Effect of Genes, Environment, and Lifetime Co-occurring Disorders on Health-Related Quality of Life in Problem and Pathological Gamblers

Department of Psychiatry, Washington University in St. Louis, San Luis, Missouri, United States
Archives of General Psychiatry (Impact Factor: 14.48). 07/2005; 62(6):677-83. DOI: 10.1001/archpsyc.62.6.677
Source: PubMed


Problem and pathological gambling are associated with many impairments in quality of life, including financial, family, legal, and social problems. Gambling disorders commonly co-occur with other psychiatric disorders, such as alcoholism and depression. Although these consequences and correlates have been reported, little is known about the health-related functional impairment associated with gambling.
To model differences in the health-related quality of life (HRQoL) among non-problem gamblers, problem gamblers, and pathological gamblers after controlling for lifetime co-occurring substance use disorders, psychiatric disorders, sociodemographics, and genetic and family environmental influences.
Cohort and co-twin studies.
Nationally distributed community sample.
Male twin members of the Vietnam Era Twin Registry: 53 pathological gamblers, 270 subclinical problem gamblers, and 1346 non-problem gamblers (controls).
We obtained HRQoL data, via the 8-Item Short-Form Health Survey, from all participants. Data from a subset of twin pairs discordant for gambling behavior was used to control for genetic and family environmental effects on HRQoL and problem gambling. Main Outcome Measure Health-related quality of life.
Results from adjusted logistic regression analyses suggest little difference across groups in the physical domains of the health survey; however, for each mental health domain, pathological gamblers had lower HRQoL scores than problem gamblers (P<.05), who in turn had lower scores than non-problem gamblers (P<.05). After controlling for genes and family environment, no significant differences existed between the non-problem gambling twins and their problem or pathological gambling brothers, but adjusted co-twin analyses resulted in statistically significant differences in 4 of 8 subscales.
Pathological and problem gambling are associated with significant decrements in HRQoL. This association is partly explained by genetic and family environmental effects and by lifetime co-occurring substance use disorders. Implications for clinicians, health care utilization, and public health issues are discussed.

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    • "The three researchers determined that this population exhibited lower physical and mental health subscale scores. Using the SF-12v2 in a sample of older adults, Erickson, Molina, Ladd, Pietrzak, and Petry (2005), as well as Pietrzak, Molina, Ladd, Kerins, and Petry (2005), discovered a negative correlation between this disorder and quality of life (see also Scherrer et al., 2005, for similar results). "
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    ABSTRACT: This study estimates the Health Related Quality of Life (HRQoL) costs of gambling addiction. Pathological gamblers were recruited from treatment centers in Western Switzerland. The difference in HRQoL between pathological gamblers (n = 52) and a sample drawn from the general population (n = 93) was measured through a multi-item instrument, the SF-6D. We used a tobit regression to estimate the effect of pathological gambling on HRQoL, controlling for comorbidities and age. Finally, to obtain a monetary value of the HRQoL loss attributable to gambling addiction, we applied an existing value of a life year estimate. Results showed that pathological gambling is significantly associated with a decrease in the quality of life by 0.076 quality adjusted life year (QALY). The resulting cost per pathological gambler and per year was estimated at CHF 3,830. This study suggests that ignoring quality of life costs results in an underestimation of the social burden of gambling addiction. © 2014, Centre for Addiction and Mental Health. All rights reserved.
    Preview · Article · Oct 2014 · Journal of Gambling Issues
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    • "Also, persons with an alcohol use disorder, who experience greater sleep problems after abstaining from alcohol, have shown significantly high rates of relapse (Brower, Aldrich & Hall, 1998; Gillin et al., 1994). Although previous research has examined health issues in individuals with gambling disorder (Desai, Maciejewski, Dausey, Caldarone & Potenza, 2004; Erickson, Molina, Ladd, Pietrzak & Petry, 2005; Pasternak and Fleming, 1999; Scherrer et al., 2005), few studies have examined sleep problems and gambling disorder. Lack of sleep itself may produce or exacerbate some of the cognitive problems associated with AUD and GD. "
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    ABSTRACT: Background and aims: Past research suggests that sleep problems are associated with increased risky decision-making. Similarly, gambling disorder and alcohol use disorder are also associated with increased risky decision-making. Individuals with gambling disorder or alcohol use disorder have also reported higher rates of sleep problems compared to normal healthy controls. As such, we sought to examine whether sleep problems play a role in the development of alcohol use disorder or gambling disorder. Methods: One hundred and forty-one individuals who gamble and use alcohol, yet do not meet criteria for gambling disorder or alcohol use disorder, were assessed to determine the correlation between sleepiness, amount of sleep obtained, decision-making, and alcohol or gambling behaviors. Results: Our results suggest that inconsistent sleep patterns may be associated with increased frequency of alcohol use and gambling. We did not, however, find a significant correlation between sleep factors and decision-making. Discussion: Further research is needed to examine the specific relationship between sleep patterns and alcohol use and gambling frequency. Overall these data suggest that sleepiness or sleep and risky decision-making is not a significant factor in gambling and alcohol use behaviors in individuals not meeting criteria for alcohol use disorder or gambling disorder.
    Full-text · Article · Sep 2014 · Journal of Behavioural Addictions
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    • "Some studies define PrG by a score of 5 or higher on the South Oaks Gambling Screen (SOGS) or by a score of 3 or higher on a short version of the SOGS (Slutske et al., 2005). In other studies gamblers who are in treatment for problematic gambling, and fulfill up to four criteria of the PG criteria, are defined as problem gamblers (Scherrer et al., 2005), or the entire studied group is defined as " problem gamblers " when not all of the participants who are in treatment fulfill five or more of the PG criteria (e.g., de Ruiter et al., 2012). In this review therefore, PrG is used, when no information is given on DSM diagnosis of PG, but when questionnaire data indicate that PrG is present. "
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    ABSTRACT: In problem gamblers, diminished cognitive control and increased impulsivity is present compared to healthy controls. Moreover, impulsivity has been found to be a vulnerability marker for the development of pathological gambling (PG) and problem gambling (PrG) and to be a predictor of relapse. In this review, the most recent findings on functioning of the brain circuitry relating to impulsivity and cognitive control in PG and PrG are discussed. Diminished functioning of several prefrontal areas and of the anterior cingulate cortex (ACC) indicate that cognitive-control related brain circuitry functions are diminished in PG and PrG compared to healthy controls. From the available cue reactivity studies on PG and PrG, increased responsiveness towards gambling stimuli in fronto-striatal reward circuitry and brain areas related to attentional processing is present compared to healthy controls. At this point it is unresolved whether PG is associated with hyper- or hypo-activity in the reward circuitry in response to monetary cues. More research is needed to elucidate the complex interactions for reward responsivity in different stages of gambling and across different types of reward. Conflicting findings from basic neuroscience studies are integrated in the context of recent neurobiological addiction models. Neuroscience studies on the interface between cognitive control and motivational processing are discussed in light of current addiction theories. Clinical implications: We suggest that innovation in PG therapy should focus on improvement of dysfunctional cognitive control and/or motivational functions. The implementation of novel treatment methods like neuromodulation, cognitive training and pharmacological interventions as add-on therapies to standard treatment in PG and PrG, in combination with the study of their effects on brain-behavior mechanisms could prove an important clinical step forward towards personalizing and improving treatment results in PG.
    Full-text · Article · May 2014 · Frontiers in Behavioral Neuroscience
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