Elsevier

Addictive Behaviors

Volume 39, Issue 7, July 2014, Pages 1172-1175
Addictive Behaviors

Short Communication
Pathological gambling subtypes: A comparison of treatment-seeking and non-treatment-seeking samples from Brazil and Canada

https://doi.org/10.1016/j.addbeh.2014.03.006Get rights and content

Abstract

Background

Pathological gambling (PG) is a heterogeneous disorder. The identification and characterization of PG subtypes could lead to tailored treatment approaches, which may, in turn, improve treatment outcomes.

Objective

To investigate PG subtypes based on personality traits across two different cultural and clinical settings. Consistent with the Pathways Model, we hypothesized the presence of three subtypes (behaviorally conditioned — BC, emotionally vulnerable — EV, and antisocial impulsivist — AI).

Methods

140 PG adults from São Paulo, Brazil (SP sample) and 352 adults with PG (n = 214) or sub-clinical PG (n = 138) from Toronto, Canada (TO sample) completed the Temperament and Character Inventory (TCI). Latent-class analysis was used to investigate subtypes.

Results

A 2-class solution was the best model for the pooled SP and TO samples. Class 1 presented a normative personality profile and was composed exclusively of participants from Toronto (BC subtype). Class 2 was characterized by high novelty seeking, high harm avoidance, and low self-directedness, and included participants from both SP and TO (EV subtype). When sub-clinical PGs were excluded from the analysis, a single-class solution better characterized the SP and TO samples.

Conclusions

Our results suggest that PG severity, rather than community or clinical settings, may have an effect on PG subtypes. The generalizability of the results is limited by the demographic and clinical features of the selected samples. Future neurobiological studies may contribute to the categorization of subjects into PG subtypes based on different underlying biological pathways.

Introduction

Several studies have proposed that the identification of pathological gambling (PG) subtypes may be an important factor in the development of more specific treatment strategies (Blaszczynski and Nower, 2002, Ledgerwood and Petry, 2010, Milosevic and Ledgerwood, 2010). Blaszczynski and Nower (2002) proposed “the pathways model” for the development of PG, which has been generally investigated in terms of three PG subtypes: (1) behaviorally conditioned (BC), (2) emotionally vulnerable (EV), and (3) antisocial impulsivist (sic) (AI). Overall, studies have confirmed the pathways model subtypes; however, questions remain as to whether subtypes that have been identified in community samples can also be identified in clinical samples (Milosevic and Ledgerwood, 2010, Slutske et al., 2005). This is a critically important issue as most individuals who develop PG never seek treatment. Further, studies to date have been performed in English-speaking countries and predominantly Anglo-Saxon cultures (i.e., U.S., Canada, and Australia), such that little information is available regarding PG subtypes in other language groups and cultures.

The Temperament and Character Inventory (TCI) (Cloninger, Svrakic, & Przybeck, 1993) has been extensively used in psychiatry research (Albayrak et al., 2012, Goekoop et al., 2011, Kampman and Poutanen, 2011, Sarisoy et al., 2012). To date, two published studies have identified four PG subtypes using the TCI, with the first study using a community-based sample (Turner, Jain, Spence, & Zangeneh, 2008) and the second study using a clinical sample (Alvarez-Moya et al., 2010).

Our objective was to investigate PG subtypes based on the TCI in two different countries (Brazil and Canada) from two different samples — a treatment-seeking PG sample recruited from a clinical setting and a sample of non-treatment-seeking PGs, recruited from a community setting. We hypothesized that we would identify three PG subtypes consistent with Blaszczynski and Nower (2002) in both settings. We expected the BC subtype to be characterized by normative TCI trait levels, whereas both the EV and AI subtypes would be characterized by high Novelty Seeking and low Self-Directedness which are correlated with impulsivity measures (Piero, 2010, Yoo et al., 2006). We expected that Harm Avoidance would differentiate the EV and AI subtypes because it has been significantly associated with mood and anxiety disorders (Cloninger, Zohar, Hirschmann, & Dahan, 2012). We also hypothesized that the EV and AI subtypes would be found more frequently in the treatment-seeking sample, whereas the BC subtype would be more frequent in the community sample.

Section snippets

Sample and assessments

Pathological gamblers seeking treatment at the University of São Paulo (Tavares, Gentil, Oliveira, & Tavares, 1999) (Brazil) between 2001 and 2004 were invited to participate in a PG study (da Silva Lobo et al., 2007). In the São Paulo sample (SP sample) individuals who met ≥ 5 DSM-IV diagnostic criteria for PG were included the study. Psychiatric comorbidities were assessed through the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) (Wing et al., 1990).

Adult gamblers from Toronto

SP × TO samples

Compared with the TO sample, the SP sample presented a higher proportion of females (χ2(df) = 8.4(1), p < .001); and of individuals who were married or living with a partner (χ2(df) = 31(1), p < .001), who were employed (χ2(df) = 17(3), p = .001), and who presented higher PG severity (corrected for gender, F(df) = 151.5(1), p < .001, d = 1.3). The TO sample presented a higher proportion of individuals who completed high school (χ2 = 5, df = 1, p = .02).

The SP sample exhibited higher scores on NS (F(df) = 22.7(1), p < 

Discussion

Consistent with our hypotheses, we found a BC subtype characterized by normative TCI trait levels (Class 1), and an EV subtype characterized by higher NS and HA and lower SD compared to normative TCI trait levels (Class 2). Contrary to our hypotheses, we did not find a class representative of the AI subtype. The fact that we did not find PG subtypes when sub-clinical PG was excluded suggests that samples with a restricted range of PG symptomatology may not exhibit the same subtypes found in

Role of Funding Sources

Contributors Study concept and design: Daniela Lobo, Hermano Tavares, James Kennedy Acquisition of data: Brazil sample was collected by Drs. Lobo, Martins and Tavares under the supervision of Dr. Vallada. The Toronto sample was collected by Dr. Kennedy.

Contributors

Analysis and interpretation of data: Daniela Lobo, Lena Quilty, Michael Bagby Critical revision of the manuscript for important intellectual content: Drs. Daniela Lobo, Lena Quilty, Silvia Martins, Homero Vallada, Hermano Tavares, Michael Bagby and James Kennedy.

Conflict of interest

The authors declare that they have no conflicts of interest.

Acknowledgments

We would like to thank Prof. Valentim Gentil for revising previous versions of this manuscript and Ms. Tamara Arenovich for reviewing the statistical analyses. We would also like to acknowledge the Fundação de Amparo a Pesquisa do Estado de São Paulo (FAPESP) (02/02653-7 and 02/00009-3) and the Ontario Problem Gambling Research Centre (OPGRC) (2277) for providing the funding for this research.

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