Pathological Gambling – Prevalence and Diagnosis – Global Dimension

Pathological gambling – prevalence and diagnostics – global dimension

INTRODUCTION

The continually increasing trend in gambling is the result of this behaviour becoming normalized in the general population. The media and the so-called “virtual society,” where it is now common to play gambling games online, at any place and any time, also contribute to it. The issue of pathological gambling became highly relevant after the transitional period when it became possible to advertise and operate gambling games through money-winning slot machines. However, gambling at that time did not come close to the frequency and variety of gambling seen today. The attractiveness of gambling, given its availability in physical casinos and gaming halls as well as in virtual casinos and gaming halls, is constantly increasing, which is a warning sign for future generations and for moral, cultural, and value norms and systems in society.

From the perspective of behavioural and human sciences it is important to emphasize that pathological gambling is a proven disabling impulse-control disorder (Hroncová and colleagues 2006), which is linked to obsessive-compulsive disorder. Gambling behaviour in many cases causes the disruption of personal, family and work relationships, but problems in the family and relationship domain can also be predisposing factors for this type of behaviour.

PREVALENCE OF PATHOLOGICAL GAMBLING

The genesis of gambling dependence can be dated to 1975. In that year, it was estimated that 68% of the total adult population in the United States had had gambling experience. By 1998, this was already 86% of the total adult population. In that statistic, all then-traditional forms of gambling (casino, lottery, horse racing) were included. Poker and internet gambling were recorded only in the following period. In 2001, this was already 10% of adult gamblers who were classified as problem gamblers (3–4% of the total population) in the USA. Even in that period, the statistics indicated that pathological gamblers were increasing worldwide. In 2001, the prevalence of pathological gambling in both the American and European populations was 1–3%. In adolescents, this figure was substantially higher, reaching 9% for problem gambling and 4% for pathological gambling. These data formed the basis for creating the first and now best-known organisations that fought gambling dependence (“Gamblers Anonymous”; “The National Council on Problem Gambling”; “Gam-Anon”). (Šerý, 2001).

The findings of a systematic review of empirical data from 2000 to 2015 by Calado and Griffiths (2016) showed that, despite missing statistical data in some countries, the prevalence of problem gambling ranges globally from 0.12% to 5.8% of the total population, while in Europe it is 0.12% to 3.4%. From the perspective of cross-country differences, it is clear that the highest prevalence of problem gambling in adults worldwide is in North America, at 2% to 5%. The lowest prevalence was found in Oceania, at 0.4% to 0.7% (Calado, Griffiths, 2016). Prevalence of pathological gambling in Asia is estimated at 0.5% to 5.8% and in Europe from 0.1% to 3.4% (Kun et al., 2012; Planzer, Gray, Shaffer, 2014; Meyer et al., 2015; Meyer, Hayer, Griffiths 2008). The highest pathological gambling prevalence has long been recorded in Hong Kong (Brodbeck, Duerrenberger, Znoj, 2009). Currently, the prevalence of problem gambling among adolescents is estimated at 1.6% to 5.3% of the total world population (Molinaro et al., 2014).

When assessing prevalence by individual countries, it is also necessary to consider intercultural differences and specificities (Kun et al. 2009). From the average of results across studies, prevalence of problem gambling in different European countries is variable: in Belgium it is 0.4% to 1.6% among adults (men: 2.3%, women: 1.8%) and 3.2% to 4% among adolescents (Druine et al. in Calado, Griffiths, 2016); in Austria 0.4% to 0.7% (Kalke et al. in Calado, Griffiths, 2016); in Norway 0.15% to 1.7% (Bakken et al., 2009; Lund, Nordlund, 2003; Götestam, Johansson, 2003); in Portugal 0.2% (Lopes, 2009); in Slovenia 0.46% to 1.46% (Nakarovič et al., 2008); in the Czech Republic 1.3% to 2.3% (Mravčík et al., 2014; Szczyrba et al., 2015); in France 0.4% to 2.2% (Costes et al. in Calado, Griffiths, 2016); in Germany 0.2% to 0.6% (Sassen et al., 2011; Buth, Stöver, 2008; Bühringer et al., 2007; Meyer et al., 2015); in Switzerland 1.6% to 2.2% (Bondolfi, Osiek, Ferrero, 2000; Bondolfi et al., 2008; Brodbeck, Duerrenberger, Znoj, 2009); in Denmark 0.3% to 3.4% (Bonke, Borregaard, 2006; Ekholm et al., 2012; Laansoo, Niit, 2009); in Finland 1.5% to 2.2% (Raisamo et al., 2014; Castrén et al., 2013); in Great Britain 0.5% to 0.9% (Wardle et al., 2007; Wardle, D´Souza, Farrel, 2009; Wardle et al., 2014); in Italy 1.2% to 6.1% (Bastiani et al., 2011; 2013; Brabaranelli, 2010; in Northern Ireland 2.2% to 4.8% (Northern Ireland Statistics and Research Agency, 2010); in Hungary 1.9% to 5.3% (Paksi et al., 2009); in the Netherlands 1% to 1.5% (Bieleman et al., 2011; Goudriaan, 2014; De Bruin et al., 2006); in Spain 0.18% to 0.92% (Becona, 2004); in Sweden 2% to 3.9% (Abbott et al., 2014; Volberg et al., 2001).

Williams, Volberg and Strevens (2012) state that pathological gambling is an important public-health issue in many countries, corresponding to an estimated 0.5% to 7.6% of pathological gambling cases worldwide among adults. The average among all countries is 2.3%, according to these authors. The public health implications of the occurrence of pathological gambling are further developed by Schaffer and Korn (2002) and Williams, Lee and Back (2013).

Okuda et al. (2009) confirm that gambling activities are now part of every culture. Research findings on pathological gambling indicate that although most individuals who gamble do not develop a gambling dependency, this risk exists for 1–3% of adult gambling populations. If pathological gambling is separated from problem gambling, the prevalence of problem gambling in the past was around 5.5%. (Shaffer et al. 1999). Shaffer, Hall, and Vander Bilt (1999) conducted a detailed meta-analysis of 119 studies over 20 years (1974–1997). The analysis results regarding the occurrence of problem compulsive gambling showed a prevalence of 2.9% of the total population, with 0.8% classified as pathological gamblers. More recent studies (1994–1997) found prevalence of problem gambling at 4.9% and pathological gambling at 1.3%. (Perkins et al., 2007).

Research studies also report that adolescents are more at risk of developing gambling dependence than adults. Csémy, based on results from the European School Study (2007), reported that 1.1% of 16-year-old boys play gambling games daily or almost daily. In this finding, experts take the position that these are already pathological gamblers, because in this age rapid progression of onset and escalation of gambling dependence is seen. (In Nešpor et al., 2011).

In Great Britain, the occurrence of pathological gambling around 2000 was at the level of 0.8% (Sproston et al., 2000). In the Asian region, prevalence of pathological gambling currently ranges from 0.07% to 2.66%, depending on the availability of legal gambling opportunities and cultural differences between countries (Liu, Luo, Hao, 2013).

The findings of individual studies during that period pointed to a similar percentage prevalence of pathological gambling in the total population. It is also important to note that among psychiatric patients there is a higher risk of developing gambling dependence. In this case, figures ranged from 6% to 12% of psychiatric patient populations, according to Sproston, Erens and Orford (2000). The prevalence among this target group is also currently significantly higher.

Thomas et al. (2017) report, from the current international perspective, an estimated prevalence of 2.3%. International studies show different prevalence by states in a range from 0.5% to 7.6%. The lowest prevalence (0.5%) is estimated in Denmark and Norway and the highest in Hong Kong (7.6%). The estimated prevalence of pathological gambling in Australia is 2.1%, while the range across regions is 0.7% to 2.6%. (Williams, Volberg, Stevens, 2012). Based on the above findings on both historical development and current prevalence of problem gambling, it is evident that its occurrence has been continuously increasing over time.

DIAGNOSTIC TOOLS DESIGNED TO MEASURE GAMBLING PROBLEMS

The prevalence of problem and pathological gambling is usually verified with the SOGS method (“The South Oaks Gambling Screen”) and its adolescent-modified version, SOGS-RA (“The South Oaks Gambling Screen – Revised Adolescent”). The method GA-20 (“Gamblers Anonymous 20 Questions”), the “Lie/Bet Questionnaire,” and G-SAS (“Gambling Symptom Assessment Scale”) are also aimed at identifying problem gamblers. Other research methods focused on the diagnosis of pathological gambling are GBI (“Gambling Behaviour Interview”), DSM-IV-MR (“DSM-IV Multiple Response”), EIGHT (“Early Intervention Gambling Gealth Test”), DIGS (“Diagnostic Interview for Gambling Schedule”), NODS (“National Opinion Research Center DSM-IV – Screen for Gambling Problems”), MAGS (“Massachusetts Gambling Screen”), TLFB (“Time-Line Follow-Back”), and GAM-IV (“Gambling Assessment Module”).

There is also a number of other research methods applied to specific characteristics of the disorder or personality of a dependent person. In our context, one research tool was developed for assessing the severity of gambling. This is the BBDPH, whose authors are Nábělek and Vongrej (2006). With this research tool, scoring and interpretation are still only vaguely specified, as the tool has not yet been standardized and compared with control groups from the general population.

There are also known several research tools that measure the severity of gambling symptoms and related variables among adolescents and young adults, such as SOGS-RA (“The South Oaks Gambling Screen Revised for Adolescents”); MAGS (“The Massachusetts Gambling Screen”); CAGI (“The Canadian Adolescent Gambling Inventory”); GABSA (“The Gambling Addictive Behavior Scale for Adolescents”); and GPSS (“The Gambling Problem Severity Subscale”). Edgren et al. (2016) provided a systematic reliability review of these research tools covering 2006 to 2015.

CONCLUSION

From the perspective of the professional community, the issue of gambling is supported mainly by medical and psychological findings within the context of social sciences and theories that seek to explain the causality of this social-pathological phenomenon. What appears useful for a comprehensive provision of data, facts and theories in pathological gambling are not only selected publications but also professional and scientific journals. In this case, we must state, however, that in our context, not only professional publications focused on gambling problems, but also scientific articles are markedly lacking.

From the present state in our context, among professional journals in which topics concerning this issue may be found, we can include, for example, the Slovak journal “Alkoholizmus a drogové závislosti” and the Czech journal “Adiktologie.”

International scientific journal databases that offer professional and scientific articles devoted exclusively to pathological gambling are Journal of Gambling Studies; International Gambling Studies; Asian Journal of Gambling Issues and Public Health; Journal of Gambling Issues; Journal of Gambling Study; Journal of Gambling Business and Economics; Journal of Gambling and Commercial Gaming Research; and Journal of Gambling Behaviour. Other journals also offer articles related to pathological gambling at the periphery, for example journals on addictive behaviour in general, such as Journal of Behavioral Addictions; Addiction; International Journal of Mental Health and Addiction; Addiction Biology; Psychology of Addictive Behavior; European Addiction Research; Journal of Addictive Diseases; Addictive Behaviors; and American Journal on Addictions.

In conclusion, in light of the facts presented in the article, we can only hope that more professionals in the humanities will begin to focus on pathological gambling, thereby emphasizing the bio-psycho-social paradigm of dependence of this type, as well as a multifactorial paradigm. In our context, the professional perspective most commonly presented is primarily biological and partly psychological. In the Czech Republic, the addictionology perspective is also worth mentioning and it also develops the issue of pathological gambling.

Author: PhDr. Michaela Dávidová, PhD. List of abbreviations and symbols

BBDPH – Banskobystrický pathological gambling questionnaire; CAGI – (“Canadian Adolescent Gambling Inventory”); A method for determining the prevalence of problem and pathological gambling among adolescents; DIGS – (“Diagnostic Interview for Gambling Schedule”); A structured and standardized diagnostic interview assessing the history of a person who gambles; DSM-IV-MR – (“Diagnostic and Statistical Manual of Mental Disorders IV Multiple Response”); A ten-item questionnaire designed to measure diagnostic criteria of adult pathological gamblers; EIGHT – (“Early Intervention Gambling Health Test”); A diagnostic tool designed for screening pathological gambling in the general population; GAM-IV – (“Gambling Assessment Module”); A method designed for diagnosing seven different types of gambling; GABSA – (“Gambling Addictive Behavior Scale for Adolescents”); A method focused on determining the prevalence of problem and pathological gambling among adolescents; GFS – (“The Gambling Follow-up Scale”); A scale recording continuation of gambling; GPSS – (“Gambling Problem Severity Subscale”); A method aimed at determining the prevalence of problem and pathological gambling; G-SAS – (“Gambling Symptom Assessment Scale”); A scale evaluating symptoms of pathological gambling; GA-20 – (“The Gamblers Anonymous 20 Questions”); A twenty-question questionnaire of Gamblers Anonymous on which it is possible to identify problem gambling; GBI – (“Gambling Behaviour Interview”); A diagnostic tool assessing pathological gambling over the last year; MAGS – (“Massachusetts Gambling Screen”); A Massachusetts gambling questionnaire for detecting gambling problems in juveniles and adults; NODS – (“National Opinion Research Center DSM-IV – Screen for Gambling Problems”); A method verifying gambling problems in the general population; SOGS – (“South Oaks Gambling Screen”); A research method aimed at determining the prevalence of problem and pathological gambling; SOGS-RA – (“South Oaks Gambling Screen – Revised Adolescent”); A method focused on determining the prevalence of problem and pathological gambling – revised version for adolescents; TLFB – (“Time-Line Follow-Back”); A method intended for retrospective assessment of gambling.

Genesis – development, historical course. Obsessive-compulsive disorder – a compulsive need to repeatedly engage in intrusive, usually unpleasant and distressing thoughts, ideas, images, impulses, or behaviours associated with unpleasant feelings and anxiety arising from them. Anxiety subsides only after performing the repetitive ritual or act. (Hartl, Hartlová, 2010). Prevalence – predominance, prevailingness, dominance, occurrence. (Tisovičová, 2007; Hartl, Hartlová, 2010). Reliability (reliable) – the extent to which a test, text or method is robust against errors (observer effect, environment, instruction and fatigue, instability over time). The ability to produce the same results under repeated measurement and the same conditions. (Tisovičová, 2007). We speak of good reliability when a test or research method repeatedly produces consistent results. If the test does not provide similar results with a different research sample, then its reliability is considered insufficient. Reliability is usually evaluated through the correlation of two sets and their obtained results. If the correlation of both forms of the test is high, this is termed “parallel reliability.” (Nolen-Hoeksema et al. 2012). Validity (valid) – determines whether a test or research method really measures what it is supposed to measure. (Nolen-Hoeksema et al., 2012).

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