Research That Matters (January 17 - 20, 2008)

Purpose: Homelessness and problem gambling are serious social concerns. Like problem gamblers, the homeless are disproportionately affected by substance abuse and mental health problems. Similarly, many problem gamblers experience serious adverse consequences leading to loss of jobs, families, and, ultimately, housing. Both groups report high rates of substance abuse, ranging as high as 40% among problem gamblers and 80% among the homeless. Despite the apparent relationship between problem gambling and homelessness, few studies have evaluated their association. This NIDA-funded study is among the first to assess the prevalence of problem gambling among the homeless and to examine substance abuse and mental health disorder comorbidities.

Methods: Data from the five-year, SUNCODA (Service Use, Needs, Costs, and Outcomes of Drug Abuse in Homeless Populations) study was used for these analyses. This study randomly recruited homeless individuals from shelters and street locations. Interviewers collected information on gambling (South Oaks Gambling Screen: SOGS), housing status (Homeless supplement to the Diagnostic Interview Schedule: DIS/HS), substance abuse/dependence (Composite International Diagnostic Interview Substance Abuse Module: CIDI/SAM), and mental health diagnoses (Diagnostic Interview Schedule: DIS).

Based on SOGS responses, respondents were divided into three groups: lifetime non-gamblers (n=65), recreational gamblers (n=147), and problem gamblers (n=63). Groups were examined for differences in demographic and housing characteristics, patterns of lifetime substance abuse/dependence, and lifetime mental health diagnoses using ANOVAs and chi-square analyses.

Results: Nearly one-quarter (23%) of participants were classified as problem gamblers – four-times the prevalence rate in the general population. Problem gamblers and recreational gamblers were more likely than non-gamblers to be male (86% vs. 77% vs. 54%) and homeless because of health concerns (8% vs. 13% vs. 0%) and less likely to self-identify as Caucasian (8% vs. 26% vs. 11%). Substantial differences were detected in substance abuse. Problem gamblers were arrested more often than recreational gamblers for lifetime public intoxication (2.07+6.23 vs. 0.35+1.05). In addition, they were more likely than both non-gamblers and recreational gamblers to meet diagnostic criteria for any drug abuse/dependence (87% vs. 57% vs. 69%) and any substance abuse/dependence (92% vs.65% vs. 79%). About 16% of problem gamblers reported rates of lifetime stimulant abuse/dependence – nearly three times that of the other two groups. Problem gamblers also reported the highest rates of lifetime cocaine abuse/dependence (62% vs. 42% vs. 39%) and were more likely than the other two groups to have ever been in drug treatment (65% vs. 39% vs. 39%). Mental health differences also emerged. Problem gamblers reported higher rates of bipolar disorder, ASPD, and any mental health disorder than recreational gamblers (bipolar: 17% vs. 7%; ASPD: 33% vs. 13%; any mental health: 70% vs. 52%).

Implications: These data confirm that substantial comorbidity exists between problem gambling and both mental health problems and substance abuse/dependence among the homeless. Social workers working with homeless shelters and health services for the homeless should screen for problem gambling, particularly when substance use/abuse and mental health disorders are detected. In addition, the importance of incorporating problem gambling treatment within addiction services will be discussed.