Regarding problem gambling status, the results of the clinical interviews and the scores on the Problem Gambling Severity Index (PGSI) formed the basis of the present findings. Out of the 18 participants, 3 participants (16.67%), two males and one female, were classified as pathological gamblers according to the criteria of the Diagnostic and statistical manual of mental disorders (4th ed., text rev.) (American Psychiatric Association ). Their scores on the PGSI were 8, 10 and 13, respectively, which indicated significant levels of negative impacts of gambling. Detailed analysis on their gambling trajectories and pathways to development of problem gambling indicates that two of them can be classified as a behaviorally conditioned gambler and the third one as an antisocial/impulsive gambler according to the Blaszczynski and Nower () model. Blaszczynski and Nower’s () pathways model of problem and pathological gambling recognises the diversity within the problem gambling population and addresses the development process of problem and pathological gambling. One basic premise of this pathways model is that the authors depict the pathways to pathological gambling as a linear model with three different groups of gamblers, each with different behavioural outcomes and treatment needs. Accessibility to gambling is crucial in the development of gambling. Gamblers either come from gambling families or grow up in a family or peer environment that condones or encourages gambling. Usually, their first encounters with gambling are positive: an early win is often reported by these gamblers. There are common influences that affect all problem gamblers, such as availability and access, classical and operant conditioning effects in the maintenance of gambling, arousal factors and biased cognitive thinking patterns. Behaviourally-conditioned gamblers are normal and function well prior to their gambling experiences. This group of gamblers may have had a stable career prior to gambling. They are not pathologically disturbed before they start to gamble excessively but, with repeated exposure to gambling activities, symptoms of the pathological gambling may emerge. These symptoms include a preoccupation with gambling, depression, chasing losses, anxiety, insomnia and even substance dependency. Their problems are the consequences of their excessive gambling behaviour. In contrast, antisocial/impulsive gamblers might have innate biological deficiencies, either neurological or neurochemical, to control impulses. These individuals are characterised by antisocial personality disorders and impulsivity and/or attention-deficit disorders. Their lack of control over the impulsivity can also be a consequence of learned behavioural patterns. These individuals may learn to seek immediate gratification of wants and desires during development. Impulsive gamblers have a propensity to seek out constant stimulation from their environment. In addition to their gambling, they tend to be clinically impulsive and display a broad range of problems, which might include substance and alcohol abuse, poor relationship skills, a propensity to commit criminal acts, and a family history of antisocial behaviour.
These characteristics best described the three pathological gamblers in the current study. For instance, Shawn’s (Male, 55 years of age) developmental history of gambling best described the pathway development of an antisocial gambler. He developed gambling habits at the age of 12 and has continued to gamble excessively since his teenage years. Although married and with two children, he has assumed little responsibility to support his family. As he has never entered any treatment program for his gambling problem, he still owes a large sum of money to loan sharks. His wife left him a few months prior to the interview and went back to the United Kingdom. However, Shawn seemed to care little for his family. His disregard for family responsibilities in favour of a carefree lifestyle in pursuit of gambling displays the characteristics of an antisocial/impulsive gambler. During his interview, he frankly admitted that he had been a pathological gambler all his life. He said: “Now, I cannot gamble as much… I have to wait till payday to gamble.” He had attended treatment for problem gambling for three times, but as he said, “I cannot quit…… just cannot.” One of his recurrent remarks, which he made during the interview was that he had been always tight on finances. Every month, he had to pay HKD 8,000 to pay off his debt. After paying off this amount, he would then gamble the rest of his money.
There were significant gender differences in game preferences. Men usually played Pai Kau[a] (排九), Sap Ng Wu (十五糊) (“Fifteen lakes” card game), bet on horse races and the outcome of Chinese chess games and purchased Mark Six (a form of state lottery). Chinese chess is a cognitive mind game, which is a favourite pastime for many, especially the elderly. Some seniors, however, who play Chinese chess, put a gambling element into this traditional game. Usually they might bet HKD 20-HKD 50 on each set. Pai Kau and Sap Ng Wu are traditional Chinese gambling games that require substantial skill and decision making analysis. Women mainly played mahjong. Mahjong is a traditional Chinese tile game played at home, which requires both luck (quality of dealt hands) and skill (to construct melds with high scores) (Ohtsuka & Chan ). All the participants identified fun and social interaction as the main motivation for their gambling. A good example is Mrs Lo (aged 71 years). She played mahjong three to four times a week, usually in the afternoon. However, she has conscious control on the wagering and the investment. As she said, “Usually, I would play mahjong after I have done my shopping in the morning. I then play mahjong with my neighbours. We are on the mahjong table till dinner time.” Mrs. Lo scored only 1 on the PGSI.
The participants’ involvement in gambling
Most interviewees started gambling at an early age. John (aged 56 years) said that he started gambling with family and friends at the age of 7 or 8. In his description, he used to enjoy watching his relatives gambling in the village. “I watched my Uncles gambling. We lived in the village where children started gambling at an early age back then.” Tong (Male, aged 58 years) also reported that he began to gamble as a child. Gambling was considered as part of family activities. There was no stigma associated with gambling. As he described his first experiences of gambling in childhood, his thoughts were dominated with positive memories. He said, “We liked to play cards when we were little. Usually we played with friends in our neighbourhood.” Such “normalcy” has also been reported by Wong et al. () in their study of problem gamblers in treatment. In the interviews with the participants, almost all used the word “play” (玩) to describe their gambling. The notion of play is evident in their involvement in gambling as the majority of them gambled on a regular basis. One of the female participants, Mrs. Lo (aged 71 years) stated that she gambled three to four times a week. One major difference between the pathological gamblers (n = 3) and the non-pathological gamblers (n = 15) found in the current study was that pathological gamblers usually recalled their early big wins in their gambling development. For example, Shawn (male, aged 55 years) once scored a big win when he was only a teenager. “In the 60’s, my monthly salary was a bit more than HKD 1,000. But on one occasion, I won more than HKD 10,000…That’s ten months’ worth of my salary then. But not long after the early winnings, I lost that big winning all in my later gambling.” Having grown up with an impoverished background, a win of HKD 10,000 represented a very big fortune. Like other pathological gamblers, Shawn enjoyed the retelling of his gambling success as if he relished the excitement and joy of gambling wins.
The second major difference between the social gamblers and the pathological gamblers was the level of control of gambling. Mrs. Fong (aged 68 years), for example, had conscious control of her gambling behaviour. She used to gamble five times a week, usually in the afternoon. However, because her daughter does not want her to gamble frequently, she stopped gambling about two years ago. “I stopped gambling as I had to move in with my daughter to take care of the young grandchildren. Now I don’t have the time to play mahjong,” she said. Mrs. Fong clearly had control over all aspects of her gambling: i.e., the control over the efforts, time and expenditure on gambling. Mrs Fong’s case supports the argument of Dickerson & O’Connor () that conscious control of gambling is a significant deficit among pathological gamblers.
Motivation for gambling
All participants cited social interaction and fun as their motivations to gamble. Mary (aged 65 years) loved to play mahjong once a week. She enjoyed the companionship that the game offered. “ My first time at the mahjong table was when I was in my twenties. I usually go to my friends’ houses to play.” Mary does not have any significant problems in gambling as she scored only 1 on the PGSI. In fact, the majority of the older adult women played mahjong or card games at least four to five times a week. To them, these games provided a cognitively stimulating pastime and an opportunity to get out of the home. Very often, the bets they placed on each round of mahjong were small, usually less than HKD 1. It seems that they played with the money and not for the money. A similar gambling behaviour has been observed among older Chinese female Electronic Gaming Machine (EGM) players in Australia: Their motivations for playing EGM are socialisation and excuses to go out, rather than for money (Ohtsuka ).