Skip to main content

Advertisement

SpringerLink
Log in

Prevalence and Clinical Characteristics of Recreational and At-Risk/Problematic Gambling Among Low-Income U.S. Veterans: Results from the National Veteran Homeless and Other Poverty Experiences (NV‐HOPE) Study

  • Original Paper
  • Published:
Journal of Gambling Studies Aims and scope Submit manuscript

Abstract

This study examined associations between recreational gambling (RG) and at-risk/problem gambling (ARPG), and clinical measures of mental illness and substance use, functionality, homelessness, in a nationally representative sample of U.S. military veterans. Data were analyzed from 781 veterans who participated National Veteran Homeless and Other Poverty Experiences (NV-HOPE) study conducted in 2021. Chi-square tests, analyses of variance (ANOVAs) and logistic regressions analyses were conducted to examine unadjusted and adjusted associations between gambling group status and sociodemographic, psychiatric, substance use, functioning, and homelessness measures. A significant minority of low-income U.S. veterans reported gambling, with 24.9% (95% confidence interval [CI] 95% CI 21.12–28.76%) exhibiting RG and 6.7% (95% CI 3.88–9.42%) screening positive for ARPG. The prevalence of ARPG was higher among younger, non-White veterans. ARPG was associated with greater symptoms of substance use and anxiety; poorer physical functioning; history of any mental illness; lifetime history of homelessness; and having any student or car loans relative to NG. Veterans who had RG were more likely to screen positive for drug use disorders relative to NG. Results of the current study provide an up-to-date estimate of the current prevalence of RG and ARPG among low-income U.S. veterans and underscore the importance of routine screening, monitoring, and development of interventions for problematic gambling severity, as well as interventions for ARPG in this population. These findings may inform targeted intervention strategies for this vulnerable subpopulation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  • Billi, R., Stone, C. A., Abbott, M., & Yeung, K. (2015). The Victorian Gambling Study (VGS) a longitudinal study of gambling and health in Victoria 2008–2012: Design and methods. International Journal of Mental Health and Addiction, 13(2), 274–296.

    Article  Google Scholar 

  • Blais, R. K., Tsai, J., Southwick, S. M., & Pietrzak, R. H. (2015). Barriers and facilitators related to mental health care use among older veterans in the United States. Psychiatric Services, 66(5), 500–506.

    Article  PubMed  Google Scholar 

  • Bovin, M. J., Marx, B. P., Weathers, F. W., Gallagher, M. W., Rodriguez, P., Schnurr, P. P., & Keane, T. M. (2016). Psychometric properties of the PTSD checklist for diagnostic and statistical manual of mental disorders–fifth edition (PCL-5) in veterans. Psychological Assessment, 28(11), 1379.

    Article  PubMed  Google Scholar 

  • Britt, T. W. (2000). The stigma of psychological problems in a work environment: Evidence from the screening of service members returning from Bosnia 1. Journal of Applied Social Psychology, 30(8), 1599–1618.

    Article  Google Scholar 

  • Castrén, S., Kontto, J., Alho, H., & Salonen, A. H. (2018). The relationship between gambling expenditure, socio-demographics, health-related correlates and gambling behaviour—A cross-sectional population-based survey in Finland. Addiction, 113(1), 91–106.

    Article  PubMed  Google Scholar 

  • Cowlishaw, S., Metcalf, O., Lawrence-Wood, E., Little, J., Sbisa, A., Deans, C., O’Donnell, M., Sadler, N., Van Hooff, M., Crozier, M., & Battersby, M. (2020). Gambling problems among military personnel after deployment. Journal of Psychiatric Research, 131, 47–53.

    Article  PubMed  Google Scholar 

  • Desai, R. A., Desai, M. M., & Potenza, M. N. (2007). Gambling, health and age: Data from the National Epidemiologic Survey on Alcohol and Related Conditions. Psychology of Addictive Behaviors, 21(4), 431.

    Article  PubMed  Google Scholar 

  • Desai, R. A., Maciejewski, P. K., Dausey, D. J., Caldarone, B. J., & Potenza, M. N. (2004). Health correlates of recreational gambling in older adults. American Journal of Psychiatry, 161(9), 1672–1679.

    Article  PubMed  Google Scholar 

  • Deutscher, K., Gutwinski, S., Bermpohl, F., Bowden-Jones, H., Fazel, S., & Schreiter, S. (2022). The prevalence of problem gambling and gambling disorder among homeless people: A systematic review and meta-analysis. Journal of Gambling Studies, 66, 1–16.

    Google Scholar 

  • Dighton, G., Roberts, E., Hoon, A. E., & Dymond, S. (2018). Gambling problems and the impact of family in UK armed forces veterans. Journal of Behavioral Addictions, 7(2), 355–365.

    Article  PubMed  PubMed Central  Google Scholar 

  • Dowling, N. A., Merkouris, S. S., Dias, S., Rodda, S. N., Manning, V., Youssef, G. J., Lubman, D. I., & Volberg, R. A. (2019). The diagnostic accuracy of brief screening instruments for problem gambling: A systematic review and meta-analysis. Clinical Psychology Review, 74, 101784.

    Article  CAS  PubMed  Google Scholar 

  • Edens, E. L., Kasprow, W., Tsai, J., & Rosenheck, R. A. (2011). Association of substance use and VA service-connected disability benefits with risk of homelessness among veterans. The American Journal on Addictions, 20(5), 412–419.

    Article  PubMed  Google Scholar 

  • Edens, E. L., & Rosenheck, R. A. (2012). Rates and correlates of pathological gambling among VA mental health service users. Journal of Gambling Studies, 28(1), 1–11.

    Article  PubMed  Google Scholar 

  • Etuk, R., Shirk, S. D., Grubbs, J., & Kraus, S. W. (2020). Gambling problems in US military veterans. Current Addiction Reports, 7(2), 210–228.

    Article  Google Scholar 

  • Goldstein, R. B., Dawson, D. A., Chou, S. P., & Grant, B. F. (2012). Sex differences in prevalence and comorbidity of alcohol and drug use disorders: Results from wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Studies on Alcohol and Drugs, 73(6), 938–950.

    Article  PubMed  PubMed Central  Google Scholar 

  • Guralnik, J. M., Ferrucci, L., Pieper, C. F., Leveille, S. G., Markides, K. S., Ostir, G. V., Studenski, S., Berkman, L. F., & Wallace, R. B. (2000). Lower extremity function and subsequent disability: Consistency across studies, predictive models, and value of gait speed alone compared with the short physical performance battery. The Journals of Gerontology Series a: Biological Sciences and Medical Sciences, 55(4), M221–M231.

    Article  CAS  PubMed  Google Scholar 

  • Hamilton-Wright, S., Woodhall-Melnik, J., Guilcher, S. J., Schuler, A., Wendaferew, A., Hwang, S. W., & Matheson, F. I. (2016). Gambling in the landscape of adversity in youth: Reflections from men who live with poverty and homelessness. International Journal of Environmental Research and Public Health, 13(9), 854.

    Article  PubMed  PubMed Central  Google Scholar 

  • Hardy, S. E., & Gill, T. M. (2004). Recovery from disability among community-dwelling older persons. JAMA, 291(13), 1596–1602.

    Article  CAS  PubMed  Google Scholar 

  • Harris, T., Kintzle, S., Wenzel, S., & Castro, C. A. (2017). Expanding the understanding of risk behavior associated with homelessness among veterans. Military Medicine, 182(9–10), e1900–e1907.

    Article  PubMed  Google Scholar 

  • Hierholzer, R., Vu, H., & Mallios, R. (2010). Pathological gambling in Combat veterans. Federal Practitioner, 27(8–12), 14–15.

    Google Scholar 

  • Holdsworth, L., & Tiyce, M. (2013). Untangling the complex needs of people experiencing gambling problems and homelessness. International Journal of Mental Health and Addiction, 11(2), 186–198.

    Article  Google Scholar 

  • Lan, C. W., Fiellin, D. A., Barry, D. T., Bryant, K. J., Gordon, A. J., Edelman, E. J., Gaither, J. R., Maisto, S. A., & Marshall, B. D. (2016). The epidemiology of substance use disorders in US Veterans: A systematic review and analysis of assessment methods. The American journal on addictions, 25(1), 7–24.

    Article  PubMed  Google Scholar 

  • Lesieur, H., & Blume, S. (1987). The South Oaks Gambling Screen (SOGS): A new.

  • Muggleton, N., Parpart, P., Newall, P., Leake, D., Gathergood, J., & Stewart, N. (2021). The association between gambling and financial, social and health outcomes in big financial data. Nature Human Behaviour, 5(3), 319–326.

    Article  PubMed  Google Scholar 

  • Nower, L., Eyrich-Garg, K. M., Pollio, D. E., & North, C. S. (2015). Problem gambling and homelessness: Results from an epidemiologic study. Journal of Gambling Studies, 31(2), 533–545.

    Article  PubMed  Google Scholar 

  • Pauli, I. B., Kennedy, C. H., Jones, D. E., McDonald, W. A., & Grayson, R. (2012). Substance abuse services and gambling treatment in the military. Military Psychology: Clinical and Operational Applications, 66, 251–280.

    Google Scholar 

  • Pickernell, D., Keast, R., Brown, K., Yousefpour, N., & Miller, C. (2013). Taking the gamble: Local and regional policy issues of access to electronic gaming machines (EGMs): A case study of Victoria, Australia. Australasian Journal of Regional Studies, 19(2), 274–294.

    Google Scholar 

  • Pietrzak, R. H., Morasco, B. J., Blanco, C., Grant, B. F., & Petry, N. M. (2007). Gambling level and psychiatric and medical disorders in older adults: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. The American Journal of Geriatric Psychiatry, 15(4), 301–313.

    Article  PubMed  Google Scholar 

  • Potenza, M. N., Wareham, J. D., Steinberg, M. A., Rugle, L., Cavallo, D. A., Krishnan-Sarin, S., & Desai, R. A. (2011). Correlates of at-risk/problem internet gambling in adolescents. Journal of the American Academy of Child & Adolescent Psychiatry, 50(2), 150–159.e153.

  • Potenza, M. N., Maciejewski, P. K., & Mazure, C. M. (2006). A gender-based examination of past-year recreational gamblers. Journal of Gambling Studies, 22, 41–64.

    Article  PubMed  Google Scholar 

  • Raisamo, S., Toikka, A., Selin, J., & Heiskanen, M. (2019). The density of electronic gambling machines and area-level socioeconomic status in Finland: A country with a legal monopoly on gambling and a decentralised system of EGMs. BMC Public Health, 19(1), 1–7.

    Article  Google Scholar 

  • Rumpf, H.-J., Hapke, U., Meyer, C., & John, U. (2002). Screening for alcohol use disorders and at-risk drinking in the general population: Psychometric performance of three questionnaires. Alcohol and Alcoholism, 37(3), 261–268.

    Article  PubMed  Google Scholar 

  • Saldanha, K., & Madangopal, D. (2019). The social dimensions of gambling among street youth in Mumbai: Is it really an addiction? Qualitative Social Work, 18(2), 265–285.

    Article  Google Scholar 

  • Sanacora, R. L., Whiting, S. W., Pilver, C. E., Hoff, R. A., & Potenza, M. N. (2016). Relationships between problem-gambling severity and psychopathology as moderated by income. Journal of Behavioral Addictions, 5(3), 429–438.

    Article  PubMed  PubMed Central  Google Scholar 

  • Saunders, J. B., Aasland, O. G., Babor, T. F., De la Fuente, J. R., & Grant, M. (1993). Development of the alcohol use disorders identification test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption-II. Addiction, 88(6), 791–804.

    Article  CAS  PubMed  Google Scholar 

  • Sharman, S. (2019). Gambling and homelessness: Prevalence and pathways. Current Addiction Reports, 6(2), 57–64.

    Article  Google Scholar 

  • Sharman, S., Butler, K., & Roberts, A. (2019). Psychosocial risk factors in disordered gambling: A descriptive systematic overview of vulnerable populations. Addictive Behaviors, 99, 106071.

    Article  PubMed  Google Scholar 

  • Sharman, S., & D’Ardenne, J. (2018). Gambling and homelessness: Developing an information sheet, screening tool and resource sheet. GambleAware.

    Google Scholar 

  • Sharman, S., Dreyer, J., Aitken, M., Clark, L., & Bowden-Jones, H. (2015). Rates of problematic gambling in a British homeless sample: A preliminary study. Journal of Gambling Studies, 31, 525–532.

    Article  PubMed  Google Scholar 

  • Sharman, S., Dreyer, J., Clark, L., & Bowden-Jones, H. (2016). Down and out in London: Addictive behaviors in homelessness. Journal of Behavioral Addictions, 5(2), 318–324.

    Article  PubMed  PubMed Central  Google Scholar 

  • Stefanovics, E. A., Potenza, M. N., & Pietrzak, R. H. (2017). Gambling in a national US veteran population: Prevalence, socio-demographics, and psychiatric comorbidities. Journal of Gambling Studies, 33(4), 1099–1120.

    Article  PubMed  Google Scholar 

  • Stefanovics, E. A., Potenza, M. N., Tsai, J., & Pietrzak, R. H. (2022). Prevalence and clinical characteristics of recreational and at-risk/problematic gambling in a national sample of US. Journal of gambling studies, 66, 1–21.

    Google Scholar 

  • Sulkunen, P., Babor, T. F., Cisneros Örnberg, J., Egerer, M., Hellman, M., Livingstone, C., Marionneau, V., Nikkinen, J., Orford, J., Room, R., & Rossow, I. (2021). Setting limits: Gambling, science and public policy—Summary of results. Addiction, 116(1), 32–40.

    Article  PubMed  Google Scholar 

  • Tsai, J. (2018). Lifetime and 1-year prevalence of homelessness in the US population: Results from the National Epidemiologic Survey on Alcohol and Related Conditions-III. Journal of Public Health, 40(1), 65–74.

    Article  PubMed  Google Scholar 

  • Tsai, J., & Hooshyar, D. (2022). Prevalence of eviction, home foreclosure, and homelessness among low-income US veterans: The National Veteran Homeless and Other Poverty Experiences study. Public Health, 213, 181–188.

    Article  CAS  PubMed  Google Scholar 

  • Tsai, J., & Kelton, K. (2023). Service use and barriers to care among homeless veterans: Results from the National Veteran Homeless and Other Poverty Experiences (NV-HOPE) study. Journal of Community Psychology, 6, 66.

    Google Scholar 

  • Tsai, J., Link, B., Rosenheck, R. A., & Pietrzak, R. H. (2016). Homelessness among a nationally representative sample of US veterans: Prevalence, service utilization, and correlates. Social Psychiatry and Psychiatric Epidemiology, 51(6), 907–916.

    Article  PubMed  Google Scholar 

  • Tsai, J., & Rosenheck, R. A. (2015). Risk factors for homelessness among US veterans. Epidemiologic Reviews, 37(1), 177–195.

    Article  PubMed  Google Scholar 

  • Turner-Bowker, D., & Hogue, S. (2014). Short form 12 health survey (SF-12). Encyclopedia of quality of life and well-being research (pp. 5954–5957).

  • Vandenberg, B., Livingstone, C., Carter, A., & O’Brien, K. (2021a). Gambling and homelessness in older adults: A qualitative investigation. Addiction, 6, 66.

    Google Scholar 

  • Vandenberg, B., Livingstone, C., Carter, A., & O’Brien, K. (2021b). Gambling and homelessness: A systematic review and meta-analysis of prevalence. Addictive Behaviors, 66, 107151.

    Google Scholar 

  • Vandenberg, B., Livingstone, C., Carter, A., & O’Brien, K. (2022). Gambling and homelessness: A systematic review and meta-analysis of prevalence. Addictive Behaviors, 125, 107151.

    Article  PubMed  Google Scholar 

  • Volberg, R. A., & Williams, R. J. (2011). Developing a brief problem gambling screen using clinically validated samples of at-risk, problem and pathological gamblers: Health Sciences.

  • Ware, J. E., GlaxoSmithKline, K. M., Dewey, J., & Gandek, B. (2001). How to score and interpret single-item health status measures: A manual for users of the of the SF-8 health survey: With a supplement on the SF-6 health survey. QualityMetric. Inc.

    Google Scholar 

  • Whiting, S. W., Potenza, M. N., Park, C. L., McKee, S. A., Mazure, C. M., & Hoff, R. A. (2016). Investigating veterans’ pre-, peri-, and post-deployment experiences as potential risk factors for problem gambling. Journal of Behavioral Addictions, 5(2), 213–220.

    Article  PubMed  PubMed Central  Google Scholar 

  • Wieczorek, Ł, Stokwiszewski, J., & Klingemann, J. I. (2019). Screening of problem gambling among a homeless population in Warsaw. Nordic Studies on Alcohol and Drugs, 36(6), 542–555.

    Article  Google Scholar 

  • Williams, R. J., Hann, R. G., Schopflocher, D. P., West, B. L., McLaughlin, P., White, N., King, K., & Flexhaug, T. (2015). Quinte longitudinal study of gambling and problem gambling. Ontario Problem Gambling Research Centre.

  • Williamson, V., Stevelink, S. A., Greenberg, K., & Greenberg, N. (2018). Prevalence of mental health disorders in elderly US military veterans: A meta-analysis and systematic review. The American Journal of Geriatric Psychiatry, 26(5), 534–545.

    Article  PubMed  Google Scholar 

  • Woodhall-Melnik, J., Hamilton-Wright, S., Guilcher, S. J., Wendaferew, A., Schuler, A., & Matheson, F. I. (2019). Reflections on poverty, Homelessness and problem gambling: Discoveries from a world cafe. Journal of Gambling Issues, 42, 66.

    Google Scholar 

Download references

Funding

This work was supported by the National Center for Homelessness for Veterans (NCHV). Dr. Stefanovics was supported by the Connecticut Council on Problem Gambling (CCPG), National Center for Homelessness for Veterans (NCHV) and the National Center for PTSD. Dr. Potenza was supported by the Connecticut Council on Problem Gambling. Drs. Tsai was supported by the National Center for Homelessness for Veterans (NCHV). This manuscript does not express the views of CCPG nor NCHV. The views and opinions expressed in this work are those of the authors.

Author information

Authors and Affiliations

  1. Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA

    Elina A. Stefanovics, Marc N. Potenza & Jack Tsai

  2. U.S. Department of Veterans Affairs New England Mental Illness Research and Education Clinical Center (MIRECC), VA Connecticut Healthcare System (116A-4), 950 Campbell Avenue, Building 36, West Haven, CT, 06516, USA

    Elina A. Stefanovics

  3. National Center on Homelessness Among Veterans, U.S. Department of Veterans Affairs, Tampa, FL, USA

    Elina A. Stefanovics & Jack Tsai

  4. Department of Management, Policy, and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA

    Jack Tsai

  5. Yale Child Study Center, Yale University, New Haven, CT, USA

    Marc N. Potenza

  6. Connecticut Mental Health Center, New Haven, CT, USA

    Marc N. Potenza

  7. Connecticut Council on Problem Gambling, Wethersfield, CT, USA

    Marc N. Potenza

  8. Department of Neuroscience, Yale University, New Haven, CT, USA

    Marc N. Potenza

  9. Wu Tsai Institute, Yale University, New Haven, CT, USA

    Marc N. Potenza

Authors
  1. Elina A. Stefanovics
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marc N. Potenza
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jack Tsai
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Elina A. Stefanovics.

Ethics declarations

Conflict of interest

The authors have no conflicts of interest to report. MNP discloses the following. MNP has consulted for Opiant Therapeutics, Game Day Data, the Addiction Policy Forum, AXA, Baria-Tek, and Idorsia Pharmaceuticals; has been involved in a patent application with Yale University and Novartis; has received research support from Mohegan Sun Casino, Children and Screens and the Connecticut Council on Problem Gambling; has participated in surveys, mailings or telephone consultations related to drug addiction, impulse-control disorders or other health topics; has consulted for and/or advised gambling and legal entities on issues related to impulse control, internet use and addictive disorders; has performed grant reviews for research-funding agencies; has edited journals and journal sections; has given academic lectures in grand rounds, CME events and other clinical or scientific venues; and has generated books or book chapters for publishers of mental health texts.

Ethical Approval and Informed Consent

All participants provided digital informe consent; the study protocl followed institutional security and human subject procedures and obtained ethical approval at Ipos. All study procedures were approved and perfome in accordance with the ethcal standards of the 1965 Declaration of Helsinki andlater amendments.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Stefanovics, E.A., Potenza, M.N. & Tsai, J. Prevalence and Clinical Characteristics of Recreational and At-Risk/Problematic Gambling Among Low-Income U.S. Veterans: Results from the National Veteran Homeless and Other Poverty Experiences (NV‐HOPE) Study. J Gambl Stud (2023). https://doi.org/10.1007/s10899-023-10257-4

Download citation

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s10899-023-10257-4

Keywords

Search

Navigation