Skip to main content

The Epidemiology of Gambling Disorder

  • Chapter
  • First Online:
Book cover Gambling Disorder

Abstract

This chapter reviews the epidemiology of gambling disorder (GD). Gambling behavior is common and occurs worldwide and is culturally universal. GD has an estimated lifetime prevalence in the USA ranging from 0.42% to 4.0%. Prevalence among youth may be even higher. Most people with GD are male and, while men have an earlier onset, women have a shorter course from onset of gambling to the development of GD. Nonwhite populations appear to be at particular risk for the development of GD, particularly African-Americans. The course of GD was once thought to be progressive and deteriorating, but more recent research suggests that the course oscillates with many individuals spontaneously improving or remitting. Suicidal thoughts and behaviors are common, often prompted by gambling losses. Psychiatric comorbidity is the rule and not the exception. Substance use disorders are highly prevalent in people with GD, followed by mood disorders, anxiety disorders, attention deficit/hyperactivity disorder, and disorders of impulse control. Personality disorders are also common, especially antisocial and borderline personality disorders. Many people with GD are highly impulsive, a personality trait that may serve as a bridge to GD. Subtypes of GD have been proposed, and there is some empirical evidence to support the “pathways” model that suggests the existence of behaviorally conditioned gamblers, emotionally vulnerable gamblers, and impulsive-antisocial gamblers.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. National Opinion Research Center (NORC). Gambling impact and behavior study. Chicago, IL: University of Chicago; 1999.

    Google Scholar 

  2. Volberg R. The prevalence and demographics of pathological gamblers – implications for public health. Am J Public Health. 1994;84:237–41.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Welte JW, Barnes M, Wieczorek WF, et al. Gambling participation in the US – results from a national survey. J Gambl Stud. 2002;18:313–37.

    Article  PubMed  Google Scholar 

  4. American Psychiatric Association, editor. Diagnostic and statistical manual of mental disorders. 5th ed. Washington, DC: American Psychiatric Association; 2013.

    Google Scholar 

  5. Shaffer HJ, Hall MN, Vander Bilt J. Estimating prevalence of disordered gambling behavior in the United States and Canada: a research synthesis. Am J Public Health. 1999;89:1369–76.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Kessler RC, Hwang I, LaBrie R, et al. DSM-IV pathological gambling in the National Comorbidity Survey Replication. Psychol Med. 2008;38:1351–60.

    CAS  PubMed  PubMed Central  Google Scholar 

  7. Petry NM, Stinson FS, Grant BF. Comorbidity of DSM-IV pathological gambling and other psychiatric disorders: results from the National Epidemiologic Survey on alcohol and related conditions. J Clin Psychiatry. 2005;66:564–74.

    Article  PubMed  Google Scholar 

  8. Welte J, Barnes G, Wieczorek W, et al. Alcohol and gambling pathology among U.S. adults: prevalence, demographic patterns and comorbidity. J Stud Alcohol. 2001;62:706–12.

    Article  CAS  PubMed  Google Scholar 

  9. Volberg RA. Prevalence studies of problem gambling in the United States. J Gambl Stud. 1996;12:111–28.

    Article  CAS  PubMed  Google Scholar 

  10. Chou KL, Afifi TO. Disordered (problem or pathological) gambling and Axis I psychiatric disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Am J Epidemiol. 2011;173:1289–97.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Volberg RA, Abbott MW, Ronnberg S, Munck IME. Prevalence and risks of pathological gambling in Sweden. Acta Psychiatr Scand. 2001;104:250–6.

    Article  CAS  PubMed  Google Scholar 

  12. Wong ILK, So EMT. Prevalence estimates of problem and pathological gambling in Hong Kong. Am J Psychiatry. 2003;160:1353–4.

    Article  PubMed  Google Scholar 

  13. Park S, Cho MJ, Jeon HJ, et al. Prevalence, clinical correlations, comorbidities, and suicidal tendencies in pathological Korean gamblers: results from the Korean Epidemiologic Catchment Area Study. Soc Psychiatry Psychiatr Epidemiol. 2010;45:621–9.

    Article  PubMed  Google Scholar 

  14. Abbott MW, Volberg RA, Ronnberg S. Comparing the New Zealand and Swedish National Surveys of gambling and problem gambling. J Gambl Stud. 2004;20:237–58.

    Article  PubMed  Google Scholar 

  15. Lesieur HR, Klein R. Pathological gambling among high school students. Addict Behav. 1987;12:129–35.

    Article  CAS  PubMed  Google Scholar 

  16. Westphal JR, Rush J. Pathological gambling in Louisiana: an epidemiologic perspective. J La State Med Soc. 1996;148:353–8.

    CAS  PubMed  Google Scholar 

  17. Blanco C, Hasin DS, Petry N, Stinson FS, Grant BF. Sex differences in subclinical and DSM-IV pathological gambling: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Psychol Med. 2006;36:943–53.

    Article  PubMed  Google Scholar 

  18. Zimmerman M, Chelminski I, Young D. Prevalence and diagnostic correlates of DSM-IV pathological gambling in psychiatric outpatients. J Gambl Stud. 2006;22:255–62.

    Article  PubMed  Google Scholar 

  19. Tavares H, Zilberman ML, Beites FJ, Gentil V. Gender differences in gambling progression. J Gambl Stud. 2001;17:151–9.

    Article  CAS  PubMed  Google Scholar 

  20. Black DW, Monahan P, Temkit M, Shaw M. A family study of pathological gambling. Psychiatry Res. 2006;141:295–303.

    Article  PubMed  Google Scholar 

  21. Black DW, Arndt S, Coryell WH, et al. Bupropion in the treatment of pathological gambling: a randomized, placebo-controlled, flexible-dose study. J Clin Psychopharmacol. 2007;27:143–50.

    Article  CAS  PubMed  Google Scholar 

  22. Black DW, Shaw M, Forbush KT, Allen J. An open-label study of escitalopram in the treatment of pathological gambling. Clin Neuropharmacol. 2007;30:206–12.

    PubMed  Google Scholar 

  23. Grant JE, Kim SW. Demographic and clinical features of 131 adult pathological gamblers. J Clin Psychiatry. 2001;62:957–62.

    Article  CAS  PubMed  Google Scholar 

  24. Grant JE, Potenza MN, Hollander E, et al. Multi-center investigation of the opioid antagonist nalmefene in the treatment of pathological gambling. Am J Psychiatry. 2006;163:303–12.

    Article  PubMed  Google Scholar 

  25. Bland RC, Newman SC, Orn H, Stebelsky G. Epidemiology of pathological gambling in Edmonton. Can J Psychiatr. 1993;38:108–12.

    Article  CAS  Google Scholar 

  26. Black DW, Coryell WH, Crowe RR, et al. Age at onset of DSM-IV pathological gambling in a non-treatment sample: early- versus later-onset. Compr Psychiatry. 2015;60:40–6.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Custer RL. Profile of the pathological gambler. J Clin Psychiatry. 1984;45:35–8.

    CAS  PubMed  Google Scholar 

  28. Lesieur HR, Rosenthal RJ. Pathological gambling: a review of the literature. J Gambl Stud. 1991;7:5–39.

    Article  CAS  PubMed  Google Scholar 

  29. LaPlante DA, Nelson SE, LaBrie RA, Shaffer HJ. Stability and progression of disordered gambling: lessons from longitudinal studies. Can J Psychiatry. 2008;53:52–60.

    Article  PubMed  Google Scholar 

  30. Abbott MW, Williams MM, Volberg RA. A prospective study of problem and regular non-problem gamblers living in the community. Subst Use Misuse. 2004;39:855–84.

    Article  PubMed  Google Scholar 

  31. DeFuentes-Merillas L, Koeter MW, Schippers GM, van den Brink W. Temporal stability of pathological scratchcard gambling among adult scratchcard buyers two years later. Addiction. 2004;99:117–27.

    Article  PubMed  Google Scholar 

  32. Shaffer HJ, Hall MN. The natural history of gambling and drinking problems among casino workers. J Soc Psychol. 2002;142:405–24.

    Article  PubMed  Google Scholar 

  33. Slutske W, Jackson KM, Sher KJ. The natural history of problem gambling from age 18 to 29. J Abnorm Psychol. 2003;112:263–74.

    Article  PubMed  Google Scholar 

  34. Winters KC, Stinchfield RD, Botzet A, Anderon N. A prospective study of youth gambling behaviors. Psychol Addict Behav. 2002;16:3–9.

    Article  PubMed  Google Scholar 

  35. Russo AM, Taber JI, McCormick RA, Ramirez LF. An outcome study of an inpatient program for pathological gamblers. Hosp Community Psychiatry. 1984;35:823–7.

    CAS  PubMed  Google Scholar 

  36. Taber JI, McCormick RA, Russo AM, et al. Follow-up of pathological gamblers after treatment. Am J Psychiatry. 1987;144:757–61.

    Article  CAS  PubMed  Google Scholar 

  37. Westermeyer J, Canive J, Thuras P, et al. Remission from pathological gambling among Hispanics and Native Americans. Community Ment Health J. 2006;42:537–52.

    Article  PubMed  Google Scholar 

  38. Goudriaan AE, Oosterlaan J, de Beurs E, van den Brink W. The role of self-reported impulsivity and reward sensitivity versus neurocognitive measures of disinhibition and decision-making in the prediction of relapse in pathological gamblers. Psychol Med. 2008;38:41–50.

    Article  CAS  PubMed  Google Scholar 

  39. Hodgins DC, Peden N. Natural course of gambling disorders: forty month follow-up. J Gambl Iss. 2005;14:1–15.

    Google Scholar 

  40. Oei TPS, Gordon LM. Psychosocial factors related to gambling abstinence and relapse in members of Gamblers Anonymous. J Gambl Stud. 2008;24:91–105.

    Article  PubMed  Google Scholar 

  41. Slutske W. Natural recovery and treatment-seeking in pathological gambling: results of two national surveys. Am J Psychiatry. 2006;163:297–302.

    Article  PubMed  Google Scholar 

  42. Sartor CE, Scherrer JF, Shah KR, et al. Course of pathological gambling symptoms and reliability of the Lifetime Gambling History measure. Psychiatry Res. 2007;152:55–61.

    Article  PubMed  Google Scholar 

  43. Black DW, Coryell W, McCormick B, Shaw M, Allen J. A prospective follow-up study of younger and older subjects with pathological gambling. Psychiatry Res. 2017;256:162–8.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Blaszczynski A, Farrell E. A case series of 44 completed gambling-related suicides. J Gambl Stud. 1998;14:93–109.

    Article  PubMed  Google Scholar 

  45. Petry NM, Kiluk BD. Suicidal ideation and suicide attempts in treatment-seeking pathological gamblers. J Nerv Ment Dis. 2002;190:462–9.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Kausch O. Suicide attempts among veterans seeking treatment for pathological gambling. J Clin Psychiatry. 2003;64:1031–8.

    Article  PubMed  Google Scholar 

  47. Ledgerwood DM, Petry NM. Gambling and suicidality in treatment-seeking pathological gamblers. J Nerv Ment Dis. 2004;192:711–4.

    Article  PubMed  Google Scholar 

  48. Battersby M, Tolchard B, Scurrah M, Thomas L. Suicide ideation and behavior in people with pathological gambling attending a treatment service. Int J Ment Health Addict. 2006;4:233–46.

    Article  Google Scholar 

  49. Black DW, Coryell WH, Crowe RR, et al. Suicide ideation, suicide attempts, and completed suicide in persons with DSM-IV pathological gambling and their first-degree relatives. Suicide Life Threat Behav. 2015;45:700–9.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Alegria AA, Petry NM, Hasin DS, et al. Disordered gambling among racial and ethnic groups in the US: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. CNS Spectr. 2009;14:132–42.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. Argo T, Black DW. The characteristics of pathological gambling. In: Grant J, Potenza M, editors. Understanding and treating pathological gambling. Washington, DC: American Psychiatric Publishing Inc.; 2004. p. 39–53.

    Google Scholar 

  52. Crockford ND, el-Guebaly N. Psychiatric comorbidity in pathological gambling: a critical review. Am J Psychiatry. 1999;43:43–50.

    Google Scholar 

  53. McCormick RA, Russo AM, Ramirez LF, Taber JI. Affective disorders among pathological gamblers seeking treatment. Am J Psychiatry. 1984;141:215–8.

    Article  CAS  PubMed  Google Scholar 

  54. Linden RD, Pope HG Jr, Jonas JM. Pathological gambling and major affective disorder: preliminary findings. J Clin Psychiatry. 1986;47:201–3.

    CAS  PubMed  Google Scholar 

  55. Specker SM, Carlson GA, Christenson GA, Marcotte M. Impulse control disorders and attention deficit disorder in pathological gamblers. Ann Clin Psychiatry. 1995;7:175–9.

    Article  CAS  PubMed  Google Scholar 

  56. Specker SM, Carlson GA, Edmonson KM, et al. Psychopathology in pathological gamblers seeking treatment. J Gambl Stud. 1996;12:67–81.

    Article  CAS  PubMed  Google Scholar 

  57. Black DW, Moyer T. Clinical features and psychiatric comorbidity of subjects with pathological gambling behavior. Psychiatr Serv. 1998;49:1434–9.

    Article  CAS  PubMed  Google Scholar 

  58. Cunningham-Williams RM, Cottler LB, Compton WM III, Spitznagel EL. Taking chances: problem gamblers and mental health disorders – results from the St. Louis epidemiologic catchment area study. Am J Public Health. 1998;88:1093–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  59. Hollander E, DeCaria CM, Mari E, et al. Short-term single-blind fluvoxamine treatment of pathological gambling. Am J Psychiatry. 1998;155:1781–3.

    Article  CAS  PubMed  Google Scholar 

  60. Hollander E, DeCaria CM, Finkell JN, et al. A randomized double-blind fluvoxamine/placebo crossover trial in pathologic gambling. Biol Psychiatry. 2000;47:813–7.

    Article  CAS  PubMed  Google Scholar 

  61. Zimmerman M, Breen RB, Posternak MA. An open-label study of citalopram in the treatment of pathological gambling. J Clin Psychiatry. 2002;63:44–8.

    Article  CAS  PubMed  Google Scholar 

  62. Black DW, Coryell WC, Crowe RR, et al. A direct, controlled, blind family study of pathological gambling. J Clin Psychiatry. 2014;75:215–21.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Blaszczynski A, Mcconaghy N, Frankova A. Crime, antisocial personality, and pathological gambling. J Gambl Behav. 1989;5:137–52.

    Article  Google Scholar 

  64. Lesieur HR, Blume SB. Evaluation of patients treated for pathological gambling in a combined alcohol, substance abuse and pathological gambling treatment unit using addiction severity index. Br J Addict. 1991;86:1017–28.

    Article  CAS  PubMed  Google Scholar 

  65. Bellaire W, Caspari D. Diagnosis and therapy of male gamblers in a university psychiatric hospital. J Gambl Stud. 1992;8:143–50.

    Article  CAS  PubMed  Google Scholar 

  66. Blaszczynski A, Steel Z. Personality disorders among pathological gamblers. J Gambl Stud. 1998;14:51–70.

    Article  PubMed  Google Scholar 

  67. Fernandez-Montalvo J, Echeburua E. Pathological gambling and personality disorder: an exploratory study with the IPDE. J Pers Disord. 2004;18:500–5.

    Article  PubMed  Google Scholar 

  68. Bagby RM, Vachon DD, Bulmash E, et al. Personality disorders and pathological gambling: a review and re-examination of prevalence rates. J Pers Disord. 2008;22:191–207.

    Article  PubMed  Google Scholar 

  69. Pelletier O, Ladouceur R, Rheaume J: Personality disorders and pathological gambling: comorbidity and treatment dropout predictors. Int Gambl Stud. 2008;8:299–313.

    Google Scholar 

  70. Odlaug BL, Schreiber LRN, Grant JE. Personality disorder and dimensions in pathological gambling. J Pers Disord. 2012;26:381–92.

    Article  PubMed  Google Scholar 

  71. Black DW, Coryell WH, Crowe RR, et al. Personality disorders, impulsiveness, and novelty seeking in persons with DSM-IV pathological gambling and their first-degree relatives. J Gambl Stud. 2015;31:1201–14.

    Article  PubMed  Google Scholar 

  72. Smart RG, Ferris J. Alcohol, drugs and gambling in the Ontario adult population. Can J Psychiatry. 1994;41:36–45.

    Article  Google Scholar 

  73. Lesieur HR, Blume SB, Zoppa RM. Alcoholism, drug abuse, and gambling. Alcohol Clin Exp Res. 1986;10:33–8.

    Article  CAS  PubMed  Google Scholar 

  74. Rosenthal RJ. Pathological gambling. Psychiatric Ann. 1992;22:72–8.

    Article  Google Scholar 

  75. Spunt B, Dupont I, Lesieur H, et al. Pathological gambling and substance misuse: a review of the literature. Subst Use Misuse. 1998;33:2535–60.

    Article  CAS  PubMed  Google Scholar 

  76. Ladd GT, Petry NM. A comparison of pathological gamblers with and without substance abuse treatment histories. Exp Clin Psychopharmacol. 2003;11:202–9.

    Article  PubMed  Google Scholar 

  77. Stinchfield RD, Winters KC. Outcome of Minnesota’s gambling treatment programs. J Gambl Stud. 2001;17:217–45.

    Article  CAS  PubMed  Google Scholar 

  78. Ibanez A, de Castro IP, Fernandez-Piqueres J, et al. Pathological gambling and DNA polymorphic markers at MAO-A and MAO-B genes. Mol Psychiatry. 2001;5:105–9.

    Article  Google Scholar 

  79. Blaszczynski A. Pathological gambling and obsessive compulsive spectrum disorders. Psychol Rep. 1999;84:107–13.

    Article  CAS  PubMed  Google Scholar 

  80. Hollander E, editor. Obsessive-compulsive related disorders. Washington, DC: American Psychiatric Press; 2003.

    Google Scholar 

  81. Bienvenu OJ, Samuels JF, Riddle MA, et al. The relationship of obsessive-compulsive disorder to possible spectrum disorders – results from a family study. Biol Psychiatry. 2000;48:387–93.

    Article  Google Scholar 

  82. Black DW, Stumpf A, McCormick B, et al. A blind re-analysis of the Iowa family study of obsessive-compulsive disorder. Psychiatry Res. 2013;209:202–6.

    Article  PubMed  Google Scholar 

  83. Goldstein L, Manowitz P, Nora R, et al. Differential EEG activation and pathological gambling. Biol Psychiatry. 1985;20:1232–4.

    Article  CAS  PubMed  Google Scholar 

  84. Carlton PL, Manowitz P. Behavioral restraint and symptoms of attention deficit disorder in alcoholics and pathological gamblers. Neuropsychobiology. 1992;25:44–8.

    Article  CAS  PubMed  Google Scholar 

  85. Rugle L, Melamed L. Neuropsychological assessment of attention problems in pathological gamblers. J Nerv Ment Dis. 1993;181:107–12.

    Article  CAS  PubMed  Google Scholar 

  86. Black DW, Smith M, Forbush K, et al. Neuropsychological performance, impulsivity, symptoms of ADHD, and Cloninger’s personality traits, in pathological gambling. Addict Res Ther. 2013;21:216–26.

    Article  Google Scholar 

  87. Achenbach TM. The Achenbach behavior checklist. Burlington, VT: University of Vermont; 1991.

    Google Scholar 

  88. Castellani B, Rugle L. A comparison of pathological gamblers to alcoholics and cocaine misusers on impulsivity, sensation-seeking, and craving. Int J Addict. 1995;30:275–89.

    Article  CAS  PubMed  Google Scholar 

  89. DeCaria C, Hollander E, Grossman R, et al. Diagnosis, neurobiology, and treatment of pathological gambling. J Clin Psychiatry. 1996;57(Suppl 8):80–4.

    PubMed  Google Scholar 

  90. Barratt EE. Anxiety and impulsiveness related to psychomotor efficiency. Percept Mot Skills. 1959;9:191–8.

    Article  Google Scholar 

  91. Grant JE, Kim SW. Comorbidity of impulse control disorders in pathological gamblers. Acta Psychiatr Scand. 2003;108:203–7.

    Article  CAS  PubMed  Google Scholar 

  92. Black DW, Coryell WH, Crowe RR, et al. The relationship of DSM-IV pathological gambling to compulsive buying and other possible spectrum disorders: results from the Iowa PG family study. Psychiatry Res. 2015;226:273–6.

    Article  PubMed  PubMed Central  Google Scholar 

  93. Vaddiparti K, Cottler LB. Personality disorders and pathological gambling. Curr Opin Psychiatry. 2017;30:45–9.

    Article  PubMed  PubMed Central  Google Scholar 

  94. Brown RIF. Pathological gambling and associated patterns of crime: a comparison with alcohol and other drug addictions. J Gambl Behav. 1987;3:98–114.

    Article  Google Scholar 

  95. Slutske WS, True WR, Goldberg J, et al. A twin study of the association between pathological gambling and antisocial personality disorder. J Abnorm Psychol. 2001;110:297–308.

    Article  CAS  PubMed  Google Scholar 

  96. Pietrzak RH, Petry NM. Antisocial personality disorder is associated with increased severity of gambling, medical, drug, and psychiatric problems among treatment-seeking pathological gamblers. Addiction. 2005;100:1183–93.

    Article  PubMed  Google Scholar 

  97. Moran E. Varieties of pathological gambling. Br J Psychiatry. 1970;116:593–7.

    Article  CAS  PubMed  Google Scholar 

  98. Steel Z, Blaszczynski A. The factorial structure of pathological gambling. J Gambl Stud. 1996;12:3–20.

    Article  CAS  PubMed  Google Scholar 

  99. Blaszczynski A, McConaghy N. Anxiety and/or depression in the pathogenesis of addictive gambling. Int J Addict. 1989;24:337–50.

    Article  CAS  PubMed  Google Scholar 

  100. Blaszczynski A, Nower L. Pathways model of problem and pathological gambling. Addiction. 2002;97:487–99.

    Article  PubMed  Google Scholar 

  101. Ledgerwood D, Petry NM. Pathological experience of gambling and subtypes of pathological gamblers. Psychiatry Res. 2006;144:17–27.

    Article  PubMed  Google Scholar 

  102. Nower L, Martins SS, Lin KH, Blanco C. Subtypes of disordered gamblers: results from the National Epidemiologic Survey of Alcohol and Related Conditions. Addiction. 2012;108:789–98.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Donald W. Black .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Black, D.W., Shaw, M. (2019). The Epidemiology of Gambling Disorder. In: Heinz, A., Romanczuk-Seiferth, N., Potenza, M. (eds) Gambling Disorder. Springer, Cham. https://doi.org/10.1007/978-3-030-03060-5_3

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-03060-5_3

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-03058-2

  • Online ISBN: 978-3-030-03060-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics