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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]

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]

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]

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.

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.

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: Gambling behaviors can be exhibited by individuals raised in families with impaired parent-child communication and individuals with more impulsive traits. However, it remains unclear how gambling-related beliefs are modulated by impulsivity traits and parent-child communication styles. Methods: A total of 95 adult patients (age ≥ 18 years) diagnosed via DSM-5 criteria with gambling disorder (GD) completed our questionnaire. Participants filled out pen-and-paper questionnaires that included basic demographic information, the Family Assessment Device (FAD), Parent-Adolescent Communication Scale (PACS), Gambling Attitude and Belief Survey (GABS), and Barratt Impulsiveness Scale (BIS). We used a moderation mediation model to explore the relationship between variables. The study results were considered statistically significant if p < 0.05, or the 95% confidence interval did not contain zero. Results: The scores of the problems in communication with mother subscale (PCMS) of PACS were significantly positively correlated with the scores of GABS and the general functioning 12-item subscale (GF12) of FAD. The relationship between the scores of GF12 and GABS was completely mediated [β = 4.83, (1.12, 10.02)] by PCMS scores, and the BIS scores moderated this relationship: the predictive path between GF12 and PCMS scores [index of moderated was b = -0.25, (-0.60, -0.04)], and the indirect predictive front path between the scores of GF12 and GABS were significant only in subjects with low BIS scores. Conclusion: These findings suggest that poor general functioning of the family may increase gambling-related beliefs as a result of communication problems with mothers, and this result is only significant for individuals with lowimpulsivity. When treating patients with GD, more treatment of mother-child communication issues and individual impulsivity may be more conducive to their recovery. [ABSTRACT FROM AUTHOR]

The relationship between bariatric surgery and alcohol use disorder (AUD) suggests that there may be a parallel connection between bariatric surgery and gambling disorder (GD), although this has never been researched before. Here, we describe observations suggesting that patients undergoing bariatric surgery may develop gambling disorders after surgery. Obese, older adults, and women may be at particular risk of developing GD because of their higher susceptibility to somatic comorbidities. We call for research addressing factors affecting the development of GD in patients undergoing bariatric surgery and how this could be prevented.

Background: Despite the demonstrated association between empathy and gambling at the behavioral level, limited neuroimaging research on empathy and gambling disorder (GD) has been conducted. Whether and how the brain network of empathy and that of gambling interact in disordered gamblers has not been investigated. This study aimed to address this research gap by examining the hierarchical organizational patterns, in which the differences of causal interactions of these networks between disordered gamblers and healthy controls were revealed. Methods: Resting-state functional magnetic resonance imaging (fMRI) data of 32 disordered gamblers and 56 healthy controls were included in the formal analysis. Dynamic causal modeling was used to examine the effective connectivity within and between empathy and gambling networks among all participants. Results: All participants showed significant effective connectivity within and between empathy and gambling networks. However, compared with healthy controls, disordered gamblers displayed more excitatory effective connectivity within the gambling network, the tendency to display more excitatory effective connectivity fromthe empathy network to the gambling network, and reduced inhibitory effective connectivity from the gambling network to the empathy network. Conclusion: The exploratory study was the first to examine the effective connectivity within and between empathy and gambling networks among disordered gamblers and healthy controls. These results provided insights into the causal relationship between empathy and gambling from the neuroscientific perspective and further confirmed that disordered gamblers show altered effective connectivity within and between these two brain networks, whichmay be considered to be a potential neural index for GD identification. In addition, the altered interactions between empathy and gambling networks may also indicate the potential targets for the neuro-stimulation intervention approach (e.g., transcranial magnetic stimulation). [ABSTRACT FROM AUTHOR]

Introduction: The purpose of this study was to explore clinical differences in Swedish treatment-seeking men and women with gambling disorder (GD). As the prevalence of GD is increasing among women, even though men are still highly overrepresented, the characteristic differences between men and women seeking treatment become increasingly important. Method: A sample of 204 patients with GD (26.5% women and 73.5% men) at an outpatient clinic were diagnosed using the SCI-GD, screened for comorbid diagnoses using the MINI, and further completed a range of selfreport questionnaires measuring demographics, GD, alcohol and other drug problems, symptoms of depression and anxiety, and pathways into gambling problems. Results: Several characteristics differed between treatment-seeking men and women in our sample. Examples of differences between genders included age, onset age, living situation, duration, alcohol and drug problems, comorbidity, and pathways leading to gambling problems. Discussion: The most evident difference was that women, in addition to GD, showed more symptoms of anxiety and depression than men, while men had a higher degree of substance use problems compared to women. The differences in clinical features between men and women are important to consider in treatment planning and possibly for future gender-based interventions. [ABSTRACT FROM AUTHOR]

IntroductionThe purpose of this study was to explore clinical differences in Swedish treatment-seeking men and women with gambling disorder (GD). As the prevalence of GD is increasing among women, even though men are still highly overrepresented, the characteristic differences between men and women seeking treatment become increasingly important.MethodA sample of 204 patients with GD (26.5% women and 73.5% men) at an outpatient clinic were diagnosed using the SCI-GD, screened for comorbid diagnoses using the MINI, and further completed a range of self-report questionnaires measuring demographics, GD, alcohol and other drug problems, symptoms of depression and anxiety, and pathways into gambling problems.ResultsSeveral characteristics differed between treatment-seeking men and women in our sample. Examples of differences between genders included age, onset age, living situation, duration, alcohol and drug problems, comorbidity, and pathways leading to gambling problems.DiscussionThe most evident difference was that women, in addition to GD, showed more symptoms of anxiety and depression than men, while men had a higher degree of substance use problems compared to women. The differences in clinical features between men and women are important to consider in treatment planning and possibly for future gender-based interventions.

Background and aims: Problem gambling causes major social and psychiatric consequences, and there is need to develop feasible harm-reducing or therapeutic interventions. It has been suggested that gambling operators with responsible gambling intentions can intervene in order to identify and help reduce the harm in problem gamblers. However, user satisfaction, and the risk of negative reactions and gamblers’ transfer to other operators, rarely have been explored scientifically. Methods: This is a retrospective survey study of gamblers reached by a motivational, telephone intervention by the Swedish state-owned gambling operator (Svenska Spel), addressing gamblers with indicators of high-risk gambling practices (n = 197). Surveys were answered approximately 10 days after the intervention. Results: Thirty-seven percent perceived their gambling to have decreased due to the intervention, whereas 7% perceived their gambling instead had increased. A large majority (80%) reported a subjective favorable experience from the intervention. Forty percent reported gambling on other operators than Svenska Spel after the intervention, but only 7% gambled on a new operator following the intervention. Conclusion: Survey data in gamblers reached with a motivational telephone intervention present mainly promising findings, and should be replicated in future studies in larger samples. The main findings display an overwhelmingly favorable subjective experience, and a limited risk of gamblers migrating to other operators. [ABSTRACT FROM AUTHOR]

This paper presents an integrative review of research on domestic and family violence (DFV), including intimate partner violence (IPV), experienced by victims and perpetrators with a gambling problem. It aims to review, critique, and synthesize research on this topic to generate fresh and alternative perspectives to guide future research. Based on a systematic search of the academic literature and a targeted search of gray literature, the paper summarizes findings from empirical studies pertaining to the prevalence of perpetration and victimization, characteristics of perpetrators and victims, and explanations for this violence. Based on this review, the paper suggests several potential improvements that can be considered in future studies. These include a shift from focusing on situational violence to also include coercive control; greater sensitivity in research design and interpretation to gender differences in experiences of violence; and the need to include economic abuse as a form of DFV/IPV. Adopting a public health lens is also recommended to broaden the research focus from victims and perpetrators to also consider contextual factors. In particular, gambling research should examine the contribution of gambling products, practices, environments, and marketing to DFV/IPV and how this might be ameliorated. While research to date has drawn much needed attention to the risks that gambling presents for DFV/IPV, this review provides some suggestions for future research so that it can provide more nuanced findings to inform policy and practice. [ABSTRACT FROM AUTHOR]

Background: Gambling disorder is the first non-substance-related addiction which is recognized as a diagnostic entity and assessed in treatment settings. However, in many clinical settings, assessment, and structured treatment for this condition is severely under-developed, and treatment seeking in many settings is low. This is a protocol paper describing the rationale and structure of a recently established quality register, allowing for structured monitoring of treatment seeking, treatment needs and treatment provision in Swedish health care settings, for gambling disorder and associated conditions. Methods: Since 2019, a Swedish quality register is in use for the systematic data collection from patients receiving treatment in specialized health care. The register is held by Region Skåne, and approved for national use. Swedish quality registers allow for the clinical monitoring of treatment uptake and needs, for quality improvement purposes, and collect systematic cohort data for these purposes. In addition, these quality registers potentially allow for future research projects, after separate ethics applications, allowing for clinical follow-up studies based on non-identified quality register data. Clinical challenges and research knowledge gaps are addressed in the present register, including mental health comorbidity, history of suicidal behavior, comorbid alcohol, drugs and gaming behaviors, and fundamental psycho- social variables such as violence victimization, concerned significant others including children's situation in families of problemgamblers, andmain income and involvements with social services and enforcement agency. In addition, patient flows, including rates of referral from primary care and other treatment settings, can be followed. The overall quality register project is registered at clinicaltrials.gov (NCT05276193). Discussion: The present protocol paper will allow for systematic reporting and future projects addressing knowledge gaps in clinical treatment for gambling disorder, and highlight the importance for evidence-based treatment in a behavioral addiction. Importantly, the current data will contribute to a better understanding of which patient groups may be less likely to seek or to be referred to treatment, and thereby may shape future initiatives to increase screening and referral in targeted, vulnerable groups. [ABSTRACT FROM AUTHOR]

Background and aimsProblem gambling causes major social and psychiatric consequences, and there is need to develop feasible harm-reducing or therapeutic interventions. It has been suggested that gambling operators with responsible gambling intentions can intervene in order to identify and help reduce the harm in problem gamblers. However, user satisfaction, and the risk of negative reactions and gamblers’ transfer to other operators, rarely have been explored scientifically.MethodsThis is a retrospective survey study of gamblers reached by a motivational, telephone intervention by the Swedish state-owned gambling operator (Svenska Spel), addressing gamblers with indicators of high-risk gambling practices (n = 197). Surveys were answered approximately 10 days after the intervention.ResultsThirty-seven percent perceived their gambling to have decreased due to the intervention, whereas 7% perceived their gambling instead had increased. A large majority (80%) reported a subjective favorable experience from the intervention. Forty percent reported gambling on other operators than Svenska Spel after the intervention, but only 7% gambled on a new operator following the intervention.ConclusionSurvey data in gamblers reached with a motivational telephone intervention present mainly promising findings, and should be replicated in future studies in larger samples. The main findings display an overwhelmingly favorable subjective experience, and a limited risk of gamblers migrating to other operators.

Objectives: Adolescent gambling is a public health concern of increasing importance. The lack of comprehensive evaluations on adolescent gambling disorder (GD) assessment tools hinders the timely detection of Chinese adolescents with gambling problems. This study aimed to evaluate the psychometric properties of South Oaks Gambling Screen-Revised for Adolescents (SOGS-RA) and determine its optimal screening cutoff score among Chinese adolescent gamblers to address this gap.Methods: We surveyed 1407 Chinese secondary school students aged 11–19 years in Macao, China, among which 258 past-year gamblers’ data was used for assessing SOGS-RA’s performance in detecting risk for adolescent GD.Results: SOGS-RA displayed satisfactory reliability and validity for assessing probable GD among Chinese adolescent gamblers. Under the DSM-5 GD framework, we proposed ≥4 as SOGS-RA’s optimal cutoff score of screening for probable GD and further identified 5.8% of past-year gamblers prone to probable GD in the present study.Conclusion: SOGS-RA can provide a reliable and valid assessment of adolescent’ GD risk in the Chinese context, facilitate early identification of probable GD cases, and alleviate the public health concern for Chinese adolescents.

This paper presents an integrative review of research on domestic and family violence (DFV), including intimate partner violence (IPV), experienced by victims and perpetrators with a gambling problem. It aims to review, critique, and synthesize research on this topic to generate fresh and alternative perspectives to guide future research. Based on a systematic search of the academic literature and a targeted search of gray literature, the paper summarizes findings from empirical studies pertaining to the prevalence of perpetration and victimization, characteristics of perpetrators and victims, and explanations for this violence. Based on this review, the paper suggests several potential improvements that can be considered in future studies. These include a shift from focusing on situational violence to also include coercive control; greater sensitivity in research design and interpretation to gender differences in experiences of violence; and the need to include economic abuse as a form of DFV/IPV. Adopting a public health lens is also recommended to broaden the research focus from victims and perpetrators to also consider contextual factors. In particular, gambling research should examine the contribution of gambling products, practices, environments, and marketing to DFV/IPV and how this might be ameliorated. While research to date has drawn much needed attention to the risks that gambling presents for DFV/IPV, this review provides some suggestions for future research so that it can provide more nuanced findings to inform policy and practice.

BackgroundGambling disorder is the first non-substance-related addiction which is recognized as a diagnostic entity and assessed in treatment settings. However, in many clinical settings, assessment, and structured treatment for this condition is severely under-developed, and treatment seeking in many settings is low. This is a protocol paper describing the rationale and structure of a recently established quality register, allowing for structured monitoring of treatment seeking, treatment needs and treatment provision in Swedish health care settings, for gambling disorder and associated conditions.MethodsSince 2019, a Swedish quality register is in use for the systematic data collection from patients receiving treatment in specialized health care. The register is held by Region Skåne, and approved for national use. Swedish quality registers allow for the clinical monitoring of treatment uptake and needs, for quality improvement purposes, and collect systematic cohort data for these purposes. In addition, these quality registers potentially allow for future research projects, after separate ethics applications, allowing for clinical follow-up studies based on non-identified quality register data. Clinical challenges and research knowledge gaps are addressed in the present register, including mental health comorbidity, history of suicidal behavior, comorbid alcohol, drugs and gaming behaviors, and fundamental psycho-social variables such as violence victimization, concerned significant others including children's situation in families of problem gamblers, and main income and involvements with social services and enforcement agency. In addition, patient flows, including rates of referral from primary care and other treatment settings, can be followed. The overall quality register project is registered at clinicaltrials.gov (NCT05276193).DiscussionThe present protocol paper will allow for systematic reporting and future projects addressing knowledge gaps in clinical treatment for gambling disorder, and highlight the importance for evidence-based treatment in a behavioral addiction. Importantly, the current data will contribute to a better understanding of which patient groups may be less likely to seek or to be referred to treatment, and thereby may shape future initiatives to increase screening and referral in targeted, vulnerable groups.

Objective: This study examined past year attempts to reduce or quit gambling among people who gamble generally and those with gambling problems specifically. Methods: Regular gamblers recruited from an online panel (N = 10,054) completed a survey of gambling, mental health and substance use comorbidity and attempts to reduce or quit gambling. The sample was weighted to match the gambling and demographic profile for the same subsample (i.e., past month gamblers) in a recent Canadian national survey. Results: 5.7% reported that they tried to cutback or stop gambling in the past year. As predicted, individuals making a change attempt had greater levels of problem gambling severity and were more likely to have a gambling problem. Of individuals with problem gambling, 59.8% made a change attempt. Of those, 90.2% indicated that they did this primarily on their own, and 7.7% accessed formal or informal treatment. Most people attempting self-change indicated that this was a personal preference (55%) but about a third reported feeling too ashamed to seek help. Over a third (31%) reported that their attempt was successful. Of the small group of people accessing treatment, 39% described it as helpful. Conclusions: Whereas gambling treatment-seeking rates are low, rates of self-change attempts are high. The public health challenge is to promote self-change efforts among people beginning to experience gambling problems, facilitate success at self-change by providing accessible support for use of successful strategies, and provide seamless bridges to a range of other treatments when desired or required. [ABSTRACT FROM AUTHOR]

ObjectiveThis study examined past year attempts to reduce or quit gambling among people who gamble generally and those with gambling problems specifically.MethodsRegular gamblers recruited from an online panel (N = 10,054) completed a survey of gambling, mental health and substance use comorbidity and attempts to reduce or quit gambling. The sample was weighted to match the gambling and demographic profile for the same subsample (i.e., past month gamblers) in a recent Canadian national survey.Results5.7% reported that they tried to cutback or stop gambling in the past year. As predicted, individuals making a change attempt had greater levels of problem gambling severity and were more likely to have a gambling problem. Of individuals with problem gambling, 59.8% made a change attempt. Of those, 90.2% indicated that they did this primarily on their own, and 7.7% accessed formal or informal treatment. Most people attempting self- change indicated that this was a personal preference (55%) but about a third reported feeling too ashamed to seek help. Over a third (31%) reported that their attempt was successful. Of the small group of people accessing treatment, 39% described it as helpful.ConclusionsWhereas gambling treatment-seeking rates are low, rates of self-change attempts are high. The public health challenge is to promote self-change efforts among people beginning to experience gambling problems, facilitate success at self-change by providing accessible support for use of successful strategies, and provide seamless bridges to a range of other treatments when desired or required.

Although some studies have been conducted on gambling behaviour in the general population or in clinical samples during the COVID-19 pandemic, less attention has been focused on Affected Family Members (AFMs) of disordered gamblers. To fill this gap, this study investigated the psychological state of disordered gamblers' AFMs during the COVID-19 lockdown in Italy, the European country first affected by the virus and with the largest gambling market. We were interested in understanding if the unavailability of most land-based gambling offerings during the lockdown created a sense of relief in AFMs. We also compared the quality of family relationships and emotional state during the lockdown of AFMs with those of their relative with Gambling Disorder (GD). Participants were 53 disordered gamblers' AFMs (77% female; mean age = 50.28). For 42 out of the 53 AFMs, we also recruited their relative with GD (86% male; mean age = 48.98). A semi-structured telephone interview was developed. Although AFMs reported a general interruption of the relative's gambling behaviour and a general sense of relief for the closure of gambling activities, accompanied by the perception of good family relationships, AFMs still felt tired, worried, and apprehensive and perceived more fear, stress, and anxiety than before the lockdown. A large proportion of AFMs engaged in potentially addictive behaviours, especially TV and mobile phone and Internet use, which increased in frequency compared to before the pandemic. They still perceived some gambling-related problematic behaviours from their relative and put in place coping strategies to manage the gambling problem. Even if they had a general positive orientation towards the future, they experienced fear when thinking about the reopening of gambling opportunities at the end of the lockdown. Compared to their relatives with GD, AFMs appeared more prone to perceiving a general negative state and a worsening of it from before the lockdown. Overall, this study shows that disordered gambling's AFMs can be considered as a particularly at-risk group who deserves focused clinical attention even during gambling closures related to pandemic lockdown. [ABSTRACT FROM AUTHOR]

Introduction: The COVID-19 outbreak and related lockdowns brought substantial changes in people's lives and led to concerns about possible increases of addictive behaviors at the initial stages of the pandemic. To examine these concerns, the aim of the present study was to assess longitudinal changes in addictive and problematic behaviors (i.e., problematic social media use, Internet gaming disorder, gambling disorder, problematic pornography use, and compulsive sexual behavior disorder) over time during the COVID-19 pandemic. Methods: Three waves of data collection took place in different stages of the COVID-19 outbreak in Hungary in a general population, from the first wave of lockdowns to the second and third waves of restrictions (May, 2020; N T 1 = 1747; June–August, 2020; N T 2 = 656; January, 2021; N T 3 = 411). Latent growth curve models were calculated to assess the potential changes in addictive and problematic behaviors over time. Results: Latent growth curve models showed that the sample varied in their initial scores, but there were no significant changes over time in any of the examined behaviors, except for compulsive sexual behavior disorder, which demonstrated a small but significant increase (i.e., positive and significant slope factor). However, the rate of this change was negligible. Overall, there were no noteworthy changes over time regarding any of the examined addictive and problematic behaviors. Conclusion: Contrary to initial concerns, no substantial changes over time were observed regarding the examined addictive behaviors during the COVID-19 pandemic and related lockdowns. These findings indicate that those who had no previous problem with these addictive behaviors, might have not developed a problem, and those who had problem with either of the behaviors previously, might have not experienced a significant increase in their symptoms. [ABSTRACT FROM AUTHOR]

Cognitive behavioral therapy (CBT) is the most successful protocol in gambling disorder (GD) treatment. However, it presents some weaknesses, especially concerning relapse prevention (RP). RP is one of the most important therapeutic steps, aiming at managing cravings and to avoid future relapse increasing perceived self-efficacy. Encouraging results come from the blending of psychotherapy and virtual reality (VR), containing gambling cues. The goal of Alter Game (approved by the Ethical Commission, Prot. No. 69346) is verifying the efficacy of an innovative psychological treatment for GD based on the integration of traditional CBT therapy and an immersive VR cue exposure therapy using a serious virtual game, which is a game designed for purposes other than entertainment. RP in virtual cue-exposure therapy allows pathological gamblers to manage the urge to gamble and to avoid relapse by becoming aware of which internal and external triggers are related to craving. We hypothesize that the integrated intervention will be more effective than simple CBT with regard to self-efficacy, craving, and gambling-related distortions. Four virtual ecological environments were developed, and a virtual app, Exludo, interfaced with a computerized multiparametric acquisition system for biofeedback, was created. A sample of about 60 patients aged between 18 and 65 with GD referring to the Addiction Medicine Unit of Verona (Rossi Hospital) will be recruited. Patients will be randomly assigned to the CBT group (16 CBT sessions) or the CBT + VR group (8 CBT sessions + 8 VR cue-exposure therapy sessions). The MCMI-III, the BIS-11, and the SOGS will be used to evaluate inclusion and exclusion criteria, while the Gambling Related Cognitions Scale and the Multidimensional Gambling Self-Efficacy Scale will be used to verify changes as a function of the treatment. Craving will be evaluated through VAS, and psychophysiological variables will be assessed through biofeedback. A pre-test/post-test experimental design with a 1-month follow-up will be conducted. This study will examine an innovative psychotherapeutic protocol for GD treatment, and it will help in identifying new virtual tools to increase the efficacy of traditional therapeutic approaches that could also be applied to treat other addictions. [ABSTRACT FROM AUTHOR]

Background: In problem gambling, normative personalized feedback interventions have demonstrated promising effects. Given the widespread increase in online gambling in recent years, internet-delivered normative feedback may serve as a promising intervention. This study aimed to examine whether such an intervention, delivered by a gambling operator and aiming to help problem gamblers decrease their gambling, may in fact be associated with lower gambling practices post-intervention. Methods: Online questions on norms and beliefs about one's own and peers' gambling habits, derived from the Gambling Quantity and Perceived Norms Scale, were followed by personalized feedback, delivered online by the Swedish state-owned gambling operator. A total of 1,453 gamblers consented to participate in a pre-post measure of wagering levels. Results: Wagering decreased significantly post-intervention (28 days) compared to pre-intervention (28 days prior). The decrease was significantly more pronounced in younger and online casino gamblers. In an 84-day follow-up, the decrease remained significant, although less pronounced. Conclusions: An online normative intervention delivered by a state-owned gambling operator, addressing norms and beliefs about gambling levels, may lower risky gambling in the short term. Implications and further research needs are discussed. [ABSTRACT FROM AUTHOR]

Although some studies have been conducted on gambling behaviour in the general population or in clinical samples during the COVID-19 pandemic, less attention has been focused on Affected Family Members (AFMs) of disordered gamblers. To fill this gap, this study investigated the psychological state of disordered gamblers' AFMs during the COVID-19 lockdown in Italy, the European country first affected by the virus and with the largest gambling market. We were interested in understanding if the unavailability of most land-based gambling offerings during the lockdown created a sense of relief in AFMs. We also compared the quality of family relationships and emotional state during the lockdown of AFMs with those of their relative with Gambling Disorder (GD). Participants were 53 disordered gamblers' AFMs (77% female; mean age = 50.28). For 42 out of the 53 AFMs, we also recruited their relative with GD (86% male; mean age = 48.98). A semi-structured telephone interview was developed. Although AFMs reported a general interruption of the relative's gambling behaviour and a general sense of relief for the closure of gambling activities, accompanied by the perception of good family relationships, AFMs still felt tired, worried, and apprehensive and perceived more fear, stress, and anxiety than before the lockdown. A large proportion of AFMs engaged in potentially addictive behaviours, especially TV and mobile phone and Internet use, which increased in frequency compared to before the pandemic. They still perceived some gambling-related problematic behaviours from their relative and put in place coping strategies to manage the gambling problem. Even if they had a general positive orientation towards the future, they experienced fear when thinking about the reopening of gambling opportunities at the end of the lockdown. Compared to their relatives with GD, AFMs appeared more prone to perceiving a general negative state and a worsening of it from before the lockdown. Overall, this study shows that disordered gambling's AFMs can be considered as a particularly at-risk group who deserves focused clinical attention even during gambling closures related to pandemic lockdown.

Cognitive behavioral therapy (CBT) is the most successful protocol in gambling disorder (GD) treatment. However, it presents some weaknesses, especially concerning relapse prevention (RP). RP is one of the most important therapeutic steps, aiming at managing cravings and to avoid future relapse increasing perceived self-efficacy. Encouraging results come from the blending of psychotherapy and virtual reality (VR), containing gambling cues. The goal of Alter Game (approved by the Ethical Commission, Prot. No. 69346) is verifying the efficacy of an innovative psychological treatment for GD based on the integration of traditional CBT therapy and an immersive VR cue exposure therapy using a serious virtual game, which is a game designed for purposes other than entertainment. RP in virtual cue-exposure therapy allows pathological gamblers to manage the urge to gamble and to avoid relapse by becoming aware of which internal and external triggers are related to craving. We hypothesize that the integrated intervention will be more effective than simple CBT with regard to self-efficacy, craving, and gambling-related distortions. Four virtual ecological environments were developed, and a virtual app, Exludo, interfaced with a computerized multiparametric acquisition system for biofeedback, was created. A sample of about 60 patients aged between 18 and 65 with GD referring to the Addiction Medicine Unit of Verona (Rossi Hospital) will be recruited. Patients will be randomly assigned to the CBT group (16 CBT sessions) or the CBT + VR group (8 CBT sessions + 8 VR cue-exposure therapy sessions). The MCMI-III, the BIS-11, and the SOGS will be used to evaluate inclusion and exclusion criteria, while the Gambling Related Cognitions Scale and the Multidimensional Gambling Self-Efficacy Scale will be used to verify changes as a function of the treatment. Craving will be evaluated through VAS, and psychophysiological variables will be assessed through biofeedback. A pre-test/post-test experimental design with a 1-month follow-up will be conducted. This study will examine an innovative psychotherapeutic protocol for GD treatment, and it will help in identifying new virtual tools to increase the efficacy of traditional therapeutic approaches that could also be applied to treat other addictions.

IntroductionThe COVID-19 outbreak and related lockdowns brought substantial changes in people’s lives and led to concerns about possible increases of addictive behaviors at the initial stages of the pandemic. To examine these concerns, the aim of the present study was to assess longitudinal changes in addictive and problematic behaviors (i.e., problematic social media use, Internet gaming disorder, gambling disorder, problematic pornography use, and compulsive sexual behavior disorder) over time during the COVID-19 pandemic.MethodsThree waves of data collection took place in different stages of the COVID-19 outbreak in Hungary in a general population, from the first wave of lockdowns to the second and third waves of restrictions (May, 2020; NT1 = 1747; June–August, 2020; NT2 = 656; January, 2021; NT3 = 411). Latent growth curve models were calculated to assess the potential changes in addictive and problematic behaviors over time.ResultsLatent growth curve models showed that the sample varied in their initial scores, but there were no significant changes over time in any of the examined behaviors, except for compulsive sexual behavior disorder, which demonstrated a small but significant increase (i.e., positive and significant slope factor). However, the rate of this change was negligible. Overall, there were no noteworthy changes over time regarding any of the examined addictive and problematic behaviors.ConclusionContrary to initial concerns, no substantial changes over time were observed regarding the examined addictive behaviors during the COVID-19 pandemic and related lockdowns. These findings indicate that those who had no previous problem with these addictive behaviors, might have not developed a problem, and those who had problem with either of the behaviors previously, might have not experienced a significant increase in their symptoms.

BackgroundIn problem gambling, normative personalized feedback interventions have demonstrated promising effects. Given the widespread increase in online gambling in recent years, internet-delivered normative feedback may serve as a promising intervention. This study aimed to examine whether such an intervention, delivered by a gambling operator and aiming to help problem gamblers decrease their gambling, may in fact be associated with lower gambling practices post-intervention.MethodsOnline questions on norms and beliefs about one's own and peers' gambling habits, derived from the Gambling Quantity and Perceived Norms Scale, were followed by personalized feedback, delivered online by the Swedish state-owned gambling operator. A total of 1,453 gamblers consented to participate in a pre-post measure of wagering levels.ResultsWagering decreased significantly post-intervention (28 days) compared to pre-intervention (28 days prior). The decrease was significantly more pronounced in younger and online casino gamblers. In an 84-day follow-up, the decrease remained significant, although less pronounced.ConclusionsAn online normative intervention delivered by a state-owned gambling operator, addressing norms and beliefs about gambling levels, may lower risky gambling in the short term. Implications and further research needs are discussed.

Background and Aims: COVID-19 pandemic and confinement have represented a challenge for patients with gambling disorder (GD). Regarding treatment outcome, dropout may have been influenced by these adverse circumstances. The aims of this study were: (a) to analyze treatment dropout rates in patients with GD throughout two periods: during and after the lockdown and (b) to assess clinical features that could represent vulnerability factors for treatment dropout. Methods: The sample consisted of n =86 adults, mostly men (n =79, 91.9%) and with a mean age of 45years old (SD =16.85). Patients were diagnosed with GD according to DSM-5 criteria and were undergoing therapy at a Behavioral Addiction Unit when confinement started. Clinical data were collected through a semi-structured interview and protocolized psychometric assessment. A brief telephone survey related to COVID-19 concerns was also administered at the beginning of the lockdown. Dropout data were evaluated at two moments throughout a nine-month observational period (T1: during the lockdown, and T2: after the lockdown). Results: The risk of dropout during the complete observational period was R =32/86=0.372 (37.2%), the Incidence Density Rate (IDR) ratio T2/T1 being equal to 0.052/0.033=1.60 (p =0.252). Shorter treatment duration (p =0.007), lower anxiety (p =0.025), depressive symptoms (p =0.045) and lower use of adaptive coping strategies (p =0.046) characterized patients who abandoned treatment during the lockdown. Briefer duration of treatment (p =0.001) and higher employment concerns (p =0.044) were highlighted in the individuals who dropped out after the lockdown. Treatment duration was a predictor of dropout in both periods (p =0.005 and p <0.001, respectively). Conclusion: The present results suggest an impact of the COVID-19 pandemic on treatment dropout among patients with GD during and after the lockdown, being treatment duration a predictor of dropout. Assessing vulnerability features in GD may help clinicians identify high-risk individuals and enhance prevention and treatment approaches in future similar situations. [ABSTRACT FROM AUTHOR]

Background and Objective: Complex associations between gambling disorder (GD) and impulsivity have been identified. However, little is known regarding how compulsivity associates with different impulsivity domains in GD. In this study, we examined associations between self-reported and behavioral measures of impulsivity–assessed through the Barratt Impulsiveness Scale (BIS-11) and the Experiential Discounting Task (EDT), respectively- and compulsivity-measured using the Padua Inventory and the Wisconsin Card Sorting Test (WCST), respectively-, in an adult sample with GD (N = 132, 94 men and 38 women, ages ranging from 18 to 69 years). GD severity was assessed using the South Oaks Gambling Screen.Methods: Structural Equation Modeling was used to examine relationships between impulsivity and compulsivity measures, age, and GD severity.Results: BIS-11 non-planning and BIS-11 total scores positively correlated with GD severity. The standardized coefficients for the SEM showed direct positive contributions of BIS-11 non-planning, Padua and EDT scores to GD severity. Only participants' ages directly contributed to WCST perseverative errors, and no direct or indirect effects were found with respect to GD severity.Conclusion: The findings suggest that specific aspects of impulsivity and compulsivity contribute to GD severity. Interventions specifically targeting domains that are most relevant to GD severity may improve treatment outcomes.

Background and Aims: COVID-19 pandemic and confinement have represented a challenge for patients with gambling disorder (GD). Regarding treatment outcome, dropout may have been influenced by these adverse circumstances. The aims of this study were: (a) to analyze treatment dropout rates in patients with GD throughout two periods: during and after the lockdown and (b) to assess clinical features that could represent vulnerability factors for treatment dropout.Methods: The sample consisted of n=86 adults, mostly men (n=79, 91.9%) and with a mean age of 45years old (SD=16.85). Patients were diagnosed with GD according to DSM-5 criteria and were undergoing therapy at a Behavioral Addiction Unit when confinement started. Clinical data were collected through a semi-structured interview and protocolized psychometric assessment. A brief telephone survey related to COVID-19 concerns was also administered at the beginning of the lockdown. Dropout data were evaluated at two moments throughout a nine-month observational period (T1: during the lockdown, and T2: after the lockdown).Results: The risk of dropout during the complete observational period was R=32/86=0.372 (37.2%), the Incidence Density Rate (IDR) ratio T2/T1 being equal to 0.052/0.033=1.60 (p=0.252). Shorter treatment duration (p=0.007), lower anxiety (p=0.025), depressive symptoms (p=0.045) and lower use of adaptive coping strategies (p=0.046) characterized patients who abandoned treatment during the lockdown. Briefer duration of treatment (p=0.001) and higher employment concerns (p=0.044) were highlighted in the individuals who dropped out after the lockdown. Treatment duration was a predictor of dropout in both periods (p=0.005 and p

Gambling Disorder (GD) has been recently re-classified in the DSM-5 under the "substance-related and addictive disorders," in light of its genetic, endophenotypic, and phenotypic resemblances to substance dependence. Diminished control is a core defining concept of psychoactive substance dependence or addiction and has given rise to the concept of "behavioral" addictions, which are syndromes analogous to substance addiction, but with a behavioral focus other than ingestion of a psychoactive substance. The main symptom clusters are represented by loss of control, craving/withdrawal, and neglect of other areas of life, whereas in a Research Domain Criteria (RDoC) perspective, GD patients exhibit deficits in the domain of "Positive valence systems," particularly in the "Approach motivation" and "Reward learning" constructs, as well as in the "Cognitive systems," primarily in the "Cognitive control" construct. In the Addictions Neuroclinical Assessment (ANA), three relevant domains for addictions emerge: "Incentive salience," "Negative Emotionality," and "Executive Function." The endocannabinoid system (ECS) may largely modulate these circuits, presenting a promising pharmaceutical avenue for treating addictions. Up to now, research on cannabidiol has shown some efficacy in Attention Deficit/Hyperactivity Disorder (ADHD), whereas in behavioral addictions its role has not been fully elucidated, as well as its precise action on RDoC domains. Herein, we review available evidence on RDoC domains affected in GD and behavioral addictions and summarize insights on the use of cannabidiol in those disorders and its potential mechanisms of action on reward, decisional, and sensorimotor processes. [ABSTRACT FROM AUTHOR]

Gambling Disorder (GD) has been recently re-classified in the DSM-5 under the “substance-related and addictive disorders,” in light of its genetic, endophenotypic, and phenotypic resemblances to substance dependence. Diminished control is a core defining concept of psychoactive substance dependence or addiction and has given rise to the concept of “behavioral” addictions, which are syndromes analogous to substance addiction, but with a behavioral focus other than ingestion of a psychoactive substance. The main symptom clusters are represented by loss of control, craving/withdrawal, and neglect of other areas of life, whereas in a Research Domain Criteria (RDoC) perspective, GD patients exhibit deficits in the domain of “Positive valence systems,” particularly in the “Approach motivation” and “Reward learning” constructs, as well as in the “Cognitive systems,” primarily in the “Cognitive control” construct. In the Addictions Neuroclinical Assessment (ANA), three relevant domains for addictions emerge: “Incentive salience,” “Negative Emotionality,” and “Executive Function.” The endocannabinoid system (ECS) may largely modulate these circuits, presenting a promising pharmaceutical avenue for treating addictions. Up to now, research on cannabidiol has shown some efficacy in Attention Deficit/Hyperactivity Disorder (ADHD), whereas in behavioral addictions its role has not been fully elucidated, as well as its precise action on RDoC domains. Herein, we review available evidence on RDoC domains affected in GD and behavioral addictions and summarize insights on the use of cannabidiol in those disorders and its potential mechanisms of action on reward, decisional, and sensorimotor processes.

Background and Aims: Internet gambling has recently grown in popularity, but relatively little is known about how online and the combination of online and offline (mixed) gambling are associated with gambling disorder (GD) and related problems. The present research examined in a cohort study sample of young Swiss men how their gambling activities and gambling-related problems differed across the spectrum from offline to online gambling.Sample: A general-population based sample from the Cohort Study on Substance Use Risk Factors (C-SURF), consisting of 5,352 young Swiss men (mean age 28.26 years old).Measures: The spectrum from exclusively offline to almost exclusively online (>90% of gambling money spent online) gambling was measured using one question about the proportion of gambling money spent online. Total money gambled and time spent on gambling were also assessed. GD severity (range 0–9) was measured using items reflecting the nine DSM-5 GD criteria. The number of gambling-related problems (e.g., financial difficulties, range 0–10), other addictive disorders and mental health problems were also inquired about.Methods: We estimated a generalised linear model using a count model (negative binomial link function) for GD severity and gambling-related problems associated with the amounts and proportions of money gambled online and offline.Results: The number of GD criteria were associated with money gambled online (IRR [95%CI] = 2.81 [2.43, 3.24]) and offline (IRR = 2.68 [2.40, 3.00]). This was also found for the number of gambling-related problems (IRR = 2.43 [2.13, 2.79] and IRR = 2.89 [2.59, 3.23]). Compared with exclusively-offline gamblers, mixed gamblers (26–90% of money gambled online) showed the highest levels of GD symptoms and gambling-related problems, followed by the almost-exclusively-online gamblers (≥91% money gambled online) and, overall, these associations were still significant after adjustment for overall involvement in gambling (time spent and money gambled). Levels of other addictive disorders and mental health problems were higher among mixed gamblers than among offline-only gamblers, but levels among almost-exclusively-online gamblers were not.Conclusions: Symptoms of gambling disorder and gambling related problems are highest among gamblers engaging in both offline and online gambling. Prevention efforts need to target the combination of offline and online gambling.

Background and Aims: Internet gambling has recently grown in popularity, but relatively little is known about how online and the combination of online and offline (mixed) gambling are associated with gambling disorder (GD) and related problems. The present research examined in a cohort study sample of young Swiss men how their gambling activities and gambling-related problems differed across the spectrum from offline to online gambling. Sample: A general-population based sample from the Cohort Study on Substance Use Risk Factors (C-SURF), consisting of 5,352 young Swiss men (mean age 28.26 years old). Measures: The spectrum from exclusively offline to almost exclusively online (>90% of gambling money spent online) gambling was measured using one question about the proportion of gambling money spent online. Total money gambled and time spent on gambling were also assessed. GD severity (range 0–9) was measured using items reflecting the nine DSM-5 GD criteria. The number of gambling-related problems (e.g., financial difficulties, range 0–10), other addictive disorders and mental health problems were also inquired about. Methods: We estimated a generalised linear model using a count model (negative binomial link function) for GD severity and gambling-related problems associated with the amounts and proportions of money gambled online and offline. Results: The number of GD criteria were associated with money gambled online (IRR [95%CI] = 2.81 [2.43, 3.24]) and offline (IRR = 2.68 [2.40, 3.00]). This was also found for the number of gambling-related problems (IRR = 2.43 [2.13, 2.79] and IRR = 2.89 [2.59, 3.23]). Compared with exclusively-offline gamblers, mixed gamblers (26–90% of money gambled online) showed the highest levels of GD symptoms and gambling-related problems, followed by the almost-exclusively-online gamblers (≥91% money gambled online) and, overall, these associations were still significant after adjustment for overall involvement in gambling (time spent and money gambled). Levels of other addictive disorders and mental health problems were higher among mixed gamblers than among offline-only gamblers, but levels among almost-exclusively-online gamblers were not. Conclusions: Symptoms of gambling disorder and gambling related problems are highest among gamblers engaging in both offline and online gambling. Prevention efforts need to target the combination of offline and online gambling. [ABSTRACT FROM AUTHOR]

Background: Serious games have shown positive results in increasing motivation, adherence to treatment and strengthening the therapeutic alliance in multiple psychiatric disorders. In particular, patients with impulse control disorders and other disorders in which the patient suffers from inhibitory control deficits (e.g., behavioral addictions) have been shown to benefit from serious games.Aim: The aim of this study was to describe the characteristics and to evaluate the usability of a new serious videogame, e-Estesia. This serious videogame was designed to improve emotion regulation in patients with gambling disorder (GD). Preliminary results from a pilot sample are also reported.Method: A pilot sample of 26 patients undergoing treatment for GD was recruited (ranging from 22 to 74 years, mean = 41.2 and SD = 12.9; 80.8% men). Participants used e-Estesia on a tablet, which was connected to a thoracic band that sent heart rate (HR) and heart rate variability (HRV) data to the videogame platform in order to provide biofeedback. The System Usability Scale was completed by patients to determine the usability of e-Estesia.Results and Discussion: e-Estesia performed comparatively well for all the explored groups (i.e., sex, age, and online vs. offline gambling: mean usability score = 83.8, SD = 13.1). Around 84.6% of the patients endorsed that it was easy to use. Female patients with GD presented higher HRV during the use of the serious videogame compared to men.

Background : Serious games have shown positive results in increasing motivation, adherence to treatment and strengthening the therapeutic alliance in multiple psychiatric disorders. In particular, patients with impulse control disorders and other disorders in which the patient suffers from inhibitory control deficits (e.g., behavioral addictions) have been shown to benefit from serious games. Aim : The aim of this study was to describe the characteristics and to evaluate the usability of a new serious videogame, e-Estesia. This serious videogame was designed to improve emotion regulation in patients with gambling disorder (GD). Preliminary results from a pilot sample are also reported. Method : A pilot sample of 26 patients undergoing treatment for GD was recruited (ranging from 22 to 74 years, mean = 41.2 and SD = 12.9; 80.8% men). Participants used e-Estesia on a tablet, which was connected to a thoracic band that sent heart rate (HR) and heart rate variability (HRV) data to the videogame platform in order to provide biofeedback. The System Usability Scale was completed by patients to determine the usability of e-Estesia. Results and Discussion : e-Estesia performed comparatively well for all the explored groups (i.e., sex, age, and online vs. offline gambling: mean usability score = 83.8, SD = 13.1). Around 84.6% of the patients endorsed that it was easy to use. Female patients with GD presented higher HRV during the use of the serious videogame compared to men. [ABSTRACT FROM AUTHOR]

Background: Gambling landscape has changed in recent years with the emergence of online gambling (OG). Greater accessibility and availability of this betting modality can increase the risk of developing a gambling disorder (GD). Online sports betting (OSB) is currently the most common type of OG, but little is known about the clinical characteristics of OSB compared to slot-machine (SM) gamblers, the most common offline gambling disorder.Methods: This was a prospective study conducted between October 2005 and September 2019, and included outpatients diagnosed with GD seen in a Pathological Gambling and Behavioral Addictions referral unit. Only patients with OSB and SM disorders were included. The main objective was to assess the clinical profile of OSB compared to SM gamblers, and to define clinical predictors for developing OSB gambling disorder. Logistic regression was performed to determine the effects of variables on the likelihood of this disorder.Results: Among 1,186 patients attended in our Unit during the study period, 873 patients were included; 32 (3.7%) were OSB gamblers and 841 (96.3%) were SM gamblers. Overall, mean age was 45 ± 13 years and 94.3% were men. Compared to SM patients, OSB patients were younger (34.9 ± 9.5 vs. 45.3 ±13), more frequently single (43.8 vs. 20.6%) and had a university education level (43.8 vs. 4.5%); they were also more frequently non-smokers (18.7 vs. 66.7%) and had fewer psychiatric comorbidities (12.5 vs. 29.4%) than SM gamblers. GD duration before treatment initiation was shorter in OSB patients than in SM gamblers, most of them (81.3 vs. 42.4%) with ≤ 5 years of GD duration. OSB gamblers showed significant differences in weekly gambling expenditure, spending higher amounts than SM patients. Younger age (OR: 0.919; 95% CI: 0.874–0.966), university education level (OR: 10.658; 95% CI: 3.330–34.119), weekly expenditure >100€ (OR: 5.811; 95% CI:1.544–21.869), and being a non-smoker (OR:13.248; 95% CI:4.332–40.517) were associated with an increased likelihood of OSB gambling behavior.Conclusions: We identified different profiles for OSB and SM gamblers. Younger age, university education level, higher weekly expenditure, and non-smoking habit were associated with OSB compared to SM disorders. Prevention strategies should help young people become aware of the severe risks of OSB.

BackgroundDistorted gambling-related cognitions are tightly related to gambling problems, and are one of the main targets of treatment for disordered gambling, but their etiology remains uncertain. Although folk wisdom and some theoretical approaches have linked them to lower domain-general reasoning abilities, evidence regarding that relationship remains unconvincing.MethodIn the present cross-sectional study, the relationship between probabilistic/abstract reasoning, as measured by the Berlin Numeracy Test (BNT), and the Matrices Test, respectively, and the five dimensions of the Gambling-Related Cognitions Scale (GRCS), was tested in a sample of 77 patients with gambling disorder and 58 individuals without gambling problems.Results and interpretationNeither BNT nor matrices scores were significantly related to gambling-related cognitions, according to frequentist (MANCOVA/ANCOVA) analyses, performed both considering and disregarding group (patients, non-patients) in the models. Correlation Bayesian analyses (bidirectional BF10) largely supported the null hypothesis, i.e., the absence of relationships between the measures of interest. This pattern or results reinforces the idea that distorted cognitions do not originate in a general lack of understanding of probability or low fluid intelligence, but probably result from motivated reasoning.

Background: Voluntary self-exclusion is a well-known harm reduction intervention in problem gambling, although primarily in operator-specific or venue-based systems. A nationwide overall self-exclusion system (“Spelpaus”) for all licensed gambling was introduced in Sweden in 2019. However, gambling in overseas companies despite national exclusion may be a concern in online gamblers. The present web survey study aimed to study self-reported self-exclusion and gambling despite exclusion in a nationwide multi-operator land-based/online exclusion system.Methods: Web survey in web panel members of a market survey company, carried out in May, 2020 (co-occurring with the COVID-19 pandemic). Past-year online gamblers (n = 997) answered questions about gambling patterns, gambling problems, psychological distress, self-exclusion since “Spelpaus” introduction, and gambling despite self-exclusion.Results: Seven percent reported ever self-excluded at Spelpaus, and this was associated with younger age, female gender, gambling problems, and chance-based games and online poker. In logistic regression, Spelpaus remained strongly associated with past-year online casino gambling, gambling problems, and absence of past-year sports betting. Among those having self-excluded, 38 percent reported gambling despite self-exclusion, most commonly online casino.Conclusions: In online gamblers in a setting with a nationwide self-exclusion system, using this was associated with past-year online casino gambling and gambling problems. Gambling despite self-exclusion appears to be common, and more commonly involves online casino. Stakeholders should aim to increase rates of self-exclusion in high-risk online gamblers, both during and beyond the COVID-19 situation in which the study was carried out. Also, policy makers should use gambling regulation in order to decrease the risk of breaching self-exclusion online, such as through the prohibition of non-registered gambling operators. Further research should focus on in-depth analysis of the reasons for gamblers to enroll or not enroll in multi-operator self-exclusion.

Background: Concerns have been raised about increased gambling problems during the coronavirus disease (COVID-19) crisis, particularly in settings with high online gambling and risks of migration from land-based to riskier online-based gambling types. However, few non-self-reported data sources are hitherto available. The present study aimed to assess changes in the online- and land-based gambling markets in Sweden during the first months affected by the societal impact of COVID-19.Methods: Data were derived from national authority data describing monthly taxations of all licensed Swedish gambling operators, whose monthly tax payments are directly based on gambling revenue. Subdivisions of the gambling market were followed monthly from before COVID-19 onset in Sweden (mainly February 2020) through June 2020, when the sports market was restarted after COVID-19 lockdown.Results: Overall revenue-based taxations in the licensed gambling decreased markedly from February to March, but stabilized onto an overall modest decrease through June. Commercial online casino/betting, despite some decrease in March, was maintained on a relatively stable level through June. However, within this category, horse betting increased steeply during the pandemic but returned to prepandemic levels later during the period. The state-owned operator in betting/online casino decreased markedly throughout the pandemic. The remaining commercial operators, mainly in online casino and online betting, demonstrated no change during the pandemic and ended on a June level 14% above the February level. Throughout the pandemic, the smaller restaurant casinos decreased markedly, while major state-owned casinos also closed entirely. State-owned lotteries and electronic gambling machines decreased markedly but were rapidly normalized to prepandemic levels.Conclusions: Commercial online gambling operators' revenues remained stable throughout the pandemic, despite the dramatic lockdown in sports. Thus, chance-based online games may have remained a strong actor in the gambling market despite the COVID-19 crisis, in line with previous self-report data. A sudden increase in horse betting during the sports lockdown and its decrease when sports reopened confirm the picture of possible COVID-19-related migration between gambling types, indicating a volatility with potential impact on gambling-related public health.

Background: Distorted gambling-related cognitions are tightly related to gambling problems, and are one of the main targets of treatment for disordered gambling, but their etiology remains uncertain. Although folk wisdom and some theoretical approaches have linked them to lower domain-general reasoning abilities, evidence regarding that relationship remains unconvincing. Method: In the present cross-sectional study, the relationship between probabilistic/abstract reasoning, as measured by the Berlin Numeracy Test (BNT), and the Matrices Test, respectively, and the five dimensions of the Gambling-Related Cognitions Scale (GRCS), was tested in a sample of 77 patients with gambling disorder and 58 individuals without gambling problems. Results and interpretation: Neither BNT nor matrices scores were significantly related to gambling-related cognitions, according to frequentist (MANCOVA/ANCOVA) analyses, performed both considering and disregarding group (patients, non-patients) in the models. Correlation Bayesian analyses (bidirectional BF10) largely supported the null hypothesis, i.e., the absence of relationships between the measures of interest. This pattern or results reinforces the idea that distorted cognitions do not originate in a general lack of understanding of probability or low fluid intelligence, but probably result from motivated reasoning. [ABSTRACT FROM AUTHOR]

Background: Gambling landscape has changed in recent years with the emergence of online gambling (OG). Greater accessibility and availability of this betting modality can increase the risk of developing a gambling disorder (GD). Online sports betting (OSB) is currently the most common type of OG, but little is known about the clinical characteristics of OSB compared to slot-machine (SM) gamblers, the most common offline gambling disorder. Methods: This was a prospective study conducted between October 2005 and September 2019, and included outpatients diagnosed with GD seen in a Pathological Gambling and Behavioral Addictions referral unit. Only patients with OSB and SM disorders were included. The main objective was to assess the clinical profile of OSB compared to SM gamblers, and to define clinical predictors for developing OSB gambling disorder. Logistic regression was performed to determine the effects of variables on the likelihood of this disorder. Results: Among 1,186 patients attended in our Unit during the study period, 873 patients were included; 32 (3.7%) were OSB gamblers and 841 (96.3%) were SM gamblers. Overall, mean age was 45 ± 13 years and 94.3% were men. Compared to SM patients, OSB patients were younger (34.9 ± 9.5 vs. 45.3 ±13), more frequently single (43.8 vs. 20.6%) and had a university education level (43.8 vs. 4.5%); they were also more frequently non-smokers (18.7 vs. 66.7%) and had fewer psychiatric comorbidities (12.5 vs. 29.4%) than SM gamblers. GD duration before treatment initiation was shorter in OSB patients than in SM gamblers, most of them (81.3 vs. 42.4%) with ≤ 5 years of GD duration. OSB gamblers showed significant differences in weekly gambling expenditure, spending higher amounts than SM patients. Younger age (OR: 0.919; 95% CI: 0.874–0.966), university education level (OR: 10.658; 95% CI: 3.330–34.119), weekly expenditure >100€ (OR: 5.811; 95% CI:1.544–21.869), and being a non-smoker (OR:13.248; 95% CI:4.332–40.517) were associated with an increased likelihood of OSB gambling behavior. Conclusions: We identified different profiles for OSB and SM gamblers. Younger age, university education level, higher weekly expenditure, and non-smoking habit were associated with OSB compared to SM disorders. Prevention strategies should help young people become aware of the severe risks of OSB. [ABSTRACT FROM AUTHOR]

Background: Concerns have been raised about increased gambling problems during the coronavirus disease (COVID-19) crisis, particularly in settings with high online gambling and risks of migration from land-based to riskier online-based gambling types. However, few non-self-reported data sources are hitherto available. The present study aimed to assess changes in the online- and land-based gambling markets in Sweden during the first months affected by the societal impact of COVID-19. Methods: Data were derived from national authority data describing monthly taxations of all licensed Swedish gambling operators, whose monthly tax payments are directly based on gambling revenue. Subdivisions of the gambling market were followed monthly from before COVID-19 onset in Sweden (mainly February 2020) through June 2020, when the sports market was restarted after COVID-19 lockdown. Results: Overall revenue-based taxations in the licensed gambling decreased markedly from February to March, but stabilized onto an overall modest decrease through June. Commercial online casino/betting, despite some decrease in March, was maintained on a relatively stable level through June. However, within this category, horse betting increased steeply during the pandemic but returned to prepandemic levels later during the period. The state-owned operator in betting/online casino decreased markedly throughout the pandemic. The remaining commercial operators, mainly in online casino and online betting, demonstrated no change during the pandemic and ended on a June level 14% above the February level. Throughout the pandemic, the smaller restaurant casinos decreased markedly, while major state-owned casinos also closed entirely. State-owned lotteries and electronic gambling machines decreased markedly but were rapidly normalized to prepandemic levels. Conclusions: Commercial online gambling operators' revenues remained stable throughout the pandemic, despite the dramatic lockdown in sports. Thus, chance-based online games may have remained a strong actor in the gambling market despite the COVID-19 crisis, in line with previous self-report data. A sudden increase in horse betting during the sports lockdown and its decrease when sports reopened confirm the picture of possible COVID-19-related migration between gambling types, indicating a volatility with potential impact on gambling-related public health. [ABSTRACT FROM AUTHOR]

Background: Voluntary self-exclusion is a well-known harm reduction intervention in problem gambling, although primarily in operator-specific or venue-based systems. A nationwide overall self-exclusion system (" Spelpaus") for all licensed gambling was introduced in Sweden in 2019. However, gambling in overseas companies despite national exclusion may be a concern in online gamblers. The present web survey study aimed to study self-reported self-exclusion and gambling despite exclusion in a nationwide multi-operator land-based/online exclusion system. Methods: Web survey in web panel members of a market survey company, carried out in May, 2020 (co-occurring with the COVID-19 pandemic). Past-year online gamblers (n = 997) answered questions about gambling patterns, gambling problems, psychological distress, self-exclusion since " Spelpaus" introduction, and gambling despite self-exclusion. Results: Seven percent reported ever self-excluded at Spelpaus , and this was associated with younger age, female gender, gambling problems, and chance-based games and online poker. In logistic regression, Spelpaus remained strongly associated with past-year online casino gambling, gambling problems, and absence of past-year sports betting. Among those having self-excluded, 38 percent reported gambling despite self-exclusion, most commonly online casino. Conclusions: In online gamblers in a setting with a nationwide self-exclusion system, using this was associated with past-year online casino gambling and gambling problems. Gambling despite self-exclusion appears to be common, and more commonly involves online casino. Stakeholders should aim to increase rates of self-exclusion in high-risk online gamblers, both during and beyond the COVID-19 situation in which the study was carried out. Also, policy makers should use gambling regulation in order to decrease the risk of breaching self-exclusion online, such as through the prohibition of non-registered gambling operators. Further research should focus on in-depth analysis of the reasons for gamblers to enroll or not enroll in multi-operator self-exclusion. [ABSTRACT FROM AUTHOR]

Background: Gambling disorder is known to be associated with increased risk of suicidal behavior. However, relatively little is known about how the risk of suicide attempts in gambling disorder is influenced by comorbid alcohol or drug use disorders, as well as other psychiatric conditions.Methods: The present study is a nationwide, diagnostic register study assessing the risk of suicide attempts (including fatal ones) in gambling disorder in Sweden in 2005–2016.Results: In a total of 2,099 individuals (23 percent women) with gambling disorder, 417 individuals had a suicide attempt (including 10 fatal cases of suicide) during the study period. Suicidal behavior was more common in patients with substance use disorders at any time during the study period (50 percent if both alcohol and drug use disorders were present, and 10 percent if none of these were present). In logistic regression, suicidal behavior was significantly associated with female gender (OR 2.13 [1.63–2.78]), mood disorders (OR 2.65 [2.00–3.50]), anxiety disorders (OR 1.78 [1.34–2.35]), and with alcohol (OR 1.95 [1.51–2.51]) or drug use disorders (OR 3.60 [2.76–4.69]), respectively.Conclusions: Suicidal behavior in clinical gambling disorder patients is common, but markedly more common in the presence of substance use and other comorbid disorders.

Wagering inducements are part of loyalty/reward programs implemented by online gambling operators to retain or attract consumers. They constitute incentives to bet that are offered to gamblers provided that they perform certain betting-related activities. They are often considered risk factors for gambling problems, but studies exploring the actual impacts of such incentives are scarce. The objective of the present study was to assess the actual impact of wagering inducements on gambling behaviors, cognitions, and emotions of online gamblers. One hundred seventy-one adults (18–65 years old) who gamble on a regular basis on the Internet, including at-risk and recreational gamblers, were recruited through media announcements and in panels from survey institutes. Participants were randomly assigned to one of four experimental conditions, in which a defined amount of money was given to the gambler with a bank e-card system during an experimental gambling session to simulate a wagering inducement (€10, €50, €100, or €200), or the control condition, in which no incentive was given. The experimental gambling session was designed to be as natural as possible (participants gambled with their own gambling account and their own money). Participants completed a pretest interview, took part in the experimental gambling session, and then completed a post-test interview. The impact of wagering inducements was estimated on objective (money wagered and time spent gambling during the gambling session) and subjective (cognitive distortions, enjoyment of gambling, loss of control, and respect of usual gambling habits) gambling endpoints that were compared between conditions. Two-thirds of participants reported having already received wagering inducements at some point of their gambling course. Although no effect was demonstrated on time spent gambling, inducements increased money wagered, gambling-related expectancies and perceived loss of control. In particular, it seems that wagering inducements could lead to extreme expenses, especially for at-risk gamblers. This research suggests that regulating wagering inducements could be helpful for prevention and early intervention. Future research on the impacts of wagering inducements is still needed, especially more ecological studies based on behavioral tracking data and studies assessing the differential impacts of various incentive types.Clinical Trial Registration: NCT01789580 (ClinicalTrials.gov).