"With African-Americans and other minority groups having both problem and pathological gambling rates that are 2-3 times higher than Caucasian gamblers, accurate diagnosis is essential to treat gambling addiction," says Renee Cunningham-Williams, Ph.D., a leading gambling addictions expert and visiting associate professor of social work at Washington University in St. Louis. Unfortunately, as with other mental health disorders, African-American and other minority groups receive disparate care from symptom recognition and diagnosis through treatment.
Renee Cunningham-Williams discusses Pathological Gambling Disorder and the latest tool to help in its diagnosis.
In a first step to close this gap in care, Cunningham-Williams successfully led the development and testing of a new assessment tool, the Gambling Assessment Module (GAM), to determine the reliability of current pathological gambling disorder (PGD) criteria. Cunningham-Williams' findings in the July issue of the Journal of Nervous and Mental Disease show that the Diagnostic and Statistical Manual for Mental Disorders (DSM)'s current criteria for PGD (DSM-IV), when assessed through the GAM, has substantial reliability. The PGD diagnosis applies equally well for Caucasians and African Americans and for game-specific disorders after adjusting for age and social class differences.
According to Cunningham-Williams, although early results are promising, more research is required to definitively conclude that the DSM-IV or earlier established DSM criteria, in conjunction with the GAM, are a reliable tool for diagnosing racial/ethnic minorities.
"The DSM, as operationalized through the GAM, appears to be a useful first step in addressing racial/ethnic disparities in this disorder," she says. "In order to appropriately plan for treatment, clinicians must be confident in their abilities to reliably diagnose this disorder. Our research is a first step in helping clinicians achieve that confidence."
Bill Michalski/WUSTL Publications
The GAM is the only existing instrument that diagnoses problem gambling across both the American Psychiatric Association's and the World Health Organization's criteria. It also is the only assessment in the world that can determine a diagnosis that is specific to the game a person plays.
"A person may play the slots, cards and the horses and be a pathological gambler, but experiences the symptoms only for slot machines," Cunningham-Williams says. "This is similar to a drug user, who uses several drugs, but only meets the criteria for cocaine dependence."
In this study, Cunningham-Williams and colleagues asked Caucasians and African-Americans about their gambling behaviors while carefully controlling for potential study biases. Two separate interviewers asked gamblers about their gambling behaviors in the exact same way, in two separate telephone interviews held about one week apart.
"When discrepancies in responses between the two time periods were evident, they occurred infrequently and were not due to racial/ethnic variation," she says.
Cunningham-Williams' current research focuses on the various behavioral treatments for this disorder, the important ethnic and cultural factors that may influence gambling behavior, and how gambling addiction is associated with other mental health and substance use disorders among adolescents, young adults and older Americans.