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Background and aim Gambling is a widespread recreational activity in the UK. A significant percentage of gamblers develop subclinical or clinically relevant problem gambling issues, but only a low percentage of them seek treatment. Although characteristics of pathological gamblers from treatment-seeking population have been examined in some research, only a few studies have explored the differences between females and males. This study aimed to examine the gender-related differences in demographics, gambling measures, and clinical variables in an outpatient sample of pathological gamblers seeking treatment. Methods A total of 1,178 treatment-seeking individuals with gambling disorder were assessed at the National Problem Gambling Clinic in London. Sociodemographic characteristics, clinical variables, and gambling behavior habits were obtained during the assessment evaluation. Of the total sample, 92.5% were males and 7.5% were females. Results Males were more likely to be younger, white, and employed than females. In addition, compared to women, men showed a lower PGSI score, an earlier age of onset of gambling behavior, a higher gambling involvement, and preferred specific forms gambling. Female gamblers were more anxious and depressed, while men were more likely to use alcohol and illicit drugs. Conclusions Our findings support the importance of gender differences in a treatment-seeking population of pathological gamblers both in sociodemographic characteristics, gambling behavior variables, and clinical variables. Males and females might benefit from group-specific treatment.
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Gender Differences in Treatment-Seeking British Pathological Gamblers
NPGC, National Problem Gambling Clinic, Central North West London NHS Foundation Trust, London, United Kingdom
Department of Surgery and Translational Medicine, University of Milano-Bicocca, Monza, Italy
Department of Mental Health, San Gerardo Hospital, Monza, Italy
Department of Medicine, Imperial College London, London, United Kingdom
(Received: July 16, 2015; accepted: March 22, 2016)
Background and aim: Gambling is a widespread recreational activity in the UK. A signicant percentage of gamblers
develop subclinical or clinically relevant problem gambling issues, but only a low percentage of them seek treatment.
Although characteristics of pathological gamblers from treatment-seeking population have been examined in some
research, only a few studies have explored the differences between females and males. This study aimed to examine
the gender-related differences in demographics, gambling measures, and clinical variables in an outpatient sample of
pathological gamblers seeking treatment. Methods: A total of 1,178 treatment-seeking individuals with gambling
disorder were assessed at the National Problem Gambling Clinic in London. Sociodemographic characteristics,
clinical variables, and gambling behavior habits were obtained during the assessment evaluation. Of the total sample,
92.5% were males and 7.5% were females. Results: Males were more likely to be younger, white, and employed than
females. In addition, compared to women, men showed a lower PGSI score, an earlier age of onset of gambling
behavior, a higher gambling involvement, and preferred specic forms gambling. Female gamblers were more
anxious and depressed, while men were more likely to use alcohol and illicit drugs. Conclusions: Our ndings support
the importance of gender differences in a treatment-seeking population of pathological gamblers both in socio-
demographic characteristics, gambling behavior variables, and clinical variables. Males and females might benet
from group-specic treatment.
Keywords: gambling disorder, pathological gambling, treatment seeking, gender differences
Gambling is a widespread recreational activity in the UK,
with the 2010 British Gambling Prevalence Survey report-
ing that 75% of males and 71% of females had gambled in
the previous year (Wardle et al., 2010). Although most
individuals gamble recreationally and do not develop
gambling-related problems, a smaller, but signicant per-
centage of gamblers develop problem gambling issues. It
has been estimated that gambling disorder (GD) has a
prevalence rate that ranged between 0.3% and 5.3% of the
general population worldwide, with an estimated rate of
0.70.9 in the UK according to the criteria set by the fourth
edition of the Diagnostic and Statistical Manual of Mental
Disorders (Wardle et al., 2010). GD is characterized by
maladaptive patterns of gambling behavior with a natural
history characterized by chronicity and recurrence.
Although GD was traditionally classied as an impulse-
control disorder, the DSM-5 reclassied it into the addic-
tion and related disorderscategory, underlining multiple
similarities with substance use disorders (American Psychi-
atric Association, 2013).
Gender differences in problem gamblers among the
general population have been increasingly explored. Preva-
lence rates of GD among females were found to be less than
half, when compared to males (Blanco, Hasin, Petry,
Stinson, & Grant, 2006); however, gures on female prob-
lematic gambling are currently increasing as changes in the
gambling market, i.e., the availability of online, more
tailored,games, and in the cultural framework, are con-
tributing to increasing female gambling participation
(Grifths, Wardle, Orford, Sproston, & Erens, 2009;
LaPlante, Nelson, LaBrie, & Shaffer, 2006). Female gam-
blers had a later initiation of problematic gambling, and a
two-fold faster development of GD (Nelson, LaPlante,
LaBrie, & Shaffer, 2006;Tavares, Zilberman, Beites, &
Gentil, 2001). Moreover, women were found to have a
preference for pure chance, non-strategictypes of gam-
bling (Potenza et al., 2001). When examining psychopath-
ological correlates of GD, it was found that associations
between GD and substance abuse, major depressive epi-
sodes, and generalized anxiety disorder were stronger
among women (Petry, Stinson, & Grant, 2005).
Although characteristics of pathological gamblers from
the general population have been examined on a satisfactory
sample, a few studies, to our knowledge, have examined the
treatment-seeking population, reporting signicant inter-
gender differences. Among the difculties of studying
this population are the relatively low percentage of indivi-
duals who seek treatment for GD, 9.9% according to one
study (Slutske, 2006), and the high rate of dropouts
* Corresponding author: Silvia Ronzitti; Department of Surgery
and Translational Medicine, University of Milano-Bicocca, Via
Cadore 48, 20900 Monza (MB), Italy; Phone: +39 346 0045094;
© 2016 The Author(s)
FULL-LENGTH REPORT Epub ahead of print: June 27, 2016
Journal of Behavioral Addictions 5(2), pp. 231238 (2016)
DOI: 10.1556/2006.5.2016.032
(Melville, Casey, & Kavanagh, 2007). A consistently
reported result was that women were older in age, and had
initiated problematic gambling behavior at an older age
than men (Echeburúa, González-Ortega, de Corral, & Polo-
opez, 2011;Granero et al., 2009;Tang, Wu, & Tang,
2007). Men, in turn, reported more debt and more money
spent on gambling (Granero et al., 2009;Lahti, Halme,
Pankakoski, Sinclair, & Alho, 2013) as well as more
relational difculties due to gambling (Granero et al., 2009).
The psychopathological prole of women was found to
be poorer than that of males, with higher scores for depres-
sion and anxiety; moreover, women were more likely to
report the use of gambling to regulate negative affect
(Granero et al., 2009). Due to the scarcity of data on this
specic population, and the absence of treatment-seeking
related data in the UK, we aimed to explore sociodemo-
graphic, gambling, and clinical correlates of GD, with a
particular attention to gender differences, in a British sample
of treatment-seeking pathological gamblers.
Data were collected from clients who were voluntarily
seeking treatment at the National Problem Gambling Clinic
(NPGC) between January 2011 and December 2013. Over
the course of the present study, we received 1,741 referral
forms. From this initial sample, there were a number of
clients excluded from the study because of not attending or
not completing assessments (n=563). The nal sample
therefore consisted of 1,178 clients.
The NPGC is the rst and only National Health Service
clinic in the UK that provides treatment for pathological
gamblers. Cognitive behavioral therapy is the main type of
treatment offered, and is delivered in three different ways; in
a group setting, individually, and remotely over the phone
for those who are unable to travel weekly to the clinic. On
their rst visit, clients are assessed thoroughly to gain
information about the clientsgambling behavior and related
information, including clinical variables (e.g., patient health
questionnaire and generalized anxiety disorder). Sociode-
mographic variables were obtained from the referral form in
which each client is required to ll in prior to assessment.
During the assessment, clients were informed that informa-
tion collected from the referral and assessment forms would
be analyzed by researchers to increase the understanding
about GD. Oral consent was obtained from clients before
lling in the assessment form.
Clinical interview. During the interview, clients were asked
to describe their gambling behavior (type of gambling,
frequency, money spent, age noted gambling became prob-
lematic, history of gambling behavior, debts, total amount
lost on gambling, and previous treatment) psychiatric,
medical and forensic histories, family psychiatric history,
family structure, and impact of gambling on family and
personal histories.
Assessment forms
Self-administered questionnaires
Problem Gambling Severity Index (PGSI). Validated
by a number of studies (Holtgraves, 2009), the PGSI is
a nine-item questionnaire, which measures gambling
severity. It consists of four questions that assess prob-
lematic gambling behavior and ve questions that
assess adverse consequences of gambling. The score
that can be obtained from the PGSI ranges from 0 to
27. A score of 8 and above indicates a problem
gambler (Ferris & Wynne, 2001).
Patient Health Questionnaire (PHQ-9). The PHQ-9 is a
nine-item instrument, which is widely used to measure
the severity of depression. The questionnaire evaluates
each of the nine DMS-IV criteria for depression
(Kroenke, Spitzer, & Williams, 2001). Scores of 5,
10, 15, and 20 are used as the cutoff points for mild,
moderate, moderately severe, and severe depression.
The PHQ-9 has been commended for its high sensitiv-
ity and specicity for diagnosing depression, good
internal consistency, convergent and discriminant
validity, robustness of factor structure, and responsive-
ness to change (Kroenke, Spitzer, Williams, & Löwe,
Generalized Anxiety Disorder (GAD-7). The widely
used seven-item GAD-7 measures anxiety over the
previous two weeks. Scores range from 0 to 27; Scores
of 5, 10, and 15 are taken as the cutoff points for mild,
moderate, and severe anxiety (Kroenke, Spitzer,
Williams, Monahan, & Löwe, 2007). The GAD-7 has
been credited with having good convergent validity
with other measures of anxiety (Kroenke et al., 2010)
and described as having good sensitivity and specici-
ty for GAD-7 (Spitzer, Kroenke, Williams, & Löwe,
Alcohol Use Disorders Identication Test-Consump-
tion Questions (AUDIT-C). The AUDIT-C consists of
three questions, two of which assess regular drinking in
terms of frequency and quantity, the third assessing
binge drinking, which is dened as six or more alcoholic
drinks in one sitting, at least once a month in the
preceding three months (Bush, Kivlahan, McDonell,
Fihn, & Bradley, 1998). Answers are ranked from 0 to 4,
and the nal score is the sum of each question. A score of
5 or more indicates hazardous drinking. The AUDIT-C
is a validated and well-established screening tool
(Meneses-Gaya et al., 2010).
Tobacco behavior. All subjects were questioned about
their tobacco use [frequency (i.e., daily) and amount,
i.e., 20].
Drug use. To determine other drug use, we adminis-
tered a specic questionnaire that asked about individ-
ual drugs (marijuana, cocaine, crack cocaine, opiates,
opiate substitutes, and ecstasy). For each drug, we
assessed lifetime use, current use, and number of days
in the past month in which the drug was used.
Type of gambling. To determine the gambling
behavior, we administered a specic questionnaire
232 |Journal of Behavioral Addictions 5(2), pp. 231238 (2016)
Ronzitti et al.
evaluating the specic forms of gambling in which the
client was involved. For each type of gambling activi-
ty, we asked if the client had ever practiced it, if she
had gambled on it in the past year and in the last 30
days, the number of gambling days in the past 30 days
and the total time spent per typical day. The specic
forms of gambling we inquired about were lottery or
scratch cards, internet gambling on computer or mobile
phone, and interactive TV or telephone; betting sports
at bookmaker or sports events, gaming machines,
Fixed Odd Betting Terminal (FOBT), casino table
games, bingo, and other forms of gambling.
Statistical analysis
Analysis was carried out using SPSS version 20.0 for
Windows. All the hypothesis tests were performed using
two-sided signicance level (α=0.05). First, differences
between the genders were tested for the signicance with
chi-square and Fishers exact testing for categorical vari-
ables, and two-tailed t-test for continuous variables, and we
calculated the odd ratio for signicant variables. For con-
tinuous variables, we also used a non-parametric alternative
to the t-test (MannWhitney U) as a control test, which is
usually used when there was a reason to believe that data
were not normally distributed. Since the results were iden-
tical, we have only reported the t-test results. Finally,
variables were entered into a logistic regression to determine
whether gender was related to categorical- and continuous-
independent variables, using NagelkerkesR
1991). Since the previous research in this eld is limited, we
used stepwise methods to include all variables in the
analysis as predictors, independently from the signicance
shown at bivariate level. We used gender as dependent
Ethical approval was not needed as the collected data were a
part of the clinics standard battery of assessment forms.
Sociodemographic characteristics
Of the 1,178 pathological gamblers assessed, 1,090 (92.5%)
were males and 88 (7.5%) were females. The subjects were
adults (18 years or older) with an average age of 36 years
old. Most of the subjects were white (74.8%), single
(53.7%), had at least a secondary educational degree
(77.8%), and were employed (66.6%). Males were younger
than females (average age of 35 versus 41, p<.001) and
were more likely to be white (p=.016; OR =1.75, 95% CI:
1.11; 2.79) and employed (p<.001; OR =2.06, 95% CI:
1.32; 3.23) (Table 1).
Gambling behavior
In terms of GD severity, there were signicant differences in
PGSI scores between males and females (average 19.67
versus 21.61, p=.001). Furthermore, men presented earlier
onset of gambling than women (average 22.97 versus 30.68,
p<.001), and longer duration of GD before contacting the
clinic (mean 12.23 versus 9.52, p=.048). Information about
the type of gambling activity over the last year was available
Table 1. Sociodemographic characteristics of the sample by gender (n=1,178)
N(%) OR (CI 95%)
Mean (SD) 35.34 (10.72) 41.09 (9.95) 35.77 t=4.839
White 791 (75.7%) 55 (64.0%) 846 (74.8%) 1.75 (1.11; 2.79) X
(p=.016)Not white 254 (24.3%) 31 (36.0%) 285 (25.2%) 1.00
Marital status
Married or cohabitant 385 (38.2%) 25 (32.0%) 410 (37.7%) X
(p=.064)Divorced or separated 79 (7.8%) 11 (14.1%) 90 (8.3%)
Widowed 2 (0.2%) 1 (1.3%) 3 (0.3%)
Single 543 (53.8%) 41 (52.6%) 584 (53.7%)
Employed 718 (67.9%) 42 (50.6%) 760 (66.6%) 2.06 (1.32; 3.23) X
(p<0.001)Unemployed 117 (16.7%) 10 (12.1%) 187 (16.4%) 1.00
Student 39 (3.7%) 1 (1.2%) 40 (3.5%)
Retired 16 (1.5%) 2 (2.4%) 18 (1.6%)
Other 108 (10.2%) 28 (33.7%) 136 (11.9%)
Educational level
None 141 (15.6%) 7 (10.3%) 148 (15.2%) X
(p=.034)CGSE or equivalent 429 (47.3%) 35 (51.5%) 464 (47.6%)
Degree or more 278 (30.7%) 16 (23.5%) 294 (30.2%)
Other 58 (6.4%) 10 (14.7%) 68 (7.0%)
Journal of Behavioral Addictions 5(2), pp. 231238 (2016) |233
Treatment-Seeking Pathological Gamblers
for 1087 patients. The most popular gambling activities in
the year prior to the assessment were lottery/scratch cards
(77.9%), betting at bookmakers or at sports events (65.8%)
and FOBT gambling (64.8%). Data about the type of
gambling in the past month were available for 903 subjects.
The most popular gambling activities in the 30 days prior to
assessment were lottery and scratch cards (56.4%) FOBT
gambling (52.0%) and betting at bookmakers or at sports
events (47.4%). There were signicant sex differences:
males were more likely to be involved in casino table games
(p=.002, OR =2.30, 95% CI: 1.35; 3.91), FOBT (p<.001,
OR =4.97, 95% CI: 3.00; 8.22), sports betting (p<.001,
OR =15.77, 95% CI: 8.01; 31.04), and other forms of
gambling (p=.004, OR =6.28, 95% CI: 1.52; 25.83), while
women were more likely to play bingo (p<.001, OR =
0.13, 95% CI: 0.08; 0.23). The analysis of the gambling
behavior in the 30 days prior to assessment conrmed one-
year results for FOBT (p<.001, OR =3.40, 95% CI: 1.93;
6.00), sports betting (p<.001, OR =10.17, 95% CI: 4.35;
23.79), and bingo (p<.001, OR =0.12, 95% CI: 0.05;
0.28). Furthermore, males were more likely to be involved
in multiple types of gambling both in last-year data (average
3.93 versus 3.01; p<.001) and in data from the last 30 days
(average 2.59 versus 2.13; p=.002), as reported in Table 2.
Clinical variables
Female gamblers were more anxious and depressed with a
higher mean score in GAD-7 (12.64 versus 10.10, p<.001)
and PHQ-9 scales (16.63 versus 12.56, p<.001), while men
had a higher mean score in the AUDIT-C scale (4.78 versus
3.41, p<.001). Furthermore, men were more likely to use
drugs (p<.007, OR =3.75, 95% CI: 1.35; 10.40) and
alcohol (p<.001, OR =2.35, 95% CI: 1.45; 3.81) in the
30 days prior to assessment. No signicant gender-related
differences were found in smoking behavior (Table 3).
Logistic regression analysis
Variables with signicant gender results (p<0.01) were
considered together in a multivariate analysis; the most
salient correlates of gender were: male are more likely to
be engage in FOBT (p<.001, AOR 0.09, 95% CI: 0.03;
0.34) and sports betting gambling (p=0.011, AOR 0.06,
95% CI: 0.01; 0.55), while women are more likely to be
older (p=.001, AOR 1.08, 95% CI: 1.03; 1.13), report an
higher PHQ-9 score (p=.004, AOR 1.12, 95% CI: 1.04;
1.21), and to engage in bingo (p=.006, AOR 113.71, 95%
CI: 3.94; 3,284.83) (Table 4).
The present study aimed to examine sociodemographic, gam-
bling-related, and clinical variables in a treatment-seeking
sample of pathological gamblers as well as to analyze gen-
der-related characteristics. The data suggest relevant differ-
ences between male and female treatment-seeking gamblers.
Our sociodemographic ndings were partially in accor-
dance with the few similar studies in the literature as the
majority of the treatment seekers had at least a secondary
degree, were employed, and belonged to the countrys
ethnic majority (Braun, Ludwig, Sleczka, Bühringer, &
Kraus, 2014;Volberg, 1994). There were mixed ndings
as to how marital status inuences the odds of attending
treatment (Braun et al., 2014;Granero et al., 2009;
Weinstock, Burton, & Rash, 2011), with one similar study
nding that female gamblers were more likely to be di-
vorced/widowed (Echeburúa et al., 2011). These results
might be partially explained by the fact that, as shown by
Evans and Delfabbro (2005), the primary motivations of
help seeking among problem gamblers were crisis driven,
and therefore the loss of a relationship, or a job, would be a
motivator for seeking professional help. However, in the
present study, a majority of male and female subjects were
employed, as was the case in one of the previous study
(Lahti et al., 2013), and more than half of male and female
subjects were never married, and not currently in a relation-
ship. We can also hypothesize that differing levels of
availability and perception of professional help seeking for
problematic gambling might inuence treatment-seeking
rates, regardless of family status. In keeping with previous
ndings (Echeburúa et al., 2011), a signicant difference in
age between male and female participants was found in our
sample as treatment-seeking females were signicantly
older than their male counterparts.
Another important result in the present study was that
males were more likely than females to be employed, and to
belong to the majority ethnic group. To our knowledge, this
is the rst such nding on a large sample. Although many
research studies have shown that GD prevalence is higher
among minority ethnicity groups; only a small percentage
from this group has sought help from the clinic (25.2%).
Females from ethnic minorities are more likely to seek
treatment compared to men (36.0% versus 24.3%), con-
rming that they may be a particular group at risk of
developing GD.
Together, these ndings support other studies and high-
light the need to make the clinic services more available or
attractive to minority groups. Language difculties and
cultural barriers could negatively impact on treatment entry
and utilization among a non-British population (Braun
et al., 2014;Potenza et al., 2001). Lower socioeconomic
class and an ethnic minority status have already been
recognized as probable obstacles to treatment access (Braun
et al., 2014;Weinstock et al., 2011); although the results in
the present study must be interpreted with caution, as
neither employment status nor ethnicity can be considered
as a direct measure of the socioeconomic status, they might
suggest that the negative effects of socioeconomic vulner-
ability factors on treatment access can be even greater on
In relation to gambling behavior variables, and unlike
previous studies (Echeburúa et al., 2011;Lahti et al., 2013),
we found that women had higher gambling severity scores.
This difference was statistically signicant, although small,
when considering the effect size. One possible explanation
could be that the increased gambling severity among treat-
ment-seeking women may reect the fact that women are
less likely than men to seek treatment, and therefore the
severity of the cases that reach clinical attention might be
higher. Another possible explanation is the fact that, in the
234 |Journal of Behavioral Addictions 5(2), pp. 231238 (2016)
Ronzitti et al.
Table 2. Comparison of gambling behavior by sex
Variable Male Female OR (CI 95%)
Problem Gambling Severity Index mean (SD) 19.67 (5.07) 21.61 (4.80) t=3.345 (p=.001)
Age of onset (years) mean (SD) 22.97 (9.07) 30.68 (11.98) t=4.996 (p<.001)
Duration of GD (years) mean (SD) 12.23 (10.53) 9.52 (8.43) t=1.977 (p<.048)
Lottery or
scratch cards
Last year Yes N(%) 783 (77.6%) 64 (82.1%) X
=0.833 (p=.361)
Past 30 days Yes N(%) 469 (56.0%) 40 (60.6%) X
=0.520 (p=.471)
Internet on computer/
mobile phone,
interactive TV or
Last year Yes N(%) 627 (62.1%) 45 (57.7%) X
=0.607 (p=.436)
Past 30 days Yes N(%) 315 (37.6%) 31 (47.0%) X
=2.256 (p=.133)
Casino table games Last year Yes N(%) 429 (42.5%) 19 (24.4) 2.30 (1.35; 3.91) X
=9.853 (p=.002)
Past 30 days Yes N(%) 145 (17.3%) 7 (10.6%) X
=1.972 (p=.160)
Gaming machine Last year Yes N(%) 536 (53.1%) 48 (61.5%) X
=2.063 (p=.151)
Past 30 days Yes N(%) 295 (35.2%) 29 (43.9%) X
=2.010 (p=.156)
FOBT Last year Yes N(%) 681 (67.5%) 23 (29.5%) 4.97 (3.00; 8.22) X
=45.828 (p<.001)
Past 30 days Yes N(%) 453 (54.1%) 17 (25.8%) 3.40 (1.93; 6.00) X
=19.720 (p<.001)
Sports at bookmaker
or sports event
Last year Yes N(%) 705 (69.9%) 10 (12.8%) 15.77 (8.01; 31.04) X
=104.686 (p<.001)
Past 30 days Yes N(%) 422 (50.4%) 6 (9.1%) 10.17 (4.35; 23.79) X
=41.908 (p<.001)
Bingo Last year Yes N(%) 57 (5.6%) 24 (30.8%) 0.13 (0.08; 0.23) X
=66.248 (p<.001)
Past 30 days Yes N(%) 15 (1.8%) 9 (13.6%) 0.12 (0.05; 0.28) X
=33.172 (p<.001)
Others Last year Yes N(%) 143 (14.2%) 2 (2.6%) 6.28 (1.52; 25.83) X
=8.440 (p=.004)
Past 30 days Yes N(%) 53 (6.3%) 2 (3.0%) X
=1.166 (p=.280)
Involvement mean (SD)
(number of different
gambling activities played)
Last year 3.92 (1.52) 3.01 (1.20) t=6.330 (p<.001)
Past 30 days 2.58 (1.36) 2.13 (1.09) t=3.173 (p<.002)
Note. FOBT =Fixed Odd Betting Terminal.
Journal of Behavioral Addictions 5(2), pp. 231238 (2016) |235
Treatment-Seeking Pathological Gamblers
literature, women reported quicker development of prob-
lematic gambling, compared to men (Nelson et al., 2006).
A signicant gender difference in the age of onset of
problematic gambling behavior was also found, with
females beginning gambling much later than males and
reporting shorter of problematic gambling before contacting
the clinic. Possible explanations for this difference have
been grouped into two main conjectures: a direct effect of
gender on problematic gambling, and a concomitance of
gender, sociodemographic, and clinical factors (the gender-
as-proxytheory; Nelson et al., 2006). The empirical evi-
dence supporting a telescoping effectin the course of GD
among women is consistent, suggesting that women are
more likely than men to move rapidly through the multiple
landmark events associated with the development and pro-
gression of GD (Grant, Oldaug, & Mooney et al., 2012;
Potenza et al., 2001). However, a recent study among a non-
treatment population did not support this theory, and sug-
gested that the use of treatment-seeking samples may lead to
incorrect conclusion about gender differences (Slutske,
Piasecki, Deutsch, Statham, & Martin, 2015).
Bivariate and multivariate analysis on preferred gambling
types showed that male gamblers had a preference for
gambling on xed-odds-betting-terminals, and sports bet-
ting, whereas gambling on bingo was strongly correlated with
female gender. The distinction between FOBTs and regular
gaming machines is another new nding of the present study.
Contrary to the previous studies (Petry, 2003), we did not
nd signicant inter-gender difference concerning lower
stakes, regular gambling machines otherwise known as fruit
machines.However, in our analysis, males were shown to
have a preference for higher stakes gambling machines
(FOBT). It is possible to mention that, as a partial explana-
tion, the effect of structural and situational characteristics,
such as the size of bets and wins, payout schedule, and venues
in which these forms of gambling are available, namely,
authorized betting shops for FOBT, as opposed to pubs,
clubs, and arcades, as is the case for regular gaming machines
(Grifths, 1993), as well as different impulsivity proles
between men and women (Echeburúa et al., 2011); a similar
explanation might be applied, on the other hand, to preference
for bingo among women in our sample (Ledgerwood & Petry,
2006). Political, social, and cultural determinants, e.g., the
perceived acceptability/unacceptability of male and female
gamblers in different gambling settings, might also play a
very important role in gender-based preference for specic
gambling types (LaPlante et al., 2006).
We found a small, although signicant, difference in
gambling involvement, in which male gamblers participated
to more gambling activities than females, although they had
lower gambling severity. The role of gambling involvement
in treatment-seeking individuals has not yet been satisfac-
torily explored; however, it would appear that, in the general
population, gambling involvement is a better predictor of
problematic gambling development than any individual
form of gambling, with the notable exception of FOBT
machines, the usage of which had a strong association with
problematic gambling behavior (LaPlante, Nelson, LaBrie,
& Shaffer, 2011); this nding might partially explain the
high rates of FOBT players in our sample.
Analysis of psychopathological variables showed that
women had higher rates of anxious and depressive symp-
toms with respect to men. These results reect previous
ndings on the GD population (Granero et al., 2009), and
might suggest that women are more inclined to utilize
gambling in an escape-oriented paradigm, a result that is
compatible with the pathways model of problem gambling
initiation, as postulated by Blaszczynski and Nower (2002).
Similar to the previous research (Grant & Potenza, 2005),
we found no signicant difference between males and
females for tobacco smoking. However, in contrast with
the previous results (Granero et al., 2009), we found that
Table 3. Comparison of clinical variables by sex
Variable Male Female OR (CI 95%)
Patient Health Questionnaire score mean (SD) 12.56 (7.12) 16.63 (7.19) t=4.941 (p<.001)
Generalized Anxiety Disorder score mean (SD) 10.10 (6.11) 12.64 (6.12) t=3.609 (p<.001)
Alcohol Use Disorders Identication Test
consumption score mean (SD)
4.78 (2.87) 3.41 (2.83) t=4.091(p<.001)
Use of drugs in
pre-assessment month
Yes N(%) 171 (17.0%) 4 (5.2%) 3.75 (1.35; 10.40) X
=7.401 (p=.007)
Use of alcohol in
pre-assessment month
Yes N(%) 789 (78.7%) 47 (61.0%) 2.35 (1.45; 3.81) X
=12.702 (p<.001)
Smokers Yes N(%) 463 (63.5%) 40 (65.6%) X
=0.103 (p=.748)
Table 4. Signicant results of logistic regression analysis
BSE Exp (B) 95% CI p
Age of onset 0.079 0.023 1.04 1.03; 1.13 .001
PHQ-9 score 0.112 0.039 1.12 1.04; 1.21 .004
Engaging in FOBT gambling 2.368 0.654 0.09 0.02; 0.34 <.001
Engaging in sports betting 2.796 1.106 0.06 0.01; 0.55 .011
Engaging in bingo 4.734 1.716 113.71 3.93; 3,284.83 .006
Note. PHQ-9 =Patient Health Questionnaire; FOBT =Fixed Odd Betting Terminal. Adjusted odd ratio [i.e., Exp (B)] greater than 1 imply
that variables are more likely to be present in females than males. Number of observations =380, X
=82.229, R
=.476, and p<0.001.
236 |Journal of Behavioral Addictions 5(2), pp. 231238 (2016)
Ronzitti et al.
males had higher levels of alcohol abuse, and higher rates of
consumption of illicit drugs. It was proposed that, in the
general population, social gender roles and biological dif-
ferences in relation to alcohol might mediate a higher level
of alcohol consumption for males. This explanation would
also be in concordance with previous ndings among
treatment-seeking pathological gamblers, showing that pa-
rental history of alcohol abuse did not signicantly differ
between genders (Grant & Kim, 2002).
It is to be mentioned that 32% of the original sample did
not complete the assessment procedure and was therefore
excluded from our analysis; one possible hypothesis on how
these assessment dropout rates might have affected our
results is that subjects who did not complete the assessment
procedures might have been patients with less severe symp-
toms who did not perceive the treatment of their gambling
behavior as essential; another hypothesis is that subjects who
did not complete the assessment were, on the other hand,
more severe gamblers, e.g., the antisocial impulsivist
gamblers, as described by Blaszczynski and Nower (2002).
The present study presented some limitations. First, we
only considered a treatment-seeking population, which was
shown to differ from the general gambling population, with
lower proportions of women, people from ethnic minorities,
and less severe problematic gamblers (Braun et al., 2014);
moreover, the clinics geographical location in the heart of a
densely populated and ethnically diverse city, as well as the
clinics own referral process and ethnic preferences in terms
of gambling behavior and gambling treatment seeking might
have further inuenced the results in terms of our samples
ethnic composition (Forrest & Wardle, 2011). Therefore, the
ndings in the present study cannot be generalized to all
pathological gamblers. A further limitation was the fact that
the measures we used were self-reported, and therefore
might suffer from recall biases. Moreover, the cross-
sectional nature of the study does not allow to verify clinical
and sociodemographic variables over time in their relation
to gambling behavior; therefore, longitudinal studies on
gender differences among treatment-seeking gamblers, in-
cluding the evolution of gambling-related, and clinical
variables would help shed more light on how gender
differences inuence the natural history of GD. Among the
strengths of this study, we cite its large sample, the fact this
is the rst study of its kind in the UK and the large number
of gambling-related variables gathered.
In conclusion, our ndings support the importance of
bearing in mind gender differences in a treatment-seeking
population of pathological gamblers, not only in terms of
sociodemographic characteristics, but also in terms of dif-
ferent gambling behaviors and clinical variables. On the
grounds of this work, we highlight the need for new
methods of empowerment and involvement in treatment,
particularly for women, to improve the access and retention
in treatment. An even greater deal of attention is suggested
in the treatment of women from minority ethnic groups and
lower socioeconomic classes.
Second, we suggest that the differences between higher
and lower stakes machines should be considered in further
studies on GD. A third implication of this study is that, due
to different gambling behavior patterns, gambling motives,
and psychiatric comorbidities, male and female gamblers
might benet from group-specic treatment offers.
Founding sources: No nancial support was received for
this study.
Authorscontribution: SR: study concept and design, anal-
ysis and interpretation of data, drafting of manuscript; VL:
interpretation of data, drafting of manuscript; NS: acquisi-
tion of data; MC: study supervision; HBJ: interpretation of
data, study supervision, critical revision.
Conict of interest: The authors declare no conict of
American Psychiatric Association. (2013). Diagnostic and statis-
tical manual of mental disorders (5th ed.). Arlington, VA:
American Psychiatric Association.
Blanco, C., Hasin, D. S., Petry, N., Stinson, F. S., & Grant, B. F.
(2006). Sex differences in subclinical and DSM-IV pathologi-
cal gambling: Results from the National Epidemiologic Survey
on Alcohol and Related Conditions. Psychological Medicine,
36, 943953. doi:10.1017/S0033291706007410
Blaszczynski, A., & Nower, L. (2002). A pathways model of
problem and pathological gambling. Addiction, 97, 487499.
Braun, B., Ludwig, M., Sleczka, P., Bühringer, G., & Kraus, L.
(2014). Gamblers seeking treatment: Who does and who
doesnt? Journal of Behavioral Addictions, 3, 189198.
Bush, K., Kivlahan, D. R., McDonell, M. B., Fihn, S. D., &
Bradley, K. A. (1998). The AUDIT alcohol consumption
questions (AUDIT-C): An effective brief screening test for
problem drinking. Archives of Internal Medicine, 158, 1789
1795. doi:10.1001/archinte.158.16.1789
Echeburúa, E., González-Ortega, I., de Corral, P., & Polo-L´opez,
R. (2011). Clinical gender differences among adult pathologi-
cal gamblers seeking treatment. Journal of Gambling Studies,
27, 215227. doi:10.1007/s10899-010-9205-1
Evans, L., & Delfabbro, P. H. (2005). Motivators for change and
barriers to help-seeking in Australian problem gamblers. Jour-
nal of Gambling Studies, 21, 133155. doi:10.1007/s10899-
Ferris, J. A., & Wynne, H. J. (2001). The Canadian problem
gambling index: User manual. Toronto: Canadian Centre on
Substance Abuse.
Forrest, D., & Wardle, H. (2011). Gambling in Asian communities
in Great Britain. Asian Journal of Gambling Issues and Public
Health, 2, 216. doi:10.1186/BF03342121
Granero, R., Penelo, E., Martínez-Giménez, R., Alvarez-Moya, E.,
omez-Pe ˜na, M., Aymamí, M. N., Bueno, B., Fernández-
Aranda, F., & Jiménez-Murcia, S. (2009). Sex differences
among treatment-seeking adult pathologic gamblers.
Comprehensive Psychiatry, 50, 173180. doi:10.1016/j.
Journal of Behavioral Addictions 5(2), pp. 231238 (2016) |237
Treatment-Seeking Pathological Gamblers
Grant, J. E., & Kim, S. W. (2002). Gender differences in patho-
logical gamblers seeking medication treatment. Comprehen-
sive Psychiatry, 43, 5662. doi:10.1053/comp.2002.29857
Grant, J. E., Oldaug, B. L., & Mooney, M. E. (2012). Telescoping
phenomenon in pathological gambling: Association with gen-
der and comorbidites. Journal of Nervous and Mental Disease,
200, 996998. doi:10.1097/NMD.0b013e3182718a4d
Grant, J. E., & Potenza, M. N. (2005). Tobacco use and pathologi-
cal gambling. Annals of Clinical Psychiatry, 17, 237241.
Grifths, M. D. (1993). Fruit machine gambling: The importance
of structural characteristics. Journal of Gambling Studies, 9,
101120. doi:10.1007/BF01014863
Grifths, M., Wardle, H., Orford, J., Sproston, K., & Erens, B.
(2009). Sociodemographic correlates of Internet gambling:
Findings from the 2007 British gambling prevalence survey.
CyberPsychology & Behavior, 12, 199202. doi:10.1089/
Holtgraves, T. (2009). Evaluating the problem gambling severity
index. Journal of Gambling Studies, 25, 105120.
Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9:
Validity of a brief depression severity measure. Journal of
General Internal Medicine, 16, 606613. doi:10.1046/j.1525-
Kroenke, K., Spitzer, R. L., Williams, J. B., & Löwe, B. (2010).
The patient health questionnaire somatic, anxiety, and depres-
sive symptom scales: A systematic review. General Hospital
Psychiatry, 32, 345359. doi:10.1016/j.genhosppsych.
Kroenke, K., Spitzer, R. L., Williams, J. B., Monahan, P. O., &
Löwe, B. (2007). Anxiety disorders in primary care: Preva-
lence, impairment, comorbidity and detection. Annals of
Internal Medicine, 146, 317325. doi:10.7326/0003-4819-
Lahti, T., Halme, J., Pankakoski, M., Sinclair, D., & Alho, H.
(2013). Characteristics of treatment seeking Finnish pathologi-
cal gamblers: Baseline data from a treatment study. Interna-
tional Journal of Mental Health and Addiction, 11, 307314.
LaPlante, D. A., Nelson, S. E., LaBrie, R. A., & Shaffer, H. J.
(2006). Men & women playing games: Gender and the gam-
bling preferences of Iowa gambling treatment program parti-
cipants. Journal of Gambling Studies, 22, 6580. doi:10.1007/
LaPlante, D. A., Nelson, S. E., LaBrie, R. A., & Shaffer, H. J.
(2011). Disordered gambling, type of gambling and gambling
involvement in the British Gambling Prevalence Survey 2007.
European Journal of Public Health, 21, 532537. doi:10.1093/
Ledgerwood, D. M., & Petry, N. M. (2006). Psychological experience
of gambling and subtypes of pathological gamblers. Psychiatry
Research, 144, 1727. doi:10.1016/j.psychres.2005.08.017
Melville, K. M., Casey, L. M., & Kavanagh, D. J. (2007).
Psychological treatment dropout among pathological gamblers.
Clinical Psychology Review, 27, 944958. doi:10.1016/j.
Meneses-Gaya, C., Zuardi, A. W., Loureiro, S. R., Hallak, J. E.,
Trzesniak, C., de Azevedo Marques, J. M., Machado-de-Sousa,
J. P., Chagas, M. H., Souza, R. M., & Crippa, J. A. (2010). Is
the full version of the AUDIT really necessary? Study of the
validity and internal construct of its abbreviated versions.
Alcoholism Clinical and Experimental Research, 34, 1417
1424. doi:10.1111/j.1530-0277.2010.01225.x
Nagelkerke, N. J. D. (1991). A note on a general denition of the
coefcient of determination. Biometrika, 78, 691692.
Nelson, S. E., LaPlante, D. A., LaBrie, R. A., & Shaffer, H. J.
(2006). The proxy effect: Gender and gambling problem
trajectories of Iowa gambling treatment program participants.
Journal of Gambling Studies, 22, 221240. doi:10.1007/
Petry, N. M. (2003). A comparison of treatment-seeking patholog-
ical gamblers based on preferred gambling activity. Addiction,
98, 645655. doi:10.1046/j.1360-0443.2003.00336.x
Petry, N. M., Stinson, F. S., & Grant, B. F. (2005). Comorbidity of
DSM-IV pathological gambling and other psychiatric disor-
ders: Results from the National Epidemiologic Survey on
Alcohol and Related Conditions. The Journal of Clinical
Psychiatry, 66, 564574. doi:10.4088/JCP.v66n0504
Potenza, M. N., Steinberg, M. A., McLaughlin, S. D., Wu, R.,
Rounsaville, B. J., & OMalley, S. S. (2001). Gender-related
differences in the characteristics of problem gamblers using a
gambling helpline. The American Journal of Psychiatry, 158,
15001505. doi:10.1176/appi.ajp.158.9.1500
Slutske, W. S. (2006). Natural recovery and treatment-seeking in
pathological gambling: Results of two U.S. national surveys.
The American Journal of Psychiatry, 163, 297302.
Slutske, W. S., Piasecki, T. M., Deutsch, A. R., Statham, D. J., &
Martin, N. G. (2015). Telescoping and gender differences in
the time of course of disordered gambling: Evidence from a
general population sample. Addiction, 110, 144151.
Spitzer, R. L., Kroenke, K., Williams, J. W., & Löwe, B. (2006). A
brief measure for assessing generalized anxiety disorder: The
GAD-7. Archives of Internal Medicine, 166, 10921097.
Tang, C. S., Wu, A. M. S., & Tang, J. Y. C. (2007). Gender
differences in characteristics of Chinese treatment-seeking
problem gamblers. Journal of Gambling Studies, 23, 145156.
Tavares, H., Zilberman, M. L., Beites, F. J., & Gentil, V. (2001).
Gender differences in gambling progression. Journal of
Gambling Studies, 17, 151159. doi:10.1023/
Volberg, R. A. (1994). The prevalence and demographics of
pathological gamblers: Implications for public health. Ameri-
can Journal of Public Health, 84, 237241. doi:10.2105/
Wardle, H., Moody, A., Spence, S., Orford, J., Volberg, R.,
Jotangia, D., Grifths, M., Hussey, D., & Dobbie, F.
(2010). British gambling prevalence survey 2010. London: The
Stationery Ofce.
Weinstock, J., Burton, S., & Rash, C. (2011). Predictors of
engaging in problem gambling treatment: Data from the West
Virginia Problem Gamblers Help Network. Psychology of
Addictive Behaviors, 25, 372379. doi:10.1037/a0023240
238 |Journal of Behavioral Addictions 5(2), pp. 231238 (2016)
Ronzitti et al.
... When only taking such studies into account, considerably more men than women seek treatment for their gambling disorder (14)(15)(16)(17)(18)(19). The largest differences were observed in treatment-seekers from Britain, where 92.5% were men and 7.5% were women (20). This is comparable to a study in a treatment-seeking population in Sweden in where 80% were men and 20% were women (19). ...
... Moreover, it has been reported that woman are older than men when they enter treatment (15,17,18,(20)(21)(22), that they tend to progress to gambling disorder faster and that they seek treatment earlier than men (14,15,(21)(22)(23)(24)(25)(26)(27)(28)(29). However, in a sample of 2,256 gamblers seeking treatment, gender contribution to problem progression did not differ when age at onset and age of gambling initiation were taken into account (30). ...
... Most studies also report that women often live alone, i.e., are likely to be divorced or widowed (21). They report that feelings of loneliness can trigger gambling initiation (35); and they are more likely to be retired, unemployed, or outside the workforce (20,22,36) or have problems with their professional life (34). However, the opposite has also been observed, with treatmentseeking women more likely to be married, living with family, and having dependent children (17). ...
Full-text available
Introduction The purpose of this study was to explore clinical differences in Swedish treatment-seeking men and women with gambling disorder (GD). As the prevalence of GD is increasing among women, even though men are still highly overrepresented, the characteristic differences between men and women seeking treatment become increasingly important. Method A sample of 204 patients with GD (26.5% women and 73.5% men) at an outpatient clinic were diagnosed using the SCI-GD, screened for comorbid diagnoses using the MINI, and further completed a range of self-report questionnaires measuring demographics, GD, alcohol and other drug problems, symptoms of depression and anxiety, and pathways into gambling problems. Results Several characteristics differed between treatment-seeking men and women in our sample. Examples of differences between genders included age, onset age, living situation, duration, alcohol and drug problems, comorbidity, and pathways leading to gambling problems. Discussion The most evident difference was that women, in addition to GD, showed more symptoms of anxiety and depression than men, while men had a higher degree of substance use problems compared to women. The differences in clinical features between men and women are important to consider in treatment planning and possibly for future gender-based interventions.
... We identified 11 studies providing information on sex differences for sociodemographic variables (Blanco et al., 2006;Bonnaire et al., 2016Bonnaire et al., , 2017Castrén, Kontto, Alho, & Salonen, 2018;Granero et al., 2009;Grant, Chamberlain, Schreiber, & Odlaug, 2012;Guillou-Landreat et al., 2016;Hing, Russell, Tolchard, & Nower, 2016;Jiménez-Murcia et al., 2020;Ronzitti, Lutri, Smith, Clerici, & Bowden-Jones, 2016;Vogelgesang, 2009). Education, income, employment status, and household composition were defined as variables of interest. ...
... All showed that, on average, men with PrG had a higher monthly income than women with PrG. Concerning unemployment, two of three studies found women more likely to be unemployed Ronzitti et al., 2016). Only Vogelgesang (2009) reported equivalent unemployment levels for men and women with PG, which, however, refer to a small sample size. ...
... The 14 studies included indicate that women who gambled prefer non-strategic types of gambling (bingo, lottery, scratch cards), whereas men who gamble prefer more strategic games (casino games, horse race and sports betting) (Bonnaire et al., 2017;Leung & Tsang, 2011;Lopez-Gonzalez, Russell, Hing, Estévez, & Griffiths, 2020;Nong, Fong, Fong, & Lam, 2020;Nower & Blaszczynski, 2006;Odlaug et al., 2011;Potenza et al., 2006;Ronzitti et al., 2016;Stevens & Young, 2010;Svensson & Romild, 2014;Toneatto & Wang, 2009;van der Maas et al., 2018;Williams et al., 2013). However, age may be an important confounding factor as younger age is associated with a preference for strategic games and men who gamble tend to start gambling earlier (Bonnaire et al., 2017;Odlaug et al., 2011). ...
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Background and aim A wide range of studies indicates that men and women with Problem (PrG) and Pathological Gambling (PG) differ in several clinical and sociodemographic characteristics. However, evidence for sex differences, such as the telescoping effect, is contradictory, and it is still unclear whether sex differences observed in offline gambling can also be found for online gambling. Furthermore, reviews have so far focused on binary sex differences but neglect gender aspects. In this study, an updated literature survey of sex- and gender-related differences in PrG and PG was conducted. Methods We searched PsyInfo, Medline/Pubmed, and the Web of Science databases from 2005 to 2020 for studies investigating sex and gender differences in gambling. A total of 126 papers were included in the literature survey. Results We are presenting our findings according to the categories ‘prevalence’ (offline, online, LGBTQI*), ‘sociodemographic factors’, ‘preferred gambling type’, ‘gambling motives’, ‘severity’, ‘progression of gambling problems’, ‘use of professional help/motivation for treatment’, ‘comorbidity’, ‘trauma’, ‘violence and criminality/delinquency’. The studies indicate that, despite some robust sex differences (e.g., concerning prevalence rates), results for most areas were mixed or suggest no sex differences (e.g., violence, gambling motives). Discussion and conclusion To date, there is a lack of studies assessing gender, and not only sex, warranting further research in this area.
... Several specific risk factors for problem gambling have been identified. Several studies confirmed that among the socio-demographic characteristics, male gender [19,[30][31][32] and a low level of education [33,34] are those most recognised and studied as well as substance use problems, high level of anxiety and a poor quality of life [1]. College students are one of the populations most at risk for pathological gambling [35]: college years are often associated with behaviours such as drinking and drug use; exam pressure can be a source of stress that is difficult to manage; accumulated tuition debt can seem insurmountable. ...
... As stated earlier, our sample does not allow us to draw firm conclusions, but it is our idea that spending time on education on this topic can have a positive influence in generating reflections on the topic of gambling. After all, the level of education is identified as a valuable factor accompanying problem gambling [31,48]. ...
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The Italian version of the South Oaks Gambling Screen questionnaire (SOGS) and a socio-demographic questionnaire were administered to a sample of 275 healthcare professions students aged 19 to 58 years (mean age = 22.17; females = 81.1%) to address the research objectives: to examine the prevalence and correlates of problem gambling in a population of university healthcare professions students in Italy. Among the sample, 8.7% (n = 24) of participants showed problem gambling and 1.5% (n = 4) pathologic gambling. Lottery and scratch cards were the most frequent type of gambling in the sample, followed by cards and bingo. Compared to females, males tend to be more involved in problem gambling and pathological gambling. Males tend to be more involved than females in different types of gambling (such as cards, sports bets, gambling at the casino). Pathological gambling is positively associated with gender, being students lagging behind the regular schedule of exams and parents' level of education. These findings have important implications in terms of prevention and intervention on gambling and pathological gambling. Universities should make available educational programs and counselling services to address this issue.
... In addition, adolescent males show greater attention biases toward sexual cues and present higher prevalence of Compulsive Sexual Behavior Disorder (Efrati & Amichai-Hamburger, 2021). The prevalence of gambling disorders in young people aged between 11 and 16 was estimated at 4.6% (Calado et al., 2017;Montiel et al., 2021), and, again, is more frequent in men than in women in adulthood (Ronzitti et al., 2016). Similarly, studies on gaming addiction have shown a higher prevalence in males than in females (Efrati et al., 2021a(Efrati et al., , 2021b. ...
... In line with the trends noted in the literature, our study confirmed male participants identifying themselves as having alcohol, tobacco, cannabis, gambling, video gaming, and sex-related addictions in greater proportions than females. The findings in this study are consistent with the results of other studies comparing the rates of addiction in men and women in terms of substance use disorder (CBHSQ, 2016;Martin et al., 2021); gambling (Ronzitti et al., 2016;Weidberg et al., 2018); video gaming (Efrati et al., 2021a(Efrati et al., , 2021bFam, 2018), and sex-related behavior (Efrati & Amichai-Hamburger, 2021;Kowalewska et al., 2020). In contrast, binge eating and social network addiction were associated with the female sample in higher proportions, corresponding with previous studies of adults that indicated higher levels of uncontrolled binge eating among women (Lewinsohn et al., 2002;Striegel-Moore et al., 2009). ...
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Unlike the consequences of substance and behavioral addictions and the profile of adolescents with substance and behavioral addictions that were extensively studied, the cognitive distortions that might be responsible to the development and maintenance of substance and behavioral addictions are less understood. The sample comprised 1948 adolescents (756 male and 1192 female) aged 14–18 years (mean age = 16.20 years; SD = 1.83) who completed the survey anonymously and with parental consent. We examined associations between substance and behavioral addictions and cognitive distortions in the form of early maladaptive schemas among adolescents. Results revealed that early maladaptive schemas are associated with adolescents’ substance and behavioral addictions. From a lay epidemiological perspective, the current research expands our knowledge about addiction among adolescents, offering potential insights for clinical applications.
... One phenomenon that has been identified regarding development of disordered gambling is "telescoping," which refers to accelerated progression from starting a potentially addictive behavior to reaching a disordered level of that behavior. In terms of gambling, it has been reported that women tend to start gambling later in life but progress faster from gambling onset to disordered gambling compared to men (González-Ortega et al., 2013;Grant et al., 2012;Ibáñez et al., 2003;Ladd & Petry, 2002;Potenza et al., 2001;Ronzitti et al., 2016;Tavares et al., 2001). Such a telescoping effect has also been observed related to other problems, such as alcohol and substance abuse (Hernandez-Avila et al., 2004;Piazza et al., 1989;Randall et al., 1999;Zilberman et al., 2004). ...
Objective: Telescoping refers to the accelerated progression from starting a potentially addictive behavior to reaching a disordered level. For disordered gambling, telescoping has been reported for women compared to men. Most previous studies on telescoping have used clinical samples and retrospective reports, but this study examined a nonclinical population of gamblers using electronically tracked gambling behavior. Method: The sample consisted of Norsk Tipping's Multix electronic gaming machine (EGM) customers during the period of March 2013-December 2018 (n = 184,113, 27.0% women, age range from 18 to 103 years, M = 41, SD = 16). We hypothesized that women would be older than men when first playing Multix and that the time between first playing Multix to reaching first loss limit (money one is allowed to lose) would be shorter for women compared to men. Results: Welch two-sample t tests revealed that women were older than men at Multix gambling onset (Women: M = 46, SD = 17; Men: M = 40, SD = 15; p < .001). Kaplan-Meier revealed a median survival time of 46 months, 95% CI [45, 47], for women and 55 months, 95% CI [54, 56], for men before the first loss limit. Cox regression showed higher risk for meeting the loss limit for women compared to men, HR = 1.22, 95% CI [1.20, 1.25], p < .001, when controlling for age. Conclusion: Prevention efforts should consider that adult women playing EGMs appear to be at risk for developing high-risk gambling faster than men. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
... In addition, males in this age group show greater attentional bias toward sexual cues and a higher prevalence of compulsive sexual behavior disorder (Efrati & Amichai-Hamburger, 2021). With regards to gambling, the prevalence of gambling disorder in young people aged between 11 and 16 years was estimated at 4.6% (Calado, Alexandre, & Griffiths, 2017;Montiel et al., 2021), and more frequent in men than in women in the adult group (Ronzitti et al., 2016). Similarly, studies on gaming addiction have shown a higher prevalence in males than in females (Efrati, Kolubinski, Marino, & Spada, 2021). ...
Full-text available
This study examined self-perceived substance and behavioral addictions among Israeli adolescents during the COVID-19 pandemic across different sociodemographic categories. The sample comprised 2,074 adolescents (40% males, 60% females) aged 12–19 years who completed the survey anonymously and with parental consent. We examined what is the prevalence of self-perceived substance and behavioral addictions in this population in the COVID-19 pandemic context. Participants reported self-perceived addictions to social networks (70%), shopping (46%), binge eating (34%), gaming (30%), sex-related behavior (15%), psychoactive substance (31%, including alcohol, tobacco, cannabis, and/or cocaine), and gambling (3%). Moreover, differences were found to be directly related to age, biological sex, religiosity, socioeconomic status, and immigration status. From a lay epidemiological perspective, the current research expands our knowledge about self-perceived addiction among adolescents during the COVID-19 pandemic, offering better understanding of the likelihood probability factors for self-perceived addiction among adolescents and its related negative outcomes, including increased risk factors for later adult life.
Although most individuals consider gambling to be an innocent and fun activity, when it develops into problem gambling, it can have detrimental outcomes to one's life, such as over-indebtedness. This cross-sectional study explores the role of maladaptive personality traits and gender in both problem gambling and over-indebtedness, in an online sample of 1479 adult gamblers (65% males) in Sweden. Participants were administered the Problem Gambling Severity Index (PGSI), the Personality Inventory for DSM-5-Brief Form (PID-5-BF), and questions addressing subjective over-indebtedness and other risk factors. Quasi-Poisson loglinear models and logistic regression analyses demonstrated that Disinhibition (OR = 1.38, 95% CI [1.24, 1.53]), and Antagonism (OR = 1.23, 95% CI [1.14, 1.34]) showed the strongest associations to problem gambling, and that only Disinhibition (OR = 1.72, 95% CI [1.22, 1.43]) and Antagonism (OR = 2.00, 95% CI [1.52, 2.66]) were significantly related to over-indebtedness. The prevalence of problem gambling and over-indebtedness was more common among women, and gender moderated the univariate relationships of Negative Affectivity, Disinhibition and Psychoticism to problem gambling. These findings call for future research addressing maladaptive personality traits, problem gambling and over-indebtedness, and highlight the need for tailored interventions and prevention strategies, particularly for women who may be at higher risk.
Gambling Disorder (GD) is a behavioural addiction that leads to high level of clinical distress and, in general, it is characterized by enduring symptomatology that presents high rates of chronicity. However, there is high variability of illness duration among patients who seek treatment for GD. Previous studies reported mixed results about the relevance of illness duration in GD treatment outcome. However, there are different profiles of patients who are diagnosed with GD. For this reason, this study aimed to evaluate the effect of illness duration in the treatment outcome of different profiles of GD patients according to their gambling preference and sex. The sample were 1699 patients diagnosed with GD. All patients received cognitive-behavioural therapy in a group format. Treatment outcome was evaluated in terms of relapsing to gambling behaviours and dropout from treatment. Results showed higher probability of poor outcome in the first years of the disorder for strategic gambling compared to non-strategic or mixed forms of gambling. Moreover, women also showed higher probability of poor outcomes than men since the first stages of the disorder. This study draws attention to the relevance of illness duration in the treatment outcome of specific profiles of GD patients. In particular, patients who presented a preference for strategic forms of gambling and women who are diagnosed with GD would have a higher risk of poor treatment outcomes since the first stages of the disorder. These results highlight the importance of an early intervention in these patients in order to prevent the chronicity of the disorder.
Con la riorganizzazione dei SerDP è stato progettato per la città di Bologna il Percorso DGA: la dipendenza da Gioco d'Azzardo è uscita dai SerDP cittadini ed è stato attivato un Servizio specialistico dedicato esclusivamente alla valutazione e cura dei pazienti affetti da Disturbo da Gioco d'Azzardo e famigliari. Il vantaggio di un ambulatorio specificatamente dedicato a tale problematica mette al centro il paziente e i suoi famigliari, come da PDTA, favorisce l'attivazione di programmi trattamentali, che nei SerDP provinciali non potrebbero essere erogati a causa del numero limitato di pazienti affetti da DGA afferenti al servizio.
Nel dibattito pubblico contemporaneo il tema del gioco d'azzardo risulta essere uno degli argomenti più dibattuti. Gli sviluppi informatici con le nuove modalità di giochi online hanno permesso infatti di ampliare il fenomeno rendendolo sempre più diffuso all'interno dei tessuti sociali delle nostre città. La riflessione teorica sembra però non stare al passo con le implicazioni sociali aperte da questo fenomeno. È del 1949, grazie agli studi di Edward Devereux, la prima analisi esplicitamente sociologica del gioco d'azzardo. Nell'ambito della sociologia non era ancora emerso un filone di studi sulle implicazioni sociali del gioco d'azzardo. Nel presente contributo si ripercorrerà la storia del contributo che le teorie sociologiche hanno dato allo studio di questo fenomeno, dividendo le prospettive ed i temi di analisi in due grandi scuole di pensiero: gli approcci funzionalisti, da Devereux in poi, e gli approcci disfunzionalisti, che hanno avuto in Herbert Bloch (1951) il loro capostipite.
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This paper examines the prevalence of gambling and problem gambling among people of Indian, Pakistani, and Bangladeshi cultural backgrounds living in Great Britain. Information was gathered from the last two versions of a large-scale national adult prevalence survey and a similar survey of children aged 11 to 15 years, all conducted since 2007. Together, the surveys yielded sub-samples of 589 Asian adults and 482 Asian children from a combined total of more than 16,000 adults and nearly 9,000 children. In both adult and child Asian populations, the 7-day participation rate in gambling (22% and 13%, respectively) was found to be low relative to that in the white majority community, yet problem gambling prevalence, measured by the adult Diagnostic and Statistical Manual of Mental Disorders, 4th edition screen (1.4%) and its juvenile equivalent (2.9%), was significantly higher, including among women. It therefore follows that those Asians who do gamble are unusually prone to experiencing problems, which has implications for public health policies such as the provision of information and help in minority languages. The relevance of the findings seems likely to extend to other countries with significantly sized Asian communities.
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Background and aims: As only a minority of pathological gamblers (PGr) presents for treatment, further knowledge about help-seeking behavior is required in order to enhance treatment utilization. The present study investigated factors associated with treatment participation in gamblers in Germany. As subclinical pathological gamblers (SPGr, fulfilling one to four DSM-IV-criteria) are target of early intervention due to high risk of transition to pathological gambling, they were subject of special interest. Methods: The study analyzed data from a general population survey (n = 234, SPGr: n = 198, PGr: n = 36) and a treatment study (n = 329, SPGr: n = 22, PGr: n = 307). A two-step weighting procedure was applied to ensure comparability of samples. Investigated factors included socio-demographic variables, gambling behavior, symptoms of pathological gambling and substance use. Results: In PGr, regular employment and non-German nationality were positively associated with being in treatment while gambling on the Internet and gaming machines and fulfilling more DSM-IV-criteria lowered the odds. In SPGr, treatment attendance was negatively associated with married status and alcohol consumption and positively associated with older age, higher stakes, more fulfilled DSM-IV criteria and regular smoking. Conclusions: In accordance to expectations more severe gambling problems and higher problem awareness and/or external pressure might facilitate treatment entry. There are groups with lower chances of being in treatment: women, ethnic minorities, and SPGr. We propose target group specific offers, use of Internet-based methods as possible adaptions and/or extensions of treatment offers that could enhance treatment attendance.
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This article describes the socio-demographic characteristics and gambling behavior of 39 pathological gamblers who participated in our treatment study in 2009. The inclusion criteria of the study were: score of five or more on both the South Oaks Gambling Screen (SOGS) and a pathological gambling screen based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). The first 39 patients meeting the inclusion criterion were recruited into the study. The average age of the subjects was 39 years, and 80 % were males. The lag-time between active gambling (at least three times per week) and the onset of a pathological gambling problem was short: within 2 years of active gambling, 62 % of the subjects reported having become pathological gamblers. Our results also indicated certain gender-specific differences in the age at initiation and in the severity of the gambling problem.
At the moment, there is no single conceptual theoretical model of gambling that adequately accounts for the multiple biological, psychological and eco- logical variables contributing to the development of pathological gambling. Advances in this area are hampered by imprecise definitions of pathological gambling, failure to distinguish between gambling problems and problem gam- blers and a tendency to assume that pathological gamblers form one, homoge- neous population with similar psychological principles applying equally to all members of the class. The purpose of this paper is to advance a pathways model that integrates the complex array of biological, personality, developmental, cognitive, learning theory and ecological determinants of problem and patho- logical gambling. It is proposed that three distinct subgroups of gamblers manifesting impaired control over their behaviour can be identified. These groups include (a) behaviourally conditioned problem gamblers, (b) emotion- ally vulnerable problem gamblers and (c) antisocial, impulsivist problem gam- blers. The implications for clinical management are discussed.
Background and aimThe course of disordered gambling in women has been described as “telescoped” compared with that in men, with a later age at initiation of gambling but shorter times from initiation to disorder. This study examined the evidence, for the first time, for such a telescoping effect in a general population rather than a treatment-seeking sample.Method Participants in a large community-based Australian twin cohort (2,001 men, 2,662 women) were assessed by structured diagnostic telephone interviews in which they reported the ages at which they had attained various gambling milestones and additional information to be used as covariates (the types of gambling in which they had participated and history of symptoms of alcohol dependence, major depression, and adult antisocial behavior). Cox proportional hazards regression models were used to examine differences between men and women in the time from gambling initiation to the first disordered gambling symptom and a diagnosis of disordered gambling.ResultsMen had a higher hazards than women for the time to the first disordered gambling symptom (HR = 3.13, p < .0001) and to a diagnosis of disordered gambling (HR = 2.53, p < .0001). These differences persisted after controlling for covariates. Earlier age of initiation was the most potent predictor of progression to the first symptom.Conclusions When assessed at the general population level, female gamblers do not appear to show a telescoped disordered gambling trajectory compared with male gamblers.
The course of pathological gambling (PG) in women has been described as having a later age of initiation but a shorter time to problematic gambling ("telescoped"). This study examined evidence for telescoping and its relationship with comorbidities. Seventy-one treatment-seeking individuals with PG underwent a diagnostic interview to examine gambling behaviors, age at initiation of gambling, and time from initiation to meeting criteria for PG. The women had a higher mean age at gambling initiation compared with that of the men (mean [SD] age, 31.3 [13.0] years, compared with 22.4 [7.9] years; p = 0.0003) and a significantly shorter time from initiation of gambling to meeting the criteria for PG (8.33 [8.7] years compared with 11.97 [9.1] years; p = 0.0476) after controlling for demographic and clinical variables. This study presents evidence for a gender-specific course of PG unrelated to psychiatric comorbidities and suggests a need for greater clinical focus on the gender differences of gambling behavior.
OBJECTIVE: While considerable attention has focused on improving the detection of depression, assessment of severity is also important in guiding treatment decisions. Therefore, we examined the validity of a brief, new measure of depression severity. MEASUREMENTS: The Patient Health Questionnaire (PHQ) is a self-administered version of the PRIME-MD diagnostic instrument for common mental disorders. The PHQ-9 is the depression module, which scores each of the 9 DSM-IV criteria as “0” (not at all) to “3” (nearly every day). The PHQ-9 was completed by 6,000 patients in 8 primary care clinics and 7 obstetrics-gynecology clinics. Construct validity was assessed using the 20-item Short-Form General Health Survey, self-reported sick days and clinic visits, and symptom-related difficulty. Criterion validity was assessed against an independent structured mental health professional (MHP) interview in a sample of 580 patients. RESULTS: As PHQ-9 depression severity increased, there was a substantial decrease in functional status on all 6 SF-20 subscales. Also, symptom-related difficulty, sick days, and health care utilization increased. Using the MHP reinterview as the criterion standard, a PHQ-9 score ≥10 had a sensitivity of 88% and a specificity of 88% for major depression. PHQ-9 scores of 5, 10, 15, and 20 represented mild, moderate, moderately severe, and severe depression, respectively. Results were similar in the primary care and obstetrics-gynecology samples. CONCLUSION: In addition to making criteria-based diagnoses of depressive disorders, the PHQ-9 is also a reliable and valid measure of depression severity. These characteristics plus its brevity make the PHQ-9 a useful clinical and research tool.
The authors compared 39 women and 38 men entering an outpatient treatment program for pathological gambling. They were diagnosed according to DSM-IV and selected by SOGS, followed by a semi-structured interview for demography and progression of the gambling behavior prior to treatment. Women were more often single (59% vs. 26%; p = .005) and started gambling significantly later than men (34.2 vs. 20.4 years; p < .001).="" the="" progression="" of="" the="" disorder="" was="" more="" than="" 2="" times="" faster="" in="" women="" than="" in="" men.="" there="" was="" no="" difference="" in="" the="" age="" of="" seeking="" treatment="" (44.7="" vs.="" 42.3="" years).="" findings="" from="" this="" study="" resemble="" gender="" differences="" in="" other="" addictions—in="" particular="" the="" faster="" progression="" among="" women—challenge="" pharmacodynamic="" hypotheses="" for="" this="" phenomenon,="" and="" suggest="" gender="" into="" account="" when="" devising="" treatment="" strategies="" for="" pathological="">