Editorial

Problem gambling is a public health concern

The heterogeneity of gambling disorder (GD) has led to the identification of different subtypes, mostly including phenotypic features, with distinctive implications on the GD severity and treatment outcome. However, clustering analyses based on potential endophenotypic features, such as neuropsychological and neuroendocrine factors, are scarce so far.

This study firstly aimed to identify empirical clusters in individuals with GD based on sociodemographic (i.e., age and sex), neuropsychological (i.e., cognitive flexibility, inhibitory control, decision making, working memory, attention, and set-shifting), and neuroendocrine factors regulating energy homeostasis (i.e., leptin, ghrelin, adiponectin, and liver-expressed antimicrobial peptide 2, LEAP-2). The second objective was to compare the profiles between clusters, considering the variables used for the clustering procedure and other different sociodemographic, clinical, and psychological features.

297 seeking-treatment adult outpatients with GD (93.6% males, mean age of 39.58 years old) were evaluated through a semi-structured clinical interview, self-reported psychometric assessments, and a protocolized neuropsychological battery. Plasma concentrations of neuroendocrine factors were assessed in peripheral blood after an overnight fast. Agglomerative hierarchical clustering was applied using sociodemographic, neuropsychological, and neuroendocrine variables as indicators for the grouping procedure. Comparisons between the empirical groups were performed using Chi-square tests (χ²) for categorical variables, and analysis of variance (ANOVA) for quantitative measures.

Three-mutually-exclusive groups were obtained, being neuropsychological features those with the greatest weight in differentiating groups. The largest cluster (Cluster 1, 65.3%) was composed by younger males with strategic and online gambling preferences, scoring higher on self-reported impulsivity traits, but with a lower cognitive impairment. Cluster 2 (18.2%) and 3 (16.5%) were characterized by a significantly higher proportion of females and older patients with non-strategic gambling preferences and a worse neuropsychological performance. Particularly, Cluster 3 had the poorest neuropsychological performance, especially in cognitive flexibility, while Cluster 2 reported the poorest inhibitory control. This latter cluster was also distinguished by a poorer self-reported emotion regulation, the highest prevalence of food addiction, as well as a metabolic profile characterized by the highest mean concentrations of leptin, adiponectin, and LEAP-2.

To the best of our knowledge, this is the first study to identify well-differentiated GD clusters using neuropsychological and neuroendocrine features. Our findings reinforce the heterogeneous nature of the disorder and emphasize a role of potential endophenotypic features in GD subtyping. This more comprehensive characterization of GD profiles could contribute to optimize therapeutic interventions based on a medicine of precision.

le regroupement transversal des addictions sous l’intitulé « Substance related and addictive disorders » dans le DSM-5 a conduit à une politique commune en matière d’addictions et à la promotion de services d’addictologie prenant en charge tous les types d’addictions, incluant les addictions comportementales. L’objectif principal de cette étude était de décrire la prévalence du jeu problématique dans une population de patients en demande de soins en addictologie. Les objectifs secondaires étaient : de décrire l’usage d’Internet et la prévalence du trouble du jeu vidéo, de l’addiction sexuelle et des achats compulsifs en ligne ; de décrire une population de patients consultant en addictologie ; d’explorer les facteurs associés au jeu problématique.

Un auto-questionnaire a été construit, évaluant les éléments socio-démographiques, le parcours addictologique, le jeu problématique et l’usage d’internet avec un focus sur le trouble du jeu vidéo, l’addiction sexuelle et les achats compulsifs. Il a été proposé aux consultants de cinq centres d’addictologie en Bretagne.

252 patients en demande de soin pour une problématique addictive ont été inclus. Le jeu problématique était présent chez 9,9 % des patients. Les joueurs problématiques étaient plus susceptibles d’avoir été questionnés sur leurs habitudes de jeu par l’équipe d’addictologie que les autres patients. Le taux de repérage des habitudes de jeu, en addictologie ou en dehors, était globalement faible. L’usage d’Internet était de 83 %. Les prévalences des autres addictions comportementales en ligne étaient faibles.

La prévalence du jeu problématique était près de quatre fois plus élevée chez les consultants en addictologie, comparativement à la population générale. Le repérage des habitudes de jeu de hasard et d’argent concernait une faible proportion des patients inclus : il existe une marge importante d’amélioration du repérage du jeu problématique, en addictologie et en dehors. Il est important de questionner les habitudes de jeu pour tout motif de consultation addictologique et de répéter ce repérage dans le temps. Internet étant largement utilisé par les consultants en addictologie, il peut représenter un élément clef de la prise en charge, tant dans le repérage des addictions comportementales que dans le suivi.

Transversal grouping of addictions under the heading “Substance related and addictive disorders” in the DSM-5 has led to a common policy on addictions and the promotion of addiction services covering all types of addictions, including behavioral addictions.

The main objective of this study was to describe the prevalence of problem gambling in a population of patients seeking treatment in addictive disorders center. Secondary objectives were: to describe the use of Internet and the prevalence of gaming disorder, sexual addiction and compulsive buying online ; to describe a population of patients consulting in addictive disorders center; to explore associated factors related to problem gambling. A self-questionnaire was built, evaluating the socio-demographic elements, the addiction pathway, problem gambling and Internet use with a focus on video game disorder, sexual addiction and compulsive buying. It was offered to consultants from five addictology centers in Brittany.

252 patients seeking treatment for addictive disorders were included. Problem gambling was present in 9.9 % of patients. Problem gamblers were more likely to have been asked about their gambling by the addictology team than other patients. The rate of identification of gambling habits, whether in addiction or outside, was generally low. Internet use was 83 %. The prevalence of other online behavioral addictions was low.

The prevalence of problem gambling is almost 4 times higher among addictology consultants, compared to the general population, probably related to addictive comorbidities. The identification of gambling habits concerned a small proportion of the patients included, whether in specialized care or outside. There is significant room for improvement in the identification of problem gambling, in addictology and beyond. It is important to question gambling habits for any reason for addiction consultation and to repeat this identification over time. As the Internet is widely used by addictology consultants, it can represent a key element in care, both in the identification of behavioral addictions and in follow-up.

To obtain insights about the accessibility of UK gambling support services from the perspectives of individuals and organisations supporting migrants experiencing gambling-related harm.

Two focus groups were conducted in Leeds and London, United Kingdom, in 2018.

Thirty-two participants shared their views and experiences from their support work with migrant communities or support services and personal experiences. Thematic analysis identified four themes: (1) the relationship between gambling-related harm and migration, (2) the ‘harm paradox’ and migrant gambling, (3) barriers to help seeking and (4) ways to improve current support.

Participants considered that individuals’ migration history may impact on their gambling participation. They considered that recent migrants experience similar gambling-related harms to the UK general population; however, their experience of harms may be exacerbated or accelerated by socio-economic circumstances. Concerns surrounding trust, confidentiality, social interaction, integration and language proficiency were interwoven with barriers that migrants may encounter when engaging in help-seeking behaviour. Participants called for better evidence and understanding of the culturally specific and contextual harms that migrants may experience from their gambling. They advocated a stronger emphasis on prevention and the development of culturally competent gambling support services.

Migrants are vulnerable to gambling-related harm; however, existing gambling support services may not meet their needs. Efforts should be made to ensure gambling support services are accessible to migrants and culturally sensitive. More research is needed to investigate gambling-related harm from the perspectives of migrants and to improve the promotion, design, delivery and accessibility of gambling support services for this population.