Gambling + alcohol is a losing proposition

It's no secret that alcohol use and gambling often coexist. Nor is it surprising to hear that people who have gambling disorders (GDs) often have alcohol use disorders (AUDs), and vice versa. New research indicates that the association between the two disorders is even more complex: gamblers tend to think about alcohol more when they are winning; gamblers take more risks and play longer when they are drinking; people with concurrent GDs and AUDs have more suicidal tendencies than people with GDs alone; and gamblers who simultaneously tackle both disorders seem to have the best outcomes.

These findings were presented at a symposium on the strong association between GDs and AUDs during the joint June 2002 Research Society on Alcoholism/International Society for Biomedical Research on Alcoholism meeting in San Francisco. Symposium proceedings can be found in the February issue of Alcoholism: Clinical & Experimental Research.

"We are clearly past the point of needing to document that these two problems are commonly comorbid conditions," said Sherry H. Stewart, associate professor of psychology, psychiatry, and community health and epidemiology at Dalhousie University, and co-presenter of the research. "This symposium nicely highlights that researchers are going beyond questions of 'whether' this comorbidity exists and are proceeding to try to understand 'why' it exists and what that implies for treatment."

Some of the symposium's key findings were:

Gambling wins are more closely linked with alcohol in memory than gambling losses, particularly among those who report a history of increasing their drinking in response to winning. In other words, gambling wins seem to activate an "alcohol memory network," which can lead to increased drinking while gambling.
"These findings suggest that therapy needs to focus on finding ways to break these over-learned or 'unconscious' associations between winning and drinking," said Stewart, "so that engaging in gambling does not have to automatically result in alcohol use for these individuals."
Even moderate consumption of alcohol by gamblers while gambling leads to increased risk taking during video lottery terminal (VLT) play, particularly among probable pathological gamblers.
"Regular gamblers who were administered a mild dose of alcohol took more risks and played longer on VLTs than those administered a non-alcoholic beverage," said Stewart. "This finding raises serious concerns about the advisability of making VLTs available in bars, or of governments allowing casinos to provide free alcoholic beverages to patrons."
Although legal gambling has been available in the United States for a number of years, Stewart noted, legal gambling in Canada has expanded rapidly only in the last two decades. Before 1970, Canadian legal gambling was largely restricted to charity bingos and midway games of chance. It has since grown to include VLTs, slot machines, and casinos. "Many of these gambling opportunities in Canada are located in premises licensed to serve alcohol," she said. "For example, VLTs in the Canadian province of Nova Scotia are restricted to bars."
Analysis of data collected from gambling helpline callers indicates that individuals with both GDs and AUDs tend to have a more severe gambling problem as well as more "outside" problems such as suicidal behavior and/or drug use than individuals with GDs alone.
Results from a preliminary one-year study of pathological gamblers who had recently quit gambling suggest that simultaneous treatment for gambling and substance abuse may possibly lead to better outcomes for the gambling disorder.

"These findings suggest that clinicians should be particularly careful to assess for the possibility of a suicide attempt in those presenting with co-existing alcohol and gambling problems," said Stewart. "They also suggest that clinicians should be trying to help comorbid individuals with strategies for tackling both problems simultaneously."

Stewart noted that conclusions based on studies presented in the symposium remain tentative until they have undergone further peer review and independent publication. She also said she would like to see future studies follow high-risk individuals over time to try to determine which problem develops first, the AUD or the GD. "I would also like to see studies examine patterns of familial transmission of GDs and AUDs, alone and in combination. This can help to distinguish vexing 'nature versus nurture' questions concerning this relationship. Finally, I believe that we need to move quickly toward conducting treatment studies to determine whether the presence of one disorder may interfere with treatment of the other disorder."

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Alcoholism: Clinical & Experimental Research (ACER) is the official journal of the Research Society on Alcoholism and the International Society for Biomedical Research on Alcoholism. The co-organizer/chair of the symposium proceedings published in ACER was Matt G. Kushner of the Department of Psychiatry at the University of Minnesota. Preparation of the manuscript was funded in part by the Ontario Problem Gambling Research Centre.

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