Exploring the associations between gambling cravings, self-efficacy, and gambling episodes: An Ecological Momentary Assessment study

Aims:To explore reciprocal relationships between real-time gambling cravings and self-efficacy with gamblingbehaviour, and the moderating role of gambling, mental health, and addiction-related variables.Design:Secondary analysis of a 4-week Ecological Momentary Assessment (EMA) study conducted in Tasmania,Australia.Setting:Data were collected via telephone interviews (pre-EMA) and smartphones (EMA).Participants:Ninety-seven regular gamblers (mean age: 45.90 years, 57.73% male) reported 5,113 observations.Measurements:EMA measures included gambling cravings (occurrence, frequency, intensity), self-efficacy(craving-related, gambling-related), and gambling behaviour (episodes, expenditure, duration). Pre-EMA mea-sures included gambling (severity; harms; motives; high-risk situations), mental health (depressive symptoms;anxiety symptoms) and addiction-related (alcohol use; smoking; substance use) moderator variables.Findings:Mixed-effects binary logistic regression analyses revealed that gambling cravings predicted gamblingepisodes (OR = 2.23, 95% CI:1.61, 3.08), gambling self-efficacy and gambling duration were reciprocally re-lated (OR = 4.65, 95% CI:1.08, 20.04; OR = 0.21, 95% CI:0.05, 0.93), and craving self-efficacy predictedgambling expenditure (OR = 0.30, 95% CI:0.10, 0.86). Moderation analyses revealed that: (1) craving self-efficacy exacerbated craving frequency with gambling expenditure; (2) coping motives exacerbated gamblingself-efficacy with gambling expenditure; (3) high-risk positive reinforcement situations exacerbated cravingintensity and gambling self-efficacy with gambling episodes, and gambling episode with craving occurrence; and(4) substance use exacerbated gambling self-efficacy with duration, and buffered gambling expenditure withcraving intensity.Conclusions:Thesefindings have implications for the development of real-time gambling interventions that aimto reduce gambling cravings and increase self-efficacy, which could be targeted to vulnerable individuals, in-cluding people who frequently gambled for coping purposes or positive reinforcement, and people with co-morbid substance use.