Psychiatric comorbidity in pathological gambling: a critical review

A Meta-Review to Guide Military Screening and Treatment of Gambling Problems

INTRODUCTION

Excessive gambling can cause substantial biopsychosocial problems (e.g., difficulties with finances, relationships, mental, and physical health). For military Service Members, it can also result in security clearance denial or revocation, failure to achieve promotions, and premature career termination. Recent congressional mandates have obligated the U.S. Department of Defense to screen for problematic gambling, the predictive values of which are a function of (i) problem prevalence and (ii) tool sensitivity and specificity. This meta-review (i.e., systematic review of systematic reviews) on the screening properties of gambling assessment tools and the effectiveness of treatments for gambling disorder is to inform military services on responding to Service Members' gambling problems.

MATERIALS AND METHODS

EBSCO Discovery Service, PubMed, PsycINFO, Ovid Medline, Social Care Online, Epistemonikos, International Health Technology Assessment, and the Cochrane Central Register of Controlled Trials electronic databases were searched up to December 2022 for systematic reviews and meta-analyses on measurements of adult subclinical or gambling, and interventions targeting individuals with GD. Three and four studies were included in each section of the current meta-review (i.e., assessment tools and treatment). For review 1, the estimated risk of bias was assessed using the Risk of Bias in Systematic Reviews.

RESULTS

Thirty-one tools were identified through the three systematic reviews. All had modest sensitivities and specificities; combined with low prevalences in the general SM population, positive results would be incorrect 64-99% of the time. However, if screening were conducted with SMs referred for alcohol problems, a positive result on the best screening tools would be correct 76% of the time. Several commonly used treatment approaches had demonstrated efficacy for GD.

CONCLUSIONS

The combination of low prevalence of GD and subclinical gambling problems in the general population, coupled with modest sensitivity and specificity, makes screening unfeasible in the general SM population. However, dual-phase screening in higher-prevalence subpopulations (i.e., SMs already identified with substance-abuse or mental-health problems) would be viable. Regarding treatment, several interventions-already used in military healthcare-with extensive empirical track records have been successfully used to treat adults with GD.

Gambling problems among Lebanese adults: Arabic-Language version of the South Oaks Gambling Screen (SOGS) scale validation and correlates

BACKGROUND

In the DSM-5, gambling disorder is recognized as the only behavioral addiction. The number of people with mental health disorders is increasing in Lebanon, especially since the economic crisis and the COVID-19 pandemic. The South Oaks Gambling Screen (SOGS), the most used tool in the world in terms of pathological gambling, has never been translated to Arabic, culturally adapted in a way that suits the Lebanese population and validated. This study's objectives were to validate an Arabic-language version of the SOGS and assess factors associated with probable pathological gambling among Lebanese adults.

METHODS

This study was carried out between February and April 2021, during the lockdown period imposed by the Lebanese government. A total of 601 individuals participated in this study by filling the online questionnaire.

RESULTS

A factor analysis, using the principal component analysis, was performed on the SOGS scale items. The SOGS items were able to explain 73.35% of the variance, with an internal reliability of KR20 = 0.947 for the total scale. The results of the confirmatory factor analysis confirmed the results of the factor analysis. More problematic alcohol use (aOR = 1.17), and more depression (aOR = 1.13) were significantly associated with higher odds of probable pathological gambling, whereas females (aOR = 0.27) had significantly lower odds of probable pathological gambling compared to males.

CONCLUSION

Our study validated an Arabic-language version of the South Oaks Gambling Screen (SOGS) for use in Lebanon, and showed some factors associated with probable pathological gambling (male gender, alcohol use disorder and depression). This reliable and valid version will hopefully contribute towards better screening for gambling disorder in Lebanon.

The Level of Gambling Prediction Using Depression and Anxiety in the Romanian Population

The gambling addiction problem, one which is present worldwide and at all social levels, is one of the most pervasive problems in contemporary society. According to the research literature, gambling addiction is determined by other psychiatric disorders. In the present study, we investigate the degree to which gambling can be predicted by depression and anxiety in a Romanian sample. The study has been conducted on a sample of 920 persons in the general population. Results show that depression predicts gambling in proportion of 26.3 percent, while anxiety predicts 31.5 percent of gambling variance. In the discussion portion of the study, we provide a psyhological interpretation of the results.

Charting a path towards a public health approach for gambling harm prevention

Aim

Gambling harm is a serious public health issue affecting the health, financial security, and social well-being of millions of people and their close relations around the world. Despite its population health implications, gambling harm is not typically viewed and treated as a public health policy issue. This paper critically reviews the evolution of the public health perspective on gambling harm. It also considers how gambling harm can be operationalized within a public health model.

Methods

A critical historical review of the emerging public health perspective on gambling harm was conducted. Key documents covering three decades of development were reviewed and appraised through a process of deliberation and debate over source impact in the fields of research, policy, and programming internationally.

Results

The first decade mainly focused on identifying gambling harm and framing the public health issue. The second decade featured the expansion of health assessment and emerging areas of policy and program development. The third decade saw an increased focus on public health frameworks that advanced understanding of harm mechanics and impact. As reflected by the essential functions of a general public health model, gambling harm prevention efforts emphasize health promotion over other key functions like health assessment and surveillance.

Conclusion

Gambling harm is a public health issue requiring greater attention to health assessment and surveillance data development.

A Randomized Clinical Trial Exploring Gambling Attitudes, Barriers to Treatment, and Efficacy of a Brief Motivational Intervention Among Ex-Offenders with Disordered Gambling

Correctional populations are disproportionately burdened by disordered gambling; yet, problem awareness is minimal among both offenders and professionals within the criminal justice system. The aims of the current study were twofold: (i) to examine gambling attitudes and problem awareness among ex-offenders, and (ii) to determine the efficacy of a brief online gambling intervention for ex-offenders. Participants (N = 126) were ex-offenders on probation and parole. Gambling attitudes, attitudes toward treatment, and disorder gambling status were assessed. Disordered gamblers (n = 102) were randomly assigned to (i) a brief intervention plus referral to treatment or (ii) referral to treatment only, and these individuals were re-assessed at a 30-day follow-up. Lifetime disordered gambling was highly prevalent (86%) in the ex-offender sample, and providing information regarding disordered gambler status and referral to treatment was effective in decreasing gambling attitudes, as well as gambling severity and frequency. The current study has direct implications for treatment and intervention efforts among ex-offenders with disordered gambling and yields a greater understanding of attitudes toward gambling among ex-offenders.

Comorbidity, family history and personality traits in pathological gamblers compared with healthy controls

Background

While DSM-5 classified pathological gambling as an addictive disorder, there is debate as to whether ICD-11 should follow suit. The debate hinges on scientific evidence such as neurobiological findings, family history of psychiatric disorders, psychiatric comorbidity, and personality variables.

Methods

In the “Baden-Württemberg Study of Pathological Gambling”, we compared a group of 515 male pathological gamblers receiving treatment with 269 matched healthy controls. We studied differences in sociodemographic characteristics, gambling-related variables, psychiatric comorbidity (lifetime), family history of psychiatric conditions, as well as personality traits such as impulsivity (Barratt Impulsiveness Scale), sensation seeking (Zuckerman's Sensation Seeking Scale) and the NEO-FFI big five. Personality traits were validated in an age- and ethnicity-matched subsample of “pure” gamblers without any psychiatric comorbidity (including nicotine dependence). Data were analyzed using two-sample t-tests, Chi2 analyses, Fisher's exact test and Pearson correlation analysis, as appropriate. Bonferroni correction was applied to correct for multiple comparisons.

Results

Only 1% of the gamblers had been diagnosed with an impulse control disorder other than gambling (ICD-10). Notably, 88% of the gamblers in our sample had a comorbid diagnosis of substance dependence. The highest axis I comorbidity rate was for nicotine dependence (80%), followed by alcohol dependence (28%). Early age of first gambling experience was correlated with gambling severity. Compared to first-degree relatives of controls, first-degree relatives of pathological gamblers were more likely to suffer from alcohol dependence (27.0% vs. 7.4%), pathological gambling (8.3% vs. 0.7%) and suicide attempts (2.7% vs. 0.4%). Significant group differences were observed for the NEO-FFI factors neuroticism, agreeableness and conscientiousness. Gamblers were also more impulsive than controls, but did not differ from controls in terms of sensation seeking.

Conclusions

Our findings support classifying pathological gambling as a behavioural addiction in the ICD-11. This decision will have a significant impact on the approaches available for prevention (e.g. age limits) and treatment.

Problem Gambling in Greece: Prevalence and Risk Factors During the Financial Crisis

In Greece no study has ever been conducted on the prevalence of problem gambling. Therefore, a cross-sectional survey was carried out amid the recession aiming to (1) estimate past year prevalence of problem gambling, (2) explore socio-economic and demographic differences among gamblers and non gamblers, (3) explore socio-economic and demographic differences among gamblers who started gambling prior and during the downturn and (4) identify its risk factors with a special interest in the influence of the recession. To this end, data emanating from a telephone and patron survey were combined. A random and representative sample of 3.404 people participated in the telephone survey and 2.400 in the patron survey. The interview schedule was the same in both studies. The presence of problem gambling was assessed with the Canadian Problem Gambling Index. Information on participants' socio-economic and demographic characteristics as well as their ways of dealing financially with the crisis were collected. Findings indicated that 2.4% of respondents met criteria for problem gambling. Male gender, minority status, living with family of origin, low educational level and low to zero income were found to constitute the risk factors of the disorder. Moreover, having started gambling during the recession increased the odds of suffering from problem gambling; however this finding was gender-specific. Thus, people end up in problem gambling through various pathways, with these trajectories being different for men and women. Any intervention should address the complexity of the issue and be tailored by gender.

Gambling and Cannabis Use: Clinical and Policy Implications

Eleven US States and the District of Columbia legally allow personal (i.e., recreational) cannabis use by adults, and an additional 22 states allow use of cannabis for medicinal purposes. Of these jurisdictions, only two do not have some form of legalized gambling available (https://www.casino.org/local/guide/). In contrast to this rapid increase in legally available marijuana is the limited knowledge about the intersection of cannabis use and gambling. This paper strives to define the current status of the relevant literatures and consider the implication for future gambling research. We describe the research literature on the prevalence of cannabis use and co-existing gambling problems and the effects of cannabis use on gambling-related cognitive functions and decision-making. We also discuss clinical considerations with treating problem gamblers with a cannabis use disorder. Finally, the potential implications for responsible gambling practices and policies and the most pressing gaps in the research literature are offered.

Problem gambling and support preferences among Finnish prisoners: a pilot study in an adult correctional population

Purpose

The purpose of this paper is to explore the prevalence of potential problem gambling among Finnish prisoners; the associations between problem gambling and demographics, substance use and crime-related factors; and problem gamblers’ support preferences.

Design/methodology/approach

Prisoners (n=96) from two Finnish prisons were recruited between December 2017 and January 2018. The estimated response rate was 31 percent. Gambling problems were measured using the Brief Biosocial Gambling Screen. The participants were asked to report their gambling both for one year prior to their incarceration and for the past year. The independent variables were demographics (age, gender and marital status), substance use (alcohol, smoking and narcotics) and crime-related factors (crime type, prison type and previous sentence). Statistical significance (p) was determined using Fischer’s exact test.

Findings

Past-year pre-conviction problem gambling prevalence was 16.3 percent and past-year prevalence 15 percent. Age, gender, smoking, alcohol or illicit drug use were not associated with past-year problem gambling before sentencing. One-third of the prisoners (33.3 percent) who were sentenced for a property crime, financial crime or robbery were problem gamblers. One-quarter (24 percent) of all participants showed an interest in receiving support by identifying one or more support preferences. The most preferred type of support was group support in its all forms.

Research limitations/implications

It is recommended that correctional institutions undertake systematic screening for potential problem gambling, and implement tailored intervention programs for inmates with gambling problems.

Originality/value

This study provides a deeper understanding of problem gambling in prisons. Problem gambling is associated with crime and also seems to be linked with serving a previous sentence. Early detection and tailored interventions for problem gambling may help to reduce reoffending rates.

The diagnostic accuracy of brief screening instruments for problem gambling: A systematic review and meta-analysis

Non-gambling specialist services, such as primary care, alcohol and other drug use, and mental health services, are well placed to enhance the identification of people with gambling problems and offer appropriate generalist first level interventions or referral. Given time and resource demands, many of these clinical services may only have the capacity to administer very short screening instruments. This systematic review was conducted to provide a resource for health service providers and researchers in identifying the most accurate brief (1-5 item) screening instruments to identify problem and at-risk gambling for their specific purposes and populations. A systematic search of peer-reviewed and grey literature from 1990 to 2019 identified 25 articles for inclusion. Meta-analysis revealed five of the 20 available instruments met criteria for satisfactory diagnostic accuracy in detecting both problem and at-risk gambling: Brief Problem Gambling Screen (BPGS-2), NODS-CLiP, Problem Gambling Severity Index-Short Form (PGSI-SF), NODS-PERC, and NODS-CLiP2. Of these, the NODS-CLiP and NODS-PERC have the largest volume of diagnostic data. The Lie/Bet Questionnaire and One-Item Screen are also promising shorter options. Because these conclusions are drawn from a relatively limited evidence base, future studies evaluating the diagnostic accuracy of existing brief instruments across settings, age groups, and timeframes are needed.

Pathways connecting socioeconomic variables, substance abuse and gambling behaviour: a cross-sectional study on a sample of Italian high-school students

OBJECTIVES

The aim of this study was to elucidate the pathway of associations linking gambling, alcohol intake, smoking habit, cannabis consumption between each other and with demographic and socioeconomic variables.

SETTING AND PARTICIPANTS

A survey was conducted in 2017 on a representative sample of 15 602 Italian 14-year-olds to 17-year-olds attending 201 secondary schools.

OUTCOME MEASURES

Structural Equation Models analysis was used to assess the pathway between gambling, alcohol intake, smoking, cannabis consumption, demographics and socioeconomic factors.

RESULTS

Irrespective of socioeconomic or demographic variables, gambling is positively associated with alcohol and cannabis consumption, while cannabis consumption is predicted by smoking and by alcohol intake, smoking is predicted by alcohol intake. Adolescents with a higher weekly income are more at risk of gambling, drinking alcohol and smoking, while the degree of economic dissatisfaction was positively associated with alcohol intake, cannabis consumption and smoking. Maternal employment appeared to be positively associated with adolescents' smoking, alcohol intake and cannabis consumption.

CONCLUSIONS

This is one of the first studies to shed light on the pathways of associations connecting various health-risk behaviours among adolescents with demographic and socioeconomic factors.

Pathological personality facets and emotion (dys)regulation in gambling disorder

A number of researches showed high prevalence of personality disorders among addicted gamblers. However, there are still few studies investigating the role of pathological personality facets in Gambling Disorder (GD). Moreover, the nature of the relationship between GD and pathological personality is not clear. We administered to a group of addicted gamblers (N = 79) and a group of healthy participants (N = 101) a battery of self-report questionnaires encompassing the South Oaks Gambling Screen (SOGS), The Personality Inventory for DSM-V (PID-5), the Difficulties in Emotion Regulation Scale (DERS) and the Emotion Regulation Questionnaire (ERQ). Analyses of variance showed that addicted gamblers, compared to healthy participants, scored higher on most of the subscales of the DERS, on the Suppression Dimension of the ERQ and on the five main domains of the PID-5 whereas they obtained lower scores on the Reappraisal subscale of the ERQ. Moreover, multiple regression analyses indicated that some specific facets of pathological personality, emotion dysregulation and lack of cognitive reappraisal, significantly predict GD's severity. Finally, emotion dysregulation levels and lack of cognitive reappraisal partially mediated the relationship between these and GD's severity. Our results confirmed the central roles played by both pathological personality and deficit in emotion regulation capacities in GD. Specifically, Impulsivity, Lack of Perseverance and Suspiciousness may be important predictors of GD severity. Moreover, emotion dysregulation and lack of adaptive emotion regulation strategies partially explained such relationship. As such, training for emotion regulation abilities appears strategically useful in the treatment of addicted gamblers with pathological personality traits.

Cued for risk: Evidence for an incentive sensitization framework to explain the interplay between stress and anxiety, substance abuse, and reward uncertainty in disordered gambling behavior

Gambling disorder is an impairing condition confounded by psychiatric co-morbidity, particularly with substance use and anxiety disorders. Yet, our knowledge of the mechanisms that cause these disorders to coalesce remains limited. The Incentive Sensitization Theory suggests that sensitization of neural "wanting" pathways, which attribute incentive salience to rewards and their cues, is responsible for the excessive desire for drugs and cue-triggered craving. The resulting hyper-reactivity of the "wanting' system is believed to heavily influence compulsive drug use and relapse. Notably, evidence for sensitization of the mesolimbic dopamine pathway has been seen across gambling and substance use, as well as anxiety and stress-related pathology, with stress playing a major role in relapse. Together, this evidence highlights a phenomenon known as cross-sensitization, whereby sensitization to stress, drugs, or gambling behaviors enhance the sensitivity and dopaminergic response to any of those stimuli. Here, we review the literature on how cue attraction and reward uncertainty may underlie gambling pathology, and examine how this framework may advance our understanding of co-mordidity with substance-use disorders (e.g., alcohol, nicotine) and anxiety disorders. We argue that reward uncertainty, as seen in slot machines and games of chance, increases dopaminergic activity in the mesolimbic pathway and enhances the incentive value of reward cues. We propose that incentive sensitization by reward uncertainty may interact with and predispose individuals to drug abuse and stress, creating a mechanism through which co-mordidity of these disorders may emerge.

The use of naltrexone in pathological and problem gambling: A UK case series

BACKGROUND AND AIMS

To investigate the potential indications and adverse effects of using the opioid antagonist naltrexone to treat problem gamblers.

CASE PRESENTATION

The files of the 1,192 patients who were referred to the National Problem Gambling Clinic between January 2015 and June 2016 were audited. Seventeen patients were considered appropriate for treatment with naltrexone, having attended and failed to respond to psychological therapies at the clinic. Fourteen patients were placed on a regimen of 50 mg/day naltrexone.

DISCUSSION

Of the 14 patients who were treated with naltrexone, there were 10 for whom sufficient follow-up existed to analyze the treatment efficacy and side effects of naltrexone. Patients showed significant decreases in their craving to gamble and the majority (60%) were able to abstain completely from gambling in the treatment period, with a further 20% reducing their gambling to almost nothing. The reported side effects from the naltrexone included: loss of appetite, gastrointestinal pain, headaches, sedation, dizziness, and vivid dreams. Two patients with concurrent alcohol-use disorder relapsed during the treatment. One patient relapsed after the treatment period.

CONCLUSIONS

The study showed significant outcomes in reducing gambling cravings for the sample set. Given the design of the study as a case series, there was no control group, and a number of patients were on other psychotropic medications. We recommend care when prescribing to those suffering from concurrent alcohol-use disorder.

Problem gambling and family violence: Findings from a population-representative study

BACKGROUND AND AIMS

Few studies have investigated the association between problem gambling (PG) and violence extending into the family beyond intimate partners. This study aimed to explore the association between PG and family violence (FV) in a population-representative sample. It was hypothesized that: (a) PG would be positively associated with FV, even after adjusting for sociodemographic variables and comorbidities and (b) these relationships would be significantly exacerbated by substance use and psychological distress. A secondary aim was to explore whether gender moderated these relationships.

METHODS

Computer-assisted telephone interviews were conducted with a population-representative sample of 4,153 Australian adults.

RESULTS

Moderate-risk (MR)/problem gamblers had a 2.73-fold increase in the odds of experiencing FV victimization (21.3%; 95% CI: 13.1-29.4) relative to non-problem gamblers (9.4%; 95% CI: 8.5-10.4). They also had a 2.56-fold increase in the odds of experiencing FV perpetration (19.7%; 95% CI: 11.8-27.7) relative to non-problem gamblers (9.0%; 95% CI: 8.0-10.0). Low-risk gamblers also had over a twofold increase in the odds of experiencing FV victimization (20.0%; 95% CI: 14.0-26.0) and perpetration (19.3%; 95% CI: 13.5-25.1). These relationships remained robust for low-risk gamblers, but were attenuated for MR/problem gamblers, after adjustment for substance use and psychological distress. MR/problem gamblers had a greater probability of FV victimization, if they reported hazardous alcohol use; and low-risk gamblers had a greater probability of FV perpetration if they were female.

DISCUSSION AND CONCLUSION

These findings provide further support for routine screening, highlight the need for prevention and intervention programs, and suggest that reducing alcohol use may be important in these efforts.

Risk Factors for Problem Gambling in California: Demographics, Comorbidities and Gambling Participation

While population surveys have been carried out in numerous jurisdictions internationally, little has been done to assess the relative strength of different risk factors that may contribute to the development of problem gambling. This is an important preparatory step for future research on the etiology of problem gambling. Using data from the 2006 California Problem Gambling Prevalence Survey, a telephone survey of adult California residents that used the NODS to assess respondents for gambling problems, binary logistic regression analysis was used to identify demographic characteristics, health-related behaviors, and gambling participation variables that statistically predicted the odds of being a problem or pathological gambler. In a separate approach, linear regression analysis was used to assess the impact of changes in these variables on the severity of the disorder. In both of the final models, the greatest statistical predictor of problem gambling status was past year Internet gambling. Furthermore, the unique finding of a significant interaction between physical or mental disability, Internet gambling, and problem gambling highlights the importance of exploring the interactions between different forms of gambling, the experience of mental and physical health issues, and the development of problem gambling using a longitudinal lens.

Gambling disorder and obsessive-compulsive personality disorder: A frequent but understudied comorbidity

Background and aims Epidemiological data have suggested that the prevalence of co-occurring personality disorders is particularly high in people with gambling disorder (GD). Among the personality disorders, obsessive-compulsive personality disorder (OCPD) appears to be the most common problem. The objective of this study was to investigate the clinical presentation of GD with and without co-occurring OCPD. Methods We studied 25 subjects with current GD and lifetime diagnosis of OCPD. They were matched for age and gender with 25 individuals with current GD but no lifetime diagnosis of any personality disorder. Results Subjects with GD and OCPD demonstrated (a) lower severity of gambling symptoms, (b) slower progression from recreational gambling to full-blown GD, (c) preferred individual forms of betting, (d) identified more triggers to gambling (specially the availability of money and stress); and (e) reported less negative impact on relational problems due to GD. Conclusions Our research provides further insight on GD co-occurring with OCPD, such as increasing social support and improvement of coping skills, especially to deal with financial difficulties and stress. Our findings may lead to more customized and effective therapeutic approaches to this frequent comorbidity.

Who Are the Subjects with Gambling-Related Problems Requiring Treatment? A Study in Northern Italy

Background: This study analyzes data related to Hospital (HOS), Public Treatment Service Dedicated to Drug Addicts (SERD), or Community Mental Health Center (CMHC) clients with a first diagnosis of Pathological Gambling (PG) in the period 2000/2016 in Northern Italy. The aims were to describe trends and characteristics of pathological gamblers (PGs) and to estimate the prevalence of other diagnoses before or after the diagnosis of PG. Methods: Participants aged over 17 years with an ICD-9 or ICD-10 PG diagnosis were selected. Results: 680 PGs were identified, mean age 47.4 years, 20% female, 13% non-natives, 30% had other mental disorders diagnoses, 9% had alcohol dependence syndrome, and 11% had drug dependence. Most participants with comorbid disorders were diagnosed before PG, with a more elevated prevalence regarding mental disorders. Almost seven years had elapsed on average between the first admission and the diagnosis of PG. Conclusions: The results of this study highlight a growing demand for PG treatment addressed not only to SERD, but also to psychiatric and hospital services, based on the increase in SERD attendance from 2013. Many of them had already been treated for mental health problems before, but their percentage remained costant over time.

Pathological gambling: an overview of assessment and treatment

Pathological gambling has so far received scant attention in the psychiatric literature. It has a prevalence rate of about 1% in most countries, and with the deregulation of gambling in the UK the prevalence is set to rise here. Pathological gambling can adversely affect the individual, family and society, and also carries high rates of psychiatric comorbidity. Early identification and appropriate treatment can limit the long-term adverse consequences and improve outcome. This article reviews assessment techniques and tools, and treatment strategies for pathological gambling.

Analysis of Gambling in the Media Related to Screens: Immersion as a Predictor of Excessive Use?

This study investigates the intricacies between the player interface proposed by the screens, (in particular on smartphone applications or in video games) and gambling. Recent research indicates connections between "immersion" and excessive screen practice. We want to understand the causal-effects between online gambling and the "immersion" variable and understand their relationship and its contingencies. This article empirically investigates whether and how it is possible to observe immersion with its sub-dimensions in gambling on different screens. The objective of this study was to analyze: (1) the costs and benefits associated with gambling practice on screens (2) the link between gambling practice and screen practice (video game, Internet, mobile screen); (3) to observe the propensity to immersion for individuals practicing gambling on screens; and (4) to examine the comorbidities and cognitive factors associated with the practice of gambling on screen. A total of 432 adults (212 men, 220 women), recruited from Ile-de-France (France), responded to a battery of questionnaires. Our study suggests that immersion variables make it possible to understand the cognitive participation of individuals towards screens in general, the practice of gambling on screens and the excessive practice of screens.

Treatment of gambling disorder patients with comorbid depression

OBJECTIVE

This study was conducted to investigate and clinically assess comorbid depression and its relevance in individuals suffering from gambling disorders. The DSM-V defines the condition of gambling disorder as a persistent and recurrent problematic gambling behaviour leading to clinically significant impairment or distress.

METHOD

A total of 61 subjects with gambling disorders were assessed using the Structured Clinical Interview for the DSM-IV (SCID-I), the South Oaks Gambling Screen (SOGS) and the Major Depression inventory (MDI).

RESULTS

Two-way analysis of variance showed highly significant treatment outcomes associated with reductions in SOGS, F(1,60)=84.79, p<0.0001, MDI, F(1,60)=38.13, p<0.0001, craving, F(1,60)=29.59, p<0.0001, and gambling control, 47.65, p<0.0001. There was also a highly significant outcome associated with comorbidity in MDI, F(1,60)=9.17, p<0.0001. Finally, there was a significant interaction effect between treatment outcome and comorbidity, F(1,60)=3.90, p<0.005, suggesting that both treatment and comorbidity contributed to reductions in depressive symptoms.

CONCLUSION

These results suggest and highlights the importance and benefits of integrated treatment of gambling disorders and its comorbidity, but also stresses the importance of adequate screening and detection of these two variables.

The Relationship Between Gambling Severity and Risk of Criminal Recidivism

Individuals involved with the criminal justice system have the highest prevalence of gambling disorder. Yet, this is an understudied area, especially in relation to postrelease functioning and recidivism risk. Participants (N = 100) were recruited from a local nonprofit organization and a federal probation office. Participants completed both self-report and interviewer-administered questionnaires assessing past-year and lifetime gambling behaviors and problems, legal history, health, and risk of recidivism. Past-year (8%) and lifetime (18%) rates of gambling disorder among the current sample are significantly greater than those of the general population and similar to rates found in incarcerated populations. Furthermore, 13% of individuals reported a direct relationship between their gambling and crime, and analyses revealed that increased gambling severity was a significant predictor of increased recidivism risk. Results suggest the need for screening and intervention efforts and call for policy reform among incarcerated and ex-offender populations.

Comorbidity of Alcohol and Gambling Problems in Emerging Adults: A Bifactor Model Conceptualization

Addictive disorders, such as pathological gambling and alcohol use disorders, frequently co-occur at greater than chance levels. Substantive questions stem from this comorbidity regarding the extent to which shared variance between gambling and alcohol use reflects a psychological core of addictive tendencies, and whether this differs as a function of gender. The aims of this study were to differentiate both common and unique variance in alcohol and gambling problems in a bifactor model, examine measurement invariance of this model by gender, and identify substantive correlates of the final bifactor model. Undergraduates (N = 4475) from a large northwestern university completed an online screening questionnaire which included demographics, quantity of money lost and won when gambling, the South Oaks Gambling Screen, the AUDIT, gambling motives, drinking motives, personality, and the Brief Symptom Inventory. Results suggest that the bifactor model fit the data well in the full sample. Although the data suggest configural invariance across gender, factor loadings could not be constrained to be equal between men and women. As such, general and specific factors were examined separately by gender with a more intensive subsample of females and males (n = 264). Correlations with motivational tendencies, personality traits, and mental health symptoms indicated support for the validity of the bifactor model, as well as gender-specific patterns of association. Results suggest informative distinctions between shared and unique attributes related to problematic drinking and gambling.

Nonmedical Prescription Stimulant Use Among Girls 10-18 Years of Age: Associations With Other Risky Behavior

PURPOSE

Little is known about the risk factors for nonmedical use (NMU) of prescription stimulants among adolescent girls. We aimed to measure the association of nonmedical prescription stimulant use with empirically linked risk factors, including weight control behavior (WCB), gambling, and depressed mood, in pre-teen and teenaged girls.

METHODS

We assessed the relationship between age and race, gambling, WCB, depressive mood, and nonmedical prescription stimulant use using multivariable logistic regression. The study sample included 5,585 females, aged 10-18 years, recruited via an entertainment venue intercept method in 10 U.S. metropolitan areas as part of the National Monitoring of Adolescent Prescription Stimulants Study (2008-2011).

RESULTS

NMU of prescription stimulants was reported by 6.6% (n = 370) of the sample. In multivariable logistic regression, 1-year increase in age was associated with a 21% (95% confidence interval [CI]: .15, .28) increase in risk for NMU. Whites and other race/ethnicity girls had 2.67 (CI: 1.85, 3.87) and 1.71 (1.11, 2.65) times higher odds for NMU, compared to African-Americans. Depressive mood (adjusted odds ratio: 2.69, CI: 2.04, 5.57) and gambling (adjusted odds ratio: 1.90, 1.23, 2.92) were associated with increased odds for NMU. A dose-response was identified between WCB and NMU, where girls with unhealthy and extreme WCB were over five times more likely to endorse NMU.

CONCLUSIONS

We contribute to the literature linking WCB, depression, gambling, and the NMU of prescription stimulants in any population and uniquely do so among girls.

Relationships Between Problem-Gambling Severity and Psychopathology as Moderated by Income

Background and aims Problem and pathological gambling have been associated with elevated rates of both Axis-I and Axis-II psychiatric disorders. Although both problem gambling and psychiatric disorders have been reported as being more prevalent among lower income vs. middle/higher income groups, how income might moderate the relationship between problem-gambling severity and psychopathology is incompletely understood. To examine the associations between problem-gambling severity and psychopathology in lower income and middle/higher income groups. Methods Data from the first wave of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) (n = 43,093) were analyzed in adjusted logistic regression models to investigate the relationships between problem-gambling severity and psychiatric disorders within and across income groups. Results Greater problem-gambling severity was associated with increased odds of multiple psychiatric disorders for both lower income and middle/higher income groups. Income moderated the association between problem/pathological gambling and alcohol abuse/dependence, with a stronger association seen among middle/higher income respondents than among lower income respondents. Discussion and conclusions The findings that problem-gambling severity is related to psychopathology across income groups suggest a need for public health initiatives across social strata to reduce the impact that problem/pathological gambling may have in relation to psychopathology. Middle/higher income populations, perhaps owing to the availability of more "disposable income," may be at greater risk for co-occurring gambling and alcohol-use psychopathology and may benefit preferentially from interventions targeting both gambling and alcohol use.

Association of Pathological Gambling with Depression in Scotland

As most research concerning gambling and depression has been conducted on clinical populations, the present study examined the relationship between gambling and depression across a large sample in Scotland in higher education and the community. A questionnaire-based cluster design involved the distribution of the South Oaks Gambling Screen and the Centre for Epidemiologic Studies Depression Scale mainly to students and staff of higher educational establishments, with small community and gambling samples also included. Thirty-seven colleges and universities across Scotland participated in the research, with a sample of 2,259 people aged sixteen years of age or over ( M = 28.9 yr., SD = 13.4) being obtained. It was found that past-year probable pathological gamblers had significantly higher depression than problem gamblers, nonproblem gamblers, and nongamblers. However, when probable pathological gamblers who had sought treatment were omitted from the analysis, the nontreatment-seeking probable pathological gambling group no longer had significantly higher depression than the problem gambling group. Female problem and probable pathological gamblers had particularly high depressive symptomatology, suggesting comorbid depression may be a prominent feature of problematic female gambling.

Problem Gambling and the Youth-to-Adulthood Transition: Assessing Problem Gambling Severity Trajectories in a Sample of Young Adults

In this study, using four wave longitudinal data, we examined problem gambling severity trajectories in a sample of young adults. Using latent growth curve modeling, we examined how initial level of problem gambling severity and the rate of change were affected by 11 time-invariant predictors: gender, age of onset of gambling, experiencing a big win early in gambling career, experiencing a big loss early in gambling career, alcohol dependence, drug dependence, anxiety, depression, perceived social support, illusion of control, and impulsiveness. Five of the eleven predictors affected initial levels of problem gambling severity; however only impulsiveness affected the rate of change across time. The mean trajectory was negative (lessening of problem gambling risk severity across time), but there was significant inter-individual variation in trajectories and initial levels of problem gambling severity. The main finding of problem gambling risk diminishing over time challenges the conventional picture of problem gambling as an inevitable "downward spiral," at least among young adults, and suggests that targeted prevention campaigns may be a cost-effective alternative for reaching treatment resistant youth.

Investigating Veterans' Pre-, Peri-, and Post-Deployment Experiences as Potential Risk Factors for Problem Gambling

Background and aims Gambling disorder and its comorbid diagnoses are observed at higher rates in military veterans than in the general population. A significant research gap exists regarding the relationships of veterans' life and service experiences to problematic gambling. The present study explored pre-, peri-, and post-deployment factors associated with problem gambling in veterans. Methods Veterans of Operation Iraqi Freedom, Operation Enduring Freedom, and Operation New Dawn (n = 738; 463 males, and 275 females) completed questionnaires via structured telephone interview. We conducted bivariate and multinomial logistic regression analyses exploring associations among problem-gambling severity and socio-demographic variables, psychiatric comorbidities, and 10 scales of the Deployment Risk and Resilience Inventory measuring experiences pre-, peri-, and post-deployment. Results Approximately 4.2% of veterans indicated at-risk or probable pathological gambling (ARPG) post-deployment (two or more DSM-IV criteria for pathological gambling). Bivariate analyses found more severe gambling in males, higher frequencies of post-traumatic stress disorder, substance dependence, traumatic brain injury, panic disorder, and depression in veterans with ARPG, and higher general harassment during deployment, and lower social support and more stressful life events post-deployment in those with ARPG. In multivariable models, both post-deployment factors remained significantly associated with ARPG. Discussion The study suggests that problem gambling among veterans is related to service experiences, and particularly to life experiences post-deployment. Conclusions Adverse service and life experiences and lack of social support may contribute to the risk of problem gambling in military veterans. Investigation of how Veterans Affairs clinical settings may serve veterans following deployment to prevent behavioral addictions is warranted.

Anxiety, Gambling Activity, and Neurocognition: A Dimensional Approach to a Non-Treatment-Seeking Sample

Background and aims Previous analyses have highlighted significant associations between gambling disorder (GD)/subsyndromal GD and increased rates of anxiety symptoms and anxiety disorders relative to the general population. However, less is known about how anxiety symptoms influence the clinical presentation of gambling problems. The objective of this study was to evaluate the association between anxiety symptoms, gambling activity, and neurocognition across the spectrum of gambling behavior. Methods The sample consisted of 143 non-treatment-seeking young adults (aged 18-29 years), in which 63 individuals (44.1%) were classified as recreational gamblers, 47 (32.9%) as having subsyndromal GD, and 33 (23.1%) met criteria for GD. Results The main findings were: (a) there was a positive correlation between anxiety severity and gambling severity measured by the number of DSM-5 GD criteria met; (b) there was a positive correlation between anxiety severity and attentional impulsiveness; (c) subjects with suicidality presented higher levels of anxiety; and (d) the severity of anxiety symptoms was negatively correlated with the quality of life. Discussion and conclusions This study suggests that anxiety may be associated with relevant clinical variables in the broad spectrum of gambling activity. Therefore, proper management of anxiety symptoms might improve the clinical presentation of gamblers in different areas.

A dangerous cocktail: Alcohol consumption increases suicidal ideations among problem gamblers in the general population

The current research examined whether alcohol consumption exacerbates suicidal ideations among gamblers in the general population. While prior research suggests problem gambling severity and excessive alcohol consumption are unique predictors of suicidal behaviors, the extant literature as almost exclusively focused on gamblers in treatment. This represents a significant gap in the literature as less than 10% of gamblers seek treatment. Furthermore, gamblers in treatment are not representative of gamblers in the general population, precluding a simple generalization of research findings. We address this gap using data obtained from the Canadian Community Health Survey (Cycle 4.1)--a cross-sectional national survey that assesses health-related information among the Canadian population. To this end, we conducted a moderation analysis with problem gambling severity as the independent variable, weekly alcohol consumption as the moderator variable and suicidal ideations (in the past 12 months) as the dependent variable. The results found that alcohol consumption alone did not reliably predict suicidal ideation among gamblers who did not gamble problematically. However, as predicted, the odds of suicidal ideation were greatest among problem gamblers who frequently consumed alcohol. Thus, it may behoove policy makers to re-visit the availability of alcohol in gambling venues. Moreover, responsible gambling-oriented education initiatives may be advanced by informing gamblers about the increased risk of suicidal ideations when problematic gambling is combined with frequent alcohol consumption.

The Prevalence of Comorbid Personality Disorders in Treatment-Seeking Problem Gamblers: A Systematic Review and Meta-Analysis

The aim of this study was to systematically review and meta-analyze the prevalence of comorbid personality disorders among treatment-seeking problem gamblers. Almost one half (47.9%) of problem gamblers displayed comorbid personality disorders. They were most likely to display Cluster B disorders (17.6%), with smaller proportions reporting Cluster C disorders (12.6%) and Cluster A disorders (6.1%). The most prevalent personality disorders were narcissistic (16.6%), antisocial (14.0%), avoidant (13.4%), obsessive-compulsive (13.4%), and borderline (13.1%) personality disorders. Sensitivity analyses suggested that these prevalence estimates were robust to the inclusion of clinical trials and self-selected samples. Although there was significant variability in reported rates, subgroup analyses revealed no significant differences in estimates of antisocial personality disorder according to problem gambling severity, measure of comorbidity employed, and study jurisdiction. The findings highlight the need for gambling treatment services to conduct routine screening and assessment of co-occurring personality disorders and to provide treatment approaches that adequately address these comorbid conditions.

Mood as Representation of Momentum

Experiences affect mood, which in turn affects subsequent experiences. Recent studies suggest two specific principles. First, mood depends on how recent reward outcomes differ from expectations. Second, mood biases the way we perceive outcomes (e.g., rewards), and this bias affects learning about those outcomes. We propose that this two-way interaction serves to mitigate inefficiencies in the application of reinforcement learning to real-world problems. Specifically, we propose that mood represents the overall momentum of recent outcomes, and its biasing influence on the perception of outcomes ‘corrects’ learning to account for environmental dependencies. We describe potential dysfunctions of this adaptive mechanism that might contribute to the symptoms of mood disorders.

With increasing use of computational models to understand human behavior, scientists have begun to model the dynamics of subjective states such as mood.

Recent data suggest that mood reflects the cumulative impact of differences between reward outcomes and expectations.

Behavioral and neural findings suggest that mood biases the perception of reward outcomes such that outcomes are perceived as better when one is in a good mood relative to when one is in a bad mood.

These two lines of research establish a bidirectional interaction between mood and reinforcement learning, which may play an important adaptive role in healthy behavior, and whose dysfunction might contribute to psychiatric disorders.

Prevalence of psychiatric co-morbidity in treatment-seeking problem gamblers: A systematic review and meta-analysis

OBJECTIVE

The aim of this paper was to systematically review and meta-analyse the prevalence of co-morbid psychiatric disorders (DSM-IV Axis I disorders) among treatment-seeking problem gamblers.

METHODS

A systematic search was conducted for peer-reviewed studies that provided prevalence estimates of Axis I psychiatric disorders in individuals seeking psychological or pharmacological treatment for problem gambling (including pathological gambling). Meta-analytic techniques were performed to estimate the weighted mean effect size and heterogeneity across studies.

RESULTS

Results from 36 studies identified high rates of co-morbid current (74.8%, 95% CI 36.5-93.9) and lifetime (75.5%, 95% CI 46.5-91.8) Axis I disorders. There were high rates of current mood disorders (23.1%, 95% CI 14.9-34.0), alcohol use disorders (21.2%, 95% CI 15.6-28.1), anxiety disorders (17.6%, 95% CI 10.8-27.3) and substance (non-alcohol) use disorders (7.0%, 95% CI 1.7-24.9). Specifically, the highest mean prevalence of current psychiatric disorders was for nicotine dependence (56.4%, 95% CI 35.7-75.2) and major depressive disorder (29.9%, 95% CI 20.5-41.3), with smaller estimates for alcohol abuse (18.2%, 95% CI 13.4-24.2), alcohol dependence (15.2%, 95% CI 10.2-22.0), social phobia (14.9%, 95% CI 2.0-59.8), generalised anxiety disorder (14.4%, 95% CI 3.9-40.8), panic disorder (13.7%, 95% CI 6.7-26.0), post-traumatic stress disorder (12.3%, 95% CI 3.4-35.7), cannabis use disorder (11.5%, 95% CI 4.8-25.0), attention-deficit hyperactivity disorder (9.3%, 95% CI 4.1-19.6), adjustment disorder (9.2%, 95% CI 4.8-17.2), bipolar disorder (8.8%, 95% CI 4.4-17.1) and obsessive-compulsive disorder (8.2%, 95% CI 3.4-18.6). There were no consistent patterns according to gambling problem severity, type of treatment facility and study jurisdiction. Although these estimates were robust to the inclusion of studies with non-representative sampling biases, they should be interpreted with caution as they were highly variable across studies.

CONCLUSIONS

The findings highlight the need for gambling treatment services to undertake routine screening and assessment of psychiatric co-morbidity and provide treatment approaches that adequately manage these co-morbid disorders. Further research is required to explore the reasons for the variability observed in the prevalence estimates.

Smoking and Gambling Disorder: Does Tobacco Use Influence Treatment Outcome?

The purpose of this study was to verify whether tobacco use influenced treatment outcome in a population of treatment seeking individuals with gambling disorder. Gambling disorder is defined as persistent and maladaptive gambling behaviour which meets four or more outlined criteria in the DSM-5. Tobacco use is the most frequent comorbidity with gambling disorder. A total of 676 treatment seeking individuals with gambling disorder were assessed at the National Problem Gambling Clinic in London. We analysed differences in socio-demographic, clinical and gambling variables between smokers and non-smokers and the relation between smoking behaviour and treatment completion and outcome. 46.4% (314) of our sample were daily tobacco users and were significantly younger, less likely to be in a stable relationship, more likely to be unemployed and have a lower education level. They were also significantly more likely to score higher on the AUDIT-C score and were significantly more likely to have used drugs in the last 30 days. There was no significant difference in PGSI score between smokers and non-smokers. We found that tobacco smokers did not have higher PGSI scores than non-smokers. Moreover, there was no significant difference between tobacco users and nonusers in terms of treatment completion and treatment outcome.

A study investigating the association between compulsive buying with measures of anxiety and obsessive-compulsive behavior among internet shoppers

BACKGROUND

Compulsive buying is a chronic, repetitive behavior that becomes a primary response to negative events and feelings. Compulsive buyers are obsessed by buying and their behavior occurs in response to negative emotions and results in a decrease in the intensity of negative emotions. Euphoria or relief from negative emotions is the most common consequence of compulsive buying. A large number of studies have investigated the association between compulsive buying and anxiety, and some studies have used the Spielberger trait-state anxiety inventory.

PROCEDURE

Compulsive buying, state and trait anxiety and general obsessive-compulsive measures were assessed among 120 habitual internet shoppers (2+ times a week, 70 men and 50 women).

RESULTS

Results showed that Edwards Compulsive Buying scale measures were associated with Spielberger trait and not state anxiety measures. Spielberger Trait anxiety measures were also correlated with measures of Yale-Brown Obsessive-Compulsive scale (Y-Bocs). Finally, there were no sex differences in this sample.

CONCLUSIONS

The results of this study support existing evidence for an association between compulsive buying and anxiety and they will be discussed in view of current research on comorbidity of behavioural addiction.

Sleepiness and cognition in young adults who gamble and use alcohol

BACKGROUND AND AIMS

Past research suggests that sleep problems are associated with increased risky decision-making. Similarly, gambling disorder and alcohol use disorder are also associated with increased risky decision-making. Individuals with gambling disorder or alcohol use disorder have also reported higher rates of sleep problems compared to normal healthy controls. As such, we sought to examine whether sleep problems play a role in the development of alcohol use disorder or gambling disorder.

METHODS

One hundred and forty-one individuals who gamble and use alcohol, yet do not meet criteria for gambling disorder or alcohol use disorder, were assessed to determine the correlation between sleepiness, amount of sleep obtained, decision-making, and alcohol or gambling behaviors.

RESULTS

Our results suggest that inconsistent sleep patterns may be associated with increased frequency of alcohol use and gambling. We did not, however, find a significant correlation between sleep factors and decision-making.

DISCUSSION

Further research is needed to examine the specific relationship between sleep patterns and alcohol use and gambling frequency. Overall these data suggest that sleepiness or sleep and risky decision-making is not a significant factor in gambling and alcohol use behaviors in individuals not meeting criteria for alcohol use disorder or gambling disorder.

Risk perception in gambling: a systematic review

Perception of the consequences of risk affects motivation and behaviour. In gambling, distorted expectations and preferences towards outcomes are associated with significant social and clinical harms. A systematic review was conducted to examine the relationship between gambling risk perception and behaviour. Sixteen studies met inclusion criteria. Studies provided evidence that disordered gamblers hold both more optimistic overall perceptions of risk, and a mixture of more positive and more negative specific outcome expectations. Preliminary evidence suggests a range of contextual and individual differences moderate risk perception affecting decision-making. Disordered gamblers appear to sustain motivation to gamble, despite more negative expectations and experiences, via cognitive processes that result in preferential emphasis on positive over negative outcomes. Given potential differences in the perception of risk between various categories of gamblers, clinicians should take into account how gamblers in treatment view gambling as a risky behaviour. Improving the accuracy of such perceptions may reduce the propensity for risk-taking behaviours.

Pathological gambling subtypes: A comparison of treatment-seeking and non-treatment-seeking samples from Brazil and Canada

BACKGROUND

Pathological gambling (PG) is a heterogeneous disorder. The identification and characterization of PG subtypes could lead to tailored treatment approaches, which may, in turn, improve treatment outcomes.

OBJECTIVE

To investigate PG subtypes based on personality traits across two different cultural and clinical settings. Consistent with the Pathways Model, we hypothesized the presence of three subtypes (behaviorally conditioned - BC, emotionally vulnerable - EV, and antisocial impulsivist - AI).

METHODS

140 PG adults from São Paulo, Brazil (SP sample) and 352 adults with PG (n=214) or sub-clinical PG (n=138) from Toronto, Canada (TO sample) completed the Temperament and Character Inventory (TCI). Latent-class analysis was used to investigate subtypes.

RESULTS

A 2-class solution was the best model for the pooled SP and TO samples. Class 1 presented a normative personality profile and was composed exclusively of participants from Toronto (BC subtype). Class 2 was characterized by high novelty seeking, high harm avoidance, and low self-directedness, and included participants from both SP and TO (EV subtype). When sub-clinical PGs were excluded from the analysis, a single-class solution better characterized the SP and TO samples.

CONCLUSIONS

Our results suggest that PG severity, rather than community or clinical settings, may have an effect on PG subtypes. The generalizability of the results is limited by the demographic and clinical features of the selected samples. Future neurobiological studies may contribute to the categorization of subjects into PG subtypes based on different underlying biological pathways.

A direct, controlled, blind family study of DSM-IV pathological gambling

OBJECTIVE

Pathological gambling is a major public health problem. We sought to examine the familiality of pathological gambling and determine patterns of familial aggregation of disorders.

METHOD

We assessed probands with DSM-IV pathological gambling, controls, and their first-degree relatives. Detailed family history information was collected on relatives who were deceased or unavailable.

RESULTS

Ninety-five pathological gambling probands, 91 controls, and their 1,075 first-degree relatives over age 18 (537 relatives of pathological gambling probands, 538 relatives of controls) were evaluated between February 2005 and June 2010. Relatives were assessed blind to proband status. Best estimate diagnoses were assigned. Rates of lifetime pathological gambling (definite/probable) was significantly greater among the first-degree relatives of probands with pathological gambling than among comparison relatives (11% vs 1%, OR = 8.19, P < .001). The prevalence of pathological gambling and subclinical pathological gambling combined was 16% and 3% in case and control relatives, respectively (OR = 6.57, P < .001). Pathological gambling relatives had higher rates of major depression (OR = 1.49, P < .05), bipolar disorder (OR = 3.82, P < .05), any mood disorder (OR = 1.59, P < .05), social anxiety disorder (OR = 4.76, P < .01), any substance use disorder (OR = 1.47, P < .05), posttraumatic stress disorder (OR = 2.59, P < .05), and antisocial personality disorder (OR = 3.72, P < .001). Antisocial personality disorder (OR = 3.12, P < .01), social anxiety disorder (OR = 4.15, P < .01), and posttraumatic stress disorder (OR = 2.85, P < .05) were more frequent in case relatives independent of the presence of pathological gambling. Age at onset of pathological gambling in case probands (< 40 years/≥ 40 years) was not related to familiality in their first-degree relatives (OR = 1.03, P = .927).

CONCLUSIONS

Pathological gambling is familial. Mood and substance use disorders may emerge as a consequence of the pathological gambling or as a more complex syndrome. In contrast, antisocial personality disorder, social anxiety disorder, and posttraumatic stress disorder may share a common familial etiology with pathological gambling. The phenotype may extend beyond pathological gambling to include subclinical forms of the disorder.

Psychiatric co-morbidity in problem and pathological gamblers: investigating the confounding influence of alcohol use disorder

Pathological gambling is known to be associated with a higher than average prevalence of psychological co-morbidities including a range of psychiatric conditions. A problem with much of this literature, however, is that such problems are also frequently found in populations affected by alcohol use disorder, which is common in populations of pathological gamblers. Accordingly, the principal aim of this study was to profile the comorbidities present in a sample of pathological gamblers, comparing those who did, and did not, additionally meet criteria for alcohol use disorder. A sample of 140 community-recruited regular gamblers completed a number of measures including the Mini International Neuropsychiatric Interview, the Personality Diagnostic Questionnaire, NORC DSM-IV Screen Self-Administered and the Alcohol Use Disorders Identification Test. Comparisons showed that most psychiatric conditions (and in particular personality disorders) were significantly more prevalent in those with a dual diagnosis, followed by problem gamblers and then by those with neither disorder. This suggests that high rates of psychiatric illness in pathological gambling may be strongly influenced by co-occurring alcohol problems.