Academic journal article Alcohol Research

Pathological Gambling and Alcohol Use Disorder

Academic journal article Alcohol Research

Pathological Gambling and Alcohol Use Disorder

Article excerpt

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. KEY WORDS: pathological gambling; AODD (alcohol and other drug dependence); comorbidity; etiology; diagnostic criteria; disinhibition; impulsive behavior; ventral tegmental area; encephalopathy; naltrexone; genetic linkage; causal path analysis; treatment outcome

Pathological gambling (PG) is characterized by a persistent maladaptive pattern of gambling behavior. PG was first formally included in the Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-- III) in 1980 (American Psychiatric Association [APA] 1980). Currently, PG is classified under the category "disorders of impulse control not elsewhere classified" (APA Committee on Nomenclature and Statistics 2000).

This article explores the association between pathological gambling and alcohol use disorders (AUDs) (i.e., the general name for either alcohol abuse or alcohol dependence). It first examines the separate and overlapping prevalences of PG and AUD as estimated by epidemiological surveys conducted in both community and clinical samples. The article then reviews the processes and mechanisms that might account for the frequent co-occurrence of these disorders. Finally, it examines what the co-occurrence of these disorders implies for treatment and highlights promising areas for future research.

Many terms have been used to describe people with problematic gambling behavior (see Cunningham-Williams and Cottler 2001). In this article, PG refers to pathological gambling as diagnosed using DSM diagnostic criteria. The term "disordered gambling behavior" is used to refer to problematic gambling behavior that is not defined by DSM diagnostic criteria. Note, however, that this term is not used as a means of identifying a less serious gambling problem compared with PG. Rather, this term is used to distinguish between problem gambling formally shown to meet the DSM criteria (PG) and all other cases of problematic gambling behavior (disordered gambling behavior).

EPIDEMIOLOGY

Pathological Gambling

During the 1990s, changes in State and local legislation encouraged the expansion of all types of wagering (e.g., casino gambling, lotteries, Internet gambling). As an apparent consequence, gambling and gambling-related problems are on the rise in the United States and Canada. A recent meta-analysis of 120 published studies estimated that 1.6 percent of adults in the United States and Canada meet the DSM criteria for pathological gambling at some point in their lives (Shaffer et al. 1999). Among people younger than 18 years of age, the current prevalence of PG is estimated to be 3.9 percent, with past-year rates for adults and adolescents estimated at 1.1 percent and 5.8 percent, respectively (Shaffer and Hall 1996).

Slightly lower prevalence rates of PG were found by a national study conducted by the National Opinion Research Center (NORC). …

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