تکانشگری عملکردی و ناکارآمد در قمار پاتولوژی

Impaired control leading to excessive gambling and subsequent adverse consequences is the primary feature of pathological gambling. Defined as an impulse control disorder, elevated traits of impulsivity are associated with increased levels of intensity of gambling and symptoms severity and are predictive of treatment dropout. However, to date, research has failed to explore the differential effects of functional and dysfunctional impulsivity in gambling and the relationship between these two forms of impulsivity to treatment compliance and treatment outcome. This study investigates the interrelationship between functional and dysfunctional impulsivity as measured by the Dickman (1990) scale, gambling severity, substance use and depression in a clinical sample of 60 pathological gamblers seeking cognitive–behavioural therapy. Results indicate that dysfunctional impulsivity is associated with poorer response to treatment but not with treatment completion.

Impulsivity is a predominant characteristic of widely utilized conceptual models of gambling: impulse control (American Psychiatric Association, 2000), addiction (Blume, 1987 and Jacobs, 1986) and obsessive–compulsive spectrum disorders (Hollander, Skodol, & Oldham, 1996). Evidence of elevated impulsivity scale scores have been found in samples of pathological gamblers in treatment (Blaszczynski et al., 1997, Castellani and Rugle, 1995 and Steel and Blaszczynski, 1996) although some contradictory results have been reported in a small number of studies (Allcock and Grace, 1988 and Langewisch and Frisch, 1998). In addition, high scores appear to be associated with correlates of behavioural impairment and psychosocial dysfunction (Steel & Blaszczynski, 1996), development of pathological gambling among adolescents (Vitaro, Arseneault, & Tremblay, 1999), and both non-response (Gonzalez-Ibanez, Mora, Gutierrez-Maldonado, Ariza, & Lourido-Ferreira, 2005) and attrition (Leblond, Ladouceur, & Blaszczynski, 2003) in gambling treatment settings. Impulsivity is a multifaceted behavioural construct, characterised by deficits in self-control expressed as a repeated failure of self-discipline, self-regulation, or sensitivity to immediate reward (Moeller et al., 2001 and Strayhorn, 2002). It is characteristically used to describe actions that are considered to be spontaneous, carried out without forethought and with disregard to their consequences, risky in nature, and often resulting in harmful outcomes (Barratt, 1983, Barratt, 1985, Dickman, 1990, Eysenck and Eysenck, 1977, Eysenck and Eysenck, 1978, Green et al., 1994 and Jaspers, 1963). Variable emphasis is placed on overt behaviours, cognitive processes, speed of responding, and environmental factors as determinants of “impulsiveness” (Claes, Vertommen, & Braspenning, 2000), with the construct inadequately differentiated from related concepts of risk, sensation seeking and behavioural disinhibition (National Research Council, 1999). Nevertheless, Moeller et al. (2001) has proposed three basic elements that generally define impulsivity: (a) decreased sensitivity to negative consequences of behaviour; (b) rapid, unplanned reactions to stimuli before complete processing of information; and (c) lack of regard for long-term consequences. Despite awareness of these elements, most studies in gambling have characterized impulsivity as uni-dimensional, correlated with but not fully defined by negative outcomes and psychopathology. In contrast, Dickman, 1990 and Dickman, 2000 reconceptualized impulsivity as multi-dimensional in nature and comprised of two factors – functional and dysfunctional impulsivity – that interact to foster positive or negative consequences, depending on unsuccessful outcomes in the context of quick and non-judicious decision-making. He suggested that a proportion of individuals receive rewards for rapid decision-making abilities despite lack of accuracy, while others experience predominantly negative consequences. Functional impulsivity refers to the tendency to engage in rapid, error-prone information processing when such a strategy is optimally beneficial. In contrast, dysfunctional impulsivity represents the tendency to engage in rapid, error-prone information processing in situations where slower methodical approaches are required. Therefore, speed of decision-making is the hallmark of high impulsives, while consequences measured by the accuracy of those decisions differentiate adaptive behaviours from those negatively labeled “impulsive”. Functional impulsives are described as enthusiastic, highly active, and productive risk-takers whose output compensates for lack of accuracy and precision (Dickman, 1990). Dysfunctional impulsives, on the other hand, are careless and inattentive, greatly exacerbating negative consequences resulting from deficits in planning and abilities to delay gratification (Dickman, 1990). To date, no studies in gambling have differentiated dysfunctional from functional impulsivity in gamblers although the construct is of fundamental importance in understanding the relationship between subtypes of impulsivity and gambling disorder. From the findings of several studies (Claes et al., 2000 and Steel and Blaszczynski, 1996) and the implications arising from the Pathways Model of problem gambling (see Blaszczynski & Nower, 2002), it can be hypothesized that problem gamblers should score higher on measures of dysfunctional impulsivity than non-problem gamblers. In particular, a sub-group of gamblers with behavioral correlates such as alcohol dependence, non-compliance with therapeutic instructions and poor response to treatment are particularly likely to exhibit heightened levels of impulsivity. The aim of the current study, therefore, is to investigate the relationship of impulsivity to treatment completion and decreases in post-treatment problem gambling behavior. In contrast to functional impulsives, it is hypothesized that individuals obtaining higher scores on a measure of dysfunctional impulsivity would be more likely to: (a) drop out of treatment, and (b) report continued gambling behavior post-treatment.

Males reported they first began gambling around age 17, in contrast to females who reported first gambling at approximately age 21, F(1, 58) = 4.61, p < 0.05. Males reported commencing commercial betting at age 19, in contrast to females who were aged around 26 when first betting at a gambling venue, F(1, 58) = 9.25, p < 0.01. Table 1 provides descriptive statistics for age and duration of gambling and problem gambling for the overall sample. Table 1. Age and duration of gambling and problem gambling for n = 60 pathological gamblers Mean SD Min. Max. Age of gambling onset 17.8 7.7 6.0 54.0 Age of onset, commercial gambling 21.0 7.8 12.0 54.0 Age of onset, problem type of gambling 24.13 9.9 13.0 60.0 Years acknowledged gambling problem 4.5 4.7 0.05 24.0 Days since last gambled 10.2 11.5 1.0 56.0 Table options A majority of participants (85%, n = 51) endorsed electronic gaming machines as their primary form of problem gambling; 10% (n = 6) endorsed horse-racing and the remaining 1.7% (n = 1), keno, casino table games and/or sports betting. These rates are consistent with those found in samples of treatment seeking problem gamblers in Australia: 87% for electronic gaming machines; 10% for horse racing, and 3% on casino card games ( Australian Gaming Council, 2007; p. 171). Nearly 92% (n = 55) of the sample indicated their primary form as their exclusive form of gambling. Overall gambling debt at time of assessment varied from zero to $400,000 (M = $18,136, SD = $57,690). Half of the participants (51.7%, n = 31) reported a debt of less than $2,000, while 27% (n = 16) indicated a debt of more than $10,000.