Canadian Problem Gambling Index Scoring
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This article is available in: HTMLPDFjgi: p. 157 Journal Information
Journal ID (publisher-id): jgi
ISSN: 1910-7595
Publisher: Centre for Addiction and Mental Health
Article Information
© 1999-2008 The Centre for Addiction and Mental Health
Received Day: 25 Month: November Year: 2007
Accepted Day: 23 Month: July Year: 2008
Publication date: December 2008
First Page: 157 Last Page: 173
Publisher Id: jgi.2008.22.2
DOI: 10.4309/jgi.2008.22.2
Inconsistency between concept and measurement: The Canadian Problem Gambling Index (CPGI) Affiliation: School of Psychology, University of Sydney, NSW, Australia. E-mail: elenas@psych.usyd.edu.au
This article was peer-reviewed. All URLs were available at the time of submission.
For correspondence: Elena Svetieva, University of Sydney, Gambling Treatment Clinic, School of Psychology, A18, University of Sydney, Camperdown, NSW 2006, Australia, phone (+612) 9036 9336, elenas@psych.usyd.edu.au
Contributors: Both authors have been personally and actively involved in substantive work leading to the report.
Competing interests: None declared.
Ethics approval: None required.
Funding: ES and MW are employed at the Gambling Treatment Clinic (GTC), University of Sydney. The GTC is funded by the NSW Government’s Rehabilitation Gambling Fund.
Professor Dr. Michael Walker is Associate Professor of Psychology, Director of the Gambling Treatment Clinic and Co-Director of the Gambling Research Unit at The University of Sydney.
Elena Svetieva is a Research Associate at the Gambling Treatment Clinic.
“Problem” and “pathological” gambling represent core concepts that guide gambling research today. However, divergent interpretation of the relation between these terms is continually misguiding the measurement and interpretation of empirical data, and may cumulatively lead to larger-scale problems of conclusion and policy formulation over the next decade. This paper first attempts to unravel the conceptual muddle by outlining the trajectory of the usage of the two terms, from a period where both were dimensionally similar concepts firmly situated in the addiction model to a more recent conception, which takes the view that problem gambling is distinct and properly measured by focusing on the problems that excessive gambling may cause to individuals, families, and communities. We then aim to analyse and criticize the Canadian Problem Gambling Index (CPGI) as a clear example of the confusion of paradigms, an index that defines problem gambling in the newer, problem-centred model, but continues to measure it with items reflecting the older, addiction-centred model. We argue that results obtained using the CPGI, much like those of its predecessors, will not adequately capture the notion of harm that underpins current definitions of problem gambling. Introduction
Research in problem gambling is notorious for being plagued with a multitude of terms that seek to capture the construct, including “compulsive,” “pathological,” and “problem” gambling. These terms are ill-defined, often being used interchangeably and without an understanding of their theoretical origins and associated paradigms. Over the years, pragmatic concerns have relegated conceptual distinction to the wayside, with the view that making advances in treatment efficacy is more important than what is seen as a largely academic debate over terms and concepts. However, we wish to draw attention to an important conceptual distinction concerning the definition of problem gambling and to show how, in certain jurisdictions, failure to understand this conceptual distinction has led to muddled thinking, resulting in a bifurcation between concept and practice in the measurement of problem gambling, a bifurcation that may have significant consequences for future research and policy decisions. The addiction-based concept of problem gambling
In the literature on problem gambling, there are two quite different conceptions of what problem gambling is. The earlier conception has its origins in the development of the related concept of pathological gambling. Pathological gambling was added to the list of psychiatric disorders in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III; American Psychiatric Association, 1980). In the revision of this manual published in 1987 (DSM-III-R), the criteria for pathological gambling were based on those for substance dependence, and an underlying explanatory model of addiction was assumed (Walker, 1992). At the same time, the South Oaks Gambling Screen (SOGS; Lesieur & Blume, 1987) was developed as a clinical screen for diagnosing individuals as probable pathological gamblers. Importantly, the SOGS included items concerned with preoccupation, tolerance, withdrawal, and loss of control that overlapped with the DSM-III-R and are the core constructs of an addiction model. Thus, the construct of pathological gambling is not theoretically neutral either in its definition or in its measurement. Rather, this construct assumes that gambling can become an addiction that can be clinically diagnosed by signs that are similar to other addictions. Indeed, excessive gambling has been referred to as a “pure addiction” because the addiction exists without the associated chemical component of drug addiction (Custer & Milt, 1985; Jacobs, 1986).
*This nine-item screening tool can be self-administered or administered by a clinician. 18 It is an briefer version of the 31-item Canadian Problem Gambling Index. 13 It uses a four-point scale (“never” to “almost always”) to describe gambling behaviour over the previous 12 months. 19 An online version, called the Gambling Quiz, is available in English and in French.
*Problem Gambling Severity Index (PGSI) of the Canadian Problem Gambling Index (CPGI) (20) To measure prevalence of problem gambling in the community and distinguish between subtypes of problem gamblers in general population surveys Canada 9 Nationally representative random sample of individuals from the general household population (N = 3,120).
*Problem gambling using either the Canadian Problem Gambling Index (CPGI) (Ferris and Wynne, 2001) or the South Oaks Gambling Screen (SOGS) (Lesieur & Blume, 1987, 1993). These instruments define problem gambling as gambling that is associated with some significant adverse consequences for the individual.
In the SOGS, probable pathological gambling is diagnosed by a score of five or more positive answers to the 20 items on the list. Problem gambling is defined as a score of three or four positive answers to the same list of 20 items. Thus, the concept of problem gambling inherent in the SOGS is as a weaker form of pathological gambling. Pathological gambling and problem gambling share a common theoretical basis as terms related to addiction to gambling. There is now an extensive literature of research and argument that assumes that problem gambling and pathological gambling are closely related and only differ in severity. This conception of problem gambling as a weaker form of pathological gambling is explicitly stated in research on the prevalence of pathological and problem gambling (Petry & Tawfik, 2001). Problem and pathological gambling lie on the same dimension and differ only in the severity of the addiction. We label this older view “addiction-based” to discriminate it from the more recent “problem-centred” view. The problem-centred concept of problem gambling
To the Canadian Problem Gambling Index that was developed by Ferris and Wynne (2001) for adults, in that it is designed to provide a continuum of problem gambling severity (Stinchfield 2010) from non-problem gambling to high risk problem gambling. D Scoring in the Canadian Problem Gambling Index D.1 E Self-exclusion programs and exclusion on welfare grounds E.1 F Survey of clients of counselling agencies 2009 F.1 G Access to cash and credit: evidence G.1 H Australian litigation on gambling H.1 I The link between accessibility and gambling harms I.1 J Counselling services J.1.
The alternative problem-centred view of problem gambling is becoming increasingly popular. This more recent conceptualization is based in the distinction between excessive gambling behaviour and problems that are a consequence of that behaviour (Walker, 1992). By defining problem gambling as gambling problems that result from excessive gambling behaviour, this alternative conceptualization of problem gambling remains theoretically neutral. In particular, there is no implication that problem gambling involves an addiction to gambling. The focus of this alternative view of problem gambling is the degree of harm caused to the individual, not the mechanisms by which the gambling behaviour becomes excessive. It is a viewpoint that has found widespread international acceptance. In the United States (Cox, Lesieur, Rosenthal & Volberg, 1997; Lesieur, 1998), Canada (Ferris & Wynne, 2001), and Britain (Sproston, Erens, & Orford, 2000), problem gambling has been defined to encompass all gambling behaviour types and patterns that cause disruption and damage to a person’s functioning. Similarly in Australia, Dickerson, McMillen, Hallebone, Volberg, and Woolley (1997) defined problem gambling as “the situation when a person’s gambling activity gives rise to harm to the individual player, and/or to his family, and may extend into the community” (p. 106).
By highlighting the harms caused by excessive gambling behaviour, this alternative definition of problem gambling fits well within a public health model. The public health approach is a broad framework providing the perspective that problem gambling “is not restricted to a narrow focus on gambling addiction” (Shaffer, 2003, p. 15); that is, it is not just a problem of addiction and individual psychopathology, but rather a problem that exists in a social setting, is multiply determined, and has broad community effects (Korn, Gibbins, & Azmier, 2003; Shaffer, 2003). Rather than focusing on the addiction-like attributes of excessive gambling, the public health model focuses on harm caused by gambling, and by this virtue is designed to allow a better determination of the socio-economic impacts of gambling. This model also has several policy functions. Gamblers experiencing harm may not necessarily be those experiencing severe personal or psychological problems. By limiting the count of problem gamblers to those with specific psychological or psychiatric symptom profiles, policy efforts may fail to reach the larger numbers of individuals who are harmed by excessive gambling. Furthermore, as Shaffer and Korn (2002) point out, although members of this larger group may not be suffering from severe psychological impairment or psychopathology at the individual level, they collectively have the greatest impact on the community. For this reason, greater individual and community benefit may accumulate from intervention, treatment, and education measures directed at this larger group that is defined by the range and intensity of the harms caused by gambling. Despite the explicit definitions of problem gambling that underpin the emerging public health approach in Australia, Britain, Canada, and the United States, discussions of the public health model and its implications have sometimes lapsed into a confusion of the addiction-based concept and problem-centred conceptions that lie at the centre of the debate. These discussions have thereby, unintentionally, led to muddled conclusions. Shaffer (2003) for example, points out how a public health approach to problem gambling is akin to other addictions and communicable diseases. He advocates an
epidemiological examination of gambling and gambling-related disorders … to understand the distribution (i.e. pattern and spread) and determinants (i.e. origins) of gambling as well as the factors that influence a transition from healthy to unhealthy gambling… [O]nce scientists identify the base rate of an illness with some degree of precision, then they should direct attention to vulnerable groups with very high rates of the disorder. (p. 2) Smith mountain lake striper slot limit.
In this view, gambling prevalence research is similar to psychiatric epidemiology that directs treatment, harm reduction, and prevention efforts. This view also makes the assumption that problem gambling is a psychiatric disorder, that there exists a point at which gambling becomes “unhealthy,” and that problem gambling is a diagnosable “illness.” It is beyond the scope of this paper to review the empirical evidence that problem gambling is an illness or psychopathology (see Walker, 1992; Walker & Dickerson, 1996), or to restate any view that the illness model serves a socio-political rather than a scientific function (see Rosecrance, 1985). Suffice to say, the assumption is contentious and places the public health model into a theory-laden framework. The greater risk is that this assumption may further legitimize the use of clinical screening tools in prevalence studies, while at the same time ignoring the true implications of theory-neutral and widely accepted public-health definitions of problem gambling. Implications of the problem-centred concept for measurement
The problem-centred view of problem gambling assumes that excessive gambling behaviour causes a range of problems for the individual, for his or her family, and for the community. What constitutes excessive gambling depends on the characteristics of the individual and the extent to which his or her circumstances will tolerate a greater or lesser expenditure of money and time on the activity. It is not simply the volume of gambling or the size of the loss that defines problem gambling. There may be heavy time and monetary expenditure on gambling activities, but if there are no consequences of that behaviour, as may often be the case for gamblers with ample leisure time and large disposable incomes, then this cannot constitute problem gambling in the public health sense. It follows that it is not the characteristics of the gambling itself that define problem gambling but rather the fact that an individual may not limit the expenditure of money and time to stay within reasonable bounds of the resources available. The characteristics of the gambling may include the attributes of addiction, but this aspect alone is not a necessary or sufficient condition for the presence of problem gambling. A person may exhibit a preoccupation with gambling, tolerance effects for session length, and withdrawal symptoms when gambling ceases. However, if the gambling involves sufficiently small bets, no problems may follow. Chasing losses is frequently associated with problem gambling, but it is not the act of chasing that marks the onset of problem gambling, but the fact that chasing may cause the individual to cross the critical threshold of tolerable monetary loss. It is for this reason that we have seen an emergence of harm-based conceptualization of problem gambling in the past decade (Dickerson et al., 1997; Neal, Delfabbro, & O’Neil, 2005). For example, Neal et al. (2005) state, “Problem gambling is characterized by difficulties in limiting money and/or time spent on gambling which leads to adverse consequences for the gambler, others, or for the community” (p. 125). According to these widely accepted definitions, if the expenditure of money and time do not cause problems for the individual, others, or the community, then the gambling does not meet the necessary condition for the occurrence of problem gambling. It follows that problem gambling must be measured by the number and extent of the problems caused by the gambling, not by whether or not the gambling behaviour has the characteristics of addiction or any other individual psychopathology. Canadian Problem Gambling Index Scoring Chart
The re-conceptualization of problem gambling in terms of the harm caused by excessive gambling implies a re-evaluation of the methods by which problem gambling is screened and measured. The SOGS (Lesieur & Blume, 1987) has been used in almost all problem gambling prevalence research across the United States, Asia, Europe, and Canada (Shaffer, Hall & Vander Bilt, 1999; Sproston et al., 2000; Volberg, Abbott, Ronnberg, & Munck, 2001). Although recent prevalence studies in the United States (Gerstein et al., 1999) have also used a screen based on DSM-IV (1994), such as the NODS, the SOGS remains as one of the most widely used prevalence measures in the world (Abbot & Volberg, 2006). Over the period of its use, the SOGS has received an accumulation of criticism directed at the context and assumptions behind its development (Volberg, 2001), its outdated criteria (Volberg, 1996), and the validity of its estimates (Walker & Dickerson, 1996). The Canadian Problem Gambling Index (CPGI)
One recently developed scale, the Canadian Problem Gambling Index (CPGI), has received attention as a potential successor to previous instruments. Developed largely as a response to the criticism around the SOGS, the CPGI has been presented as a modern and promising tool for use in problem gambling prevalence research. The scale as a whole contains 31 items (plus demographics) that cover gambling involvement, problem gambling assessment, and correlates of problem gambling (Ferris & Wynne, 2001). Only nine of those items are scored, and they comprise the Problem Gambling Severity Index (PGSI), an index designed to serve both as a prevalence measure and a general population screen that is brief, reliable, and provides adequate estimates of the problem.
In the first stage of the development of the CPGI, the Canadian Inter-Provincial Task Force on Problem Gambling adopted the following definition of problem gambling: “Problem gambling is gambling behaviour that creates negative consequences for the gambler, others in his or her social network, or for the community” (Ferris & Wynne, 2001, Introduction at 1.2). This definition takes as its focus the consequences or harm of gambling activity, and is very similar to that proposed earlier by Dickerson et al. (1997) and Neal et al. (2005). Although it is a problem-centred definition suitable for use within the public health model, the developers of the CPGI state that that they still sought to develop the PGSI as a measure of both problem behaviour and adverse consequences (Ferris & Wynne, 2001).
In addition to adopting a harm-based operational definition, the PGSI also involved the creation of a range of categories into which respondents may fall: non-gamblers, non-problem gamblers, low-risk gamblers, moderate-risk gamblers, and problem gamblers. The ordinal sub-types of the PGSI suggest a problem gambling continuum, and so are seen as a substantial improvement to the dichotomous and discrete variables encompassed in instruments such as the DSM-IV (1994) and the SOGS. In brief, in the CPGI’s rationale and associated fea
https://diarynote-jp.indered.space
This article is available in: HTMLPDFjgi: p. 157 Journal Information
Journal ID (publisher-id): jgi
ISSN: 1910-7595
Publisher: Centre for Addiction and Mental Health
Article Information
© 1999-2008 The Centre for Addiction and Mental Health
Received Day: 25 Month: November Year: 2007
Accepted Day: 23 Month: July Year: 2008
Publication date: December 2008
First Page: 157 Last Page: 173
Publisher Id: jgi.2008.22.2
DOI: 10.4309/jgi.2008.22.2
Inconsistency between concept and measurement: The Canadian Problem Gambling Index (CPGI) Affiliation: School of Psychology, University of Sydney, NSW, Australia. E-mail: elenas@psych.usyd.edu.au
This article was peer-reviewed. All URLs were available at the time of submission.
For correspondence: Elena Svetieva, University of Sydney, Gambling Treatment Clinic, School of Psychology, A18, University of Sydney, Camperdown, NSW 2006, Australia, phone (+612) 9036 9336, elenas@psych.usyd.edu.au
Contributors: Both authors have been personally and actively involved in substantive work leading to the report.
Competing interests: None declared.
Ethics approval: None required.
Funding: ES and MW are employed at the Gambling Treatment Clinic (GTC), University of Sydney. The GTC is funded by the NSW Government’s Rehabilitation Gambling Fund.
Professor Dr. Michael Walker is Associate Professor of Psychology, Director of the Gambling Treatment Clinic and Co-Director of the Gambling Research Unit at The University of Sydney.
Elena Svetieva is a Research Associate at the Gambling Treatment Clinic.
“Problem” and “pathological” gambling represent core concepts that guide gambling research today. However, divergent interpretation of the relation between these terms is continually misguiding the measurement and interpretation of empirical data, and may cumulatively lead to larger-scale problems of conclusion and policy formulation over the next decade. This paper first attempts to unravel the conceptual muddle by outlining the trajectory of the usage of the two terms, from a period where both were dimensionally similar concepts firmly situated in the addiction model to a more recent conception, which takes the view that problem gambling is distinct and properly measured by focusing on the problems that excessive gambling may cause to individuals, families, and communities. We then aim to analyse and criticize the Canadian Problem Gambling Index (CPGI) as a clear example of the confusion of paradigms, an index that defines problem gambling in the newer, problem-centred model, but continues to measure it with items reflecting the older, addiction-centred model. We argue that results obtained using the CPGI, much like those of its predecessors, will not adequately capture the notion of harm that underpins current definitions of problem gambling. Introduction
Research in problem gambling is notorious for being plagued with a multitude of terms that seek to capture the construct, including “compulsive,” “pathological,” and “problem” gambling. These terms are ill-defined, often being used interchangeably and without an understanding of their theoretical origins and associated paradigms. Over the years, pragmatic concerns have relegated conceptual distinction to the wayside, with the view that making advances in treatment efficacy is more important than what is seen as a largely academic debate over terms and concepts. However, we wish to draw attention to an important conceptual distinction concerning the definition of problem gambling and to show how, in certain jurisdictions, failure to understand this conceptual distinction has led to muddled thinking, resulting in a bifurcation between concept and practice in the measurement of problem gambling, a bifurcation that may have significant consequences for future research and policy decisions. The addiction-based concept of problem gambling
In the literature on problem gambling, there are two quite different conceptions of what problem gambling is. The earlier conception has its origins in the development of the related concept of pathological gambling. Pathological gambling was added to the list of psychiatric disorders in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III; American Psychiatric Association, 1980). In the revision of this manual published in 1987 (DSM-III-R), the criteria for pathological gambling were based on those for substance dependence, and an underlying explanatory model of addiction was assumed (Walker, 1992). At the same time, the South Oaks Gambling Screen (SOGS; Lesieur & Blume, 1987) was developed as a clinical screen for diagnosing individuals as probable pathological gamblers. Importantly, the SOGS included items concerned with preoccupation, tolerance, withdrawal, and loss of control that overlapped with the DSM-III-R and are the core constructs of an addiction model. Thus, the construct of pathological gambling is not theoretically neutral either in its definition or in its measurement. Rather, this construct assumes that gambling can become an addiction that can be clinically diagnosed by signs that are similar to other addictions. Indeed, excessive gambling has been referred to as a “pure addiction” because the addiction exists without the associated chemical component of drug addiction (Custer & Milt, 1985; Jacobs, 1986).
*This nine-item screening tool can be self-administered or administered by a clinician. 18 It is an briefer version of the 31-item Canadian Problem Gambling Index. 13 It uses a four-point scale (“never” to “almost always”) to describe gambling behaviour over the previous 12 months. 19 An online version, called the Gambling Quiz, is available in English and in French.
*Problem Gambling Severity Index (PGSI) of the Canadian Problem Gambling Index (CPGI) (20) To measure prevalence of problem gambling in the community and distinguish between subtypes of problem gamblers in general population surveys Canada 9 Nationally representative random sample of individuals from the general household population (N = 3,120).
*Problem gambling using either the Canadian Problem Gambling Index (CPGI) (Ferris and Wynne, 2001) or the South Oaks Gambling Screen (SOGS) (Lesieur & Blume, 1987, 1993). These instruments define problem gambling as gambling that is associated with some significant adverse consequences for the individual.
In the SOGS, probable pathological gambling is diagnosed by a score of five or more positive answers to the 20 items on the list. Problem gambling is defined as a score of three or four positive answers to the same list of 20 items. Thus, the concept of problem gambling inherent in the SOGS is as a weaker form of pathological gambling. Pathological gambling and problem gambling share a common theoretical basis as terms related to addiction to gambling. There is now an extensive literature of research and argument that assumes that problem gambling and pathological gambling are closely related and only differ in severity. This conception of problem gambling as a weaker form of pathological gambling is explicitly stated in research on the prevalence of pathological and problem gambling (Petry & Tawfik, 2001). Problem and pathological gambling lie on the same dimension and differ only in the severity of the addiction. We label this older view “addiction-based” to discriminate it from the more recent “problem-centred” view. The problem-centred concept of problem gambling
To the Canadian Problem Gambling Index that was developed by Ferris and Wynne (2001) for adults, in that it is designed to provide a continuum of problem gambling severity (Stinchfield 2010) from non-problem gambling to high risk problem gambling. D Scoring in the Canadian Problem Gambling Index D.1 E Self-exclusion programs and exclusion on welfare grounds E.1 F Survey of clients of counselling agencies 2009 F.1 G Access to cash and credit: evidence G.1 H Australian litigation on gambling H.1 I The link between accessibility and gambling harms I.1 J Counselling services J.1.
The alternative problem-centred view of problem gambling is becoming increasingly popular. This more recent conceptualization is based in the distinction between excessive gambling behaviour and problems that are a consequence of that behaviour (Walker, 1992). By defining problem gambling as gambling problems that result from excessive gambling behaviour, this alternative conceptualization of problem gambling remains theoretically neutral. In particular, there is no implication that problem gambling involves an addiction to gambling. The focus of this alternative view of problem gambling is the degree of harm caused to the individual, not the mechanisms by which the gambling behaviour becomes excessive. It is a viewpoint that has found widespread international acceptance. In the United States (Cox, Lesieur, Rosenthal & Volberg, 1997; Lesieur, 1998), Canada (Ferris & Wynne, 2001), and Britain (Sproston, Erens, & Orford, 2000), problem gambling has been defined to encompass all gambling behaviour types and patterns that cause disruption and damage to a person’s functioning. Similarly in Australia, Dickerson, McMillen, Hallebone, Volberg, and Woolley (1997) defined problem gambling as “the situation when a person’s gambling activity gives rise to harm to the individual player, and/or to his family, and may extend into the community” (p. 106).
By highlighting the harms caused by excessive gambling behaviour, this alternative definition of problem gambling fits well within a public health model. The public health approach is a broad framework providing the perspective that problem gambling “is not restricted to a narrow focus on gambling addiction” (Shaffer, 2003, p. 15); that is, it is not just a problem of addiction and individual psychopathology, but rather a problem that exists in a social setting, is multiply determined, and has broad community effects (Korn, Gibbins, & Azmier, 2003; Shaffer, 2003). Rather than focusing on the addiction-like attributes of excessive gambling, the public health model focuses on harm caused by gambling, and by this virtue is designed to allow a better determination of the socio-economic impacts of gambling. This model also has several policy functions. Gamblers experiencing harm may not necessarily be those experiencing severe personal or psychological problems. By limiting the count of problem gamblers to those with specific psychological or psychiatric symptom profiles, policy efforts may fail to reach the larger numbers of individuals who are harmed by excessive gambling. Furthermore, as Shaffer and Korn (2002) point out, although members of this larger group may not be suffering from severe psychological impairment or psychopathology at the individual level, they collectively have the greatest impact on the community. For this reason, greater individual and community benefit may accumulate from intervention, treatment, and education measures directed at this larger group that is defined by the range and intensity of the harms caused by gambling. Despite the explicit definitions of problem gambling that underpin the emerging public health approach in Australia, Britain, Canada, and the United States, discussions of the public health model and its implications have sometimes lapsed into a confusion of the addiction-based concept and problem-centred conceptions that lie at the centre of the debate. These discussions have thereby, unintentionally, led to muddled conclusions. Shaffer (2003) for example, points out how a public health approach to problem gambling is akin to other addictions and communicable diseases. He advocates an
epidemiological examination of gambling and gambling-related disorders … to understand the distribution (i.e. pattern and spread) and determinants (i.e. origins) of gambling as well as the factors that influence a transition from healthy to unhealthy gambling… [O]nce scientists identify the base rate of an illness with some degree of precision, then they should direct attention to vulnerable groups with very high rates of the disorder. (p. 2) Smith mountain lake striper slot limit.
In this view, gambling prevalence research is similar to psychiatric epidemiology that directs treatment, harm reduction, and prevention efforts. This view also makes the assumption that problem gambling is a psychiatric disorder, that there exists a point at which gambling becomes “unhealthy,” and that problem gambling is a diagnosable “illness.” It is beyond the scope of this paper to review the empirical evidence that problem gambling is an illness or psychopathology (see Walker, 1992; Walker & Dickerson, 1996), or to restate any view that the illness model serves a socio-political rather than a scientific function (see Rosecrance, 1985). Suffice to say, the assumption is contentious and places the public health model into a theory-laden framework. The greater risk is that this assumption may further legitimize the use of clinical screening tools in prevalence studies, while at the same time ignoring the true implications of theory-neutral and widely accepted public-health definitions of problem gambling. Implications of the problem-centred concept for measurement
The problem-centred view of problem gambling assumes that excessive gambling behaviour causes a range of problems for the individual, for his or her family, and for the community. What constitutes excessive gambling depends on the characteristics of the individual and the extent to which his or her circumstances will tolerate a greater or lesser expenditure of money and time on the activity. It is not simply the volume of gambling or the size of the loss that defines problem gambling. There may be heavy time and monetary expenditure on gambling activities, but if there are no consequences of that behaviour, as may often be the case for gamblers with ample leisure time and large disposable incomes, then this cannot constitute problem gambling in the public health sense. It follows that it is not the characteristics of the gambling itself that define problem gambling but rather the fact that an individual may not limit the expenditure of money and time to stay within reasonable bounds of the resources available. The characteristics of the gambling may include the attributes of addiction, but this aspect alone is not a necessary or sufficient condition for the presence of problem gambling. A person may exhibit a preoccupation with gambling, tolerance effects for session length, and withdrawal symptoms when gambling ceases. However, if the gambling involves sufficiently small bets, no problems may follow. Chasing losses is frequently associated with problem gambling, but it is not the act of chasing that marks the onset of problem gambling, but the fact that chasing may cause the individual to cross the critical threshold of tolerable monetary loss. It is for this reason that we have seen an emergence of harm-based conceptualization of problem gambling in the past decade (Dickerson et al., 1997; Neal, Delfabbro, & O’Neil, 2005). For example, Neal et al. (2005) state, “Problem gambling is characterized by difficulties in limiting money and/or time spent on gambling which leads to adverse consequences for the gambler, others, or for the community” (p. 125). According to these widely accepted definitions, if the expenditure of money and time do not cause problems for the individual, others, or the community, then the gambling does not meet the necessary condition for the occurrence of problem gambling. It follows that problem gambling must be measured by the number and extent of the problems caused by the gambling, not by whether or not the gambling behaviour has the characteristics of addiction or any other individual psychopathology. Canadian Problem Gambling Index Scoring Chart
The re-conceptualization of problem gambling in terms of the harm caused by excessive gambling implies a re-evaluation of the methods by which problem gambling is screened and measured. The SOGS (Lesieur & Blume, 1987) has been used in almost all problem gambling prevalence research across the United States, Asia, Europe, and Canada (Shaffer, Hall & Vander Bilt, 1999; Sproston et al., 2000; Volberg, Abbott, Ronnberg, & Munck, 2001). Although recent prevalence studies in the United States (Gerstein et al., 1999) have also used a screen based on DSM-IV (1994), such as the NODS, the SOGS remains as one of the most widely used prevalence measures in the world (Abbot & Volberg, 2006). Over the period of its use, the SOGS has received an accumulation of criticism directed at the context and assumptions behind its development (Volberg, 2001), its outdated criteria (Volberg, 1996), and the validity of its estimates (Walker & Dickerson, 1996). The Canadian Problem Gambling Index (CPGI)
One recently developed scale, the Canadian Problem Gambling Index (CPGI), has received attention as a potential successor to previous instruments. Developed largely as a response to the criticism around the SOGS, the CPGI has been presented as a modern and promising tool for use in problem gambling prevalence research. The scale as a whole contains 31 items (plus demographics) that cover gambling involvement, problem gambling assessment, and correlates of problem gambling (Ferris & Wynne, 2001). Only nine of those items are scored, and they comprise the Problem Gambling Severity Index (PGSI), an index designed to serve both as a prevalence measure and a general population screen that is brief, reliable, and provides adequate estimates of the problem.
In the first stage of the development of the CPGI, the Canadian Inter-Provincial Task Force on Problem Gambling adopted the following definition of problem gambling: “Problem gambling is gambling behaviour that creates negative consequences for the gambler, others in his or her social network, or for the community” (Ferris & Wynne, 2001, Introduction at 1.2). This definition takes as its focus the consequences or harm of gambling activity, and is very similar to that proposed earlier by Dickerson et al. (1997) and Neal et al. (2005). Although it is a problem-centred definition suitable for use within the public health model, the developers of the CPGI state that that they still sought to develop the PGSI as a measure of both problem behaviour and adverse consequences (Ferris & Wynne, 2001).
In addition to adopting a harm-based operational definition, the PGSI also involved the creation of a range of categories into which respondents may fall: non-gamblers, non-problem gamblers, low-risk gamblers, moderate-risk gamblers, and problem gamblers. The ordinal sub-types of the PGSI suggest a problem gambling continuum, and so are seen as a substantial improvement to the dichotomous and discrete variables encompassed in instruments such as the DSM-IV (1994) and the SOGS. In brief, in the CPGI’s rationale and associated fea
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