For the past three years, since the start of the pandemic, NCPG has offered virtual workshops prior to its regularly scheduled annual conference. This year NCPG presented a range of speakers and topics over the course of two afternoons. One advantage of online workshops is the ability to host international speakers, who might not ordinarily be able to travel. It’s also helpful for those who cannot travel to the NCPG annual conference, providing access to excellent resources from the comfort of their computers.
Several of the presenters were from the United Kingdom, where they have been dealing with the backlash from the 2005 policies that blew the door open on gambling accessibility and are now feverishly working to increase treatment services, prevention and research.Attendees benefited from listening to the lessons learned and hopefully can apply those lessons in their own backyards.
Several researchers presented on their most recent studies looking at the effectiveness of self-exclusion programs, the links between gambling and problem debt, the ever-evolving changes in gambling and responsible gambling language, and the value of providing peer support groups for women. We heard from clinicians and their experiences treating gambling as a co-occurring disorder and about a fairly new integrative treatment model called Congruence Couple Therapy (CCT), which has been shown to have a relative advantage over individual treatment for reducing addictive and mental health symptoms and improving emotional regulation among couples. There was also a panel discussion advocating for gambling policies to move into the national spotlight. With no federal funding, and the increased opportunities to gamble, the field of gambling disorder is behind in workforce development, research and programs regulating gambling harm.
Video games have drawn the attention of activists and public health advocates since as early as the 1970’s. Many of these activists have focused on the intense depictions of violence in video games and suggest that these depictions may lead to real-life violence. One area that is often neglected, however, are depictions of substance use and gambling in video games. Although regulators have begun to investigate loot boxes and their relationship with problem gambling, other forms of gambling in video games have received less attention. For example, skin betting (i.e., exchanging virtual goods for digital gambling currency) — which was first popularized by the game Counter-Strike: Global Offensive — has evolved from betting on in-game matches to skins being used as currency in other games of chance such as roulette. Many of those involved in these underground gambling networks are adolescents who are unable to engage in traditional gambling. This week, the WAGER reviews a study by Nancy Greer and colleagues that examined links between esports, skin betting, and problem gambling.
What was the research question?
How does esports and skin betting relate to other forms of gambling and gambling harms?
What did the researchers do?
The researchers recruited participants through Amazon Mechanical Turk and social media posts in online gaming communities to participate in an online survey. All participants reported either esports cash or skin betting, or gambling skins on games of chance in the past 6 months. In total, 737 participants completed the survey. The survey itself focused on four broad categories: (1) video game involvement, (2) video game-related gambling (including betting on esports), (3) traditional gambling, and (4) problem gambling and gambling-related harms. The researchers used ordinal logistic regression to test the hypothesis that video game involvement increases the likelihood of engaging in video game-related gambling, which in turn increases the likelihood of engaging in traditional gambling and experiencing gambling harms.
What did they find?
Though video game involvement related to video game-related gambling, video game-related gambling was only slightly related to traditional gambling. Consider three different video game-related types of gambling: esports cash betting, esports skin betting, and skin betting on other games of chance. Of these, only esports cash betting frequency significantly predicted involvement in traditional gambling activities. Interestingly, although the sample overall reported high rates of problem gambling and gambling harms, neither esports cash betting nor esports skin betting significantly predicted problem gambling or gambling harms. When controlling for other forms of traditional gambling, only skin gambling on games of chance was predictive of problem gambling and gambling harms (see Figure).
Figure. This figure displays the odds of experiencing problem gambling and gambling harms based on video game-related gambling behaviors. Odds ratios above 1.00 indicate that for every one unit increase in the predictor variable (video game-related gambling behaviors) the odds of being one category higher in the outcome variable (problem gambling or gambling harms) increases by X times. An odds ratio below 1.00 indicates that the odds decrease by X times. For example, a one unit increase in esports cash betting frequency would mean a participant is 1.033 times as likely to experience a one unit increase in their problem gambling severity. Only skin betting on games of chance was significantly associated with either outcome variable. Click image to enlarge.
Why do these findings matter?
These findings suggest that buying skins and esports gambling are not risk factors for problem gambling in and of themselves. Rather, skin gambling on games of chance appears to increase the risk of gambling harms. It remains unclear whether individuals who gamble skins on games of chance do so because they have exhausted other financial resources, or if skin gambling on games of chance directly increases the risk of problem gambling and other gambling harms. Regardless, these findings suggest that regulatory bodies should consider focusing on gambling operators who facilitate skin gambling on games of chance, rather than other more traditional esports focused operators.
Every study has limitations. What are the limitations in this study?
This study has significant limitations in terms of its generalizability. Participants were required to have gambled either on esports or via using skins in the past six months, so the results likely do not represent video game players as a whole. The study also failed to include anyone under the age of 18 despite the fact that many people who gamble using skins are adolescents. Additionally, due to the study’s limited sample size, the researchers were unable to conduct path analysis, an analytical technique that allows for estimating causal effects instead of only statistical associations.
For more information:
Individuals who are concerned about their gambling behaviors or simply want to know more about problem gambling may benefit from visiting the National Council on Problem Gambling. Others who want to learn more about video game addiction can find information via the Cleveland Clinic. Additional resources can be found at the BASIS Addiction Resources page.
Editor’s Note: Today’s review is part of our month-long Special Series on Asian American/Pacific Islander (AAPI) Addiction Research. Throughout May, The BASIS is examining forms of addiction among AAPI communities.
Emerging research indicates that the Asian American community is at greater risk for problem gambling than the general population. However, research often fails to include or accurately capture the realities of gambling and problem gambling within this community, particularly the experiences of Asian American working-class immigrant communities. This week, as part of our Special Series on Asian American/Pacific Islander Addiction Research, The WAGER reviews a study by Mia Han Colby and colleagues that investigated the systemic issues that contribute to gambling in the Greater Boston Asian American community.
What was the research question?
What are the systemic issues that contribute to gambling in the Asian American community of the Greater Boston area?
What did the researchers do?
The authors conducted forty semi-structured interviews with adult members of Asian1 immigrant communities in the Greater Boston area who had a family member, friend, neighbor, or coworker who gambled. Using a community-based participatory research approach, bilingual/bicultural community fieldworkers who had experience working in their respective communities interviewed participants. Participants were asked about their perceptions of gambling in their community, as well as impacts of gambling on families and the community more generally. The researchers analyzed the interviews for common themes pertaining to systemic issues related to gambling and problem gambling in the Asian community in the Greater Boston area.
What did they find?
The interviews revealed how the underlying issues of poverty and social and cultural loss due to immigration contribute to gambling in this community (see Figure). Many participants spoke about the challenges of making a decent living as an immigrant while working low-wage and stressful jobs. Gambling was viewed as a way to make money and improve a family’s financial situation. For example, one participant expressed that gambling gave them “hope that they can have freedom of money.” It was also seen as a way to relieve work-related stress.
Participants also spoke about the challenges of integrating into American society due to cultural and linguistic barriers. Many discussed the lack of appropriate and accessible social and recreational activities, which contributed to experiences of social isolation, loneliness, and boredom. Gambling—especially within casinos—was viewed as a means of socializing and connecting with other Asian community members. Many participants spoke about the ways that casinos targeted Asian clientele, including busing directly to casinos from Asian communities (e.g., from Boston’s Chinatown neighborhood), creating an Asian-friendly casino environment (e.g., employees speak Asian languages, concerts and events featuring Asian artists), and incentives (e.g., free food and discounts).
Figure. Reasons for gambling in Asian communities in the Greater Boston area, by percentage of respondents who identified each reason for gambling (n = 40). Click image to enlarge.
Why do these findings matter?
These findings illustrate the complex and systemic issues that contribute to gambling in Asian communities in the United States, including social and cultural isolation due to challenges integrating into American society, and struggles working low-wage and stressful jobs. Asian CARES (Center for Addressing Research, Education, and Services) of Boston created actionable recommendations for change based on these findings. They recommend investing in neighborhoods where Asian immigrants live and work to create inclusive spaces that facilitate social and recreational activities other than gambling. Additionally, Asian CARES recommended increasing funding to trusted community-based organizations (e.g., Boston Chinatown Neighborhood Center) that provide culturally and linguistically responsive problem gambling, mental health, and social services (e.g., services that help individuals find and maintain employment).
Every study has limitations. What are the limitations of this study?
Data were self-reported and based on past experiences, so the results might be subject to recall bias. Findings from this study might not be generalizable to other geographic areas or to other immigrant populations.
For more information:
Do you think you or someone you know has a gambling problem? Visit the National Council on Problem Gambling for screening tools and resources. For individuals in Massachusetts looking for culturally and linguistically relevant problem gambling services, call the Massachusetts Problem Gambling Helpline (800-327-5050) or visit the Boston Chinatown Neighborhood Center website.
1. Interviews were conducted with members of the Khmer, Chinese, Korean, and Vietnamese immigrant communities in the Greater Boston area.
“All you’ve got to do is stay away from gambling.” A woman described her experience with the stigma and blame of gambling problems by saying, “They look at it as being a weak person that is a problem gambler, someone that’s got no control over what they’re doing.” Shame and self-blame are common among people experiencing problem gambling, and they might intensify gambling problems by making it harder for people to regulate their emotions adaptively. This week, The WAGER reviews a study by Ana Estévez and colleagues that examined the relationship between shame and blame and problem gambling severity, as well as how emotion regulation mediates that relationship.
What was the research question?
How do shame and blame relate to problem gambling severity, and how does emotion regulation mediate that relationship?
What did the researchers do?
The authors surveyed 158 adolescents and young adults (119 males and 39 females of ages 12-30) from Northern Spain. Participants were divided into a non-clinical at-risk gambler group, a non-clinical problem gambling group, and a clinical problem gambler group based on their scores on the Spanish language version of the South Oaks Gambling Screen-Revised Adolescents scale. The researchers recruited the non-clinical samples from schools and the clinical sample from a treatment center. The researchers measure positive and negative moods, gambling motives, and emotion regulation. Next, they used Pearson’s r to assess the relationship between problem gambling severity, blame and shame, emotion regulation strategies for coping with negative life events, and gambling motives. Finally, the authors conducted a mediation analysis to examine the role of emotion regulation as a potential mediator in the relationship between problem gambling severity, and blame and shame.
What did they find?
Participants with more severe problem gambling reported feeling more shame and blame. Additionally, they were more likely to report that they gambled to enhance their moods and cope with stress (but not to socialize) and to use several strategies to cope with negative life events: self-blame, acceptance, rumination, positive reappraisal, and catastrophizing. Three strategies for coping with negative life events–positive refocusing, putting things into perspective, and re-focusing on planning–were unrelated to problem gambling severity, and blaming others was negatively related to problem gambling severity. Finally, in the mediation analyses, using self-blame to cope with negative life events partially accounted for the relationship between problem gambling severity and shame at present and during the past 2 weeks.
Figure. Key points from Estévez et al. (2022) about the relationship between blame, shame, emotion regulation, gambling motives, and problem gambling severity, showing variables that were statistically significantly related to problem gambling severity. Click image to enlarge.
Why do these findings matter?
Findings from studies such as this one can help inform evidence-based approaches to treatment and prevention. For example, learning that emotion regulation strategies like rumination and catastrophizing are related to problem gambling severity will allow for better-informed interventions such as dialectical behavior therapy (DBT), that teach healthier coping skills. Additionally, this study highlights the importance of conducting research on problem gambling in different contexts than the U.S., which speaks to the generalizability of predictors in other geographic locations, as (speaking very generally) blame is more prevalent in Western cultures, while shame is more dominant in Eastern cultures.
Every study has limitations. What are the limitations of this study?
This study had a small sample size, so the results might not be generalizable across Spain or other countries, such as the United States. Furthermore, because socio-cultural factors were not recorded, it is unclear whether they had an impact on the role of blame and shame. The results are also likely not representative of populations in other countries and cultures where blame and shame may have different prevalence levels. Additionally, this is a cross-sectional study, so causal relationships cannot be determined.
For more information:
Do you think you or someone you know has a gambling problem? Visit the National Council on Problem Gambling for screening tools and resources. For individuals in Spain, visit this article for information on the Problem Gambling helpline.
Editor’s Note: Today’s review is part of our month-long Special Series on Pathways to Addiction. Throughout March, The BASIS is highlighting risk factors for and pathways to addiction.
The development of the pathways model of problem and pathological gambling in 2002 was an important step towards recognizing the heterogeneity of individuals who face gambling-related harms. The model identified distinct subgroups of people experiencing problem or pathological gambling based on a variety of social, biological, and environmental risk factors. The authors, Alex Blaszczynski and Lia Nower, identified three distinct subtypes of individuals experiencing gambling problems: (1) those who were behaviorally conditioned, (2) those with pre-existing emotional vulnerabilities (e.g., anxiety, depression), and (3) those who reported frequent impulsive and/or antisocial behavior. This week, as a part of our Special Series on Pathways to Addiction, The WAGER reviews a study by Lia Nower and colleagues that updated and revised the original pathways model.
What were the research questions?
Does the pathways model of problem and pathological gambling require revision? What revisions or additions should be made to the pathways model?
What did the researchers do?
The researchers surveyed 1,168 individuals with moderate to severe gambling problems seeking treatment across the United States, Canada, and Australia. Participants completed the Problem Gambling Severity Index (PGSI) and the Gambling Pathways Questionnaire (GPQ). The PGSI is a well-regarded and frequently used research instrument to measure the presence and severity of an individual’s gambling problems. On the other hand, the GPQ is an instrument designed to categorize individuals experiencing problem gambling based on the risk factors that they might have experienced. Using participants’ scores on the 11 subscales of the GPQ, the researchers performed latent class analysis to identify subgroups of individuals experiencing problem gambling.
What did they find?
Similar to the original pathways study, the latent class analysis identified three distinct subgroups. Class 1, the largest class, had the lowest average (i.e., mean) scores on each of the GPQ subscales. Class 2 was characterized by high levels of anxiety and depression, both pre- and post-problem gambling, in addition to a high rate of childhood maltreatment (see Figure 1). Finally, Class 3 comprised individuals who scored high in impulsivity and reported frequent risk-taking and/or antisocial behavior (see Figure 2). In terms of problem gambling severity, Class 2 had the highest average scores, while Class 3 scored only slightly lower. Notably, the research team also found some overlap between classes. For example, Classes 2 and 3 both reported gambling to cope with stress, though only Class 3 reported gambling to find meaning.
Figure 1. Gambling Pathways Questionnaire (GPQ) subscales that differentiate Class 2 from Classes 1 and 3. The total possible range for each GPQ subscale varies and is calculated by summing the responses within each subscale. Click image to enlarge.
Figure 2. Gambling Pathways Questionnaire (GPQ) subscales that differentiate Class 3 from Classes 1 and 2. The total possible range for each GPQ subscale varies and is calculated by summing the responses within each subscale. Click image to enlarge.
Why do these findings matter?
Recognizing the heterogeneity of pathways to problem gambling within this population is important because it allows treatment professionals to focus on the most salient risk factors for gambling problems rather than more tangential issues. For example, impulsivity is considered an important risk factor for Gambling Disorder and some interventions focus on modulating impulsivity. However, because only a subset of participants experienced heightened impulsivity, it is possible that significantly more people who experience gambling problems would instead benefit from safer product design that disrupts the conditioning aspects of gambling, such as mandatory breaks or the use of self-limit features (e.g., limiting time or amount wagered per gambling session).
Every study has limitations. What are the limitations in this study?
This study only included individuals who were seeking treatment for Gambling Disorder, so the findings might not apply to non-treatment seeking individuals experiencing gambling problems. Additionally, the GPQ measures pre-gambling anxiety/depression by asking participants to retrospectively recall their feelings though research suggests these measures are unreliable.
Read the original article on the Basis website HERE.
By John Slabczynski
With online gambling revenue projected to surpass $150 billion by 2030, developing a better understanding of the causes and consequences of gambling-related problems is especially important. A key focus in those suffering from gambling problems is the family, as family members are greatly impacted by problem gambling. However, some evidence also indicates that one’s family can potentially contribute to the risk of developing gambling problems. This week, The WAGER reviews a study by Marie Aime Uwiduhaye and colleagues that examined the role of family in the relationships among psychosocial risks, gambling problems, and other adverse outcomes.
What were the research questions?
What are the psychosocial correlates of gambling problems? Does family dysfunction moderate the relationship among gambling problems and negative outcomes, including drug misuse, alcohol dependence, anti-social behavior, and poor sleep quality?
What did the researchers do?
The researchers recruited 104 men from casinos in Musanze, Rwanda during 2019. Participants completed a number of self-report survey items, including questions about their gambling, substance use, sleep quality, family relationships, and mental health. The researchers used a combination of Pearson’s r correlation analyses and regression analyses to examine relationships. First, they examined the correlations between gambling problems and all other variables. Next, they examined these relationships through a series of regression analyses that also assessed the role of family dysfunction as a moderator.
What did they find?
Nearly half (44%) of participants reported high-risk gambling, with 37% reporting moderate risk gambling and 19% reporting low-risk gambling (see Figure). As expected, people with more severe gambling problems reported worse drug and alcohol problems (perhaps due to self-medication), as well as more insomnia, anti-social behavior, and family dysfunction. However, among participants with relatively high levels of family dysfunction, the links between problem gambling severity, and drug misuse, alcohol dependence, and insomnia (but not anti-social behavior) were stronger, suggesting that family dysfunction elevates the risk for these gambling harms.
Figure. Proportion of participants in the low-risk, moderate-risk, and high-risk gambling categories, and correlates of high-risk gambling. Click image to enlarge.
Why do these findings matter?
These findings help explain the relationship between gambling problems and frequently comorbid conditions including substance misuse. Clinicians need to understand each individual client’s pattern of co-occurring conditions, including which are primary and which are secondary, to address the root causes of distress. In addition, improving our understanding of both the causes and consequences of gambling-related problems can help enhance evidence-based treatments, which can be administered earlier in the development of problems. For example, the results of this study suggest that evidence-based treatments focused on the family, such as community reinforcement and family training, may decrease substance misuse in addition to gambling by improving family functioning.
Every study has limitations. What are the limitations in this study?
This study’s recruiting strategy was rather limited. The authors employed a convenience sample that only included men gambling at a casino. As a result, their findings might not be representative of other gamblers and the rate of high-risk gambling should not be interpreted as a prevalence estimate. Additionally, due to the cross-sectional nature of the data, we cannot be certain whether one variable causes another. Future studies should include a wider range of participants and collect data over time to better assess causality.
