Debi A. LaPlante

Toward a Syndrome Model of Addiction: Multiple Expressions, Common Etiology

It is common for clinicians, researchers, and public policymakers to describe certain drugs or objects (e.g., games of chance) as “addictive,” tacitly implying that the cause of addiction resides in the properties of drugs or other objects. Conventional wisdom encourages this view by treating different excessive behaviors, such as alcohol dependence and pathological gambling, as distinct disorders. Evidence supporting a broader conceptualization of addiction is emerging. For example, neurobiological research suggests that addictive disorders might not be independent:2 each outwardly unique addiction disorder might be a distinctive expression of the same underlying addiction syndrome. Recent research pertaining to excessive eating, gambling, sexual behaviors, and shopping also suggests that the existing focus on addictive substances does not adequately capture the origin, nature, and processes of addiction. The current view of separate addictions is similar to the view espoused during the early days of AIDS diagnosis, when rare diseases were not

The Road Less Travelled: Moving From Distribution to Determinants in the Study of Gambling Epidemiology

This article reviews the current status of gambling epidemiology studies and suggests that it is time to move from general population-prevalence research toward the investigation of risk and protective factors that influence the onset of gambling disorders. The study of incidence among vulnerable and resilient populations is a road yet to be taken. In this review, we briefly introduce the history of the field and thoroughly review the epidemiologic research on disordered gambling before providing a critical assessment of the current diagnostic tools. Overall, the extant research shows that disordered gambling is a relatively stable phenomenon throughout the world. Given that certain segments of the population (for example, adolescents and substance users) have elevated prevalence rates, we suggest focusing future prevalence studies on groups with apparently increased vulnerability. Moreover, we suggest that, for the field of gambling studies to progress, researchers need to take the road less travelled and examine more carefully the onset and determinants of disordered gambling. That said, given the problems with the current diagnostic screens, investigators need to refine their theoretical concepts and the epidemiologic tools used to examine them before the field can travel down this new road.

Laying the foundation for quantifying regional exposure to social phenomena: considering the case of legalized gambling as a public health toxin.

Exposure and adaptation models provide competing perspectives of the environmental influence on the development of addictive disorders. Exposure theory suggests that the presence of environmental toxins (e.g., casinos) increases the likelihood of related disease (e.g., gambling-related disorders). Adaptation theory proposes that new environmental toxins initially increase adverse reactions; subsequently, symptoms diminish as individuals adapt to such toxins and acquire resistance. The authors describe a new public health regional exposure model (REM) that provides a tool to gather empirical evidence in support of either model. This article demonstrates how the strategic REM, modified to examine gambling exposure, uses standardized indices of exposure to social phenomena at the regional level to quantify social constructs.

Inside the virtual casino: a prospective longitudinal study of actual Internet casino gambling

BACKGROUND Participation in Internet gambling is growing rapidly, as is concern about its possible effects on the publics health. This article reports the results of the first prospective longitudinal study of actual Internet casino gambling behaviour. METHODS Data include 2 years of recorded Internet betting activity by a cohort of gamblers who subscribed to an Internet gambling service during February 2005. We examined computer records of each transaction and transformed them into measures of gambling involvement. The sample included 4222 gamblers who played casino games. RESULTS The median betting behaviour was to play casino games once every 2 weeks during a period of 9 months. Subscribers placed a median of 49 bets of euro4 each playing day. Subscribers lost a median of 5.5% of total monies wagered. We determined a group of heavily involved bettors whose activity exceeded that of 95% of the sample; these players bet every fifth day during 17.5 months. On each playing day, these most involved bettors placed a median of 188 bets of euro25. Their median percent of wagers lost, 2.5%, was smaller than that lost by the total sample. CONCLUSION Our findings suggest that Internet casino betting behaviour results in modest costs for most players, while some, roughly 5%, have larger losses. The findings also show the need to consider time spent as a marker of disordered gambling. These findings provide the evidence to steer public health debates away from speculation and toward the creation of empirically-based strategies to protect the public health.

Population trends in Internet sports gambling

The Internet is a controversial new medium for gambling. This study presents the first longitudinal analysis of online gambling participation and activity among a population of newly subscribed Internet bettors. Our analyses indicate that this population of gamblers adapted to the new subscription service rapidly, as evidenced by quickly developing declines in population participation, number of bets, and size of stakes. Adaptation was not uniformly evident in our population. Among subgroups of heavily involved bettors, adaptation was generally slower or not apparent. Rather than adapt, involved bettors often maintained the high level of betting they escalated to in the days following subscription. This was particularly evident for one type of game: live-action betting. These involved individuals and the effect of live-action play require close scrutiny and ongoing examination.

Disordered gambling, type of gambling and gambling involvement in the British Gambling Prevalence Survey 2007.

BACKGROUND The purpose of this study was to examine the relationships between types of gambling and disordered gambling, with and without controlling for gambling involvement (i.e. the number of types of games with which respondents were involved during the past 12 months). METHODS We completed a secondary data analysis of the 2007 British Gambling Prevalence Survey (BGPS), which collected data in England, Scotland and Wales between September 2006 and March 2007. The sample included 9003 residents, aged 16 or older, recruited from 10 144 randomly selected addresses. 5832 households contributed at least one participant. Post-facto weighting to produce a nationally representative sample yielded 8968 observations. The BGPS included four primary types of measures: participation in gambling (during the past 12 months and during the past 7 days), disordered gambling assessments, attitudes toward gambling and descriptive information. RESULTS Statistically controlling for gambling involvement substantially reduced or eliminated all statistically significant relationships between types of gambling and disordered gambling. CONCLUSIONS Gambling involvement is an important predictor of disordered gambling status. Our analysis indicates that greater gambling involvement better characterizes disordered gambling than does any specific type of gambling.

Virtual harm reduction efforts for Internet gambling: effects of deposit limits on actual Internet sports gambling behavior

BackgroundIn an attempt to reduce harm related to gambling problems, an Internet sports betting service provider, bwin Interactive Entertainment, AG (bwin), imposes limits on the amount of money that users can deposit into their online gambling accounts. We examined the effects of these limits on gambling behavior.MethodsWe compared (1) gambling behavior of those who exceeded deposit limits with those who did not, and (2) gambling behavior before and after exceeding deposit limits. We analyzed 2 years of the actual sports gambling behavior records of 47000 subscribers to bwin.ResultsOnly 160 (0.3%) exceeded deposit limits at least once. Gamblers who exceeded deposit limits evidenced higher average number of bets per active betting day and higher average size of bets than gamblers who did not exceed deposit limits. Comparing the gambling behavior before and after exceeding deposit limits revealed slightly more unfavorable gambling behavior after exceeding deposit limits.ConclusionOur findings indicate that Internet gamblers who exceed deposit limits constitute a group of bettors willing to take high risks; yet, surprisingly, they appear to do this rather successfully because their percentage of losses is lower than others in the sample. However, some of these gamblers exhibit some poor outcomes. Deposit limits might be necessary harm reduction measures to prevent the loss of extremely large amounts of money and cases of bankruptcy. We discuss how these limits might be modified based on our findings.

Sitting at the virtual poker table: A prospective epidemiological study of actual Internet poker gambling behavior

Internet gambling is a potential object of addictive behavior and consequently an important concern for public health. Epidemiological analyses of Internet gambling are necessary to determine the extent of public health threat. This paper reports the results of the first prospective epidemiological study of actual Internet poker gambling behavior. Participants were 3445 Internet gambling service subscribers who enrolled during February 2005. Data include two years of recorded poker outcomes (i.e., chips bought and sold) for each poker session played. Among our sample, we identified two subgroups of poker players. Approximately 95% of the sample bought a median of @?12 worth of chips at each of two poker sessions per week during a median duration from first to last bet of six months. A smaller subgroup (i.e., 5%) of most involved poker players bought a median of @?89 worth of chip at each of 10 sessions per week during a median duration from first to last bet of 18 months. In addition to level differences, we report the differences in patterns of behavior observed between these two subgroups. The analyses presented in this paper suggest that the majority of Internet poker players moderated their behavior based on their wins and losses. A minority of most involved players did not show such moderation. These results have important implications for both gambling-and addiction-related research.

Using the theory of planned behavior to predict gambling behavior

Gambling is an important public health concern. To better understand gambling behavior, we conducted a classroom-based survey that assessed the role of the theory of planned behavior (TPB; i.e., intentions, subjective norms, perceived behavioral control, and attitudes) in past-year gambling and gambling frequency among college students. Results from this research support the utility of the TPB to explain gambling behavior in this population. Specifically, in TPB models to predict gambling behavior, friend and family subjective norms and perceived behavioral control predicted past-year gambling, and friend and family subjective norms, attitudes, and perceived behavioral control predicted gambling frequency. Intention to gamble mediated these relationships. These findings suggest that college-based responsible gambling efforts should consider targeting misperceptions of approval regarding gambling behavior (i.e., subjective norms), personal approval of gambling behavior (i.e., attitudes), and perceived behavioral control to better manage gambling behavior in various situations. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

Stability and Progression of Disordered Gambling: Lessons From Longitudinal Studies

Objective: Few studies have explicitly examined the stability (that is, the tendency for individuals to stay at one diagnostic level as opposed to moving to another improved or worsened level) or progression of disordered gambling; however, conventional wisdom holds that disordered gambling is intractable and escalating. The objective of this study was to examine these assumptions. Method: We reviewed 5 recent prospective studies of gambling behaviour among nontreatment samples for evidence related to the stability and progression of disordered gambling. Results: Our review found no evidence to support the assumption that individuals cannot recover from disordered gambling (that is, the persistence assumption), no evidence to support the assumption that individuals who have more severe gambling problems are less likely to improve than individuals who have less severe gambling problems (that is, the selective-stability assumption), and no evidence to support the assumption that individuals who have some gambling problems are more likely to worsen than individuals who do not have gambling problems (that is, the progression assumption). Conclusion: Contrary to professional and conventional wisdom suggesting that gambling problems are always progressive and enduring, this review demonstrates instability and multidirectional courses in disordered gambling.