Problem gambling and homelessness: results from an epidemiologic study

Homeless people: a review of personality disorders

Personality disorders in homeless people pose a challenge to the medical community and society, requiring specialized approaches for these super-difficult patients. The prevalence of personality disorders is higher in homeless populations than in the general population. However, there is a knowledge gap regarding personality disorders among people experiencing homelessness, and the implications of this lack of recognition are substantial. This paper provides a brief narrative review of personality disorders among homeless individuals. The primary importance and specificity of these disorders in this population remain unexplored. We searched PubMed and Web of Science databases in February and November 2023 using the keywords 'homeless' and 'personality disorder', and selected fifty-eight studies to be included in this literature review. The main themes of the results were personality disorders in homeless individuals and comorbid psychiatric disorders; risk factors and other psychological and behavioral data; clinical and intervention outcomes; and challenges linked to assessment, treatment, and intervention. The homeless population experiences significant diagnostic variability and the diagnosis of personality disorders is still evolving, contributing to difficulties in diagnosis, assessment, and treatment. A future challenge is to raise clinical awareness and optimize research knowledge, assessment, and intervention in personality disorders among homeless individuals with comorbid psychiatric disorders.

Disordered gambling among people with psychotic disorders: a systematic review

Disorders of gambling are more common among the mentally ill, including in people with psychotic disorders. The aim of this study was to conduct a systematic review of the literature regarding the prevalence and correlates of gambling disorders in people with psychotic disorders. We systematically reviewed English-language literature through searches of six bibliographic databases, all run on 11 November 2022: Medline ALL, Embase, Emcare, APA PsycINFO, CINAHL and the Cochrane Library. Observational studies that reported the prevalence of gambling in psychotic disorders or psychosis among gamblers were included. Studies were critically appraised using the Joanna Briggs Institute Critical Appraisal Tools. Sixteen studies, including 1,116,103 participants, from across a range of settings, were included. Most studies were done on males and recruited participants with a mean age of 40 years. Most of the studies (n = 12) were cross-sectional, and the remaining were case control in design. Most of the studies rated fair in quality. The prevalence of gambling among psychotic population ranged from 0.32 to 19.3%, with the majority of the studies reporting rates between 6.4 and 17%. The rates were 5-25 times higher than in the general population. While there were no consistent associations found with socio-demographic indices, several studies reported an association between gambling behaviours and substance use disorder among those with psychotic illnesses. Our research suggests that clinicians should assess for comorbid gambling among those with psychotic illness, particularly in those with mood symptoms, impulsivity, and substance use disorders. Gambling can negatively impact on their financial and social situations. Future research should study specific strategies or therapies among those with comorbid gambling and psychotic disorders.

Prevalence and Clinical Characteristics of Recreational and At-Risk/Problematic Gambling Among Low-Income U.S. Veterans: Results from the National Veteran Homeless and Other Poverty Experiences (NV-HOPE) Study

This study examined associations between recreational gambling (RG) and at-risk/problem gambling (ARPG), and clinical measures of mental illness and substance use, functionality, homelessness, in a nationally representative sample of U.S. military veterans. Data were analyzed from 781 veterans who participated National Veteran Homeless and Other Poverty Experiences (NV-HOPE) study conducted in 2021. Chi-square tests, analyses of variance (ANOVAs) and logistic regressions analyses were conducted to examine unadjusted and adjusted associations between gambling group status and sociodemographic, psychiatric, substance use, functioning, and homelessness measures. A significant minority of low-income U.S. veterans reported gambling, with 24.9% (95% confidence interval [CI] 95% CI 21.12-28.76%) exhibiting RG and 6.7% (95% CI 3.88-9.42%) screening positive for ARPG. The prevalence of ARPG was higher among younger, non-White veterans. ARPG was associated with greater symptoms of substance use and anxiety; poorer physical functioning; history of any mental illness; lifetime history of homelessness; and having any student or car loans relative to NG. Veterans who had RG were more likely to screen positive for drug use disorders relative to NG. Results of the current study provide an up-to-date estimate of the current prevalence of RG and ARPG among low-income U.S. veterans and underscore the importance of routine screening, monitoring, and development of interventions for problematic gambling severity, as well as interventions for ARPG in this population. These findings may inform targeted intervention strategies for this vulnerable subpopulation.

Prevalence of gambling disorder and its correlates among homeless men in Osaka city, Japan

Internationally, the prevalence of gambling disorder has been reported to be higher among homeless people than the general population; however, little is known about the factors associated with gambling disorder in this population. The present study aimed to investigate the prevalence of gambling disorder and its associated factors among homeless men using shelters in Osaka City. A cross-sectional survey was conducted from 30 to 2018 to 4 January 2019, using the 2017 Japanese National Survey of Gambling (JNSG) questionnaire, supplemented with questions about homeless experiences, drinking, and smoking. Using the South Oaks Gambling Screen, the presence of gambling disorder was determined by a score ≥ 5 out of 20. Multivariate logistic regression was conducted to explore factors associated with lifetime gambling disorder. Lifetime and past-year prevalence of gambling disorder among 103 participants was 43.7% (95% confidence interval [CI]: 34.5-53.3) and 3.9% (95% CI: 1.5-9.6), respectively, which are higher than the 6.7% and 1.5% found among men in the 2017 JNSG. Reasons reported for currently gambling less were primarily financial. Factors associated with lifetime GD included "more than 20 years since the first incidence of homelessness" (adjusted odds ratio [AOR]: 4.97, 95% CI: 1.50-16.45) and "more than five incidences of homelessness" (AOR: 4.51, 95% CI: 1.06-19.26). When homeless individuals with gambling disorder try to rebuild and stabilize their lives, the presence or resurgence of gambling disorder may hinder the process and pose a risk of recurring homelessness. Comprehensive support services for homeless individuals with gambling disorder are required. (250 words).

Personality and attachment in the homeless: A systematic review

BACKGROUND

Homeless people present high rates of psychopathology, including personality disorders. Given the link between personality disorders and attachment, and the potential importance of these two traits for understanding homeless populations.

AIMS

Our aim was to review all studies focusing on attachment and on the full assessment of personality disorders in the homeless.

METHOD

Overall, 213 studies were screened through title and abstract. Of these, 63 articles were chosen for full-text assessment.

RESULTS

A total of 14 articles met eligibility criteria and were included in the present review. Six studies evaluated personality disorders and eight studies assessed attachment in the homeless. In general, reports suggested that personality disorders are highly common in the homeless, with frequencies ranging between 64% and 79% for any personality disorder. The most common personality diagnoses were paranoid (14%-74%), borderline (6%-62%), avoidant (14%-63%), and antisocial (4%-57%) personality disorders. Attachment reports differed in the methods used and presented diverse results and correlates. Even so, insecure types of attachment dominated in the homeless, accounting for 62% to 100% of the samples.

CONCLUSIONS

The high prevalence of personality disorders and insecure types of attachment in the homeless may impact intervention strategies for these people. The available literature evaluating attachment and the full assessment of personality disorders in the homeless is scarce, which supports the need for more research on these two topics.

Prevalence and Clinical Characteristics of Recreational and At-Risk/Problematic Gambling in a National Sample of U.S. Military Veterans

Gambling among U.S. military veterans is common, with more extensive involvement linked to gambling disorder and associated problems. This study examined associations between recreational gambling (RG) and at-risk/problem gambling (ARPG), and clinical measures (psychiatric disorders, substance use), behaviors (suicidality, homelessness, arrests) and functioning in a nationally representative sample of U.S. military veterans. Data were analyzed from 4069 veterans who participated in the National Health and Resilience in Veterans Study. Chi-square tests, analyses of variance (ANOVAs) and logistic regressions were conducted to examine unadjusted and adjusted associations between gambling group status and lifetime and current psychiatric diagnoses and behavioral and functioning measures. A significant minority of U.S. veterans reported gambling, with 27.3% (95% confidence interval [CI] 25.5-29.1%) exhibiting RG and 4.9% (95% CI 4.0-5.9%) screening positive for ARPG. The prevalence of ARPG was higher among younger, non-White, male veterans, while RG was more prevalent among retired veterans and those with higher household incomes relative to non-gambling (NG) individuals. ARPG was associated with greater trauma burden, lifetime and current psychiatric diagnoses, mental health treatment, alcohol and drug use disorders, suicidal ideation, homelessness, arrests, and poorer functioning relative to NG and RG, with stronger magnitude differences relative to NG. RG was associated with substance use disorders and arrest histories relative to NG. Results of the current study provide an up-to-date estimate of the current prevalence of RG and ARPG among U.S. veterans and underscore the importance of routine screening and monitoring of gambling problems, as well as interventions for ARPG in this population.

Chronically homeless veterans with gambling disorder: Epidemiology, clinical correlates, and traumatic experiences

BACKGROUND

Gambling disorder (GD) is often a concern for people living in poverty. Although GD has been correlated with homelessness, there has been no study of factors related to chronic homelessness among veterans with GD.

METHOD

This study used data from specialized homeless programs from the U.S. Department of Veterans Affairs Homeless Operations Management System to explore prevalence and correlates of chronic homelessness among veterans with GD in this program and to describe initial descriptive epidemiology. Chi-square tests, analyses of variance, and logistic regressions were conducted to examine differences in sociodemographic, military, clinical, and behavioral characteristics between veterans with versus without chronic homelessness.

RESULT

Of 6053 veterans with GD, 1733 (28.6%) had chronic homelessness. Veterans with versus without chronic homelessness were more likely to be older, male, unemployed, and of low educational attainment and report having spent fewer years in the military. Chronic homelessness was associated with elevated odds of mental health and medical diagnoses, traumatic experiences, incarceration, and suicidal thoughts. Veterans with versus without chronic homelessness more frequently reported needing substance use, medical and psychiatric treatments but expressed low interest in participation in psychiatric treatment.

CONCLUSION

Veterans with GD and chronic homelessness have more clinical and behavioral concerns and needs for treatment, but participate in treatment at lower rates. It may be important to address both chronic homelessness and GD concurrently in order to effectively support veterans facing these challenges.

Exploring the Gaps in Programming for Men and Women with a Gambling Disorder in the Correctional System in Canada

The prevalence of problem gambling in the correctional system is about 10 times higher than in the general population, but programming for gambling problems in the correctional system is scarce. Examined barriers to treatment for problem gamblers in the correctional system, sex or gender differences, and options for program design. We conducted interviews with 16 experts who had worked with problem gamblers in the correctional system and analyzed the data in terms of themes. For barriers, the experts discussed a lack of awareness about problem gambling, as well as stigmatization and lockdowns. Experts described the content of current programs as equally applicable to both men and women, but that emotional components were more important for women. Finally, the experts had mixed views on whether programming should be integrated with other programs such as substance abuse. Programming implications for this population are discussed.

The Prevalence of Problem Gambling and Gambling Disorder Among Homeless People: A Systematic Review And Meta-Analysis

Gambling problems are often associated with homelessness and linked to elevated psychiatric morbidity and homelessness chronicity. We performed a systematic review and meta-analysis on prevalence rates of problem gambling (PG) and gambling disorder (GD) in homeless people. Following PRISMA guidelines, we searched databases Medline, Embase and PsycINFO from inception of databases to 4th may 2021. We included studies reporting prevalence estimates on clinical gambling problems in representative samples of homeless people based on standardized diagnostics. Risk of bias was assessed. A random effects meta-analysis was performed, and subgroup analyses based on methodological characteristics of primary studies were conducted. We identified eight studies from five countries, reporting information on 1938 participants. Prevalence rates of clinically significant PG and GD ranged from 11.3 to 31.3%. There was evidence for substantial heterogeneity with I2 = 86% (95% CI 63–97%). A subgroup of four low risk of bias studies displayed a significantly lower results ranging from 11.3 to 23.6%. Additionally, high rates of subclinical problem gambling were reported (11.6–56.4%). At least one in ten homeless persons experiences clinically significant PG or GD. Social support and health care services for the homeless should address this problem by implementing models for early detection and treatment.

Gambling and homelessness in older adults: a qualitative investigation

BACKGROUND AND AIMS

Homelessness is one of the most significant harms associated with gambling and appears to affect older adults disproportionately, but the relationship has received little research attention. This exploratory study investigated how gambling and homelessness is linked in older adults.

METHODS

Using qualitative research methods, we undertook in-depth semi structured face-to-face individual and group interviews to gather data from a purposive sample (n = 48) of key informants working in service provision for older adults (aged 50+ years) experiencing gambling-related harm and/or homelessness in Victoria, Australia. Thematic analysis of data focused on evaluating mechanisms and identifying contextual conditions that activate pathways between gambling and homelessness.

RESULTS

The relationship between gambling and homelessness in older adults is often indirect and non-linear, and can represent a reflexive cycle. Experiencing periods of homelessness into older age can contribute to gambling, often because the adverse impacts of homelessness on older adults' mental and material wellbeing increase the appeal of gambling. Additionally, comorbidities (e.g. substance use, mental illness, past trauma) and structural conditions (e.g. gambling accessibility, poverty, housing insecurity) can activate gambling. Furthermore, because gambling in the older homeless adult population is frequently hidden and regularly overlooked by service providers, it often continues unabated. Gambling in older adults can also contribute to the onset of first-time homelessness. Large and rapid losses from high-intensity gambling frequently characterize this route to homelessness. Such gambling is often triggered by major life events and changes (e.g. bereavement, job loss, relationship difficulties), and the outcomes are often worsened by the conduct of gambling operators and creditors.

CONCLUSIONS

The link between gambling and homelessness in older adults is complex, with connecting mechanisms often contingent upon individual, interpersonal and structural conditions and contexts. There is potential for preventative and ameliorative action given many of the underlying conditions appear modifiable through policy intervention.

Filling the GAP: Integrating a gambling addiction program into a shelter setting for people experiencing poverty and homelessness

The burden of harm from problem gambling weighs heavily on those experiencing poverty and homelessness, yet most problem gambling prevention and treatment services are not designed to address the complex needs and challenges of this population. To redress this service gap, a multi-service agency within a shelter setting in a large urban centre developed and implemented a population-tailored, person-centred, evidence-informed gambling addiction program for its clients. The purpose of this article is to report on qualitative findings from an early evaluation of the program, the first designed to address problem gambling for people experiencing poverty and/or homelessness and delivered within a shelter service agency. Three themes emerged which were related to three program outcome categories. These included increasing awareness of gambling harms and reducing gambling behaviour; reorienting relationships with money; and, seeking, securing, and stabilizing shelter. The data suggest that problem gambling treatment within the context of poverty and homelessness benefits from an approach and setting that meets the unique needs of this community. The introduction of gambling treatment into this multi-service delivery model addressed the complex needs of the service users through integrated and person-centered approaches to care that responded to client needs, fostered therapeutic relationships, reduced experiences of discrimination and stigma, and enhanced recovery. In developing the Gambling Addiction Program, the agency drew on evidence-based approaches to problem gambling treatment and extensive experience working with the target population. Within a short timeframe, the program supported participants in the process of recovery, enhancing their understanding and control of their gambling selves, behaviours, and harms. This project demonstrates that gambling within the context of poverty requires a unique treatment space and approach.

Racial Associations Between Gambling and Suicidal Behaviors Among Black and White Adolescents and Young Adults

Purpose of Review

Suicide is the second leading cause of death among Black youth ages 10-19 years. Between 1991 and 2017, rates of suicide among Black youth have been increasing faster than rates among any other race/ethnic group. There are many factors that may explain this increase, with gambling being suggested as one such potential risk factor. This review examines the association between gambling and suicide behaviors, and how these associations may vary between Black and White youth and young adults. The current review examines these associations using data from the Missouri Family Study (MOFAM).

Recent Findings

Recent findings have revealed distinct patterns of substance use initiation and gambling behaviors between Black youth and White youth. While strong links between gambling and suicide behaviors have also been reported, whether the associations were consistent across race/ethnicity groups was not investigated, nor in these cross-sectional analyses was it possible to determine whether the gambling behaviors preceded or followed suicidality. Thus, there is a need to investigate whether there are differences in the associations of gambling and suicide behaviors at the race/ethnicity level in tandem with data that examine the sequence of the behaviors. The current report focuses on racial/ethnic differences using data that allow for sequencing the occurrence of the behaviors via the age of first gambling experience, and of first suicidal symptom, to better distinguish the nature of the association.

Summary

The current findings revealed that gambling initiation predicted suicide ideation among Black youth, while no significant association was found among White youth. This is of major public health concern, given the rising rates of suicide among Black youth, and the increased availability of gambling. The report did not find a link between gambling and suicide attempts. Culturally tailored interventions should be considered among schools, families, and clinicians/providers, to highlight the risk of adolescent gambling, particularly among Black youth.

Gambling and homelessness: A systematic review and meta-analysis of prevalence

INTRODUCTION

There is growing concern internationally about co-occurring gambling and homelessness. We systematically review prevalence estimates in help-seeking and community samples.

METHODS

Adopting PRISMA guidelines, we searched CINAHL Plus, Cochrane Library, Embase, Ovid MEDLINE, PsychINFO, Proquest Central, PubMed, Scopus, Web of Science, and Google Scholar for relevant peer-reviewed articles in English. Primary outcomes examined in narrative and quantitative syntheses included prevalence of: (i) gambling in persons experiencing homelessness; (ii) harmful gambling in persons experiencing homelessness; and, (iii) homelessness in persons experiencing harmful gambling.

RESULTS

Searches identified 917 records after removing duplicates. After screening, 45 articles providing 54 prevalence estimates across 12 countries were included, with help-seeking (k = 37) and community based sample (k = 8) estimates pooled separately. Gambling prevalence (all timeframes) in help-seeking samples of persons experiencing homelessness is low (28.7%, 95% CI: 17.3-41.7, k = 14) compared to the general population (approximately 60-80%). However, harmful gambling prevalence (including problem, pathological, and disordered gambling) in help-seeking samples of persons experiencing homelessness is high (16.5%, 95% CI: 10.2-24.2, k = 20) compared to the general population (approximately 1-7%). Additionally, homelessness prevalence is high in help-seeking samples of persons experiencing harmful gambling (23.6%, 95% CI: 18.4-29.2, k = 4) compared to the general population (<1%). Meta-analysis found high between-study heterogeneity and risk of bias from small samples sizes.

CONCLUSIONS

There are high rates of harmful gambling in persons experiencing homelessness and, concurrently, high rates of homelessness in persons experiencing harmful gambling. Improvements in sampling and measurement are needed to strengthen robustness and generalizability of prevalence estimates, which can potentially inform the scale and targeting of clinical interventions, support services, and policy responses.

Social disadvantage and gambling severity: a population-based study with register-linkage

Background

Studies have found an association between problem gambling and poverty. However, there is relatively little research on social inequalities and problem gambling using population representative data.

Methods

A population-representative self-report web-based and postal survey with register-based linkage was conducted in the three geographical areas of Finland. Participants (n = 7186, aged 18 or older) were randomly selected from the population register. Sociodemographic factors and social welfare benefits were studied among gambling groups and their statistical difference were examined by χ² test. Seven logistic regression models were calculated, where unemployment, social security benefits and low income were treated as dependent variables and where sex, age, family structure and education were controlled as covariates. The results were presented as odds ratios (OR) with 95% confidence intervals (CIs).

Results

Problem and at-risk gambling (ARG) was more common among people who were unemployed [PG: χ²=6.4 (1), P < 0.01, ARG: χ²=12.4 (1), P < 0.001] or had received social security benefits [PG: χ²=41.6 (1), P < 0.001, ARG: χ²=22.9 (1), P < 0.001]. The OR for problem gambling was high as 5.6 (CI: 3.22–9.61) among respondents who had received social assistance even when covariates were taking into count. Almost a third of those experiencing problem or at-risk gambling received at least one form of social security benefit.

Conclusions

The most important task of gambling policy should be reducing gambling-related harms and diminishing social inequality. However, even in government organized system where gambling profits are used for common good, profits come from the most socially disadvantaged people thereby exacerbating inequality.

Prevalence of Problem Gambling Among Women Using Shelter and Drop-in Services

People experiencing poverty/homelessness have higher rates of problematic gambling than the general population. Yet, research on gambling among this population is sparse, notably among women. This study examined prevalence of problematic gambling among women using shelter and drop-in services in Ontario, Canada. The NORC Diagnostic Screen for Disorders was administered to women during visits to 15 sites using time/location methodology. Within a sample of 162 women, the prevalence of at-risk (6.2%), problem (9.3%), and pathological gambling (19.1%) was higher than the general population. Among women who scored at-risk or higher, 55.4% met criteria for pathological gambling. The findings suggest that women seeking shelter and drop-in services are vulnerable to problematic gambling. Creating awareness of this vulnerability within the shelter and drop-in service sector is an important first step to support women with gambling problems who face financial and housing precarity.

Gambling Disorder and comorbid PTSD: A systematic review of empirical research

BACKGROUND AND AIMS

Gambling Disorder (GD) and Posttraumatic Stress Disorder (PTSD) are frequently comorbid and often associated with a more severe clinical profile compared to those with either diagnosis alone. Despite recent growing interest in this comorbidity, there has been little effort to synthesize this domain of research and define areas of need for future research.

DESIGN

The present work details a systematic review of empirical studies examining the relationship between PTSD and GD-related factors. This review encompassed 74 studies each examining the overlap between GD and the following domains: PTSD, Trauma, Adverse Childhood Experiences, and Stressful Life Events.

FINDINGS

The included studies yielded 91 independent samples each providing associations between the above-mentioned constructs. The present work found that stress, trauma, and symptom severity of PTSD each influence the severity of both GD and subclinical levels of GD. The severity, type, and time at which trauma occurs in the lifespan all appear to influence the predictive strength of trauma on GD severity. However, PTSD symptoms appear to have a greater impact on GD severity compared to trauma alone.

CONCLUSION

PTSD symptoms result in increased severity of GD, and pathological dissociation plays a particularly important role in exacerbating this relationship. Clinical and etiological implications, as well as direction for future research from these findings, are revealed and discussed.

Screening of problem gambling among a homeless population in Warsaw

Background:

While homelessness and problem gambling are both recognised as social and public health concerns and the prevalence of addictive disorders among homeless populations tends to be high. These questions have been studied predominantly independently.

Aim:

The aim of the study was to explore the co-occurrence of the two phenomena among the homeless population using shelters and night shelters in Warsaw, and, more specifically, to provide information about the forms and frequency of gambling in this homeless population.

Method:

Homeless persons (N = 690) were interviewed in rehabilitation-shelters (n = 17) and night-shelters (n = 2) in Warsaw from November 2015 until January 2016. The core component of the questionnaire was a screening test (Problem Gambling Severity Index). In addition, data regarding the intensity of gambling and various types of games or settings were collected.

Results:

The prevalence of problem gambling in this population of homeless people was 11.3%, whereas the prevalence of problem gambling in the general population in Poland is much lower (0.7%). Similarly to the general population, the most prevalent gambling games in the homeless population were lotteries; however, homeless people gambled in lotteries almost three times more often compared to the general population.

Conclusions:

This is the first study examining the prevalence of problem gambling in the homeless population in Poland. The findings of the study suggest that problem gambling among the homeless is a significant social and public health concern. High rates of problem gambling in the homeless population show the need to identify and monitor this problem in shelters and consequently to provide easier access to gambling treatment or prevention programmes.

What Can be Done to Reduce the Public Stigma of Gambling Disorder? Lessons from Other Stigmatised Conditions

Gambling is embedded in Australian cultural history, and perceived as a normal, legitimate leisure activity. Despite this normalisation, people who experience gambling problems are heavily stigmatised which can lead to a variety of harms that extend beyond the individual. The stigma from the general public appears to be based on a stereotype of a typical "problem gambler"-selfish, greedy, impulsive and irresponsible. However, research suggests that people experiencing gambling problems have widely varying characteristics and do not conform to this stereotype. Regardless of whether the stigma is justified, it is both present and problematic. Gamblers experiencing problems delay help-seeking due to feelings of shame and, not unwarranted, expectations of negative judgement because of the heavy stigma associated with the stereotype. As stigma is a primary barrier to treatment and a reason why gambling problems can take longer to acknowledge, it is important to understand and address how stigma can be reduced to minimise the negative consequences of gambling on individuals, their families and friends and the wider community. There is little research on reducing gambling-related stigma, so there is a need to examine strategies used in other stigmatised conditions, such as mental health, to understand the general principles of effective stigma reduction measures. Because gambling disorder is unique, well-hidden and consequently not well understood, there is a need to recognise that techniques used in other domains may differ in their effectiveness within the context of gambling stigma.

Problem gambling among homeless clinic attenders

OBJECTIVE

To examine the relationship between problem gambling and homelessness.

METHOD

A consecutive sample of attenders at psychiatric clinics at three inner-city homeless hostels over 8.5 years. The demographic characteristics, comorbid conditions, pathway and pattern of homelessness of those identified to have problem gambling were compared with those who did not report problem gambling.

RESULTS

A total of 2388 individuals were seen at the clinics in the 8 years of the study, of whom 289 (12.1%) reported problem gambling, mainly on poker machines. Those with problem gambling were more likely to be male, to have been married, employed for more than a year and to have a diagnosis of mood disorder. They were less likely to have a diagnosis of psychosis. However, the combination of psychosis and problem gambling was associated with the likelihood of having their financial affairs placed under the control of the Public Trustee.

CONCLUSIONS

The findings suggest that earlier attention to problem gambling might reduce the likelihood of becoming homeless, as well as the need for routine enquiry about gambling behaviour, measures to reduce gambling, including expert counselling, restrictions on the availability of addictive forms of gambling and assisting vulnerable individuals with money management.

Psychosocial risk factors in disordered gambling: A descriptive systematic overview of vulnerable populations

BACKGROUND

Gambling is a behaviour engaged in by millions of people worldwide; for some, gambling can become a severely maladaptive behaviour, and previous research has identified a wide range of psychosocial risk factors that can be considered important for the development and maintenance of disordered gambling. Although risk factors have been identified, the homogeneity of risk factors across specific groups thought to be vulnerable to disordered gambling is to date, unexplored.

METHODS

To address this, the current review sought to conduct a systematic overview of literature relating to seven vulnerable groups: young people and adolescents, older adults, women, veterans, indigenous peoples, prisoners, and low socio-economic/income groups.

RESULTS

Multiple risk factors associated with disordered gambling were identified; some appeared consistently across most groups, including being male, co-morbid mental and physical health conditions, substance use disorders, accessibility and availability of gambling, form and mode of gambling, and experience of trauma. Further risk factors were identified that were specific to each vulnerable group.

CONCLUSION

Within the general population, certain groups are more vulnerable to disordered gambling. Although some risk factors are consistent across groups, some risk factors appear to be group specific. It is clear that there is no homogenous pathway in to disordered gambling, and that social, developmental, environmental and demographic characteristics can all interact to influence an individual's relationship with gambling.

Are Video Games a Gateway to Gambling? A Longitudinal Study Based on a Representative Norwegian Sample

The scope and variety of video games and monetary gambling opportunities are expanding rapidly. In many ways, these forms of entertainment are converging on digital and online video games and gambling sites. However, little is known about the relationship between video gaming and gambling. The present study explored the possibility of a directional relationship between measures of problem gaming and problem gambling, while also controlling for the influence of sex and age. In contrast to most previous investigations which are based on cross-sectional designs and non-representative samples, the present study utilized a longitudinal design conducted over 2 years (2013, 2015) and comprising 4601 participants (males 47.2%, age range 16-74) drawn from a random sample from the general population. Video gaming and gambling were assessed using the Gaming Addiction Scale for Adolescents and the Canadian Problem Gambling Index, respectively. Using an autoregressive cross-lagged structural equation model, we found a positive relationship between scores on problematic gaming and later scores on problematic gambling, whereas we found no evidence of the reverse relationship. Hence, video gaming problems appear to be a gateway behavior to problematic gambling behavior. In future research, one should continue to monitor the possible reciprocal behavioral influences between gambling and video gaming.

Correlates of At-Risk and Problem Gambling Among Veterans in Massachusetts

Few studies have examined problem gambling among veterans and, of those studies, there are conflicting conclusions surrounding correlates of problem gambling in veterans. Our study aims to assess problem gambling prevalence among veterans using non-Veterans Affairs data and to evaluate correlates of problem gambling among veterans in a general population sample. We obtained a probability sample of adult Massachusetts residents using address based sampling in 2013-2014. Participants completed a questionnaire on demographics, veteran status, and gambling behaviors and motivations. We identified n = 129 problem gamblers from a sample of n = 9578 participants. Of the problem gamblers who had veteran status information, 20.6% were veterans. Due to sample size limitations, we analyzed veteran problem and at-risk gamblers compared to veteran recreational gamblers. Having friends and family members engaged in gambling and engaging in more gambling formats were significantly, positively associated with veteran problem and at-risk gambler status. Participating in raffles in the past year was associated with lower odds of being a veteran problem and at-risk gambler compared to veteran recreational gamblers (OR 0.31, 95% CI 0.18-0.52). These discriminators of at-risk and problem gambling may be useful in developing clinical treatment approaches for veteran problem gamblers. Future studies should focus on changes in the prevalence of veteran problem gambling and additional correlates that may better capture social support domains and gambling activity among veterans.

Behavioral addictions in bipolar disorders: A systematic review

Clinical and epidemiological research suggests that behavioral addictions (BA) are associated with a wide range of psychiatric disorders. However, the relationship between BA and bipolar disorders (BD) has not been thoroughly explored. The aim of this systematic review was to critically summarize and evaluate the current available evidence regarding a possible association between BA and BD. A systematic review of major electronic databases according to PRISMA guidelines was conducted from inception to 31st December 2017. We sought quantitative studies data concerning prevalence of comorbidity, features and treatment related to BA-BD comorbidity. Data were narratively synthesized. Of the 1250 studies returned from the search, a total of 28 articles were included in this review. BA may be overrepresented in BD samples, and the other way around. Pathological gambling and kleptomania were the most prevalent conditions followed by compulsive buying, compulsive sexual behavior and internet addiction. BA was also associated with other mood disorders, anxiety disorders and substance use disorder. BD-BA comorbidity was related with more severe course of illness. Studies on treatment strategies for BD-BA comorbidity are rather limited; only one randomized controlled trial that fulfilled inclusion criteria was identified. Methodological heterogeneity in terms of design and results among studies was found. BD-BA commonly co-occurs although there is a need for rigorous studies. Routine screening and adequate assessment may be helpful in BD patients to identify individuals at risk for BA and to effectively manage the complex consequences associated with BA-BD comorbidity.

Caler K. Widening the net: A syndemic approach to responsible gambling

Abstract. Background: Attempts to address gambling-related harms have evolved rubrics to foster responsible gambling and informed choice. Those efforts have largely focused on apportioning the relative responsibility placed on government, industry, and individuals for reducing excessive gambling that leads to adverse consequences. Empirical evaluations of responsible gambling measures, together with proposed frameworks that set out guidelines for accountability, have met with mixed results and criticism from divergent groups of stakeholders. Aim: While harm reduction remains a worthy goal, this position paper argues against maintaining a stringent focus on the government-industry-individual triumvirate in favor of adopting a syndemic approach to gambling-related harms. Approach: A syndemic perspective suggests that gambling disorder intersects, coexists, precedes or follows other comorbid conditions and interacts with social and environmental factors that promote and enhance the negative consequences of gambling problems. This paper discussions potential syndemic stakeholders and challenges in the implementation of this approach. Conclusions: Initiatives to reduce gambling-related harm should adopt a broader perspective, involving stakeholders from diverse syndemic problem areas in developing a network to identify and address gambling problems in early stages of development across multiple settings.

Problem gambling among ethnic minorities: results from an epidemiological study

A few studies have examined gambling behavior and problem gambling among minorities and reported higher rates of both participation and gambling problems among particular minority groups in comparison to Whites who gamble. The present study utilized a representative, epidemiological sample of adults in New Jersey to explore gambling behavior, gambling problem severity, substance use, problem behavior, and mental health issues among minorities. Univariate analyses were conducted, comparing Whites (n = 1341) to respondents who identified as Hispanic (n = 394), Black (n = 261), or Asian/other (n = 177). Overall, the highest proportion of Hispanics were high-risk problem gamblers. Hispanic participants were also significantly more likely than other groups to use and abuse substances and to report mental health problems in the past month, behavioral addictions, and/or suicidal ideation in the past year. Primary predictors of White high risk problem gamblers were being young and male with friends or family who gambled, fair to poor health status, substance use, gambling once a week or more both online and in land-based venues, and engaging in a number of gambling activities. In contrast, gender was not a predictor of minority high risk problem gamblers, who were characterized primarily by having friends or family who gambled, gambling online only, having a behavioral addiction and playing instant scratch-offs and gaming machines. Implications for research and practice are discussed.

Gambling Problems Among Community Cocaine Users

Cocaine use is highly prevalent and a major public health problem. While some studies have reported frequent comorbidity problems among cocaine users, few studies have included evaluation of gambling problems. This study aimed to estimate the prevalence of gambling problems and compare those who were at-risk gamblers with non-problem gamblers in terms of mental health problems, substance use problems, and some risk factors (i.e. family antecedents, erroneous perceptions and coping strategies) among individuals who smoke or inject cocaine. A total of 424 smoked or injected cocaine users recruited through community-based programs in Montreal (Quebec) completed the questionnaire, including the Canadian Pathological Gambling Index, the Composite International Diagnostic Interview, the CAGE, and the Severity Dependence Scale. Of the sample, 18.4 % were considered at-risk gamblers, of whom 7.8 % had problems gambling and 10.6 % were moderate-risk gamblers. The at-risk group was more likely to have experienced a recent phobic disorder and alcohol problems than the non-problem group. A multivariate analysis showed that, compared to those who were non-problem gamblers, the at-risk ones were more likely to have lost a large sum of money when they first started gambling, believed that their luck would turn, and gambled in reaction to painful life events. These results indicate the need to include routines for screening to identify gambling problem among cocaine users.

“It’s Only a Game of Chance”: A Portrait of Gambling Among Street Children in Mumbai

For street children in Mumbai, gambling is mostly a social and recreational activity. This study is based on data gathered from a survey of 70 youths aged 12 to 24, two focus groups, and participant observation. It offers glimpses into various facets of their gambling, including age patterns, games played, venues, and how group and street subculture strongly influence participation. Street children perceive gambling as a “game of chance,” implying it is a form of recreation, not to be taken seriously. Given the pervasiveness of gambling and the absence of other recreational and money-saving opportunities, there is a need to design educational and preventive interventions for street children.

Personality disorders and pathological gambling

PURPOSE OF REVIEW

To explore recent developments in the field of personality disorders and their association with pathological gambling or gambling disorder. The review covers literature published from 2015 to present time (August 2016) to understand the prevalence rates of common personality disorders among pathological gamblers.

RECENT FINDINGS

Commonly seen personality disorders among pathological or problem gamblers represent Cluster B disorders. There are reports indicating prevalence of Clusters A and C personality disorders as well. The rates of personality disorders among pathological gamblers reported in these studies align with Hill's guidelines - Strength, Specificity, Temporality, Biological gradient, Plausibility and Replicability indicating a strong association between pathological gambling and personality disorders. Studies are predominantly cross-sectional and consistently show that the presence of a personality disorder is associated with gambling severity and early age of onset pathological gambling.

SUMMARY

Research on pathological gambling should advance beyond estimating rates of personality disorders and focus on longitudinal research to understand the pathways between personality disorders and onset and severity of pathological gambling.

Gambling Disorder in the DSM-5: Opportunities to Improve Diagnosis and Treatment Especially in Substance Use and Homeless Populations

In the fifth edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-5), gambling disorder (GD) underwent several changes. This paper reviews recent research related to the revisions, including the elimination of the illegal acts criterion and the newly lowered diagnostic threshold. These studies suggest the removal of the illegal acts criterion has little impact in terms of prevalence or loss of diagnostic status among gamblers, especially when considered in combination with the newly lowered diagnostic threshold. Overall prevalence rates will increase modestly with the lowered threshold in community samples of gamblers. However, increases in GD prevalence rates may be more notable in settings that serve individuals at higher risk for gambling problems (e.g., substance abuse treatment clinics and homeless persons). GD is now aligned more closely with substance use addictions in DSM-5. This re-categorization, along with the lower threshold for diagnosis under DSM-5 diagnostic criteria, may lead to increased recognition of gambling problems, particularly in settings that serve high risk populations. These changes also may necessitate the training of more clinicians in the delivery of efficacious gambling treatments.

Gambling in the Landscape of Adversity in Youth: Reflections from Men Who Live with Poverty and Homelessness

Most of the research on gambling behaviour among youth has been quantitative and focused on measuring prevalence. As a result, little is known about the contextual experiences of youth gambling, particularly among those most vulnerable. In this paper, we explore the previous experiences of youth gambling in a sample of adult men experiencing housing instability and problem gambling. We present findings from a qualitative study on problem gambling and housing instability conducted in Toronto, Canada. Thirty men with histories of problem or pathological gambling and housing instability or homelessness were interviewed. Two thirds of these men reported that they began gambling in youth. Five representative cases were selected and the main themes discussed. We found that gambling began in early life while the men, as youth, were also experiencing adversity (e.g., physical, emotional and/or sexual abuse, neglect, housing instability, homelessness, substance addiction and poverty). Men reported they had access to gambling activity through their family and wider networks of school, community and the streets. Gambling provided a way to gain acceptance, escape from emotional pain, and/or earn money. For these men problematic gambling behaviour that began in youth, continued into adulthood.

Addressing the Needs of Problem Gamblers With Co-Morbid Issues: Policy and Service Delivery Approaches

Most people with gambling problems have at least one co-occurring condition and many experience multiple co-occurring conditions simultaneously. In many Western jurisdictions, a specialist service response has developed, with separate agencies and workforces established to respond to gambling problems. Despite the number of co-occurring issues that occur alongside gambling, research is limited on the prevalence of problem gambling across some service systems, such as mental health and family service sectors. However, it is reasonable to conclude that significant numbers of people with gambling problems are currently engaged in other health and welfare service sectors. Partnership work with other service sectors is therefore vital to respond to the needs of these people. In Victoria, Australia, a partnership program was established in gambling help services to improve integration and co-ordination between gambling, alcohol and drug, family support, and mental health service sectors. From the experience acquired in developing the program, we seek in this article to outline the benefits and challenges of implementing a cross-sector approach in gambling treatment service systems and to recommend effective strategies to develop a cross-sector approach, including creating an authorising environment at the government policy level.

Down and Out in London: Addictive Behaviors in Homelessness

Backgrounds and aims Problem gambling occurs at higher levels in the homeless than the general population. Past work has not established the extent to which problem gambling is a cause or consequence of homelessness. This study sought to replicate recent observations of elevated rates of problem gambling in a British homeless sample, and extend that finding by characterizing (a) the temporal sequencing of the effect, (b) relationships with drug and alcohol misuse, and (c) awareness and access of treatment services for gambling by the homeless. Methods We recruited 72 participants from homeless centers in Westminster, London, and used the Problem Gambling Severity Index to assess gambling involvement, as well as DSM-IV criteria for substance and alcohol use disorders. A life-events scale was administered to establish the temporal ordering of problem gambling and homelessness. Results Problem gambling was evident in 23.6% of the sample. In participants who endorsed any gambling symptomatology, the majority were categorized as problem gamblers. Within those problem gamblers, 82.4% indicated that gambling preceded their homelessness. Participants displayed high rates of substance (31.9%) and alcohol dependence (23.6%); these were not correlated with PGSI scores. Awareness of treatment for gambling was significantly lower than for substance and alcohol use disorders, and actual access of gambling support was minimal. Discussion and conclusions Problem gambling is an under-recognized health issue in the homeless. Our observation that gambling typically precedes homelessness strengthens its role as a causal factor. Despite the elevated prevalence rates, awareness and utilization of gambling support opportunities were low compared with services for substance use disorders.

Rates of problematic gambling in a British homeless sample: a preliminary study

Homelessness and problem gambling are two public health concerns in the UK that are rarely considered concurrently, and little is known about the extent of gambling involvement and problematic gambling in the homeless. We recruited 456 individuals attending homelessness services in London, U.K. All participants completed a screen for gambling involvement, and where gambling involvement was endorsed, the Problem Gambling Severity Index (PGSI) was administered. The PGSI risk categories were compared against data from the 2010 British Gambling Prevalence Survey (BGPS). PGSI problem gambling was indicated in 11.6% of the homeless population, compared to 0.7% in the BGPS. Of participants endorsing any PGSI symptoms, a higher proportion of homeless participants were problem gamblers relative to the low and moderate risk groups, compared to the BGPS data. These results confirm that the homeless constitute a vulnerable population for problem gambling, and that diagnostic tools for gambling involvement should be integrated into homelessness services in the U.K.