Substance Abuse Disorders & Problem Gambling

By Sasha C. Russell, M.A., Program Specialist, Communications, The Massachusetts Council on Compulsive Gambling





Many pathological gamblers often simultaneously suffer with a serious mental health disorder or substance use disorder.  When this happens it is called a co-occurring disorder, formerly known as dual diagnosis. The most common co-occurring disorders in conjunction with gambling disorders are: substance use disorders, mood disorders (depression and bipolar), anxiety disorders, and personality disorders.

Though it can be debatable which disorder causes the other disorder, there are many reasons why gambling and substance use are prevalent together. According to the Massachusetts Council on Compulsive Gambling’s Gambling Disorders & Substance Use Disorders Fact Sheet, “for some who gamble, a dependency on the ‘action’ of gambling takes place in a similar way to a dependency on the effects of alcohol or other drugs.” A 2008 study has shown that about 75% of all pathological gamblers have had problems with alcohol, while 38% of all pathological gamblers have had problems with other drugs.

In the Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment report Substance Abuse Treatment For Persons With Co-Occurring Disorders (Problem Gambling p. 243) the following are suggested reasons co-occurrence may develop:

·         Cocaine use and problem gambling may coexist as part of a broader antisocial lifestyle.

·         Someone who is addicted to cocaine may see gambling as a way of getting money to support drug use.

·         A pathological gambler may use cocaine to maintain energy levels and focus during gambling and sell drugs to obtain gambling money.

·         Cocaine may artificially inflate a gambler’s sense of certainty of winning and gambling skill, contributing to taking greater gambling risks.

·         The gambler may use drugs or alcohol as a way of celebrating a win or relieving depression.

·         One of the more common patterns that has been seen clinically is that of a sequential addiction. A frequent pattern is that someone who has had a history of alcohol dependence—often with many years of recovery and AA attendance—develops a gambling problem.

When treating a co-occurring disorder, the clinician must recognize that “treatment success is enhanced by maintaining integrated treatment relationships providing disease management interventions for both disorders continuously across multiple treatment episodes, balancing case management support with detachment and expectation at each point in time” (2006 Midwest Conference on Problem Gambling and Substance Abuse presentation). What this breaks down to is that basically, if someone is a gambler and abuses alcohol, both problems need to be treated separately for what they are. Triggers for each disorder need to be defined and treatment must be aware of multiple disorders all at once, treating them separately, yet together.

The Addiction Blog points out that in many cases when people are being treated for a disorder, gambling tends to go unnoticed. More and more awareness is being raised about problem and pathological gambling and its relationship to other mental health disorders. As mentioned above, it’s not always easy to pinpoint the start of one disorder over another, or which disorder led to the other, or even why some disorders stay mild, while others are severe. The important thing is continuing to promote protective factors (prevention blog post) in our communities and being able to recognize risk factors.