1. The impact of childhood maltreatment on youth gambling problems Jeffrey L. Derevensky, Ph.D. Jennifer Felsher, Ph.D. Rina Gupta, Ph.D. McGill University International Centre for Youth Gambling Problems and High-Risk Behaviors www.youthgambling.com Nova Scotia Responsible Gambling Annual Conference October, 2011

2. Background Adolescent gambling and problem gambling rates have been well established Considerable knowledge has been gained concerning the correlates associated with youth problem gambling There has been a growing interest in identifying predisposing factors for risk of adolescent problem gambling

3. Etiology of Problem Gambling Blaszczynski and Nower (2002) identified three distinct subgroups of pathological gamblers: – Behaviourally conditioned problem gambler – Emotionally vulnerable problem gambler – Antisocial impulsivist problem gambler Emotionally vulnerable problem gambler: – Anxiety – Depression – Poor coping and problem solving – Experience negative life experiences – Use gambling to modulate affective states

4. Jacob’s General Theory Jacob’s (1986) General Theory of Addiction Importance of childhood maltreatment

5. Maltreatment Increased chronic stress Maladaptive psychological adjustment Increased social adjustment difficulties Mental health problems Increased risk for addictive problems (substance abuse disorders)

6. Childhood Maltreatment Physical abuse Emotional abuse Sexual abuse Emotional neglect Physical neglect

7. Current Research To determine whether childhood maltreatment is a risk factor in the development of gambling problems Investigated role of life experiences (stress, psychiatric symptomatology and resilience) as contributing factors for youth with gambling problems

8. Participants 566 males Mean age = 18.72 757 femalesMean age = 18.61 Total 1327Mean age = 18.66

9. Instruments DSM-IV Criteria for Pathological Gambling - (APA, 2000) Gambling Activities Questionnaire (GAQ) - (Gupta & Derevensky, 1996) The Adolescent Diagnostic Interview - Light (ADI-L) - (Winters & Henly, 1993; Winters, Stinchfield, Fulkerson, & Henly, 1993) Childhood Trauma Questionnaire (CTQ) - (Bernstein & Fink, 1998) Perceived Stress Scale (PSS) - (Cohen, Kamarck, & Mermelstein, 1983) Brief Symptom Inventory (BSI) - (Derogatis, 1993) The Personal Style Inventory (PSI) - (Sheridan, 2003)

10. Table 1 Gambling Severity by Gender ¹ DSM-IV score (0-2). ² DSM-IV score (3-4). ³ DSM score (≥ 5). 4 participants did not complete the GAQ or DSM-IV.

11. Table 2 Involvement in Gambling Activities: Gender Differences ActivitiesGambling Involvementª Occasional¹Regular² MaleFemaleMaleFemale Cards**37.728.77.72.9 Scratch tickets*41.746.91.93.0 Lottery draws30.331.23.72.0 Sports lottery**19.53.34.30 Sports pools**28.17.03.70.1 Bingo**9.918.90.50.8 Casino32.625.52.50.1 VLT machines**27.518.72.50.3 Internet*2.82.60.90 Stock Market**10.43.22.30.3 Racetrack**4.01.10.90.1 Other11.32.12.30.4 ª Percentage. ¹ Refers to gambling less than once a week. ² Refers to gambling once a week or more *p <.05. **p <.001.

12. Table 3a Severity of Childhood Maltreatment by Genderª CTQ Subscales¹Degree of Maltreatment (MT) ² None or minimal Low- moderate Moderate- severe Severe- extreme Total MT Endorsement Emotional Abuse* Male68.620.75.65.131.4 Female61.025.07.56.539.0 Total64.323.16.75.935.7 Physical Abuse Male79.010.84.95.321.0 Female82.27.94.55.417.8 Total80.89.14.75.419.2 Sexual Abuse Male89.44.94.21.410.5 Female85.44.65.84.114.5 Total87.24.85.12.912.8 ª Percentage. ¹ CTQ = Childhood Trauma Questionnaire. ² Severity of maltreatment based on standardized cut scores. *p <.05.

13. Table 3b Severity of Childhood Maltreatment by Genderª CTQ Subscales¹Degree of Maltreatment (MT) ² None or minimal Low- moderate Moderate- severe Severe- extreme Total MT Endorsement Emotional Neglect* Male56.329.48.75.643.7 Female64.526.05.44.135.5 Total61.027.46.84.839.0 Physical Neglect Male66.119.89.24.933.9 Female75.714.16.53.724.3 Total71.616.67.64.228.4 ª Percentage. ¹ CTQ = Childhood Trauma Questionnaire. ² Severity of maltreatment based on standardized cut scores. *p <.05.

14. Table 4a Severity of Childhood Maltreatment by Gambling Severityª CTQ subscale¹Degree of Maltreatment ² None or minimal Low- moderate Moderate- severe Severe- extreme Total MT Endorsement Emotional Abuse** Non gambler62.521.28.1 37.4 Social gambler66.822.65.94.733.2 At-risk gambler38.236.414.510.961.8 Pathological gambler53.625.07.114.3 46.4 N = 1320 Physical Abuse** Non gambler84.86.03.95.315.2 Social gambler81.98.74.84.618.1 At-risk gambler50.929.17.312.749.1 Pathological gambler67.910.73.617.9 32.2 N = 1320 Sexual Abuse** Non gambler84.84.26.44.615.2 Social gambler89.04.74.12.211.0 At-risk gambler72.77.314.55.527.3 Pathological gambler75.07.110.77.1 24.9 N = 1319 ª Percentage ¹ CTQ = Childhood Trauma Questionnaire. ² Severity of maltreatment based on standardized cut scores. *p <.05. **p <.001.

15. CTQ subscale¹Degree of Maltreatment ² None or minimal Low- moderate Moderate- severe Severe- extreme Total MT Endorsement Emotional Neglect** Non gambler61.524.48.55.738.6 Social gambler62.627.75.83.937.4 At-risk gambler43.634.59.112.756.3 Pathological gambler32.135.721.410.7 67.8 N = 1316 Physical Neglect** Non gambler74.914.16.44.625.1 Social gambler72.016.87.73.628.1 At-risk gambler63.618.212.75.536.4 Pathological gambler33.3 11.122.2 66.6 N = 1325 Table 4b Severity of Childhood Maltreatment by Gambling Severityª ª Percentage ¹ CTQ = Childhood Trauma Questionnaire. ² Severity of maltreatment based on standardized cut scores. *p <.05. **p <.001.

16. Figure 1: Moderate to extreme maltreatment by gambling severity

17. Table 5a Childhood Maltreatment by Gender and Gambling Severity CTQ subscalesªGambling Group Non GamblerSocial Gambler¹Problem Gambler² NMSDM M Emotional Abuse** Male5648.243.777.663.129.894.98 Female7538.754.248.373.7410.103.11 Total13178.574.088.073.519.944.59 Physical Abuse** Male5656.332.146.452.637.954.38 Female7546.543.366.312.639.004.61 Total13186.472.976.372.638.204.43 Sexual Abuse* Male5655.351.525.271.166.543.88 Female7536.313.655.732.666.302.58 Total13175.963.085.542.186.483.59 ª CTQ = Childhood Trauma Questionnaire. ¹ DSM-IV score (0-2). ² Combined at-risk and probable pathological gambling group (DSM-IV score ≥ 3). * p <.05. ** p <.001.

18. Table 5b Childhood Maltreatment by Gender and Gambling Severity CTQ subscalesªGambling Group Non GamblerSocial Gambler¹Problem Gambler² NMSDM M Emotional Neglect** Male5659.884.049.494.0911.515.33 Female7538.934.468.733.9411.004.38 Total13179.274.339.054.0211.395.10 Physical Neglect** Male5656.952.416.832.408.514.06 Female7556.432.456.532.357.552.37 Total13296.622.456.652.388.283.74 ª CTQ = Childhood Trauma Questionnaire. ¹ DSM-IV score (0-2). ² Combined at-risk and probable pathological gambling group (DSM-IV score ≥ 3). * p <.05. ** p <.001.

19. Table 6a Severity of Childhood Maltreatment by Substance Groupª CTQ subscale¹Degree of Maltreatment² None/ minimal Low- moderate Moderate- severe Severe- extreme Total MT Endorsement Emotional Abuse* No substance problems68.220.96.24.731.8 Substance abuse61.923.46.58.338.2 Substance dependence55.228.89.26.8 44.8 N = 1308 Physical Abuse* No substance problems84.77.43.64.215.2 Substance abuse76.612.25.06.123.3 Substance dependence74.410.86.88.0 25.6 N = 1308 Sexual Abuse No substance problems89.04.64.51.911.0 Substance abuse86.34.06.13.613.7 Substance dependence83.66.05.64.8 16.4 N = 1304 ª Percentage. ¹ CTQ = Childhood Trauma Questionnaire. ²Severity of maltreatment based on standardized cut scores. *p <.05. **p <.001.

20. Table 6b Severity of Childhood Maltreatment by Substance Groupª CTQ subscale¹Degree of Maltreatment² None/ minimal Low- moderate Moderate- severe Severe- extreme Total MT Endorsement Emotional Neglect** No substance problems66.324.25.54.033.7 Substance abuse55.830.27.96.144.2 Substance dependence51.833.39.65.2 48.1 N = 1304 Physical Neglect* No substance problems74.715.95.93.525.3 Substance abuse69.814.79.46.130.2 Substance dependence64.421.110.04.4 35.5 N = 1308 ª Percentage. ¹ CTQ = Childhood Trauma Questionnaire. ²Severity of maltreatment based on standardized cut scores. *p <.05. **p <.001.

21. Table 7a Childhood Maltreatment by Gender and Substance Group CTQ subscales¹Substance Groups No Substance Use Problems Substance Abuse Substance Dependence NMSDM M Emotional Abuse** Male5597.653.188.234.148.553.60 Female7468.073.689.084.119.803.93 Total13057.923.528.654.149.073.78 Physical Abuse** Male5606.212.156.662.897.283.69 Female7476.212.656.833.196.783.24 Total13076.212.496.743.047.083.52 Sexual Abuse* Male5605.341.435.321.355.692.58 Female7475.602.306.343.666.393.79 Total13075.512.045.832.795.983.14 ¹ CTQ = Childhood Trauma Questionnaire. *p <.05. **p <.001.

22. Table 7b Childhood Maltreatment by Gender and Substance Group CTQ subscales¹Substance Groups No Substance Use Problems Substance Abuse Substance Dependence NMSDM M Emotional Neglect** Male5609.494.239.804.4110.304.24 Female7468.443.929.414.229.824.37 Total13068.814.079.614.3110.104.29 Physical Neglect* Male5606.802.326.902.797.573.09 Female7486.362.246.972.726.592.27 Total13086.512.286.932.757.162.82 ¹ CTQ = Childhood Trauma Questionnaire. *p <.05. **p <.001.

23. Figure 2: Moderate to extreme maltreatment by substance group Percent 0 2 4 6 8 10 12 14 16 18 Emotional Abuse Physical Abuse Sexual Abuse Emotional Neglect Physical Neglect Type of maltreatment No substance use problem Substance abuse Substance dependence

24. Table 8 Psychological Symptoms by Gender and Gambling Group BSIªGambling Groups Non GamblerSocial Gambler¹Problem Gambler² NMSDM M Global Severity Index** Male544.54.55.51.52.74.80 Female742.65.69.67.641.08.89 Total1286.62.65.61.83 Positive Symptom Total* Male55317.1114.1516.2612.9619.8516.29 Female74418.6113.6720.1414.0628.2014.87 Total129718.0513.8418.5313.7421.9416.27 Positive Symptom Distress* Male5521.39.681.43.601.56.79 Female7421.55.751.51.631.89.77 Total12941.49.721.49.621.64.79 ª BSI = Brief Symptom Inventory. ¹ DSM-IV score (0 - 2). ² Combined at-risk and probable pathological gambling group (DSM-IV score ≥ 3). *p <.05. **p <.001.

25. Conclusions General gambling prevalence rates: –78% of young adults reported gambling in past year (81% males; 76% females) –20% are gambling at least weekly –2.1% severe gambling problems (pathological gambling) (4.1% M; 0.7% F) –4.2% considered at-risk gamblers (7.1% M; 2.0% F)

26. Maltreatment Strong linear trend for each form of maltreatment (emotional abuse, physical abuse, sexual abuse, emotional neglect, physical neglect) related to gambling problems Fewest problems occurring for non-gamblers and most for pathological gamblers Among adolescents and young adults who reported maltreatment, 10.9% of at-risk gamblers and 14.8% of pathological gamblers report their maltreatment impacted their daily life

27. At-risk gamblers more likely to report emotional abuse and neglect Pathological gamblers more likely to report emotional and physical neglect Sexual abuse least form of reported abuse. However, twice as many at-risk and pathological gamblers reported some form of sexual abuse compared to non-gamblers and social gamblers.

28. No significant gender findings (possibly due to small number of female problem gamblers) Female problem gamblers reported elevated mean scores on emotional and physical abuse subscales Male problem gamblers reported higher scores on sexual abuse subscale Across all psychological system subscales of the Brief Symptom Inventory, at-risk and pathological gamblers reported more problems

29. Similar trends were for substance abuse Evidence appears to support both Jacobs’ (1986) and Blaszczynski and Nower’s (2002) theories Finally, McCormick, Delfabbro & Denson (2011) in Australia recently reported similar findings

30. Implications Clinicians need to directly assess for maltreatment and address unresolved issues