Comorbidity is the simultaneous presence of two or more chronic diseases or conditions in a patient. In the case of someone with a gambling addiction, for example, this could mean they are also an alcoholic.

Problem gambling often stems from a complex mix of issues that your client may be experiencing, including inter-personal, intra-personal and health challenges.

In many cases, problem gambling does not occur in isolation. It often occurs in company with a range of other co-presenting and co-morbid issues, including:

    • Depression
    • Anxiety
    • Alcohol and drug issues
    • Bad health
    • Domestic violence
    • Homelessness
    • Financial hardship
    • Legal problems
    • Unemployment
    • Relationship breakdown1

While technically comorbid disorders must exist at the same time, it’s possible that one of the conditions or disorders may have started before the other. For example, someone may first develop an alcohol problem and then later become a gambling addict as well. Or, both conditions may develop at the same time, but one may stop while the other continues.2

During the period of time when symptoms of both disorders overlap, they are considered to be comorbid.2

What the Primary Care Clinician Should Know about Comorbidity with Gambling

Gambling and Substance Abuse:

    • The rate of current and lifetime substance abuse is higher among problem gamblers than that of the general population.
    • There is a strong correlation between severity of substance use and severity of problem gambling; higher rates and severity of substance use are predictive of more severe gambling problems and vice versa.
    • The degree of substance abuse may be a telling factor in those who gamble recreationally and those who have a gambling problem. The greater the number of substances used, the more likely severe gambling problems are experienced.
    • Those with problem gambling behavior often have increased impulsivity, antisocial tendencies and the inability to control anger.
    • Gambling at an earlier age increases the risk for multiple addictions and risky behavior.
    • Those with gambling problems and comorbid substance use may make poor decisions because of increased impulsivity.
    • The inability to accurately assess risk and impaired impulse control often occurs with gambling and substance abuse orders.
    • Higher rates of gambling relapse may occur when there is a failure to treat comorbid substance use disorders.
    • People with comorbid substance use and gambling problems are more likely to report other psychiatric histories.3

Gambling and Mental Disorders:

    • High rates of gambling are often associated with mental health problems. Most problem gamblers have more than one psychiatric disorder.
    • While there is correlation between comorbid problem gambling and other mental disorders, a causative relationship has not yet been determined.
    • The activity of gambling may relieve other conditions, such as anxiety and depression.
    • The early onset of gambling addiction is often associated with pre-existing depression.
    • Gambling may worsen mental disorders such as depression and anxiety.
    • People who have major mental disorders and are socially isolated are most at risk for problem gambling.
    • Behavioral and motivational treatment of problem gambling has been shown to reduce use of psychiatric medication, suggesting that anxiety and depression may be secondary to gambling, at least in some people.
    • Women are more likely to use gambling to escape depressed moods and anxiety. Women with a gambling addiction are also significantly more likely to seek treatment for their mood or anxiety disorder.
    • Mood disorders are more common in problem gamblers than they are in the general population.
    • People with bipolar disorder are more likely to have a gambling addiction than the general population.
    • There is a correlation between those with high rates of anxiety and those with more severe gambling problems.
    • People with gambling problems have increased rates of obsessive compulsive disorder.
    • Problem gambling is highly correlated with a variety of personality disorders, including antisocial, borderline and obsessive compulsive personality disorders.
    • Impulse control disorders (including kleptomania, impulsive shopping and impulsive sexual behavior) and purging type eating disorders3 have high comorbidity with problem gambling.

Gambling and Suicide:

    • Suicide thoughts and suicide attempts are much more likely to occur with problem gamblers than with the general population.
    • Early onset problem gambling is associated with increased risk of suicide.
    • Actual gambling-related suicide attempts are more likely to be made by older people.
    • The risk of suicide in people with gambling problems3 is increased by comorbid substance use and comorbid mental disorders.

Approaches to Those with Gambling Comorbidity:

    • The effectiveness of treatment for a gambling problem is not diminished by a history of substance use and mental disorders.
    • People predisposed to have a gambling problem or substance use should be careful to avoid replacing one addiction with another.
    • Lithium*** has been shown to significantly reduce gambling thoughts, urges and manic behavior for people with gambling problems and bipolar spectrum disorder.
    • SSRIs as a combined treatment may be effective in treating co-occurring anxiety and gambling* as well as depression.3

For more information on comorbidity and mental health, please see here:

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