Co-Morbid Alcohol Use and Alcohol Use Disorders within Pathological

Gamblers

Jeremiah Weinstock, PhDSaint Louis University

Presentation Overview

1. Alcohol use and gambling2. Alcohol use disorders (AUD) and pathological

gambling (PG)3. Alcohol use during treatment 4. Implications

Drinking & Gambling

Some clients will report that they currently:

1. Drink and gamble at the same time.2. Do both, but never at the same time.

Meanwhile, others report only a history of alcohol problems.

Drinking & Gambling

Many gambling environments serve free or reduced cost alcoholic beverages. Why?

1. Alcohol impairs our ability make good decisions.2. Alcohol weakens our ability to recognize the

importance/salience of gambling losses. 3. Individuals frequently wager more than they

intend while intoxicated.

Cronce &Corbin, 2010; Giacoppassi et al., 1998; Nelson et al., 2011

Pathological Gamblers Who Drink

Epidemiological studies find: – Gamblers who drink 3 or more per occasion were

more likely to be problem gamblers– If both disorders are present, severity of both

disorders are closely linked.– Drinking predicts long-term gambling problems in

problem and pathological gamblers.

Abbott et al., 2004; Blankenship et al., 2007; French et al., 2008;

How Much Do They Overlap?

Epidemiological studies estimate: – 28% of pathological gamblers have comorbid

alcohol use disorder.– Lifetime rates are even higher (~50%).

Which came first?PG 1st Alcohol 1st Same Time

Alcohol Abuse

18.7% 70.9% 10.4%

Alcohol Dependence

44.3% 55.7% 0.0%Lorains et al., 2011; Kessler et al., (2008)

Prevalence in Treatment Centers

Comorbidity is rule rather than the exception:– Alcohol use disorders range from 33% to 64% of

treatment seekers.

– Depends upon the setting. • Addiction clinics higher prevalence.• Outpatient clinics slightly lower.

Ibanez et al., 2001; Black & Moyer, 1998; Kausch, 2003

Why Do They Overlap?

Genetics?– Genetic factors account for ~50% - 60% of alcohol

use disorders.– Genetic factors account for ~50% - 60% of

pathological gambling.– Overlap of genetic factors between the two

disorders is about 12% - 20%.– Most overlap revolves around impulsivity and

poor decision making.

Shah et al., 2005; Sherrer et al., 2005

Addictive Personality?

Slutske et al., 2005

Implications for Treatment

Comorbid AUD & PG – A blessing and a curse: – One study found current AUD at treatment entry

predicted gambling abstinence at 3 month follow-up. Why?

– History of AUD is associated with lower rates of initial abstinence after treatment.

– History of AUD is associated with higher rates of relapse after achieving 6 months of abstinence (37% vs. 17%).

Hodgins et al., 2005, 2010

Symptom Substitution?

If a client stops drinking will his or her gambling get worse?

If a client stops gambling, will his or her drinking get worse?

Empirical question!

Drinking During Treatment?

We examined this very question in a large pathological gambling treatment seeking sample (N = 293).

Drinking assessed via the Timeline Followback.

Slightly more than half (56%) report drinking any alcohol in the 3 months prior to and six months after starting gambling treatment.

Rash, Weinstock, & Petry, 2011

At-Risk Drinking

Almost half of the drinkers (47%) were classified as “At-Risk Drinkers.”

At-Risk Drinkers:– MEN: > 14 drinks/week or > 4 drinks/episode– WOMEN: > 7 drinks/week or > 3 drinks/episode

At-Risk Drinkers were more likely to be:– Male, younger, greater PG severity, and drink 25%

of pre-treatment days with an mean of 5.0 drinks.

Pre-Treatment Weekly Drinking

Pre-treatment weeks -------------------------->

During Treatment, Weekly Drinking

Treatment Week -------------------------------------------------->

Post-Treatment Drinking

Post-Treatment Follow-Up ------------>

All Together

Other Important Findings

At-Risk Drinkers:– Had lower rates of PG treatment adherence

Reductions in drinking occurred as individuals entered treatment. – Possibly part of a broader health behavior

change.

Implications

Many gamblers seeking treatment will come in with either:– A history of alcohol problems– Currently at-risk drinking

Conceptualize it as an opportunity!– History = experience making significant change– Current drinking = chance to make global health

changes

THANK YOU!

jweinsto@slu.edu