ADHD rate high in adult gambling-treatment population in Singapore
A substantial number of patients with gambling addiction screen positive for attention-deficit/hyperactivity disorder (ADHD), according to a Singapore study. Furthermore, these patients have lower levels of gambling-related cognitions, suggesting that their gambling behaviour is rather guided by impulsivity.
“These findings may have implications on conventional approaches to the management of pathological gambling. Routine screening for the presence of ADHD and providing treatment options to address the impulsivity aspects of the condition may add value to the overall treatment outcome,” the authors said.
The study included 65 patients (mean age 36.3 years; 98.5 percent male; 86.2 percent Chinese; 96.9 percent had secondary school education; 80 percent employed) presenting for gambling addiction treatment. Gambling status was pathological in the majority of patients (95 percent), while the remaining 5 percent were classified as having problem gambling. In total, 20 percent met the criteria for ADHD. [Int J Environ Res Public Health 2018;doi:10.3390/ijerph15071307]
Notably, compared with those who did not have the neurodevelopmental condition, patients with ADHD had numerically lower mean GABS (Gambling Attitudes and Beliefs Survey) score (83.92 vs 89.12; p=0.236), a measure of gambling-related cognitions (eg, cognitive bias, irrational beliefs, attitudes to gambling), wherein a higher overall score indicates the presence of irrational progambling attitudes and beliefs.
Gambling-related cognitions had no significant association with ADHD symptoms.
While the lack of association may be attributed to the relatively low number of the sample population, one possible explanation for the finding is that gambling activity is driven by impulsivity in patients with ADHD and by gambling-related cognition in patients without the comorbidity, the authors pointed out.
In Singapore, pathological gamblers are quite different from their counterparts in other parts of the world. These individuals are highly likely to possess at least secondary school education, be in active employment and predominantly middle-aged men of Chinese origin, as reflected by the study population.
“This unique profile of the Singaporean pathological gambler may be attributable to cultural and social acceptance of gambling as a viable pastime among well-established and financially successful individuals, and the need for stable financial resources to engage in gambling activities, for example, to incur the cost of an entry levy to enter a casino in Singapore,” the authors explained.
However, mobile phones and smartphones have enabled an increasingly widespread access to online gambling, with smartphones often providing an immersive virtual reality environment for users, leading to internet gaming disorder. [Int J Environ Res Public Health 2018;15:832; Technol Health Care 2017;25: 367-372]
“It is important to note that both internet gaming disorder and internet addiction are associated with ADHD. There is a possibility that these conditions are mediating factors between pathological gambling and ADHD,” the authors said. “Further research is required to study the mediating effect.”