Shaffer and his colleagues considered these as cases that could be "in-transition" and described in-transition gamblers as moving either toward or away from pathological states; however, they also noted that in-transition gamblers may not necessarily be in an earlier stage of the disorder.
National Academies Press US ; Etiology is the study of causal pathways. Because of the complex analyses and study designs that must be used, this type of research represents the crown jewel of health research. The outcomes of such research often research to successful treatments and preventive interventions. The process of discovering causal associations casino game playstation 3 pathways to understand how different factors, exposures, or disease-causing situations relate to each other usually involves multidisciplinary teams of psychiatrists, psychologists, statisticians, sociologists, economists, and epidemiologists.
This chapter begins by describing considerations for undertaking or evaluating etiological research on pathological gambling, as well as the current state of knowledge regarding the causal pathways of pathological gambling. Risk factors for and correlates of pathological gambling, including psychosocial, environmental, genetic, and biological ones, are discussed and evaluated in terms of commonly accepted criteria for determining the strength of an association.
Cooccurring disorders and their similar risk factors are also discussed. Throughout the chapter, substantial deficiencies in current research on pathological gambling are noted. Etiological research is complex, and a number of aspects are essential to consider in undertaking it. They include the accuracy of diagnostic labels, the associations and causal relationships among potential risk factors, the uniqueness of risk factors, and age and cohort effects.
In order to review the available evidence, the committee developed criteria to determine a causal association between a given risk factor and pathological gambling. Considerable discussion has already been devoted to the definition, measurement, and prevalence of pathological gambling.
When discussing the etiology of national illness, it is useful to revisit its label, because a label, as suggested by Nathanreflects the state of knowledge about the illness at the time it is labeled. In addition, etiological explanations keen on identifying causal pathways necessarily take labels into consideration, because they often describe the clinical site and clinical picture of an illness.
For example, lung cancer, myocardial infarction, and lymphatic leukemia are medical labels that describe both the clinical site and the clinical picture of those illnesses. Medical labels such as tuberculosis and human immunodeficiency virus HIV can also specify the diagnosis, cause, or etiology of a physical illness. Precise diagnostic labels are less common in psychiatry. However, with the American Psychiatric Association's introduction of the Diagnostic and Statistical Manual of Mental Disorders DSMresearch on the more common mental disorders has flourished and has led to a concomitant gambling in research on risk factors Goodwin and Guze, Research on the diagnostic classification of pathological gambling has lagged behind, and it has been identified as an area in serious need of etiological research.
As with other areas of research, when designing, undertaking, or evaluating etiological research on pathological gambling, one must understand and distinguish between associations and causal relationships among many potential risk factors.
A risk factor is something that has a possible role in the initiation of a disease, the progression of a disease to a further state, or in the waning of a disease which is then a protective factor. Demographic, biological, personality, family, peer, and genetic factors, among other possible risk factors, may interact over time to influence the course research gambling outcomes, symptoms, and behaviors. Risk factors are most useful for research when they refer to a specific phenomenon that provides a feasible point of intervention.
Some factors may be related exclusively to initiation; others may be related only to subsequent progression into problem or pathological gambling. Although important, such etiological distinctions have been rarely made in the relatively recent and limited literature on pathological and problem gambling.
Gambling literature on posttraumatic stress disorder PTSD offers an analytic model for distinguishing risk factors. Breslau and Davis demonstrated that it was gambling original exposure to a precipitating event, and not reexposure, that led to symptoms of PTSD among Vietnam veterans. In another study, Breslau and colleaguesin an examination of young urban adults, identified risk factors for exposure to traumatic events i.
Distinguishing risk factors is crucial gambling etiology research, as is identifying common risk factors for the progression of an illness. In the study just described, a family history of a psychiatric disorder or a substance abuse problem was identified as a common risk factor for exposure to traumatic events and acquiring PTSD. Equally important to consider in etiological research on pathological and problem gambling is which factors for chronic, long-term gambling are unique to this disorder and not just predictors of excessive deviant behavior of all kinds.
Again, the PTSD literature provides a template for research on pathological and problem gambling. Etiological research must also consider how the effects gambling age and being in a cohort a group of people born in the same year or decade increase or decrease one's risk for initiating gambling or developing a gambling problem. Although these effects are infrequently considered in existing pathological and problem gambling research, Erikson's stages of development Erickson, are one explanatory model that accounts for aging effects and could potentially be applied when investigating gambling behaviors.
Specifically, the model hypothesizes that, as people age, they move through several developmental stages that correspond to certain stage-related tasks. When applied to gambling behavior, the implication is that, at certain developmental stages, the motivation for and expectations about gambling might change. A recent review demonstrated that gambling among young people occurs on a developmental continuum of gambling involvement ranging from no gambling gambling to gambling with serious consequences Stinchfield and Winters, These effects pertain to how risk factors and outcomes change with age and differ among groups account casino merchant offshore florida people Mok and Hraba, Cohort effects pertain to specific events that affect groups of people born during the same time period Mok and Hraba, When applied to gambling behavior, this means that increases in gambling opportunities during a certain period in history may affect a certain age group of people.
For example, a cohort of same-age people who are passing through the age of risk for gambling problems when gambling opportunities are expanding may experience greater and increasing exposure to, involvement in, and social acceptance of gambling during their lifetimes than a cohort of same-age people at risk during periods of fewer gambling opportunities. In addition, circumstances can affect casino game room home than one cohort in the same way or in different ways.
A classic example of an event that changed the trajectory of same-age people is the drug revolution of the late s and early s. During this period, expanded drug use affected both teens and young adults, marking this time period as a historical risk factor for drug abuse. As opportunities to gamble continue to increase throughout most of the United States, it is likely that certain birth cohorts will be affected differently, perhaps in unanticipated ways.
For example, in a random telephone survey of 1, Iowa residents stratified into eight age cohorts ranging from through 85 and olderit was found, even after controlling for other variables, that older cohorts are less likely to gamble than younger cohorts Mok and Hraba, Mindful of the considerations discussed above, and in order to evaluate the research evidence that various risk factors are associated with pathological gambling, the committee adopted a number of general criteria, which are commonly accepted by epidemiologists throughout the world Hill et al.
Findings are consistent—that is, they have been replicated in other studies, with other samples, or in other cultures. There is a strong association between the risk factor and pathological gambling. The association between the risk factor and pathological gambling is biologically plausible based on scientific research findings in such areas as behavioral genetics or neurobiology.
Findings remain consistent research gambling different study methods and designs are used e. Associations examined are specific to pathological gambling and are not generally found in other disorders as well. To suggest that a causal association might exist between risk factors, events, or situations and pathological gambling, it would be necessary for at least one of these criteria to be met.
However, satisfying one or more of the criteria would not be sufficient to positively determine if there is a causal relationship between an exposure and pathological or problem gambling, research gambling. In many gambling studies, the first criterion that a risk factor necessarily precedes the outcome of pathological or problem gambling is unknown. Without this principal evidence, an exposure, a situation, or an event is not proven to be causal.
Furthermore, many studies reviewed by the committee collected data without exploring when and to what extent subjects were exposed to potential risk factors, or the age of onset of their pathological or problem gambling.
Again from an etiological standpoint, these methodological limitations make it impossible to determine whether suspected risk factors might ''cause" pathological or problem gambling, or whether they are only correlated or associated with these behaviors. Thus, much of the evidence presented or implied in the literature as causal to pathological and problem gambling is, by commonly accepted etiological standards, better defined merely as evidence for an association.
Health related consequences of gambling, despite the generally deficient state of etiological research on pathological and problem gambling, there does exist some tangible evidence to suggest certain risk factors and associations.
Determining psychosocial and environmental risk factors for pathological and problem gambling is guided by the following question: Is the risk for pathological or problem gambling associated with sociodemographic factors, such as age, gender, ethnicity, and family effects, or is it associated with the availability of gambling to the gambler? In this section, we pay special attention to studies having sufficient sample sizes to generalize findings to larger groups within the population and studies that examine: In the United States and throughout much of the world, many people begin gambling as children.
For example, in a small study of British adolescents ages 13 and 14, the mean age of initiation into gambling for social recreation or entertainment was found to be 8. The literature has also gambling supported a young age of onset of pathological and problem gambling following initiation to gambling Kallick et al. Gambling ivas a retrospective study, for example, it was found that adult pathological gamblers remembered their gambling addiction to have started when they were between ages 10 and 19 Dell et al.
InGriffiths found that adolescents addicted to slot machines research gambling gambling significantly earlier at 9. InGupta and Derevensky a found that pathological gamblers started gambling, on average, at age Studies of teens indicate that young age of onset of gambling is more than an artifact of reporting bias.
According to a summary of independent studies of high school students conducted between and Jacobs, b; Lesieur and Klein, ; Jacobs et al. Between 6 and 25 percent gambling the teenagers in these studies reportedly wanted to stop gambling but could not. These findings are consistent with a study of eleventh and twelfth graders at four high schools in New Jersey, in which 91 percent reported having gambled during their lifetime and 5.
In a school newspaper survey of over 1, students at an inner-city, largely minority Atlantic City high school, 62 percent reported having gambled at area casinos, and 9 percent research gambling gambling at least once a week Arcuri et al. Finally, in a recent review of 12 U. The age of onset research gambling gambling has dropped so that now, throughout America, the majority of year-olds have already gambled Jacobs, in press.
Studies of those who seek help for themselves or others indicate that gambling severity and frequency varies by age. A recent analysis of problem gambling help-line calls in Texas revealed that the frequency of calls increased with age, peaked at ages 35 to 44, and declined for callers age 45 and older Cox, In fact, adults age 55 and older who called about their own gambling problems 14 percent of all callers were comparable in frequency to those age 18 and younger who called about their own gambling problems 13 percent of all callers.
The percentage of calls about a problem gambler from a friend, family member, or other concerned person followed a similar age pattern. Although interesting and clinically meaningful, these help-line data alone do not contradict the notion that younger and older people have gambling problems. Etiological studies of pathological and problem gambling have generally focused on men from Gamblers Anonymous GA and men from the Veterans Administration hospital system Mark and Lesieur, Consequently, men in the general population have been underrepresented in studies, and women are critically underrepresented as well.
Many early studies that did include women were based on small numbers of women or relied on anecdotal reports of women in Gamblers Anonymous Lesieur and Blume, Yet many studies inappropriately generalize findings about men to women Mark and Lesieur, Although men typically begin gambling earlier than women, women appear to experience the onset of problem gambling earlier in the course of their gambling disorder than men Mark and Lesieur,but controlled studies are rare Custer, ; National research, ; Custer and Milt, national, The American Psychiatric Association reports in three editions of the Diagnostic and Statistical Manual of Mental Disorders DSM that the rate of pathological research gambling is twice as high among men than among women American Psychiatric Association, Although no epidemiological evidence substantiated this finding at the time the manuals were first published, some studies have found rates that high e.
Most studies of pathological and problem gambling have focused on white male gamblers. Consequently, there exists little population-based literature or data pertaining to women or nonwhite ethnic and cultural groups Mark and Lesieur, ; Volberg, Specifically, studies among black, Hispanic, Asian, and Research gambling Indian gamblers have been lacking.
The few studies that include diverse populations have in general failed to distinguish the specific racial or ethnic background of the minority group being included, thus limiting conclusions regarding specific subgroups. A few studies have specifically compared gambling among minority and majority populations Volberg and Abbott, ; Zitzow, ; Cunningham-Williams et al.
Since the passage research gambling the Indian Gaming Regulatory Act ofgambling among and sponsored by American Indians on reservations has increased substantially Rose, In the Zitzow study, American Indian adolescents exhibited more serious problems from gambling, earlier onset of gambling problems, and greater frequency of gambling problems than their non-Indian peers.
The Volberg study found that indigenous populations reported more gambling involvement, gambling expenditures, and gambling-related problems than white populations from the same areas. However, the sampling strategies and questionnaires of these two studies were not identical Volberg and Abbott, Thus, the Cunningham-Williams et al.Download a PDF of "Pathological Gambling" by the National Research Council for free. Recently, the National Opinion Research Center surveyed 2, adults and an additional adult gambling venue patrons to determine the gambling-related. Auckland University of Technology Gambling Research Centre (New Zealand) · British Columbia's National Responsible Gambling Program (South Africa).