WAGER: What are the cognitive behavioral therapy (CBT) outcomes among women with Gambling Disorder?

WAGER: What are the cognitive behavioral therapy (CBT) outcomes among women with Gambling Disorder?

The WAGER, Vol. 26(10)

Written By Taylor Lee

Read the original article on The Basis website Here.

Problem gambling occurs more frequently among men, but it is still present among women and is understudied in this population. Gambling Disorder (GD) refers to persistent and problematic gambling behavior leading to distress, and that causes financial, relationship, and psychological harm. The effectiveness of GD treatment has received limited attention in the scientific literature. Common factors that might influence treatment effectiveness include discontinuing treatment and relapse. This week, The WAGER reviews a study by Marta Baño and colleagues that examined the short-term therapy outcomes of group CBT among women with Gambling Disorder.

What were the research questions?
What is the short-term effectiveness of group standardized cognitive behavioral therapy (CBT) among women with GD? Also, what are the most important predictors of primary therapy outcomes (discontinuing treatment and relapse)?

What did the researchers do?
The researchers assigned 214 women seeking treatment for Gambling Disorder at the Pathological Gambling and Behavioral Addictions Unit at the Bellvitge University Hospital in Barcelona, Spain to a group CBT program. Participants attended weekly 90-minute sessions for 16 weeks and learned CBT strategies to recondition cognitive distortions and improve emotional regulation, with the ultimate goal of absolute and continued abstinence from all gambling behavior. These CBT strategies included education on vulnerability factors, ways to avoid possible triggers, and how to respond to urges with alternative healthier behaviors. The researchers used logistic regression, negative binomial regression, and survival analysis to assess predictors of discontinuing treatment and relapse.

What did they find?
During the course of treatment in the study, 90 women (42%) skipped three consecutive treatment sessions and 77 women (36%) had at least one relapse. Women with relatively less severe Gambling Disorder, and experiencing greater psychological distress, were more likely to discontinue treatment. On the other hand, relapse risk was higher among women with lower education levels, those without gambling-related debt, and divorced women. Drug use (other than smoking), placing more maximum bets per gambling-episode1, preferring gambling games that rely on chance alone such as bingo or slot machines2, and lower socioeconomic status were also associated with higher relapse rates during CBT (see Figure).

Figure. Statistically significant predictors of primary therapy outcomes—discontinuing treatment and relapses— among women in CBT treatment for Gambling Disorder (n = 214). Arrows indicate significant predictors of either discontinuing treatment or relapse. Click image to enlarge.

Why do these findings matter?
Learning more about female gambling behavior and identifying specific predictors of discontinuing treatment and relapse can help clinicians provide better GD treatment. For example, severe emotional distress may indicate a need for greater emphasis on emotional regulation techniques (e.g., through mindfulness meditation) or healthy coping mechanisms. CBT might also need to be adapted for those with lower education levels to be more engaging and comprehensible. These findings also demonstrate a clear need for future research on women with GD to understand their unique lived experiences.

Every study has limitations. What are the limitations of this study?
As a study with only female participants, the findings can not be generalized to men. Additionally, measures such as amount bet per gambling episode relied on self-reported data, in which participants may have over- or underestimated their actual gambling behavior.

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.

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[1] In this context, “maximum bets per gambling-episode” refers to most bets placed during any single past gambling experience.
[2] As opposed to games like poker, which include both chance and skill.

Gambling during COVID: The impact of COVID-19 on gambling behavior and gambling-related problems

Gambling during COVID: The impact of COVID-19 on gambling behavior and gambling-related problems

Article by The Wager.

Read original article Here.

Editor’s Note: Today’s review is part of our month-long Special Series on Managing Addiction during COVID. Throughout September, The BASIS is highlighting how the COVID-19 pandemic has impacted people managing addiction. This Special Series is generously sponsored by the Greater Boston Council on Alcoholism.

The COVID-19 pandemic has permeated just about every area of our society, causing massive changes in our world. Some changes—like working remotely and staying home instead of going to sporting events, bars, and casinos—might outlast the virus. Certainly during the first year of the pandemic, people couldn’t gamble in land-based venues even if they wanted to. It’s important to understand how people’s relationship with gambling changed during COVID because some of these changes might be long lasting. Therefore, this week, as part of our Special Series on Managing Addiction during COVID, The WAGER reviews a study by David Hodgins and Rhys Stevens on the impact of COVID-19 on gambling and gambling-related problems.

What was the research question?
How has the COVID-19 pandemic impacted gambling behavior and gambling-related problems?

What did the researchers do?
The researchers searched several online databases for peer-reviewed scientific articles and other relevant published works (e.g., research reports) that examined changes in gambling and risk factors for gamblingrelated problems during the COVID-19 pandemic. Their criteria for selecting articles in the study included: (1) the examination of individual gamblers, (2) assessment of the impact of COVID-19 on gambling, and (3) publication in English after March 2020. Seventeen distinct articles were located that fit these inclusion criteria.

What did they find?
The articles were limited geographically to middle- and upper-income Western countries, though they included a variety of recruitment methods and recruited participants from a variety of different population groups within those countries. Most (65%) of the studies were cross-sectional and 35% were longitudinal, and all of the studies used online surveys as one of the data collection approaches. While changes in participants’ gambling behavior varied across studies, all 17 studies showed an overall decrease in gambling behavior, measured as reduced gambling frequency and/or money spent on gambling. Though only two studies investigated the causes behind this decline, the most common in descending order were: (1) financial reasons, (2) absence of live sports, (3) not wanting to gamble around family, (4) thinking they were gambling too much, and (5) shopping less overall. On the other hand, some individuals increased their gambling behavior, which can lead to increased risk of gambling-related problems. Several risk factors were associated with increased gambling behavior (See Figure).

 

WAGER: Is spending on trading cards related to problem gambling?

WAGER: Is spending on trading cards related to problem gambling?

The WAGER, Vol. 26(7) – Is spending on trading cards related to problem gambling?

Read the original article from The Wager Here.

Written by: Taylor Lee

Various in-person and online games allow players to purchase randomized packs of rewards, such as collectible card packs and virtual items. Some places are imposing regulations on video games offering loot boxes—purchasable virtual containers with randomized items—as they seem to fit traditional definitions of gambling. Indeed, people who report more problem gambling symptoms tend to spend more on loot boxes. Due to some similarities with loot boxes, collectible card game ‘booster packs’ have come under scrutiny as well. Collectible card games (CCGs) allow for the purchasing of physical booster packs containing cards that are sealed and random in game value. This week, The WAGER reviews a study by David Zendle and colleagues that examined the association between problem gambling symptoms and the amount of money spent on physical booster packs of trading cards.

What was the research question?
What is the relationship between the severity of problem gambling symptoms and the quantity of money spent on collectible card game booster packs in real-world and digital stores?

What did the researchers do?
The researchers used a cross-sectional survey advertised on the online message board Reddit, and obtained 726 usable responses from participants 18 and older. About 60% of respondents were from the U.S., but many different countries were represented. The survey asked participants about CCG physical booster pack spending in (1) real-world stores and (2) digital stores within the past month. It also assessed problem gambling using the Problem Gambling Severity Index (PGSI). The researchers used PGSI scores to classify respondents as non-problem gamblers (n = 429), low-risk gamblers (n = 244), moderate-risk gamblers (n = 35), and people experiencing gambling problems (n = 18). They then used Kruskal–Wallis tests to examine if respondents in different PGSI groups differed in terms of how much money they spent on physical booster packs in real-world stores and digital stores.1

What did they find?
Zendle and colleagues did not find evidence for an association between problem gambling and quantity spent on booster packs in real-world stores (see Figure). Even though there was a statistically significant relationship for problem gambling and the quantity of money spent on booster packs in digital stores, the effect was too small to be considered clinically significant. There was also no significant difference in quantity spent on booster packs between people with and without gambling problems.

Figure. Problem gambling severity and spending (in US dollars) on booster packs in real-world stores among survey respondents (total n = 726). Although the authors performed their statistical tests on mean ranks, we provide medians to illustrate the trends across PGSI categories. The interquartile range (IQR) around each median was $39 for people without gambling problems (n = 429), $50 for low-risk gamblers (n = 244), $69 for moderate-risk gamblers (n = 35), and $119 for people experiencing gambling problems (n = 18). Click image to enlarge.

Why do these findings matter?
This study suggests that while booster packs in collectible card games may appear similar to gambling in some ways, users do not seem to engage with them in ways comparable to traditional gambling activities. Thus, regulations—like those developed for loot boxes—might not be necessary for booster packs. This suggests that there is likely a difference in the ways that players interact with physical booster packs and digital loot boxes. Ultimately, the findings were cross-sectional, so the researchers could not establish causality; additional longitudinal and/or experimental research would help better illuminate the specific factor that accounts for the difference in loot box and booster packs’ relationship with problem gambling symptoms.

Every study has limitations. What are the limitations of this study?
Participants were recruited from Reddit’s online message boards targeting fervent players of collectible card games. An over-representation of enthusiastic players in the study’s sample may lead to findings that are not representative of more casual players. Social desirability bias through self-reporting may also contribute to participants misrepresenting their true spending or gambling behaviors. The most severe PGSI category had only 18 people in it, which likely limited the chances that the authors would statistically detect a difference among groups.

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 additional resources, including gambling and self-help tools, please visit The BASIS Addiction Resources page.

— Taylor Lee

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[1] The authors used rank transformations and Kruskal–Wallis tests to replicate past research in this area, and because they could not be sure if their spending data would meet the normality distribution assumptions of ANOVA.

WAGER: What do big data have to say about gambling and negative life outcomes?

WAGER: What do big data have to say about gambling and negative life outcomes?

Read the original article from The Wager Here.

Gambling can result in serious financial, emotional, social, and health problems for some people who gamble. Better understanding the extent and timing of the relationship between gambling and negative outcomes can help us improve interventions designed to reduce gambling-related harm. However, most past work is confined to self-report surveys and small-scale studies, which might have limitations due to inaccurate reporting or memory lapses. This week, the WAGER reviews a study by Naomi Muggleton and colleagues that was one of the first to examine gambling and gambling-related harms in a large sample using actual financial data measured across time.

 

What was the research question?

What is the association between gambling (as measured through gambling transactions) and financial, lifestyle/leisure, and health-related outcomes (as measured through financial transactions related to these domains)?

 

What did the researchers do?

The researchers used financial data from two samples of customers of a large UK bank: a random sample of 102,195 customers who were active (i.e., had active bank accounts) in 2018 (Sample 1); and all 6,515,557 customers who were active in 2013 (Sample 2). They measured how much of customers’ spending in a given month was spent on gambling transactions. Next, they created all of their outcome variables from information about customers’ transactions (e.g., whether they take a payday loan in a given month, or how much they spend on fitness-related activities and products). In Sample 1, they used regression models to look at the relationship between gambling spend in one month and measures of financial distress, financial planning/inclusion, lifestyle spending, health and well-being spending, and leisure and interests spending one month later during 2018. In Sample 2, they used logistic regression models and survival analysis to look at the relationship between spending on gambling in 2013 and measures of disability, unemployment, and mortality from 2014-2019.

 

What did they find?

In Sample 1, people who spent a greater percent of their money on gambling transactions in one month were more likely to experience financial distress (e.g., using an overdraft, missing a credit card, loan, or mortgage payment), less likely to engage in financial planning and inclusion (e.g., holding a mortgage or having savings, paying down a mortgage or loan), less likely to spend on health or well-being (e.g., transactions related to fitness or self-care), and less likely to spend on other leisure and interests (e.g., transactions related to education or social activities) in the next month. These associations were non-linear; as the Figure shows, most relationships were much stronger at high levels of gambling. Gambling spend did not demonstrate a consistent relationship with lifestyle spending (e.g., spending on gaming or tobacco).

In Sample 2, people who spent a greater percent of their money on gambling transactions in 2013 were more likely to experience unemployment or disability (as measured by unemployment and disability

payments) in 2014-2019, and had higher mortality (as measured by a flag placed on a customer’s account following that customer’s death) in those same years.

Figure. Common associations between spending on gambling transactions and financial, health, and leisure & interests. In these graphs, the x-axis shows percentile of gambling spend (e.g., 1% includes individuals in the sample who were in the lowest 1% in terms of how much of their spending was on gambling; 99% includes individuals in the sample who were in the 99th percentile in terms of how much of their spending was on gambling). The y-axis measures either the level of the outcome (e.g., how many pounds [£] an individual has in savings), or the percent of customers who had that outcome (e.g., the percent who missed a mortgage payment). The charts do not depict actual data from the study, but representative curves for each set of outcomes. Adapted from Muggleton et al. (2021). Click image to enlarge.

 

Why do these findings matter?

This study confirmed that gambling is associated with a wide range of negative outcomes, using objective, representative data based on millions of banking records. It is one of the largest studies ever conducted on gambling transactions and how they relate to other financial transactions. However, the study also showed that in most cases, these relationships are much stronger at higher levels of gambling. The results of these studies can be used to guide interventions and prevention efforts. For example, banks could develop messaging to send to customers whose spend on gambling in relation to the rest of their spending exceeded a certain level providing information about gambling and its risks or helpful tools and resources. This would be similar to current efforts to determine lower-risk thresholds for gambling and raise awareness of those thresholds among gamblers. All messaging efforts should be tested to ensure they have the intended effects.

 

Every study has limitations. What are the limitations of this study?

This study staggered measurements of gambling spend and outcomes in time, but this approach does not definitively establish causality. It is possible that both high levels of gambling and high levels of these negative outcomes reflect other underlying factors that drive both the gambling behavior and other behaviors.

 

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 additional resources, including gambling and self-help tools, please visit The BASIS Addiction Resources page.

What do you think? Please use the comment link below to provide feedback on this article.

— Sarah Nelson, Ph.D.

A Review of Sports Wagering & Gambling Addiction Studies — Executive Summary

A Review of Sports Wagering & Gambling Addiction Studies — Executive Summary

The following is taken from the National Council on Problem Gambling:

This report on recent research suggests that gambling problems may increase as sports gambling grows explosively at the same time that mobile and online technologies evolve to create seemingly unlimited types of wagering opportunities. Here are important highlights from a special review of more than 140 studies and reports on the connections between sports betting and gambling addiction.

Sports Betting and Online Gambling: A Potentially Volatile Mix

The rate of gambling problems among sports bettors is at least twice as high as among gamblers in general. When sports gambling is conducted online, the rate of problems is even higher, with one study of online sports gamblers indicating that 16% met clinical criteria for gambling disorder and another 13% showed some signs of gambling problems.

Concerns About Modern Sports Gambling

Nearly half of American adults have bet on a sporting event. More and more are betting online, with 45% of sports wagering now taking place on the internet. Today’s online sports betting is particularly concerning for several reasons:

  • Access: internet gambling is available virtually all the time.
    – It’s more convenient and provides more privacy.
    – Early research shows that those who bet using mobile devices have higher rates of problem gambling.
  • Live “In-Play” Betting: today’s sports gamblers can bet on much more than just the winner of a game.
    – Sports gamblers can bet — during the game — on hundreds and potentially thousands of discrete events. Any aspect of a team or player’s performance or activity that can be measured is now a potential wager.
    – This shortens the lag between bet and reward, increasing the speed and frequency of gambling, which increases the risk of problematic behavior.
Professional Athletes Frequently Gamble on Sports

Sports gambling is widespread among professional athletes. While no study of gambling among U.S. professional athletes is publicly available, such studies have been conducted elsewhere. One recent European report showed that 57% of professional athletes surveyed gambled on sports in the previous year, with 8% exhibiting problem gambling behavior, roughly three times greater than the general population.

Youth are at Higher Risk

Data from 2018 shows that more than 75% of students gambled. This is a big concern given the risk-taking behavior that takes place in adolescence and young adulthood, along with gambling being more socially acceptable and glamorized. More than 13% of adolescents wagered money on sports teams according to a study in 2017. Students most often bet on professional football and college basketball. Youth gamblers have higher rates of gambling problems than adults. Males are far more likely than females to both gamble on sports and to experience gambling problems.

Popularity and Growth of Fantasy Sports Gambling

From 2004 to 2018, participation in fantasy sports gambling quadrupled — from 14 million to 57 million. Higher fantasy game participation is associated with significant increases in problem gambling severity.

The Profile of a Sports Bettor

Heavy sports bettors who meet the criteria for clinical gambling disorder are typically male, young (up to age 35), single, fully employed, and have a high level of education. They think sports gambling is more skill than luck, suggesting they’re prone to distortions in thinking. They affiliate with others who favor sports betting, frequently taking advantage of different types of promotions, and are generally highly impulsive.

Marketing Inhibits Ability to Stop Gambling

Aggressive promotions in all forms of marketing and advertising make it more difficult for sports bettors who are trying to curtail their gambling. Ads that emphasize ‘free play,’ tout the ease of placing a bet, or offer risk-free bonuses are particularly problematic.

Looking Ahead

Sports gambling is growing rapidly with significant potential to create or worsen gambling problems. Twenty-three states to date have legalized sports betting. Moreover, it’s clear that substantial prevention and treatment efforts need to be developed and targeted to those most vulnerable to developing an addiction through sports gambling.

The review was conducted by Jeffrey Derevensky, PhD, and Ken Winters, PhD in the autumn of 2018. The full report, A Comprehensive Review of Sports Wagering and Gambling Addiction, is available here.

The Importance of Further Refining Responsible Gambling Tools

The Importance of Further Refining Responsible Gambling Tools

By Susan Sheridan Tucker

In early March 2020, I attended the annual New Horizons Conference on Responsible Gambling. It’s a conference that always provides great insights and this year did not disappoint.

The theme was Future-Proofing the Gambling Industry, an aspirational goal where a gambling operator no longer makes money from those exhibiting problem gambling. This may seem like pie-in-the-sky, but several countries are taking steps through advancements in technology that enable them to better identify customers taking too many gambling risks and to engage them in conversations about risks and potential financial harm. We are seeing a subtle shift in the goals of responsible gambling from providing safeguards and prevention initiatives to supporting safer gambling for all, including reinforcing “ideal” consumer behaviors.

“Future-Proofing the Industry: Player Safeguards and Prevention”
There was much discussion about a paper by Judith Glynn of Strategic Science titled, “Future Proofing the Industry: Player Safeguards and Prevention.” The paper sparked conversation about the role of responsible gambling tools, how to make those tools more efficient and effective, and determining ways in which the risks can be identified and addressed. The paper called for greater cooperation between regulators, operators and players, recognizing each has an important role in determining the best ways to minimize the harms associated with gambling.

Some highlights of the paper include:

  • Establish the objective as making gambling safer for all players through education and awareness resources. This includes limit-setting tools, self-assessment tools and revising policies for on-site access to personal credit (ATMs, credit cards and limits on house credit, which ensures that the operator has ownership in the process).
  • Operators must take a direct role in keeping their players safe. They see firsthand the risky behavior in their customers and have the ability to understand their players’ playing activities and payment practices.
  • Operators can respond to a customer exhibiting risky behavior through well-designed messages and personal intervention with trained staff on the floor intervening when a customer escalates their risk levels.
  • Success in “future-proofing” will require cooperative efforts from operators, regulators and customers.

The issue that remains with responsible gambling programs is evidence showing that reliable and effective changes ensue in a customer’s behavior. While there is some evidence showing that responsible gambling tools create positive changes in behavior and reduce risk, the adoption rate of such tools is still too low. More work needs to be done to provide messaging that stimulates self-evaluation and personal relevance. Players need to receive messaging that instills autonomy and assists the player in their decision making.

Additionally, self-assessment tools must provide immediate results with personalized and actionable feedback. It’s equally important to respond to the risk as much as just identifying it. While self-assessment tools provide a window to communicate with players, more research is needed to evaluate its effectiveness on actual behavioral change.

 

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