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Gambling knowledge and experience among clinical social workers
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Abstract
Despite the rapid expansion of legalized gambling, few social workers are trained to identify problem gambling symptoms. This study explored gambling knowledge, behavior, and problem symptoms in a sample of 1,777 clinical social workers through an online survey. Findings indicate about 77% of social workers gambled and more than 4% of those who gambled reported at least one problem gambling symptom. Participants answered less than half of the knowledge questions correctly, and a majority were unaware of the current diagnostic classification for gambling disorder or the legal age for gambling. Results of a multivariate regression analysis found that social workers in practice 8 to 15 years, employed in substance treatment facilities or universities, and/or with training in gambling treatment had higher levels of knowledge about gambling and gambling treatment. Findings underscore the need for social work schools and organizations to prioritize education and training for problem gambling identification and treatment.
... cognitive behavioral therapy similar to psychologists and psychiatrists. However, typically, they have not been trained to screen for or treat gambling disorder in the eight years since the disorder was recognized as an addiction in the DSM-5 (Nower et al., 2022). That is likely due to two factors. ...
Purpose
To explore the personal gambling behavior and problem symptoms of social workers and other mental health providers to gauge their level of self-awareness, an important prerequisite to identifying and assisting clients who gamble.
Method
A survey was conducted with a convenience sample of 2,317 social workers and other mental health providers.
Results
Bivariate and regression analyses found that than 76% of participants reported gambling in the past year, and nearly 30% gambled at moderate or high frequency. About 5% reported one or more problem gambling symptom. Nearly 78% of participants, endorsing between two and ten gambling activities, denied they gambled, and 23% gambled at moderate to high frequency. Overall, 55% of all participants with at least one problem gambling symptom denied gambling.
Discussion/Conclusion
It is critical for providers to receive training and education to understand their own gambling behaviors and problem symptoms, which could adversely impact the therapeutic relationship.
People experiencing poverty/homelessness have higher rates of problematic gambling than the general population. Yet, research on gambling among this population is sparse, notably among women. This study examined prevalence of problematic gambling among women using shelter and drop-in services in Ontario, Canada. The NORC Diagnostic Screen for Disorders was administered to women during visits to 15 sites using time/location methodology. Within a sample of 162 women, the prevalence of at-risk (6.2%), problem (9.3%), and pathological gambling (19.1%) was higher than the general population. Among women who scored at-risk or higher, 55.4% met criteria for pathological gambling. The findings suggest that women seeking shelter and drop-in services are vulnerable to problematic gambling. Creating awareness of this vulnerability within the shelter and drop-in service sector is an important first step to support women with gambling problems who face financial and housing precarity.
Gambling is an ordinary pastime for some people, but is associated with addiction and harmful outcomes for others. Evidence of these harms is limited to small-sample, cross-sectional self-reports, such as prevalence surveys. We examine the association between gambling as a proportion of monthly income and 31 financial, social and health outcomes using anonymous data provided by a UK retail bank, aggregated for up to 6.5 million individuals over up to 7 years. Gambling is associated with higher financial distress and lower financial inclusion and planning, and with negative lifestyle, health, well-being and leisure outcomes. Gambling is associated with higher rates of future unemployment and physical disability and, at the highest levels, with substantially increased mortality. Gambling is persistent over time, growing over the sample period, and has higher negative associations among the heaviest gamblers. Our findings inform the debate over the relationship between gambling and life experiences across the population.
Gambling problems commonly co-occur with other mental health problems. However, screening for problem gambling (PG) rarely takes place within mental health treatment settings. The aim of the current study was to examine the way in which mental health clinicians respond to PG issues. Participants (n = 281) were recruited from a range of mental health services in Victoria, Australia. The majority of clinicians reported that at least some of their caseload was affected by gambling problems. Clinicians displayed moderate levels of knowledge about the reciprocal impact of gambling problems and mental health but had limited knowledge of screening tools to detect PG. Whilst 77% reported that they screened for PG, only 16% did so “often” or “always” and few expressed confidence in their ability to treat PG. However, only 12.5% reported receiving previous training in PG, and those that had, reported higher levels of knowledge about gambling in the context of mental illness, more positive attitudes about responding to gambling issues, and more confidence in detecting/screening for PG. In conclusion, the findings highlight the need to upskill mental health clinicians so they can better identify and manage PG and point towards opportunities for enhanced integrated working with gambling services.
Background:
Neuroimaging and neuropsychological studies have suggested that common features characterize both Gambling Disorder (GD) and Alcohol Use Disorder (AUD), but these conditions have rarely been compared.
Methods:
We provide evidence for the similarities and differences between GD and AUD in neural correlates of executive functions by performing an activation likelihood estimation meta-analysis of 34 functional magnetic resonance imaging studies involving executive function processes in individuals diagnosed with GD and AUD and healthy controls (HC).
Results:
GD showed greater bilateral clusters of activation compared with HC, mainly located in the head and body of the caudate, right middle frontal gyrus, right putamen, and hypothalamus. Differently, AUD showed enhanced activation compared with HC in the right lentiform nucleus, right middle frontal gyrus, and the precuneus; it also showed clusters of deactivation in the bilateral middle frontal gyrus, left middle cingulate cortex, and inferior portion of the left putamen.
Conclusions:
Going beyond the limitations of a single study approach, these findings provide evidence, for the first time, that both disorders are associated with specific neural alterations in the neural network for executive functions.
Aim
To explore the views of professionals working within health, care and other agencies about harmful gambling among adults with health and social care needs.
Background
Gambling is increasingly seen as a public health rather than an individual problem. Opportunities to gamble have grown in England in the last decade since the liberalisation of the gambling industry meaning that gambling is widely available, accessible and advertised within society. An estimated two million people in the UK are at risk of developing a gambling problem, some of whom may be adults with health and social care needs.
Methods
Twenty-three key informants from primary care, social care services and third sector organisations in England were interviewed about their understanding of the risks to adults with health and social care needs from gambling participation.
Findings
Thematic analysis revealed four themes: (1) gambling-related harm as a public health problem; (2) identification of groups of adults with health and social care needs who may be vulnerable to gambling-related harm; (3) factors potentially impeding the identification of gambling-related harm among adults with health and social care needs and subsequent help-seeking behaviour and (4) calls for professional development activities. Informants reported a perceived lack of awareness of gambling-related harm and a lack of a clear pathway or guidance which they could follow when supporting individuals experiencing gambling-related harm. Interviewees called for professional development activities to improve their knowledge and expertise in this area.
It is well known that many problem gamblers also suffer from other psychiatric conditions. However, knowledge regarding the temporal sequencing of the conditions is lacking, as well as insight in possible gender specific patterns. The aim of this study was to examine the risk for psychiatric comorbidity among problem gamblers compared to non-problem gamblers in the general Swedish population, as well as the age of onset and the temporal sequencing of problem gambling and the comorbid psychiatric conditions among lifetime problem gamblers. A case–control study nested in the Swelogs cohort was used. For both the female and the male problem gamblers, the risk for having had a lifetime psychiatric condition was double or more than double compared to the controls. Having experienced anxiety or depression before gambling onset, constituted a risk for developing problem gambling for the women but not for the men. Further, the female cases initiated gambling after their first period of anxiety, depression and problems with substances, and problem gambling was the last condition to evolve. Opposite this, the male cases initiated gambling before any condition evolved, and depression and suicidal events emerged after problem gambling onset. There were large differences in mean age of onset between the female cases and their controls, this was not the case for the males. Gender specific patterns in the association between problem gambling and psychiatric comorbidity, as well as in the development of problem gambling needs to be considered in treatment planning as well as by the industry in their advertising.
Problem gambling is known to be prevalent among prisoners. However, it is not systematically screened and often remains undetected. This pilot study explores prison workers’ (N = 21) knowledge, views, and opinions about problem gambling in two Finnish prisons with a view to improving training and to developing better guidelines for identifying and responding to gambling problems. Four-fifths (81%) of prison workers considered problem gambling a serious issue in Finland. During the past year, more than nine in ten (94.1%) had encountered a prisoner with a gambling problem. Problem gambling was identified in connection with discussions about prisoners’ illegal activity (50%), financial situation (25%), or other problems (25%). Nearly half of the participants felt they did not have adequate training or information about problem gambling and related issues and expressed an interest in continuing education. This pilot study provides important direction for the development of tailored training programs for prison workers. The next step is to increase awareness of gambling programs in a wider national context and to develop and evaluate the effectiveness of training programs.
It is generally believed that there is an instrumental relationship between problem gambling and crime such that some gamblers resort to illegal activity to recoup financial shortfalls resulting from their gambling. However, a clear understanding of the risk factors for the commission of crimes beyond financial stresses is absent in the literature. The aim of this review was to identify the nature of crimes perpetrated by problem gamblers and the factors that contribute to the commission of gambling-related crimes. A systematic review adhering to guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement searching eight databases-PsycINFO, Westlaw AU, Heinonline, Legal Source via Ebsco, Legaltrac via Gale, PubMed, Scopus, and Medline-was conducted. A total of 21 papers were included after screening and application of exclusion criteria. All studies examined reported crimes committed by problem gamblers, with a validated assessment tool measuring problem gambling. The review provided evidence that gambling-related crime typically consists of non-violent, income-generating offences. However, it also revealed that problem gamblers may commit violent crimes at a higher than expected rate, which may have been concealed by deliberate and unintentional under-reporting of gambling-related crimes. The causal relationship between problem gambling and violent crime, however, remains uncertain. Based on this review, suggestions are offered for the evaluation of perpetrators of gambling-related crime on a case-by-case basis, to better understand the relationship between gambling and crime and facilitate more frequent application of therapeutic jurisprudence in future.
Background and aims
Relatively little is known about co-occurring gambling problems and their overlap with other addictive behaviors among individuals attending mental health services. We aimed to determine rates of gambling and substance use problems in patients accessing mental health services in Victoria, Australia.
Methods
A total of 837 adult patients were surveyed about their gambling and administered standardized screening tools for problem gambling and harmful tobacco, alcohol, and drug use. Prevalence of gambling problems was estimated and regression models used to determine predictors of problem gambling.
Results
The gambling participation rate was 41.6% [95% CI = 38.2–44.9]. The Problem Gambling Severity Index identified 19.7% [CI = 17.0–22.4] as “non-problem gamblers,” 7.2% [CI = 5.4–8.9] as “low-risk” gamblers, 8.4% [CI = 6.5–10.2] as “moderate-risk” gamblers, and 6.3% [CI = 4.7–8.0] as “problem gamblers.” One-fifth (21.9%) of the sample and 52.6% of all gamblers were identified as either low-risk, moderate-risk, or problem gamblers (PGs). Patients classified as problem and moderate-risk gamblers had significantly elevated rates of nicotine and illicit drug dependence (p < .001) according to short screening tools. Current diagnosis of drug use (OR = 4.31 [CI = 1.98–9.37]), borderline personality (OR = 2.59 [CI = 1.13–5.94]), bipolar affective (OR = 2.01 [CI = 1.07–3.80]), and psychotic (OR = 1.83 [CI = 1.03–3.25]) disorders were significant predictors of problem gambling.
Discussion and conclusions
Patients were less likely to gamble, but eight times as likely to be classified as PG, relative to Victoria’s adult general population. Elevated rates of harmful substance use among moderate-risk and PG suggest overlapping vulnerability to addictive behaviors. These findings suggest mental health services should embed routine screening into clinical practice, and train clinicians in the management of problem gambling.
A few studies have examined gambling behavior and problem gambling among minorities and reported higher rates of both participation and gambling problems among particular minority groups in comparison to Whites who gamble. The present study utilized a representative, epidemiological sample of adults in New Jersey to explore gambling behavior, gambling problem severity, substance use, problem behavior, and mental health issues among minorities. Univariate analyses were conducted, comparing Whites (n = 1341) to respondents who identified as Hispanic (n = 394), Black (n = 261), or Asian/other (n = 177). Overall, the highest proportion of Hispanics were high-risk problem gamblers. Hispanic participants were also significantly more likely than other groups to use and abuse substances and to report mental health problems in the past month, behavioral addictions, and/or suicidal ideation in the past year. Primary predictors of White high risk problem gamblers were being young and male with friends or family who gambled, fair to poor health status, substance use, gambling once a week or more both online and in land-based venues, and engaging in a number of gambling activities. In contrast, gender was not a predictor of minority high risk problem gamblers, who were characterized primarily by having friends or family who gambled, gambling online only, having a behavioral addiction and playing instant scratch-offs and gaming machines. Implications for research and practice are discussed.
Despite high rates of comorbidity between problem gambling and mental health disorders, few studies have examined barriers or facilitators to the implementation of screening for problem gambling in mental health services. This exploratory qualitative study identified key themes associated with screening in mental health services. Semi-structured interviews were undertaken with 30 clinicians and managers from 11 mental health services in Victoria, Australia. Major themes and subthemes were identified using qualitative content analysis. Six themes emerged including competing priorities, importance of routine screening, access to appropriate screening tools, resources, patient responsiveness and workforce development. Barriers to screening included a focus on immediate risk as well as gambling being often considered as a longer-term concern. Clinicians perceived problem gambling as a relatively rare condition, but did acknowledge the need for brief screening. Facilitators to screening were changes to system processes, such as identification of an appropriate brief screening instrument, mandating its use as part of routine screening, as well as funded workforce development activities in the identification and management of problem gambling.
It is well-documented that the downward spiral of disordered gambling often leads to serious financial and legal difficulties, including the commission of criminal acts. Ultimately, most gamblers will adversely impact their credit, some will file for bankruptcy, and many will face arrest or incarceration. This chapter reviews the scholarly research and legal decisions in these areas, summarizing major findings in US court cases that provide guidance for those dealing with disordered gamblers with legal and financial problems. One long-standing hypothesis holds that gamblers commit crimes to fund their gambling, particularly since studies have concluded that a disproportionately high percentage of gambling revenues are derived from disordered gamblers. The drug that fuels disordered gambling is money. For that reason, disordered gamblers historically accumulate staggering amounts of debt.
A prevalence of gambling disorders is diversified depending on the region of the world. Almost three quarters of pathological gamblers had never sought a professional treatment as well as an assistance in self-help groups. Reasons why they do not initiate a treatment are complex. The aim of the article is to compare barriers to the treatment for people with gambling disorders found in presented study and barriers to alcohol and drug treatment identified in the available literature. The semi structured interviews were applied and conducted with people with gambling disorders, social workers, therapists employed in the addiction treatment facilities, General Practitioners and psychiatrists. Selection of the respondents was based on purposive sampling. In total, 90 interviews were completed. Respondents identified individual barriers as well as structural ones. Individual barriers include internal resistance and a fear of the treatment. In turn structural barriers apply to the organization of the therapy, infrastructure, personnel, and the therapeutic program. A comparison of barriers experienced by people with gambling disorders and substance use disorders showed that they are largely similar, but people with gambling disorders also experience specific barriers. Empirical studies focused specifically on treatment needs of people experiencing gambling disorders may improve an offer of help for them. More adequate treatment options could contribute to the increasing in the number of people who start the treatment. It can result in improving their quality of life and may have positive impact on public health.
Background and aims
Problem gambling has been identified as an emergent public health issue, and there is a need to identify gambling trends and to regularly update worldwide gambling prevalence rates. This paper aims to review recent research on adult gambling and problem gambling (since 2000) and then, in the context of a growing liberalization of the gambling market in the European Union, intends to provide a more detailed analysis of adult gambling behavior across European countries.
Methods
A systematic literature search was carried out using academic databases, Internet, and governmental websites.
Results
Following this search and utilizing exclusion criteria, 69 studies on adult gambling prevalence were identified. These studies demonstrated that there are wide variations in past-year problem gambling rates across different countries in the world (0.12–5.8%) and in Europe (0.12–3.4%). However, it is difficult to directly compare studies due to different methodological procedures, instruments, cut-offs, and time frames. Despite the variability among instruments, some consistent results with regard to demographics were found.
Discussion and conclusion
The findings highlight the need for continuous monitoring of problem gambling prevalence rates in order to examine the influence of cultural context on gambling patterns, assess the effectiveness of policies on gambling-related harms, and establish priorities for future research.
Previous research has shown that gambling is a popular activity among ado- lescents. Following a rapid expansion of legalized gambling opportunities and the emergence of new forms of gambling, many researchers have carried out studies on adolescent gambling and problem gambling. The present paper reviews studies that have been con- ducted worldwide since 2000, and then presents a more detailed picture of adolescent gambling research in Europe, by providing a country-by country analysis. After an extensive search on academic databases and following an exclusion process, 44 studies were identified. The findings showed that 0.2–12.3 % of youth meet criteria for problem gambling, notwithstanding differences among assessment instruments, cut-offs, and timeframes. However, despite this variability, several demographic characteristics were associated with adolescent gambling involvement and problem gambling. It is concluded that a small but significant minority of adolescents have gambling-related problems. Such findings will hopefully encourage more research into youth gambling to further understand the determinants of this phenomenon.
Mental health professionals are well versed in addressing multiple adolescent risky behaviours and play a primary role in the identification of and referral process and service provision for young people who engage in such behaviours. Given their ‘person-in-environment’ approach, training in multi-sectoral collaboration, and awareness of social policies, social workers are especially equipped to provide needed mental health services to young people. The aim of the current study was to examine Israeli mental health professionals’ awareness of and attitudes towards adolescent high-risk behaviours, including gambling. Child psychologists, social workers and school counsellors (N = 273) completed an online survey addressing concerns related to high-risk behaviours. Findings revealed that social workers perceived gambling as being among one of the least concerning adolescent mental health issues and reported feeling the least confident in their abilities to provide services to young people with gambling problems. The results suggest the importance of youth gambling addictions being incorporated into social work training curricula.
There exists only a small number of empirical studies investigating the patterns of family violence in problem gambling populations, although some evidence exists that intimate partner violence and child abuse are among the most severe interpersonal correlates of problem gambling. The current article reports on the Australian arm of a large-scale study of the patterns and prevalence of co-occurrence of family violence and problem gambling in Australia, New Zealand and Hong Kong. The current study screened 120 help-seeking family members of problem gamblers in a range of clinical services for both family violence and problem gambling. The main results showed that 52.5% reported some form of family violence in the past 12 months: 20.0% reported only victimisation, 10.8% reported only perpetration and 21.6% reported both victimisation and perpetration of family violence. Parents, current and ex-partners were most likely to be both perpetrators and victims of family violence. There were no gender differences in reciprocal violence but females were more likely to be only victims and less likely to report no violence in comparison to males. Most of the 32 participants interviewed in depth, reported that gambling generally preceded family violence. The findings suggest that perpetration of family violence was more likely to occur as a reaction to deeply-rooted and accumulated anger and mistrust whereas victimisation was an outcome of gambler’s anger brought on by immediate gambling losses and frustration. While multiple and intertwined negative family impacts were likely to occur in the presence of family violence, gambling-related coping strategies were not associated with the presence or absence of family violence. The implications of the findings for service providers are discussed.
Studieshaveshownthatmentalhealthserviceproviderperceptionsofproblemsand knowledge of resources are among the largest determinants of service provision and referral. The current study aims at exploring mental health professionals’ awareness of, attitudes towards and beliefs regarding high-risk behaviors in youth, including gambling. Child psy- chologists, social workers, and psychoeducators (n=649) responded to an online survey. Findings revealed that problem gambling was viewed by most professionals as the least serious adolescent risk behavior, and few reported feeling confident in their abilities to deal with youth with gambling problems. However, the majority of professionals felt that they have a significant role to play in the prevention of youth gambling problems, and many endorsed strong interest in receiving continuing education in the prevention, identification, and treat- ment of problem gambling. Results highlight the importance of continued efforts in increasing awareness regarding youth problematic gambling, as well as the need for greater continuing education training on adolescent gambling for mental health professionals.
Problem gambling attracts little attention from health and social care agencies in the UK. Prevalence surveys suggest that 0.6% of the population are problem gamblers and it is suggested that for each of these individuals, 10–17 other people, including children and other family members, are affected. Problem gambling is linked to many individual and social problems including: depression, suicide, significant debt, bankruptcy, family conflict, domestic violence, neglect and maltreatment of children and offending. This makes the issue central to social work territory. Yet, the training of social workers in the UK has consistently neglected issues of addictive behaviour. Whilst some attention has been paid in recent years to substance abuse issues, there has remained a silence in relation to gambling problems. Social workers provide more help for problems relating to addictions than other helping professions. There is good evidence that treatment, and early intervention for gambling problems, including psycho-social and public health approaches, can be very effective. This paper argues that problem gambling should be moved onto the radar of the social work profession, via inclusion on qualifying and post-qualifying training programmes and via research and dissemination of good practice via institutions such as the Social Care Institute for Excellence (SCIE).
The purpose of this study was to investigate the prevalence of gambling disorder and comorbid psychiatric disorders in a homeless population and identify features related to potential subtypes. At baseline, participants were administered a structured interview including socio-demographic sections of the National Comorbidity Study (NCS) interview; seven diagnostic sections of the Diagnostic Interview Schedule (DIS); the alcohol and drug abuse sections of the Composite International Diagnostic Interview-Substance Abuse Module (CIDI-SAM); and the Homeless Supplement to the DIS. At nine months post-baseline assessment, participants were administered additional NCS family history questions and the South Oaks Gambling Screen (SOGS). Participants were an epidemiologic sample of 275 predominately African-American homeless individuals, grouped as lifetime non-gamblers (n = 60), recreational gamblers (n = 152), and problem gamblers (n = 63), recruited on the street and through homeless shelters. Results indicate that lifetime rates of sub-clinical problem (46.2 %) and disordered (12.0 %) gambling were significantly higher than in the general population. Problem gamblers were more likely than non-problem gamblers to meet diagnostic criteria for antisocial personality disorder, post-traumatic stress disorder, bipolar disorder, and any psychiatric disorder, and more likely than non-gamblers to use illicit drugs or meet criteria for abuse/dependence for nicotine, alcohol, or any substance. This study provides evidence that problem gambling is a significant public health issue among the African-American homeless population. Homeless services should include assessment for problem gambling along with psychiatric disorders and referrals to resources and treatment programs. Future studies should explore the relationship of the onset and course of problem gambling and other psychiatric disorders with homelessness as well as racial differences in gambling patterns and problem severity over time.
Presents an analysis of the psychological and sociological aspects of compulsive gambling. Topics include the relation between occupation and gambling, the bookmaker and his business relations, getting money through the gambling setting, and abstinence and relapse cycles among compulsive gamblers. (5 p ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
To develop a pathological gambling (PG) screen for efficient application to the household population and for clinicians to use with treatment seekers.
We applied a series of multivariate discriminant functions to past-12-month Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR)-based, gambling-related problems; the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) measured and collected this data. The NESARC conducted computer-assisted personal interviews with 43 093 households and identified the largest sample of pathological gamblers drawn from the general household population.
We created a 3-item, brief biosocial gambling screen (BBGS) with high sensitivity (Sensitivity = 0.96; 76 of 79 pathological gamblers correctly identified) and high specificity (Specificity = 0.99; 10 892 of 11 027 nonpathological gamblers correctly identified).
Major US studies reveal extensive comorbidity of PG with other mental illnesses. The BBGS features psychometric advantages for health care providers that should encourage clinicians and epidemiologists to consider current PG along with other problems. The BBGS is practical for clinical application because it uses only 3 items and they are easy to ask, answer, and include in all modes of interviewing, including self-administered surveys. The BBGS has a strong theoretical foundation because it includes 1 item from each of the addiction syndrome 3 domains: neuroadaptation (for example, withdrawal); psychosocial characteristics (for example, lying); and adverse social consequences of gambling (for example, obtaining money from others).
At the moment, there is no single conceptual theoretical model of gambling that adequately accounts for the multiple biological, psychological and ecological 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 gamblers and a tendency to assume that pathological gamblers form one, homogeneous 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 pathological 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) emotionally vulnerable problem gamblers and (c) antisocial, impulsivist problem gamblers. The implications for clinical management are discussed.
The burden of gambling problems is felt more strongly among people who experience poverty. A small but emerging body of research is developing with no identified reviews exploring the scope of the academic literature on the confluence of poverty and gambling problems. The Arksey and O’Malley scoping study framework was used to map research on this multifaceted topic. We synthesized findings of 27 studies, spanning several national contexts on prevalence of problem gambling and associations of it with poverty. Findings indicated that gambling problems were associated with several poverty measures including employment/unemployment, housing instability, homelessness, low income, and neighborhood disadvantage. The complex interplay of gambling problems with social and health issues emerged in qualitative papers. Relatively few studies explored the connection between poverty and gambling problems despite higher prevalence of gambling problems in this population. Those experiencing both concerns face myriad challenges necessitating surveillance and treatment within vulnerable populations. Further research should explore pathways to gambling problems and poverty and also the associative nature and temporal sequencing of the two phenomena. Global awareness on the topic from a research and clinical/community service perspective is necessary.
Active military members and veterans both show elevated risk of Gambling Disorder. However, research comparing these groups to civilians in epidemiological samples is sparse. There is also some research suggesting that there is a stronger association between military service and poor mental outcomes for women.
The current study applies bivariate analyses and generalized linear modelling predicting Problem Gambling Severity Index scores to a representative, complex survey sample of 2176 New Jersey adult residents.
The results show that problem gambling scores for past and current military service members were more than double that of the civilian participants after controlling for relevant demographic and behavioral characteristics. Additionally, the relationship between problem gambling scores and military service was significantly stronger for women than men. Bivariate analyses indicated that active military service members scored higher on the Problem Gambling Severity Index, indicated greater weekly participation in online gambling, lottery, electronic gambling machine, and sports betting, and nearly 20 times the rate of suicidal ideation compared with civilians. Additional regression analysis show that among military service members problem gambling scores were associated with suicidal ideation, tobacco use, and substance use problems.
The results are discussed in the context of a period of expansion of online gambling opportunities. Constrained options for leisure coupled with the high propensity for risk taking among military service members and the relative ease of concealing online gambling on base may expose military service members to disproportionately higher risk of Gambling Disorder.
While problem gambling and mental illnesses are highly comorbid, there are few examples of integrated problem gambling and mental illness services. This has meant that it is unclear whether such services are needed, why they may be utilised, and how they operate to support clients impacted by the comorbidity and clinicians providing them care. This study reported on data collected via telephone questionnaire-assisted interviews of 20 clients and 19 referrers who had accessed one such Australian integrated problem gambling and mental illness program between July 2014 and June 2016. Data revealed that clients often were referred in the context of psychiatric or psychosocial crisis, or when clinicians encountered clients who were not making progress and wanted a second opinion about diagnosis and treatment. Improved management of illness symptoms or gambling behaviour were commonly reported benefits and a number of clients reported gaining a feeling of reassurance and hope following assessment due to gaining a deeper understanding of their issues and available treatment options. Access to dual specialist problem gambling and mental illness expertise may therefore enhance treatment planning, management during crises and cross-sector collaboration to enhance access to and the impact of care for people experiencing comorbidity.ResumeBien que le jeu problématique et les maladies mentales aient un taux élevé de comorbidité, il existe peu d’exemples de services intégrés pour le jeu et la maladie mentale. En d’autres termes, il n’est pas clair si de tels services sont nécessaires, à quelles fins ils peuvent être utilisés et la manière dont ils fonctionnent pour aider les clients touchés par cette comorbidité et les cliniciens qui leur fournissent des soins. La présente étude a rendu compte des données recueillies lors d’entretiens assistés par un questionnaire téléphonique menés auprès de 20 clients et de 19 répondants qui avaient eu accès à l’un des programmes australiens intégrés de lutte contre le jeu problématique et la maladie mentale entre juillet 2014 et juin 2016. Les données révèlent que les clients étaient souvent recommandés à d’autres services dans le contexte d’une crise psychiatrique ou psychosociale ou lorsque les cliniciens rencontraient des clients qui n’avaient pas fait de progrès et qui souhaitaient obtenir un deuxième avis sur le diagnostic et le traitement. Une gestion améliorée des symptômes de la maladie ou du comportement de jeu constituait des avantages souvent rapportés, et un certain nombre de clients ont déclaré avoir ressenti du réconfort et de l’espoir après une évaluation, en raison d’une meilleure compréhension de leurs problèmes et des options de traitement disponibles. L’accès à une double expertise en matière de jeu problématique et de maladie mentale peut donc améliorer la planification du traitement, la gestion de crise et la collaboration intersectorielle afin d’améliorer l’accès aux soins et l’incidence des soins pour les personnes souffrant de cette comorbidité.
Gambling disorder is a common condition that was previously listed as an impulse control disorder, but is now considered a substance-related and addictive disorder. Gambling disorder has been associated with various untoward long-term outcomes including impaired quality of life, relationship break-ups, debt and mortgage foreclosure, and elevated risk of suicidality. This paper provides a concise primer on gambling disorder, with a special focus on its parallels with substance use disorders. We consider clinical presentations, comorbid expression, heritability, and treatment approaches (psychological and pharmacological). Lastly, we highlight new treatment directions suggested by the literature.
This chapter reviews the epidemiology of gambling disorder (GD). Gambling behavior is common and occurs worldwide and is culturally universal. GD has an estimated lifetime prevalence in the USA ranging from 0.42% to 4.0%. Prevalence among youth may be even higher. Most people with GD are male and, while men have an earlier onset, women have a shorter course from onset of gambling to the development of GD. Nonwhite populations appear to be at particular risk for the development of GD, particularly African-Americans. The course of GD was once thought to be progressive and deteriorating, but more recent research suggests that the course oscillates with many individuals spontaneously improving or remitting. Suicidal thoughts and behaviors are common, often prompted by gambling losses. Psychiatric comorbidity is the rule and not the exception. Substance use disorders are highly prevalent in people with GD, followed by mood disorders, anxiety disorders, attention deficit/hyperactivity disorder, and disorders of impulse control. Personality disorders are also common, especially antisocial and borderline personality disorders. Many people with GD are highly impulsive, a personality trait that may serve as a bridge to GD. Subtypes of GD have been proposed, and there is some empirical evidence to support the “pathways” model that suggests the existence of behaviorally conditioned gamblers, emotionally vulnerable gamblers, and impulsive-antisocial gamblers.
Research on handling problem gambling has mostly been concentrated on therapeutic treatment and individual psychotherapy. The treatment focus, however, underscores the financial troubles of problem gamblers. In the Nordic welfare state, citizens’ financial problems fall under the umbrella of social services. Eleven Finnish social services directors were interviewed via email or telephone on their professional experiences with problem gambling and about the support methods available in their institutions. The social services directors believed that gambling problems are rooted in the contemporary consumer society with its financial inequality and pressures of belonging. They had no shared definition or method of recognising problem gambling. Despite being in a supervisory position, the social services directors were unable to give an estimate of the degree of problem gambling among their institution’s clients. A register of cases related to problem gambling in Finnish social services seems necessary. The results indicate, furthermore, that tools should be developed for the early identification of problem gambling in social services as well as for improvement of the linkage between the financial support of social services and therapeutic treatment in specialised centres.
Background and aims:
Despite the over-representation of people with gambling problems in mental health populations, there is limited information available to guide the selection of brief screening instruments within mental health services. The primary aim was therefore to compare the classification accuracy of nine brief problem gambling screening instruments (2-5 items) with a reference standard among patients accessing mental health services.
Design:
The classification accuracy of nine brief screening instruments was compared with multiple cut-off scores on a reference standard.
Setting:
Eight mental health services in Victoria, Australia.
Participants:
837 patients were consecutively recruited between June 2015 and January 2016.
Measurements:
The brief screening instruments were the Lie/Bet Questionnaire, Brief Problem Gambling Screen [BPGS] [2-5-item versions], NODS-CLiP, NODS-CLiP2, Brief Biosocial Gambling Screen [BBGS], and NODS-PERC. The Problem Gambling Severity Index (PGSI) was the reference standard.
Findings:
The 5-item BPGS was the only instrument displaying satisfactory classification accuracy in detecting any level of gambling problem (low-risk, moderate-risk, or problem gambling) [sensitivity=0.803, specificity=0.982, diagnostic efficiency=0.943]. Several shorter instruments adequately detected both problem and moderate-risk, but not low-risk, gambling: two 3-item instruments (NODS-CLiP, 3-item BPGS) and two 4-item instruments (NODS-PERC, 4-item BPGS) [sensitivity=0.854-0.966, specificity=0.901-0.954, diagnostic efficiency=0.908-0.941]. The 4-item instruments, however, did not provide any considerable advantage over the 3-item instruments. The very brief (2-item) instruments (Lie/Bet and 2-item BPGS) similarly adequately detected problem gambling [sensitivity=0.811-0.868, specificity=0.938-0.943, diagnostic efficiency=0.933-0.934], but not moderate-risk or low-risk gambling.
Conclusions:
The optimal brief screening instrument for mental health services wanting to screen for any level of gambling problem is the 5-item Brief Problem Gambling Screen (BPGS). Services wanting to employ a shorter instrument or to screen only for more severe gambling problems (moderate-risk/problem gambling) can employ the NODS-CLiP or the 3-item BPGS. Services that are only able to accommodate a very brief instrument can employ the Lie/Bet Questionnaire or the 2-item BPGS.
Social workers have a long history of working with clients with alcohol and drugs problems and collaborating with specialist addictions services. In England, while gambling participation has soared since 2007, the impact on social work is largely unknown. This article investigates what is known about social work practice in working with adults who have care and support needs and may be at risk of gambling-related harm. The scoping review included studies and commentaries covering the risks of gambling-related harm as reported in social work practice and education. The scoping review revealed limited evidence specific to social work, and therefore, we developed an arching theme for the analysis of ‘invisibility’ in relation to three areas: the near ‘invisible’ social worker in gambling research; the ‘invisibility’ of gambling in most professional qualifying social work programmes; and the near ‘invisibility’ of the impact of gambling on social work clients. Implications for policy and practice are that the social work profession could take steps to ensure it is better informed about identifying, minimising risks and providing support. Professional qualifying social work programmes may wish to consider including resources addressing the prevalence of gambling-related harms. Consideration should be given to whether screening for gambling-related harm should be introduced if social workers are to be better informed about gambling risks.
TIIVISTELMÄ
Sari Castrén & Hannu Alho & Anne H. Salonen: Rahapeliongelma
sosiaali- ja terveydenhuollossa – ammattilaisten
näkemyksiä
Rahapeliongelmien tunnistaminen on haastavaa sosiaali-
ja terveydenhuollon ammattilaisille. Rahapeliongelmien
hoitotarjonta on hajanaista Suomessa, ja toistaiseksi
rahapeliongelmat eivät sisälly sosiaali- ja terveydenhuollon
koulutusohjelmiin muiden riippuvuushäiriöiden
lailla. Ammattilaisten rahapeliongelmiin liittyviä
mielipiteitä, kokemuksia ja koulutuksen antamia
valmiuksia ei ole aikaisemmin selvitetty Suomessa.
Jäsenkyselyillä kartoitettiin sosiaali- ja terveydenhuollon
ammattilaisten rahapeliongelmiin liittyviä mielipiteitä,
rahapeliongelmasta kärsivien asiakkaiden kohtaamista
ja rahapeliongelman ilmenemistapaa sekä koulutuksen
antamia valmiuksia, ammattilaisten tietojen
riittävyyttä ja täydennyskoulutustarvetta. Aineistona
olivat seuraavien tahojen jäsenet: Suomen Lääkäriliitto,
Suomen Sairaanhoitajaliitto ry, Suomen Terveydenhoitajaliitto
ry, Talentia ry ja Päihdelääketieteen yhdistys.
Jäsenkyselyihin vastasi yhteensä 729 sosiaali- ja terveydenhuollon
ammattilaista.
Vastaajista 70,2 prosenttia koki rahapelien ongelmapelaamisen
vakavaksi ongelmaksi Suomessa. Yli kolme
neljästä edellisen vuoden aikana asiakastyössä olleesta
vastaajasta oli kohdannut rahapeliongelmaisia työssään
kyselyn toteuttamista edeltävän 12 kuukauden aikana.
Rahapeliongelma esiintyi tyypillisesti asiakkaan toissijaisena
ongelmana: ensisijainen ongelma oli tavallisimmin
mielenterveys- tai päihdeongelma. Rahapeliongelmia
eniten aiheuttaneet pelit olivat rahapeliautomaatit
ja internetin rahapelit. Rahapeliongelma tuli tyypillisesti
esiin asiakkaan kertomana: sosiaalialan ammattilaiset
olivat aktiivisimpia ottamaan rahapeliongelman itse puheeksi.
Yleisin yhteistyötaho oli A-klinikka. Enemmistö
(70,0 %) koki niin koulutuksensa antamat valmiudet
kuin tämänhetkiset tietonsa (52,3 %) rahapeliongelmista
riittämättömiksi. Vastaajat olivat kiinnostuneita
saamaan lisätietoa rahapeliongelman tunnistamisesta,
arvioinnista, hoitoon liittyvästä koulutuksesta sekä saatavilla
olevista tuki- ja hoitopalveluista.
Pätevöityminen sosiaali- ja terveydenhuollon ammattilaiseksi
ei takaa riittäviä valmiuksia tunnistaa ja hoitaa
rahapeliongelmista kärsiviä asiakkaita. Rahapeliongelmat
tulisi sisällyttää sosiaali- ja terveydenhuollon koulutusohjelmiin,
ja ammattilaisille pitäisi mahdollistaa
aikaisempaa enemmän täydennyskoulutusta rahapeliongelmista.
This study is an up-to-date examination of gambling behaviours as well as gambling problems and their relationships to substance use and abuse. Further, the co-occurrence between problem gambling and substance abuse is studied using a large-scale, representative sample of adults aged 18 years and older in the United States. This random-digit-dial national survey was carried out in 2011–2013 with completed interviews from 2963 respondents. Of the four gambling and substance use behaviours considered, past-year gambling was the most prevalent (76.9%), followed by alcohol use (67.6%), tobacco use (28.7%) and marijuana use (11.2%). Problem gambling and the three substance abuse measures were highly related. Current problem gambling (3+DIS criteria) was predicted by being male, being black, having low socio economic status and by alcohol abuse/dependence, tobacco dependence and marijuana abuse/dependence. Thus, problem gambling is linked to other problem behaviours, especially substance abuse. Consequently, effective treatment approaches should screen and intervene for both problem gambling as well as co-occurring substance abuse.
Problem and pathological gamblers show high rates of suicidal behavior. However, previous research of suicide among this population has been inconsistent. Discrepancies may stem from methodological issues, including variable use of suicide nomenclature and selection bias in study samples. Furthermore, earlier research has rarely examined gambling severity aside from problem or pathological categories. This study utilized subgroups derived from a nationally representative data set, examining different characteristics of suicidal behaviors and several gambling levels, including subclinical groups.
Participants included 13,578 individuals who participated in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) and provided information on gambling behavior, lifetime suicidal ideation, and/or lifetime suicide attempts. Five gambling groups were derived using DSM-IV criteria for pathological gambling; non-gambling, low-risk gambling, at-risk gambling, problem gambling, and pathological gambling.
Problem gambling was associated with suicidal ideation [adjusted odds ratio (AOR) = 1.64, 95% confidence interval (CI) = 1.19-2.26] and suicide attempts [(AOR) = 2.42, 95% (CI) = 1.60-3.67] after adjustment for sociodemographic variables. Pathological gambling was associated with suicidal ideation [(AOR) = 2.86, 95% (CI) = 1.98-4.11] and suicide attempts [(AOR) = 2.77, 95% (CI) = 1.72-4.47) after adjustment for sociodemographic variables.
Our results from this population sample reinforce increased rates of suicidal behavior amongst smaller, clinical samples of problem and pathological gamblers. Education for providers about gambling is recommended, including screening for gambling-related symptoms such as suicidal behavior.
© American Academy of Addiction Psychiatry.
Few studies have examined the prevalence of problem and pathological gambling among clients of homeless service agencies. The objective of this study was to estimate the prevalence of problem gambling among these clients. We collected primary data on gambling using the NORC diagnostic screen for disorders. Using a modified time-location recruitment approach 264 clients of a community homeless service agency were screened for lifetime gambling problems. Descriptive statistics were produced using SPSSX. The prevalence of lifetime problem gambling was 10 % and that of pathological gambling was 25 % in this sample. The prevalence of lifetime problem and pathological gambling was alarmingly high relative to the general population lifetime prevalence. Better insight into interventions for gambling that might reduce risk of homelessness will help service agencies gauge the needs of their clients and to implement change to service delivery and screening practices.
With an estimated 9 % of the population in the United States having a substance use disorder, it is a rare social worker that has not encountered a substance abuser or a family member of one in his or her clinical practice. This article provides a brief history of social workers’ role in the treatment of substance abusing clients, an overview of the current, evidence-based treatment approaches and some of the issues that will be impacting this field in the future. A case study is used to illustrate some of the dynamics of substance abusing individuals, the impact on the family and effective treatment approaches.
This paper reviews evidence pertaining to the prevalence of common comorbid disorders, including alcohol use disorder, depression, substance use disorders, nicotine dependence, anxiety disorders and antisocial personality disorder, in population-representative samples of problem and pathological gamblers.
A systematic search was conducted for peer-reviewed and unpublished articles reported between 1 January 1998 and 20 September 2010. Only studies which examined the prevalence of comorbid conditions in problem and/or pathological gamblers from a general population sample using randomized sampling methods and standardized measurement tools were included. Meta-analysis techniques were then performed to synthesize the included studies and estimate the weighted mean effect size and heterogeneity across studies.
Eleven eligible studies were identified from the literature. Results from across the studies indicated that problem and pathological gamblers had high rates of other comorbid disorders. The highest mean prevalence was for nicotine dependence (60.1%), followed by a substance use disorder (57.5%), any type of mood disorder (37.9%) and any type of anxiety disorder (37.4%). However, there was evidence of moderate heterogeneity across studies, suggesting that rate estimates do not necessarily converge around a single population figure, and that weighted means should be interpreted with caution.
Problem and pathological gamblers experience high levels of other comorbid mental health disorders and screening for comorbid disorders upon entering treatment for gambling problems is recommended. Further research is required to explore the underlying causes of variability observed in the prevalence estimates.
This paper employs a general equilibrium framework to analyze the effects on economic growth of global expansions in casino gaming, which exports gambling services largely to non-residents. Both domestic and foreign investments in the gaming sector bring in not only substantial revenues but also positive spillover effects on related sectors and even on the entire local economy. However, an over-expansion of commercial gambling may lead to deterioration in the terms of trade with an adverse impact on real income. If this situation persists, it would not be impossible for immiserizing growth to occur. As a highly profitable sector, casino gaming may enable its operators to diversify out of this risk if they invest retained profits in non-gaming sectors to cash in on the spillover effects it has created. The gaming-dominant economy can then be directed on a more balanced and sustainable growth path, and will become less susceptible to business cycles. Indeed, economic experiences in the world's major casino resorts are consistent basically with this argument for diversification. We believe that after the current global crisis fades away, economic growth and resulting surges in global demand for gambling services can provide further opportunities for the expansion of existing casino resorts and the development of new gaming markets.
Commercial gaming revenue tracker 2020
American Gaming Association. (2021). Commercial gaming revenue tracker 2020. Retrieved February
2, 2021, from https://www.americangaming.org/wp-content/uploads/2021/02/Q4-Email-PDF.pdf
Diagnostic and statistical manual of mental disorders
American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders (3rd
ed.). Washington D.C. https://doi.org/10.1176/appi.books.9780890420188
Beating the odds: Preparing graduates to address gambling-related problems
- R J Engel
- J Bechtold
- Y Kim
- E Mulvaney
Engel, R. J., Bechtold, J., Kim, Y., & Mulvaney, E. (2012). Beating the odds: Preparing graduates to
address gambling-related problems. Journal of Social Work Education, 48(2), 321-335. https://doi.
org/10.5175/JSWE.2012.201000128
Running a "winning" prize promotion in the United States
- S R Paintin
Paintin, S. R. (2013). Running a "winning" prize promotion in the United States. International Inhouse Counsel Journal, 6(22), 1-16.
Key substance use and mental health indicators in the United States: Results from the 2019 national survey on drug use and health
Substance Abuse and Mental Health Services Administration. (2020). Key substance use and mental
health indicators in the United States: Results from the 2019 national survey on drug use and health.
Retrieved November 6, 2021, from https://www.samhsa.gov/data/sites/default/files/reports/
rpt29393/2019NSDUHFFRPDFWHTML/2019NSDUHFFR1PDFW090120.pdf
International statistical classification of diseases and related health problems
World Health Organization. (2019). International statistical classification of diseases and related
health problems (11th ed.). Geneva. Retrieved November 5, 2021, from https://icd.who.int/