Elsevier

Drug and Alcohol Dependence

Volume 150, 1 May 2015, Pages 129-134
Drug and Alcohol Dependence

Should pathological gambling and obesity be considered addictive disorders? A factor analytic study in a nationally representative sample

https://doi.org/10.1016/j.drugalcdep.2015.02.018Get rights and content

Highlights

  • An addiction factor includes substance use disorders and pathological gambling.

  • Obesity does not load into the addiction factor.

  • The data are supportive of pathological gambling as addictive disorder.

  • Future research should investigate whether certain obesity subtypes are addictions.

Abstract

Objective

Pathological gambling (PG) is now aligned with substance use disorders in the DSM-5 as the first officially recognized behavioral addiction. There is growing interest in examining obesity as an addictive disorder as well. The goal of this study was to investigate whether epidemiological data provide support for the consideration of PG and obesity as addictive disorders.

Method

Factor analysis of data from a large, nationally representative sample of US adults (N = 43,093), using nicotine dependence, alcohol dependence, drug dependence, PG and obesity as indicators. It was hypothesized that nicotine dependence, alcohol dependence and drug use dependence would load on a single factor. It was further hypothesized that if PG and obesity were addictive disorders, they would load on the same factor as substance use disorders, whereas failure to load on the addictive factor would not support their conceptualization as addictive disorders.

Results

A model with one factor including nicotine dependence, alcohol dependence, drug dependence and PG, but not obesity, provided a very good fit to the data, as indicated by CFI = 0.99, TLI = 0.99 and RMSEA = 0.01 and loadings of all indicators >0.4.

Conclusion

Data from this study support the inclusion of PG in a latent factor with substance use disorders but do not lend support to the consideration of obesity, as defined by BMI, as an addictive disorder. Future research should investigate whether certain subtypes of obesity are best conceptualized as addictive disorders and the shared biological and environmental factors that account for the common and specific features of addictive disorders.

Introduction

Inclusion of pathological gambling (renamed as gambling disorder) in the substance-related and addictive disorders chapter of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has brought to the fore considerations of which disorders or behaviors are best conceptualized as addictive disorders. This debate is important because the nosological status of a disorder is an important determinant of its lines of research (Blanco et al., 2009, Moreyra et al., 2002), treatment models (Greene et al., 2011, Petry et al., 2006) and approaches to policy and funding for treatment and research (Petry and Blanco, 2013).

Among the potential candidates that were considered to join the substance related and addictive disorders category in DSM-5, few garnered more attention than pathological gambling (PG) and obesity, possibly due to their devastating impact and recent increases in prevalence (Swinburn et al., 2011, Ziauddeen et al., 2012). Clinical experience and research evidence have suggested that PG shares many features with substance use disorders. These include high levels of comorbidity in clinical (Black and Moyer, 1998, Ibanez et al., 2001) and epidemiological samples (Kessler et al., 2008, Petry et al., 2005), shared genetic variance (Blanco et al., 2012, Slutske et al., 2000), high levels of impulsivity (Blanco et al., 1996, Blanco et al., 2009, Petry, 2001), performance in biobehavioral studies (Leeman and Potenza, 2012) and brain imaging studies (Leeman and Potenza, 2012, van Holst et al., 2010). Furthermore, both pharmacological (Grant et al., 2006, Kim et al., 2001) and psychotherapy treatments for PG have been often based on its conceptualization as an addictive disorder (Hodgins et al., 2001, Petry et al., 2006).

Data supporting the consideration of obesity as an addictive disorder have been more mixed. Some empirical studies and reviews have supported the conceptualization of obesity as an addiction based on data suggesting overlapping molecular and cellular mechanisms and reward brain circuits as well as shared genetic vulnerabilities (Galanti et al., 2007, Grucza et al., 2010, Kenny, 2011a, Kenny, 2011b, Lilenfeld et al., 2008, Volkow et al., 2011, Weller et al., 2008), but other studies have provided countervailing evidence (Fernandez-Castillo et al., 2010, Haltia et al., 2007, Munafo et al., 2009, Smith et al., 2008, Ziauddeen et al., 2012).

We sought to contribute to those lines of research by conducting a factor analysis using data from the National Epidemiologic Survey on Alcohol and Related Conditions, a large, nationally representative sample of US adults. We hypothesized that substance use disorders, i.e., nicotine dependence, alcohol dependence and drug use dependence, would load on a single factor, consistent with prior analyses (Kessler et al., 2011, Krueger et al., 1998). Furthermore, we hypothesized that if PG and obesity were addictive disorders, they would load on the same factor as substance use disorders. By contrast, failure to load on the addictive factor would not support their conceptualization as addictive disorders, at least not as defined within this dataset.

Section snippets

NESARC sample

The 2001–2002 NESARC is a survey of a representative sample of the United States sponsored by the NIAAA (Grant et al., 2003b, Grant and Kim, 2002). The target population was individuals age 18 years and older in the civilian non-institutional population residing in households and group quarters. The survey included those residing in the continental United States, District of Columbia, Alaska and Hawaii. Face-to-face personal interviews were conducted with 43,093 respondents. The survey response

Results

The 12-month prevalence of obesity, nicotine dependence, alcohol dependence, drug dependence, and pathological gambling were 21.8 (95% CI = 21.0–22.6), 12.8% (95% CI = 12.0–13.6), 3.8% (95% CI = 3.5–4.1), 0.6% (95% CI = 0.4–0.8), and 0.16% (95% CI = 0.12–0.20), respectively. The mean BMI in the sample was 26.7 (95% CI = 26.6–26.9). Bivariate analyses indicated that PG was significantly and positively associated to nicotine, alcohol and drug dependence, with ORs ranging from 2.82 for drug dependence to 8.17

Discussion

In a large, nationally representative sample of US adults, nicotine, alcohol and drug dependence and pathological gambling loaded on the same factor. By contrast, the loading of obesity on the addictive factor was very low. Furthermore, the findings were robust to model specification as indicated by the results of sensitivity analyses that used disordered gambling and DSM-5 gambling disorder as indicators of the factor.

Consistent with our first hypothesis, we found that nicotine, alcohol and

Author disclosures

Role of funding sources

Funding for this study was provided in parts by NIH grants DA019606 and CA133050 and the New York State Psychiatric Institute (Dr. Blanco). The NIH and the NYSPI had no further role in the study design, collection, analysis or interpretation of the data, the writing of the manuscript or the decision to submit the paper for publication.

Contributors

Carlos Blanco designed the study and wrote the initial draft of the manuscript. Shuai Wang and Melanie Wall undertook the

Conflict of interest

All the authors declare that they have no conflicts of interest.

References (74)

  • B.A. Swinburn et al.

    The global obesity pandemic: shaped by global drivers and local environments

    Lancet

    (2011)
  • B. Ustun et al.

    WHO Study on the reliability and validity of the alcohol and drug use disorder instruments: overview of methods and results

    Drug Alcohol Depend.

    (1997)
  • R.J. van Holst et al.

    Why gamblers fail to win: a review of cognitive and neuroimaging findings in pathological gambling

    Neurosci. Biobehav. Rev.

    (2010)
  • A. Verdejo-Garcia et al.

    The role of interoception in addiction: a critical review

    Neurosci. Biobehav. Rev.

    (2012)
  • N.D. Volkow et al.

    Reward, dopamine and the control of food intake: implications for obesity

    Trends Cogn. Sci.

    (2011)
  • R.E. Weller et al.

    Obese women show greater delay discounting than healthy-weight women

    Appetite

    (2008)
  • Y. Yalachkov et al.

    Functional neuroimaging studies in addiction: multisensory drug stimuli and neural cue reactivity

    Neurosci. Biobehav. Rev.

    (2012)
  • A. Agrawal et al.

    A latent class analysis of illicit drug abuse/dependence: results from the National Epidemiological Survey on Alcohol and Related Conditions

    Addiction

    (2007)
  • A. Agresti

    Categorical Data Analysis

    (2002)
  • D.W. Black et al.

    Clinical features and psychiatric comorbidity of subjects with pathological gambling behavior

    Psychiatr. Serv.

    (1998)
  • C. Blanco et al.

    Sex differences in subclinical and DSM-IV pathological gambling: results from the National Epidemiologic Survey on Alcohol and Related Conditions

    Psychol. Med.

    (2006)
  • C. Blanco et al.

    Mapping common psychiatric disorders: structure and predictive validity in the National Epidemiologic Survey on Alcohol and Related Conditions

    Arch. Gen. Psychiatry

    (2013)
  • C. Blanco et al.

    Gambling, disordered gambling and their association with major depression and substance use: a web-based cohort and twin-sibling study

    Psychol. Med.

    (2012)
  • C. Blanco et al.

    Testing the drug substitution switching-addictions hypothesis a prospective study in a nationally representative sample

    JAMA Psychiatry

    (2014)
  • C. Blanco et al.

    Pathological gambling and platelet MAO activity: a psychobiological study

    Am. J. Psychiatry

    (1996)
  • G. Canino et al.

    The Spanish Alcohol Use Disorder and Associated Disabilities Interview Schedule (AUDADIS): reliability and concordance with clinical diagnoses in a Hispanic population

    J. Stud. Alcohol Drugs

    (1999)
  • W.M. Compton et al.

    Prevalence, correlates, disability, and comorbidity of DSM-IV drug abuse and dependence in the United States: results from the national epidemiologic survey on alcohol and related conditions

    Arch. Gen. Psychiatry

    (2007)
  • N. Fernandez-Castillo et al.

    Association study between the DAT1, DBH and DRD2 genes and cocaine dependence in a Spanish sample

    Psychiatr. Genet.

    (2010)
  • K. Galanti et al.

    Test meal intake in obese binge eaters in relation to impulsivity and compulsivity

    Int. J. Eat. Disord.

    (2007)
  • A.N. Gearhardt et al.

    Body mass index and alcohol consumption: family history of alcoholism as a moderator

    Psychol. Addict. Behav.

    (2009)
  • A.N. Gearhardt et al.

    Food addiction: an examination of the diagnostic criteria for dependence

    J. Addict. Med.

    (2009)
  • A.N. Gearhardt et al.

    Neural correlates of food addiction

    Arch. Gen. Psychiatry

    (2011)
  • B.F. Grant et al.

    The Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV Version

    (2001)
  • B.F. Grant et al.

    Prevalence, correlates, and disability of personality disorders in the United States: results from the national epidemiologic survey on alcohol and related conditions

    J. Clin. Psychiatry

    (2004)
  • B.F. Grant et al.

    Source and Accuracy Statement: Wave 1 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)

    (2003)
  • B.F. Grant et al.

    Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions

    Arch. Gen. Psychiatry

    (2004)
  • B.F. Grant et al.

    Co-occurrence of 12-month alcohol and drug use disorders and personality disorders in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions

    Arch. Gen. Psychiatry

    (2004)
  • Cited by (0)

    View full text