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Uncovering the different subtypes of Problem Gamblers: An empirical testing of the Pathways Model and its clinical implications. Gupta, Blaszczynski, Nower, Derevensky, & Faregh. March 11, 2010 Sacramento, California. Context.
Gupta, Blaszczynski, Nower, Derevensky, & Faregh
March 11, 2010
After many years of researching and working with teens, it became evident that not all were similar in their presentation and etiology.
Their gambling behaviors may have been similar, but distinct sub-types of people were emerging.
Apply a theoretical framework to represent a complex phenomenon
Measure this phenomenon with identifiable and measurable units of information
A scientific approach will never reflect the true depth of human behavior, but it may reflect enough so that we may advance the current state of knowledge
Jacobs’ General Theory of Addictions (1989) postulates that all addictions are a “…dependant state acquired over time by a predisposed person in an attempt to relieve a chronic stress condition”
Under/ Overactive physiological resting state
Psychological characteristics such as low self-esteem
Blaszczynski’s model is based on the premise that there exist different typologies of gamblers and that it is counter productive to merge distinctly different types of people into a single heterogeneous group.
Proposed that the Pathways model can also serve as:
“…an effective template for the development of early intervention, prevention, & targeted clinical management strategies for adolescent and young adult gamblers.”
This theoretical model is based on the premise that there exist different typologies of gamblers and that it is counter-productive to merge distinctly different types of people into a single heterogeneous group
These youth develop gambling problems as a result of conditioning rather than impaired control. They are characterized by an absence of premorbid psychopathology. Anxiety can surface as a consequence of gambling problems.
These young gamblers present with premorbid depression and/or anxiety, low self-esteem, poor coping, a history of familial neglect or abuse, and present with other adverse behaviors.
These young gamblers present with premorbid psychopathology suggestive of neurochemical dysfunctions. They share many things in common with Pathways 2 individuals, but they are distinct in their features of impulsivity and antisocial personality disorder which impair their overall psychosocial functioning.
Testing a model empirically is a very complex undertaking.
This study is the first to attempt to do so, and should be considered exploratory in nature.
This study is limited by its cross-sectional nature and needs replication.
1133 students from Ontario and Quebec schools
All English speaking
49.5% male, 50.5% female
Grades 7 through 12
Non-gamblers 19.3% (n= 214)
Social gamblers 70.4% (n= 779)
At-Risk gamblers 7.2% (n= 80)
PPG 3% (n= 33)
Millon Adolescent Clinical Inventory (MACI)
Conners-Wells self report scale
Erroneous cognitions questions
160 item self-report inventory designed specifically for assessing adolescent personality characteristics and clinical syndromes.
“It is useful in the evaluation of troubled adolescents, and it may be used for developing treatment plans and as an outcome measure.”
-p. 1 manual
12 personality patterns
8 expressed concerns
7 clinical syndromes
Internal consistency alpha coefficients range from 0.73 to 0.91
Test-retest obtained a median stability coefficient of 0.82
* 9 variables selected based on Pathways Model postulates
* Sample size adjusted
Variable C1 C2 C3 C4 Control group (N=924)
Self-demeaning 19.3 29.5 90.0 56.1 45.623
Family discord 36.8 76.5 77.8 61.3 59.15
Childhood abuse 9.9 25.9 70.6 32.6 28.51
SAP** 19.5 84.7 73.2 39.5 43.53
Impulsivity 31.5 73.7 72.3 46.9 47.67
Anxious feeling 63.9 30.4 55.8 64.5 59.76
Depressive affect 35.4 30.7 99.1 73.1 59.87
Suicidal tendency 8.4 13.9 78.5 30.7 26.19
*A mean MACI score of > 60 reflects clinical range
** Substance abuse propensity
Class 2: Impulsive, prone to abusing substances (poor coping/ impulsive nature), reported family discord
Class 3: Impulsive, prone to abusing substances, reported family discord, childhood abuse*, self-demeaning (very significant), depressive affect (very significant), suicidal tendency
Class 4: Anxious feelings, depressive affect, family discord (minimally significant)
* Self-demeaning, suicidal tendencies, and high depressive affect linked to childhood abuse only
Problem gamblers are more likely to fall into class 3 (distinguished by childhood abuse, and combination of impulsivity and mood disorder) than any other class
No significance in endorsement rates of DSM-IV-MR-J items between classes
No significant differences in types of gambling activities and rates of play between classes
Pathway 1= latent class 1
Pathway 2= latent class 4. However, unlike those in PM, those experiencing childhood abuse are in a class of their own.
Pathway 3= latent class 3
Blaszczynski was onto something.
Nower and Blaszczynski were also warranted in their belief that this pathways model could apply to youth.
Replication studies are necessary, with different methodologies and larger subject pools, before any modifications or additions to the Pathways Model are warranted.
Having said that, further exploration into the validity of a 4th pathway is warranted at this time.
Assessment on intake of gamblers in treatment should be extensive (clinical syndromes, history of abuse, impulsivity, personality concerns).
Treatment should be tailored to these etiological factors and co-morbid disorders.