Massachusetts passed legislation in the fall of 2012 to allow the construction of three casinos and a slot parlor in the state. The prevalence of problem gambling in the state and in areas where casinos will be constructed is of particular interest. The goal is to evaluate the change in prevalence after construction of the casinos, using a multi-mode address based sample survey. The objective of this thesis is to evaluate and describe ways of using statistical inference to estimates prevalence rates in finite populations. Four methods were considered in an attempt to evaluate the prevalence of problem gambling in the context of the gambling study. These methods were evaluated unconditionally and conditionally, controlling for gender, using mean square error (MSE) as a measure of accuracy. The simple mean, the post-stratified mean, the best linear unbiased predictor (BLUP), and the empirical best linear unbiased predictor (EBLUP) were considered in three examples. Conditional analyses of a population with N=1,000 and a crude problem gambling rate of 1.5, samples of n=200 led to the simple mean and the post-stratified mean to perform better in certain situations, as measured by their low MSE values. When there are less females than expected in a sample, the post-stratified mean produces a lower mean MSE over the 10,000 simulations. When there are more females than expected in a sample, the simple mean produces a lower mean MSE over the 10,000 simulations. Conditional analysis provided more appropriate results than unconditional analysis.

Objective: The aims of this systematic review and meta-analysis were to examine the overall prevalence of dropout from psychological treatments for problem gambling and gambling disorder and to examine how study, client, and treatment variables influenced dropout rates. Method: A systematic search was conducted to identify studies of cognitive and/or behavioral therapies and motivational interventions for problem gambling and gambling disorder. Meta-analysis was used to calculate an overall weighted dropout rate. Random effect meta-regressions were used to examine covariates of dropout rates. Mixed-effect subgroup analyses were used to examine moderators of dropout rates. Results: The systematic search identified 24 studies (31 dropout rates) comprising 2,791 participants. Using a random-effects model, the overall weighted dropout rate was 39.1%, 95% CI [33.0%, 45.6%]. Increases in the percentage of married participants were significantly associated with lower dropout rates. Dropout rates were significantly higher when dropout was defined as attending all sessions of a treatment protocol compared to when defined as attending a prespecified number of sessions different from the total in the protocol and when defined as study therapists judging participants to be dropouts. Insufficient reporting of some gambling-related variables and other psychological symptom variables prevented a thorough examination of covariates and moderators. Conclusions: A large proportion of individuals drop out of treatment for problem gambling and gambling disorder. Future research should examine the reasons for dropout across marital statuses and should adopt dropout definitions that consider session-by-session symptom change. (PsycInfo Database Record (c) 2021 APA, all rights reserved) This review suggests that a significant proportion of individuals drop out of psychological treatments for problem gambling and gambling disorder. This review also recommends that the field adopt symptom-based dropout definitions to determine the adequate dosage of psychological treatment for problem gambling and gambling disorder. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

京都大学 / 新制・論文博士 / 博士(医学) / 乙第13571号 / 論医博第2297号 / 新制||医||1069(附属図書館) / (主査)教授 川上 浩司, 教授 渡邉 大, 教授 村井 俊哉 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM

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Background: Persistent stress contributes to the onset and maintenance of problem gambling (PG), increasing risks for physiological disturbances. However, minimal research examines acute stress effects and relationships with PG features such as impulsivity or gambling urges. Purpose: The current study examines multiple facets of acute subjective and physiological stress responses in PG. Stress effects on gambling urges and relationships with impulsivity are also explored. Methods: A PG (n=21) and healthy control (HC; n=21) group were exposed to acute psychosocial stress. Saliva samples were collected while participants completed self-report measures of mood and gambling urges. Gambling urges, salivary cortisol (sC), salivary alpha-amylase (sAA), and subjective stress reactivity and recovery were compared within and between groups from baseline up to an hour following stress. Relationships between trait impulsivity, gambling urges, and all aspects of the acute stress response were examined. Results: The PG group showed blunted sC reactivity but reported heightened mood disturbances compared to HCs, while sAA levels did not differ between groups. Within PG and HC groups, sAA had a more rapid acute stress onset than sC, but between-marker differences were pronounced in PG. Self-reported gambling urges were high among PG participants but remained relatively unchanged following acute stress. Impulsivity was positively associated with gambling urges, however, it was not correlated with the acute stress response. Conclusions: This study provides a novel and wide-ranging assessment of the acute stress response in PG, for which research is currently limited. These results indicate that high stress in PG contributes to multi-faceted alterations of the acute stress response relative to HCs. Self-reported gambling urges are elevated and associated with greater trait impulsivity in PG but are unaffected by acute stress exposure. Our findings provide insight into acute stress processing dysfunction in PG and have implications for potential harms, such as increased suicide risk. / Thesis / Master of Science (MSc) / Chronic or continuous life stress can increase the risk of developing and sustaining gambling problems. The current study assessed the effects of a 20-minute stressful task on mood, physiological reactions, the desire to gamble, and their relationships with impulsivity in healthy individuals compared to those with problem gambling (PG). Results showed that after the stressor, the PG group reported more negative mood, but physiological reactions were reduced when compared to healthy participants. In individuals with PG, a greater desire to gamble was correlated with being more impulsive. Overall, our findings show that the long-term stress typically experienced by individuals with PG can affect their mental and physiological reactions to temporary stressors. Additionally, more impulsive individuals show a greater desire to gamble, which may contribute to problematic gambling behaviours. Future research should assess the life impacts of chronic stress in PG, such as the risk of gambling relapse and suicide.

Under recent years the gambling industry has been moving towards providing their customer the possibility to gamble online instead of visiting a physical location. Aggressive marketing, fast growth and a multitude of actors within the market have resulted in a spike of customers who have developed a gambling problem. Decision makers are trying to fight back by regulating markets in order to make the companies take responsibility and work towards preventing these problems. One method of working proactively in this regards is to identify vulnerable customers before they develop a destructive habit. In this work a novel method of predicting customers that have a higher risk in regards to gambling-related problems is explored. More concretely, a recurrent neural network with long short-term memory cells is created to process raw behaviour data that are aggregated on a daily basis to classify them as high-risk or not. Supervised training is used in order to learn from historical data, where the usage of permanent self-exclusions due to gambling related problems defines problem gamblers. The work consists of: obtain a local optimal configuration of the network which enhances the performance for identifying problem gam- blers who favour the casino section over sports section, and analyze the model to provide insights in the field. This project was carried out together with LeoVegas Mobile Gaming Group. The group offers both online casino games and sports booking in a number of countries in Europe. This collaboration made both data and expertise within the industry accessible to perform this work. The company currently have a model in production to perform these predictions, but want to explore other approaches. The model that has been developed showed a significant increase in performance compared to the one that is currently used at the company. Specifically, the precision and recall which are two metrics important for a two class classification model, increased by 37% and 21% respectively. Using raw time series data, instead of aggregated data increased the responsiveness regarding customers change in behaviour over time. The model also scaled better with more history compared to the current model, which could be a result of the nature of a recurrent network compared to the current model used.

Problem gambling currently affects between 5-7% of youth ages 12-18 (Hardooon & Derevensky, 2002); however, rates of problem gambling among youth who are involved with the Juvenile Justice System are more than twice that of school sample rates (Lieberman & Cuadrado, 2002). Furthermore, disordered gambling often co-occurs with substance use and criminal activity (Huang & Boyer, 2007), issues that are compounded in the Juvenile Justice population. The current study assessed gambling behaviors and risk factors of 145 youth involved in juvenile, juvenile drug, and family courts. Results indicated that nearly 13% of these youth are currently problem gamblers, and that males and African-Americans had higher problem gambling rates than female and Caucasian youth. Furthermore, gambling-related crime, substance use, scope of gambling activities, and time in detention facilities were all predictive of problem gambling severity, while suicidal ideation, urban environment, and lottery sales per capita were not. Finally, having a parent with a gambling problem also emerged as a risk factor;however, the risk was greater for males than for females. These results present a distinct need for youth to be screened for gambling problems upon entering and exiting the Juvenile Justice System, and for prevention and intervention services to be offered within juvenile and family court settings. Furthermore, communities need to take an active role in preventing youth gambling problems through increasing public awareness and insuring that appropriate and accurate messages reflecting gambling opportunities and outcomes are presented.

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Psychological interventions can improve outcomes and reduce symptom severity for individuals with gambling disorder. This chapter provides an overview of current evidence from moderate- to large-scale randomized controlled trials of psychotherapy interventions for the treatment of gambling problems. Interventions include full-length professionally delivered therapies (behavior therapy, cognitive therapy, and cognitive-behavioral therapy), as well as self-directed workbooks and computer-facilitated programs. Motivational interventions, including motivational interviewing, motivational enhancement therapy, and personalized feedback, are also reviewed. This chapter highlights gambling-related treatment outcomes and comparisons between conditions for randomized trials, with an emphasis on treatment dropout. Attrition rates are generally high across all multi-session intervention modalities and formats. Overall, findings suggest that no specific treatment consistently outperforms other active treatments, but cognitive-behavioral therapy does have the most empirical support for the treatment of gambling disorder. In addition, brief motivational interventions are sufficient for some gamblers to change their behavior, particularly those experiencing only a few adverse symptoms from their gambling involvement. Future research efforts will benefit from further refining existing treatments to improve retention, which in turn may enhance effectiveness.