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

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          Abstract

          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.

          Methods

          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.

          Results

          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 references21

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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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              Impulse control disorders in adult psychiatric inpatients.

              The authors' goal was to examine the prevalence of impulse control disorders in psychiatric inpatients. They used the Minnesota Impulsive Disorders Interview, a semistructured clinical interview assessing pathological gambling, trichotillomania, kleptomania, pyromania, intermittent explosive disorder, compulsive buying, and compulsive sexual behavior, to screen 204 consecutively admitted psychiatric inpatients. One hundred twelve of the inpatients were women (54.9%), and the mean age of the 204 inpatients was 40.5 years (SD=13.2, range=18-83). Patients whose screen was positive for an impulse control disorder were evaluated with structured clinical interviews. Sixty-three patients (30.9%) were diagnosed with at least one current impulse control disorder. The most common impulse control disorders were compulsive buying (N=19 [9.3%]), kleptomania (N=16 [7.8%]), and pathological gambling (N=14 [6.9%]). Patients with and without co-occurring impulse control disorders did not differ significantly from each other on demographic measures or number or type of psychiatric diagnoses other than impulse control disorders. Impulse control disorders appear common among psychiatric inpatients. Additional, larger studies are needed to examine the prevalence of impulse control disorders in the general population and specific psychiatric groups.
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                Author and article information

                Journal
                jba
                JBA
                Journal of Behavioral Addictions
                J Behav Addict
                Akadémiai Kiadó (Budapest )
                2062-5871
                2063-5303
                30 August 2017
                September 2017
                : 6
                : 3
                : 406-415
                Affiliations
                [ 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@ 123456schoolph.umass.edu
                Article
                10.1556/2006.6.2017.054
                5700728
                28856904
                ed675e2c-c676-4568-be89-e0dae285abdd
                © 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.

                History
                : 08 May 2017
                : 13 July 2017
                : 26 July 2017
                : 08 August 2017
                Page count
                Figures: 2, Tables: 4, Equations: 1, References: 25, Pages: 10
                Funding
                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.
                Categories
                FULL-LENGTH REPORT

                Evolutionary Biology,Medicine,Psychology,Educational research & Statistics,Social & Behavioral Sciences
                All-Payer Claims Data,behavioral addictions,mental health disorders,treatment provision,clinician specialty,pathological gambling

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