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Screening Tests for Gambling Disorder Get Poor Marks

Researchers and addiction specialists use the term problem gambler to refer informally to people who develop dysfunctional patterns of gambling-related behavior. In the U.S., doctors can officially diagnose this behavior as a form of behavioral addiction called gambling disorder. There are a number of screening tests available to help identify problem gamblers. In a study published in 2014 in the journal International Gambling Studies, a team of U.S. and Canadian researchers used a large-scale project to explore the accuracy of these tests. The researchers concluded that several of the most widely used measurements for problem gambling vary considerably in their level of precision. 

Problem Gambling

A number of symptoms can indicate the presence of problematic involvement in gambling activities. Examples of these symptoms include losing the ability to limit gambling participation, taking part in progressively risky gambling activities, turning to gambling as an escape from unwanted emotions or feelings, experiencing an increase in moodiness when gambling options are not available, lying to conceal gambling participation and returning rapidly to gambling after losing considerable amounts of money. In order to qualify for a gambling disorder diagnosis under the terms set forth by the American Psychiatric Association (APA), any given individual must have at least four out of nine possible symptoms. The APA includes gambling disorder in a category called addictive disorders specifically reserved for behavioral addictions. The diagnosis was established in 2013 and replaces an outmoded condition called pathological gambling, which relied on a similar but different set of criteria to classify serious gambling problems.

Gambling Screening Tests

Screening tests used to identify gambling problems and potential candidates for an official diagnosis in the U.S. and other countries include the Problem and Pathological Gambling Measure (PPGM), the NORD DSM-IV Screen for Gambling Problems (NODS), the Canadian Problem Gambling Index (CPGI) and the South Oaks Gambling Screen (SOGS-R). All of these tools probe questions related to gambling behaviors; however, the specific questions asked and the format of the provided answers varies from test to test. For example, the Problem and Pathological Gambling Measure uses 14 questions to explore gambling-related issues, as well as more general issues concerning the inability to control one’s behavior. The Canadian Problem Gambling Index, on the other hand, uses 31 questions to probe problematic gambling behaviors. The well-known South Oaks Gambling Screen relies on 20 questions with various answer formats (yes/no, multiple choice, etc.) to identify potential gambling problems.

Gauging Accuracy

In the study published in International Gambling Studies, researchers from Gemini Research and Canada’s University of Lethbridge used a project involving 7,272 adults to gauge the accuracy of the Problem and Pathological Gambling Measure, the Canadian Problem Gambling Index, the South Oaks Gambling Screen and the NORD DSM-IV Screen for Gambling Problems. For all four tests, this process included a comparison to the real-world results of doctors who diagnose gambling problems in their patients. Each study participant took the four gambling tests and then underwent assessment by two doctors. The researchers concluded that all four tests do a good job at identifying people who do not qualify as problem gamblers, characterized by such things as accurately predicting who won’t go on to develop diagnosable symptoms and specifying the traits of non-problematic gamblers. However, they also concluded that the tests do not perform equally well when it comes to deciding who does qualify as a problem gambler. The test that consistently produced the most accurate results is the Problem and Pathological Gambling Measure. One of the remaining tests, the NORD DSM-IV Screen for Gambling Problems, partially predicted who will develop diagnosable gambling problems, but didn’t do a good job of specifying the traits of problem gamblers. The two other tests did only a passable job of predicting who will develop diagnosable problems. The study’s authors undertook their project, in part, because the results of screening tests for gambling problems often don’t match up with the symptoms doctors regularly observe in their patients. Overall, they concluded that the South Oaks Gambling Screen, Canadian Problem Gambling Index and NORD DSM-IV Screen actually produced better results than previous research efforts had indicated. Still, they note that these three procedures are still relatively inaccurate when compared to the Problem and Pathological Gambling Measure. However, the authors also specifically note that fairly modest adjustments in the minimum qualifications used to identify problems could considerably improve the reliability of all three of these screening tests.  

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