Latent class analysis of gambling subtypes and impulsive/compulsive associations: Time to rethink diagnostic boundaries for gambling disorder?

• Published in: Addictive behaviors 2017-09, Vol.72, p.79-85
• Main Authors: Chamberlain, Samuel R, Stochl, Jan, Redden, Sarah A, Odlaug, Brian L, Grant, Jon E
• Format: Article
• Language: English
• Subjects: Addiction; Addictions; Adolescent; Adult; Adults; Alcoholic beverages; Analysis of Variance; Bayesian analysis; Classification; Clinical decision making; Cognition; Cognition - physiology; Cognitive ability; Compulsive Behavior - diagnosis; Decision making; Diagnosis, Differential; Disruptive, Impulse Control, and Conduct Disorders - diagnosis; Female; Gambling; Gambling - classification; Gambling - diagnosis; Humans; Impairment; Impulsive behavior; Impulsive Behavior - physiology; Impulsivity; Latent; Latent class analysis; Male; Measurement methods; Medical diagnosis; Mental disorders; Multivariate analysis; Nicotine; Psychiatric Status Rating Scales; Psychiatry; Quality of Life; Subtypes; Variance analysis; Young Adult; Young adults
• ISSN: 0306-4603; 1873-6327
• DOI: 10.1016/j.addbeh.2017.03.020

Abstract Background Gambling disorder has been associated with cognitive dysfunction and impaired quality of life. The current definition of non-pathological, problem, and pathological types of gambling is based on total symptom scores, which may overlook nuanced underlying presentations of gambling symptoms. The aims of the current study were (i) to identify subtypes of gambling in young adults, using latent class analysis, based on individual responses from the Structured Clinical Interview for Gambling Disorder (SCI-GD); and (ii) to explore relationships between these gambling subtypes, and clinical/cognitive measures. Methods Total 582 non-treatment seeking young adults were recruited from two US cities, on the basis of gambling five or more times per year. Participants undertook clinical and neurocognitive assessment, including stop-signal, decision-making, and set-shifting tasks. Data from individual items of the Structured Clinical Interview for Gambling Disorder (SCI-GD) were entered into latent class analysis. Optimal number of classes representing gambling subtypes was identified using Bayesian Information Criterion and differences between them were explored using multivariate analysis of variance. Results Three subtypes of gambling were identified, termed recreational gamblers (60.2% of the sample; reference group), problem gamblers (29.2%), and pathological gamblers (10.5%). Common quality of life impairment, elevated Barratt Impulsivity scores, occurrence of mainstream mental disorders, having a first degree relative with an addiction, and impaired decision-making were evident in both problem and pathological gambling groups. The diagnostic item ‘chasing losses’ most discriminated recreational from problem gamblers, while endorsement of ‘social, financial, or occupational losses due to gambling’ most discriminated pathological gambling from both other groups. Significantly higher rates of impulse control disorders occurred in the pathological group, versus the problem group, who in turn showed significantly higher rates than the reference group. The pathological group also had higher set-shifting errors and nicotine consumption. Conclusions Even problem gamblers who had a relatively low total SCI-PG scores (mean endorsement of two items) exhibited impaired quality of life, objective cognitive impairment on decision-making, and occurrence of other mental disorders that did not differ significantly from those seen in the pathological gamblers. F