Problem gambling and substance use in patients attending community mental health services

J Behav Addict. 2017 Dec 1;6(4):678-688. doi: 10.1556/2006.6.2017.077. Epub 2017 Dec 19.

Abstract

Background and aims Relatively little is known about co-occurring gambling problems and their overlap with other addictive behaviors among individuals attending mental health services. We aimed to determine rates of gambling and substance use problems in patients accessing mental health services in Victoria, Australia. Methods A total of 837 adult patients were surveyed about their gambling and administered standardized screening tools for problem gambling and harmful tobacco, alcohol, and drug use. Prevalence of gambling problems was estimated and regression models used to determine predictors of problem gambling. Results The gambling participation rate was 41.6% [95% CI = 38.2-44.9]. The Problem Gambling Severity Index identified 19.7% [CI = 17.0-22.4] as "non-problem gamblers," 7.2% [CI = 5.4-8.9] as "low-risk" gamblers, 8.4% [CI = 6.5-10.2] as "moderate-risk" gamblers, and 6.3% [CI = 4.7-8.0] as "problem gamblers." One-fifth (21.9%) of the sample and 52.6% of all gamblers were identified as either low-risk, moderate-risk, or problem gamblers (PGs). Patients classified as problem and moderate-risk gamblers had significantly elevated rates of nicotine and illicit drug dependence (p < .001) according to short screening tools. Current diagnosis of drug use (OR = 4.31 [CI = 1.98-9.37]), borderline personality (OR = 2.59 [CI = 1.13-5.94]), bipolar affective (OR = 2.01 [CI = 1.07-3.80]), and psychotic (OR = 1.83 [CI = 1.03-3.25]) disorders were significant predictors of problem gambling. Discussion and conclusions Patients were less likely to gamble, but eight times as likely to be classified as PG, relative to Victoria's adult general population. Elevated rates of harmful substance use among moderate-risk and PG suggest overlapping vulnerability to addictive behaviors. These findings suggest mental health services should embed routine screening into clinical practice, and train clinicians in the management of problem gambling.

Keywords: alcohol; illicit drugs; mental health; nicotine; problem gambling.

MeSH terms

  • Adult
  • Anxiety Disorders / epidemiology*
  • Australia / epidemiology
  • Bipolar Disorder / epidemiology*
  • Community Mental Health Services*
  • Comorbidity
  • Depressive Disorder, Major / epidemiology*
  • Female
  • Gambling / epidemiology*
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Prevalence
  • Psychotic Disorders / epidemiology*
  • Substance-Related Disorders / epidemiology*
  • Victoria / epidemiology

Grants and funding

Funding sources: This research was supported by the Victorian Responsible Gambling Foundation. VM has received funding for research from multiple sources over the past 36 months including the National Health and Medical Research Council (NHMRC), VicHealth, the Victorian Department of Health and Human Services (DHHS), and the Victorian Responsible Gambling Foundation (VRGF). These include government departments or agencies that are primarily funded by government departments (some through hypothecated taxes from gambling revenue). She has not knowingly received direct funding from the gambling industry or any industry-sponsored organization.