Prevention is Better than Cure: Vulnerability Markers for Problem Gambling.

Problem gambling commonly leads to severe negative effects not only on the gambler but on their family and peers, not to mention the economic expense due to criminal activity, lost productivity and such other factors. It is fair to say that problematic gambling affects us all.

With this in mind, research into the factors underlying problematic gambling is of great importance as it will allow the severity of its associated impacts to lessen. One important area of research is the identification of “vulnerability markers” for problem gambling. Vulnerability markers are factors in an individual that are thought to increase the susceptibility of developing a particular psychiatric issue. Research into vulnerability markers is incredibly important as they allow the development of assessments which will identify individuals at risk of developing a gambling addiction but, critically, before such addiction develops. If so wished, these individuals (and, perhaps, their family and peers) can then obtain education to increase their awareness of the development of problematic gambling with the intention of minimising, or even negating, the chances of developing a gambling problem. This research field, therefore, is concerned with halting the spread of problematic gambling. Such an approach falls in line with the core objectives of some health services, such as the National Health Service within the United Kingdom, of which one of their aims is to shift from a curative to preventative healthcare system (NHS, 2009), the outcomes of which will be significantly increased quality of life within the population and decreased spending on this area of public health.

This chapter will provide a review of the markers that have been evidenced to increase vulnerability specifically for problematic gambling. Unfortunately, a complete list of vulnerability markers cannot be given at the current time as significantly more research is required. The chapter will identify factors for which causality can be determined (i.e. the factor predates and predicts problem gambling). Factors for which causality cannot be determined will not be included unless there is some suggestive evidence that they may be potential vulnerability markers. This makes this review separate from other important reviews (e.g. Johansson et al., 2009) which have identified risk factors and have not separated out those factors which can be used in an early, pre-morbid, assessment. The aim of this review is to provide a single reference source with which individuals can begin to craft assessments for the early detection of problematic gambling. This review can be split into three sections. The first section will focus on vulnerability markers which have a valid and robust underlying evidence base and, as such, seriously warrant inclusion in any assessment for problematic gambling. The second section will detail those markers which have been identified as potential vulnerability markers. Markers described in this section have suggestive, yet little, evidence. The third section will cover potential biological and physiological markers. Although the focus of this chapter is to permit individuals to create brief assessments that can be carried out in the field, such as the psychiatrist’s office, knowledge of biological markers is important as it will allow researchers and healthcare providers to assess individuals using other platforms, such as neuroimaging. Although such techniques are significantly more expensive than a field assessment, they are another method by which susceptible individuals can be screened.