M Grall-Bronnec1, G Bouju, M Landréat-Guillou, J-L Vénisse. 1. Service d'addictologie, centre de référence sur le jeu excessif, pavillon Louis-Philippe, hôpital Saint-Jacques, 85, rue Saint-Jacques, 44093 Nantes cedex 01, France. marie.bronnec@chu-nantes.fr
Abstract
INTRODUCTION: International studies estimate the incidence of pathological gambling among adults at 0.2-3%. Following the lead of Anglo-Saxon countries, France has only just begun to consider this "new" addiction in studying its own population of pathological gamblers, attempting to understand the causes of the illness, and proposing specific treatments. OBJECTIVE: The purpose of this study was to carry out a multiaxial assessment of French pathological gamblers, current or former outpatients of the addiction ambulatory care center of the University Hospital of Nantes, in order to compare our findings with those of the international literature. METHOD: During a single personal interview, the participants filled in a set of questionnaires including a description of gambling characteristics (pathological gambling section in the DSM-IV, South Oaks Gambling Screen, gambling history), a screening for axis I (Mini International Neuropsychiatric Interview) and II (structured clinical interview for DSM-IV Axis II Personality Disorders), comorbidities and personality tests using a dimensional approach (Minnesota Multiphasic Personality Inventory, Sensation Seeking Scale, Barratt Impulsiveness Scale, Toronto Alexithymia Scale). The number of subjects to include was not previously calculated, since the size of the sample depended upon each subject's availability and on the inclusion time period limited to 4 months. Continuous variables were described in terms of means and standard deviations, while categorical variables were described in terms of percentages. The protocol was accepted by the Advisory Committee for the Protection of Biomedical Research Subjects. RESULTS: Analysis of the findings was based on a sample of 24 subjects. Half of the subjects fell into severe pathological gambling. Gambling had started at an average age of 24.9 years (S.D.=12.3). The gambling problem appeared on average 9.4 years later (S.D.=8.1). Casinos (41.7%) and sports pools (45.8%) were the most commonly reported types of games. Seventy-five percent of the sample suffered from at least one axis I psychiatric comorbidity. Most common among these were current (20.9%) and past (37.5%) episodes of major depression. Risk of suicide was observed in 36% of subjects, and nearly half of them were not currently suffering from an episode of major depression. The second most common psychiatric comorbidity was substance abuse (including alcohol) (54.2%). Personality disorders were common (54.2%) and mainly cluster B disorders (29.2%). Impulsiveness and alexithymia scores were above average, unlike sensation seeking scores. CONCLUSIONS: The results go along the same lines as those mentioned in the international literature and show how important it is to carry out multidimensional assessments within the context of pathological gambling, since comorbidities are such a burden. This study brings to light several perspectives. It would be interesting to repeat the assessment using a much larger sample. We plan to study those factors that influence the emergence of pathological gambling, and the initiation of specific treatments for pathological gamblers. Upon completion, the study would allow us to propose the treatment that is best suited to each gambler's profile.
INTRODUCTION: International studies estimate the incidence of pathological gambling among adults at 0.2-3%. Following the lead of Anglo-Saxon countries, France has only just begun to consider this "new" addiction in studying its own population of pathological gamblers, attempting to understand the causes of the illness, and proposing specific treatments. OBJECTIVE: The purpose of this study was to carry out a multiaxial assessment of French pathological gamblers, current or former outpatients of the addiction ambulatory care center of the University Hospital of Nantes, in order to compare our findings with those of the international literature. METHOD: During a single personal interview, the participants filled in a set of questionnaires including a description of gambling characteristics (pathological gambling section in the DSM-IV, South Oaks Gambling Screen, gambling history), a screening for axis I (Mini International Neuropsychiatric Interview) and II (structured clinical interview for DSM-IV Axis II Personality Disorders), comorbidities and personality tests using a dimensional approach (Minnesota Multiphasic Personality Inventory, Sensation Seeking Scale, Barratt Impulsiveness Scale, Toronto Alexithymia Scale). The number of subjects to include was not previously calculated, since the size of the sample depended upon each subject's availability and on the inclusion time period limited to 4 months. Continuous variables were described in terms of means and standard deviations, while categorical variables were described in terms of percentages. The protocol was accepted by the Advisory Committee for the Protection of Biomedical Research Subjects. RESULTS: Analysis of the findings was based on a sample of 24 subjects. Half of the subjects fell into severe pathological gambling. Gambling had started at an average age of 24.9 years (S.D.=12.3). The gambling problem appeared on average 9.4 years later (S.D.=8.1). Casinos (41.7%) and sports pools (45.8%) were the most commonly reported types of games. Seventy-five percent of the sample suffered from at least one axis I psychiatric comorbidity. Most common among these were current (20.9%) and past (37.5%) episodes of major depression. Risk of suicide was observed in 36% of subjects, and nearly half of them were not currently suffering from an episode of major depression. The second most common psychiatric comorbidity was substance abuse (including alcohol) (54.2%). Personality disorders were common (54.2%) and mainly cluster B disorders (29.2%). Impulsiveness and alexithymia scores were above average, unlike sensation seeking scores. CONCLUSIONS: The results go along the same lines as those mentioned in the international literature and show how important it is to carry out multidimensional assessments within the context of pathological gambling, since comorbidities are such a burden. This study brings to light several perspectives. It would be interesting to repeat the assessment using a much larger sample. We plan to study those factors that influence the emergence of pathological gambling, and the initiation of specific treatments for pathological gamblers. Upon completion, the study would allow us to propose the treatment that is best suited to each gambler's profile.