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Today’s Agenda

The Birth of the Pathological Gambler PPT and
Discussion and Individual Exercises Using
Assessment Tools
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Assessment Tool Creation
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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 . . .
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What do you associate with the term?
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Does anyone see a problem with this construct
or for lack of a better word “LABEL.”

Or,

Is it a label?
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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?
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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)
D)
E)
And it wasn’t just a moral issue (i.e., medicalisation, physiology
of addiction, GA)
But governments, agencies, businesses, could make a great deal of
money off it,
Hence, as law continues to be influenced by the Psy sciences. . .
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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.
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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.
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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.
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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.
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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
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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.
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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.
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The social casual gambler,
makes up the majority of
gamblers found in the
general population today
(National Research Council,
1999).
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Serious social gambling, is often gateway toward
pathological gambling (Custer & Milt, 1985),
and ushers in Custer progressive gambling
paradigm.
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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).
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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.
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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).
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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).
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For instance, the escape gambler gambles to escape from a
dysphoric mood instead of gambling for the euphoria or
high.
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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).
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Alternatively, the compulsive gambler, or better-known
today as the pathological gambler, encompasses the final
stage.
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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”.
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According to Custer (1985), this stage is where one may find
individuals committing crimes in order to continue to
gamble.
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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.
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Hence, we have seen that Custer delineated
gambling into 4 phases:
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
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Winning
Losing
Desperation
Hopelessness
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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.
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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.
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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”
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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).
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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.
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What do folks think?
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Break
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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.
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Different theories or societal conceptions of problem
gambling can produce different screening tools, thus
generating different empirical findings about the
prevalence of the problem.
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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.
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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.
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
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.
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
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).
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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.
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The accuracy of any instrument is measured by looking at the
reliability and validity of the instrument (Litwin 1995).
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The reliability of an instrument refers to the ability to
reproduce the results of the application of the test.
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The validity of an instrument refers to the ability of the
instrument to measure what it is intended to measure.
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
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.
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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.
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Don’t know the ins and outs of how the scale was
developed.
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Don’t know how many people it was normed with.
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How has not been empirically tested in detail.
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Does it tenets reflect 12 step ideology/philosophy, and
thus answering seven or more capture gambling or an
entirely different creature?
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The original South Oaks Gambling Screen (SOGS) (Lesieur and Blume, 1987) is
a validated, reliable instrument for screening populations for gambling problems.
(Maybe).
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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.
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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.
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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.
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A score of 5 or more was found to be the optimal cut-off point for
reducing false positive and false negative codings.
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The SOGS was found to be highly correlated with scores on the DSMIII-R. Reliability was confirmed through an internal consistency check
(using Cronbach's alpha) and test-retest correlation.
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1 thru three not scored.
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4 thru 6 have particular criteria (see sheet).
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Question 12, 16j, 16k not scored.
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Max score is 20
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0 no problem
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1-4 some problems with gambling
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5 or more probable pathological gambler
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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?
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Dickerson has commented that the SOGS reinforces a
dichotomy between social and pathological gamblers and
underemphasizes problem gamblers.
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Measures lifetime not past year/past six months.
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No questions examine ethnicity and related gambling.
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Too much detail spent on examining money.
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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 sociocultural 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.
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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.
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Three Scores
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Rarely = 1; Sometimes = 2; Often = 3; Always = 4
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Enjoyment (sum 1,2, and 3); 0 = no enjoyment; 12 great
enjoyment
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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)
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The Harm to Self scale is used to
identify problem gamblers in the
following way:
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0–8 normal
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9–13 Borderline problem gambler
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Problem gambler 14 – 20
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21+ Pathological gambler
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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.
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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.
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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.
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Using the CPGI, survey respondents are divided into 5
groups:
 Non-gambling
 Non-problem gambling
 Low risk gambling
 Moderate risk gambling
 Problem gambling
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The problem gambling group is equivalent to the DSMIV’s diagnostic criteria for pathological gambling.
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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.
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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 underrepresented populations.
Such an inclusion of the correlates of problem
gambling also allows for the development of profiles
toward capturing specific types of problem gambling.
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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.
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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.
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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.
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
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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.
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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.
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Find lowest/highest scores
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Do you think these scores reflect your gambling participation?
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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?
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After reading week
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Read chapters 11 and 12!
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2nd Inquiry pushed back until March 11th