DSM-IV Criteria For Pathological Gambling Research Articles

Gender Differences in Gambling Exposure and At-risk Gambling Behavior.

This study aimed to evaluate the differences in gambling exposure and onset of gambling problems among male and female gamblers by comparing their demographic and behavioral profiles. This study utilized data from the gambling section of the First Brazilian National Alcohol Survey and Related Behaviors. Interviews were conducted with 3007 participants who were recruited after screening for at-risk gambling behaviors. Individuals who tested positive for at-risk gambling behaviors completed the Gambling Progression Questionnaire comprising items on games of chance, and were evaluated using the DSM-IV pathological gambling criteria. The participants' "lifetime gambling exposure" was 12.5%, with 4% having experienced gambling problems during their lifetime. Majority of the male at-risk gamblers (78%) reported that they began gambling in their 20s and took approximately 3years to start experiencing gambling-related problems. Contrastingly, female at-risk gamblers started gambling in their 30s and they took about 12years to start experiencing gambling-related problems. The present results show that men were 2.3 times more at risk of gambling exposure and 3.6 times more likely to experience gambling-related problems. Male at-risk male gamblers seemed to be lonelier and to have a low socioeconomic status, while women seemed to have lower income and social insertion. Considering these significant differences, more studies evaluating gender differences in gambling behavior are necessary.

Cognitive Behavioural Group Therapy for Problem Gamblers who Gamble over the Internet: A Controlled Study

Several studies have found higher rates of problem gambling among Internet gamblers than non-Internet gamblers. Because of easy access and convenience, along with other gaming characteristics, many researchers in the field have advanced the argument that Internet gambling is potentially more addictive and problematic than land-based gambling activities. However, research examining the efficacy of treatments for problem gamblers who gamble over the Internet has not yet been conducted. The purpose of the present study was to examine the efficacy of group cognitive behavioural therapy for self-identified problem Internet gamblers. Thirty-two participants were randomly assigned to either the treatment group (n = 16) or wait list (delayed treatment) comparison group (n = 16). Results indicated that the treatment was efficacious in improving three of the four dependent variables from pre- to post-test/treatment: number of DSM-IV criteria for pathological gambling endorsed, perception of control over gambling, and number of sessions gambled. No significant pre- to post-test/treatment difference was found between groups on desire to gamble. Groups were combined to examine treatment outcome over time, with results showing significant pre- to post-treatment and pre- to three-month post-treatment improvement for all four dependent variables.

Investigating Veterans' Pre-, Peri-, and Post-Deployment Experiences as Potential Risk Factors for Problem Gambling.

Background and aimsGambling disorder and its comorbid diagnoses are observed at higher rates in military veterans than in the general population. A significant research gap exists regarding the relationships of veterans’ life and service experiences to problematic gambling. The present study explored pre-, peri-, and post-deployment factors associated with problem gambling in veterans.MethodsVeterans of Operation Iraqi Freedom, Operation Enduring Freedom, and Operation New Dawn (n = 738; 463 males, and 275 females) completed questionnaires via structured telephone interview. We conducted bivariate and multinomial logistic regression analyses exploring associations among problem-gambling severity and socio-demographic variables, psychiatric comorbidities, and 10 scales of the Deployment Risk and Resilience Inventory measuring experiences pre-, peri-, and post-deployment.ResultsApproximately 4.2% of veterans indicated at-risk or probable pathological gambling (ARPG) post-deployment (two or more DSM-IV criteria for pathological gambling). Bivariate analyses found more severe gambling in males, higher frequencies of post-traumatic stress disorder, substance dependence, traumatic brain injury, panic disorder, and depression in veterans with ARPG, and higher general harassment during deployment, and lower social support and more stressful life events post-deployment in those with ARPG. In multivariable models, both post-deployment factors remained significantly associated with ARPG.DiscussionThe study suggests that problem gambling among veterans is related to service experiences, and particularly to life experiences post-deployment.ConclusionsAdverse service and life experiences and lack of social support may contribute to the risk of problem gambling in military veterans. Investigation of how Veterans Affairs clinical settings may serve veterans following deployment to prevent behavioral addictions is warranted.

The Extent and Distribution of Gambling-Related Harms and the Prevention Paradox in a British Population Survey.

ObjectivesTo examine whether the “prevention paradox” applies to British individuals in relation to gambling-related harm.MethodsData were derived from 7,756 individuals participating in the British Gambling Prevalence Survey 2010, a comprehensive interview-based survey conducted in Great Britain between November 2009 and May 2010. Gambling-related harm was assessed using an adapted version of the DSM-IV Pathological Gambling criteria. The previous year’s prevalence of problem gamblers was examined using the Problem Gambling Severity Index. Gambling involvement was measured by gambling frequency and gambling participation (gambling volume as expressed by time and money spent gambling).ResultsThe prevalence rates for past-year gambling harms were dependence harm (16.4%), social harm (2.2%), and chasing losses (7.9%). Gambling-related harms were distributed across low- to moderate-risk gamblers (and not limited to just problem gamblers) and were reported by the majority of gamblers who were non-high time and spend regular gamblers than high time and spend regular gamblers.ConclusionsThe prevention paradox is a promising way of examining gambling-related harm. This suggests that prevention of gambling might need to consider the population approach to minimizing gambling harm.

Type of gambling as an independent risk factor for suicidal events in pathological gamblers.

Individuals with pathological gambling have an increased risk for suicidal events. Additionally, the prevalence of comorbid psychiatric disorders is high among pathological gamblers. This study analyzes whether the type of gambling is associated with suicidal events in pathological gamblers independently from comorbidity. Participants were recruited in 4 different ways: via random telephone sample from the general population, via individual invitation for study participation in gambling locations, through various media and the distribution of a leaflet in various settings, and via inpatient treatment facilities for pathological gambling. The final sample included 442 participants with a lifetime diagnosis of pathological gambling. A standardized clinical interview was conducted. High financial losses were associated with suicidal events (odds ratio [OR] = 1.94, 95% 95% confidence interval [CI], [1.11, 3.37]), as were mood disorders (OR = 7.70, 95% CI, [4.44, 13.37]) and female gender (OR = 2.52, 95% CI, [1.20, 5.28]). Gambling on electronic gambling machines in gambling halls or bars was associated with increased odds of suicidal events (OR = 2.94, 95% CI, [1.38, 6.24]). Other types of gambling, such as casino games or betting on sports, or the number of DSM-IV criteria for pathological gambling were not associated independently with suicidal events. Our findings suggest that gambling on electronic gambling machines in gambling halls or bars is associated with suicidal events in pathological gamblers independently of comorbidity. This result shows that the type of gambling needs to be considered as a relevant factor in gambling research.

Profiles of problem and non-problem gamblers, depending on their preferred gambling activity

Background and aims: The objective was to compare the gamblers’ profiles and practices depending on their preferred gambling activity, especially for two structural characteristics: presence of skill and expected value linked to the game. Another objective was to compare the profiles between non-problem and problem gamblers, and especially to identify how they evolve once problem gambling has emerged. Methods: Six hundred twenty-eight non-problem and problem gamblers were assessed with a structured interview, including sociodemographic characteristics, gambling habits, DSM-IV criteria for pathological gambling, gambling-related cognitions, personality profile, psychiatric comorbidities and Attention Deficit Hyperactivity Disorder. We used a stepwise logistic regression with backward elimination to compare gamblers’ profiles depending on: (1) the presence of skill in their favourite game, (2) the expected value of their favourite game. Each regression was performed twice, in non-problem and then in problem gamblers. Results: Contrary to what was expected, the gamblers’ profiles did not differ in gambling-related cognitions according to their chosen game, even at a problematic level of gambling. Problem gamblers of bank games of pure chance showed high levels of persistence and higher frequencies of suicidal risk, problem gamblers of bank games with an element on skill displayed more illegal acts, and gamblers of social games lost their cooperativeness profile on reaching a problematic level of gambling. Conclusions: Significant differences in the profiles of gamblers were identified based on their preferred gambling activity, especially in problem gamblers. Specific therapeutic and protective approaches which could be developed for these different profiles are proposed.

Gambling disorder in financial markets: Clinical and treatment-related features.

Background and AimsTo date, few studies have examined the clinical manifestation of disordered gamblers in financial markets. This study examined the differences in the clinical and treatment-related features of gambling disorder between financial markets and horse races.MethodsSubjects who met the DSM-IV criteria for pathological gambling (PG) and who sought treatment were assessed by retrospective chart review. One hundred forty-four subjects were included in this sample, which consisted of the following groups: financial markets (n = 45; 28.6%) and horse races (n = 99; 71.4%).ResultsMultiple similar manifestations were found between the groups, including severity of PG, age of PG onset, amounts of gambling debts, drinking days per week, depressive mood, duration of seeking treatment after the onset of PG, and treatment follow-up duration. However, disordered gamblers who invested in the financial market were significantly more likely to be educated (p = 0.003), live with their spouses (p = 0.007), have full-time jobs (p = 0.006), and they were more likely to participate in the first type of gambling than the horse races group (p<0.001). Furthermore, the financial markets group received the anti-craving medication less often than the horse races group (p = 0.04). Discussion and Conclusions: These findings suggest that disordered gamblers in financial markets show different socio-demographic, clinical and treatment-related features compared with the horse race gamblers, despite a similar severity of gambling disorder. Understanding these differential manifestations may provide insight into prevention and treatment development for specific types of gambling.

A Self-Help Manual for Problem Gamblers: the Impact of Minimal Therapist Guidance on Outcome

We tested the impact of minimal therapist guidance with a workbook designed to aid in reducing or stopping gambling. Randomly assigned participants recruited from the community who met at least 2 DSM-IV criteria for pathological gambling received a workbook completed with therapist guidance (WB+G) or a workbook (WB only). Both groups met with a research assistant to monitor chapter completion and for data collection at each study visit. We examined the proportion of participants reporting any gambling, money spent gambling, and G-SAS scores during treatment, at the end of treatment, and at 1-year follow-up. Abstinence rates were higher among those in the WB+G condition, money spent gambling was lower for the WB only group during treatment, and both groups reported fewer G-SAS gambling symptoms at treatment completion and follow up. The workbook with guidance increased abstinence from gambling while in treatment and at follow-up more than the workbook alone.

Correlates of gambling on high-school grounds

ObjectiveThis study examined adolescent gambling on school grounds (GS+) and how such behavior was associated with gambling-related attitudes. Further, we examined whether GS+ moderated associations between at-risk problem-gambling (ARPG) and gambling behaviors related to gambling partners. MethodParticipants were 1988 high-school students who completed survey materials. Demographic, perceptions, attitudes, and gambling variables were stratified by problem-gambling severity (ARPG versus recreational gambling) and GS+ status. Chi-square and adjusted logistic regression models were used to examine relationships among study variables. ResultsNearly 40% (39.58%) of students reported past-year GS+, with 12.91% of GS+ students, relative to 2.63% of those who did not report gambling on school grounds (GS−), meeting DSM-IV criteria for pathological gambling (p<0.0001). In comparison to GS− students, GS+ students were more likely to report poorer academic achievement and more permissive attitudes towards gambling behaviors. Weaker links in GS+ students, in comparison with GS−, students, were observed between problem-gambling severity and gambling with family members (interaction odds ratio (IOR)=0.60; 95% CI=0.39–0.92) and gambling with friends (IOR=0.21; 95% CI=0.11–0.39). ConclusionsGS+ is common and associated with pathological gambling and more permissive attitudes towards gambling. The finding that GS+ (relative to GS−) youth show differences in how problem-gambling is related to gambling partners (friends and family) warrants further investigation regarding whether and how peer and familial interactions might be improved to diminish youth problem-gambling severity. The high frequency of GS+ and its relationship with ARPG highlights a need for school administrators and personnel to consider interventions that target school-based gambling.

Suicidal ideation and suicide attempts in five groups with different severities of gambling: Findings from the National Epidemiologic Survey on Alcohol and Related Conditions.

Problem and pathological gamblers show high rates of suicidal behavior. However, previous research of suicide among this population has been inconsistent. Discrepancies may stem from methodological issues, including variable use of suicide nomenclature and selection bias in study samples. Furthermore, earlier research has rarely examined gambling severity aside from problem or pathological categories. This study utilized subgroups derived from a nationally representative data set, examining different characteristics of suicidal behavior and several gambling levels, including subclinical groups. Participants included 13,578 individuals who participated in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) and provided information on gambling behavior, lifetime suicidal ideation, and/or lifetime suicide attempts. Five gambling groups were derived using DSM-IV criteria for pathological gambling; non-gambling, low-risk gambling, at-risk gambling, problem gambling, and pathological gambling. Problem gambling was associated with suicidal ideation [adjusted odds ratio (AOR) = 1.64, 95% confidence interval (CI) = 1.19-2.26] and suicide attempts [(AOR) = 2.42, 95% (CI) = 1.60-3.67] after adjustment for sociodemographic variables. Pathological gambling was associated with suicidal ideation [(AOR) = 2.86, 95% (CI) = 1.98-4.11] and suicide attempts [(AOR) = 2.77, 95% (CI) = 1.72-4.47) after adjustment for sociodemographic variables. Our results from this population sample reinforce increased rates of suicidal behavior amongst smaller, clinical samples of problem and pathological gamblers. Education for providers about gambling is recommended, including screening for gambling-related symptoms such as suicidal behavior.

On the latent structure of problem gambling: a taxometric analysis.

To test whether problem gambling is a categorical or dimensional disorder on the basis of two problem gambling assessments. This distinction discriminates between two different conceptualizations of problem gambling: one that problem gambling is defined by its addictive properties, the other that it is a continuum of harm. Using The British Gambling Prevalence Survey 2010, a nationally representative sample of the United Kingdom conducted by the National Centre for Social Research, five different taxometric analyses were carried out on cases from two problem gambling screens: the Problem Gambling Severity Index (PGSI) and a measure derived from the DSM-IV Pathological Gambling criteria. Two further analyses were conducted on the total scores for these measures. There was strong evidence that both scales were measuring a categorical construct. Fit indices consistently supported a categorical interpretation [comparison curve fit index (CCFI) > 0.6]. The PGSI analysis indicated the presence of a taxon (CCFIs = 0.633, 0.756). The analysis conducted on the adapted DSM-IV criteria indicated stronger quantitative support for a taxon (CCFIs = 0.717, 0.811 and 0.756) but items probing a loss of control were inconsistent. The taxometric analyses of both scales support a categorical interpretation (CCFIs = 0.628, 0.567), but extreme caution should be used due to high nuisance covariance. Two problem gambling screens (the Problem Gambling Severity Index and a measure derived from the DSM-IV Pathological Gambling criteria) appear to measure a categorical construct that taps into a categorical, loss of control model of problem gambling. There is some evidence that the two screens measure different aspects of an addiction construct.

An Examination of a Proposed DSM-IV Pathological Gambling Hierarchy in a Treatment Seeking Population: Similarities with Substance Dependence and Evidence for Three Classification Systems

Toce-Gerstein et al. (Addiction 98:1661-1672, 2003) investigated the distribution of Diagnostic and Statistical Manual for Mental Disorders, 4th edition (DSM-IV) pathological gambling criteria endorsement in a U.S. community sample for those people endorsing a least one of the DSM-IV criteria (n = 399). They proposed a hierarchy of gambling disorders where endorsement of 1-2 criteria were deemed 'At-Risk', 3-4 'Problem gamblers', 5-7 'Low Pathological', and 8-10 'High Pathological' gamblers. This article examines these claims in a larger Australian treatment seeking population. Data from 4,349 clients attending specialist problem gambling services were assessed for meeting the ten DSM-IV pathological gambling criteria. Results found higher overall criteria endorsement frequencies, three components, a direct relationship between criteria endorsement and gambling severity, clustering of criteria similar to the Toce-Gerstein et al. taxonomy, high accuracy scores for numerical and criteria specific taxonomies, and also high accuracy scores for dichotomous pathological gambling diagnoses. These results suggest significant complexities in the frequencies of criteria reports and relationships between criteria.

Gambling onset and progression in a sample of at-risk gamblers from the general population

The goal of this study was to investigate gambling-related behavior, onset and progression in a sample of at-risk gamblers from the community. A national household survey was conducted in Brazil, covering individuals 14 years old or older. Subjects were screened for at-risk gambling, those testing positive answered a questionnaire about gambling progression, preferred games and DSM-IV pathological gambling criteria. Out of 3007 respondents, 118 were considered at-risk gamblers according to the Lie/Bet Questionnaire. According to the DSM-IV, 32.7% and 24.9% of those were considered problem and pathological gamblers, respectively. Early at-risk gamblers (onset prior to 20 years of age), were more likely to be male, to prefer non-commercially structured games, and to chase losses while gambling. Young pathological gamblers (under 35 years of age) progressed faster from regular to problem gambling (roughly 2 years) than mature pathological gamblers (12 years). Such findings had not been described before because previous reports focused mostly on clinical samples that lack young, male, early-onset gamblers. Gambling programs have not satisfactorily covered this segment of gamblers. Outreach strategies and early interventions should be provided to prevent these individuals from rapidly evolving into pathological gambling.

Reliability and Validity of Three Instruments (DSM-IV, CPGI, and PPGM) in the Assessment of Problem Gambling in South Korea

Most research on the assessment, epidemiology, and treatment of problem gambling has occurred in Western jurisdictions. This potentially limits the cross-cultural validity of problem gambling assessment instruments as well as etiological models of problem gambling. The primary objective of the present research was to investigate the reliability and validity of three problem gambling assessment instruments within a South Korean context. A total of 4,330 South Korean adults participated in a comprehensive assessment of their gambling behavior that included the administration of the DSM-IV criteria for pathological gambling (NODS), the Canadian Problem Gambling Index (CPGI), and the Problem and Pathological Gambling Measure (PPGM). Cronbach alpha showed that all three instruments had good internal consistency. Concurrent validity was established by the significant associations observed between scores on the instruments and measures of gambling involvement (number of gambling formats engaged in; frequency of gambling; and gambling expenditure). Most importantly, kappa statistics showed that all instruments have satisfactory classification accuracy against clinical assessment of problem gambling conducted by South Korean clinicians (NODS κ = .66; PPGM κ = .62; CPGI κ = .51). These results confirm that Western-derived operationalizations of problem gambling have applicability in a South Korean setting.

Association of Sociodemographic, Psychopathological and Gambling-Related Factors with Treatment Utilization for Pathological Gambling

Background/Aims: Only a small percentage of pathological gamblers utilizes professional treatment for gambling problems. Little is known about which social and gambling-related factors are associated with treatment utilization. The aim of this study was to look for factors associated with treatment utilization for pathological gambling. Methods: The study followed a sampling design with 3 different recruitment channels, namely (1) a general population-based telephone sample, (2) a gambling location sample and (3) a project telephone hotline. Pathological gambling was diagnosed in a telephone interview. Participants with pathological gambling (n = 395) received an in-depth clinical interview concerning treatment utilization, comorbid psychiatric disorders and social characteristics. Results: Variables associated with treatment were higher age [odds ratio (OR) 1.05, 95% confidence interval (CI) 1.03-1.08], an increased number of DSM-IV criteria for pathological gambling (OR 1.34, 95% CI 1.06-1.70), more adverse consequences from gambling (OR 1.10, 95% CI 1.03-1.16) and more social pressure from significant others (OR 1.17, 95% CI 1.07-1.27). Affective disorders were associated with treatment utilization in the univariate analysis (OR 1.81, 95% CI 1.19-2.73), but multivariate analysis showed that comorbid psychiatric disorders were not independently associated. Conclusion: These results indicate that individuals with more severe gambling problems utilize treatment at an older age when more adverse consequences have occurred. Further research should focus on proactive early interventions.

Problem gambling severity and the incidence of Axis I psychopathology among older adults in the general population

To examine the longitudinal relationship between past-year problem-gambling severity and incident Axis I psychopathology among older adults (aged 55–90), analyses were conducted on data from the National Epidemiologic Study of Alcohol and Related Conditions (NESARC). This nationally-representative population-based survey was conducted in two waves (Wave 1, 2000–2001; and Wave 2, 2004–2005). Past-year problem-gambling severity at Wave 1 and incident Axis I psychopathology at Wave 2 were evaluated with the Alcohol Use Disorder and Associated Disabilities Interview Schedule—Diagnostic and Statistical Manual of Mental Disorders—Fourth Edition. Multivariate logistic regression modeling was conducted on groups categorized into low-frequency gambling/non-gambling (LFG/NG), low-risk gambling (LRG), and at-risk/problem/pathological gambling (ARPG) based on DSM-IV criteria for pathological gambling. Relative to LFG/NG, ARPG at Wave 1 was positively associated with the incidence of generalized anxiety disorder (OR = 2.51; p = .011) and any substance use disorder (OR = 2.61; p = .0036); LRG was negatively associated with the incidence of hypomania (OR = 0.33; p = .017). Models were adjusted for demographic characteristics, psychiatric comorbidity, health behaviors, physical health, and stressful life events assessed at baseline. While gambling may represent a positive activity for some older adults, data suggest that risky/problematic gambling behavior may be associated with the development of psychiatric problems in this population. Older-adult gamblers, as well as their clinicians, friends, and family, should be aware of potential risks associated with gambling, adopt strategies to prevent the onset of secondary disorders, and monitor themselves and others for signs of problems.

Neurocognitive dysfunction in strategic and non-strategic gamblers.

It has been theorized that there may be subtypes of pathological gambling, particularly in relation to the main type of gambling activities undertaken. Whether or not putative pathological gambling subtypes differ in terms of their clinical and cognitive profiles has received little attention. Subjects meeting DSM-IV criteria for pathological gambling were grouped into two categories of preferred forms of gambling - strategic (e.g., cards, dice, sports betting, stock market) and non-strategic (e.g., slots, video poker, pull tabs). Groups were compared on clinical characteristics (gambling severity, and time and money spent gambling), psychiatric comorbidity, and neurocognitive tests assessing motor impulsivity and cognitive flexibility. Seventy-seven subjects were included in this sample (45.5% females; mean age: 42.7±14.9) which consisted of the following groups: strategic (n=22; 28.6%) and non-strategic (n=55; 71.4%). Non-strategic gamblers were significantly more likely to be older, female, and divorced. Money spent gambling did not differ significantly between groups although one measure of gambling severity reflected more severe problems for strategic gamblers. Strategic and non-strategic gamblers did not differ in terms of cognitive function; both groups showed impairments in cognitive flexibility and inhibitory control relative to matched healthy volunteers. These preliminary results suggest that preferred form of gambling may be associated with specific clinical characteristics but are not dissociable in terms of cognitive inflexibility and motor impulsivity.

Pathological gambling severity and co-occurring psychiatric disorders in individuals with and without anxiety disorders in a nationally representative sample

While anxiety disorders (ADs) and pathological gambling (PG) frequently co-occur with each other and other Axis I and Axis II disorders, previous studies have not examined the relative influence of ADs on the co-occurrences between PG severity and non-anxiety psychopathologies. The current study used data from the National Epidemiologic Survey on Alcohol and Related Conditions (N=43,093) to examine the influence of past-year ADs on the associations between past-year PG severity measures based on DSM-IV criteria for PG and non-anxiety psychiatric disorders. The findings revealed that increased PG severity was associated with Axes I and II psychopathology in both the groups with and without ADs. Significant anxiety-by-gambling-group interactions were also observed, particularly with respect to mood and personality disorders. The interactions indicate a stronger relationship between PG severity and psychopathology in participants without ADs than in those with ADs. Future research should investigate specific factors contributing to the co-occurrence of anxiety, gambling, and other psychiatric disorders and how the co-occurrences might influence clinically relevant phenomena such as treatment selection or course.

Alexithymia and Gambling: A Risk Factor for All Gamblers?

The purpose of this study was to investigate alexithymia (in relation with depression) in three groups of French gamblers (n=186) recruited in their gambling location: at the racetracks (n=80 males; mean age 28.1years), in the slot machine rooms (n=65; 29 males, 36 females; mean age 34.6years), and in the traditional gaming rooms (n=41 males; mean age 36years). Gambling behavior was measured by the South Oaks Gambling Screen and DSM-IV criteria for pathological gambling, Alexithymia by the Toronto Alexithymia Scale (TAS-20) and depression with the Beck Depression Inventory (BDI-13). For racetracks and slot machine gambling, pathological gamblers differed from non-pathological gamblers, regarding their alexithymia scores. These results remained stable after controlling for depression scores among the racetracks gamblers only. The relationship between alexithymia and depression depends on the type of pathological gambler. These findings are consistent with the idea of identifying clinically distinct subgroups of gamblers.

Health/Functioning Characteristics, Gambling Behaviors, and Gambling-Related Motivations in Adolescents Stratified by Gambling Problem Severity: Findings from a High School Survey

In adults, different levels of gambling problem severity are differentially associated with measures of health and general functioning, gambling behaviors, and gambling-related motivations. Here we present data from a survey of 2,484 Connecticut high school students, and investigate the data stratifying by gambling problem severity based on DSM-IV criteria for pathological gambling. Problem/pathological gambling was associated with a range of negative functions; for example, poor academic performance, substance use, dysphoria/depression, and aggression. These findings suggest a need for improved interventions related to adolescent gambling and a need for additional research into the relationship (eg, mediating factors) between gambling and risk and protective behaviors.