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Comorbidity

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Patterns of Substance Abuse in Pathological Gamblers Undergoing Treatment. Luis F. Ramirez, Richard A. McCormick, Angel M. Russo, Julian I. Taber. Addictive Behavior. 8, 425-428, 1983. One of the first studies of the linkage between pathological gamblers and substance abuse, this paper reports high levels of alcohol and drug abuse in pathological gamblers and their biological families. 39 percent of the 51 pathological gamblers studied met criteria for alcohol or drug abuse during the year prior to admission to the gambling treatment program, with 47 percent meeting the criteria at some point in their life. Half reported alcohol or drug abuse by at least one biological parent, and 36 percent reported substance abuse by a sibling. The researchers also found a very strong linkage between substance abuse and major depressive disorder.

The Prevalence and Impact of Major Life Stressors among Pathological Gamblers. Julian I. Taber, Richard A. McCormick, Luis F. Ramirez. The International Journal of the Addictions 22:1, 71-79, 1987. The authors studied 44 individuals admitted to an inpatient gambling treatment program and found that 23 percent had experienced severe trauma during their lives with another 16 percent reporting moderately heavy trauma. Those with traumatic experiences also reported higher rates of substance abuse, depression, and anxiety than those without such experience. They conclude that clinicians need to assess a patientâs trauma history when devising a patientâs treatment plan.

Crime, Antisocial Personality and Pathological Gambling. Alex Blaszczynski, Neil McConaghy, A. Frankova. Journal of Gambling Behavior, 5:137-152, 1989. Structured interviews of 109 Australian pathological gamblers found that 37 percent had committed no criminal offense, 40 percent committed gambling-related offenses, 9 percent non-gambling offenses, and 14 percent both gambling and non-gambling offenses. Only 14 percent qualified for a diagnosis of antisocial personality disorder. Most crimes were nonviolent crimes against property.

A General Theory of Addictions: Rationale for and Evidence Supporting a New Approach for Understanding and Treating Addictive Behaviors. Durand F. Jacobs. In Compulsive Gambling: Theory,Research, and Practice. Lexington, MA: Lexington Books, 1989. Jacobs defines an addiction as "a dependent state acquired over time by a predisposed person in an attempt to relieve a chronic stress condition." He further states that to be predisposed, a person must first have a persistent state of either chronic excitement or depression – and "childhood experiences that have produced a deep sense of personal inadequacy and rejection." Further, a conducive environment for the addictive behavior must exist, and the individual must experience "a chance triggering event" which leads them to pursue future experiences of that type. Jacobs concludes that addicts of different types use their addictions as a way of "entering and maintaining a dissociative-like state" – a altered state of identity that manifests itself in conditions like the "trance" of the problem gambler.

Characteristics of Pathological Gamblers Identified Among Patients on a Psychiatric Admissions Service. Henry R. Lesieur and Sheila B. Blume. Hospital and Community Psychiatry, p1009-1012, Sept. 1990. Psychiatric patients were found to have a much higher incidence of pathological gambling than the general population. A significant number also came from families with a history of problem gambling.

Compulsive Gambling. Henry R. Lesieur. Society p43-50, May/June, 1992. This article explores the costs of compulsive gambling to society and to individual gamblers. One study of Gamblers Anonymous members found that pathological gamblers are responsible for an estimated 1.3 billion dollars in insurance-related fraud per year. Children of pathological gamblers were more likely to have gambling problems. Studies of prisoners, alcohol and drug abusing inpatients, Veteran's Administration inpatients and Gamblers Anonymous members found that approximately two-thirds of non-incarcerated and 97 percent of incarcerated pathological gamblers admit engaging in illegal behavior to finance their gambling activities. Surveys indicate that 1 to 2 percent of the adult population are probably pathological gamblers and 2 to 3 percent are problem gamblers.

Prevalence of Pathological Gambling and Related Problems Among College Students in the Quebec Metropolitan Area. Robert Ladouceur, Dominique Dubé, and Annie Bujold. Canadian Journal of Psychiatry, Vol. 39, p298-293. June, 1994. A sample of 1,461 college students was given the South Oaks Gambling Screen as well as questions on substance abuse and other problematic behavior. The authors identified positive correlations between SOGS scores and tobacco use, alcohol abuse, illegal substance use, excessive eating, not eating at all, bulimic tendencies, criminal arrests, and suicide attempts. Unlike other studies, an inverse relationship was found between student gambling and parental gambling.

Impulse Control Disorders and Attention Deficit Disorder in Pathological Gamblers. Sheila M. Specker, Gregory A. Carlson, Gary A. Christenson and Michael Marcotte. Annals of Clinical Psychiatry, Vol. 7(4), p175-179, 1995. This study found significantly higher rates of other impulse control disorders and attention deficit disorder in compulsive gamblers than in a control group of "normal" individuals. 35 percent of the compulsive gamblers were found to have an impulse control disorder with attention deficit disorder found in 20 percent. Of particular interest were high rates of compulsive buying and compulsive sexual behavior among the compulsive gamblers.

Psychopathology in Pathological Gamblers Seeking Treatment: Gender Comparisons. Sheila M. Specker, Gregory A. Carlson, Karen M. Edmonson, Paula E. Johnson and Michael Marcotte. Journal of Gambling Studies, Vol. 12(1), p67-81, Spring, 1996. This report found high rates of Axis I psychopathology, such as depression and substance abuse/dependency, in pathological gamblers as compared to controls. Rates of affective and substance use disorders were equally high in men and women. Axis II personality disorders, such as paranoia or avoidant behaviors, were not frequent and did not differ significantly from controls. Significant rates of sexual/physical abuse were found. Pathological gambling is probably not a homogeneous disorder. Persons with psychiatric and substance abuse disorders may be at higher risk to develop pathological gambling.

Psychological Characteristics of Volunteers in Studies on Gambling. Robert Ladouceur, Caroline Arsenault, Dominique Dubé, Mark H. Freeston, Christian Jacques. Journal of Gambling Studies, Vol.13(1), p69-84, Spring, 1997. The authors used a newspaper ad to solicit volunteers for a study of gambling and compared the results to a general problem gambling prevalence study in the Province of Quebec. The volunteer group had more than 24 times the rate of "probable pathological gambling" (as measured by the South Oaks Gambling Screen) than was found using a random sample. These results suggest the need for extreme caution when evaluating measures of problem gambling obtained by using a self-selected group or a survey with a low response rate. The probable pathological gamblers reported much higher rates of poor psychosocial functioning than did the rest of the population. Interestingly, the psychosocial functioning of those with SOGS scores of 3 or 4 (often labeled as "potential pathological gamblers") was statistically indistinguishable from that of nongamblers.

Profiling the Pathological Gambler. Steve Ranney. Paradigm, p12-13, Winter, 1997. A summary of the study conducted by the Illinois Institute for Addiction Recovery of pathological gamblers within the treatment setting. The results of a cross section of 62 medical records selected randomly over a three-year period showed a high occurrence of substance dependence (73 percent) and depression (70 percent). Fifty-two percent reported a family history of addiction and nearly half of the patients (47 percent) had received prior treatment for various problems.

Personality Disorders Among Pathological Gamblers. Alex Blaszczynski and Zachary Steel. Journal of Gambling Studies 14(1) p51-71. Spring, 1998. This study of 82 consecutive admissions to an Australian gambling treatment center found that 93 percent met diagnostic criteria for at least one personality disorder, with the average patient experiencing 4.73 disorders. The most commonly found disorders were in the "dramatic" cluster – those characterized by impulsivity, lack of inhibitions, and extreme shifts in mood in response to environmental stimulation. The authors conclude that "pathological gamblers exhibit rates of personality disorders that are comparable to those found in general psychiatric patient populations."

Taking Chances: Problem Gamblers and Mental Health Disorders – Results From the St. Louis Epidemiologic Catchment Area Study. Renee M. Cunningham-Williams, Linda B. Cottler, Wilson M. Compton, and Edward L. Spitznagel. American Journal of Public Health 88:7 p1093-1096, July 1998. A 1981 epidemiological study collected information on problem gambling and other disorders from over 3,000 adults in St. Louis. Problem gamblers were found to be at increased risk for several psychiatric diagnoses, most notable antisocial personality disorder, alcoholism, and tobacco dependence.

Prevalence estimates of pathological gambling in Switzerland. G. Bondolfi, C. Osiek, F. Ferrero. Acta Psychiatrica Scandinavica 2000: 101: 473-475. This survey of 2,526 Swiss households found that 0.8% of adult respondents could be classified as probable pathological gamblers. In addition, 36 percent of pathological and problem gamblers were also classified as probable alcohol abusers compared to 8 percent of those with a SOGS score of less than 3.

Common Genetic Vulnerability for Pathological Gambling and Alcohol Dependence in Men. Wendy S. Slutske, Seth Eisen, William R. True, Michael J. Lyons, Jack Goldberg, Ming Tsuang. Arch Gen Psychiatry 57:666-673, July 2000. The authors studied adult male twin pairs to assess the existence of a common genetic factor behind pathological gambling and alcohol dependence. They found a "significant but relatively modest" linkage. Previous studies of the same population have shown genetic linkages between alcohol dependence and nicotine and marijuana dependence as well. However, the authors caution that the modest degree of linkage suggests that there are risk factors that pathological gambling does not share with alcohol dependence.

Problem Gambling and Attention-Deficit Hyperactivity Disorder. Nina Littman-Sharp and Umesh Jain. The Electronic Journal of Gambling Issues 2. August, 2000. This article summarizes evidence linking problem gambling and attention-deficit hyperactivity disorder (ADHD). They present four case studies of individuals with a dual diagnosis of pathological gambling and ADHD, discuss the additional linkage with depression, and summarize clinical implications and intervention approaches.

Pathological gambling among cocaine-dependent outpatients G.W. Hall, N.J. Carriero, R.Y. Takushi, I.D. Montoya, K.L. Preston, D.A. Gorelick. American Journal of Psychiatry, 147: 1127-1133 (2000). This study of 313 Maryland patients in treatment for cocaine dependency found a pathological gambling prevalence of 8.0 percent, significantly higher than the 1.5 percent estimated for the entire state population. They also found that the age of onset and duration of cocaine addiction was no different for pathological gamblers than those without a gambling problem.

Gambling Behavior of Louisiana Students in Grades 6 Through 12. James R. Westphal, Jill A. Rush, Lee Stevens, and Lera Joyce Johnson. Psychiatric Services (51:1, 96-99), January 2000. The article reports the results of a survey of over 12,000 Louisiana students, finding that 14 percent have never gambled, 70 percent gambled without problems, 10 percent indicated past year problem gambling, and 5.8 percent indicated past year pathological gambling as measured by the SOGS-RA. High levels of association were found with other risk behaviors, notably alcohol, tobacco, marijuana, and other drugs. 59 percent of those with problem or pathological gambling reported frequent alcohol and/or illicit drug use.

Gambling Involvement and Drug Use Among Adolescents. Ken C. Winters and Nikki Anderson. Journal of Gambling Studies. 16:2/3, 175-198 Summer 2000. Many studies have found relationships between adolescent gambling and drug use. The authors believe that there is a "striking overlap" between the two behaviors that suggest at least some common causal factors and suggest the development of prevention strategies aimed at these common factors. Among the risk factors listed for both drug abuse and problem gambling are low self-esteem, depression or suicidality, being a victim of abuse, poor school performance, a history of delinquency, being male, early drug or gambling experience, parental drug or gambling problem activity, and easy accessibility.

Gender-Related Differences in the Characteristics of Problem Gamblers Using a Gambling Helpline Marc A. Potenza, Marvin A. Steinberg, Susan D. McLaughlin, Ran Wu, Bruce J. Rounsaville, Stephanie S. O'Malley. American Journal of Psychiatry 158:9, 1500-1505, 2001. While focusing on gender differences, this article makes important observations about the general mental health of problem gamblers. A survey of 562 gamblers calling a helpline revealed high rates of anxiety (93%) and depression (80%), along with a relatively high rate of suicidality (27%). The authors note that the rate of prior mental health treatment (23%) was much lower than the rates of psychiatric symptoms, suggesting "a need for additional efforts to engage problem gamblers into mental health treatment."

Psychiatric Comorbidity in Pathological Gamblers Seeking Treatment. Angela Ibanez, Darlos Blanco, Elizabeth Donahue, Henry R. Lesieur, Ignacio Perez de Castro, Jose Fernandez-Piqueras, Jeronimo Saiz-Ruiz. American Journal of Psychiatry 158:10, 1733-1735. October 2001. An evaluation of 69 pathological gamblers admitted to a treatment program led to diagnosis of a comorbid psychiatric disorder in 62 percent of the gamblers. The most frequent diagnoses were personality disorders (42%), alcohol abuse or dependence (33%) and adjustment disorders (17%). The gamblers with a comorbid disorder had significantly higher South Oaks Gambling Screen scores than those without a comorbid disorder. Significant genetic differences between the two groups involving a dopamine receptor gene were also found.

A Twin Study of the Association Between Pathological Gambling and Antisocial Personality Disorder. Wendy S. Slutske, Seth Eisen, Hong Xian, William R. True, Michael J. Lyons, Jack Goldberg, and Ming Tsuang. Journal of Abnormal Psychology 2001, 110:2, 297-308. Using a sample of 7,869 men in 4,497 twin pairs, the authors found a significant association between pathological gambling and antisocial personality disorder; the odds of a lifetime diagnosis of antisocial personality disorder were determined to be 6.4 times greater among pathological gamblers than among non-pathological gamblers. They also found elevated rates of childhood conduct disorder among the pathological gamblers, suggesting that the personality disorder preceeded, and therefore was not caused by, the gambling behavior. The authors also concluded that "there probably is at least one genetic locus that jointly increases the susceptibility" for pathological gambling and antisocial personality disorder.

Comparison of Problem-Gambling and Non-Problem-Gambling Youths Seeking Treatment for Marijuana Abuse. Nancy M. Petry and Zeena Tawfik. Journal of the American Academy of Child and Adolescent Psychiatry 2001, 40:11, 1324-1331. A sample of youth entering treatment for marijuana abuse found higher percentage (22%) experiencing gambling problems than is generally measured in the overall adolescent population. Compared to the non-problem gamblers, the problem gamblers showed a greater frequency of drug and alcohol use, more illegal activity, greater psychiatric problems, more sexual activity, and are more likely to have been victims of abuse. The authors recommend that screening for gambling problems should become a routine part of substance abuse treatment programs.

Pathological Gamblers, With and Without Substance Use Disorders, Discount Delayed Rewards at High Rates. Nancy M. Petry, Journal of Abnormal Psychology 2001, 110:3, 482-487. This study attempted to measure impulsivity in pathological gamblers by asking them to choose between smaller, immediate rewards and larger, delayed rewards. 60 pathological gamblers and 26 control group members were asked to choose between different combinations of immediate rewards of $1 to $999 and an award of $1000 delayed between six hours and 25 years. They found that the pathological gamblers valued immediate rewards significantly more than the control group, and that pathological gamblers with a history of substance abuse discount future rewards at extraordinarily high levels.

Gambling, Delinquency, and Drug Use During Adolescence: Mutual Influences and Common Risk Factors. Frank Vitaro, Mara Brendgen, Robert Ladouceur, and Richard E. Tremblay. Journal of Gambling Studies, Vol 17(3), p171-190, Fall 2001. This longitudinal study of 717 adolescent boys first measured their impulsivity, amount of parental supervision, and delinquency of friends at age 13 and 14, and their gambling behavior, substance abuse, and delinquency at ages 16 and 17. Impulsivity, parental supervision, and deviant friends were all found to be significant predictors of all three problem behaviors, while the problem behaviors were not found to significantly influence each other. The authors conclude that the results support the concept of a ãgeneral problem behavior syndromeä fed by generic risk factors.

Alcohol and Gambling Pathology among U.S. Adults: Prevalence, Demographic Patterns and Comorbidity. John Welte, Grace Barnes, WilliamWieczorek, Marie-Cecile Tidwell and John Parker. Journal of Studies on Alcohol, September 2001 (706-712). The results of a telephone survey of 2,638 U.S. adults were used to measure the relationship between pathological gambling and alcohol dependence. The authors found that those who are alcohol-dependent are 23 times more likely to be pathological gamblers than those without alcohol dependence. This relationship was found to be strongest among respondents of higher socio-economic status. They also found that drinkers who average more than four drinks per day are over five times as likely as abstainers to be problem or pathological gamblers.

Problem gambling in the partner of the emergency department patient as a risk factor for intimate partner violence. R. L. Muelleman, T. DenOtter, M.C. Wadman, P. Tran and J. Anderson. The Journal of Emergency Medicine, 23(3), 307-312.(2002). This study interviewed 286 women admitted to a hospital emergency department, asking about relationship status, intimate partner violence (IPV), partner alcohol abuse, and partner problem gambling. They found that women whose partner was a problem drinker (but not a problem gambler) were six times more likely to report IPV than those whose partner had neither problem and those whose partner had a gambling problem (but not a drinking problem) were ten times more likely to report IPV (though this result should be taken with caution given the low number of those reporting a partner with only a gambling problem). Women most at risk were those whose partner was both a problem gambler and a problem drinker - their risk of IPV was 50 times greater than those whose partners had neither problem. The study points out the need for those treating problem gamblers to be aware of the potential for IPV in family relationships.

 Comorbid mental disorders among the patients with alcohol abuse and dependence in Korea. M.J. Cho, B.-J. Hahm, T. Suh, G.-H Suh, S. -J Cho, and C. K. Lee. Journal Korean Med Sci, 17, 236-241, 2002. A nationwide epidemiological study of 5,176 Korean households identifed 32 males and no females who had suffered from both an alcohol disorder and problem gambling at some point in their lives. Of these, seven developed pathological gambling first, five developed both at the same time, and 20 developed the alcohol disorder before becoming pathological gamblers. They also studied 500 men with both an alcohol disorder and tobacco dependence, and found that 431 of these developed the tobacco dependence first. Only 32 developed tobacco dependence after their alcohol disorder.