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Impaired Awareness of Problem and Pathological Gambling: A Review

Abstract

Although well-recognized and clinically relevant, impaired awareness of problem and pathological gambling (IAPPG) is a poorly understood phenomenon that contributes to treatment denial and negative clinical and social outcomes. In this study, we aimed to conduct a systematic review of the measures available to assess problem gambling awareness, evaluate their psychometric properties, and determine the extent to which they cover the core domains of illness awareness: General Disorder Awareness, Symptom Attribution, Awareness of Need for Treatment, and Awareness of Negative Consequences. A systematic search using OVID database (Medline®, PsycINFO, and Embase) was performed to identify English language papers describing gambling awareness measures. We identified only 8 measures partially assessing IAPPG. Measures differed in their effectiveness and comprehensiveness in evaluating IAPPG. Most measures were principally developed to evaluate barriers or motivators to treatment-seeking among gamblers and were not specific to IAPPG. Two were psychometrically validated, but the items were not specific to the evaluation of subjective awareness of the disorder and they only covered up to two domains of IAPPG. With the development and psychometric validation of an easy-to-use, comprehensive measure of subjective IAPPG, future studies will be able to investigate the role of IAPPG in help-seeking behavior, treatment adherence, and clinical and social outcomes.

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Acknowledgements

This work was supported by the Campbell Family Mental Heath Research Institute at the Centre for Addiction and Mental Health (CAMH), the Canadian Institutes of Health Research (CIHR), and the Ontario Mental Health Foundation (OMHF) (PG).

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Correspondence to Philip Gerretsen.

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Authors PS, LQ, and JK report no conflict of interest. Author AGG has received support from the United States National Institute of Health, Canadian Institutes of Health Research (CIHR), Ontario Mental Health Foundation (OMHF), Consejo Nacional de Ciencia y Tecnología, the Instituto de Ciencia y Tecnología del DF, the Brain & Behavior Research Foundation (Formerly NARSAD), the Ontario Ministry of Health and Long-Term Care, the Ontario Ministry of Research and Innovation Early Research Award, and Janssen. Author PG has received research support from CIHR, Ontario Ministry of Health and Long-Term Care, OMHF, and the Centre for Addiction and Mental Health (CAMH).

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Shah, P., Quilty, L., Kim, J. et al. Impaired Awareness of Problem and Pathological Gambling: A Review. J Gambl Stud 36, 39–50 (2020). https://doi.org/10.1007/s10899-019-09926-0

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  • DOI: https://doi.org/10.1007/s10899-019-09926-0

Keywords

  • Illness awareness
  • Illness denial
  • Insight into illness
  • Gambling disorder
  • Problem gambling
  • Pathological gambling