[Pathological gambling: risk factors]. / Jeu pathologique : facteurs impliqués.

CONTEXT AND OBJECTIVE: In France, consumption of gambling games increased by 148% between 1960 and 2005. In 2004, gamblers lost approximately 0.9% of household income, compared to 0.4% in 1960. This represents approximately 134 Euros per year and per head. In spite of this important increase, the level remains lower than the European average (1%). However, gambling practices may continue to escalate in France in the next few years, particularly with the recent announce of the legalisation of online games and sports betting. With the spread of legalised gambling, pathological gambling rates may increase in France in the next years, in response to more widely available and more attractive gambling opportunities. In this context, there is a need for better understanding of the risk factors that are implicated in the development and maintenance of pathological gambling. METHODS: This paper briefly describes the major risk factors for pathological gambling by examining the recent published literature available during the first quarter of 2008. This documentary basis was collected by Inserm for the collective expert report procedure on Gambling (contexts and addictions). Seventy-two articles focusing on risk factors for pathological gambling were considered in this review. Only 47 of them were taken into account for analysis. The selection of these 47 publications was based on the guide on literature analysis established by the French National Agency for Accreditation and Assessment in Health (ANAES, 2000). Some publications from more recent literature have also been added, mostly about Internet gambling. RESULTS: We identify three major types of risk factors implicated in gambling problems: some of them are related to the subject (individual factors), others are related to the object of the addiction, here the gambling activity by itself (structural factors), and the last are related to environment (contextual or situational factors). Thus, the development and maintenance of pathological gambling seems to be conditioned by the interaction of a person and a gambling activity, in a particular context. This conceptual model is based on the well-known theory of Olivenstein on toxicomania, which was proposed in the seventies. The structural factors that appeared to be highly related to pathological gambling development and maintenance are payment modality, entertaining dimension, temporality, reward level, educational messages, gambling ambiance, gambling medium and part of hazard. Among contextual factors, availability and accessibility of gambling opportunities are well known. However, social and economic factors (e.g. culture, ethnicity, religion, education) are also important. Lastly, among individual factors, psychosocial factors are gender, age, familial and personal antecedents and psychiatric comorbidities. Neurobiological factors are not discussed here. CONCLUSIONS: This paper briefly summarises risk factors for development and maintenance of pathological gambling. It highlights that these factors are very similar to those that are implicated in substance use disorders, except for the gambling activity and context. Prevention regarding behavioural addictions should, in the future, take advantage of the findings on substance use disorder, since behavioural addictions are less known. Conversely, it seems obvious that findings on pathological gambling, and more widely behavioural addictions, could highlight all types of addiction. It appears that this fact is especially valid with regards to the evolution and stability of addictive status, which must be taken into account for treatment proposals.

[Socio-demographic and clinical assessment, and trajectory of a sample of French pathological gamblers]. / Évaluation sociodémographique, clinique et du parcours de jeu d'un échantillon de joueurs pathologiques français.

INTRODUCTION: International studies estimate the incidence of pathological gambling among adults at 0.2-3%. Following the lead of Anglo-Saxon countries, France has only just begun to consider this "new" addiction in studying its own population of pathological gamblers, attempting to understand the causes of the illness, and proposing specific treatments. OBJECTIVE: The purpose of this study was to carry out a multiaxial assessment of French pathological gamblers, current or former outpatients of the addiction ambulatory care center of the University Hospital of Nantes, in order to compare our findings with those of the international literature. METHOD: During a single personal interview, the participants filled in a set of questionnaires including a description of gambling characteristics (pathological gambling section in the DSM-IV, South Oaks Gambling Screen, gambling history), a screening for axis I (Mini International Neuropsychiatric Interview) and II (structured clinical interview for DSM-IV Axis II Personality Disorders), comorbidities and personality tests using a dimensional approach (Minnesota Multiphasic Personality Inventory, Sensation Seeking Scale, Barratt Impulsiveness Scale, Toronto Alexithymia Scale). The number of subjects to include was not previously calculated, since the size of the sample depended upon each subject's availability and on the inclusion time period limited to 4 months. Continuous variables were described in terms of means and standard deviations, while categorical variables were described in terms of percentages. The protocol was accepted by the Advisory Committee for the Protection of Biomedical Research Subjects. RESULTS: Analysis of the findings was based on a sample of 24 subjects. Half of the subjects fell into severe pathological gambling. Gambling had started at an average age of 24.9 years (S.D.=12.3). The gambling problem appeared on average 9.4 years later (S.D.=8.1). Casinos (41.7%) and sports pools (45.8%) were the most commonly reported types of games. Seventy-five percent of the sample suffered from at least one axis I psychiatric comorbidity. Most common among these were current (20.9%) and past (37.5%) episodes of major depression. Risk of suicide was observed in 36% of subjects, and nearly half of them were not currently suffering from an episode of major depression. The second most common psychiatric comorbidity was substance abuse (including alcohol) (54.2%). Personality disorders were common (54.2%) and mainly cluster B disorders (29.2%). Impulsiveness and alexithymia scores were above average, unlike sensation seeking scores. CONCLUSIONS: The results go along the same lines as those mentioned in the international literature and show how important it is to carry out multidimensional assessments within the context of pathological gambling, since comorbidities are such a burden. This study brings to light several perspectives. It would be interesting to repeat the assessment using a much larger sample. We plan to study those factors that influence the emergence of pathological gambling, and the initiation of specific treatments for pathological gamblers. Upon completion, the study would allow us to propose the treatment that is best suited to each gambler's profile.