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The National Center for Responsible Gaming launchedwww.CollegeGambling.orgthis week as part of its ongoing efforts to develop tools to help higher education institutions address gambling disorders and responsible gaming on campus. The first site of its kind, CollegeGambling.org is a comprehensive resource to help current and prospective students, campus administrators, campus health professionals and parents address gambling and gambling-related harms on campus. The site is a valuable resource for those interested in learning more about college gambling, including information about responsible gaming for students of legal age to gamble and resources for those who may encounter problems. As a part of this launch, the NCRG sat down with Patricia Ketcham, Ph.D., CHES, chair of the CollegeGambling.org Advisory Committee, to learn her perspective on the new site.

NCRG:How did the vision for the CollegeGambling.org resource come about?

PK:It all started with the Task Force on College Gambling. The NCRG and the Division on Addictions at the Cambridge Health Alliance (a teaching affiliate of Harvard Medical School) began the Task Force in 2008 to examine research findings and real-world experiences in student health and university policy issues to develop science-based campus gambling policies.

At that time, the Task Force worked to combine scientific research findings and real-world university experiences to develop science-based recommendations about gambling that would help higher education institutions. We published those recommendations in 2009 in a report titledA Call to Action;Addressing College Gambling: Recommendations for Science-Based Policies and Programs.When completing that report, we realized that universities didn’t have access to tools ready for them to discuss gambling issues with their students. We first wanted to expand the resources to a unique niche – college administrators, students and their parents. Thus, the foundation for CollegeGambling.org was created.

NCRG:What was your role in development of CollegeGambling.org?

PK:The entire Task Force provided content and feedback for the site from our 2009 report and the scientific research findings on student health. We also included other information we gathered from our experiences at our various universities. We watched as CollegeGambling.org began to take shape and offered suggestions along the way. We wanted to make sure that it gave help current and prospective students, campus administrators, campus health professionals and parents the help they really need.

NCRG:What is most exciting for you about the launch of CollegeGambling.org?

PK:For me, there are two aspects of this website that I’m very excited about. First, it is another step toward making sure that more campus administrators and health professionals are aware of the issues. In many cases, gambling problems were not on the radar for many university administrators in their campus policy issues. Currently in the United States, only 22 percent of colleges and universities have formal policies on gambling. Students who admit to having a problem sometimes find a lack of support on campus. An important piece of this resource is to simply heighten the issue on a campus level.

Second, CollegeGambling.org is the first site of its kind for students and their parents. It is a comprehensive resource for those who want to learn more about college gambling, especially discussing what responsible gaming looks like for students who can legally gamble and sharing information with those who want to know more about resources to help those who may have gambling problems. It also opens up conversations between students and parents that may not have happened before.

NCRG:What do you see in the future of CollegeGambling.org?

PK:As the body of literature continues to expand about this subject area, the website will be charged with keeping pace with progress and movement on these issues. We are hopeful that many will refer to it as a key resource in their campus communities, and will continue to find up-to-date information on CollegeGambling.org as it is available.

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Patricia Ketcham, Ph.D., CHES is the Associate Director of Health Promotion, Student Health Services at Oregon State University. With more than 20 years experience in college health, she is also a member of the Task Force on College Gambling Policies and the chair of the CollegeGambling.org Advisory Committee.

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Stories about a recent study on gambling and alcohol use across the lifespan have begun popping up around the Internet with contradictory titles like“Gambling Problems Are More Common Than Drinking Problems, According To First-Of-Its-Kind Study”and“Are Gambling Problems More Common than Drinking Problems? Maybe Not”. The study, published in theJournal of Gambling Studies,is from the Research Institute on Addictions at the University at Buffalo, N.Y.(Welte, Barnes, Tidwell, & Hoffman, 2010). The study is primarily about patterns of gambling behavior across the lifespan compared to patterns of alcohol use and other potentially problematic behaviors, but the researchers also report findings that compare gambling and alcohol problems in the general population. These differences have caused some confusion on the issue.

The researchers state that “after age 21 problem gambling is considerably more common than alcohol dependence” (Welte et al., 2010, p. 57). At first, this statement seems to be at odds with previously published research. It is generally accepted that the rate of alcohol dependence is about double that of pathological gambling (Keyes, Geier, Grant, & Hasin, 2009; Stucki & Rihs-Middel, 2007).

However, a look at the definitions the researchers use explains the apparent discrepancy. The “problem gambling” they refer to is defined as anyone who endorses three or more items on the Diagnostic Interview Schedule (DIS) for the DSM-IV,the handbook for psychiatric disorder in the United States (American Psychiatric Association, 1994). This is a standard way to define problem gambling, a less severe form of the disorder, with pathological gambling being defined as endorsing “five or more criteria,” as the researchers state in the methods section of the paper (Welte et al., 2010, p. 53). The researchers found this broadest definition of problem and pathological gambling to be between 3 and 5 percent for people ages 22 to 60. This is in line with previous research on the subject.

The confusion comes from comparing this broadest definition of disordered gambling with a narrow definition of alcohol disorders. Like gambling disorders, alcohol use disorders are categorized by severity. Alcohol abuse is the less severe disorder while alcohol dependence is the most severe, and the two together are called alcohol use disorders. One of the largest studies of alcohol use disorders is the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) (Hasin, Stinson, Ogburn, & Grant, 2007). The NESARC is a nationally representative survey consisting of face-to-face interviews with more than 43,000 Americans. The NESARC found that people ages 30 to 44 suffered from alcohol abuse at 6 percent and alcohol dependence at 3.8 percent, for a total alcohol use disorder rate of 9.7 percent. When the rate of 9.7 percent is compared with the combined rate of problem and pathological gambling in the Welte et al. study, about 4.5 percent, we find that alcohol use disorders are about double gambling disorders. Note that Welte et al. divided their age groups differently, so this analysis combines the 31-40 and 41-50 groups.

The researchers at the University of Buffalo did not discuss the discrepancies in definitions in their study. However, their larger discussion of alcohol use and gambling across the lifespan is an interesting one that certainly deserves more in-depth study.

More information about the University of Buffalo study is available on theJournal of Gambling Studieswebsite. As always, we welcome your thoughts and questions in the Comments section below.

References

American Psychiatric Association. (1994).DSM-IV: Diagnostic and Statistical Manual of Mental Disorders. Washington, DC: American Psychiatric Association.

Hasin, D. S., Stinson, F. S., Ogburn, E., & Grant, B. F. (2007). Prevalence, correlates, disability, and comorbidity of DSM-IV alcohol abuse and dependence in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions.Archives of General Psychiatry,64(7), 830-842. doi:10.1001/archpsyc.64.7.830

Keyes, K. M., Geier, T., Grant, B. F., & Hasin, D. S. (2009). Influence of a drinking quantity and frequency measure on the prevalence and demographic correlates of DSM-IV alcohol dependence.Alcoholism, Clinical and Experimental Research,33(5), 761-771. doi:10.1111/j.1530-0277.2009.00894.x

Stucki, S., & Rihs-Middel, M. (2007). Prevalence of Adult Problem and Pathological Gambling between 2000 and 2005: An Update.Journal of Gambling Studies / Co-Sponsored by the National Council on Problem Gambling and Institute for the Study of Gambling and Commercial Gaming. doi:10.1007/s10899-006-9031-7

Welte, J. W., Barnes, G. M., Tidwell, M. O., & Hoffman, J. H. (2010). Gambling and Problem Gambling Across the Lifespan.Journal of Gambling Studies / Co-Sponsored by the National Council on Problem Gambling and Institute for the Study of Gambling and Commercial Gaming. doi:10.1007/s10899-010-9195-z

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TheTask Force on College Gambling Policiesissued a report in 2009 recommending that student health professionals screen for gambling problems among students engaged in risky behaviors. Since the release of this report, new research has been published that provides evidence that a single question can open up information about risky behaviors.

For example, alcohol use by college students – and binge drinking in particular – has been associated with a range of risky behaviors, including gambling. A new study published in theAmerican Journal on Addictionsprovides further evidence of this link by focusing on thequalityof drinking behavior rather than on thequantityof alcohol consumed , which is the typical measure used by researchers to identify students at risk for alcohol-related problems (Pedrelli et al., 2010). Specifically, this study examined compulsive drinking, described as “persistent thoughts about alcohol, inability to control alcohol consumption, and a compulsive drive to consume alcohol” (Pedrelli et al., 2010, p. 15). The authors of the study hypothesized that this behavior would be associated with an increased likelihood of substance use, unsafe sex and gambling.

The 904 study participants were undergraduates at three universities in various regions who were predominantly female (54.8 percent), Caucasian (57.1 percent) and living on campus (39.5 percent). They were asked questions from the Consumptive Habits Questionnaire (Guidi et al., 2009). One question asked respondents to report on whether they engaged in a number of risky behaviors, including compulsive use of street drugs, prescription drugs, alcohol and caffeine and activities such as compulsive gambling.

Both females and males who reported compulsive alcohol use were at a greater risk for risky behaviors. However, while males in this group were more likely to gamble, there was no statistically significant association in females between compulsive drinking and gambling.

The authors offered several possible reasons for the link between compulsive drinking and risky behaviors: the pharmacological effect of alcohol and drugs in lifting inhibitions; the possibility that problematic behaviors share a biological foundation; shared personality traits such as sensation-seeking and impulsivity; and that students who report compulsive drinking might be more at ease reporting on other risky behaviors.

The practical implications of these findings suggest that researchers can identify the risky behaviors with a single question, which bodes well for enabling college student health professionals to identify potentially problematic behaviors. The authors explained, “In light of the limited resources available on college campuses overall, and in particular in settings where screening can be conducted such as at health centers, asking about compulsive drinking may represent a helpful strategy to identify high-risk college students” (Pedrelli et al., 2010, p.19).

References

Guidi, J., Pender, M., Hollon, S.D., et al. (2009). The prevalence of compulsive eating and exercise among college students: An exploratory study.Psychiatry Research, 165, 154-162.

Pedrelli, P., Bitran, S., Shyu, I., Baer, L., Guidi, J., Tucker, D. D., et al. (2010). Compulsive alcohol use and other high-risk behaviors among college students.American Journal on Addictions, 20(1), 14-20.

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Addiction researchers have found associations between numerous addictive behaviors, with individuals often being involved with many addictive substances and behaviors at the same time. Though this relationship is common, it is not well understood. The intermingling relationships of less thoroughly studied addictive behaviors, such as gambling and prescription drug misuse (PDM), are particularly unclear. A recent study led by Cheryl Currie, a Ph.D. candidate at the University of Alberta, Canada, was published in theCanadian Journal of Psychiatryand explores the relationship between prescription drug misuse, demographics and addictive behaviors including gambling (Currie, Schopflocher, & Wild, 2011). Currie won the Outstanding Poster Award at the 2010 NCRG Conference on Gambling and Addiction, and discussed early findings from this study with us in anaudio interviewconducted at the conference.

The researchers surveyed a representative sample of 3,511 adults living in Alberta, Canada, about their PDM, illicit drug and alcohol use and abuse, tobacco use, gambling behavior and demographics. They found that 8.2 percent of Albertans had misused a prescription drug in the previous 12 months, and the strongest demographic predictors for PDM were disabled status, younger age, and high school graduates with no college experience. These correlations are not unexpected, as younger people use more illicit drugs generally, and disabled persons use more prescription drugs than adults generally (e.g. to control pain). What was not expected was the strong relationship between PDM and problem gambling.

After disabled status, problem gambling was the second strongest predictor for PDM, with problem gamblers misusing prescription drugs three times more often than others. This finding is unexpected because PDM is a form of substance abuse, and it would be logical to assume that people who misuse prescription drugs might also abuse other substances like alcohol or cannabis. In fact, alcohol and cannabis dependenceismore common in people with past-12-month PDM, but gambling is the most common addictive predictor of PDM in this study.

Since the relationship between gambling and PDM has not yet been comprehensively examined, there is no way of knowing how or why the two behaviors interact. The authors suggest that problem gamblers may be misusing prescription drugs to “cope with gambling losses, deal with gambling urges, to stay awake while gambling, or they may engage in both PDM and gambling to escape other life stressors,” (Currie et al., 2011, p. 32). Certainly this surprising finding deserves more research attention as the complex relationships between addictive disorders are further explored.

More information on the article is available onthe journal’s website, and the full interview with Cheryl Currie can be heard on theGambling Disorders 360 post from November 15th. Are you surprised by these findings? Let us know in the Comments section below.

References

Currie, C. L., Schopflocher, D. P., & Wild, T. C. (2011). Prevalence and correlates of 12-month prescription drug misuse in alberta.Canadian Journal of Psychiatry. Revue Canadienne De Psychiatrie,56(1), 27-34.

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