Pathological Gambling Using Assessment Tools to Critically Examine the Addiction Model

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Pathological Gambling Using Assessment Tools to
Critically Examine the Addiction Model

• Christopher John Hunt, Michael Walker Elena
  Svetieva, Gambling Treatment Clinic, School of
  Psychology, University of Sydney

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Assessment of Pathological Gambling

• Researchers in gambling often use DSM-IV criteria
  classify participants.
• These criteria contain substance use concepts
• E.g. tolerance, withdrawal, craving
• And gambling specific concepts
• E.g chasing loses, need for bail-out

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Assessment of Pathological Gambling

• No one widely accepted instrument for assessing
  DSM criteria.
• Different studies have utilised clinical
  interviews or brief screening questionnaires.
• E.g. National Opinion Research Centre DSM Screen
  for Gambling Problems (NODS)
• Alcohol Use Disorder and Associated Disabilities
  Interview Schedule (AUDADIS-IV)

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Assessment of Pathological Gambling

• Questions in screening instruments stay as close
  to wording of DSM-IV items as possible.
• We have argued that the wording of these criteria
  is somewhat ambiguous or open to interpretation
  (Walker et. al., 2006).

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The Structured Clinical Interview for
Pathological Gambling (SCIP)

• The SCIP was developed by Walker et. al., 2006 in
  order to address these concerns.
• It is a structured clinical interview that uses
  sub-criteria to help determine whether a
  individual meets a given criterion

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The Structured Clinical Interview for
Pathological Gambling (SCIP)

• The SCIP requires that there is CLEAR,
  BEHAVIOURAL evidence that each individual
  criterion is met
• It requires that a significant level of pathology
  must be evident for any given criterion to be met

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Comparison of Measures- Screening Measures
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Comparison of Measures- SCIP
Increase in amount gambled between gambling
sessions?
Increase in bet size within gambling sessions?
DOES NOT MEET CRITERION
Does increase make gambling more exciting?
Does increase make gambling more exciting?
Is that excitement significant?
Is the excitement significant?
MEETS CRITERION
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Previous Research on the SCIP

• Rates of various DSM-IV criteria were roughly
  similar to that in studies using other
  instruments.
• Two exceptions
• Criterion 2 (tolerance)
• Criterion 4 (withdrawal)

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Previous Research on the SCIP

• Both these criteria were endorsed much less
  frequently when the SCIP was used.
• It was suggested that this difference was the
  result of the more stringent requirements in the
  SCIP.

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Current Study

• To compare the rates of endorsement of DSM-IV
  criteria when the SCIP vs. alternative methods.
• To explain any differences through systematic
  analysis of the relevant criteria and
  sub-criteria.

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Method

• 166 clients at the Gambling Treatment Clinic at
  the University of Sydney. Mean age of 38.4 years
  (range 19-79). 33 female 133 male.
• SCIP was given to assess clients at initial
  session.
• Assessors were all psychologists or clinical
  psychologists trained in SCIP administration

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Results

• 82 out of 166 (49) met the 5 DSM-IV criteria
  required for a diagnosis of pathological gambling
• Very high level of agreement of rates of endorsed
  criteria in current when compared with previous
  study that also used the SCIP.

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Results- Comparisons between studies

• General agreement between studies on certain
  criteria (preoccupation, chasing, bail out,
  illegal activities) regardless of the measure.

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Results- Comparisons between studies

• Studies using treatment samples found higher
  rates of endorsement for loss of control and
  social impact than those using community
  samples
• This is as would be expected.

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Results- Comparisons between studies

• Conversely, there is little agreement with
  regards to the escape criterion (our rate of
  74, range from other studies 31-84).
• Even studies that used similar tools and samples
  reported discrepant findings for this criterion

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Results- SCIP vs. Other Instruments

• Studies using the SCIP showed lower rates of
  endorsement for three criteria
• tolerance
• withdrawal
• lying

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Tolerance

• 68 of gamblers in current study increased their
  bet size
• However, up to 55 of these do not experience any
  increase in excitement from this
• Furthermore, for up to 71 of these, the
  increase in excitement was minimal or not
  significant

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Withdrawal

• 64 of pathological gamblers reported some
  psychomotor agitation when cutting down or
  stopping gambling
• However, 63 of these reported that this
  agitation produced no or minimal distress or
  disruption to their daily life.

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Lying

• 94 pathological gamblers reported lying on
  multiple occasions about their gambling
• However, up to 60 of those stated that the real
  or potential consequences of those lies being
  discovered was minimal.

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Conclusions

• SCIP generally agrees with other methods of
  assessment on the rates of endorsement of most
  criteria
• Escape criterion produces no consistency
  between studies. This criterion may be poorly
  defined and requires further examination in
  future editions of DSM

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Conclusions

• Increase in bet size are often for reasons other
  than increase in excitement
• More common explanation given by gamblers appears
  to be attempt to win back lost money.
• Hence, this phenomena is NOT directly comparable
  to tolerance seen in substance use

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Conclusions

• Irritability and agitation found after cessation
  of gambling tends to be minimally disruptive to
  the gamblers daily life
• Hence, it is NOT directly comparable to
  withdrawal symptoms seen in drug and alcohol
  use disorders

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Conclusions

• Lying- SCIP produces a lower rate due to
  insistence on lies having potential to cause
  major disruptions.
• Thus the majority of lies reported appear to be
  of minimal consequence

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Implications

• Screening instruments are simple to administer in
  community studies.
• BUT near verbatim paraphrasings of DSM criteria
  may be interpreted by lay individuals differently
• Warnings against diagnoses made in a cookbook
  fashion from criteria are made in the DSM-IV
  introduction, which highlights clinical
  interpretation and judgement.

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Implications

• Should behavioural addictions (such as
  gambling) be included with substance-use
  disorders?
• If physical addiction model is used, focusing on
  dependence through tolerance and withdrawal,
  gambling does not appear to fit.

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Implications

• If a broader model of addiction is used gambling
  may still be encompassed
• However, it is crucial to note the differences in
  how gambling behaviour is maintained.

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THANK YOU

• To all the staff at GTC at University of Sydney
  for their assistance with this project
• If you have further questions, contact at
• chrish_at_psych.usyd.edu.au
• 61 2 9036 7342