1

Revisin de antecedentes y marco conceptual sobre bienestar y juego patolgico. La idea es que sea el
apartado de introduccin del artculo de NODS. Con 4 o 5 pginas creo que sera suficiente.
1. (Brizuela, 2011)
P23
Se entiende por Juego Patolgico (JP) o Ludopata al fracaso crnico y progresivo en resistir los impulsos a
jugar (juegos de azar) los cuales dominan la vida del sujeto. Esta conducta de juego compromete o lesiona
sus objetivos personales, familiares o vocacionales. El DSM IV TR lo ubica dentro de los Trastornos del
control de los impulsos no clasificados en otros apartados.
Los criterios diagnsticos en dicho manual son los siguientes:
A. Comportamiento de juego desadaptativo, persistente y recurrente, como indican por los
menos cinco (o ms) de los siguientes tems:
1. Preocupacin por el juego.
2. Necesidad de jugar con cantidades crecientes de dinero para conseguir el grado de excitacin
deseado.
3. Fracaso repetido de los esfuerzos para controlar, interrumpir o detener el juego.
4. Inquietud o irritabilidad cuando intenta interrumpir o detener el juego.
5. El juego se utiliza como estrategia para escapar de los problemas o para aliviar la disforia.
6. Despus de perder el dinero en el juego, se vuelve otro da para intentar recuperarlo (tratando de
cazar las propias prdidas).
7. Se engaa a los miembros de la familia, terapeutas u otras personas para ocultar el grado de
implicacin con el juego.
8. Se cometen actos ilegales para financiar el juego.
9. Se han arriesgado o perdido relaciones interpersonales significativas, trabajo y oportunidades
educativas o profesionales debido al juego.
10. Se confa en que los dems proporcionen dinero que alivie la desesperada situacin financiera
causada por el juego.
B. El comportamiento de juego no se explica mejor por la presencia de un episodio manaco
Sobre la manera de jugar de la poblacin, la nomenclatura establecida por el National Research Council
(1999) y Shaffer, Hall y Vander Bilt (1999) refiere:

El nivel 0 representa a la gente que no juega,

El nivel 1 son aquellas personas que juegan de manera recreativa sin sufrir consecuencias
adversas,
El nivel 2 se asocia a una clase con un amplio rango de consecuencias negativas derivadas del
juego,
El nivel 3 incluye a las personas que tienen consecuencias adversas que son lo suficientemente
importantes para reunir los criterios diagnsticos de juego patolgico del DSM-IV (APA,1994), y
El nivel 4 incluye a los jugadores que buscan ayuda por sus problemas de juego, sin importar el
grado de estrs o afectacin que estn padeciendo.

P24
Se trata de un trastorno de baja prevalencia poblacional. Estudios multicntrico ( Kallick, Suits, Dielman y
Hybels, 1979; Shaffer y Hall, 2001; Volberg, Abbot, Ronnberg y Munck, 2001; Bondolfi, Osiek y Ferrero,
2000; Abbott, 2001; Sproston,Erens y Oxford, 2000; Collins y Barr, 2001) en Estados Unidos de Amrica,
Suecia, Suiza, Nueva Zelanda, Gran Bretaa, Africa y Hong Kong, nos revelan los siguientes datos de
media estadstica: 0,5 % a 2,5 % de la poblacin que juega padece de Juego Patolgico y de 3 % a 5 %
tiene problemas con su manera de jugar (riesgo de desarrollar la enfermedad). El 30 % de esta poblacin
es de gnero femenino. Siempre est relacionado al juego de apuestas. Es independiente del dinero que se
juegue. De instalacin lenta y engaosa. Siempre se niega el problema. Hay un desconocimiento general
del tema.

2
Una amplia mayora de los apostadores (cercana al 95%) juega de manera recreativa, sin sufrir ninguna
consecuencia adversa. Estudios realizados en EEUU y Canad indican que los problemas relacionados con
el Juego Patolgico son ms frecuentes en los adolescentes que en los adultos. Ellos tienen cuatro veces
ms riesgo para desarrollar problemas con el juego. Preocupa la aparicin de la adiccin a los juegos de
azar que parece estar estimulada por una mayor disponibilidad y promocin de los mismos. El costo en
trminos sociales para la familia por las relaciones disfuncionales, violencia, presin financiera e
interrupcin de los proyectos individuales y familiares puede ser de magnitud. La mayor prevalencia de los
juegos de azar y los problemas relacionados entre la poblacin adolescente, incluyendo las apuestas
deportivas en colegios y universidades motiva la bsqueda de soluciones innovadoras. Otros grupos
vulnerables como la poblacin de mayor edad y en estado de retiro jubilatorio, poblaciones migrantes,
individuos que abusan de sustancias o padecen de trastornos de salud mental, pueden verse tambin
involucrados negativamente por la expansin de los juegos de azar que al impactar en la salud como as
tambin en la esfera social y econmica merecen la atencin de la Salud Pblica (S.P.).
Otro aspecto importante a considerar es la dimensin lograda por los juegos de azar a travs de las
nuevas tecnologas de la informacin y la comunicacin. Problemas vinculados a las innovaciones de la
computacin por la frecuencia, accesibilidad y variedad de juegos de azar ofrecidos. La inquietante
disponibilidad y potencial adictivo de las terminales de lotera, como as tambin la generalizada oferta de
sitios on line de apuestas con caractersticas de casinos pero sin regulacin alguna, son nuevas
alternativas a tener en cuenta desde la perspectiva de la S.P.
P25
Salud Pblica y Juego Patolgico
Considerando que en la primera dcada de este nuevo siglo se ha producido en el mundo una expansin
notable del juego legalizado, presumiendo que obedece a las siguientes razones:
a) La bsqueda por parte de los gobiernos de nuevas fuentes de ingreso sin recurrir a nuevos
impuestos a la poblacin.
b) El desarrollo de las empresas de turismo para destinos de ocio y entretenimiento que suman los
juegos de azar como parte integral de las mismas.
c) El advenimiento de juegos de azar a travs de nuevas tecnologas de comunicacin (juegos de
apuestas online, terminales de loteras, juegos y equipos offshore) con total disposicin horaria y
sin control alguno. (Offshore: deslocalizacin de un recurso o proceso productivo)
Las acciones de la S.P. conllevan al diseo de estrategias ms efectivas y comprensivas para prevenir,
minimizar y tratar los problemas relacionados a la forma de jugar (juegos de azar) en forma inmoderada y
los surgidos del J.P.

2. (Carbonell, Talam, Beranuy, Oberst, & Graner, 2009)

P202
No obstante, el juego de los adultos puede resultar conflictivo. En qu casos se podra afirmar tal cosa?
En principio, y ms all de los criterios del DSM IV (APA, 2000) o la CIE-10 (OMS, 1992) en relacin con las
conductas adictivas, podramos decir que una actividad de juego se ha convertido en patolgica cuando
aparecen la dependencia psicolgica y los efectos perjudiciales (Echebura, 1999; Griffits 2000; SnchezCarbonell, Beranuy, Castellana, Chamarro y Oberst, 2008; Washton y Boundy, 1989). En este sentido
podemos hablar de una autntica adiccin conductual, similar a la adiccin a ciertas sustancias.
P203
La dependencia psicolgica se manifiesta a travs del deseo, ansia o pulsin irresistible (craving); la
polarizacin o focalizacin atencional; la modificacin del estado de nimo (sensacin creciente de tensin
que precede inmediatamente al inicio del cambio de conducta del probable futuro dependiente, ya sea,

3
placer o alivio o incluso euforia mientras se mantiene esa conducta; agitacin o irritabilidad si no es
posible satisfacerla), y la prdida de control e impotencia.
Para considerarlos perjudiciales, los efectos tienen que ser graves y alterar tanto el mbito intrapersonal
(experimentacin subjetiva de malestar) como el interpersonal (trabajo, estudio, finanzas, ocio, relaciones
sociales, problemas legales, etctera). Los sntomas deben estar presentes durante un periodo de tiempo
continuado. En el DSM-IV la duracin mnima para establecer un diagnstico de dependencia de sustancias
es de 12 meses.
Si se aplican estos criterios a la conducta de jugar, cabra suponer que todo tipo de juego podra llegar a
ser adictivo, ya que la patologa no radica tanto en el objeto de la adiccin sino en el sujeto que la
manifiesta (Mattioli, 1989). En este sentido cualquier juego, desde el ms inocente al aparentemente ms
daino, podra llegar a constituirse en objeto de adiccin para ciertas personas. Sin embargo, existe un
tipo de juego que los especialistas reconocen potencialmente muy adictivo: el juego de azar con
recompensa econmica. La patologa relacionada se denomina hoy juego patolgico (APA, 2000) o
ludopata (OMS, 1992).
P204
Si intentamos establecer una tipologa de juegos, podemos distinguir entre los recreativos (de destreza, de
suerte, o que combinan ambos factores) y los de azar, donde suele existir una recompensa econmica que
depende por completo del azar.
P205
Mientras los juegos tipo arcade son juegos de mquina que desarrollan destrezas, las mquinas
tragaperras se han convertido en el paradigma de mquina que incita al juego de azar con recompensa
econmica. La diferencia fundamental entre las antiguas mquinas del milln o de marcianitos y las
tragaperras es que la recompensa que obtiene el jugador en stas ltimas es econmica. En estos casos,
cuando se trata de un jugador patolgico, el componente ldico de jugar se pierde por el grado de
ansiedad y/o compulsin (en el sentido de irreprimible e inevitable) de la actividad en s misma. Las
tragaperras estn a disposicin del jugador en bares y casinos y, tal como su nombre indica, la apuesta es
pequea. Por ello, el jugador tiene la sensacin de controlar, de que sus elecciones incrementan la
posibilidad de ganar y de que no depende exclusivamente de la suerte como sucede en la ruleta. Nada de
todo ello es cierto: las acciones del sujeto estn determinadas por un programa de reforzamiento
intermitente y no por su habilidad. Hoy tambin existe la posibilidad de jugar este tipo de juegos online de
forma interactiva (por ejemplo ruleta online), lo cual multiplica el nmero de jugadores patolgicos
potenciales.
Los mecanismos de la adiccin
Cabe destacar que psicolgicamente el juego de azar es un reto a la suerte, mediante el cual una persona
intenta poner a prueba sus fantasas de cambiar mgicamente su destino. El aspecto mgico del juego es
primordial. Se llaman juegos de azar porque no hay forma de controlar sistemticamente los resultados del
juego y, por tanto, apenas intervienen las habilidades de la persona. Un criterio importante para distinguir
los juegos es el tipo de recompensa que se obtiene al jugar. Tanto es as que en ingls se distingue entre
gambling (jugar juegos en los que se arriesga algo para obtener una ganancia) y playing (jugar juegos en
los que slo se persigue el entretenimiento).
P206
El jugador de tragaperras recibe una respuesta a su accin, sabe si su jugada ha sido ganadora o
perdedora, cada cinco segundos. Es una actividad repetitiva, autoestimuladora.
Cuando los psiclogos del aprendizaje analizan una conducta se fijan en el programa de reforzamiento y
las caractersticas de los reforzadores (Domjan, 2004; Tarpy, 1999). El juego de azar es claramente un caso
de lo que se llama programa de reforzamiento intermitente: no todas las conductas son reforzadas y no
siempre. Las mquinas se disean para premiar cada determinado nmero de jugadas,

4
independientemente del tipo de accin efectuada, porque se sabe que el reforzamiento intermitente es el
mecanismo ms potente para mantener una conducta establecida, en este caso la de jugar por dinero.
En cuanto a la intensidad o potencia del reforzador sabemos que el dinero es un potente reforzador y su
ausencia un potente reforzador negativo (en principio, la disminucin o falta de recompensa econmica
reducira la ocurrencia de la conducta de jugar). El jugador patolgico, para recuperar el dinero perdido, se
enfrasca en una espiral cada vez ms perjudicial, porque sabe que alguna vez podra ganar (refuerzo
positivo intermitente)
La disponibilidad del estmulo es otro factor y tiene dos aspectos: el espacial y el temporal. Las mquinas
son ms adictivas que otros juegos de apuestas porque estn ms disponibles en bares, bingos y casinos
que otros juegos que slo se encuentran en casinos, mucho menos extendidos en nuestro territorio que los
bares.
P207
Asociacin con otros trastornos
Frecuentemente el juego patolgico est asociado a otros trastornos. En contra de lo que apuntan el lobby
del juego y algunas corrientes de la psicologa de la personalidad, no es necesario padecer un trastorno
mental o un trastorno de personalidad para llegar a ser adicto. S que hay circunstancias en la vida de una
persona que pueden hacerla ms vulnerable o ms segura frente a los posibles problemas. Estados
depresivos, de ansiedad, sentimientos de soledad o de prdida pueden hacer que una persona recurra al
juego o al consumo de sustancias para lograr el bienestar. Otros trastornos pueden ser simultneos o
paralelos. El consumo de alcohol puede desarrollarse en paralelo al del juego. A ms alcohol ms juego y
al revs. Por ltimo, algunos trastornos son consecuencia de la conducta adictiva. Un jugador puede caer
en una profunda depresin al ser consciente de las consecuencias econmicas, familiares, legales,
etctera, que le ha provocado el juego. Lo que sabemos hasta el momento es que las personas que
solicitan tratamiento por su adiccin a Internet suelen tener tambin otros trastornos psiquitricos
(Shapira, Goldsmith, Keck Jr, Khosla y McElroy, 2000; Shapira, Lessig, Goldsmith, Szabo, Lazoritz et al.,
2003).
3. (Cotte, 1997)
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4. (Cuadra & Florenzano, 2003)

P85
El BS se refiere a lo que las personas piensan y sienten acerca de sus vidas y a las conclusiones
cognoscitivas y afectivas que ellos alcanzan cuando evalan su existencia. Comnmente se denomina
felicidad al BS experimentado cuando se sienten ms emociones agradables y pocas desagradables,
cuando estn comprometidos en actividades interesantes y cuando estn satisfechos con sus vidas. Lo
central es entonces, la propia evaluacin que la persona hace de su vida (Diener, 2000).
DIENER, E. (2000). Subjective well-being: The science of happiness and a proposal for a
national index. American Psychologist. 55; 34 43.
El optimismo puede ser considerado como una caracterstica cognitiva - una meta, una expectativa o una
atribucin causal sensible a la creencia en ocurrencias futuras sobre las cuales los individuos tengan
fuertes sentimientos. El optimismo no es tan solo una fra cognicin sino que es tambin motivador y
motivante. De hecho, las personas necesitan sentirse optimistas con respecto a algunas materias
(Peterson, 2000). Al parecer, los optimistas son personas que sin negar sus problemas, tienen esperanzas
y crean estrategias de accin y de afrontamiento de la realidad.
Avia y Vazquez (1999) plantean que nuestra naturaleza nos impulsa a la esperanza y a albergar ilusiones:
el optimismo es algo constitutivo de la vida y por lo tanto es posible aprenderlo. Lo definen como la
tendencia a esperar que el futuro depare resultados favorables. Lo consideran como una dimensin de la
personalidad relativamente estable. Est determinado, en parte, por la herencia y, en parte, por
experiencias tempranas, pero es posible en etapas maduras, aprender a ver las cosas de otra manera.
Diferencian entre un optimismo absoluto e incondicional al que consideran una forma de escape
patolgico; otra forma de optimismo blando que puede en ocasiones hacer perder un tiempo precioso para
llevar a cabo otras estrategias ms protectoras. Finalmente, definen un optimismo inteligente que es una
forma realista de ver las cosas ya que la vida tiene mltiples significados que cada cual va construyendo a
lo largo de su existencia y colectivamente a lo largo de la historia.
AVIA, M. D., VAZQUEZ, C. (1999). Optimismo Inteligente. Madrid: Alianza Editorial, S.A.
P86
La felicidad es un concepto que engloba el BS y la satisfaccin vital, por lo tanto, incluye las dimensiones
afectivas y cognitivas del sujeto.
Se han estudiado las posibles asociaciones entre la felicidad y el bienestar econmico, los ingresos
personales, las relaciones afectivas cercanas y la fe religiosa. Diener (2000) encontr que hay cierta
tendencia a encontrar gente ms satisfecha en las naciones ms desarrolladas; cuando las personas de las
naciones pobres comparan sus estilos de vida con los de las naciones ms ricas, pueden darse cuenta ms
de su pobreza relativa. Diener, Diener y Diener (1995) encontraron que la riqueza tiende a confundirse con
otras variables relacionadas, tales como los derechos humanos, la alfabetizacin y el nmero de aos que
se vive en democracia. Al preguntarse si la gente es ms feliz a medida que aumenta sus ingresos, la

11
evidencia muestra que la relacin es tenue, aunque muchos se aferran a la idea de que mayores ingresos
redundan en mayor felicidad.
DIENER, E.; DIENER, M., Y DIENER, C. (1995). Factor predicting the subjective wellbeing of
nations. Journal of Personality and Social Psychology. 69; 653 - 663.
Csikszentmihalyi explora otra dimensin de la felicidad: la experiencia de flujo, definida como el estado
de envolvimiento total en una actividad que requiere la concentracin completa o el estado en el cual
las personas se hallan tan involucradas en la actividad que nada ms parece importarles; la experiencia,
por s misma, es tan placentera que las personas la realizarn incluso aunque tengan un gran costo, por el
puro motivo de hacerla. La alternativa espiritual puede ser entendida como psicolgica si se parte de la
premisa que la felicidad es un estado mental que las personas pueden llegar a controlar
cognoscitivamente: la felicidad podra enfocarse as en los procesos en que la conciencia humana usa sus
habilidades (Csikszentmihalyi, 1999).
CSIKSZENTMIHALYI, M. (1999). Fluir. Una psicologa de la felicidad. Barcelona: Ed. Kairos, 7
ed. (Orig. 1990 )
La felicidad y las relaciones afectivas cercanas se correlacionan. La necesidad de pertenencia y de
relacionarse socialmente est dada por el carcter de proteccin y de reconocimiento que necesita el ser
humano. Por ello, el exilio y el confinamiento solitario estn entre los castigos ms graves que puede
recibir una persona.
P87
El dinero es importante en la medida que se transforma en un medio para lograr fines del individuo, pero
en s no es un predictor muy seguro de la felicidad. Por otra parte, se ha visto que la cantidad de dinero
ganada se correlaciona con la felicidad en la medida que la persona est satisfecha con su nivel de
ingresos.
P88
Para Diener y Fujita (1995), la extraversin es un recurso que ayuda al bienestar porque es probable que
ayude a los individuos a lograr cierto tipos de metas, como tener amigos. La autoestima es relacionada por
Wilson con el bienestar. Los occidentales usan muchas estrategias cognitivas para mantener su
autoestima. Diener y Diener (1995) en una investigacin transcultural encontraron que la relacin entre la
autoestima y la satisfaccin de vida es menor en las culturas colectivistas. Extendiendo este hallazgo,
Kwan, Bond y Singelis (1997) encontraron una fuerte relacin entre autoestima y satisfaccin de vida en
los Estados Unidos y tambin descubri que ocurra algo similar en Hong Kong. Piensan que la autoestima
no puede ser un fuerte predictor en culturas que valoran el grupo sobre el individuo.
DIENER, E., Y FUJITA, F., (1995). Resources, Personal striving, and subjective well-being: A
nomothetic and idiographic approach. Journal of Personality and Social Psychology. 68; N 5,
926 935.
DIENER, E., Y DIENER, M. (1995). Cross cultural correlates of life satisfaction and selfesteem.
Journal of Personality and Social Psychology 68: 653 663. En: Oishi, S. 2000).
P89
La Teora de la Autodeterminacin (SDT, Self-Determination Theory) propuesta por Ryan y Deci (2000)
parten del supuesto que las personas pueden ser proactivas y comprometidas o bien, inactivas o alienadas
y que ello dependera en gran parte como una funcin de la condicin social en la que ellos se
desarrollan y funcionan. La investigacin se enfoca en las condiciones que facilitan el contexto social
versus las que dificultan los procesos naturales de la auto-motivacin y el desarrollo psicolgico sano. Los
seres humanos tendran ciertas necesidades psicolgicas innatas que seran la base de una personalidad
automotivada e integrada y que adems, los ambientes sociales en que se desarrollen fomentaran o
dificultaran estos procesos positivos. Estos contextos sociales son claves en el desarrollo y funcionamiento
exitoso. Los contextos que no proporcionan apoyos para estas necesidades psicolgicas contribuyen a la
alienacin y enfermedad del sujeto. Usando metodologas empricas, identificaron tres necesidades

12
psicolgicas bsicas, universales e innatas: ser competente, autonoma y relaciones interpersonales. La
gratificacin de estas necesidades es una clave predictiva del bienestar subjetivo y el desarrollo social.
RYAN, R. M., & DECI, E. L. (2000). Self-determination theory and the facilitation of intrinsic
motivation, social development, and well being. American Psychologist. 55; 68 78.
El Modelo Multidimensional del BS est basado en la literatura sobre desarrollo humano, Ryff (1989 a, 1989
b; Ryff y Keyes 1995) propone que el funcionamiento psicolgico estara conformado por una estructura de
seis factores: autoaceptacin, crecimiento personal, propsitos de vida, relaciones positivas con otros,
dominio medio ambiental y autonoma. En sus investigaciones, los autores encontraron que el crecimiento
personal y los propsitos de vida disminuyen con el tiempo (ambas caractersticas propias de la adultez) y
que el dominio medio ambiental y la autonoma crecen con el tiempo (adultez tarda y vejez). Estos
hallazgos sugieren que el significado o la experiencia subjetiva de bienestar cambia a lo largo de la vida.
RYFF, C. D. (1989 A). Happiness is everything, or is it? Exploration on the meaning of
psychological well-being. Journal of
Personality and Social Psychology. 57: 1069 1081. En: Oishi, S. 2000.
RYFF, C. D. (1989 B). In the eye of the beholder: Views of psychological well-being in middle
and old-aged adults. Psychological and Aging. 4: 195 210. En: Oishy, S. 2000
RYFF, C. D., Y KEYES, L. M. (1995). The structure of psychological well-being revisited. Journal
Of Personality and Social Psychology. 69: 719 727. En: Oishi S. 2000.
El Modelo de Acercamiento a la Meta considera las diferencias individuales y los cambios de desarrollo en
los marcadores de bienestar. En esta lnea han investigado Brunstein 1993; Cantor y cols. 1991; Diener y
Fujita 1995; Emmons 1986, 1991; Harlow y Cantor 1996; Palys y Little 1983; Sanderson y Cantor 1997
(Oishi, 2000).Las metas (estados internalizados deseados por los individuos) y los valores son guas
principales de la vida, mientras que las luchas personales (lo que los individuos hacen caractersticamente
en la vida diaria) son metas de un orden inferior. Este modelo plantea que los marcadores del bienestar
varan en los individuos dependiendo de sus metas y sus valores (Oishi, 2000). La premisa de la meta
como un modelo moderador es que la gente gana y mantiene su bienestar principalmente en el rea en
que ellos le conceden especial importancia y esto en la medida en que los individuos difieren en sus metas
y valores, ellos diferirn en sus fuentes de satisfaccin. Diener y Fujita (1995) investigaron una covariacin
de recursos (dinero, apoyo familiar, habilidades sociales e inteligencia) obteniendo un ndice de recursos
que asociaron con el bienestar, concluyendo que las personas escogen luchas personales en las que tienen
recursos pertinentes, con un grado de congruencia en sus metas y sus recursos, eran predictivos de
bienestar.
OISHI, S. (2000). Goals as Cornerstones of subjective well-being: Linking individuals and
cultures. En: Diener, E. y Suh, E. M., (Eds.), (2000) Culture and Subjective Well-being, pp 87 112, Cambridge, MA: MIT Press).
P90
Slo en el caso que los recursos son escasos pero esenciales para lograr ciertas metas (ej. las necesidades
biolgicas) contina una fuerte relacin recursosbienestar.
La Teora del Flujo de Csikszentmihalyi (1999) indica que el bienestar estara en la actividad humana en s
y no en la satisfaccin o logro de la meta final. La actividad o el comportamiento, es decir, lo que el
individuo hace, produce un sentimiento especial de flujo. La actividad que produce dicho sentimiento, es lo
que se refiere al descubrimiento permanente y constante que est haciendo el individuo de lo que significa
vivir, donde va expresando su propia singularidad y al mismo tiempo va reconociendo y experienciando
en diferentes grados de conciencia - la complejidad del mundo en que vive.
El modelo universalista del bienestar predice que la autonoma y las relaciones de calidad sern ndices de
bienestar a travs de las culturas. Por otra parte, la meta como modelo moderador predice que la
autonoma ser un fuerte predictor del bienestar de los individuos en culturas individualistas, mientras que
la calidad de las relaciones con los otros ser un fuerte predictor en culturas colectivistas.

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P91

El IH o la autonoma est relacionado positivamente con la satisfaccin de vida en las naciones ms

individualistas (EUA, Australia, Alemania y Finlandia).
El IH no est asociado con la satisfaccin de vida en la mayora de las naciones colectivistas (China,
Colombia, Pakistn, Corea, Per, Ghana, Tanzania, Bahrain, Singapur, Turqua, Taiwn y Japn).
El CH u orientacin hacia las relaciones, no est relacionado con la satisfaccin de vida en la
mayora de las naciones individualistas y est positivamente asociado en algunas naciones
colectivistas, tales como China, Colombia, Portugal o Taiwn.
El IV o competitividad se relacion negativamente con la satisfaccin de vida en pases
individualistas tales como Noruega y Finlandia.
El CV o conformidad estuvo positivamente correlacionado con la satisfaccin de vida en Colombia,
Espaa y Hungra, mientras lo hizo negativamente en Indonesia, Taiwn, Sudfrica, Puerto Rico y
Dinamarca.

P92
En las naciones occidentales la gratificacin de necesidades psicolgicas tales como la autonoma y las
relaciones parecen ser un indicador importante en la satisfaccin de vida (Oishi, 2000). En naciones no
occidentales, los individuos autnomos no estaban ms satisfechos con sus vidas que aquellos que lo eran
menos.
5. (Desai, Maciejewski, Dausey, Caldarone, & Potenza, 2004)
P1672
Problem and pathological gambling have been demonstrated to be associated with negative measures
such as high rates of job loss, receipt of welfare benefits, bankruptcy, arrest, incarceration, divorce,
mental health problems,and poor general health (3). However, a relatively small proportion of individuals
exhibit problem or pathological gambling (up to approximately 5% of the general adult population) (3, 6).
The majority of adults in the United States gamble recreationally, at levels not considered problematic or
pathological. Recreational gamblers, who by definition do not meet the diagnostic criteria for pathological
gambling at a threshold (pathological gambling) or subthreshold (problem gambling) level, do not
experience interference in areas of life functioning related to gambling similar to that of problem and
pathological gamblers.
Recently, we showed that past-year recreational gambling is associated with both negative and positive
measures of health and well-being: past-year recreational gamblers were found to have elevated rates of
alcohol abuse/dependence, substance abuse/dependence, depression, and incarceration (7). However,
they also had higher rates of good to excellent subjectively rated general personal health.
P1673
Data suggest that recreational gambling can have both beneficial and detrimental effects (11, 12). Among
olderadults, recreational gambling, like many enjoyable leisure activities, may provide opportunities for
socialization, sensory and cognitive stimulation, and other benefits. However, data also suggest that older
adults may be particularly vulnerable to gambling-related problems. First, there is some suggestion that
slot machine games, which are popular among older gamblers (11), may be more addictive than other
types of gambling (12). Second, early stages of dementia and other cognitive deficits may put older people
at increased risk: excessive lottery and sweepstakes participation have been described in people with
dementia (13). Several state attorneys general have brought lawsuits on behalf of sweepstakes victims,
many of whom are older adults (14). Third, older adults may face greater problems related to excessive
gambling because, although they are not necessarily poor, they often have restricted incomes and limited
ability to work in order to replace savings or recover losses such as the substantial ones often incurred by
problem or pathological gamblers (15, 16).
P1675
Health and Well-Being

14
Several significant differences were observed in measures of health and well-being between older adult
recreational gamblers and non-gamblers (Table 2). After sociodemographic factors were adjusted, older
gamblers were significantly more likely to have used alcohol in the previous year (2=4.07, df=1, p<0.05),
were marginally more likely to have a lifetime history of depression (2=2.71, df= 1, p=0.10), and were
2.49 times more likely (95% confidence interval=1.464.25) to report good or excellent subjective general
health (2=11.17, df=1, p=0.0008). In the younger adult age group, the variables of alcohol use (2=
71.13, df=1, p=0.0001), alcohol abuse/dependence (2= 6.4, df=1, p<0.02), substance
abuse/dependence (2= 12.61, df=1, p=0.0004), and incarceration (2=14.28, df=1, p=0.0002)
distinguished the past-year recreational gamblers and non-gamblers, while the variables of bankruptcy and
depression showed marginal significance (Table 2). In all cases, higher rates were observed in the
gambling group (Table 2).
P1676
We found that, in comparison to the findings for younger adults, there are fewer negative measures of
health and well-being associated with recreational gambling in older adults. Specifically, the findings of
increased rates of alcohol abuse/dependence, substance abuse/dependence, and incarceration that are
found among younger recreational gamblers were not observed in the older recreational gamblers. In
addition, we found that subjective ratings of general health were more strongly associated with
recreational gambling in older, compared with younger adults, such that older gamblers report being in
better health than their non-gambling peers.
P1678
The most significant finding from the present study is that recreational gambling in older adults does not
appear to be associated with adverse health measures, as observed in younger gamblers, and may even
possibly provide some beneficial effect.
6. (Dickerson, 1990)
P188
'Pathological' gambling was first defined in the Diagnostic and Statistical Manual III [8] and retained with
substantial modifications in DSM-III [9]. In the latter, maladaptive gambling behaviour is indicated by at
least four of the following:
1)
2)
3)
4)
5)
6)
7)
8)
9)

Frequent preoccupation with gambling or obtaining money to gamble.

Often gambles larger amounts of money or over a longer period than intended.
Need to increase the size or frequency of bets to achieve the desired excitement.
Restlessness or irritability if unable to gamble.
Repeatedly loses money gambling and returns another day to win back losses ('chasing').
Repeated efforts to cut down or stop gambling.
Often gambles when expected to fulfil social, educational or occupational obligations.
Has given up some important social, occupation or recreational activity in order to gamble.
Continues to gamble despite inability to pay mounting debts, or despite other significant social,
occupational, or legal problems that the individual knows to be exacerbated by gambling.

These criteria have been the focus of a single, limited validation study comparing the responses of GA
members and a small group of gamblers currently attending for treatment with two 'normal' samples of
convenience, university students and hospital employees. The identification of a mental disorder in this
manner perpetuates the assumption that the universe of gamblers consists of the 'pathological' and the
'social'; the latter gambling infrequently and with control. The important conceptual issues that are
obscured by this assumption are discussed in the final section of this review. Although serious and
fundamental criticisms have been made of this sort of approach to personal problems it can be argued that
the medicalization of the harmful effects of gambling has been instrumental in the development of
treatment and counselling services, particularly in the USA.
In this paper preference is given to the terms excessive or problematic gambling, defined as gambling that
is frequent, is at times uncontrolled and has resulted in some harmful effects. 'Excessive' implies that it is

15
a matter of degree and involves personal judgement. Certainly observations support the commonsense
view that involvement in gambling varies from 'not at all' to 'a great deal' and there is no one particular
level or amount of gambling that can be said to be excessive. In his valuable theoretical overview of
addictive behaviours, Orford writes of excess as 'costly' behaviour where there is an imbalance of positive
and negative outcomes. As in most addictive-like behaviours, how this imbalance is evaluated will differ
from individual to individual and according to whether it is the gambler or his or her family who are
evaluating the 'excess'. 'Excessive' gambling seems a readily understood term, makes no assumptions
about causes or cures and provided it is supported by specific descriptions of the extent and nature of the
'costs' of gambling, permits readers to make their own evaluation. Hereafter the term 'pathological' is only
used when referring to papers in which the authors have stated that their subjects satisfy the DSM-III
criteria.
P189
When all too rarely pathological gamblers have been compared with regular gamblers, no differences in
personality measures have been found or that regular gamblers were healthier or more self-actualized
than non-gamblers. Now, it is preferable to assume that excessive gamblers are a heterogeneous group of
people; evidence does not permit their excess to be attributed to a specific weakness, predisposition or
type of personality.
The characteristics of the gambling behaviour
With reference to the form or type of gambling it is very rare for excess to be associated with popular
forms of gambling such as Lotto and pools, where the cycles of stake play and determination are
discontinuous or separated by lengthy periods of time. Most gamblers who seek help have a continuous
form of gambling such as poker machines, off-course agency betting or casino gaming as the focus of their
excessive involvement.
There are of course many people who use such forms of gambling without progressing to excessive levels
and this failure to find a clear discrimination of excessive players seems true regardless of the gambling
characteristic examined. Certainly observations support the commonsense view that involvement in
gambling varies from 'not at all' to 'a great deal' and that there is no one particular level or amount of
gambling that can be said to be excessive.
P190
Similarities between high-frequency gamblers and identified problem gamblers who have
sought help from treatment agencies or GA
As the expenditure of these players is indistinguishable from some gamblers who seek help it is clear that
financial losses per se are not an adequate basis for judging excess. The occurrence of debts arising from
gambling expenditure is more likely amongst gamblers who seek help but does also occur among regular
players.
Chasing and control
The two items in Table 3 that refer to player beliefs about their gambling indicate that such cognitive
factors may have a significant impact on the persistence of players at all levels of involvement. The belief
that one can predict when a randomly controlled machine will pay out borders on the magical and is more
strongly present in the excessive players. Such beliefs can be considered to be aspects of the concept of
'chasing' about which Lesieur has written so persuasively. 'Chasing' is essentially a cluster of beliefs and
behaviours that lead a person to continue to gamble despite heavy losses, 'because a run of bad luck must
end', 'because a machine owes them money', 'because it is the only way to get their money back', etc. As
Oldman has pointed out, there is an element of rationality to chasing; to stop leaves the player with the
certainty of losses or debts, to continue provides the possibility, however marginal, of winning.
The more a person gambles the more likely they are to report spending more than planned, chasing and
wishing to reduce their gambling expenditure. None-the-less even members of GA may report that control
was readily achieved, stopping gambling was easy.

16
Rather than leave the reader with the appropriate but none-the-less intellectual conclusion that excessive
gambling has no clear-cut characteristics, it may be helpful to note that in terms of gambling behavior
excess is more likely to be associated with:
-

a continuous form of gambling

a frequency of more than one session per week
a session length of more than 1h
weekly losses in excess of $50
gambling-related debts
a variety of beliefs and behaviours that may be categorized as comprising impaired control
motives of winning rather than playing for entertainment.

P191-192
Indirect harmful effects of excessive gambling
When a person's level of involvement in gambling results in bankruptcy, the termination of a marital
relationship or the loss of a job, there may be a much greater likelihood that there will be agreement that
the gambling was excessive. Certainly the potential spread of the harmful effects of excessive gambling is
not gambling but for a related issue such as depression or a mysterious and can be considered under five
headings:
-

individual mental health

o high rate of psychiatric disorders
major depressive disorder
suicide attempt
o multiple addictions
alcohol/drug abuse
relationships, marital and family
o Over 60% of GA members thought that they used to lie, not just to cover up the extent of
their gambling, but eventually quite gratuitously. Given that repeated lying undermines the
sense of trust that may be essential to most relationships it is understandable that up to
50% of pathological gamblers are assessed as requiring marital therapy.
o Spouses of male pathological gamblers [4 I] indicated some of the stresses experienced and
the range of reactions to the situation of living with a person who is apparently addicted to
gambling
Two-thirds of the women reported having to obtain loans to pay for basic needs such
as rent, heating and food. A similar proportion reported being harassed or threatened
by bill collectors.
Within the relationship the women commonly reported being ridiculed in front of
children or friends and being blamed by their partner for causing them to gamble.
Over 8o% of the women reacted with feelings of violent anger and 60% reported
hitting or throwing something at their partner.
Almost a third separated from their partner.
Non-adaptive coping such as binge eating, starving and abusing alcohol was
common, as were reports of a wide range of stress-related disorders such as
headache and hypertension; 47% reported depression and 14% attempted suicide.
o Similar descriptive studies have been completed with children of pathological gamblers,
indicating a high level of psychosocial maladjustment than for children without 'troubled'
parents.
Financial
employment and productivity
o He [Lesieur] established that as the level of supervision or time monitoring decreased so the
hours absent from work increased. Furthermore, even while at work it has been estimated
that the excessive gambler may function at no more than 50% of his/her productivity.
Certainly it would appear that the thinking of excessive gamblers becomes preoccupied, not
just with the gambling but with the problems of how to meet debts and how to 'maintain'
promises that they have ceased to gamble.

17
-

related legal problems/offences

o The theory has been advanced that pathological gamblers, while under pressure to maintain
their cash flow while losing, eventually exhaust all legally available options. and slowly,
depending on individual peceptions and opportunities, become involved in more and more
serious illegal activity ranging from check forgery, embezzlement, employee theft to larceny
and armed robbery. Such a 'spiral of options' has reasonable face validity. In Australia the
limited available evidence confirms that up to 50% of members of GA may have committed
an offence to obtain funds to maintain their gambling.

P193
The treatment of excessive gamblers
Orford J. Pathological gambling and its treatment. Br Med J 1985; 296:729-30.
The general principles for treating compulsive gambling are the same as those for treating alcohol
dependence or abuse; good assessment, individual and family counselling, and consultation or referral if
necessary. As with alcohol problems specialist treatments such as aversion therapy or psychotherapy do
not confer any advantage in most cases. The emphasis is now on a less specialised approach that is more
within the realm of general medical practise: recognising the problem and addressing it openly and
positively within an established and trusted relationship may be more valuable than the search for
specialist treatment. (p. 729)
P196
Finally, research needs to distinguish between beginning a new session of gambling and persisting with an
ongoing one. As it has been argued in relation to drinking alcohol [8x], the factors and processes involved
in each may differ significantly. The development in the individual of more frequent sessions of gambling
may to a great extent be a function of the availability of time and ready access to whatever form of
gambling is preferred, e.g. flexible or unsupervised work hours and a nearby TAB or club. As a person
becomes a regular player there may also be a change in attitudes and beliefs; from playing to be sociable
and for entertainment, to playing to win money and stronger beliefs that a win is likely.
Positive and negative emotions also seem to have a differential effect on infrequent as opposed to regular
gamblers. Feelings such as excitement and well-being would seem to both precipitate a 'new' session and
maintain an ongoing one. In contrast it is possible that negative emotions such as frustration, hostility and
depression makes a new session less likely or 'shortens' an ongoing one but only in irregular players. It
seems likely that the persistence of regular, high-frequency gamblers is increased by such
negative moods.
7. (Domnguez-lvarez, 2009)
P4
Los distintos estudios epidemiolgicos en varios pases han ido observando un incremento de la patologa
del juego, paralelo al nmero de apuestas en el juego legalizado en las ltimas dcadas, as como al
aumento de los distintos tipos de juego. Este incremento afecta a la poblacin en general,
independientemente del sexo, raza, cultura y nivel socioeconmico. Sin embargo, hay una preocupacin
generalizada sobre la elevada incidencia de juego patolgico en poblacin de riesgo como jvenes por lo
que se insiste en la necesidad de programas educativos. De hecho, el porcentaje de adolescentes con
ludopata en estos ltimos aos es relativamente ms elevado que el de los adultos (Muoz-Molina, 2008).
Los expertos sealan que el aumento de juegos legalizados junto con la facilidad para jugar y la
publicidad, han repercutido en la incidencia de este trastorno, ya que a ms oferta de juego, ms
oportunidad de jugar y mayor nmero de jugadores patolgicos.
P6
Y es que la adolescencia resulta una etapa del desarrollo durante la cual el sujeto puede resultar
especialmente vulnerable y que se resolver de manera ms o menos adecuada dependiendo de varios

18
factores (Griffiths y Wood, 2000). Las ansias por encontrar dinero rpido estn disparando los casos de
jvenes adictos a las tragaperras. La escasez econmica de los adolescentes est provocando la bsqueda
de otras fuentes de ingreso para divertirse o comprarse sus caprichos y prueban suerte en las mquinas
tragaperras hasta que caen en la ludopata.
El retardo en la emancipacin de los jvenes puede ser un hecho que influya, ya que significa tener
disponibilidad econmica sin ningn tipo de responsabilidad, ya que no tiene que afrontar los costos de
una casa, destinando todo el dinero en actividades de ocio. Hay que tener presente adems que la
mayora de las personas con un problema de ludopata, deja los estudios para ponerse a trabajar, lo que
significa que disponen de dinero siendo muy jvenes.
Siguiendo a Becoa (1999), las caractersticas descriptivas ms importantes de los jugadores patolgicos
(Becoa, 1993; 1995; Echebura, Bez y Fernndez-Montalvo, 1994; Garca, Daz y Aranda, 1993; Legarda
y cols., 1992; Ochoa y Labrador, 1994; Jimnez y Fernndez de Haro, 1999), sobre todo referidas a
caractersticas sociodemogrficas, son las siguientes (Domnguez lvarez, 2007): proporcin hombre-mujer
2:1, predominancia de jugadores jvenes, menor nivel educativo, menos ingresos econmicos, ocupacin
laboral semejante a la del resto de la poblacin no jugadora, mquinas tragaperras como juego
predominante y ciudad de residencia grande.
P7
Clasificacin del DSM-IV y CIE-10
Como veamos anteriormente y en Domnguez lvarez (2007a), el juego patolgico se halla categorizado
en el DSM-IV (APA, 1995) dentro de los trastornos del control de los impulsos, donde como grupo,
comparte una serie de caractersticas con los otros trastornos:
a) Dificultad para resistir un impulso, deseo o tentacin de llevar a cabo algn acto que es daino o
perjudicial para el propio individuo o para los dems.
P8
b) Antes de cometer el acto, en general el sujeto percibe una progresiva sensacin de malestar emocional,
en forma de tensin o activacin interior.
c) Durante la realizacin del acto, el individuo experimenta placer, gratificacin o liberacin.
d) Despus de realizar el acto pueden o no aparecer sentimientos negativos como arrepentimiento, auto
reproches, culpa, vergenza o remordimientos, cuando se consideran sus consecuencias.
Por tanto, segn la DSM-IV, para el diagnstico de juego patolgico, se considera necesario que la persona
se vea afectada por, al menos, cinco de los criterios representados en la tabla 2.
DSM-IV
A. Comportamiento de juego desadaptativo, persistente y recurrente, como indican por lo menos cinco
(o ms) de los siguientes tems:
1. Preocupacin por el juego (por ejemplo, preocupacin por revivir experiencias pasadas de juego,
compensar ventajas entre competidores o planificar la prxima aventura, o pensar formas de
conseguir dinero con el que jugar).
2. Necesidad de jugar con cantidades crecientes de dinero para conseguir el grado de excitacin
deseado.
3. Fracaso repetido de los esfuerzos para controlar, interrumpir o detener el juego.
4. Inquietud o irritabilidad cuando intenta interrumpir o detener el juego.
5. El juego se utiliza como estrategia para escapar de los problemas o para aliviar la disforia (por
ejemplo, sentimientos de desesperanza, culpa, ansiedad, depresin).
6. Despus de perder dinero en el juego, se vuelve otro da para intentar recuperarlo (tratando de
cazar las propias prdidas).
7. Se engaa a los miembros de la familia, terapeutas u otras personas para ocultar el grado de
implicacin con el juego.
8. Se cometen actos ilegales, como falsificacin, fraude, robo, o abuso de confianza, para financiar

19
el juego.
9. Se han arriesgado o perdido relaciones interpersonales significativas, trabajo y oportunidades
educativas o profesionales debido al juego.
10. Se confa en que los dems proporcionen dinero que alivie la desesperada situacin financiera
causada por el juego
B. El comportamiento de juego no se explica mejor por la presencia de un episodio manaco.
CIE-10
1. Tres o ms periodos de juego durante un periodo de al menos un ao.
2. Continuacin de estos episodios a pesar del malestar emocional y la interferencia con el
funcionamiento personal en la vida diaria.
3. Incapacidad para controlar las urgencias para jugar, combinado con una incapacidad de parar.
4. Preocupacin por el juego o las circunstancias que lo rodean.
Adems de considerar al juego patolgico como un trastorno mental, sujeto a determinados criterios
diagnsticos, esta problemtica puede abordarse desde algunas formas de juego que no constituyen un
trastorno mental (los veremos a continuacin en la tipologa de los jugadores):
a) Juego social: tiene lugar entre amigos o compaeros, su duracin es limitada, y con prdidas aceptables
que se han determinado previamente.
b) Juego profesional: el juego no es una actividad ldica, sino una forma de ganarse la vida; los riesgos son
limitados y la disciplina es un elemento primordial; algunos individuos presentan problemas asociados al
juego pero no cumplen todos los criterios para el juego patolgico.
P9
c) Juego problemtico: en el que se evidencia un aumento en la cuanta de las apuestas y en la frecuencia
de stas, as como en el tiempo dedicado al juego, e incluso es probable que el sujeto incremente su
implicacin en el juego coincidiendo con algn acontecimiento vital estresante.
P11
Entre todas las clasificaciones, la propuesta por Ochoa y Labrador (1994) es la que ms se aproxima a la
que se sigue manejando actualmente tanto en cuanto que centra el foco en la conducta desplegada por el
jugador y los efectos socioambientales y familiares que pueden generar.
Segn estos autores, el jugador social sera el que juega ocasional o regularmente a juegos populares o
legalmente permitidos, siempre por entretenimiento, diversin, etc, siendo su caracterstica principal el
control sobre esa conducta de juego, es decir, puede interrumpirla cuando lo desee.
El jugador profesional sera el que vive del juego, apuesta de la forma ms racional, intentando no dejar
nada al azar, para lo que participa en juegos donde es importante la habilidad o hace trampas para ganar.
El jugador problema se caracterizara por jugar frecuente o diariamente, con un gasto habitual de dinero y
tendra menos control de sus impulsos que el jugador social, aunque suele llevar una vida normal, tanto
familiar como laboral. Suelen ser personas con alto riesgo de convertirse en jugador patolgico, si se les
va de las manos el aumento de tiempo empleado en jugar y el gasto de dinero principalmente.
Y por ltimo el jugador patolgico sera aquel que tiene una dependencia emocional del juego, y por lo
tanto una prdida de control con respecto al juego y una interferencia en el funcionamiento normal de la
vida diaria. La frecuencia de juego as como la cantidad de tiempo y dinero invertidos son muy altas. Existe
en l una necesidad subjetiva de jugar para recuperar lo perdido y el fracaso continuo en el intento de
resistir los impulsos de jugar. Suelen ser frecuentes los pensamientos distorsionados o irracionales como el
optimismo irracional y el pensamiento supersticioso.
Algunos de los primeros sntomas del jugador problemtico son el jugar diariamente, jugar ms dinero del
previsto y la preocupacin por recuperar el dinero perdido. Ello da lugar a un fracaso crnico y progresivo

20
en resistir los impulsos de jugar, declarndose la patologa, entendida como juego compulsivo, que
acaba por romper los objetivos personales del jugador.
El juego patolgico o ludopata se retroalimenta siguiendo un mecanismo especfico y caracterstico: el
autoengao. Un ludpata juega convencido de que hace lo correcto, que al final l podr resolver los
problemas (principalmente econmicos) en los que se encuentra. Para el ludpata no es posible dar
marcha atrs, la nica alternativa es seguir jugando, y buscar dinero desesperadamente. Sin embargo,
el dinero y su carencia ya no es el motivo cuando uno cae en la ludopata sino la propia enfermedad, que
no se suele reconocer.
La persona con problemas de juego patolgico, al igual que la que tiene problemas con el alcohol y otros
adictos, se caracteriza por no reconocer su adiccin; la ilusin por poder controlar el azar, enteramente
improbable, le incita a seguir jugando. As mismo dejar de jugar, al igual que con otras drogas, implica un
sndrome de abstinencia, caracterizado por cefaleas, trastornos digestivos, alteracin del sueo, debilidad,
sudoracin, palpitaciones y temblores.
La mayora de los jugadores se enganchan en la fase de ganancia. Seguirn jugando, apostando cada vez
ms dinero, hasta perderlo todo. En ese momento se produce la necesidad inminente y subjetiva de
recuperar el dinero perdido, para ello buscarn ms dinero, invertirn todo su tiempo y arriesgarn todo lo
que tienen, incluso pueden recurrir a la estafa o al delito.
P12
Finalmente, comentar que dentro del que llamaramos jugador patolgico, podran darse diferentes
caractersticas, cambiantes en el tiempo por la propia evolucin de la sociedad, pero centrndonos en el
perfil actual del mismo, tendramos un hombre en torno a los 30 aos, casado y con dos hijos, con un nivel
de estudios medios, activo y por tanto con ingresos propios.
Factores implicados
Entre los factores implicados en el juego patolgico, al igual que en otras adicciones, podemos
encontrarnos como se desarrolla en Domnguez lvarez (2007b), con factores predisponentes o de riesgo
(factores generadores o reforzadores de la conducta de juego y que a su vez pueden ser predictores de la
misma), factores mantenedores (aquellos que estn relacionados con la explicacin de que una persona
siga jugando y llegue a desarrollar una dependencia, a pesar de todas las consecuencias negativas y el
deterioro que le ocasiona en todos los niveles) y factores de proteccin (aquellos valores, integracin
familiar, entorno comunitario, actividades culturales, deporte, prevencin escolar, etc., que interactuando
con sobre los factores predisponentes o de riesgo impediran o modularan la conducta de juego
desadaptativa (EDIS, 2003)).
Factores predisponentes o de riesgo
Nos los encontramos en el inicio de la conducta de juego y a su vez se dividen en factores personales,
familiares y socioambientales (EDIS, 2003; Garrido, Jan y Domnguez, 2004).
Factores personales
Se corresponderan con las caractersticas que posee la persona y que le predisponen a utilizar el juego
como una va de escape a sus problemas, tanto de estado de nimo, ansiedades, bsqueda de
sensaciones y ocupacin del tiempo, otro tipo de adicciones, etc.
P13
a) Caractersticas de personalidad: segn Secades y Villa (1998), desde la perspectiva de los rasgos
generales de la personalidad, aunque los resultados de los estudios que han tratado de identificar los
rasgos generales que caracterizan a los jugadores patolgicos son contradictorios, se considerara que los
jugadores patolgicos tienden a presentar un alto nivel de neuroticismo y de extraversin. No obstante,
como no se puede sustentar de forma adecuada, no se puede identificar dimensiones generales de
personalidad en los jugadores que los caractericen y diferencien (Lesieur y Rosenthal, 1991; Ochoa y
Labrador, 1994; Robert y Botella, 1994). Sin embargo, se han analizado factores ms especficos como

21
predisponentes de la conducta de juego, como podra ser la bsqueda de sensaciones (Zuckerman,
1979).
b) Factores biolgicos: desde las teoras biolgicas, un nivel de activacin anormal es el responsable del
mantenimiento de la conducta de juego. Segn Jacobs (1986), dentro de la Teora General de las
Adicciones, en el Sndrome de Personalidad Adictiva (APS), las personas con alteraciones crnicas de la
activacin psicolgica (aunque tambin con alteraciones de activacin psicofisiolgica, influda por la
psicolgica), son las que corren mayor riesgo de adquirir dependencia, lo que conllevara el alivio de esa
situacin de estrs crnico.
c) Factores de aprendizaje: la exposicin al juego, as como el aprendizaje de la conducta de juego
mediante el modelado por parte de los padres o personas cercanas a la persona se corresponden con uno
de los factores predisponentes. No obstante, siempre debemos tener en cuenta la interaccin de estos
factores con otros a la hora de explicar la aparicin de este trastorno (Robert y Botella, 1994).
d) Variables cognitivas: para las teoras cognitivas, como la Teora Racional Emotiva (RET) de la Adiccin o
la de Percepcin Ilusoria de Control, existen ciertas alteraciones cognitivas que influyen en el inicio y
mantenimiento de la conducta de juego o son agravadas por sta. Se establecen pensamientos
irracionales, distorsionados y errneos, que llevan a asumir ms riesgos, desarrollando una cierta ilusin o
percepcin de control sobre el resultado del juego (Echebura, 1992).
Ejemplos de factores de riesgo personales seran entre otros (EDIS, 2003): sensacin de no poder superar
dificultades, prdida de la confianza en s mismo, insatisfaccin en su vida actual, insatisfaccin en los
estudios o trabajo y la sensacin de agobio o tensin.
Factores familiares
Entre los factores familiares que parecen ser de riesgo o predisponentes al juego, nos encontramos segn
la Sociedad Americana de Psiquiatra (APA, 1995) entre otros con una disciplina familiar inadecuada,
inconsistente o excesivamente permisiva, la exposicin al juego durante la adolescencia, la ruptura del
hogar, unos valores familiares apoyados sobre smbolos materiales y financieros, la falta de planificacin y
el despilfarro familiar, etc. Sin embargo, hay veces en que los vnculos familiares pueden frenar el
desarrollo del juego patolgico (Robert y Botella, 1994).
Luego los factores de riesgo familiares podramos resumirlos en (EDIS, 2003): malas relaciones padres e
hijos, malas relaciones entre la pareja (padres), abuso de alcohol, drogas o juego en los padres y la mala
situacin econmica. En relacin a este tema, son varias las investigaciones que han puesto de manifiesto
que existe una importante relacin entre el desarrollo de juego patolgico o abuso de juego entre los
jvenes y el juego patolgico en uno de los progenitores, sobre todo en el caso de los padres.
Factores socioambientales
Entre los factores sociales y culturales nos encontramos con la gran disponibilidad y el acceso fcil al
juego, as como la aceptacin social, que incrementan la prevalencia del juego patolgico en la poblacin
(Allcock, 1986). Dentro de la exposicin al juego, tambin podramos distinguir varios aspectos como
seran el tipo y nmero de juegos legalizados, el acceso a los juegos, el poder adictivo del juego y las
primeras experiencias con ste.
P15
Ejemplos de factores de riesgo socioambientales seran entre otros (EDIS, 2003): grupo de iguales
jugadores, conducta de juego en lugares de diversin, facilidad de acceso al juego, no participacin social,
mala situacin contractual o paro, trabajo a destajo o alto rendimiento, jornadas de trabajo prolongadas y
cansancio intenso o estrs en el trabajo.
Otro factor de riesgo importante parece estar relacionado con la oferta y el consumo de drogas y alcohol.
En la mayora de los estudios realizados se demuestra que es muy habitual que junto al problema del
juego se asocian otras actividades ilegales, conductas delictivas y consumo de drogas y alcohol (Gupta y
Deverensky, 1998), dndose en ocasiones una situacin de comorbilidad entre estos tres aspectos.

22
Factores mantenedores
Refuerzos positivos y negativos
Los refuerzos positivos de la conducta de juego (el valor reforzante del juego) pueden ser muy diversos
segn para la persona que juegue. Entre ellos encontramos el dinero que se puede ganar, las ilusiones de
riqueza, xito, grandeza, poder, etc., el refuerzo social, as como la activacin fisiolgica de la que antes se
habl. Estos refuerzos son de naturaleza intermitente y de razn variable, as como producen un mayor
arousal, lo que los convierten en poderosos a la hora de mantener una conducta, en este caso la del juego.
Los refuerzos negativos los encontramos cuando una persona realiza una o varias conductas para liberarse
de algo que le es desagradable o molesta. En el caso de los jugadores el juego les ayuda a disminuir o
eliminar sensaciones o emociones desagradables como podran ser la tristeza, aburrimiento, nerviosismo,
malestar con uno mismo, etc., ya que lo utilizan para evadirse de todos sus problemas. Pero como los
problemas aumentan a medida que ms se introduce en la conducta de juego, la persona entrar en un
crculo vicioso del que le ser difcil salir.
Estmulos discriminativos
Los estmulos discriminativos son los que atraen la atencin del jugador y favorecen que se produzca la
respuesta de juego (tensin emocional suscitada por los estmulos asociados al juego). Entre ellos estn
por ejemplo los sonidos, las luces, la msica, etc., que el jugador los llega asociar con las sensaciones
agradables que le produce o el alivio de las desagradables.
Sesgos cognitivos/creencias y pensamientos irracionales Cuando los jugadores llevan a cabo la conducta
de jugar, procesan la informacin que reciben de un modo que da lugar a pensamientos errneos que en
ese momento los dan por vlidos, dando lugar a los sesgos cognitivos, as como a creencias y
pensamientos irracionales como ya se coment anteriormente.
Entre estos errores nos encontramos con la relacin causa efecto, el formular hiptesis sobre el juego, la
confirmacin o prediccin de una hiptesis, as como sorpresa cuando no se confirma, la personificacin de
la mquina, el situar el mrito o el error en uno mismo, percepcin de habilidad personal y/o control,
referencia a habilidades personales y la referencia a un estado personal. Los sesgos cognitivos ms
importantes que afectan a la percepcin del juego son: la ilusin de control, atribuciones diferenciales en
funcin del resultado y el sesgo confirmatorio.
P16
Falta de habilidades para hacer frente al impulso de jugar
La ausencia de habilidades y de autocontrol, de manejo del dinero, de resolucin de problemas, de
afrontamiento del estrs, etc., influyen sobre el aumento de los problemas y de la conducta de juego.
Factores de proteccin
Segn algunos estudios (Robles y Martnez, 1999), algunos factores de proteccin seran las normas de
conducta en la familia y la escuela, las relaciones satisfactorias, el apego familiar, el apoyo social, la
implicacin en actividades religiosas, la auto aceptacin y la existencia de valores positivos respecto al
cuerpo y a la vida. Por otra parte, los factores de proteccin (familiares, escolares, comunitarios,
personales, de valores, de relacin social, grupales y laborales) se pueden agrupar en cuatro bloques:
valores alternativos, actividades alternativas, integracin familiar y entorno y prevencin (EDIS, 2003).
Entre los valores alternativos tendramos los siguientes factores de proteccin: mantenerse al margen de
la conducta de juego, renuncia satisfacciones por futuro, objetivos claros de lo que quiere y colaborar con
los dems.
Entre las actividades alternativas: participar en las actividades sociales, participar en actividades
humanitarias, participar en actividades religiosas y practicar deportes.

23
Entre la integracin familiar: dilogos entre pareja y padres e hijos en general, relaciones familiares
satisfactorias, contar los problemas en casa y dialogar sobre riesgos adicciones.
Y entre el entorno y prevencin encontraramos: prevencin de adicciones en general, prevencin
adicciones en escuelas y trabajos e integracin en el barrio.
8. (Garca-Viniegras & Gonzlez-Bentez, 2000)
P586
Uno de los componentes fundamentales del bienestar es la satisfaccin personal con la vida. Esa
satisfaccin surge a punto de partida de una transaccin entre el individuo y su entorno micro y
macrosocial, con sus elementos actuales e histricos, donde se incluyen las condiciones objetivas
materiales y sociales, que brindan al hombre determinadas oportunidades para la realizacin personal.
P587
El bienestar subjetivo es parte de la salud en su sentido ms general y se manifiesta en todas las esferas
de la actividad humana. Es de todos conocido que cuando un individuo se siente bien es ms productivo,
sociable y creativo, posee una proyeccin de futuro positiva, infunde felicidad y la felicidad implica
capacidad de amar, trabajar, relacionarse socialmente y controlar el medio.1 Est demostrada la
asociacin entre algunos estados emocionales y respuestas de enfrentamiento al estrs de un tipo u otro.2
Todo esto explica por s solo la relacin del bienestar psicolgico con los niveles de salud.
El bienestar subjetivo es parte integrante de la calidad de vida que tiene un carcter temporal y
plurideterminado.
Otros autores han considerado el bienestar subjetivo como expresin de la afectividad. 4 Para Lawton, el
bienestar es visto como una valoracin cognitiva, como la evaluacin de la congruencia entre las metas
deseadas y las obtenidas en la vida,5 mientras que Diener y otros6 brindan una concepcin ms
integradora del bienestar subjetivo considerndolo como la evaluacin que hacen las personas de su vida,
que incluye tanto juicios cognitivos como reacciones afectivas (estados de nimo y emociones).
Existe una ntima relacin de lo afectivo y lo cognitivo por lo que el bienestar es definido por la mayora de
los autores como la valoracin subjetiva que expresa la satisfaccin de las personas y su grado de
complacencia con aspectos especficos o globales de su vida, en los que predominan los estados de nimo
positivos.
P588
El bienestar psicolgico puede ser considerado como la parte del bienestar que compone el nivel
psicolgico, siendo el bienestar general o bienestar subjetivo el que est compuesto por otras influencias,
como por ejemplo la satisfaccin de necesidades fisiolgicas.
El bienestar psicolgico trasciende la reaccin emocional inmediata, el estado de nimo como tal.
Aunque hay una fuerte evidencia a favor de la existencia tanto de aspectos estables como de aspectos
transitorios del bienestar subjetivo, los aspectos estables parecen tener efectos significativamente ms
fuertes que los aspectos transitorios.
El bienestar psicolgico es un constructo que expresa el sentir positivo y el pensar constructivo del ser
humano acerca de s mismo, que se define por su naturaleza subjetiva vivencial y que se relaciona
estrechamente con aspectos particulares del funcionamiento fsico, psquico y social. El bienestar posee
elementos reactivos, transitorios, vinculados a la esfera emocional, y elementos estables que son
expresin de lo cognitivo, de lo valorativo; ambos estrechamente vinculados entre s y muy influidos por la
personalidad como sistema de interacciones complejas, y por las circunstancias medioambientales,
especialmente las ms estables.
Puede esperarse que las causas del bienestar difieran segn el ciclo vital, las condiciones de vida, el nivel
educacional, la ocupacin o el grupo social.

24
El bienestar es una experiencia humana vinculada al presente, pero tambin con proyeccin al futuro,
pues se produce justamente por el logro de bienes. Es en este sentido que el bienestar surge del balance
entre las expectativas (proyeccin de futuro) y los logros (valoracin del presente), lo que muchos autores
llaman satisfaccin, en las reas de mayor inters para el ser humano y que son el trabajo, la familia, la
salud, las condiciones materiales de vida, las relaciones interpersonales, y las relaciones sexuales y
afectivas con la pareja. Esa satisfaccin con la vida surge a punto de partida de una transaccin entre el
individuo y su entorno micro y macrosocial, donde se incluyen las condiciones objetivas materiales y
sociales, que brindan al hombre determinadas oportunidades para la realizacin personal.
Las condiciones materiales de vida, por constituir las condiciones reales en que los hombres producen y
reproducen su existencia social e individual, aporta elementos decisivos al bienestar humano, sin
embargo, ellas constituyen slo un aspecto en su naturaleza plurideterminada. Las condiciones de vida no
son ms que aquellas condiciones materiales, espirituales y de actividad en las que transcurre la vida de
las personas. Entre las condiciones de vida estn la disponibilidad de fuentes de trabajo, condiciones de
vivienda, servicios de atencin mdica, disponibilidad de alimentos, existencia de centros culturales y
deportivos, saneamiento ambiental, transporte, comunicaciones, etctera.
P589
El nivel de vida es el grado en que se satisfacen las necesidades humanas expresadas a travs de un
conjunto de indicadores cuantitativos; son aquellas caractersticas cuantitativas del consumo de los
grupos.
Por otra parte, el modo de vida, es una categora tambin estrechamente relacionada con la calidad de
vida y el bienestar. Este es ante todo un concepto sociolgico que se conceptualiza como la expresin
integrada de la influencia socioeconmica en el conjunto de formas de la actividad vital, en la vida
cotidiana de los individuos, grupos y clases sociales. l sintetiza en la actividad vital del hombre lo
biolgico y lo social.8 El modo de vida caracteriza las principales propiedades existentes en una
determinada sociedad.9
El modo de vida significa el modo por el que los miembros de la sociedad utilizan y desarrollan las
condiciones de vida, y a su vez estas condiciones de vida lo modifican. Es necesario tener en cuenta la
actitud subjetiva del hombre hacia su modo de vida, porque la satisfaccin o la insatisfaccin son los
inspiradores ms importantes de su modificacin.
Ese estilo de vida refleja el comportamiento del sujeto en su contexto social y su especificidad psicolgica
en la realizacin de su actividad vital. Tiene un carcter activo y est regulado por la personalidad, y
representa el conjunto de conductas del individuo en su medio social, cultural y econmico.
El estilo de vida abarca los hbitos y la realizacin personal en todas las esferas de la vida del hombre, el
rea laboral, la cultura material (manera de vestir, tiles domsticos), higiene personal, cultura sanitaria,
actividad cultural y sociopoltica, as como las relaciones sociales y sexualidad.
P590
La calidad de vida se ha definido como un equivalente de bienestar en el mbito social, de estado de salud
en el terreno mdico, llamada tambin calidad de vida de salud y de satisfaccin vital en el campo
psicolgico.
La definicin que adoptamos con relacin a la calidad de vida es la siguiente: El resultado de la compleja
interaccin entre factores objetivos y subjetivos; los primeros constituyen las condiciones externas
(econmicas, sociopolticas, culturales, ambientales, etc.), que facilitan o entorpecen el pleno desarrollo
del hombre, de su personalidad. Los factores subjetivos estn determinados en ltima instancia por la
valoracin que el sujeto hace de su propia vida en funcin del nivel de satisfaccin que alcanza en las
esferas o dominios ms importantes de su vida.
P591

25
En la estructura del rea subjetiva de la calidad de vida tenemos, pues, como ncleo central, una
dimensin psicolgica la cual expresa el nivel de correspondencia entre las aspiraciones y expectativas
trazadas por el sujeto y los logros que ha alcanzado o puede alcanzar a corto o mediano plazo.
9. (Mathews & Volberg, 2013)
P128
Impact of gambling on family financial well-being
Financially, the revelation alone of the magnitude of debts incurred by the gambler can be traumatic
(Dickson-Swift, James,&Kippen, 2005). At times this can mean the loss of all the non-gamblers life savings
to settle legal or illegally acquired debts, lifestyle adjustments which include returning to work if they have
not been working, and moving to another home because of the need to downsize and take other costcutting measures (McComb, Lee, & Sprenkle, 2009). Most of these financial stressors are recurring and do
not cease with the gambler stopping gambling, since the debts often accrue substantial interest (McComb
et al., 2009).
P129
Impact of gambling on family emotional/psychological well-being
Among the respondents,84%of spouses reported that they considered themselves to be emotionally ill
because of their partners gambling problems. Common emotional issues included anger and resentment
at the gamblers financial losses (Hodgins, Shead, & Makarchuk, 2007; Lorenz & Yaffee, 1989); feelings of
guilt and self-blame (Blaszczynski et al., 1998; Dickson-Swift et al., 2005; Lorenz & Yaffee, 1988); worry
about the future (Blaszczynski et al., 1998) and increased depressive thoughts. When Ciarrocchi and
Reinert (1993) surveyed a sample of married female members of GamAnon (a fellowship group for spouses
of members of Gamblers Anonymous), they found that many of the emotional pains associated with their
partner remained even after two years of the gamblers abstinence. This was partly because they had lost
trust in their spouse and this trust did not seem easy to rebuild (Lee, 2002).
Jacobs et al.s (1989) study, which compared 52 high school students who had one or both parents who
were problem gamblers with a control group consisting of 792 of their classmates, showed that these
children tended to engage in more health-risk behaviours such as smoking, drinking, drug use or
overeating; had higher incidence of emotional problems such as depression, anxiety, poor self image and
suicidal attempts; and were more likely to have problems with the legal system.
Impact of gambling on family social/relational well-being
In two Australian studies, Patford (2008, 2009) interviewed 13 men and 23 women about their current or
previous partners gambling to explore their experiences, understandings and responses. Themes that
emerged from these studies included diminished quality of life for these partners, financial conflicts,
difficulties and losses, relationship tensions and loss of trust, and effects on children. Study participants
used a range of strategies to manage their partners gambling over time, sought help from family
members, friends and work colleagues and struggled with decisions to separate. Overall, these studies
demonstrate that partners and adult children of gamblers are both victims and enablers of gambling
behaviour who provide extensive informal control and care and seek formal and informal help for the
gambler and themselves.
P137
As in these places, families in Singapore experience substantial financial distress with its accompanying
woes which reduce the familys resources and lead to some level of deprivation. Emotionally, family
members experience substantial anger and anxiety as they deal with the decisions and actions of the
problem gambler. The social impact of problem gambling includes relational breakdowns and the
increasing social isolation experienced by the family.
P138

26
While the impacts on families seem similar across societies, there are subtle but significant differences in
the Asian case. First, it is very noticeable from this study that the family, including the extended family, is
routinely mobilized to bear the burden of the problem gambler. Because of the strong cultural ethic for
collective responsibility within the family in Singapore and in many Asian societies (Tsui & Shultz, 1985),
the resulting burden on the family is probably greater than may be the case in contexts where extended
families are not considered the main source of social organization, support and social security. In the Asian
case, the issues related to shame and embarrassment further compound
Although gambling may be
socially acceptable, incurring substantial debts is not viewed favourably, particularly because such debts
can result in significant problems for others who come into contact with the family. Loan sharks have
ingeniously preyed on the sense of collective responsibility that many Singaporeans share for family
members and their sense of shame. By vandalizing apartment units and displaying signs on house walls
and doors, indicating that an occupant has not paid up debts, loan sharks manage to shame the family and
force it to settle these debts as soon as possible to avoid further shame. Loan sharks harass relatives and
other family members as well as neighbours in the hope that through their endeavours they will make at
least some family members pitch in to settle the debts incurred through gambling.
10.(Raylu & Po Oei, 2004)
P1088
PG occurs when gambling is out of control and it begins causing individuals social, personal, and
interpersonal problems. A number of terms have been used in the gambling literature to indicate PG. This
paper, similar to the Raylu and Oei (2002) review, will use PG in a broader senseas gambling behavior
that meets the Diagnostic Statistical Manual IV (DSM-IV) diagnostic criteria (American Psychiatric
Association [APA], 1994) as well as those individuals experiencing gambling problems but do not meet the
diagnostic criteria.
Problem gamblers (PGs) generally appear to be a heterogeneous group. However, several groups have
been reported more likely to gamble and/or develop PG. Our recent review (Raylu & Oei, 2002) highlighted
that although some studies suggest that certain demographic characteristics such as gender,
socioeconomic status, employment status, marital status, and age may be linked to PG, not all studies are
in agreement. However, rates of gambling and PG have been found to vary greatly from country to country
as well as in different locations within a country (e.g., states or cities), and there are many anecdotal
accounts and media reports of significantly high rates of gambling and PG among certain cultural groups
(Murray, 1993; Productivity Commission Report [PCR], 1999; Raylu & Oei, 2002).
Variance in the rates of gambling and PG can be at least partially attributed to the number of ways in
which gambling is available and marketed in different locations. Such differences in gambling rates could
also be due to cultural differences of the geographical regions. Cultural differences could also influence
variations in gambling behaviors between the different cultural groups. These include variations in the
functions/objectives of the games, gender differences, and forms of gambling chosen (GAMECS Project,
1999; Goodale, 1987; Heine, 1991; Raylu & Oei, 2002; Sexton, 1987; VCGA, 1999; Zimmer, 1986).
The cultural variables that have been constantly identified in the gambling literature as playing a role in
initiating and maintaining mental health problems (e.g., substance-related problems) include beliefs and
values of a cultural group, culturally determined help-seeking behaviors, and the process of acculturation
(De-La-Rosa et al., 2000; Escobar, Nervi, & Gara, 2000; Loue, 1998; Westermeyer, 1999).
P1090
The terms culture, race, and ethnicity have often been used interchangeably in the mental health
literature. For this review, culture encompasses traditions, social practices, customs, and laws of a group of
people. It refers to an intentional world composed of conceptions, evaluations, judgments, goals and other
mental representations already embodied in socially inherited institutions, practices, ritual, myths,
artifacts, technologies, art forms, texts, and modes of discourse (Shweder, 1991). It is these inherited
conceptions, evaluations, judgments, and goals that influence members thinking, via which members

27
build their lives, and with respect to which they give substance to their minds, wills, and directed actions.
Consequently, culture can affect an individuals intelligence, cognitive development, personality, sex roles,
values, beliefs, identity, and attitudes (Shweder, 1991).
1094
Gambling, similar to any social behavior, receives meaning by reference to the contexts in which it occurs
(Abt & McGurrin, 1992). It is possible that cultural history and what rationales the culture dictates,
influences the meanings that are given to gambling behavior, the motivations for gambling, the monetary
costs and benefits of gambling, the advantages and disadvantages of gambling, and the concept of PG
(Abt, McGurrin, & Smith, 1985).
P1095
PG appears to be higher among those whose parents gamble (Gambino, Fitzgerald, Shaffer, Renner, &
Courtnage, 1993; Jacobs, Marston, & Singer, 1985; Lesieur, Blume, & Zoppa, 1986; Lesieur et al., 1991;
Lesieur & Heineman, 1988; Lesieur & Klien, 1987; Wallisch, 1996). There is evidence that children who
gamble tend to gamble with friends and family members (Daghestani, Elenz, & Crayton, 1996; Gupta &
Derevensky, 1997) and are more likely to have begun gambling with parents (Griffiths, 1995). Wynne,
Smith, and Jacobs (1996) reported that PGs were more likely to view gambling as part of their family
norms. Second, values or beliefs regarding gambling can also be passed to members indirectly (e.g., by
showing their approval and tolerance of gambling or by sharing historicaltexts, stories, and myths with
their members that show approval and acceptance of gambling). Positive parental attitudes or approval
toward substance use have been found to link to substance use among their children (Kandel, 1978, 1982;
Kim, 1979; Newcomb & Bentler, 1986). On the other hand, negative parental attitudes or disapproval
toward substance usehave been found to link to reduced substance use among their children (Catalano et
al., 1992). Barnes and Welte (1986) found that adolescent abstainers from alcohol were more likely to have
parents who disapprove of drinking.
P1099
Studies from different countries and states have provided evidence that legalization of gambling and
increased accessibility to gambling has led to an increase in the number of regular gamblers and PGs
(Raylu & Oei, 2002).
1100
A limited number of studies have shown that stress can play a role in the development and maintenance of
gambling problems. Friedland, Keinan, and Regev (1992) tested the hypothesis that stress, which
undermines persons sense of control, would engender illusory perceptions of controllability. Control might
then be sought by undertaking acts, the effect of which on the environment is illusory. Results showed that
highly stressed (compared lowly stressed) subjects preferred gambling forms that heightened perceptions
of control. Researchers have often associated stress with PG (Coman et al., 1997; Raylu & Oei, 2002; Taber,
McCormick, & Ramirez, 1987; Zuckerman, 1999).
1103
Cultural beliefs and values (which are reinforced by members of the family and through the cultures
history) can influence not only gambling behaviors (e.g., frequency of gambling, mode of gambling chosen,
etc.) but also help-seeking attitudes. It suggested that cultures that have cultural values and beliefs that
favor gambling (such as the Chinese) are more likely to gamble or develop PG compared to cultures that
do not have values that encourage gambling (e.g., Muslims). Cultures that show high conformity to cultural
norms, values, laws, and attitudes and/ or follow a collectivistic way of life tend to regard family as
important and are more likely to follow the norms, values, laws, and attitudes their cultures dictate
(Shweder, 1991). Individuals with values in terms of individualization (giving priority to personal goals over
group goals) compared to collectivism (giving priority to group goals over personal goals) would be less
likely to have similar attitudes towards seeking professional psychological help as other members. Also,
cultures who have negative attitudes towards getting professional help are less likely to try and get help

28
when they initially begin experiencing problems with their gambling and, thus, are more likely to continue
gambling and subsequently develop PG.
Acculturation, however, in turn, can influence an individuals beliefs and values and consequently
gambling behaviors and help-seeking attitudes. The review suggests that it is possible that cultural groups
that value abstinence and integrate it into their values and belief systems have low rates of gambling/PG,
as long as individuals remain within that group. However, if they leave the group and associate with
another cultural group, the chance for gambling increases if this other group has high acceptance and
practice of gambling. It is therefore possible that those that are more acculturated (i.e., similar to the host
country) are more likely to have help-seeking attitudes of the host country than of the origin country.
1104
A family systems approach might have to be taken for treatment if a collective role in PG is implicated.
Information and support for the relatives of PGs may be especially important.
P106
Researchers exploring gambling among children and adolescents have suggested that rates of gambling
and PG are high among this group. For a significant minority of youth, gambling occurs during
preadolescence when family factors are likely to exert a strong influence. Early initiation has also been
associated with later problems of abuse.
This is significant as it has already been found that PGs are more likely to have parents who gamble, have
begun gambling with parents, and view gambling as part of their family norm (Raylu & Oei, 2002).
Raylu, N., & Oei, T. P. S. (2002). Pathological gambling: A comprehensive review. Clinical
Psychology Review, 22(7), 10091061.
11.(Rickwood, Blaszczynski, Delfabbro, Dowling, & Heading, 2010)
P1
Definitions and types of gambling
Gambling involves the staking of an item of value, such as money or property, on an outcome that is
determined in part by chance. In some cases, this element of chance is an inevitable feature of the activity
itself due to incomplete knowledge (e.g., racing, sports-betting) or due to the random nature of the
outcomes (e.g., lotteries, gaming machines, or casino games). Some forms of speculation (e.g., stockmarket trading) may also be considered forms of gambling depending on how people make decisions,
although the market is not, by its nature, designed to generate chance-determined or random outcomes.
Gambling is generally divided into three categories: (1) Wagering and betting, placing a bet or wager on
the outcome of an event such as a sporting event or race; (2) Gaming, which involves placing bets on
games that are constrained by mathematically pre-determined rules and theoretical returns of players
(gaming machines and casino table games); and (3) Lottery style games, including Cross-Lotto, Powerball,
Pools, scratch tickets and Keno, all of which award prizes based on the selection of winning symbol or
number combinations (Delfabbro & LeCouteur, 2008).
Delfabbro, P.H., & LeCouteur, A.L. (2009). Australasian gambling review (4th Ed.). Adelaide:
Independent Gambling Authority of South Australia.
P2
Almost all of these forms of gambling are designed to provide a negative return to players; that is, players
typically should expect to lose a certain percentage of each amount gambled.
Some activities offer players some opportunity to influence their chance of winning by using skills,
knowledge or strategies (e.g., wagering and casino card games), whereas others such as gaming
machines, roulette and lotteries have outcomes that are entirely chance-determined. Gambling activities
also vary in their frequency and continuity. Some activities (e.g., lotteries) are referred to as non-

29
continuous because draws occur infrequently, whereas gaming machines and casino games allow players
to make repeated gambles often in a short period of time (e.g., every 10 seconds on gaming machines on
average).
P6
The lack of consensus is mostly around the conceptualisation of gambling harm. A number of different
terms are used to described harmful gambling, but problem and pathological are the two most common.
In Australia, problem gambling, or gambling problems, is defined as difficulties in limiting money and/or
time spent on gambling which leads to adverse consequences for the gambler, others, or for the
community (Neal, Delfabbro, & ONeil, 2005, p.i). Consistent with a public health approach, this definition
views problem gambling on a continuum that encompasses the full spectrum of harm, from mild to severe,
and encapsulates the impact of gambling problems on those who gamble, as well as their family and
friends, businesses and the community (Korn, Gibbons, & Azmier, 2003). By contrast, the term
pathological gambling refers to the psychiatric or medical definition from the Diagnostic and Statistical
Manual of Mental Disorders (DSM-IV-TR), and implies the existence of a diagnosable disorder that is usually
defined in terms of a combination of elements considered central to impulse control disorders and
traditional addictions, including tolerance, withdrawal, craving, and impaired control, as well as significant
disruptions to normal everyday functioning.
Neal, P., Delfabbro, P.H., & ONeil, M. (2005). Problem gambling and harm: Towards a national
definition. Gambling Research Australia: Melbourne.
Korn, D., Gibbons, R., & Azmier, J. (2003). Framing public policy towards a public health
paradigm for gambling. Journal of Gambling Studies, 19, 235-256.
It has been argued that use of pathologising terms such as compulsive, pathological, or problem
gambler implies that the individual is the problem, rather than taking a broader psycho-social and
environmental approach. The term responsible gambling has emerged recently from harm minimisation
approaches, but is an ambiguous term that can relate to informed choice, gambling industry initiatives, or
have the inference that consumers with gambling problems are irresponsible (Korn, Gibbons, & Azmier,
2003).
P7
Gambling harm
Gambling can give rise to different types and levels of harm and these can be personal, social, vocational,
financial and legal. The most obvious harm is financial, and this is clearly related to many of the other
harms. In terms of psychological harm, it has been found that 40-60% of problem gamblers in treatment
samples experience clinical depression (Battersby & Tolchard, 1996; MacCallum, Blaszczynski, Joukhador,
& Bettie, 1999), display suicidal ideation (Battersby & Tolchard, 1996; Sullivan, Abbott, & McAvoy, 1994), or
have significant levels of anxiety (Battersby & Tolchard, 1996). Problem gamblers also have a greater
likelihood of engaging in other behaviours that compromise their wellbeing, particularly substance use.
Data suggest that 50 60% of gamblers smoke compared to 22% of the general population, and that 30
40% have a concurrent substance dependence or abuse (MacCallum & Blaszczynski, 2002; Rodda & Cowie,
2005) as well as poorer physical health (Delfabbro & LeCouteur, 2009).
Battersby, M., & Tolchard, B. (1996). The effect of treatment of pathological gamblers referred
to a behavioural psychotherapy unit: II - Outcome of three kinds of behavioural intervention.
In B. Tolchard (Ed.). Towards 2000: The future of gambling: Proceedings of the 7th annual
conference of the National Association for Gambling Studies (pp. 219-227), Adelaide, South
Australia.
MacCallum, F., Blaszczynski, A., Joukhador, J., & Beattie, L. (1999). Suicidality and pathological
gambling: A systematic assessment of severity and lethality. In J. MacCallum, F., &
Blaszczynski, A. (2002). Pathological gambling and co-morbid substance use. Australian and
New Zealand Journal of Psychiatry, 36, 411-415.

30
MacCallum, F. & Blaszczynski, A. (2003). Pathological gambling and suicidality: an analysis of
severity and lethality. Suicide and Life Threatening Behavior, 33, 8897.
Problem gambling can have significant effects on many aspects of the gamblers life, including their
relationships and employment. Many problem gamblers report intimate relationship and family difficulties
(Dowling, Smith, & Thomas, 2009a) or having lost or jeopardised relationships as a result of gambling
(Dickerson, Boreham, & Harley, 1995; Jackson et al., 1997). Others report having put off activities or
neglected their families because of gambling (Productivity Commission, 1999; S.A. Department of Human
Services, 2001), and most report having lied to family members or engaged in furtive activities so as to
conceal the extent of their gambling and the resultant losses (Productivity Commission, 1999).
Dowling, N., Smith, D., & Thomas, T. (2009a). The family functioning of female pathological
gamblers. International Journal of Mental Health and Addiction, 7(1), 29-44.
Dickerson, M.G., Boreham, P., & Harley, W. (1995). The extent, nature and predictors of
problems associated with machine gambling in Queensland-a survey-based analysis and
assessment. Report to the Department of Family and Community Services, Queensland
Government.
Consequently, problem gambling can be particularly devastating for families because the nature and
extent of the gambling problem often can be concealed for long periods. Apart from the betrayal of trust
that may be felt by families when the problem is finally revealed, the hidden nature of gambling can mean
that family finances are depleted before family members have an opportunity to assist the gambler and
direct them to treatment.
P8
Similarly, although relatively less is known about the vocational impacts of problem gambling, there is
evidence that those affected report having given up time from work to gamble, have lost jobs due to
gambling, or have used their workplace to commit crimes to continue funding their gambling (Delfabbro &
LeCouteur, 2009; Productivity Commission, 1999; 2009). In a detailed analysis of the offending record of
306 problem gamblers in treatment, Blaszczynski and McConaghy (1994) showed that larceny,
embezzlement, and the misappropriation of funds were the most common crimes reported. Many of those
who committed these crimes did not have a previous history of conviction and were found to work in
white-collar professions that provided them with direct access to money.
P12
Motivation to gamble
There are many reasons why people gamble recreationally. These may be broadly classified under two nonmutually exclusive types of motivation: the desire for positively reinforcing subjective excitement and
arousal; and the desire for the negatively reinforcing relief or escape from stress or negative emotional
states. Both social and monetary reward expectancies facilitate gambling due the learnt association with,
and capacity to enhance or regulate, positive affect (Shead & Hodgins, 2009).
Shead, N.W., & Hodgins, D.C. (2009). Affect-regulation expectancies among gamblers. Journal
of Gambling Studies, 25, 357375.
By its very nature, gambling represents an opportunity to win money, and subject to the potential size of
the prize, to change ones lifestyle. The prospect of winning large prizes (expectancies of reward)
generates excitement by allowing participants to dream and fantasise about the impact that such a
windfall would have on their work, finances, leisure, and capacity to support immediate family members.
Smaller wins are also exciting since these provide a gain to the player and enable further gambling in
pursuit of larger wins.
Importantly, the form of gambling and the environment in which it is conducted is conducive to social
interaction and this adds substantially to its inherent enjoyment. Hotel, club, casino and on-course venues
are recreational locations that offer a range of entertainment options (food, beverage and shows). Within

31
these contexts, gamblers can readily meet, interact socially, and test their luck and skill in pleasant and
safe surroundings leading to enhanced social integration and stimulation, self-esteem, and a positive sense
of recreation/leisure. Gambling is also a means of overcoming boredom.
P13
The capacity for gambling to narrow ones focus of attention (Anderson & Brown, 1984) and produce
dissociative states (Jacobs, 1986) accounts for the reason why many individuals use gambling as a
maladaptive coping strategy to deal with problems, emotional distress and stress/tension. Gamblers often
report that gambling represents a means, albeit temporary, of isolation and distraction from worry,
demands and responsibilities, and confronting problems. This is one of the more powerful motivators
underpinning persistent gambling in samples of problem gamblers (see Petry, 2005), and forms a central
component of a number of psychological models of gambling (Blaszczynski & Nower, 2002; Jacobs, 1986;
Sharpe, 2002). The affect-regulation component of gambling is driven by a need to maintain optimal levels
of arousal and accounts in part for the selection of certain forms of gambling low skill activities to
alleviate anxiety and stress, and high skill games to generate excitement and elevate mood (Blaszczynski
& McConaghy, 1989; Petry 2005).
Anderson, G., & Brown, R.I.F. (1984). Real and laboratory gambling: Sensation-seeking and
arousal. British Journal of Psychology, 75, 401-410.
Jacobs, D.F. (1986). A general theory of addictions: A new theoretical model. Journal of
Gambling Behavior, 2, 15-31.
Blaszczynski, A., & Nower, L. (2002). A pathways model of problem and pathological gambling.
Addiction, 97, 487-499.
Blaszczynski, A., & McConaghy.N. (1994). Criminal offences in Gamblers Anonymous and
hospital treated pathological gamblers. Journal of Gambling Studies, 10, 99-127.
Petry, N.M. (2005). Pathological gambling: Etiology, comorbidity and treatment. Washington
D.C.: American Psychological Association.
Evidence suggests that problem and non-problem gamblers have similar motivations to gamble but the
motivational strength differs for problem gamblers. In particular, winning money (chasing losses) and
relieving tension, stress and emotional distress are implicated in promoting continued gambling (Clarke,
Tse, Abbott, Townsend, Kingi, & Manaia, 2007; Platz & Millar, 2001).
Clark, D., Tse, S., Abbott, M.W., Townsend, S., Kingi, P., & Manaia, W. (2007). Reasons for
starting and continuing a gambling in a mixed ethnic community sample of pathological and
non-pathological gamblers. International Gambling Studies, 7, 299-313.
Platz, L., & Millar, M. (2001). Gambling in the context of other recreation activity: A
quantitative comparison, casual and pathological student at gamblers. Journal of Leisure
Research, 33, 383-395.
There are gaps in our knowledge about gender and age differences in respect to gambling motivations.
Some studies have found that females are more likely to gamble in response to intrapsychic factors such
as loneliness, depression, and to gain control over their lives and emotional issues. Males respond to
external factors such as peer groups, financial pressures and employment related conflicts (Petry, 2005).
Others have found no significant gender differences for either commencing or continuing gambling (e.g.,
Clarke, Tse, Abbott, Townsend, Kingi, & Manaia, 2007). Age differences in gambling motivation are not well
understood.
12.(Ruiz-Reynosa, 2013)
P56
Los sujetos del presente estudio fueron adultos jvenes, comprendidos en edades de 20 a 30 aos, de sexo
masculino, de la Ciudad de Guatemala, que poseen caractersticas de ludopata.

32
Con el presente estudio se demostr que el nivel de bienestar psicolgico de las personas que
presentan caractersticas de ludopata, es bajo debido a que las consecuencias de esta condicin
son graves y afectan diferentes reas de la vida de los participantes.
La ludopata es un trastorno en el que la persona se ve obligada, por una urgencia
psicolgicamente incontrolable, a jugar. Aunque existen factores sociales, culturales e incluso
bioqumicos en el juego patolgico, est considerado un trastorno de caractersticas psicolgicas.
La ludopata acaba en una dependencia emocional respecto del juego. Es decir, implica un deterioro
progresivo en la conducta de juego, partiendo de momentos iniciales en los que el juego y las
apuestas son escasos hasta llegar al juego patolgico.
Los indicadores principales que se manifiestan en los ocho casos investigados son la preocupacin
por el juego, poner en riesgo o perder relaciones significativas e inestabilidad econmica.
Dentro de los resultados del estudio, se pudo observar que en la mayora de casos, se presenta un
mnimo porcentaje de Bienestar Psicolgico.
El nivel de Bienestar Subjetivo fue relativamente mayor a los dems tipos de bienestar.
El nivel de Bienestar de pareja fue el ms bajo debido a que no todos los sujetos se encontraban
actualmente en una relacin o la haban perdido a consecuencia del juego.
Algunos de los participantes cometieron actos ilcitos para recuperar dinero u obtenerlo a costa de
familiares o amigos.
La mayora de participantes coment haber sentido culpa, tristeza, frustracin y ambicin debido al
juego.
La ludopata se caracteriza por frecuentes recadas por la incapacidad del sujeto para controlar el
impulso de jugar.
13.(Shead, Deverensky, & Gupta, 2010)

Ver PDF.

14.(Tang & Oei, 2011)

P511
Recent research in Korea (Lee, LaBrie, Grant, Kim, & Shaffer, 2008), Hong Kong (Tang, Wu, & Tang, 2007),
Macau (Vong, 2007), Singapore (Teo, Mythily, Anantha, & Winslow, 2007), and Australia and New Zealand
(Oei, Lin & Raylu, 2008; Storer, Abbott, & Stubbs, 2009) indicates that with greater access to new forms of
gambling, there are more people who have problem gambling and who are seeking help. Excessive
gambling hampers peoples physical, psychological, social, and financial well-being. Problem gamblers
often report poorer mental health than nongamblers, with frequent depressed and anxious mood (Oei et
al., 2008; Petry, 2005; Scherrer et al., 2009).
Stress, according to Lazarus (1993), refers to the negative cognitive and emotional states when people
realize that environmental demands strain their resources and threaten their well-being. What determines
an event or a series of event is stressful is peoples appraisal of the event in relation to their resources and
coping skills. Stress as a precipitating and perpetuating factor is implicated in major psychological models
of problem gambling (Blaszczynski & Nower, 2002; Sharpe, 2002; Sharpe & Tarrier, 1993). These models
suggest that stress may comprise peoples executive function and impair cognitive appraisal, with
distorted general cognition surrounding self, own function, and immediate environment as well as
erroneous gambling cognition, leading to the onset and persistence in disruptive gambling. Indeed,
experimental studies have found that stressed people were susceptible to illusion of control and preferred
gambling activities that heightened their perception of control (Friedland, Keinan, & Regev, 1992). When
people were exposed to anticipatory stress, they manifested poor explicit knowledge about contingencies
of choices and poor performance in a gambling task (Preston, Buchannan, Stansfield, & Bechara, 2007).
P512
Review studies have consistently documented that stress, either measured by stressful life events or
subjective perception of stress, was related to gambling in both White (Coman, Burrows, & Evans, 1997;
Raylu & Oei, 2002) and Chinese gamblers (Loo, Raylu, & Oei, 2008; Tang et al., 2007). Stress has also been

33
found to precipitate relapse and impede recovery from problem gambling (Coman et al., 1997; Friedland et
al., 1992). More severe gamblers were found to report a greater number of stressors than social gamblers,
who in turn reported a greater number of stressful events than nongamblers (Bergevin, Gutpa,
Derevensky, & Kaufman, 2006).
Cognition surrounding gambling expectancy includes belief that gambling will lead to many positive
outcomes; belief that outcome of gambling activities can be influenced, controlled, or predicted by salient
cues, luck, and past wins and losses; and belief that continued gambling will eventually recoup lost money
(Ladouceur, 2004; Raylu & Oei, 2002, 2004a; Steenbergh, Meyers, May, & Whelan, 2002; Toneatto, 1999).
Positive biases in gambling expectancy have been found to associate with the motivation and persistence
in gambling among White (Oei et al., 2008; Raylu & Oei, 2002, 2004a; Steenbergh et al., 2002) and
Chinese gamblers (Loo et al., 2008; Oei et al., 2008; Tang & Wu, 2010). Furthermore, problem gamblers as
compared to social gamblers showed a greater tendency to become attached and obsessive with
erroneous gambling expectancy, leading to persistence in gambling despite repeated losses (Ladouceur,
2004; Rousseau, Vallerand, Ratelle, Mageau, & Provencher, 2002).
Gambling refusal efficacy is an action-outcome belief regarding whether or not people perceive they have
the ability to resist an opportunity to gamble in given situations (Casey, Oei, Melville, Bourke, &
Newcombe, 2008). It influences gambling behavior through its effect on behavioral choice, effort
expenditure, and persistence in the face of difficulty. When under stress, people may interpret high levels
of arousal as a sign of incapacity, leading to negative emotional state such as depression through the
process of negative self-evaluation (Bandura, 1997). Gambling thus represents an attempt to cope with
this negative emotional state. Gambling refusal efficacy was found to associate with the acquisition,
maintenance, and treatment of problem gambling among White (Casey et al., 2008; May, Whelan,
Steenbergh, & Meyers, 2003; Oei et al., 2008; Sylvain, Ladouceur, & Boisvert, 1997; Symes & Nicki, 1997)
and Chinese samples (Oei et al., 2008; Tang & Wu, 2010).
Subjective well-being refers to peoples emotional and cognitive evaluations of their lives in general,
including what lay people call happiness, peace, fulfillment, and life satisfaction (Diener, Oishi,& Lucas,
2003). It comprises affective dimensions of positive affect and absence of negative affect, as well as a
cognitive dimension of satisfaction with important life domains such as marriage, work, and leisure
(Diener, 2000). Researchers typically use either a single or a combination of these dimensions to assess
subjective well-being (Diener et al., 2003). Beyond the fulfillment of basic needs, subjective well-being is
also affected by peoples self-evaluation, life goals, life circumstances, and cultural values(Diener & Lucas,
2000). Studies have shown that stress stemming from significant life events and life changes has
important implication for subjective well-being (Diener et al., 2003; Grant & Kim, 2005; Ng, Diener, Aurora,
& Harter, 2009). A recent survey on 125,077 respondents from 121 countries found that people who
experienced more stress tended to report lower scores on measures of subjective well-being as in lower life
satisfaction and happiness (Ng et al., 2009).
Compared to gambling cognition, there is relatively less research on how general cognition or subjective
well-being influences the impact of stress on problem gambling. Sharpe (2002) has suggested that people
tend to have negative perception of the high arousal state that accompanies stress. They may engage in
high arousal activities such as gambling to give a positive interpretation of the stress-related arousal in the
form of excitement associated with winning and losing. This positive interpretation in turn becomes
reinforcing through a negative reinforcement paradigm. Although the direction of causality has not been
established, research has consistently found associations between problem gambling and the affective
dimension of subjective well-being as in depression and anxiety among White (see review by Raylu & Oei,
2002) and Chinese samples (see review by Loo et al., 2008).
Regarding other aspects of subjective well-being, Grant and Kim (2005) found that compared to
nongamblers, problem gamblers reported poorer life satisfaction and quality of life. Rousseau et al. (2002)
also noted that gamblers who showed an obsessive passion toward gambling tended to report low life
satisfaction and pervasive negative mood. In a multisite study on large samples of older Chinese
immigrants in Canada, Lai (2005) found that the odds of gambling were lower with increases in life
satisfaction. He suggested that when older Chinese felt happy and fulfilled, they did not need to use
gambling as a way to meet their emotional needs. Grant and Kim (2005) also argued that problem

34
gamblers poor life satisfaction may be related to their feelings of shame and guilt triggered by their
distorted views of themselves and life in general as well as their problematic gambling behavior.
P513
The overall objective of the study was to unravel cognitive and affective processes underlying problem
gambling in clinical samples of problem gamblers. A multiple mediation framework was proposed to
specify that gambling cognition and subjective well-being would mediate the influence of perceived stress
on problem gambling.
Specific pathways of the proposed mediation models were hypothesized as follows:
1. Perceived stress would correlate positively with problem gambling, gambling expectancy bias, and
negative affect, but negatively with gambling refusal efficacy and life satisfaction.
2. Problem gambling would correlate positively with gambling expectancy bias and negative affect,
but negatively with gambling refusal efficacy and life satisfaction.
3. Influence of perceived stress on problem gambling would be positively mediated by gambling
expectancy bias and negative affect, but negatively mediated by gambling refusal efficacy and life
satisfaction.
(SWLS & SOGS)
P517
For both samples, results indicated that gambling-related cognition and subjective well-being as a set fully
mediated the influence of perceived stress on problem gambling. In particular, perceived stress did not
directly influence problem gambling when other psychosocial factors were also taken into consideration.
Instead, it exerted an indirect influence via various mediators, mainly through low levels of refusal efficacy
and life satisfaction. Other studies have also noted indirect, but not direct, link between stress and
excessive gambling via different coping style among young recreational gamblers (Bergevin et al., 2006;
Lightsey & Hulsey, 2002). These finding were generally in line with the basic diathesis-stress perspective
(Lazarus, 1993) and psychological models of gambling (Blaszczynski & Nower, 2006; Sharpe, 2001; Sharpe
& Tarrier, 1993). These models typically suggest that stress may trigger cognitive and emotional
vulnerabilities, which may in turn relate to the onset and maintenance of problem gambling.
P518
These findings were consistent with the stress literature that indicates stress being associated with
erroneous gambling cognition (Friedland et al., 1992; Preston et al., 2007), negative affect (Bandura,
1997), and low levels of life satisfaction (Diener et al., 2003; Grant & Kim, 2005; Ng et al., 2009). For both
samples, significant paths from mediators to problem gambling included paths from refusal efficacy and
life satisfaction. Previous research also found that gambling refusal efficacy was associated with the onset
and maintenance of disruptive gambling (Casey et al., 2008; May et al., 2003; Oei et al., 2008; Tang & Wu,
2010) and that problem gamblers often reported poor life satisfaction and quality of life (Grant & Kim,
2005; Lai, 2005; Rousseau et al., 2002).

35

15.(Vzquez, Hervs, Rahona, & Gmez, 2009)

P17
Los componentes del bienestar: Hedonismo y Eudaimonia

16.(Volberg, Reitzes, & Boles, 1997)

P322
Although proponents of legal gambling have portrayed it as part of the entertainment industry, opponents
have raised two primary concerns. Some view gambling from a moral stance and decry the "get-rich-quick"
associations with gambling. Other gambling opponents concentrate on the economic, political, and social
issues associated with the spread of legal gambling. These include the uncertain economic benefits of
legal gambling, the lack of broadbased political support for gaming initiatives, and the question of whether
the increased availability of gambling will lead to increases in problem gambling (Doocey 1995). As legal
gambling continues to spread and as new technologies increase both the speed of gambling games and

36
the opportunities to gamble (e.g., casino and sports wagering are now available on the Internet), concerns
about the negative consequences of gambling have risen.
Although there is emerging evidence that increases in the availability of legal gambling may lead to
increases in the prevalence of gambling-related difficulties in the general population (Volberg 1995a), little
is known about the characteristics of problem gamblers. This lack of knowledge is due to a number of
factors: (a) disagreement about what label to give those who spend too much time or money gambling
(are these individuals pathological, compulsive, addicted, or problem gamblers?), (b) a predominantly
clinical approach to understanding gambling behavior, and (c) a preponderance of experimental research
divorced from the context of real gamblers' experiences (Rosecrance 1985a; Shaffer 1989; Dickerson
1993).
P323
Gambling
Beginning with Edward Devereux's (1949) study of gamblers, sociologists have seen a connection between
gambling behavior and the gambler's position in the social structure. Although gambling has long been
condoned among the upper classes, the same activities have been frowned on by the middle class and
broadly tolerated among the lower classes (Rosecrance 1988). Since the 1970s, there has been a shift in
the perception of gambling as a deviant behavior. Some reasons for this shift include (a) a growing
perception that gambling can be controlled through technology and corporate management systems; (b)
the medicalization of problem gambling, such that the ill effects of gambling come to be viewed as
solvable; (c) the expanding role of the state in regulating and operating gambling activities; and (d) the
growing acceptance of gambling by the middle class (Lesieur & Browne 1993).
A common misconception about gambling is that this term refers to a single, easily defined and
homogeneous activity. The reality is that gambling refers to a range of quite distinct activities, from the
purchase of instant lottery tickets to sophisticated trades of futures and options on the stock market.
Different types of gambling are characterized by different levels of luck and skill, by different speeds in the
outcome of each wager, by the size of the potential win in relation to the amount wagered, and by ease of
access to potential gamblers (Walker 1992; Dickerson 1993; Volberg & Banks 1994).
P324
Whether playing cards or slot machines, betting on horse races or cockfights, most gamblers are engaged
in activities that give them the opportunity to socialize with others with similar interests, demonstrate their
skills and knowledge, and engage in tests of character (Hindland 1971; Hayano 1982; Rosecrance 1985b;
Fisher 1993; Mumpower 1995). Until recently, sociological observations of gambling have been limited to
lower class settings, and gambling has been viewed largely as a behavior engaged in by poor, single,
minority-group men who see themselves as having little control over their lives and few opportunities to
improve their economic situation other than by striking it rich. For these individuals, gambling provides
action, the illusion of control over fate, and the opportunity to act with grace under pressure (Bloch 1951;
Zola 1964; Kaplan 1988).
Although gambling-related difficulties were first recognized as an identifiable medical disorder in 1980
(American Psychiatric Association 1980), major theoretical debates about whether problem gambling is an
addiction or a matter of impulse control continue today. Problem gambling was at first viewed as a
compulsion; the gambler had a problem of impulse control, much like pyromaniacs and kleptomaniacs.
Although there are still those who see gambling as a compulsion (Lacey & Evans 1986), problem gambling
is now most often viewed as an addiction.
Those who see problem gambling as an addiction seek to link it with other addictions (i.e., heroin, cocaine,
and alcohol). Viewed as an addictive behavior, it is assumed that problem gambling is preceded by certain
psychological states, such as guilt, inadequacy, and, in particular, low self-esteem. The addictive behavior
temporarily diminishes these negative feelings and allows the addicted person to engage in pleasurable
fantasies about the self (Brown 1993; Jacobs 1993; Rosenthal 1993). Others who posit a relationship

37
between low self-esteem and problem gambling include Custer and Milt (1985) and Carlton and Goldstein
(1987).
P325
Although a few researchers have suggested that some gamblers may have high self-esteem as a result of
their perceived expertise in the arcana of gambling (Herman 1967; Kusyszyn & Rutter 1985), the selfesteem of gamblers, problem or non-problem, has not yet been empirically investigated.
P328
Demographic and Social Psychological Characteristics of Problem Gamblers
In general, problem gamblers are more likely than others in the general population to be male, young, and
single; to be members of minority groups; and to have relatively low levels of education (Ladouceur 1996;
Volberg 1996; Volberg & Dickerson 1996).
P335
The variables most predictive of problem gambling among these respondents were race, gender, marital
status, employment status, and self-esteem. Nongamblers were most likely to be female, to be older, and
to live in the smallest households and were the least likely to be employed. They were less likely to be
White than non-problem gamblers and had lower incomes, education, and self-esteem scores. The picture
that emerges of nongamblers is one of older women, perhaps retired, with modest educational attainment
and household incomes.
In contrast to nongamblers, problem gamblers were most likely to be male, non-White, and single. Their
educational attainment and household income were close to that of non-problem gamblers, but they had
significantly lower self-esteem scores. In fact, they had the lowest self-esteem scores of the three groups.
Non-problem gamblers were most likely to be White, employed, and married. These respondents had the
highest educational attainment and income as well as the highest self-esteem scores. Although not all of
these differences are significant, together they suggest that nonproblem gamblers are better off
socioeconomically and sociopsychologically than either nongamblers or problem gamblers.
P336
This relationship accounts for assumptions about both the low self-esteem of problem gamblers and the
high self-esteem of non-problem gamblers.
The sociocognitive model developed by Walker (1992), for example, posits the confluence of (a) cultural
and reference group support for gambling, (b) psychological and physiological needs for stimulation by the
individual, (c) the presence of crises or stressors in the individual's life, and (d) sufficient leisure time and
financial resources to gamble.
In accordance with the sociocognitive model, we suggest that the problem gamblers in our sample were
embedded in a subculture where gambling is acceptable. Combined with the stresses that are part of the
life of young minority and blue-collar men, gambling on dice and sports as well as at casinos presents a
challenging opportunity to get some action, demonstrate one's skills, and beat the system. One limitation
of our study is that we cannot determine whether the problem gamblers' low self-esteem existed before
their involvement in gambling. However, we suggest that the circumstances of the lives of the problem
gamblers in our sample above and beyond their involvement in gambling, may lay the foundation for lower
self-esteem among them.
For problem gamblers, gambling is a socially sanctioned activity that gives status to the participants.
Problem gamblers spend significantly more time and money gambling than do non-problem gamblers.
They play a wider variety of games, and they spend more money in casinos, on the lottery, and playing
dice and betting with bookmakers. Moreover, problem gamblers reported starting to gamble at
significantly younger ages than non-problem gamblers and were more likely to acknowledge using drugs or
alcohol when gambling.

38
For non-problem gamblers, the majority of whom were members of the middle class, gambling was an
adjunct to a comfortable lifestyle. These individuals tended to be married and employed and to have a
positive self-image. In the main, non-problem gamblers played the lottery with an occasional trip to the
casino or horse or dog races. They were unlikely to acknowledge gambling with bookmakers or playing
dice. They were significantly less likely than problem gamblers to acknowledge using alcohol or drugs
while gambling.
P337
Following the sociocognitive approach of Walker (1992), we found that problem gamblers were primarily
young, minority and blue-collar men embedded in a subculture supportive of gambling. As a result of their
life circumstances, these individuals, who already had relatively low self-esteem, may have come to see
gambling as a way to take control of their lives, beat the system, and gain prestige among their friends.
Eventually, some of these gamblers became caught in the downward spiral of chasing gambling losses.
As far as changes in gambling participation are concerned, more middle-class individuals, more women,
and more young people are likely to become gamblers as the availability of casinos and lotteries continues
to expand in the United States.
P338
One of the short-term "benefits" of gambling is the illusion of control that many of these games offer
(Letarte, Ladouceur, and Mayrand 1986).
Further, as legal gambling spreads, young people are growing up in a social milieu where gambling is
widely viewed as harmless and acceptable. There is already evidence that young adults gamble more than
older adults (Volberg & Banks 1994). Following the pattern with women, the more young adults participate
in gambling, the greater the likelihood that some of them will experience difficulties related to their
involvement.
17.(Walker & Dickerson, 1996)
P235
It is important to be aware that historically, culturally, and statistically, gambling is not a uniform or
homogeneous activity in society. Hence, when research concerned with the prevalence of gambling
problems is cited, we must ask which people, in which culture, in what type of games, have what kind of
problems. Although gambling is a heterogeneous collection of activities, the fact remains that individuals
who have become heavily involved in any particular form of gambling may suffer problems as a result, and
seek help from clinicians, welfare agencies, and self-help groups. The problems caused by heavy
involvement in gambling include debts and associated pressures to repay loans When no money is
available, disrupted family life, individual pathologies such as physical illness and depression, loss of
employment, criminal charges and gaol sentences, and estrangement from the range of social supports
normally available to an individual in trouble (Blaszczynski, 1988; Custer & Milt, 1985; Lesieur, 1979).
Gamblers who seek help in dealing with their gambling-related problems have been labelled in various
ways: compulsive, pathological, excessive, and problem.
One of the central criteria for compulsion is that the behavior continues even though it is an unwanted
burden or bane for the individual. Gambling is seen not as a bane but as an attractive activity which grips
the gambler, and thus, strictly speaking, does not fit the notion of compulsion (Maze, 1987). However, the
terms "pathological gambling," "excessive gambling," and "problem gambling" are widely used and each
has been the object of prevalence studies.
P236
Whereas as incidence refers to the number of new cases of some class of maladaptive behavior that
develop over a period of time, prevalence refers to the percentage of cases occurring in the community at
a given time. Thus the prevalence of "pathological gambling" refers to the percentage of individuals in a
given community at a given time who can properly be labelled as pathological gamblers. When we inspect

39
this definition closely, it is clear that there are three requirements: (1) that the community be specified; (2)
that the time at which the count of cases is made be specified; and (3) that the criteria for determining the
presence of "pathological gambling" be specified.
237
What are the most likely sources of bias in drawing a sample for the purposes of estimating the prevalence
of pathological gambling? The sources of bias considered here are: (1) the exclusion of particular groups
from the sample; (2) under-sampling of specific ethnic or cub rural groups; and (3) the likelihood that
pathological gamblers, specifically, are under-represented.
Most prevalence studies omit children from the population sampled. Typically, the population sampled is
that which is eighteen years and older. Prevalence studies of pathological gambling in children have been
reported (for example, Ladouceur & Mireault, 1988; Winters, Stinchfield & Fulkerson, 1993), but have not
been integrated with adult rates to provide population estimates. The rates of pathological gambling in
children reported in these studies are high (3-8%). For the purposes of this critique, the studies of children
and underage gambling will not be considered further.
P238
Strictly speaking, prevalence refers to the rate of occurrence of the phenomenon at a given time. Thus, the
prevalence of cyclists wearing safety helmets refers to the percentage of cyclists wearing helmets on a
given day at a given time. In practice, prevalence estimates refer to the occurrence of examples or cases
of a phenomenon or condition in a set period of time. The period of time chosen may be a matter of
convenience but should be short with respect to the rate at which the phenomenon is likely to change.
Thus, whatever criteria are chosen to define cases of pathological gambling, those criteria must refer to
the present either conceived as ~now" or as a short period in the past leading up to now.
P239
If lifetime prevalence has a valid meaning, then it refers to the occurrence of some characteristic that, if
present at all, is present for life. The notion of lifetime prevalence as applied to pathological gambling
would be meaningful (though redundant) if it was true that "pathological gambler" was an enduring
description of a person: once a pathological gambler, always a pathological gambler. However, there is
little evidence that pathological gambling is a lifelong problem (see for example, Blaszczynski, 1988), a
point that Volberg (1993) acknowledges. As it is currently used in research, lifetime prevalence refers to
two aspects of gambling: (1) the time frame within which questions concerning gambling-related problems
are to be answered; and (2) an indication of the proportion of the population who at any time in their lives
have gambled "pathologically." The meaning of such an estimate is obscure given the likelihood that some
people are likely to move into and out of problematic levels of gambling without recourse to any
intervention.
P242
Excessive gambling is defined by Orford (1985) as gambling where the positive returns (not necessarily
monetary) are outweighed by the costs. In practice, excessive gambling is difficult to quantify. Dickerson
and Hinchy (1988) use the term to refer to losing more than planned and thereby incurring debts. The
effect on the gambler is that he or she wants to cut back or stop gambling and has tried to do so.
Depending on the number of these criteria included, so the prevalence of excessive gambling declines.
Even with this small number of criteria, Dickerson and Hinchy obtained very low prevalence rates when all
of the criteria were included.
P243
According to Allcock (1994, May-June), the term "problem gambler" avoids many of the negative
judgements and conceptual issues associated with the notion of pathological gambling.
What constitutes problem gambling? Presumably, the term is intended to refer to the problems created by
gambling. However, even this interpretation excludes gamblers who gamble in order to escape problems, a

40
criterion for the pathological gambling category in the DSM-IV (American Psychiatric Association, 1994).
Among the problems created by gambling are those intrinsic to gambling such as which horse to back in
the next race. Those who use the term "problem gambling" are likely to want to exclude such intrinsic
problems as not the kind of problems that are relevant. But which problems are relevant?
P244
One step removed from the intrinsic problems are the problems associated with betting strategies. Chasing
losses is one betting strategy which is included as a criterion for problem gambling in the SOGS, yet other
strategies which may also be dangerous are excluded.
The use of the term ~problem gambling ~ highlights the absence of any theory or conceptual scheme
showing how gambling problems may be related to or differentiated, from one another. Categorizations of
the negative consequences of gambling have been based purely on face validity (Dickerson, 1993) in the
following way:
(1) individual, including loss of self esteem and depressed mood;
(2) interpersonal, including the impact on marital and family relationships;
(3) employment, including the loss of productivity and job loss itself;
(4) economic, including gambling debts; and
(5) legal, including illegal acts in support of gambling and related legal proceedings.
This has typically left a final category relating to the gambling behavior itself such as chasing losses.
P246
To recapitulate, prevalence studies of problem gambling/pathological gambling should comprise:
(1) a detailed assessment of the expenditure of cash (and time) per week on each available gambling
product for a representative sample of the general population; and
(2) the development of profiles of the increasing level of risk of negative consequences of different levels
of expenditure for each type of gambling.
18.(Wanner, Ladouceur, Auclair, & Vitaro, 2006)
P289
Affects and emotions have been recognized to represent significant, prevalent, and relevant products of
recreational activities (Hull, 1991). Indeed, individuals are motivated to pursue disparate recreational
activities such as gambling and sports to experience specific emotional states (e.g., Platz & Millar, 2001).
In turn, pursuit of recreational activities can serve the regulation of general well-being and life satisfaction
(e.g., Csikszentmihalyi, 1990). For a minority of individuals emotional experiences during recreational
activities have the potentially negative aspect in that they can become addictive (Jacobs, 1986, 1989). In
particular, for gambling it is well established that a small percentage of individuals suffer from negative
personal, familial, financial and professional consequences, although reported prevalence rates vary
largely across studies. Between one and two percent of adults suffer from severe and pathological
gambling (Ladouceur, 1996; Volberg, 1996) and prevalence rates tend to be higher for younger people
(Derevensky, Gupta, & Winters, 2003; Shaffer & Hall, 1996).
P290
Dissociation
According to Jacobs (1989) general theory of addiction, the experience of a specific set of dissociative
symptoms differentiates between addicted and non-addicted individuals. Jacobs posits that his ... general
theory reserves this kind of dissociative state to that minority of predisposed persons who reveal
themselves by their dogged pursuit of one or another addictive pattern of behavior. (p. 49). Thus, only

41
addicted individuals such as pathological gamblers are posited to experience a blurring of reality or
trancelike states, out-of-body feeling, amnesia or blackouts, and positively altered self-perceptions of being
a successful and popular person.
The theory posits a mechanism, which causes dissociative experiences during any potentially addictive
activity. The mechanism includes three components: (1) blurred reality which is caused by completely
concentrating ones attention on series of specific hereand- now events; (2) reduction of self-criticism
through an internal cognitive shift that deflects preoccupation with ones personal or social inadequacies;
this is supported by the social setting which signals acceptance and encouragement of the addictive
behavior; (3) opportunity for flattering daydreams about oneself and wish-fulfilling fantasies which, in turn,
facilitate positively altered self-perceptions.
Although studies show that addicted individuals such as pathological gamblers experienced higher levels
of dissociation than non-addicted individuals, they also show that non-addicted individuals experienced to
some, although limited, extent dissociation (Diskin & Hodgins, 1999; Jacobs, 1988). Moreover, some
studies even found that pathological gamblers levels of dissociation did not differ from levels of
dissociation experienced by occasional gamblers (Diskin & Hodgins, 2001 with adults; Gupta &
Derevensky, 1998a with adolescents) and normal controls (Grant & Kim, 2003).
P291
Flow
Flow occurs when the performer is totally connected to the performance and represents an optimal
psychological state. When in flow an individual experiences a number of positive experiential
characteristics of which the feeling of enjoyment represents the core characteristic. In total, nine different
dimensions of flow have been identified(Jackson & Marsh, 1996; Marsh & Jackson, 1999): enjoyment,
transformation of time, merging of action and awareness, concentration on the task at hand, lack of selfconsciousness, clear goals, unambiguous feedback, sense of control, and balance of challenge and skill.
More accurately, the latter four dimensions (i.e., clear goals, unambiguous feedback, sense of control, and
balance of challenge and skill) represent preconditions for the experience of enjoyment and flow (e.g.,
Bandura, 1997; Mannell, 1979). The dimension balance of challenge and skill refers to the most
important precondition for the experience of flow. It is believed that flow results from a perceived match
between challenge and skills but only if both challenges and skills exceed the level that is typical for the
day to day experiences of the individual (M. Csikszentmihalyi & I. Csikszentmihalyi, 1988). Importantly, it is
a well-established finding that gamblers tend to overestimate their skills as well as the challenge in
gambling activities (e.g., Dixon, Hayes, & Ebbs, 1998; Langer, 1975). Consequently, gamblers may
perceive a match between high levels of challenge and skills when gambling and thus they may
experience flow. On the basis of Csikszentmihalyis (e.g., 1990) position that some individuals may be
addicted to flow experiences, it can even be hypothesized that this applies to pathological gamblers. Thus,
pathological gamblers may have higher mean levels of flow than recreational gamblers and athletes who,
in turn, may not differ in this regard.
P292
In contrast to the dissociation perspective, Csikszentmihalyi (e.g., 1990) believes that high levels of flow
are associated with high levels of positive well-being and personal growth. In support of the latter
assumption, findings show that flow experiences are linked to positive affective states and reduced stress
(Han, 1988; Hull, 1991; Massimini & Carli, 1988).
P300
In spite of the latter finding, pathological gamblers high levels of dissociation provided support for Jacobs
position that the experience of dissociation represents the addictive aspect of addictive activities.
Moreover, the findings showed that each dimension of flow was also experienced across each group.
However, pathological gamblers had lower mean levels with respect to the majority of flow dimensions
(i.e., enjoyment, preconditions, concentration, and actionawareness merging) than athletes, whereas
recreational gamblers lay in between the previous two groups in this regard. Only two flow dimensions
yielded different patterns of mean level differences than the remaining flow dimensions. Specifically,

42
transformed time was equally frequently experienced across each group. In contrast, self-consciousness
showed similar mean level patterns as found for dissociation. Thus, pathological gamblers had higher
levels of self-consciousness than recreational gamblers and athletes, whereas the latter groups did not
differ in this regard. Hence, with respect to the dimensions of flow, only pathological gamblers high levels
of self-consciousness supported the assumption that flow experiences may be addictive.
In a similar vein, the finding that athletes and recreational and pathological gamblers equally experienced
time as being transformed may be due to the positive association of this flow dimension with dissociation.
The finding of a positive association of transformed time with dissociation is in line with previous findings
(e.g., Diskin & Hodgins, 1999, 2001; Gupta & Derevensky, 1998a). Finally, the flow dimension actionawareness merging also showed a positive, although low, link to dissociation. Thus, the feeling that things
happen automatically when experiencing flow and the feeling like being in trance when experiencing
dissociation appear to tap into similar experiential phenomena. Hence, although the majority of flow
dimensions were independent of dissociation, three dimensions of flow (i.e., selfconsciousness,
transformed time, and action-awareness merging) showed commonalities with dissociation.
With respect to both self-consciousness and time transformation, commonalities with dissociation may also
explain similarities of those flow dimensions with dissociation in regard to patterns of associations with
general emotional well-being (i.e., positive and negative affect). Specifically, similarly to dissociation, time
transformation and self-consciousness were positively associated with negative affect.
19.(Wiebe & Volberg, 2007)
P4
Severe Problem Gambling: Varied terminology has been used to label the highest levels of problems,
including probable pathological (SOGS), pathological (NODS), severe problem gambling (PGSI) and
compulsive (GA- 20).2 For the purposes of this review, the label severe problem gambling will be used to
indicate the highest level of gambling problems regardless of the instrument used.
P5
It is important to remember that the comparison of prevalence studies is imperfect due to variations in
measurement instruments, classification schemes, sampling procedures and response rates. To get an
appreciation of the different ways that problem gambling is assessed, Appendix B contains the survey
questions for a few of the more common problem gambling instruments, including the South Oaks
Gambling Screen Revised (SOGS-R), the Problem Gambling Severity Index (PGSI) of the Canadian Problem
Gambling Index (CPGI) and the National Opinion Research Center DSM Screen for Gambling Problems
(NODS).
P13
The majority of research on problem gambling prevalence rates has come from Canada and the United
States. However, in the past ten years, there has been an increase of research coming from countries
outside North America. Although several studies have been conducted, it remains difficult to make
comparisons because of the different measurement tools utilized to derive problem gambling prevalence
rates.
P14

43
Figure 3: Severe Problem Gambling Prevalence Rates outside North America

AUSTRALIA, GERMANY, GREAT BRITAIN, HONG KONG, NEW ZEALAND, NORWAY, SINGAPORE, SOUTH
AFRICA, SPAIN, SWITZERLAND, SWEDEN
Figure 1: Severe Problem Gambling Prevalence Rates by Canadian Province

44

45
Figure 2: Severe Problem Gambling Prevalence Rates by State

P16
It is widely believed that increased gambling exposure leads to increased problem gambling rates.
Hundreds of articles in the gambling literature assert the existence of a link between gambling availability
and problems. Major reviews (e.g. Abbott & Volberg, 2000; Shaffer et al., 1997; Wildman, 1998) have, with
varying degrees of qualification, concluded that research findings are generally consistent with the view
that increased availability leads to more gambling and problem gambling.
This association is often attributed to certain forms of gambling, particularly casinos and Electronic Gaming
Machines (EGM) (Abbott, 2001; Polzin et al., 1998; Productivity Commission, 1999). As Collins and Barr
(2006) acknowledge, it seems obvious that if you make more gambling more easily available you are
going to find more people succumbing to the temptation to gamble in excess (p.5). Upon further analysis,
however, the relationship between gambling expansion and problem gambling rates may not be as
straightforward as one would think.
As shown in the previous discussion, during the early years of gambling expansion, a number of
jurisdictions experienced increases in problem gambling prevalence rates, followed by a leveling off and in
some instances a decline. Similarly, Volberg (2004) observed a correlation between availability and
problem gambling rates, but also found that rates in a number of jurisdictions were stabilizing or declining
in the face of gambling expansion.
P17
Stated tentatively, it appears that the introduction and expansion of new forms of gambling, most
especially electronic gaming machines, initially result in increased levels of problem gambling with
particular population sectors, including males and youth, most affected. Over time and in some
jurisdictions, problems extend to groups that previously had low levels of participation and gambling
problems, such as women and older adults. In other jurisdictions that have experienced prolonged
increased availability, prevalence rates have remained constant or declined.

46
Based on his analysis, Abbott (2006) concludes that exposure to the agent gambling is multidimensional
and that the effects of exposure are complex (p.1).

20.(Williams, Volberg, & Stevens, 2012)

P41
The standardized past year rate of problem gambling ranges from 0.5% in Denmark (2005) and the
Netherlands (2004) to 7.6% observed in Hong Kong in 2001. The average rate across jurisdictions is 2.3%.
In general, the lowest standardized prevalence rates of problem gambling tend to occur in Europe, with
intermediate rates in North America and Australia, and the highest rates in Asia.
More specifically, the lowest standardized prevalence rates of problem gambling occur in Denmark, the
Netherlands, and Germany. Lower than average rates are seen in Great Britain, South Korea, Iceland,
Hungary, Norway, France, and New Zealand (excluding 1991). Average rates occur in Sweden, Switzerland,
Canada, Australia, United States, Estonia, Finland, and Italy. Above average rates occur in Belgium and
Northern Ireland. The highest rates are observed in Singapore, Macau, Hong Kong, and South Africa.
It is beyond the scope of this report to explore the many reasons for these differences. However, one factor
may be the age difference between jurisdictions (Appendix E shows that younger average population age
is strongly associated with problem gambling). The correlation between average standardized problem
gambling prevalence rate (over all time periods) and median age in 2010 for national jurisdictions is r =
-.49, (p = .025; 2 tail; 24 pairs).

47

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