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Recent Research on the Comorbidity of Alcoholism and Pathological Gambling
Abstract
This article summarizes a symposium held at the 2002 Annual Meeting of the Research Society on Alcoholism in San Francisco, CA, and was prepared on behalf of the symposium participants by the symposium co-organizers/co-chairs. Prior research with both clinical and nonclinical populations indicates a high comorbidity between alcohol-use disorders and pathological gambling. This symposium involved a set of papers in which exciting new research on this form of comorbidity was presented. The studies spanned populations of problem-gambling helpline callers, problem gamblers attempting to recover, and community-recruited gambler research volunteers. The studies used methodologies ranging from questionnaire and interview to laboratory-based paradigms (i.e., cognitive and alcohol challenge). Study designs ranged from cross-sectional to longitudinal and from correlation to experiment. The symposium highlighted novel approaches that researchers are using to enhance understanding of functional relations that may underlie this common comorbidity.
Supplementary resource (1)
... Co-occurrence of gambling disorder and alcohol-use disorders (AUD) is a quite common phenomenon. In many population studies, high rates of co-occurrence have been reported [6,7]. Studies conducted from the late 1960s to the end of the 1990s show that 9-33% of patients who were treated because of alcohol-related problem also had co-occurring gambling disorder [5]. ...
... Financial problems caused by gambling can act as a psychological stressor and contribute to drug use or relapse incidence [29]. Alcohol can also be used to alleviate unpleasant emotional states [7,20] like shame [30,31]. The use of psychoactive substances can reduce the ability of rational judgment, and encourage risky behaviour like gambling [5]. ...
... The study confirmed the internal factors identified in the literature which can contribute to development of pathological gambling and substance-use disorder comorbidity. Psychoactive substances can serve to relieve an anxiety associated with negative consequences of gambling [7,20,41]; use of psychoactive substances can reduce the ability of rational judgment, and encourage risky behaviour like gambling [5,32], a significant increase in the willingness to gamble when alcohol was consumed [33] and, in the early stages, gambling can be a way to finance the purchase of psychoactive substances [41]. ...
... For example, in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-Text Revision (DSM-IV-TR; American Psychiatric Association 2000), substance dependence and pathological gambling are both characterized by preoccupation, a need to increase the behaviour to achieve the desired effect, symptoms of withdrawal, loss of important social, occupational, or recreational activities, and continuation despite knowledge of its negative consequences. There is a high co-occurrence between substance use disorders and gambling disorders (Stewart and Kushner 2003), which is not surprising given the striking similarities in their defining features as well as common variables that contribute to the development of both disorders. ...
... First, we aimed to replicate the factor structure of the GEQ (Stewart and Wall 2005) and use this measure to subtype gamblers according to the type of affect-regulation expectancies (i.e., relief expectancies versus reward expectancies) they have about gambling. Given the high comorbidity of gambling and alcohol use disorders (Stewart and Kushner 2003), along with pathological gambling's categorization as an ''impulse control disorder'' in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-Text Revision (DSM-IV-TR; American Psychiatric Association 2000), we were also interested in seeing how alcohol use and impulsivity related to these types of gambling expectancies. In addition, positive and negative affect expectancy words were generated using an implicit measure of gambling expectancies. ...
Factor scores on a gambling expectancy questionnaire (GEQ) were used to subtype 132 university students who gamble regularly (37.9% male; M age = 22.6 years, SD = 6.04) as: Reward Expectancy Gamblers (Reward EGs)-have strong expectations that gambling augments positive mood, Relief Expectancy Gamblers (Relief EGs)-have strong expectations that gambling relieves negative affect, and Non-Expectancy Gamblers (Non-EGs)-have neither strong expectation. Gambling on a high-low card game was compared across subtypes following priming for either "relief" or "reward" affect-regulation expectancies with the Scrambled Sentence Test (SST). The hypothesized Prime type x GEQ subtype interaction was not significant. When a more stringent set of criteria for GEQ subtyping was imposed, the "purified" sub-sample (n = 54) resulted in the hypothesized statistically significant Prime type x GEQ subtype interaction. Relief EGs gambled more after being primed with the construct "relief of negative emotions" compared to after being primed with the construct "augmentation of positive emotion." Planned orthogonal contrasts showed a significant linear increase in number of bets made across GEQ subtypes when prime type corresponded to GEQ subtype. The results suggest a need for components in gambling treatment programs that address clients' expectancies that gambling can provide a specific desirable emotional outcome.
... This pattern of findings is consistent with the unpublished findings of Leiserson et al. (2001) showing that intoxicated subjects scoring above the SOGS cutoff for probable pathological gambling borrowed more money and chased more losses on a computerized Blackjack game. There are several models that have been proposed to explain the high rate of co-occurrence of gambling and alcohol use disorders (see Stewart & Kushner, 2003). One potential explanation is that alcohol use disorder causes pathological gambling. ...
... However, sensitivity to the effects of alcohol was only observed in the present study among those who had already developed gambling problems (i.e., those scoring high on the SOGS). The results create problems for this causal explanation, as, presumably, those who are at increased risk for gambling problems would also show sensitivity to these alcohol effects (see Stewart & Kushner, 2003). To better test this model, one would need to compare the responses to alcohol among three groups of regular gamblers: pathological gamblers, those ''at risk'' for pathological gambling, and those not likely to develop gambling problems. ...
This study tested whether alcohol increases behaviors associated with video lottery terminal (VLT) play, particularly among probable pathological gamblers. Forty-four regular VLT players were designated either probable pathological gamblers or non-pathological gamblers on the basis of scores on the South Oaks Gambling Screen (SOGS); [Lesieur & Blume (1997). American Journal of Psychiatry, 144, 1184-1188] Gamblers from each SOGS category were randomly assigned to either a moderately intoxicating alcohol dose or a control beverage condition (n = 11 per cell in the 2 x 2 between-subjects design). Following beverage consumption and absorption, participants played a video poker VLT game for up to 30 minutes. Four behaviors were measured: "power-bets" (doubling bet after viewing only two cards of the five-card poker hand); total money spent; mean bet magnitude; and number of minutes played. Alcohol increased time spent playing and rate of power-bets, particular among the probable pathological gamblers. Post hoc analyses revealed that alcohol also influenced the proportion of losing hands played--increasing them among the probable pathological gamblers while decreasing them among the non-pathological gamblers. Clinical and policy implications of the findings are discussed.
... Often the comorbidity of substance addiction and problem gambling can lead to dire financial circumstances (Stewart & Kushner, 2003). So too can the cooccurrence of mental health, criminal justice involvement, and housing problems. ...
Although the Life in Recovery series has provided valuable insights into the transformation of the lives of people in recovery and has helped to frame that by recovery method and approach, by gender and by location, it has not assessed the impact of recovery on those immediately surrounding the person in recovery. The Families Living in Addiction and Recovery (FLAR) survey was an attempt to address this by inviting family members to report on their experiences, as witnesses and in their own right as people going through their own version of recovery. Based on two half-day workshops in London and Sheffield, a revised survey for family members was developed that assessed the family member’s observations of recovery and their own personal journey. In total, 1,565 surveys were completed and returned, reflecting much of the positive experience of the previous surveys. They also showed the extent of adverse effects of addiction and the subsequent benefits of recovery to family members. However, recovery is not a linear process, and much of the data in this article discusses the impact of user relapse on family member functioning. The implications for ongoing support for family members and further research around the recovery journeys of family members are discussed.
... For example, in the DSM-IV-TR (31), substance dependence and pathological gambling are both characterized by preoccupation, a need to increase the behavior to achieve the desired effect, symptoms of withdrawal, loss of important social, occupational, or recreational activities, and continuation despite knowledge of its negative consequences. Among adults, there is a high co-occurrence between substance use disorders and gambling disorders (44), which is not surprising given the striking similarities in their defi ning features, suggesting that common variables contribute to the development of both disorders. ...
... Współwystępowanie zaburzeń hazardowych i uzależnienia od alkoholu Z literatury przedmiotu wynika, że współwystępowanie zaburzeń hazardowych i zaburzeń związanych z używaniem alkoholu jest powszechnym zjawiskiem. W wielu badaniach populacyjnych odnotowano wysokie odsetki współwystępowania tego rodzaju zaburzeń [22,23]. ...
Introduction: The problem of gambling and mental disorder comorbidity has been well documented. The aim of the review is to discuss issues concerning the comorbidity of gambling disorders and substance use and other mental disorders.
Method: The literature review was carried out in July and August 2015 with use of scientific databases MEDLINE and ProQuest. Two search terms “gambling” and “comorbidity” were used to cover a broad spectrum of scientific problems related to the issue of comorbidity of gambling disorders and substance use and other mental disorders. Finally, after eliminating items not related to the review subject, 47 articles were included.
Results: The article presents data on the prevalence of the comorbidity problem and characterises the issue of gambling and mental disorder comorbidity, including disorders related to alcohol and illicit psychoactive substances use. The social determinants of the comorbidity problem are presented as well as the diagnostic and therapeutic possibilities and their limitations.
Summary: The comorbidity of gambling and mental disorders is a significant problem because of its relatively great prevalence and implications for a clinical practice. Due to the high prevalence of gambling and mental disorder comorbidity, professionals working in psychiatric treatment as well as in the addiction field should carry out the possible complex diagnosis with use of gambling disorder screening tests.
... Whilst gambling is promoted by the gambling industry as an enjoyable leisure activity [2], there is significant evidence that gambling results in a range of health and social harms to individuals, their families and communities [3,4]. Specific harms include anxiety and depression [5], lowered work productivity and job loss [6], suicidal ideation and attempts [7], substance abuse [8], family and partner breakdown [9], financial hardship [10], crime [11], homelessness [12] and, domestic violence [13,14]. ...
Background
Since 2008, Australia has seen the rapid emergence of marketing for online and mobile sports wagering. Previous research from other areas of public health, such as tobacco and alcohol, has identified the range of appeal strategies these industries used to align their products with culturally valued symbols. However, there is very limited research that has investigated the tactics the sports wagering industry uses within marketing to influence the consumption of its products and services.
Method
This study consisted of a mixed method interpretive content analysis of 85 sports wagering advertisements from 11 Australian and multinational wagering companies. Advertisements were identified via internet searches and industry websites. A coding framework was applied to investigate the extent and nature of symbolic appeal strategies within advertisements.
Results
Ten major appeal strategies emerged from this analysis. These included sports fan rituals and behaviours; mateship; gender stereotypes; winning; social status; adventure, thrill and risk; happiness; sexualised imagery; power and control; and patriotism. Symbols relating to sports fan rituals and behaviours, and mateship, were the most common strategies used within the advertisements.
Discussion/Conclusions
This research suggests that the appeal strategies used by the sports wagering industry are similar to those strategies adopted by other unhealthy commodity industries. With respect to gambling, analysis revealed that strategies are clearly targeted to young male sports fans. Researchers and public health practitioners should seek to better understand the impact of marketing on the normalisation of sports wagering for this audience segment, and implement strategies to prevent gambling harm.
... Gambling, tobacco smoking and alcohol drinking often co-occur at both the syndrome and event levels. High rates of co-morbidity of gambling-, tobacco-, and alcohol-related disorders have been documented in both clinical and community samples (Grant and Potenza, 2005; Grant et al., 2009; McGrath and Barrett, 2009; Stewart and Kushner, 2003, 2005; Toneatto and Brennan, 2002) and the rates of tobacco dependence and alcohol dependence among pathological gamblers have been estimated to be approximately 60% and 73% respectively (Petry et al., 2005). Moreover gamblers often report drinking and smoking when they gamble, and gamblers who are smokers are more likely to use alcohol when gambling than non-smoking gamblers (McGrath et al., 2012a). ...
Rationale: Gamblers often use alcohol and/or tobacco when they gamble but little is known about the extent to which drinking or smoking affects gambling behavior.
Objectives: This study examined the acute effects of alcohol and nicotine-containing tobacco administration on the subjective and behavioral responses to video-lottery terminal (VLT) gambling in 16 regular video-lottery terminal players (11 male) who were also regular consumers of alcohol and tobacco.
Methods: During four double-blind, counterbalanced sessions, participants assessed the subjective effects of nicotine-containing tobacco or denicotinized tobacco following the administration of a moderately intoxicating dose of alcohol or a placebo beverage. They were then given $40 and provided with an opportunity to gamble using an authentic VLT.
Results: Alcohol administration was associated with increased ratings of several subjective descriptors including “intoxicated”, “high”, “want alcohol”, “crave cigarette”, and “want to gamble” but did not affect subsequent gambling behavior. In contrast, relative to denicotinized tobacco, the administration of nicotine containing tobacco was associated with increased average wagers, but did not significantly alter subjective state.
Conclusions: Findings suggest that both alcohol and nicotine-containing tobacco may acutely increase the propensity to gamble using VLTs, but they may do so through separate processes.
... Gambling, tobacco smoking and alcohol drinking often co-occur at both the syndrome and event levels. High rates of co-morbidity of gambling-, tobacco-, and alcohol-related disorders have been documented in both clinical and community samples (Grant and Potenza, 2005; Grant et al., 2009; McGrath and Barrett, 2009; Stewart and Kushner, 2003, 2005; Toneatto and Brennan, 2002) and the rates of tobacco dependence and alcohol dependence among pathological gamblers have been estimated to be approximately 60% and 73% respectively (Petry et al., 2005). Moreover gamblers often report drinking and smoking when they gamble, and gamblers who are smokers are more likely to use alcohol when gambling than non-smoking gamblers (McGrath et al., 2012a). ...
Rationale: Gamblers often use alcohol and/or tobacco when they gamble but little is known about the extent to which drinking or smoking affects gambling behavior.
Objectives: This study examined the acute effects of alcohol and nicotine-containing tobacco administration on the subjective and behavioral responses to video-lottery terminal (VLT) gambling in 16 regular video-lottery terminal players (11 male) who were also regular consumers of alcohol and tobacco.
Methods: During four double-blind, counterbalanced sessions, participants assessed the subjective effects of nicotine-containing tobacco or denicotinized tobacco following the administration of a moderately intoxicating dose of alcohol or a placebo beverage. They were then given $40 and provided with an opportunity to gamble using an authentic VLT.
Results: Alcohol administration was associated with increased ratings of several subjective descriptors including “intoxicated”, “high”, “want alcohol”, “crave cigarette”, and “want to gamble” but did not affect subsequent gambling behavior. In contrast, relative to denicotinized tobacco, the administration of nicotine containing tobacco was associated with increased average wagers, but did not significantly alter subjective state.
Conclusions: Findings suggest that both alcohol and nicotine-containing tobacco may acutely increase the propensity to gamble using VLTs, but they may do so through separate processes.
... Gambling, tobacco smoking and alcohol drinking often co-occur at both the syndrome and event levels. High rates of co-morbidity of gambling-, tobacco-, and alcohol-related disorders have been documented in both clinical and community samples (Grant & Potenza, 2005;Grant et al. 2009;Toneatto & Brennan 2002;McGrath & Barrett 2009;Stewart & Kushner 2003 and the rates of tobacco dependence and alcohol dependence among pathological gamblers have been estimated to be approximately 60% and 73% respectively (Petry et al. 2005). Moreover gamblers often report drinking and smoking when they gamble, and gamblers who are smokers are more likely to use alcohol when gambling than non-smoking gamblers (McGrath et al. 2012a). ...
Rationale:
Gamblers often use alcohol and/or tobacco when they gamble but little is known about the extent to which drinking or smoking affects gambling behavior.
Objectives:
This study examined the acute effects of alcohol and nicotine-containing tobacco administration on the subjective and behavioral responses to video-lottery terminal (VLT) gambling in 16 regular video-lottery terminal players (11 male) who were also regular consumers of alcohol and tobacco.
Methods:
During four double-blind, counterbalanced sessions, participants assessed the subjective effects of nicotine-containing tobacco or denicotinized tobacco following the administration of a moderately intoxicating dose of alcohol or a placebo beverage. They were then given $40 and provided with an opportunity to gamble using an authentic VLT.
Results:
Alcohol administration was associated with increased ratings of several subjective descriptors including "intoxicated", "high", "want alcohol", "crave cigarette", and "want to gamble" but did not affect subsequent gambling behavior. In contrast, relative to denicotinized tobacco, the administration of nicotine containing tobacco was associated with increased average wagers, but did not significantly alter subjective state.
Conclusions:
Findings suggest that both alcohol and nicotine-containing tobacco may acutely increase the propensity to gamble using VLTs, but they may do so through separate processes.
... Many studies have found youth and adult individuals with problem gambling in community and clinical settings drink alcohol and consume illicit substances at several times the general population rates Fisher, 1993;Gupta & Derevenski, 2000). Surveys indicate that a high percentage of regular gamblers consume alcohol while gambling and that this may be especially so during electronic gaming machine participation (Stewart & Kushner, 2003). ...
... Prominent characteristics of problem gamblers include social isolation (Wiebe, Single, & Falkowski-Ham, 2001), high incidence of childhood trauma and abuse in both gamblers and their partners (Broffman, 2001;Jacobs, 1987;Lee, 2002c), marital distress (Ciarrocchi & Hohmann, 1989;Ciarrocchi & Franklin, 2002;McCown & Chamberlain, 2000;Lee, 2002c); depression and anxiety (Toneatto, 2002), poor coping abilities (McCormick, 1994), and comorbidity with other types of addiction and psychiatric disorders (Stewart & Kushner, 2003;Shaffer, Hall, & VanderBilt, 1999;Rupcich, Frisch, & Govoni, 1997;Toneatto & Skinner, 2000). ...
Congruence Couple Therapy (CCT) is a new, humanistic, systemic model for problem gambling treatment. In the development of empirically supported treatments, counsellor training is a critical step. This study evaluates the effectiveness of CCT training in imparting key concepts, skills, and values of CCT to a sample of problem gambling counsellors (N = 21) from 13 Ontario problem gambling treatment programs. CCT training comprised of a 4-day residential workshop followed by 12 weeks of CCT application, with 1 to 2 clients per counsellor supported by teleconference consultation. Two cycles of training were conducted: Cycle 1 (N = 21) was a randomized controlled trial comparing counsellors with CCT training and a control group. Immediately after the completion of Cycle 1, the control group (n = 9) received identical CCT training in Cycle 2. A within-subjects design compared Cycle 2 counsellors at three points: at baseline, after a 15-week waiting period, and after 15 weeks of CCT Training. Five interrelated levels of CCT training were evaluated: 1) counsellor satisfaction; 2) counsellor outcomes; 3) organizational support and change; 4) counsellor application of CCT; and 5) client satisfaction and outcomes. Triangulated findings indicated that counsellors significantly increased their knowledge of CCT concepts, values, and skills from both training cycles. Areas of high satisfaction were the trainer-supported CCT application, intense residential workshop in retreat setting, safety and collegiality, experiential learning approach, and framing the training in a research context. Further training was desired by all participants to advance their competence in CCT. The timing of the CCT training seemed to coincide with an emerging trend in some Ontario organizations to adopt more couple-focused counselling for problem gamblers, and an interest in linking research and practice. The need for expanded supervision and support for adopting treatment innovations in organizations is a topic for discussion. Client outcomes with CCT counsellor trainees showed significantly reduced problem gambling symptoms, improved couple communication and relationship, increased selfawareness, and positive spin-offs in family and work relationships. Clients rated their CCT treatment and outcomes very highly. These client results support findings from an earlier CCT pilot study; however, with the absence of a control group, client results should be treated as promising but preliminary. Further studies on CCT and CCT training are recommended in light of the positive multilevel results to date. Key words: Congruence Couple Therapy, counsellor, training, evaluation, empirically supported treatment, problem gambling, outcomes, innovation
... ( Male, 30s) In trajectories of progression as well as nonlinearlity, we frequently heard narratives in which alcohol encouraged excessive play by hindering or reducing control over gambling behaviour. The cooccurrence of alcohol and gambling problems has been well-documented (Crockford & El-Guebaly, 1998;Stewart & Kushner, 2003). In addition, however, many narratives also documented the fact that alcohol premises were often situated alongside gambling ones, providing an environmental association between the two types of behaviour that moves beyond the level of the individual. ...
This article presents findings from a five year study of ‘gambling careers’ designed to explore the ways that individuals move in and out of problematic behaviour over time. A longitudinal qualitative methodology was used to investigate patterns of stability and change in a cohort of 50 problem and recreational gamblers. The study found that change, rather than stability, was the norm in gambling behaviour and identified four different trajectories of behaviour: progression, reduction, consistency and non-linearity. Drawing on rich narrative accounts of respondents’ gambling behaviour, the study begins to suggest reasons for these different types of movement, highlighting the role of material factors such as employment, environment and social context in each. It concludes that gambling behaviour is highly variable over time, and recommends that future research focus on patterns of behaviour rather than on ‘types’ of gamblers.
... It remains unclear whether decision-making deficits in DG caused by SUD or DG itself considering that prevalence rates of SUD comorbidity in DG (Stewart and Kushner 2003) go as high as almost 60% (Black and Moyer 1998;Cunningham-Williams et al. 1998;Premper and Schulz 2008;Lorains et al. 2011), with lifetime prevalence at 73% for alcoholism and 60% for smoking (Petry et al. 2005). Existing evidence has made a distinction between those DGs with SUD comorbidity and those without suggesting that DGs with SUD constitute a group with more severe symptoms and poorer performance on measures of decision making (Petry 2001). ...
Background
Disordered gambling (DG) has often been associated with impaired decision-making abilities, suggesting a dysfunction in the ventromedial prefrontal cortex (vmPFC).AimsTo our knowledge, no previous study has accurately considered the effect of substance use disorder (SUD) comorbidity (including nicotine dependence) on decision-making impairments in DG.Methods and MaterialsWe employed the Cambridge Gambling Task (CGT) to assess a big cohort of patients diagnosed with DG (N = 80) against matched healthy controls (HCs) (N = 108). The cohort included DG patients with nicotine and alcohol dependence, alcohol dependence only and 12 “pure” nonsmokers with only DG diagnosis.ResultsPure nonsmoking, nicotine dependent as well as alcoholic DGs with current nicotine dependence, demonstrated a decision making profile, characterized by poor decision-making abilities and failure to make right choices (rational), closely resembling that of patients with vmPFC damage.DiscussionThis suggests that DGs with and without SUD comorbidity are equally affected in that domain of decision making abilities. Additionally, gambling diagnosis combined with alcohol and nicotine dependence involves a group of gambling patients with a relatively riskier decision making profile, showing that these patients apart from making irrational decisions take also more risks. Our findings highlight the importance of accounting for SUD comorbidities with useful implications for future research and therapy. Limitations of the current investigation are discussed.
... For example, in an epidemiological study of six countries including Canada, alcohol disorders were found to be highly co-morbid with mood and anxiety disorders (Merikangas et al. 1998). As another example, in recent reviews of the literature by Canadian researchers (Crockford & el-Guebaly 1998; Stewart & Kushner 2003), alcohol disorders were shown to be highly co-morbid with pathological gambling. Although these studies cannot establish whether the alcohol disorder causes the associated mental health problem or vice versa (or even if the two problems are causally related), there is some evidence from other sources that heavy drinking may cause or worsen some associated mental health problems. ...
Given its ubiquitous use over time and across many cultures, and its multitude of desirable effects for the user, alcohol has been described as "the world's number one psychoactive substance" (Ray & Ksir 1990). Although moderate drinking is a normative and accepted activity at social gatherings in Canadian culture, we also ironically view alcohol as an agent of disease and destruction. As in Scandinavian countries, there is has long been a preoccupation in Canada with drinking as a social problem (Smart 1985). As a result, Canada has been a world-leader in alcohol research for several decades (Smart 1985). Examining the history of alcohol use in Western civilization in general, and in Canadian culture in particular, can help clarify how we have come develop our ambivalent attitudes about this drug. History. For most of the past 10,000 years, alcoholic beverages were the most popular and common daily drink among people in Western civilization. However, according to Vallee (1998), Distinguished Senior Professor at Harvard Medical School, until the availability of sufficient clean, pure water supplies in the 19 th century, the health advantages of consuming alcohol far outweighed its dangers. In fact, alcohol was likely a very important source of fluids to meet the human need for physiological hydration in a world of contaminated water supplies. Alcohol was also very likely a crucial source of calories in meeting human energy requirements when groups faced food shortages. These health advantages earned alcohol the label "aqua vitae" or "the water of life" in the Middle Ages (Vallee 1998). By 6400 B.C., berry wines were being produced. The discovery of wine-making led to the domestication of particularly sweet grapes and the development of viniculture in what is now Armenia (Firestone & Korneluk 2003; Vallee 1998). Before the third millennium B.C., Egyptians and Babylonians were drinking beers that they made from barley and wheat (Vallee 1998). According to Vallee (1998), the alcohol content of these early wines and beers was very low by today's standards. It wasn't until around 700 A.D. (after about 9,000 years of use of low concentration alcohol in Western society) that the procedures involved in the distillation of spirits were discovered by Arabian alchemists (Firestone & Korneluk 2003; Vallee 1998). The advent of distillation led to the introduction of alcohol in much more concentrated form. This in turn led to the proliferation of beverages with sufficient alcohol content to contribute to widespread social and health problems that are directly related to alcohol use (Vallee 1998). The excessive use of alcohol has been reported throughout the ages (Firestone & Korneluk 2003; Vallee 1998). Alcohol was not a problem for Native Canadians until the French brought brandy and the British brought rum soon after immigrations from Europe began (Smart, 1985). Reports of the early missionaries contain many descriptions of intoxication among the natives and early settlers (e.g., Daily 1968); government control activities and anti-drinking movements quickly followed (Smart 1985). However, all 2 attempts to regulate alcohol use throughout the centuries have largely failed (Firestone & Korneluk 2003). In the 19 th century, the physician and American political figure Benjamin Rush began clinical research on the effects of prolonged consumption of hard liquor. Although his research was fuelled by his religious beliefs (i.e., Methodism), his research and publications provided an early description of symptoms associated with alcohol use disorders and the recognition of alcoholism as a chronic, life-threatening disease (Vallee 1998). Ideas such as these fuelled the Temperance Movement which allowed for the benefits of moderate drinking while morally condemning the heavy use of spirits (Vallee 1998). The Women's Christian Temperance Union tried to have alcohol education courses introduced into schools and was successful in several Canadian provinces (Smart 1985). The work of individuals such as Rush and the viewpoints expressed by proponents of the Temperance Movement paved the way for the American Prohibition (1919-1933). Although prohibition did reduce overall levels of use in the United States, it had some unintended side-effects such as increases in organized crime and bootlegging, some of which originated in Canada (Firestone & Korneluk 2003). These problems led to the repeal of Prohibition near the beginning of the Depression. Alcohol use steadily increased in the United States following Prohibition until it peaked in the 1980s. Canadian's per capita use of alcohol followed a comparable pattern (Firestone & Korneluk 2003). A longitudinal study by Mäkelä et al. (1981) compared alcohol use in Ontario, Canada to that in six other cultures (Switzerland, the United States, the Netherlands, Poland, Ireland, and Finland) from the years 1950 to 1980. Over the study period, alcohol consumption rose greatly in each culture studied. Variations between countries decreased over this time period, although great differences still existed by 1980. Throughout this time period, alcohol use in Ontario, Canada was on the upper end of the distribution of consumption of the seven countries studied, but remained lower than per capita consumption in Switzerland and the United States. Current Prevalence. An examination of Canadian liquor sales data shows a declining trend in alcohol sales through the 1980s and 1990s (see Canadian Profile 1999; Canadian Centre for Substance Abuse (CCSA)). Interestingly, however, this trend did not continue in most recent statistics. Liquor sales increased from 7.4 litres per person to 7.6 litres per person from 1995-96 to 1996-97. This is the first increase in per capita alcohol sales since the early 1980's (CCSA 1999). In 1996-97, the average Canadian spent almost $500 on alcohol. A 1993 survey of over 10,000 Canadians collected data on people's drinking habits (the General Social Survey, conducted by Statistics Canada; as cited in Firestone & Korneluk 2003). About three-quarters of those surveyed indicated that they had consumed some alcohol in the previous year. Another 18% were categorized as former drinkers and about 8% reported never having used alcohol. The rate of those drinking in the 12 months prior to the survey represented a significant reduction from rates in 1978 where 84% of those surveyed reported having consumed alcohol in the year prior to the survey. This significant decrease may be due to an increased awareness among Canadians about the risks associated with alcohol consumption and/or to the fact that during this time period, a larger proportion of the Canadian population moved into the 60+ age range where drinking rates decrease relative to rates of alcohol use in younger people (Firestone & Korneluk 2003).
... Many studies have found that youth and adults with problem gambling in community and clinical settings drink alcohol and consume illicit substances at several times the general population rates (e.g., Abbott, 2001; Gupta & Derevenski, 1998). Surveys indicate that a high percentage of regular gamblers consume alcohol while gambling and that this may be especially so during electronic gaming machine participation (Stewart & Kushner, 2003). Typically 30–50% of adults seeking treatment for pathological gambling have co-morbid alcohol and/or other substance misuse disorders (Crockford & el-Guebaly, 1998; Petry, 2002). ...
At the International Gambling Conference: Policy, Practice and Research in 2004 (Clarke, eCommunity-International Journal of Mental Health and Addiction, 3:29–40, 2005), a paper was presented which proposed key indicators of the transition from social to problem gambling and to recovery, based on a review of literature on factors leading to substance abuse. They included availability of gambling activities, lack of social and cultural empowerment, low socioeconomic status, and personal loss of control. Subsequently, a multidisciplinary team collected data on why people gamble. Four New Zealand ethnic groups (Päkehä/New Zealand European, Mäori, Pacific peoples and Asians) in South Auckland were targeted for both phases of the study. Phase 1 involved qualitative analysis of data from individual interviews and focus groups. Phase 2 surveyed 345 adults using a questionnaire developed from the first phase. From both phases, key indicators for problem gambling were similar to the indicators for substance abuse. Public health interventions such as reducing access to electronic gaming machines and empowerment of cultural groups, and a longitudinal study of the development of gambling in the community are suggested.
... Relatively little is known about the co-occurrence of drinking and gambling at a single point in space and time [6]. An understanding of co-occurrence is potentially important in explaining the interaction between population level comorbidities [7] as well as in the development of effective regulation and harm minimisation strategies [8]. ...
Introduction and aims:
Despite the well-documented comorbidity between disordered alcohol use and problem gambling, little is known about the co-occurrence of drinking and gambling in gambling venues. This paper appears to be the first to investigate the association between drinking and gambling behaviour among a large sample of gamblers during a specific, non-laboratory gambling episode.
Design and methods:
We conducted a mail survey of all available households in the Northern Territory of Australia, including questions on drinking and gambling behaviour on the last visit to a gambling venue. We estimate the effect of moderate (1-4 standard drinks) and risky (>4 standard drinks) alcohol consumption on gambling participation and gambling duration for both problem and non-problem gamblers using regression analysis of 7044 survey responses.
Results:
The probability of participating in electronic gaming machine (EGM) gambling decreased with alcohol consumption for non-problem gamblers, while the probability of participating in TAB (Totalisator Agency Board, off-course totalisator) gambling increased with risky alcohol consumption for all gamblers. Alcohol consumption was not associated with EGM gambling participation for problem gamblers. Moderate alcohol consumption was negatively associated with EGM gambling duration, with a stronger effect observed for problem gamblers.
Discussion and conclusions:
Moderate alcohol consumption is inversely correlated with both the duration of play and probability of participation for EGM gambling. Current laboratory studies do not predict the drinking-gambling behaviour of the general population in non-laboratory settings. Future research on alcohol and gambling co-occurrence must explicitly consider the drinking and gambling environment in order to produce policy-relevant findings.
... Another interesting point lies in the relationship between pG, severity of dependence and abstinence. In agreement with previous reports (Stewart and Kushner, 2003), we found a positive correlation between the frequency of pG and the AUDIT score, with the highest rate of pG among those patients with an AUDIT > = 13, a value commonly accepted as the hallmark of dependence on alcohol; but conversely, we observed only a slight and non-significant decrease in pG frequency in patients who had stopped drinking, and this weakens the hypothesis that alcohol use disorder (AUD) causes pG; from the practical point of view, this reminds us that abstainers from alcohol still remain at risk of pG and thus should be questioned about it. The most popular forms of gambling in our sample were scratch cards and lotteries. ...
To estimate the prevalence of pathological gambling (pG) in people addicted to alcohol and drugs, particularly those with alcohol use disorders (AUDs), including new forms of gambling such as video and on-line games; and to update the socio-demographic profile of people suffering from both AUD and pG.
A cross-sectional survey was conducted in 1 week of 2009 in 55 French addiction treatment centres, including all consecutive patients attending that centre, using an anonymous questionnaire which included a tool specific for pG screening, the DEBA-jeu questionnaire (Détection et Besoin d'Aide en regard du Jeu Excessif).
A total of 2790 patients entered the study. The most frequent reason for attending the Addiction Centres was AUD (77%). According to the DEBA test, 6.5% of the patients were pathological gamblers and 12% were subsyndromal gamblers. pG affected all age groups and did not decrease with abstinence from alcohol. pG was significantly associated with male sex [relative risk (RR) = 2.4; P < 0.001)] and, at a lower level of significance, with homelessness (RR = 1.52; P = 0.03) and unemployment (RR = 1.47; P = 0.04).
pG appears to be a common feature of the French people with alcohol and drug disorders. Apart from male sex, no parameter had discriminatory power sufficient to target pG screening on a specific subgroup. Therefore, any patient attending a centre for drug or AUD should be asked about his gambling. Moreover, clinical teams should be trained to treat this addiction.
... drinking, as well as other forms of substance misuse, and the need to consider these relationships carefully in treatment programs. This matter has been discussed recently by Langenbucher et al. (2001) as well as by Stewart and Kushner (2003). Both prospective assessments and respondent retrospective reports indicate a substantial reduction in gambling participation on the part of probable pathological and problem gamblers in this study. ...
Little is known about the life course of gambling problems and there have been no prospective studies of problem gambling. This article describes a study of 77 problem gamblers and 66 nonproblem gamblers recruited from a national prevalence survey in New Zealand in 1991 and reassessed in 1998. While most 1991 problem gamblers were nonproblematic at follow-up, a significant minority had developed more serious problems. Multiple logistic regression analysis identified more severe gambling problems, hazardous drinking, and a preference for track betting as the strongest independent predictors of subsequent problem gambling. These findings contradict conventional notions that pathological gambling is invariably a chronic or chronically relapsing disorder. The findings have implications for the interpretation of previous research, conduct of future research, and problem gambling policy and treatment.
... As hypothesized, and consistent with our earlier study (Stewart et al., 2005), we did see that the degree of increase from predrinking to VLT play was greater for those in the alcohol condition. Thus, the combination of VLT play and alcohol consumption does appear to be linked to an additional heart-rate increase, compared with the heart rate increase associated with engaging in either addictive behavior alone, which may help explain the frequent pairing of these two activities in both clinical and nonclinical populations (Focal Research, 1998; Stewart & Kushner, 2003; Stewart et al., 2002). Although most aspects of our original study (Stewart et al., 2005) were replicated, there were some important differences as well. ...
The authors examined heart-rate responses to alcohol consumption and video lottery terminal (VLT) play. Regular VLT players (30 probable pathological gamblers [PPGs]; 30 nonpathological gamblers [NPGs]) were randomized to an alcohol (mean postdrinking blood alcohol concentration = 0.056%) or placebo condition. Heart rate was recorded at pre- and postdrinking baselines and during VLT play. Consistent with an earlier study, alcohol-condition participants displayed elevated heart rates relative to placebo-condition participants only at postdrinking and VLT play. Moreover, alcohol-condition participants showed a greater heart rate increase to VLT play than did placebo-condition participants. However, PPGs were not more susceptible to alcohol- and/or VLT play-induced heart rate accelerations than were NPGs. Implications for gambling/alcohol-disorder comorbidity are discussed.
... As available opportunities for gambling increase, it appears that problem gambling is increasing in prevalence [1]. Gambling disorders have been shown to have high comorbidity with the use of tobacco [1] , problem drink- ing [2,3], other substance misuse [4], and mood disorder [5]. As well as impacting on an individual's health and well-being, problematic gambling may have serious harmful effects on the patient's family, financial security and career. ...
Problem gambling often goes undetected by family physicians but may be associated with stress-related medical problems as well as mental disorders and substance abuse. Family physicians are often first in line to identify these problems and to provide a proper referral. The aim of this study was to compare a group of primary care patients who identified concerns with their gambling behavior with the total population of screened patients in relation to co-morbidity of other lifestyle risk factors or mental health issues.
This is a cross sectional study comparing patients identified as worrying about their gambling behavior with the total screened patient population for co morbidity. The setting was 51 urban and rural New Zealand practices. Participants were consecutive adult patients per practice (N = 2,536) who completed a brief multi-item tool screening primary care patients for lifestyle risk factors and mental health problems (smoking, alcohol and drug misuse, problem gambling, depression, anxiety, abuse, anger). Data analysis used descriptive statistics and non-parametric binomial tests with adjusting for clustering by practitioner using STATA survey analysis.
Approximately 3/100 (3%) answered yes to the gambling question. Those worried about gambling more likely to be male OR 1.85 (95% CI 1.1 to 3.1). Increasing age reduced likelihood of gambling concerns - logistic regression for complex survey data OR = 0.99 (CI 95% 0.97 to 0.99) p = 0.04 for each year older. Patients concerned about gambling were significantly more likely (all p < 0.0001) to have concerns about their smoking, use of recreational drugs, and alcohol. Similarly there were more likely to indicate problems with depression, anxiety and anger control. No significant relationship with gambling worries was found for abuse, physical inactivity or weight concerns. Patients expressing concerns about gambling were significantly more likely to want help with smoking, other drug use, depression and anxiety.
Our questionnaire identifies patients who express a need for help with gambling and other lifestyle and mental health issues. Screening for gambling in primary care has the potential to identify individuals with multiple co-occurring disorders.
Individuals with disordered gambling often report at least one other lifetime psychiatric diagnosis. Although prevalence rates vary, there is substantial evidence for co-morbidity being the rule rather than the exception. Despite this known association, there has not been a recent comprehensive review of co-morbidity in disordered gambling other than prevalence surveys. The goal of this study was to broadly summarize and review the current literature on the extent, range and nature of disordered gambling co-morbidity. Following an initial search and screening of 6 databases, 251 articles were included in the final synthesis and evaluation. The main findings showed that few studies examine the mechanisms of co-morbidity in gambling beyond prevalence rates; few studies report on temporal sequencing of gambling and co-morbid disorders; there is a lack of treatment evaluation studies designed specifically for dual-diagnosis individuals; there is a need for system-level initiatives to address co-morbidity at the policy level; and the substance use literature may act as a useful model for guiding future gambling research on co-morbidity. The results suggest that despite a reasonable amount of published research on co-morbidity in disordered gambling, most study conclusions relegate to acknowledgements of high co-occurrence between disorders without follow-up.
The purpose of this research was to examine the sociodemographic characteristics of alcohol addicts treated at the Department of Psychiatry of Dubrovnik General Hospital. All patients hospitalized because of alcohol addiction at the Department of Psychiatry of Dubrovnik General Hospital during 1992, 2000 and 2005 were included in this research. Data used in order to perform this research was gathered from hospital records and patients' case histories. Criteria assessed were: gender, age, marital status, employment and level of education. Results show that alcohol addicts still account for a great deal of psychiatric hospitalizations, although there is a noticeable tendency of decreasing the number of alcohol related hospitalizations. Furthermore, the majority of patients hospitalized because of alcohol addiction are male. Patients hospitalized are mostly middle-aged, married and employed. Acquired research data gives us a valuable insight into the sociodemographic characteristics of alcohol addicts in Dubrovačko-neretvanska County and enables further planning of quality psychiatric care of alcohol addicts.
El objetivo de este estudio es evaluar la presencia de patrones de personalidad patológicos y explorar su relación con los síndromes clínicos, en una muestra de 212 varones jugadores patológicos pertenecientes a un centro de rehabilitación. Asimismo explorar la posible existencia de perfiles patológicos, comunes en los jugadores, en los que puedan coexistir distintos trastornos de personalidad y síndromes clínicos. Se ha utilizado el Inventario Clínico Multiaxial de Millon (MCMI-II). Los resultados muestran cuatro patrones de personalidad clínicos de mayor frecuencia: dependiente, obsesivo-compulsivo, narcisista y antisocial. Los síndromes clínicos más frecuentes son el abuso de alcohol y el abuso de drogas. Se analiza la relación existente entre cada uno de los patrones de personalidad y los síndromes clínicos. Posteriormente se realiza un análisis de cluster y se identifican dos perfiles de personalidad diferenciados, con rasgos pertenecientes a distintas escalas, que se han denominado �perfil antisocial� y �perfil obsesivo compulsivo�, cada uno de ellos se relaciona de manera muy diferente con los síndromes clínicos. Mostrando el grupo antisocial, de forma estadísticamente significativa, puntuaciones más altas en todos los síndromes clínicos, siendo cercanas a la puntuación clínica en abuso de alcohol, abuso de drogas, pensamiento psicótico y trastorno delirante.
This paper investigates how various socio-demographic as well as psychological factors are related to the purchasing frequency of Le Millionaire scratch card in Mauritius. In order to obtain a refined description and understanding of consumer behaviour, special attempts have been made to control for the personality traits of an individual. The OCEAN model of personality is thereby considered. We employ cross-sectional micro-data acquired from a household drop-off survey with a sample size of 1135 observations. Within a double-hurdle framework, gender, residential location, educational level, household income, alcohol consumption, other forms of gambling activities, and personality traits are found to be determining factors affecting an individual's decision to gamble in the scratch card market. Our findings help us to draw attention to the consequences of risk-taking behaviours and how personality-specific policies can be designed to influence gambling behaviour.
There appears to be an association between substance use and pathological gambling disorders in the research. This will present concerns for clinicians in substance use treatment programs as clients present with the co-occurring disorders. This exploratory study provides descriptive information learned from calls made to a problem gambling helpline by people reporting co-occurring substance use and gambling disorders. The information can be used by educators to inform students of the characteristics of this population.
The aim of this study is to evaluate the prevalence and percentages of personality patterns, and explore their relationship with clinical syndromes in a sample of 212 pathological gamblers from a rehabilitation center. The study also explores the possibility of profiles, common in gamblers, in which personality disorders and clinical syndromes coexist. The Millon Clinical Multiaxial Inventory (MCMIII) was employed. Four clinical personality patterns were the most frequently identified: dependent, obsessive-compulsive, narcissistic and antisocial. The relationship between personality patterns and clinical syndromes was also analyzed. Subsequent cluster analysis revealed two personality profiles, with features belonging to different scales, called "antisocial profile" and "obsessive-compulsive profile". These two profiles differ considerably in their relation to clinical syndromes. The "antisocial" group scores significantly higher on all clinical syndromes, and close to the clinical score in the cases of alcohol abuse, drug abuse, psychotic thinking and delusional disorder.
Sweet taste is a powerful factor influencing food acceptance. There is considerable variation in sweet taste perception and preferences within and among species. Although learning and homeostatic mechanisms contribute to this variation in sweet taste, much of it is genetically determined. Recent studies have shown that variation in the T1R genes contributes to within- and between-species differences in sweet taste. In addition, our ongoing studies using the mouse model demonstrate that a significant portion of variation in sweetener preferences depends on genes that are not involved in peripheral taste processing. These genes are likely involved in central mechanisms of sweet taste processing, reward and/or motivation. Genetic variation in sweet taste not only influences food choice and intake, but is also associated with proclivity to drink alcohol. Both peripheral and central mechanisms of sweet taste underlie correlation between sweet-liking and alcohol consumption in animal models and humans. All these data illustrate complex genetics of sweet taste preferences and its impact on human nutrition and health. Identification of genes responsible for within- and between-species variation in sweet taste can provide tools to better control food acceptance in humans and other animals.
Risk factors for youth gambling problems are best understood within an ecological model recognizing the interwoven relationship that exists between the individual and their environment. Empirical studies covering individual, relationship, community, and societal factors associated with adolescent gambling problems are reviewed. The cumulative body of research suggests that males who are exposed to gambling at an earlier age are at greater risk of developing gambling problems. Individuals who report poor family cohesion, have family members or friends who also gamble, and those exposed to and engaged in a wider variety of gambling options are at greater risk. Adolescents with impulsive, high sensation-seeking personalities and exhibit emotion-focused coping styles are more likely to experience gambling problems. Anxiety, depression, ADHD, poor academic performance, substance use, and delinquency are also strong predictors. Many of these risk factors appear to predict a general behavior syndrome encompassed by overall mental health problems, substance abuse, delinquency, and problem gambling. Increased exposure to gambling opportunities and marketing of gambling is recognized as a potential risk factor at a community level while gambling-permissive cultures may instill positive attitudes and beliefs toward gambling. A call is made for more research that can identify the causal risk factors that lead to gambling problems among youth which will ultimately improve our prevention efforts.
In the wake of rapid expansion of legal gambling internationally, studies of adolescent gambling involvement and problem gambling prevalence have been carried out in numerous jurisdictions. This paper reviews adolescent gambling prevalence studies that have been carried out in North America, Europe, and Oceania. Based on this review, work is clearly needed to assess the impact of survey methods on identified prevalence rates and to improve the measurement of problem gambling among adolescents. From a substantive perspective, several clear demographic and behavioral characteristics are associated with gambling involvement and problem gambling among youth. However, early assumptions about youth gambling and problem gambling must give way to more nuanced understandings of how these phenomena change in response to changes in the social and cultural environment. We may have traveled some distance down the road toward understanding the determinants as well as the distribution of youth gambling and problem gambling, but we still have a long way to go.
Elevated alcohol consumption is associated with enhanced preference for sweet substances across species and may be mediated by oral alcoholinduced activation of neurobiological substrates for sweet taste. Here, we directly examined the contribution of the T1r3 receptor protein, important for sweet taste detection in mammals, to ethanol intake and preference and the neural processing of ethanol taste by measuring behavioral and central neurophysiological responses to oral alcohol in T1r3 receptor-deficient mice and their C57BL/6J background strain. T1r3 knockout and wild-type mice were tested in behavioral preference assays for long-term voluntary intake of a broad concentration range of ethanol, sucrose, and quinine. For neurophysiological experiments, separate groups of mice of each genotype were anesthetized, and taste responses to ethanol and stimuli of different taste qualities were electrophysiologically recorded from gustatory neurons in the nucleus of the solitary tract. Mice lacking the T1r3 receptor were behaviorally indifferent to alcohol (i.e., ∼50% preference values) at concentrations typically preferred by wild-type mice (5-15%). Central neural taste responses to ethanol in T1r3-deficient mice were significantly lower compared with C57BL/6J controls, a strain for which oral ethanol stimulation produced a concentration-dependent activation of sweet-responsive NTS gustatory neurons. An attenuated difference in ethanol preference between knockouts and controls at concentrations >15% indicated that other sensory and/or postingestive effects of ethanol compete with sweet taste input at high concentrations. As expected, T1r3 knockouts exhibited strongly suppressed behavioral and neural taste responses to sweeteners but did not differ from wild-type mice in responses to prototypic salt, acid, or bitter stimuli. These data implicate the T1r3 receptor in the sensory detection and transduction of ethanol taste.
The purpose of this research was to examine the sociodemographic characteristics of alcohol addicts treated at the Department of Psychiatry of Dubrovnik General Hospital. All patients hospitalized because of alcohol addiction at the Department of Psychiatry of Dubrovnik General Hospital during 1992, 2000 and 2005 were included in this research. Data used in order to perform this research was gathered from hospital records and patients' case histories. Criteria assessed were: gender, age, marital status, employment and level of education. Results show that alcohol addicts still account for a great deal of psychiatric hospitalizations, although there is a noticeable tendency of decreasing the number of alcohol related hospitalizations. Furthermore, the majority of patients hospitalized because of alcohol addiction are male. Patients hospitalized are mostly middle-aged, married and employed. Acquired research data gives us a valuable insight into the sociodemographic characteristics of alcohol addicts in Dubrovacko-neretvanska County and enables further planning of quality psychiatric care of alcohol addicts.
It has long been recognized that gambling is an activity that is often combined with alcohol intake. Not only do the behaviors of drinking and gambling frequently co-occur, alcohol use disorders and pathological gambling are also commonly co-morbid conditions in both clinical and non-clinical samples. This article introduces a special issue of the Journal
of
Gambling
Studies focusing on cutting edge findings on the relations between gambling and alcohol use behaviors and their associated disorders. We set the stage for the following series of six novel empirical papers and integrative commentary by reviewing the theoretical pathways through which alcohol use and gambling disorders may be linked. We conclude by describing some of the novel contributions of each of the empirical studies from within the context of these theoretical models.
This review focuses on behavioral genetic studies of sweet, umami, bitter and salt taste responses in mammals. Studies involving mouse inbred strain comparisons and genetic analyses, and their impact on elucidation of taste receptors and transduction mechanisms are discussed. Finally, the effect of genetic variation in taste responsiveness on complex traits such as drug intake is considered. Recent advances in development of genomic resources make behavioral genetics a powerful approach for understanding mechanisms of taste.
Pathological gamblers who drink when gambling (n=158; 77% men; mean age=36.0 years) completed the Inventory of Gambling Situations (IGS) and gambling and drinking criterion measures. Principal components analysis on the IGS subscales revealed negative (e.g., Unpleasant Emotions) and positive (e.g., Pleasant Emotions) gambling situation factors. Subjecting IGS factor scores to cluster analysis revealed three clusters: (a) enhancement gamblers, with low negative and high positive factor scores; (b) coping gamblers, with very high negative and high positive factor scores; and (c) low emotion regulation gamblers, with low negative and positive factor scores (59%, 23%, and 18% of the sample, respectively). Clusters were validated with a direct measure of gambling motives. Additional validity analyses showed that coping gamblers scored higher than the other groups on a variety of different gambling activities, gambling problems, drinking frequency, drinking problems, and coping drinking motives, whereas low emotion regulation gamblers scored lower than the other groups on gambling frequency, gambling problems, drinking quantity, and enhancement drinking motives. The findings validate this empirical approach to subtyping gamblers and suggest consistency of motives across addictive behaviors.
Implicit and explicit alcohol-related cognitions were measured in 2 dimensions: positive-negative (valence) and arousal-sedation, with 2 versions of the Implicit Association Test (IAT; A. G. Greenwald, D. E. McGhee, & J. L. Schwartz) and related explicit measures. Heavy drinkers (n = 24) strongly associated alcohol with arousal on the arousal IAT (especially men) and scored higher on explicit arousal expectancies than light drinkers (n = 24). On the valence IAT, both light and heavy drinkers showed strong negative implicit associations with alcohol that contrasted with their positive explicit judgments (heavy drinkers were more positive). Implicit and explicit cognitions uniquely contributed to the prediction of 1-month prospective drinking. Heavy drinkers' implicit arousal associations could reflect the sensitized psychomotor-activating response to drug cues, a motivational mechanism hypothesized to underlie the etiology of addictive behaviors.
Social behavior is ordinarily treated as being under conscious (if not always thoughtful) control. However, considerable evidence now supports the view that social behavior often operates in an implicit or unconscious fashion. The identifying feature of implicit cognition is that past experience influences judgment in a fashion not introspectively known by the actor. The present conclusion—that attitudes, self-esteem, and stereotypes have important implicit modes of operation—extends both the construct validity and predictive usefulness of these major theoretical constructs of social psychology. Methodologically, this review calls for increased use of indirect measures—which are imperative in studies of implicit cognition. The theorized ordinariness of implicit stereotyping is consistent with recent findings of discrimination by people who explicitly disavow prejudice. The finding that implicit cognitive effects are often reduced by focusing judges’ attention on their judgment task provides a basis for evaluating applications (such as affirmative action) aimed at reducing such unintended discrimination.
Problematic gambling is more common among people with alcohol use disorders (AUDs) (i.e., either alcohol abuse or dependence) compared with those without AUDs. This association holds true for people in the general population and is even more pronounced among people receiving treatment. No broadly accepted explanation for the link between problematic gambling and AUD currently exists. The available literature suggests that common factors may increase the risk for both conditions. For example, a defect of functioning in a particular brain system may underlie both conditions. This hypothesis should be further developed using brain imaging and psychopharmacological studies. Effective treatment and prevention will require additional research into relevant associations on both the event level (e.g., the effects of drinking on gambling behavior and vice versa) and the syndrome level (e.g., the relative onset and course of each condition among those who have either one or both disorders). A prudent interpretation of the available data suggests careful screening and treatment when necessary for problematic gambling among people with alcohol abuse and for alcohol abuse among people with gambling problems.
The South Oaks Gambling Screen is a 20-item questionnaire based on DSM-III criteria for pathological gambling. It may be self-administered or administered by nonprofessional or professional interviewers. A total of 1,616 subjects were involved in its development: 867 patients with diagnoses of substance abuse and pathological gambling, 213 members of Gamblers Anonymous, 384 university students, and 152 hospital employees. Independent validation by family members and counselors was obtained for the calibration sample, and internal consistency and test-retest reliability were established. The instrument correlates well with the criteria of the revised version of DSM-III (DSM-III-R). It offers a convenient means to screen clinical populations of alcoholics and drug abusers, as well as general populations, for pathological gambling.
An implicit association test (IAT) measures differential association of 2 target concepts with an attribute. The 2 concepts appear in a 2-choice task (2-choice task (e.g., flower vs. insect names), and the attribute in a 2nd task (e.g., pleasant vs. unpleasant words for an evaluation attribute). When instructions oblige highly associated categories (e.g., flower + pleasant) to share a response key, performance is faster than when less associated categories (e.g., insect & pleasant) share a key. This performance difference implicitly measures differential association of the 2 concepts with the attribute. In 3 experiments, the IAT was sensitive to (a) near-universal evaluative differences (e.g., flower vs. insect), (b) expected individual differences in evaluative associations (Japanese + pleasant vs. Korean + pleasant for Japanese vs. Korean subjects), and (c) consciously disavowed evaluative differences (Black + pleasant vs. White + pleasant for self-described unprejudiced White subjects).
This study determined prevalence estimates of problem gambling and relationships to other psychiatric and substance use disorders.
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.
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.
Clinicians treating alcoholism and tobacco dependence may need to screen for problem gambling. Additional research in the context of increased gambling opportunities is needed.
In comparison with alcohol dependence (AD), relatively little is known about the causes of pathological gambling (PG). Given the high rate of comorbidity between PG and AD, knowledge about the causes of AD may be applied to understanding those of PG.
Subjects were adult male twin pairs from the Vietnam Era Twin Registry. Lifetime histories of PG and AD were assessed by structured psychiatric telephone interview. The validity of a continuum of PG liability was tested to determine whether the causes of subclinical PG, or problem gambling, are quantitatively or qualitatively distinct from those of DSM-III-R PG disorder. Genetic model-fitting methods were used to quantify the extent to which the genetic and environmental risk for PG could be explained by the risk for AD.
Tests of the continuity model of PG were all consistent with the hypothesis that subclinical PG and DSM-III-R PG disorder have many, perhaps all, of the same risk factors and thus differ quantitatively rather than qualitatively. Depending on the PG definition, between 12% and 20% of the genetic variation and between 3% and 8% of the nonshared environmental variation in the risk for PG were accounted for by the risk for AD.
Subclinical PG, or problem gambling, may be a milder form of PG, rather than an etiologically distinct syndrome. Risk for AD accounts for a significant but modest proportion of the genetic and environmental risk for subclinical PG and DSM-III-R PG disorder.
Implicit and explicit alcohol-related cognitions were measured in 2 dimensions: positive-negative (valence) and arousal-sedation, with 2 versions of the Implicit Association Test (IAT; A. G. Greenwald, D. E. McGhee, & J. L. Schwartz) and related explicit measures. Heavy drinkers (n = 24) strongly associated alcohol with arousal on the arousal IAT (especially men) and scored higher on explicit arousal expectancies than light drinkers (n = 24). On the valence IAT, both light and heavy drinkers showed strong negative implicit associations with alcohol that contrasted with their positive explicit judgments (heavy drinkers were more positive). Implicit and explicit cognitions uniquely contributed to the prediction of 1-month prospective drinking. Heavy drinkers' implicit arousal associations could reflect the sensitized psychomotor-activating response to drug cues, a motivational mechanism hypothesized to underlie the etiology of addictive behaviors.
The legalization and availability of new forms of gambling are increasing in most Western countries. This trend has contributed to the fact that more individuals are developing gambling problems. As a result, there is a need for effective treatments. Although gambling treatment dates several decades, few empirically supported treatments for pathological gambling have been developed. This critical review includes only controlled treatment studies. The primary inclusion criterion was randomization of participants to an experimental group and to at least 1 control group. Eleven studies were identified and evaluated. Key findings showed that cognitive-behavioral studies received the best empirical support. Recommendations to improve gambling treatment research include better validated psychometric measures, inclusion of process measures, better definition of outcomes, and more precise definition of treatments.
• A test-retest reliability study of the Structured Clinical Interview for DSM-III-R was conducted on 592 subjects in four patient and two nonpatient sites in this country as well as one patient site in Germany. For most of the major categories, ks for current and lifetime diagnoses in the patient samples were above.60, with an overall weighted k of.61 for current and.68 for lifetime diagnoses. For the nonpatients, however, agreement was considerably lower, with a mean k of.37 for current and.51 for lifetime diagnoses. These values for the patient and nonpatient samples are roughly comparable to those obtained with other structured diagnostic instruments. Sources of diagnostic disagreement, such as inadequate training of interviewers, information variance, and low base rates for many disorders, are discussed.
Social behavior is ordinarily treated as being under conscious (if not always thoughtful) control. However, considerable evidence now supports the view that social behavior often operates in an implicit or unconscious fashion. The identifying feature of implicit cognition is that past experience influences judgment in a fashion not introspectively known by the actor. The present conclusion--that attitudes, self-esteem, and stereotypes have important implicit modes of operation--extends both the construct validity and predictive usefulness of these major theoretical constructs of social psychology. Methodologically, this review calls for increased use of indirect measures--which are imperative in studies of implicit cognition. The theorized ordinariness of implicit stereotyping is consistent with recent findings of discrimination by people who explicitly disavow prejudice. The finding that implicit cognitive effects are often reduced by focusing judges' attention on their judgment task provides a basis for evaluating applications (such as affirmative action) aimed at reducing such unintended discrimination.
To critically review the current literature on pathological gambling as regards the significant psychiatric comorbidities associated with it.
The authors synthesized information found via electronic searches (MEDLINE) and bibliographic-directed searches in over 60 publications.
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.
Pathological gambling is associated with significant psychiatric comorbidity. Recommendations for future research are described.
Despite relatively high prevalence rates and significant morbidity and mortality associated with pathological gambling (PG), our understanding of the neurobiological basis of PG lags in comparison to that for other psychiatric illnesses of comparable magnitude. An improved understanding of the neurobiology of PG would facilitate targeted investigations into more effective treatments. Emerging data suggest shared neurobiological features determine in part pathological gambling and substance use disorders. These findings both challenge current conceptualizations of addictions and provide a substantial basis of knowledge on which to design investigations into the understanding and treatment of pathological gambling. The findings that substance use disorders and the behavioral "addiction" of PG share common causative features raise the question as to what extent other compulsive disorders (eg, compulsive shopping, compulsive sexual behaviors, compulsive computer use) might be biologically related.
This study was designed to determine the prevalence and demographic distribution of problem gambling, pathological gambling, alcohol abuse and alcohol dependence in the United States, and to examine the co-occurrence of gambling pathology and alcohol pathology in the United States.
A representative sample (N = 2,638) of U.S. adults age 18 and older was surveyed in the year 2000 using computer-assisted telephone interviewing. Respondents' gambling pathology and alcohol dependence were assessed by the South Oaks Gambling Screen (SOGS) and the Diagnostic Interview Schedule (DIS).
Current pathological gambling had an overall prevalence of 1.3% as measured by the DIS and 1.9% as measured by the SOGS, with a higher prevalence among minorities and lower socioeconomic status (SES) respondents. Current and lifetime alcohol pathology was more common among males and young adults than among females and older adults. Current pathological gambling and alcohol dependence were correlated, and the highest correlation was found among higher SES respondents.
The rate of current pathological gambling in the United States is higher than reported in past surveys. Minorities and lower SES Americans have higher than average rates of current pathological gambling. However, when higher SES persons are classified as current pathological gamblers, they are more likely than lower SES persons to be dependent on alcohol.
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.
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