Gambling Disorders 360°

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Brief Interventions for Disordered Gambling in College Students

by: Nancy M. Petry, Ph.D., and Jeremiah Weinstock, Ph.D. | Mar 1, 2010

March Madness refers not just to the National Collegiate Athletic Association’s basketball tournament, but also to the uptick in gambling activity that ranges from office pools to betting online. An increased awareness during this time of year about gambling on college sports usually leads to questions about gambling by college students. Consequently, we have devoted the March edition of Issues & Insights to new research on college gambling.

The Task Force on College Gambling Policies emphasized the importance of using evidence-based strategies to help students with gambling problems in its Call to Action report published in September 2009, but raised concerns about the dearth of research on interventions tailored for this population. A recently published study by Dr. Nancy Petry and colleagues fills a serious gap in the literature. Dr. Petry and Dr. Jeremiah Weinstock summarize the findings of this study of brief interventions for disordered gambling in college students (Petry, Weinstock, Morasco, & Ledgerwood, 2009).

College students are in a transition from adolescence to adulthood. This period is important developmentally and marked by increasing responsibility, independence, exploration and identity formation (Arnett, 2000). Unfortunately, engagement in risky behaviors also increases during this time, and gambling is one such risky behavior. 

Although most college students gamble without problems, some do develop difficulties, and these difficulties can persist for years (Gourdiann, Slutske, Krull, & Sher, 2009).  The prevalence of disordered gambling in college students ranges from 3 percent to 14 percent (Shaffer, Hall, & Vander Bilt, 1999). Disordered gambling is associated with poor academic performance, heavy alcohol consumption, illicit drug use, nicotine use and suicide attempts. (In the context of this article, disordered gambling refers to both problem and pathological gambling.)

Despite the prevalence and adverse consequences of disordered gambling in college students, very few college students seek treatment for gambling. Thus, active identification of students with problems is necessary. In our study, we advertised on college campuses for free and confidential gambling screening and treatment services. We also actively screened students for gambling problems and provided a small incentive (e.g., a pen or candy bar) for students to complete the gambling screen.

Students identified with problem or pathological gambling in the screening process were invited to participate in a brief intervention study. We evaluated three brief interventions that focused on reducing gambling behavior in comparison to an assessment-only control condition (i.e., they were assessed for gambling problems but were not involved in an intervention). The interventions were: 10 minutes of brief advice; one session of motivational enhancement therapy[1]; and one session of motivational enhancement therapy plus three sessions of cognitive behavioral therapy.[2]

A total of 117 college students with disordered gambling participated in the study and were randomly assigned to one of the three interventions or the assessment-only control condition. We assessed demographics and gambling behavior three times: at the beginning of the study, six weeks later, and nine months later. 

The vast majority of student participants were male, with a mean age of 20 years. The average age they started gambling was 14 years, and about a third met criteria for pathological gambling (with the remainder classified as problem gamblers). The most common form of problematic gambling in the sample was betting on card games, endorsed by about half the participants.

In comparison to the assessment-only condition, students randomized to any of the brief interventions significantly decreased the number of days gambled and dollars wagered. On average, they gambled about 14 days per month at the start of the study. Nine months later, those who had received the brief interventions reduced the number of days gambled per month to approximately five to six days, while those assigned to the assessment-only control condition were still wagering an average of 10 days per month. In comparison to the assessment-only control condition, students who received the motivational enhancement intervention were almost three–and-a-half times more likely to demonstrate clinically significant reductions in gambling, defined as wagering less than 10.5 percent of their incomes.  

Overall, results from this study show that administering very brief intervention strategies – such as one session of motivational enhancement therapy – can assist in substantially decreasing gambling for up to at least a nine-month period in almost two-thirds of college students with disordered gambling. Given the lack of efficacious interventions for this population, these results are noteworthy. As awareness of gambling problems on college campuses grows, more counselors, administrators and professors are expressing interest in learning about this disorder, and this study provides support for brief interventions in college students.

Nancy M. Petry, Ph.D., is professor of psychiatry at the University of Connecticut Health Center. Dr. Jeremiah Weinstock is assistant professor in the Calhoun Cardiology Center, University of Connecticut Health Center.

References

Arnett, J.J. (2000). Emerging adulthood: A theory of development from the late teens through the twenties. American Psychologist, 55, 469-480.

Gourdiann, A.E., Slutske, W.S., Krull, J.L., & Sher, K.J. (2009). Longitudinal patterns of gambling activities and associated risk factors in college students. Addiction, 104, 1219-1232.

Miller, W.R., Zweben, A., DiClemente, C.C., & Rychtarik, R.G. (1994). Motivational enhancement therapy manual: A clinical research guide for therapists treating individuals with alcohol abuse and dependence. Project MATCH Monograph Series, Vol. 2. DHHS Publication No. 94-3723. Rockville MD: NIAAA.

Petry, N.M., Weinstock, J., Morasco, B.J., & Ledgerwood, D. M. (2009). A randomized trial of brief interventions for problem and pathological gambling college students. Addiction, 104, 1569-1578.

Reilly, C., & Shaffer, H.J. (2007). Roads to recovery from gambling addiction. In Roads to Recovery from Gambling Addiction (pp. 2-5). Washington, DC: National Center for Responsible Gaming.Shaffer H.J., Hall M.N., & Vander Bilt, J. (1999). Estimating the prevalence of disordered gambling behavior in the United States and Canada: A research synthesis. American Journal of Public Health, 89, 1369-1376.

 [1] According to the Motivational Enhancement Therapy Manual published by the National Institute on Alcohol Abuse and Alcoholism, “Motivational Enhancement Therapy is based on principles of motivational psychology and is designed to produce rapid, internally motivated change. This treatment strategy does not attempt to guide and train the client, step by step, through recovery, but instead employs motivational strategies to mobilize the client’s own resources.” (Miller, Zweben, DiClemente, & Rychtarik, 1994).

[2] Using cognitive behavioral therapy (CBT) for gambling problems involves a focus on reducing the individual’s excessive gambling by correcting erroneous perceptions about probability, skill and luck that only reinforce problematic gambling behaviors. Cognitive behavioral treatment techniques include: cognitive correction, social skills training, problem solving training and relapse prevention (Reilly & Shaffer, 2007).

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