Richard A. LaBrie

DSM-IV pathological gambling in the National Comorbidity Survey Replication

BACKGROUND Little is known about the prevalence or correlates of DSM-IV pathological gambling (PG). METHOD Data from the US National Comorbidity Survey Replication (NCS-R), a nationally representative US household survey, were used to assess lifetime gambling symptoms and PG along with other DSM-IV disorders. Age of onset (AOO) of each lifetime disorder was assessed retrospectively. AOO reports were used to study associations between temporally primary disorders and the subsequent risk of secondary disorders. RESULTS Most respondents (78.4%) reported lifetime gambling. Lifetime problem gambling (at least one Criterion A symptom of PG) (2.3%) and PG (0.6%) were much less common. PG was significantly associated with being young, male, and Non-Hispanic Black. People with PG reported first gambling significantly earlier than non-problem gamblers (mean age 16.7 v. 23.9 years, z=12.7, p<0.001), with gambling problems typically beginning during the mid-20s and persisting for an average of 9.4 years. During this time the largest annual gambling losses averaged US

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

4800. Onset and persistence of PG were predicted by a variety of prior DSM-IV anxiety, mood, impulse-control and substance use disorders. PG also predicted the subsequent onset of generalized anxiety disorder, post-traumatic stress disorder (PTSD) and substance dependence. Although none of the NCS-R respondents with PG ever received treatment for gambling problems, 49.0% were treated at some time for other mental disorders. CONCLUSIONS DSM-IV PG is a comparatively rare, seriously impairing, and undertreated disorder whose symptoms typically start during early adulthood and is frequently secondary to other mental or substance disorders that are associated with both PG onset and persistence.

Pathological gambling among adolescents: Massachusetts Gambling Screen (MAGS).

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 describes the development of the Massachusetts Gambling Screen (MAGS). The purpose of the MAGS is to provide a brief clinical screening instrument that can (1) yield an index of non-pathological and pathological gambling during a 5 to 10 minute survey or interview and (2) document the first psychometric translation of the proposed DSM-IV pathological gambling criteria into a set of survey or clinical interview questions. The development data for this instrument were obtained from a survey of 856 adolescents who were students in suburban Boston high schools. The results provided evidence that weighted item scores (i.e., discriminant function coefficients) could correctly classify 96% of adolescent gamblers as pathological, in transition or non-pathological when DSM-IV criteria were employed as the conceptual referent. The results also describe the prevalence of a variety of social and emotional problems associated with adolescent gambling. Finally, the discussion examined the normalization and contemporary social context of gaming and the impact of these influences on the measurement and identification of pathological gambling.

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

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.

Velopharyngeal function in nonsyndromic cleft palate: relevance of surgical technique, age at repair, and cleft type.

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

OBJECTIVE The goal of this study was to determine the relative importance of surgical technique, age at repair, and cleft type for velopharyngeal function. DESIGN This was a retrospective study of patients operated on by two surgeons using different techniques (von Langenbeck and Veau-Wardill-Kilner [VY]) at Childrens Hospital, Boston, MA. PATIENTS We included 228 patients who were at least 4 years of age at the time of review. Patients with identifiable syndromes, nonsyndromic Robin sequence, central nervous system disorders, communicatively significant hearing loss, and inadequate speech data were excluded. MAIN OUTCOME MEASURE Need for a pharyngeal flap was the measure of outcome. RESULTS Pharyngeal flap was necessary in 14% of von Langenbeck and 15% of VY repaired patients. There was a significant linear association (p = .025) between age at repair and velopharyngeal insufficiency (VPI). Patients with an attached vomer, soft cleft palate (SCP), and unilateral cleft lip/palate (UCLP) had a 10% flap rate, whereas those with an unattached vomer, hard/soft cleft palate (HSCP), and bilateral cleft lip/palate (BCLP) had a 23% flap rate (p = .03). Age at repair was critical for the unattached-vomer group (p = .03) but was not statistically significant for the attached-vomer group (p = .52). CONCLUSIONS Surgical technique was not a significant variable either in aggregate or for the Veau types. Patients in the earliest repair group (8-10 months) were the least likely to require a pharyngeal flap. Early repair was more critical for HSCP and BCLP patients. There was no correlation between velopharyngeal insufficiency and Veau hierarchy. The attached vomer/levator muscle complex may be a more important predictor of surgical success than the anatomic extent of cleft.

Population trends in Internet sports 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.

Prevalence of tardive dyskinesia in an outpatient population

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.

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

Tardive dyskinesia (TD) is a disorder of abnormal involuntary choreothetotic movements associated with the use of neuroleptic drugs. The reported prevalence of TD among patients taking antipsychotic agents varies markedly, from 3% to 56%,1–8 accounted for, in part, by the use of different diagnostic criteria. Although most investigators use the Abnormal Involuntary Movement Scale (AIMS) to assess signs of TD, the methods of analyzing resulting data have varied widely, and there is disagreement as to the severity of abnormal movements needed to qualify for a diagnosis of TD. This divergence in severity criteria is further complicated by the heterogeneous nature of this disorder and by the effects of drugs on the appearance of the movements. For example, abnormal movements can develop temporarily when antipsychotic medication is withdrawn, but may fade over time—a syndrome more properly termed “withdrawal dyskinesias” rather than true TD. Antipsychotics can also “mask” the movements of TD. Gardos9 has coined the term “covert dyskinesia” to describe movements that only become apparent when a neuroleptic dose is lowered, but that persist over time. In other patients, TD “breaks through” a stable neuropleptic dose, but may be controlled by increasing the dose. Over the past 3 yr we have conducted a study of the prevalence of TD within our mental health system. This article presents data from the study and prevalence data based on four different severity criteria for the diagnosis of TD. In addition, epidemiological correlations are presented and their possible implications discussed. Finally, we will present a new scale, Targeting Abnormal Kinetic Effects (TAKE), which rates extrapyramidal signs and forms a natural companion piece to the AIMS (see Appendix 1).