{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T08:41:27Z","timestamp":1790671287522,"version":"4.1.0"},"reference-count":62,"publisher":"Akademiai Kiado Zrt.","issue":"2","license":[{"start":{"date-parts":[[2016,6,1]],"date-time":"2016-06-01T00:00:00Z","timestamp":1464739200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/3.0\/"}],"content-domain":{"domain":["akjournals.com"],"crossmark-restriction":true},"short-container-title":["J Behav Addict"],"published-print":{"date-parts":[[2016,6,27]]},"abstract":"<jats:sec sec-type=\"background and aims\">\n          <jats:title>Background and aims<\/jats:title>\n          <jats:p>Pathological gambling is associated with comorbid disorders, such as anxiety, depression, and drug and alcohol abuse. Difficulties of emotion regulation may be one of the factors related to the presence of addictive disorders, along with comorbid symptomatology in pathological gamblers. Therefore, the aim of this study was to evaluate the difficulties of emotion regulation, drug and alcohol abuse, and anxious and depressive symptomatology in pathological gamblers, and the mediating role of difficulties of emotion regulation between anxiety and pathological gambling.<\/jats:p>\n        <\/jats:sec>\n        <jats:sec sec-type=\"methods\">\n          <jats:title>Methods<\/jats:title>\n          <jats:p>The study sample included 167 male pathological gamblers (mean age\u2009=\u200939.29 years) and 107 non-gamblers (mean age\u2009=\u200933.43 years). Pathological gambling (SOGS), difficulties of emotion regulation (DERS), drug and alcohol abuse (MUTICAGE CAD-4), and anxious and depressive symptomatology (SA-45) were measured. Student\u2019s <jats:italic>t<\/jats:italic>, Pearson\u2019s <jats:italic>r<\/jats:italic>, stepwise multiple linear regression and multiple mediation analyses were conducted. The study was approved by an Investigational Review Board.<\/jats:p>\n        <\/jats:sec>\n        <jats:sec sec-type=\"results\">\n          <jats:title>Results<\/jats:title>\n          <jats:p>Relative to non-gamblers, pathological gamblers exhibited greater difficulties of emotion regulation, as well as more anxiety, depression, and drug abuse. Moreover, pathological gambling correlated with emotion regulation difficulties, anxiety, depression, and drug abuse. Besides, emotion regulation difficulties correlated with and predicted pathological gambling, drug and alcohol abuse, and anxious and depressive symptomatology. Finally, emotion regulation difficulties mediated the relationship between anxiety and pathological gambling controlling the effect of age, both when controlling and not controlling for the effect of other abuses.<\/jats:p>\n        <\/jats:sec>\n        <jats:sec sec-type=\"discussion and conclusions\">\n          <jats:title>Discussion and conclusions<\/jats:title>\n          <jats:p>These results suggest that difficulties of emotion regulation may provide new keys to understanding and treating pathological gambling and comorbid disorders.<\/jats:p>\n        <\/jats:sec>","DOI":"10.1556\/2006.5.2016.038","type":"journal-article","created":{"date-parts":[[2016,6,27]],"date-time":"2016-06-27T12:35:17Z","timestamp":1467030917000},"page":"251-260","update-policy":"https:\/\/doi.org\/10.1556\/policypage.crossmark.crossref.2","source":"Crossref","is-referenced-by-count":82,"title":["Pathological Gambling and Associated Drug and Alcohol Abuse, Emotion Regulation, and Anxious-Depressive Symptomatology"],"prefix":"10.1556","volume":"5","author":[{"given":"Paula","family":"Jauregui","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"Est\u00e9vez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irache","family":"Urbiola","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"425","reference":[{"issue":"2","key":"B1","series-title":"Clinical Psychology Review,","first-page":"217","article-title":"Emotion-regulation strategies across psychopathology: A meta-analytic review","volume":"30","author":"Aldao, A.","year":"2010","unstructured":"Aldao, A.\n            , \n            \n              Nolen-Hoeksema, S.\n            , & \n            \n              Schweizer, S.\n           (2010). Emotion-regulation strategies across psychopathology: A meta-analytic review. Clinical Psychology Review,30(2), 217\u2013237. doi:10.1016\/j.cpr.2009.11.004"},{"issue":"1","key":"B2","series-title":"The American Journal of Drug and Alcohol Abuse,","first-page":"37","article-title":"Emotion regulation and substance use frequency in women with substance dependence and borderline personality disorder receiving dialectical behavior therapy","volume":"37","author":"Axelrod, S.\u00a0R.","year":"2011","unstructured":"Axelrod, S.\u00a0R.\n            , \n            \n              Perepletchikova, F.\n            , \n            \n              Holtzman, K.\n            , & \n            \n              Sinha, R.\n           (2011). Emotion regulation and substance use frequency in women with substance dependence and borderline personality disorder receiving dialectical behavior therapy. The American Journal of Drug and Alcohol Abuse,37(1), 37\u201342. doi:10.3109\/00952990.20.10.535582"},{"issue":"1","key":"B3","series-title":"International Gambling Studies,","first-page":"55","article-title":"Gambling and substance use: Co-occurrence among adults in a recent general population study in the United States","volume":"15","author":"Barnes, G.\u00a0M.","year":"2015","unstructured":"Barnes, G.\u00a0M.\n            , \n            \n              Welte, J.\u00a0W.\n            , \n            \n              Tidwell, M.\u00a0C.\u00a0O.\n            , & \n            \n              Hoffman, J.\u00a0H.\n           (2015). Gambling and substance use: Co-occurrence among adults in a recent general population study in the United States. International Gambling Studies,15(1), 55\u201371. doi:10.1080\/14459795.2014.990396"},{"issue":"5","key":"B4","series-title":"Addiction,","first-page":"487","article-title":"A pathways model of problem and pathological gambling","volume":"97","author":"Blaszczynski, A.","year":"2002","unstructured":"Blaszczynski, A.\n            , & \n            \n              Nower, L.\n           (2002). A pathways model of problem and pathological gambling. Addiction,97(5), 487\u2013499. doi:10.1046\/j.1360-0443.2002.00015.x"},{"key":"B5","series-title":"Affect regulation and the development of psychopathology","author":"Bradley, S.","year":"2000","unstructured":"Bradley, S.\n           (2000). Affect regulation and the development of psychopathology. New York, NY: Guilford Press."},{"issue":"5","key":"B6","series-title":"Computers in Human Behavior,","first-page":"1089","article-title":"Theory and measurement of generalized problematic Internet use: A two-step approach","volume":"26","author":"Caplan, S.\u00a0E.","year":"2010","unstructured":"Caplan, S.\u00a0E.\n           (2010). Theory and measurement of generalized problematic Internet use: A two-step approach. Computers in Human Behavior,26(5), 1089\u20131097. doi:10.1016\/j.chb.2010.03.012."},{"issue":"1","key":"B7","series-title":"Psychological Bulletin,","first-page":"155","article-title":"A power primer","volume":"112","author":"Cohen, J.","year":"1992","unstructured":"Cohen, J.\n           (1992). A power primer. Psychological Bulletin,112(1), 155\u2013159. doi:10.1037\/0033-2909.112.1.155"},{"issue":"3","key":"B8","series-title":"Psychology of Addictive Behaviors,","first-page":"237","article-title":"Life stress, physiological and subjective indexes of negative emotionality, and coping reasons for drinking: Is there evidence for a self-medication model of alcohol use?","volume":"15","author":"Colder, C.\u00a0R.","year":"2001","unstructured":"Colder, C.\u00a0R.\n           (2001). Life stress, physiological and subjective indexes of negative emotionality, and coping reasons for drinking: Is there evidence for a self-medication model of alcohol use?Psychology of Addictive Behaviors,15(3), 237\u2013245. doi:10.1037\/0893-164X.15.3.237"},{"issue":"5","key":"B9","series-title":"Journal of Personality and Social Psychology,","first-page":"990","article-title":"Drinking to regulate positive and negative emotions: A motivational model of alcohol use","volume":"69","author":"Cooper, M.\u00a0L.","year":"1995","unstructured":"Cooper, M.\u00a0L.\n            , \n            \n              Frone, M.\u00a0R.\n            , \n            \n              Russell, M.\n            , & \n            \n              Mudar, P.\n           (1995). Drinking to regulate positive and negative emotions: A motivational model of alcohol use. Journal of Personality and Social Psychology,69(5), 990\u20131005. doi:10.1037\/0022-3514.69.5.990"},{"key":"B10","series-title":"Why people drink","first-page":"291","article-title":"Incentive motivation, affective change, and alcohol use: A model","author":"Cox, W.\u00a0M.","year":"1990","unstructured":"Cox, W.\u00a0M.\n            , & \n            \n              Klinger, E.\n           (1990). Incentive motivation, affective change, and alcohol use: A model. In W.\u00a0M.Cox (Ed.), Why people drink (pp. 291\u2013311). New York, NY: Gardner Press."},{"issue":"3","key":"B11","series-title":"Assessment,","first-page":"259","article-title":"Development of a brief, multidimensional, self-report instrument for treatment outcomes assessment in psychiatric settings: Preliminary findings","volume":"4","author":"Davison, M.\u00a0K.","year":"1997","unstructured":"Davison, M.\u00a0K.\n            , \n            \n              Bershadsky, B.\n            , \n            \n              Beiber, J.\n            , \n            \n              Silversmith, D.\n            , \n            \n              Maruish, M.\u00a0E.\n            , & \n            \n              Kane, R.\u00a0L.\n           (1997). Development of a brief, multidimensional, self-report instrument for treatment outcomes assessment in psychiatric settings: Preliminary findings. Assessment,4(3), 259\u2013276. doi:10.1177\/107319119700400306"},{"key":"B12","series-title":"SCL-90-R. Cuestionario de 90 \u00edtems [SCL-90-5. 90 items questionnaire]","author":"Derogatis, L.\u00a0R.","year":"2002","unstructured":"Derogatis, L.\u00a0R.\n           (2002). SCL-90-R. Cuestionario de 90 \u00edtems [SCL-90-5. 90 items questionnaire]. Madrid: TEA Ediciones."},{"key":"B13","series-title":"An\u00e1lisis y Modificaci\u00f3n de Conducta,","first-page":"769","article-title":"El Cuestionario de Juego de South Oaks (SOGS): Validaci\u00f3n espa\u00f1ola [South Oaks Gambling Screen (SOGS): Spanish validation]","volume":"20,","author":"Echebur\u00faa, E.","year":"1994","unstructured":"Echebur\u00faa, E.\n            , \n            \n              B\u00e1ez, C.\n            , \n            \n              Fern\u00e1ndez-Montalvo, J.\n            , & \n            \n              P\u00e1ez, D.\n           (1994). El Cuestionario de Juego de South Oaks (SOGS): Validaci\u00f3n espa\u00f1ola [South Oaks Gambling Screen (SOGS): Spanish validation]. 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Journal of Gambling Studies,22(3), 275\u2013287. doi:10.1007\/s10899-006-9016-6."},{"issue":"2","key":"B15","series-title":"Drug and Alcohol Dependence,","first-page":"298","article-title":"Difficulties in emotion regulation and impulse control during cocaine abstinence","volume":"89","author":"Fox, H.\u00a0C.","year":"2007","unstructured":"Fox, H.\u00a0C.\n            , \n            \n              Axelrod, S.\u00a0R.\n            , \n            \n              Paliwal, P.\n            , \n            \n              Sleeper, J.\n            , & \n            \n              Sinha, R.\n           (2007). Difficulties in emotion regulation and impulse control during cocaine abstinence. 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Addictive Behaviors,33(2), 388\u2013394. doi:10.1016\/j.addbeh.2007.10.002."},{"issue":"1","key":"B17","series-title":"Journal of Psychopathology and Behavioral Assessment,","first-page":"41","article-title":"Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the Difficulties in Emotion Regulation Scale","volume":"26","author":"Gratz, K.\u00a0L.","year":"2004","unstructured":"Gratz, K.\u00a0L.\n            , & \n            \n              Roemer, L.\n           (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the Difficulties in Emotion Regulation Scale. Journal of Psychopathology and Behavioral Assessment,26(1), 41\u201354. doi:10.1023\/B:JOBA.0000007455.08539.94"},{"issue":"1","key":"B18","series-title":"International Journal of Mental Health and Addiction,","first-page":"1","article-title":"Internet gambling, health, smoking and alcohol use: Findings from the 2007 British Gambling Prevalence Survey","volume":"9","author":"Griffiths, M.","year":"2011","unstructured":"Griffiths, M.\n            , \n            \n              Wardle, H.\n            , \n            \n              Orford, J.\n            , \n            \n              Sproston, K.\n            , & \n            \n              Erens, B.\n           (2011). Internet gambling, health, smoking and alcohol use: Findings from the 2007 British Gambling Prevalence Survey. International Journal of Mental Health and Addiction,9(1), 1\u201311. doi:10.1007\/s11469-009-9246-9"},{"key":"B19","series-title":"Handbook of emotion regulation","author":"Gross, J.\u00a0J.","year":"2013","unstructured":"Gross, J.\u00a0J.\n           (2013). Handbook of emotion regulation. New York, NY: Guilford Press."},{"issue":"3","key":"B20","series-title":"Clinical Psychology: Science and Practice,","first-page":"255","article-title":"Clarifying the construct of mindfulness in the context of emotion regulation and the process of change in therapy","volume":"11","author":"Hayes, A.\u00a0M.","year":"2004","unstructured":"Hayes, A.\u00a0M.\n            , & \n            \n              Feldman, G.\n           (2004). Clarifying the construct of mindfulness in the context of emotion regulation and the process of change in therapy. Clinical Psychology: Science and Practice,11(3), 255\u2013262. doi:10.1093\/clipsy.bph080"},{"issue":"4","key":"B21","series-title":"Adicciones,","first-page":"282","article-title":"El papel mediador de la regulaci\u00f3n emocional entre el juego patol\u00f3gico, uso abusivo de Internet y videojuegos y la sintomatolog\u00eda disfuncional en j\u00f3venes y adolescentes [Mediating role of emotional regulation between impulsive behavior in gambling, Internet and videogame abuse, and dysfunctional symptomatology in young adults and adolescents]","volume":"26","author":"Est\u00e9vez, A.","year":"2014","unstructured":"Est\u00e9vez, A.\n            , \n            \n              Herrero-Fern\u00e1ndez, D.\n            , \n            \n              Sarabia, I.\n            , & \n            \n              Jauregui, P.\n           (2014). El papel mediador de la regulaci\u00f3n emocional entre el juego patol\u00f3gico, uso abusivo de Internet y videojuegos y la sintomatolog\u00eda disfuncional en j\u00f3venes y adolescentes [Mediating role of emotional regulation between impulsive behavior in gambling, Internet and videogame abuse, and dysfunctional symptomatology in young adults and adolescents]. Adicciones,26(4), 282\u2013290. doi:10.20882\/adicciones.26"},{"issue":"2","key":"B22","series-title":"Cl\u00ednica y Salud,","first-page":"139","article-title":"Adaptaci\u00f3n al castellano de la Escala de Dificultades en la Regulaci\u00f3n Emocional [Adaptation into Spanish of the Difficulties of Emotion Regulation Scale]","volume":"19","author":"Herv\u00e1s, G.","year":"2008","unstructured":"Herv\u00e1s, G.\n            , & \n            \n              J\u00f3dar, R.\n           (2008). Adaptaci\u00f3n al castellano de la Escala de Dificultades en la Regulaci\u00f3n Emocional [Adaptation into Spanish of the Difficulties of Emotion Regulation Scale]. Cl\u00ednica y Salud,19(2), 139\u2013156."},{"issue":"5","key":"B23","series-title":"Depression and Anxiety,","first-page":"409","article-title":"Emotion dysregulation model of mood and anxiety disorders","volume":"29","author":"Hofmann, S.\u00a0G.","year":"2012","unstructured":"Hofmann, S.\u00a0G.\n            , \n            \n              Sawyer, A.\u00a0T.\n            , \n            \n              Fang, A.\n            , & \n            \n              Asnaani, A.\n           (2012). Emotion dysregulation model of mood and anxiety disorders. Depression and Anxiety,29(5), 409\u2013416. doi:10.1002\/da.21888"},{"issue":"12","key":"B24","series-title":"Addictive Behaviors,","first-page":"1144","article-title":"Anxiety sensitivity, distress tolerance, and discomfort intolerance in relation to coping and conformity motives for alcohol use and alcohol use problems among young adult drinkers","volume":"35","author":"Howell, A.\u00a0N.","year":"2010","unstructured":"Howell, A.\u00a0N.\n            , \n            \n              Leyro, T.\u00a0M.\n            , \n            \n              Hogan, J.\n            , \n            \n              Buckner, J.\u00a0D.\n            , & \n            \n              Zvolensky, M.\u00a0J.\n           (2010). Anxiety sensitivity, distress tolerance, and discomfort intolerance in relation to coping and conformity motives for alcohol use and alcohol use problems among young adult drinkers. 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Addictive Behaviors,38(3), 1852\u20131858. doi:10.1016\/j.addbeh.2012.11.002"},{"key":"B26","series-title":"Problem behavior and psychosocial development: A longitudinal study of youth","author":"Jessor, R.","year":"1977","unstructured":"Jessor, R.\n            , & \n            \n              Jessor, S.\u00a0L.\n           (1977). Problem behavior and psychosocial development: A longitudinal study of youth. New York, NY: Academic."},{"issue":"11","key":"B27","series-title":"American Journal of Psychiatry,","first-page":"1259","article-title":"The self-medication hypothesis of addictive disorders: Focus on heroin and cocaine dependence","volume":"142","author":"Khantzian, E.\u00a0J.","year":"1985","unstructured":"Khantzian, E.\u00a0J.\n           (1985). The self-medication hypothesis of addictive disorders: Focus on heroin and cocaine dependence. 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Experimentaland Clinical Psychopharmacology,11(3), 202\u2013209. doi:10.1037\/1064-1297.11.3.202"},{"issue":"9","key":"B31","series-title":"American Journal of Psychiatry,","first-page":"1184","article-title":"The South Oaks Gambling Screen (SOGS): A new instrument for the identification of pathological gamblers","volume":"144","author":"Lesieur, H.\u00a0R.","year":"1987","unstructured":"Lesieur, H.\u00a0R.\n            , & \n            \n              Blume, S.\u00a0B.\n           (1987). The South Oaks Gambling Screen (SOGS): A new instrument for the identification of pathological gamblers. American Journal of Psychiatry,144(9), 1184\u20131188. doi:10.1176\/ajp.144.9.1184"},{"issue":"6","key":"B32","series-title":"Journal of American College Health,","first-page":"443","article-title":"Exploring the relationship between experiential avoidance, alcohol use disorders, and alcohol-related problems among first-year college students","volume":"60","author":"Levin, M.\u00a0E.","year":"2012","unstructured":"Levin, M.\u00a0E.\n            , \n            \n              Lillis, J.\n            , \n            \n              Seeley, J.\n            , \n            \n              Hayes, S.\u00a0C.\n            , \n            \n              Pistorello, J.\n            , & \n            \n              Biglan, A.\n           (2012). Exploring the relationship between experiential avoidance, alcohol use disorders, and alcohol-related problems among first-year college students. Journal of American College Health,60(6), 443\u2013448. doi:10.1080\/07448481.2012.673522"},{"issue":"3","key":"B33","series-title":"Addiction,","first-page":"490","article-title":"Prevalence of comorbid disorders in problem and pathological gambling: Systematic review and meta\u2010analysis of population surveys","volume":"106","author":"Lorains, F.\u00a0K.","year":"2011","unstructured":"Lorains, F.\u00a0K.\n            , \n            \n              Cowlishaw, S.\n            , & \n            \n              Thomas, S.\u00a0A.\n           (2011). Prevalence of comorbid disorders in problem and pathological gambling: Systematic review and meta\u2010analysis of population surveys. Addiction,106(3), 490\u2013498. doi:10.1111\/j.1360-0443.2010.03300.x"},{"issue":"1","key":"B34","series-title":"International Journal of Clinical Health & Psychology,","first-page":"141","article-title":"La Terapia de Aceptaci\u00f3n y compromiso (ACT) en el consumo de sustancias como estrategia de Evitaci\u00f3n Experiencial. [Acceptance and Commitment Therapy in substance consumption as a strategy of Experiential Avoidance]","volume":"10","author":"Luciano, C.","year":"2010","unstructured":"Luciano, C.\n            , \n            \n              P\u00e1ez-Blarrina, M.\n            , & \n            \n              Valdivia-Salas, S.\n           (2010). La Terapia de Aceptaci\u00f3n y compromiso (ACT) en el consumo de sustancias como estrategia de Evitaci\u00f3n Experiencial. [Acceptance and Commitment Therapy in substance consumption as a strategy of Experiential Avoidance]. International Journal of Clinical Health & Psychology,10(1), 141\u2013165."},{"issue":"4","key":"B35","series-title":"Journal of Clinical Psychology,","first-page":"459","article-title":"Mechanisms of change in dialectical behavior therapy: Theoretical and empirical observations","volume":"62","author":"Lynch, T.\u00a0R.","year":"2006","unstructured":"Lynch, T.\u00a0R.\n            , \n            \n              Chapman, A.\u00a0L.\n            , \n            \n              Rosenthal, M.\u00a0Z.\n            , \n            \n              Kuo, J.\u00a0R.\n            , & \n            \n              Linehan, M.\u00a0M.\n           (2006). Mechanisms of change in dialectical behavior therapy: Theoretical and empirical observations. Journal of Clinical Psychology,62(4), 459\u2013480. doi:10.1002\/jclp.20243"},{"issue":"12","key":"B36","series-title":"Child Abuse & Neglect,","first-page":"967","article-title":"Emotion dysregulation and risky sexual behavior in revictimization","volume":"34","author":"Messman-Moore, T.\u00a0L.","year":"2010","unstructured":"Messman-Moore, T.\u00a0L.\n            , \n            \n              Walsh, K.\u00a0L.\n            , & \n            \n              DiLillo, D.\n           (2010). Emotion dysregulation and risky sexual behavior in revictimization. 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Journal of Psychiatric Practice,20(3), 207\u2013219. doi:10.1097\/01.pra.0000450320.98988.7c"},{"issue":"4","key":"B38","series-title":"Trastornos Adictivos,","first-page":"269","article-title":"Validaci\u00f3n de un instrumento para la detecci\u00f3n de trastornos del control de impulsos y adicciones: el MULTICAGE CAD-4[Validation of a tool for screening of impulse control disorders and addiction: The MULTICAGE CAD-4]","volume":"9","author":"Pedrero P\u00e9rez, E.\u00a0J.","year":"2007","unstructured":"Pedrero P\u00e9rez, E.\u00a0J.\n            , \n            \n              Rodr\u00edguez Monje, M.\u00a0T.\n            , \n            \n              Gallardo Alonso, F.\n            , \n            \n              Fern\u00e1ndez Gir\u00f3n, M.\n            , \n            \n              P\u00e9rez L\u00f3pez, M.\n            , & \n            \n              Chicharro Romero, J.\n           (2007). 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Journal of Gambling Studies,17(3), 217\u2013245. doi:10.1023\/A:1012268322509"},{"issue":"1","key":"B55","series-title":"Journal of Personality and Social Psychology,","first-page":"53","article-title":"Emotional distress regulation takes precedence over impulse control: If you feel bad, do it!","volume":"80","author":"Tice, D.\u00a0M.","year":"2001","unstructured":"Tice, D.\u00a0M.\n            , \n            \n              Bratslavsky, E.\n            , & \n            \n              Baumeister, R.\u00a0F.\n           (2001). 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