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Sex differences in subclinical and DSM-IV pathological gambling: results from the National Epidemiologic Survey on Alcohol and Related Conditions
Abstract
Background. To examine sex differences in DSM-IV subclinical and pathological gambling in nationally representative data of the US population. Method. Data come from a large (n=43093) representative sample of the adult US population. Results. The lifetime prevalence rate of DSM-IV pathological gambling was 0·64% (95% CI 0·50–0·78) for men and 0·23% (95% CI 0·17–0·29) for women, whereas the lifetime prevalence of subclinical pathological gambling was 6·79% (95% CI 6·32–7·26) for men and 3·26% (95% CI 2·93–3·59) for women. For subclinical pathological gambling, men were significantly (p<0·01) more likely than women to have smoked more than two packs of cigarettes a day, to be classified as heavy drinkers and to have lifetime diagnoses of alcohol and drug use disorders. Women with subclinical and pathological gambling were significantly more likely than men to have lifetime mood and anxiety disorders. With respect to pathological gambling, women had later ages of onset of the disorder, and were significantly more likely than men to report gambling to relieve depressed mood and to prefer casino gambling. Rates of treatment-seeking for DSM-IV pathological gambling were low for both men and women. Conclusions. There are important sex differences in the prevalence, symptom pattern, sociodemographic and clinical correlates and course of DSM-IV subclinical and pathological gambling. Results underscore the need to investigate sex differences in the social determinants, neurobiology and treatment response of DSM-IV subclinical and pathological gambling.
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“Additionally, the lifetime prevalence of anxiety disorders in females with clinical gambling involvement (61.93%) is much greater than that observed for women in the general population (30%) (Blanco, Hasin, Petry, Stinson, & Grant, 2006; J. E. Grant et al., 2006; Kessler et al., 2005).”
From Cued for Risk: Evidence for an Incentive Sensitization Framework to Explain the Interplay between Stress and Anxiety, Substance Abuse, and Reward Uncertainty in Disordered Gambling Behavior (2019) · cites this paper as Blanco, Hasin, Petry, Stinson, & Grant, 2006
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“One study utilized the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) data to show that among respondents with subclinical pathological gambling, men were significantly more likely to be classified as heavy drinkers (Blanco et al. 2006).”
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“A further reduction in the threshold to three, two or even one criteria could also be considered, and has been associated with impairment (Blanco et al., 2006; Toce-Gerstein et al., 2003).”
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BackgroundMaintenance of attention and pathological gambling.
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Trombly, D. R. C., & Zeigler‐Hill, V. (2016) · Current Psychology · doi:10.1007/s12144-016-9461-z · Cited by 29
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BackgroundClustering of treatment-seeking women with gambling disorder
Granero, R., Fernández‐Aranda, F., Mestre‐Bach, G., Steward, T., García-Caro, B., Prever, F., Gavriel‐Fried, B., del Pino‐Gutiérrez, A., Moragas, L., Aymamí, N., et al. (2018) · Journal of Behavioral Addictions · doi:10.1556/2006.7.2018.93 · Cited by 28
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Moderator effect of sex in the clustering of treatment-seeking patients with gambling problems
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BackgroundInfluentialGender-related Differences in Individuals Seeking Treatment for Kleptomania
Grant, J., & Potenza, M. (2008) · CNS Spectrums · doi:10.1017/s1092852900028492 · Cited by 16
Male and Female Pathological Gamblers: Bet in a Different Way and Show Different Mental Disorders
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BackgroundConformity to masculine norms among treatment-seeking male problem gamblers
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“Otros autores (e.g., Blanco et al., 2006) respaldan esta idea de la multifactorialidad en la etiología de la prevalencia de ansiedad entre las mujeres.”
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“…between recreational gambling and substance use and psychiatric disorders have also been established (Potenza et al., 2002b; Welte et al., 2004a; Blanco et al., 2006; Desai et al., 2006; Duhig et al., 2007; Liu et al., 2009); however, one aspect of recreational gambling that has not been…”
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“Given that the prevalence of problem gambling generally is higher [7,38] and school grades lower [29] in these groups, this selective attrition could have lead to an underestimation of the association between low school grades and problem gambling in our study.”
BackgroundPathological Gamblers and a Non-Psychiatric Control Group Taking Gender Differences into Account
Echeburúa, E., González–Ortega, I., de Corral, P., & Polo-López, R. (2013) · The Spanish Journal of Psychology · doi:10.1017/sjp.2013.2 · Cited by 22
“Alcohol can be used as a strategy to cope with emotional trouble in men (Blanco et al., 2006).”
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“We chose to study only men because men generally respond more to visual sexual stimuli than women (Hamann et al., 2004; Rupp and Wallen, 2008) and because there is a higher prevalence of pathological gambling among men than among women (Blanco et al., 2006; Kessler et al., 2008).”
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BackgroundOn the Processes Underlying the Relationship Between Alexithymia and Gambling Severity
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“The gender differences in problem gambling are well-known from the general population and from clinical populations (Blanco et al., 2006; Calado & Griffiths, 2016; Ekholm et al., 2014; Håkansson et al., 2017).”
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Self-citationAn Ecological Approach to Electronic Gambling Machines and Socioeconomic Deprivation in Germany
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Clustering Treatment Outcomes in Women with Gambling Disorder
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“This particular profile of women pertaining to low social groups who exhibit distress could use gambling as an means of escape to deal with the effects of their chronic stress [such as physical symptoms (fatigue, eating problems, sleeping disorders or general illnesses), cognitive performance (difficulty concentrating…”
BackgroundJeu pathologique : facteurs impliqués
Challet‐Bouju, G., Grall‐Bronnec, M., Guillou-Landréat, M., & Vénisse, J.-L. (2011) · L Encéphale · doi:10.1016/j.encep.2011.01.003 · Cited by 27
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“Understanding the contributions to subclinical gambling outcomes in younger adults is especially important for intervention/prevention techniques since the average age of onset for pathological gambling occurs between ages 29-34 (Blanco et al. 2006), which is later than average onset ages for numerous psychiatric diso…”
BackgroundExamination of Proposed DSM‐5 Changes to Pathological Gambling in a Helpline Sample
Weinstock, J., Rash, C. J., Burton, S., Moran, S., Biller, W., O'Neil, K., & Kruedelbach, N. (2013) · Journal of Clinical Psychology · doi:10.1002/jclp.22003 · Cited by 16
Sociocultural Influences on Gambling and Alcohol Use Among Native Americans in the United States
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“Native Americans comprised only 1.3 % of the entire group of 195 pathological gamblers (i.e., 2.5 individuals, Petry et al. 2005; Blanco et al. 2006).”
InfluentialEtxandi, M., Baenas, I., Munguía, L., Mestre‐Bach, G., Granero, R., Gómez‐Peña, M., Moragas, L., del Pino‐Gutiérrez, A., Codina, E., Mora‐Maltas, B., et al. (2021) · Journal of Gambling Studies · doi:10.1007/s10899-021-10071-w · Cited by 16
“The Drug Use Disorders Identification Test (DUDIT) (Berman et al., 2003) is an 11-item self-administered instrument to identify non-alcohol drug use patterns and related problems in individuals likely to meet criteria for a substance dependence diagnosis.”
MethodPathological Women Gamblers: Gender-Related Aspects of Control
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“comparing the two genders found that women are drawn more to luck-related gambling such as bingo, scratch cards, slot machines and video games (Blanco et al. 2006; Grant and Kim 2002; Wenzel and Dahl 2009).”
BackgroundEvaluating a Reflecting-Team Couples Approach to Problem Gambling
Garrido‐Fernández, M., Rincón, P. J., & García‐Martínez, J. (2010) · Journal of Constructivist Psychology · doi:10.1080/10720537.2011.530481 · Cited by 15
“Regarding gender differences, data show that the lifetime prevalence rate of pathological gambling is 64% for men and 23% for women ( Blanco, Hasin, Petry, Stinson, & Grant, 2006 ).”
BackgroundGambling Disorder as a Clinical Phenomenon
Hunt, C. J., & Blaszczynski, A. (2019) · Gambling Disorder · doi:10.1007/978-3-030-03060-5_2 · Cited by 15
Kapetanovic, S., Gurdal, S., Einarsson, I., Werner, M., André, F., Håkansson, A., & Claesdotter‐Knutsson, E. (2023) · JMIR Research Protocols · doi:10.2196/44318 · Cited by 14
“Moreover, earlier studies suggest that important correlates to child and adolescent problem gaming are male gender [12], neuropsychiatric disorder [13], difficulties with cognitive regulation [14], and substance use [15].”
Bonnaire, C., Bungener, C., & Varescon, I. (2017) · Psychiatry Research · doi:10.1016/j.psychres.2017.01.057 · Cited by 14
The Risk of Gambling Problems in the General Population: A Reconsideration
Harrison, G. W., Lau, M. I., & Ross, D. (2019) · Journal of Gambling Studies · doi:10.1007/s10899-019-09897-2 · Cited by 14
Black, D. W., Allen, J., & Bormann, N. L. (2021) · Journal of Gambling Studies · doi:10.1007/s10899-021-10000-x · Cited by 14
Hudson, A., Jacques, S., & Stewart, S. H. (2013) · Psychology of Addictive Behaviors · doi:10.1037/a0031863 · Cited by 14
Rudd, C., & Thomas, S. D. M. (2015) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-015-9604-8 · Cited by 14
“Again, consistent with the available evidence in the community and in treatment samples (Blanco et al. 2006; Delfabbro 2011), the prevalence of problem gamblingwas higher for males than for females.”
BackgroundResultPatten, R. V., Weinstock, J., & McGrath, A. B. (2017) · Journal of Gambling Studies · doi:10.1007/s10899-017-9712-4 · Cited by 14
Pathological Gambling: Clinical Gender Differences
González–Ortega, I., Echeburúa, E., de Corral, P., & Polo-López, R. (2014) · Springer eBooks · doi:10.1007/978-3-319-05870-2_32 · Cited by 14
“On the other hand, men abuse alcohol and other drugs more than women do [12, 39, 47, 48].”
BackgroundResultGambling onset and progression in a sample of at-risk gamblers from the general population
Carneiro, E., Tavares, H., Sanches, M., Pinsky, I., Caetano, R., Zaleski, M., & Laranjeira, R. (2014) · Psychiatry Research · doi:10.1016/j.psychres.2014.01.035 · Cited by 13
“Our finding that male gender was strongly related with early onset of gambling behavior is in agreement with those of population-based surveys carried out in high-income countries (Blanco et al., 2006).”
ResultDisordered Gambling Prevalence: Methodological Innovations in a General Danish Population Survey
Harrison, G. W., Jessen, L. J., Lau, M. I., & Ross, D. (2017) · Journal of Gambling Studies · doi:10.1007/s10899-017-9707-1 · Cited by 14
“Blanco et al. [2006]), but most screens other than the PGSI simply classify them with other respondents who are not DGs.”
BackgroundPrevalence of problem gambling among Japanese adults
Mori, T., & Goto, R. (2020) · International Gambling Studies · doi:10.1080/14459795.2020.1713852 · Cited by 14
Davies, N., Roderique‐Davies, G., Drummond, L. C., Torrance, J., Sabolova, K., Thomas, S. L., & John, B. (2022) · Journal of Public Health · doi:10.1007/s10389-021-01678-9 · Cited by 18
“A screening tool/test for gambling behaviour that is only validated with males is not generalisable to females due to the meaningful gender differences found in the literature (Blanco et al. 2006).”
MethodScandroglio, F., Ferrazzi, G., Giacobazzi, A., Vinci, V., Marchi, M., Galeazzi, G., Musetti, A., & Pingani, L. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20010452 · Cited by 10
“The result obtained from the multiple linear regression analysis showed that pathological gambling was positively associated with the male gender [30,32,57].”
BackgroundFortgang, R. G., Hoff, R., & Potenza, M. (2018) · Journal of Gambling Studies · doi:10.1007/s10899-018-9757-z · Cited by 15
“This may suggest differential etiology of PPG in males versus females with schizophrenia, consistent with prior work showing gender-related differences in gambling trajectory, patterns, and motivations (Blanco et al. 2006; Potenza et al. 2001, 2006), and implies that self-control-related interventions may be more effe…”
ResultGambling and Aging: An Overview of a Risky Behavior
Fontaine, M., Lemercier, C., Bonnaire, C., Giroux, I., Py, J., Varescon, I., & Floch, V. L. (2023) · Behavioral Sciences · doi:10.3390/bs13060437 · Cited by 17
Clinical characteristics of veterans with gambling disorders seeking pain treatment
Ronzitti, S., Kraus, S. W., Decker, S. E., & Ashrafioun, L. (2019) · Addictive Behaviors · doi:10.1016/j.addbeh.2019.03.014 · Cited by 13
Gender and Gambling Behaviors: a Comprehensive Analysis of (Dis)Similarities
Venne, D. M., Mazar, A., & Volberg, R. A. (2019) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-019-00116-y · Cited by 12
Gender and gambling disorder: Differences in compulsivity-related neurocognitive domains
Mallorquí‐Bagué, N., Mestre‐Bach, G., Lozano‐Madrid, M., Granero, R., Vintró‐Alcaraz, C., Fernández‐Aranda, F., Gómez‐Peña, M., Moragas, L., del Pino‐Gutiérrez, A., Menchón, J. M., et al. (2020) · Addictive Behaviors · doi:10.1016/j.addbeh.2020.106683 · Cited by 13
Shokri, O., Potenza, M. N., & Sanaeepour, M. H. (2017) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-017-9738-y · Cited by 13
“…tendencies for women to acknowledge more frequently negativereinforcement motivations for engaging in risky/addictive behaviors (e.g., escaperelated motivations in pathological gambling (Blanco et al. 2006)), we hypothesized that this relationship would be stronger for women as compared to men.”
ResultProblem Gambling in the Fitness World—A General Population Web Survey
Håkansson, A., Entezarjou, A., Kenttä, G., Fernández‐Aranda, F., Jiménez‐Múrcia, S., & Gunnarsson, B. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17041342 · Cited by 11
“However, the male-to-female prevalence ratio for problem gambling or gambling disorder is typically in the range of 3:1 or 4:1 [3,4], including in clinical samples in the present geographical setting [17,36].”
BackgroundBerge, J., Abrahamsson, T., Lyckberg, A., Franklin, K., & Håkansson, A. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.602846 · Cited by 10
“in the development of problem gambling, with a later onset (40) and higher psychiatric comorbidity in women (28, 41, 42).”
BackgroundSimilar roles for recovery capital but not stress in women and men recovering from gambling disorder
Gavriel‐Fried, B., Moretta, T., & Potenza, M. N. (2019) · Journal of Behavioral Addictions · doi:10.1556/2006.8.2019.73 · Cited by 11
Vintró‐Alcaraz, C., Mestre‐Bach, G., Granero, R., Caravaca, E., Gómez‐Peña, M., Moragas, L., Baenas, I., del Pino‐Gutiérrez, A., Valero-Solís, S., Lara-Huallipe, M. L., et al. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11164669 · Cited by 10
Huggett, S. B., Winiger, E. A., Palmer, R. H. C., Hewitt, J. K., Corley, R. P., & Stallings, M. C. (2020) · Addictive Behaviors · doi:10.1016/j.addbeh.2020.106662 · Cited by 13
“Since the typical onset age of pathological gambling ranges from 29 to 34 (Blanco et al. 2006), research should clarify behavioral correlates preceding clinical gambling outcomes in early adulthood.”
BackgroundRole of exercise in the treatment of gambling disorder
Okechukwu, C. E. (2019) · Nigerian Journal of Experimental and Clinical Biosciences · doi:10.4103/njecp.njecp_11_19 · Cited by 11
“The prevalence rates of GD among females were found to be less than half when compared to the males.[24] A standard individualized‐tailored exercise program in support of psychotherapeutic and pharmacological treatment of GD will enable clinicians to improve the fitness and mental wellness in PGs and to develop more e…”
Background
Metadata
- Authors
- BLANCO, C., HASIN, D. S., PETRY, N., STINSON, F. S., & GRANT, B. F.
- Affiliations
- New York State Psychiatric Institute (US)
- UConn Health (US)
- National Institutes of Health (US)
- Venue
- Psychological Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 2006-05-02
- Volume
- 36
- Issue
- 7
- Pages
- 943-953
- ISSN
- 0033-2917 (ISSN-L)
- 1469-8978
- OpenAlex
- W1992338801
- Cited by
- 297
- References
- 0
- Citations by year
- 2026: 2 · 2025: 6 · 2024: 7 · 2023: 20 · 2022: 13 · 2021: 12 · 2020: 12 · 2019: 22 · 2018: 14 · 2017: 15 · 2016: 15 · 2015: 26 · 2014: 25 · 2013: 25 · 2012: 19
- FWCI
- 10.71
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychological Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Alliance for Research on Schizophrenia and Depression
- National Institutes of Health (5p50aa003510-27)
- National Institute on Alcohol Abuse and Alcoholism (K05AA014223, P50- AA03510)
- National Institute of Mental Health (R01MH060417, R01 MH60417)
- National Institute on Drug Abuse (R01DA014618, R03-5R03DA15559, K23-DA00482, R01-DA14618, R01-DA13444, P50DA009241, R01DA016855, K23DA000482, P50-DA-0-9241, R01DA013444, R03DA015559)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Gambling Behavior and Treatments
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
- Keywords
- gambling addiction, sex differences, prevalence, DSM-IV diagnostic criteria, mood disorders, anxiety disorders, alcoholism, drug use disorders, heavy drinking, cigarette smoking, age of onset, treatment seeking, casino gambling, NESARC
- MeSH terms
- Adolescent, Adult, Aged, Alcoholism, Demography, Female, Gambling, Humans, Disruptive, Impulse Control, and Conduct Disorders, Interviews as Topic, Male, Middle Aged, National Institutes of Health (U.S.), Sex Characteristics, Tobacco Use Disorder, United States, Prevalence
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