DSM-5 gambling disorder: Prevalence and characteristics in a substance use disorder sample.
Open accessAbstract
The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) replaced the fourth edition's (DSM-IV) diagnosis of Pathological Gambling (PG) with Gambling Disorder (GD). GD differs from PG in that it requires 4 rather than 5 criteria for diagnosis and excludes the "Illegal Acts" criterion. We examined the prevalence of GD and its characteristics and validity in a substance-use disorder (SUD) sample. Participants (N = 6,613) in genetic studies of substance dependence underwent a semistructured psychiatric interview. Individuals who reported ever having gambled $10 at least monthly (n = 1,507) were the focus of the analyses. Approximately one third of acknowledged gamblers (n = 563; 8.5% of the total sample) received PG (DSM-IV) and GD (DSM-5) diagnoses and 678 (10.3% of the total) received only a DSM-5 diagnosis, representing an increase of 20.4% relative to DSM-IV. Although the 3 groups were comparable demographically, the DSM-5-Only group was intermediate between the other 2 groups on the prevalence of comorbid SUDs, the distribution of DSM-IV PG criteria endorsed, and the types of gambling reported. Multinomial logistic regression analysis showed that the DSM-5-Only group was more likely than the No-Diagnosis group and less likely than the Both-Diagnoses group to acknowledge a gambling problem. In conclusion, there was a high prevalence of PG in this SUD sample. Analysis of non-DSM variables suggested that the increased sensitivity of the DSM-5 GD diagnosis successfully identifies a broader set of individuals with clinically significant gambling-related problems. Prospective studies of individuals with GD are needed to validate this finding.
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Individuals with nicotine or alcohol related substance use disorders are more likely to meet diagnostic criteria for gambling disorder compared to the general population.
“Similarly, individuals with nicotine or alcohol related substance use disorders are also more likely to meet the diagnostic criteria for GD compared to the general population (Krmpotich et al., 2015; Petry et al., 2005; Rennert et al., 2014).”
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 Rennert et al., 2014
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Cites
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“This change also reflects recognition of the similarities between pathological gambling behavior and addiction to substances (Grant et al. 2010).”
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“There are high rates of gambling problems in individuals with substance use disorders (SUDs) (Oleski et al., 2011) and of SUDs in pathological gamblers (Lorains et al., 2011).”
BackgroundDSM-IV pathological gambling in the National Comorbidity Survey Replication
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BackgroundInfluentialAlcohol and gambling pathology among U.S. adults: prevalence, demographic patterns and comorbidity.
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“Although epidemiological studies have estimated the rate of PG to be 0.4% to 4.0% (Petry, 2007), the prevalence is higher in individuals with an SUD (Welte et al., 2001; Petry, 2007; Kessler et al., 2008; Rush et al., 2008).”
BackgroundInfluentialImpulsivity, personality disorders and pathological gambling severity
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“Future studies should employ a standard measure, such as the NODS, which together with measures of personality (e.g., impulsivity) could provide a more comprehensive evaluation of the validity of the DSM-5 diagnosis of GD (Steel and Blaszczynski, 1998).”
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“…from an “Impulse-Control Disorder Not Elsewhere Classified” to one of the “Substance-Related and Addictive Disorders” in an effort to clarify the diagnosis and treatment of GD, to increase its recognition, and to improve research efforts directed to the disorder (Petry et al., 2013; O'Brien, 2011).”
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“However, three studies of the concurrent validity of DSM-IV PG (Stinchfield, 2003; Stinchfield et al., 2005; Jimenez-Murcia et al., 2009) showed consistently better diagnostic accuracy with a cutoff of four diagnostic criteria than with five criteria.”
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“This group was similar to those in our sample who met only DSM-5 GD criteria, one-third of whom reported that gambling caused problems for them compared to only 10% in the No-Diagnosis group and 70% in the Both-Diagnoses group (Toce-Gerstein et al., 2003).”
BackgroundResultDiagnostic reliability of the Semi-structured Assessment for Drug Dependence and Alcoholism (SSADDA)
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“…were interviewed with the Semi-Structured Assessment for Drug Dependence and Alcoholism (SSADDA), a computer-assisted interview that yields demographic data and lifetime DSM-IV diagnoses of PG, SUDs, and other psychiatric disorders (Pierucci-Lagha et al., 2005; Pierucci-Lagha et al., 2007).”
MethodSelf-citationAn empirical evaluation of proposed changes for gambling diagnosis in the DSM-5
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BackgroundResultInfluentialEvaluation of the continuum of gambling problems using the DSM‐IV
Strong, D. R., & Kahler, C. W. (2007) · Addiction · doi:10.1111/j.1360-0443.2007.01789.x · Cited by 145 · see citing works
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“…were interviewed with the Semi-Structured Assessment for Drug Dependence and Alcoholism (SSADDA), a computer-assisted interview that yields demographic data and lifetime DSM-IV diagnoses of PG, SUDs, and other psychiatric disorders (Pierucci-Lagha et al., 2005; Pierucci-Lagha et al., 2007).”
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“However, three studies of the concurrent validity of DSM-IV PG (Stinchfield, 2003; Stinchfield et al., 2005; Jimenez-Murcia et al., 2009) showed consistently better diagnostic accuracy with a cutoff of four diagnostic criteria than with five criteria.”
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“However, three studies of the concurrent validity of DSM-IV PG (Stinchfield, 2003; Stinchfield et al., 2005; Jimenez-Murcia et al., 2009) showed consistently better diagnostic accuracy with a cutoff of four diagnostic criteria than with five criteria.”
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“Proposed changes that result in substantial differences in prevalence or that occur at the cost of reduced validity could adversely affect the diagnosis and treatment of a disorder (Agrawal et al., 2011).”
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“…as with the DSM-5 revision of SUDs that captures a less-severe form of SUD [i.e., "diagnostic orphans" (Harford et al., 2010; Moss et al., 2010; Peer et al. 2013)], the DSM-5 GD criteria appear to capture a group of less-severe problem gamblers whose disordered behavior may warrant treatment.”
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“…of the SSADDA as a method by which to diagnose gambling disorder is unknown, most of the SSADDA items are similar to those included in the National Opinion Research Center DSM Screen for Gambling Problems (NODS), a validated and commonly used measure of gambling disorder (Wickwire et al. 2008).”
MethodGambling and Substance Use Disorders: Current Status and Future Directions
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“Although epidemiological studies have estimated the rate of PG to be 0.4% to 4.0% (Petry, 2007), the prevalence is higher in individuals with an SUD (Welte et al., 2001; Petry, 2007; Kessler et al., 2008; Rush et al., 2008).”
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“, "diagnostic orphans" (Harford et al., 2010; Moss et al., 2010; Peer et al. 2013)], the DSM-5 GD criteria appear to capture a group of less-severe problem gamblers whose disordered behavior may warrant treatment.”
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“There are high rates of gambling problems in individuals with substance use disorders (SUDs) (Oleski et al., 2011) and of SUDs in pathological gamblers (Lorains et al., 2011).”
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“…clearly less severe than the 1.4% of gamblers who were classified as “antisocial impulsive gamblers,” the preoccupied chaser group generally met one to four DSM-IV PG criteria and, despite not receiving a diagnosis of PG, showed evidence of gambling-related impairment (McBride et al., 2010).”
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“Consistent with this view, endorsement of the Illegal Acts criterion by individuals at the diagnostic threshold occurs infrequently, so that a GD diagnosis is unlikely to be contingent upon this criterion (Zimmerman et al., 2006; Petry et al., 2013).”
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“, "diagnostic orphans" (Harford et al., 2010; Moss et al., 2010; Peer et al. 2013)], the DSM-5 GD criteria appear to capture a group of less-severe problem gamblers whose disordered behavior may warrant treatment.”
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“There are high rates of gambling problems in individuals with substance use disorders (SUDs) (Oleski et al., 2011) and of SUDs in pathological gamblers (Lorains et al., 2011).”
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“The DSM-5, after a long debate, considers gambling an addiction and not an impulse control disorder anymore (Rennert et al., 2014).”
BackgroundTest Performance Variation Between Settings and Populations
Gambino, B. (2017) · Journal of Gambling Studies · doi:10.1007/s10899-017-9728-9 · Cited by 2 · see citing works
“594) given the unusually high P = 40% (Cowlishaw et al. 2014; Rennert et al. 2014) in the sample (the high P may reflect the specific types of substance abusers included, e.”
BackgroundResultPilatti, A., Michelini, Y., & Pautassi, R. M. (2020) · CES Psicología · doi:10.21615/cesp.13.2.4 · Cited by 1 · see citing works
ADDICTIVE BEHAVIORS (GAMBLING-INTERNET) IN PATIENTS WITH PSYCHOACTIVE SUBSTANCE USE DISORDER
Abdou, T. A., Mohamed, Y., Awaad, M. I., Sabry, W., & Fahmy, A. M. (2020) · Ain Shams Medical Journal · doi:10.21608/asmj.2020.148951 · Cited by 1 · see citing works
“On the other hand, Functional Consequences of Gambling Disorder may occur from repeatedly lying to others to cover up the extent of gambling or from requesting money that is used for gambling or to pay off gambling debts(10).”
BackgroundInfluentialAhluwalia, Y., Jangra, D., Singh, S., Sarkar, S., & Balhara, Y. P. S. (2026) · Psychiatry Research · doi:10.1016/j.psychres.2026.117000 · Cited by 1 · see citing works
Process of Forming Sensation-Seeking Behavior in Online Slot Gambling Players
Fiyanda, F. N., Setyawati, R., Herdian, H., & ., S. (2024) · Indigenous Jurnal Ilmiah Psikologi · doi:10.23917/indigenous.v9i3.6483 · Cited by 1 · see citing works
Coriale, G., Ceccanti, M., Filippis, S. D., Caravasso, C. F., Persis, S. D., & Rieti, A. (2016) · Cited by 1 · see citing works
Brody, A., & Billieux, J. (2020) · Sciences du jeu · doi:10.4000/sdj.2776 · Cited by 1 · see citing works
Van DSM IV-TR naar DSM-5: middelengebruik en gedragsverslavingen
Sigling, H. (2016) · Verslaving · doi:10.1007/s12501-016-0087-5
Harris, A. (2018) · Nottingham Trent University's Institutional Repository (Nottingham Trent Repository)
Μούτσου, Ε., & Γεωργάκα, Ε. (2020) · Psychology the Journal of the Hellenic Psychological Society · doi:10.12681/psy_hps.23272
Βάσιος, Α. Λ., & Ρούσσος, Π. (2020) · Psychology the Journal of the Hellenic Psychological Society · doi:10.12681/psy_hps.23255
Tecnologias Viciantes e suas Implicaçôes para o Enforcement Antitruste
Rosenquist, J. N., Morton, F. S., & Weinstein, S. (2023) · Direito Público · doi:10.11117/rdp.v20i107.7563
A Person Is Never a Problem: Narrative Externalization and Reconciliation
Zepeda, S. G., & Loredo, S. (2025) · Integratus · doi:10.1521/intg.2025.3.1.58
Pharmacological Management of Behavioral Addictions
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- Authors
- Rennert, L., Denis, C., Peer, K., Lynch, K. G., Gelernter, J., & Kranzler, H. R.
- Affiliations
- University of Pennsylvania (US)
- Yale University (US)
- Venue
- Experimental and Clinical Psychopharmacology
- Published
- 2014-02
- Volume
- 22
- Issue
- 1
- Pages
- 50-56
- ISSN
- 1064-1297 (ISSN-L)
- 1936-2293
- PMC
- PMC4019046
- OpenAlex
- W2035078571
- Cited by
- 56
- References
- 26
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 6 · 2023: 1 · 2022: 5 · 2021: 5 · 2020: 8 · 2019: 7 · 2018: 5 · 2017: 2 · 2016: 10 · 2015: 1 · 2014: 2
- FWCI
- 5.90
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Experimental and Clinical Psychopharmacology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (R01 DA12690, R01 DA12849; R01 DA18432; R01 AA11330; R01 AA017535)
- Veterans Integrated Service Networks 1 and 4
- Topics
- Social Sciences › Psychology › Clinical Psychology › Gambling Behavior and Treatments
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Keywords
- gambling addiction, DSM-5, DSM-IV, diagnostic criteria, prevalence, substance use disorders, comorbidities, diagnostic validity
- MeSH terms
- Adolescent, Adult, Aged, Female, Gambling, Humans, Male, Middle Aged, Sensitivity and Specificity, Prevalence, Logistic Models, Substance-Related Disorders, Diagnostic and Statistical Manual of Mental Disorders, Young Adult
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