Cowlishaw Sean, Hakes Jahn K
School of Social and Community Medicine, University of Bristol, United Kingdom.
Centre for Gambling Research, College of Arts Social Sciences, School of Sociology, The Australian National University (ANU), Australia.
Am J Addict. 2015 Aug;24(5):467-74. doi: 10.1111/ajad.12242. Epub 2015 May 7.
Pathological and problem gambling may be common yet frequently undetected conditions in substance use treatment. This paper reports findings on the prevalence of gambling comorbidities in these clinical contexts that are generalizable across regions and settings. It indicates the implications of such conditions for treatment of substance use problems.
A U.S. representative sample of n = 402 patients reporting past-year treatment for substance use problems was derived from wave 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Weighted prevalence estimates were produced and regression analyses used to examine correlates of gambling symptoms.
Rates of lifetime pathological gambling (5+ DSM-IV symptoms) and problem gambling (3+ DSM-IV symptoms) were 4.3% (s.e. = 1.3%) and 7.2% (s.e. = 1.6%), respectively. Lifetime gambling symptoms were associated with Axis II disorders, but no Axis I diagnoses. There was limited evidence of associations with substance usage, mental or physical health and medical utilization. There were associations with financial crises and relationship breakdown, during and after treatment.
Gambling problems are elevated in substance use treatment but may be less common than previously thought; when considered nationally and across clinical settings. They may have modest associations with clinical characteristics given high levels of psychiatric severity that characterise treatment seeking samples overall. Notwithstanding, the results suggest that gambling comorbidities should be standard considerations in substance use treatment. They may signal complex conditions characterised by pervasive underlying psychopathology, and psychosocial difficulties that accumulate over time.
病理性赌博和问题赌博在物质使用治疗中可能很常见，但往往未被发现。本文报告了在这些临床环境中赌博共病的患病率调查结果，这些结果在不同地区和环境中具有普遍性。它指出了这些情况对物质使用问题治疗的影响。
从全国酒精及相关疾病流行病学调查（NESARC）的第1波和第2波中抽取了一个n = 402名报告过去一年接受过物质使用问题治疗的患者的美国代表性样本。生成加权患病率估计值，并使用回归分析来检查赌博症状的相关因素。
终生病理性赌博（5种及以上DSM-IV症状）和问题赌博（3种及以上DSM-IV症状）的发生率分别为4.3%（标准误 = 1.3%）和7.2%（标准误 = 1.6%）。终生赌博症状与轴II障碍有关，但与轴I诊断无关。与物质使用、心理或身体健康及医疗利用之间的关联证据有限。在治疗期间和治疗后，与金融危机和关系破裂存在关联。
在物质使用治疗中，赌博问题有所增加，但可能比以前认为的要少见；从全国范围和临床环境来看都是如此。鉴于总体上寻求治疗样本的精神疾病严重程度较高，它们与临床特征的关联可能较小。尽管如此，结果表明赌博共病应成为物质使用治疗中的标准考量因素。它们可能预示着以普遍存在的潜在精神病理学和随着时间积累的心理社会困难为特征的复杂情况。
