlling impulsive behaviour can be extremely difficult for individuals with gambling disorder, and several studies have found a relationship between impulsivity and problem gambling (Clark et al., 2012). The Hybrid Response Inhibition study will use functional magnetic resonance imaging (fMRI) to investigate differences in brain activations during Sebastian et al.’s (2013) “Hybrid Response Inhibition Task. Transcranial Magnetic Stimulation (TMS) will then be used to target brain regions engaged during response inhibition to examine the biological underpinnings of cognitive control in these groups.

Responsible Gambling Programs & Resources

  • There is a 24-hour, toll-free B.C. Gambling Support Line: 1-888-795-6111 
  • To learn more about gambling, problem gambling, and support options, individuals can visit https://www.bcresponsiblegambling.ca 
  • Support options include outreach support, which is an early-intervention service supporting at-risk individuals
  • Clinical counselling (provided free to B.C. residents)
  • Prevention and community engagement efforts
  • Educational programs for students from kindergarten to grade 12
  • Training programs for student leadership programs
  • Information sessions for various community groups
  • Awareness for elderly adult populations
  • Training for community professionals
  • Culturally relevant gambling awareness programs

 

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

Blaszczynski, A., & Nower, L. (2002). A pathways model of problem and pathological gambling. Addiction (Abingdon, England), 97(5), 487-499. https://doi.org/10.1046/j.1360-0443.2002.00015.x

Campbell, C. S., & Smith, G. J. (2003). Gambling in canada, from vice to disease to responsibility: A negotiated history. Canadian Bulletin of Medical History = Bulletin Canadien d’Histoire De La Médecine, 20(1), 121-149. https://doi.org/10.3138/cbmh.20.1.121

Clark, L., Stokes, P. R., Wu, K., Michalczuk, R., Benecke, A., Watson, B. J., Egerton, A., Piccini, P., Nutt, D. J., Bowden-Jones, H., & Lingford-Hughes, A. R. (2012). Striatal dopamine D2/D3 receptor binding in pathological gambling is correlated with mood-related impulsivity. NeuroImage (Orlando, Fla.), 63(1), 40-46. https://doi.org/10.1016/j.neuroimage.2012.06.067

Gooding, P., & Tarrier, N. (2009). A systematic review and meta-analysis of cognitive-behavioural interventions to reduce problem gambling: Hedging our bets? Behaviour Research and Therapy, 47(7), 592-607. https://doi.org/10.1016/j.brat.2009.04.002

Goodwin, B. C., Browne, M., Rockloff, M., & Rose, J. (2017). A typical problem gambler affects six others. International Gambling Studies, 17(2), 276-289. https://doi.org/10.1080/14459795.2017.1331252

Ferris, J., & Wynne, H. (2001). The Canadian Problem Gambling Index: Final report. Canadian Centre on Substance Abuse. https://doi.org/10.1007/s10899-010-9224-y. 

Finkenwirth, S., MacDonald, K., Deng, X., Lesch, T., & Clark, L. (2021). Using machine learning to predict self-exclusion status in online gamblers on the PlayNow.com platform in british columbia. International Gambling Studies, 21(2), 220-237. https://doi.org/10.1080/14459795.2020.1832132

Kessler, R., Hwang, I., LaBrie, R., Petukhova, M., Sampson, N., Winters, K., & Shaffer, H. (2008). DSM-IV pathological gambling in the national comorbidity survey replication. Psychological Medicine, 38(9), 1351-1360. https://doi.org/10.1017/S0033291708002900

Ipsos. (2021). Report: 2020 British Columbia Online Problem Gambling Prevalence Study 2020 BC Problem Gambling Prevalence Study. https://www2.gov.bc.ca/assets/gov/sports-recreation-arts-and-culture/gambling/gambling-in-bc/reports/bc_online_problem_gambling_prevalence_report_2020.pdf. 

Petry, N. M. (2002). A comparison of young, middle-aged, and older adult treatment-seeking pathological gamblers. The Gerontologist, 42(1), 92-
99. https://doi.org/10.1093/geront/42.1.92 

Reuter, T. Raedler, M. Rose, I. Hand, J. Glascher, C. Buchel. (2005). Pathological gambling is linked to reduced activation of the mesolimbic reward system. Nat. Neurosci. 8(2). https://doi.org/10.1038/nn1378

Sebastian, A., Pohl, M. F., Klöppel, S., Feige, B., Lange, T., Stahl, C., Voss, A., Klauer, K. C., Lieb, K., & Tüscher, O. (2013). Disentangling common and specific neural subprocesses of response inhibition. NeuroImage (Orlando, Fla.), 64(1), 601-615. https://doi.org/10.1016/j.neuroimage.2012.09.020

Schuler, A., Ferentzy, P., Turner, N. E., Skinner, W., McIsaac, K. E., Ziegler, C. P., & Matheson, F. I. (2016). Gamblers anonymous as a recovery pathway: A scoping review. Journal of Gambling Studies, 32(4), 1261-1278. https://doi.org/10.1007/s10899-016-9596-8

Williams, R.J., Volberg, R.A., Stevens, R.M.G., Williams, L.A., & Arthur, J.N. (2017). The definition, dimensionalization, and assessment of gambling participation. Report prepared for the Canadian Consortium for Gambling Research.

Yakovenko, I., Quigley, L., Hemmelgarn, B. R., Hodgins, D. C., & Ronksley, P. (2015). The efficacy of motivational interviewing for disordered gambling: Systematic review and meta-analysis. Addictive Behaviors, 43, 72-82. https://doi.org/10.1016/j.addbeh.2014.12.011

Zald, D. H., Boileau, I., El-Dearedy, W., Gunn, R., McGlone, F., Dichter, G. S., & Dagher, A. (2004). Dopamine transmission in the human striatum during monetary reward tasks. The Journal of Neuroscience, 24(17), 4105-4112. https://doi.org/10.1523/JNEUROSCI.4643-03.2004