Intersection of gambling with smoking and alcohol use in Great Britain: a cross-sectional survey in October 2022.

OBJECTIVES: Gambling is associated with cigarette smoking and alcohol consumption. We explored the intersection of gambling across all risk levels of harm with smoking and alcohol use among adults in Great Britain. DESIGN: A nationally representative cross-sectional survey in October 2022. SETTING: Great Britain. PARTICIPANTS: A weighted total of 2398 adults (18+ years). OUTCOME MEASURES: We examined the prevalence of past-year gambling and, among those reporting gambling, assessed the associations between the outcome of any risk of harm from gambling (scoring >0 on the Problem Gambling Severity Index) and the binary predictor variables of current cigarette smoking and higher risk alcohol consumption (AUDIT-C score≥4). We also explored data on weekly expenditure on gambling with smoking and alcohol use among those categorised at any-risk of harm from gambling. RESULTS: Overall, 43.6% (95% CI 41.2% to 45.9%) of adults gambled in the past year. Among these, 7.3% (95% CI 5.3% to 9.3%) were classified at any-risk of harm from gambling, 16.0% (95% CI 13.2% to 18.8%) were currently smoking and 40.8% (95% CI 37.2% to 44.4%) were drinking at increasing and higher risk levels. There were no associations between any risk of harm from gambling and current smoking (OR adjusted=0.80, 95% CI 0.35 to 1.66) or drinking at increasing and higher risk levels (OR adjusted=0.94, 95% CI 0.52 to 1.69), respectively. Analyses using Bayes factors indicated that these data were insensitive to distinguish no effect from a range of associations (OR=95% CI 0.5 to 1.9). The mean weekly spend on gambling was £7.69 (95% CI £5.17 to £10.21) overall, £4.80 (95% CI £4.18 to £5.43) among those classified as at no risk and £45.68 (95% CI £12.07 to £79.29) among those at any risk of harm from gambling. CONCLUSIONS: Pilot data in a population-level survey on smoking and alcohol use yielded similar estimates to other population-level surveys on gambling participation and at-risk gambling. Further data are needed to elucidate the intersections more reliably between gambling, smoking and alcohol use and inform population-level approaches to reduce harm.

Safer gambling and consumer protection failings among 40 frequently visited cryptocurrency-based online gambling operators.

OBJECTIVE: Online gambling has increased the accessibility and range of gambling products available to people all over the world. This trend has been particularly noticeable in the United Kingdom. Cryptocurrency-based gambling is a new, largely unregulated, way to gamble online, which uses mostly anonymous blockchain-based technologies, such as Bitcoin. The present research investigated consumer protection features of 40 frequently visited and U.K.-accessible cryptocurrency-based online gambling operators. METHOD: A content analysis was performed by visiting all 40 cryptocurrency-based online operators and recording their safer gambling and consumer protection practices. Coded features included aspects of the sign-up process, features of any safer gambling pages, customer support practices, and Identity verification. RESULTS: Results revealed significant failings in the account registration process; none of the operators verified the identity of new users, and 35% required only an email or no personal information for sign-up. Overall, 37.5% of operators offered no safer gambling tools and a further 20% offered only one. Additionally, 64.7% of operators continued to email promotional material after being informed of a user's impaired control when gambling. Less than half of the analyzed operators held a valid license (47.5%), and none of the operators with an available deposit page required identity verification before enabling deposits. CONCLUSIONS: These results highlight the potential risks for young and vulnerable individuals, especially when a lack of identity verification is paired with the inherent anonymity of cryptocurrencies. Furthermore, it emphasizes the need for greater policy and research attention toward cryptocurrency-based online gambling. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Gambling and crime: An exploration of gambling availability and culture in an English prison.

BACKGROUND: There is evidence that prisoners have the highest rate of problem gambling in any population, but little is known about the nature of in-prison gambling, the motives for it or how it relates to prior gambling behaviour. AIMS: To investigate the prevalence and type of gambling prior to prison and the prevalence, type, and reasons for gambling in prison. METHODS: Two hundred and eighty-two male volunteers in a Category B male prison in England completed a questionnaire which included the Problem Gambling Severity Index (PGSI). RESULTS: One hundred and twenty-six (45%) reported gambling in prison, with eighty-one (30%) of participants reporting that gambling was a normal part of prison life. Pre-prison behaviour, whether type of index offence or prior gambling, had little relationship to in-prison gambling. Frequency of gambling in prison increased with increasing PGSI risk category. The most common types of gambling in prison were card/dice games, sports and ball games, while the most common motives were entertainment, excitement or sense of challenge and to win prizes, with significant differences in motive between PGSI risk categories. Prison canteen items formed the most common currency gambled. People within the higher PGSI risk category were more likely to have borrowed items from other prisoners. CONCLUSIONS: Our research has added to existing literature by identifying high rates of gambling in prison and showing that prisoners' perceptions of gambling are as a normal part of prison life. Findings suggest that screening and support should be available to manage gambling in prison, including support to reduce gambling-related debt, particularly given associations between debt and violence in prison. Relief from boredom and need for excitement were among the most common reasons for gambling in prison, indicating that there is a need to provide a more appropriately stimulating prison environment.

Gambling and COVID-19: Initial Findings from a UK Sample.

In response to the COVID-19 pandemic, the UK Government placed society on 'lockdown', altering the gambling landscape. This study sought to capture the immediate lockdown-enforced changes in gambling behaviour. UK adults (n = 1028) were recruited online. Gambling behaviour (frequency and weekly expenditure, perceived increase/decrease) was measured using a survey-specific questionnaire. Analyses compared gambling behaviour as a function of pre-lockdown gambling status, measured by the Brief Problem Gambling Scale. In the whole sample, gambling participation decreased between pre- and during-lockdown. Both gambling frequency and weekly expenditure decreased during the first month of lockdown overall, but, the most engaged gamblers did not show a change in gambling behaviour, despite the decrease in opportunity and availability. Individuals whose financial circumstances were negatively affected by lockdown were more likely to perceive an increase in gambling than those whose financial circumstances were not negatively affected. Findings reflect short-term behaviour change; it will be crucial to examine, at future release of lockdown, if behaviour returns to pre-lockdown patterns, or whether new behavioural patterns persist.

Predictors of suicide attempts in male UK gamblers seeking residential treatment.

BACKGROUND: Disordered gambling can have serious negative consequences for the individual and those around them. Previous research has indicated that disordered gamblers are at an increased risk of suicidal thoughts, ideation and attempts. The current study sought to utilise data from a clinical sample to identify factors that are associated with prior suicide attempts. METHODS: The sample included 621 patients entering a gambling-specific residential facility in the UK. A series of Chi-Square analyses and binary logistic regressions were run to identify clinical and sociodemographic variables associated with suicide attempts. RESULTS: Of the 20 variables analysed using Chi-square statistics, five were significantly associated with the outcome variable (lifetime attempted suicide): loss of family relationships, loss of home, prior depression, prior suicidal thoughts, and medication use. Regression analysis showed that individuals were more likely to have reported suicide attempts if they had experienced loss of family relationships (1.65 times), loss of a home (1.87 times), prior depression (3.2 times), prior suicidal thoughts (6.14 times), or were taking medication (1.95 times) compared to those not reporting such individual events. CONCLUSIONS: Disordered gamblers are vulnerable to suicide; a number of factors have been identified in the current study that predict an increased likelihood of attempted suicide. The factors mainly revolve around loss: not financial loss, but rather disintegration of an individual's support network and deterioration in the individual's mental health. Findings indicate that isolation and negative affect associated with gambling are most influential in attempted suicide and should therefore be more strongly considered when creating and providing the legislative, educational and treatment environments for those experiencing gambling related harm.

Gambling in COVID-19 Lockdown in the UK: Depression, Stress, and Anxiety.

To combat the spread of COVID-19, the UK Government implemented a range of "lockdown" measures. Lockdown has necessarily changed the gambling habits of gamblers in the UK, and the impact of these measures on the mental health of gamblers is unknown. To understand the impact of lockdown on gamblers, in April 2020, after ~6 weeks of lockdown, participants (N = 1,028, 72% female) completed an online questionnaire. Gambling engagement data was collected for pre-lockdown via the Brief Problem Gambling Screen (BPGS) allowing participants to be classified as Non-Gamblers (NG), Non-Problem Gamblers (NPG) or Potential Problem Gamblers (PPG). The Depression, Stress, and Anxiety Scale (DASS21) was used to measure depression, stress, and anxiety scores both pre- and during-lockdown. Results indicate that depression, stress and anxiety has increased across the whole sample. Participants classified in the PPG group reported higher scores on each sub scale at both baseline and during lockdown. Increases were observed on each DASS21 subscale, for each gambler group, however despite variable significance and effect sizes, the magnitude of increases did not differ between groups. Lockdown has had a significant impact on mental health of participants; whilst depression stress and anxiety remain highest in potential problem gamblers, pre-lockdown gambler status did not affect changes in DASS21 scores.

Recollected usage of legal youth gambling products: Comparisons between adult gamblers and non-gamblers in the UK and Australia.

The UK is rare in allowing a number of gambling forms to be used legally by children under the age of 18. Some previous research indicates that adult problem gamblers are more likely to recollect using these products as children. However, no research has as yet assessed recollected levels of use irrespective of adult gambling status, or investigated these issues in other countries. This is relevant given that at least two of the tested products, coin push machines and crane grab machines, exist in other countries. The present research involves cross-sectional surveys conducted amongst UK (N = 2010) and Australian adults (N = 640), associating recollected legal youth gambling usage with past 12-month gambling, and levels of problem gambling amongst adult gamblers. Adult gamblers recollected using more legal youth gambling products than non-gamblers. For example, 66.6% of UK gamblers reported legally buying National Lottery tickets aged 16-17, compared to 20.9% of UK non-gamblers; 60.8% of Australian gamblers reported using coin push machines as a child, compared to 48.6% of Australian non-gamblers. Overall, 18 of 19 tested associations were significant and in the hypothesized direction for the UK sample, compared to five of eight for the Australian sample. The legal provision of gambling to children is a topic for further international research and policy consideration.

Associations between recalled use of legal UK youth gambling products and adult disordered gambling.

BACKGROUND AND AIMS: The UK allows a number of gambling products to be legally used by people under the age of 18. The aim of this study was to explore associations between recalled legal usage of five youth gambling products and adult disordered gambling. METHODS: A retrospective cross-sectional study of 1,057 adult UK gamblers, aged 18-40. Recalled legal use of five youth gambling products (category D fruit machines, coin push machines, crane grab machines, the National Lottery, and National Lottery scratchcards) was correlated with adult disordered gambling symptoms as measured by the Problem Gambling Severity Index (PGSI). RESULTS: Recalled rates of legal engagement with each product ranged from 50.9% for Category D fruit machines to 96.6% for coin push machines. For category D fruit machines, the National Lottery, and National Lottery scratchcards, merely having legally engaged with these products as a child was associated with adult disordered gambling. Furthermore, higher levels of recalled legal youth usage with each of the five products was also associated with adult disordered gambling. DISCUSSION AND CONCLUSIONS: These results relate to recent government proposals to increase the National Lottery scratchcard legal age to 18, and add to a wider literature on youth gambling and subsequent gambling-related harm.

Predictors of Dropout in Disordered Gamblers in UK Residential Treatment.

Within the cohort of individuals who seek treatment for disordered gambling, over half fail to complete treatment. The current study sought to identify predictors of treatment dropout in a sample of gamblers attending a residential treatment facility for disordered gamblers in the UK and to report differences in voluntary and enforced dropout. Data on 658 gamblers seeking residential treatment with the Gordon Moody Association (GMA) was analysed, collected between 2000 and 2015. Measurements included demographic data, self-reported gambling behavior, (including the Problem Gambling Severity Index), mental and physical health status, and a risk assessment. Binary logistic regression models were used to examine predictors of treatment termination. Results confirm a high percentage of treatment dropout among disordered gamblers (51.3%). Significant predictors of treatment dropout included older age of the client, higher levels of education, higher levels of debt, online gambling, gambling on poker, shorter duration of treatment, higher depression, experience of previous treatment programmes and medication, and adverse childhood experiences. Within non-completers, significant predictors of enforced dropout included lifetime homelessness, less debt, sports gambling, depression and lifetime smoking. Those who were on a longer treatment programme and had previously received gambling treatment or support were less likely to be asked to leave. Clinicians working in inpatient support need to be aware of the increased psychopathogical and psychosocial problems in those who are at risk of termination and make attempts to retain them in treatment and increase patient compliance.

Exposure to Gambling and Alcohol Marketing in Soccer Matchday Programmes.

The UK's Premier League and Championship are two of the most well attended soccer leagues worldwide; however, little is known regarding exposure to gambling marketing through the matchday experience. The current study sought to quantify exposure to gambling and alcohol marketing, and responsible gambling messages within matchday programmes. Programmes for each team in the English Premier League and Championship were analysed across consecutive matchday weekends, made available to 1,269,404 match-going fans. Direct adverts for, and incidental exposure to, gambling, alcohol, and responsible gambling marketing or messages were coded. Direct adverts were counted, as were absolute counts and percentage of pages with incidental exposure. Programmes averaged 2.3 direct gambling adverts and 37.8 instances of incidental gambling marketing exposure. Incidental gambling marketing was found on 22.2% of pages. There was more gambling marketing than either alcohol marketing or responsible gambling messages. This was observed across: number of direct adverts (p < .001), incidents of exposure (p < .001) and the percentage of pages with exposure (p < .001). Teams with gambling shirt sponsors had more incidental marketing exposure, in both absolute count (p < .001) and percentage of pages (p < .001) but did not have more direct gambling adverts (p = .63). Incidental exposure to gambling marketing was present in 59.0% of children's specific sections of programmes. There was greater exposure to gambling marketing in soccer matchday programmes. Gambling marketing was frequently evident in child specific sections of matchday programmes. Attending soccer matches and reading the matchday programme increases exposure to gambling.

Correction to: Predictors of Dropout in Disordered Gamblers in UK Residential Treatment.

The original version of this article contained errors in Table 1. The numbers (N) and percentages (%) in the 'completed treatment' column were incorrect. It is now corrected with this erratum.

Heterogeneity in Disordered Gambling: Decision-Making and Impulsivity in Gamblers Grouped by Preferred Form.

Background: Previous research has indicated that disordered gamblers display deficits in impulsivity and risky decision-making, compared to healthy control groups. However, disordered gamblers are not a homogenous group, and differences in performance on neurocognitive tasks may be related to the form of gambling in which an individual chooses to engage. The present study used neurocognitive tasks and questionnaire measures to ascertain group differences in gamblers grouped by preferred form of gambling. Method: Treatment-seeking pathological gamblers from the National Problem Gambling Clinic, London (n = 101), completed a neurocognitive assessment comprising the Cambridge gamble task (CGT), the stop-signal task (SST), a probabilistic reversal learning task (PRL), and the Kirby Monetary Choice Questionnaire, as well as questionnaire measures of gambling severity, impulsivity, depression, and anxiety. Analyses compared gamblers who favored fixed-odds betting terminals (FOBTs) (the modal form) to gamblers who preferred other forms of gambling (non-FOBT). Results: The FOBT group showed impaired decision-making under risk on the CGT compared to the non-FOBT group, choosing the likely option less on more uncertain decisions. The FOBT group made fewer perseverative errors on the PRL task, had lower depression and anxiety scores, and were less likely to have a family history of problem gambling than the non-FOBT group. Discussion: Decision-making and cognitive flexibility differences between gamblers grouped by gambling type supports preferred form as an important source of heterogeneity in gambling disorder. Decision-making strategies and risk attitudes should be considered when approaching cognition-focused treatment strategies, allowing interventions to be targeted at specific cognitive deficits.

Psychosocial risk factors in disordered gambling: A descriptive systematic overview of vulnerable populations.

BACKGROUND: Gambling is a behaviour engaged in by millions of people worldwide; for some, gambling can become a severely maladaptive behaviour, and previous research has identified a wide range of psychosocial risk factors that can be considered important for the development and maintenance of disordered gambling. Although risk factors have been identified, the homogeneity of risk factors across specific groups thought to be vulnerable to disordered gambling is to date, unexplored. METHODS: To address this, the current review sought to conduct a systematic overview of literature relating to seven vulnerable groups: young people and adolescents, older adults, women, veterans, indigenous peoples, prisoners, and low socio-economic/income groups. RESULTS: Multiple risk factors associated with disordered gambling were identified; some appeared consistently across most groups, including being male, co-morbid mental and physical health conditions, substance use disorders, accessibility and availability of gambling, form and mode of gambling, and experience of trauma. Further risk factors were identified that were specific to each vulnerable group. CONCLUSION: Within the general population, certain groups are more vulnerable to disordered gambling. Although some risk factors are consistent across groups, some risk factors appear to be group specific. It is clear that there is no homogenous pathway in to disordered gambling, and that social, developmental, environmental and demographic characteristics can all interact to influence an individual's relationship with gambling.

Psychosocial correlates in treatment seeking gamblers: Differences in early age onset gamblers vs later age onset gamblers.

BACKGROUND: Age of onset is an important factor in the development and trajectory of psychiatric disorders; however, little is known regarding the age of onset in relation to disordered gambling in treatment seeking samples in the UK. Utilising a large residential treatment seeking gambler cohort, the current study examined the relationship between age of gambling onset and a range of variables thought to be associated with disordered gambling. METHOD: Data were collected from 768 gamblers attending residential treatment for disordered gambling. Individuals were grouped per the age they started gambling as either a child (≤12), adolescent (13-15), or young adult/adult (≤16). Data were analysed using linear, backward stepwise, and multinomial logistic regressions to identify significant relationships between age of onset and variables of theoretical significance. RESULTS: Results indicate the younger age of gambling onset was associated with increased gambling severity. Those who began gambling at an earlier age were more likely to have abused drugs or solvents, committed an unreported crime, been verbally aggressive and experienced violent outbursts. They are less likely to report a positive childhood family environment and are more likely to have had a parent with gambling and/or alcohol problems. DISCUSSION: Gamblers who began gambling at an earlier age experience negative life events and exhibit some antisocial behaviors more than later onset gamblers, indicating that when addressing gambling behavior, it is important to consider the developmental trajectory of the disorder, rather than merely addressing current gambling behavior. However, the direction of the relationship between gambling and significant variables is in some instance unclear, indicating a need for further research to define causality.

Trends and patterns in UK treatment seeking gamblers: 2000-2015.

BACKGROUND AND AIMS: Gambling is an activity that for some can become disordered, with severe negative consequences. Existing literature does little to inform us regarding changing gambling habits of treatment seeking gamblers; the current study sought to measure trends and patterns in UK treatment seeking gambler behaviour and demographics over a 15-year period. METHODS: Case files for 768 gamblers seeking residential treatment with the Gordon Moody Association (GMA) were analysed, collected between 2000 and 2015. Case files comprised initial assessment questionnaires, demographic data, current gambling behaviour, mental and physical health status, and a risk assessment. Chi-squared analyses were used to measure change in categorical distribution. RESULTS: Prevalence of different forms of gambling identified as problematic have changed over time: Fixed Odds Betting Terminals (FOBTs), sports betting, and poker have become more common; horse and dog racing, and the National Lottery have become less common. Online gambling has also increased over time. In more recent years, gamblers are also more likely to have attempted suicide, to report a co-occurring mental health disorder, and to start treatment having already been prescribed medication. DISCUSSION AND CONCLUSIONS: This is the first study to demonstrate that UK treatment seeking gambler behaviour has changed over time; major changes relate to the forms of gambling engaged in problematically, and the mental health of disordered gamblers. Whilst much media focus is directed towards one form of gambling, this should not detract focus from other forms and associated disorders, and the impact of the legislative environment.

Down and Out in London: Addictive Behaviors in Homelessness.

Backgrounds and aims Problem gambling occurs at higher levels in the homeless than the general population. Past work has not established the extent to which problem gambling is a cause or consequence of homelessness. This study sought to replicate recent observations of elevated rates of problem gambling in a British homeless sample, and extend that finding by characterizing (a) the temporal sequencing of the effect, (b) relationships with drug and alcohol misuse, and (c) awareness and access of treatment services for gambling by the homeless. Methods We recruited 72 participants from homeless centers in Westminster, London, and used the Problem Gambling Severity Index to assess gambling involvement, as well as DSM-IV criteria for substance and alcohol use disorders. A life-events scale was administered to establish the temporal ordering of problem gambling and homelessness. Results Problem gambling was evident in 23.6% of the sample. In participants who endorsed any gambling symptomatology, the majority were categorized as problem gamblers. Within those problem gamblers, 82.4% indicated that gambling preceded their homelessness. Participants displayed high rates of substance (31.9%) and alcohol dependence (23.6%); these were not correlated with PGSI scores. Awareness of treatment for gambling was significantly lower than for substance and alcohol use disorders, and actual access of gambling support was minimal. Discussion and conclusions Problem gambling is an under-recognized health issue in the homeless. Our observation that gambling typically precedes homelessness strengthens its role as a causal factor. Despite the elevated prevalence rates, awareness and utilization of gambling support opportunities were low compared with services for substance use disorders.

Mixed Emotions to Near-Miss Outcomes: A Psychophysiological Study with Facial Electromyography.

Near-misses occur across many forms of gambling and are rated as unpleasant while simultaneously increasing the motivation to continue playing. On slot machines, the icon position relative to the payline moderates the effects of near-misses, with near-misses before the payline increasing motivation, and near-misses after the payline being rated as aversive. Near-misses are also known to increase physiological arousal compared to full-misses, but physiological measures to date have not been able to dissociate positive and negative emotional responses. The present study measured facial electromyography at the corrugator (brow) and zygomaticus (cheek) sites, as well as electrodermal activity (EDA), following gambling outcomes on a two-reel slot machine simulation in 77 novice gamblers. Behavioral data was collected using trial-by-trial ratings of motivation and valence. Wins were rated as more pleasant and increased motivation to continue playing, compared to non-win outcomes. Wins were also accompanied by increased EDA and zygomaticus activity. Near-misses after the payline were rated as more aversive than other non-wins, and this was accompanied by increased EDA and zygomaticus activity. Near-misses before the payline increased motivation to continue playing, and were accompanied by increased EDA. Thus, both subjective and physiological responses to near-misses differ for events falling either side of the payline. The 'near-miss effect' is not a unitary phenomenon. Facial EMG has differential sensitivity to positive and negative valence and may be a useful measure for future studies of gambling behavior.