by: Declan T. Barry, Ph.D., Assistant Professor of Psychiatry Department of Psychiatry, Yale University School of Medicine | Feb 1, 2011
Gambling and gambling related problems are common among all racial and ethnic groups in the United States, but there is new evidence that African Americans are more likely to experience gambling-related problems than white Americans. Differences in problem and pathological Gambling (PPG) among people of different races are not well understood. A better understanding of gambling behaviors, gambling problem severity and other psychiatric disorders associated with PPG in minority populations could benefit gambling prevention and treatment programs. For this reason we have devoted the February edition of Issues & Insights to new research on the differences in gambling behavior and PPG between black and white Americans.
A recently published study by Dr. Declan Barry and colleagues (Barry, Stefanovics, Desai, & Potenza, 2011) analyzed data from The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), the largest prevalence study of psychiatric disorders in the United States (Petry, Stinson, & Grant, 2005). Dr. Barry and co-authors compared black and white respondents on measures of gambling behavior, PPG, mental health, and the co-occurrence of mental disorders and gambling. In the following interview, Dr. Barry clarifies and expands on the findings in his recent paper.
I & I: What are the major findings of this study?
Dr. Barry: Among a nationally representative sample of 32,316 black and white adults in the United States, black respondents (.96 percent) were more likely than white respondents (45 percent) to exhibit past-year PPG. Higher proportions of black problem or pathological gamblers, as compared with white ones, were women (49 percent vs. 32 percent). Elevated rates of anxiety, mood, and substance use disorders, as well as personality disorders, were found among black and white problem or pathological gamblers. Black respondents were more likely than white ones to exhibit a stronger relationship between subsyndromal[i] gambling and any mood disorder, hypomania, and any substance-related disorder.
I & I: Are these findings consistent with past research on this subject?
Dr. Barry: Consistent with previous research, we found that black respondents exhibited higher rates of PPG than white respondents. Our finding that higher proportions of black problem or pathological gamblers were women, as compared to the white population, is consistent with prior findings that racial minority women may be at particularly high risk of PPG. Similar to previous studies, we found that PPG was associated with elevated rates of Axis I and Axis II[ii] psychopathology for black and white respondents. However, we also found that, in comparison to white respondents, black respondents were more likely to exhibit a stronger relationship between subsyndromal gambling and any mood disorder, hypomania, and any substance-related disorder.
I & I: How do these findings compare to research about minorities and other addictive disorders such as substance use disorders?
Dr. Barry: Studies have found that community-dwelling (that is, non-institutionalized) blacks and whites generally have similar prevalence rates of psychiatric disorders; however, more African Americans belong to at-risk groups (e.g., homeless) that typically exhibit higher rates of psychopathology. Prior research using NESARC data has found that blacks and whites exhibit comparable rates of past-year drug use disorders.
I & I: Why is it important to study the effects of race or gender on gambling disorders?
Dr. Barry: In the long term, an increased understanding of the effects of race or gender may provide important information about the development and maintenance of PPG and may suggest targeted treatment for PPG. For example, possible differences in motivation among men and women or among individuals from different racial backgrounds may suggest optimal intervention strategies. Thus, if differences emerge on proclivity to engage in gambling to escape distress, these differences might be specifically targeted by clinicians.
I & I: How can findings like these help clinicians working with people with gambling problems, or public health policy makers?
Dr. Barry: The robust associations between PPG and Axis I and II disorders offer support for the routine assessment of psychiatric disorders among patients seeking gambling treatment. Our findings suggest that public health policy makers might benefit from attending to subsyndromal levels of gambling (and not solely PPG) since race-related differences in the association between subsyndromal levels of gambling and mood as well as substance-use disorders were found in the present study.
Declan Barry, Ph.D., is a clinical psychologist, an assistant professor in the department of psychiatry at Yale University School of Medicine, and director of the APT Foundation Inc, Pain Treatment Services. Dr. Barry’s research is aimed at: (1) developing and evaluating treatments for patients with co-occurring opioid addiction (e.g., prescription opiates, heroin) and chronic pain (i.e., physical pain lasting at least 3 months); and (2) examining the role of sociocultural factors in the occurrence and treatment of addictions (e.g., gambling, eating disorders, substance-related disorders).
Barry, D. T., Stefanovics, E. A., Desai, R. A., & Potenza, M. N. (2011). Differences in the Associations between Gambling Problem Severity and Psychiatric Disorders among Black and White Adults: Findings from the National Epidemiologic Survey on Alcohol and Related Conditions. The American Journal on Addictions, 20(1), 69-77. doi:10.1111/j.1521-0391.2010.00098.x
Petry, N. M., Stinson, F. S., & Grant, B. F. (2005). Comorbidity of DSM-IV pathological gambling and other psychiatric disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. The Journal of Clinical Psychiatry, 66(5), 564-574.
[i] A person with subsyndromal gambling exhibits gambling-related behaviors and problems that do not meet the threshold for pathological gambling.
[ii] Axis I refers to psychiatric disorders such as depression or bipolar disorder, while Axis II refers to personality disorders such as borderline personality disorder or antisocial personality disorder.