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Background and aims The effect of internet-based psychological treatment for gambling problems has not been previously investigated by meta-analysis. The present study is therefore a quantitative synthesis of studies on the effects of internet-based treatment for gambling problems. Given that effects may vary according to the presence of therapist support and control conditions, it was presumed that subgroup analyses would elucidate such effects. Methods A systematic search with no time constraints was conducted in PsycINFO, MEDLINE, Web of Science, and the Cochrane Library. Two authors independently extracted data using a predefined form, including study quality assessment based on the Cochrane risk of bias tool. Effect sizes were calculated using random-effects models. Heterogeneity was indexed by Cochran’s Q and the I 2 statistics. Publication bias was investigated using trim and fill. Results Thirteen studies were included in the analysis. Random effects models at post-treatment showed significant effects for general gambling symptoms (g = 0.73; 95% CI = 0.43–1.03), gambling frequency (g = 0.29; 95% CI = 0.14–0.45), and amount of money lost gambling (g = 0.19; 95% CI = 0.11–0.27). The corresponding findings at follow-up were g = 1.20 (95% CI = 0.79–1.61), g = 0.36 (95% CI = 0.12–0.60), and g = 0.20 (95% CI = 0.12–0.29) respectively. Subgroup analyses showed that for general gambling symptoms, studies with therapist support yield larger effects than studies without, both post-treatment and at follow-up. Additionally, on general gambling symptoms and gambling frequency, there were lower effect sizes for studies with a control group compared to studies without a control group at follow-up. Studies with higher baseline severity of gambling problems were associated with larger effect sizes at both posttreatment and follow-up than studies with more lenient inclusion criteria concerning gambling problems. Discussion and conclusions Internet-based treatment has the potential to reach a large proportion of persons with gambling problems. Results of the meta-analysis suggest that such treatments hold promise as an effective approach. Future studies are encouraged to examine moderators of treatment outcomes, validate treatment effects cross-culturally, and investigate the effects of novel developments such as ecological momentary interventions.

Pop-up messages utilized by gambling operators are normally presented to gamblers during gambling sessions in order to prevent excessive gambling and/or to help in the appraisal of maladaptive gambling cognitions. However, the effect of such messages on gambling behavior and gambling cognitions has not previously been synthesized quantitatively. Consequently, a meta-analysis estimating the efficacy of pop-up messages on gambling behavior and cognitions was conducted. A systematic literature search with no time constraints was performed on Web of Science, PsychInfo, Medline, PsychNET, and the Cochrane Library. Search terms included “gambling,” “pop-up,” “reminder,” “warning message,” and “dynamic message.” Studies based on randomized controlled trials, quasi-experimental designs and pre-post studies reporting both pre- and post-pop-up data were included. Two authors independently extracted data using pre-defined fields including quality assessment. A total of 18 studies were included and data were synthesized using a random effects model estimating Hedges' g. The effects of pop-ups were g = 0.413 for cognitive measures (95% CI = 0.115–0.707) and g = 0.505 for behavioral measures (95% CI = 0.256–0.746). For both outcomes there was significant between-study heterogeneity which could not be explained by setting (laboratory vs. naturalistic) or sample (gambler vs. non-gamblers). It is concluded that pop-up messages provide moderate effects on gambling behavior and cognitions in the short-term and that such messages play an important role in the gambling operators' portfolio of responsible gambling tools.

Background and aims Although alcohol intake and gambling often co-occur in related venues, there is conflicting evidence regarding the effects of alcohol expectancy and intake on gambling behavior. We therefore conducted an experimental investigation of the effects of alcohol expectancy and intake on slot machine gambling behavior. Methods Participants were 184 (females = 94) individuals [age range: 18–40 (mean = 21.9) years] randomized to four independent conditions differing in information/expectancy about beverage (told they received either alcohol or placebo) and beverage intake [actually ingesting low (target blood alcohol concentration [BAC] 0.40 mg/L; ≈0.80 mg/L) amounts of alcohol]. All participants completed self-report questionnaires assessing demographic variables, subjective intoxication, alcohol effects (stimulant and sedative), and gambling factors (behavior and problems, evaluation, and beliefs). Participants also gambled on a simulated slot machine. Results A significant main effect of beverage intake on subjective intoxication and alcohol effects was detected as expected. No significant main or interaction effects were detected for number of gambling sessions, bet size and variation, remaining credits at termination, reaction time, and game evaluation. Conclusion Alcohol expectancy and intake do not affect gambling persistence, dissipation of funds, reaction time, or gambling enjoyment.

Negative wins refer to wins smaller than the original stake on a bet. Previous studies including large numbers of mandatory trials have shown that negative wins reinforce gambling intensity. We conducted an experimental investigation of the effect of negative wins on slot machine gambling intensity, game evaluation, and gambling beliefs based on a small number of mandatory trials/games. Participants were 92 (females = 57) undergraduate students (age range = 19 to 31, mean = 21.6, years) randomized to either an experimental (n = 43) or control (n = 49) group. They were instructed to play for a minimum of 50 trials and were each allocated 500 credits for placing bets. Participants in the experimental group were each exposed to a 30% negative win condition whereas the control group participants had no such exposure. All participants completed self-report questionnaires assessing demographic and gambling variables. In contrast to our hypotheses, the groups did not differ significantly on total bet size, mandatory phase (first 50 trials) bet size, number of bets placed after the mandatory phase, bet size variation, and remaining credits after the mandatory phase. Our findings indicate that with a small number of mandatory trials, negative wins do not reinforce gambling intensity, game evaluation, and gambling beliefs.

Aim: Contextual factors, such as venue characteristics appear to influence gambling behavior. However, few studies have compared the relationship between gambling behavior in alcohol-serving venues (ASVs) and non-alcohol serving venues (NASVs). The aim of the study was to examine individual gambling behavior in ASVs and NASVs.\ud \ud Method: A repeated-measures design was used to examine individual gambling behavior in ASVs and NASVs covering a month. The sample comprised 1,452 observations of 726 individuals (25.2% female). A quantile regression model was conducted to examine individual differences in gambling behavior (number of days, sessions, bets made, stake and time spent, net balance, and average bet size) across ASVs and NASVs. Analyses were broken down by gambler category (those that reached legal mandatory spending limits and those that did not) as well as on time frame (overall gambling behavior and average in-session gambling behavior). \ud \ud Results: Individuals gambled regularly in NASVs and occasionally in ASVs. Compared to NASVs, in-session gambling behavior was more variable in ASVs. In-session analysis showed that non-limit reaching gamblers staked less money in ASVs than in NASVs but lost more money in ASVs than in NASVs. Limit reaching gamblers showed no differences in gambling behavior across venues. \ud \ud Conclusion: The findings show that in-session gambling behavior is more variable in ASVs compared to NASVs regardless of gambling category. Non-limit reaching gamblers may be more sensitive to contextual factors than limit reaching gamblers and appear to be more willing to take more risk in ASVs compared to NASVs. The contextual implications are discussed.

Research article There is a paucity of longitudinal investigations of gambling behavior in the transition from adolescence to emerging adulthood. We conducted a longitudinal investigation of the associations and patterns of change between mental health symptoms and gambling behavior. A representative sample of Norwegians completed questionnaires containing demographic, mental health, and gambling measures at age 17 (N = 2055), and at ages 18 (N = 1334) and 19 (N = 1277). Using latent class analysis, three classes of gambling behavior were identified: consistent non-gambling (71.1%), consistent non-risk gambling (23.8%), and risky-and-problem gambling (5.1%). Being male, showing higher physical and verbal aggression and having more symptoms of depression were associated with greater odds of belonging to the risky-and-problem gambling class at age 17. Overall, the risky-and-problem gambling class had the highest physical and verbal aggression, anxiety, and depression at 19 years. Our findings elucidate the reciprocal relationship between mental health and gambling behavior in the transition from adolescence to emerging adulthood, and the importance of recognizing these factors in designing targeted interventions. This work was supported by the Research Council of Norway (project number: 213757). The funding source had no influence on the study design, data collection and analysis, interpretation of the data, writing of the paper, and the decision to submit the paper for publication.

Losses disguised as wins (LDWs) appear to reinforce gambling persistence. However, little research has examined this phenomenon with real gamblers in natural gambling settings. We aimed to examine the relationship between within-session outcome size and subsequent gambling persistence. Account-based gambling data of individuals playing LDW games over a randomly selected day (2,035,339 bets made by 8636 individuals) was examined. We used a logistic mixed effects model to examine the relationship between the outcome of the previous bet (loss, LDW and real wins) and the odds of continuing betting in a game session. The odds of continuing betting in a game session were positively associated with the outcome of the previous bet. Compared to LDWs, losses lowered the odds of continuing a game session. In contrast, real wins implied greater odds of continuing a game session compared to LDWs. It is concluded that LDWs increase the likelihood of continuing betting compared to losses, but decrease the likelihood of continuing to gamble compared to real wins. As LDWs increase the number of bets made within a gambling session, and hence within-session gambling persistence, LDWs may potentially play an etiological role in the development of gambling problems over time. publishedVersion

The aim of this study was to examine the relationship between the structural characteristics and gambling behavior among video lottery terminal (VLT) gamblers. The study was ecological valid, because the data consisted of actual gambling behavior registered in the participants natural gambling environment without intrusion by researchers. Online behavioral tracking data from Multix, an eight game video lottery terminal, were supplied by Norsk-Tipping (the state owned gambling company in Norway). The sample comprised the entire population of Multix gamblers (N = 31,109) who had gambled in January 2010. The individual number of bets made across games was defined as the dependent variable, reward characteristics of a game (i.e., payback percentage, hit frequency, size of winnings and size of jackpot) and bet characteristics of a game (i.e., range of betting options and availability of advanced betting options) served as the independent variables. Control variables were age and gender. Two separate cross-classified multilevel random intercepts models were used to analyze the relationship between bets made, reward characteristics and bet characteristics, where the number of bets was nested within both individuals and within games. The results show that the number of bets is positively associated with payback percentage, hit frequency, being female and age, and negatively associated with size of wins and range of available betting options. In summary, the results show that the reward characteristics and betting options explained 27 % and 15 % of the variance in the number of bets made, respectively. It is concluded that structural game characteristics affect gambling behavior. Implications of responsible gambling are discussed. publishedVersion