Journal of Gambling Studies

, Volume 22, Issue 3, pp 321–328 | Cite as

A Comment on the Utility of Prevalence Estimates of Pathological Gambling

  • Blasé Gambino


The case is presented that researchers interested in policy aimed at treating the pathological gambler need to shift focus to improving the utility of prevalence estimates. It is argued that researchers supplement prevalence estimates with practical and well-defined measures of severity and other predictors and correlates of help-seeking. The dimension of severity is emphasized as one means of providing estimates that are relevant to policy makers when placed in the context of additional measures that improve their meaning and utility. Estimates may then be partitioned along these dimensions to ascertain the proportion of gamblers most likely to need or seek treatment for gambling-related disorders. The recommendations provided are subject to a number of possible objections and are presented in the interest of stimulating further discussion such as the distinction between symptom assessment and the measurement of severity.


Prevalence Pathological gambling Public health policy Utility Severity Disability 


  1. Abbott, M. W., Williams M. M., & Volberg, R. A. (1999). Seven years on: A follow-up study of frequent and problem gamblers living in the community. Report No. 2 of the New Zealand Gaming Survey. Wellington, New Zealand: Department of Internal Affairs.Google Scholar
  2. Blaszczynski, A., Ladouceur, R., & Shaffer, H. J. (2004). A science-based framework for responsible gambling. Journal of Gambling Studies, 20, 301–317.CrossRefGoogle Scholar
  3. Clarke, D. M., & McKenzie, D. P. (1994). A caution on the use of cut-points applied to screening instruments or diagnostic criteria. Journal of Psychiatric Research, 28, 185–188.CrossRefGoogle Scholar
  4. Cunningham-Williams, R. M., & Cottler, L. B. (2001). The epidemiology of pathological gambling. Seminars in Clinical Neuropsychiatry, 6, 155–166.CrossRefGoogle Scholar
  5. Cunningham-Williams, R. M., Cottler L. B., & Womack, S. B. (2004). Epidemiology. In J. E. Grant & M. N. Potenza (Eds.), Pathological gambling: A clinical guide to treatment (pp. 25–36). Washington, DC: American Psychiatric Publishing.Google Scholar
  6. Derevensky, J. L., Gupta, R., & Dickson, L. (2004). Prevention and treatment of adolescent problem and pathological gambling. In J. E. Grant & M. N. Potenza (Eds.), Pathological gambling: A clinical guide to treatment (pp. 159–168). Washington, DC: American Psychiatric Publishing.Google Scholar
  7. Derevensky, J. L., Gupta, R., & Winters, K. (2003). Prevalence rates of youth gambling problems: Are the current rates inflated? Journal of Gambling Studies, 19, 405–425.CrossRefGoogle Scholar
  8. Eisen, S. A., Lin, N., Lyons, M. J., et al. (1998). Familial influences on gambling behavior: An analysis of 3359 twin pairs. Addiction, 93, 1375–1384.CrossRefGoogle Scholar
  9. Evans, R. I. (2003). Some theoretical models and constructs generic to substance abuse prevention programs for adolescents: Possible relevance and limitations for problem gambling. Journal of Gambling Studies, 19, 287–302.CrossRefGoogle Scholar
  10. Finlayson, T. L., Moyer, C. A., & Sonnad S. S. (2004). Assessing symptoms, disease severity, and quality of life in the clinical context: A theoretical framework. The American Journal of Managed Care, 10, 336–344.Google Scholar
  11. Gambino, B. (2004). To test or not to test that is the question. Weekly Addiction Gambling Education Report, 9, 1–16 (January).Google Scholar
  12. Gambino, B. (2005). Interpreting prevalence estimates of pathological gambling: Implications for policy. Journal of Gambling Issues, 14, 1–19.CrossRefGoogle Scholar
  13. Gordis, L. (1996). Epidemiology. Philadelphia: W.B. Saunders.Google Scholar
  14. Hadorn, D. C. (2000). Setting priorities for waiting lists: Defining our terms. Canadian Medical Association Journal, 163, 857–860.Google Scholar
  15. Hodgins, D. C., & el-Guebaly, N. (2000). Natural and treatment-assisted recovery from gambling problems: A comparison of resolved and active gamblers. Addiction, 95, 777–789.CrossRefGoogle Scholar
  16. Ibanez, A., Blanco, C., Donahue, E., Lesieur, H. R., Perez de Castro, I., Fernandez-Piqueras, J., & Saiz-Ruiz, J. (2001). Psychiatric comorbidity in pathological gamblers seeking treatment. American Journal of Psychiatry, 158, 1733–1735.CrossRefGoogle Scholar
  17. Jenkins, R. (2003). Making psychiatric epidemiology useful: The contribution of epidemiology to government policy. International Review of Psychiatry, 15, 188–200.CrossRefGoogle Scholar
  18. Kessler, R. C. (2002). Epidemiologic perspectives for the development of future diagnostic systems. Psychopathology, 35, 158–161.CrossRefGoogle Scholar
  19. Kessler, R. C., et al. (1996). The twelve-month prevalence and correlates of serious mental illness (SMI). In R. W. Manderscheid & M. A. Sonnenschein (Eds.), Mental health, United States (pp. 96–3098). DHHS Pub. no (SMA) 96-3098. Washington, DC: U.S. Government Printing Office.Google Scholar
  20. Kessler, R. C., Merikangas, K. R., Berglund, P., Eaton, W. W., Koretz, D. S., & Walters, M. S. (2003). Mild disorders should not be eliminated from the DSM-V. Archives of General Psychiatry, 60, 1117–1122.CrossRefGoogle Scholar
  21. Koeter, M. J. W., de Fuentes-Merillas, L., Schippers, G. M., & van den Brink, W. (2003). Severity of gambling addiction: Development of a new assessment instrument. World Psychiatry, 2(Supplement 1).Google Scholar
  22. Korn, D. A., & Shaffer, H. J. (2004). Practice guidelines for treating gambling-related problems. Boston: Massachusetts Council on Compulsive Gambling.Google Scholar
  23. Ladd, G., & Petry, N. M. (2003). A comparison of pathological gamblers with and without substance abuse histories. Experimental Clinical Psychopharmacology, 11, 202–209.CrossRefGoogle Scholar
  24. Lesieur, H. R., & Blume, S. B. (1987). South Oaks Gambling Screen (SOGS): A new instrument for the identification of pathological gamblers. American Journal of Psychiatry, 144, 1184–1188.Google Scholar
  25. Lopez, A. D. (2003). Evidence and information for health policy: A decade of change. Medical Journal of Australia, 179, 396–397.Google Scholar
  26. Mechanic, D. (2002). Removing barriers to care among persons with psychiatric symptoms. Health Affairs, 21, 137–147.CrossRefGoogle Scholar
  27. Mechanic, D. (2003). Is the prevalence of mental disorders a good measure of the need for services? Health Affairs, 22, 8–20.CrossRefGoogle Scholar
  28. Narrow, W. E., Rae, D. S., Robins, L. S., & Regier, D. A. (2002). Revised prevalence estimates of mental disorders in the United States: Using a clinical significance criterion to reconcile 2 survey estimates. Archives of General Psychiatry, 59, 115–123.CrossRefGoogle Scholar
  29. Nathan, P. E. (2003). The role of natural recovery in alcoholism and pathological gambling. Journal of Gambling Studies, 19, 279–286.CrossRefGoogle Scholar
  30. Newman, S. C., & Thompson, A. H. (2003). A population-based study of the association between pathological gambling and attempted suicide. Suicide and Life Threatening Behavior, 33, 80–87.CrossRefGoogle Scholar
  31. Oakley-Browne, M. A., Adams, P., & Mobberley, P. M. (2002). Interventions for pathological gambling (Cochrane Review), The Cochrane Library (p. 23). Oxford: Update Software.Google Scholar
  32. O’Conner, R. (2004). Measuring quality of life in health. London: Elsevier.Google Scholar
  33. Orford, J., Sproston, K., & Erens, B. (2003). SOGS and DSM-IV in the British gambling prevalence survey: Reliability and factor structure. International Gambling Studies, 3, 53–65.CrossRefGoogle Scholar
  34. PA-05-037 (December, 30, 2004). Functional assessment of people with mental disorders. Available at http://grants, Scholar
  35. Petry N. M., & Armentano, C. (1999). Prevalence, assessment, and treatment of pathological gambling: A review. Psychiatric Services, 50, 1021–1027.Google Scholar
  36. Petry, N. M., & Kiluk, B. D. (2002). Suicidal ideation and suicide attempts in treatment-seeking pathological gamblers. Journal of Nervous & Mental Disease, 190, 462–469.CrossRefGoogle Scholar
  37. Pincus, H. A., Zarin, D. A., & First, M. (1998). “Clinical significance” and DSM IV. Archives of General Psychiatry, 55, 1145.CrossRefGoogle Scholar
  38. Potenza, M. N., Steinberg, M. A., McLaughlin, S. D., Rounsaville, B. J., & O’Malley, S. S. (2000). Illegal behaviors in problem gambling: Analysis of data from a gambling helpline. Journal of American Academy of Psychiatry and Law, 28, 389–403.Google Scholar
  39. Poulin, C. (2002). An assessment of the validity and reliability of the SOGS-RA. Journal of Gambling Studies, 18, 67–93.CrossRefGoogle Scholar
  40. Productivity Commission (1999). Australia’s gambling industries. Report No. 10, AusInfo, Canberra, Australia.Google Scholar
  41. Rockloff, M. J., & Schofield, G. (2004). Factor analysis of barriers to treatment for problem gambling. Journal of Gambling Studies, 20, 121–126.CrossRefGoogle Scholar
  42. Rosenbaum, J. F., & Pollack, R. A. (2002). DSM-V – Plans and perspectives. Program and abstracts of the American Psychiatric Association, 155th Annual Meeting; May 18–23, Philadelphia: PA.Google Scholar
  43. Schmitz, N., Kruse, J., & Tress, W. (2000). Application of stratum-specific likelihood ratios in mental health screening. Social Psychiatry & Psychiatric Epidemiology, 35, 375–379.CrossRefGoogle Scholar
  44. Shaffer, H. J., & Hall, M. N. (2002). The natural history of gambling and drinking Problems among casino employees. The Journal of Social Psychology, 142, 405–424.CrossRefGoogle Scholar
  45. Shaffer, H. J., & Kidman, R. (2004). Gambling and the public health. In J. E. Grant & M. N. Potenza (Eds.), Pathological gambling: A clinical guide to treatment (pp. 3–23). Washington, DC: American Psychiatric Publishing.Google Scholar
  46. Shaffer, H. J. & Korn, D. A. (2002). Gambling and related mental disorders: A public health analysis. Annual Review of Public Health, 23, 171–212.CrossRefGoogle Scholar
  47. Shaffer, H. J., Hall, M. N., & Vanderbilt, J. (1997). Estimating the prevalence of disordered gambling in the United States and Canada: A meta-analysis. Boston: Division on Addictions, Harvard Medical School.Google Scholar
  48. Shaffer, H. J., LaBrie, R. A., LaPlante, D. A., Nelson, S. E., & Stanton, M. V. (2004). The road less traveled: Moving from distribution to determinants in the study of gambling epidemiology. Canadian Journal of Psychiatry, 49, 504–516.Google Scholar
  49. Shah, K. R., Potenza, M. N., & Eisen, S. A. (2004). Biological basis for pathological gambling. In J. E. Grant & M. N. Potenza (Eds.), Pathological gambling: A clinical guide to treatment (pp. 127–142). Washington, DC: American Psychiatric Publishing.Google Scholar
  50. Slutske, W. S., Eisen, S., True, W. R., Lyons, M. J., Goldberg, J., & Tsuang, M. (2000). Common genetic vulnerability for pathological gambling and alcohol dependence in men. Archives of General Psychiatry, 57, 666–673.CrossRefGoogle Scholar
  51. Slutske, W. S., Jackson, K. M., & Sher, K. J. (2003). The natural history of problem gambling from age 18 to 29. Journal of Abnormal Psychology, 112, 263–274.CrossRefGoogle Scholar
  52. Spitzer, R. L. (1998). Diagnosis and need for treatment are not the same. Archives of General Psychiatry, 55, 120.CrossRefGoogle Scholar
  53. Stinchfield, R., & Winters, K. C. (2001). Outcome of Minnesota’s gambling treatment programs. Journal of Gambling Studies, 17, 191–215.CrossRefGoogle Scholar
  54. Strong, D. R., Breen, R. B., Lesieur, H. R., & Lejuez, C. W. (2003). Using the Rasch model to evaluate the South Oaks Gambling Screen for use with nonpathological gamblers. Addictive Behavior, 28, 1465–1472.CrossRefGoogle Scholar
  55. Tavares, H., Zilberman, M. L., Beites, F. J., & Gentil, V. (2001). Brief communications. Gender differences in gambling progression. Journal of Gambling Studies, 17, 151–159.CrossRefGoogle Scholar
  56. Toce-Gerstein, M., Gerstein, D. R., & Volberg, R. A. (2003). A hierarchy of gambling disorders in the community. Addiction, 98, 1661–1672.CrossRefGoogle Scholar
  57. Toneatto, T. (2005). A perspective on problem gambling treatment: Issues and challenges. Journal of Gambling Studies, 21, 75–80.CrossRefGoogle Scholar
  58. Tremayne, K., Masterman-Smith, H., & McMillen, J. (2001). Survey of the nature and extent of gambling and problem gambling in the ACT. Australian Institute for Gambling Research, University of Western Sydney.Google Scholar
  59. Ustun, T. B., & Rehm, J. (1998). Limitations of diagnostic paradigm: It doesn’t Explain need. Archives of General Psychiatry, 55, 1145–1146.CrossRefGoogle Scholar
  60. Vogel, D. L., & Wester, S. R. (2003). To seek help or not to seek help: The risks of self-disclosure. Journal of Counseling Psychology, 50, 351–361.CrossRefGoogle Scholar
  61. Volberg, R. A. (2004). Fifteen years of problem gambling prevalence research: What do we know? Where do we go? The Electronic Journal of Gambling Issues, 10, 1–19.Google Scholar
  62. Wakefield, J. C., & Spitzer, R. L. (2002). Lowered estimates—but of what? Archives of General Psychiatry, 59, 129–130.CrossRefGoogle Scholar
  63. Walters, G. D. (2001). Behavior genetic research on gambling and problem gambling: A preliminary meta-analysis of available data. Journal of Gambling Studies, 17, 255–271.CrossRefGoogle Scholar
  64. Welte, J. W., Barnes, G. M., Wieczorek, W. F., Tidwell, M., & Parker, J. (2001). Alcohol and gambling among U.S. adults: Prevalence, demographic patterns and comorbidity. Journal of Studies on Alcohol, 62, 706–712.Google Scholar
  65. Welte, J. W., Barnes, G. M., Wieczorek, W. F., Tidwell, M., & Parker J. (2002). Gambling participation in the U.S. Results from a national survey. Journal of Gambling Studies, 18, 313–337.CrossRefGoogle Scholar
  66. Welte, J. W., Barnes, G. M., Wieczorek, W. F., Tidwell, M., & Parker, J. (2004). Risk Factors for pathological gambling. Addictive Behaviors, 29, 323–335.CrossRefGoogle Scholar
  67. WHO (2004). Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. Journal of the Medical Association, 291, 2581–2590.CrossRefGoogle Scholar
  68. Winters, K. C., Specker, S., & Stinchfield, R. (1997). Brief manual for use of the diagnostic interview for gambling severity. Minneapolis, MN: University of Minnesota Medical School.Google Scholar
  69. Winters, K. C., Stinchfield, R. D., Botzet, A., & Anderson, N. (2002). A prospective study of youth gambling behaviors. Psychology of Addictive Behaviors, 16, 3–9.CrossRefGoogle Scholar
  70. Yaffee, R. C. (1990). Severity of compulsive gambling and co-addiction in Maryland. Prepared for the Maryland Task Force on Gambling Addiction. Available at Scholar

Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  1. 1.BostonUSA

Personalised recommendations