April/May 2002 Article 1 Article 2

Alcohol and Gambling Pathology Among U.S. Adults: Prevalence, Demographic Patterns, and Comorbidity John W. Welte, Ph.D., Grace M. Barnes, Ph.D., and Marie-Cecile Tidwell, Ph.D. Research Institute on Addictions, University at Buffalo, The State University of New York John Parker, Ph.D. Vassar College, Poughkeepsie, New York William F. Wieczorek, Ph.D. Center for Health and Social Research, Buffalo State College, The State University of New York Abstracted from the Journal of Studies of Alcohol, 62, 706-712, 2001. In a study designed to determine the prevalence and demographic distribution of problem gambling, pathological gambling, alcohol abuse, and alcohol dependence in the United States, researchers found that the odds for having a gambling problem for individuals with an alcohol problem are 23 times higher than for individuals who do not have an alcohol problem. The study, one of the first of its kind, was spearheaded by John W. Welte and Grace M. Barnes, both senior research scientists at RIA. Definitions For the purposes of this discussion, two types of gamblers will be considered: pathological and problem. Pathological gamblers are persons who cannot control their gambling and whose personal lives are seriously harmed by their gambling. Problem gamblers are persons whose gambling behavior is harmful but not severe enough to be classified as pathological. History Prior to this study, only two national surveys of gambling had been conducted. In 1974, University of Michigan researchers (Kallick et al., 1979) found that 61 percent of adults reported gambling in the past year, while 68 percent reported having gambled in their lifetimes. Less than one percent of the U.S. population was estimated to be compulsive gamblers, a term comparable to pathological gambling. A second survey, conducted in 1998 by the National Opinion Research Center (1999) at the behest of the National Gambling Impact Study Commission, found that 63 percent of U.S. adults had gambled in the previous year, and 86 percent had gambled in their lifetimes. The prevalence of pathological gambling was found to be 0.8 percent with another 1.3 percent considered to be problem gamblers. Table 1. Rates of gambling and ethanol pathology and behavior, in percent (N=2,638)   Current Lifetime   All Male Female All Male Female SOGS pathological gambling SOGS pathological or problem gambling 1.9 5.5 2.1 6.4 1.8 4.7 4.0 11.5 5.2 14.3 2.9 8.9 DIS pathological gambling DIS pathological or problem gambling 1.3 3.5 1.3 4.1 1.4 3.0 2.0 4.8 2.0 5.7 2.0 3.9 DIS alcohol abuse DIS alcohol dependence DIS alcohol abuse or dependence 1.4 1.8 2.5 2.2 2.2 3.6 0.8 1.4 1.5 13.9 11.3 18.0 18.8 15.3 24.3 9.4 7.7 12.2 Gambling past year Gambling 104+ times past year 82.1 10.2 84.4 13.4 80.0 7.3       Alcohol past year Alcohol 2 drinks/day past year 67.1 8.9 69.4 12.9 65.1 5.1       Reprinted with permission from Journal of Studies on Alcohol, vol. 62, pp. 706-712, 2001. Copyright by Alcohol Research Documentation, Inc., Rutgers Center of Alcohol Studies, Piscataway, NJ 08854. RIA Study While previous studies had found that alcohol involvement and gambling involvement often occur in the same people, additional research was needed on the relationship of gambling to other problem behaviors. The RIA study used the Diagnostic Interview Schedule (DIS) (Robins et al., 1996) which evaluates the American Psychiatric Association Diagnostic and Statistical Manual, Version IV (American Psychiatric Association, 1994) diagnostic criteria to assess gambling pathology. This is also the first national survey to use the most common assessment of gambling pathology, the revised South Oaks Gambling Screen (SOGS) (Abbott and Volberg, 1991). In 2000, trained interviewers at RIA contacted a total of 14,700 telephone numbers chosen by random-digit-dialing. Individuals were surveyed using computer-assisted telephone interviewing and ultimately 2,631 adults (age 18 and older) were interviewed. Participants were recruited from all 50 states plus the District of Columbia and were spread evenly across the United States. Discussion “Between one and two percent of the population – one or two people in every 100 – have a compulsive gambling problem,” according to John W. Welte, Ph.D., principal investigator on this project. “Given the increase in gambling availability, it is reasonable to suspect that the rate of current pathological gambling is increasing in the U.S.” Pathological gambling, like other problem behaviors, is more prevalent among the young. Researchers speculate that as the population ages, the percentage of persons with a diagnosable gambling problem may decrease. As previously stated, pathological gamblers are much more likely to be problem drinkers than the average person. Gambling pathology and alcohol abuse/dependence are more common among males and young adults than among females and older adults. This is not surprising because that same pattern occurs for substance use, criminal conduct, and other problem behaviors. It is possible that some of the relationship between gambling and alcohol pathology occurs because drinking facilitates gambling, just as alcohol can promote other risky behaviors. It is also possible that unsuccessful gamblers occasionally “drown their sorrows.” However, it is likely that part of the drinking/gambling nexus arises from an underlying disposition that gives rise to both behaviors – a tendency to ignore social rules and long-range consequences. Additionally, pathological gambling and alcohol dependence are both related to antisocial personality disorder (e.g., Cunningham-Williams et al., 1998; Spunt et al., 1998). Both pathological gambling and alcohol dependence can be secondary consequences of antisocial personality disorder. Non-drinkers were less likely than drinkers to have gambled in the past year, but for drinkers, the amount of alcohol consumed makes little difference in the prevalence of gambling. However, the prevalence of current-frequent and current-pathological gambling increases with increased alcohol consumption. Drinkers who average more than four drinks (a “drink” is 0.5 oz. pure ethanol) per day are over five times as likely as abstainers to be problem or pathological gamblers. Current heavy drinking and alcohol pathology were about equal in prevalence among the racial and ethnic groups, but frequent, current problem and current pathological gambling were much more common among minority groups than among whites. Welte said the rate of current gambling pathology among African-Americans (3.7 percent) and Hispanic-Americans (4.2 percent) was seven to eight times the rate among Caucasian-Americans (0.5 percent). In addition, pathological gambling was found to be greater among individuals with lower incomes. However, when persons from higher socioeconomic groups are classified as pathological gamblers, they are more likely than lower income persons to be dependent on alcohol. “These trends have been found by other studies,” according to Welte, “but they seem to be stronger in this study. The negative effects of gambling disproportionately hit respondents with lower socioeconomic status and some minorities.” Persons from lower SES groups may consider gambling to be a form of investing along with the possibility of quick gratification (Weiss, 1988), hence the higher number of lottery tickets sold to lower income persons. Writing about the lottery, Clotfelter and Cook (1989) point out that it can be thought of as a highly regressive tax, to which the poor contribute disproportionately. Clinical Implications Treatment providers working with individuals with alcohol abuse/dependence issues might also assess clients’ gambling behaviors. Clinicians should be aware that gambling pathology is more prevalent among individuals with lower SES; in addition, persons from higher SES who gamble pathologically are more likely to also be alcohol dependent. References Abbott, M., & Volberg, R. (1991). Gambling and problem gambling in New Zealand: Report on phase one of the national survey of problem gambling (Research Series No. 12). Wellington, New Zealand: Research Unit, Department of Internal Affairs. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.) Washington, DC: Author. Clotfelter, C. T., and Cook, P. J. (1989). Selling hope: State lotteries in America. Cambridge, MA: Harvard Univ. Press. Cunningham-Williams, R.M., Cottler, L. B., Compton, W. M., III , & Spitznagel, E. L. (1998). Taking chances: Problem gamblers and mental health disorders. Results from the St. Louis Epidemiologic Catchment Area Study. American Journal of Public Health, 88, 1093-1096. Kallick, M., Suits, D., Dielman, T., & Hybees, J. (1979). A survey of American gambling attitudes and behavior. Ann Arbor, MI: Institute for Social Research, University of Michigan. National Opinion Research Center. (1999). Gambling impact and behavior study. Chicago, IL: National Opinion Research Center. Robins, L., Marcus, L., Reich, W., Cunningham, R., & Gallagher, T. (1996). NIMH diagnostic interview schedule: Version IV. St. Louis, MO: Washington University. Spunt, B., Dupont, I., Lesieur, H., Liberty, H. J., & Hunt, D. (1998). Pathological gambling and substance misuse: A review of the literature. Substance Use and Misuse 33, 2535-2560. Weiss, M. J. (1988). The clustering of America. New York: Harper & Row. Welte, J. W., Barnes, G. M., Tidwell, M.C., Parker, J., & Wieczorek, W. F. (2001). Alcohol and gambling pathology among U.S. adults: Prevalence, demographic patterns, and comorbidity, Journal of Studies on Alcohol, 62, 706-712. The National Institute on Alcohol Abuse and Alcoholism grant AA11402, awarded to John W. Welte, funded this research. Article 1

William R. Greiner, President

Back to Top.
Questions / Comments to webmaster@ria.buffalo.edu	Last updated 5/9/02