research challenges

What affects the prevalence of gambling disorders in a given area? Is it access to gambling activities in general, access to a specific type of gambling activity, demographic characteristics, local norms, the presence of an underlying addictive syndrome, or some combination of these factors and others? These questions have been asked for many years and have inspired much debate in both political and academic circles. Studying a question like this requires competent and willing researchers, but also a favorable situation for research.

Unlike clinical trials, people cannot be randomly assigned to live within a certain distance of a casino, to prefer a particular gambling activity, or to have some particular demographic trait. This limitation can be overcome by taking advantage of “natural experiments,” times when some variable in a community changes and researchers can isolate the effect that variable has on the prevalence of gambling disorders in the community.

One such natural experiment will take place in Maryland over the next several years with the legalization of slot machines. The results of the first study measuring baseline disordered gambling in the state has just been released to the public, and further studies will be completed over the next several years to assess the effect (if any) of the addition of slot machines to existing gambling opportunities (Shinogle, Norris, et al., 2011).              

Measuring addictive behaviors accurately is very difficult. Among the many complications are recruiting subjects, relying on their memory and self-report and quantifying the difference between pathological actions and actions that are merely unusual or uncommon. (Jerome Wakefield, Ph.D., discussed this topic in detail at the NCRG conference 2010.) One particularly difficult aspect of studying addiction is the diagnostic screening instrument (when scored, the instrument shows whether or not a person should be diagnosed with a particular disorder). Diagnostic screens of all kinds pose the problem of advancement versus consistency: It is always possible to make a newer and better instrument, but a new instrument means that studies conducted with the older one cannot be directly compared to studies conducted with the new instrument. This tension dictates that new instruments must be shown as better along several lines to make them worth implementing. Two researchers at the forefront of this discussion for gambling disorders are Erica Fortune and Adam Goodie, Ph.D., at the University of Georgia. Fortune and Goodie recently published a study, partly funded by a grant from the NCRG to Dr. Goodie, that compares the performance of two diagnostic screens in a population of college students (Fortune & Goodie, 2010).   

Sunday's third general session at the 11th annual NCRG Conference on Gambling and Addiction focused on an innovative approach to connecting health care providers and researchers with people in under-served communities.

Linda Cottler, Ph.D., professor of of epidemiology at Washington University School of Medicine in St. Louis, presented “HealthStreet: An Innovative Strategy for Involving Under-served Populations in Research on Gambling and Other Disorders.” The HealthStreet program, which began in the 1990s as an HIV treatment program housed in a rundown movie theater, has expanded to collect data on dozens of health measures, while connecting people to health resources and research studies in every corner of St. Louis.

The recently proposed changes to the definition of pathological gambling for the next edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) prompted us to think about the dizzying pace of change within the field over the past 30 years.

In this month’s Issues & Insights, four researchers reflect on the progress of the field by answering the question, “What has been the most significant change in how scientists look at disordered gambling over the past 30 years?” Their conclusions range from the inclusion of pathological gambling in the DSM-III in 1980 to advances in understanding the neurobiology of disordered gambling behavior. All agree that there have been tremendous advances in the field in the past three decades. You can read their full comments in June’s Issues & Insights.

What do you think has been the most significant change in gambling research during the past 30 years? Share your thoughts with us in the comments section below.

To understand why tribal governments are reluctant to allow “outside” researchers to study their communities, consider the following story. In 2004, the Havasupai Tribe filed a lawsuit against Arizona State University (ASU) charging that ASU researchers had misused blood samples taken from tribal members who had been told that the sample material would be used for a study on the genetics of diabetes. The Havasupai later learned that the samples were also used for research on schizophrenia, inbreeding and migration patterns, without the tribe’s consent.