Differential Associations Between Problem and Pathological Gambling and Psychiatric Disorders in Individuals With and Without Alcohol Abuse or Dependence

Background: Alcohol abuse and/or dependence, alcohol use disorders (AUDs), and problem and/or pathological gambling (PPG) frequently co-occur with each other and other psychiatric disorders. However, prior studies have not investigated the relative influence of AUDs on the associations between PPG and other psychiatric disorders. Methods: Nationally representative data from the National Epidemiologic Survey on Alcohol and Related Conditions (n=43,093; United-States residents >= 18 years of age) was used to examine the influence of AUDs on the associations between gambling and other psychiatric disorders and behaviors. The main outcome measures were co-occurrence of past-year AUD and Axis I and II disorders and severity of gambling based on the 10 inclusionary diagnostic criteria for pathological gambling. Results: Among non-AUD respondents, increasing gambling severity was associated with increasingly elevated odds for the majority of Axis I and 11 disorders. Among AUD respondents, this pattern was typically not observed. Alcohol-by-gambling-group interactions for PPG were also found and the odds of these disorders was significantly increased in non-AUD respondents with PPG, but either unchanged or significantly lower in AUD respondents with PPG. Conclusions: Gambling-related associations exist with multiple psychiatric disorders, but particularly in those without AUD. These associations have important implications with respect to conceptualization, prevention, and treatment of psychiatric disorders in individuals with gambling and/or AUDs. CNS Spectr. 2010; 15(1):33-44