Pathological and problem gambling in substance use treatment: Results from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)

Background and Objectives Pathological and problem gambling may be common yet frequently undetected conditions in substance use treatment. This paper reports findings on the prevalence of gambling comorbidities in these clinical contexts that are generalizable across regions and settings. It indicates the implications of such conditions for treatment of substance use problems. Methods A U.S. representative sample of n = 402 patients reporting past-year treatment for substance use problems was derived from wave 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Weighted prevalence estimates were produced and regression analyses used to examine correlates of gambling symptoms. Results Rates of lifetime pathological gambling (5+ DSM-IV symptoms) and problem gambling (3+ DSM-IV symptoms) were 4.3% (s.e. = 1.3%) and 7.2% (s.e. = 1.6%), respectively. Lifetime gambling symptoms were associated with Axis II disorders, but no Axis I diagnoses. There was limited evidence of associations with substance usage, mental or physical health and medical utilization. There were associations with financial crises and relationship breakdown, during and after treatment. Conclusions and Scientific Significance Gambling problems are elevated in substance use treatment but may be less common than previously thought; when considered nationally and across clinical settings. They may have modest associations with clinical characteristics given high levels of psychiatric severity that characterise treatment seeking samples overall. Notwithstanding, the results suggest that gambling comorbidities should be standard considerations in substance use treatment. They may signal complex conditions characterised by pervasive underlying psychopathology, and psychosocial difficulties that accumulate over time.