Short communicationGambling problems in treatment for affective disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)
Introduction
The terms ‘pathological gambling’ or ‘gambling disorder’ describe psychiatric conditions in the ICD-10 (World Health Organization, 1992) and DSM-5 (American Psychiatric Association, 2013), respectively, which are characterised by persistent and recurrent maladaptive gambling that precedes gambling-related harms (e.g., severe debt, relationship breakdown). The term ‘problem gambling’ is often used to describe a broader spectrum of difficulties that are defined by occurrences of gambling-related harms, and these range from moderate problems to severe harms (Delfabbro, 2013). The latter terminology is aligned with a public health framework (Korn et al., 1999) that recognises additional impacts of gambling at lower levels of severity, which are commonly described in terms of ‘at-risk’ gambling (Toce-Gerstein et al., 2003). Such problems co-occur frequently with other Axis I conditions, the most common of which are substance use, mood and anxiety disorders (reported by around 58%, 38% and 37% of problem gamblers, respectively) (Lorains et al., 2011). Although rates of gambling problems among individuals suffering other primary disorders are generally lower, there are studies showing non-trivial levels (>10%) of moderate to severe problems in patients seeking treatment for various psychiatric conditions, including psychotic (Haydock et al., 2015) and posttraumatic stress (Biddle et al., 2005) disorders. These include treatment for substance use problems, where studies indicate around 23% of patients that report difficulties across the spectrum of problem gambling (Cowlishaw et al., 2014). Within such contexts, these co-occurring issues are associated with psychosocial harms (e.g., relationship breakdown) (Cowlishaw et al., 2015) that highlight implications for treatment and prognosis of the primary presenting problem.
Data from patients in treatment for affective disorders also indicates high levels of comorbid conditions (Brown et al., 2001), including obsessive-compulsive and substance-related disorders (Rush et al., 2005). However, there has been limited recognition of gambling problems in treatment for affective disorders, with only two relevant studies available (Quilty et al., 2011, Kennedy et al., 2010). These recruited patients (n=275 (Quilty et al., 2011) and n=579 (Kennedy et al., 2010)) from selected treatment services (k=1 (Quilty et al., 2011) and k=6 (Kennedy et al., 2010)) in Canada and the US. They indicated rates of gambling problems among patients with depression that range from 5 to 13%, with variablity observed across studies, measurement scales, and levels of problem severity. Comparable estimates in bipolar disorder extend from 3 to 12% (Quilty et al., 2011, Kennedy et al., 2010). These studies indicate associations with clinical outcomes including severity of mood disorders and suicide risk. Such findings, however, should be interpreted cautiously given the limited number of studies and their limitations. The latter include a tendency to derive data from small numbers of services that do not generalise across regions or settings, and consideration of limited correlates. There are no relevant studies that have examined treatment for anxiety disorders (apart from one study of posttraumatic stress disorders) (Biddle et al., 2005). In this context, the purpose of this short communiction is to describe an evaluation of prevalence and clinical correlates of gambling problems in a nationally representative sample reporting treatment for a range of affective disorders. This was derived from the U. S. National Epidemiologic Survey of Alcohol and Related Conditions (NESARC) (Grant et al., 2004).
Section snippets
Sample
The NESARC is a representative survey of U. S. adults (≥18 years) in non-institutionalised settings, which was conducted in 2001–02. The study was based on a multi-stage stratified sampling design, with Census primary sampling units (PSUs; stratified by socio-demographics), households, and individuals sampled in succession. Black and Hispanic households were oversampled. One person from each household (or ‘group living’ arrangement) was randomly selected, with respondents aged 18–24 years
Results
Table 1 provides weighted estimates of lifetime and past-year gambling problems. In treatment for any affective disorder, the estimated rates of lifetime and past-year problem gambling (3+ symptoms) were 3.1% (95% CI=2.4–4.0%) and 1.4% (95% CI=0.9–2.1%), respectively. Across disorders, the rates of lifetime problem gambling ranged from 3.1% (depression: 95% CI=2.3–4.3%) to 5.4% (social phobia: 95% CI=3.2–9.0%), with past-year disorders ranging from 0.9% (dysthymia: 95% CI=0.4–2.1%) to 2.4%
Discussion
In a representative sample reporting past-year treatment for affective disorders, the results indicated that around 3.1% of respondents reported lifetime problem gambling, and around 1.4% demonstrated a comparable condition in the past year. These estimates are towards the lower end of comparable figures from two prior studies of smaller samples of patients in treatment services (Quilty et al., 2011, Kennedy et al., 2010), but are elevated relative to the general population (the rate of
Role of the funding source
None of the funding sources listed below had any role in the design, analysis or interpretation of the data, writing of the report, or decision to submit the article for publication.
Authors’ contributions
SC was primarily responsible for all stages of this paper. JH contributed to the design and interpretation of the findings, and conducted the analyses. ND contributed to writing of the paper.
Conflict of interests
The authors report no conflicts of interest.
Acknowledgements
SC receives salary support from the University of Bristol (UK). JH receives salary support from the U. S. Census Bureau. ND receives salary support from Deakin University (Australia). There were no other funding sources for this research. The opinions expressed are those of the authors and do not necessarily reflect those of the U.S. Census Bureau or the NIAAA.
References (20)
- et al.
Pathological and problem gambling in substance use treatment: a systematic review and meta-analysis
J. Subst. Abus. Treat.
(2014) - et al.
The Alcohol Use Disorder and Associated Disabilities Interview Schedule-IV (AUDADIS-IV): reliability of alcohol consumption, tobacco use, family history of depression and psychiatric diagnostic modules in a general population sample
Drug Alcohol Depend.
(2003) - et al.
Prevalence and correlates of problem gambling in people with psychotic disorders
Compr. Psychiatry
(2015) - et al.
Comorbid psychiatric disorders in depressed outpatients: demographic and clinical features
J. Affect. Disord.
(2005) The Diagnostic and Statistical Manual of Mental Disorders
(2013)- et al.
Screening, Brief Intervention, and Referral to Treatment (SBIRT): toward a public health approach to the management of substance abuse
Subst. Abus
(2007) - et al.
Problem gambling in Australian PTSD treatment-seeking veterans
J. Trauma Stress
(2005) - et al.
Current and lifetime comorbidity of the DSM-IV anxiety and mood disorders in a large clinical sample
J. Abnorm Psychol.
(2001) - et al.
Pathological and problem gambling in substance use treatment: Results from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)
Am. J. Addict.
(2015) Problem and pathological gambling: a conceptual review
J. Gambl. Bus. Econ.
(2013)
Cited by (23)
A ghost in the machine? The predictive role of metacognitive beliefs, cognitive biases, and machine-related features in the severity of problematic slot machine gambling
2021, Personality and Individual DifferencesCitation Excerpt :For many people, gambling represents a harmless recreational activity. But for a relevant subgroup, it becomes addictive, resulting in psychological, financial, and social impairment (Cowlishaw, Hakes, & Dowling, 2016; Gainsbury et al., 2014). With the advent of slot machines, the prevalence of gambling-related disorders has increased, and there is broad consensus among experts that slot machine gambling is especially addictive (Binde, Romild, & Volberg, 2017; Derevensky & Gilbeau, 2019; Hodgins et al., 2012; Scalese et al., 2016).
Gambling problems among military personnel after deployment
2020, Journal of Psychiatric ResearchCitation Excerpt :Furthermore, PG was associated with a near 7-fold increase in harmful drinking, a 5-fold increase in high psychological distress, and an almost 3-fold increase in fair to poor QOL. Such findings are consistent with literature indicating common co-occurrence of gambling with other mental health and substance use problems (Cowlishaw et al., 2014, 2016a; Lorains et al., 2011), which may be explained in various ways. For example, gambling comorbidity may reflect shared vulnerabilities, including genetic factors (Slutske et al., 2013).
Prevalence and implications of gambling problems among firefighters
2020, Addictive BehaviorsCitation Excerpt :These implications were inferred from bivariate associations and cross-sectional data, and may thus reflect different processes including unidirectional or bidirectional effects, mediation and confounding. However, the findings are consistent with literature indicating common co-occurrence of gambling problems with other mental health and substance use problems (Cowlishaw et al., 2016; Cowlishaw, 2014; Lorains et al., 2011), which may be explained in various ways including shared underlying vulnerabilities, as well as potential impacts of gambling on wellbeing. Alternatively, such findings may also reflect the usage of gambling in order to regulate distress or mood states associated with mental disorders, which is consistent with notions of self-medication (Frone, 2016) or gambling to escape (Thomas et al., 2009).
The diagnostic accuracy of brief screening instruments for problem gambling: A systematic review and meta-analysis
2019, Clinical Psychology ReviewCitation Excerpt :Individuals with problem gambling also present to other services, such as family violence (2.2%) and financial counselling services (10.6%; Dowling et al., 2014). The presence of problem gambling complicates the clinical profile of patients with mental health disorders as it is associated with more severe psychiatric symptoms, alcohol and drug use problems, interpersonal and financial problems, poorer physical health and social functioning, cognitive impairment, impulsivity, suicidality, and personality disorder pathology (Biddle, Hawthorne, Forbes, & Coman, 2005; Cowlishaw et al., 2016; Di Nicola et al., 2010; Haydock et al., 2015; Henderson, 2004; Jones et al., 2015; Kennedy et al., 2010; Manning et al., 2017; McIntyre et al., 2007; Zimmerman, Chelminski, & Young, 2006). Moreover, the findings of age of onset studies using retrospective methodologies suggest that at least one other psychiatric disorder typically occurs after the development of problem gambling in approximately one-quarter of cases (Hodgins, Peden, & Cassidy, 2005; Kessler et al., 2008).
“I was Treated by the Program, the Therapist, and Myself”: Feasibility of an Internet-Based Treatment Program for Gambling Disorder
2023, Journal of Gambling StudiesRisk Factors for Gambling Disorder: A Systematic Review
2023, Journal of Gambling Studies