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Participation in various types of gambling is associated with age and gender. Younger men tend to be drawn toward online gambling whereas women and older individuals tend to engage more in land-based gambling such as electronic gaming machines (EGMs). The present study examined how annual trends in theoretical loss, a robust measure of risk propensity/gambling intensity, varied according to age groups and gender among an EGM-population in Norway (N = 195,318, 26.5% women, age range 18 to 103 years [M = 40.13, SD = 16.29]). Quantile regression on the 25th percentile, median, and 90th percentile theoretical loss showed that higher theoretical loss at these quantiles were associated with older age. At the 90th percentile: Individuals aged 60–69 years had highest theoretical loss at 15,343 NOK (1,784 USD). Compared to men, women had higher 90th percentile theoretical loss (1,658 NOK≈193 USD). Interaction analyses showed that the positive association between age and theoretical loss was stronger for men compared to women. Gambling expenditure is positively associated with disordered gambling and the findings suggests that older individuals and women represent more vulnerable groups among the EGM population. publishedVersion

(1) Background: The inclusion of Internet Gaming Disorder in the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) led to a rapid development of assessment instruments based on the suggested diagnosis. However, previous studies suggest that some of the symptoms in the diagnosis reflect engagement in gaming rather than a disorder or addiction. The aim of the present cross-sectional study was to investigate mental health associations with different typologies of gamers. (2) Methods: Data stemmed from a large national survey of students (SHoT2022) that was conducted between February and April 2022 (N = 59,544). Participants were categorized into non-gamers, recreational gamers, engaged gamers, problematic gamers, and addicted gamers. Logistic regression models adjusted for age were analyzed with and without gender-stratification for mental distress and life satisfaction as dependent variables across gaming categories. (3) Results: The proportion reporting case-level mental distress was lower for recreational gamers compared to non-gamers, indicating fewer mental health problems for recreational gamers. However, after stratifying the analysis by gender, female recreational gamers had higher levels of mental distress compared to female non-gamers, reflecting Simpson’s paradox. (4) Conclusions: Future studies investigating mental health and gaming should include a gender perspective. publishedVersion

Objective: Telescoping refers to the accelerated progression from starting a potentially addictive behavior to reaching a disordered level. For disordered gambling, telescoping has been reported for women compared to men. Most previous studies on telescoping have used clinical samples and retrospective reports, but this study examined a nonclinical population of gamblers using electronically tracked gambling behavior. Method: The sample consisted of Norsk Tipping’s Multix electronic gaming machine (EGM) customers during the period of March 2013–December 2018 (n = 184,113, 27.0% women, age range from 18 to 103 years, M = 41, SD = 16). We hypothesized that women would be older than men when first playing Multix and that the time between first playing Multix to reaching first loss limit (money one is allowed to lose) would be shorter for women compared to men. Results: Welch two-sample t tests revealed that women were older than men at Multix gambling onset (Women: M = 46, SD = 17; Men: M = 40, SD = 15; p < .001). Kaplan–Meier revealed a median survival time of 46 months, 95% CI [45, 47], for women and 55 months, 95% CI [54, 56], for men before the first loss limit. Cox regression showed higher risk for meeting the loss limit for women compared to men, HR = 1.22, 95% CI [1.20, 1.25], p < .001, when controlling for age. Conclusion: Prevention efforts should consider that adult women playing EGMs appear to be at risk for developing high-risk gambling faster than men. acceptedVersion

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.

Aim: This study aimed to examine the co-morbidity and temporal relationship between substance abuse disorders (SUDs) and gambling disorder (GD). \ud \ud Method: Cross-tabulated census data were retrieved from the Norwegian Patient Registry. The data included the number of patients by year of first-time incidence of GD and/or SUD diagnoses, age and sex from 2008 to 2017. \ud \ud Results: Approximately 22.5% of GD patients were also diagnosed with SUD, whereas 0.7% of SUD patients were also diagnosed with GD. Among GD patients, males had a greater risk of SUD in the same year compared to females, whereas the risk of SUD a year or more after the onset of GD was greater among females compared to males. Among SUD patients, males had a greater risk of GD in all age categories and across all time periods except among those aged 40–66 years. The risk of GD three to four years after the onset of SUD among those aged 40–66 years was similar between SUD males and females. \ud \ud Discussion: The overall co-morbidity of SUD and GD was low. However, the risk of the other addictive disorder was contingent upon the nature of the first disorder. The risk of SUD among GDs over time was greater among females compared to males. \ud \ud Conclusions: The risk of the other addictive disorder appears to be contingent upon the first addictive disorder. There are sex differences in the risk trajectories of the other addictive disorder over time between GD patients and SUD patients.

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