comorbidity

Many people may not know that 95 percent of people with gambling disorder also have another mental health disorder as well (Kessler et al., 2008). This stunning reality should influence every aspect of how researchers, clinicians and even the media approach the topic of understanding, diagnosing and treating gambling disorders. This co-occurrence of multiple disorders in an individual (called “comorbidity”) presents many unique challenges for the identification and treatment of gambling disorder. Research that can provide insights into comorbid conditions can be beneficial for clinicians and researchers alike.

One recent study on this topic came from Iman Parhami, M.D., M.P.H., a psychiatry resident at the Delaware Division of Substance Abuse and Mental Health, who conducted a survey to examine many health-related issues associated with gambling behaviors and other demographic data. Longtime readers may remember that Dr. Parhami won the outstanding poster award at the NCRG conference in 2011.

To understand pathological gambling (PG) one must understand the disorders that co-occur with PG. A 2005 study of more than 43,000 representative Americans found that people with PG often have other mental health disorders at the same time (called comorbid disorders). Examples of these include alcohol use disorders (73 percent), drug use disorders (38 percent), mood disorders (49 percent), anxiety disorders (41 percent) and personality disorders (60 percent) (N. M. Petry, Stinson, & Grant, 2005). While it is reasonable to hypothesize that genetic and environmental factors are both responsible for these co-occurrences, more research is necessary to learn how the two variables work together. One study that addresses these questions was recently published in the Journal of Affective Disorders (Giddens, Xian, Scherrer, Eisen, & Potenza, 2011). The study used data from 7,869 male twins to examine the relationship between PG and two anxiety disorders, generalized anxiety disorder (GAD) and panic disorder (PD).     

Why do so many people relapse when they are trying to stop gambling? It has been estimated that 50 to 75 percent of gamblers resume gambling after attempting to quit (N. M. Petry et al., 2006), but what are the thoughts, feelings and situations that precede these events? Researchers who study alcohol and drug abuse – disorders with similarly high rates of relapse –  have developed a questionnaire designed to answer these questions for their audiences. A recent study published in the journal Experimental and Clinical Psychopharmacology attempts to validate this same type of questionnaire for people with gambling disorders (Nancy M Petry, Rash, & Blanco, 2010). The new study attempts to extend and validate Petry’s previous work adapting the Inventory of Drinking Situations for gambling situations (called the Inventory of Gambling Situations, IGS).

Addiction researchers have found associations between numerous addictive behaviors, with individuals often being involved with many addictive substances and behaviors at the same time. Though this relationship is common, it is not well understood. The intermingling relationships of less thoroughly studied addictive behaviors, such as gambling and prescription drug misuse (PDM), are particularly unclear. A recent study led by Cheryl Currie, a Ph.D. candidate at the University of Alberta, Canada, was published in the Canadian Journal of Psychiatry and explores the relationship between prescription drug misuse, demographics and addictive behaviors including gambling (Currie, Schopflocher, & Wild, 2011). Currie won the Outstanding Poster Award at the 2010 NCRG Conference on Gambling and Addiction, and discussed early findings from this study with us in an audio interview conducted at the conference.       

Treatment and prevention are two of the most important and challenging areas for addiction researchers. Prevention is a particularly difficult undertaking even when working with the most understood disorders, and can be even more difficult in an emerging field such as gambling disorders. One way to advance prevention research is to better understand the relationship between pathological gambling (PG) and psychological traits that have been more thoroughly studied. One recent study by Erica Fortune and Adam Goodie, Ph.D., at the University of Georgia, takes this approach. The study, which was published in the December 2010 edition of the Journal of Gambling Studies (Fortune & Goodie, 2009), was partially funded by a grant from the NCRG to Dr. Goodie and attempts to clarify the relationship between PG and sensation seeking.

The National Center for Responsible Gaming (NCRG) presented the first installment of the 2010 NCRG Webinar Series to more than 100 participants in June. Led by Dr. Marc Potenza, the webinar focused on “Co-Occurring Disorders: How Research is Informing the Identification and Treatment of Pathological Gambling.” Visit the NCRG website for an archived version of the presentation.

The study of addiction often involves quantifying personal information to make it usable in objective research. This process is an important part of developing sound science that increases understanding about gambling disorders and related addictions, and can inform the development of effective prevention, treatment and education efforts. In efforts to raise awareness about addictive disorders and address the stigma surrounding them, the arts can help translate scientific topics into compelling educational information for a broader audience.

One example of the arts helping to translate science is “Expressions of Addiction,” an online collection of photographs taken by addictions researcher and award-winning photographer Dr. Howard J. Shaffer. Expressions of Addiction was created to increase awareness and understanding of addiction and contribute to community programs and resources to prevent and treat addiction. The exhibit features pictures of people in various stages and expressions of addiction, including problems with alcohol, drugs and gambling, along with descriptions of how addiction has affected their lives. Shaffer, a licensed psychologist and director of the Division on Addictions at Cambridge Health Alliance, is one of the foremost researchers on gambling disorders.

The study of addiction often involves quantifying personal information to make it usable in objective research. This process is an important part of developing sound science that increases understanding about gambling disorders and related addictions, and can inform the development of effective prevention, treatment and education efforts. In efforts to raise awareness about addictive disorders and address the stigma surrounding them, the arts can help translate scientific topics into compelling educational information for a broader audience.

One example of the arts helping to translate science is “Expressions of Addiction,” an online collection of photographs taken by addictions researcher and award-winning photographer Dr. Howard J. Shaffer. Expressions of Addiction was created to increase awareness and understanding of addiction and contribute to community programs and resources to prevent and treat addiction. The exhibit features pictures of people in various stages and expressions of addiction, including problems with alcohol, drugs and gambling, along with descriptions of how addiction has affected their lives. Shaffer, a licensed psychologist and director of the Division on Addictions at Cambridge Health Alliance, is one of the foremost researchers on gambling disorders.

The National Center for Responsible Gaming kicks off its 2010 NCRG Webinar Series on June 17, 2010 from 2 p.m. - 3 p.m. EDT with “Co-Occurring Disorders: How Research is Informing the Identification and Treatment of Pathological Gambling.” In this session, Dr. Marc Potenza of Yale University School of Medicine will discuss how the high rate of co-occurring disorders among disordered gamblers affects how we understand and treat pathological gambling, and the influence of this research on the proposed changes to the definition of pathological gambling in the DSM-V. The program is free but advance registration is required.

The National Center for Responsible Gaming kicks off its 2010 NCRG Webinar Series on June 17, 2010 from 2 p.m. - 3 p.m. EDT with “Co-Occurring Disorders: How Research is Informing the Identification and Treatment of Pathological Gambling.” In this session, Dr. Marc Potenza of Yale University School of Medicine will discuss how the high rate of co-occurring disorders among disordered gamblers affects how we understand and treat pathological gambling, and the influence of this research on the proposed changes to the definition of pathological gambling in the DSM-V. The program is free but advance registration is required.