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Published in final edited form as: Drug Alcohol Depend. 2008 Nov 20;100(1-2):164–168. doi: 10.1016/j.drugalcdep.2008.09.011

The relationship between recreational gambling and substance abuse/dependence: Data from a nationally representative sample

Timothy Liu a, Paul K Maciejewski a, Marc N Potenza a,b
PMCID: PMC2656572  NIHMSID: NIHMS93785  PMID: 19022590

Abstract

Background

Although recreational gambling is prevalent and co-occurs with substance abuse/dependence, few studies have investigated the relationship between the two.

Methods

Logistic regression analyses were performed on data from a nationally representative sample from the Gambling Impact and Behavior Study.

Results

Substance-abusing recreational gamblers, as compared to non-substance-abusing ones, differed in gambling motivations, began gambling at earlier ages, reported heavier gambling, and preferred and performed strategic forms of gambling.

Conclusions

As compared with non-substance-abusing gamblers, substance-abusing gamblers demonstrated different gambling profiles including heavier gambling. These findings suggest the need for additional research on whether and how substance use might promote gambling and vice-versa.

Keywords: recreational gamblers, substance abuse, gambling motivations, impulsivity, national survey

1. Introduction

Most adults have gambled within the past-year (National Research Council, 1999). As the proportion that experiences problem/pathological gambling is small (Petry, 2007), an improved understanding of recreational gambling has significant public health implications (Shaffer and Korn, 2002).

Recreational gambling has been associated with substance use and psychiatric disorders across age groups (Desai et al., 2007; Desai et al., 2004; Desai et al., 2005; Martins et al., 2007; Pietrzak et al., 2007) and gender (Desai et al., 2005; Martins et al., 2008; Potenza et al., 2006). Among types of substance abuse/dependence, alcohol has been most associated with recreational gambling (Desai et al., 2007; Desai et al., 2004; Desai et al., 2005; Duhig et al., 2006; Pietrzak et al., 2007). Motivational factors, such as excitement-seeking, have been associated with heavier gambling and substance abuse amongst recreational gamblers (Pantalon et al., 2008). These studies suggest a robust relationship between substance use and recreational gambling, warranting a study of gambling behaviors in substance abusers as compared to non-abusers.

Data from the Gambling Impact and Behavior Study (GIBS) were used to examine relationships between substance abuse/dependence and socio-demographic and gambling measures among recreational gamblers. We hypothesized that substance-abusing recreational gamblers as compared to non-substance-abusing ones would have different gambling patterns and preferences, engage in heavier gambling, have earlier ages at gambling onset, gamble more frequently for excitement, and more frequently prefer and perform strategic forms of gambling typically involving competitive risk-taking.

2. Method

2.1. Sampling and Study Design

The GIBS surveyed a nationally representative sample of 2,417 adults taken from the telephone component of the civilian household population of the U.S., which covered 95% of U.S. households (Gerstein et al., 1999). It employed National Opinion Research Center’s (NORC) standard sampling method for random-digit-dialing (RDD) surveys stratified by state lottery status (state lottery, no state lottery)–a list-assisted approach which covers almost 98% of telephone households with small non-coverage bias (Brick et al, 1995; Gerstein et al., 1999). The RDD sampling ensured that the sample within each stratum was representative of that stratum. The number of telephone numbers obtained within each stratum was directly proportional to the stratum’s population with no over-sampling, and no demographic groups were under- or over-represented (Gerstein et al., 1999). A RDD sample of 9,200 telephone numbers was purchased from Survey Sampling Inc., 4,358 of which were classified as working residential numbers eligible for interview, and 3,281 were successfully screened to select one household adult for interview (using a variant of the Troldahl-Carter-Bryant method). Finally 2,417 interviews were completed (screening completion rate=75.3%; post-screening completion rate=73.7%; final cooperation rate=55.5%) (Gerstein et al., 1999).

In this study, the GIBS-RDD sample was restricted to past-year recreational gamblers with complete data for all socio-demographic measures presented in Table 1 (N=1,390). Past-year gamblers omitted due to missing socio-demographic data (87 of 1,477 gamblers=5.9%) did not significantly differ from those included in the study with respect to any socio-demographic measure presented in Table 1.

Table 1.

Sociodemographic characteristics of substance abusing and non-substance abusing past-year recreational gamblers (N = 1,390)

Variable Category Substance Abusing Past-year Recreational Gamblers (%) N = 142 Non-Substance Abusing Past-year Recreational Gamblers (%) N = 1,248 Chi Square df P Value
Age 18 – 29 52.1 20.3 14.14 4 < .0001
30 – 39 20.9 25.4
40 – 49 18.4 21.6
50 – 64 4.8 18.6
> 65 3.8 14.1
Gender Female 31.3 51.2 48.83 1 < .0001
Male 68.7 48.8
Race/Ethnicity Caucasian 75.4 73.1 1.75 3 0.627
African American 8.5 8.6
Hispanic 7.9 11.3
Other 8.3 7.0
Education Under 12 years 7.2 10.3 2.57 2 0.277
12 years 27.0 30.3
Over 12 years 65.9 59.4
Marital Status Married/cohabitating 38.7 61.9 54.52 3 < .0001
Divorced/separated 9.4 11.0
Never married 51.4 23.3
Widowed 0.5 3.9
Employment Full time 73.2 65.0 4.40 2 0.111
Part time 9.8 10.4
Unemployed 17.0 24.6
Income < 24K 22.3 27.2 6.75 3 0.080
24K – 50K 28.5 32.6
50K – 100K 33.7 30.7
100K 15.5 9.5
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Note: Sample sizes (N) listed indicate sum of sample weights.

2.2. Survey Measures

2.2.1. Recreational, problem and pathological gambling

Problem and pathological gambling were defined as acknowledgement of three or four or five or more (respectively) past-year or lifetime DSM-IV–based diagnostic criteria for pathological gambling (American Psychiatric Association, 1994), as assessed by the NORC-DSM Screen, shown, in limited testing, to have strong internal consistency, test-retest reliability and validity in identifying pathological gamblers (Gerstein et al., 1999). Past-year recreational gambling was defined as any betting or game-playing involving money stakes in the last year which did not fulfill the criteria for problem/pathological gambling.

2.2.2. Substance abuse/dependence

Participants were classified as having “Past-year substance abuse/dependence” if they met three or more DSM-IV criteria for substance dependence as implemented in the National Household Survey on Drug Abuse (e.g., questions about tolerance, withdrawal, and adverse medical, social, and psychiatric consequences of use) (Gerstein et al., 1999). Respondents needed to meet a threshold criterion of non-medical use of a substance (not including nicotine or caffeine) on ≥ 5 days in the previous year in order to be queried about DSM-IV criteria for dependence (Gerstein and Toce, 1999). This definition for “Past-year substance abuse/dependence” has been used in this fashion in previous publications (Desai et al., 2004; Desai et al., 2005; Duhig et al., 2006). Substances targeted included marijuana/hashish, cocaine/crack, stimulants like methamphetamine, amphetamines or speed, tranquilizers such as alprazolam for non-medical uses.

2.2.3. Socio-demographic measures

Socio-demographic variables were derived directly from questions in the GIBS (Gerstein and Toce, 1999) and presented in Table 1.

2.2.4. Gambling measures

Gambling measures were adapted directly from the GIBS (Gerstein and Toce, 1999) with responses grouped as in Table 2. Strategic, non-strategic and machine gambling were defined as previously done (Desai et al., 2004; Potenza et al., 2006). .

Table 2.

Factors distinguishing substance abusing and non-substance abusing past-year recreational gamblers (N = 1,390)

Group, Variable, Category Substance Abusing Past-year Recreational Gamblers (%) N = 142 Non-substance Abusing Past-year Recreational Gamblers (%) N = 1,248 Adjusted Odds Ratio 95% Confidence Interval P Value
Reasons for Gambling
 Gambling for social activity 51.6 36.5 1.69 1.17, 2.45 0.005
 Gambling for personal services 21.5 20.2 1.01 0.65, 1.57 0.976
 Gambling to be around people 41.5 28.0 1.62 1.12, 2.37 0.012
 Gambling for excitement 59.2 35.9 2.03 1.40, 2.94 < .001
 Gambling to win money 76.7 61.3 1.73 1.13, 2.63 0.011
Patterns of Gambling
 Earliest age gambled less than 18 years 46.9 21.7 1.99 1.36, 2.92 < .001
 Gambled at least once per month in past year 61.2 48.3 1.90 1.30, 2.78 0.001
 Usually gamble with someone 73.6 63.2 1.59 1.06, 2.41 0.027
 Largest win in past year > $100 62.1 49.2 1.81 1.24, 2.64 0.002
 Largest loss in past year > $100 44.0 28.4 1.84 1.27, 2.69 0.001
Types of Gambling Performed
 Strategic, any 56.6 26.6 2.70 1.86, 3.93 < .0001
 Non-strategic, any 80.3 86.2 0.72 0.45, 1.15 0.163
 Machine, any 25.8 20.0 1.46 0.96, 2.23 0.078
 Casino, past year 44.0 39.8 1.24 0.86, 1.78 0.258
 Non-casino, past year 94.3 92.4 1.18 0.55, 2.53 0.679
Favorite Type of Gambling
 Strategic 47.2 27.1 1.82 1.25, 2.65 0.002
 Non-strategic 33.8 50.3 0.64 0.43, 0.94 0.022
 Machine 16.9 25.6 0.82 0.51, 1.32 0.407
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Note: Sample sizes (N) listed indicate sum of sample weights. The number of missing data (based on sum of sample weights) for each variable are as follows: social activity (3), personal services (7), to be around people (4), for excitement (2), earliest age ever gambled (6), frequency gambled in past year (8), gamble with someone (14), largest win (19), favorite type strategic (1), favorite type non-strategic (1), and favorite type machine (1). All other variables have no missing values. Odds ratios adjusted for age, gender, and marital status.

2.3. Data Analysis

Individuals missing information on gambling status (n=4) or with past-year or lifetime problem/pathological gambling (n=51) were excluded to generate a sample consisting of past-year recreational gamblers and past-year non-gamblers. Substance-abusing past-year recreational gamblers were compared to non-substance-abusing ones on socio-demographic and gambling measures. Statistical analyses were performed using the weight variable (scaled to the actual sample size in our study, N=1,390) provided by the GIBS. This weight variable makes adjustments associated with the RDD sampling methodology, as described in the GIBS documentation (Gerstein et al., 1999). To be consistent with the statistics reported in the Tables, sample sizes (N) were reported based on sum of sample weights. Use of the sample weights has no impact on the inferences drawn. Every statistical test that is significant in an analysis using the sample weights reported is also significant in an analysis not using the sample weights.

Socio-demographic characteristics that were significantly associated with past-year substance abuse (i.e., age, gender and marital status) were included as covariates in the multiple logistic regression models. All parameter estimates for associations consisted of odds ratios which were tested for significance using a Wald chi-square test.

3. Results

The sample consisted of 1,390 past-year recreational gamblers, among which 142 were substance-abusing.

3.1. Socio-demographic characteristics

Substance-abusing and non-substance-abusing gamblers differed on age, gender and marital status. Substance-abusers were younger and had a larger proportion of males. Fewer substance-abusers were married/cohabitating and more were never married (Table 1).

3.2. Gambling measures

3.2.1. Reasons for gambling

Compared to non-substance-abusing gamblers, higher proportions of substance-abusers endorsed gambling for social activity, to be around people, for excitement and to win money (Table 2).

3.2.2. Gambling patterns

Higher proportions of substance-abusing gamblers, as compared to non-abusers, began gambling before 18 years; gambled at least once a month; had largest maximal daily wins and losses in the past year of >$100; and endorsed usually gambling with someone (Table 2).

Larger proportions of substance-abusers favored and performed strategic forms of gambling. Conversely, a higher proportion of non-abusers preferred non-strategic gambling (Table 2).

4. Discussion

This study represents the first to our knowledge to use a large, nationally representative sample to investigate systemically relationships between substance abuse/dependence and gambling measures among recreational gamblers. Results support our hypothesis that, as compared to non-substance-abusing gamblers, substance-abusing ones have different gambling motivations and engage in heavier gambling.

4.1. Socio-demographic characteristics

Substance-abusing gamblers were younger and more likely to be male and never married. Gender differences in gambling behaviors and co-morbidities have been previously reported (Blanco et al., 2006; Desai et al., 2005; Potenza et al., 2006). Our results are consistent with a NESARC study which found that male gamblers not meeting criteria for pathological gambling were more likely to have substance use disorders (Blanco et al., 2006). As men and male gamblers frequently score high on sensation-seeking measures (Zuckerman et al., 1993; McDaniel and Zuckerman, 2003), male sensation-seeking may underlie engagement in multiple risk-taking behaviors.

Our results are consistent with previous observation that young adults are more likely than older adults to participate in multiple risk-taking activities (Gupta and Derevensky, 2000; Potenza, 2003). Neurobiological data linking the neurodevelopmental stage of young adults, excitement-seeking, and engagement in risk-taking behaviors are emerging and warrant further investigation (Chambers and Potenza, 2003; Chambers et al., 2003).

4.2. Gambling behaviors

Substance-abusing and non-substance-abusing recreational gamblers reported different gambling-related motivations, preferences and behaviors. These characteristics may be interrelated.

4.2.1. Monetary motivation and gambling behaviors

Consistent with previous research (Coman et al., 1997; Lee et al., 2007; Mississippi State University Gambling Group, 1995), “to win money” was the most commonly endorsed reason to gamble, particularly amongst substance abusers. Financial problems associated with substance abuse may contribute to the motivation to gamble for money. Such motivation may contribute to substance abusers’ heavier gambling, given previous research showing that monetary motivations may exercise greater influences than other motivations on gambling severity (Coman et al., 1997; Neighbors et al., 2002).

4.2.2. Excitement-seeking and gambling behaviors

Our findings that substance-abusers more frequently endorsed gambling for excitement, gambled more heavily, and preferred and performed strategic gambling may be interrelated. First, previous studies associated excitement-seeking with higher gambling frequency (Kuley and Jacobs, 1988; McDaniel and Zuckerman, 2003), larger size of bets (Anderson and Brown, 1984), and loss of control over gambling (Coventry and Hudson, 2001), Second, strategic gambling involves competitive interaction which may be particularly closely related to excitement or impulse dyscontrol. Together, the results suggest that substance-abusing recreational gamblers may have particularly poor impulse control and be particularly prone to multiple risk behaviors. Impulse dyscontrol may represent a common construct linking risk behaviors, consistent with studies of behavioral measures in substance abusers/gamblers (Petry, 2001a; Petry, 2001b), biological correlates of impulsivity (e.g., low 5-hydroxyindoleacetic acid levels) (Asberg et al., 1976; Coccaro et al., 1989; Nordin and Eklundh, 1999; Potenza, 2001), and treatment development strategies (Grant and Potenza, 2006).

4.2.3. Socialization motivation

Socialization has been suggested as an important motivation in substance use (Cooper et al., 1992; Fite et al., 2006; Neighbors et al., 2002) and gambling (Lynch et al., 2004; Jacobs, 2000). Substance abusers’ frequent endorsement of socialization motivation may reflect social skill deficits that may contribute to excessive substance use and represent a target for intervention (Monti et al., 1981; Van Hasselt et al., 1993).

4.2.4. Age at gambling onset

Underage gambling (Shaffer and Hall, 1996) appears particularly common among substance abusers. Given that adult pathological gamblers typically have gambling onset before adulthood (Volberg, 1994), and that existing data associate early gambling onset with heavier gambling and more severe psychosocial and substance abuse problems (Burge et al., 2006; Lynch et al., 2004; National Research Council, 1999; Volberg, 1994), substance-abusing recreational gamblers may be at significant risk for developing gambling problems. Longitudinal studies to investigate temporal relationships of substance use and gambling are needed since multiple non-mutually exclusive hypotheses exist. Substance abuse onset may be secondary to excitement/stress from gambling. Conversely, substances may lead to disinhibition and onset of gambling. Alternatively, both may be manifestations of underlying impulse dyscontrol.

4.3 Limitations and Strengths

The study’s cross-sectional design does not allow for examination of causal relationships in observed associations. Biases related to incorrect reporting of information by respondents may exist. Diagnostic interviews were not performed to assess psychiatric conditions. The well-designed, RDD methodology and the large, nationally representative sample are strengths of the study.

5. Conclusions

Differences in gambling motivations, age at gambling onset, and intensity and types of gambling between substance-abusing and non-substance-abusing recreational gamblers found in this study suggest overall heavier gambling in substance abusers. Differences in motivations suggest that winning money, socializing and experiencing excitement are all particularly relevant reasons for gambling amongst substance abusers. Additional research is needed from longitudinal studies to examine relationships between substance use and gambling.

Footnotes

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