Comorbidities of problem gambling

Although gambling addiction serves as an issue on its own, many times it’s not the only problem the client is facing.  Jon Grant, JD, MD, MPH, Professor of Psychiatry & Behavioral Neuroscience at the University of Chicago, where he also supervises an outpatient clinic for addictive-impulsive disorders, discussed co-occuring disorders in problem gamblers in an Addiction Professional webinar earlier this week titled, “Counseling the Pathological Gambler.”

Grant says that comorbidities are more the norm than the exception when it comes to this population. 

Substance use disorder is very common in those with gambling issues, and in fact, Grant says the rate of substance abuse about gamblers is seven times greater than that of non-gamblers. The most common substances used by problem gamblers are nicotine and alcohol. 

The chart below shows the co-occuring disorders in pathological gambling.

Of those individuals who may suffer from multiple addictions, Grant describes seven dynamics of multiple addictions:

·        Alternating: Cycling from one addiction to another in a patterned, systematic way

·        Masking: Using denial around one addiction to cover up for another

·        Ritualizing: One addiction is part of the ritualizing for another

·        Switching: Replacing one addiction with another

·        Intensifying: Using addictive patterns simultaneously to intensity the overall experience

·        Numbing: Using addiction to medicate shame and pain due to another addiction

·        Disinhibiting: Using one addiction to lower inhibitions for other addictive acting out

Grant, who is also the Director of a Center of Excellence in Gambling Research supported by the National Center for Responsible Gaming, and editor-in-chief of the Journal of Gambling Studies, says that apart from other addictive behaviors, problem and pathological gambling is also associated with high rates of divorce, poor general health, mental health problems, job loss/lost wages, bankruptcy, arrest and incarceration.  

He went on to discuss statistics of mental health problems seen in those with problem gambling issues. 

·        76% of an inpatient PG treatment sample met criteria for major depressive disorder. 

·        24% lifetime prevalence of bipolar disorder in persons with problem gambling. 

·        20% of problem gamblers met criteria for lifetime attention-deficit hyperactivity disorder.

·        Problem gamblers suffer from high rates of lifetime anxiety (16% - 40%) disorders.

To treat comorbidities, Grant advises to prioritize the problems and treat the disorders simultaneously.  He also says that cognitive behavioral therapy basics can apply to multiple issues as can medication management. 

Criminal behavior is often related to problem gamblers as well.  Grant says that 20-80% of pathological gamblers have engaged in criminal behavior and 21% have been charged with a crime.