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      Comorbid pathological gambling, mental health, and substance use disorders: Health-care services provision by clinician specialty

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          Background and aims

          Pathological gambling (PG) is an impulse control disorder. This study assessed the burden of co-occurring behavioral addictions and mental health disorders in treatment-seeking patients and estimated the likelihood of receiving care for these disorders by clinician specialty.


          Study data were derived from the Massachusetts All-Payer Claims Database, a representative database, for the period 2009–2013. The sample included commercially insured adult residents of Massachusetts. Univariate and multivariate logistic regressions were used to estimate the likelihood of provision of care by clinician specialty adjusting for patient’s demographic characteristics and level of care. Bonferroni correction was applied to adjust for multiple testing.


          The study sample included 869 patients. Treatment-seeking patients who had a diagnosis of PG were mostly males (71%), aged 45–54 years (26.7%) and enrolled in a health maintenance organization (47%). The most prevalent co-occurring disorders among patients with PG as principal diagnosis were anxiety disorders (28%), mood disorders (26%), and substance use disorders (18%). PG was associated with a more than twofold likelihood of receiving care from social workers and psychologists ( p < .05). Depressive disorders were associated with a three times greater likelihood of receiving care from primary care physicians (PCPs) ( p < .05). Having three and four or more diagnosis was associated with a greater likelihood of receiving care from PCPs.

          Discussion and conclusions

          Psychiatric and substance use disorders are prevalent among treatment-seeking pathological gamblers. The likelihood of receiving care from specialty clinicians significantly varies by clinical diagnosis and patient clinical complexity.

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          Most cited references 21

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          Comorbidity of DSM-IV pathological gambling and other psychiatric disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions.

          To present nationally representative data on lifetime prevalence and comorbidity of pathological gambling with other psychiatric disorders and to evaluate sex differences in the strength of the comorbid associations. Data were derived from a large national sample of the United States. Some 43,093 household and group quarters residents age 18 years and older participated in the 2001-2002 survey. Prevalence and associations of lifetime pathological gambling and other lifetime psychiatric disorders are presented. The diagnostic interview was the National Institute on Alcohol Abuse and Alcoholism Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV Version. Fifteen symptom items operationalized the 10 pathological gambling criteria. The lifetime prevalence rate of pathological gambling was 0.42%. Almost three quarters (73.2%) of pathological gamblers had an alcohol use disorder, 38.1% had a drug use disorder, 60.4% had nicotine dependence, 49.6% had a mood disorder, 41.3% had an anxiety disorder, and 60.8% had a personality disorder. A large majority of the associations between pathological gambling and substance use, mood, anxiety, and personality disorders were overwhelmingly positive and significant (p .05). Pathological gambling is highly comorbid with substance use, mood, anxiety, and personality disorders, suggesting that treatment for one condition should involve assessment and possible concomitant treatment for comorbid conditions.
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            Risk factors for problematic gambling: a critical literature review.

            This article is a critical review of risk factors for pathological gambling categorized by demographics, physiological and biological factors, cognitive distortions, comorbidity and concurrent symptoms, and personality symptoms and characteristics. There is also a varia section (availability, parents playing, sensory characteristics, schedules of reinforcement, age of onset, and playing duration). The review found very few well established risk factors for pathological gambling (i.e. more than two studies to support the conclusions). Well established risk factors included demographic variables (age, gender), cognitive distortions (erroneous perceptions, illusion of control), sensory characteristics, schedules of reinforcement, comorbid disorders (OCD, drug abuse), and delinquency/illegal acts. An understanding of risk factors for pathological gambling should enhance prevention and treatment approaches.
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              Psychiatric comorbidity in pathological gamblers seeking treatment.

              The authors' goal was to determine the frequency of psychiatric comorbidity among treatment-seeking pathological gamblers, compare the severity of gambling and psychological problems in gamblers with and without comorbid disorders, and investigate differences between gamblers with and without comorbid disorders in the dopamine D(2) receptor gene (DRD(2)). Sixty-nine pathological gamblers who consecutively applied to a specialized outpatient treatment program were evaluated with structured interviews, self-report questionnaires, and psychological scales and were genotyped for a DRD(2) polymorphism. A comorbid psychiatric disorder was present in 43 (62.3%) of the gamblers. The most frequent diagnoses were personality disorders (N=29 [42.0%]), alcohol abuse or dependence (N=23 [33.3%]), and adjustment disorders (N=12 [17.4%]). Gamblers with comorbid psychiatric disorders had gambling scores and psychological scale scores indicating greater severity of gambling and psychopathology. Significant differences in DRD(2) allele distribution were found in gamblers with and without comorbid disorders. Psychiatric comorbidity is common among pathological gamblers and is associated with greater severity of clinical problems. The DRD(2) gene could be a liability genetic factor for psychiatric comorbidity in pathological gambling.

                Author and article information

                Journal of Behavioral Addictions
                J Behav Addict
                Akadémiai Kiadó (Budapest )
                30 August 2017
                September 2017
                : 6
                : 3
                : 406-415
                [ 1 ] School of Public Health and Health Sciences, University of Massachusetts Amherst , Amherst, MA, USA
                Author notes
                [* ]Corresponding author: Rosa Rodriguez-Monguio, PhD, MS; School of Public Health and Health Sciences, University of Massachusetts Amherst, 715 N. Pleasant Street, 322 Arnold House, Amherst, MA 01003, USA; Phone: +1 413 545 7427; E-mail: rmonguio@
                © 2017 The Author(s)

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium for non-commercial purposes, provided the original author and source are credited.

                Page count
                Figures: 2, Tables: 4, Equations: 1, References: 25, Pages: 10
                Funding sources: This research was partially funded by the Massachusetts Gaming Commission in Boston, MA. The Massachusetts Gaming Commission did not participate in any aspects of the research process, drafting, or editing of the manuscript. The findings, interpretations, and conclusions expressed in this manuscript are entirely those of the authors and do not represent the views of the Massachusetts Gaming Commission.
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