Sogs Gambling Assessment
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*Sogs Gambling Assessment Definition
*Sogs Gambling Assessment Questionnaire
*Gambling Assessment Tools
Income, debt) to use in their assessment of the persons problem gambling status. Results showed that the ability of the NODS, SOGS, and CPGI to distinguish problem from non- problem gamblers was better than had been suggested in prior research, but that overall. The South Oaks Gambling Screen (SOGS) is a psychometric instrument widely used internationally to assess the presence of pathological gambling. Developed by Lesieur and Blume (1987) in the United States of America (USA) as a self-rated screening instrument, it is based on DSM-III and DSM-III-R criteria. Sydney Laval University Gambling Screen (SLUGS) (31) To determine the number of gamblers who report impaired control (putative pathological gamblers), problem gamblers gambling more time or money then can be afforded resulting in harm that may require intervention, and those who express a desire for treatment Scotland 7 Staff and students from specific college and university institutions in Scotland (N=2069) Past 12 months.85 (31) Victorian Gambling Screen (VGS) (35). The South Oaks Gambling Screen (SOGS) is a psychometric instrument widely used internationally to assess the presence of pathological gambling. Developed by Lesieur and Blume (1987) in the United States of America (USA) as a self-rated screening instrument, it is based on DSM-III and DSM-III-R criteria. This paper describes the origins and psychometric development of the SOGS and comments.Journal Information
Journal ID (publisher-id): jgi
ISSN: 1910-7595
Publisher: Centre for Addiction and Mental Health
Article Information
© 1999-2006 The Centre for Addiction and Mental Health
Received Day: 15 Month: April Year: 2005
Accepted Day: 16 Month: March Year: 2006
Publication date: August 2006
Publisher Id: jgi.2006.17.10
DOI: 10.4309/jgi.2006.17.10
The South Oaks Gambling Screen (SOGS): A rebuttal to critics Affiliation: Boston, Massachusetts, USA. E-mail: blasegambinophd@aol.com
Affiliation: Rhode Island Hospital, Providence, Rhode Island, USA
For correspondence: Blasé Gambino, PhD, 10 Ellet Street, Suite 314, Boston, Massachusetts, USA 02122. Phone: (617) 282-2560, fax: (617) 426-4555, e-mail: blasegambinophd@aol.com
Contributors: Both authors contributed equally to this paper.
Competing interests: For GB, none declared. HL is one of the co-authors of the SOGS.
Ethical approval: None required.
Funding: Not applicable.
Blasé Gambino (PhD, experimental psychology, University of Massachusetts at Amherst) has studied addiction science and addiction practice since the publication of Theory and Practice in the Addictions (1979) with co-author Howard Shaffer. Among other publications, he was co-editor of Compulsive Gambling: Theory, Research and Practice (1989), to which he contributed a chapter on the development of prescriptive interventions through applying the principles of clinical epidemiology. He serves on the editorial review board of the Journal of Gambling Studies. He has contributed articles on mathematical models to eliminate bias in prevalence estimation research for single- and two-stage prevalence designs and articles on the epidemiology of pathological gambling and the evaluation of the outcomes of training programs in pathological gambling for employee assistance programs. His current interests are in the epidemiology of pathological gambling and the validation of alternative screening and diagnostic test instruments for pathological gamblers.
Henry R. Lesieur (PhD, sociology, University of Massachusetts, Amherst, in 1976, and PsyD in clinical psychology, Massachusetts School of Professional Psychology, in 2001, and postdoctorate studies at Brown University) is a staff psychologist at Rhode Island Hospital in Providence and a clinical psychologist in the Rhode Island Gambling Treatment Program. Dr. Lesieur is a member of the Board of Directors of the National Council on Problem Gambling and President of the Rhode Island Council on Problem Gambling, as well as being on the advisory board of other organizations. He and Sheila Blume, MD, are co-authors of the South Oaks Gambling Screen. Dr. Lesieur has run workshops and given numerous professional presentations on problem gambling and addictions. E-mail: Hlesieur@lifespan.org
A review of the literature reveals strong support for the construct validity of interpretations based on scores obtained with the original and more recent versions and/or variants of the South Oaks Gambling Screen (SOGS). Criticisms of the SOGS are shown to lack merit, to be offset by more important criteria, or to be no longer relevant. The evidence reviewed indicates that the construct of pathological gambling as represented by the SOGS and its variants provides a robust definition and implies that the SOGS meets the important criterion of validity generalization. The construct of chasing and behaviors related to chasing is shown to provide powerful measures by which to discriminate between the presence and absence of pathological gambling. The viability of the SOGS to continue to make important contributions to the understanding of pathological gambling is discussed in terms of the criteria for selecting a research instrument. Introduction
The South Oaks Gambling Screen (SOGS) (Lesieur & Blume, 1987) has been the subject of a number of critical reviews (e.g., Battersby, Thomas, Tolchard, & Esterman, 2002; Gerstein et al., 1999; Shaffer & Korn, 2002; Volberg, 1999; Walker & Dickerson, 1996), beginning with Culleton’s analysis of methods (1989). Closest casino to watonga ok. This has led to calls for replacement of the SOGS as the primary research instrument used in prevalence studies of the general population.
Although Lesieur (1994) and Gambino (1997) have provided responses to some of the issues, it is clear that a more detailed response is needed. Our goal is to demonstrate that the SOGS remains an important and viable choice among current alternatives by arguing the case that the major criticisms lack merit, are outweighed by other criteria, or are simply no longer relevant.
The SOGS is a 20-item instrument initially developed to screen clinical populations, for example, substance abusers, for the presence of pathological gambling. Responses to the 20 items are summed, and endorsement of 5 or more items is interpreted as evidence of the presence of pathological gambling. Criteria from the DSM-III and DSM-III-R were used in the development of the SOGS; the interested reader will find the original validation data in Lesieur and Blume (1987). The first use of the SOGS as a screen to detect pathological gambling in the general population was by Volberg and Steadman (1988). It is impossible in a short report to do justice to a review of the SOGS. We have therefore limited our response to what we believe are the most relevant and important issues. A more detailed report by the second author is available by request at hlesieur@lifespan.org. This includes an extensive list of references through early 2003 and a set of summary tables. In part, the criticisms leveled at the SOGS reflect the scarcity of systematic reviews and evaluation of the literature, i.e., meta-analysis. The references compiled by the second author should provide an excellent starting point for those investigators planning such analyses. A brief review
A wide selection of validation strategies have been employed to demonstrate the validity of the SOGS. These include the use of single-stage (e.g., Gambino, 1997; Poulin, 2002) and multiple-stage (e.g., Abbott & Volberg, 1996; Abbott, Williams, & Volberg, 1999; Gambino, 1999a) designs, a description of the mathematical models for evaluating the accuracy of estimates based on these designs (Gambino, 1997, 1999a), and methods for evaluating the precision and cost-efficiency of these designs (Gambino, 1999b). Other investigators have employed statistical modeling techniques for the purpose of validation, including factor analysis (e.g., Winters, Stinchfield, & Fulkerson, 1993), logistic regression (e.g., Poulin, 2002; Welte, Barnes, Wieczorek, Tidwell, & Parker, 2001), Rasch analysis (Strong, Lesieur, Breen, Stinchfield, & Lejuez, 2004), and stratification analysis (e.g., Tavares, Zilberman, Beites, & Gentil, 2001).
Evidence supporting the psychometric soundness of the SOGS, while less extensive than evidence that supports the validity of the many applications of the SOGS, continues to be accumulated (e.g., Abbot & Volberg, 1996; Lesieur & Blume, 1987; Stinchfield, 2002; Winters et al., 1993). These include measurement of internal validity (e.g., Stinchfield & Winters, 2001; Volberg, 2002; Welte et al., 2001), the use of concurrent validation strategies (e.g., Doiron & Nicki, 2001; Westphal & Johnson, 2000), postdictive or retrospective criterion validity (e.g., Gambino, Fitzgerald, Shaffer, Renner, & Courtnage, 1993; Ladouceur, Jacques, Giroux, Ferland, & Leblond, 2000), and the use of convergent and discriminant validation strategies (e.g., Lesieur & Blume, 1987; Stinchfield, 2002). Convergent validity as demonstrated by the correlation between the SOGS and its variants with the DSM, both earlier and current versions, is impressive in its consistency and ranges from moderate (e.g., Sproston, Erens, & Orford, 2000) to high (e.g., Welte et al., 2001). These correlations hold for both clinical (Stinchfield & Winters, 2001) and general (Stinchfield, 2002) population samples as well as comparisons among both adult and adolescent versions (e.g., Volberg, 1996, 1998).
Much of the criticism of the SOGS has its roots in the failure to recognize what qualify as statements of validity (Gambino, 2003a). For example, the proposed relationships between pathological gambling and frequency of gambling (e.g., Hing & Breen, 2001), duration of gambling (e.g., Wong, McAuslan, & Bray, 2000), distance to gambling (e.g., Gerstein et al., 1999), and expenditures on gambling (Cox, Kwong, Michaud, & Enns, 2000), are all statements of construct validity (Cronbach, 1988). Recent epidemiologic studies have provided additional support by employing the SOGS to measure the strength (relative risk) and magnitude (attributable risk) of the relation of pathological gambling to suspected indicators of enhanced risk such as age, adults versus adolescents; severity, clinical versus general populations (e.g., Shaffer, Hall, & Vanderbilt, 1997); and comorbidity, e.g., substance use disorders (e.g., Feigelman, Wallisch, & Lesieur, 1998).
Several investigators have used the SOGS to search for the putative causes of pathological gambling in terms of genetic (e.g., Walters, 2001) or neurobiological (e.g., Ibáñez, Blanco, de Castro, Fernandez-Piqueras, & Saiz-Ruiz, 2003) factors; track its natural history (e.g., Shaffer & Korn, 2002); and measure the progression from gambling onset to diagnosis of pathological gambling (e.g., Tavares et al., 2001). Others have employed the SOGS to examine the construct of pathological gambling from a theoretical perspective, e.g., the debate over whether to view pathological gambling as an obsessive-compulsive or addictive disorder (Frost, Meagher, & Riskind, 2001).
If pathological gambling lies on a continuum of severity (Shaffer & Korn, 2002), then strong support for the validity of the SOGS would be found by showing that predictions of pathological gambling, in terms of the likelihood that a specific score discriminates the pathological from the nonpathological gambler, should increase as scores on the SOGS increase. Evidence in support of the SOGS is presented in Table 1 employing the likelihood ratio (LR). The LR is a measure recommended by clinical epidemiologists for validating clinical indicators and instruments (Kraemer, 1992). LRs can be used to validate individual clinical indicators, diagnostic and screening tests, or a range of test scores. The interested reader will find more detailed descriptions elsewhere (Chu, 1999; Koch, Capurso, & Llewelyn, 1995; Kraemer, 1992; McGee, 2000; Sackett, Haynes, & Tugwell, 1991; Schmitz, Kruse, & Tress, 2000; Zhou, Obuchowski, & McClish, 2002).
The LR provides an empirical measure of the goodness of a test definition (or individual criterion) by defining the odds of finding a particular test result in those with versus those without the disorder. It is this difference of frequency of occurrence that is looked for when assessing the validity of a symptom, sign, or test result (Koch et al., 1995). It measures the degree of certainty with respect to the diagnosis being confirmed. Larger values for the LR are interpreted as indicative of greater certainty that the presumptive diagnosis is correct; i.e., one may have greater confidence in the diagnosis. Values of LR equal to one mean that the results have no diagnostic value, and values of LR less than one indicate that the disorder is less likely to be present.
The LR is defined as the true-positive rate (sensitivity) divided by the false-positive rate (1 − specificity). Estimates of sensitivity and specificity were obtained following well-established procedure (Zhou et al., 2002). Sensitivity was estimated by assuming that gamblers in treatment represent individuals known to have the disorder; specificity was estimated by assuming that gamblers from the general population represent individuals free of the disorder. These are surrogate definitions since there will be some probability that some gamblers in the general population will be false negatives and some probability that some gamblers in treatment will be false positives. The use of these two populations as surrogates is reasonable since the analysis assumes that these labels apply on average, and not in any individual case (Schlesselman, 1982). This form of validation is equivalent to correlating test items with the total score. The LR provides an empirical estimate of the power of an instrument, one or more items, or a range of scores to discriminate the pathological gambler from the nonpathological gambler. The LR is interpreted as a measure of the credibility of the instrument or item(s) in accounting for the empirical evidence (Clayton & Hills, 1996).
Table 1, based on a reanalysis of Stinchfield’s data (2002), provides evidence to support this view and demonstrates that the SOGS meets this strong criterion for validity as indicated by increasing estimates of the LR with increasing scores on the SOGS.
The evidence clearly demonstrates support for the validity of the SOGS as an instrument for research on both clinical and general population samples (e.g., Volberg, 1994), its usefulness in case finding in clinical (e.g., Petry & Armentano, 1999) and correctional settings (Walters, 1997), the identification and testing of hypotheses about the determinants of pathological gambling (e.g., Cox et al., 2000; Gambino et al., 1993), and its usefulness in evaluating treatment outcomes (e.g., Stinchfield & Winters, 2001) and tracking long-term changes in prevalence rates among adults (Volberg & Moore, 1999) and adolescents (Winters, Stinchfield, Botzet, & Anderson, 2002), among others.
In sum, the SOGS has been employed for a multitude of purposes, in a wide array of settings, with diverse populations and cultures, and has been translated into at least 36 languages for use on six continents (contact the second author for a list of SOGS translations). These studies have found consistent replicable relationships between pathological gambling, as measured by the original and revised versions of the SOGS; personal attributes across times, places, communities, and clinical settings; and comparison with other instruments. The consistency of these findings provides strong support for the construct validity of the SOGS (e.g., Beaudoin & Cox, 1999; Hodgins & el-Guebaly, 2000).
Our review of the evidence in support of the validity of the SOGS is not presented as an argument that efforts to develop alternatives are misguided. Indeed, the continuing appearance of studies designed to validate improved alternatives is to be encouraged and represents a welcome challenge (e.g., Cunningham-Williams & Cottler, 2001; Fisher, 2000; Gerstein et al., 1999; Smith & Wynne, 2002; Stinchfield, Govoni, & Frisch, 2001). Comparisons among alternative instruments will continue to help identify the strengths and weaknesses in contrasting and related views on how to define the construct of pathological gambling; it may be expected that the SOGS will continue to contribute to this important task. Criticisms of the SOGS
The initial evaluation. The criticism that the SOGS was validated on clinical samples, thus making invalid its application to the general population, was reasonable, but it should not have been implicitly accepted in the absence of support for or against the application’s validity. The apparent unquestioning acceptance of this criticism represents a failure to understand that it is not the test that is being validated, but inferences and conclusions based on test score interpretations (Rubin, 1988). This criticism has subsequently been shown to be unwarranted in view of the strong support for the construct validity of findings employing the SOGS and its variants in studies of the general population. More specifically, recent research has validated the SOGS with general population samples in a number of settings and cultures (e.g., Abbott & Volberg, 1996; Volberg, Abbott, Ronnberg & Munck, 2001; Stinchfield, 2002; Volberg & Vales, 1998
Items on the SOGS. An additional set of criticisms revolve around the specific items on the SOGS, particularly its emphasis on borrowing. Table 2 presents an analysis of the 20 SOGS items, based on the data reported by Stinchfield (2002), that rebuts this criticism. The primary measure employed in Table 2 is the LR described earlier. An interpretation of the LR has been provided by Jaeschke, Guyatt, and Sackett (1994). These investigators propose the following interpretive guidelines: greater than 10 (large, often conclusive), 5 to 10 (moderate), 2 to 5 (small but sometimes important), and 1 to 2 (small, rarely important). The data show clearly that exceptionally high LRs were obtained for all items.
Two findings are of special interest. First, chasing as defined in the Stinchfield (2002) study (Table 2) is a strong discriminant (LR = 57.1) for separating pathological and nonpathological gamblers. Second, the five most discriminative items and seven of the top ten were items assessing borrowing. In view of the importance of the concept of chasing as a major characteristic of the pathological gambler (Lesieur, 1984) and the obvious relationship between chasing and the need to obtain money to chase, the discriminato
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This article is available in: HTMLjgi:
*Sogs Gambling Assessment Definition
*Sogs Gambling Assessment Questionnaire
*Gambling Assessment Tools
Income, debt) to use in their assessment of the persons problem gambling status. Results showed that the ability of the NODS, SOGS, and CPGI to distinguish problem from non- problem gamblers was better than had been suggested in prior research, but that overall. The South Oaks Gambling Screen (SOGS) is a psychometric instrument widely used internationally to assess the presence of pathological gambling. Developed by Lesieur and Blume (1987) in the United States of America (USA) as a self-rated screening instrument, it is based on DSM-III and DSM-III-R criteria. Sydney Laval University Gambling Screen (SLUGS) (31) To determine the number of gamblers who report impaired control (putative pathological gamblers), problem gamblers gambling more time or money then can be afforded resulting in harm that may require intervention, and those who express a desire for treatment Scotland 7 Staff and students from specific college and university institutions in Scotland (N=2069) Past 12 months.85 (31) Victorian Gambling Screen (VGS) (35). The South Oaks Gambling Screen (SOGS) is a psychometric instrument widely used internationally to assess the presence of pathological gambling. Developed by Lesieur and Blume (1987) in the United States of America (USA) as a self-rated screening instrument, it is based on DSM-III and DSM-III-R criteria. This paper describes the origins and psychometric development of the SOGS and comments.Journal Information
Journal ID (publisher-id): jgi
ISSN: 1910-7595
Publisher: Centre for Addiction and Mental Health
Article Information
© 1999-2006 The Centre for Addiction and Mental Health
Received Day: 15 Month: April Year: 2005
Accepted Day: 16 Month: March Year: 2006
Publication date: August 2006
Publisher Id: jgi.2006.17.10
DOI: 10.4309/jgi.2006.17.10
The South Oaks Gambling Screen (SOGS): A rebuttal to critics Affiliation: Boston, Massachusetts, USA. E-mail: blasegambinophd@aol.com
Affiliation: Rhode Island Hospital, Providence, Rhode Island, USA
For correspondence: Blasé Gambino, PhD, 10 Ellet Street, Suite 314, Boston, Massachusetts, USA 02122. Phone: (617) 282-2560, fax: (617) 426-4555, e-mail: blasegambinophd@aol.com
Contributors: Both authors contributed equally to this paper.
Competing interests: For GB, none declared. HL is one of the co-authors of the SOGS.
Ethical approval: None required.
Funding: Not applicable.
Blasé Gambino (PhD, experimental psychology, University of Massachusetts at Amherst) has studied addiction science and addiction practice since the publication of Theory and Practice in the Addictions (1979) with co-author Howard Shaffer. Among other publications, he was co-editor of Compulsive Gambling: Theory, Research and Practice (1989), to which he contributed a chapter on the development of prescriptive interventions through applying the principles of clinical epidemiology. He serves on the editorial review board of the Journal of Gambling Studies. He has contributed articles on mathematical models to eliminate bias in prevalence estimation research for single- and two-stage prevalence designs and articles on the epidemiology of pathological gambling and the evaluation of the outcomes of training programs in pathological gambling for employee assistance programs. His current interests are in the epidemiology of pathological gambling and the validation of alternative screening and diagnostic test instruments for pathological gamblers.
Henry R. Lesieur (PhD, sociology, University of Massachusetts, Amherst, in 1976, and PsyD in clinical psychology, Massachusetts School of Professional Psychology, in 2001, and postdoctorate studies at Brown University) is a staff psychologist at Rhode Island Hospital in Providence and a clinical psychologist in the Rhode Island Gambling Treatment Program. Dr. Lesieur is a member of the Board of Directors of the National Council on Problem Gambling and President of the Rhode Island Council on Problem Gambling, as well as being on the advisory board of other organizations. He and Sheila Blume, MD, are co-authors of the South Oaks Gambling Screen. Dr. Lesieur has run workshops and given numerous professional presentations on problem gambling and addictions. E-mail: Hlesieur@lifespan.org
A review of the literature reveals strong support for the construct validity of interpretations based on scores obtained with the original and more recent versions and/or variants of the South Oaks Gambling Screen (SOGS). Criticisms of the SOGS are shown to lack merit, to be offset by more important criteria, or to be no longer relevant. The evidence reviewed indicates that the construct of pathological gambling as represented by the SOGS and its variants provides a robust definition and implies that the SOGS meets the important criterion of validity generalization. The construct of chasing and behaviors related to chasing is shown to provide powerful measures by which to discriminate between the presence and absence of pathological gambling. The viability of the SOGS to continue to make important contributions to the understanding of pathological gambling is discussed in terms of the criteria for selecting a research instrument. Introduction
The South Oaks Gambling Screen (SOGS) (Lesieur & Blume, 1987) has been the subject of a number of critical reviews (e.g., Battersby, Thomas, Tolchard, & Esterman, 2002; Gerstein et al., 1999; Shaffer & Korn, 2002; Volberg, 1999; Walker & Dickerson, 1996), beginning with Culleton’s analysis of methods (1989). Closest casino to watonga ok. This has led to calls for replacement of the SOGS as the primary research instrument used in prevalence studies of the general population.
Although Lesieur (1994) and Gambino (1997) have provided responses to some of the issues, it is clear that a more detailed response is needed. Our goal is to demonstrate that the SOGS remains an important and viable choice among current alternatives by arguing the case that the major criticisms lack merit, are outweighed by other criteria, or are simply no longer relevant.
The SOGS is a 20-item instrument initially developed to screen clinical populations, for example, substance abusers, for the presence of pathological gambling. Responses to the 20 items are summed, and endorsement of 5 or more items is interpreted as evidence of the presence of pathological gambling. Criteria from the DSM-III and DSM-III-R were used in the development of the SOGS; the interested reader will find the original validation data in Lesieur and Blume (1987). The first use of the SOGS as a screen to detect pathological gambling in the general population was by Volberg and Steadman (1988). It is impossible in a short report to do justice to a review of the SOGS. We have therefore limited our response to what we believe are the most relevant and important issues. A more detailed report by the second author is available by request at hlesieur@lifespan.org. This includes an extensive list of references through early 2003 and a set of summary tables. In part, the criticisms leveled at the SOGS reflect the scarcity of systematic reviews and evaluation of the literature, i.e., meta-analysis. The references compiled by the second author should provide an excellent starting point for those investigators planning such analyses. A brief review
A wide selection of validation strategies have been employed to demonstrate the validity of the SOGS. These include the use of single-stage (e.g., Gambino, 1997; Poulin, 2002) and multiple-stage (e.g., Abbott & Volberg, 1996; Abbott, Williams, & Volberg, 1999; Gambino, 1999a) designs, a description of the mathematical models for evaluating the accuracy of estimates based on these designs (Gambino, 1997, 1999a), and methods for evaluating the precision and cost-efficiency of these designs (Gambino, 1999b). Other investigators have employed statistical modeling techniques for the purpose of validation, including factor analysis (e.g., Winters, Stinchfield, & Fulkerson, 1993), logistic regression (e.g., Poulin, 2002; Welte, Barnes, Wieczorek, Tidwell, & Parker, 2001), Rasch analysis (Strong, Lesieur, Breen, Stinchfield, & Lejuez, 2004), and stratification analysis (e.g., Tavares, Zilberman, Beites, & Gentil, 2001).
Evidence supporting the psychometric soundness of the SOGS, while less extensive than evidence that supports the validity of the many applications of the SOGS, continues to be accumulated (e.g., Abbot & Volberg, 1996; Lesieur & Blume, 1987; Stinchfield, 2002; Winters et al., 1993). These include measurement of internal validity (e.g., Stinchfield & Winters, 2001; Volberg, 2002; Welte et al., 2001), the use of concurrent validation strategies (e.g., Doiron & Nicki, 2001; Westphal & Johnson, 2000), postdictive or retrospective criterion validity (e.g., Gambino, Fitzgerald, Shaffer, Renner, & Courtnage, 1993; Ladouceur, Jacques, Giroux, Ferland, & Leblond, 2000), and the use of convergent and discriminant validation strategies (e.g., Lesieur & Blume, 1987; Stinchfield, 2002). Convergent validity as demonstrated by the correlation between the SOGS and its variants with the DSM, both earlier and current versions, is impressive in its consistency and ranges from moderate (e.g., Sproston, Erens, & Orford, 2000) to high (e.g., Welte et al., 2001). These correlations hold for both clinical (Stinchfield & Winters, 2001) and general (Stinchfield, 2002) population samples as well as comparisons among both adult and adolescent versions (e.g., Volberg, 1996, 1998).
Much of the criticism of the SOGS has its roots in the failure to recognize what qualify as statements of validity (Gambino, 2003a). For example, the proposed relationships between pathological gambling and frequency of gambling (e.g., Hing & Breen, 2001), duration of gambling (e.g., Wong, McAuslan, & Bray, 2000), distance to gambling (e.g., Gerstein et al., 1999), and expenditures on gambling (Cox, Kwong, Michaud, & Enns, 2000), are all statements of construct validity (Cronbach, 1988). Recent epidemiologic studies have provided additional support by employing the SOGS to measure the strength (relative risk) and magnitude (attributable risk) of the relation of pathological gambling to suspected indicators of enhanced risk such as age, adults versus adolescents; severity, clinical versus general populations (e.g., Shaffer, Hall, & Vanderbilt, 1997); and comorbidity, e.g., substance use disorders (e.g., Feigelman, Wallisch, & Lesieur, 1998).
Several investigators have used the SOGS to search for the putative causes of pathological gambling in terms of genetic (e.g., Walters, 2001) or neurobiological (e.g., Ibáñez, Blanco, de Castro, Fernandez-Piqueras, & Saiz-Ruiz, 2003) factors; track its natural history (e.g., Shaffer & Korn, 2002); and measure the progression from gambling onset to diagnosis of pathological gambling (e.g., Tavares et al., 2001). Others have employed the SOGS to examine the construct of pathological gambling from a theoretical perspective, e.g., the debate over whether to view pathological gambling as an obsessive-compulsive or addictive disorder (Frost, Meagher, & Riskind, 2001).
If pathological gambling lies on a continuum of severity (Shaffer & Korn, 2002), then strong support for the validity of the SOGS would be found by showing that predictions of pathological gambling, in terms of the likelihood that a specific score discriminates the pathological from the nonpathological gambler, should increase as scores on the SOGS increase. Evidence in support of the SOGS is presented in Table 1 employing the likelihood ratio (LR). The LR is a measure recommended by clinical epidemiologists for validating clinical indicators and instruments (Kraemer, 1992). LRs can be used to validate individual clinical indicators, diagnostic and screening tests, or a range of test scores. The interested reader will find more detailed descriptions elsewhere (Chu, 1999; Koch, Capurso, & Llewelyn, 1995; Kraemer, 1992; McGee, 2000; Sackett, Haynes, & Tugwell, 1991; Schmitz, Kruse, & Tress, 2000; Zhou, Obuchowski, & McClish, 2002).
The LR provides an empirical measure of the goodness of a test definition (or individual criterion) by defining the odds of finding a particular test result in those with versus those without the disorder. It is this difference of frequency of occurrence that is looked for when assessing the validity of a symptom, sign, or test result (Koch et al., 1995). It measures the degree of certainty with respect to the diagnosis being confirmed. Larger values for the LR are interpreted as indicative of greater certainty that the presumptive diagnosis is correct; i.e., one may have greater confidence in the diagnosis. Values of LR equal to one mean that the results have no diagnostic value, and values of LR less than one indicate that the disorder is less likely to be present.
The LR is defined as the true-positive rate (sensitivity) divided by the false-positive rate (1 − specificity). Estimates of sensitivity and specificity were obtained following well-established procedure (Zhou et al., 2002). Sensitivity was estimated by assuming that gamblers in treatment represent individuals known to have the disorder; specificity was estimated by assuming that gamblers from the general population represent individuals free of the disorder. These are surrogate definitions since there will be some probability that some gamblers in the general population will be false negatives and some probability that some gamblers in treatment will be false positives. The use of these two populations as surrogates is reasonable since the analysis assumes that these labels apply on average, and not in any individual case (Schlesselman, 1982). This form of validation is equivalent to correlating test items with the total score. The LR provides an empirical estimate of the power of an instrument, one or more items, or a range of scores to discriminate the pathological gambler from the nonpathological gambler. The LR is interpreted as a measure of the credibility of the instrument or item(s) in accounting for the empirical evidence (Clayton & Hills, 1996).
Table 1, based on a reanalysis of Stinchfield’s data (2002), provides evidence to support this view and demonstrates that the SOGS meets this strong criterion for validity as indicated by increasing estimates of the LR with increasing scores on the SOGS.
The evidence clearly demonstrates support for the validity of the SOGS as an instrument for research on both clinical and general population samples (e.g., Volberg, 1994), its usefulness in case finding in clinical (e.g., Petry & Armentano, 1999) and correctional settings (Walters, 1997), the identification and testing of hypotheses about the determinants of pathological gambling (e.g., Cox et al., 2000; Gambino et al., 1993), and its usefulness in evaluating treatment outcomes (e.g., Stinchfield & Winters, 2001) and tracking long-term changes in prevalence rates among adults (Volberg & Moore, 1999) and adolescents (Winters, Stinchfield, Botzet, & Anderson, 2002), among others.
In sum, the SOGS has been employed for a multitude of purposes, in a wide array of settings, with diverse populations and cultures, and has been translated into at least 36 languages for use on six continents (contact the second author for a list of SOGS translations). These studies have found consistent replicable relationships between pathological gambling, as measured by the original and revised versions of the SOGS; personal attributes across times, places, communities, and clinical settings; and comparison with other instruments. The consistency of these findings provides strong support for the construct validity of the SOGS (e.g., Beaudoin & Cox, 1999; Hodgins & el-Guebaly, 2000).
Our review of the evidence in support of the validity of the SOGS is not presented as an argument that efforts to develop alternatives are misguided. Indeed, the continuing appearance of studies designed to validate improved alternatives is to be encouraged and represents a welcome challenge (e.g., Cunningham-Williams & Cottler, 2001; Fisher, 2000; Gerstein et al., 1999; Smith & Wynne, 2002; Stinchfield, Govoni, & Frisch, 2001). Comparisons among alternative instruments will continue to help identify the strengths and weaknesses in contrasting and related views on how to define the construct of pathological gambling; it may be expected that the SOGS will continue to contribute to this important task. Criticisms of the SOGS
The initial evaluation. The criticism that the SOGS was validated on clinical samples, thus making invalid its application to the general population, was reasonable, but it should not have been implicitly accepted in the absence of support for or against the application’s validity. The apparent unquestioning acceptance of this criticism represents a failure to understand that it is not the test that is being validated, but inferences and conclusions based on test score interpretations (Rubin, 1988). This criticism has subsequently been shown to be unwarranted in view of the strong support for the construct validity of findings employing the SOGS and its variants in studies of the general population. More specifically, recent research has validated the SOGS with general population samples in a number of settings and cultures (e.g., Abbott & Volberg, 1996; Volberg, Abbott, Ronnberg & Munck, 2001; Stinchfield, 2002; Volberg & Vales, 1998
Items on the SOGS. An additional set of criticisms revolve around the specific items on the SOGS, particularly its emphasis on borrowing. Table 2 presents an analysis of the 20 SOGS items, based on the data reported by Stinchfield (2002), that rebuts this criticism. The primary measure employed in Table 2 is the LR described earlier. An interpretation of the LR has been provided by Jaeschke, Guyatt, and Sackett (1994). These investigators propose the following interpretive guidelines: greater than 10 (large, often conclusive), 5 to 10 (moderate), 2 to 5 (small but sometimes important), and 1 to 2 (small, rarely important). The data show clearly that exceptionally high LRs were obtained for all items.
Two findings are of special interest. First, chasing as defined in the Stinchfield (2002) study (Table 2) is a strong discriminant (LR = 57.1) for separating pathological and nonpathological gamblers. Second, the five most discriminative items and seven of the top ten were items assessing borrowing. In view of the importance of the concept of chasing as a major characteristic of the pathological gambler (Lesieur, 1984) and the obvious relationship between chasing and the need to obtain money to chase, the discriminato
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