J Gambl Stud

DOI 10.1007/s10899-012-9322-0
ORIGINAL PAPER

Problem Gambling in Adolescents: An Examination

of the Pathways Model
Rina Gupta Lia Nower Jeffrey L. Derevensky Alex Blaszczynski
Neda Faregh Caroline Temcheff

Springer Science+Business Media, LLC 2012

Abstract This research tests the applicability of the Integrated Pathways Model for
gambling to adolescent problem gamblers, utilizing a cross-sectional design and self-report
questionnaires. Although the overall sample consisted of 1,133 adolescents (Quebec:
n = 994, 87.7 %; Ontario: n = 139, 12.3 %: Male = 558, 49.5 %; Female = 569,
50.5 %), only problem gamblers were retained in testing the model (N = 109). Personality
and clinical features were assessed using the Millon Adolescent Clinical Inventory,
attention deficit hyperactivity (ADHD) using the ConnersWells Adolescent Self-Report
Scale, and the DSM-IV-MR-J and Gambling Activities Questionnaire to determine gambling severity and reasons for gambling. Latent class analysis concluded 5 classes, yet still
provided preliminary support for three distinct subgroups similar to those proposed by the
Pathways Model, adding a depression only subtype, and a subtype of problem gamblers
experiencing both internalizing and externalizing disorders. ADHD symptoms were found
to be common to 4 of the 5 classes.
R. Gupta (&)
J. L. Derevensky
N. Faregh
International Centre for Youth Gambling Problems and High-Risk Behaviors, McGill University,
Montreal, QC, Canada
e-mail: rina.gupta@mcgill.ca
J. L. Derevensky
e-mail: jeffrey.derevensky@mcgill.ca
N. Faregh
e-mail: neda.faregh@mail.mcgill.ca
L. Nower
Center for Gambling Studies, Rutgers University, New Brunswick, NJ, USA
e-mail: lnower@ssw.rutgers.edu
A. Blaszczynski
Gambling Research Unit, School of Psychology, University of Sydney, Sydney, Australia
e-mail: alex.blaszczynski@sydney.edu.au
C. Temcheff
Departement de Psychoeducation, Universite de Sherbrooke, Sherbrooke, QC, Canada
e-mail: Caroline.Temcheff@usherbrooke.ca

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Keywords Adolescent gambling
Problem gambling
Etiology
Gambling subtypes

Co morbidity

Introduction
There are clear empirical and clinical findings that suggest problem and pathological
gamblers are not a homogeneous group. The Pathways Model, proposed by Blaszczynski
and Nower (2002), theoretically integrates current empirical and clinical knowledge
concerning the biological, personality, developmental, cognitive, learning theory and
environmental factors associated with problem gambling into one coherent framework in
an attempt to better understand different subtypes of pathological gamblers. Such a
framework, if applicable, could prove useful in guiding future screening, prevention and
treatment efforts through pathway-specific assessment and treatment protocols. This study
is the first to test the applicability of this model for youth problem gamblers.

Literature Review
Pathological gambling is characterized by persistent and recurrent maladaptive gambling
behavior, leading to significant deleterious legal, financial, physical and psychosocial
consequences (American Psychiatric Association 2000). Adult lifetime prevalence rates of
pathological gambling range from approximately 1 to 5 % worldwide (Gerstein et al. 1999;
National Research Council 1999), with higher rates (35 %) reported among youth who
commonly view gambling and wagering as a popular activity (Derevensky and Gupta
2004; Jacobs 2004; National Research Council 1999; Volberg et al. 2010). Despite higher
prevalence rates of problem gambling among youth, studies suggest that, similar to adults,
adolescent problem gamblers are, in fact, not a homogenous group (Gupta and Derevensky
1997).
Several divergent theoretical approaches have attempted to explain problem and pathological gambling including addiction, psychodynamic, biological/genetic, neurobiological, learning, cognitive-behavioral, and sociological theories (Gupta and Derevensky 2004;
Petry 2005). Conceptually, most of these models perceive pathological gambling either as
a categorical or a spectrum disorder. While many of these models share common elements,
they each assume that the interaction of significant bio-psycho-social and environmental
variables in the etiological process may be accounted for by one set of fundamental
principles. The underlying assumption is that disordered gamblers are essentially a relatively homogeneous population. As a consequence, theoretically driven treatments are
applied indiscriminately to all individuals with gambling problems irrespective of gender,
ethnicity, type of gambling, developmental history, or neurobiology.
The majority of explanatory models of pathological gambling to date have failed to
differentiate specific typologies of gamblers and pathological gamblers despite the recognition of multiple causes precipitating gambling problems and possible causal pathways
(Blaszczynski and Nower 2002; Nower and Blaszczynski 2004). Based on the research and
clinical literature, Blaszczynski and Nower (2002) hypothesized a conceptual Pathways
Model that identifies three primary subgroups of gamblers: (a) behaviorally-conditioned;
(b) emotionally-vulnerable, and (c) anti-social impulsivist problem gamblers. The term
biologically-based is more preferable to anti-social impulsivist in describing the third
pathway as it recognizes the importance of underlying neurobiological factors and

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de-emphasizes the anti-social component. All three groups have common exposure to
related ecological and cultural factors (e.g., availability, accessibility, and acceptability),
cognitive processes and distortions, and contingencies of reinforcement. However, the
model suggests that predisposing emotional stressors and affective disturbances for some
individuals and biological impulsivity for others represent significant additive risk factors.
Their differential Pathways Model has significant implications for both the assessment and
treatment of adult and adolescent pathological gamblers (Blaszczynski and Nower 2002;
Nower and Blaszczynski 2004; Petry 2005). Within the Pathways Model three subtypes of
pathological gamblers are articulated:
Pathway 1: Behaviorally Conditioned Problem Gamblers
Pathway 1 gamblers are distinguished by the absence of specific pre-morbid features of
psychopathology. They fluctuate between regular/heavy and excessive gambling largely as
a result of the effects of conditioning, distorted cognitions surrounding the probability of
winning as well as a disregard for the notion of independence of events, and/or a series of
bad judgments and poor decision-making rather than because of impaired control. Pathway
1 gamblers initially gamble primarily for reasons associated with entertainment and
socialization, facilitated by easy access and availability. Problem gambling-related
symptoms, including a preoccupation with gambling, chasing losses, substance dependence, depressive symptomatology and state anxiety are conceptualized as the consequence and not the cause of patterns of excessive gambling behavior.
Pathway 2: Emotionally Vulnerable Problem Gamblers
Similar to Pathway 1 individuals, Pathway 2 gamblers share similar ecological determinants,
conditioning processes, and cognitive schemas. However, these gamblers also present with
anxiety and/or depression, problematic family background experiences, and major traumatic
life events. It is hypothesized that these factors cumulatively contribute to the development
of an emotionally vulnerable gambler whose participation in gambling is motivated by a
desire to modulate affective states and/or meet specific psychological needs. Gambling and
pre-morbid drug abuse is used to alleviate aversive states by providing an escape or arousal
(Jacobs 2004). Psychological dysfunction in these gamblers results in more resistance to
change and necessitates differential treatment, addressing underlying vulnerabilities as well
as excessive gambling and, in some cases, substance abusing behaviors.
Pathway 3: Biologically-Based Problem Gamblers
Pathway 3 gamblers also possess psychosocial and biologically-based vulnerabilities
similar to Pathway 2 gamblers, but are primarily distinguished by features of impulsivity,
antisocial personality traits and behaviors, and attention deficits, manifesting in severe
multiple maladaptive behaviors. Specifically, impulsivity directly affects the gamblers
general level of psychosocial functioning. Clinically, these impulsive gamblers exhibit a
wide array of behavioral problems independent of the type of gambling in which they
engage (Blaszczynski et al. 1997; Rugle and Melamed 1993). Excessive alcohol and
multiple drug experimentation, poor interpersonal relationships, non-gambling related
criminality and a family history of antisocial behavior and alcohol problems are typically
characteristic of Pathway 3 individuals. As such, these gamblers will be less motivated to

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seek treatment and will demonstrate poor treatment compliance and poor response rates to
any form of intervention (Blaszczynski and Nower 2002).
Since the publication of the Pathways Model, a number of studies have identified
relationships among various predisposing factors identified in the model as relevant to
distinguishing among subgroups of problem gamblers. One study of personality disorders
in problem and pathological gamblers (Sacco et al. 2008) found that pathological gamblers
reported more symptoms of borderline personality disorder before, but not after controlling
for depression, suggesting a complex relationship among these variables. Similarly (Clark
2006) and (Bagby et al. 2007) both reported that trait impulsivity and emotional vulnerability were additional risk factors for pathological gambling, though Clark further
hypothesized that impulsivity served as a mediator for depression. A number of other
studies have found relationships between problem gambling and other factors including
sensation-seeking (Bonnaire et al. 2007), negative affect and distress tolerance (Daughters
and Lejuez 2005), autonomic arousal (Moodie and Finnigan 2005), and antisocial personality disorder (Pietrzak and Petry 2005).
Only a few studies have explored the possibility of heterogeneous subtypes among
problem gamblers, which is the conceptual framework of the Pathways Model. Using a
measure of gambling experiences (Ledgerwood and Petry 2006) identified three subgroups
of problem gamblers; those who gamble (a) to escape negative emotions, (b) as a primary
means of avoidance and dissociation, and (c) to seek attention for narcissistic reasons. In
another study of male pathological gamblers in Spain (Gonzalez-Ibanez et al. 2003)
assessed gamblers on measures of depression, psychoticism, somatization, impulsiveness,
interpersonal sensitivity and phobic anxiety. These authors identified three distinct clusters,
each exhibiting progressively more severe symptoms of psychopathology on these variables, suggesting that subgroups differed by degree of psychopathology rather than merely
by the appearance of psychological symptoms. This finding is consistent with Pathways 2
and 3 gamblers, though the authors did not measure the presence or absence of these
symptoms in relation to the development of gambling problems. In a more recent study,
Stewart and colleagues (Stewart et al. 2008) conducted a principal components analysis on
subscales of the Inventory of Gambling Situations prior to submitting obtained factor
scores to cluster analysis. Similar to other research, they found three clusters of problem
gamblers: (a) those who reported gambling for enhancement without negative emotional
factors; (b) those with low positive and negative emotional regulation; and (c) those with
very high negative and positive emotional factors in gambling situations together with
more significant gambling and alcohol problems. Their findings also lend general support
to the notion that distinct subgroups of problem gamblers exist, though none of these
explorations examined the range of factors identified by the Pathways Model.

Research Goals and Hypotheses

Although the Pathways Model has both empirical and clinical implications for a better
understanding and treatment of problem gambling, no one, to our knowledge, has undertaken the task of examining its efficacy amongst young teenaged problem gamblers. The
current study aimed to assess whether or not the profile and the defining characteristics that
form the three subtypes of disordered gamblers proposed in the Pathways Model are
applicable to adolescents. It is hypothesized youth problem gamblers will group into
distinct etiological subtypes, characterized by the presence or absence of emotional

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vulnerabilities, family problems, abuse and impulsivity. Attentional deficits are hypothesized to be unique to some subtypes but not all.

Method
Participants
A total of 1,133 adolescents (male = 558, 49.5 %; female = 569, 50.5 %) from Englishspeaking high schools in Quebec (n = 994, 87.7 %) and Ontario (n = 139, 12.3 %) participated in the study. The ages of participants from the overall sample ranged from 13 to
18 (mean = 15.6, SD = 1.05). Those meeting the criteria for problem gambling
(N = 109) were retained for the testing of the model. Ages in the test sample ranged from
14 to 18, with a mean age of 15.6 (SD = 1.10).
Procedure
Ethical approval was obtained from the McGill University Research Ethic Board prior to data
collection. A detailed research proposal package was submitted to school boards across Eastern
Ontario and Southern Quebec. Individual high schools were contacted once school boards
granted permission. All schools were requested to allocate 4550 min of in-class testing time
for completion of the instruments. Parental consent was obtained prior to participation.
Participants completed multiple instruments during class time under the supervision of
trained research assistants, who provided clarification during administration when necessary. Participants were provided with the definition of gambling as any activity that
involved an element of risk where money is wagered and could be won or lost.
Students were instructed that they were not obliged to participate, that all responses were
anonymous, and that they were free to refuse to answer any questions and withdraw from the
study at any time. They were briefed on the importance of thoughtful, accurate responding.
Data was analyzed using SPSS and MPlus software packages.
Data Analysis
Demographic information, gambling severity membership, proportion of sample reporting
gambling, and gambling activity participation are described and compared using basic
statistical procedures (e.g., means, percentages, and Chi-square analyses). Latent class
analysis (LCA), using a step-wise mixture modeling technique with Mplus 5.1 (Muthen
and Muthen 2008), was performed to identify whether subgroups of individuals who were
identified as problem gamblers existed. Given that the goal of the research was to identify
subgroups of individuals with gambling problems, individuals who failed to endorse three
(3) or more gambling-related problems on the gambling severity screen (DSM-IV-MR-J)
were omitted from the LCA. The 109 individuals retained for the analysis represent a
combination of at-risk and probable pathological gamblers (PPG).
Instruments
Gambling Activities Questionnaire (Gupta and Derevensky 1996) provides information
about frequency of participation in different forms of gambling (e.g., poker, lottery). For

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purposes of this study, this instrument was used only to identify overall gambling behavior
and reasons for gambling. The GAQ is reported to have good face validity, questions are
analyzed individually, and no cumulative scores are calculated.
Diagnostic and Statistical Manual of Mental Disorders-Fourth edition-Multiple
Response- Juvenile (DSM-IV-MR-J) (Fisher 2000). This measure of youth problem gambling includes 12-items (9-categories) used to screen for pathological gambling during
adolescence. The items are modeled after the DSM-IV (American Psychiatric Association
1994) criteria for diagnosis of adult pathological gambling and the original DSM-IV-J for
adolescents (Fisher 1992). This instrument was revised by Fisher to allow for a four
response option; never, once or twice, sometimes, or often to each question. The
DSM-IV-MR-J therefore represents a more conservative classification system of problem
and pathological gambling groups in that various questions require an endorsement above a
certain severity level to receive an endorsement. Internal consistency reliability for this
scale is adequate, with Cronbachs alpha = .75 (although slightly lower than .78 for the
original DSM-IV-J screen) (Fisher 2000). A score of 4 or more is indicative of a probable
pathological gambler (PPG). For purposes of this study a respondent who indicated having
gambled in the previous year and scored a 3 was categorized as an at-risk gambler. This
cutoff was defined by us, as a means of increasing our sample size, and not by the author of
the instrument. Only those individuals who scored three or more on the DSM-IV-MR-J
were included in the LCA.
Millon Adolescent Clinical Inventory (MACI) (Millon et al. 2006) is a widely used and
standardized instrument for assessing adolescent personality characteristics and clinical
syndromes among adolescents exhibiting a wide range of problems. Although originally
designed for clinical use, the instrument was particularly applicable to the present study as
it (a) is designed specifically for adolescents; (b) assesses 29 traits, providing information
on a broad range of clinical problems and a holistic overview of the youths personality and
(c) is comprised of 160 items geared to a sixth-grade reading level, and is therefore easy for
adolescents to complete. The MACI is based on both Millons personality theory and
recent developments in the DSM. Additionally, scores are adjusted for gender and age.
Adjusted scores greater than 60 are considered to be syndrome significant.
The MACI is used infrequently for large-scale research projects because the calculation
of scores requires considerable time and attention to detail. The current study followed the
scoring guidelines described in the manual (Millon et al. 2006). For purposes of this study,
the following subscales were selected as grouping variables based upon the tenets proposed
in the Pathways Model: (a) self-demeaning; (b) family discord; (c) childhood abuse;
(d) impulse propensity; (e) depressive affect; (f) suicidal tendency; and (g) social insensitivity. Testretest reliability is adequate for these 7 variables with coefficients ranging
between .78 and .91, and internal consistency reliability coefficients range from .79 to .90.
ConnersWells Adolescent Self-Report Scale (Conners and Wells 1997) is a self-report
measure commonly used for the assessment of attention deficit/hyperactivity disorder
(ADHD) in children and adolescents. The current study used the ADHD, DSM Inattentive
and DSM Hyperactive-Impulsive subscales of the instrument. The assessment of ADHD
consists of 18 statements commonly endorsed by adolescents with ADHD. Respondents
rate items using a scale ranging from 0 to 4: not true at all, just a little true, pretty
much true, and very much true. Total raw scores are converted into standardized
T scores (adjusted for age and gender). This scale contains derived subscales that relate
directly to the DSM-IV criteria (American Psychiatric Association 1994). Reliability,
internal consistency coefficients range between 0.75 and 0.90 and 68 week testretest
reliability ranges are reported to range from 0.60 to 0.90 for the different subscales.

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Results
Data Treatment
There were no missing data from the clinical subsample on any of the DSM-IV-MR-J
items or MACI variables. The mean item scores were imputed for missing data on the
ConnersWells subscales, representing less than 3 % of the data. Syntax files were created
to calculate the MACI raw scores, and raw scores were transformed to standardized scores.
Syntax files were also created to calculate the standardized scores of the ConnersWells
ADHD scale. Reliability checks on scores (every fifth to tenth) were calculated manually to
ensure that these procedures were error-free.
Sample Characteristics
Based upon the results of the GAQ and DSM-IV-MR-J scores, it was determined that from
the overall sample of 1,133 individuals, 70.3 % gambled socially, 6.9 % were at-risk
gamblers, and 2.7 % met criteria for probable pathological gambling. These proportions
are comparable to those found in prior studies using community samples. Consistent with
other research, females are more likely to be non-gamblers, and males are more likely to be
experiencing gambling-related problems. These gender differences were statistically significant, v2(3, 1,133) = 6.64, p \ .001).
As previously mentioned, the mean age of the testing sample (n = 109) is 15.6 years
(SD = 1.10) with a greater number of males than females (78 males, 31 females). Table 1
displays the breakdown of gender across the at-risk and PPG groups.
Identifying Gambler Subtypes
The primary analysis of this study consisted of an empirical classification of homogenous
subtypes by distinctive patterns of personality through seven MACI (continuous) variables.
A latent model consisting of five (5) classes was obtained. The five-class solution had the
lowest Bayesian information criterion (BIC).
In addition, the entropy of a model encapsulates a measure of classification uncertainty
(Nylund et al. 2007). The entropy varies between zero and one, with higher values indicating greater certainty with respect to classification. Significant variability in the entropy
values for our solutions was not observed. The entropy for the five-class model was found
to be equal to .94, whereas the entropy for the other models were found to be between .93
and .95.
The LoMendellRubin test had a significance value of p = .04 for the five-class
solution, suggesting a significantly better fit of the five- class solution over the four-class
solution. The six-class solution had a LoMendellRubin test significance value of

Table 1 Distribution of test sample according to problem gambling severity and gender
Male

Female

Total

At-risk gambler

57

73.1

21

26.9

78

100.0

PPG

27

87.1

12.9

31

100.0

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Table 2 The fit indices for the
LCA conducted on test sample
(N = 109)

Optimal solution (5 classes) is in

bold

# of classes

BIC

LoMendell
Rubin (p value)

Entropy

6,913

.00

.94

6,799

.01

.94

6,762

.57

.93

6,738

.04

.94

6,747

.51

.94

6,758

.19

.95

p = .51, suggesting that the six-class solution is not advantageous over the five-class
solution. Therefore, based upon the BIC and the LoMendellRubin test, the five-class
solution emerged as the optimal one. The fit indices are shown in Table 2.
Class Demographics
Gambling severity and gender differences were examined among the latent classes. The Chisquare analysis of gambling category (at-risk and PPG) by modal class was not significant.
The analysis of gender by modal class was also not significant such that males were equally
over-represented in the classes of problem gamblers. Nonetheless, Class 5 had the greatest
representation of females (43.8 %). No age differences were found across the classes.
Class mean scores on MACI subscales are found in Table 3. A score of 60 or above is
considered to be clinically meaningful (Millon et al. 2006). Class 1 accounts for 14 % of
individuals with gambling problems (n = 15), and is characterized by very high scores on
the Social Insensitivity measure as well as clinically meaningful levels of Impulsive
Propensity and Family Discord. These youth appear to be highly antisocial.
Class 2 represents approximately 34 % of individuals with gambling problems
(n = 37), and is distinguished by the fact that class members had sub-clinical rates of
endorsement on seven of the seven MACI subscales used.
Participants in Class 3 represent only 10 % of individuals with gambling problems
(n = 11), and were distinguished by high levels of both internalizing symptoms (Depressive
Affect, Self-Demeaning) as well as externalizing behaviors (Impulsive Propensity), antisocial traits (Social Insensitivity) and Family Discord. Individuals in this class resemble
those in Class 1, but also have internalizing symptoms of depression and self-criticism.
Table 3 The mean adjusted scores of MACI variables according to latent class (clinical range in bold),
with univariate statistics
MACI variable

C1

C2

C3

C4

C5

Sign

Self-demeaning

33.0

17.8

74.4

54.2

91.0

Family discord

71.0

37.6

85.6

54.2

79.4

125.2
23.805

.000
.000

Childhood abuse

29.6

9.9

42.5

28.1

72.6

75.16

.000
.000

Impulsive propensity

76.9

31.5

74.5

35.7

71.7

54.96

Depressive affect

39.9

34.4

75.1

73.1

101.1

61.99

.000

Suicidal tendency

17.6

7.9

44.8

29.1

78.9

129.26

.000

Social insensitivity

82.9

56.5

68.5

48.4

57.4

17.31

.000

* Adjusted mean scores [60 are at least one standard deviation above the standardized mean and are
considered to be clinically meaningful

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Class 4 is represented by approximately 27 % of problem gamblers (n = 30) and is

distinguished only by clinically meaningful levels Depressive Affect. All remaining MACI
variables are sub-clinical.
Class 5 is represented by approximately 15 % of those meeting problem gambling
criteria (n = 16). Individuals in this class are unique in their reported histories of Childhood Abuse and Suicidal Tendencies, both meeting clinical significance. Scheffe post hoc
analyses indicate they score significantly higher than those in the other classes on measures
of Depressive Affect and Self-Demeaning tendencies (p \ .001). Their scores of Impulsive
Propensity and Family Discord are also clinically significant. The only MACI not meeting
significance is Social Insensitivity.
A pictorial comparison of differentiating characteristics can be found in Fig. 1. To
confirm differences across the modal classes, univariate analyses on all the seven MACI
variables were conducted along with Sheffe post hoc analyses. The seven variables yielded
significant differences across the five classes (see Table 3). Post hoc comparisons indicate
that the Impulsive Propensity variable does not differ significantly between those in
Classes 1 and 3, and 1 and 5. Depressive Affect does not differ between Classes 3 and 4,
and Family Discord does not differ between Classes 1 and 5, and 1 and 3. All other
comparisons were significant.
Attention Deficits
Behaviors relevant to ADHD were examined by using three subscales from the Connors
Wells self-report scale (ADHD, Inattentive, and Hyperactive-Impulsive). The mean scores

Fig. 1 Depiction of modal class characteristics

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Table 4 ConnersWells mean
T scores for the five latent classes

Class

1
2
3
4
5
* T scores [60 are clinically
meaningful

Table 5 Latent classes by gambling severity category

ADHD
index

DSM-IV
inattentive

DSM-IV
hyperactiveimpulsive

Mean

59.6

64.5

51.7

SD

14.4

13.7

10.4

Mean

62.7

65.5

52.1

SD

13.9

14.8

9.2

Mean

57.8

57.0

47

SD

16.9

13.9

10.0

Mean

62.1

66.9

53.2

SD

15.9

17.4

11.6

Mean

61.5

67.5

52.3

SD

18.0

16.0

9.8

Class

Gambling category

Total

At-risk

PPG

Count

12

Within class (%)

80.0

20.0

100.0

Count

29

37

Within class (%)

78.4

21.6

100.0

Count

11

Within class (%)

63.6

36.4

100.0

Count

18

12

30

Within class (%)

60.0

40.0

100.0

Count

12

16

Within class (%)

75.0

25.0

100.0

15

and their standard deviations for each of the scales are presented in Table 4. T scores
greater than 60 are indicative of clinical significance according to the norming criteria.
Univariate analyses conducted across classes for each of the scales revealed no significant
differences; however, it is worth noting that individuals in Class 3 did not meet clinical
significance for any of the 3 subscales. Also interesting is the finding that despite the high
levels of impulsivity in Class 1, they only met clinical criteria for ADD Inattentive type.
Class Demographics
Gambling severity and gender differences were examined among the latent classes. The
Chi-square analysis of gambling category (at-risk and PPG) by modal class was not significant, such that the distribution of at-risk and PPG gamblers is similar across classes.
The analysis of gender by modal class was also not significant with males being equally
over-represented across the 5 modal classes (see Tables 5, 6). Class 5 does however have
the greatest representation of females. Furthermore, there were no age differences across
the modal classes.

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Table 6 Gender distribution
among the five latent classes

Class

Gender
Male

1
2
3
4
5

Total
Female

Count

12

15

Within class (%)

80.0

20.0

100.0

Count

30

37

Within class (%)

81.1

18.9

100.0

Count

11

Within class (%)

63.6

36.4

100.0

Count

26

30

Within class (%)

86.7

13.3

100.0

Count

16

Within class (%)

56.2

43.8

100.0

Reasons for Gambling

The adolescents across the first 4 classes cited gambling to make money and for enjoyment/excitement as their primary reasons for gambling. Gambling for social reasons (to
make or maintain friends) was equally reported across the 4 classes. However, youth in
Class 5 were significantly more likely to report gambling to alleviate depression (43 vs.
7 % in Class 1, 14 % in Class 2, 14 % in Class 3, and 22 % in Class 4) [v2 (4,
109) = 11.53, p \ .021], and for purposes of escape (36 vs. 12 % in Class 1, 17 % in Class
2, 5.2 % in Class 3, and 29 % in Class 4) [v2 (4, 109) = 7.84, p \ .032].

Discussion
The notion of identifying subtypes of problem gamblers has great appeal to clinicians and
prevention specialists as it may ultimately lead to the development of more efficient
individualized screening and treatment protocols that target specific etiological factors.
The Pathways Model originally proposed by Blaszczynski and Nower (2002) for adults,
and later refined for adolescents (Nower and Blaszczynski 2004), provides an important
overarching framework for understanding and differentiating among subtypes of problem
and pathological gamblers. Although the model was initially developed to target pathological gamblers (i.e., those meeting DSM-IV-TR clinical criteria), it has been applied
more broadly to problem gamblers in general, since the model assumes pre-morbid etiological processes. The current study sought to test the models major constructs empirically
to evaluate the efficacy of the model for adolescent problem gamblers. The original
Pathways Model proposed that accessibility, availability and acceptability of gambling,
combined with operant conditioning patterns, were prerequisites for all problem gamblers
irrespective of their ontological pathway.
The current study did not investigate specific conditions (attitudes, towards gambling,
ecological factors and operant conditioning), and as such, only represents a partial testing
of Blaszczynski and Nowers comprehensive model. Nevertheless, the findings provide
empirical evidence for identifiable subtypes of adolescents experiencing gambling-related
problems. While the sample size precluded only using adolescents with the most severe
gambling-related problems (pathological gamblers), the inclusion of those identified as

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at-risk for a gambling (i.e., at-risk gamblers endorsing three items on the DSM-IV-MR-J)
allowed for an examination of identifying distinguishing characteristics of those adolescents experiencing gambling-related problems. While ideally a replication study should
include a much larger community or clinical sample allowing for a sufficiently large
subsamples of youth meeting the criteria for pathological gambling, there is ample evidence that those identified as at-risk are similar in many respects to pathological gamblers
(Derevensky et al. 2007; Dickson et al. 2008; van Hamel et al. 2007).
The current findings support many of the tenets of the Pathways Model. In particular,
the results support the idea of several distinct subtypes of adolescents experiencing
gambling-related problems. The results from the LCA concludes five distinct subtypes/
pathways of adolescent problem gamblers, three of which bearing great resemblance to
those originally proposed by Nower and Blaszczynski (2004) for adolescents. As
hypothesized in the model, we found a subtype of problem gamblers who are devoid of any
psychopathology (Class 2) as proposed for Pathway 1; we also obtained a subtype of
problem gamblers who are characterized by past trauma (childhood abuse), depression,
self-hatred, family conflict, and suicidal tendencies (Class 5) as proposed for Pathway 2;
and similar to what was proposed for Pathway 3, we obtained a subtype of problem
gamblers that is primarily antisocial and impulsive in nature (Class 1). In addition, we
obtained a depression only subtype (which might be unique to an adolescent sample) as
well as a subtype that has both internalizing and externalizing symptoms. Actually, the
Pathways Model does account for such a subtype, hypothesizing some overlap between
Pathways 2 and 3 for indicators of emotional functioning.
The highly antisocial nature of individuals in Class 1 appear to be what make them
distinct from the other classes, which is also consistent with tenets of the Pathways Model
for the 3rd Pathway. The reported childhood abuse and suicidal tendencies are what make
those in Class 5 unique as well, also consistent with the Pathways Model stipulating
traumatic pasts and suicidality for those in Pathway 2. Despite the distinctiveness of the
classes, some overlap was obtained which could cause one to question whether in fact the
classes reflect variation in intensity of traits as opposed to distinctiveness, especially with
regards to family conflict, impulsivity, and internalizing tendencies. This cross section
snapshot in time does reflect meaningful differences between the classes which make sense
when clinical cutoffs are taken into consideration. We recognize that all the variables used
to discriminate the classes are in fact continuous in nature and we believe that any
breakpoints that can be established to group individual patterns are somewhat arbitrary
when taking account a developmental trajectory perspective.
Considering adolescence is a time of rapid change and development, only longitudinal
research can inform as to whether youth transition from one class to the next due to
variations in intensity of trait expression over time. A distinction from the Pathways Model
is that ADHD (inattentive) characteristics were found to be present across four of the five
classes, as was ADHD combined subtype. None of the classes reached significance for the
hyperactive/impulsive subtype of ADHD despite the fact that Blaszczynski and Nower
(2002) hypothesized that only those problem gamblers in Pathway 3 would predominantly
manifest this syndrome due to their impulsive nature. The interrelationship between
ADHD/inattentiveness and problem gambling among youth merits further investigation as
the inattention aspect of it appears to be a common risk or contributing factor.
The issue of childhood abuse as a risk factor for the development of problem gambling
is highlighted in these findings. This subtype of gambler engages in the activity to escape
problems and to alleviate feelings of depression. The female to male ratio within this
subtype of gambler was found to be more evenly distributed than typically observed among

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problem gamblers. Further research to better understand the abusegender relationship as it

pertains to problem gambling seems warranted.
As in most behavioral research there are a number of limitations to this study. Although
the study employed a large community sample of adolescents, only 109 met the criteria for
problem gambling resulting in a relatively small clinical sample available for analysis and
therefore limiting the generalizability of findings. Nevertheless, we are confident that our
results, though preliminary given the small sample are substantive and statistically and
clinically significant. We believe this for several reasons. First, there was no class that
accounted for fewer than 5 % of individuals in the sample. Second, the use of the BIC and
LMR test to determine the number of classes within small samples has been supported by
past simulation studies (Nylund et al. 2007).
The study utilized self-report measures that are subject to respondent bias, particularly
among those individuals with the greatest psychopathology. Such individuals may be
underrepresented in the total sample due to high school dropout rates. Assessment is
further hampered by the need to assess multiple constructs in a limited amount of time in
school settings. Finally, since the original Pathways Model has some temporal assumptions
(i.e., defining characteristics preceding the onset of problem gambling), future research
should also include a methodology sensitive to assessing temporal factors, for example,
whether depression contributed, or is a result of gambling problems.
Despite these limitations, the current study provides preliminary support for the major
tenets of the Pathways Model for adolescents while at the same time identifying some
deviations from the theory as it pertains to youth. While we are confident about the finding
of etiologically distinct subtypes of young problem gamblers, we do not feel that it is
warranted at this time to propose changes to the Pathways Model. Rather, we view the
current findings as being preliminary in nature, requiring replication with a larger clinical
sample, using a prospective design.

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