The WAGER, Vol. 18(3) – Three roads to pain: Testing the pathways model for problem gambling

During 2002, Blaszczynski and Nower proposed that there are
three pathways to problem and pathological gambling. In their first pathway,
problem gambling develops as a matter of behavioral conditioning, not as a
matter of psychopathology. In their second pathway, factors such as mood disorders,
 poor coping skills, and traumatic life
events contribute to the production of an “emotionally vulnerable gambler” who
gambles to relieve pain (Blaszczynski & Nower, 2002). In their third pathway, emotional
vulnerability combines with impulsivity and attention and personality disorders
to create many problems, including gambling. Today’s WAGER reports on research (Nower, Martins, Lin, & Blanco, 2012) that searches for symptom
clusters corresponding to these three pathways  using data from of the National
Epidemiological Survey on Alcohol and Related Conditions.

Methods

• The study used data from the U.S. National
  Epidemiological Survey on Alcohol and Related Conditions (NESARC) (Grant & Dawson, 2006).
  • The data were reduced to include only and all
    disordered gambling participants (n =
    581).[1]
  • The researchers analyzed participants’ responses
    to questions about alcohol use, tobacco use, other medications and drugs,
    psychological disorders, family history of addiction and psychological
    problems, gambling, medical conditions and victimization.
• The researchers used latent
  class analysis to identify subgroups within the NESARC disordered gambling
  population based on a combination of 17 clinical indicators.  
  • They
    evaluated models with between 1 and 5 classes to identify the optimal model
    (i.e. the model that best fit the observed data).
  • The researchers identified the optimal model by
    examining statistics (i.e. log-likelihood
    statistics, AIC
    and BIC)..

Results

• Out of the five models, the optimal one was the
  one with three classes.
• The probability that someone in Class 1 (n =
  295) had a prior-to-past-year experience with a substance use disorder was 55%.
  The probabilities for most other indicators of psychological problems were
  under 10%. Participants in this group reported relatively high mental health
  functioning.
  • Based on these clinical indicators, researchers
    suggested that Class 1 corresponds to the first Blaszczynski and Nower (2002) pathway.
• The probability that someone in Class 2 (n =
  117) had a prior-to-past-year experience with a substance use disorder was 74%.
  Other probabilities of note were those of physical fights due to drinking
  (33%), anti-social personality disorder (23%), panic disorder or general
  anxiety disorder (22%), and onset of the first episode of depression in the
  past year (22%).
  • Because of the elevated probabilities of signs
    of emotional vulnerability, the researchers suggested that Class 2 was
    generally consistent with the second Blaszczynski and Nower (2002) pathway.
• The probability that someone in Class 3 (n =
  169) had a prior-to-past-year experience with a substance use disorder was 78%.
  Additionally, the probabilities of a history of antisocial personality
  disorder, past-year substance abuse disorder, and involvement in drinking-related
  physical fights were 49%, 43% and 40%, respectively.
  • Class 3 had the highest probabilities out of the
    three classes for 12 out of the 17 indicators. The researchers drew parallels
    between Class 3 and the third Blaszczynski and Nower (2002) pathway.
• Figure 1 is a 3-dimensional graph with the
  probabilities for prior-to-past-year alcohol abuse, prior-to-past-year history
  of drinking-related physical fights, and lifetime anti-social personality
  disorder, for the three classes. These three example indicators and the three
  locations in space illustrate the differences between Class 1, Class 2, and
  Class 3.

Figure 1: Probabilities of lifetime anti-social personality
disorder, prior-to-past-year abuse or dependence of alcohol or drugs, and
prior-to-past-year history of physical fights due to drinking, for each of the
three classes. Adapted from Nower et al., 2013.