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Aims To help refine the definition and diagnosis of gambling disorders, we investigated the distribution among US gamblers of the 10 DSM-IV criteria for Pathological Gambling. Design We drew data from two stratified random surveys ( n = 2417, n = 530) of gambling behavior and consequences among community-based samples of US adults. A fully structured questionnaire, administered by trained lay interviewers, screened for the life-time prevalence of problem and Pathological Gambling. Per DSM-IV definitions, anyone meeting five or more of 10 itemized criteria was considered a pathological gambler. We analyzed these criteria among all gamblers who met one or more criteria ( n = 399). Findings Most gamblers who met only one or two criteria reported 'chasing their losses'. At subclinical levels (three to four criteria), gamblers also reported elevated rates of gambling-related fantasy: lying, gambling to escape and preoccupation. Pathological gamblers with five to seven criteria reported marked elevations of loss of control, withdrawal symptoms and tolerance (internalizing dimensions of dependence); risking their social relationships and needing to be bailed out financially (externalizing dimensions). Most of the highest-level pathological gamblers (eight to 10 criteria) reported committing illegal acts to support gambling. Conclusion Dependence in a biobehavioral sense appears to be a hallmark of Pathological Gambling, but it marks only one threshold in a qualitative hierarchy of disorders beginning with a common subclinical behavior, 'chasing'. Epidemiological assessments and future DSM revisions might consider explicit recognition of a problem gambling disorder, identifying people presenting some cognitive symptoms of Pathological Gambling but not clear signs of dependence. Pathological gamblers in turn appear to have two distinct levels of severity.

OBJECTIVES. A study of pathological gambling in five states provides information needed to address the public health threat that the expanding availability of legalized gambling poses to at-risk groups in the general population. METHODS. Over the course of this project, epidemiological data were collected to determine the prevalence of probable pathological gambling in the general population in each study state and demographic data were collected from pathological gamblers entering treatment programs in each state. RESULTS. Among the states surveyed, the availability of and involvement in gambling differ significantly, as does the prevalence of pathological gambling. Despite these differences, the demographics of pathological gamblers in these states are similar. Like those in the general population, pathological gamblers entering treatment in each state are similar. However, pathological gamblers entering treatment do not represent the full spectrum of individuals in the general population who experience gambling-related problems. CONCLUSIONS. These findings raise a number of issues, including the potential impacts of continued gambling legalization on the overall rate of gambling problems in the general population and on specific at-risk groups, including women, minorities, and children. They thus have implications for policy and program decisions now being made throughout the United States.

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The present study investigated the impact of survey administration format, survey description and gambling behaviour thresholds on obtained population prevalence rates of problem gambling. A total of 3028 adults were surveyed about their gambling behaviour, with half of these surveys administered face-to-face and half over the telephone, and half of the surveys being described as a 'gambling survey' and half as a 'health and recreation' survey. Population prevalence rates of problem gambling using the CPGI were 133% higher in 'gambling' vs 'health and recreation' surveys and 55% higher in face-to-face administration compared to telephone administration. If people with less than Can$300 in annual gambling expenditures are not asked questions about problem gambling, then the obtained problem gambling prevalence rate is 42% lower. When all of these elements are aligned they result in markedly different problem gambling prevalence rates (4.1% vs 0.8%). The mechanisms for these effects and recommended procedures for future prevalence studies are discussed.

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The purpose of this study was to explore the association between problem gambling (PG) and participation in different forms of gambling in order to elucidate relationships between PG, gambling involvement and gambling intensity. Using data from the first wave of the Swedish Longitudinal Gambling Study (Swelogs) (n = 4,991), the study tested four hypotheses, namely that (1) some forms of gambling are more closely associated with PG than other forms; (2) high gambling involvement is associated with PG; (3) gambling involvement is positively associated with the intensity of gambling; and (4) the relationship between gambling involvement and PG is influenced by the specific forms of gambling in which individuals participate. All four hypotheses were supported. More specifically, the study found that while many PGs regularly participate in multiple forms of gambling, half of PGs participate regularly in only one or two forms of gambling. The study concluded that some forms of gambling are more closely associated with problem gambling than other forms, and that gambling policy and regulation, as well as the development of responsible gambling initiatives, should focus on these forms.

Objectives To describe and evaluate tests of the performance of the NODS-CLiP, an efficient standardized diagnostic interview instrument for adult pathological and problem gambling. Setting and Samples Identical batteries of diagnostic questions about gambling behavior, motives, and thoughts were administered to participants in eight general adult population field studies conducted in the United States between 1999 and 2003, including six state-level random-digit-dial (RDD) telephone surveys, one national RDD survey, and one in-person systematic random sample survey of commercial gambling patrons in eight states. Total survey N =17,180. Response rates ranged from 24% to 71%. Measures Data from all experienced gamblers (N=8,867) were re-analyzed to compare diagnostic status derived from the 17-item NORC Diagnostic Screen for Gambling Disorders (NODS), a validated DSM-IV-based instrument, with results from all 2- to 4-item subsets of NODS items. Results Three NODS questions, pertaining to loss of Control, Lying, and Preoccupation (the “CLiP”), requiring one minute to administer, identified virtually all pathological gamblers and most problem gamblers diagnosed by the complete NODS. The CLiP has excellent sensitivity and specificity for NODS constructs. Conclusions A two-stage NODS-CLiP procedure appears quite promising as an efficient epidemiological instrument for general population research and clinical triage for gambling disorders.