Problem and Pathological Gambling in Schizophrenia: Exploring Links with Substance Use and Impulsivity
High rates of both problem and pathological gambling (PPG) and substance-use disorders (SUDs) have been reported in schizophrenia, and yet PPG frequently goes undetected in clinical practice and unexamined in research. Here, we aimed to examine the relationship between PPG and SUDs in a large sample of patients across several factors related to both gambling and substance use, including poly-substance use. Additionally, delay discounting is a form of impulsivity known to positively associate with both PPG and SUDs and thought to underlie mechanisms of addiction in both contexts. We aimed to investigate the relationship between PPG and delay discounting in schizophrenia. 337 individuals with schizophrenia completed structured face-to-face interviews regarding gambling behaviors, substance use, and delay discounting. PPG in schizophrenia was associated with substance use, in particular with poly-substance use, and with delay discounting among males. Factors related to substance use were strongly linked with gambling in this sample, but not always with PPG more than recreational gambling. Our findings overall support the notions that multiple forms of gambling in schizophrenia are clinically relevant, that gambling may share common substrates with substance use, and that delay discounting represents a potential mechanism of this association in males.
KeywordsDelay discounting Addiction Behavioral addiction Psychosis Schizophrenia
Supported in part by: (1) the Veterans Administration, (2) the National Center for Responsible Gaming, (3) the National Center on Addiction and Substance Abuse, and (4) the Connecticut Department of Mental Health and Addiction Services. The funding agencies did not provide input into the content of the manuscript beyond the Grant funding.
Compliance with Ethical Standards
Conflict of interest
The authors report no conflicts of interests with respect to the content of this manuscript. Dr. Potenza has received financial support or compensation for the following. Dr. Potenza has consulted for Ironwood, Lundbeck, Shire, INSYS, RiverMend Health, Opiant/Lakelight Therapeutics, and Jazz Pharmaceuticals; has received research support from Mohegan Sun Casino, the National Center for Responsible Gaming, and Pfizer pharmaceuticals; has participated in surveys, mailings or telephone consultations related to drug addiction, impulse control disorders or other health topics; has consulted for law offices and gambling entities on issues related to impulse control disorders; provides clinical care in the Connecticut Department of Mental Health and Addiction Services Problem Gambling Services Program; has performed grant reviews for the National Institutes of Health and other agencies; has guest-edited 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.
The investigation was conducted in accordance with the Declaration of Helsinki, and the study design was approved by the institutional review boards of the West Haven VA in Connecticut and Yale University. Thus, all procedures were in accordance with the ethical standards of the institutional review boards and with the 1964 Helsinki declaration and its later amendments.
- Association, A. P. (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TR. American Psychiatric Publishing, Inc.Google Scholar
- Cunningham-Williams, R. M., Cottler, L. B., Compton, W., 3rd, & Spitznagel, E. L. (1998). Taking chances: Problem gamblers and mental health disorders–results from the St. Louis Epidemiologic Catchment Area Study. American Journal of Public Health, 88(7), 1093–1096.CrossRefPubMedPubMedCentralGoogle Scholar
- Dursun, S. M., Szemis, A., Andrews, H., Whitaker, P., & Reveley, M. A. (2000). Effects of clozapine and typical antipsychotic drugs on plasma 5-HT turnover and impulsivity in patients with schizophrenia: A cross-sectional study. Journal of Psychiatry and Neuroscience, 25(4), 347.PubMedPubMedCentralGoogle Scholar
- Fager, M. (2007). How does one measure gambling problems. International Journal of Testing, 6, 25–39.Google Scholar
- Gerstein, D., Hoffmann, J., Larison, C., Engelman, L., Murphy, S., Palmer, A., et al. (1999). Gambling impact and behavior study. Report to the National Gambling Impact Study Commission. Chicago: National Opinion Research Center at the University of Chicago.Google Scholar
- Martin, C. A., Milich, R., Martin, W. R., Hartung, C. M., & Haigler, E. D. (1997). Gender differences in adolescent psychiatric outpatient substance use: Associated behaviors and feelings. Journal of the American Academy of Child and Adolescent Psychiatry, 36(4), 486–494.CrossRefPubMedGoogle Scholar
- Robins, L., Cottler, L., Bucholz, K., & Compton, W. (1995). Diagnostic interview schedule for dsm-iv (dis-iv). St. Louis: Washington University.Google Scholar
- Verdejo-García, A., Lawrence, A. J., & Clark, L. (2008). Impulsivity as a vulnerability marker for substance-use disorders: Review of findings from high-risk research, problem gamblers and genetic association studies. Neuroscience and Biobehavioral Reviews, 32(4), 777–810.CrossRefPubMedGoogle Scholar
- Zhornitsky, S., Rizkallah, É., Pampoulova, T., Chiasson, J.-P., Lipp, O., Stip, E., et al. (2012). Sensation-seeking, social anhedonia, and impulsivity in substance use disorder patients with and without schizophrenia and in non-abusing schizophrenia patients. Psychiatry Research, 200(2), 237–241.CrossRefPubMedGoogle Scholar