Problem gambling : From practice research to grounded theory.

This study combined the use of a single case experimental design with replications with the use of a grounded theory approach in a study of treatment-seeking problem gamblers. The sample for the single case experimental design was a case series of nine men meeting DSM IV criteria (APA 1994) for pathological gambling. They primarily gambled in off-course bookmakers and on slot machines, and had self-reported histories of problem gambling of between four and eighteen years duration. A cognitive behavioural approach to treatment based on that of Sharpe and Tarrier (1993) was utilised. This treatment incorporated motivational interviewing, self-monitoring, stimulus control, cognitive restructuring, cue exposure and relapse prevention. The approach was ineffective for a majority of the clients, with drop-out prior to completion of treatment the outcome for six of the clients. The three clients who completed treatment all achieved clinically significant changes in gambling behaviour. Proposed links between depressed mood and gambling behaviour, and anxiety and gambling behaviour were not supported.The grounded theory approach was in two parts. The first study investigated the reported gambling experiences of treatment-seeking men who met DSM IV criteria (APA 1994) for pathological gambling. Clinical materials and session transcripts from the treatment study formed the initial material. A further four interviews with informants selected for theoretical sampling reasons provided provisional verification of the grounded theory. The grounded theory identified gambling as emotion management as the core category. The use of gambling for this purpose interacted with the costs of gambling and the individual's experience and perception of control of gambling to determine behaviour in the context of gambling related triggers.The second grounded theory study involved an analysis of the reported experiences of seven regular but non-problematic gamblers for confirmatory purposes. Similarities and differences between the problem and non-problem gamblers were identified. Three aspects of the reported experiences of the gamblers appeared to differentiate problematic and nonproblematic experiences. These were the extensive use of gambling to manage negative emotions, beliefs regarding winning money back and perception of control.The study addressed both theoretical and treatment issues in problem gambling. The proposal that arousal is a major motivating variable in gambling was supported (Anderson and Brown 1984). The proposal that the use of gambling to moderate negative emotional states is a feature of problem gambling (Jacobs 1985; McConaghy 1988) was supported. The view that misperception of randomness is a feature of problem gambling was supported (Ladouceur and Walker 1996). The importance of self-efficacy in efforts at moderating gambling (Bandura 1977) was supported.Clear benefits were identified of combining a single case experimental design with a grounded theory approach. The use of a grounded theory approach with a deviant sample for confirmatory purposes was also beneficial.