Exploring the pathways model in a sample of patients with gambling disorder

ABSTRACT

From clinical and research perspectives, the Pathways Model has been supported in adolescent and adult populations as a theoretical explanatory framework for considering gambling disorder (GD). However, it has been less well explored in clinical samples. Therefore, the aim of this study was to explore the Pathways Model, specifically pathways 2 (emotionally vulnerable) and 3 (antisocial impulsivist), in 241 consecutive treatment-seeking adults with GD. Structural equation modeling was used. Path analyses that considered continuous variables provided, in general, support for the Pathways Model in this clinical population, albeit with some caveats. The results suggest the presence of different profiles of gamblers, with some having emotions and others impulsivity-related factors more prominently involved. Additional associations, not raised by the model, were also found. For example, a greater role for anxiety as compared with depression was observed in pathway 2, and important mediating roles for cognitive distortions and habituation were observed across pathways. Using an approach that considered variables dimensionally may help aid in understanding clinically relevant relationships. The current findings suggest complexities regarding relationships between factors involved in GD clinical samples. These findings have implications for characterizing subtypes of GD and development of optimal prevention and treatment approaches.

KEYWORDS:

• Gambling
• impulsivity
• addictive behavior
• depression
• substance abuse

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Acknowledgements

We thank Carla Araoz and Berta Pamies for their help with the elaboration of Figure 1.

Disclosure statement

Dr. Mestre-Bach was supported by a postdoctoral grant from FUNCIVA. We thank CERCA Programme/Generalitat de Catalunya for institutional support. This work was additionally supported by grants from the Ministerio de Ciencia, Innovación y Universidades (grant RTI2018-101837-B-100). The research was also funded by the Delegación del Gobierno para el Plan Nacional sobre Drogas (2017I067 and 2019I47), Instituto de Salud Carlos III (ISCIII) (PI17/01167) and co-funded by FEDER funds/European Regional Development Fund (ERDF), a way to build Europe. CIBERObn is an initiative of ISCIII. The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the publication of this research output. Dr. Potenza has consulted for and advised Opiant Pharmaceuticals, Idorsia Pharmaceuticals, AXA, Game Day Data and the Addiction Policy Forum; has been involved in a patent application with Yale University and Novartis; has received research support from the Mohegan Sun Casino, Connecticut Council on Problem Gambling and National Center for Responsible Gaming; has participated in surveys, mailings or telephone consultations related to drug addiction, impulse control disorders or other health topics; has contributed to a patent application for gambling and gaming disorder treatment; and has consulted for law offices and gambling entities on issues related to impulse control or addictive disorders.

Preregistration statement

No preregistration was declared by the authors in relation to this manuscript.

Data availability statement

The data will be available through a direct request to the authors, who will evaluate the type of information requested with the Clinical Research Ethics Committee at the University Hospital of Bellvitge.

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Notes on contributors

Gemma Mestre-Bach

Dr. Gemma Mestre-Bach, Psychologist with PhD in translational research. Master degrees in clinical psychology, sexual and couple therapy, third generation therapies and criminology. Professor and researcher at the Universidad Internacional de la Rioja, Spain.

Roser Granero

Dr. Roser Granero, Professor of Methodology of Health Sciences at the Department of Psychobiology and Methodology, at the Autonomous University of Barcelona (since 2001). Researcher at the CIBERobn Group (Center for Biomedical Research in Network for Obesity and Nutrition, Instituto Carlos III, Spain).

Fernando Fernández-Aranda

Dr. Fernando Fernández-Aranda Specialist in Clinical Psychology, has been the Director of the eating disorders (ED) Unit at the Dept. of Psychiatry (University Hospital Bellvitge, Barcelona, Spain), Head of Group CIBERobn (Excellent Spanish Research Network for Obesity and Nutrition) and Distinguished Professor at the University of Barcelona. Scientific Director of IDIBELL.

Marc N. Potenza

Dr. Marc N. Potenza Professor of Psychiatry, Child Study and Neuroscience, Yale School of Medicine; Senior Scientist, Connecticut Council on Problem Gambling

Susana Jiménez-Murcia

Dr. Susana Jiménez-Murcia, Clinical Psychologist and PhD in Psychology. Director of the Pathological Gambling and Behavioral Addictions Unit at the Department of Psychiatry (University Hospital Bellvitge-HUB/IDIBELL). Co-PI of Group CIBERobn (Excellent Spanish Research Network for Obesity and Nutrition), Associate Professor, School of Medicine, University of Barcelona. More than 270 published articles.