Gambling disorder/Internet gaming disorder Flashcards
Key definitions
Gambling: placing a bet on an predominantly chance based outcome which will result in the possibility of winning a prize of monetary value
Gambling related harms: Negative consequences as a result of gambling such as financial, psychological or social
Problem gambling: a recurrent pattern of gambling in which the individual is unable to control their gambling and which results in negative consequences
Gambling disorder: formal DSM/ICD diagnosis
DSM-3 classified as impulse disorder
Formally added into DSM-5 as gambling disorder into the ‘Substance-related and addictive disorders’
- Only disorder under non-substance related and addictive disorders
- Reclassification based on similarities with substance abuse disorders, but this is still debated
Prevalence
Estimated 0.1-5.8% of adults across different countries
- methodological issues make comparisons across countries difficult
- different conceptualizations make this estimate difficult
Risk factors
Why do people gamble?
Gambling activity:
- Moderate to large associations with continuous play formats of gambling, casino games, poker and daily lottery participation
Psychosocial:
- Moderate associations with suicidal ideation/attempts, anxiety, depression, family history
- Associated with substance use (Alcohol/drug-related problems)
Sociodemographic risk factors
- Men tend to engage in sports betting
- Problems related to electronic gaming machines more common among older women.
Why?
- Social, financial, fun/thrill
Affect regulation is a DIRECT predictor of gambling disorder
- Negative affect downregulation (coping strategy)
- Positive affect upregulation (e.g, to feel good)
Cognitive biases in gambling
- Illusions of control - tendency to believe you have more control than you actually do
- Superstitious beliefs: “sitting in this way increases my chances of winning”
- Gamblers fallacy: sequence of losses makes one think chances of winning are imminent
- Recall bias: Remember the wins, forget the losses
- Attention bias: Gamlbing-related cues stand out
- Short-term “24 hour” thinking style: winner today, but what about past 1,2,3,4,10 years
Comorbidities in gambling disorder
Nationally representative survey of 9200 US citizens
- Prevalence of 0.6%
- 96% of those with a gambling disorder met criteria for another DSM-5 condition.
- Mood disorders: 56%
- Anxiety disroders: 60%
- Impulse control disorders: 42%
- Substance use disorders: 76%
OVerall, gambling disorder often occurs secondary to other disorders
- 74% of comorbidities preceded gambling disorder
24% came after gambling disorder
- 2% began in the same year
Pathways model of problem gambling
Pathway 1: behaviourally conditioned
- No premorbid psychopathology
Pathway 2: Emotionally vulnerable
- emotional vulnerability
- childhood maltreatment
- coping motivation
Pathway 3: antisocial impulsivist
- Gamlbing to satisfy meaning and purpose
- Impulsive, antisocial traits
- Risk-taking
Ecological factors + cognitive distortions + conditioning effects (variable ratio reinforcement) = problem gambling
Treatment/prevention for Gambling disorder
- Low rates of help-seeking
- Help-seeking often motivated by financial and relationship problems
- Treatment of comorbidites for pathway 2/3
- High treatment dropout rates
CBT
- Addressing gambling related cognitive distortions
- Managing urges/cravings and considering alternatives to gambling
- Integration of motivational interviewing techniques (RULE)
- Short term benefits, but limited evidence for long term benefits
Prevention
Public health approaches focus on population level strategies to reduce harm and minimise risk
- Policy and regulation
- Product characteristics
- Advertising
- Behavioural tracking
- Consumer protection tools
Internet gaming disorder
Controversies?
DSM 5TR includes only online gaming diagnosis - concerns around adequate justification for this exclusion
ICD11 contains both online and offline - concerns around whether addition is appropriate given:
- Low quality evidence underpinnning diagnosis (Confirmatory approach, Cross-sectional designs with mostly healthy participants, Inconsistent measurement approaches)
- Functional impairment may be low
- Arbitrary focus on gaming over other activities
- Pathologisation of video gaming creates moral panic
ICD diagnostic criteria for gaming disorder
Prevalence?
MUST HAVE
- Impaired control
- Increasing priority over other life interests and daily activities
- Continued use despite negative life consequences
- Manifests over 12 months
- Not better accounted for by another mental disorder
- Cause significant distress or impairment
Prevalnece: 2-3% of adolescents and adults worldwide (higher among adolescent males)
Conceptual issues
- Is problematic gaming a disorder or a coping process?
- Is it just a manifestation of another disorder? (e.g., Social anxiety disorder)
- Gaming -gambling convergence (social casino games, loot boxes, esports betting)
- Is gaming a gateway to gambling problems?
