Behaviour Change Strategies Endorsed by Gamblers Subtyped by Psychological Distress, Risky Alcohol Use, and Impulsivity

  • Brenna Knaebe
  • Simone N. RoddaEmail author
  • David C. Hodgins
  • Dan I. Lubman
Original Paper


Problem gambling is often accompanied by co-morbid psychiatric disorders and maladaptive personality traits. Subtyping gamblers based on these pervasive comorbidities has been attempted so as to aid understanding of the aetiology of problem gambling and inform treatment options. However, there has been less focus on subtyping gamblers with (past or current) or without a history of problem gambling, or on providing more specific treatment or self-help recommendations. The current study sought to subtype current-, past-, and non-problem gamblers using three common comorbidities; psychological distress, risky alcohol use, and impulsivity. Participants’ endorsement of helpful behaviour change strategies was also examined by subtype membership. A total of 385 participants were recruited who had a current gambling problem (n = 128; 33%), a past gambling problem (n = 131, 34%) or never had a gambling problem (n = 126, 33%). Hierarchical cluster analysis identified distinct subtypes of current (i.e., low comorbidity, high psychological distress, risky alcohol use and high comorbidity), past (i.e., low comorbidity, high psychological distress and high comorbidity) and non-problem gamblers (i.e., low comorbidity, high psychological distress, risky alcohol use and moderate impulsivity). The most helpful change strategies for current and past gamblers were similar across subtypes (i.e., accept that gambling needs to change, remind yourself of the negative consequences). Non-problem gamblers reported the most helpful strategy as setting financial limits. This study indicated that treatment of psychological distress, risky alcohol use or impulsivity may be important for all gamblers regardless of their level of risk.


Behaviour change Gambling Subgroups Treatment Self-help Comorbidity Prevention 


Authors Contribution

SNR, DCH, DIL designed the study and wrote the protocol. BK conducted the data analysis. BK wrote the first draft of the manuscript and all authors contributed to and have approved the final manuscript.


Funding for this study was provided by Gambling Research Australia (GRA) (Grant No. CD/13/160721). GRA had no role in the study design, collection, analysis or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication. Funding for the preparation of this paper was from the Faculty of Medical Health Sciences, University of Auckland (3714127). University of Auckland had no role in the study design, collection, analysis or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Supplementary material

10899_2018_9803_MOESM1_ESM.pdf (117 kb)
Supplementary material 1 (PDF 116 kb)


  1. Black, D. W., & Moyer, T. (1998). Clinical features and psychiatric comorbidity of subjects with pathological gambling behavior. Psychiatric Services, 49(11), 1434–1439.CrossRefGoogle Scholar
  2. Blaszczynski, A., & Nower, L. (2002). A pathways model of problem and pathological gambling. Addiction, 97(5), 487–499.CrossRefGoogle Scholar
  3. Bush, K., Kivlahan, D. R., McDonell, M. B., Fihn, S. D., & Bradley, K. A. (1998). The AUDIT alcohol consumption questions (AUDIT-C): An effective brief screening test for problem drinking. Archives of Internal Medicine, 158(16), 1789–1795.CrossRefGoogle Scholar
  4. Cattell, R. B. (1966). The scree test for the number of factors. Multivariate Behavioral Research, 1(2), 245–276.CrossRefPubMedCentralGoogle Scholar
  5. Clatworthy, J., Buick, D., Hankins, M., Weinman, J., & Horne, R. (2005). The use and reporting of cluster analysis in health psychology: A review. British Journal of Health Psychology, 10(3), 329–358.CrossRefPubMedCentralGoogle Scholar
  6. Commission, Productivity. (2010). Gambling. Canberra: Productivity Commission.Google Scholar
  7. Dawson, D. A., Grant, B. F., Stinson, F. S., & Zhou, Y. (2005). Effectiveness of the derived alcohol use disorders identification test (AUDIT-C) in screening for alcohol use disorders and risk drinking in the US general population. Alcoholism: Clinical and Experimental Research, 29(5), 844–854.CrossRefGoogle Scholar
  8. Dowling, N., Merkouris, S., Manning, V., Oakes, J., Greenwood, C., Rodda, S., et al. (2017). Determining cut-off values for the problem gambling severity index in treatment-seeking gamblers. Paper presented at the National Association of Gambling Studies, Melbourne.Google Scholar
  9. Dowling, N. A., Cowlishaw, S., Jackson, A. C., Merkouris, S. S., Francis, K. L., & Christensen, D. R. (2015). Prevalence of psychiatric co-morbidity in treatment-seeking problem gamblers: A systematic review and meta-analysis. Australian and New Zealand Journal of Psychiatry, 49(6), 519–539.CrossRefGoogle Scholar
  10. Dowling, N. A., Merkouris, S. S., Manning, V., Volberg, R., Lee, S. J., Rodda, S. N., et al. (2018). Screening for problem gambling within mental health services: A comparison of the classification accuracy of brief instruments. Addiction, 113(6), 1088–1104.CrossRefPubMedCentralGoogle Scholar
  11. el-Guebaly, N., Casey, D. M., Currie, S. R., Hodgins, D. C., Schopflocher, D. P., Smith, G. J., et al. (2015). The leisure, lifestyle, & lifecycle project (LLLP): A longitudinal study of gambling in Alberta. Final Report for the Alberta Gambling Research Institute. Alberta Gambling Research Institute.Google Scholar
  12. Ferris, J. A., & Wynne, H. J. (2001). The Canadian problem gambling index: User manual. Toronto, ON: Canadian Centre on Substance Abuse.Google Scholar
  13. Hing, N., Nuske, E., & Gainsbury, S. (2011). Gamblers at-risk and their help-seeking behaviour. Melbourne: Gambling Research Australlia.Google Scholar
  14. Hodgins, D. C., & el-Guebaly, N. (2000). Natural and treatment-assisted recovery from gambling problems: A comparison of resolved and active gamblers. Addiction, 95(5), 777–789.CrossRefGoogle Scholar
  15. Holtgraves, T. (2009). Evaluating the problem gambling severity index. Journal of Gambling Studies, 25(1), 105. Scholar
  16. Ibáñez, A., Blanco, C., Donahue, E., Lesieur, H. R., Pérez de Castro, I., Fernández-Piqueras, J., et al. (2001). Psychiatric comorbidity in pathological gamblers seeking treatment. American Journal of Psychiatry, 158(10), 1733–1735.CrossRefPubMedCentralGoogle Scholar
  17. Kessler, R. C., Andrews, G., Colpe, L. J., Hiripi, E., Mroczek, D. K., Normand, S.-L., et al. (2002). Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychological Medicine, 32(6), 959–976.CrossRefGoogle Scholar
  18. Langham, E., Thorne, H., Browne, M., Donaldson, P., Rose, J., & Rockloff, M. (2015). Understanding gambling related harm: A proposed definition, conceptual framework, and taxonomy of harms. BMC Public Health, 16(1), 80.CrossRefGoogle Scholar
  19. Lorains, F. K., Cowlishaw, S., & Thomas, S. A. (2011). Prevalence of comorbid disorders in problem and pathological gambling: Systematic review and meta-analysis of population surveys. Addiction, 106(3), 490–498.CrossRefGoogle Scholar
  20. Lubman, D., Rodda, S., Hing, N., Cheetham, A., Cartmill, T., Nuske, E., et al. (2015). Gambler self-help strategies: A comprehensive assessment of self-help strategies and actions. Melbourne: Gambling Research Australia.Google Scholar
  21. Merkouris, S. S., Thomas, A. C., Shandley, K. A., Rodda, S. N., Oldenhof, E., & Dowling, N. A. (2016). An update on gender differences in the characteristics associated with problem gambling: A systematic review. Current Addiction Reports, 3(3), 254–267.CrossRefGoogle Scholar
  22. Milosevic, A., & Ledgerwood, D. M. (2010). The subtyping of pathological gambling: A comprehensive review. Clinical Psychology Review, 30(8), 988–998.CrossRefGoogle Scholar
  23. Moore, S. M., Thomas, A. C., Kyrios, M., & Bates, G. (2012). The self-regulation of gambling. Journal of Gambling Studies, 28(3), 405–420.CrossRefPubMedCentralGoogle Scholar
  24. Murtagh, F., & Legendre, P. (2014). Ward’s hierarchical agglomerative clustering method: Which algorithms implement Ward’s criterion? Journal of Classification, 31(3), 274–295.CrossRefGoogle Scholar
  25. Petry, N. M., Stinson, F. S., & Grant, B. F. (2005). Comorbidity of DSM-IV pathological gambling and other psychiatric disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. The Journal of Clinical Psychiatry, 66(5), 564–574.CrossRefGoogle Scholar
  26. Prochaska, J. J., Sung, H. Y., Max, W., Shi, Y., & Ong, M. (2012). Validity study of the K6 scale as a measure of moderate mental distress based on mental health treatment need and utilization. International Journal of Methods in Psychiatric Research, 21(2), 88–97.CrossRefPubMedCentralGoogle Scholar
  27. Rodda, S. N., Bagot, K., Cheetham, A., Hodgins, D. C., Hing, N., & Lubman, D. I. (2018a). Types of change strategies for limiting or reducing gambling behaviours and their perceived helpfulness: A factor analysis. Psychology of Addictive Behaviors, 32(6), 679–688. Scholar
  28. Rodda, S. N., Hing, N., Hodgins, D. C., Cheetham, A., Dickins, M., & Lubman, D. I. (2016). Change strategies and associated implementation challenges: An analysis of online counselling sessions. Journal of Gambling Studies. Scholar
  29. Rodda, S. N., Hing, N., Hodgins, D. C., Cheetham, A., Dickins, M., & Lubman, D. I. (2018b). Behaviour change strategies for problem gambling: An analysis of online posts. International Gambling Studies. Scholar
  30. Rodda, S. N., Lubman, D., Iyer, R., Gao, C., & Dowling, N. (2015). Subtyping based on readiness and confidence: The identification of help-seeking profiles for gamblers accessing web-based counselling. Addiction, 110(3), 494–501.CrossRefPubMedCentralGoogle Scholar
  31. Stanford, M. S., Mathias, C. W., Dougherty, D. M., Lake, S. L., Anderson, N. E., & Patton, J. H. (2009). Fifty years of the Barratt Impulsiveness Scale: An update and review. Personality and Individual Differences, 47(5), 385–395.CrossRefGoogle Scholar
  32. Suomi, A., Dowling, N. A., & Jackson, A. C. (2014). Problem gambling subtypes based on psychological distress, alcohol abuse and impulsivity. Addictive Behaviors, 39(12), 1741–1745.CrossRefGoogle Scholar
  33. Vasconcelos, A. G., Malloy-Diniz, L., & Correa, H. (2012). Systematic review of psychometric proprieties of Barratt Impulsiveness Scale Version 11 (BIS-11). Clinical Neuropsychiatry, 9(2), 61–74.Google Scholar
  34. Ward, J. H., Jr. (1963). Hierarchical grouping to optimize an objective function. Journal of the American statistical association, 58(301), 236–244.CrossRefGoogle Scholar
  35. Yakovenko, I., & Hodgins, D. C. (2018). A scoping review of co-morbidity in individuals with disordered gambling. International Gambling Studies, 18(1), 143–172.CrossRefGoogle Scholar
  36. Yim, O., & Ramdeen, K. T. (2015). Hierarchical cluster analysis: Comparison of three linkage measures and application to psychological data. The Quantitative Methods for Psychology, 11(1), 8–21.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.School of Population Health, Faculty of Medical and Health SciencesUniversity of AucklandAucklandNew Zealand
  2. 2.Turning PointRichmondAustralia
  3. 3.School of PsychologyDeakin UniversityGeelongAustralia
  4. 4.Department of PsychologyUniversity of CalgaryCalgaryCanada
  5. 5.Eastern Health Clinical SchoolMonash UniversityMelbourneAustralia

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