Gender differences in the relationship between gambling problems and the incidence of substance-use disorders in a nationally representative population sample☆
Introduction
Research has illuminated gender-related differences in gambling and its correlates For instance, motivations for gambling and gambling preferences vary by gender (Potenza et al., 2006), and women progress more quickly than men from the initiation of gambling to experiencing gambling problems, a process called “telescoping” (Grant and Kim, 2002, Potenza et al., 2001, Tavares et al., 2001). Gender-related differences extend to pathological gambling (PG), with stronger links to substance-use disorders observed in women and women more likely to report negative reinforcement motivations for gambling (American Psychiatric Association, 2000, Blanco et al., 2006, Grant and Kim, 2002). Subclinical levels of PG are also differentially associated with psychopathology and poor health/functioning among boys/men and girls/women (Blanco et al., 2006, Desai and Potenza, 2008, Morasco et al., 2006, Yip et al., 2011).
Significant gender-related differences in the co-occurrence of substance-use disorders and PG and subsyndromal gambling have also been observed. Wave-1 data from the nationally representative National Epidemiologic Study Survey on Alcohol and Related Disorders (NESARC) indicate stronger associations between PG and alcohol dependence, any drug-use disorder, drug abuse, and nicotine dependence, among women compared to men (Petry et al., 2005). Past-year problem-gambling severity was associated more strongly with nicotine dependence in women compared to men (Desai and Potenza, 2008), and similar (non-significant) patterns for alcohol abuse/dependence and drug abuse/dependence were observed.
To the best of our knowledge, the gender-related differences observed in cross-sectional data have not been explored longitudinally. From a public health perspective, understanding the prospective relationships between problem gambling and substance-use disorders is important, as problem gambling may influence the onset, course, and treatment of substance-use disorders. Characterization of gender-related differences in these relationships would help optimize prevention and treatment strategies.
Two studies indicate that problem gambling may be associated with the incidence of substance-use disorders, although neither study examined gender as a possible moderator of this relationship. In the NESARC, past-year problem gamblers were more likely than non-disordered gamblers to develop incident alcohol-use disorders (Chou and Afifi, 2011). Among older adults in the NESARC sample, at-risk/problem/pathological gambling (ARPG) was associated with elevated odds for incident substance-use disorders, relative to non-gambling/low-frequency gambling (Pilver et al., 2013). In retrospective age-of-onset analysis of the cross-sectional National Comorbidity Survey-Replication, PG was associated with the onset of substance-use disorders (Kessler et al., 2008).
In order to address existing gaps in knowledge, we investigated whether the prospective association between ARPG status and incident substance-use disorders differed in women compared to men among a general population sample of US adults. Given cross-sectional evidence for stronger associations between PG and substance-use disorders in women versus men (Desai and Potenza, 2008, Petry et al., 2005), we hypothesized that ARPG status would be more strongly associated with incident substance-use disorders in women as compared to men.
Section snippets
NESARC methods
The NESARC was conducted by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the US Census Bureau; prior publications provide a detailed methodology (Grant and Kaplan, 2005, Grant et al., 2003b). Ethical review and approval was conducted by the U.S. Census Bureau and the U.S. Office of Management and Budget. Data are de-identified and publicly available, exempting analyses from further Institutional Review Board (IRB) review (as confirmed by the Yale University IRB for these
Sample characteristics, by ARPG status and gender (Table 1)
Among women, APRG status was associated with race, education, any mood disorder, any anxiety disorder, alcohol-use disorders, nicotine dependence, drug-use disorders, and any Axis-II disorder (all p < 0.01). The prevalence of ARPG appeared highest among women who were black, divorced/separated/widowed, had not graduated college, and had any mood disorder, any anxiety disorder, alcohol-use disorders, nicotine dependence, drug-use disorders, or any Axis-II disorder. Among men, ARPG status was
Discussion
This is the first study to examine whether ARPG status is differentially associated with incident substance-use disorders among women and men; based on findings from cross-sectional research, we hypothesized that ARPG status would be more strongly associated with the incident substance-use disorders in women as compared to men. Results indicated that ARPG status was differentially associated with the incidence of some substance-use disorders among women and men. Specifically, significant
Role of funding source
This research was funded in part by NIMH training grant T-32-MH01 4235-37; NIH grants from NIAAA (RL1 AA017539); Office of Academic Affiliations, Advanced Fellowship Program in Mental Illness Research and Treatment, Department of Veterans Affairs; the Connecticut State Department of Mental Health and Addictions Services; the Connecticut Mental Health Center; the VA Connecticut Healthcare System; an unrestricted research gift from the Mohegan Sun casino; and the Yale Gambling Center of Research
Contributors
Drs. Pilver, Libby, Hoff and Potenza contributed to the design and approach of the study. Dr. Pilver performed the data analyses and generated the initial draft of the manuscript. Drs. Pilver, Libby, Hoff and Potenza reviewed, revised and approved the manuscript for submission to the journal.
Conflict of interest
The authors report no conflict of interest with respect to content of the manuscript.
Acknowledgements
The authors disclose the following for past-36-month activities. Dr. Potenza has consulted for Lundbeck and Ironwood pharmaceuticals; has had financial interests in Somaxon pharmaceuticals; received research support from Mohegan Sun Casino, Psyadon pharmaceuticals, the National Center for Responsible Gambling, the National Institutes of Health (NIH), Veterans Administration; has participated in surveys, mailings, or telephone consultations related to drug addiction, impulse-control disorders,
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Supplementary material can be found by accessing the online version of this paper. Please see Appendix A.