Gender differences in the relationship between gambling problems and the incidence of substance-use disorders in a nationally representative population sample

High stakes: Associations between substance use and gambling behaviors by race in the United States

BACKGROUND AND AIMS

This study examined how substance use patterns influence gambling behaviors across racial/ethnic groups, amid expanding legalization of both substances and gambling in the US.

METHODS

A nationally representative survey of 6543 US adults was conducted from December 2023 to January 2024. Participants reported on alcohol, cannabis, opioid, and stimulant use, along with gambling activities. Multivariate logistic regression models analyzed substance-gambling associations, incorporating race-substance use interaction terms and demographic controls.

RESULTS

Substance use showed robust associations with gambling behaviors, with stimulant use demonstrating the strongest relationships (online gambling OR=4.694, 95 % CI: 1.876-11.745; casino gaming OR=3.055, 95 % CI: 1.318-7.084). These associations varied markedly by race/ethnicity: Hispanic adults showed the strongest substance-gambling patterns, with cannabis use associated with substantial increases in online gambling (22.6 %, p =0.003), casino table games (19.1 %, p =0.037), and machine gaming (19.2 %, p =0.044). Non-Hispanic Black adults demonstrated high baseline gambling odds independent of substance use but showed specific cannabis-sports gambling associations (15.0 %, p =0.011). Non-Hispanic White adults exhibited moderate substance-associated increases, particularly in online gambling (6.7 %, p =0.001) and casino gaming (5.6 %, p =0.010). Any past-year drug use was significantly associated with multiple gambling types (OR range: 1.376-2.330, p <0.05).

CONCLUSION

Race and ethnicity significantly moderate substance-gambling associations, suggesting distinct addiction vulnerability pathways across populations. The concurrent expansion of substance access and novel gambling modalities, particularly mobile platforms, presents emerging public health challenges that require longitudinal investigation of causal mechanisms and development of culturally-informed prevention strategies.

Obstetrician/Gynecologists' Knowledge, Attitudes, and Practice Regarding Suicide Screening Among Women

Background: Suicide is a public health issue, and there are differences between men and women in terms of suicide ideation, behavior, and completion. Obstetrician/gynecologists (OB/GYNs) are uniquely positioned to assess women's suicide risk. Methods: A 53-question survey was distributed to the Pregnancy-Related Care Research Network, assessing practice, attitudes, and knowledge regarding suicide risk assessment and management, and personal experience with suicide. Wilcoxon signed-rank tests with paired samples were used to compare the frequency of screening and interventions for different groups of women, and practices of those with and without suicide experience. Significance was set at p < 0.05. Results: Response rate was 31.9%. Respondents were largely White females. OB/GYNs reported more frequently screening for suicide ideation/intent/behavior among pregnant and postpartum patients than nonpregnant/nonpostpartum patients of childbearing age. The most common assessment tool was the Edinburgh Postnatal Depression Scale; half ask about past suicide ideation/behavior or current thoughts/plans. The most common intervention for at-risk patients was a mental health referral; all interventions were reported more frequently for pregnant patients. Common barriers to screening were inadequate mental health services, time constraints, and inadequate training. Most agreed suicide screening is within their purview, and were knowledgeable about the topic, although gaps were identified. Few reported adequate training in suicide risk assessment, and believed continuing education would be beneficial. A majority endorsed experience with suicide and some practice differences emerged. Conclusions: OB/GYNs view suicide risk assessment in their scope. Some knowledge gaps were identified, and respondents believe additional training would be beneficial.

Clustering Treatment Outcomes in Women with Gambling Disorder

The rising prevalence of gambling disorder (GD) among women has awakened considerable interest in the study of therapeutic outcomes in females. This study aimed to explore profiles of women seeking treatment for GD based on a set of indicators including sociodemographic features, personality traits, clinical state at baseline, and cognitive behavioral therapy (CBT) outcomes. Two-step clustering, an agglomerative hierarchical classification system, was applied to a sample of n = 163 women of ages ranging from 20 to 73 years-old, consecutively attended to by a clinical unit specialized in the treatment of G. Three mutually exclusive clusters were identified. Cluster C1 (n = 67, 41.1%) included the highest proportion of married, occupationally active patients within the highest social status index. This cluster was characterized by medium GD severity levels, the best psychopathological functioning, and the highest mean in the self-directedness trait. C1 registered 0% dropouts and only 14.9% relapse. Cluster C2 (n = 63; 38.7%) was characterized by the lowest GD severity, medium scores for psychopathological measures and a high risk of dropout during CBT. Cluster C3 (n = 33; 20.2%) registered the highest GD severity, the worst psychopathological state, the lowest self-directedness level and the highest harm-avoidance level, as well as the highest risk of relapse. These results provide new evidence regarding the heterogeneity of women diagnosed with GD and treated with CBT, based on the profile at pre- and post-treatment. Person-centered treatments should include specific strategies aimed at increasing self-esteem, emotional regulation capacities and self-control of GD women.

Gambling, Substance Use and Violence in Male and Female Adolescents

The study systematically examined the link between history of gambling, and substance-use and violence-related measures in male and female adolescents, and compared association differences between genders in representative youth risk behavior surveillance data. An anonymous survey was administered to 2425 9th- to 12th-grade students in the state of Connecticut to assess risk behaviors that impact health. Reported past-12-months gambling was the independent variable of interest. Chi squares and adjusted odds-ratios were computed to determine gambling associations with demographic variables, substance-use, and violence-related measures, and whether associations were different between genders. Among students, 18.6% reported gambling. Reported gambling in males and females associated with lifetime use of any drugs, marijuana, cocaine, inhalants, heroin, methamphetamines, ecstasy, synthetic marijuana, non-medical pain-relievers, and injected drugs, in addition to past-30-days cigarette smoking, alcohol and heavy alcohol drinking, and marijuana use. Gambling associated with reported weapon-carrying, being threatened or injured with a weapon, forced sexual intercourse, bullying, and electronic bullying in males; physical dating violence in females; and physical fighting and sexual dating violence in both groups. Gambling and gender interaction terms did not associate with outcome measures except synthetic marijuana use, which trended towards significance (P = 0.052). Gambling in adolescence was similarly linked to risk behaviors involving substance-use in males and females, though gambling relationships with different violence-measures varied between genders. Assessing gambling behavior may be important for targeted preventions focused on adolescents at risk for substance-use disorder and physical violence.

Problem Gambling in the Fitness World-A General Population Web Survey

The world of sports has a complex association to problem gambling, and the sparse research examining problem gambling in athletes has suggested an increased prevalence and particularly high male predominance. The present study aimed to study frequency and correlates of problem gambling in populations with moderate to high involvement in fitness or physical exercise. This is a self-selective online survey focusing on addictive behaviors in physical exercise distributed by ‘fitness influencers’ on social media and other online fitness forums to their followers. Respondents were included if they reported exercise at least thrice weekly, were above 15 years of age, and provided informed consent (N = 3088). Problem gambling, measured with the Lie/Bet, was studied in association with demographic data, substance use, and mental health variables. The occurrence of lifetime problem gambling was 8 percent (12 percent in men, one percent in women). In logistic regression, problem gambling was associated with male gender, younger age, risky alcohol drinking, obsessive-compulsive disorder, and less frequent exercise habits. In conclusion, in this self-recruited population with moderate to high fitness involvement, problem gambling was moderately elevated. As shown previously in elite athletes, the male predominance was larger than in the general population. The findings strengthen the link between problem gambling and the world of sports.

Psychosocial risk factors in disordered gambling: A descriptive systematic overview of vulnerable populations

BACKGROUND

Gambling is a behaviour engaged in by millions of people worldwide; for some, gambling can become a severely maladaptive behaviour, and previous research has identified a wide range of psychosocial risk factors that can be considered important for the development and maintenance of disordered gambling. Although risk factors have been identified, the homogeneity of risk factors across specific groups thought to be vulnerable to disordered gambling is to date, unexplored.

METHODS

To address this, the current review sought to conduct a systematic overview of literature relating to seven vulnerable groups: young people and adolescents, older adults, women, veterans, indigenous peoples, prisoners, and low socio-economic/income groups.

RESULTS

Multiple risk factors associated with disordered gambling were identified; some appeared consistently across most groups, including being male, co-morbid mental and physical health conditions, substance use disorders, accessibility and availability of gambling, form and mode of gambling, and experience of trauma. Further risk factors were identified that were specific to each vulnerable group.

CONCLUSION

Within the general population, certain groups are more vulnerable to disordered gambling. Although some risk factors are consistent across groups, some risk factors appear to be group specific. It is clear that there is no homogenous pathway in to disordered gambling, and that social, developmental, environmental and demographic characteristics can all interact to influence an individual's relationship with gambling.

A systematic review of gambling-related findings from the National Epidemiologic Survey on Alcohol and Related Conditions

BACKGROUND AND AIMS

This systematic review analyzes and summarizes gambling-related findings from the nationally representative US National Epidemiological Survey on Alcohol and Related Conditions (NESARC) data.

METHODS

Systematic literature searches in accordance with PRISMA guidelines found 51 eligible studies that met inclusion criteria. Eight studies utilized both Waves 1 and 2 NESARC data, and selection of sample sizes varied from 185 to 43,093 individuals, consistent with specified research objectives of each study.

RESULTS

The prevalence of lifetime pathological gambling was 0.42% (0.64% among men, 0.23% among women), while past-year prevalence was 0.16%. Pathological gambling rates were generally higher in populations with substance-use disorders and other psychiatric diagnoses. Rates of adverse childhood experiences and suicidal attempts were higher among individuals with problem or pathological gambling. Early-onset gamblers were more likely to be male, be never married, have incomes below $70,000, belong to younger cohorts and have Cluster B personality disorders, but less likely to be diagnosed with mood disorders. While pathological gambling was related to obesity, increased stress, and poorer physical health among general age groups, recreational gambling was linked with improved physical and mental functioning in older adults.

CONCLUSIONS

The NESARC has provided important information on the correlates of pathological gambling and subdiagnostic patterns of gambling behaviors. Additional studies should examine these relationships in the current gambling environment and longitudinally with aims of implementing policies to improve the public health.

The Reciprocal Association between Problem Gambling and Mental Health Symptoms/Substance Use: Cross-Lagged Path Modelling of Longitudinal Cohort Data

To date, studies have highlighted cross-sectional and unidirectional prospective relationships between problem gambling and mental health symptoms or substance use. The current study aims to: (1) examine the reciprocal relationships between problem gambling and mental health symptoms (depression, generalized anxiety)/substance use variables (hazardous alcohol use, daily tobacco use, and drug use) using cross-lagged path models in a prospective general population cohort sample; and (2) determine whether these associations are moderated by age and gender. This study involved secondary data analysis from 1109 respondents who provided data during Wave 2 or 3 (12-months apart) of the Tasmanian Longitudinal Gambling Study (Australia). Depression (odds ratio (OR) = 2.164) and generalized anxiety (OR = 2.300) at Wave 2 were found to have cross-lagged associations with the subsequent development of any-risk gambling (low-risk, moderate-risk, or problem gambling) at Wave 3. Hazardous alcohol use, daily tobacco use, and drug use at Wave 2 were not associated with the development of any-risk gambling at Wave 3. Any-risk gambling at Wave 2 was not associated with the subsequent development of any mental health symptoms or substance use variables at Wave 3. Age and gender failed to be significant moderators in the associations between any-risk gambling and mental health symptoms or substance use variables. Future longitudinal and event-level research is required to further substantiate these prospective relationships, with a view to developing targeted preventions and interventions.

Weapon-carrying is associated with more permissive gambling attitudes and perceptions and at-risk/problem gambling in adolescents

BACKGROUND AND AIMS

A recent call to action highlighted the need to understand the relationship between problem gambling, violence, and health/functioning. As weapon-carrying and gambling behaviors are prevalent in adolescents, this study systematically examined relationships between weapon-carrying status and measures of problem gambling severity and gambling perceptions and attitudes, as well as how weapon-carrying status moderated relationships between problem gambling severity and measures of health/functioning and gambling behavior.

METHODS

Participants were 2,301 Connecticut high-school adolescents. χ² and logistic regression models were conducted.

RESULTS

Weapon-carriers reported greater problem gambling severity, more permissive gambling perceptions, greater parental approval of gambling, and more family gambling concerns, compared to non-weapon-carriers. At-risk/problem gambling was more strongly associated with family, peers, and adult gambling partners among non-weapon-carriers (vs. weapon-carriers) and with machine gambling among weapon-carriers (vs. non-weapon-carriers).

DISCUSSION AND CONCLUSIONS

Greater problem gambling severity and more permissive gambling perceptions and perceived parental approval of gambling in weapon-carrying adolescents suggest that parent-child relationships are important to be considered in prevention efforts. The moderated relationship by weapon-carrying status between problem gambling severity and gambling partners suggests a problem gambling risk group that may be less linked to gambling with traditional social support groups, and this group may benefit from targeted interventions.

The Mediator Role of Early Maladaptive Schemas Between Childhood Sexual Abuse and Impulsive Symptoms in Female Survivors of CSA

Child abuse is a traumatic experience that may have psychological consequences such as dysfunctional beliefs. The aim of this study was to analyze the impulsive behaviors (alcohol abuse, gambling, drug abuse, eating disorders, Internet abuse, videogame abuse, shopping and sex addiction) in sexual abuse survivors and to study the mediating role of early maladaptive schemas in the appearance of impulsive behaviors in adult female victims. The sample consisted of 182 adult women who had suffered childhood sexual abuse (CSA), mostly referred by associations for the treatment of childhood abuse and maltreatment. Sexual abuse was found to be positively related to the domains of Disconnection/Rejection and Impaired Autonomy. Moreover, these domains were significantly related to impulsivity and impulsive behaviors. Finally, the Disconnection/Rejection domain was found to mediate between CSA and eating disorders and alcohol abuse. These results may provide important guidance for clinical intervention.

Clustering of treatment-seeking women with gambling disorder

BACKGROUND

The prevalence of gambling disorder (GD) in women has increased, but, to date, few studies have explored the features of clinical GD subtypes in female samples.

AIMS

The aim of this study is to identify empirical clusters based on clinical/sociodemographic variables in a sample of treatment-seeking women with GD.

METHODS

Agglomerative hierarchical clustering was applied to a sample of n = 280 patients, using sociodemographic variables, psychopathology, and personality traits as indicators for the grouping procedure.

RESULTS

Three mutually exclusive groups were obtained: (a) Cluster 1 (highly dysfunctional; n = 82, 29.3%) endorsed the highest levels in gambling severity, comorbid psychopathology, novelty seeking, harm avoidance, and self-transcendence, and the lowest scores in self-directedness and cooperativeness; (b) Cluster 2 (dysfunctional; n = 142, 50.7%) achieved medium mean scores in gambling severity and psychopathological symptoms; and (c) Cluster 3 (functional; n = 56, 20.0%) obtained the lowest mean scores in gambling severity and in psychopathology, and a personality profile characterized by low levels in novelty seeking, harm avoidance, and self-transcendence, and the highest levels in self-directedness and cooperativeness.

DISCUSSION AND CONCLUSIONS

This study sheds light on the clinical heterogeneity of women suffering from GD. Identifying the differing features of women with GD is vital to developing prevention programs and personalized treatment protocols for this overlooked population.

Problem gambling and gaming in elite athletes

Background

High-level sports have been described as a risk situation for mental health problems and substance misuse. This, however, has been sparsely studied for problem gambling, and it is unknown whether problem gaming, corresponding to the tentative diagnosis of internet gaming disorder, may be overrepresented in athletes. This study aimed to study the prevalence and correlates of problem gambling and problem gaming in national team-level athletes.

Methods

A web-survey addressing national team-level athletes in university studies (survey participation 60%) was answered by 352 individuals (60% women, mean age 23.7), assessing mental health problems, including lifetime history of problem gambling (NODS-CLiP) and problem gaming (GASA).

Results

Lifetime prevalence of problem gambling was 7% (14% in males, 1% in females, p < 0.001), with no difference between team sports and other sports. Lifetime prevalence of problem gaming was 2% (4% in males and 1% in females, p = 0.06). Problem gambling and problem gaming were significantly associated (p = 0.01).

Conclusions

Moderately elevated rates of problem gambling were demonstrated, however with large gender differences, and interestingly, with comparable prevalence in team sports and in other sports. Problem gaming did not seem more common than in the general population, but an association between problem gambling and problem gaming was demonstrated.

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Problem gambling is moderately elevated in national team-level athletes in Sweden.

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Problem gambling is markedly more common in male athletes than in female athletes.

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Problem gambling may be associated with problem gaming.

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Problem gaming in athletes is not clearly more common than in the general population.

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Problem gaming in athletes may be more common among males than females.

Gambling Type, Substance Abuse, Health and Psychosocial Correlates of Male and Female Problem Gamblers in a Nationally Representative French Sample

Many studies carried out on treatment-seeking problem gamblers (PG) have reported high levels of comorbid substance use disorders, and mental and physical health problems. Nevertheless, general population studies are still sparse, most of them have been carried out in the United States or Canada, and gender differences have not always been considered. Thus, the aim of this study was to describe the type of games, and psychological and physical correlates in male and female PG in a nationally representative French sample. The total sample studied involved 25,647 subjects aged 15-85 years, including 333 PG and 25,314 non-problem gamblers (NPG). Data were extracted from a large survey of a representative sample of the French general population. They were evaluated for sociodemographic variables, gambling behavior, type of gambling activity, substance use, psychological distress, body mass index, chronic disease, and lack of sleep. Overall, there were significant differences between PG and NPG in gender, age, education, employment and marital status, substance use disorders (alcohol, tobacco, cannabis, cocaine and heroin), psychological distress, obesity, lack of sleep and type of gambling activity. Although male and female PG had different profiles, the gambling type, especially strategic games, appeared as an important variable in the relationship between gender and problem gambling. This research underlines the importance of considering gender differences and gambling type in the study of gambling disorders. Identifying specific factors in the relationship between gender, gambling type and gambling problems may help improve clinical interventions and health promotion strategies.

Risk factors for gambling and substance use among recent college students

BACKGROUND

While it is well known that substance use and gambling overlap, the degree to which this overlap can be explained by shared risk factors has not been fully explored. This study aimed to identify common and unique risk factors for gambling and substance use among young adults.

METHODS

Young adults (n=1,019) in a longitudinal study since college entry were interviewed annually. Past-year frequency of seven gambling activities was assessed once (Year 5). Structural equation models evaluated suspected risk factors in two models, one for gambling with substance use as an intermediary variable, and one for substance use with gambling as the intermediary variable.

RESULTS

Sixty percent gambled; 6% gambled weekly or more. Examination of the two structural models supported the existence of significant paths (a) from two of the five substance use variables (alcohol, drugs) to gambling frequency, and (b) from gambling frequency to all five substance use variables. Every risk factor associated with gambling was also associated with one or more substance use variables. Risk factors common to gambling and substance use were sex, race/ethnicity, extracurricular involvement (fraternity/sorority, athletics), impulsive sensation-seeking, and behavioral dysregulation. Risk factors unique to substance use were conduct problems, anxiety, and parent's history of alcohol and mental health problems.

CONCLUSIONS

Gambling and substance use are interrelated, but with incomplete overlap in their respective risk factors. Results underscore the need for longitudinal research to elucidate their distinct etiologies.

Independent Versus Co-occurring Substance Use in Relation to Gambling Outcomes in Older Adolescents and Young Adults

PURPOSE

Gambling is prevalent among college students and can be associated with significant negative consequences. Students who report gambling also tend to report use of alcohol and cannabis, but little research has explored the associated risks of using these substances in relation to gambling episodes. This study explored associations between the independent and co-occurring use of alcohol and cannabis before/during gambling episodes and gambling outcomes.

METHODS

Students (n = 1,834) completed an online survey that included measures of gambling frequency, amount lost, negative gambling consequences, gambling problem severity, and substance use.

RESULTS

As hypothesized, individuals who reported using either alcohol or cannabis alone or both substances before/while gambling endorsed greater gambling quantity, frequency, negative consequences, and problem severity than individuals who used alcohol and cannabis in general but denied use of either substance before/while gambling. Use of both substances compared to use of alcohol alone was associated with greater gambling quantity, frequency, and negative consequences, although these groups did not differ on gambling problem severity. Cannabis use alone was no different on any outcome than use of both substances, and alcohol use alone was no different than cannabis use alone on any outcome.

CONCLUSIONS

Use of cannabis alone before/while gambling may confer the same level of risk for negative gambling outcomes as use of both cannabis and alcohol. Prevention efforts may, therefore, benefit from targeting cannabis use in relation to gambling. Additional investigation is needed in light of recent and upcoming state legislation on the legalization of cannabis.

Sensation seeking in a community sample of French gamblers: Comparison between strategic and non-strategic gamblers

The purpose of this research is to examine the relationship between sensation seeking and gambling disorder (GD) in a community sample of gamblers (when controlling for the effect of substance use, gender and age) and see whether sensation seeking scores depend on the gambling activity when comparing strategic and non-strategic gamblers. A total of 380 gamblers was recruited. First, pathological gamblers (PGs) (n =143) were compared to non-pathological gamblers (NPGs) (n =237). Second, strategic gamblers (n =93) were compared to non-strategic gamblers (n =110). Sociodemographic data, gambling behavior (SOGS, DSM-IV), tobacco and alcohol use (CAGE), and sensation seeking (SSS) were evaluated. PGs have higher boredom susceptibility scores than NPGs and this factor is associated with GD. Nevertheless, the relationship between sensation seeking and GD depends on the gambling activity. In fact, sensation seeking is associated with GD in strategic gamblers only. PGs playing strategic games display different profiles from non-strategic PGs. Thus, factors associated with GD differ when the gambling activity is taken into account. These findings are consistent with the idea of it being essential to identify clinically distinct subgroups of PGs in the treatment of GD.

Risk Factors for Gambling Problems: An Analysis by Gender

Differences in problem gambling rates between males and females suggest that associated risk factors vary by gender. Previous combined analyses of male and female gambling may have obscured these distinctions. This study aimed to develop separate risk factor models for gambling problems for males and for females, and identify gender-based similarities and differences. It analysed data from the largest prevalence study in Victoria Australia (N = 15,000). Analyses determined factors differentiating non-problem from at-risk gamblers separately for women and men, then compared genders using interaction terms. Separate multivariate analyses determined significant results when controlling for all others. Variables included demographics, gambling behaviour, gambling motivations, money management, and mental and physical health. Significant predictors of at-risk status amongst female gamblers included: 18-24 years old, not speaking English at home, living in a group household, unemployed or not in the workforce, gambling on private betting, electronic gaming machines (EGMs), scratch tickets or bingo, and gambling for reasons other than social reasons, to win money or for general entertainment. For males, risk factors included: 18-24 years old, not speaking English at home, low education, living in a group household, unemployed or not in the workforce, gambling on EGMs, table games, races, sports or lotteries, and gambling for reasons other than social reasons, to win money or for general entertainment. High risk groups requiring appropriate interventions comprise young adults, especially males; middle-aged female EGM gamblers; non-English speaking populations; frequent EGM, table games, race and sports gamblers; and gamblers motivated by escape.

Gambling involvement indicative of underlying behavioral and mental health disorders

BACKGROUND AND OBJECTIVES

In spite of increased gambling opportunities, risk factors associated with recreational gambling remain poorly understood. This study assessed behavioral risk factors associated with frequency of recreational gambling.

METHODS

Data were derived from the 2013 Massachusetts Behavioral Risk Factor Surveillance System. Gambling frequency was divided into two or more times per week, 1-4 times a month, less than 10 times in total, and not at all. Health risk behaviors included smoking, drinking, obesity, seat belt use, and sleep patterns. Multivariate logistic regression was used to assess relationships between overall gambling participation and gambling frequency and behavioral risk behaviors. Final analytical sample included 3,988 survey respondents. Statistical analyses were performed using STATA.

RESULTS

Significant differences exist in the socio-demographic characteristics of recreational gamblers. Highest gambling frequency is associated with increased odds of alcohol consumption (ie, having at least one alcohol drink during the past 30 days) (OR 1.9; p < .05), binge drinking (ie, having five or more alcohol drinks at least once during the past 30 days) (OR 3.7; p < .001), and tobacco use (ie, having smoked at least 100 cigarettes in a lifetime) (OR 3.4; p < .001). The odds of having fourteen days of poor mental health are twofold for recreational gamblers who gamble two or more times per week (OR 2.2; p < .05).

CONCLUSION AND SCIENTIFIC SIGNIFICANCE

Differing behavioral and mental health risk factors emerge among recreational gamblers by gambling frequency. Gambling frequency may be a better proxy for assessing the risk of developing gambling related behavioral disorders than overall endorsement of gambling participation.

A Longitudinal Study of the Temporal Relation Between Problem Gambling and Mental and Substance Use Disorders Among Young Adults

OBJECTIVE

Relatively little is known about the temporal relation between at-risk gambling or problem gambling (PG) and mental and substance use disorders (SUDs) in young adulthood. Our study aimed to examine whether past-year, at-risk, or PG is associated with incident mental disorders and SUDs (that is, depression, generalized anxiety disorder, obsessive-compulsive disorder [OCD], or alcohol dependence) and illegal drug use, and whether past-year mental disorders and SUDs and illegal drug use is associated with incident at-risk or PG.

METHOD

Data for this longitudinal study were drawn from the Manitoba Longitudinal Study of Young Adults (MLSYA). Respondents aged 18 to 20 years in 2007 were followed prospectively for 5 years.

RESULTS

In cross-sectional analyses, at-risk or PG was associated with increased odds of depression, OCD, alcohol dependence, and illegal drug use. In longitudinal analysis at-risk or PG at cycle 1 was associated with incident major depressive disorder, alcohol dependence, and illegal drug use in the follow-up period. Only illegal drug use at cycle 1 was associated with incident at-risk or PG during follow-up.

CONCLUSIONS

At-risk or PG was associated with more new onset mental disorders and SUDs (depression, alcohol dependence, and illegal drug use), compared with the reverse (illegal drug use was the only association with new onset at-risk or PG). Preventing at-risk or PG from developing early in adulthood may correspond with decreases in new onset mental disorders and SUDs later in adulthood.

The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) Waves 1 and 2: review and summary of findings

PURPOSE

The NESARC, a "third-generation" psychiatric epidemiologic survey that integrated detailed measures of alcohol and drug use and problems has been the data source for over >850 publications. A comprehensive review of NESARC findings and their implications is lacking.

METHOD

NESARC was a survey of 43,093 participants that covered alcohol, drug and psychiatric disorders, risk factors, and consequences. Wave 1 of the NESARC was conducted in 2001-2002. Three years later, Wave 2 follow-up re-interviews were conducted with 34,653 of the original participants. Scopus and Pubmed were used to search for NESARC papers, which were sorted into topic areas and summarized.

RESULT

The most common disorders were alcohol and posttraumatic stress disorders, and major depression. Females had more internalizing disorders and males had more externalizing disorders, although the preponderance of males with alcohol disorders (the "gender gap") was less pronounced than it was in previous decades. A race/ethnic "paradox" (lower risk among disadvantaged minorities than whites) remains unexplained. Younger participants had higher risk for substance and personality disorders, but not unipolar depressive or anxiety disorders. Psychiatric comorbidity was extensive and often formed latent trans-diagnostic domains. Since 1991-1992, risk for marijuana and prescription drug disorders increased, while smoking decreased, although smoking decreases were less pronounced among those with comorbidity. A nexus of comorbidity, social support, and stress predicted transitions in diagnostic status between Waves 1 and 2. Childhood maltreatment predicted psychopathology. Alcohol and drug use disorders were seldom treated; attitudinal barriers (little perceived need, perceived alcoholism stigma, pessimism about efficacy) were more important in predicting non-treatment than financial barriers.

CONCLUSIONS

Understanding comorbidity and the effects of early stressors will require research incorporating biologic components, e.g., genetic variants and brain imaging. The lack of treatment for alcohol and drug disorders, predicted by attitudinal rather than financial variables, suggests an urgent need for public and professional education to reduce the stigma associated with these disorders and increase knowledge of treatment options.

Personality traits of problem gamblers with and without alcohol dependence

INTRODUCTION

A large proportion of individuals with gambling disorder also present with a history of alcohol dependence, but few studies have directly examined the relationship between these two conditions. This study's primary and secondary aims were to 1) examine the relationship of personality traits to co-occurring lifetime (current/past) alcohol dependence status, while 2) accounting for differences in gambling characteristics and co-occurring psychiatric disorders among problem/pathological gamblers recruited from the community.

METHODS

Problem/pathological gamblers (N=150) completed measures of personality traits and gambling characteristics (e.g., gambling severity, gambling involvement, delayed discounting of monetary rewards), and were clinically interviewed for co-occurring psychiatric disorders.

RESULTS

A co-occurring lifetime diagnosis of alcohol dependence (n=61, 40.7%) was associated with lower personality scores for Control, Well-Being, Achievement, Traditionalism, and Harm Avoidance, as well as higher scores for Alienation (Tellegen & Waller, 1994) in bivariate analyses. Problem/pathological gamblers with lifetime alcohol dependence reported greater lifetime gambling severity, greater past-year gambling involvement, steeper delayed discounting, and a greater likelihood of current and lifetime substance dependence, lifetime antisocial personality disorder, and current unipolar mood disorders. Multivariate analyses indicated that lower Control, Traditionalism, and Well-Being and a co-occurring lifetime substance dependence diagnosis best accounted for a co-occurring lifetime alcohol dependence diagnosis in problem/pathological gamblers.

CONCLUSIONS

Problem/pathological gamblers with co-occurring lifetime alcohol dependence demonstrate addictive behavior across multiple domains and report a personality style characterized by hopelessness, impaired control, and resistance to externally-motivated treatment approaches. Implications for the treatment of these complex cases are discussed.

Annual research review: Optimal outcomes of child and adolescent mental illness

BACKGROUND

'Optimal outcomes' of child and adolescent psychiatric disorders may mean the best possible outcome, or the best considering a child's history. Most research into the outcomes of child and adolescent psychiatric disorder concentrates on the likelihood of adult illness and disability given an earlier history of psychopathology.

METHODS

In this article, we review the research literature (based on a literature search using PubMed, RePORT and Google Advanced Scholar databases) on including optimal outcomes for young people with a history of anxiety, depression, attention-deficit/hyperactivity disorder, conduct disorder, oppositional defiant disorder, or substance use disorders in childhood or adolescence. We consider three types of risks that these children may run later in development: future episodes of the same disorder, future episodes of a different disorder, and functional impairment. The impact of treatment or preventative interventions on early adult functioning is briefly reviewed.

RESULTS

We found that very few studies enabled us to answer our questions with certainty, but that in general about half of adults with a psychiatric history were disorder-free and functioning quite well in their 20s or 30s. However, their chance of functioning well was less than that of adults without a psychiatric history, even in the absence of a current disorder.

CONCLUSIONS

Among adults who had a psychiatric disorder as a child or adolescent, about half can be expected to be disorder-free as young adults, and of these about half will be free of significant difficulties in the areas of work, health, relationships, and crime. Optimal outcomes are predicted by a mixture of personal characteristics and environmental supports.

Gambling disorder and other behavioral addictions: recognition and treatment

Addiction professionals and the public are recognizing that certain nonsubstance behaviors--such as gambling, Internet use, video-game playing, sex, eating, and shopping--bear resemblance to alcohol and drug dependence. Growing evidence suggests that these behaviors warrant consideration as nonsubstance or "behavioral" addictions and has led to the newly introduced diagnostic category "Substance-Related and Addictive Disorders" in DSM-5. At present, only gambling disorder has been placed in this category, with insufficient data for other proposed behavioral addictions to justify their inclusion. This review summarizes recent advances in our understanding of behavioral addictions, describes treatment considerations, and addresses future directions. Current evidence points to overlaps between behavioral and substance-related addictions in phenomenology, epidemiology, comorbidity, neurobiological mechanisms, genetic contributions, responses to treatments, and prevention efforts. Differences also exist. Recognizing behavioral addictions and developing appropriate diagnostic criteria are important in order to increase awareness of these disorders and to further prevention and treatment strategies.

Sex differences in addictive disorders

Gender-dependent differences in the rate of initiation and frequency of misuse of addicting drugs have been widely described. Yet, men and women also differ in their propensity to become addicted to other rewarding stimuli (e.g., sex, food) or activities (e.g., gambling, exercising). The goal of the present review is to summarize current evidence for gender differences not only in drug addiction, but also in other forms of addictive behaviours. Thus, we first reviewed studies showing gender-dependent differences in drug addiction, food addiction, compulsive sexual activity, pathological gambling, Internet addiction and physical exercise addiction. Potential risk factors and underlying brain mechanisms are also examined, with particular emphasis given to the role of sex hormones in modulating addictive behaviours. Investigations on factors allowing the pursuit of non-drug rewards to become pathological in men and women are crucial for designing gender-appropriate treatments of both substance and non-substance addictions.