Gambling Disorder and Women: Does Gender Make a Difference?

March 15, 2016

Christine Reilly

Senior Research Director

National Center for Responsible Gaming

Today, it is widely accepted that examining the role of sex and gender in health is vital to conducting rigorous research, developing effective public health policies and enhancing clinical treatment. In the past, however, health research has not always adequately addressed sex and gender. This oversight was characteristic of early research on gambling addiction because so many investigations were focused on veterans and because many more men gambled than women. Although men still outnumber women as gamblers in the US, women are catching up, thanks in part to the expansion of legalized gambling during the past 30 years. During the past 20 years, gambling researchers have not only included women as research participants but also have increasingly addressed the role of gender in studies of gambling disorder. As is common in young fields of research, we still don’t have a strong consensus on the gender issue in the gambling field. Here are a few of the questions that are driving research on the relationship between gambling disorder and women.

Is “telescoping” — moving from health to disorder quickly — more characteristic of women than men?

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Researchers have long noted gender differences in the trajectory of gambling disorder with women having a later age of initiation but a shorter time developing a gambling problem, a phenomenon also observed in other addictive disorders (Grant, Odlaug, & Mooney, 2012). One study asked if co-occurring disorders had an impact on this course and found that the telescoping effect was not due to anxiety disorders (Grant et al., 2012), as has been reported in alcohol use disorders (Kushner, Maurer, Menary, & Thuras, 2011), concluding that telescoping is due to gender-related differences in gamblers (Grant et al., 2012).

However, it is important to note that studies that found a telescoping effect were based on treatment-seeking samples. In other words, they studied people in treatment or interested in being in treatment. This is significant because the rate of treatment or help-seeking among disordered gamblers is only about 15 percent (Slutske, 2006) and, therefore, treatment-seeking samples are not considered representative of the general population of disordered gamblers. Newer research focused on community samples has called into question the telescoping phenomenon. 

For example, one recent study analyzed data from a large community-based Australian twin cohort (2001 men, 2662 women) (Slutske, Piasecki, Deutsch, Statham, & Martin, 2015). The researchers did not find a telescoped disordered gambling trajectory compared with male gamblers. Rather, they observed that men initiated gambling at an earlier age and progressed more rapidly to weekly gambling, symptoms of disordered gambling and a diagnosis of gambling disorder than did women.

Do co-occurring disorders affect women differently?

According to two major national studies—the National Comorbidity Survey Replication (Kessler et al., 2008) and NESARC (National Epidemiologic Survey on Alcohol and Related Conditions) (Petry, Stinson, & Grant, 2005)—disordered gamblers have a high rate of co-occurring disorders. Kessler et al. reported that 96 percent of disordered gamblers had a co-occurring psychiatric disorder in their lifetime and that 75 percent developed gambling problems after the onset of the co-occurring disorders.

Clearly, having another addictive or psychiatric disorder is a major risk factor for developing a gambling problem. However, in some cases, the gambling disorder might cause the onset or exacerbate another addictive disorder. Researchers looking at the gender question have wondered if there are differences between men and women in the relationship between gambling disorder and other disorders. In an analysis of the NESARC, Pilver et al. found that women at risk for gambling disorder may be more vulnerable to nicotine dependence and at-risk men more vulnerable to the development of alcohol use disorders (Pilver, Libby, Hoff, & Potenza, 2013). This finding is consistent with research showing that women are more likely than men to smoke for stress relief and men are more likely than women to consume alcohol in response to stress.

Is there a gender difference in disordered gamblers’ readiness to change behavior?

Because so few disordered gamblers seek help, understanding how gender and emotions play a role in motivational reasons for changing gambling behavior is vital to strengthening the effectiveness of both self-help interventions and treatment strategies. A Canadian study investigated this issue in a sample of adult problem gamblers with an interest in quitting or reducing their gambling (Kushnir, Godinho, Hodgins, Hendershot, & Cunningham, 2015). The researchers found few gender differences in this sample. But they did find significant differences in emotional traits between men and women:

In general, women reported greater levels of shame and guilt proneness compared to men, whereas men reported greater trait-detachment than women. They suggest that while females may report experiencing more emotion in general, female and male problem gamblers may experience different emotions towards their gambling behaviors as well (Kushnir et al., 2015).

What are the clinical implications of the research on women and gambling?

The research on women and gambling suggests that clinicians keep in mind the following:

• Remember to include women as well as men if you begin to screen clients for gambling disorder. Although men continue to gamble more than women, female gamblers are increasing. An excellent three-question screen is the Brief Biosocial Gambling Screen. For more information, visit http://www.divisiononaddiction.org/bbgs_new/

• Avoid outdated gender stereotypes that may influence both anecdotal reports and research. For example, it is not a given that men prefer the thrill of gambling and hence play casino games, but women prefer to gamble to escape from reality and, therefore, like non-strategic games such as slot machines. As LaPlante et al. observed, “Such gross generalizations about men and women are unlikely to maintain any predictive power in specific settings or over time as gender roles evolve and change (LaPlante, Nelson, LaBrie, & Shaffer, 2006, p. 67).

To stay in touch with new research on gambling disorder, subscribe to Gambling Disorders 360°, the blog of the National Center for Responsible Gaming and The WAGER, an online research report sponsored by the Division on Addiction, Cambridge Health Alliance.

Christine Reilly, Senior Research Director, NCRG, administers the NCRG research grant programs and coordinates educational activities such as the annual NCRG Conference on Gambling and Addiction and the EMERGE Training program (Executive, Management, and Employee Responsible Gaming Education). From 2008 to 2009, Christine served as the executive director of the Institute for Research on Pathological Gambling and Related Disorders. She was also the first executive director of the NCRG from 1997 to 2000. 

References

Grant, J. E., Odlaug, B. L., & Mooney, M. E. (2012). Telescoping phenomenon in pathological gambling: association with gender and comorbidities. The Journal of Nervous and Mental Disease, 200(11), 996–998. http://doi.org/10.1097/NMD.0b013e3182718a4d

Kessler, R. C., Hwang, I., LaBrie, R., Petukhova, M., Sampson, N. A., Winters, K. C., & Shaffer, H. J. (2008). DSM-IV pathological gambling in the National Comorbidity Survey Replication. Psychological Medicine, 38(9), 1351–60. http://doi.org/S0033291708002900 [pii] 10.1017/S0033291708002900

Kushner, M. G., Maurer, E., Menary, K., & Thuras, P. (2011). Vulnerability to the rapid (“telescoped”) development of alcohol dependence in individuals with anxiety disorder. Journal of Studies on Alcohol and Drugs, 72(6), 1019–1027.

Kushnir, V., Godinho, A., Hodgins, D. C., Hendershot, C. S., & Cunningham, J. A. (2015). Gender differences in self-conscious emotions and motivation to quit gambling. Journal of Gambling Studies.

LaPlante, D. A., Nelson, S. E., LaBrie, R. A., & Shaffer, H. J. (2006). Men and women playing games: Gender and the gambling preferences of Iowa Gambling Treatment Program participants. Journal of Gambling Studies, 22(1), 65–80.

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. Journal of Clinical Psychiatry, 66(5), 564–74.

Pilver, C. E., Libby, D. J., Hoff, R. A., & Potenza, M. N. (2013). Gender differences in the relationship between gambling problems and the incidence of substance-use disorders in a nationally representative population sample. Drug and Alcohol Dependence, 133(1), 204–211.

Slutske, W. S. (2006). Natural recovery and treatment-seeking in pathological gambling: Results of two U.S. national surveys. American Journal of Psychiatry, 163(2), 297–302. http://doi.org/163/2/297 [pii] 10.1176/appi.ajp.163.2.297

Slutske, W. S., Piasecki, T. M., Deutsch, A. R., Statham, D. J., & Martin, N. G. (2015). Telescoping and gender differences in the time course of disordered gambling: evidence from a general population sample. Addiction, 110(1), 144–151. http://doi.org/10.1111/add.12717