NCRG Conference on Gambling and Addiction

Monday, November 12, 2007

Are Gambling Behaviors Stable or Shifting Over Time?

According to DSM-IV, pathological gambling is defined as “persistent and recurring maladaptive gambling behavior,” and is widely considered to have a progressive course. Both Dr. LaPlante and Dr. Nelson presented recent empirical work that challengea this conventional wisdom.

Debi LaPlante, Ph.D., instructor of psychology in psychiatry at Harvard Medical School, addressed population-level stability, especially the effect of exposure, and individual-level stability in relation to persistence, selective-stability and progression.

With regard to population-level stability, the typical public health infection curve can be used as an analogy to understand the long-term consequences of exposure to gambling. The infection curve shows a high increase shortly after exposure, followed by a decline over time due to adaptation and resistance. This model receives general empirical support, and is supported by data from a recent study of online gambling behavior (bwin) showing that new subscribers show a rapid adaptation in their gambling activities. Data from bwin also suggests that a small segment of the new subscribers were heavily involved in gambling and adapted slower or not at all to the new exposure. The effects of exposure seem to differ in relation to individuals, regions, time points, and the initial effect of exposure declines over time.

With regard to individual-level stability, analyses on data from four former studies conducted by Winters et al., Abbott et al., Shaffer & Hall, and DeFuentes et al. indicate that the common wisdom that gambling is a persistent disorder is false – pathological gamblers do actually improve more than expected. The data show that high severity gamblers and low severity gamblers are equally likely to improve, and do not support the assumption about selective stability. Finally the data show that the progression or worsening of gambling symptoms is less common than expected.

LaPlante also emphasized the importance of recognizing the people who do not improve or recover from gambling symptoms, who do not adapt to new exposure, and who jump addictions. In addition, though people do not meet the diagnostic criteria for pathological gambling they can still experience problems.

Sarah Nelson, Ph.D., instructor of psychology in psychiatry at Harvard Medical School, presented data on individual stability across time, especially with focus on the fluctuations in the number of symptoms endorsed and the symptom profile.

According to DSM-IV a diagnosis of pathological gambling is given when a patient endorses five of the ten symptoms of pathological gambling. Even though the number of symptoms is crucial for a diagnosis, differences in symptom profile can make a huge clinical difference.

Research has found that the most reported symptoms are chasing, escape and preoccupation. Women are more likely than men to report “gambling to escape from problems.” “Risked relationships because of gambling” and “committing illegal acts to finance gambling” are the least reported symptoms, and are only reported by the most severe gamblers.

Analysis of the NESARC data – a national telephone survey – showed high fluctuations of the number of symptoms endorsed prior to the past year compared to the past year, high fluctuations in the specific symptoms endorsed prior to the past year compared to the past year, that stability decreases with the severity of gambling, that the most stable symptoms are escape and preoccupation, and that escape reported prior to past year is the best predictor of past year pathological gambling.

Nelson emphasized the importance of repeated assessment of gambling symptoms and the need for longitudinal studies of pathological gamblers. Though the overall gambling prevalence is relatively stable, this does not mean that individuals who meet the diagnosis are the same across time. According to Nelson, there seem to be great fluctuations in the number of symptoms and the specific symptoms over time.


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