Today’s Agenda

The Birth of the Pathological Gambler PPT and Discussion and Individual Exercises Using Assessment Tools

Assessment Tool Creation

The “pathological gambler”, has become a common term in society and although many may not know what it completely encapsulates, it seems to carry with it connotations . . .

What do you associate with the term?

Does anyone see a problem with this construct or for lack of a better word “LABEL.”

Or,

Is it a label?

http://www.youtube.com/watch?v=-D50bjRjwHc

http://www.youtube.com/watch?v=CVk8Y--Ry0o&mode=related&search=

Need five of these characteristics

Should we add something? And if yes what?

Should we take away anything? And if yes what?

Well 50 years or ago or so, such a definition did not exist?

Hence, the author of your reading, Collins, asks us why this is so?

His argument suggests that the government learned that they could not. . .

A) Prohibit it, just doesn’t work, but

B) Their were still a proportion of society that disagreed with it.

C) And it wasn’t just a moral issue (i.e., medicalisation, physiology of addiction, GA)

D) But governments, agencies, businesses, could make a great deal of money off it,

E) Hence, as law continues to be influenced by the Psy sciences. . .

Not to mention that governments realized that gambling wasn’t going away, and considering the age of neo-liberalism. . .

It became possible for an “explicit construction of government [sic] to pay attention to the psychology of the gambler” (Collins in Cosgrave, 2006. p. 377).

Alas, their was a “space” for the emergence of the compulsive gambler to be taken more seriously, a space that would soon be occupied in greater detail by the Psy. Sciences.

Thus, whether we agree or disagree with the label or whether or not the Psy. Sciences have become just another industry, whereby they reduce human behavior into categories. . .

It appears that these categories are here to stay.

Thus, in future lectures will look more closely at how the gambler/problem or pathological gambler and his or her behavior is conceptualized and understood.

For today, however, we will talk about gambling as a progressive entity and how these levels of progression so to speak, are assessed.

Before that, let’s take a look at the progressive level of gambling.

Custer is considered the father of modern gambling theory or pioneer (began in later 70’s).

Prior to his research, the gambling literature was considered by some to be inconsequential and seemingly based on case study phenomena.

This highly debatable mind you, but in the age of empiricism the phenomenological experience of the gambler is sometimes forgotten.

Custer (1985) delineated gamblers into one of six categories along with delineating a progressive problem gambling paradigm.

professional

antisocial

casual social

serious social

escape or relief, and

compulsive gambler (or what we consider today as the pathological gambler.delineated gamblers into one of six categories: the professional, antisocial, casual social, serious social, escape or relief, and compulsive gambler

Before we break down these classifications and how gambling proceeds in stages, Custer eloquently describes such a progression:

The metamorphosis from a recreational gambler into a pathological gambler is subtle. It can be compared to a man in a canoe who is floating gently beyond the periphery of a whirlpool and then drifts leisurely into the outer whirls. At this stage, the water seems calm and safe. But there has been a change: the man no longer controls the canoe’s direction. The canoe picks up speed, slowly at first, then with frightening rapidity, the man is carried to his doom.

The first level of development in moving towards becoming a problem/pathological gambler is simply playing for the fun of it or taking in the entertainment value that the gambling venue provides.

The social casual gambler, makes up the majority of gamblers found in the general population today (National Research Council, 1999).

Serious social gambling, is often gateway toward pathological gambling (Custer & Milt, 1985), and ushers in Custer progressive gambling paradigm.

This phenomenon occurs usually after a “big win,” (1st stage) and instils the gambler via the rush and operant reward with the belief that he or she can win an even larger jackpot / score (Custer & Milt, 1985).

However, over a period of time, the wins lose out to the house (2nd stage) and the serious social gambler begins to chase his or her losses in an attempt to recoup what he or she has already spent.

Desperation, our 3rdstage, is where the gambler loses complete control of his or her gambling, bets increase, and the individual’s behaviour becomes riskier (Walker, 1992).

During this time, the gambler’s behaviours can help identify his or her gambling subtype as either a compulsive gambler or delineate him or her as an escape gambler, but in most cases, the escape gambler will not completely display traits from the compulsive category (Custer & Milt, 1985).

For instance, the escape gambler gambles to escape from a dysphoric mood instead of gambling for the euphoria or high.

These individuals usually gamble to distract themselves from a life that they consider to be empty, which could be reflective of an ongoing state of being, or from a recent loss, marital break-up, or death in the family (Bazargan, Bazargan, & Akanda, 2000; Custer & Milt, 1985).

Alternatively, the compulsive gambler, or better-known today as the pathological gambler, encompasses the final stage.

He or she is one who routinely chases his or her losses, gambles to avoid withdrawal symptoms, is no longer solely interested in the big win, repeatedly experiences euphoria and dysphoria, and “hits bottom”.

According to Custer (1985), this stage is where one may find individuals committing crimes in order to continue to gamble.

Moreover, by the time they come in for treatment, they are not only destitute relevant to finances, but also have little or no support systems and basic ego functioning is tattered.

Hence, we have seen that Custer delineated gambling into 4 phases:

Winning Losing Desperation Hopelessness

A strength of this particular perspective is its delineation of categories for the different subtypes of gamblers, as such; this paradigm places gambling behaviours on a continuum from non-gambling to extreme gambling, whereby, not all gamblers are labelled as having a permanent disease or pathology.

Secondly, from the developmental orientation a gambler may be treated by many forms of therapy. Thus, the addict can take charge of his or her own treatment path.

Following the second advantage, gambling can rightly be perceived as a normal behaviour, where a great proportion of gamblers gamble for recreational and social pursuits, whereas “ideographic (individual factors), based mostly on chance, combine to encourage gambling addiction”

Although the Custer delineates classifications of gamblers and establishes a process by which one becomes a compulsive gambler. . .

His account of how or why one does or doesn’t become a pathological gambler stands on chance phenomena (Shaffer et al., 1987).

Nor does his perspective offer a hypothesis as to why over the past 20 years a greater percentage of younger and older adults are becoming pathological gamblers.

What do folks think?

Break

Following public criticism of the harmful impacts of commercial gambling, particularly casinos and electronic gaming machines (EGMs), several national governments have commissioned studies into the prevalence of problem gambling in the community.

However, the precise definition of problem gambling and the most valid and reliable way to measure prevalence rates have been the subject of recent debate.

Different theories or societal conceptions of problem gambling can produce different screening tools, thus generating different empirical findings about the prevalence of the problem.

And off course different prevalence rates

In many countries, the most common tool to measure problem gambling has been the SOGS. Developed in the USA in the 1980s (Lesieur and Blume, 1987).

The SOGS quickly was adopted as the de facto

standard in the field (Volberg and Banks, 1990). Thus problem gambling came to be seen as a disorder or disease / medicalized.

By the late 1990s,, there was strong disagreement among researchers and clinicians about the validity of the different problem gambling measures commonly in use (Productivity Commission, 1999 ).

Many researchers and service providers had become increasingly critical of SOGS as a research tool, arguing that it did not accurately assess problem gambling in large population studies.

Today there has been a push to understand gambling from more of a holistic perspective.

Some Researchers and clinicians are now defining problem gambling as a broad social and public health issue rather than an addiction or disordered behavior originating in the individual.

This contrasts with the predominant ‘medicalised’ view in the USA and many other countries that problem or ‘pathological’ gambling is a psychiatric disorder or mental illness, identifiable by clinical tests that differentiate problem gamblers from other gamblers.

Rather than a problem of individual pathology or psychological disorder, the prevailing view is that problem gambling occurs when gambling gives rise to harm to the individual gambler, families, other groups and the community as a whole.

Whereas screens developed in the medical model defined problem gambling by the attributes of the behavior itself, Australian and Canadian researchers have emphasized a ‘harm’ model defined by the consequences of behavior (Dickerson et al., 1997).

Before we begin speaking about assessment tools, a word about their use, validity, and reliability.

The use of an assessment tool should be used in concert with a competent clinical interviewer. Thus, the assessment tool along with professional consultation provides the client with reassurance that their problem will be diagnosed and treated properly (hopefully).

Other uses, research, given with a battery of tests so as to capture the overall picture of clients problem.

The accuracy of any instrument is measured by looking at the reliability and validity of the instrument (Litwin 1995).

The reliability of an instrument refers to the ability to reproduce the results of the application of the test.

The validity of an instrument refers to the ability of the instrument to measure what it is intended to measure.

GA assessment tool that uses 20 questions for the purposes of identifying a compulsive gambler.

A score 7 or higher indicates that the respondent is a compulsive gambler.

Appears to clearly differentiate problem gamblers from social gamblers.

Developed by those who have or had a gambling problem and therefore has good face validity.

Brief and simple to administer.

Don’t know the ins and outs of how the scale was developed.

Don’t know how many people it was normed with.

How has not been empirically tested in detail.

Does it tenets reflect 12 step ideology/philosophy, and thus answering seven or more capture gambling or an entirely different creature?

The original South Oaks Gambling Screen (SOGS) (Lesieur and Blume, 1987) is a validated, reliable instrument for screening populations for gambling problems. (Maybe).

Since its introduction in 1987, it has been used in numerous studies and with patients in therapeutic communities and psychiatric admissions services, as well as for initial screening in the treatment for combined pathological gambling, aalcoholism and chemical dependency.

The SOGS was originally constructed using a total of 1,616 subjects including 867 patients admitted to South Oaks Hospital for psychoactive substance use disorders or pathological gambling, 213 members of Gamblers Anonymous, 384 university students and 152 hospital employees.

Validity was examined by cross-checking patient scores on the test at various stages of its development with counselor and family member assessments, as well as examination of scores of GA members, university students and hospital employees.

A score of 5 or more was found to be the optimal cut-off point for reducing false positive and false negative codings.

The SOGS was found to be highly correlated with scores on the DSM-III-R. Reliability was confirmed through an internal consistency check (using Cronbach's alpha) and test-retest correlation.

1 thru three not scored.

4 thru 6 have particular criteria (see sheet).

Question 12, 16j, 16k not scored.

Max score is 20

0 no problem

1-4 some problems with gambling

5 or more probable pathological gambler

Find lowest highest scores

Do you think these scores reflect your gambling participation?

Would you add to the screen?

Does you think the screen truly captures the problem / pathological gambler?

Dickerson has commented that the SOGS reinforces a dichotomy between social and pathological gamblers and underemphasizes problem gamblers.

Measures lifetime not past year/past six months.

No questions examine ethnicity and related gambling.

Too much detail spent on examining money.

In 2000, following a review of issues and evidence (Dickerson et al., 1997) the Victorian Casino and Gaming Authority commissioned Flinders Technologies Pty Ltd to develop a new screen for application in large population surveys (Ben-Tovim et al., 2001).

The resulting Victorian Gambling Screen (VGS) was supposed to better accommodate the specific socio-cultural context in Australia and was conceptualized in terms of personal and social harm.

The VGS was originally developed as a 21-item instrument that tapped into three aspects: enjoyment of gambling, harm to others and harm to self.

A pilot study testing this screen distinguished these three factors empirically, but found only the 15-item ‘harm-to self’ subscale to be significantly related to problem gambling externally defined (Ben-Tovim et al., 2001).

Only for this scale, the pilot study established cut-off scores.

The VGS uses for all 15 items on a five-point rating scale (0 1/4 never, 1 1/4 rarely, 2 1/4 sometimes, 3 1/4 often, 4 1/4 always), and items are summed up to yield the overall score.

Three Scores

Rarely = 1; Sometimes = 2; Often = 3; Always = 4

Enjoyment (sum 1,2, and 3); 0 = no enjoyment; 12 great enjoyment

Harm to partner (sum 16b, 17b, 18b) as follows – no = 0; partly = 1; and yes = 2; 0 = no harm to 6 = high harm

Harm to self scale (sum 4 to 15 and 19 to 21) remembering that Rarely = 1; Sometimes = 2; Often = 3; Always = 4)

The Harm to Self scale is used to identify problem gamblers in the following way:

0–8 normal 9–13 Borderline problem gambler

Problem gambler 14 – 20

21+ Pathological gambler

The CPGI was developed by a group of researchers pulled together by the Canadian Centre on Substance Abuse in response to an RFP issued by the Inter-Provincial Task Force on Problem Gambling.

The goal was to develop a new, more meaningful measure of problem gambling for use in general population surveys, one that reflected a more holistic view of gambling and placed it in a more social context.

The instrument produced was a synthesis of the most current research available, and draws on the measures that have been used in the past for many of its key items.

What was produced was less a "new" product, and more an evolution of older measures, with additions reflecting the operational definition developed by the research team:

Problem gambling is gambling behaviour that creates negative consequences for the gambler, others in his or her social network, or for the community.

The prevalence rate for problem gambling produced by the CPGI falls between the rates obtained using the DSM-IV and the SOGS.

It does produce higher rates for those considered to be at risk, and this again was an anticipated result given the definition of problem gambling that directed the development of this index.

Using the CPGI, survey respondents are divided into 5 groups:

Non-gambling Non-problem gambling Low risk gambling Moderate risk gambling Problem gambling

The problem gambling group is equivalent to the DSM-IV’s diagnostic criteria for pathological gambling.

The CPGI differs from most of the measures currently in use because of its relative emphasis on social and environmental factors related to problem gambling.

This emphasis is reflected in both the composition of the nine scored items, and in the correlates that compose much of the rest of the index.

As such, and through the norming process there were a larger proportion of the population that was categorized as at low or moderate risk.

In the past, prevalence surveys have used measures developed using clinical samples of problem gamblers, which are known to be demographically different than problem gamblers in general.

Treatment program populations have traditionally under-represented women, ethnic minorities and individuals with lower socio-economic status than average.

Hence, this index that includes items which address the social and environmental context, resulting in an index that better captures some of the typically under-represented populations.

Such an inclusion of the correlates of problem gambling also allows for the development of profiles toward capturing specific types of problem gambling.

In all, using type of gambling activity and level of involvement a more detailed picture of those with problem or at risk levels of gambling are generated, which may also allow researchers to track the progression of moderate risk or low risk and how this may manifest into becoming a problem or pathological gambler.

It terms of validity the CPGI lines up well with the SOGS and has been scrutinized and given approval by 12 of the world’s foremost gambling experts providing their feed back on the CPGI items and dimensions.

The CPGI has good reliability, somewhat lower than the NODS, but higher than the SOGS.

Non-problem gambling: Score of 0 on the CPGI.

Respondents in this group will have responded "never" to most of the indicators of behavioural problems, although there may well be a frequent gambler with heavy involvement in terms of time and money.

The "professional" gambler would fit into this category. This group probably will not have experienced any adverse consequences of gambling, nor will they agree with the distorted cognition items.

Low risk gambling: Score between 1 and 2 on the CPGI

Respondents in this group will have responded "never" to most of the indicators of behavioral problems, but will have one or more sometimes responses.

Gamblers may be at risk if they are heavily involved in gambling and if they respond positively to at least two of the correlates of problem gambling.

This group likely will not have experienced any adverse consequences from gambling.

Moderate risk gambling: Score between 3 and 7 on the CPGI

Respondents in this group will have responded "never" to most of the indicators of behavioural problems, but will have one or more "most of the time" or "always" responses.

Gamblers may be at risk if they are heavily involved in gambling; this group may or may not have experienced adverse consequences from gambling.

Problem gambling: Score between 8 and 27 on the CPGI

Respondents in this group are those who have experienced adverse consequences from their gambling, and may have lost control of their behaviour.

Involvement in gambling can be at any level, but is likely to be heavy. This group is more likely to endorse the cognitive distortion items.

Find lowest/highest scores

Do you think these scores reflect your gambling participation?

Would you add anything to the screen?

Do you think the screen captures the problem / pathological gambler.

Which screen do you think is better of the four, why?

After reading week

Read chapters 11 and 12!

2nd Inquiry pushed back until March 11th