 |
 |
 |
|
|
The DSM-IV has modelled pathological gambling after substance dependence (1). Symptoms defining pathological gambling strongly resemble those for substance dependence (for example, preoccupation with gambling, tolerance to gambling-related excitement, gambling-related withdrawal symptoms, and repeated efforts to cut down or stop gambling [2]). Further, treatment approaches for problem gambling have tended to resemble those offered to substance abusers, including residential, outpatient, and self-help approaches such as Gamblers Anonymous (3). Discussions of treatment for both chemical and behavioural addictions commonly employ concepts such as high-risk situations, relapse prevention, urges and cravings, denial, abstinence, and withdrawal. Not surprisingly, a considerable body of research has established a robust relation between chemical dependencies and pathological gambling (4,5). In general, higher rates of alcoholism and other substance use have been reported among gamblers, compared with the general population (6–8). Likewise, rates of pathological gambling appear to be higher among substance-abusing populations than among the general population (9–12). Spunt and others have noted that most of the available data have focused on subjects with alcohol or methadone-maintained opiate addictions (4); much less is known about gambling and other psychoactive substances. The primary goals of this study were to assess the prevalence of problem gambling in samples of treatment-seeking subjects with alcohol, cocaine, cannabis, and opiate dependencies, and to evaluate whether problem gambling rates among substance abusers were affected by the introduction of the Niagara Casino in Niagara Falls, Ontario in 1996. To do this, we examined gambling behaviour and problem gambling rates among substance abusers in the 2 subsequent years (1997 and 1998). Room and colleagues recently found that the general rate and level of casino gambling increased significantly within 1 year of the introduction of the Niagara Casino but that there was little measurable impact on other gambling in the community (13). In addition, gambling problems and rates of related problems among family and friends were also found to rise. Since a strong association has been established between gambling and other psychopathology that includes addictions (5), substance abusers may be a group at a higher risk for developing gambling problems, compared with the general population, when access to gambling venues and activities is increased. MethodWe asked a consecutive sample of 853 individuals seeking residential substance-addiction treatment during a 36-month period to complete the 20-item South Oaks Gambling Screen (SOGS) (14) as part of the general intake assessment. This assessment also collected demographic data and information on the primary substance problem and self-reported lifetime psychiatric problem. The SOGS is a widely used and extensively validated screening measure for gambling problems (6). Results and DiscussionDemographic Variables Table 1 describes the sample’s demographic characteristics. Problem gamblers and nonproblem gamblers did not differ on the following variables: rates of salaried vs socially assisted employment, sex, legal problems, self-reported psychiatric treatment, or participation in partnered relationships. The mean age of the sample was 33.8 years (SD 8.8).
The mean (SD) SOGS score for the entire sample was 1.3 (2.9). Using the standard criterion for determining a potentially clinically significant gambling problem (scores > 4) (14), 10.4% (n = 89) of the sample could be considered to have a gambling problem. An additional 3.9% (n = 33) endorsed 3 or 4 symptoms, considered an indication of a potential or preclinical gambling problem. Thus, 14.3% of this sample of treatment-seeking substance abusers reported clinically significant gambling-related symptoms within the past year. About one-third of the sample (n = 277; 32.5%) scored positive on at least 1 item on the SOGS. These rates are comparable to other studies of gambling among substance-abusing populations (for example, 9) and are much higher than the rates reported in the general population (7,15). Stimulants were the most common primary problem substances, followed by alcohol, opiates, and cannabis. Problem gambling was significantly related to primary substance type, (c2 = 13.76, df 6; P < 0.05): subjects who primarily abused cannabis were more likely also to have a gambling problem (22.9%). These data suggest that the problem and nonproblem gambler groups were very similar demographically, except that cannabis use was more likely among subjects with a gambling problem.
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||