Nicki A. Dowling

Screening for Internet dependence: Do the proposed diagnostic criteria differentiate normal from dependent Internet use?

There is continued discussion of including Internet dependence as a diagnosis in future editions of the Diagnostic and Statistical Manual of Mental Disorders. The primary aim of the study was to evaluate the utility of the proposed diagnostic criteria for Internet dependence as measured by Youngs Diagnostic Questionnaire (YDQ). Although the YDQ does not provide any measure of severity, there is emerging recognition that some Internet users may display less severe or at risk Internet dependence. The degree to which the cutoff of 5 out of 8 criteria is appropriate to differentiate nondependent from dependent Internet use was evaluated by comparing the Internet usage and psychological dysfunction of 424 university students endorsing 3 and 4 diagnostic criteria (at-risk Internet dependence) to those endorsing less than 3 criteria (nondependent) and those endorsing 5 or more criteria (Internet dependence). The findings suggest that the proposed diagnostic criteria do not adequately discriminate individuals scoring 3 or 4 from those currently classified as Internet dependent. The implications of the findings for the assessment, diagnosis, and treatment of Internet dependence are discussed.

Prevalence of psychiatric co-morbidity in treatment-seeking problem gamblers: A systematic review and meta-analysis

Objective: The aim of this paper was to systematically review and meta-analyse the prevalence of co-morbid psychiatric disorders (DSM-IV Axis I disorders) among treatment-seeking problem gamblers. Methods: A systematic search was conducted for peer-reviewed studies that provided prevalence estimates of Axis I psychiatric disorders in individuals seeking psychological or pharmacological treatment for problem gambling (including pathological gambling). Meta-analytic techniques were performed to estimate the weighted mean effect size and heterogeneity across studies. Results: Results from 36 studies identified high rates of co-morbid current (74.8%, 95% CI 36.5–93.9) and lifetime (75.5%, 95% CI 46.5–91.8) Axis I disorders. There were high rates of current mood disorders (23.1%, 95% CI 14.9–34.0), alcohol use disorders (21.2%, 95% CI 15.6–28.1), anxiety disorders (17.6%, 95% CI 10.8–27.3) and substance (non-alcohol) use disorders (7.0%, 95% CI 1.7–24.9). Specifically, the highest mean prevalence of current psychiatric disorders was for nicotine dependence (56.4%, 95% CI 35.7–75.2) and major depressive disorder (29.9%, 95% CI 20.5–41.3), with smaller estimates for alcohol abuse (18.2%, 95% CI 13.4–24.2), alcohol dependence (15.2%, 95% CI 10.2–22.0), social phobia (14.9%, 95% CI 2.0–59.8), generalised anxiety disorder (14.4%, 95% CI 3.9–40.8), panic disorder (13.7%, 95% CI 6.7–26.0), post-traumatic stress disorder (12.3%, 95% CI 3.4–35.7), cannabis use disorder (11.5%, 95% CI 4.8–25.0), attention-deficit hyperactivity disorder (9.3%, 95% CI 4.1–19.6), adjustment disorder (9.2%, 95% CI 4.8–17.2), bipolar disorder (8.8%, 95% CI 4.4–17.1) and obsessive-compulsive disorder (8.2%, 95% CI 3.4–18.6). There were no consistent patterns according to gambling problem severity, type of treatment facility and study jurisdiction. Although these estimates were robust to the inclusion of studies with non-representative sampling biases, they should be interpreted with caution as they were highly variable across studies. Conclusions: The findings highlight the need for gambling treatment services to undertake routine screening and assessment of psychiatric co-morbidity and provide treatment approaches that adequately manage these co-morbid disorders. Further research is required to explore the reasons for the variability observed in the prevalence estimates.

Adolescent Gambling Behaviour and Attitudes: A Prevalence Study and Correlates in an Australian Population

There is considerable evidence that a range of risk factors are associated with adolescent problem gambling. Using a representative sample of 2,788 eighth grade students in Victoria, Australia, the primary aim of this study was to examine the degree to which these risk factors are associated with different levels of adolescent gambling participation, rather than gambling at problematic levels. This study also aimed to obtain prevalence estimates of adolescent gambling and examine the gambling attitudes of adolescents. It was found that there were significant associations between different levels of gambling involvement and a range of risk factors. However, when all predictor variables were considered simultaneously in the prediction of higher involvement in gambling activities, only male gender, drinking alcohol, using marijuana, and few perceived rewards at school were statistically significant predictors. For males, the most important predictors for greater gambling involvement were other antisocial and risk-taking behaviours. In contrast, dissatisfaction with peers and school connectedness was important in predicting greater gambling involvement for females. The study shows the usefulness of a risk and protective factor approach to understanding gambling participation in an adolescent population and that there is much to be gained from understanding the nuances of gendered gambling behaviour in the context of studying gambling participation and attitudes rather than simply in the context of studying disordered or problematic gambling.

Treatment of Female Pathological Gambling: The Efficacy of a Cognitive-Behavioural Approach

Given that a substantial proportion of current pathological gamblers are female, it is evident that women are underrepresented in the treatment outcome literature. The current study was designed to redress the limited information on the treatment of female pathological gambling. Although the use of cognitive-behavioural therapy is the most highly recommended approach as ‘best practice’ for the treatment of pathological gambling, no attempt to date has been made to evaluate the efficacy of this approach for female pathological gambling. Nineteen female pathological gamblers with electronic gaming machine problems were treated with a cognitive-behavioural program. While pathological gamblers placed on a waiting list did not show significant improvement on gambling behaviour and psychological functioning measures, the female pathological gamblers showed significant improvement on these measures over the treatment period, and maintained this improvement at the 6-month follow-up evaluation. By the completion of the follow-up period, 89% of participants no longer met diagnostic criteria for pathological gambling. Although further scientific demonstration and replication are required, the outcomes of this study indicate that the therapy that is considered ‘best practice’ in the treatment of pathological gambling is effective for female pathological gambling.

The family functioning of female pathological gamblers

The available evidence suggests that pathological gambling significantly disrupts family relationships and has a substantial impact on family members. However, these conclusions are based almost exclusively on male pathological gamblers and their female spouses or partners. The current study, which was a secondary study derived from a treatment outcome study for female pathological gamblers, surveyed three samples with the aim to evaluate (1) the quality of the dyadic and family relationships of treatment-seeking female pathological gamblers; (2) the psychological and relationship functioning of their spouses or partners; and (3) the psychological functioning of their children. Although the findings of this study revealed substantial dysfunction in the intimate and family relationships of female pathological gamblers, the partners and children of the female pathological gamblers in this study did not display elevated rates of psychological dysfunction. It is evident that female-specific research and direct gender comparisons are warranted in this area of research.

Using the CPGI to Determine Problem Gambling Prevalence in Australia: Measurement Issues

Most states and territories in Australia have adopted the Problem Gambling Severity Index (PGSI) of the Canadian Problem Gambling Index as the standard measure of problem gambling in their prevalence studies and research programs. However, notwithstanding this attempted standardisation, differences in sampling and recruitment methodologies and in some cases the modification of the scoring methods used in the PGSI have lead to substantial difficulties in comparison of the prevalence rates obtained in different studies. This paper focuses on how these two actions may significantly underestimate the true prevalence percent of problem gambling in Australian studies of the prevalence of problem gambling. It is recommended that the original and validated version of the PGSI is used in future Australian prevalence studies and that prevalence in community studies is studied across the whole community not arbitrarily restricted sub-samples. The adoption of valid scoring methods and unbiased sampling procedures will lead to more accurate and comparable prevalence studies.

A prospective study of adolescent risk and protective factors for problem gambling among young adults

There is a paucity of research examining prospective predictors of problem gambling. The current study utilised a large longitudinal data set (N = 2328) to examine a large range of adolescent risk and protective factors for problem gambling in young adulthood. These risk and protective factors covered the domains of the community, family, school, peer group and individual. Numerous predictors associated with the family, school and peer-individual were statistically significant in analyses adjusted for gender and age. However, in the fully adjusted multivariate analyses, only two predictors were statistically significant. Within this model, gender (female) was associated with a reduced risk of young adult problem gambling, while family rewards for prosocial involvement moderated the risk relationship between adolescent alcohol use and young adult problem gambling. These findings highlight the importance of adolescent alcohol use and family environment as potentially modifiable predictors of young adult problem gambling.

Mindfulness-Based Cognitive Therapy for Problem Gambling

This article describes treatment of a female problem gambler using mindfulness-based cognitive therapy (MBCT). The treatment protocol was adapted for problem gamblers from the manualized MBCT intervention developed by Segal, Williams, and Teasdale. Gambling behavior and mindfulness practice were monitored using daily diary entries maintained by the participant. The Beck Anxiety Inventory, Beck Depression Inventory—II, and the Five Facet Mindfulness Questionnaire were administered at pretreatment, posttreatment, 4-week follow-up, and 10-week follow-up phases. The Client Satisfaction Questionnaire was also used to assess acceptability of the intervention. The participant abstained from gambling, and anxiety and depression scores significantly reduced to subclinical levels over the assessment period. Exploration of mindfulness facets revealed that MBCT for problem gambling (MBCT-PG) may be useful in promoting acceptance of distressing thoughts and emotions. However, the participant did not maintain an intensive mindfulness-meditation practice over the follow-up phase of the intervention. The clinical implications of this case study are discussed.

Web-Based Counseling for Problem Gambling: Exploring Motivations and Recommendations

Background For highly stigmatized disorders, such as problem gambling, Web-based counseling has the potential to address common barriers to treatment, including issues of shame and stigma. Despite the exponential growth in the uptake of immediate synchronous Web-based counseling (ie, provided without appointment), little is known about why people choose this service over other modes of treatment. Objective The aim of the current study was to determine motivations for choosing and recommending Web-based counseling over telephone or face-to-face services. Methods The study involved 233 Australian participants who had completed an online counseling session for problem gambling on the Gambling Help Online website between November 2010 and February 2012. Participants were all classified as problem gamblers, with a greater proportion of males (57.4%) and 60.4% younger than 40 years of age. Participants completed open-ended questions about their reasons for choosing online counseling over other modes (ie, face-to-face and telephone), as well as reasons for recommending the service to others. Results A content analysis revealed 4 themes related to confidentiality/anonymity (reported by 27.0%), convenience/accessibility (50.9%), service system access (34.2%), and a preference for the therapeutic medium (26.6%). Few participants reported helpful professional support as a reason for accessing counseling online, but 43.2% of participants stated that this was a reason for recommending the service. Those older than 40 years were more likely than younger people in the sample to use Web-based counseling as an entry point into the service system (P=.045), whereas those engaged in nonstrategic gambling (eg, machine gambling) were more likely to access online counseling as an entry into the service system than those engaged in strategic gambling (ie, cards, sports; P=.01). Participants older than 40 years were more likely to recommend the service because of its potential for confidentiality and anonymity (P=.04), whereas those younger than 40 years were more likely to recommend the service due to it being helpful (P=.02). Conclusions This study provides important information about why online counseling for gambling is attractive to people with problem gambling, thereby informing the development of targeted online programs, campaigns, and promotional material.

Mindfulness and Problem Gambling: A Review of the Literature

This article reviews the literature with respect to mindfulness and its potential for reducing the severity of problem gambling behaviour. Interest in the role of mindfulness as a treatment for problem gambling has gained the attention of researchers across Australia, the United States, and Canada. However, the literature is limited and current studies have severe methodological limitations. Despite this issue, investigations have revealed that dispositional mindfulness is related to less severe problem gambling outcomes and that psychological distress, overconfidence and risk willingness, myopic focus on reward and ego involvement may act as mediators in this relationship. Moreover, the literature indicates that the inverse relationship between dispositional mindfulness and psychological distress may be mediated by factors such as values clarification; emotional, cognitive, and behavioural flexibility; non-attachment; emotion dysregulation/distress intolerance; thought suppression; and rumination. This article discusses the theoretical and clinical implications of these relationships with respect to mindfulness-based interventions for problem gambling. It is recommended that the approach be considered with cautious optimism.