Few studies have explicitly examined the stability (that is, the tendency for individuals to stay at one diagnostic level as opposed to moving to another improved or worsened level) or progression of disordered gambling; however, conventional wisdom holds that disordered gambling is intractable and escalating. The objective of this study was to examine these assumptions.
Method:
We reviewed 5 recent prospective studies of gambling behaviour among nontreatment samples for evidence related to the stability and progression of disordered gambling.
Results:
Our review found no evidence to support the assumption that individuals cannot recover from disordered gambling (that is, the persistence assumption), no evidence to support the assumption that individuals who have more severe gambling problems are less likely to improve than individuals who have less severe gambling problems (that is, the selective-stability assumption), and no evidence to support the assumption that individuals who have some gambling problems are more likely to worsen than individuals who do not have gambling problems (that is, the progression assumption).
Conclusion:
Contrary to professional and conventional wisdom suggesting that gambling problems are always progressive and enduring, this review demonstrates instability and multidirectional courses in disordered gambling.
References
1.
National Research Council. Pathological gambling: A critical review. Washington (DC): National Academy Press; 1999.
ShafferHJStantonMVNelsonSE. Trends in gambling studies research: Quantifying, categorizing, and describing citations. J Gambl Stud. 2006;22:427–442.
4.
CrockfordDNel-GuebalyN.Psychiatric comorbidity in pathological gambling: A critical review. Can J Psychiatry. 1998;43:43–50.
5.
Cunningham-WilliamsRMCottlerLBComptonWMProblem gambling and comorbid psychiatric and substance use disorders among drug users recruited from drug treatment and community settings. J Gambl Stud. 2000;16:347–376.
6.
ShafferHJKornDA. Gambling and related mental disorders: A public health analysis. Annu Rev Public Health. 2002;23:171–212.
7.
American Psychiatric Association. DSM IV-TR: Diagnostic and statistical manual of mental disorders. 4th ed. Text revision. Washington (DC): American Psychiatric Association; 2000.
8.
What is problem gambling? [Internet]. Washington (DC): National Council on Problem Gambling [cited May 17 2006]. Available from: http://www.ncpgambling.org/.
SlutskeWS. Natural recovery and treatment-seeking in pathological gambling: Results of two US national surveys. Am J Psychiatry. 2006;163:297–302.
11.
AfifiTOCoxBJSareenJ.Gambling-related problems are chronic and persist for the majority of individuals with a lifetime diagnosis of pathological gambling [letter]. Am J Psychiatry. 2006;163:1297.
12.
SlutskeWS. On the limits of cross-sectional retrospective data for characterizing the course of pathological gambling and its relation with comorbid psychopathology: A reply to Afifi, Cox, and Sareen [letter]. Am J Psychiatry. 2006;163:1297–1298.
13.
ShafferHJHallMN. Updating and refining prevalence estimates of disordered gambling behaviour in the United States and Canada. Can J Public Health. 2001;92:168–172.
14.
ShafferHJLaBrieRLaPlanteDThe road less travelled: Moving from distribution to determinants in the study of gambling epidemiology. Can J Psychiatry. 2004;49:504–516.
15.
AbbottMW. Problem and non-problem gamblers in New Zealand: A report on phase two of the 1999 National Prevalence Survey. Report number six of the New Zealand Gaming Survey. Wellington (NZ): New Zealand Department of Internal Affairs; 2001.
16.
BondolfiGOsiekCFerreroF.Prevalence estimates of pathological gambling in Switzerland. Acta Psychiatr Scand. 2000;101:473–475.
GötestamKGJohanssonA.Characteristics of gambling and problematic gambling in the Norwegian context: A DSM-IV-based telephone interview study. Addict Behav. 2003;28:189–97.
19.
PetryNMStinsonFSGrantBF. Comorbidity of DSM-IV pathological gambling and other psychiatric disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry. 2005;66:564–574.
20.
PlantMMillerPPlantM.The relationship between alcohol consumption and problem behaviours: Gender differences among British adults. Journal of Substance Use. 2005;10:22–30.
SprostonKErensBOrfordJ.Gambling behaviour in Britain: Results from the British gambling prevalence survey. London (GB): National Centre for Social Research; 2000. p 91.
23.
VolbergRAAbbottMWRoennbergSPrevalence and risks of pathological gambling in Sweden. Acta Psychiatr Scand. 2001;104:250–256.
24.
RobinsLNDavisDHGoodwinDW. Drug use by US Army enlisted men in Vietnam: A follow-up on their return home. Am J Epidemiol. 1974;99:235–249.
25.
DawsonDAGrantBFStinsonFSRecovery from DSM-IV alcohol dependence: United States, 2001–2002. Addiction. 2005;100:281–289.
26.
de BruijnCVan den BrinkWde GraafRThe three year course of alcohol use disorders in the general population: DSM-IV, ICD-10 and the Craving Withdrawal Model. Addiction. 2006;101:385–392.
27.
AbbottMWWilliamsMMVolbergRA. A prospective study of problem and regular nonproblem gamblers living in the community. Subst Use Misuse. 2004;39:855–884.
28.
BarnesGMWelteJWHoffmanJHShared predictors of youthful gambling, substance use, and delinquency. Psychol Addict Behav. 2005;19:165–174.
29.
DeFuentes-MerillasLKoeterMWSchippersGMTemporal stability of pathological scratchcard gambling among adult scratchcard buyers two years later. Addiction. 2004;99:117–127.
30.
HodginsDCel-GuebalyN.Retrospective and prospective reports of precipitants to relapse in pathological gambling. J Consult Clin Psychol. 2004;72:72–80.
31.
JacquesCLadouceurRFerlandF.Impact of availability on gambling: A longitudinal study. Can J Psychiatry. 2000;45:810–815.
32.
ShafferHJHallMN. The natural history of gambling and drinking problems among casino employees. J Soc Psychol. 2002;142:405–424.
33.
SlutskeWSCaspiAMoffittTEPersonality and problem gambling: A prospective study of a birth cohort of young adults. Arch Gen Psychiatry. 2005;62:769–775.
34.
SlutskeWSJacksonKMSherKJ. The natural history of problem gambling from age 18 to 29. J Abnorm Psychol. 2003;112:263–274.
35.
VachonJVitaroFWannerBAdolescent gambling: Relationships with parent gambling and parenting practices. Psychol Addict Behav. 2004;18:398–401.
36.
Vander BiltJDodgeHPandavRGambling participation and social support among older adults: A longitudinal community study. J Gambl Stud. 2004.
WintersKCStinchfieldRDBotzetAA prospective study of youth gambling behaviors. Psychol Addict Behav. 2002;16:3–9.
39.
WintersKCStinchfieldRDBotzetAPathways of youth gambling problem severity. Psychol Addict Behav. 2005;19:104–107.
40.
ShafferHJHallMN. Estimating the prevalence of adolescent gambling disorders: A quantitative synthesis and guide toward standard gambling nomenclature. J Gambl Stud. 1996;12:193–214.
41.
ShafferHJEberGBHallMNSmoking behavior among casino employees: Self-report validation using plasma cotinine. Addict Behav. 2000;25:693–704.
42.
ShafferHJFreedCRHealeaD.Gambling disorders among homeless persons with substance abuse disorders seeking treatment at a community center. Psychiatr Serv. 2002;53:1112–1117.
43.
ShafferHJHallMNVander BiltJ.Estimating the prevalence of disordered gambling behavior in the United States and Canada: A research synthesis. Am J Public Health. 1999;89:1369–1376.
44.
WestphalJRRushJAStevensL.Problem and pathological gambling behaviors within specific populations in the state of Indiana. Shreveport (LA): Gambling Studies Unit, Department of Psychiatry, Louisiana State University Medical Center; 1998.
45.
ZinbergNEHardingWM. Control over intoxicant use: Pharmacological, psychological, and social considerations. New York (NY): Free Press; 1982.
46.
ZinbergNEHardingWMWinkellerM.A study of social regulatory mechanisms in controlled illicit drug users. J Drug Issues. 1977;7:117–133.
47.
ZinbergNEJacobsonRC. The natural history of chipping. Am J Psychiatry. 1976;133:37–40.
48.
CunninghamJASobellLCSobellMBResolution from alcohol problems with and without treatment: Reasons for change. J Subst Abuse. 1995;7:365–372.
49.
SobellLCCunninghamJASobellMB. Recovery from alcohol problems with and without treatment: Prevalence in two population surveys. Am J Public Health. 1996;86:966–972.
50.
HodginsDCWynneHMakarchukK.Pathways to recovery from gambling problems: Follow-up from a general population survey. J Gambl Stud. 1999;15:93–104.
51.
SchachterS.Recidivism and self-cure of smoking and obesity. Am Psychol. 1982;37:436–444.
52.
ShafferHJJonesSB. Quitting cocaine: The struggle against impulse. Lexington (MA): Lexington Books; 1989.
53.
WaldorfD.Natural recovery from opiate addiction: Some social-psychological processes of untreated recovery. J Drug Issues. 1983:237–280.
54.
WaldorfDBiernackiP.Natural recovery from opiate addiction: A review of the incidence literature. J Drug Issues. 1979;9:282–289.
55.
WaldorfDBiernackiP.The natural recovery from opiate addiction: Some preliminary findings. J Drug Issues. 1981;9:61–76.
56.
WaldorfDBiernackiP.Natural recovery from heroin addiction: A review of the incidence and literature. In: ZinbergNEHardingWM, editors. Control over intoxicant use: Pharmacological, psychological, and social considerations. New York (NY): Human Sciences Press; 1982. p 173–181.
57.
WaldorfDReinarmanCMurphyS.Cocaine changes: The experience of using and quitting. Philadelphia (PA): Temple University Press; 1991.
58.
WinickC.Maturing out of narcotic addiction. Bull Narc. 1962;14:1–7.
59.
ShafferHJLaPlanteDALaBrieRAToward a syndrome model of addiction: Multiple expressions, common etiology. Harv Rev Psychiatry. 2004;12:367–374.
60.
HodginsDCMakarchukKEl-GuebalyNWhy problem gamblers quit gambling: A comparison of methods and samples. Addiction Research and Theory. 2002;10:203–218.
61.
RobinsLNHelzerJECroughanJLNational Institute of Mental Health Diagnostic Interview Schedule: Its history, characteristics, and validity. Arch Gen Psychiatry. 1981;38:381–389.
62.
LesieurHRBlumeSB. The South Oaks Gambling Screen (SOGS): A new instrument for the identification of pathological gamblers. Am J Psychiatry. 1987;144:1184–1188.
63.
WintersKCStinchfieldRDFulkersonJ.Toward the development of an adolescent gambling problem severity scale. J Gambl Stud. 1993;9(1):63–84.
