Elsevier

Drug and Alcohol Dependence

Volume 133, Issue 1, 1 November 2013, Pages 204-211
Drug and Alcohol Dependence

Gender differences in the relationship between gambling problems and the incidence of substance-use disorders in a nationally representative population sample

https://doi.org/10.1016/j.drugalcdep.2013.05.002Get rights and content

Abstract

Background

Cross-sectional studies have demonstrated gender-related differences in the associations between problem-gambling severity and substance-use disorders; however, these associations have not been examined longitudinally. We aimed to examine the prospective associations between problem-gambling severity and incident substance-use disorders in women versus men.

Methods

Analyses were conducted using Wave-1 and Wave-2 NESARC data focusing on psychiatric diagnoses from 34,006 non-institutionalized US adults. Inclusionary criteria for pathological gambling were used to categorize Wave-1 participants as at-risk/problem gambling (ARPG) and non-ARPG (i.e. non-gambling/low-frequency gambling/low-risk gambling). Dependent variables included the three-year incidence of any substance-use disorder, alcohol-use disorders, nicotine dependence, drug-use disorders, prescription drug-use disorders, and illicit drug-use disorders.

Results

Significant gender-by-ARPG status interactions were observed with respect to the three-year incidence of nicotine dependence and prescription drug-use disorders, and approached significance with respect to incident alcohol-use disorders. ARPG (relative to non-ARPG) was positively associated with nicotine dependence among women (OR = 2.00; 95% CI = 1.24–3.00). ARPG was negatively associated with incident prescription drug-use disorders among men (OR = 0.30; 95% CI = 0.10–0.88)). Finally, ARPG was positively associated with incident alcohol-use disorders among men (OR = 2.20; 95% CI = 1.39–3.48).

Conclusions

Gambling problems were associated with an increased 3-year incidence of nicotine dependence in women and alcohol dependence in men. These findings highlight the importance of considering gender in prevention and treatment initiatives for adults who are experiencing gambling problems. Moreover, the specific factors underlying the differential progressions of specific substance-use disorders in women and men with ARPG warrant identification.

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,

References (41)

  • A. Blaszczynski et al.

    Impulsivity in pathological gambling: the antisocial impulsivist

    Addiction

    (1997)
  • T.M. Chaplin et al.

    Gender differences in response to emotional stress: an assessment across subjective, behavioral, and physiological domains and relations to alcohol craving

    Alcohol. Clin. Exp. Res.

    (2008)
  • K.L. Chou et al.

    Disordered (pathologic or problem) gambling and axis I psychiatric disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions

    Am. J. Epidemiol.

    (2011)
  • K.L. Chou et al.

    Three-year incidence and predictors of first-onset of DSM-IV mood, anxiety, and substance use disorders in older adults: results from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions

    J. Clin. Psychiatry

    (2011)
  • E. Dakwar et al.

    Exercise and mental illness: results from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)

    J. Clin. Psychiatry

    (2012)
  • D.A. Dawson et al.

    The association between stress and drinking: modifying effects of gender and vulnerability

    Alcohol Alcohol.

    (2005)
  • R.A. Desai et al.

    Gambling, health and age: data from the National Epidemiologic Survey on Alcohol and Related Conditions

    Psychol. Addict. Behav.

    (2007)
  • R.A. Desai et al.

    Health correlates of recreational gambling in older adults

    Am. J. Psychiatry

    (2004)
  • R.A. Desai et al.

    Gender differences in adolescent gambling

    Ann. Clin. Psychiatry

    (2005)
  • R.A. Desai et al.

    Gender differences in the associations between past-year gambling problems and psychiatric disorders

    Soc. Psychiatry Psychiatr. Epidemiol.

    (2008)
  • Cited by (32)

    • Problem gambling and gaming in elite athletes

      2018, Addictive Behaviors Reports
      Citation Excerpt :

      In young individuals in the general population, alcohol drinking and problem gambling are associated (Barnes et al., 1999; Buja et al., 2017; Peters et al., 2015). In the general population, it has been described that the association between problem gambling and alcohol can be seen only in men (Pilver et al., 2013). Due to the low number of female problem gamblers in the present study, it cannot be fully tested whether gender interacts with this lacking association, but we carried out a post hoc sub-analysis of men only, still demonstrating a clear lack of significant association between gambling and alcohol (p = 0.43).

    • Risk factors for gambling and substance use among recent college students

      2017, Drug and Alcohol Dependence
      Citation Excerpt :

      A recent study utilizing adolescent twin pairs found a significant genetic influence on both gambling and substance use (Vitaro et al., 2014), which is consistent with other research among adults (Slutske et al., 2000; Slutske et al., 2013). Longitudinal data examining gender as a risk factor show an association between gambling problems and incident alcohol dependence among men (Pilver et al., 2013). Affiliation with delinquent peers or poor parental supervision are also common etiological factors to substance use and gambling among adolescents (Vitaro et al., 2001).

    • Sensation seeking in a community sample of French gamblers: Comparison between strategic and non-strategic gamblers

      2017, Psychiatry Research
      Citation Excerpt :

      With regard to alcohol use, pathological gamblers have higher alcohol use (number of glasses per day) than non-pathological gamblers but this result is only true for males, which is in line with the results in the general French population (Beck et al., 2015). Previous studies have found no association between gambling and alcohol consumption in females and a highly significant association in males (Blanco et al., 2006; Griffiths et al., 2010; Pilver et al., 2013). Nevertheless, alcohol misuse (CAGE) is not associated with GD.

    • Epidemiologic Research on the Relationship of Nicotine Dependence to Psychiatric and Substance Use Disorders

      2017, Negative Affective States and Cognitive Impairments in Nicotine Dependence
    View all citing articles on Scopus

    Supplementary material can be found by accessing the online version of this paper. Please see Appendix A.

    View full text