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PubMed2004

Body mass index and alcohol use.

BACKGROUND: Obesity, inactivity and being overweight are leading causes of morbidity and mortality in the United States. The relationship between eating, overeating, and addiction have been discussed, debated and more recently investigated. We have hypothesized that drugs of abuse compete with food for brain reward sites. Overeating and obesity may act as protective factors reducing drug reward and addiction. METHODS: In the first part of this study, 374 charts of all active weight management patients in a 12-month period were examined. Demographic information, laboratory testing, psychiatric diagnostic interview, alcohol and drug history were reviewed. A detailed alcohol use, abuse, dependence history was present in 298 charts as part of the pre-bariatric evaluation. The relationship between BMI and alcohol use among female patients (n = 298) was then analyzed. RESULTS: We found a significant (p <.05) inverse relationship between BMI and alcohol consumption. The more obese the patient was, the less alcohol they consumed. The percentage of women who consumed alcohol in the past year decreased as BMI level increased. These results confirmed our surgeons' perception that it is rare to find a morbidly obese patient excluded for bariatric surgery because of excessive alcohol consumption. CONCLUSIONS: Obese patients have lower rates of alcohol use than found in the general population of women. As BMI increases, lower rates of alcohol consumption are found. Overeating may compete with alcohol for brain reward sites, making alcohol ingestion less reinforcing.

Adolescent↗

PubMed2002

Cigarette smoking is associated with increased severity of gambling problems in treatment-seeking gamblers.

AIMS: Cigarette smoking and gambling often co-occur, but very little is known about smoking or its correlates in disordered gamblers. This study compared gambling and psychosocial problems in treatment-seeking gamblers who smoke versus those who do not. METHODS: At intake to gambling treatment programs, gamblers completed the addiction severity index (ASI) and gambling questionnaires. Subjects were categorized into non-daily smokers (n=107) and daily smokers (n=210). Differences in demographics, gambling variables and ASI composite scores were compared between the groups. RESULTS: The daily smokers were more likely to have a history of treatment for a substance use disorder than the non-daily smokers. After controlling for substance abuse treatment histories, gender and age, the daily smokers demonstrated more severe gambling, family/social and psychiatric problems. Compared to non-daily smokers, the daily smokers gambled on more days and spent more money gambling; they also 'craved' gambling more and had lower perceived control over their gambling. The daily smokers were more likely to be taking psychiatric medications, and they experienced psychiatric symptoms, especially anxiety symptoms, on a greater number of days than non-daily smokers. IMPLICATIONS: Results from this study suggest that about two-thirds of treatment-seeking gamblers are current daily cigarette smokers, and smoking status is associated with more severe gambling and psychiatric symptoms. These results warrant further investigation of smoking in gamblers and whether smoking adversely affects the course of treatment or outcomes among gamblers.

Adult↗

PubMed2003

"It's like an addiction first thing...afterwards it's like a habit": daily smoking behaviour among people living in areas of deprivation.

The paper draws on qualitative interviews with a sample of male and female smokers who live in areas of disadvantage in Edinburgh, Scotland, to examine their perceptions of habit and addiction and the implications for smoking behaviour. The paper shows how smokers have a sophisticated understanding of these concepts and the way in which they affected their smoking behaviour across the course of a 'typical' day. The paper argues that daily contexts which smokers inhabit either constrain or facilitate smoking and as such play a central role in the way in which they smoke. In contexts where smoking was constrained (by externally or self-imposed restrictions) smokers described how they employed various strategies to achieve and maintain what they perceived to be a desirable level of nicotine intake, such as by anticipatory smoking. Where restrictions on smoking were absent, men's and women's smoking appeared remarkably similar. However, for the most part, the contexts which men and women inhabited over the course of the day differed, with women assuming the largest share of domestic and child care responsibilities. Apparent gender differences in smoking behaviour appeared to be related to the different daily contexts which men and women inhabited. Crucially, the influences on smoking described by respondents in this study were closely related to circumstances of socio-economic deprivation.

Adaptation, Psychological↗

PubMed1997

Sensitivity and specificity to amphetamine of a French version of the 49-item form of the addiction research center inventory.

The main metrological characteristics of a French version of the 49-item addiction research center inventory (ARCI) were evaluated using data collected in three controlled studies in healthy subjects. An analysis of variance showed no study effect, so the three studies were pooled. The test-retest reliability coefficients after placebo evaluated by a Spearman rank correlation test were 0.64 (P < 0.0001) for subscale A, 0.49 (P < 0.0001) for subscale BG, 0.55 (P < 0.0001) for MBG, 0.58 (P < 0.0001) for PCAG and 0.27 for LSD (not significant). Using the same test, the test-retest reliability coefficients after amphetamine were 0.73 (P < 0.0001) for subscale A, 0.61 (P < 0.0001) for subscale BG, 0.71 (P < 0.0001) for MBG, 0.46 (P < 0.0001) for PCAG and 0.66 for LSD (P < 0.0001). In order to assess the predictive validity of the translated questionnaire, areas under curves were calculated from the ROC diagrams for the three scores, amphetamine (A), benzedrine group (BG) and morphine benzedrine group (MBG). Two criteria validity were used: the desire to take amphetamine another time and the discrimination of the allocated treatment (amphetamine or placebo). The calculated areas under curves indicated a good capacity of prediction of the three ARCI subscales (A, BG, MBG) for both criteria.

Adolescent↗

PubMed2000

Craving research: future directions.

Many prospective clinical studies have concluded that craving does not reliably predict relapse and that the concept is of little or no clinical utility. Contrary to earlier more simplistic clinical models of addiction, more recent models do not require that craving be present for relapse to occur. New approaches to study human craving may enhance its predictive validity and yield more knowledge of its nature, course, behavioural sequelae and regulatory function in alcohol/drug consumption. These approaches include empirical research that focuses on: (1) the elucidation of the domains of craving (i.e. subjective experience, physiological responses, behavioural sequelae and their inter-relationships); (2) the temporal dynamics of craving (i.e. its course over minutes or days, as well as its natural history over the course of a drinking career); (3) the factors that may mediate/moderate/determine the development and resolution of craving; (4) studies of the predictive validity of craving measures; and (5) the development of valid methods of measuring the different domains of craving. The conclusions are that future craving research should: (1) incorporate more sophisticated general theories of behaviour (conditioning, cognitive social learning, neurobiological, and genetic); (2) apply more sophisticated and standardized measurement methods and experimental paradigms, including studies in which alcohol is made available to human subjects; and (3) effective development of new pharmacological and behavioural therapies for relapse prevention depend on greater understanding of the nature and measurement of craving.

Behavior, Addictive↗

PubMed2006

The efficacy of olanzapine for decreasing cue-elicited craving in individuals with schizophrenia and cocaine dependence: a preliminary report.

OBJECTIVE: Although a growing body of research suggests that atypical neuroleptic medications are efficacious in the treatment of cocaine addiction among individuals with schizophrenia, more rigorously controlled trials are needed. To extend this research, we performed a 6-week double-blind study comparing olanzapine to haloperidol with the primary objective of reducing cue-elicited cocaine craving and the secondary aims of decreasing substance use, improving psychiatric symptoms, and determining an effect size for future studies. METHODS: Thirty-one subjects with cocaine dependence and schizophrenia were randomized to olanzapine or haloperidol, underwent a cue-exposure procedure, and completed psychiatric and substance abuse ratings. RESULTS: Individuals in the olanzapine group who completed the study had a significant reduction on the energy subscale of the Voris Cocaine Craving Scale at study completion compared with individuals in the haloperidol group. The olanzapine-treated group also had lower, but not statistically significant, PANSS General Psychopathology Subscale scores and fewer positive urine toxicology screens compared with those in the haloperidol group. CONCLUSION: This small, but rigorously controlled, pilot trial provides additional evidence for the use of atypical antipsychotics for the treatment of individuals with co-occurring schizophrenia and cocaine dependence. Reductions in craving were associated with medium to large effect sizes.

Adult↗

PubMed1992

The 'anatomy' of research funding of mental illness and addictive disorders.

To assess the level and sources of research funding for mental illness and substance abuse fields, we undertook a systematic survey of public and private funding entities. Applying standard definitions, we found that research support in these fields totaled approximately $859 million in fiscal 1988. This level of research support for mental illness and substance abuse is extremely limited and disproportionate to the overall costs to society by these disorders. Mental disorders and substance abuse accounted for $66.8 billion in health care costs in 1988; in the same year, research on these disorders represented only 4.7% of all health research support nationwide. The three institutes of the Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA) (namely, the National Institute of Mental Health [NIMH], the National Institute of Drug Abuse [NIDA], and the National Institute on Alcoholism and Alcohol Abuse [NIAAA]) support 64% of all mental illness and substance abuse research; other federal agencies add little more than 7.5%, with the Department of Veterans Affairs the largest at 2%. The pharmaceutical and hospital industries account for another 17% of all support; state funding is 8%, which is particularly surprising in light of the states responsibility for the chronically mentally ill. While there has been recent significant growth in the research budgets of the NIMH, the NIDA, and the NIAAA, other sectors have not grown commensurately, leaving the field vulnerable to the funding vicissitudes of these institutes. Greater coalition building and advocacy are necessary to expand the breadth and depth of research resources for the field.(ABSTRACT TRUNCATED AT 250 WORDS)

Behavior, Addictive↗

PubMedDate not supplied

Subjective appraisal of problem severity and the ASI: secondary data or second opinion? Addiction Severity Index.

The Addiction Severity Index is a popular research and clinical tool for the characterization of individuals grappling with substance abuse problems. For research, use of the seven objectively calculated composite scores of problem severity is recommended. In contrast, clinical use of the instrument relies more upon its subjectively derived interviewer and client severity rating scores. However, little systematic research has looked at the comparability of these two sources of client data. This study compared the objective and subjective scores of the ASI of male (n=141) and female (n=58) clients entering substance abuse treatment. In addition, clients' narratives about their most worrisome problems were recorded and put to content analyses. While significant correlations were found among the various subjective indices, little relationship could be discerned between the objective composite scores and any of the subjective indices derived from either the ASI or the clients' narratives. As the focus of outcome research shifts from objective client and treatment characteristics to a better understanding of the process of intervention, empirical characterization of substance abuse treatment outcome may be enriched by the inclusion of subjective data that taps into the client's own perceptions of problems and treatment efficacy in addition to more objective sources of data.

Adolescent↗

PubMed2003

A comparison of treatment-seeking pathological gamblers based on preferred gambling activity.

AIMS: To compare and contrast gamblers with different forms of problematic gambling activities. DESIGN, SETTING AND MEASUREMENTS: Pathological gamblers completed the Addiction Severity Index (ASI) and gambling questionnaires when initiating out-patient treatment. PARTICIPANTS: Participants (n = 347) were categorized by their most problematic form of gambling activity: sports, horse/dog-races, cards, slots and scratch/lottery tickets. Differences in demographics, gambling variables, and ASI composite scores were compared across groups. FINDINGS: After controlling for demographic variables, the types of gamblers differed in severity of gambling, alcohol and psychiatric problems. Horse/dog-race gamblers were generally older, male and less educated; they began gambling regularly at a young age and spent relatively high amounts of money gambling. Sports gamblers were young males and had intermediary gambling problems; they had relatively high rates of current substance use but few psychiatric problems. Card players spent low to moderate amounts of time and money gambling, and they generally reported few alcohol problems and little psychiatric distress. Slot machine players were older and more likely to be female. Slot gamblers began gambling later in life, had high rates of bankruptcy and reported psychiatric difficulties. Scratch/lottery gamblers spent the least amount of money gambling, but they gambled the most frequently and had relatively severe alcohol and psychiatric symptoms. CONCLUSIONS: Gambling patterns and severity of psychosocial problems vary by form of problematic gambling, and these differences may influence treatment recommendations and outcomes.

Adult↗

PubMed2000

Reappraisal of the association between the DRD2 gene, alcoholism and addiction.

We analysed the impact of the TaqI A1 allele of the D2 dopamine receptor gene on the risk for alcoholism, trying to depict three explanations frequently proposed to explain discrepancies in association and linkage studies: that the A1 allele may act as a marker rather than as a vulnerability factor, that stratification biases and unevaluated controls may explain positive results, and that the A1 allele is modifying the phenotype rather than increasing the risk for alcoholism. We thus tested another (dinucleotide STRP) marker within the DRD2 gene, selected a new homogenous sample of 113 alcoholic patients and 49 unaffected controls strictly matched for ethnic origins, and systematically assessed both samples with a semi-structured interview to detect (in both samples) alcohol dependence, but also such related traits as specificities of complications. The frequency of the A1 allele was not significantly different between alcoholics and controls but when comparing different subgroups of alcoholics, the A1 allele was significantly more frequent in alcoholic patients with somatic complications (OR = 3.00, CI[1.37-6.62]), social and professional complications (OR = 2. 72, CI[1.25-5.90]), or with co-morbid dependence (OR = 2.88, 95% IC [1.16-7.15]). The association for co-morbid dependence and somatic complications was also positive when taking into consideration both STRP and TaqIA polymorphisms. The A1 allele does not increase the risk for alcoholism per se in our sample, but may be involved in a related trait which is partially dependent on the diagnosis of alcoholism, through a disequilibrium with another close mutation.

Adult↗

PubMed2005

Comparison of craving between pathological gamblers and alcoholics.

BACKGROUND: Craving is a central phenomenon in addiction. Temperament factors are also important for pathologic gambling and other addictions. The aim of this study was to compare craving between pathologic gamblers (PG) and alcohol-dependent subjects (ADS), correlating craving with personality. METHODS: Forty-nine PG and 101 ADS willing to start treatment were recruited. A trained psychiatrist diagnosed them according to DSM-IV criteria. To be included in this study, subjects had to be abstinent for at least five days and no longer than 21 days. Alcoholics should have no significant physical withdrawal symptoms by the time of craving assessment. Subjects with current comorbidity with other addictions were excluded, except nicotine. ADS rated craving for alcohol and PG rated craving for gambling on the same questions, respectively. Both answered a semistructured interview, the Temperament and Character Inventory and the Beck Scales for anxiety and depression. RESULTS: Pathologic gamblers scored higher than ADS on craving measures (p<0.001) and novelty seeking (p=0.01). ADS scored higher in harm avoidance (p=0.01). Alcohol craving correlated positively with anxiety and novelty seeking and negatively with length of abstinence and persistence. Gambling craving correlated positively with depression and negatively with length of abstinence and reward dependence CONCLUSIONS: Pathologic gamblers experienced stronger cravings than did ADS. This may be a disturbing experience for PG and a potential cause for relapse. The higher scores on novelty seeking concur with previous studies that associate PG and impulsivity. ADS higher scores on harm avoidance suggest anxiety vulnerability. The positive relation between alcohol craving, anxiety, and harm avoidance suggests that ADS rely on alcohol to deal with a proclivity to negative emotions. The positive relation of gambling craving to depression and negative relation to reward dependence suggests that individuals who have a lesser susceptibility to experience positive emotions are the ones who most miss gambling when abstaining.

Adult↗

PubMed2005

Shorter time to first cigarette of the day in menthol adolescent cigarette smokers.

Menthol smoking is thought to contribute to the addictiveness of smoking. Given the high prevalence of menthol smoking among youth, the aim of the current analysis was to examine differences in consumption and tobacco dependence, including smoking urgency among menthol and non-menthol adolescent smokers. Data for the current analysis were collected from telephone interviews with adolescent smokers applying to a cessation treatment study. Of 572 adolescent smokers (mean age=15.6+/-1.6 years; 55.1% female; 46.9% African American, 48.2% European American), 531 smoked menthol cigarettes and 41 smoked non-menthol as their usual brand. Analysis using Fisher's Exact (one-tailed) Test revealed that menthol smokers had a significantly shorter time to first (TTF) cigarette of the day compared to non-menthol smokers (smoking within the first 5 min of the day, 45% vs. 29%, respectively; p<0.04). Independent t tests revealed no significant difference in number of cigarettes per day (CPD) (mean=12.2+/-8.5 vs. 11.4+/-8.8; p<0.28) or Fagerstrom Test for Nicotine Dependence (FTND) scores (3.4+/-1.4 vs. 3.2+/-1.3; p<0.23). While preliminary, our findings suggest greater smoking urgency among menthol compared to non-menthol adolescent cessation-treatment seekers. Further study in a broader sample of adolescent smokers is warranted to elucidate the mechanisms underlying the effects of menthol smoking for youths.

Adolescent↗

PubMed2006

Contingency knowledge is necessary for learned motivated behaviour in humans: relevance for addictive behaviour.

AIMS: Many forms of human conditioned behaviour depend upon explicit knowledge of the predictive contingency between stimuli, responses and the reinforcer. However, it remains uncertain whether the conditioning of three key behaviours in drug addiction-selective attention, instrumental drug-seeking behaviour and emotional state--are dependent upon contingency knowledge. To test this possibility, we employed an avoidance procedure to generate rapidly these three forms of conditioned behaviour without incurring the methodological problems of drug conditioning. DESIGN: In two experiments, participants (16 students) were trained on a schedule in which one stimulus (S +) predicted the occurrence of a startling noise, which could be cancelled by performing an instrumental avoidance response. MEASUREMENTS: The allocation of attention to the S + and the rate and probability of the avoidance response in the presence of S + were measured. Following training, participants were tested for their knowledge of the stimulus-noise contingencies arranged in the study and rated the emotional qualities of the stimuli. FINDINGS: Both experiments showed that S + gained control of selective attention, instrumental avoidance behaviour and subjective anxiety, but only in participants who reported explicit knowledge of the Pavlovian contingency between the S + and the startling noise. CONCLUSIONS: The implication of the present findings is that the control of selective attention, instrumental drug-seeking behaviour and emotional state by drug-paired stimuli is mediated by cognitive knowledge of the predictive contingency between the stimulus and the drug.

Adult↗

PubMed2005

Substance-dependent women attending a de-addiction center in North India: sociodemographic and clinical profile.

BACKGROUND: Treatment-seeking is limited in women substance abusers. Studying the sociodemographic and clinical profile of treatment-seeking substance-dependent women can help us to understand the problem better and respond appropriately in terms of primary and secondary prevention strategies. AIM: To study the sociodemographic and clinical profile of women attending a de-addiction centre in North India. DESIGN AND METHODOLOGY: Retrospective structured chart review of 35 women substance abusers. RESULTS: The results indicated that a typical subject was urban (86%), married (63%), nuclear family (60%), based housewife (57%), educated up to school completion (54%), and having poor social support (57%). The common substances were opioids (60%), followed by alcohol (17%), and tobacco and benzodiazepines (11.5% each). The mean age at onset of substance use was 30.5 years, the mean duration of use was 9 years and mean duration to develop dependence was 5.5 years. The common reasons for initiating use were medical (63%) and curiosity (34%). Comorbidity profile was: physical illness (34%), psychiatric illness (23%) and dependence on another substance (14%). Only 20% had a family history of substance dependence. The social impairment ranged from 77% for social to 40% for financial and none for legal aspects. A typical subject had followed up 4.2 times in 8.4 months, while 54% were abstaining, 40% were continuing their substance dependence at the last follow up. CONCLUSIONS: The results suggest that the development of substance dependence in women is a combination of genetic, personal, and social vulnerability factors, including the drug culture of the social milieu and the poor social support. Comorbidity and impairment are common features.

Adult↗

PubMed2004

Using [11C]diprenorphine to image opioid receptor occupancy by methadone in opioid addiction: clinical and preclinical studies.

Substitute methadone prescribing is one of the main modes of treatment for opioid dependence with established evidence for improved health and social outcomes. However, the pharmacology underpinning the effects of methadone is little studied despite controversies about dosing in relation to outcome. We therefore examined the relationship between methadone dose and occupation of opioid receptors in brain using the positron emission tomography (PET) radioligand [(11)C]diprenorphine in humans and rats. Eight opioid-dependent subjects stable on their substitute methadone (18-90 mg daily) had an [(11)C]diprenorphine PET scan at predicted peak plasma levels of methadone. These were compared with eight healthy controls. No difference in [(11)C]diprenorphine binding was found between the groups, with no relationship between methadone dose and occupancy. Adult male Sprague-Dawley rats that had been given an acute i.v. injection of methadone hydrochloride (0.35, 0.5, 0.7, or 1.0 mg kg(-1)) before [(11)C]diprenorphine showed a dose-dependent increase in biodistribution but no reduction in [(11)C]diprenorphine binding. We suggest that the lack of a dose-dependent relationship between methadone dose, either given chronically in human or acutely in rat, and occupancy of opioid receptor measured with [(11)C]diprenorphine PET is related to efficacy of this opioid agonist at very low levels of opioid receptor occupancy. This has implications for understanding the actions of methadone in comparison with other opioid drugs such as partial agonists and antagonists.

Adult↗

PubMed2005

Effect of fluoxetine and cocaine on the expression of clock genes in the mouse hippocampus and striatum.

Long-term drug-induced alterations in CNS gene expression may be responsible for some therapeutic effects, such as antidepressant action, as well as for psychopathological conditions, such as drug addiction and abuse. Transcription factors called "clock" genes can be affected by psychotropic drugs and may modify the expression pattern of other genes. In this study in mice, we investigated the delayed effects of single and repeated (i.e. 14 days) administration of the antidepressant fluoxetine and the psychostimulant cocaine on the brain expression of clock genes Period1, Period2, Period3, Clock, Bmal1, Cryptochrome1, Cryptochrome2, and NPAS2 (neuronal PAS domain protein 2), and their putative target gene, serotonin N-acetyltransferase. Mice were treated at ZT05 (lights on at 5:00 am; ZT00). Brain samples (i.e. hippocampus, striatum, and prefrontal cortex) were processed for a semi-quantitative mRNA assay. Repeated but not single treatment with either drug increased serotonin N-acetyltransferase expression in all areas tested. On the other hand, the expression of clock genes was differentially affected depending on the drug (i.e. fluoxetine and cocaine), treatment schedule (i.e. single and repeated), and brain area (i.e. hippocampus and striatum) tested. More pronounced changes were induced by repeated rather than single administrations of fluoxetine or cocaine. We propose that the effects of psychoactive drugs on clock transcription factors may mediate long-term drug-induced changes, possibly by regulating the expression of a second set of genes (i.e. clock-controlled genes).

Animals↗

PubMed2004

Auricular acupuncture in the treatment of cocaine/crack abuse: a review of the efficacy, the use of the National Acupuncture Detoxification Association protocol, and the selection of sham points.

BACKGROUND: The United Kingdom has had a significant increase in addiction to and use of cocaine among 16-29-year olds from 6% in 1998 to 10% in 2000. In 2000, the United Kingdom had the highest recorded consumption of "recent use" cocaine in Europe, with 3.3% of young adults. Acupuncture is quick, inexpensive, and relatively safe, and may establish itself as an important addiction service in the future. AIM: To select investigations that meet the inclusion criteria and critically appraise them in order to answer the question: "Is acupuncture effective in the treatment of cocaine addiction?" The focus shall then be directed toward the use of the National Acupuncture Detoxification Association (NADA) protocol as the intervention and the selection of sham points for the control group. DATA SOURCES: The ARRC database was accessed from Trina Ward (M. Phil. student) at Thames Valley University. AMED, MEDLINE and Embase were also accessed along with "hand" searching methods at the British Library. INCLUSION AND EXCLUSION CRITERIA: People addicted to either cocaine or crack cocaine as their main addiction, needle-acupuncture, single-double-blinded process, randomized subjects, a reference group incorporating a form of sham points. EXCLUSION CRITERIA: use of moxibustion, laser acupuncture, transcutaneous electrical nerve stimulation (TENS) electroacupuncture or conditions that did not meet the inclusion criteria. QUALITY ASSESSMENT: The criteria set by ter Riet, Kleijnen and Knipschild (in 1990); Hammerschlag and Morris (in 1990); Koes, Bouter and van der Heijden (in 1995), were modified into one set of criteria consisting of 27 different values. RESULTS: Six randomized controlled trials (RCTs) met the inclusion criteria and were included in this review. All studies scored over 60 points indicating a relatively adequate methodology quality. The mean was 75 and the standard deviation was 6.80. A linear regression analysis did not yield a statistically significant association (n = 6, p = 0.11). CONCLUSIONS: This review could not confirm that acupuncture was an effective treatment for cocaine abuse. The NADA protocol of five treatment points still offers the acupuncturist the best possible combination of acupuncture points based upon Traditional Chinese Medicine. Throughout all the clinical trials reviewed, no side-effects of acupuncture were noted. This paper calls for the full set of 5 treatment points as laid out by the NADA to be included as the treatment intervention. Points on the helix, other than the liver yang points, should be selected as sham points for the control group.

Acupuncture Points↗

PubMed2002

A comparison of young, middle-aged, and older adult treatment-seeking pathological gamblers.

PURPOSE: Pathological gambling is an increasing public health concern, but very little is known about this disorder in older adults. This study evaluated gambling and psychosocial problems across age groups in treatment-seeking gamblers. DESIGN AND METHODS: At intake to gambling treatment programs, 343 pathological gamblers completed the Addiction Severity Index (ASI) and gambling questionnaires. Participants were categorized by age into young adults (ages 18-35 years; n = 97), middle-aged adults (ages 36-55 years, n = 197), and older adults (aged older than 55 years, n = 49). Differences in demographics, gambling variables, and ASI composite scores were compared across the groups. RESULTS: The middle- and older age gamblers were more likely to be female (45%-55%) than were the younger gamblers (23%), but the groups were similar with respect to most other demographic variables. When controlled for gender, older age was associated with increased employment problems, but fewer social, legal, and substance-abuse difficulties. Compared with middle-aged gamblers, older gamblers wagered on fewer days. Age x Gender effects emerged in onset of gambling problems and amount spent gambling. Older women did not begin gambling regularly until an average age of 55 years, whereas older male gamblers generally reported a lifelong history of gambling. The older female gamblers also wagered the greatest amounts in the month prior to treatment entry. IMPLICATIONS: These data suggest that older adults compose a minority of treatment-seeking gamblers, but differences in psychosocial problems across the age groups may suggest the need for interventions tailored to particular issues encountered by older pathological gamblers. Specifically, treatments focusing on later life development of problems may be indicated for older female gamblers.

Adult↗