Elsevier

Addictive Behaviors

Volume 97, October 2019, Pages 20-26
Addictive Behaviors

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

https://doi.org/10.1016/j.addbeh.2019.05.013Get rights and content

Highlights

  • Early age onset gamblers (12 and under) reported increased gambling severity.

  • They were more likely to have abused drugs or solvents than the older age of onset group.

  • Early age onset gamblers were more likely to have committed an unreported crime.

  • They were more likely to have a parent with a gambling problem.

  • Age of onset was not associated with treatment completion or dropout.

Abstract

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.

Introduction

Gambling is a common activity, with figures indicating that 56.2% of adults aged 16 or over in England had spent money on at least one gambling activity (including the lottery) in the last year (Gambling Commission, 2018a). However, gambling does not begin at 16; recent figures report 39% of 11–16-year olds have spent their own money on gambling in the past year (Gambling Commission, 2018b). An increase in gambling marketing has resulted in a concurrent increase in childhood exposure: research has demonstrated that consistent exposure to gambling marketing solidifies brand recognition amongst children (Bestman, Thomas, Randle, & Thomas, 2015; Djohari, Weston, Cassidy, Wemyss, & Thomas, 2019; Thomas et al., 2016) and introduces children to gambling at a younger age, thus normalising gambling within sport for children (Pitt, Thomas, Bestman, Stoneham, & Daube, 2016).

Age of onset is thought to be significant in the development and trajectory of psychiatric disorders including alcohol use disorders (Hingson, Heeren, & Winter, 2006), and has relevance in diagnosis, prognosis and treatment adherence (Leggio, Kenna, Fenton, Bonenfant, & Swift, 2009). Age of onset is a key factor is distinguishing typologies of alcohol dependence in the Cloninger typologies model (Cloninger, Bohman, & Sigvardsson, 1981), however few gambling studies have considered the age individuals commenced the activity. Lynch, Maciejewski, and Potenza (2004) sought to examine psychiatric correlates of gambling in adolescents aged 16–17, and young adults aged 18–29 and found that earlier onset of gambling problems was associated with more severe psychiatric issues, particularly in relation to substance use disorders. Additionally, gamblers who began gambling at a younger age were more likely to experience depression and substance use disorders than their non-gambling counterparts. In a later study recruiting high school students, Rahman et al. (2012) found that age of gambling onset was associated with problem gambling severity, whilst in a general population sample, Carneiro et al. (2014) found that at-risk gamblers who began gambling before they turned 20, were more likely to be male, and to chase gambling losses. Recruiting a more elderly sample of gamblers, Burge, Pietrzak, Molina, and Petry (2004) found that those who started gambling earlier in life experienced more medical and psychiatric problems than later onset gamblers.

In treatment seeking gamblers, there is increased gambling severity, more suicidal ideation and a history of inpatient psychiatric treatment, alongside psychosocial and substance abuse problems in early onset gamblers (Burge, Pietrzak, & Petry, 2006). Likewise, late onset gamblers have been shown to be less likely to declare bankruptcy, to have a parent with a gambling problem (Grant, Kim, Odlaug, Buchanan, & Potenza, 2009), and to have lower rates of pathological gambling severity (Jiménez-Murcia et al., 2010). More recently, compared to older onset gamblers, early onset gamblers were more likely to gamble online and take anti craving medication such as naltrexone, however, were less likely to engage in non-strategic gambling (e.g. lotteries) and to be an escape-type gamblers (Shin et al., 2014). A further study reported that gender had a direct effect on the onset of gambling disorders and depression symptoms, with males experiencing gambling related harm earlier than females, and reporting fewer depression symptoms (Jiménez-Murcia et al., 2016).

Previous studies have found mixed evidence for a relationship between age at treatment start, and treatment drop out, e.g. no association (Leblond, Ladouceur, & Blaszczynski, 2003), and increased risk of drop-out associated with older (Echeburúa, Báez, & Fernández-Montalvo, 1996), or younger age (Aragay et al., 2015). Research that has investigated the relationship between age of gambling onset and treatment outcome has generally found that despite being significantly associated with the development and trajectory of the disorder, age of onset was not associated with treatment outcome (Jiménez-Murcia et al., 2010; Ronzitti, Soldini, Smith, Clerici, & Bowden-Jones, 2017; Shin et al., 2014). Although past research has sought to understand how age of gambling onset relates to subsequent gambling behaviour, no studies have sought to relate different adolescent age of onset groups with subsequent adult gambling behaviour. For example, early age onset has been categorised as under 25 (Grant et al., 2009; Shin et al., 2014), under 21 (Burge et al., 2004) or under 20 (Carneiro et al., 2014; Jiménez-Murcia et al., 2010); categorisation of adolescent gamblers in to a homogenous group creates the potential overlook more nuanced differences between age of onset at different stages of adolescence. Rahman et al. (2012) classified early onset as ≤11, however then only classified an older onset group as ≥12 and up to age 18, therefore not allowing comparison with adult age onset.

To date, no studies have utilised a large UK treatment seeking sample to specifically investigate the relationship between age of gambling onset and a range of variables thought to be associated with the development and maintenance of disordered gambling, specifically examining differences between children, adolescents and young adults/adults. Therefore, the current study sought to address this gap in the literature, and aimed to explore the relationship between age of gambling onset and other associated variables, with the following predictions:

In accordance with previous results (e.g. Burge et al., 2006; Jiménez-Murcia et al., 2010; Rahman et al., 2012), it was predicted that early-age onset gamblers would report increased gambling severity compared to later age onset gamblers. Furthermore, it was hypothesised that earlier-age onset of gambling would be associated with increased likelihood of demonstrating antisocial behavior such as getting in to physical fights, stealing and substance use disorders (e.g. Burge et al., 2006; Jackson, Dowling, Thomas, Bond, & Patton, 2008; Lynch et al., 2004) and with experience of a negative family background (e.g. parental gambling, Grant et al., 2009). Finally, consistent with previous literature (Jiménez-Murcia et al., 2010; Ronzitti et al., 2017; Shin et al., 2014) it was hypothesised that age of onset would not be associated with treatment outcome.

Section snippets

Treatment facility

The Gordon Moody Association (GMA) is a UK-wide gambling support service that provides different treatment options, including an intensive residential treatment programme at one of two UK centres (located in Dudley, West Midlands, and Beckenham, South-East London), relapse prevention housing, a mixed model of care (short intensive residential stays with at-home counselling support), post-treatment outreach support, and online support through Gambling Therapy. Individuals can be referred by

Gambling severity

Analysis indicated a statistically significant difference across the three groups for gambling severity (SOGS scores (Mean (s.d.): age ≤ 12 = 16.26 (2.47); age13–15 = 16.19 (2.36); age ≥ 16 = 15.35 (2.68)), F(2,353) = 5.247, p = .006. Post hoc Bonferroni tests (corrected for multiple comparisons) using a probability value of 0.006 indicated a non-statistically significant difference between the 16+ age group and the 13–15-year-old group (p = .035) as well as a non-statistically significant

Discussion

The current study sought to examine the relationships between age of gambling onset and a range of variables thought to be important to the development and maintenance of disordered gambling, in a cohort of pathological gamblers receiving treatment at a residential treatment facility. Implications of the results are discussed and avenues for further research are suggested.

Severity and gambling form

Results in the current study indicate that those who started gambling at a younger age reported more severe gambling problems at point of entry into treatment, than those who started gambling at a later age, supporting our first hypothesis. Although this finding is consistent with data reported by Burge et al. (2006), Jiménez-Murcia et al. (2010) and Rahman et al. (2012), the effect size was small and only a small amount of variance in SOGS scores was accounted for by age of gambling onset. It

Anti-social behavior

Our mixed results reflect inconsistencies observed in previous studies. The current study found younger age onset gamblers were more likely to abuse drugs or solvents, findings that although not directly comparable due to screening tools used, are broadly in line with the direction of previous findings in which early onset gamblers were more likely to have received treatment for alcohol use disorder, have started drinking at an earlier age, and to report lifetime cannabis and cocaine use (Burge

Negative experiences

Analysis indicates that gamblers who started at or under the age of 12 are significantly more likely to have endured a variety of negative experiences than gamblers with a later age of gambling onset, supporting our hypothesis, in part. Although not directly comparable as different screening tools were used, results are broadly congruent with previous research: Burge et al. (2006) found younger age onset gamblers scored higher on ASI subscales (Addiction Severity Index, McLellan et al., 1985)

Role of funding sources

The Principal Investigator, AR was awarded a Grant from the Research Investment Fund (RIF) at the University of Lincoln to code and analyse the initial Gordon Moody Data set. The funding source had no involvement in the study design, collection, analysis or interpretation of data, writing the manuscript, or the decision to submit the manuscript for publication.

Contributors

RM conducted the statistical analysis. SS wrote the first draft of the manuscript and all authors contributed to and have approved the final manuscript. All views expressed are those of the author(s).

Declaration of interest

In the last three years the research team have received the following funding: SS receives funding from the Society for the Study of Addiction via 3-year Academic Fellowship, has previously received grants from GambleAware and the NIHR, and was employed on AR's Research Investment Fund award. RM declares no conflict, and no funding sources. AR has received funding from Santander (Gambling and Interpersonal Violence), and an internal University of Lincoln award, the Research Investment Fund to

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