Journal of Gambling Studies

, Volume 32, Issue 2, pp 591–604 | Cite as

The Relationship Between Problem Gambling and Attention Deficit Hyperactivity Disorder

  • O. R. Waluk
  • G. J. Youssef
  • N. A. Dowling
Original Paper


Recent studies indicate that treatment-seeking problem gamblers display elevated rates of ADHD and that adolescents who screen positive for ADHD are more likely to engage in gambling, develop gambling problems, and experience a greater severity in gambling problems. This study aimed to (a) compare the prevalence of ADHD in treatment-seeking problem gamblers to the general population; (b) investigate the relationships between ADHD and problem gambling severity, cluster B personality disorders, motor impulsivity, alcohol use, substance use, gender, and age; and (c) investigate the degree to which these factors moderate the relationship between ADHD and problem gambling severity. Participants included 214 adults (154 males, 58 females, 2 unspecified) who sought treatment for their gambling problems at a specialist gambling agency in Melbourne, Australia. Almost one-quarter (24.9 %) of treatment-seeking problem gamblers screened positively for ADHD, which was significantly higher than the 14 % prevalence in a community sample. ADHD was significantly positively correlated with problem gambling severity, motor impulsivity, and cluster B personality disorders, but was not associated with alcohol and substance use, gender or age. None of the factors significantly moderated the relationship between ADHD and problem gambling severity. These findings suggest that a considerable proportion of treatment-seeking problem gamblers report ADHD and that their clinical profile is complicated by the presence of high impulsivity and cluster B personality disorders. They highlight the need for specialist gambling agencies to develop screening, assessment, and management protocols for co-occurring ADHD to enhance the effectiveness of treatment.


Problem gambling Gambling Attention deficit hyperactivity disorder ADHD Treatment Comorbidity 



The authors wish to acknowledge the efforts of the staff at Gamblers Help (City) and all of the clients who contributed data to this project.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

This study was approved by the Deakin Human Research Ethics Committee (Reference No. 2014-209) and the University of Melbourne’s Human Research Ethics Committee (0932410.1). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.


  1. Barkley, R. A. (2006). Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment (3rd ed.). New York: Guilford Press.Google Scholar
  2. Blaszczynski, A., & Nower, L. (2002). A pathways model of problem and pathological gambling. Addiction, 97(5), 487–499. doi: 10.1046/j.1360-0443.2002.00015.x.CrossRefPubMedGoogle Scholar
  3. Blaszczynski, A., Steel, Z., & McConaghy, N. (1997). Impulsivity in pathological gambling: The antisocial impulsivist. Addiction, 92(1), 75–87.CrossRefPubMedGoogle Scholar
  4. Breyer, J., Botzet, A., Winters, K., Stinchfield, R., August, G., & Realmuto, G. (2009). Young adult gambling behaviors and their relationship with the persistence of ADHD. Journal of Gambling Studies, 25(2), 227–238. doi: 10.1007/s10899-009-9126-z.CrossRefPubMedPubMedCentralGoogle Scholar
  5. Brown, M., Allen, J. S., & Dowling, N. A. (2014). The application of an etiological model of personality disorders to problem gambling. Journal of Gambling Studies. doi: 10.1007/s10899-014-9504-z.PubMedPubMedCentralGoogle Scholar
  6. Dannon, P. N., Lowengrub, K., Shalgi, B., Sasson, M., Tuson, L., Saphir, Y., & Kotler, M. (2006). Dual psychiatric diagnosis and substance abuse in pathological gamblers: A preliminary gender comparison study. Journal of Addictive Diseases, 25(3), 49–54.CrossRefPubMedGoogle Scholar
  7. De Graaf, R., Kessler, R. C., Fayyad, J., ten Have, M., Alonso, J., Angermeyer, M., & Posada-Villa, J. (2008). The prevalence and effects of adult attention-deficit/hyperactivity disorder (ADHD) on the performance of workers: Results from the WHO World Mental Health Survey Initiative. Occupational and Environmental Medicine, 65(12), 835–842. doi: 10.1136/oem.2007.038448.CrossRefPubMedPubMedCentralGoogle Scholar
  8. Dell’Osso, B., Allen, A., & Hollander, E. (2005). Comorbidity issues in the pharmacological treatment of pathological gambling: A critical review. Clinical Practice and Epidemiology in Mental Health,. doi: 10.1186/1745-0179-1-21.Google Scholar
  9. Dowling, N. A., Cowlishaw, S., Jackson, A. C., Merkouris, S. S., Francis, K. L., & Christensen, D. R. (2014). The prevalence of comorbid personality disorders in treatment-seeking problem gamblers: A systematic review and meta-analysis. Journal of Personality Disorders. doi: 10.1521/pedi_2014_28_168.
  10. Dowling, N. A., Cowlishaw, S., Jackson, A. C., Merkouris, S. S., Francis, K. L., & Christensen, D. R. (2015). The prevalence of psychiatric comorbidity in treatment-seeking problem gamblers: A systematic review and meta-analysis. Australian and New Zealand Journal of Psychiatry, 49(6), 519–539.CrossRefPubMedPubMedCentralGoogle Scholar
  11. Ebejer, J. L., Medland, S. E., van der Werf, J., Gondro, C., Henders, A. K., Lynskey, M., et al. (2012). Attention deficit hyperactivity disorder in Australian adults: Prevalence, persistence, conduct problems and disadvantage. PLoS One, 7(10), e47404. doi: 10.1371/journal.pone.0047404.CrossRefPubMedPubMedCentralGoogle Scholar
  12. Faregh, N., & Derevensky, J. (2011). Gambling behavior among adolescents with attention deficit/hyperactivity disorder. Journal of Gambling Studies, 27(2), 243–256. doi: 10.1007/s10899-010-9211-3.CrossRefPubMedGoogle Scholar
  13. Ferris, J., & Wynne, H. (2001). The Canadian problem gambling index: Final report. Retrieved July 13, 2007, from
  14. Graham, J. W. (2009). Missing data analysis: Making it work in the real world. Annual Review of Psychology, 60, 549–576.CrossRefPubMedGoogle Scholar
  15. Grall-Bronnec, M., Wainstein, L., Augy, J., Bouju, G., Feuillet, F., Vénisse, J.-L., & Sébille-Rivain, V. (2011). Attention deficit hyperactivity disorder among pathological and at-risk gamblers seeking treatment: A hidden disorder. European Addiction Research, 17(5), 231–240. doi: 10.1159/000328628.CrossRefPubMedGoogle Scholar
  16. Grant, J. E., & Kim, S. W. (2005). Quality of life in kleptomania and pathological gambling. Comprehensive Psychiatry, 46(1), 34–37. doi: 10.1016/j.comppsych.2004.07.022.CrossRefPubMedGoogle Scholar
  17. Hansen, C., Weiss, D., & Last, C. G. (1999). ADHD boys in young adulthood: Psychosocial adjustment. Journal of the American Academy of Child and Adolescent Psychiatry, 2, 165.CrossRefGoogle Scholar
  18. Hawthorne, G., & Elliot, P. (2005). Imputing cross-sectional missing data: Comparison of common techniques. Australian and New Zealand Journal of Psychiatry, 39, 583–590.CrossRefPubMedGoogle Scholar
  19. Ibanez, A., Blanco, C., Donahue, E., Lesieur, H. R., Perez de Castro, I., Fernandez-Piqueras, J., & Saiz-Ruiz, J. (2001). Psychiatric comorbidity in pathological gamblers seeking treatment. American Journal of Psychiatry, 158, 1733–1735.CrossRefPubMedGoogle Scholar
  20. Kausch, O. (2003). Patterns of substance abuse among treatment-seeking pathological gamblers. Journal of Substance Abuse Treatment, 25, 263–270.CrossRefPubMedGoogle Scholar
  21. Kerber, C. S., Black, D. W., & Buckwalter, K. (2008). Comorbid psychiatric disorders among older adult recovering pathological gamblers. Issues in Mental Health Nursing, 29(9), 1018–1028.CrossRefPubMedGoogle Scholar
  22. Kessler, R. C., Adler, L., Ames, M., Demler, O., Faraone, S., Hiripi, E., et al. (2005). The World Health Organization Adult ADHD Self-Report Scale (ASRS). Psychological Medicine, 35(2), 245–256.CrossRefPubMedGoogle Scholar
  23. Kessler, R. C., Adler, L., Barkley, R., Biederman, J., Conners, C. K., Demler, O., et al. (2006). The prevalence and correlates of adult ADHD in the United States: Results from the National Comorbidity Survey Replication. The American Journal of Psychiatry, 163(4), 716–723.CrossRefPubMedPubMedCentralGoogle Scholar
  24. Kessler, R. C., Adler, L. A., Gruber, M. J., Sarawate, C. A., Spencer, T., & Van Brunt, D. L. (2007). Validity of the world health organisation adult ADHD self-report scale (ASRS) screener in a representative sample of health plan members. International Journal of Methods in Psychiatric Research, 16(2), 52–65. doi: 10.1002/mpr.208.CrossRefPubMedPubMedCentralGoogle Scholar
  25. Kruedelbach, N., Walker, H., Chapman, H., Haro, G., Mateu, C., & Leal, C. (2006). Comorbidity on disorders with loss of impulse-control: Pathological gambling, addictions and personality disorders. Actas Espanolas de Psiquiatria, 34, 76–82.PubMedGoogle Scholar
  26. Ladouceur, R., Sylvain, C., Sevigny, S., Poirier, L., Brisson, L., Dias, C., et al. (2006). Pathological gamblers: Inpatients’ versus outpatients’ characteristics. Journal of Gambling Studies, 22, 443–450.CrossRefPubMedGoogle Scholar
  27. Langbehn, D. R., et al. (1999). The IOWA Personality Disorders Screen: Development and preliminary validation of a brief screening interview. Journal of Personality Disorders, 13(1), 75–89.CrossRefPubMedGoogle Scholar
  28. Lorains, F. K., Cowlishaw, S., & Thomas, S. A. (2011). Prevalence of comorbid disorders in problem and pathological gambling: systematic review and meta-analysis of population surveys. Addiction, 106(3), 490–498.CrossRefPubMedGoogle Scholar
  29. Lorains, F., Stout, J. C., Bradshaw, J. L., Dowling, N. A., & Enticott, P. (2014). Self-reported impulsivity and inhibitory control in problem gamblers. Journal of Clinical and Experimental Neuropsychology, 36(2), 144–157.CrossRefPubMedGoogle Scholar
  30. Medcal Online Calculator Retrieved 29 September 2014, from
  31. Milosevic, A., & Ledgerwood, D. M. (2010). The subtyping of pathological gambling: A comprehensive review. Clinical Psychology Review, 30, 988–998.CrossRefPubMedGoogle Scholar
  32. Neal, P., Delfabbro, P., & O’Neil, M. (2005). Problem gambling and harm: Towards a national definition. Report commissioned by Gambling Research Australia and prepared for the SA Centre for Economic Studies with the University of Adelaide Department of Psychology.Google Scholar
  33. Polanczyk, G., de Lima, M. S., Horta, B. L., Biederman, J., & Rohde, L. A. (2007). The worldwide prevalence of ADHD: A systematic review and metaregression analysis. American Journal of Psychiatry, 164(6), 942–948.CrossRefPubMedGoogle Scholar
  34. Ramsay, J. R. (2010). ADHD in adulthood Nonmedication treatments for adult ADHD: Evaluating impact on daily functioning and well-being (pp. 9–35). Washington, DC: American Psychological Association.CrossRefGoogle Scholar
  35. Reid, R. C., Cyders, M. A., Moghaddam, J. F., & Fong, T. W. (2014). Psychometric properties of the Barratt Impulsiveness Scale in patients with gambling disorders, hypersexuality, and methamphetamine dependence. Addictive Behaviors, 39(11), 1640–1645. doi: 10.1016/j.addbeh.2013.11.008. Epub 2013 Nov 19.CrossRefPubMedGoogle Scholar
  36. Rubin, D. B. (1976). Inference and missing data. Biometrika, 63(3), 581–592. doi: 10.1093/biomet/63.3.581.CrossRefGoogle Scholar
  37. Rubin, D. B. (2004). Multiple imputation for nonresponse in surveys. New York: Wiley-InterscienceGoogle Scholar
  38. Rugle, L., & Melamed, L. (1993). Neuropsychological assessment of attention problems in pathological gamblers. Journal of Nervous and Mental Disease, 181(2), 107–112. doi: 10.1097/00005053-199302000-00006.CrossRefPubMedGoogle Scholar
  39. SCRGSP (Steering Committee for the Review of Government Service Provision). (2010). Report on Government Services 2010. Canberra: Productivity Commission.Google Scholar
  40. Shaffer, H. J., & Hall, M. N. (2001). Updating and refining prevalence estimates of disordered gambling behaviour in the United States and Canada. Canadian Journal of Public Health, 92(3), 168–172.PubMedGoogle Scholar
  41. Specker, S. M., Carlson, G. A., Christenson, G. A., & Marcotte, M. (1995). Impulse control disorders and attention deficit disorder in pathological gamblers. Annals of Clinical Psychiatry, 7(4), 175–179.CrossRefPubMedGoogle Scholar
  42. Spencer, T. J., Biederman, J., & Mick, E. (2007). Attention-deficit/hyperactivity disorder: Diagnosis, lifespan, comorbidities, and neurobiology. Ambulatory Pediatrics, 7(Suppl. 1), 73–81.CrossRefPubMedGoogle Scholar
  43. Spinella, M. (2007). Normative data and a short form of the Barratt Impulsiveness Scale. International Journal of Neuroscience, 117(3), 359–368.CrossRefPubMedGoogle Scholar
  44. Suomi, A., Dowling, N. A., & Jackson, A. C. (2014). Problem gambling subtypes based on psychiatric distress, alcohol abuse and impulsivity. Addictive Behaviors, 39, 1741–1745.CrossRefPubMedGoogle Scholar
  45. Westphal, J. R., & Johnson, L. J. (2007). Multiple co-occurring behaviours among gamblers in treatment: Implications and assessment. International Gambling Studies, 7(1), 73–99. doi: 10.1080/14459790601157905.CrossRefGoogle Scholar
  46. Willcutt, E. G. (2012). The prevalence of DSM-IV attention-deficit/hyperactivity disorder: A meta-analytic review. Neurotherapeutics, 9(3), 490–499. doi: 10.1007/s13311-012-0135-8.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • O. R. Waluk
    • 1
  • G. J. Youssef
    • 1
    • 2
  • N. A. Dowling
    • 1
    • 3
    • 4
    • 5
  1. 1.School of PsychologyDeakin UniversityMelbourneAustralia
  2. 2.Monash Clinical and Imaging Neuroscience, School of Psychological Sciences and Monash Biomedical ImagingMonash UniversityMelbourneAustralia
  3. 3.Melbourne Graduate School of EducationUniversity of MelbourneMelbourneAustralia
  4. 4.School of Psychological SciencesMonash UniversityMelbourneAustralia
  5. 5.Centre for Gambling ResearchAustralian National UniversityCanberraAustralia

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