Pathological gambling and substance misuse: a review of the literature

The steroidogenic inhibitor finasteride reverses pramipexole-induced alterations in probability discounting

Pramipexole is a potent agonist of D₃ and D₂ dopamine receptors, currently approved for clinical use in Parkinson's disease (PD) and restless leg syndrome. Several studies have shown that pramipexole significantly increases the risk of pathological gambling and impulse-control disorders. While these iatrogenic complications can impose a severe social and financial burden, their treatment poses serious clinical challenges. Our group previously reported that the steroidogenic inhibitor finasteride reduced pathological gambling severity in PD patients who developed this complication following pramipexole treatment. To study the mechanisms underlying these effects, here we tested the impact of finasteride in a rat model of pramipexole-induced alterations of probability discounting. We previously showed that, in rats exposed to low doses of the monoamine-depleting agent reserpine (1mg/kg/day, SC), pramipexole (0.3mg/kg/day, SC) increased the propensity to engage in disadvantageous choices. This effect was paralleled by a marked D₃ receptor upregulation in the nucleus accumbens. First, we tested how finasteride (25-50mg/kg, IP) intrinsically affects probability discounting. While the highest dose of finasteride produced a marked lack of interest in lever pressing (manifested as a significant increase in omissions), the 25mg/kg (IP) dose did not intrinsically modify probability discounting. However, this finasteride regimen significantly reduced the adverse effects of reserpine and pramipexole in probability discounting by diminishing rats' propensity to engage in highly disadvantageous probabilistic choices. The same regimen also reversed the upregulation of D₃ receptors in the nucleus accumbens induced by reserpine and pramipexole. These findings confirm that finasteride opposes the impulsivity caused by pramipexole and suggest that this effect may be underpinned by a normalizing effect on D₃ receptor expression in the nucleus accumbens.

Gambling and substance use: Comorbidity and treatment implications

Gambling disorder is a common condition that was previously listed as an impulse control disorder, but is now considered a substance-related and addictive disorder. Gambling disorder has been associated with various untoward long-term outcomes including impaired quality of life, relationship break-ups, debt and mortgage foreclosure, and elevated risk of suicidality. This paper provides a concise primer on gambling disorder, with a special focus on its parallels with substance use disorders. We consider clinical presentations, comorbid expression, heritability, and treatment approaches (psychological and pharmacological). Lastly, we highlight new treatment directions suggested by the literature.

Italian Adolescent Gambling Behaviour: Psychometric Evaluation of the South Oaks Gambling Screen: Revised for Adolescents (SOGS-RA) among a sample of Italian students

Since no Italian validated instrument focuses specifically on the measurement of pathological gambling in very young people, with this study, we aim to adapt an international instrument (SOGS-RA) and assess its psychometric properties in a sample (n = 14.910) of young Italian students aged between 15 and 19 years. Cross-cultural adaptation of the instrument was performed through translation, synthesis of translation, back-translation, expert committee review, and pre-testing. The kappa statistic for test-retest concordance ranged from 0.53 to 0.80. Internal validity was assessed by the MCA that identified one principal component with eigenvalue equal to 3,875: the Divgi index and very simple structure analysis also pointed out one common factor, so uni-dimensionality of the SOGS-RA was accepted. Moreover the SOGS-RA was found to have acceptable internal consistency (α = 0.780). Cronbach's alpha was also assessed separately among males and females (respectively 0.786 and 0.707). The SOGS-RA was assessed in relation to gambling frequency, alcohol and drug use: Chi squared test revealed a strong association both for males and females with gambling frequency (p value ≤ 0.0001), frequent use of illicit drugs (for each drug p value ≤ 0.0001) and having had 3 or more occasions of binge drinking in the last month (p value ≤ 0.0001). At the end we can say that, the results of our study suggest that the SOGS-RA screen may be useful to assess at-risk or problem gambling for both genders in comprehensive youth surveys.

Decoding Problem Gamblers' Signals: A Decision Model for Casino Enterprises

The aim of the present study is to offer a validated decision model for casino enterprises. The model enables those users to perform early detection of problem gamblers and fulfill their ethical duty of social cost minimization. To this end, the interpretation of casino customers' nonverbal communication is understood as a signal-processing problem. Indicators of problem gambling recommended by Delfabbro et al. (Identifying problem gamblers in gambling venues: final report, 2007) are combined with Viterbi algorithm into an interdisciplinary model that helps decoding signals emitted by casino customers. Model output consists of a historical path of mental states and cumulated social costs associated with a particular client. Groups of problem and non-problem gamblers were simulated to investigate the model's diagnostic capability and its cost minimization ability. Each group consisted of 26 subjects and was subsequently enlarged to 100 subjects. In approximately 95% of the cases, mental states were correctly decoded for problem gamblers. Statistical analysis using planned contrasts revealed that the model is relatively robust to the suppression of signals performed by casino clientele facing gambling problems as well as to misjudgments made by staff regarding the clients' mental states. Only if the last mentioned source of error occurs in a very pronounced manner, i.e. judgment is extremely faulty, cumulated social costs might be distorted.

An exploratory examination of marijuana use, problem-gambling severity, and health correlates among adolescents

BACKGROUND AND AIMS

Gambling is common in adolescents and at-risk and problem/pathological gambling (ARPG) is associated with adverse measures of health and functioning in this population. Although ARPG commonly co-occurs with marijuana use, little is known how marijuana use influences the relationship between problem-gambling severity and health- and gambling-related measures.

METHODS

Survey data from 2,252 Connecticut high school students were analyzed using chi-square and logistic regression analyses.

RESULTS

ARPG was found more frequently in adolescents with lifetime marijuana use than in adolescents denying marijuana use. Marijuana use was associated with more severe and a higher frequency of gambling-related behaviors and different motivations for gambling. Multiple health/functioning impairments were differentially associated with problem-gambling severity amongst adolescents with and without marijuana use. Significant marijuana-use-by-problem-gambling-severity-group interactions were observed for low-average grades (OR = 0.39, 95% CI = [0.20, 0.77]), cigarette smoking (OR = 0.38, 95% CI = [0.17, 0.83]), current alcohol use (OR = 0.36, 95% CI = [0.14, 0.91]), and gambling with friends (OR = 0.47, 95% CI = [0.28, 0.77]). In all cases, weaker associations between problem-gambling severity and health/functioning correlates were observed in the marijuana-use group as compared to the marijuana-non-use group.

CONCLUSIONS

Some academic, substance use, and social factors related to problem-gambling severity may be partially accounted for by a relationship with marijuana use. Identifying specific factors that underlie the relationships between specific attitudes and behaviors with gambling problems and marijuana use may help improve intervention strategies.

An analysis of problem gambling among the Finnish working-age population: a population survey

Background

Gambling problems currently affect approximately 100 000 Finns. In order to prevent and reduce gambling-related harms it is crucial for the Finnish public health authorities to gain a stronger understanding of the association between gambling problems and related socio-demographic factors, other commonly co-occurring dependencies (e.g. alcohol and nicotine) and the type of games gambled. In this article the prevalence of problem gambling in Finland and the socio-demographic profiles of problem gamblers are studied.

Method

An annual postal survey entitled Health Behaviour and Health among the Finnish Adult Population AVTK was sent to a random sample of Finnish adults (N=5000) aged between 15 and 64. The sample was derived from the Finnish Population Register. The survey was mailed to the participants in April 2010. Gender differences in socio-demographic variables and Problem Gambling Severity Index PGSI were assessed. A multinomial regression model was created in order to explore the association between socio-demographic factors and the severity of gambling.

Results

A total of 2826 individuals (1243 males and 1583 females) replied to the survey. Of the respondents, 1.1% (2.1% of males, 0.3% of females) were identified as problem gamblers. Those who were of younger age, gender, had less than twelve years of education, consumed alcohol at risk level and smoked had higher odds of having low or moderate levels of gambling problems. Whereas, unemployment and smoking predicted significantly for problem gambling. Females gambled Lotto and slot machines less frequently than males and had more low level gambling problems. Males gambled more with a higher frequency and had a more severe level of gambling problems. Females were more attracted to scratch card gambling and daily Keno lotteries compared to males. In comparison, males gambled more on internet poker sites than females. Overall, a high frequency of gambling in Lotto, daily lotteries, slot machines, horse race betting and internet gambling was significantly associated with a more severe level of problem gambling.

Conclusion

Gambling problems affect tens of thousands of individuals annually, therefore certain vulnerabilities should be noted. Comorbid dependencies, smoking in particular, ought to be screened for and recognised in the public health sector. Regulating the availability of slot machine gambling and enforcement of the age limit should be acknowledged. In establishing new gambling venues, prevalence rates in those particular areas should be actively monitored.

Illicit drug use and problem gambling

Problem gambling, substance use disorders, and their cooccurrence are serious public health concerns. We conducted a comprehensive review of the literature to understand the present state of the evidence on these coaddictions. Our main focus was illicit drug use rather than misuse of legal substances. The review covers issues related to gambling as a hidden problem in the illicit drug use community; prevalence, problem gambling, and substance use disorders as kindred afflictions; problem gambling as an addiction similar to illicit drug use; risk factors and problems associated with comorbidity, and gender issues. We end with some suggestions for future research.

Prevalence of the addictions: a problem of the majority or the minority?

An increasing number of research studies over the last three decades suggest that a wide range of substance and process addictions may serve similar functions. The current article considers 11 such potential addictions (tobacco, alcohol, illicit drugs, eating, gambling, Internet, love, sex, exercise, work, and shopping), their prevalence, and co-occurrence, based on a systematic review of the literature. Data from 83 studies (each study n = at least 500 subjects) were presented and supplemented with small-scale data. Depending on which assumptions are made, overall 12-month prevalence of an addiction among U.S. adults varies from 15% to 61%. The authors assert that it is most plausible that 47% of the U.S. adult population suffers from maladaptive signs of an addictive disorder over a 12-month period and that it may be useful to think of addictions as due to problems of lifestyle as well as to person-level factors.

Correlates of gambling-related problems among older adults in Ontario

Although the literature suggests that gambling among older adults is influenced by unique age-related factors, there is little information on the factors associated with the experience of gambling-related problems among older adults. The purpose of this study was to identify the sociodemographic health determinants and mental health-related problems, including alcohol and drug dependence, that are associated with the experience of gambling problems among older adults in Ontario. The research was an exploratory analysis of data from Ontario adults, aged 55 and over, who completed the Canadian Community Health Survey -Mental Health and Well-being, Cycle 1.2 (1,904 males and 2,622 females). Logistic regression analyses were conducted to identify sociodemographic, gambling behaviour, and mental health correlates of the experience of any gambling-related problems, as identified by responses to the Canadian Problem Gambling Index. Being married or living common law and having a higher education level were associated with reduced risk of gambling problems. Among mental health variables, alcohol dependence and any substance dependence significantly increased the odds of reporting a gambling problem. Gambling behaviour measures, such as more frequent gambling, participating in more types of gambling, and spending more on gambling were significant correlates of gambling problems.

Substitute addiction: a concern for researchers and practitioners

An understanding of the role of substitute addictions remains unclear. This article examines the range and possible reward functions of substitute addictions. We suggest that prevention education and treatment need to take into account substitute addictions as an influential aspect ofrecovery. Research is needed to better understand the prevalence and functions of, and solutions to substitute addictions.

Mapping the prevalence of problem gambling and its association with treatment accessibility and proximity to gambling venues

This study examined geographic variation in the prevalence of problem gambling in Ontario and the association with various demographic factors and proximity to treatment for problem gambling and gambling venues. Drawing upon multiple sources, secondary data analysis was undertaken based on multivariate statistical methods and techniques of geographic information systems (GIS). Regional variation in prevalence of problem gambling was found in the province. P revalence of problem gambling was associated with many demographic characteristics, as well as mental disorders, co-occurring substance abuse problems, and physical health status. Geographic access to treatment was not associated with the risk of being a problem gambler. However, proximity to gambling venues was marginally important in predicting risk of problem gambling. Results are interpreted in the context of needs-based planning of treatment and prevention programs for problem gambling.

Indicated prevention of problem gambling among college students

This research provides a brief qualitative description of the development of an indicated prevention intervention for college student gamblers. The proposed intervention integrates alcohol prevention strategies with elements of gambling treatment. The intervention combines cognitive-behavioral skills-training and motivational interviewing and includes personalized normative feedback, cognitive correction, discussion of gambling consequences, and relapse prevention techniques. Examples detailing all phases of the intervention are provided from interviews conducted in a pilot of the intervention. Preliminary pilot data suggests the intervention shows promise in reducing high risk gambling among college students.

On a roll: the process of initiation and cessation of problem gambling among adolescents

As gambling becomes more accessible and acceptable in society, problems associated with gambling and gaming have begun to affect ever increasing numbers of adolescents. Although restricted from most forms of gambling by law, many adolescents are finding a path into problem gambling. Some are becoming compulsive gamblers early in their gambling career, facing a future filled with consequences and problems. Understanding the pathway or process by which these adolescents become engaged in gambling behavior and how they can extricate themselves from this addictive behavior can enhance the efficiency and effectiveness of our interventions. This article offers a perspective on the initiation and cessation of compulsive gambling using the basic elements of the process of intentional behavior change outlined in the Stages of Change from the Transtheoretical Model. The process of initiation of a problematic behavior is similar to the process of modification or cessation of a problematic behavior in terms of these stages of change. With adolescents it is important to distinguish between the process of initiation, which has implications for prevention of gambling problems, and the process of cessation, which often necessitates the assistance of treatment. Creating interventions that parallel the process of change offers the potential for personalizing and potentiating efforts to reduce the prevalence and consequences associated with compulsive or pathological and problem gambling. Application of this model to gambling behavior offers a heuristic that is intriguing and requires substantiation through rigorous research.

Gamblers Anonymous: A critical review of the literature

This study surveys existing literature on Gamblers Anonymous (GA) and issues that help to contextualise our understanding of this mutual aid association. While GA has been the subject of investigation by social scientists, it is still understudied, with a notable shortage of research on issues facing women and ethnic minorities. A need exists for large-scale assessments of GA's effectiveness, more detailed accounts of GA beliefs and practices, increased knowledge of the ways in which GA attendance interacts with both formal treatment and attendance at other mutual aid organisations, and a better understanding of the profiles of gamblers best (and least) suited to GA, along with a clearer grasp of what GA was able to offer those gamblers that it seems to have helped. This assessment of the current state of knowledge underscores the embryonic state of our collective inquiry into the nature of GA, and the authors emphasise that significant advances have been made. Notably, important targets for study are being identified.

A comparison of pathological gamblers with and without substance abuse treatment histories

This study evaluated the prevalence and correlates of substance abuse histories in 341 consecutive admissions to gambling treatment programs. After controlling for gender, income, and site, gamblers with substance abuse treatment histories (SATH; 31%) had more severe problems than gamblers with no substance abuse treatment histories (NSATH) on the Gambling, Alcohol, Drug, Psychiatric, and Employment scales of the Addiction Severity Index. The SATH group had more years of gambling problems and gambled more days in the month prior to initiating gambling treatment. The SATH gamblers were also more likely to be receiving treatment for mental health problems and reported greater lifetime psychiatric distress than NSATH gamblers. These data suggest that pathological gamblers with substance abuse treatment histories may present more persistent and severe gambling dysfunction and psychiatric problems than those without such histories.

Validity of a gambling scale for the addiction severity index

This study assessed the validity of an adaptation of the Addiction Severity Index (ASI) for evaluating severity of gambling problems. Participants (N = 597) from four different populations (pathological gamblers enrolled in a treatment study, pathological gamblers initiating outpatient treatment at a community-based program, frequent gamblers recruited from advertisement, and substance abusers) completed the ASI, along with a supplemental gambling subscale (ASI-G). Internal consistency of the ASI-G was good (alpha =.90), and a principal components analysis indicated a single factor explained 73% of the variance in responses. ASI-G scores demonstrated excellent convergent validity with other measures of gambling and convergent validity with external sources, including collateral informant and clinician-rated reports. ASI-G scores discriminated among the samples tested. Temporal stability of ASI-G scores was high during a 1-month period for patients with substance abuse disorder who were not seeking gambling treatment. For treatment-seeking gamblers, the number of treatment sessions attended was significantly associated with reductions in ASI-G scores. Together, these data suggest that the ASI-G subscale may be a useful tool for assessing severity of gambling problems in a variety of populations.

Neurodevelopment, impulsivity, and adolescent gambling

The prevalence of problem and pathological gambling in adolescence and young adulthood has been found to be two- to fourfold higher than in adulthood. Given that these high rates might predict future increases across all age groups, it is important to explore the causes of the elevated rates of problem and pathological gambling among youths. This article reviews evidence for a neurobiological basis for adolescent vulnerability to problem and pathological gambling behaviors. We propose that a common trait motif of impulsivity might underlie phenomenology of pathological gambling, commonly comorbid psychiatric disorders, and related aspects of adolescent behavior. Recent advances in understanding the brain mechanisms involved in motivation, reward, and decision-making allow a discussion of neural circuitry underlying impulsivity. Emerging data indicate that important neurodevelopmental events during adolescence occur in brain regions associated with motivation and impulsive behavior. We hypothesize that immaturity of frontal cortical and subcortical monoaminergic systems during normal neurodevelopment underlies adolescent impulsivity as a transitional trait-behavior. While these neurodevelopmental processes may confer advantage by promoting a learning drive for optimal adaptation to adult roles, they may also confer an increased vulnerability to addictive behaviors such as problem and pathological gambling. An exploration of the developmental changes in neural circuitry involved in impulse control has significant implications for understanding adolescent behaviors and treating problem and pathological gambling among youths.

Effect of a new casino on problem gambling in treatment-seeking substance abusers

Problem gambling rates are frequently found to be higher in those who abuse substances than in the general population, and this group represents a well-established high-risk population for developing the disorder. In this study of 853 residential substance abusers, approximately 10% scored in the problem gambling range on the South Oaks Gambling Screen (SOGS). On most descriptive variables, these subjects appeared to be similar to substance abusers who do not have gambling problems. However, they tended to participate in more gambling behaviours and had more relationships with individuals who also gambled. There is some evidence that the introduction of a new casino in the community increased the SOGS scores for subjects who gambled most frequently on such casino-related gaming as slot machines, cards, and casino games.

Pathological gambling. A comprehensive review

Due to recent changes of gambling laws, accessibility to gambling has become more widespread and thus, there has also been an increase in the prevalence of pathological gambling (PG). The wide range of social, economic, and psychological problems associated with PG are well known. There is a need for better understanding of PG and this review attempts to do so. Literature searches using the Medline and PsycINFO databases were used. Critical examining of the literature showed that familial/genetic, sociological, and individual factors (e.g., an individual's personality, biochemistry, psychological states, and cognitions) are implicated in the development and maintenance of PG, yet at present, the evidences are not solid. Similarly, there have been a lot of theories for PG but again, none of them are solid enough to provide a clear understanding of PG. Recent psychological-based theories seem to provide some solid ground for further research. We highlight four areas for future consideration for research. (1) Most studies have generalized findings from one form of gambling to another. It is suggested that it is now not tenable to consider gambling as a single phenomenon that can explain all forms of gambling. (2) Almost all of the studies in the gambling literature are Western-based and the results are often generalized to other ethnic and cultural groups. There is now an urgent need to close this gap. (3) Future studies need to address methodological problems in the current gambling/PG literature. (4) Almost all of the gambling literature has focused on the issue of why people start gambling. It is suggested that looking at variables as to why people stop gambling in a single episode may be a more fruitful area of research then why people start gambling. This is because what motivates one to continue gambling, despite losses in a session and across sessions, is a characteristic that distinguishes nonproblem gamblers from problem gamblers and pathological gamblers (PGs).

Relationship between problem gambling and substance use in a methadone maintenance population

Few studies have examined the relationship between pathological gambling and substance abuse treatment outcome. This study assessed the gambling behavior of 62 patients enrolled in a methadone maintenance treatment program. Eleven (17.7%) met current SOGS criteria for probable pathological gambling. Patients with and without probable pathological gambling were compared on substance abuse treatment outcome measures including urine toxicology results for heroin and cocaine use, and clinic dropout. Results indicated that those who were probable pathological gamblers were more likely to use cocaine through therapy, and more likely to drop out of the clinic treatment program than nonpathological gamblers. Implications for substance abuse treatment are discussed.

Patterns of substance use in treatment-seeking problem gamblers: impact on treatment outcomes

Accumulating evidence suggests that treatment-seeking problem gamblers have high rates of substance abuse. However, relatively little is known about the relation between gambling problems and specific psychoactive substances apart from alcohol and methadone-treated opiate addicts. In this study of 169 individuals seeking outpatient treatment for problem gambling, lifetime drug use and medication use were very high. Approximately half of the sample were using a psychiatric medication at the time they sought gambling treatment while very few individuals were using other drugs. Gambling treatment outcomes were unrelated to history of drug or medication use. No evidence was found for substitution of psychoactive substance use for gambling during the follow-up year. These findings indicate that gamblers are more likely to be involved with drug and medication use compared to the general population, but that such histories are not associated with gambling treatment outcomes.

An assessment of the validity and reliability of the SOGS-RA

The present is a validation study seeking to determine the degree of confidence that can be placed on inferences about problem gambling among adolescents in the Atlantic provinces, based on their South Oaks Gambling Screen-Revised for Adolescents (SOGS-RA) scores. The major source of data was a 1998 survey of 13,549 students in junior and high school of the public school systems of the 4 Atlantic provinces of Canada. The SOGS-RA was found to have adequate stability and internal consistency reliability. Statistically significant gender differences were demonstrated relative to endorsement and construct validity. Regarding the latter, this study shows that the existing cut-point of the SOGS-RA score for problem gambling identifies as problem gamblers, markedly different proportions of male than female daily gamblers. Regarding construct validity in relation to the Atlantic Alcohol and Drug Risk Continua, this study suggests that while statistically highly significant, the association between problem gambling and substance-related problems may be of low clinical significance. Regarding criterion validity, there is an urgent need to perform the types of enquiry that will allow clarification about how adolescent problem gambling is conceptualized, by adults versus adolescents, by males versus females, and from a clinical versus a public or population health perspective.

Pathological gambling and comorbid substance use

OBJECTIVE

The objective of this study was to determine the rates of substance use problems in a sample of diagnosed pathological gamblers seeking treatment in a university teaching hospital cognitive behavioural outpatient clinic.

METHODS

A semistructured interview schedule and the composite international diagnostic interview (CIDI-auto) were administered to assess substance dependence in a sample of 75 poker-machine gamblers meeting DSM-IV and South Oaks gambling screen (SOGS) criteria for pathological gambling. Both the self-reported rates and the proportion meeting criteria for a psychiatric disorder were determined.

RESULTS

The rates for substance use disorder within a sample of treatment-seeking pathological gamblers is higher as compared to general population figures. Gender differences were found with more current alcohol-abuse problems reported among male than female participants. Non-alcohol-related substance abuse was relatively lower than rates reported by other studies in the literature.

CONCLUSIONS

Substance abuse is a common comorbid condition of pathological gambling and therefore should be screened for in routine clinical assessments. Failure to identify and treat comorbid substance-use disorders in gamblers may lead to higher relapse rates.

Pathological gambling and substance misuse

This paper first discusses the ways in which pathological gambling (a disorder of impulse control) and substance misuse are similar. It then examines research focusing on substance misuse among pathological gambles, and research on pathological gambling among substance misusers, focusing on a study examining gambling among 462 methadone patients from New York City. That study found that 21% of the sample were probable pathological gamblers, while an additional 9% were problem gamblers, i.e., they had some problem related to their gambling. The treatment implications of these findings and future research directions are also discussed.

Cigarette smoking is associated with increased severity of gambling problems in treatment-seeking gamblers

AIMS

Cigarette smoking and gambling often co-occur, but very little is known about smoking or its correlates in disordered gamblers. This study compared gambling and psychosocial problems in treatment-seeking gamblers who smoke versus those who do not.

METHODS

At intake to gambling treatment programs, gamblers completed the addiction severity index (ASI) and gambling questionnaires. Subjects were categorized into non-daily smokers (n=107) and daily smokers (n=210). Differences in demographics, gambling variables and ASI composite scores were compared between the groups.

RESULTS

The daily smokers were more likely to have a history of treatment for a substance use disorder than the non-daily smokers. After controlling for substance abuse treatment histories, gender and age, the daily smokers demonstrated more severe gambling, family/social and psychiatric problems. Compared to non-daily smokers, the daily smokers gambled on more days and spent more money gambling; they also 'craved' gambling more and had lower perceived control over their gambling. The daily smokers were more likely to be taking psychiatric medications, and they experienced psychiatric symptoms, especially anxiety symptoms, on a greater number of days than non-daily smokers.

IMPLICATIONS

Results from this study suggest that about two-thirds of treatment-seeking gamblers are current daily cigarette smokers, and smoking status is associated with more severe gambling and psychiatric symptoms. These results warrant further investigation of smoking in gamblers and whether smoking adversely affects the course of treatment or outcomes among gamblers.

Pathological gambling in treatment-seeking substance abusers

Accumulating evidence suggests that treatment-seeking substance abusers have high rates of gambling problems. However, relatively little is known about the relation between gambling problems and specific psychoactive substances apart from alcohol and methadone-treated opiate addicts. In this study of 580 individuals admitted to a residential addictions program, 10.5% were found to score in the pathological gambling range on the South Oaks Gambling Screen (SOGS) within the past year. The rate of pathological gambling was much higher for cannabis abusers (24%) than for alcohol (4%), cocaine (11.5%), and opiate abusers (4.8%). Men also reported higher rates of pathological gambling (11.9%) than women (7.5%). Individuals with a pathological gambling problem tended to report family histories of gambling problems as well.

Gambling in mild-moderate alcohol-dependent outpatients

There is a growing interest in the comorbidity of "substance use disorder" and "problem gambling." although there has been little study specifically on people with "alcohol dependence" who are being treated in general alcohol- and drug-user outpatient settings. This study aimed to determine the nature and extent of gambling in a sample of 124 mild-moderate alcohol-dependent outpatients. Of these, 79.8% had gambled in the previous 6 months and 29.8% on at least a weekly basis. Although a wide range of gambling modes was used, by far the commonest was Lotto, a national weekly lottery, at 60.5%. Some 19.4% were found to manifest current "problem gambling" [i.e., scored at least 1 on the South Oaks Gambling Screen (SOGS) instrument], and a further 4.0% were found to manifest pathological gambling confirmed by Diagnostic and Statistical Manual of Mental Disorders Version IV (DSMIV) diagnosis. "Problem gamblers" were significantly more likely to be involved in all modes of gambling compared with non problem gamblers. However, the most differentiating modes, in order, were gambling machines, dogs, casino, and horses. Treatment implications of these findings are discussed. A two-arm model of intervention for problem gambling within the alcohol- and drug-user treatment setting is proposed.

Comparison of problem-gambling and non-problem-gambling youths seeking treatment for marijuana abuse

OBJECTIVE

To evaluate the prevalence and correlates of problem gambling (PG) in marijuana-abusing adolescents.

METHOD

A retrospective analysis was conducted of data collected from participants entering treatment for marijuana abuse in Philadelphia, Pennsylvania, and Hartford, Connecticut, between 1998 and 2000.

RESULTS

Of 255 adolescents interviewed, 22% experienced gambling problems. Compared with non-problem gamblers (NPGs), PGs were more likely to be male, of African-American ethnicity, and to live in single-parent homes. Multivariate general linear models compared the two groups with respect to psychosocial problems. After controlling for age, gender, and race, differences between the groups emerged in drug use severity, legal difficulties, psychiatric problems, and human immunodeficiency virus risk behaviors. PGs reported a greater frequency of overall drug and alcohol use and greater intensity of marijuana use than their NPG counterparts. They had more illegal activity and greater somatization and anxiety symptoms, as well as higher levels of victimization. Compared with NPGs, PGs also reported more recent sexual partners.

CONCLUSIONS

These data suggest that PG is common in marijuana-abusing youths and that they have increased psychosocial problems. These data suggest the need for early identification and treatment of PG in substance-abusing adolescents.

Substance abuse, pathological gambling, and impulsiveness

This study evaluated behavioral and self-report indices of impulsiveness in pathological gambling substance abusers (n=27), non-pathological gambling substance abusers (n=63), and non-pathological gambling/non-substance abusing controls (n=21). The Bechara card task measured preferences for decks of cards that ranged in magnitude and probability of delayed and immediate rewards and punishers. The Stanford Time Perception Inventory (STPI) assessed orientation to the future, the Zuckerman Sensation Seeking Scale evaluated sensation seeking, and the Eysenck and Barratt scales measured impulsivity. A Principal Components analysis revealed that these personality measures comprised three distinct measures of impulsivity: impulse control, novelty seeking and time orientation. Linear contrast analyses revealed that substance abuse and pathological gambling resulted in additive effects on the impulse control and time orientation factors, but not on the novelty-seeking scale. Performance on the card task did not correlate with any of the three factors derived from the personality scale scores, but the presence of both substance abuse and pathological gambling had an additive effect on preferences for decks containing greater immediate gains but resulting in large punishers and overall net losses. These results provide further evidence of an association among substance abuse, pathological gambling, and impulsivity.

Clinical features of pathological gambling in an addictions treatment cohort

This study examined the prevalence and descriptive psychopathology of pathological gambling in a heterogeneous treatment sample of 372 substance users. About 14% of male participants and 10% of female participants were identified as presumptive pathological gamblers (PGs) on the South Oaks Gambling Screen (SOGS). The authors contrasted 49 PGs with 323 participants who were not pathological gamblers (NPGs) on a host of variables measuring premorbid risk, pathological patterns of substance use, consequences of use, and psychiatric comorbidity. PGs showed more disturbance than NPGs on some measures of premorbid risk, pathological substance use, social consequences of use, and psychiatric comorbidity. Gambling status may be an important comorbid condition in addictions treatment settings and a significant covariate in research.

Pathological and nonpathological gamblers: a survey in gambling settings

In this first study on gambling in Brazil, pathological and non-pathological gamblers were surveyed at three bingo clubs, one video poker club, and one horse-racing club in São Paulo. The South Oaks Gambling Screen and a questionnaire were administered to 171 subjects. When compared to nonpathological gamblers, a significantly higher proportion of pathological gamblers played cards, horse races, video poker, and dice in their lifetime. The two groups were similar with respect to socially acceptable games such as lotteries, bingo, sports, and the stock market. No significant differences were observed in drug consumption except for a higher lifetime consumption of tobacco among pathological gamblers. Only 4.9% of the gamblers sought help for gambling-related problems, suggesting that gambling is not generally perceived as a mental health problem by these subjects.

Relationship between gender and substance use among treatment-seeking gamblers

Very little is known about gender differences in psychoactive substance use among gamblers. In this study, 200 individuals seeking treatment for problem gambling were assessed with respect to lifetime and current use and abuse of licit and illicit substances. As a group, they were found to have experience with psychoactive substances exceeding that reported for the general population. There were no gender differences in patterns of illicit drugs; however, the women gamblers reported greater experience with psychiatric medications over the lifetime and during the treatment and follow-up periods.