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Introduction: Gender differences in problem gambling have attracted much attention in recent gambling literature. However, relatively little is known about how gender norms relate to social strain and self-control in predicting gambling disorder within a spousal context. This study aimed to increase knowledge about gambling disorder in Chinese married couples by assessing the threeway interaction effects between social strain, self-control, and gender norms. Methods: A total of 1,620 Chinese married couples were recruited from a representative sample of households in Hong Kong. Results: The results of the generalized ordered logit model revealed the selfcontrol mitigation effect of composite strain on the propensity for gambling disorder is strong in men who accept traditional gender norms. In contrast, in women who accept traditional gender roles, self-control attenuates the effect of recent stressful life events on the propensity for gambling disorder, but selfcontrol exacerbates the effect of negative relationships with offspring on the propensity for gambling disorder. Discussion: Although reinforcing self-control is a protective factor that can alleviate social strain and disordered gambling for both men and women, the prominent contribution of gender norms to the self-control exacerbation effect deserves close attention for social workers who provide services to these gambling families. [ABSTRACT FROM AUTHOR]

Problem gambling (PG) represents a significant public health concern with widespread effects in various cultures and regions globally, with younger individuals and males at a particularly higher risk. This disparity is attributed to a mix of cultural, developmental, and biological influences. To date, there has not been a comprehensive examination to determine whether this risk pattern holds consistently across different jurisdictions. We performed a systematic review and meta-analysis using the PRISMA framework, identifying 21 eligible studies from 18 countries, encompassing 156,249 participants (47.6% male and 52.4% female). The studies varied considerably by region (Asia: 19%, Europe: 52%, Oceania: 19%, North America: 10%), the diagnostic criteria for PG, and participation rates in gambling (ranging from 12% to 92%). Data on PG prevalence was categorised by gender and three age groups (young: 18–35, middle: 30–55, and older: 45–65). Using a random-effects meta-analysis, we found a global PG prevalence of 1.9%. Europe reported a significantly lower prevalence (1.3%) compared to North America (5.3%). Men were found to be 3.4 times more likely than women to engage in problem gambling, although the gap narrows in North America. The young demographic showed a 1.51 times higher likelihood of reporting PG compared to the middle-aged group, whereas older adults were 0.80 times less likely to report PG. Notably, age-related effects varied significantly across regions. Our findings confirm that age and gender significantly influence PG risk across cultures, with significant heterogeneity observed across jurisdictions. [ABSTRACT FROM AUTHOR]

Abstract The easy access to Internet through increased availability and ownership of Internet-enabled facilities such as smart/android phones and communication data by adolescents have increased their vulnerability to problem gambling (PG). There is therefore need to understand the relationship between PG and some psychological and situational factors that have the capacity to influence its development and severity. The present study is a test of a moderated mediation model in which the effect of quality of life (QoL) on PG was mediated by escape, and this mediation effect was further moderated by gambling craving (GAC). Participants (N = 197: 83% male, M age = 24.05 years, SD age = 7.23 years) online gamblers took part in the survey and responded to the Problem Gambling Severity Index (PGSI), GQoL scale, Gambling Outcome Expectancies Scale-Escape (GOES-E), and the GAC scale. PROCESS macro analysis result reveals a significant moderated mediation effect of the escape-PG path by GAC. The findings provide support for escape as a potential pathway through which the QoL-PG association may thrive, and this support was further influenced by GAC. This is a significant contribution to the QoL-PG literature. However, we emphasize the need for further investigation of GAC as a criterion for PG.

Abstract Background Dysfunctional decision-making and intense craving represent pivotal aspects across all addictive behaviors, notably evident in gambling addiction where these factors significantly shape chasing behavior—continuing gambling to recoup losses—indicative of problematic gambling. This study explores the correlation between chasing behavior, craving, affective decision-making, decision-making styles, and gambling severity among habitual Italian gamblers. Methods One hundred and sixty-six participants from diverse gambling venues completed assessments including the South Oaks Gambling Screen (SOGS), the Iowa Gambling Task (IGT), the General Decision-Making Style (GDMS), the Gambling Craving Scale (GACS), and a computerized task to measure chasing behavior. Participants were randomly assigned to Control and Loss chasing conditions. Results Regression analyses revealed craving as a predictor of chasing behavior. Interestingly, individuals with a dependent decision-making style exhibited lower tendencies to chase. While IGT performance correlates with chasing frequency, it is not associated with the decision to continue or cease gambling. Intriguingly, gambling severity (SOGS total score) did not feature in the final models of both regression analyses. Discussion These findings emphasize the significant role of craving in driving chasing behavior. Additionally, this study introduces, for the first time, the idea that a dependent decision-making style could potentially serve as a safeguard against chasing proneness. Conclusions The study suggests a fundamental dichotomy between chasers and nonchasers among gamblers, irrespective of gambling severity. This distinction could be instrumental in tailoring more effective intervention strategies for gambling disorder treatment.

Background Gambling disorder (GD) has become a wide concern in Indonesia, as many negative consequences arise from this psychiatric condition. Prompt treatment with an appropriate method of delivery is required to achieve optimal outcomes in GD patients. This protocol paper outlines a study to determine the effectiveness, acceptability, and feasibility of internet-based cognitive behavioral therapy (iCBT) in treating GD in Indonesia. Methods This non-randomized pilot and feasibility study will recruit 20 people with GD. All participants will receive the iCBT intervention through self-learning videos and guided weekly group sessions. The effectiveness of the intervention will be assessed at baseline (week 0), post- treatment completion (week 10), and 6 weeks post-treatment (week 16). The outcomes measured will be the change in gambling symptoms, gambling urges, cognitive distortions, readiness to change, emotional problems, and quality of life of the participants. Discussion The feasibility of iCBT for GD patients in Indonesia will be assessed by this study. The study’s results will give an indication of the acceptability of the intervention and the feasibility of a subsequent conclusive trial. The delivery of iCBT may help to address the issue of treatment access in an extensive geographical region and provide immediate implications as a treatment resource for GD in practice.

Background: Dysfunctional decision-making and intense craving represent pivotal aspects across all addictive behaviors, notably evident in gambling addiction where these factors significantly shape chasing behavior—continuing gambling to recoup losses—indicative of problematic gambling. This study explores the correlation between chasing behavior, craving, affective decision-making, decision-making styles, and gambling severity among habitual Italian gamblers. Methods: One hundred and sixty-six participants from diverse gambling venues completed assessments including the South Oaks Gambling Screen (SOGS), the Iowa Gambling Task (IGT), the General Decision-Making Style (GDMS), the Gambling Craving Scale (GACS), and a computerized task to measure chasing behavior. Participants were randomly assigned to Control and Loss chasing conditions. Results: Regression analyses revealed craving as a predictor of chasing behavior. Interestingly, individuals with a dependent decision-making style exhibited lower tendencies to chase. While IGT performance correlates with chasing frequency, it is not associated with the decision to continue or cease gambling. Intriguingly, gambling severity (SOGS total score) did not feature in the final models of both regression analyses. Discussion: These findings emphasize the significant role of craving in driving chasing behavior. Additionally, this study introduces, for the first time, the idea that a dependent decision-making style could potentially serve as a safeguard against chasing proneness. Conclusions: The study suggests a fundamental dichotomy between chasers and nonchasers among gamblers, irrespective of gambling severity. This distinction could be instrumental in tailoring more effective intervention strategies for gambling disorder treatment. [ABSTRACT FROM AUTHOR]

Objective: Although gender-specific evidence on Gambling Disorder (GD) is still limited, some studies reported specific differences, mainly in psychopathological profiles, gambling behavior patterns, and pathogenesis. In order to further examine the role of gender in GD, we conducted a multicenter investigation in a sample of Italian outpatients. Method: One hundred-four outpatients with a diagnosis of GD based on DSM-5 criteria were consecutively recruited at two clinics based in Milan. Socio-demographic and clinical variables were collected for the whole sample and analyzed for the effect of gender. The severity of illness was assessed using the Canadian Problem Gambling Index and the Gambling Attitudes and Beliefs (GABS). Results: Among females, a significantly higher mean age (52.23 ± 10.95 vs. 40.96 ± 15.76; p=0.005) and older age at illness onset emerged (43.5 ± 11.92 vs. 29.22 ± 14.26; p<0.001). Females showed a significantly higher rate of psychiatric comorbidities, lifetime suicide ideation, stressful events at GD onset, and positive family history for GD compared to males. A predictive effect of male gender was found for the GABS questionnaires by performing a linear regression model, with males showing a higher risk to reach higher scores compared to females (B= 11.833; t=2.177; p=0.034). Conclusions: Our study seems to confirm the hypotheses that gender in GD may influence psychopathological profiles, course, and comorbidity. GD in female gender is frequently a comorbid condition with other specific clinical characteristics compared to males. Identifying specific clinical factors by gender may prompt more focus on the public health of women in relation to gambling, while still recognizing that males are at-risk of earlier gambling problems. These findings should be considered in therapeutic perspectives. [ABSTRACT FROM AUTHOR]

While the concept of recovery is receiving increasing attention in the context of gambling disorder (GD), no consensus has yet been reached regarding its definition. This scoping review aims to map the literature on GD recovery, identify gaps, and provide insights for a more holistic and patient-centred perspective. A systematic search of three databases was conducted (PubMed, PsycINFO, and ScienceDirect). Based on the method by which the results of these studies were produced, the studies included were sorted into four categories (quantitative, instrument validation, qualitative, and mixed studies) and subsequently examined using conceptual analysis. One hundred thirteen articles were included in this research after the screening process. In the quantitative and instrument validation studies, recovery was defined or operationalized in terms of abstinence, the absence of a GD diagnosis, or mild GD severity, or by reference to treatment outcomes or controlled gambling. A meta-synthesis of the results of the qualitative studies revealed four core features of recovery (insight, empowerment and commitment, wellbeing enhancement, and reconsideration of the issue of relapse). Discrepancies in definitions, outcomes, and variables used were evident across studies. Additionally, the quantitative and standardized approaches employed in most studies exhibited severe limitations with regard to defining recovery from the subjective and multidimensional perspectives of people recovering from GD. This lack of definitional clarity emphasizes the necessity for further qualitative research. This research should encompass multiple stakeholder perspectives to develop a working definition promoting recovery from a holistic, patient-centred, and tailored approach. [ABSTRACT FROM AUTHOR]

The purpose of this article is to analyze the legislation of Ukraine on the protection of gambling players from the formation of gambling addiction, to identify ways and means of protection, to evaluate their effectiveness and to formulate proposals for improving (strengthening) the protection of the rights of gambling players. The research used general scientific and special scientific methods of scientific knowledge. In particular, the dialectical method of learning the phenomena of the surrounding reality, comparative-legal, systemic-structural, methods of logic (analysis, synthesis, induction, deduction, analogy). Many prevention measures have already been implemented in Ukraine. In addition, the player is protected by the right to receive free psychosocial assistance in the event of problems with gambling and free medical assistance in the event of a diagnosis of gambling addiction. The state also provides free socio-psychological rehabilitation of players during and after treatment for gaming addiction. The disadvantage is the bringing of the player to administrative responsibility for participating in illegal gambling and the impossibility of recognizing him as a victim in criminal proceedings to compensate for the damage caused by the crime (engagement in the gambling business). [ABSTRACT FROM AUTHOR]

Background Gambling disorder (GD) has become a wide concern in Indonesia, as many negative consequences arise from this psychiatric condition. Prompt treatment with an appropriate method of delivery is required to achieve optimal outcomes in GD patients. This protocol paper outlines a study to determine the effectiveness, acceptability, and feasibility of internet-based cognitive behavioral therapy (iCBT) in treating GD in Indonesia. Methods This non-randomized pilot and feasibility study will recruit 20 people with GD. All participants will receive the iCBT intervention through self-learning videos and guided weekly group sessions. The effectiveness of the intervention will be assessed at baseline (week 0), post- treatment completion (week 10), and 6 weeks post-treatment (week 16). The outcomes measured will be the change in gambling symptoms, gambling urges, cognitive distortions, readiness to change, emotional problems, and quality of life of the participants. Discussion The feasibility of iCBT for GD patients in Indonesia will be assessed by this study. The study’s results will give an indication of the acceptability of the intervention and the feasibility of a subsequent conclusive trial. The delivery of iCBT may help to address the issue of treatment access in an extensive geographical region and provide immediate implications as a treatment resource for GD in practice.

Gambling always carries risks for the player's mental health, as it can provoke the development of gaming addiction. A direct connection between the socio-psychological portrait of the player, his gaming behavior, and the risks of game addiction can be traced. The purpose of the work is to form a socio-psychological portrait of a "pathological" gambler. The work was performed based on the State Institution "Institute of Forensic Psychiatry of the Ministry of Health of Ukraine". Methods used: CAWI (Computer Assisted Web Interviewing) questionnaires in online gambling establishments; CAPI (Computer Assisted Per­sonal Interviews - server event tracking method) in land-based casinos (more than 9,000 people were inter­viewed); statis­tical (for selection and analysis of materials). A questionnaire specially developed by the authors with a point evaluation of the results (from 71 to 90 points) allows us to conclude that the interviewee is a pathological gamb­ler. For the first time in Ukraine, the survey was conducted exclusively among gamblers at gambling establishments. The obtained results made it possible to form a statistically reliable р

Background Gambling disorder (GD) has become a wide concern in Indonesia, as many negative consequences arise from this psychiatric condition. Prompt treatment with an appropriate method of delivery is required to achieve optimal outcomes in GD patients. This protocol paper outlines a study to determine the effectiveness, acceptability, and feasibility of internet-based cognitive behavioral therapy (iCBT) in treating GD in Indonesia. Methods This non-randomized pilot and feasibility study will recruit 20 people with GD. All participants will receive the iCBT intervention through self-learning videos and guided weekly group sessions. The effectiveness of the intervention will be assessed at baseline (week 0), post- treatment completion (week 10), and 6 weeks post-treatment (week 16). The outcomes measured will be the change in gambling symptoms, gambling urges, cognitive distortions, readiness to change, emotional problems, and quality of life of the participants. Discussion The feasibility of iCBT for GD patients in Indonesia will be assessed by this study. The study's results will give an indication of the acceptability of the intervention and the feasibility of a subsequent conclusive trial. The delivery of iCBT may help to address the issue of treatment access in an extensive geographical region and provide immediate implications as a treatment resource for GD in practice.

Gambling disorder can be treated with cognitive behavioral therapy (CBT), but treatment is under-dimensioned in many settings. For example, in Sweden, a setting with mixed responsibility for addiction treatment between health care and social services, treatment for gambling disorder has only recently been introduced in the responsibilities of public institutions. After the introduction of gambling in treatment legislation in 2018, few studies have assessed the real-world feasibility of such treatment. In addition, treatment in social services specifically has not been documented or evaluated, and therefore, in a pioneer gambling treatment facility in such a setting, this study aimed to investigate treatment outcome in patients with gambling disorder six months after completed CBT treatment within a social service setting. Twenty patients receiving CBT treatment during 2018–2020 were followed with respect to gambling habits at end of treatment and at follow-up six months after treatment. The National Opinion Research Center DSM Screen for Gambling Problems (NODS) was used as screening tool. Rates of gambling abstinence, as well as subjective experience of the treatment, are reported. Ninety percent of the patients were abstinent from gambling at six-month follow-up, and 95 percent of the patients no longer fulfilled criteria of a gambling disorder. In conclusion, these pilot results suggest that CBT treatment is a feasible method for treatment of gambling disorder also in a social service setting. However, due to the limited sample size of this pilot study, and the limited background information of clients who could not be reached, future studies with larger sample sizes are needed.

Background: In 1990, the United States' Institute of Medicine promoted the principles of outcomes monitoring in the alcohol and other drugs treatment field to improve the evidence synthesis and quality of research. While various national outcome measures have been developed and employed, no global consensus on standard measurement has been agreed for addiction. It is thus timely to build an international consensus. Convened by the International Consortium for Health Outcomes Measurement (ICHOM), an international, multi-disciplinary working group reviewed the existing literature and reached consensus for a globally applicable minimum set of outcome measures for people who seek treatment for addiction. Methods: To this end, 26 addiction experts from 11 countries and 5 continents, including people with lived experience (n = 5; 19%), convened over 16 months (December 2018–March 2020) to develop recommendations for a minimum set of outcome measures. A structured, consensus-building, modified Delphi process was employed. Evidence-based proposals for the minimum set of measures were generated and discussed across eight videoconferences and in a subsequent structured online consultation. The resulting set was reviewed by 123 professionals and 34 people with lived experience internationally. Results: The final consensus-based recommendation includes alcohol, substance, and tobacco use disorders, as well as gambling and gaming disorders in people aged 12 years and older. Recommended outcome domains are frequency and quantity of addictive disorders, symptom burden, health-related quality of life, global functioning, psychosocial functioning, and overall physical and mental health and wellbeing. Standard case-mix (moderator) variables and measurement time points are also recommended. Conclusions: Use of consistent and meaningful outcome measurement facilitates carer–patient relations, shared decision-making, service improvement, benchmarking, and evidence synthesis for the evaluation of addiction treatment services and the dissemination of best practices. The consensus set of recommended outcomes is freely available for adoption in healthcare settings globally. [ABSTRACT FROM AUTHOR]

Gambling disorder (GD) is a mental health condition characterized by persistent and problematic betting behavior. GD generates distress and impairment, and treatment options include psychological and pharmacological interventions. This narrative review explores existing pharmacological treatments for GD. The following classes of medications were considered: opioid-receptor antagonists (e.g. naltrexone and nalmefene), serotonin reuptake inhibitors (e.g. fluvoxamine, paroxetine, sertraline, escitalopram, and citalopram), glutamatergic agents (e.g. N-acetylcysteine (NAC), acamprosate, and memantine), mood stabilizers (e.g. topiramate, carbamazepine, lithium), and other medications (e.g. modafinil, nefazodone, olanzapine, haloperidol, tolcapone, and bupropion). Due to the limitations of the studies reviewed, solid conclusions regarding the optimal choice of pharmacotherapy for individuals with GD are challenging to draw at this time. Despite some medications, such as naltrexone and nalmefene, showing promising results, efficacy has varied across studies. The review highlights current gaps/limitations, including small sample sizes, limited diversity in participant demographics, the need for exploring different gambling subtypes and treatment responses, high placebo response rates, lack of longer-term longitudinal information, limited investigation of neurobiological correlates and co-occurring disorders, and the importance of implementation research. Further research is needed to address these gaps and explore additional medications, as well as interventions like neuromodulation. [ABSTRACT FROM AUTHOR]

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Introduction: While research in online sports betting is dominated by studies using objective player tracking data from providers to identify risky gambling behavior, basicresearch has identified various putative individual risk factors assumed to underlie the development of gambling disorder across all types of gambling. This study aims to examine individual risk factors and their longitudinal clinical relevance in online sports bettors. Methods: German online sports bettors (N = 607, Mage = 34, 92% male) from a provider based sample took part in an online survey. The study team randomly preselected customers to be invited. N = 325 (53,45%) of the participants also took part in an online follow-up survey one year later. Crosssectional and longitudinal associations of putative risk factors and DSM-5 gambling disorder in online sports bettors were analyzed. These risk factors include alcohol and tobacco use, impulsivity, difficulties in emotion identification, emotion regulation strategies, comorbid mental disorders and stress. Results: We found more pronounced impulsivity, difficulties in emotion identification, emotion suppression, comorbid mental disorders and stress were cross-sectionally associated with gambling disorder, and longitudinally predicted gambling disorder in online sports bettors (with the exception of emotion suppression). In an overall model only lack of premeditation and perceived helplessness remained significant as predictors for gambling disorder. Online sports bettors with gambling disorder predominantly showed more pronounced risk factors, which were also confirmed longitudinally as relevant for the maintenance of gambling disorder. Discussion: Risk factors such as impulsivity and stress and appropriate coping mechanisms should consequently be integrated not only into prevention efforts to identify individuals at risk early, but also into intervention efforts to tailor treatment. [ABSTRACT FROM AUTHOR]

Background and aims: The ICD-11 chapter on mental, behavioral and neurodevelopmental disorders contains new controversial diagnoses including compulsive sexual behavior disorder (CSBD), intermittent explosive disorder (IED) and gaming disorder. Using a vignette-based methodology, this field study examined the ability of mental health professionals (MHPs) to apply the new ICD-11 diagnostic requirements for impulse control disorders, which include CSBD and IED, and disorders due to addictive behaviors, which include gaming disorder, compared to the previous ICD-10 guidelines. Methods: Across eleven comparisons, members of the WHO's Global Clinical Practice Network (N 5 1,090) evaluated standardized case descriptions that were designed to test key differences between the diagnostic guidelines of ICD-11 and ICD-10. Results: The ICD- 11 outperformed the ICD-10 in the accuracy of diagnosing impulse control disorders and behavioral addictions in most comparisons, while the ICD-10 was not superior in any. The superiority of the ICD-11 was particularly clear where new diagnoses had been added to the classification system or major revisions had been made. However, the ICD-11 outperformed the ICD-10 only in a minority of comparisons in which mental health professionals were asked to evaluate cases with non-pathological high involvement in rewarding behaviors. Discussion and Conclusions: Overall, the present study indicates that the ICD-11 diagnostic requirements represent an improvement over the ICD-10 guidelines. However, additional efforts, such as training programs for MHPs and possible refinements of diagnostic guidance, are needed to avoid over-diagnosis of people who are highly engaged in a repetitive and rewarding behavior but below the threshold for a disorder. [ABSTRACT FROM AUTHOR]

Background and aims: Decisions and learning processes are under metacognitive control, where confidence in one's actions guides future behaviour. Indeed, studies have shown that being more confident results in less action updating and learning, and vice versa. This coupling between action and confidence can be disrupted, as has been found in individuals with high compulsivity symptoms. Patients with Gambling Disorder (GD) have been shown to exhibit both higher confidence and deficits in learning. Methods: In this study, we tested the hypotheses that patients with GD display increased confidence, reduced action updating and lower learning rates. Additionally, we investigated whether the action-confidence coupling was distorted in patients with GD. To address this, 27 patients with GD and 30 control participants performed a predictive inference task designed to assess action and confidence dynamics during learning under volatility. Action-updating, confidence and their coupling were assessed and computational modeling estimated parameters for learning rates, error sensitivity, and sensitivity to environmental changes. Results: Contrary to our expectations, results revealed no significant group differences in action updating or confidence levels. Nevertheless, GD patients exhibited a weakened coupling between confidence and action, as well as lower learning rates. Discussion and conclusions: This suggests that patients with GD may underutilize confidence when steering future behavioral choices. Ultimately, these findings point to a disruption of metacognitive control in GD, without a general overconfidence bias in neutral, non-incentivized volatile learning contexts. [ABSTRACT FROM AUTHOR]

Background and aims: Smartphone, computer and land-based betting platforms each have distinctive features. This study examined 1) preferred features of sports betting platforms amongst young adults and 2) whether feature preferences vary with gambling severity. Methods: The study surveyed 616 Australians aged 18-29 years who bet at-least monthly on sports, esports and/or daily fantasy sports. Participants provided a simple rating of the importance of 24 features of betting platforms and then completed a discrete choice experiment to indicate their preferences amongst different groups of features. Results: Smartphones were the only platform providing all preferred features. The most important feature was ability to bet instantly 24/7 from any location, followed by electronic financial transactions. Less important features were ability to access betting information online and to bet with multiple operators. Social and privacy features, and access to promotions, did not significantly predict platform choice. The experiment found no significant differences in preferred features by gambling severity group or by gender. The non-experimental descriptive data, however, indicated that participants in the moderate risk/problem gambling categories placed significantly more importance on privacy, ability to place in-play bets, bet with cash, bet with a credit card, see frequent promotions, and bet with multiple operators. Discussion and conclusions: Most features that bettors prefer can intensify betting. Curtailment of betting promotions, in-play betting, and credit card betting are measures that can assist higher-risk gamblers without unduly affecting other gamblers. Consumer protection tools, including mandatory pre-commitment, need strengthening to help counter the unique risks of smartphone betting. [ABSTRACT FROM AUTHOR]

Background and aims: COVID-19 lockdowns limited access to gambling but simultaneously elevated psychosocial stressors. This study assessed the relative effects of these changes on gambling risk status during and after the Australian COVID-19 lockdown from late-March to late-May 2020. Methods: The study administered three surveys to people who had gambled within the past year at T1. Wave 1 asked about before (T1, N 5 2,125) and during lockdown (T2, N 5 2,125). Subsequent surveys focused on one year (T3; N 5 649) and two years after lockdown (T4, N 5 458). The dependent variable was changes in reporting any problem gambling symptoms (PGSI 0 vs 1+). Bivariate analyses and multinomial logistic regression tested for significant associations with: demographics, psychosocial stressors (perceived stress, psychological distress, loneliness, health anxiety about COVID, financial hardship, stressful life events), gambling participation and gambling frequency. Results: Gambling participation and at-risk gambling decreased between T1 and T2, increased at T3, with little further change at T4. When gambling availability was curtailed, decreased gambling frequency on EGMs, casino games, sports betting or race betting, and lower psychosocial stress, were associated with transitions from at-risk to non-problem gambling. When gambling availability resumed, increased EGM gambling frequency, decreased online gambling frequency, and higher psychosocial stress were associated with transitions from non-problem to at-risk gambling. Discussion and conclusions: Gambling availability appears a stronger influence on gambling problems, at the population level, than psychosocial risk factors. Reducing the supply of high-risk gambling products, particularly EGMs, is likely to reduce gambling harm. [ABSTRACT FROM AUTHOR]

Gambling disorder is a severe mental health and behavioural problem with harmful consequences, including financial, relationship and mental health problems. The present paper initiates discussion on the use of psychedelics combined with psychotherapeutic support as a potential treatment option for people living with a gambling disorder. Recent studies have shown promising results using psychedelic-assisted therapy (PAT) to treat anxiety, depression, post-traumatic stress disorder, and various substance use disorders. Considering the similarities in the underlying psychosocial and neurobiological mechanisms of gambling disorder and other addictive disorders, the authors suggest that psychedelic-assisted therapy could be effective in treating gambling disorder. The paper also underscores the need for further research into the viability and effectiveness of psychedelic-assisted therapy for gambling disorder. [ABSTRACT FROM AUTHOR]

Objectives: The Gambling Disorder Identification Test (GDIT) is a recently developed self‐report measure. The GDIT includes items with multiple response options that are either based on frequency or time, and item response theory evaluations of these could yield vital knowledge on its measurement performance. Methods: The GDIT was evaluated using Rasch analysis in a study involving 597 Swedish gamblers. Results: In a three‐dimensional Rasch model, the item response difficulty range extended from −1.88 to 4.06 and increased with higher time‐ and frequency‐based responses. Differential item functioning showed that some GDIT items displayed age and gender‐related differences. Additionally, person‐separation reliability indicated the GDIT could reliably be divided into three to four diagnostic levels. Conclusions: The frequency‐ and time‐based item response options of the GDIT offer excellent measurement, allowing for elaborate assessment across both lower and higher gambling severity. The GDIT can be used to detect DSM‐5 Gambling Disorder, thereby holding significance from both epidemiological and clinical standpoints. Notably, the 3‐item GDIT Gambling Behavior subscale also shows potential as a brief screening tool for identifying at‐risk gambling behavior. [ABSTRACT FROM AUTHOR]

Objective: This study protocol describes the RIGAB study, a prospective case‐control‐study assessing online sports betting behaviour and underlying risk factors for the development of gambling disorder (GD). It has two aims: (1) to characterise sports bettors concerning putative risk factors and their gambling behaviour, and (2) to predict the development of GD from these factors. Methods: At baseline, online sports bettors took part in an online survey comprising a GD screening (DSM‐5), questions on gambling behaviour and on the putative risk factors emotion regulation, impulsivity, comorbidities, stress, and substance use. Participants were reinvited for a 1‐year follow‐up online survey. In a nested design, a subsample was invited in‐person to take part in a cognitive‐behavioural task battery and a clinical interview. Results: Of the initial 6568 online sports bettors invited, 607 participated at baseline (rate: 9.2%), 325 took part in the 1‐year follow‐up and 54 participated in the nested in‐person assessment. Conclusion: The RIGAB study combines different fields of GD studies: player tracking data and putative risk factors from self‐report and behavioural tasks. The results of this study will support the development of preventive measures for participants of online gambling based on the combined findings from previously rather distinct research fields. [ABSTRACT FROM AUTHOR]

Introduction: With the inclusion of gaming disorder in the ICD-11, diagnostic criteria were introduced for this relatively new disorder. These criteria may be applied to other potential specific Internet-use disorders. The 11-item Assessment of Criteria for Specific Internet-use Disorders (ACSID-11) was developed for consistent screening of gaming disorder, online buying-shopping disorder, online pornography-use disorder, social networks-use disorder, and online gambling disorder. This study tested the construct validity of the ACSID-11, including convergent and divergent measures. Methods: The ACSID-11 measures five behavioral addictions with the same set of items by following the principles of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). The ACSID-11 was administered to a convenience sample of active Internet users (N = 1597) together with validated and established measures of each specific Internet-use disorder along with screeners for mental health. Included are the Ten-Item Internet Gaming Disorder Test (IGDT-10), the Bergen Shopping Addiction Scale (BSAS), the Problematic Pornography Consumption Scale (PPCS), the Bergen Social Media Addiction Scale (BSMAS) and the Berlin Inventory of Gambling behavior – Screening (BIG-S). The ACSID-11 was compared convergently and divergently through a multitrait-multimethod approach along with contingency tables with the other Internet-use disorder screeners. Results: The multitrait-multimethod results shows that each behavior assessed with the ACSID-11 has moderate to strong correlations (r's from 0.462 to 0.609) with the scores of the corresponding established measures and, furthermore, positive correlations (r's from 0.122 to 0.434) with measures of psychological distress and further shows that the ACSID-11 can be used for a comprehensive assessment of different behaviors. The contingency tables reveal large divergences between the ACSID-11 and other screening instruments concerning the classification of problematic specific Internet use based on the given cut-off values. Conclusion: The current work provides additional validation for the ACSID-11. Accordingly, this tool can be considered as reliable and valid for the simultaneous assessment of different Internet-use disorders: gaming disorder, online buying-shopping disorder, online pornography use disorder, social networks use disorder, and online gambling disorder. With a subsequent clinical validation of the scale and the proposed cut-off score, the ACSID-11 will be a thoroughly validated useful screening tool for clinical practice.

Abstract Background Based on social cognitive theory, this study aimed to examine whether and how social abilities (i.e., cognitive empathy and emotional empathy) are associated with gambling disorder (GD) by incorporating attitudes toward general risk (i.e., risk aversion) and responsible gambling as potential mediators of this link. Methods A convenience sample of 580 past-year lottery gamblers (M age = 34.07, SD = 13.36; 50.4% female), recruited near lottery sales shops, completed an anonymous paper-version questionnaire on site. Data were collected using the DSM-5 diagnostic criteria for GD, Interpersonal Reactivity Index, Risk Aversion Scale, Positive Play Scale, and demographic items. Path analysis and mediation analysis were applied to examine the effects of cognitive empathy and emotional empathy on GD and the mediating roles of risk aversion and responsible gambling attitude. Results Our results showed that cognitive empathy, but not emotional empathy, was significantly and negatively correlated with GD. Also, the effect of cognitive empathy on GD was fully mediated by risk aversion and responsible gambling attitude, whilst the total indirect effect of emotional empathy on GD was nonsignificant. As hypothesized, the indirect paths from both types of empathy to GD were significantly and serially mediated by risk aversion and responsible gambling attitude. Conclusion Cognitive empathy, distinct from emotional empathy, was a statistically significant correlate of GD. Moreover, the path model results also suggest that responsible gambling attitude was a salient protective factors against GD. Future GD prevention efforts may benefit from paying more attention to the role of responsible gambling attitude.

Introduction: Recovery from complex conditions such as gambling disorders (GD) often entail considerable change and require a range of adaptable interventions in the health care system. Outcomes from such avenues to change are influenced by multifarious contextual factors, which are less frequently considered in treatment outcome studies. Accordingly, this scoping review aims to map the level of evidence and explore how contextual factors influence the provision and outcomes of GD interventions. Methods: A systematic search in selected health and social science research databases yielded a total of 2.464 unique references. The results were screened in three selection steps--titles (n = 2.464), abstracts (n = 284) and full-text (n = 104). The scoping approach was applied to provide a narrative account of the final included references (n = 34). Results and discussion: Findings suggest that the research on GD treatment is in the early stages of development. Additionally, studies on GD interventions are characterized by cultural biases (Region and ethnicity and Gender perspectives), while three key elements are described as successful avenues to recover from GD (Competence, Perception and Utilization). In line with these findings, proposals for future research and treatment designs are made. [ABSTRACT FROM AUTHOR]

Background and aims: Few studies have tested the effect of a motivational telephone intervention from a gambling operator to clients with high-risk gambling practices. This study aimed to study subsequent limit setting, selfexclusions and gambling post-intervention, compared to controls. Methods: The study assessed a motivational, personalized telephone intervention by the state-owned Swedish gambling operator AB Svenska Spel within its subsection of sports, poker, online casino and bingo gambling. Clients successfully reached with the telephone intervention (n = 1,420) were compared to clients who could not be reached (n = 1,504). Gambling practices during 8 weeks pre-intervention were assessed, and outcome measures limit setting, self-exclusion, and gambling 4 weeks post-intervention. Results: The telephone intervention was associated with increased limit settings (10 vs. 5 percent, p < 0.001), self-exclusions (11 vs. 8 percent, p < 0.01), lowered theoretical losses (p < 0.001), but not significantly associated with gambling abstinence (18 vs. 15 percent, p = 0.07). In unadjusted analyses of sub-groups, significant associations of the intervention with full gambling abstinence were seen in people who gamble on online casino/bingo (19 vs. 14 percent, p < 0.01), but not in sports bettors. In logistic regression, the intervention was not associated with full week 1-4 abstinence. Conclusion: A personalized motivational telephone intervention to people displaying high-risk gambling, delivered by a gambling operator, is promising, and effects were seen on the uptake of responsible gambling tools postintervention. Effects may be more pronounced in users of chance-based, online games, than in sports bettors. [ABSTRACT FROM AUTHOR]

Background: Based on social cognitive theory, this study aimed to examine whether and how social abilities (i.e., cognitive empathy and emotional empathy) are associated with gambling disorder (GD) by incorporating attitudes toward general risk (i.e., risk aversion) and responsible gambling as potential mediators of this link. Methods: A convenience sample of 580 past-year lottery gamblers (Mage = 34.07, SD = 13.36; 50.4% female), recruited near lottery sales shops, completed an anonymous paper-version questionnaire on site. Data were collected using the DSM-5 diagnostic criteria for GD, Interpersonal Reactivity Index, Risk Aversion Scale, Positive Play Scale, and demographic items. Path analysis and mediation analysis were applied to examine the effects of cognitive empathy and emotional empathy on GD and the mediating roles of risk aversion and responsible gambling attitude. Results: Our results showed that cognitive empathy, but not emotional empathy, was significantly and negatively correlated with GD. Also, the effect of cognitive empathy on GD was fully mediated by risk aversion and responsible gambling attitude, whilst the total indirect effect of emotional empathy on GD was nonsignificant. As hypothesized, the indirect paths from both types of empathy to GD were significantly and serially mediated by risk aversion and responsible gambling attitude. Conclusion: Cognitive empathy, distinct from emotional empathy, was a statistically significant correlate of GD. Moreover, the path model results also suggest that responsible gambling attitude was a salient protective factors against GD. Future GD prevention efforts may benefit from paying more attention to the role of responsible gambling attitude. [ABSTRACT FROM AUTHOR]

Gambling always carries risks for the player's mental health, as it can provoke the development of gaming addiction. A direct connection between the socio-psychological portrait of the player, his gaming behavior, and the risks of game addiction can be traced. The purpose of the work is to form a socio-psychological portrait of a "pathological" gambler. The work was performed based on the State Institution "Institute of Forensic Psychiatry of the Ministry of Health of Ukraine". Methods used: CAWI (Computer Assisted Web Interviewing) questionnaires in online gambling establishments; CAPI (Computer Assisted Personal Interviews - server event tracking method) in land-based casinos (more than 9,000 people were interviewed); statistical (for selection and analysis of materials). A questionnaire specially developed by the authors with a point evaluation of the results (from 71 to 90 points) allows us to conclude that the interviewee is a pathological gambler. For the first time in Ukraine, the survey was conducted exclusively among gamblers at gambling establishments. The obtained results made it possible to form a statistically reliable р<0.05 socio-psychological portrait of a pathological gambler, mostly men (87.7%) aged 25-35 years (52.4%) with secondary special (43.4%) or higher education (37.7%). In this group, 94% of people declared their inability to resist the desire to play, and 83.0% thought about stealing money to continue. Of pathological gamblers, 85.0% consider gaming as a means of earning money. All interviewed pathological gamers have experienced continuous gaming for more than 5 hours; 79.2% play almost every day. Such players in 95.0% noticed that they lost more money or spent more time than they planned, 96.0% felt culpable for the game, and 95.0% started the day with a game. Based on this portrait, the authors derived quantitative criteria that the organizer of gambling games can use to prevent gambling addiction among players within the framework of the application of the principles of responsible gaming [ABSTRACT FROM AUTHOR]

Gambling disorder is a dramatic phenomenon that is spreading, in Italy as well as around the world, among younger and younger people every year. Activities in mathematics lessons at school can help pre-vent it, but it is necessary to know with which attitudes and beliefs students approach such mathematics lessons, as well as the role of the social environment. Thus, in this study, within a sample of secondary school students who experienced gambling at various levels of addiction (from none to high), we investigate the role of: mathematics-related beliefs, emotions, social relationships, attitudes towards gambling and behaviour, through a set of calibrated self-report multiple-choice questionnaires. This represents for us an opportunity to understand the complex relations among affective variables in mathematics educational activities aimed at preventing gambling disorder. For example, we found a positive correlation between mathematics-related beliefs and gambling frequency, and a negative correlation between emotional regulation and gambling frequency. Hence, we can say that affective variables such as emotions and beliefs have an effect on gambling behavior. [ABSTRACT FROM AUTHOR]

Background: Data implicate overlaps in neurobiological pathways involved in appetite regulation and addictive disorders. Despite different neuroendocrine measures having been associated with both gambling disorder (GD) and food addiction (FA), how appetiteregulating hormones may relate to the co-occurrence of both entities remain incompletely understood. Aims: To compare plasma concentrations of ghrelin, leptin, adiponectin, and liver-expressed antimicrobial peptide 2 (LEAP-2) between patients with GD, with and without FA, and to explore the association between circulating hormonal concentrations and neuropsychological and clinical features in individuals with GD and FA. Methods: The sample included 297 patients diagnosed with GD (93.6% males). None of the patients with GD had lifetime diagnosis of an eating disorder. FA was evaluated with the Yale Food Addiction Scale 2.0. All patients were assessed through a semi-structured clinical interview and a psychometric battery including neuropsychological tasks. Blood samples to measure hormonal variables and anthropometric variables were also collected. Results: From the total sample, FA was observed in 23 participants (FA+) (7.7% of the sample, 87% males). When compared participants with and without FA, those with FA+ presented both higher body mass index (BMI) (p < 0.001) and leptin concentrations, after adjusting for BMI (p = 0.013). In patients with FA, leptin concentrations positively correlated with impulsivity, poorer cognitive flexibility, and poorer inhibitory control. Other endocrine measures did not differ between groups. Discussion and conclusions: The present study implicates leptin in co-occurring GD and FA. Among these patients, leptin concentration has been associated with clinical and neuropsychological features, such as impulsivity and cognitive performance in certain domains. [ABSTRACT FROM AUTHOR]

Gambling disorder is associated with deficits in reward-based learning, but the underlying computational mechanisms are still poorly understood. Here, we examined this issue using a stationary reinforcement learning task in combination with computational modeling and functional resonance imaging (fMRI) in individuals that regular participate in gambling (n = 23, seven fulfilled one to three DSM 5 criteria for gambling disorder, sixteen fulfilled four or more) and matched controls (n = 23). As predicted, the gambling group exhibited substantially reduced accuracy, whereas overall response times (RTs) were not reliably different between groups. We then used comprehensive modeling using reinforcement learning drift diffusion models (RLDDMs) in combination with hierarchical Bayesian parameter estimation to shed light on the computational underpinnings of this performance deficit. In both groups, an RLDDM in which both non-decision time and decision threshold (boundary separation) changed over the course of the experiment accounted for the data best. The model showed good parameter and model recovery, and posterior predictive checks revealed that, in both groups, the model accurately reproduced the evolution of accuracies and RTs over time. Modeling revealed that, compared to controls, the learning impairment in the gambling group was linked to a more rapid reduction in decision thresholds over time, and a reduced impact of value-differences on the drift rate. The gambling group also showed shorter non-decision times. FMRI analyses replicated effects of prediction error coding in the ventral striatum and value coding in the ventro-medial prefrontal cortex, but there was no credible evidence for group differences in these effects. Taken together, our findings show that reinforcement learning impairments in disordered gambling are linked to both maladaptive decision threshold adjustments and a reduced consideration of option values in the choice process.

Abstract Objective This study protocol describes the RIGAB study, a prospective case‐control‐study assessing online sports betting behaviour and underlying risk factors for the development of gambling disorder (GD). It has two aims: (1) to characterise sports bettors concerning putative risk factors and their gambling behaviour, and (2) to predict the development of GD from these factors. Methods At baseline, online sports bettors took part in an online survey comprising a GD screening (DSM‐5), questions on gambling behaviour and on the putative risk factors emotion regulation, impulsivity, comorbidities, stress, and substance use. Participants were reinvited for a 1‐year follow‐up online survey. In a nested design, a subsample was invited in‐person to take part in a cognitive‐behavioural task battery and a clinical interview. Results Of the initial 6568 online sports bettors invited, 607 participated at baseline (rate: 9.2%), 325 took part in the 1‐year follow‐up and 54 participated in the nested in‐person assessment. Conclusion The RIGAB study combines different fields of GD studies: player tracking data and putative risk factors from self‐report and behavioural tasks. The results of this study will support the development of preventive measures for participants of online gambling based on the combined findings from previously rather distinct research fields.

Abstract Objectives The Gambling Disorder Identification Test (GDIT) is a recently developed self‐report measure. The GDIT includes items with multiple response options that are either based on frequency or time, and item response theory evaluations of these could yield vital knowledge on its measurement performance. Methods The GDIT was evaluated using Rasch analysis in a study involving 597 Swedish gamblers. Results In a three‐dimensional Rasch model, the item response difficulty range extended from −1.88 to 4.06 and increased with higher time‐ and frequency‐based responses. Differential item functioning showed that some GDIT items displayed age and gender‐related differences. Additionally, person‐separation reliability indicated the GDIT could reliably be divided into three to four diagnostic levels. Conclusions The frequency‐ and time‐based item response options of the GDIT offer excellent measurement, allowing for elaborate assessment across both lower and higher gambling severity. The GDIT can be used to detect DSM‐5 Gambling Disorder, thereby holding significance from both epidemiological and clinical standpoints. Notably, the 3‐item GDIT Gambling Behavior subscale also shows potential as a brief screening tool for identifying at‐risk gambling behavior.

Abstract Background A loot box is a gaming term for an electronic lottery that randomly provides items that enhance the gaming experience. In recent years, loot boxes have been increasingly discussed as a risk factor of gaming disorder (GD). While they may be purchased for a few dollars at a time, the cumulative expenses resulting from their addictive use have become a social problem. Case Presentation This paper presents a case of GD involving a substantial financial burden incurred through the use of a Japanese loot box called Gacha. Conclusion The randomness in the selection of virtual items in loot boxes resembles gambling, triggering the reward system and contributing to an addiction to purchasing more loot boxes. For therapeutic purposes, understanding the motivations behind purchasing loot boxes and considering individual developmental characteristics are crucial to helping patients find satisfaction and a sense of achievement in activities besides gaming.

BackgroundTreatment seeking for gambling disorder is known to be low and there has been a lack of longitudinal research regarding treatment opportunities. The present study aimed to assess possible changes in treatment uptake after a formal introduction of gambling disorder in social services and health care legislations, by using register data, including patient characteristics with respect to socio-demographics and comorbidities.MethodsNationwide register data were collected for the years 2005–2019, describing diagnoses in specialized out-patient health care and in in-patient hospital care. Numbers and characteristics of patients with gambling disorder were followed longitudinally. Also, a new legislation for treatment by public institutions was introduced in 2018, and data were compared for the years before and after the shift in legislation, both nationally, for each of the three major urban regions, and for the rest of the country. Comparisons were made with respect to concurrent mental health comorbidities, age and gender.ResultsThe number of out-patient gambling disorder diagnoses increased over time, but without any significant step changes around the shift in legislation. Over time, patients were younger, became more likely to have gambling disorder as their primary diagnosis, and less likely to have mental health comorbidities, whereas gender distribution did not change. Among the smaller group of patients diagnosed in in-patient settings, mental health comorbidity increased over time. Despite gradual changes over time, no changes in demographics were seen around the actual shift in legislation, although the psychiatric comorbidity appeared to increase after this change.ConclusionAfter the introduction of gambling disorder in the responsibility of social services and health care settings in Sweden, the number of patients diagnosed with gambling disorder increased only modestly. Likely, further implementation of gambling disorder treatment is required in the health care services. Also, longer longitudinal studies are needed in order to understand to what extent patients not seeking health care treatment are received by municipal social services or remain outside the treatment system.

Background: Self-paced internet interventions for gambling problems offer cost-effective, accessible, and private alternatives to traditional psychotherapy for a population that rarely seeks help. However, these interventions have been relatively slow to develop, evaluate, and deploy at scale relative to those for other addictive behaviors. Moreover, user engagement remains low despite the high interest. Motivational interviews have improved the effectiveness gambling bibliotherapy but have not been augmented with an analogous web-based self-guided program. Objectives: This trial aimed to replicate and extend prior work by translating a paperback workbook to the internet and pairing it with a single motivational interview. It was hypothesized that the motivational interview would enhance program engagement and gambling outcomes. Methods: A two-arm randomised controlled trial was conducted. Treatment-seeking Canadian adults recruited solely via social media received one year of access to a web-based self-guided program, either alone (N = 158) or in combination with a virtual motivational interview completed upon enrolment (N = 155). The program was based on principles of cognitive-behavioral therapy and motivational interviewing. Gambling severity, expenditures, frequency, and duration were assessed via online questionnaires at baseline and 3-, 6-, and 12-months post-baseline, along with secondary outcomes (i.e., depression, anxiety, nonspecific psychological distress, alcohol consumption). Results: Baseline characteristics were indicative of severe gambling problems and concurrent mental health problems but not problematic alcohol consumption in this sample. Both treatment groups demonstrated roughly equal improvements across all gambling outcomes and most secondary outcomes over time, except alcohol consumption, which did not meaningfully change. Changes were most prominent by 3 months, followed by more gradual change by 6 and 12 months. Only 57 % of gamblers who were assigned to receive a motivational interview completed that interview. About 40 % of users did not complete any program modules and 11 % completed all four. No group differences in program engagement were observed, although the number of modules completed was associated with greater reductions in gambling behaviors in both groups. Discussion: The problem of user engagement with web-based self-help programs remains. There is a dose-response relationship between engagement and outcomes when engagement is measured in terms of therapeutic content completed. Conclusions: The addition of a motivational interview to a web-based self-help program for gambling problems was unsuccessful in improving engagement or outcomes. Future work should aim to make self-guided programs more engaging rather than solely making users more engaged. Trial registration: Registered on 7 July 2020 (ISRCTN13009468).

Abstract Background The study investigated ethnicity as a risk factor for gambling disorder (GD), controlling for demographics, citizenship, and years of residency in Norway. Methods The sample comprised 65,771 individuals from a national patient registry (n = 35,607, age range 18–88 years) and a national social insurance database in Norway (n = 30,164, age rage 18–98 years). The data covered the period from 2008 to 2018. Results The results showed that when controlling for age and sex, ethnic minorities were overall less likely than those born in Norway to be diagnosed with GD (odds ratio [OR] ranging from 0.293 to 0.698). After controlling for citizenship and years of residency in Norway, the results were reversed and indicated that ethnic minorities were overall more likely to be diagnosed with GD (OR ranging from 1.179 to 3.208). Conclusion The results suggest that citizenship and years of residency are important variables to account for when assessing the relationship between ethnicity and being diagnosed with GD. Our results may be explained by people from ethnic minority groups being more likely to experience gambling problems but less likely to seek contact with healthcare services for gambling problems.

BackgroundPatients in methadone maintenance treatment (MMT) with problem gambling (PG) experience worse psychosocial outcomes than their non-PG counterparts. Interventions targeting PG in MMT may enhance psychosocial functioning beyond gambling reduction and abstinence. The present study was a secondary data analysis that examined the trajectories of non-gambling outcomes of three brief PG interventions (i.e., brief psychoeducation, brief advice, motivational enhancement therapy plus cognitive-behavioral therapy [MET + CBT]) among MMT patients.MethodsParticipants (N = 109) were engaged in substance use disorder treatment, met criteria for PG, and had a current or lifetime history of MMT. Latent growth curve models examined outcome trajectories of psychiatric, medical, legal, employment, and social problems, as well as psychological distress and quality of life. Follow-up analyses examined clinically significant change.ResultsMET + CBT patients reported lower medical problems at baseline and over time than the brief interventions. There was no evidence of differences between interventions on the other outcomes. Psychiatric problems and psychological distress decreased over time for the entire sample, regardless of the PG intervention. About 24% and 13% of the sample demonstrated clinically significant improvements in psychological distress from baseline to 5 months, and 5 months to 12 months, respectively. Nearly 21% of the sample showed clinically significant improvements in psychiatric problems from 5 months to 12 months. Among all patients, men and those with more severe opioid dependence symptoms demonstrated the greatest psychological improvements.ConclusionsMany patients in MMT with PG experience improvements in psychological problems, including long-term improvement, regardless of the PG intervention offered.

Abstract Background Voluntary self-exclusion from gambling is a common harm reduction tool in individuals with a gambling disorder. Previous data have demonstrated that many gamblers breach their own self-exclusion, typically through other online services outside the jurisdiction in which they are self-excluded. The present study aimed to carry out a new follow-up measure—similar to previous studies in the same setting—of self-exclusion and its breaching in Sweden, in order to allow for the follow-up assessment of a nationwide, multi-operator self-exclusion system introduced in Sweden in 2019. Methods A web survey to the web panel of a market survey company addressed 1505 past-year gamblers, who responded to a number of questions about gambling habits, including screening for gambling problems using the Problem Gambling Severity Index and self-exclusion-related items corresponding to previous studies. Results Nine percent of past-year gamblers had self-excluded using the Spelpaus service. In logistic regression, self-exclusion was significantly associated with gambling problems, past-year online casino gambling, and absence of online poker gambling. Among self-excluders, 49 percent had ever gambled despite being self-excluded. Among those breaching their self-exclusion, the most common gambling types during self-exclusion were online casino (82 percent), sports betting (47 percent) and lotteries (43 percent). Discussion Self-exclusion remains a popular harm reduction tool against problem gambling, more common than in previous studies, mostly in individuals with recent gambling problems and in online casino gamblers. However, breaching self-exclusion is somewhat more common than in previous research. Online casino represents the most common means of self-exclusion breaching. Policy-making in the area needs to further address the risk of breaching one’s self-exclusion and may further address the risk of overseas gambling.

IntroductionWhile research in online sports betting is dominated by studies using objective player tracking data from providers to identify risky gambling behavior, basicresearch has identified various putative individual risk factors assumed to underlie the development of gambling disorder across all types of gambling. This study aims to examine individual risk factors and their longitudinal clinical relevance in online sports bettors.MethodsGerman online sports bettors (N = 607, Mage = 34, 92% male) from a provider based sample took part in an online survey. The study team randomly preselected customers to be invited. N = 325 (53,45%) of the participants also took part in an online follow-up survey one year later. Crosssectional and longitudinal associations of putative risk factors and DSM-5 gambling disorder in online sports bettors were analyzed. These risk factors include alcohol and tobacco use, impulsivity, difficulties in emotion identification, emotion regulation strategies, comorbid mental disorders and stress.ResultsWe found more pronounced impulsivity, difficulties in emotion identification, emotion suppression, comorbid mental disorders and stress were cross-sectionally associated with gambling disorder, and longitudinally predicted gambling disorder in online sports bettors (with the exception of emotion suppression). In an overall model only lack of premeditation and perceived helplessness remained significant as predictors for gambling disorder. Online sports bettors with gambling disorder predominantly showed more pronounced risk factors, which were also confirmed longitudinally as relevant for the maintenance of gambling disorder.DiscussionRisk factors such as impulsivity and stress and appropriate coping mechanisms should consequently be integrated not only into prevention efforts to identify individuals at risk early, but also into intervention efforts to tailor treatment.

IntroductionRecovery from complex conditions such as gambling disorders (GD) often entail considerable change and require a range of adaptable interventions in the health care system. Outcomes from such avenues to change are influenced by multifarious contextual factors, which are less frequently considered in treatment outcome studies. Accordingly, this scoping review aims to map the level of evidence and explore how contextual factors influence the provision and outcomes of GD interventions.MethodsA systematic search in selected health and social science research databases yielded a total of 2.464 unique references. The results were screened in three selection steps—titles (n = 2.464), abstracts (n = 284) and full-text (n = 104). The scoping approach was applied to provide a narrative account of the final included references (n = 34).Results and discussionFindings suggest that the research on GD treatment is in the early stages of development. Additionally, studies on GD interventions are characterized by cultural biases (Region and ethnicity and Gender perspectives), while three key elements are described as successful avenues to recover from GD (Competence, Perception and Utilization). In line with these findings, proposals for future research and treatment designs are made.

Gambling disorder is a dramatic phenomenon that is spreading, in Italy as well as around the world, among younger and younger people every year. Activities in mathematics lessons at school can help pre-vent it, but it is necessary to know with which attitudes and beliefs students approach such mathematics lessons, as well as the role of the social environment. Thus, in this study, within a sample of secondary school students who experienced gambling at various levels of addiction (from none to high), we investigate the role of: mathematics-related beliefs, emotions, social relationships, attitudes towards gambling and behaviour, through a set of calibrated self-report multiple-choice questionnaires. This represents for us an opportunity to understand the complex relations among affective variables in mathematics educational activities aimed at preventing gambling disorder. For example, we found a positive correlation between mathematics-related beliefs and gambling frequency, and a negative correlation between emotional regulation and gambling frequency. Hence, we can say that affective variables such as emotions and beliefs have an effect on gambling behavior.

Abstract Background The fifth version of the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) and its revised version (DSM-5-TR) propose severity levels for gambling disorder (GD) based on the number of criteria met. However, this taxonomy has some limitations. We aimed to assess the centrality of each criterion and its relationship by conducting a network analysis while considering sex differences. Methods We performed a network analysis with the DSM-5 criteria for GD with data from 4,203 treatment-seeking patients (3,836 men and 367 women) diagnosed with GD who sought for treatment in a general tertiary hospital which has a unit specialized in behavioral addictions. Results The withdrawal criterion (“Restless or irritable when attempting to cut down or stop gambling”) showed the highest centrality values in both sexes. In men, the second most central criterion was the tolerance criterion (“Needs to gamble with increasing amounts of money in order to achieve the desired excitement”); while among women, the second was the chasing losses criterion (“After losing money gambling, often returns another day to get even”). Conclusions The most central criteria identified are associated with compulsivity-driven behaviors of the addictive process. Taking into account the high relevance and transitive capacity of withdrawal in both men and women, as well as tolerance in men, and chasing losses in women, the recognition and understanding of these symptoms are fundamental for the accurate diagnosis and severity assessment of GD.

Background and aimsFew studies have tested the effect of a motivational telephone intervention from a gambling operator to clients with high-risk gambling practices. This study aimed to study subsequent limit setting, self-exclusions and gambling post-intervention, compared to controls.MethodsThe study assessed a motivational, personalized telephone intervention by the state-owned Swedish gambling operator AB Svenska Spel within its subsection of sports, poker, online casino and bingo gambling. Clients successfully reached with the telephone intervention (n = 1,420) were compared to clients who could not be reached (n = 1,504). Gambling practices during 8 weeks pre-intervention were assessed, and outcome measures limit setting, self-exclusion, and gambling 4 weeks post-intervention.ResultsThe telephone intervention was associated with increased limit settings (10 vs. 5 percent, p

Background Individuals with cocaine use disorder or gambling disorder demonstrate impairments in cognitive flexibility: the ability to adapt to changes in the environment. Flexibility is commonly assessed in a laboratory setting using probabilistic reversal learning, which involves reinforcement learning, the process by which feedback from the environment is used to adjust behavior. Aims It is poorly understood whether impairments in flexibility differ between individuals with cocaine use and gambling disorders, and how this is instantiated by the brain. We applied computational modelling methods to gain a deeper mechanistic explanation of the latent processes underlying cognitive flexibility across two disorders of compulsivity. Method We present a re-analysis of probabilistic reversal data from individuals with either gambling disorder (n = 18) or cocaine use disorder (n = 20) and control participants (n = 18), using a hierarchical Bayesian approach. Furthermore, we relate behavioural findings to their underlying neural substrates through an analysis of task-based functional magnetic resonanceimaging (fMRI) data. Results We observed lower ‘stimulus stickiness’ in gambling disorder, and report differences in tracking expected values in individuals with gambling disorder compared to controls, with greater activity during reward expected value tracking in the cingulate gyrus and amygdala. In cocaine use disorder, we observed lower responses to positive punishment prediction errors and greater activity following negative punishment prediction errors in the superior frontal gyrus compared to controls. Conclusions Using a computational approach, we show that individuals with gambling disorder and cocaine use disorder differed in their perseverative tendencies and in how they tracked value neurally, which has implications for psychiatric classification.

Background and aims: Numerous studies point to the comorbidity between gambling disorder (GD) and attention deficit hyperactivity disorder (ADHD). However, there is a lack of research exploring how ADHD symptoms might influence psychological treatment outcomes for GD. Therefore, we aimed to explore differences between patients with GD with and without self-reported ADHD symptoms regarding psychopathology, personality, sociodemographic and treatment outcome measures. Method: This longitudinal study included 170 patients with GD receiving cognitive behavioral therapy. Multiple self-reported instruments were used to assess clinical variables and sociodemographic measures prior to treatment. Results: A clinical profile characterized by greater GD severity, higher psychopathology and impulsivity, and less adaptive personality features was observed in patients with self-reported ADHD symptoms compared to those without. No significant differences in treatment response (measured by dropout and relapse rates) were observed between the two groups. However, patients with self-reported ADHD symptoms experienced more severe relapses (i.e., gambled more money) and GD patients who relapsed scored higher on measures of ADHD, particularly inattention. Conclusion: Individuals with GD and self-reported symptoms of ADHD may experience more severe relapses following treatment, suggesting a need for more vigilant follow-up and interventions for patients with this comorbidity.

Background: The heterogeneity of gambling disorder (GD) has led to the identification of different subtypes, mostly including phenotypic features, with distinctive implications on the GD severity and treatment outcome. However, clustering analyses based on potential endophenotypic features, such as neuropsychological and neuroendocrine factors, are scarce so far. Aims: This study firstly aimed to identify empirical clusters in individuals with GD based on sociodemographic (i.e., age and sex), neuropsychological (i.e., cognitive flexibility, inhibitory control, decision making, working memory, attention, and set-shifting), and neuroendocrine factors regulating energy homeostasis (i.e., leptin, ghrelin, adiponectin, and liver-expressed antimicrobial peptide 2, LEAP-2). The second objective was to compare the profiles between clusters, considering the variables used for the clustering procedure and other different sociodemographic, clinical, and psychological features. Methods: 297 seeking-treatment adult outpatients with GD (93.6% males, mean age of 39.58 years old) were evaluated through a semi-structured clinical interview, self-reported psychometric assessments, and a protocolized neuropsychological battery. Plasma concentrations of neuroendocrine factors were assessed in peripheral blood after an overnight fast. Agglomerative hierarchical clustering was applied using sociodemographic, neuropsychological, and neuroendocrine variables as indicators for the grouping procedure. Comparisons between the empirical groups were performed using Chi-square tests (χ2) for categorical variables, and analysis of variance (ANOVA) for quantitative measures. Results: Three-mutually-exclusive groups were obtained, being neuropsychological features those with the greatest weight in differentiating groups. The largest cluster (Cluster 1, 65.3%) was composed by younger males with strategic and online gambling preferences, scoring higher on self-reported impulsivity traits, but with a lower cognitive impairment. Cluster 2 (18.2%) and 3 (16.5%) were characterized by a significantly higher proportion of females and older patients with non-strategic gambling preferences and a worse neuropsychological performance. Particularly, Cluster 3 had the poorest neuropsychological performance, especially in cognitive flexibility, while Cluster 2 reported the poorest inhibitory control. This latter cluster was also distinguished by a poorer self-reported emotion regulation, the highest prevalence of food addiction, as well as a metabolic profile characterized by the highest mean concentrations of leptin, adiponectin, and LEAP-2. Conclusions: To the best of our knowledge, this is the first study to identify well-differentiated GD clusters using neuropsychological and neuroendocrine features. Our findings reinforce the heterogeneous nature of the disorder and emphasize a role of potential endophenotypic features in GD subtyping. This more comprehensive characterization of GD profiles could contribute to optimize therapeutic interventions based on a medicine of precision.