Developing and validating lower risk online gambling thresholds with actual bettor data from a major Internet gambling operator.

OBJECTIVE: To help individuals avoid potential negative consequences associated with their gambling, researchers have developed lower risk limits for time and financial involvement among populations of land-based gamblers. The present study extended these efforts to online gambler populations with prospective longitudinal data. METHOD: We used receiver operating characteristic curve analysis and logistic regression models predicting a positive Brief Biosocial Gambling Screen (BBGS; Gebauer et al., Canadian Journal of Psychiatry, 55, 2010, 82-90) to develop lower risk limits for six measures of gambling involvement among subscribers to an online gambling operator. We also tested the utility of these six newly developed online limits and three existing land-based limits for the BBGS outcome and proxies for gambling problems including: (a) voluntary self-limiting, (b) voluntary self-exclusion, (c) closing one's account, and (d) being assigned a flag for potential problem gambling by customer service. RESULTS: We identified five optimal limits for lower risk online gambling with adequate sensitivity and specificity for predicting BBGS-positive status, and four of those that also received additional empirical support. These four empirically supported gambling limits were: (a) wagering 167.97 Euros or less each month; (b) spending 6.71% or less of one's annual income on online gambling wagers; (c) losing 26.11 Euros or less on online gambling per month; and (d) demonstrating variability (i.e., standard deviation) in daily amount wagered of 35.14 Euros or less during one's duration active. CONCLUSIONS: Our findings have implications for lower risk gambling limits research and suggest that unique limits might apply to online and land-based gambler populations. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Predicting future harm from gambling over a five-year period in a general population sample: a survival analysis.

BACKGROUND: There is little longitudinal evidence on the cumulative risk of harm from gambling associated with excess spending and frequency of play. The present study sought to assess the risk of gambling problems over a five-year period in adults who exceed previously derived low-risk gambling limits compared to those who remain within the limits after controlling for other modifiable risk factors. METHODS: Participants were adults (N = 4212) drawn from two independent Canadian longitudinal cohort studies who reported gambling in the past year and were free of problem gambling at time 1. Multivariate Cox regression was employed to assess the impact over time of gambling above low-risk gambling thresholds (frequency ≥ 8 times per month; expenditure ≥75CAD per month; percent of household income spent on gambling ≥1.7%) on developing moderate harm and problem gambling. Covariates included presence of a DSM5 addiction or mental health disorder at time 1, irrational gambling beliefs, number of stressful life events in past 12 months, number of game types played each year, and playing electronic gaming machines or casino games. RESULTS: In both samples, exceeding the low-risk gambling limits at time 1 significantly increased the risk of moderate harm (defined as ≥2 consequences on the Problem Gambling Severity Index [PGSI]) within 5 years after controlling for other modifiable risk factors. Other significant predictors of harm were presence of a mental disorder at time 1, cognitive distortions about gambling, stressful life events, and playing electronic gaming machines or casino games. In one sample, the five-year cumulative survival rate for moderate harm among individuals who stayed below all the low-risk limits was 95% compared to 83% among gamblers who exceeded all limits. Each additional low-risk limit exceeded increased the cumulative probability of harm by 30%. Similar results were found in models when the outcome was problem gambling. CONCLUSIONS: Level of gambling involvement represents a highly modifiable risk factor for later harm. Staying below empirically derived safe gambling thresholds reduces the risk of harm over time.

Gambling Self-Control Strategies: A Qualitative Analysis.

There is limited research exploring the perceptions of people who gamble on the self-control strategies used to limit their gambling. This qualitative study examines self-control strategies used to limit money spent gambling, frequency of gambling, and time spent gambling. A total of 56 people who gamble (27 males and 29 females) participated in nine focus groups and five individual interviews in Montreal, Calgary, and Toronto (Canada). Self-control strategies used to limit their gambling expenditure were more common than frequency or time limiting strategies. Strategies to limit expenditure included: restricting access to money; keeping track of money allocated to gambling activities; and avoiding certain types of gambling activities. Various contextual factors were identified to influence those strategies, including social influences; winning or losing; using substances. Findings from this study emphasize the importance of communicating clear gambling limits to people who gamble, as well as the value of developing individual self-control strategies to limit frequency, time and money spent gambling.

Validation of a Comprehensive Patient Experience Survey for Addiction and Mental Health that was Co-designed with Service Users.

A rigorous survey development process was undertaken to design and test a novel, comprehensive patient experience measure that can be used across the full continuum of addiction and mental health programs. Service users were involved in all aspects of the measure's development, including the selection of items, pre-testing, naming of the scales, and interpretation of the results. Survey data was collected from 1222 patients in treatment in a variety of service settings across Alberta, Canada (89% outpatients; 60% female). An exploratory factor analysis identified five subscales-patient-centred care, treatment effectiveness, staff behaviour, availability and coordination of care, and communication. The subscales had high internal reliability (Cronbach's alpha = 0.77 to 0.85) and test-retest reliability ranged from 0.53 to 0.82 across the five scales. Scores on the new instrument were correlated with treatment outcomes. The assessment of patient experience should be integrated into a continuous, sustainable quality improvement process to be truly effective.

Use of Self-control Strategies for Managing Gambling Habits Leads to Less Harm in Regular Gamblers.

There is little research on the control strategies used by the general public to self-manage gambling habits and avoid harmful consequences. The current study sought to identify the most common self-control strategies of people who gamble regularly, the characteristics of those who use them, and assess the effectiveness of limit-setting strategies in reducing gambling-related harm. We recruited a large sample (N = 10,054) of Canadian adults who reported gambling activity in the past 12 months. Participants completed a survey that assessed gambling habits, use of control strategies including quantitative limit setting, and gambling related harm. The most common control strategies were setting predetermined spending limits, tracking money spent, and limiting alcohol consumption. The number of self-control strategies used by gamblers was positively associated with gambling involvement, annual income, problem gambling severity and playing electronic gaming machines. Approximately 45% of respondents failed to adhere to self-determined quantitative limits for spending, frequency, and time spent gambling. People who stayed within their gambling limits were less likely to report harm even after controlling for other risk factors. However, the effectiveness of remaining within one's personal spending limit decreased for those whose limits exceed $200CAN monthly. The findings support public health interventions that promote lower-risk gambling guidelines aimed at helping gamblers stay within spending, frequency and duration limits.

A research plan to define Canada's first low-risk gambling guidelines.

From a public health perspective, gambling shares many of the same characteristics as alcohol. Notably, excessive gambling is associated with many physical and emotional health harms, including depression, suicidal ideation, substance use and addiction and greater utilization of health care resources. Gambling also demonstrates a similar 'dose-response' relationship as alcohol-the more one gambles, the greater the likelihood of harm. Using the same collaborative, evidence-informed approach that produced Canada's Low-Risk Alcohol Drinking and Lower Risk Cannabis Use Guidelines, a research team is leading the development of the first national Low-Risk Gambling Guidelines (LRGGs) that will include quantitative thresholds for safe gambling. This paper describes the research methodology and the decision-making process for the project. The guidelines will be derived through secondary analyses of several large population datasets from Canada and other countries, including both cross-sectional and longitudinal data on over 50 000 adults. A scientific committee will pool the results and put forward recommendations for LRGGs to a nationally representative, multi-agency advisory committee for endorsement. To our knowledge, this is the first systematic attempt to generate a workable set of LRGGs from population data. Once validated, the guidelines inform public health policy and prevention initiatives and will be disseminated to addiction professionals, policy makers, regulators, communication experts and the gambling industry. The availability of the LRGGs will help the general public make well-informed decisions about their gambling activities and reduce the harms associated with gambling.

Deriving low-risk gambling limits from longitudinal data collected in two independent Canadian studies.

AIMS: To derive low-risk gambling limits using the method developed by Currie et al. (2006) applied to longitudinal data. DESIGN: Secondary analysis of data from the Quinte Longitudinal Study (n = 3054) and Leisure, Lifestyle and Lifecycle Project (n = 809), two independently conducted cohort studies of the natural progression of gambling in Canadian adults. SETTING: Community-dwelling adults in Southeastern Ontario and Alberta, Canada. PARTICIPANTS: A total of 3863 adults (50% male; median age = 44) who reported gambling in the past year. MEASUREMENTS: Gambling behaviours (typical monthly frequency, total expenditure and percentage of income spent on gambling) and harm (experiencing two or more consequences of gambling in the past 12 months) were assessed with the Canadian Problem Gambling Index. FINDINGS: The dose-response relationship was comparable in both studies for frequency of gambling (days per month), total expenditure and percentage of household income spent on gambling (area under the curve values ranged from 0.66 to 0.74). Based on the optimal sensitivity and specificity values, the low-risk gambling cut-offs were eight times per month, $75CAN total per month and 1.7% of income spent on gambling. Gamblers who exceeded any of these limits at time 1 were approximately four times more likely to report harm at time 2 [95% confidence interval (CI) = 2.9-6.6]. CONCLUSIONS: Longitudinal data in Canada suggest low-risk gambling thresholds of eight times per month, $75CAN total per month and 1.7% of income spent on gambling, all of which are higher than previously derived limits from cross-sectional data. Gamblers who exceed any of the three low-risk limits are four times more likely to experience future harm than those who do not.

Problem gambling symptomatology and alcohol misuse among adolescents: A parallel-process latent growth curve model.

The objective of the current study was to examine the possible temporal associations between alcohol misuse and problem gambling symptomatology from adolescence through to young adulthood. Parallel-process latent growth curve modeling was used to examine the trajectories of alcohol misuse and symptoms of problem gambling over time. Data were from a sample of adolescents recruited for the Leisure, Lifestyle, and Lifecycle Project in Alberta, Canada (n = 436), which included 4 assessments over 5 years. There was an average decline in problem gambling symptoms followed by an accelerating upward trend as the sample reached the legal age to gamble. There was significant variation in the rate of change in problem gambling symptoms over time; not all respondents followed the same trajectory. There was an average increase in alcohol misuse over time, with significant variability in baseline levels of use and the rate of change over time. The unconditional parallel process model indicated that higher baseline levels of alcohol misuse were associated with higher baseline levels of problem gambling symptoms. In addition, higher baseline levels of alcohol misuse were associated with steeper declines in problem gambling symptoms over time. However, these between-process correlations did not retain significance when covariates were added to the model, indicating that one behavior was not a risk factor for the other. The lack of mutual influence in the problem gambling symptomatology and alcohol misuse processes suggest that there are common risk factors underlying these two behaviors, supporting the notion of a syndrome model of addiction. (PsycINFO Database Record

Comorbid Problem Gambling and Major Depression in a Community Sample.

Major depression is among the most common comorbid conditions in problem gambling. However, little is known about the effects of comorbid depression on problem gambling. The present study examined the prevalence of current major depression among problem gamblers (N = 105) identified from a community sample of men and women in Alberta, and examined group differences in gambling severity, escape motivation for gambling, family functioning, childhood trauma, and personality traits across problem gamblers with and without comorbid depression. The prevalence of major depression among the sample of problem gamblers was 32.4%. Compared to problem gamblers without depression (n = 71), problem gamblers with comorbid depression (n = 34) reported more severe gambling problems, greater history of childhood abuse and neglect, poorer family functioning, higher levels of neuroticism, and lower levels of extraversion, agreeableness, and conscientiousness. Furthermore, the problem gamblers with comorbid depression had greater levels of childhood abuse and neglect, worse family functioning, higher neuroticism, and lower agreeableness and conscientiousness than a comparison sample of recreational gamblers with depression (n = 160). These findings underscore the need to address comorbid depression in assessment and treatment of problem gambling and for continued research on how problem gambling is related to frequently co-occurring disorders such as depression.

Validation of the problem gambling severity index using confirmatory factor analysis and rasch modelling.

The Problem Gambling Severity Index (PGSI), a screening tool used to measure the severity of gambling problems in general population research, was subjected to confirmatory factor analysis and Rasch modelling to (a) confirm the one-factor structure; (b) assess how well the items measure the continuum of problem gambling severity; (c) identify sources of differential item functioning among relevant subpopulations of gamblers. Analyses were conducted on a nationally representative sample of over 25,000 gamblers compiled by merging data from the Canadian Community Health Survey and Canadian Problem Gambling Index (CPGI) integrated datasets. Results provided support for a one-factor model that was invariant across gender, age, income level, and gambler type. Rasch modelling revealed a well-fitting, unidimensional model with no miss-fitting items. The average severity assessed by the PGSI is consistent with moderately severe problem gambling. The PGSI is therefore weak in assessing low to moderate problem severity, a notable limitation of most brief gambling screens. Evidence of clinically significant differential item functioning was found with only one item, borrowing money to gamble, which behaved differently in gamblers who play electronic gaming machines or casino games compared to gamblers who avoid these games.

Validity of the Problem Gambling Severity Index interpretive categories.

The Problem Gambling Severity Index (PGSI) is a widely used nine item scale for measuring the severity of gambling problems in the general population. Of the four gambler types defined by the PGSI, non-problem, low-risk, moderate-risk and problem gamblers, only the latter category underwent any validity testing during the scale's development, despite the fact that over 95% of gamblers fall into one of the remaining three categories. Using Canadian population data on over 25,000 gamblers, we conducted a comprehensive validity and reliability analysis of the four PGSI gambler types. The temporal stability of PGSI subtype over a 14-month interval was modest but adequate (intraclass correlation coefficient = 0.63). There was strong evidence for the validity of the non-problem and problem gambler categories however the low-risk and moderate-risk categories showed poor discriminant validity using the existing scoring rules. The validity of these categories was improved with a simple modification to the scoring system.

Examining the predictive validity of low-risk gambling limits with longitudinal data.

AIMS: To assess the impact of gambling above the low-risk gambling limits developed by Currie et al. (2006) on future harm. To identify demographic, behavioural, clinical and environmental factors that predict the shift from low- to high-risk gambling habits over time. DESIGN: Longitudinal cohort study of gambling habits in community-dwelling adults. SETTING: Alberta, Canada. PARTICIPANTS: A total of 809 adult gamblers who completed the time 1 and time 2 assessments separated by a 14-month interval. MEASUREMENTS: Low-risk gambling limits were defined as gambling no more than three times per month, spending no more than CAN$1000 per year on gambling and spending less than 1% of gross income on gambling. Gambling habits, harm from gambling and gambler characteristics were assessed by the Canadian Problem Gambling Index. Ancillary measures of substance abuse, gambling environment, major depression, impulsivity and personality traits assessed the influence of other risk factors on the escalation of gambling intensity. FINDINGS: Gamblers classified as low risk at time 1 and shifted into high-risk gambling by time 2 were two to three times more likely to experience harm compared to gamblers who remained low risk at both assessments. Factors associated with the shift from low- to high-risk gambling behaviour from time 1 to time 2 included male gender, tobacco use, older age, having less education, having friends who gamble and playing electronic gaming machines. CONCLUSIONS: An increase in the intensity of gambling behaviour is associated with greater likelihood of future gambling related harm in adults.

Chronic conditions and major depression in community-dwelling older adults.

OBJECTIVES: To estimate (1) the prevalence of long-term medical conditions and of comorbid major depression, and (2) the associations between major depression and various chronic medical conditions in a general population of older adults (over 50 years of age) and in persons who are traditionally classified as seniors (65 years and older). METHODS: Data from the Canadian Community Health Survey- Mental Health and Wellbeing (CCHS-1.2) were analyzed. Non-institutionalized individuals over 15 years of age in the 10 Canadian provinces were sampled in the CCHS-1.2. The entire sample of the CCHS-1.2 consisted of 36,894 individuals, for the main analyses in this study the dataset was restricted to those aged 50 and over (n=15,591). Chronic health conditions were assessed using a self-report method of doctor diagnosis. The World Mental Health-Composite Diagnostic Interview was used to asses major depressive episodes based on DSM-IV criteria. RESULTS: The overall prevalence of having at least one chronic condition in those over 50 years of age was 82.4%, compared to 62.0% in those under 50. The prevalence of a major depressive episode in those over 50 with one chronic condition was 3.7%, compared with 1.0% in those without a long-term medical condition. The top 3 chronic health conditions in seniors aged 65 or older were arthritis/rheumatism, high blood pressure and back problems. Chronic Fatigue Syndrome, fibromyalgia and migraine headache had the highest comorbidity with major depression in the senior population. LIMITATIONS: The use of self-report data on chronic health conditions, potential diagnostic overlap between conditions, and the inability to make causal inferences due to the cross-sectional nature of the data are all limitations of the current study. CONCLUSIONS: Differences were found between rates of chronic conditions and major depression between the general population, older adults and seniors in this study. Further research is needed to delineate the direction of these relationships in seniors. Primary and secondary prevention efforts should target seniors who exhibit symptoms of depression or highly prevalent chronic health conditions.

Stacked Deck: an effective, school-based program for the prevention of problem gambling.

School-based prevention programs are an important component of problem gambling prevention, but empirically effective programs are lacking. Stacked Deck is a set of 5-6 interactive lessons that teach about the history of gambling; the true odds and "house edge"; gambling fallacies; signs, risk factors, and causes of problem gambling; and skills for good decision making and problem solving. An overriding theme of the program is to approach life as a "smart gambler" by determining the odds and weighing the pros versus cons of your actions. A total of 949 grade 9-12 students in 10 schools throughout southern Alberta received the program and completed baseline and follow-up measures. These students were compared to 291 students in 4 control schools. Four months after receiving the program, students in the intervention group had significantly more negative attitudes toward gambling, improved knowledge about gambling and problem gambling, improved resistance to gambling fallacies, improved decision making and problem solving, decreased gambling frequency, and decreased rates of problem gambling. There was no change in involvement in high risk activities or money lost gambling. These results indicate that Stacked Deck is a promising curriculum for the prevention of problem gambling.

Randomized trial of brief motivational treatments for pathological gamblers: More is not necessarily better.

The efficacy of brief treatments for media-recruited pathological gamblers was tested in a randomized clinical trial design (N = 314). Two self-directed motivational interventions were compared with a 6-week waiting list control and a workbook only control. Brief motivational treatment involved a telephone motivational interview and a mailed self-help workbook. Brief motivational booster treatment involved a telephone motivational interview, a workbook, and 6 booster telephone calls over a 9-month period. Primary outcomes were gambling frequency and dollar losses. As hypothesized, brief and brief booster treatment participants reported less gambling at 6 weeks than those assigned to the control groups. Brief and brief booster treatment participants gambled significantly less often over the first 6 months of the follow-up than workbook only participants. However, the workbook only participants were as likely to have significantly reduced their losses over the year and to have not met criteria for pathological gambling. Contrary to the hypothesis, participants in the brief booster treatment group showed no greater improvement than brief treatment participants. These results provide further support for the value of brief motivational treatments for pathological gambling.

A population-based study on ways of dealing with daily stress: comparisons among individuals with mental disorders, with long-term general medical conditions and healthy people.

OBJECTIVE: Stress plays an important role in the etiology of mental and physical disorders. The effect of stress on health may be moderated by how people deal with stress. The objectives of this analysis were to (1) estimate the population proportions using various ways of dealing with stress in healthy people, in people with mental disorders and substance dependence and in individuals with general medical conditions only, and (2) identify factors associated with ways of dealing with stress. METHODS: Data from the Canadian Community Health Survey, Mental Health and Well-being (CCHS-1.2) were used (n = 36,984). This was a national mental health survey which used a probability sample and incorporated a version of the Composite International Diagnostic Interview. RESULTS: Participants with mental disorders differed from healthy people in ways of dealing with stress. Among participants with mental disorders, women were more likely to report that they "talk to others" and "eat more/less" to deal with stress. Men were more likely to use "avoid people" and "drink alcohol" to deal with stress than women. Age differences within groups in ways of dealing with stress were found and having a history of mental disorders was also associated with reported ways of dealing with stress. CONCLUSIONS: Ways of dealing with stress differ by gender and age, but there is no over-arching pattern of maladaptive coping associated with mental disorders that applies across illness, age and gender categories. Healthy behaviors should be promoted as ways to relieve stress, leading to better self-care skills.

Replication of low-risk gambling limits using canadian provincial gambling prevalence data.

A set of low-risk gambling limits were recently produced using Canadian epidemiological data on the intensity of gambling behavior and related consequences (Currie et al. Addiction 101:570-580, 2006). The empirically derived limits (gambling no more than two to three times per month, spending no more than $501-$100o CAN per year or no more than 1% of gross income spent on gambling) accurately predicted risk of gambling-related harm after controlling for other risk factors. The present study sought to replicate these limits on data collected in three independently conducted Canadian provincial gambling surveys. Dose-response curves and logistic regression analyses were applied to gambling prevalence data collected in surveys conducted in 2001-2002 within the provinces of Alberta, British Columbia, and Ontario (combined sample N = 7,675). A comparable dose-response relationship between gambling intensity and risk of harm was found in each province. The optimal thresholds for defining an upper limit of low-risk gambling were similar across the three provinces despite variations in the availability and organization of legalized gambling opportunities within each region. These results provide additional evidence supporting the validity of the low-risk gambling limits. Quantitative limits could be used to augment existing responsible gambling guidelines.

A Canadian population level analysis of the roles of irrational gambling cognitions and risky gambling practices as correlates of gambling intensity and pathological gambling.

Using population data (N = 11,562) drawn from five Canadian gambling prevalence surveys conducted between 2000 and 2005, the current study investigated the relationship between irrational gambling cognitions and risky gambling practices upon (a) gambling intensity, as measured by percent of income spent on gambling and (b) tolerance, a diagnostic indicator of pathological gambling. First, we found irrational gambling cognitions and risky gambling practices to be positively related. Second, irrational gambling cognitions moderated the relationship between risky gambling practices and gambling intensity. Specifically, people engaging in risky practices, spent less of their income on gambling when they had fewer irrational gambling cognitions compared to those with more irrational cognitions. Third, irrational gambling cognitions moderated the relationship between risky gambling practices and tolerance. Of the people engaging in risky practices, those with no irrational cognitions reported lower levels of tolerance than those with at least one irrational cognition. Interactions with gender are reported and discussed. These findings demonstrate the importance of both gambling cognitions and gambling practices upon the intensity of gambling and pathological gambling.

Outcome from a community-based smoking cessation program for persons with serious mental illness.

Six and 12-month outcomes are reported on 79 mentally ill persons attending either a 4- or 8-session community-based smoking cessation group. Quit rates at post, 3-, 6-, and 12-month follow-ups were 16, 19, 16, and 19%, respectively, with no significant effect of program length. These success rates are comparable to outcomes reported following group-based treatment with mentally healthy smokers. The majority of quitters used nicotine replacement therapy. Psychotropic medication dosages did not vary over time in quitters or non-quitters. No reductions in smoking were observed among non-quitters. Quitting smoking had no untoward effects on symptoms of mental illness or general functioning.

Does providing extended relapse prevention bibliotherapy to problem gamblers improve outcome?

Relapse rates among pathological gamblers are high with as many as 75% of gamblers returning to gambling shortly after a serious attempt to quit. The present study focused on providing a low cost, easy to access relapse prevention program to such individuals. Based on information collected in our ongoing study of the process of relapse, a series of relapse prevention booklets were developed and evaluated. Individuals who had recently quit gambling (N = 169) were recruited (through media announcements) and randomly assigned to a single mailing condition in which they received one booklet summarizing all of the relapse prevention information or a repeated mailing condition in which they received the summary booklet plus 7 additional booklets mailed to them at regular intervals over the course of a year period. Gambling involvement over the course of the 12-month follow-up period, confirmed by family or friends, was compared between the two groups. Results indicated that participants receiving the repeated mailings were more likely to meet their goal, but they did not differ from participants receiving the single mailing in frequency of gambling or extent of gambling losses. The results of this project suggest that providing extended relapse prevention bibliotherapy to problem gamblers does not improve outcome. However, providing the overview booklet may be a low cost, easy to access alternative for individuals who have quit gambling.