THE ETIOLOGY OF PROBLEM GAMBLING Dr. Robert Williams Faculty of Health Sciences & Alberta Gambling Research Institute University of Lethbridge, Alberta AGRI ANNUAL CONFERENCE BANFF, ALBERTA APRIL 5, 2014
Correlates of from Academic Research Genetic history of PG Male gender Substance use and abuse Presence of other Behavioural Addictions Delinquency and/or Antisocial personality Mood Disorders Impulsivity Attention Deficit Hyperactivity Risk taking Sensation seeking Abusive or neglectful upbringing Parental modelling of excessive gambling Peer group involvement in gambling
Correlates of PG from Academic Research Lower income Less education Societal acceptance of gambling Younger age Gambling opportunities being readily available Stress Poor support systems Gambling being provided in a commercially unsafe manner Erroneous cognitions (gambling fallacies) Gambling serving a psychological need Early big wins Gambling at a young age Engaging in continuous forms of gambling
Problems with these Research Correlates These correlates: Have been identified from research conducted primarily in U.S., Canada, and Australia Many of these correlates have been identified within clinical populations, who are not representative of problem gamblers more generally More useful to identify correlates from population surveys, particularly international prevalence surveys
2012 202 jurisdiction-wide adult prevalence studies of problem gambling from 1975 2012 68 TIOL studies 27 Australian state and territorial studies 40 Canadian provincial studies 67 U.S. state and territorial studies
Correlates of PG from Population Prevalence Studies Male gender Young age (<35) Less education than average Lower income than average Not being married Non-Caucasian Playing continuous forms of gambling (EGM, table games) and forms requiring knowledge/skill (wagering)
Problems with these Population Prevalence Correlates Correlates not assessed to an equal extent Demographic and game type only variables consistently assessed Many potential correlates assessed infrequently or not at all: personality, substance use/abuse, mental health problems, other addictions, gambling motivation, gambling fallacies, proximity to gambling, family history of PG, stress, early big win, etc.
Problems with all Correlates They tell you nothing about whether they caused PG, developed coincident with PG, or developed because of PG Longitudinal Research is the only way of understanding this chronology
Longitudinal Studies of Gambling and PG ~30 small scale studies Some just looking at gambling, some just looking at problem gambling Some just looking at covariationof G or PG with other variables over time (rather than determining which variables actually predict subsequent PG)
Predictors of Subsequent Gambling from Small Scale Longitudinal Studies Substance use or misuse (5 studies) Impulsivity (4 studies) Male (2 studies) Financial problems (2 studies) Delinquency (1 study) School problems (1 study) Moral disengagement (1 study) Depression (1 study) Emotional distress (1 study) Younger age (1 study) Greater social support (1 study)
Predictors of Subsequent Problem Gambling from Small Scale Longitudinal Studies Depression (5 studies) Impulsivity (4 studies) Substance abuse (3 studies) Parental gambling (2 studies) Early onset of gambling (2 studies) Gambling with family at young age (1 study) Conduct Disorder (2 studies) Antisocial Personality (1 study) Risk-taking propensity (1 study) Phobias (1 study) Aggression (1 study) Alienation (1 study) Male (1 study) Poor school performance (1 study)
Problems with these Small Scale Longitudinal Studies Very circumscribed demographic (e.g., just youth, just elderly, just casino employees). Very small sample sizes and/or small number of people who become problem gamblers during course of the study. Very short time span and/or a small number of assessment periods. Short questionnaire examining only small subset of variables potentially involved in the etiology of problem gambling. Poor retention rates with differentially higher attrition for certain demographic groups (e.g., males, younger people) and people who are heavy gamblers and/or problem gamblers.
Large Scale Longitudinal Studies Swedish Longitudinal Study (SWELOGS) 5.5 years; 4 waves; n= 4,188 Wave 3 Victorian Gambling Study (VGS) 4 years; 4 waves; n= 3,700 Wave 4 Leisure, Lifestyle, Lifecycle Project (LLLP) 5 years; 4 waves; n= 1,343 Wave 4 Quinte Longitudinal Study (QLS) 5 years; 5 waves; = 3,795 Wave 5
Predictors of Subsequent Problem Gambling from SWELOGS (to date) Started to gamble at work or at school Immigrant Computer gambling (online or EGMs) Past year gambling Risky alcohol consumption Poor mental health Death of someone close Increased arguments with someone close Poor physical health
Predictors of Subsequent Problem Gambling from VGS (to date) Subclinical problem gambling symptomatology Previous problem gambling High frequency of gambling participation (all forms, but particularly table games, sports betting, and EGMs) Anxiety Smoking Alcohol dependence Less education Non-English speaking Male One parent families Poor health
LLLP Funded by AGRI 2006 2013 1808 Albertans 524 oversampled for at risk characteristics (>70 th percentile for gambling frequency or expenditure within age group) 5 initial age groups: 13-15; 18-20; 23-25; 43-45; 63-65 5 comprehensive assessments (2 4 hrs each; primarily selfadministered) with 18-20 month intervals between the start of each assessment 76.1% retention rate after 4 th assessment
Quinte Longitudinal Study Funded by OPGRC Quinte Region in southeastern Ontario, Canada 2006 2011 4123 Ontario adults 1216 oversampled for at risk characteristics Initial age range: 17 90 5 comprehensive assessments (1.5 2.5 hrseach; all selfadministered) with 12 months between start of each assessment 93.9% retention rate (because of the uniqueness of this accomplishment a 229 page manual has been developed)
(for the 134 PPGM PGs in QLS & the 43 CPGI 5+ PGs in LLLP) DEMOGRAPHICS QLS LLLP Age Gender Never Married Married Common-Law Separated Divorced Widowed
DEMOGRAPHICS QLS LLLP Immigrant NonCaucasian Aboriginal African Asian (Eastern) Asian (Southern) European (Eastern) European (Western) Latin American Other Ethnicity
RELIGION QLS LLLP Catholic Protestant Other Religion Athiest or Agnostic Religiosity Score
DEMOGRAPHICS QLS LLLP No more than elementary school No more than technical college Completed college or university Unemployed Retired Homemaker Full-time Student On leave/strike Employed Part-time Employed Full-time
INCOME & DEBT QLS LLLP Household (HH) Income Less than $30,000 HH Income Between $30,000 - $49,999 HH Income Between $50,000 - $89,999 HH Income over $90,000 Average HH Debt
PHYSICAL HEALTH QLS LLLP Disability/Health Concern General Physical Health Rating Currently taking Prescription Medication
LIFETIME GAMBLING QLS LLLP Age first gambled Frequency of gambling prior to age 19 Big gambling win prior to 19 Big gambling win and loss prior to 19 Parents or siblings regular gamblers when growing up Parents or siblings gambled with person when growing up Parents or siblings problem gamblers when growing up
GAMBLING QLS LLLP Attitude Toward Gambling Number of Different Gambling Formats Engaged in within Past Year
GAMBLING FREQUENCY IN PAST YEAR QLS LLLP ALL FORMS Lottery Purchase Instant Win Tickets Play Bingo EGM Play Casino Table Game Play Games of Skill for Money Sports Betting Horse Race Betting High Risk Stocks/Options/Futures
PAST YEAR SPENDING ON GAMBLING QLS LLLP OVERALL spending per month on gambling Spending per month on EGMs Largest amount won in single day Largest amount lost in single day Frequency of ATM use in gambling venues
GAMBLING MOTIVATION & FALLACIES QLS LLLP Gamble for fun/excitement/entertainment Gamble to win money Gamble to escape/distraction Gamble to socialize Gamble to support worthy causes Gamble to feel good about oneself Gambling Fallacies
GAMBLING CONTEXT QLS LLLP Membership in Gambling Rewards Program Gamble alone vs with friends Drink alcohol when gambling Use tobacco when gambling Use [street] drugs when gambling Gambling on Internet
GAMBLING SOCIAL EXPOSURE QLS LLLP Number of close friends/family that are regular gamblers Number of close friends/family that have gambling problems Other adults in household with gambling problems Opportunities to gamble at workplace (or school) Exposed to prevention or awareness campaign
PROXIMITY TO EGM VENUES QLS LLLP Driving time to nearest venue with EGMs Actual distance to nearest venue with EGMs Casinos/Racinos within 5km driving distance
GAMBLING AS LEISURE ACTIVITY QLS LLLP Gambling as one of 5 favourite leisure activities Gambling as favorite leisure activity
PERSOLITY(NEO-PI) & COPING SKILLS QLS LLLP Neuroticism Depression Vulnerability Impulsivity Extraversion Excitement Seeking Agreeableness Conscientiousness Openness Coping Skills
TRAUMA QLS LLLP Abused as a Child Past Year Post-Traumatic Stress Disorder (CIDI)
STRESS & WELL-BEING QLS LLLP Number of Stressful Events in Past Year Average Stress Level Average Happiness Average Life Satisfaction Personal Wellness Index Score
PERSOL VALUES Money is Most Important Power is Most Important Fame is Most Important Friendship is Most Important None of the Above is Most Important Wealth is a Good Indicator of Success QLS LLLP
LIFETIME ADDICTION & MENTAL HEALTH QLS LLLP Lifetime history of drugs/alcohol addiction Lifetime history of addiction to other behaviours (not including gambling) Lifetime history of mental health problems (prior to past year) Parents or siblings with history of other addictions (not including gambling) Parents or siblings with history of mental health problems
MENTAL HEALTH PROBLEMS IN PAST YEAR QLS LLLP ANY MENTAL HEALTH PROBLEM Major Depression Manic Episode Generalized Anxiety Panic Attacks Obsessive Compulsive Disorder Eating Disorder Schizophrenia and/or Delusional Disorder Specific Phobias ADHD
PAST YEAR ADDICTION QLS LLLP Substance Abuse (ASSIST for QLS) Substance Dependence (ASSIST for QLS) Any Other Addiction (sex, video games, exercise, etc.) Other Adults in Household with Substance Abuse
SOCIAL FUNCTIONING & SUPPORT QLS LLLP Marital Satisfaction (if applicable) Overall Family Functioning Social Support (PAI) Community Involvement Job Satisfaction (if applicable) Job Stress (if applicable)
SEXUAL ORIENTATION QLS LLLP Heterosexual Bisexual, Homosexual, or Prefer not to say
ILLEGAL ACTIVITY AND ANTISOCIALITY QLS LLLP Number of Illegal Behaviours in Lifetime Number of Illegal Behaviours in Past Year Antisociality (PAI)
INTELLIGENCE & FRONTAL LOBE FUNCTIONING QLS LLLP Overall Intelligence (SB-IV or WAIS-R) Below Average Intellect Wisconsin Card Sorting Test
MOST IMPORTANT & ROBUST VARIABLES BEST PREDICTING FUTURE PROBLEM GAMBLING FROM THE QLS & LLLP STUDIES Demographics NonCaucasian (particularly East Asian) Gambling Early big win Family member(s) regular gamblers &/or PGs Gambling with family prior to 19 Number of types engaged in Overall frequency of gambling Overall gambling expenditure Membership in gambling rewards program Gambling as favoured leisure activity Current friends/family with gambling problems
MOST IMPORTANT & ROBUST VARIABLES BEST PREDICTING FUTURE PROBLEM GAMBLING FROM THE QLS & LLLP STUDIES Mental Health Lifetime history of addiction Presence of any mental health disorder Substance abuse or dependence Presence of any behavioural addiction Other Illegal activities in past year Below average intellect
VARIABLES BEST PREDICTING FUTURE HEAVY GAMBLING FROM QLS & LLLP Positive attitudes toward gambling Gambling as a favorite leisure activity Close friends and/or family members currently regular gamblers Gambling prior to 19 Family involvement in gambling when growing up Excitement seeking Low openness Less education Lower intelligence
ETIOLOGICAL MODEL OF PROBLEM GAMBLING EMERGING FROM ALL STUDIES Early gambling Family gambling Male Positive gambling attitudes Gambling fallacies Early big win Gambling availability Cultural acceptance of gambling Family hx PG Lower intelligence Impulsivity Excitement seeking Lower income Less education Substance use Family hx mental health problems &/or addictions Childhood abuse Trauma/Stresss Life Events Heavy Gambling Mental Health Problems & Substance Abuse Subclinical PG (& Associated Comorbidities)