The incidence of pathological gambling among Native Americans treated for alcohol dependence

Gambling Disorder in Veterans: A Review of the Literature and Implications for Future Research

To review the scientific literature examining gambling behavior in military veterans in order to summarize factors associated with gambling behavior in this population. Database searches were employed to identify articles specifically examining gambling behavior in military veterans. Cumulative search results identified 52 articles (1983-2017) examining gambling behavior in veteran populations. Articles generally fell into one or more of the following categories: prevalence, psychological profiles and psychiatric comorbidities, treatment evaluations, measurement, and genetic contributions to gambling disorder. Results from reviewed articles are presented and implications for future research discussed. Research to date has provided an excellent foundation to inform potential screening, intervention and research activities going forward. The authors suggest that a public health approach to future research endeavors would strengthen the evidence base regarding gambling in veteran populations and better inform strategies for screening, prevention and treatment.

The benefits of genetic addiction risk score (GARS™) and pro-dopamine regulation in combating suicide in the American Indian population

It is well-known that Native Americans (NA) clinically present with a very high rate of alcoholism and other drugs of abuse. It is also known that NA also display a very high rate of suicide compared to other ethnic groups. Furthermore, individuals with various psychiatric disorders (e.g., depression) also have higher rates of suicide that are frequently alcohol related. Males are as much as four times more likely to die from suicide than females. Studies comparing Native to other populations within the same geographic regions in North America divulged, almost universally, that alcohol involvement is higher among Native suicides than among the local, non-Native people. Unfortunately, suicide is the eighth leading cause of death in the U.S. and is the third cause of death in those ages 15-24. With these disappointing statistics, we are hereby proposing that because of such a high genetic risk as supported by the work of Barr and Kidd showing that NA carriers the DRD2 A1 allele at the rate of 86%, compared to a highly screened reward deficiency free control of only 3%. It seems reasonable that early identification, especially in children, be tested with the Genetic Addiction Risk Score (GARS) and concomitantly be offered the precision pro-dopamine regulator (KB220PAM), one that matches their unique brain polymorphisms involving serotonergic, endorphinergic, glutaminergic, gabaergic and dopaminergic pathways among others. We believe that using the Precision Addiction Management (PAM) platform at an early age may be prophylactic, while in adults PAM may reduce substance craving affecting tertiary treatment and even relapse and mortality prevention.

Pensionnats autochtones : impact intergénérationnel

Les pensionnats autochtones sont des institutions ayant été en activité de la fin du 19e siècle à la fin du 20e siècle, que des enfants autochtones ont été forcés de fréquenter au Canada. Des enquêtes ont démontré que plusieurs jeunes fréquentant ces institutions y ont été victimes de négligence et de mauvais traitements. Les conséquences négatives découlant des mauvais traitements durant l’enfance ont été amplement documentées, notamment à travers les travaux de la Commission de vérité et réconciliation du Canada. Néanmoins, très peu d’études quantitatives ont été réalisées à ce sujet. L’objectif de cette recherche est de documenter, chez une population autochtone du Québec, les impacts associés à la fréquentation des pensionnats chez les survivants, mais également chez leurs enfants devenus adultes. Au total, 301 participants autochtones ont été rencontrés. Parmi les participants, 26,9 % ont fréquenté les pensionnats et 45,5 % ont un parent qui les a fréquentés. Les résultats indiquent que la fréquentation des pensionnats est associée à une probabilité plus élevée d’avoir vécu des traumas (agression sexuelle, agression physique, violence conjugale, etc.) dans l’enfance ou à l’âge adulte. Les résultats révèlent également que la fréquentation des pensionnats est associée à plusieurs difficultés, notamment à la consommation problématique d’alcool ou de drogues, au jeu problématique et à la détresse psychologique. Les résultats de cette étude soulignent l’importance de tenir compte des conséquences des traumatismes historiques et intergénérationnels liés aux pensionnats dans notre compréhension de la situation actuelle des peuples autochtones du Canada.

Problem-gambling severity and psychiatric disorders among American-Indian/Alaska native adults

INTRODUCTION

Little is known about the association between problem-gambling severity and psychiatric disorders among American-Indian/Alaska-Native (AI/AN) individuals. Thus, we examined these factors among a nationally representative sample of AI/AN and other American adults in the USA.

METHOD

Using the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) data, we conducted separate Wald tests and multinomial logistic regression analyses comparing AI/AN to black/African American, white/Caucasian, and all other racial/ethnic groups, respectively.

RESULTS

Relative to other American adults, AI/AN adults were least likely to report non-/low-frequency gambling (NG: AI/AN 66.5%, white/Caucasian 70.5%, black/African American 72.8%, other racial/ethnic group 72.3%) and most likely to report low-risk gambling (LRG: AI/AN 30.1%, white/Caucasian 26.5%, black/African American 23.4%, other racial/ethnic group 24.7%). The association between at-risk/problem-gambling (ARPG) and any past-year Axis-I disorder was stronger among AI/AN versus other American adults. Although ARPG and LRG were associated with multiple past-year Axis-I and lifetime Axis-II psychiatric disorders in both AI/AN and other American adults, LRG was more strongly associated with both Axis-I disorders (particularly major depression, generalized anxiety disorder and nicotine dependence) and Cluster-B Axis-II (particularly antisocial personality disorder) disorders in AI/AN versus other American adults.

DISCUSSION

A stronger association between problem-gambling severity and past-year psychiatric disorders among AI/AN relative to other American adults suggests the importance of enhancing mental health and problem-gambling prevention and treatment strategies that may help AI/AN individuals.

The association between at-risk gambling and binge drinking in the general Swedish population

While the association between problem gambling and alcohol use disorders has been studied previously, little is known about the association between risk gambling and risk drinking. This study aimed at examining the association between at-risk gambling and binge drinking in the general Swedish population and to test whether this association remained after controlling for demographic factors. The data was part of a larger ongoing survey in the general Swedish population. Respondents (N = 19 530) were recruited through random digit dialing and interviewed about their alcohol habits (binge drinking), at-risk gambling (the Lie/Bet questionnaire) and demographics (gender, age, education, residence size, marital status, labor market status, country of origin and smoking). There was an association between lifetime at-risk gambling and current (12 months) weekly binge drinking for both men (OR = 1.73; CI 95%: 1.27-2.35) and women (OR = 2.27; CI 95%: 1.05-4.90). After controlling for demographics this association no longer remained significant (OR = 1.38; CI 95%; .99-1.90 for men and OR = 1.99; CI 95%: .94-4.66 for women). Age and smoking had the largest impact on this association. At-risk gambling and binge drinking are associated behaviors. However, it seems as if this association may be confounded by demographic variables. We hypothesize that similarities in personality profiles and health aspects could account for an additional part of the association.

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.

Pathological and problem gambling in substance use treatment: a systematic review and meta-analysis

Pathological and problem gambling refer to a class of disorders, including those meeting criteria for a psychiatric diagnosis (i.e., pathological gambling), and others comprising a spectrum of severity defined by significant personal and social harm (i.e., problem gambling), that may be common in substance use treatment but are frequently unrecognized. This paper presents a systematic review and meta-analysis of available evidence indicating the prevalence of such gambling disorders in substance use treatment. It provides weighted mean estimates from across studies of clinical samples of substance users, and suggests around 14% of patients that demonstrate comorbid pathological gambling. Around 23% suffer conditions along the broader spectrum of problem gambling. The review also highlights important limitations of existing evidence, including scant data on current versus lifetime comorbidity, as well as reliance on convenience samples and self-administered measures of gambling problems. Notwithstanding a concomitant need for caution when applying these results, the findings suggest a strong need to identify and manage gambling comorbidity in substance use treatment. Strategies for identification of gambling disorders, and therapies that may provide useful adjunctive interventions in substance use treatment are discussed.

Aboriginal Gambling and Problem Gambling: A Review

The prevention of gambling-related problems amongst Aboriginal communities has been neglected by most public health strategies which concentrate on mainstream populations. Research indicates that rates of problem gambling are higher for Aboriginal groups than the general population. Specific cultural, familial, and social patterns influence gambling by Aboriginal groups, which are individually different, making it difficult to implement a cohesive strategy to address gambling-related harms. Because of this complexity, a thorough literature review is necessary to identify gaps in policy and research. This paper uses a public health framework to consider multi-dimensional influences (personal, environmental, economic, cultural and social) that affect gambling uptake. Such analysis is also important for identifying risk factors which facilitate the development and maintenance of problem gambling and potentially for underpinning protection, prevention and treatment programs. It is advised that strategies be developed in consultation with Aboriginal peoples to guide public health policy and research to minimise any gambling-related harms.

Drinkers and bettors: investigating the complementarity of alcohol consumption and problem gambling

Regulated gambling is a multi-billion dollar industry in the United States with greater than 100% increases in revenue over the past decade. Along with this rise in gambling popularity and gaming options comes an increased risk of addiction and the associated social costs. This paper focuses on the effect of alcohol use on gambling-related problems. Variables correlated with both alcohol use and gambling may be difficult to observe, and the inability to include these items in empirical models may bias coefficient estimates. After addressing the endogeneity of alcohol use when appropriate, we find strong evidence that problematic gambling and alcohol consumption are complementary activities.

Gambling and alcohol use: trends in the state of New Mexico from 1996-1998

Alcohol consumption and its relationship to gambling was examined in a statewide New Mexico survey in 1996 and 1998. Data regarding both drinking habits and gambling behavior were obtained from a stratified random sample of the adult population (N = 2674) across the entire State of New Mexico via phone survey. These surveys were carried out shortly after a period when New Mexico experienced an initial surge in the legalized gaming industry. Fifty-seven percent of survey respondents reported drinking in the past month, while 43.1% reported no drinking in the past 30 days. Results show that while the number of days in the past 30 that a person drinks is significantly correlated with some types of gambling behavior (e.g., in 1998, drinking more days was associated with more card gambling and sports gambling), it is the amount of alcohol consumed per occasion that is associated with more gambling behavior. For example, in both 1996 and 1998, drinking more per occasion was associated with more sports betting, dice gambling, number/lottery gambling, gambling using machines, and paper game gambling (e.g., pull tabs, punchboard). These results suggest that problem gambling behavior is not affected as much by the number of occasions on which one consumes alcohol, as by the amount of alcohol consumed per occasion.

Prevalence and Diagnostic Correlates of DSM-IV Pathological Gambling in Psychiatric Outpatients

Studies of the prevalence of pathological gambling (PG) in psychiatric and substance abusing patients suggest that the disorder is not rare. Most studies have been of substance abusers in treatment, and the rate of PG has been found to be several times higher than the rate found in community based epidemiological surveys. However, only one study has examined the prevalence of PG in a heterogeneous sample of patients, and this was a study of psychiatric inpatients. We are not aware of any prior study of the prevalence of PG in a psychiatric outpatient sample. In the present report from the Rhode Island Methods to Improve Diagnosis and Services (MIDAS) project we examined the current and lifetime prevalence of PG in 1,709 psychiatric outpatients interviewed with a semi-structured diagnostic interview that included a module to diagnose DSM-IV PG. Forty (2.3%) patients had a lifetime history of DSM-IV PG, all of whom had at least one other DSM-IV axis I disorder. Patients with PG had significantly more axis I disorders than patients without PG, and had significantly higher rates of bipolar disorder, social phobia, panic disorder with agoraphobia, alcohol use disorder, and other impulse control disorders. Possible reasons for the low prevalence of PG in our sample are discussed.

Lifetime prevalence of pathological gambling among american Indian and Hispanic American Veterans

OBJECTIVES

We examined the prevalence and clinical correlates of pathological gambling among 1228 American Indian and Hispanic American veterans in the southwest and north central regions of the United States.

METHODS

We surveyed a community sample of American Indian and Hispanic American veterans to obtain data on psychiatric disorder and treatment.

RESULTS

American Indian veterans had a 10% lifetime prevalence of pathological gambling. The Hispanic American lifetime prevalence was less than that of the American Indian veterans but higher than the prevalence found for Hispanic American veterans in other surveys. Comorbid conditions associated with pathological gambling included substance, mood, and antisocial personality disorders. Ready access to casino gambling may encourage, support, or contribute to high rates of pathological gambling in both men and women.

CONCLUSIONS

A 70% lifetime comorbidity of psychiatric disorders suggests that early interventions for pathological gambling should consider common psychiatric conditions rather than focusing on pathological gambling alone.

Juvenile gambling in North America: an analysis of long term trends and future prospects

Long term trends, based on findings from twenty independent prevalence studies surveying middle and high school youth in North America, suggest that within the past year two out of three legally underage youth have gambled for money. In the United States and Canada as many as 15.3 million 12-17 year olds have been gambling with or without adult awareness or approval, and 2.2 million of these are experiencing serious gambling-related problems. Lottery play dominates legalized forms of gambling among juveniles in both the United States and Canada. Trends between 1984-1999 indicate a substantial increase in the proportion of juveniles who report gambling within the past year, and a parallel increase in the proportion of juveniles reporting serious gambling-related problems. Yet, there continues to be little public awareness or concern about the extent, or the potential hazards associated with juvenile gambling. A composite profile of juveniles reporting numerous gambling problems is contrasted with their peers who reported few or none. Future prospects concerning this growing problem are offered.

Alcohol Consumption and Self-Control of Gambling Behaviour

This paper reports the results of a preliminary investigation into whether the drinking of alcohol contributes to impaired control of gambling behaviour. The sampling method consisted of a two-phase survey design, collecting data both prospectively 'within session' and retrospectively via a take-home questionnaire. One hundred sixteen people were interviewed while in a gaming venue playing on an electronic gaming machine (egm) of whom 34 men and 11 women also returned take-home surveys. Comparisons of the sample to previous studies suggested that the sample was representative of the population of egm players. Results indicated a consistent theme of alcohol use contributing significantly to impaired control of gambling behaviour, with level of involvement (Corless & Dickerson, 1989) contributing the most significant variance in the independent variables. Limitations of the study are discussed, but the case is argued that this type of 'process' research is essential in better understanding how these two types of popular leisure activities may interact, possibly leading to the previously recorded chronic, excessive alcohol intake and problematic gambling (e.g. McCormick, Russo, Ramirez & Taber, 1984).

Exaggerated ethanol-induced cardiac reactivity as an indicator of increased risk for gambling

Pathological gambling and alcohol dependence show a high rate of co-occurrence. Some individuals at risk for alcohol dependence display an exaggerated heart rate (HR) increase following alcohol consumption, a characteristic suggesting sensitivity to reward. This study examined whether exaggerated ethanol-induced cardiac reactivity was associated with increased gambling behaviors. One hundred five young men (M = 20.13 years, SD = 1.07) consumed 1 ml of ethanol (95% volume) per kilogram of body weight. HR was measured and participants completed the South Oaks Gambling Screen (SOGS; H. R. Lesieur & S. B. Blume, 1987). Those with higher intoxicated HRs reported significantly greater scores on the SOGS (p = .02). This suggests that ethanol-induced HR increase is a possible marker for addictive disorders.

Gambling and related mental disorders: a public health analysis

This article reviews the prevalence of gambling and related mental disorders from a public health perspective. It traces the expansion of gambling in North America and the psychological, economic, and social consequences for the public's health, and then considers both the costs and benefits of gambling and the history of gambling prevalence research. A public health approach is applied to understanding the epidemiology of gambling-related problems. International prevalence rates are provided and the prevalence of mental disorders that often are comorbid with gambling problems is reviewed. Analysis includes an examination of groups vulnerable to gambling-related disorders and the methodological and conceptual matters that might influence epidemiological research and prevalence rates related to gambling. The major public health problems associated with gambling are considered and recommendations made for public health policy, practice, and research. The enduring value of a public health perspective is that it applies different 'lenses' for understanding gambling behaviour, analysing its benefits and costs, as well as identifying strategies for action. Harvey A. Skinner (160, p. 286)

A laboratory-based investigation of relations among video lottery terminal (VLT) play, negative mood, and alcohol consumption in regular VLT players

Thirty regular video lottery terminal (VLT) players were randomly assigned to 90 min of VLT play or a control activity (viewing a movie) to examine the impact of VLT play on alcohol use. Ratings of dysphoric mood were taken at baseline, midactivity, and postactivity. Alcoholic and nonalcoholic control beverages were available throughout. As hypothesized, those in the VLT condition were more likely to consume alcoholic than nonalcoholic control beverages (i.e., 73% drank alcohol and 20% drank control beverages), whereas no such preference for alcohol was observed in the movie control condition (i.e., 40% drank alcohol and 47% drank control beverages). Consistentwith predictions derived from Steele and Josephs' [J. Abnorm. Psychol. 97 (1988) 196; Am. Psychol. 45 (1990) 921.] attention allocation model, VLT condition participants who drank alcohol showed increases in dysphoric effect over the course of testing. No such changes in negative mood were observed in VLT participants who did not consume alcohol or in movie control participants regardless of whether they drank alcohol. An observed temporal pattern of greater drinking during the early phase of VLT play indicated that the relation between alcohol use and dysphoric affect among VLT condition participants could not readily be explained by drinking to relieve dysphoria induced by VLT losses. Clinical and policy implications are discussed.

A reformulated cognitive-behavioral model of problem gambling. A biopsychosocial perspective

With most Western countries expanding the availability of gambling facilities in recent decades, considerable research interest has developed in those people who develop problematic levels of gambling. In the recent decade, a large body of research has been conducted into the determinants of gambling behavior in an attempt to understand this complex social and psychological problem. Research has varied in its nature from investigating underlying biological, psychological, or social factors that are hypothesized to contribute to gambling behavior. Evidence now exists that biological, psychological, and social factors are all relevant to the development of problematic levels of gambling. However, the theoretical explanation for gambling has lagged behind the advances in empirical work in recent years. The purpose of the current paper is to provide a review of the major research findings in the area of gambling and propose a biopsychosocial model that integrates diverse areas of research. The model described is empirically derived, and it is hoped it will stimulate future research work that investigates not only individual factors and their relationship to gambling, but also the interactions between different variables.

Problem and pathological gambling in North American Aboriginal populations: a review of the empirical literature

This literature review attempts to: estimate Aboriginal population prevalence rates for problem and pathological gambling and compare these rates to the general population; determine factors associated with the Aboriginal population problem gambling behaviour; and identify other salient findings and issues. Materials used in the review were drawn from available research literature and bibliographies. There were no time restrictions or study design criteria included in the review. Key words used: Aboriginal, Indians, First Nations, Native, lotteries, gambling, casinos, and gaming. Eleven descriptive studies were identified. Gambling appears to be problematic among Aboriginal people. Aboriginal adolescents have higher rates of problem gambling, as do Aboriginal adults for both problem and pathological gambling than their non-Aboriginal counterparts. The odds ratios indicate that the Aboriginal population has a problem gambling behaviour rate 2.2 to 15.69 times higher than the non-Aboriginal population. A number of factors associated with Aboriginal population problem and pathological gambling were identified. Gambling literature specific to the Aboriginal population is limited and there is extensive variation in estimates of their increased risk. Several associated factors were identified but whether these are specific to the Aboriginal population or to all problem and pathological gamblers needs to be determined. More research, particularly qualitative, into these factors is warranted.

Estimating the prevalence of disordered gambling behavior in the United States and Canada: a research synthesis

OBJECTIVES

This study developed prevalence estimates of gambling-related disorders in the United States and Canada, identified differences in prevalence among population segments, and identified changes in prevalence over the past 20 years.

METHODS

A meta-analytic strategy was employed to synthesize estimates from 119 prevalence studies. This method produced more reliable prevalence rates than were available from any single study.

RESULTS

Prevalence estimates among samples of adolescents were significantly higher than estimates among samples of adults for both clinical (level 3) and subclinical (level 2) measures of disordered gambling within both lifetime and past-year time frames (e.g., 3.9% vs 1.6% for lifetime estimates of level 3 gambling). Among adults, prevalence estimates of disordered gambling have increased significantly during the past 20 years.

CONCLUSIONS

Membership in youth, treatment, or prison population segments is significantly associated with experiencing gambling-related disorders. Understanding subclinical gamblers provides a meaningful opportunity to lower the public health burden associated with gambling disorders. Further research is necessary to determine whether the prevalence of disordered gambling will continue to increase among the general adult population and how prevalence among adolescents will change as this cohort ages.

Gambling and risk-taking behavior among university students

The present study examines the relationships between risk taking, sensation seeking, and level of gambling involvement. The intent of this research was to investigate whether risk taking and/or sensation seeking are determinants in distinguishing pathological gamblers from problem gamblers and whether risk taking and gambling behavior for a university population are positively correlated for both males and females. Results indicated that the Risk-Taking Questionnaire (RTQ), the Arnett Inventory of Sensation Seeking (AISS), and the Sensation Seeking Scale (SSS) distinguished between probable/pathological gamblers and nonproblem gamblers with probable/pathological gamblers scoring the highest on each measure. However, the RTQ was the only measure able to distinguish probable/pathological gamblers from gamblers experiencing some problems relating to their gambling behavior. Females encountering some problems resulting from their gambling behavior consistently reported higher risk-taking and sensation seeking scores than males with no gambling problems. Results indicate that excessive gamblers are significantly greater risk takers than social gamblers, a finding which could prove useful in advising treatment regimens.

Pathological gambling and substance misuse: a review of the literature

This paper reviews research conducted on the link between pathological gambling and substance misuse. We first examine the phenomenon of "pathological gambling," including similarities between pathological gambling and substance misuse, instruments used to measure pathological gambling, and the prevalence of pathological gambling in the United States and internationally. We then examine research on substance misuse among pathological gamblers, pathological gambling among substance misusers, and the treatment of the pathological gambler-substance misuser. We conclude with a discussion of future research needs.

Taking chances: problem gamblers and mental health disorders--results from the St. Louis Epidemiologic Catchment Area Study

OBJECTIVES

This study determined prevalence estimates of problem gambling and relationships to other psychiatric and substance use disorders.

METHODS

In 1981, the Diagnostic Interview Schedule was used to collect epidemiological information on problem gambling and other disorders from 3004 adults in St. Louis, Mo.

RESULTS

The lifetime prevalence of pathological gambling was 0.9%; 46% of those surveyed gambled recreationally. Problem gamblers (those reporting at least one gambling-related problem) were 9.2% of the sample and were predominately White (69%), male (78.2%), and young than nongamblers. They were at increased risk for several psychiatric diagnoses, especially for antisocial personality disorder, alcoholism, and tobacco dependence.

CONCLUSIONS

Clinicians treating alcoholism and tobacco dependence may need to screen for problem gambling. Additional research in the context of increased gambling opportunities is needed.

Psychiatric comorbidity in pathological gambling: a critical review

OBJECTIVE

To critically review the current literature on pathological gambling as regards the significant psychiatric comorbidities associated with it.

METHOD

The authors synthesized information found via electronic searches (MEDLINE) and bibliographic-directed searches in over 60 publications.

RESULTS

Pathological gamblers frequently have comorbid substance use disorders. In addition, a subset appear to have comorbid antisocial personality disorder, but they represent a minority when compared with those people who have acquired their antisocial traits as a consequence of their gambling behaviour. A comorbidity with the mood disorders is probable, but methodological concerns and inconsistencies with the data prevent further delineation of this. Emerging research for other disorders possibly associated with pathological gambling is also reviewed.

CONCLUSION

Pathological gambling is associated with significant psychiatric comorbidity. Recommendations for future research are described.

Gambling and problem gambling among indigenous peoples

This paper compares results from studies of gambling and problem gambling among indigenous groups in New Zealand and in North Dakota. The samples for each of these studies included substantial numbers of indigenous respondents, and the methods used in these studies were similar enough to allow comparisons of Caucasian and indigenous groups from these two distinct cultures. Analysis shows that gambling involvement, gambling expenditures, and gambling-related problems are far higher among indigenous respondents than among Caucasian respondents in both New Zealand and North Dakota. These comparisons suggest that differences between indigenous peoples and Caucasians in gambling behaviors may be due to factors distinct from culture or milieu.

Gambling among methadone patients

In this paper we assess participation in various forms of gambling activities and establish the prevalence of pathological gambling in a sample of patients (N = 117) enrolled in a large methadone maintenance treatment program in New York City. Respondents were interviewed with a protocol that incorporates the South Oaks Gambling Screen. We found that gambling was a common part of the regular activities of many patients, that 15% of the patients had some problem with gambling, and that an additional 16% were probable pathological gamblers. The implications of our findings are discussed.