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(p. 571) Adolescent Gambling 

(p. 571) Adolescent Gambling
Chapter:
(p. 571) Adolescent Gambling
Author(s):

Jeffrey L. Derevensky

and Lynette Gilbeau

DOI:
10.1093/med-psych/9780199928163.003.0027
Page of

date: 14 November 2018

(p. 572) Overview

The landscape of gambling throughout the world continues to evolve, with more states and countries expanding gambling opportunities. This has resulted in a significant increase in availability, more diversity, and alternative types of gambling opportunities, with easier accessibility for both adults and youth. What began with state-sponsored lotteries in the United States (44 states currently operate a lottery) and a limited number of casinos in Nevada and New Jersey has mushroomed, with the number of gambling opportunities (lotteries, casinos, poker parlors, gambling machines, horse and dog tracks, sports wagering, online gambling) throughout the United States and worldwide increasing exponentially during the past decade. No longer do individuals have to travel considerable distances or even venture outside of their homes to place a wager. Gamblers can bet on a wide diversity of activities and games via the Internet on their computer or smartphone using gambling apps, online wagering, and state-supported games. During the past decade, gambling has been one of the fastest changing and growing industries in the world. While some jurisdictions (e.g., Atlantic City) have showed declines in gambling revenues, these revenues have been accounted for by increases in neighboring states. Gambling opportunities have become so widespread that it is difficult to find jurisdictions in which some form of gambling is not controlled, regulated, organized, or owned by the government. Internationally, gambling has become a socially acceptable pastime and form of entertainment despite the recognized social and personal costs associated with excessive problematic gambling.

Adolescent Gambling

While gambling has been traditionally viewed as an adult activity, there is a growing body of research suggesting its popularity among adolescents (Derevensky, 2012; Volberg, Gupta, Griffiths, Olason, & Delfabbro, 2010). This is likely a result of gambling’s general social acceptability, governmental support and regulation, advertisements, the glitz and glamour associated with casinos, and the way in which gambling has been positively portrayed in the media. With television shows and movies depicting its glamour and excitement (e.g., 21, Runner Runner, Casino Royale, Rounders, Vegas, The Gambler) and televised world championship poker tournaments where young people win millions of dollars (the recent World Series of Poker multimillion-dollar tournament winners have most often been in their twenties), gambling has grown in popularity among youth. The perceived ease of becoming wealthy without working has resulted in gambling taking on a new level of status among adolescents. Even though almost all jurisdictions prohibit children and adolescents from engaging in government-sponsored and/or -regulated forms of gambling (e.g., lottery, casinos, horse racing, machine gambling, online wagering), many young people continue to be actively engaged in both regulated and nonregulated (e.g., card games and sports wagering among peers, fantasy sports leagues) forms of gambling.

Research studies throughout North America, Europe, Asia, and Australasia all suggest gambling’s popularity among adolescents. Survey and prevalence findings examining youth gambling behavior have consistently revealed that adolescents (12–17 years of age) have managed to participate, to some degree, in practically all forms of social, government-sanctioned, and nonregulated gambling available in their homes and communities (Volberg et al., 2010). Typical forms of gambling among teens include card playing for money (poker, while waning, is still popular), sports wagering, dice, and board games with family and friends; betting with peers on games of personal skill (e.g., pool, bowling, basketball and other sports); playing arcade or video games for money; and purchasing lottery tickets (especially scratch-off tickets). While some youth engage in other forms of gambling, such as wagering at horse and dog tracks, gambling in bingo halls and card rooms, gambling on electronic gambling machines (slot machines, video poker machines), sports wagering through a bookmaker, and wagering (p. 573) via Internet gambling sites, these are more often limited due to age and accessibility (Derevensky, 2012; Derevensky & Gupta, 2007; Griffiths & Parke, 2010; Griffiths & Wood, 2007; Jacobs, 2004; Jackson, Dowling, Thomas, Bond & Patton, 2008; Productivity Commission, 2010; Volberg et al., 2010; Wardle et al., 2011; Welte, Barnes, Tidwell & Hoffman, 2008). A recent study from the United Kingdom suggests that one in six children ages 11 to 15 had spent their own money on gambling in the last week; however, the overall self-reported rate of gambling among 11- to 15-year-olds has remained relatively static over time despite the increased availability of different forms of gambling (Ipsos MORI, 2014). In the United Kingdom, “fruit machines” (low-cost slot machines that are legal without any age restrictions) remain the most popular form of gambling among youngsters, followed by placing a bet and playing cards for money with friends. A relatively small percentage of youth participate in lottery activities (6%).

Adolescents’ wagering behaviors have often been found to depend on a number of factors, including the following:

While there is ample research suggesting that adolescents typically have gambled for money sometime before reaching 18 years of age, most teens do so occasionally with few gambling and/or gambling-related problems. Adolescent gambling behavior, similar to adult gambling behavior, can be viewed on a continuum ranging from not gambling at all, to social/occasional/recreational gambling, to problem/pathological/disordered gambling (DSM-5 now refers to the most serious form of gambling problems as disordered gambling). In the adolescent gambling literature, the terms social, occasional, nonproblematic, and recreational gambling have typically been used to denote occasional, infrequent use where the individual is experiencing relatively few gambling-related problems. Those adolescents deemed to be at risk for a gambling disorder begin exhibiting some gambling-related problems yet fail to reach the clinical level identified in the DSM-5. The terms disordered, problem, pathological, and compulsive gambling are used to denote behaviors reaching the clinical criteria and most often result in severe psychosocial, behavioral, economic, interpersonal, mental health, and legal difficulties.

Adolescent Problem/Disordered Gambling

While most adolescents gamble occasionally for money and don’t experience significant problems, there is a large body of research suggesting that adolescents as a developmental group constitute a high-risk population for gambling problems (Abbott et al., 2004; Derevensky, 2012; National Research Council, 1999; Volberg et al., 2010; Wardle et al., 2011; Welte et al., 2008). Volberg et al. (2010), while noting significant methodological differences in prevalence studies, concluded that between 60% and 80% of adolescents report having engaged in some form of gambling for money during the past year (depending on age and accessibility), with most of these adolescents being social, recreational, and occasional gamblers. However, they also noted that prevalence studies have revealed that between 2% and 8% of adolescents report experiencing serious gambling problems, with another 10% to 15% being at risk for the development of a gambling problem. The prevalence rates for adolescent problem gambling (p. 574) are two to four times that of adults. Further, there is considerable research pointing to young adults (ages 18–25) experiencing the highest prevalence of gambling problems among adults (National Research Council, 1999; Productivity Commission, 2010).

Interestingly, despite the increased diversity of gambling activities and their increased availability and accessibility, these prevalence rates have remained relatively constant for the past two decades and in some cases may have actually declined. There is certainly evidence that cultural, regional, and ethnic differences may impact the prevalence rates (Volberg et al., 2010). However, as the population of young people increases, the absolute number of individuals with gambling problems increases despite stable prevalence rates.

Adolescents with gambling problems have been reported to experience a wide range of social, economic, personal, academic, mental health, familial, criminal, delinquent, and legal problems. They also have increased rates of suicide ideation and attempts, and difficult peer relationships resulting from their gambling. All of these behaviors place the adolescent with gambling problems at high risk for a diversity of mental health issues (Derevensky, 2012; Derevensky & Gupta, 2004; Derevensky, Pratt, Hardoon, & Gupta, 2007; Dickson, Derevensky, & Gupta, 2008; Felsher, Derevensky, & Gupta, 2010; Griffiths, King, & Delfabbro, 2009; Hardoon et al., 2002, 2004; Petry, 2005; Shead et al., 2010; Winters & Anderson, 2000).

Problem gambling among adolescents is typically marked by the following:

  • Being preoccupied with gambling

  • Attempting to recoup losses

  • Increasing wagers

  • Lying to family members, peers, and friends about their gambling

  • Exhibiting anxiety and/or depression when trying to reduce their gambling

Adolescents with a severe gambling disorder frequently report using gambling as a coping mechanism to escape daily problems (familial, peer, and school-related). Given that gambling by its nature requires increasing amounts of money, many youth acquire their funds illegally, often stealing money from family members (who are reluctant to report such thefts to the police) and sometimes resorting to criminal behavior outside of their home. These adolescents may also borrow large sums of money from friends, peers, and loan sharks. The adolescent’s preoccupation with gambling and the necessity to recoup losses becomes paramount. Other behaviors can include a preoccupation with watching TV shows or movies with gambling themes, playing online social casino games for virtual currency (to improve their skills), and reading books related to gambling strategies (Derevensky, 2012).

Pathological/disordered gamblers are not a homogeneous group; for instance, sports gamblers are often different from poker players, who are different from casino gamblers. Also, some types or forms of gambling, due to their structural or situational factors, may be more problematic and symptomatic of problem gamblers. Slot machines and electronic gambling machines, for example, have been called the “crack cocaine” of gambling because they are designed to result in repetitive play (Schüll, 2012).

There is little doubt that the vast majority of adolescent gamblers will ultimately wind up losing their money. Why, then, do some individuals continue to gamble in spite of repeated losses? In a number of studies, we found that the predominant reason youth report gambling is for the enjoyment, excitement, and entertainment associated with gambling. While making money is not necessarily the primary reason initially given for gambling, it often propels problem gamblers to keep wagering in order to recoup their losses and “get even.” Similarly, as the thrill and exhilaration associated with gambling plateau, to keep it exciting and maintain or enhance the adrenaline rush derived from gambling, gamblers must increase both the frequency and amounts of money wagered. This typically accounts for the increasing escalation of wagers, which ultimately results in increased losses (Derevensky, 2012; Derevensky & Gupta, 2004).

(p. 575) Other factors have also been shown to account for gamblers’ continued play. Stinchfield (2000) has suggested that adolescents may be engaging in this behavior as a form of experimenting with adult behaviors. Derevensky (2012) has speculated that gambling in general may be conceived as a rite of passage. Most adolescents report gambling for multiple reasons (see Derevensky, 2012; Shead, Derevensky, & Gupta, 2010 for reviews), such as the following:

  • For the competition

  • As a potential profession

  • To fulfill mental health needs (e.g., coping with adversity, escaping from daily stressors, reducing anxiety and depression)

  • To facilitate peer relationships and socialization

  • To escape from boredom

  • To relieve loneliness

  • To pass time

  • To help with financial pressures or difficulties

Adolescent problem gamblers typically report an early age of onset (approximately 10 or 11 years of age) compared with peers who report gambling but have few gambling-related problems (Derevensky & Gupta, 2001; Gupta & Derevensky, 1997, 1998b; Productivity Commission, 2010; Vitaro, Wanner, Ladouceur, et al., 2004; Volberg et al., 2010; Wynne et al., 1996). Among adolescents, there often is a rapid movement from social/occasional/recreational gambling to problem/disordered gambling (Derevensky & Gupta, 1999; Gupta & Derevensky, 1998a; Volberg et al., 2010). These youth frequently report having had an early “big win” during their early gambling experiences (the size of the win can vary considerably, and the perception of a “big win” often depends on age and socioeconomic status) (Gupta & Derevensky, 1997; Productivity Commission, 1999; Wynne et al., 1996).

Pathological/disordered gamblers’ initial gambling experiences often occur with family members at home (Gupta & Derevensky, 1997), with both parents and older siblings having an early influence. It is not atypical for parents to report giving their children a scratch-off lottery ticket for holidays or special occasions (Campbell et al., 2011). As children get older, the peer group becomes more important. Problem gamblers also begin seeking out peers with similar gambling behaviors (Derevensky, 2012).

Correlates and Risk Factors Associated with Problem Gambling

Problem gambling, similar to other mental health disorders, has been shown to have multiple associated risk factors. Given the general acceptance that adolescent problem or disordered gamblers are not a homogeneous group, there is no single constellation of risk factors that alone can predict with certainty that an individual will develop a gambling disorder. Nevertheless, considerable research during the past 25 years has focused on identifying those risk factors associated with excessive gambling problems and has identified possible protective factors as a way to minimize problems through early prevention strategies as well as informing evidence-based treatment strategies (Derevensky, 2012; Dickson, Derevensky, & Gupta, 2002, 2004; Shead et al., 2010).

While there are multiple constellations of risk factors that, in conjunction with a lack of specific protective factors, likely place certain adolescents at high risk for a specific problem, the etiology underlying gambling problems is not universal. Risk factors may be different for individuals, and a number of distinct pathways may exist that lead to pathological gambling (Gupta, Nower, Derevensky, Blaszczynski, Faregh, & Temcheff, 2013; Nower & Blaszczynski, 2004). These pathways also have implications for the treatment of gambling disorders.

Gupta et al. (2013) have suggested that adopting a biopsychosocial–environmental framework may facilitate our understanding of the onset and developmental course of gambling problems. In spite of the adoption of the framework, understanding the risk factors may better influence our prevention and treatment programs. The reviews by Derevensky (2012) and Shead et al. (2010) point to the empirical studies supporting behavioral patterns, correlates, and risk factors associated with adolescent gambling and problem gambling.

(p. 576) The following risk factors have been identified and will be discussed: gender; parents and peers; attitudes toward gambling; cultural and regional factors; personality traits; mental health disorders; and behavioral, situational, and environment influences.

Gender Differences

In adolescence, gambling remains more popular among males than females, with more adolescent males than females exhibiting severe gambling-related behaviors (Abbott et al., 2004; Derevensky & Gupta, 2004; National Research Council, 1999; Ipsos MORI, 2014; Productivity Commission, 2010; Volberg et al, 2010; Wardle et al., 2011; Welte et al., 2008). Disordered gambling can be two to four times more common among males than females (Derevensky & Gupta, 2004; Gupta & Derevensky, 1998a; Stinchfield, 2000; Volberg et al., 2010). In general, males have been found to make larger gross wagers (Derevensky et al., 1996), gamble on more diverse activities, gamble more frequently, spend more time and money, have an earlier age of onset, and experience more gambling-related problems than females (Jacobs, 2000, 2004). Whereas males prefer sports betting and wagering on games of skill, females tend to prefer gambling on the lottery and bingo (Derevensky, 2012; Wilson & Ross, 2011). While there is speculation that there is a greater genetic component among males, parents have been found to be more likely to encourage their son’s gambling, and males report gambling more often with their parents (Campbell, Derevensky, Meerkamper, & Cutajar, 2011; Ladouceur et al., 1994).

Parental and Peer Influences

Adolescents with gambling problems often report having parents whom they perceive gamble excessively, are involved in other addictive behaviors, and/or have been involved in illegal activities (Abbott & Volberg, 2000; Campbell et al, 2011; Hardoon et al., 2004; Raylu & Oei, 2002; Ipsos MORI, 2014). As previously noted, for older adolescents the peer group plays an important role in endorsing or promoting gambling (King, Abrams, & Wilkinson, 2010). Dickson, Derevensky, and Gupta (2008) reported that 40% of disordered gamblers indicated that they had friends with similar gambling interests. Adolescents who were taught to maintain a budget, save money, and be financially responsible were less likely to show an interest in gambling (Delfabbro & Thrupp, 2003).

Attitudes Toward Gambling

Adolescents in general and especially those with gambling problems report positive attitudes toward gambling. Gambling is viewed as a highly socially acceptable behavior and recreational pastime (Derevensky, 2012). While these youth typically fail to comprehend both the immediate and long-term negative consequences of their gambling behaviors, many are cognizant of the problems associated with excessive gambling. Hardoon et al. (2003) reported that even though adolescent problem gamblers scored exceedingly high on gambling severity indices, they nevertheless did not perceive themselves as having a gambling problem. As such, the risks associated with disordered gambling are viewed as a long-term consequence and not of immediate concern (Gillespie, Gupta, Derevensky, et al., 2005). In an interesting study, Hanss et al. (2014) reported that in addition to gender, degree of sensation seeking, agreeableness, a family history of gambling, and family and peer approval of gambling were the most powerful influences on adolescents’ attitudes toward gambling.

Cultural and Regional Factors

Overall prevalence rates of gambling and problem gambling vary between countries (Volberg et al., 2010). These differences may be due to differing data collection methodologies (telephone surveys, school-based survey), situational factors (e.g., availability, ease of accessibility, age restrictions), advertisements, or cultural/attitudinal factors. Arndt and Palmer (2013) reported significant racial/ethnic differences among (p. 577) students who have gambled, with white (26.0%) and Asian (25.8%) adolescents having had the least lifetime exposure and Latino (30.1%), African-American (32.6%), and American Indian (34.1%) adolescents having the highest exposure. In Canada, Ellenbogen, Gupta, and Derevensky (2007) reported significant cultural differences in adolescents’ gambling behaviors among Francophones (French-speaking families), Anglophones (English-speaking families), and allophones (neither English nor French was their mother tongue), with allophones exhibiting the highest rates of problem gambling.

Personality Traits

A number of studies have identified personality traits and clusters associated with adolescent problem gambling. Problem gamblers have been found to score more highly on measures of excitability and extroversion, they tend to have difficulty conforming to societal norms, and they experience difficulties with self-discipline (Gupta, Derevensky, & Ellenbogen, 2006; Hardoon et al., 2002, 2003, Ste-Marie, Gupta, & Derevensky, 2006). They have been similarly shown to exhibit higher state and trait anxiety scores (Gupta & Derevensky, 1998b; Ste-Marie, Gupta, & Derevensky 2002), are more impulsive (Derevensky et al., 2007; Gupta, Nower, Derevensky, et al., 2013; Nower, Derevensky, & Gupta, 2004; Vitaro, Ferland, Jacques, & Ladouceur, 1998; Vitaro et al., 2001), are greater risk takers (Abbott et al., 2004; Nower, Derevensky, & Gupta, 2004; Zuckerman, 1994), and are more self-blaming and guilt-prone (Gupta & Derevensky, 2000).

Adolescent problem gamblers exhibit higher scores on measures of disinhibition, boredom susceptibility, and other self-regulatory behaviors (e.g., conformity to norms, self-indulgence) (Gupta, Nower, Derevensky, et al., 2013; Nower, Derevensky & Gupta, 2004; Shead et al., 2010).

Mental Health Disorders

Consistent with the Pathways Model (the theoretical integration of biological, personality, developmental, cognitive, learning theory, and environmental factors) that describes the etiology of different subtypes of problem gamblers (see Gupta et al., 2013; Nower & Blaszczynski, 2004), adolescents with gambling disorders report multiple mental health problems, including high levels of anxiety and depressive symptomatology (Bergevin, Gupta, Derevensky, & Kaufman, 2006; Felsher, Derevensky, & Gupta, 2010; Gupta & Derevensky, 1998b; Gupta, Derevensky, & Ellenbogen, 2006). Other research, using latent class analyses (Kong et al., 2014), as well as two recent longitudinal research projects with adults, has strongly supported these findings (el-Guebaly et al., 2015; Williams et al., 2015). Youth with gambling problems are at heightened risk for suicide ideation and attempts (Nower, Gupta, Blaszczynski, & Derevensky, 2004), they exhibit an increased frequency of substance abuse and psychosomatic problems, and they tend to be involved in a wide variety of risky behaviors (Gupta & Derevensky, 1998a; Hammond et al., 2014; Jacobs et al., 1989; Leeman et al., 2014; Lesieur & Rothschild, 1989; Rahman et al., 2012).

Behavioral, Situational, and Environmental Factors

Today’s social acceptability of gambling, prolific advertisements, and ease of accessibility has enabled young people to gamble on a greater variety of activities in spite of prohibitions on regulated forms of gambling. Whether buying a lottery ticket at a convenience store, entering gambling establishments when they are underage, or gambling online, most adolescents have figured out a way to circumvent restrictions. Major reviews have in general concluded that the greater the availability and accessibility of gambling, the greater gambling participation and gambling-related problems (Ariyabuddhiphongs, 2013; Blinn-Pilke et al., 2010; Derevensky, 2012; Raylu & Oie, 2002; St-Pierre, Walker, Derevensky, & Gupta, 2014). While an alternative gambling exposure and adaptation model has been presented (Laplante & Shaffer, 2007), there is ample evidence to suggest that gambling among adolescents will not (p. 578) dissipate, especially in light of social casino gambling, online gambling, and mobile gambling (Derevensky & Gainsbury, 2016). However, despite the proliferation of gambling internationally, new technological forms of gambling, and widespread advertising and the glamorization of gambling, prevalence rates of problem/disordered gambling among adolescents and adults have not risen dramatically. Indeed, there is some evidence that in certain jurisdictions the prevalence rates of both gambling and problem gambling among adolescents have decreased somewhat, supporting Shaffer et al.’s (2007) contention of adaptation. Others have argued that stricter enforcement of age restrictions, more punitive fines and sanctions for gambling establishments that permit underage gambling, and increased prevention interventions may have accounted for these decreases.

Protective Factors

While most studies have focused on the risk factors associated with adolescent problem gambling, a number of studies have sought to identify those attributes thought to protect youth from developing a gambling problem. Such studies have focused on identifying the protective and buffering factors thought to reduce and minimize the incidence of adolescent disordered gambling. While there are some unique risk factors associated with problem gambling compared with other adolescent high-risk and addictive behaviors (e.g., substance and alcohol abuse), Dickson, Derevensky, and Gupta (2008), using multiple self-report measures, concluded that poor family and school connectedness was symptomatic of adolescent problem gambling, with family cohesion playing a significant role as a protective factor. If one also looks at the attitudinal research, there is evidence that familial and peer disapproval of gambling may be a reliable protective factor (Hanss et al., 2014). Research by Kundu et al. (2013; see also Rahman et al., 2012) suggests that giving lottery tickets to underage minors has been associated with more permissive attitudes toward gambling. This has resulted in the annual Holiday Campaign, a collaborative initiative of McGill University’s International Centre for Youth Gambling Problems and High Risk Behaviors and the U.S. National Council on Problem Gambling designed to educate parents on the relationship between an early onset of gambling and later gambling problems.

In several studies, Lussier, Derevensky, and Gupta (2004) and Lussier, Derevensky, Gupta, and Vitaro (2014) sought to examine the role of resilience in the presence of identified risk factors as a possible protective factor for youth gambling problems and other adolescent high-risk behaviors (this was also addressed in a study of the impact of physical, sexual, and mental abuse upon disordered gambling by Felsher et al., 2010). Early findings revealed that adolescents perceived to be Vulnerable (high risk/low protective factors) had a mean gambling severity score nine times larger than the Resilient group (high risk/high protective factors), eight times larger than the Fortunate group (low risk/low protective factor), and 13 times larger than the Ideal group (low risk/high protective factors). The Vulnerable group were at the greatest risk for experiencing gambling problems. All of the adolescents identified as pathological/disordered gamblers and 87% of those identified as being at risk for problem gambling (exhibiting a number of clinical difficulties but not reaching the clinical criteria for a formal diagnosis of pathological gambling) scored on the resilience measure as being Vulnerable, while only 4.3% of the youth categorized as Resilient were identified as at-risk gamblers, and none of them were pathological gamblers despite their reporting high levels of risk exposure. Thus, the construct of resilience appears to be a key protective factor and should be addressed in mental health initiatives and problem gambling prevention initiatives (Felsher et al., 2010; Lussier, Derevensky, Gupta, & Vitaro, 2014; Nower et al., 2004).

Assessing and Measuring Gambling Severity

Despite advances in our understanding of the etiology, correlates, and risk and protective factors (p. 579) associated with adolescent problem gambling, our ability to accurately assess and measure gambling severity has been limited. While a number of instruments have been developed to identify adolescent problem gamblers, most have been adapted from adult instruments (using adult criteria while modifying or replacing questions to make them more age-appropriate) and none of the instruments have undergone rigorous psychometric evaluation (Stinchfield, 2010). The most commonly used instruments include the South Oaks Gambling Screen-Revised for Adolescents (SOGS-RA; Winters, Stinchfield, & Fulkerson, 1993), DSM-IV-J (Fisher, 1992) and its revision the DSM-IV-MR-J (Fisher, 2000), the Massachusetts Adolescent Gambling Screen (MAGS; Shaffer, LaBrie, Scanlan, & Cummings, 1994; Stinchfield, 2010), and the Canadian Adolescent Gambling Inventory (CAGI; Wiebe, Wynne, Stinchfield, & Tremblay, 2005, 2007). A number of studies of older adolescents have employed the GA-20 (Gamblers Anonymous) questions (Blinn-Pike et al., 2010).

Among these instruments, only the CAGI was originally developed for adolescents. The CAGI, which has been used in only a limited number of studies to date, moves beyond a single scale of measurement (one score) to include multiple domains of problem gambling severity; it measures gambling behavior itself as well as problem gambling severity (Stinchfield, 2010). Using a more limited timeframe for assessing gambling behavior (3 months; most instruments assess past-year gambling-related problems), it assesses and identifies behavior in five distinct areas:

  1. 1. Types of gambling behaviors/activities in which the individual engages

  2. 2. Frequency of participation in each of these behaviors/activities

  3. 3. Time spent on each of the gambling activities

  4. 4. Money wagered

  5. 5. Severity of gambling problems

Similar to adult instruments (the DSM-5 being the new gold standard), a number of common constructs underlie most of the instruments, including both psychological factors and the negative financial and behavioral costs associated with excessive gambling. Stealing money to support gambling (this item no longer exists in DSM-5), occupational/school-related problems, disrupted relationships, chasing losses, lying or deception about one’s gambling problems, disrupted familial relationships, the need to increase the frequency and amount wagered, preoccupation with gambling, and concern/criticism from others are common constructs examined by these instruments. Derevensky (2012) concluded after considerable research that the DSM-IV-MR-J seems to be a more conservative measure of gambling severity. (For a more comprehensive description of the instruments, see Blinn-Pike et al., 2010; Derevensky, 2012; and Stinchfield, 2010. An online search can also produce these instruments.)

Treatment of Youth with Gambling disorders

As there remains no single identifiable cause or universally accepted theoretical model for understanding problem gambling, treatment approaches have differed. Individuals’ motivations to gamble and gamble excessively vary greatly, thus necessitating different treatment approaches. The current treatment approaches for adolescents have been based upon a wide variety of theoretical approaches paralleling those used for adults, including the following:

For a more comprehensive overview of these various therapeutic models and their efficacy in treating gambling problems, see reviews by Grant and Potenza (2011), Hodgins, Stea, and Grant (2011), Ladouceur and Shaffer (2005), Petry (2005), and Richard et al. (2013).

There is unequivocal evidence that most adults and adolescents learn from their past mistakes. While most individuals occasionally exceed their preset gambling limits (time and/or money) and may suffer some short-term negative consequences, most individuals eventually refrain from excessive gambling. Some individuals may stop gambling altogether; others regain control of their behavior, curtailing their gambling in terms of both frequency and money wagered. Yet for some individuals, their physiological and psychological needs, perceived skill and knowledge, erroneous cognitions, and/or need for escape from daily and long-term stressors and mental health issues lead them to increase the frequency and intensity of their gambling even though they know that their odds of winning are limited.

Paradigms for the treatment of gambling problems in youth have traditionally incorporated a relatively narrow focus depending on the therapist’s theoretical orientation and conceptualization of the etiology of a gambling disorder, the therapist’s background work in the field of addictions, and whether the therapist believes in “controlled gambling” versus abstinence (Derevensky, 2012). The development of empirically based prevention programs has been hampered by a lack of theoretical understanding of the etiology underlying problem gambling (the biomedical model, arguing that there is a strong underlying biological basis for disordered gambling, dominates the treatment community in the United States), the lack of public awareness of the needs for such programs, and the resistance of adolescents to recognize the severity of their problem and to seek treatment. Problem/disordered gambling has often been referred to as a “hidden addiction” (Derevensky, Shek, & Merrick, 2011). Unlike a drug, alcohol, or tobacco addiction, it is often difficult to detect a gambling disorder; there are also no blood or urine tests to confirm it. Denial of the problem is common by teens, even though they score high on gambling severity measures and acknowledge that their parents, siblings, and/or peers view their behavior as problematic. While adolescents in general typically do not want to seek help for any addiction or mental health disorder, this is likely even more common among adolescent problem gamblers.

The fact that only a very small percentage of individuals (both adolescents and adults) with a severe gambling disorder perceive themselves as having a problem helps account for the low turnout of adolescents seeking help for a gambling disorder (Derevensky, Temcheff, & Gupta, 2011; Hardoon, Derevensky, & Gupta, 2003). Even among adults with gambling disorders, the fact that only approximately 10% of these individuals present for treatment is a serious concern (Hodgins, 2014; Hodgins, Stea, & Grant, 2011; Slutske, Blaszczynski, & Martin, 2009). Perceived barriers to seeking treatment include a desire to manage the problem themselves, denial, and shame (Suurvali, Hodgins, & Cunningham, 2010). For the adolescent, logistical travel considerations and their unwillingness to acknowledge a problem to their parents place them at an even greater disadvantage.

There is considerable empirical support suggesting that gambling involves a complex and dynamic interaction between ecological, psychophysiological, developmental, cognitive, and behavioral components, with environmental issues (e.g., accessibility, availability, and game type) being important considerations (Hodgins et al., 2011). Derevensky (2012), Derevensky, Temcheff, and Gupta (2011), Gupta and Derevensky (2000, 2004), and Gupta, Nower, Derevensky, Blaszczynski, Faregh, and Temcheff (2013) have long asserted that in the absence of empirically validated treatment programs and the varying underlying reasons for gambling, (p. 581) a dynamic interactive approach needs to take into account the multiplicity of interacting factors in a treatment paradigm for youth with significant gambling problems. Empirical support for Jacobs’ General Theory of Addiction and a Pathways Model approach (see Gupta et al., 2013) for adolescent problem gamblers (Gupta & Derevensky, 1998b) suggests that adolescent pathological gamblers exhibit evidence of abnormal physiological resting states, report significantly greater emotional distress and anxiety, have increased levels of dissociation when gambling, demonstrate erroneous cognitions when gambling (e.g., they believe that they can predict the outcome of the game even when the outcome is based purely on randomness, they report exaggerated levels of skill, they have little pragmatic understanding of randomness and independence of events), and display depressive symptomatology and other mental health issues. As such, Gupta and Derevensky (2004) contend that treating gambling problems in isolation from other social, psychological, developmental, cognitive, and emotional difficulties may lead only to limited, short-term success. Their clinical experience has suggested that ultimately many of these adolescents will relapse, sometimes with concomitant substance abuse disorders (Ledgerwood, Loree, & Lundahl, 2013).

Derevensky, Temcheff, and Gupta (2011) and Gupta and Derevensky (2000, 2004) have presented a treatment model predicated on their research and clinical findings with youth problem gamblers. Their results suggest that adolescent pathological gamblers generally exhibit depressive symptomatology, somatic disorders, anxiety, impulsivity, attention deficits, mood disorders, high risk taking, and poor coping skills along with a host of academic, social, personal, and familial problems. The vast majority of adolescent problem gamblers use gambling as a distraction to escape from daily problems. It becomes a way to fill a void, to deal with boredom and multiple problems, and to reduce stress and anxiety.

While Gupta and Derevensky acknowledge that adolescent pathological gamblers experience numerous erroneous cognitive beliefs and distortions, they strongly recommend that clinicians simultaneously address underlying psychological problems as well as the presenting gambling problem. This is especially true in light of many comorbid factors, such as attention-deficit/hyperactivity disorder, substance abuse, and legal and antisocial problems. Understanding the causes and triggers of the gambling behavior remains crucial.

While many clinicians view pathological/disordered gambling as a continuous and progressive disorder, there is some clinical and empirical support suggesting that it in fact may be episodic: individuals may gamble excessively for a limited time, experience difficulties, and then stop for undetermined amounts of time. This may be viewed as binge gambling; see Gupta and Derevensky (2011) for a discussion of adolescent binge gambling.

Combinations of behavioral and psychopharmacological therapies have been shown to be successful for youth with other addictive disorders, but there are currently no drugs approved by the U.S. Food and Drug Administration for the treatment of adolescent gambling disorders. Gupta et al. (2013) contend that best practices for helping teens with gambling problems cannot be achieved until we refine our ability to match treatment strategies with gambler typologies.

Prevention

Unlike prevention programs for substance abuse and other mental health issues, gambling prevention programs have been hindered by a number of beliefs and common misconceptions, such as (1) age restrictions on gambling activities deter adolescent participation and (2) adolescents have little available discretionary funds for gambling. Nevertheless, the need for the early development and implementation of prevention programs is predicated upon the fact that youth often begin gambling at a young age.

Abstinence Versus Harm-Minimization Approaches

Prevention approaches can be categorized into two general paradigms: abstinence and harm minimization (sometimes referred to as harm reduction). While these two approaches are not mutually exclusive, they are predicated on different goals and processes. A harm-reduction (p. 582) framework encompasses policies, programs, or strategies that help individuals to reduce the harmful, negative consequences incurred through involvement in a risky behavior without requiring abstinence (Ariyabuddhiphongs, 2013; Dickson, Derevensky, & Gupta, 2004). In most jurisdictions, youth are prohibited to enter government-regulated gambling venues, supporting an abstinence approach. However, is abstinence a realistic goal for youth when the majority of adolescents report having gambled and report that their peers take part in unregulated gambling activities? This highlights both the paradox and the confusion as to which primary prevention approach to promote, abstinence or harm reduction (Dickson et al., 2004)

Harm-Minimization Programs

In general, universal adolescent harm-reduction programs are intended to modify inappropriate attitudes toward risky behaviors, enhance positive decision making, and educate youth about the short- and long-term risks associated with a particular behavior (Derevensky & Gupta, 2011). Most youth gambling prevention programs foster a harm-minimization framework and emphasize responsible gambling (Derevensky & Gupta, 2011). Ample research highlights that the age of onset of gambling is a significant factor associated with problem gambling (Dickson et al., 2002, 2004; Jacobs, 2004; National Research Council. 1999; Productivity Commission, 1999; Volberg et al., 2010). As such, delaying the age of onset may well be beneficial in minimizing gambling-related harm.

The available gambling prevention programs designed for youth have typically incorporated the following harm-minimization and educational objectives:

  1. 1. Highlight the difference between games of chance and games of skill

  2. 2. Educate participants about probability and the independence of events

  3. 3. Dispel erroneous cognitions concerning the “illusion of control” regarding random events

  4. 4. Address issues of independence of events

  5. 5. Articulate the characteristics and warning signs of problem gambling

  6. 6. Provide resources to aid individuals either experiencing a gambling problem or who are at risk for a gambling problem (Derevensky, 2012; Ladouceur, Goulet, & Vitaro, 2013; Turner, Macdonald, & Somerset, 2008)

Some more comprehensive prevention curricula seek to encourage the development of interpersonal skills, foster effective coping strategies, provide techniques to improve self-esteem, and offer ideas for resisting peer pressure (Derevensky & Gupta, 2011).

Comprehensive and substantive elementary and high school prevention programs for problem gambling are relatively uncommon but do exist in some jurisdictions (Williams, West, & Simpson, 2012). Several adolescent gambling prevention and awareness initiatives currently in use internationally are presented in Table 27.1.

Table 27.1 Youth Gambling Prevention Programs

Prevention Program

School Level

Developer

Website

Amazing Chateau

Grades 4–6

International Centre for Youth Gambling Problems and High-Risk Behaviors, McGill University

www.youthgambling.com

Clean Break

Grades 8–12

International Centre for Youth Gambling Problems and High-Risk Behaviors, McGill University

www.youthgambling.com

Don’t Bet on It

Grades 10–12

Responsible Gambling Council

http://curriculum.org/resources/dont-bet-on-it-8211-a-youth-problem-gambling-prevention-program

Facing the Odds

Grades 5–8

Harvard Medical School, Division of Addictions

http://www.divisiononaddictions.org/curr/facing_the_odds.htm

Hooked City

Grades 6–8

International Centre for Youth Gambling Problems and High-Risk Behaviors, McGill University

www.youthgambling.com

Stacked Deck

Grades 9–12

Robert Williams and Robert Wood

http://www.uleth.ca/research/alberta -gambling-research-institute-agri

Wanna Bet?

Grades 3–8

Minnesota Council on Compulsive Gambling

http://www.nati.org/prevention_tools/youth.aspx

Youth Gambling: An Awareness and Prevention Workshop—Level I

Grades 4–6

International Centre for Youth Gambling Problems and High-Risk Behaviors, McGill University

www.youthgambling.com

Youth Gambling: An Awareness and Prevention Workshop—Level II

Grades 7–10

International Centre for Youth Gambling Problems and High-Risk Behaviors, McGill University

www.youthgambling.com

Youth Making Choices: A Curriculum-Based Gambling Prevention Program

Grades 10–12

Centre for Addiction and Mental Health (CAMH)

http://www.problemgambling.ca/EN/ResourcesForProfessionals/Pages/CurriculumYouthMakingChoices.aspx

As the role of and the interaction of risk and protective factors become better understood, a complementary understanding of resiliency is achieved (Shead, Derevensky, & Gupta, 2010). Research suggests that resilient youth possess a constellation of skills including competent problem-solving abilities, social competence (effective communication skills, flexibility, concern for others), autonomy, and a sense of purpose (Masten, Best, & Garmezy, 1990). One of the central goals of science-based prevention initiatives is to promote resilience (Dickson et al., 2002). Lussier et al. (2007), using Jessor’s (1998) Adolescent Risk Behavior model, explored the concept of resilience and its relationship to youth problem gambling. Their findings suggest that a variety of risk and protective factors interact uniquely to contribute to the predictive model of gambling problems. The promotion and development of resilience should, therefore, be among the factors included in mental health initiatives and prevention programs.

Evaluating Prevention Programs

Evaluating the success or effectiveness of prevention programs is fundamental to improving public (p. 583) health (Dickson-Gillespie, Rugle, Rosenthal, & Fong, 2008). There have been relatively few published evaluations of youth gambling prevention or intervention programs (Blinn-Pike, Worthy, & Jonkman, 2010). Ladouceur, Goulet, and Vitaro (2013), in their review of youth gambling prevention program evaluations, concluded that the majority of the evaluative studies did not (p. 584) include measures of gambling behaviors or long-term outcomes. Short-term benefits of these prevention programs point to improved knowledge and a reduction in misconceptions about gambling among youth (Ladouceur et al., 2013; Lupu & Lupu, 2013). However, without follow-up evaluations and measurement of gambling behaviors, it is unclear whether gambling behavior is actually affected in the long term (Ladouceur et al., 2013).

Future Directions

There is a real need to raise awareness among the general public, parents, teachers, and mental health professionals about the extent of adolescent problem gambling (Campbell et al., 2011; Derevensky, St-Pierre, Temcheff, & Gupta, 2014; Hayer, Griffiths, & Meyer, 2005; Temcheff, Derevensky, St-Pierre, Gupta, & Martin, 2014). It makes intuitive sense to incorporate gambling-related information and prevention efforts into existing and effective mental health and education programs to form a more comprehensive mental health curriculum (Derevensky, 2012; Hayer, Griffiths, & Meyer, 2005).

Conclusion

The landscape of gambling is continually changing with technological advances, new forms of gambling, and ever-increasing ease of access. The thrill, excitement, and entertainment associated with gambling contribute to the positive perception of gambling. This changing landscape, with a heavy emphasis on online and mobile gambling, the inclusion of social casino games, and the normalization and social acceptability of gambling, represents a renewed challenge to help minimize problems.

Clinicians and researchers studying adolescence have long suggested that it is a developmental stage marked by significant physical, social, cognitive, and emotional changes. The continued expansion of gambling, the enticing advertisements, the glitz and glamour associated with gambling, and the social acceptance of the industry’s expansion may spell trouble for our youth. Research is only beginning to highlight the determinants of both the risk and protective factors associated with different forms of gambling. Researchers and clinicians have not yet realized best practices for treatment or prevention. Nevertheless, youth gambling, like so many other risky behaviors among teens, is an important public health issue that needs to be addressed. Incorporating youth gambling into a public health framework (Messerlian & Derevensky, 2005; Messerlian, Derevensky, & Gupta, 2005), using a multidimensional perspective recognizing the individual and social determinants while simultaneously drawing upon health promotion principles, represents a plausible approach for better addressing the issues of youth gambling and problem gambling.