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I. Adolescent problem gambling: Developing a gambling expectancy instrumentMeredith A. M. Gillespie, Jeffrey Derevensky, & Rina
Gupta, International Centre for Youth Gambling Problems and High-Risk
Behaviors, Montreal, Quebec, Canada. AbstractPositive and negative outcome expectancies have been found
to play a significant role in adolescents' decisions to engage in drug and
alcohol use. In light of the parallel risk and protective factors among
high-risk behaviors, youth gambling outcome expectancies were explored
through the development of the 23-item Gambling Expectancy Questionnaire
(GEQ) using a sample of 1,013 students aged 12 to 18. The resulting GEQ
consists of three positive expectancy scales (enjoyment/arousal,
self-enhancement, money) and two negative expectancy scales (overinvolvement,
emotional impact). The potential utility of this scale is discussed. IntroductionGiven the negative psychological, social, and economic
consequences of gambling problems, it is essential to identify the factors
that contribute to problem gambling behavior among youth. What is attracting
young people to gambling activities and why do some develop problems when
others do not? Jessor's (1998) Adolescent Risk Behavior Model
conjectures that engagement in high-risk behaviors is determined by an
interplay between psychosocial instigators (i.e., risk factors) and controls
(i.e., protective factors), which can lead to health/life-compromising
outcomes. These risk and protective factors interact in and across various
domains—biology, social environment, perceived environment, personality, and
behavior. The risk factors associated with adolescent high risk behaviours
in general, and youth gambling problems in particular, have been well
documented (Derevensky & Gupta, 2004; Gupta & Derevensky, 1998b; Hardoon,
Derevensky, & Gupta, 2002; Langhinrichsen-Rohling, Rohde, Seeley, & Rohling,
2004; Stinchfield, 2000, 2004). The common risk factors, however, cannot fully explain why
some adolescents gamble excessively, just as they cannot fully explain why
other youth develop drug or alcohol problems. As such, there must be
specific reasons why an adolescent engages in gambling behavior. Social
cognitive models of health behavior (e.g., Health Belief Model, Becker,
1974; Theory of Planned Behavior, Ajzen, 1991) place importance on proximal
predictors of behavior, specifically the subjective cognitions related to
behavior choice. As Osgood, Johnston, O'Malley, and Bachman (1988) suggest,
each individual high-risk behavior, whether it is gambling, substance use,
tobacco use, or unprotected sex, likely has its own specific determinants.
The influence of risk and protective factors (i.e., common determinants) is
thought to be mediated through these behavior-specific cognitions (Fishbein
& Ajzen, 1975). As delineated in the substance use literature, the specific
determinants of high-risk behavior often include the perceived positive and
negative outcomes of behavior; personal, peer, and public
approval/disapproval; and perceived role model behavior and accessibility ( Within the gambling literature, the discussion of the
specific determinants of youth gambling behavior has largely focused on
societal attitudes and environmental characteristics. Wynne, Smith, and
Jacobs (1996) attribute accessibility, availability, and acceptance as
factors that account for the high prevalence rates of youth problem
gambling. Wynne et al. (1996) propose that the multiplicity of gambling
venues, lax regulations regarding proof of age to gamble, advertising that
encourages gambling and minimizes its potential harmful effects, and adult
attitudes that minimize the dangers of youth gambling are specific
determinants that likely promote gambling among youth. In general, adults
condone youth gambling, particularly the purchase of lottery tickets, as a
harmless activity (Felsher, Derevensky, & Gupta, 2004; Gupta & Derevensky,
1997; Winters, Stinchfield, & Kim, 1995). Similarly, public policy and
regulatory legislation foster an environment where gambling activities are
socially accepted, encouraged, and actively promoted (Nower & Blaszczynski,
2004). In contrast, little research has directly explored
adolescents' beliefs about the consequences of gambling behavior, and, in
turn, how these positive and negative outcome expectancies influence their
gambling participation. In general, adolescents frequently disregard the
potential negative consequences of high-risk behaviors (Clayton, 1992).
Furthermore, they have been shown to be more attuned to the positive
consequences that such experiences may yield (e.g., pleasure and excitement,
peer approval, relaxation) (Moore & Gullone, 1996). Research in addictive
behaviors suggests that the positive outcomes of addictive behaviors are
often associated with perceived immediate positive outcomes and hence are
more influential (Stacy, Widaman, & Marlatt, 1990). In keeping with social
cognition theories, an individual's decision to engage in gambling
activities may, to a certain extent, reflect the salience of their perceived
positive outcomes and the denial of negative outcomes. Outcome expectancies: Implications from drug and alcohol researchFindings from drug and alcohol research validate the
importance of understanding the role of outcome expectancies in adolescents'
decisions to engage in high-risk behavior. Perceptions of the harmfulness of
a drug tend to be a leading indicator of future changes in use among young
people. In many cases, shifts in the perceived risk of a drug, as recorded
by the National Institute on Drug Abuse's large-scale Monitoring the
Future surveys, have preceded inflections in actual use ( Related findings on gambling motives and risksWhile the predictive utility of expectancy models has been
examined within the alcohol and drug literature, related research in the
field of gambling has largely focused on gambling motives. In general, the
results of a number of studies suggest that individuals gamble for a variety
of reasons. In particular, money, enjoyment, excitement, and social reasons
are often cited as primary motivators and thus may be conceptualized as
being strong positive outcome expectancies for adolescents and young adults
(Gupta & Derevensky, 1998a; Neighbours, Lostutter, Cronce, & Larimer, 2002).
Moreover, while the motives of enjoyment, money, and excitement were highly
endorsed by all gamblers, more adolescent problem and pathological gamblers
reported gambling to escape problems, to alleviate depression, to cope with
loneliness, to relax, and to interact socially with others. However, these
positive outcome expectancies may depend on an individual's level of
gambling severity. The findings support the need for further exploration of
how positive outcome expectancies may vary as a function of gambling
severity. Adolescents' beliefs regarding the risks associated with
problem gambling have not been clearly delineated in previous research. The
prevailing belief is that gambling is a mode of entertainment and that it
has very few negative consequences (Winters, Arthur, Leitten, & Botzet,
2004). While the risks of gambling are extremely salient to researchers and
clinicians working with pathological gamblers, it is likely that they are
perceived quite differently among adolescents. The diagnostic criteria for
gambling problems (e.g., DSM-IV) speak to the harm related to pathological
gambling behaviors: significant financial losses, preoccupation and chasing
behavior, cognitive and emotional turmoil, relational disruptions among
friends and family members, stealing and other criminal acts, etc. (APA,
1994; Fisher, 2000). Whether or not adolescents are aware of these negative
outcomes, however, remains unknown. Developing a gambling expectancy questionnaire (GEQ)By extrapolating from the gambling literature, as well as
from the adolescent alcohol and drug literature, it seems plausible to
suggest that adolescent gambling expectancies may encompass a diverse array
of discrete biological, psychological, and social outcomes. From a
biopsychosocial perspective, the expected positive outcomes of gambling
likely include biological and arousal-related benefits (e.g., excitement,
boredom, interest), cognitive and mood-related benefits (e.g., desire to
win, enjoyment, coping, escape), and social benefits (e.g., money/power,
conformity, autonomy) (Griffiths & Delfabbro, 2001). As noted, these themes
have been endorsed as significant gambling motives in both adolescent and
adult gambling studies (Gupta & Derevensky, 1998a; Neighbours et al., 2002;
Platz & Millar, 2001). In contrast, the reality that gambling may be a
costly activity, that it can promote negative feelings and thoughts, and
that it can take a toll on one's relationships with friends and family
members may be acknowledged by adolescents as well. The negative outcomes of
financial costs, detrimental emotional effects, preoccupation, and
relational disruptions should be considered as potential risks of gambling
involvement, as they are empirically recognized as harmful consequences of
problem gambling. In order to assess the influence of outcome expectancies
on gambling behavior, it is first necessary to develop a gambling expectancy
instrument. Considering the success with which alcohol expectancy
instruments have delineated the positive and negative outcome expectancies
of adolescent drinking behavior (e.g., Alcohol Expectancy
Questionnaire—Adolescent Version (AEQ-A), Brown, Christiansen, & Goldman,
1987; Comprehensive Effects of Alcohol (CEOA), Fromme, Stroot, & Kaplan,
1993; Outcome Expectancy Questionnaire (OEQ), Leigh & Stacy, 1993) (see
Table 1), they provide a useful framework for the development of a GEQ. Table 1.
As such, a youth GEQ should incorporate the key features
of previous expectancy measures used in alcohol research, in keeping with
themes found in the current gambling literature. Many of the gambling
expectancy themes (e.g., excitement, enjoyment, social enhancement, escape,
social and emotional impairment, cognitive difficulties) are similar to
those found in alcohol expectancy measures. Before the relationship between
gambling outcome expectancies and gambling severity can be evaluated, a GEQ
that effectively represents the positive and negative effects of gambling on
adolescent behavior, mood, and emotions needs to be developed. MethodParticipantsParticipants were 1,013 students [males = 432 (42.6%);
females = 581 (57.4%)] from grades 7 to 11 (age range = 11–18; mean age =
14.77 years; SD = 1.52). The majority of these students lived in the
greater Approval was requested and obtained from four school
boards in the greater ProcedureDerived from the gambling and alcohol literature, 48
items, referring to the multifaceted consequences of gambling, were
presented in questionnaire form to students (see Appendix A). These risk and
benefit items addressed the psychological, physiological, and behavioral
outcomes associated with gambling involvement. Among statements considered
to be benefits of gambling, items were created pertaining to one of seven
themes that were empirically supported in the literature regarding gambling
motives (Gupta & Derevensky, 1998a; Neighbours et al., 2002; Platz & Millar,
2001): money, mood enhancement/ enjoyment, excitement/arousal, relief from
boredom, social interaction, escape/tension reduction, and
independence/autonomy. Among the risk statements, items pertained to one of
four themes, created based on knowledge of adolescent gambling awareness,
consequences associated with excessive gambling, and developmental concerns
(APA, 1994; Fisher, 2000): financial cost, negative emotions, preoccupation,
and relational disruptions. A 7-point Likert scale was employed to capture a
wide range of expectancy strength: (1) no chance, (2) very unlikely, (3)
unlikely, (4) neither likely nor unlikely, (5) likely, (6) very likely, and
(7) certain to happen. Furthermore, items were pilot-tested for readability
with a sample of 10 students (mean age = 16). It should also be noted that a total of 34 focus groups
(198 students, ages 12–18) were conducted in The questionnaire was group-administered to participants
in classrooms and/or conference rooms by several trained research
assistants. Groups ranged from 10 to 60 students, with the number of
research assistants varying according to group size. Students were given a
brief description of the types of questions that would be asked (e.g., "Some
questions will ask you about your gambling behavior; some questions will ask
you about what you expect to happen when you gamble") as well as
instructions regarding the completion of the questionnaire ("Please make
sure to take your time and read all the questions and instructions
carefully. Also make sure to fill in the circles completely with the pencil
that has been provided"). Students were also given a definition of gambling
to keep in mind when they responded ("Gambling is any activity that you play
in which you are putting money, or something of monetary value, at risk
since winning and/or losing is based on chance"). Research assistants were present at all times to answer all questions and concerns. Participants required approximately 35 minutes to complete the questionnaire. The remaining class time was used to debrief the participants about the aims of the study. During the remaining class time, research assistants also facilitated discussion about excessive gambling and its potential risks and negative consequences. ResultsData analysesThe 48 gambling expectancy items were included in a
principal components analysis (PCA) to reduce the items to a smaller number
of variables. A Varimax rotation was used to simplify factors by maximizing
the variance loadings across variables, with the spread in the factor
loadings being maximized (Tabachnick & Fidell, 1996). Varimax rotation also
reapportions variance among factors such that they become relatively equal
in importance. PCAs were performed with expectancy items being removed until
the criterion of simple structure was met, whereby several variables
correlated highly with each other and only one factor correlated highly with
each variable. Simple structures are beneficial as they allow for a more
definite interpretation of factors. In addition, correlations between items
were observed in order to further reduce the linearity between factors.
Cronbach alphas were then calculated as an index of internal reliability for
each factor/scale. PCAsAll 48 gambling expectancy items were entered into the
first PCA. The Kaiser–Meyer–Olkin (KMO) measure of sampling adequacy was
estimated as .93, a value deemed excellent by Kaiser (1974). Large values of
the KMO suggest that data reduction via factor analysis or PCA is
beneficial, as observed correlations between pairs of items are likely
explained by overarching variables. The PCA extracted seven factors with
eigenvalues > 1. An examination of the rotated component matrix identified
17 items that loaded roughly equally (within 0.20 of each other) on more
than one factor. These included items reflecting the themes of escape (five
items), negative emotions (one item), relational disruptions (two items),
financial costs (four items), boredom (one item), independence (one item),
social interactions (one item), and arousal (two items). Again, these items
were removed to avoid ambiguity in the interpretation of the factors (Tabachnick
& Fidell, 1996). A second PCA was performed using the 31 items that
remained. This PCA extracted five factors with eigenvalues > 1. Examination
of the rotated component matrix identified two items that loaded roughly
equally (within 0.20 of each other) on more than one factor and one item
that minimally loaded on one factor (< .50). These three items, which were
removed from the analysis, reflected feeling sad or depressed and feeling
like one's own person. A third PCA was run on the remaining 29 items, once
again resulting in a five-factor model. However, correlations between
created factors were found to be high (> .50) and thus bivariate
correlations between items loading on different factors were analyzed in
order to reduce linearity between factors. Six additional items were removed
from the model because their presence inflated correlations between scales.
These items reflected themes of parental disapproval (two items), cognitive
preoccupation, stress, financial losses, and boredom. A final PCA was performed on the remaining 23 items,
confirming a final model consisting of five factors. The five factors
retained accounted for 66.8% of the overall variance in GEQ item scores,
with three to eight loadings on each factor. The overall solution has a
simple structure (Tabachnick & Fidell, 1996) and the final KMO was estimated
as 0.90. The rotated principal components matrix is presented in Table 2.
Table 2.
1 = enjoyment/arousal, 2 = overinvolvement, 3 =
self-enhancement, 4 = emotional impact, 5 = money Based on the rotation sums of squares loadings, the first
factor accounted for 18.9% of the variance in item scores. Variables that
loaded onto the first factor mainly reflected the gambling benefits of
enjoyment, arousal, and entertainment. This factor was labeled
enjoyment/arousal. The second factor accounted for 16.9% of the variance
in item scores. Items that loaded highly on this factor reflected the
gambling risks of cognitive, affective, and social preoccupation with
gambling. This factor was termed overinvolvement. The third factor
accounted for 11.3% of the variance in item scores. This factor reflected
the gambling benefits of feeling in control, feeling powerful, and feeling
more accepted by peers; it was labeled self-enhancement. The fourth
factor accounted for 10.8% of the variance in item scores. This factor
reflected negative emotions (guilt, shame, loss of control) as a result of
gambling; it was labeled emotional impact. Finally, the fifth factor
accounted for 8.9% of the variance in item scores, reflecting the benefit of
financial gain as a result of gambling; it was labeled money. A
correlation matrix of the five factors is provided in Table 3. Table 3.
** Correlation is significant at the .01 level (2-tailed), N = 1004. Internal consistencyCronbach alpha coefficients were calculated for each of
the five factors: enjoyment/arousal (a
= .86), overinvolvement (a = .91),
self-enhancement (a = .81),
emotional impact (a = .85), and
money (a = .78). Each of these
interitem alpha coefficients represents adequate to good internal
reliability (Cronbach, 1951). Examination of frequencies revealed a significant positive
skew for self-enhancement, overinvolvement, and emotional impact. However,
the transformations applied to these distributions (logarithmic and square
root transformations) could not establish univariate normality. DiscussionThe primary goal of this study was to develop an
instrument to measure youth gambling outcome expectancies. Forty-eight
gambling expectancy items representing 11 benefit and risk themes—money,
excitement/arousal, enjoyment, boredom, social interaction, independence,
escape/tension reduction, financial costs, preoccupation, negative emotional
effects, and relational disruptions—were presented to participants. The
resulting 23-item GEQ consists of three discrete scales of positive outcome
expectancies (enjoyment/arousal, self-enhancement, money) and two discrete
scales of negative outcome expectancies (overinvolvement, emotional impact).
The retained items of the GEQ are presented in Table 4. Table 4.
Scale constructionThe original 48 gambling expectancy items used to develop
the GEQ touched upon a diverse array of bio-psycho-social outcomes
empirically related to gambling involvement. While alcohol expectancy scales
were used as a template (AEQ-A, Brown et al., 1987; CEOA, Fromme et al.,
1993; OEQ, Leigh & Stacy, 1993), gambling items were chosen based on the
clarity with which they depicted the target theme, as well as their
consistency with related items. Items reflecting seven gambling benefit
themes—money, excitement, enjoyment, boredom, escape/tension reduction,
social interaction, and independence—were originally selected based on their
endorsements as gambling motives in both adolescent and adult gambling
studies (Gupta & Derevensky, 1998a; Neighbours et al., 2002; Platz & Millar,
2001). Similarly, items reflecting four gambling risk themes—financial cost,
negative emotional effects, preoccupation, and relational disruptions—were
used as they denoted the recognized signs of problem gambling (APA, 1994).
Of the 48 items entered into the original factor analyses, 23 items were
retained and included in the GEQ. The three positive expectancy scales of the resulting GEQ
reflect a combination of the benefit themes originally suggested to
participants. In keeping with previous research (Gupta & Derevensky, 1998a;
Neighbours et al., 2002), adolescents viewed money as a distinct positive
outcome of gambling; all three items that were used to denote money-making
possibilities remained representative of the construct and encompassed the
money scale. The complexity of items found within the enjoyment/arousal and
self-enhancement scales, however, suggest that other positive outcome
expectancies of gambling are not as discrete. The enjoyment/arousal scale
includes items denoting enjoyment, excitement, relief from boredom,
escape/tension reduction, and social interaction. The structure of the
enjoyment/arousal scale suggests that adolescents anticipate and view
gambling as a socially acceptable form of entertainment, an activity that
holds the potential to stimulate high levels of excitement while
simultaneously relieving stress as a form of escape. Adolescents positively
perceive gambling as a diversion from the tediousness of daily life.
Moreover, gambling activities serve to facilitate social interactions with
friends and/or family. The self-enhancement scale includes items reflecting
potential outcomes of social gains as well as independence. The composition
of the self-enhancement scale suggests that adolescents further perceive
gambling as providing an opportunity to feel good about themselves and to
assert their own importance by impressing others and/or by establishing
autonomy from others. The self-enhancement scale represents a new way of
viewing gambling from an adolescent perspective, one that was not fully
identified in previous research with adolescent and college-age samples
(Gupta & Derevensky, 1998a; Neighbours et al., 2002; Platz & Millar, 2001). Noticeably absent from the positive expectancy scales of
the GEQ are five of the six escape/tension reduction items thought to be an
important determinant of problem gambling. At the outset of the analyses,
escape-related items loaded equally on both positive and negative expectancy
scales and therefore were removed. On one hand, "escape" was perceived as a
negative outcome of gambling, as adolescents perceived potential danger in
being able to escape problems through gambling; on the other hand,
adolescents also perceived the benefit of escaping problems through such an
activity and entering into a dissociated state as a positive attribute.
Since the measure was developed based on the pooled responses of all
adolescents, it is likely that these discrepancies are a result of the
divergent perceptions of non-problem gamblers and problem gamblers (Gupta &
Derevensky, 1998a). Due to factor analytic techniques employed in the
development of the GEQ, differences based upon degree of gambling severity
on such escape-related items were not examined. Further research is
therefore warranted to define their perceived meaning as an expectancy
construct among adolescents. The two negative outcome expectancy scales represent both
the cognitive-behavioral and emotional risks associated with gambling.
The overinvolvement scale includes items originally conceptualized as
representing the themes of preoccupation and relational disruptions. The
scale generally reflects a loss of control over gambling, behaviorally,
psychologically, and socially. In comparison, the emotional impact scale
consists of items representing the negative emotions resulting from
excessive gambling. The scale reflects the toll gambling may take on an
individual's emotional wellbeing, sense of self, and mental health ( Surprisingly, adolescents did not perceive the financial
costs of gambling as a discrete negative outcome expectancy. Items
reflecting the risk of losing money loaded approximately equally on all
negative outcome expectancy scales at the outset of the analyses and were
therefore removed. These analyses suggest that adolescents perceive the risk
of losing money as being parallel to the cognitive, behavioral, and
emotional risks of gambling. Intuitively, the financial cost of gambling is
a negative outcome, yet the results of the factor analysis suggest that it
may not be distinct from other types of negative gambling outcomes in the
minds of adolescents. Similar conclusions can be made for items targeting
the risk of relational problems. Items reflecting the loss of trust and
approval from family and friends loaded equally across the negative outcome
expectancy scales; the items failed to fall within one scale. One can
propose that although adolescents perceive the negative impact that gambling
can have on one's relationships with family and friends, it is also subsumed
within other negative gambling outcomes. The resulting GEQ includes many of the same themes found
in alcohol expectancy scales (AEQ-A, Brown et al., 1987; CEOA, Fromme et
al., 1993; OEQ, Leigh & Stacy, 1993). Adolescents expect similar
positive outcomes from gambling as they do from drinking alcohol—social
interactions and peer acceptance, entertainment, relaxation, and increased
arousal and excitement. Likewise, they also perceive comparable negative
outcomes—emotional and social problems and cognitive and behavioral
difficulties. In contrast, money and independence outcomes were found to be
specific to gambling activities. The GEQ provides us with a better understanding of how
adolescents perceive both the positive and the negative outcomes of gambling
behavior. Although some of the original risk and benefit themes are not
included within the final instrument, the clustering of items within each
scale meaningfully represents the complexity of adolescents' perceived
outcome expectancies. For example, adolescents do not simply perceive
excitement in gambling, nor do they discretely perceive the potential for
social interactions or enjoyment. Instead, as demonstrated by the
enjoyment/arousal scale, they perceive a complex combination of positive
outcomes that are related to each other and cannot be teased apart.
Therefore, not only are the internal and empirical validities of the measure
intact, but the external validity of the GEQ is strong as well. These findings support the need for further research in
the area of youth gambling outcome expectancies. In particular, it is
important to explore the salience of these positive and negative outcome
expectancies across age, gender, and degree of gambling-related problems. It
is likely that using this scale provides a viable method of understanding
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Jacobs, D. F. (1996). Adolescent gambling and
problem gambling in Manuscript history: submitted: February 28, 2006;
accepted: August 8, 2006. All URLs were active at the time of submission.
This article was peer-reviewed. For
correspondence: Meredith Gillespie, International Centre for Youth Gambling
Problems and High-Risk Behaviors, McGill University, 3724 McTavish Street,
Montreal, Quebec, Canada
H3A 1Y2. E-mail:
merdith.gillespie@mail.mcgill.ca
Contributors: This paper represents the first author's (Meredith Gillespie)
master's thesis, which was codirected by the second and third authors. While
the primary authorship belongs with Ms. Gillespie, Drs. Derevensky and Gupta
made substantial contributions. This research was partially supported by a
grant awarded to Drs. Derevensky and Gupta from the Fonds québécois de la
recherche sur la société et la culture (FQRSC). Competing
interests: None. Ethics
approval: Funding:
This research was supported by a Social Sciences and Humanities Research
Council (SSHRC) Master's Scholarship awarded to Ms. Gillespie, and by an
Ontario Problem Gambling Research Centre grant awarded to Drs. Derevensky
and Gupta. Meredith Gillespie, MA, is currently a doctoral student at Jeffrey L. Derevensky, PhD, is a Professor of the Rina Gupta, PhD, is a child psychologist and Assistant
Professor (part time) of the Appendix A
Benefit Themes Money 1. I get rich. 2. I win money. 3. I make a profit. Enjoyment 1. I enjoy myself. 2. I have fun. 3. I feel good. 4. I have a good time. Excitement/Arousal 1. I feel a rush. 2. I get a thrill out of gambling. 3. I feel excited. Boredom 1. I will pass time. 2. I will deal with boredom. 3. I will stop being bored. Social Interactions 1. I spend time with friends and family. 2. I am surrounded by similar people. 3. I spend time with people I like. 4. I feel more accepted by people. 5. My friends and classmates think I am cool. Escape/Tension Reduction 1. I feel more relaxed. 2. I take my mind off my problems. 3. I escape my problems. 4. I shut the world out. 5. I am distracted from my life. 6. I forget things I want to forget. Independence/Autonomy 1. I feel independent. 2. I feel in control. 3. I feel powerful. 4. I feel like my own person. Risk Themes Financial Costs 1. I lose all my money. 2. I spend more money than I want to. 3. I spend more money than I should. 4. I have no money left. Negative Emotional Effects 1. I feel ashamed of myself. 2. I feel guilty. 3. I feel sad or depressed. 4. I feel anxious or tense. 5. I feel stressed. Preoccupation/Loss of Control 1. I want to gamble more and more. 2. All I think about is gambling. 3. I get hooked. 4. I'm not able to stop. 5. I feel in over my head. 6. I want to gamble all the time. Relational Disruptions 1. My family gets upset. 2. I lose friends. 3. I lose the trust of my friends/family. 4. I only want to spend time with people who gamble.
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