Is gambling like a virus?: A conceptual framework and proposals based on empirical data for the prevention of gambling addiction.

OBJECTIVE: The objective of this study is to present a conceptual framework for the prevention of gambling disorder and try to corroborate some of its postulates. The assumption of gambling as if it were acting like a virus may have important considerations in terms of preventing gambling disorder in society and, therefore, it could be a relevant public health issue. BACKGROUND: Like COVID-19, gambling disorder is a disease which is caused by the action of an external agent. The external agent was already in existence, but certain environmental conditions (absence of regulatory measures based on the prevention of gambling disorder) favored its propagation. Regarding immunization, for SARS-CoV-2, it is obtained through vaccination and prevention of exposure. However, it is unlikely that immunization can be developed for any gambling addiction prevention program to immunize everyone who is exposed to the "gambling virus". So, in the case of gambling disorder, preventive strategies should rather prevent gambling from affecting most people by limiting availability (supply) and accessibility (ease of access) to gambling. STUDY DESIGN: This research is a quasi-experimental investigation aimed to evaluate the effects of anti-COVID measures on the frequency of gambling and evolution of gambling disorder. The present study analyzed gambling patterns and the problems caused by gambling in 2,903 people, including those who were at-risk gamblers or had a gambling disorder. RESULTS: In general terms, restrictive measures to combat COVID-19 worked to prevent the consolidation of gambling habits and the appearance of gambling disorder, but they did not seem to be sufficient for people who already had this disorder. The most affected games were electronic games machines (EGMs) that took place in public places (gambling halls, bars and restaurants, etc.). CONCLUSIONS: The findings of this work support the hypothesis that, just as the SAR-CoV-2 virus is responsible for the global pandemic of COVID-19, which can only be stopped with vaccines and social distancing, in the case of gambling, the absence of an effective vaccine for "gambling virus" can lead to an epidemic of gambling disorders in societies, if the environmental conditions that are favorable for the spread of such virus are not modified. Some preventive strategies that can be useful from a public health frame of reference are suggested.

Problematic Internet Use among Adults: A Cross-Cultural Study in 15 Countries.

BACKGROUND: The present study compared adult usage patterns of online activities, the frequency rate of problematic internet use (PIU), and risk factors (including the psychopathology associated with PIU, i.e., distress and impulsivity) among adults in 15 countries from Europe, America, and Asia. METHODS: A total of 5130 adults from Belgium, Finland, Germany, Italy, Spain, France, Switzerland, Hungary, Poland, UK, Norway, Peru, Canada, US, and Indonesia completed an online survey assessing PIU and a number of psychological variables (i.e., depression, anxiety, stress, and impulsivity). The sample included more females, with a mean age of 24.71 years (SD = 8.70). RESULTS: PIU was slightly lower in European countries (rates ranged from 1.1% in Finland to 10.1% in the UK, compared to 2.9% in Canada and 10.4% in the US). There were differences in specific PIU rates (e.g., problematic gaming ranged from 0.4% in Poland to 4.7% in Indonesia). Regression analyses showed that PIU was predicted by problematic social networking and gaming, lack of perseverance, positive urgency, and depression. CONCLUSIONS: The differences in PIU between countries were significant for those between continental regions (Europe versus non-European countries). One of the most interesting findings is that the specific PIU risks were generally low compared to contemporary literature. However, higher levels of PIU were present in countries outside of Europe, although intra-European differences existed.

Crisis, What Crisis? The Effect of Economic Crises on Spending on Online and Offline Gambling in Spain: Implications for Preventing Gambling Disorder.

(1) Background: In the period between 2008 and 2020, the world experienced two global economic crises that affected people's way of life and well-being: the financial crisis of 2008 and that precipitated by the COVID-19 pandemic. Despite the crises' radically different causes, their consequences for economic activity have been equally dramatic; (2) Methods: This article analyzes the consequences of both crises on gambling spending in Spain and compares traditional (offline) games with more recent online offerings. The data were collected from databases maintained by the Spanish government and gambling companies; (3) Results: The paper offers two main conclusions. The first is that, while traditional (offline) gambling has been significantly affected by economic crises, online gambling has exhibited consistent growth since its legalization. The second is that the measures implemented to resolve the two economic crises differed significantly and thus had different impacts on spending on the various types of gambling; (4) Conclusions: The key conclusion is that purchasing power (measured in terms of GDP) can only explain spending on less addictive gambling games, such as lotteries. However, the availability and accessibility of games are both directly related to spending on games of all types.

Tecnotest: A screening tool for technological addictions and gambling disorder. / Tecnotest: Desarrollo de una herramienta de screening de adicciones tecnológicas y juego.

One of the most pressing social and scientific issues, as reflected in the current priority lines of the National Drugs Plan (PNSD), is the development of screening tools for the early detection of addictions, particularly behavioral addictions, due to the impact that these problems are having on the growth of addictions in recent years, especially in adolescents and young people. GOAL: The main goal of this research was to develop a screening tool for technological addictions (video games, mobile and social networks) and gambling for early detection in people suffering this kind of behavioral addiction. PROCEDURE: With technologies, in the absence of agreed clinical criteria, those participants who perceived themselves as having problems and, in addition, had received treatment for it, were selected. Regarding gambling, the diagnostic criteria of the DSM-5 were used. The three items that scored the highest Positive Predictive Values (PPV) in each of the four validated tests were selected. These indicators serve to distinguish those who use the technologies and/or gamble in a functional way and do not have any problems from those who already have an addictive problem with video games, mobile, social networks or gambling. RESULTS: This paper shows the finished screening tool with its main psychometric properties, which can be used by professionals working with adolescents in order to detect people who could have some addictive problem, in which case the psychologist can refer them to a specialized healthcare resource.

Una de las demandas sociales y científicas más acuciantes, que se plasma en las actuales líneas prioritarias del Plan Nacional sobre Drogas (PNSD) es el desarrollo de herramientas de screening para la detección temprana de adicciones, singularmente adicciones sin sustancia, debido al impacto que estas están teniendo en el desarrollo de adicciones desde hace unos años, especialmente en adolescentes y jóvenes. Objetivo. El objetivo principal de esta investigación fue el desarrollo de una herramienta de screening de adicciones tecnológicas (videojuegos, móvil y redes sociales) y al juego para vincular la detección temprana con la intervención y la prevención en el campo de las adicciones conductuales. Método. Participantes. Participaron en el estudio 1.813 estudiantes de entre 11 y 19 años de 13 comunidades autónomas. Instrumentos. Se desarrolló una encuesta con cuatro pruebas validadas sobre adicciones tecnológicas y al juego. Procedimiento. Para la construcción de la herramienta de screening se seleccionaron los tres elementos que obtuvieron mayor Valor Predictivo Positivo (VPP) de cada una de las cuatro pruebas validadas para diferenciar entre quienes utilizaban las tecnologías y/o jugaban de un modo social y no tenían ningún problema de aquellos que ya tenían un problema adictivo. Resultados. Se obtuvo una herramienta de uso de las tecnologías y juego que consta de 24 ítems (12 ítems de cribado de las cuatro tecnologías y 12 de uso de las mismas) con sus principales propiedades psicométricas (fiabilidad, estructura factorial). Discusión. La escala tiene unas adecuadas propiedades psicométricas y es congruente teóricamente. Se presenta la herramienta definitiva de screening, la cual queda a disposición de las/os psicólogas/os para la detección temprana de personas que puedan padecer alguna de estas adicciones, en cuyo caso podrían ser derivados a los recursos sanitarios especializados.

Pictograms to aid laypeople in identifying the addictiveness of gambling products (PictoGRRed study).

The structural addictive characteristics of gambling products are important targets for prevention, but can be unintuitive to laypeople. In the PictoGRRed (Pictograms for Gambling Risk Reduction) study, we aimed to develop pictograms that illustrate the main addictive characteristics of gambling products and to assess their impact on identifying the addictiveness of gambling products by laypeople. We conducted a three-step study: (1) use of a Delphi consensus method among 56 experts from 13 countries to reach a consensus on the 10 structural addictive characteristics of gambling products to be illustrated by pictograms and their associated definitions, (2) development of 10 pictograms and their definitions, and (3) study in the general population to assess the impact of exposure to the pictograms and their definitions (n = 900). French-speaking experts from the panel assessed the addictiveness of gambling products (n = 25), in which the mean of expert's ratings was considered as the true value. Participants were randomly provided with the pictograms and their definitions, or with a standard slogan, or with neither (control group). We considered the control group as representing the baseline ability of laypeople to assess the addictiveness of gambling products. Each group and the French-speaking experts rated the addictiveness of 14 gambling products. The judgment criterion was the intraclass coefficients (ICCs) between the mean ratings of each group and the experts, reflecting the level of agreement between each group and the experts. Exposure to the pictograms and their definition doubled the ability of laypeople to assess the addictiveness of gambling products compared with that of the group that read a slogan or the control group (ICC = 0.28 vs. 0.14 (Slogan) and 0.14 (Control)). Laypeople have limited awareness of the addictive characteristics of gambling products. The pictograms developed herein represent an innovative tool for universally empowering prevention and for selective prevention.

Perceptions Underlying Addictive Technology Use Patterns: Insights for Cognitive-Behavioural Therapy.

Cognitive-Behavioural Therapy (CBT) is considered the 'gold standard' in the treatment of addictive disorders related to excessive technology use. However, the cognitive components of problematic internet use are not yet well-known. The aim of the present study was to explore the cognitive components, that according to problematic users, can lead to potential internet addiction. A total of 854 European adults completed an online survey using a mixed-methods design. Internet problems and attachment styles were assessed, prevalence rates estimated, correlations, chi-squared automatic interaction detection, and content analysis were performed. Self-reported addictions to social networking, internet, and gaming had a prevalence between 1.2% (gaming) to 2.7% (social networking). Self-perception of the addiction problem and preoccupied attachment style were discriminative factors for internet addiction. In an analysis of qualitative responses from self-identified compulsive internet users, a sense of not belonging and feeling of disconnection during life events were perceived as causes for internet addiction. The development depended on a cycle of mixed feelings associated with negative thoughts, compensated by a positive online identity. The severity of this behaviour pattern produced significant impairment in various areas of the participants' functioning, suggesting a possible addiction problem. It is suggested that health professionals administering CBT should target unhealthy preoccupations and monitor mixed feelings and thoughts related to internet use to support coping with cognitive distortions.

Ludens: A Gambling Addiction Prevention Program Based on the Principles of Ethical Gambling.

Gambling is legal in most countries. However, despite having some economic benefits, certain characteristics of gambling can have health consequences, rendering it a public health issue. The effects can be summarized according to the following three "laws" of ethical gambling: "Gambling Dynamics Law": companies' economic gains come directly from players' losses; "Expected Loss Law": the more one gambles, the greater the probability of losing; and "Addiction Law": the more one gambles, the greater the need to play again, leading to further losses. Ludens is a gambling addiction prevention program that has four goals: inform participants about gambling and gambling addiction; sensitize participants to the risk of gambling for health, especially addiction; promote a change in attitudes toward gambling; and alert participants to risky behaviors that can lead to addiction. The prevention program was implemented during 2017 to 2019. Fourteen psychologists presented it to 2372 adolescents (48.8% females, 51.2% males) aged 14-19 years, none of whom were university students, recruited from 42 Spanish high schools in 132 groups taking different courses. The main dependent variables analyzed were the monthly frequencies of gambling, at-risk gambling, and gambling addiction (as measured by the National Opinion Research Center DSM-IV Screen for Gambling Problems, adapted to diagnose gambling disorder according to DSM-5, in which pathological gambling is considered an addictive disorder). Given that all of the gamblers were adolescents (most were minors), fulfilment of 1-3 the DSM-5 diagnostic criteria was considered to indicate a risk of problem gambling. After the administration of Ludens, statistically significant reductions were observed in the three variables of interest: monthly frequency of gambling, percentage of adolescents with risky gambling, and percentage of adolescents with gambling disorder. The results were analyzed according to sex and age (minors vs. adolescents between 18 and 19 years old). The results obtained after applying the prevention program indicate that Ludens is effective as a universal prevention program for gambling addiction.

Cross-Cultural Validation of the Compulsive Internet Use Scale in Four Forms and Eight Languages.

The 14-item Compulsive Internet Use Scale (CIUS) is one of the most frequently internationally adapted psychometric instruments developed to assess generalized problematic Internet use. Multiple adaptations of this instrument have led to versions in different languages (e.g., Arabic and French), and different numbers of items (e.g., from 5 to 16 items instead of the original 14). However, to date, the CIUS has never been simultaneously compared and validated in several languages and different versions. Consequently, the present study tested the psychometric properties of four CIUS versions (i.e., CIUS-14, CIUS-9, CIUS-7, and CIUS-5) across eight languages (i.e., German, French, English, Finnish, Spanish, Italian, Polish, and Hungarian) to (a) examine their psychometric properties, and (b) test their measurement invariance. These analyses also identified the optimal versions of the CIUS. The data were collected via online surveys administered to 4,226 voluntary participants from 15 countries, aged at least 18 years, and recruited from academic environments. All brief versions of the CIUS in all eight languages were validated. Dimensional, configural, and metric invariance were established across all languages for the CIUS-5, CIUS-7, and CIUS-9, but the CIUS-5 and CIUS-7 were slightly more suitable because their model fitted the ordinal estimate better, while for cross-comparisons, the CIUS-9 was slightly better. The brief versions of the CIUS are therefore reliable and structurally stable instruments that can be used for cross-cultural research across adult populations.

Measurement Invariance of the Short Version of the Problematic Mobile Phone Use Questionnaire (PMPUQ-SV) across Eight Languages.

The prevalence of mobile phone use across the world has increased greatly over the past two decades. Problematic Mobile Phone Use (PMPU) has been studied in relation to public health and comprises various behaviours, including dangerous, prohibited, and dependent use. These types of problematic mobile phone behaviours are typically assessed with the short version of the Problematic Mobile Phone Use Questionnaire (PMPUQ⁻SV). However, to date, no study has ever examined the degree to which the PMPU scale assesses the same construct across different languages. The aims of the present study were to (i) determine an optimal factor structure for the PMPUQ⁻SV among university populations using eight versions of the scale (i.e., French, German, Hungarian, English, Finnish, Italian, Polish, and Spanish); and (ii) simultaneously examine the measurement invariance (MI) of the PMPUQ⁻SV across all languages. The whole study sample comprised 3038 participants. Descriptive statistics, correlations, and Cronbach's alpha coefficients were extracted from the demographic and PMPUQ-SV items. Individual and multigroup confirmatory factor analyses alongside MI analyses were conducted. Results showed a similar pattern of PMPU across the translated scales. A three-factor model of the PMPUQ-SV fitted the data well and presented with good psychometric properties. Six languages were validated independently, and five were compared via measurement invariance for future cross-cultural comparisons. The present paper contributes to the assessment of problematic mobile phone use because it is the first study to provide a cross-cultural psychometric analysis of the PMPUQ-SV.

Addiction-Like Mobile Phone Behavior - Validation and Association With Problem Gambling.

Mobile phone use and its potential addiction has become a point of interest within the research community. The aim of the study was to translate and validate the Test of Mobile Dependence (TMD), and to investigate if there are any associations between mobile phone use and problem gambling. This was a cross-sectional study on a Swedish general population. A questionnaire consisting of a translated version of the TMD, three problem gambling questions (NODS-CLiP) together with two questions concerning previous addiction treatment was published online. Exploratory factor analysis based on polychoric correlations was performed on the TMD. Independent samples T-tests, Mann-Whitney test, logistic regression analyses and ANOVA were performed to examine mean differences between subjects based on TMD test score, gambling and previous addiction treatment. A total of 1,515 people (38.3% men) answered the questionnaire. The TMD showed acceptable internal consistency (Cronbach's alpha: 0.905), and significant correlation with subjective dependence on one's mobile phone. Women scored higher on the TMD and 15-18 year olds had the highest mean test score. The TMD test score was significantly associated with problem gambling, but only when controlling for age and sex. Various separated items related to mobile phone use were associated with problem gambling. The TMD had acceptable internal consistency and correlates with subjective dependence, while future confirmatory factor analysis is recommended. An association between mobile phone use and problem gambling may be possible, but requires further research.

Análisis psicométrico del test de dependencia de videojuegos (TDV) en población peruana / Psychometric analysis of the Test of Dependence of Videogames (TDV) in Peruvian population

Resumen El objetivo del presente trabajo es validar en población peruana, el Test de Dependencia de Videojuegos (TDV) (Chóliz & Marco, 2011). Los resultados obtenidos demuestran que se trata de una herramienta confiable y válida. Se encontró una sola estructura factorial, en lugar de cuatro dimensiones, como plantearon los autores del TDV. Este factor podría denominarse genéricamente: adicción a videojuegos, y podría servir como evidencia de la existencia de este trastorno, que coincidiría con el denominado 'Trastorno de Juego por Internet', que aparece en la Sección III del DSM-5. Los resultados hallados se discuten en relación a lo planteado por Chóliz y Marco (2011), en lo que se refiere a las diferencias en cuanto a sexo, edad y la estructura interna del instrumento.

Abstract The objective of this work is the validation of the Test of Dependence of Videogames (TDV) (Chóliz & Marco, 2011) in Peruvian population. The results show that it is a reliable and valid tool. We found a single factorial structure, rather than four dimensions as the authors of the TDV raised. This factor could be generically called: 'Addiction to video games', and could serve as evidence of the existence of this disorder, which would coincide with the so-called "Disorder online Game" listed in Section III of the DSM-5. The results found are discussed in relation to Chóliz & Marco (2011) in terms of differences in sex, age and the internal structure of the instrument.

Self-reported dependence on mobile phones in young adults: A European cross-cultural empirical survey.

Background and aims Despite many positive benefits, mobile phone use can be associated with harmful and detrimental behaviors. The aim of this study was twofold: to examine (a) cross-cultural patterns of perceived dependence on mobile phones in ten European countries, first, grouped in four different regions (North: Finland and UK; South: Spain and Italy; East: Hungary and Poland; West: France, Belgium, Germany, and Switzerland), and second by country, and (b) how socio-demographics, geographic differences, mobile phone usage patterns, and associated activities predicted this perceived dependence. Methods A sample of 2,775 young adults (aged 18-29 years) were recruited in different European Universities who participated in an online survey. Measures included socio-demographic variables, patterns of mobile phone use, and the dependence subscale of a short version of the Problematic Mobile Phone Use Questionnaire (PMPUQ; Billieux, Van der Linden, & Rochat, 2008). Results The young adults from the Northern and Southern regions reported the heaviest use of mobile phones, whereas perceived dependence was less prevalent in the Eastern region. However, the proportion of highly dependent mobile phone users was more elevated in Belgium, UK, and France. Regression analysis identified several risk factors for increased scores on the PMPUQ dependence subscale, namely using mobile phones daily, being female, engaging in social networking, playing video games, shopping and viewing TV shows through the Internet, chatting and messaging, and using mobile phones for downloading-related activities. Discussion and conclusions Self-reported dependence on mobile phone use is influenced by frequency and specific application usage.

Eficacia de las técnicas de control de la impulsividad en la prevención de la adicción a videojuegos / Effectiveness of impulsivity control techniques to videogame addiction prevention

El objetivo principal de esta investigación consistió en el análisis de la eficacia de las técnicas de control de la impulsividad para la prevención de la adicción a videojuegos añadidas a un programa de prevención previamente validado (PrevTec 3.1). Los resultados se tomaron en cuatro momentos: línea base, pre-test (primera sesión), post-test (última sesión) y seguimiento (a los tres meses). Los resultados indican que, mientras los grupos que permanecen en lista de espera no presentan cambios ni en el patrón de uso ni en la dependencia de videojuegos, aquellos en los que se aplica el programa sí que experimentan un descenso significativo. Las dos modalidades del programa de prevención son eficaces en la reducción de las variables analizadas, pero los resultados se mantienen más consistentes durante el seguimiento a quienes se entrenaron las técnicas de control de la impulsividad.

The main objective of this research has been the analysis of the effectiveness of some impulsivity control techniques to prevent videogame addiction. It has compared the results obtained with a prevention program that it had been already validated with the same program in which additional impulsiveness control techniques were added. Four periods were selected for the analysis: baseline, pre-test, post-test and follow-up. Two experimental conditions were designed: a) conventional prevention program, and b) program with impulsiveness control techniques. Results were compared with a group control (waiting list). Results indicate that, while groups that remain on waiting list do not present changes in pattern of use, those which the program was applied decrease significantly. The two modalities of prevention program were effective in the reduction of the analyzed variables, but the changes produced by the implementation of impulsive control techniques were more consistent and lasting in time.

Why is it (also) so difficult to legislate gambling in Spain? 'Déjà vu' of what occurred with alcohol. / ¿Por qué (también) es tan difícil legislar sobre juego en España? Un 'déjà vu' de lo ocurrido con el alcohol.

Editorial of vol 28-4.

Editorial del vol 28-4.

Regulating gambling to prevent addiction: more necessary now than ever. / Regular el juego para prevenir la adicción: hoy más necesario que nunca.

The American Psychiatric Association published the 5th Edition of DSM in May 2013, in which the gambling disorder is included within the category of addictive disorders -a long-standing and recurrent demand from the clinical, social and scientific fields. Nevertheless, the harmful effects of gambling have not been considered by the Government, which is the main area of addiction prevention.The present article is a proposal for the regulation of gambling by the Government through the different levels of the State (national, regional and even local), which has the ultimate goal of preventing gambling addiction. This proposal has been presented to the Chamber of Deputies of the Congress, as part of the Congress-Senate Joint Committee for the Study of Drug Problems. The proposed regulation is based on the evidence provided by scientific studies on the prevention of addiction.

En mayo de 2013 apareció la quinta edición de la clasificación de los trastornos mentales (DSM-5) de la American Psychiatric Association (APA, 2013), en la cual se incluye el trastorno de juego dentro de la categoría de trastornos adictivos, que es algo que era demandado desde hace décadas desde los ámbitos clínicos, sociales y científicos. El juego de azar, que según la propia APA tiene la misma consideración que las drogas o el alcohol en cuanto a la activación de los circuitos cerebrales de recompensa y a las consecuencias clínicas del trastorno del juego, no tiene, sin embargo, esa consideración desde el principal ámbito desde donde se debe llevar a cabo la prevención de la adicción, que es en los poderes públicos.El trabajo que presentamos es una propuesta de regulación del juego para llevar a cabo desde la Administración mediante acciones de gobierno que competen a diferentes niveles de la misma (estatal, autonómico e incluso local), con el objetivo final de  prevenir la adicción al juego. Dicha propuesta ha sido presentada tanto a la Dirección General de Ordenación del Juego como a la Cámara del Congreso de los Diputados, esta última en el marco de la Comisión Mixta Congreso-Senado para el Estudio del Problema de las Drogas. En este trabajo se defiende la propuesta de regulación desde la evidencia que proporcionan los estudios científicos en materia de prevención de las adicciones.

Development of a Brief Multicultural Version of the Test of Mobile Phone Dependence (TMDbrief) Questionnaire.

UNLABELLED: The Test of Mobile Phone Dependence (TMD) questionnaire (Chóliz, 2012) evaluates the main features of mobile phone dependence: tolerance, abstinence syndrome, impaired impulse control, associated problems, excessive use, etc. OBJECTIVE: The objective of this study was to develop a multicultural version of the TMD (TMDbrief) adapted to suit the novel communication tools of smartphones. PROCEDURE: In this study, the TMD was completed by 2,028 young respondents in six distinct world regions: Southern Europe, Northwest Europe, South-America, Mesoamerica, Pakistan, and India. RESULTS: Psychometric analysis of the reliability of the instrument and factor analysis were performed to adapt the TMDbrief for use in these regions. Differences among regions with respect to TMD Mobile Phone Dependence scores were obtained. CONCLUSION: A brief questionnaire for the evaluation of mobile phone addiction in cross-cultural studies was successfully developed.

The Challenge of Online Gambling: The Effect of Legalization on the Increase in Online Gambling Addiction.

It is possible that the growth and promotion of online gambling will result in substantially increased use of these types of games in countries where they are legal. This may be especially true for young people due to their interest in such games. In this context, it is important to note that online gambling is more addictive than any other type of game due its structural characteristics, such as immediacy, accessibility, ease of betting, and so on. This study examined the effect of online gambling in Spain 2 years after its legalization. The sample included 1277 pathological gamblers in recovery at 26 gambling addiction treatment centers. Our results showed a significant increase in young pathological gamblers since the legalization of this activity. This is a very relevant issue because, as in the case of Spain, many countries are currently in process of legalization of many types of online games. Scientific research can be useful to adapt the adequate gambling policies in order to prevent the gambling addiction.

Video game addiction in gambling disorder: clinical, psychopathological, and personality correlates.

OBJECTIVE: We studied the prevalences of video game use (VGU) and addiction (VGA) in gambling disorder (GD) patients and compared them with subjects with non-video game use (non-VGU) in relation to their gambling behavior, psychopathology, and personality characteristics. METHOD: A sample of 193 GD patients (121 non-VGU, 43 VGU, and 29 VGA) consecutively admitted to our pathological gambling unit participated in the study. Assessment. Measures included the video game dependency test (VDT), symptom checklist-90-revised, and the temperament and character inventory-revised, as well as a number of other GD indices. RESULTS: In GD, the observed prevalence of VG (use or addiction) was 37.3% (95% CI :30.7% ÷ 44.3),VGU 22.3% (95% CI :17.0% ÷ 28.7), and VGA 15% (95% CI :10.7% ÷ 20.7). Orthogonal polynomial contrast into logistic regression showed positive linear trends for VG level and GD severity and other measures of general psychopathology. After structural equation modeling, higher VG total scores were associated with younger age, general psychopathology, and specific personality traits, but not with GD severity. Patients' sex and age were involved in the mediational pathways between personality traits and VG impairment. CONCLUSIONS: GD patients with VG are younger and present more dysfunctional personality traits, and more general psychopathology. The presence of VG did not affect the severity of GD.