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Original article

Predictors of remission from problem and pathological gambling: Results from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)

Author

S. Bernardi 1, N.M. Petry2, S.S. Martins3, D.S. Hasin1,4, S. Liu1, B.F. Grant5, C. Blanco1

Affiliations

1 Department of Psychiatry, Columbia University/New York State Psychiatric Institute, New York, NY
2  Department of Psychiatry, University of Connecticut Health Center, Farmington, CT
3 Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
4 Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
5 Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland

Corresponding author

Carlos Blanco, M.D., Ph.D.
Department of Psychiatry
New York State Psychiatric Institute/Columbia University
1051 Riverside Drive, Unit 69
Phone: 212-543-6533
Fax: 212-543-6515
E-mail: cb255@columbia.edu

Abstract

Objectives. Gambling disorder remits naturally, however, little is known about the time course of remission and potential predictors. Methods. We analyzed data from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a US nationally representative sample (N = 43,093). Bivariate analyses and logistic regressions were used to examine predictors of remission status during the last 12-month. Survival analysis were used to estimate time to remission in individuals with pathological gambling (PG). Results. The rates of past 12-month remission were 45.24% for problem gamblers (<5 DSM-IV criteria) and 36.72% for PGs (>5 DSM-IV criteria). Some demographic factors and specific DSM-IV criteria were associated with lower likelihood of remission. Survival analyses estimated an 85.6% cumulative probability of remission from PG, with a median time of 19 years. Conclusions. Lifetime remission is common among severe gamblers, but occurs slowly (with an average of19 years). Given the high personal and societal costs associated with GD and the long latency to remission, there is a need to improve interventions for the prevention and treatment of GDs. Here we suggest a cluster of demographic and phenotypic factors can help identify cases in need of greater help.

Keywords

Pathological gambling, remission, survival analysis, prognosis, outcome

Introduction

This article adopts the DSM-IV terminology for gambling disorder to remain consistent with the data collection method.
Pathological gambling (PG), a persistent and recurrent maladaptive pattern of gambling behavior, preoccupation with gambling activities, loss of control, and continued gambling despite impairment of social or occupational functioning, is associated with significant financial losses, legal problems [1], and disrupted interpersonal and familial relationships [2]. Individuals with PG have an increased risk for new onset psychiatric disorders [3], suicide attempts [4], and several medical conditions [5]. Genetic epidemiological studies [6,7,8] indicate that problematic gambling behavior, operationally defined for the purposes of this report and Others [9,10] as meeting between one and four PG criteria, and PG (defined as meeting five or more criteria) are aligned on a severity continuum with the same phenotype [11]. Similarly to individuals with PG, those with problematic gambling behavior have substantial personal, familial, and societal burden [12] and high rates of psychiatric comorbidity [9].
Studies in nationally representative [10,13] and community samples [14,15] indicate that up to 39% of individuals with PG and about 45% of individuals with problematic gambling behavior achieve remission at some point in their lives. However, it remains unknown how long does it take for gamblers to recover and if there are predictors of remission. Given the high rates of suicide among non treatment-seeking gamblers [16], and the significant consequences of PG over time [1,2,4,5,17], it remains important to characterize the time course of PG.
Clinical [18,19] and community studies [15,20] have indicated that being married, employed and having higher educational attainment facilitate spontaneous remission. Although some of these studies also noticed an association between psychiatric comorbidity and lower rates of remission [15,18,19], results about the relationship between PG and psychiatric comorbidities are mixed. For example, community studies have shown that higher rates of mood disorder are associated with the persistence of PG [21], and clinical studies have shown that mood disorders are associated with early onset of PG and worse treatment response [18]. However, when the stability of symptoms is taken into account, there is no evidence of a significant association between mood disorders and PG[22].
Similarly, results regarding the effects of substance and alcohol use on remission are mixed. Two studies in convenience samples have found that lifetime drug and current alcohol use have no impact on PG outcomes [23,24], whereas a study in a clinical sample reported that comorbid alcohol use predicted a faster remission of gambling problems [20]. In contrast, study of a sub-sample of problem and pathological gamblers, selected from a larger sample, indicated that hazardous or problematic alcohol use decreased the probability of remission from gambling problems [13].
Previous research has shown that individuals who endorse a greater number of PG criteria have a lower likelihood of remission [3,13,15]. However, to date, only one study has examined symptom patterns among remitted gamblers.  Westermeyer et al. [15] found that individuals who endorsed the criterion “after losing money gambling, often returns another day to get even” had higher remission rates, whereas those who endorsed “increased preoccupation with gambling” had greater persistence of PG [15].
To date, only one study [3] has examined predictors of remission from problematic gambling behavior and PG in a national representative sample, the National Comorbidity Survey Replication (NCS-R). The results showed greater odds of remission among individuals aged 18-44 years and among non-students [3]. In contrast with findings from clinical and community studies [13,15,18,19,20], remission from problematic gambling behavior or PG did not differ significantly by level of education, employment or marital status, or the presence of psychiatric comorbidity. Individuals who endorsed fewer diagnostic criteria had greater odds of remission, but the value of specific symptoms as predictors of remission was not investigated [3].
Despite this growing body of knowledge, important questions remain regarding predictors of remission from problematic gambling behavior and PG. At present, there are no published data on the duration of illness prior to remission. Results regarding the effects of substance use disorders [13,20,24] on the odds of remission from problematic gambling behavior and PG are mixed. It remains unknown whether the findings from clinical or geographically restricted samples [14,15,20,23,25] about demographic factors, comorbidity and clinical predictors extend to problem and pathological gamblers in the general population. Furthermore, previous studies have not examined the influence of personality disorders and family history of psychiatric disorders on remission.
We examined predictors of remission from problematic gambling behavior and PG (defined as not meeting any DSM-IV PG criteria in the 12 months prior to the interview) using data from the National Epidemiological Survey on Alcohol and Related Conditions (NESARC) [26], a large, nationally representative sample of US adults. The specific goals of this study were to: 1) estimate the proportion of problem and pathological gamblers who achieved remission during the last 12 months; 2) investigate sociodemographic, psychiatric, familial, and clinical predictors of 12 months-remission from problem and pathological gambling; and, 3) estimate the per-year and cumulative probability of remission and the median delay before lifetime remission among individuals with PG.

Method

NESARC sample

The 2001–2002 NESARC is a survey of a representative sample of the USA sponsored by the NIAAA [27,28]. The target population was individuals aged ≥18 years in the civilian non-institutional population residing in households and group quarters. The survey included those residing in the continental United States, District of Columbia, Alaska and Hawaii. Face-to-face personal interviews were conducted with 43,093 respondents. The survey response rate was 81%. Blacks, Hispanics, and young adults (ages 18–24 years) were over-sampled. All potential NESARC respondents were informed in writing about the nature of the survey, the statistical uses of the survey data, the voluntary aspect of their participation and the Federal laws that rigorously provide for the strict confidentiality of identifiable survey information. Those respondents consenting to participate after receiving this information were interviewed. The research protocol, including informed consent procedures, received full ethical review and approval from the U.S. Census Bureau and the U.S. Office of Management and Budget.
Data were weighted to reflect design characteristics of the NESARC survey and to account for oversampling. Adjustment for non-response across numerous variables, including age, race-ethnicity, sex, region and place of residence, was performed at the household and person level. Weighted data were then adjusted to be representative of the civilian population of the USA on a variety of socio-economic variables including region, age, race-ethnicity and sex based on the 2000 Decennial Census.

Measures

Sociodemographic characteristics

Sociodemographic measures included sex, race-ethnicity, nativity, age, education, marital status, urbanicity, region of the US, employment status, personal and family income measured, and insurance type.

DSM-IV PG and problematic gambling behavior 

The diagnostic interview was the Alcohol Use Disorder and Associated Disabilities Interview Schedule–DSM-IV version (AUDADIS-IV), a state-of-the-art structured diagnostic interview designed for use by experienced lay interviewers [29]. All respondents who had gambled five or more times in at least one year of their life were asked about the symptoms of DSM-IV PG. Specifically, the gatekeeping question asked was ‘Now I’d like to ask you a few questions about gambling. By gambling I mean playing cards for money, betting on the horses or dogs or sports games, playing the stock or commodities market, buying lottery tickets or playing bingo or keno or gambling at a casino, including playing the slot machines. Have you ever gambled at least five times in any one year of your life?’ Those who responded affirmatively were asked the DSM-IV PG questions.
Consistent with DSM-IV, lifetime and past year AUDADIS-IV diagnoses of PG required the respondent to meet at least five of the 10 DSM-IV criteria. Fifteen symptom items operationalized and were categorized in the 10 PG criteria. The DSM-IV criterion for chasing one’s losses was expanded to include chasing one’s winnings. Internal consistency reliability of the PG symptom items (α = 0.92) and criteria for PG (α = 0.80) were excellent [30]. Test–retest reliability of lifetime symptoms was also excellent, with κ= 0.76, 95% confidence interval (95% CI) = 0.68–0.82 [26]. Additional information regarding validity of PG diagnosis has been described elsewhere [9]. Because prior studies have defined problematic gambling behavior in different ways [29], we conducted analyses defining problematic gambling behavior in two manners: (1) meeting at least one DSM-IV criterion, and (2) meeting at least 3 DSM-IV criteria. According to DSM-IV, PG was defined as meeting between 5 and 10 criteria. Remission was defined as having a lifetime history of problematic gambling behavior or PG but not endorsing any DSM-IV PG criterion in the past 12 months (remission status). This means that gambling symptoms can have remitted at any time, even 5 years before, and that within the 12 months before the interview the gambler had maintained abstinence.
For individuals with lifetime DSM-IV PG (but not for those with problematic gambling behavior), information was available about the course of illness and the time to remission.  For lifetime pathological gamblers, age of onset and offset were collected using the questions: “About how old were you the fist time some of these experiences began to happen around the same time?” and “About how old were you when you finally stopped gambling or stopped having any of these experiences? By finally stopped I mean they never started again”.  This additional information allowed us to estimate the lifetime time course of illness in the most severe cases (PG as defined by DSM-IV).

Psychiatric comorbidity

Assessment of all diagnoses was made according to DSM-IV criteria using the AUDADIS-IV. The AUDADIS-IV included an extensive list of symptom questions that operationalized DSM-IV criteria for nicotine dependence and alcohol and drug-specific abuse and dependence for 10 classes of drugs: sedatives, tranquilizers, opiates (other than heroin or methadone), stimulants, hallucinogens, cannabis, cocaine, inhalants/solvents, heroin, and other drugs. The DSM-IV mood and anxiety diagnoses in the AUDADIS-IV were major depressive disorder, dysthymia, bipolar I, bipolar II, panic disorder, social anxiety disorder, specific phobia, and generalized anxiety disorder. Substance-induced mood and anxiety disorders or those due to a general medical condition were ruled out; hence only ‘primary’ or independent lifetime mood and anxiety disorders were included. Depressive episodes entirely accounted for by bereavement also were excluded. Lifetime (including past and last 12 months conditions) avoidant, dependent, obsessive-compulsive, paranoid, schizoid, histrionic, and antisocial personality disorders were assessed.
Test-retest reliability [26,32,33,34] and validity [26,28,32,35] of the AUDADIS-IV measures are well documented in psychometric studies conducted in clinical and general population samples. In addition, reliability and validity of AUDADIS substance use disorders were found to be good to excellent in several countries participating in the National Institutes of Health/World Health Organization Reliability and Validity Study[34,36,37,38]. All comorbid diagnoses were assessed on a lifetime basis. Test-retest reliabilities for AUDADIS-IV mood, anxiety and personality disorder diagnoses in the general population and clinical settings were fair to good (κ=0.40-0.77) [32,26] and selective diagnoses showed good agreement (κ=0.64–0.68) with psychiatrist reappraisals [32,26]. Avoidant, obsessive-compulsive, paranoid, histrionic, dependent, schizoid, and antisocial personality diagnoses have fair to good test-retest reliability (κ= 0.42-0.67) [26].

Family history

Family history of depression, substance and alcohol use disorders, and antisocial personality disorder were also assessed. Respondents to the NESARC survey were asked about the number of their first-degree relatives (parents, children, brothers and sisters) with these diseases. Test-retest reliability of family history variables (computed as number of first degree relatives with a lifetime diagnosis of the disorder) is good to excellent (κ= 0.54-0.87) [26,33,34].

Statistical Analyses

We conducted identical analyses in two different samples: one including individuals meeting 1-10 DSM-IV PG criteria (n=2279) and then restricting the sample to individuals who met 3-10 PG criteria (n=581). Weighted percentages, means and odd ratios and p-values were computed to derive, stratified by 12-month-remission status, sociodemographic, clinical, comorbid, and family characteristics of the two groups of respondents, individuals meeting 1-10 DSM-IV PG diagnostic criteria and individuals meeting 3-10 DSM-IV diagnostic criteria. We consider significant odds ratios in which the CI did not overlap with 1.00. In order to adjust bivariate associations for sociodemographic characteristics and psychiatric comorbidities and highlight independent associations, a second logistic regression model examined predictors of remission, again defined as no PG criteria in the past 12 months. Predictors were selected stepwise, using as the entry criterion p = 0.20 and as the removal criterion p = 0.05. Odd ratios were adjusted for all sociodemographic characteristics and psychiatric comorbidities that differed between remitters and non-remitters.
We present the analyses conducted on the largest group (at least one PG criterion) and also indicate differences with the analyses of the more restricted sample (3-10 PG criteria). Full results of the logistic regression are presented for both groups.
Survival analysis was used to predict time from onset to remission of PG. Because age of onset and offset were available only for individuals with PG (meeting 5 or more PG criteria), discrete time survival analyses were carried out only in this subgroup. Cumulative lifetime probability of remission curves were constructed using the actuarial method [39]. Standard errors and 95% confidence intervals for all analyses were estimated using SUDAAN to adjust for the design effects of the NESARC.

Results

Socio-demographic correlates of remission

The lifetime prevalence of problematic gambling behavior, defined as meeting 1-10 DSM-IV PG criteria, was 5.2%, the lifetime prevalence of problematic gambling behavior defined as meeting 3-10 DSM-IV criteria was 1.3%, and the lifetime prevalence of PG (≥ 5 DSM-IV criteria) 0.4%. Among individuals meeting 1-10 lifetime DSM-IV criteria, 45.24 % (CI=42.35-48.17) were not actively gambling during the 12 months prior to the interview; among individuals meeting 3-10 lifetime DSM-IV criteria, 36.88 % (CI=31.80-42.26) were not actively gambling during the 12 months prior to the interview; and, among individuals with lifetime PG (≥ 5 DSM-IV criteria), 36.72 % (CI=27.71-46.76) were not actively gambling during the 12 months prior to the interview. Furthermore, among individuals who met ≥ 8 DSM-IV PG criteria (n=44), 41.83% (CI=24.33-61.66) were not actively gambling during the 12 months prior to the interview.
In the sample of individuals meeting 1 or more lifetime DSM-IV PG criteria, the odds of not being active during the 1 year interval preceeding remission were significantly higher for males than females and for Native American than for Whites. Older individuals, individuals who were unemployed and those with public or no health insurance were more likely to remit. Never married individuals were significantly less likely to remit than those married (Table I). When the sample was restricted to individuals meeting 3-10 lifetime DSM-IV PG criteria (data not shown; available from authors), the odds of remission maintained the same direction for each previously significant predictor, but the number of statistically significant predictors decreased. Only being unemployed and being never married were significantly associated with greater and lower likelihood of remission, respectively.

 

Table I. Lifetime Comorbidity of individuals with lifetime Problem and Pathological Gambling by remission status.

Psychiatric comorbidity and familial history correlates of remission* Difference significant at 0.05, two-sided test.

Individuals with a lifetime diagnosis of drug dependence were significantly more likely to remit from problematic gambling behavior and PG than those without lifetime drug dependence comorbidity. There were no other significant relationships between Axis I and II disorders on remission status of problematic gambling behavior and PG, and the number of first degree relatives with a history of psychiatric disorders did not impact remission status (Table II). When the sample was restricted to individuals meeting 3-10 lifetime DSM-IV PG criteria (data not shown; available from authors), again only lifetime diagnosis of drug dependence was significantly associated with past 12-month remission rates from problem and pathological gambling.

Table II. Symptom Profile by Remission Status of Problem Gamblers and Pathological Gamblers.

* Difference significant at 0.05, two-sided test.

** Difference significant at 0.001, two-sided test.

Remission status by symptoms profile

The number of DSM-IV PG criteria met during lifetime was significantly higher among non-remitters than among remitters. When examining each criterion separately, remitters had lower odds than non-remitters of endorsing the following lifetime criteria: increased preoccupation with gambling, need to gamble increasing amounts of money to achieve excitement, gamble as a way of escaping problems, and lying to conceal the extent of gambling involvement (Table III). When the sample was restricted to individuals meeting 3-10 DSM-IV lifetime PG criteria (data not shown; available from authors), the odds of remission maintained the same direction but only the association between to gambling as a way of escaping problems and lower likelihood of remission remained significant.

Table III. Symptom Profile by Remission Status of Problem Gamblers and Pathological Gamblers.

ogistic regression model* Difference significant at 0.05, two-sided test.

** Difference significant at 0.001, two-sided test.

After adjusting for covariates, male gender, older age, and a lifetime history of drug dependence predicted remission from problematic gambling behavior and PG. Having a high school education was negatively associated with remission. Although the total number of lifetime PG criteria endorsed per se did not predict remission, endorsement of three specific criteria (increased preoccupation with gambling, need to gamble with increasing amounts of money and gambling to escape from problems or relieve a dysphoric mood) were associated with lower likelihood of remission (Table IV). When restricting the sample to individuals endorsing 3-10 lifetime DSM-IV PG criteria, lack of employment as well as a history of drug dependence remained significantly associated with higher likelihood of remission. Gambling to escape from problems or relieve a dysphoric mood, and having been never married, were significantly associated with lower likelihood of remission as well. No other association reached significance in this model.

Table IV: Logistic regression model of Predictors of Remission From Problematic gambling behavior and Pathological Gambling.

GAMBLERS 1-10 DSM-IV criteriA (n = 2,279)
AORa 95%CI
Sex
Male    1.30* 1.05 1.60
Female 1.00 1.00 1.00
Age b    1.01* 1.00 1.02
Education
<High School  0.73 0.52 1.01
High School    0.72* 0.55 0.95
College or higher 1.00 1.00 1.00
Employment Status
Employed 1.00 1.00 1.00
Unemployed  1.31 0.95 1.82
private 1.00 1.00 1.00
public 1.15 0.82 1.60
none . 1.53* 1.13 2.09
Lifetime psychiatric comorbidity
Drug dependence   2.23* 1.48 3.36
PG symptoms
Preoccupation with gambling 0.69* 0.55 0.87
Need to gamble with increasing amounts of money in order to achieve the desired excitement 0.77* 0.60 1.00
Gambling to escape problems or relieve depressed mood 0.48* 0.38 0.60

 

*  Difference significant at 0.05, two-sided test.
a. Adjusted for all other variables in the model.
b. Computed as continuous variable.

Time course of remission in PG (5-10 criteria)

The probability of remission showed a bimodal distribution with the first peak 16 years after the onset of PG, and the second peak occurring 34 years after PG onset (Figure 1). The cumulative probability of remission from PG was calculated with survival analyses.  The proportion of pathological gamblers who remitted within the first year and within five years from the onset of PG was 3.7% and 11.0%, respectively. The projected cumulative lifetime probability of remission was 85.6%. However, the median time to remission was 19 years (Figure 2).

Figure 1: Probability of remission from pathological gambling (5-10 DSM-IV criteria) distributed by year.

Discussion

In a large, nationally representative sample of US adults, almost half of the individuals with a lifetime history of problematic gambling behavior – and close to a fourth of those with lifetime PG – did not meet any diagnostic criteria for PG during the previous 12 months. Twelve-month remission from problematic gambling behavior and PG was associated with a variety of sociodemographic, comorbidity and clinical variables including age, unemployment, history of drug dependence, and three specific PG diagnostic criteria. Consistent with genetic studies [6,7,8], community surveys [40] and Rasch analyses [11,41] suggesting that gambling disorders are aligned on a uni-dimensional severity continuum, the variables associated with remission were stable across our two definitions of problematic gambling behavior. When the analyses were restricted to individuals with PG, estimates from survival analysis indicated that 85.6% pathological gamblers would eventually remit at some point in their life. However, remission from PG was slow: 3.7% of the sample remitted within the first year and only 11.0% within 5 years from the onset. The median time to remission was 19 years.
Consistent with previous findings [20], a lifetime history of drug dependence increased the odds of remission. Several mechanisms may explain this association. Quitting one addiction may facilitate the process of quitting the other. Overcoming drug dependence may facilitate recovery having allowed the acquisition of coping strategies with urges, paralleling findings of dual recovery from smoking among naturally recovered individuals with alcohol use disorders [42]. Comorbid substance use disorders may also increase motivation of individuals with problematic gambling behavior and PG for behavioral change [43] increasing awareness of their condition [44]. Furthermore, remission from problematic gambling behavior and PG may be facilitated by remission from other addictive disorders because of the loss of a synergistic effect of the two addictive behaviors [45,46]. On the basis of a hypothesized synergistic potential of nicotine an alcohol [42] successful attempts to quit nicotine have been shown to increase the likelihood of natural recovery from alcohol dependence [42,45] , and similarly, the combination of problematic gambling behavior or PG and drug dependence may have a synergic effect on impulse control [47]. The present study is unable to distinguish between the different potential mechanisms due to its observational nature. Nevertheless, given the high comorbidity of PG with substance use disorders [48,49], the higher prevalence of lifetime drug dependence among remitters may constitute an artifact. This finding should be therefore considered cautiously.
Age increased the odds of remission. Older age may be associated with more cessation attempts, and thus facilitate remission through learning of coping mechanisms, paralleling findings in substance use disorders [50,51]. Alternatively, a longer course and consequently increased negative consequences of problem and pathological gambling in older individuals may increase motivation to quit.
External factors such as markers of economic instability (e.g., unemployment and lack of insurance) increased the likelihood of problematic gambling behavior and PG remission. Financial pressure has a key role in promoting natural recovery from PG [13,52].
In the bivariate analyses, the odds of remission were higher for individuals who endorsed fewer overall criteria, consistently with the results of the NCS-R [3]. A lower number of criteria may imply lower levels of severity and therefore facilitate natural recovery, the most common pathway to gambling remission [10]. However, this finding did not hold in the logistic regression analyses, whereas the endorsement of any of three specific criteria did predict lower odds of remission: increased preoccupation with gambling, need to gamble increasing amounts of money and gambling as a way of escaping from problems or relieving a dysphoric mood.
Increased preoccupation with gambling may reflect non-declarative, implicit gambling memories or habit Learning [53,54], making the individual more vulnerable to triggers and interfering with remission [55]. Tolerance to gambling also predicted a chronic course. Increased tolerance to risk may reflect desensitization to the costs of the obtaining reward [56], to the negative consequences of gambling, possibly diminishing the motivation to change behavior [52], and thus decreasing the probability of remission. Gambling as a way of escaping from problems or relieving a dysphoric mood may signal a subtype of pathological gamblers [57,58] with particular difficulties to stop gambling due their difficulties to tolerate negative affects, including those associated to abstinence [59,60].  Improvement of emotional coping skills could speed the remission latency decreasing the most common motivation to gamble [61], mood regulation.
Consistent with recent results from the NCS-R [3], survival analyses in our sample indicated that the median time to remission among individuals with PG was 19 years after onset of the disorder. The lifetime probability of remission had a bimodal distribution with peaks at 16 and 34 years after the onset of the disorder. The first peak of remission may resemble the “maturing out” phenomenon described in alcohol use disorders [62], i.e., an age-based form of natural recovery related to the assumption of adult and family responsibilities [63,64]. The second peak may be more closely related to higher number of quit attempts. Overall, our results suggest a rather chronic course for most individuals with PG, and associated prolonged exposure to its associated negative consequences.
This study has several limitations, many common to most large-scale surveys. First, estimates of course of problematic gambling behavior and PG were collected retrospectively and may be subject to recall bias. Second, the NESARC did not collect information on family history of problem and pathological gambling, which may be an important predictor of remission. Third, the NESARC is limited to adults and did not collect information other groups that may be at increased risk for problem and problematic gambling behavior, such as children and adolescents [65]. Fourth, the survey did not allow for estimation of time to remission of problematic gambling behavior. Fifth, we defined remission as not meeting any PG criteria rather than as abstinence from gambling. Therefore, remitters could still be actively gambling, without experiencing adverse effects. Sixth, family history was obtained indirectly from the gamblers (the survey respondents) and not directly from family members.

Conclusion

Our findings suggest that remission is common among individuals with problematic gambling behavior and PG, but often occurs long after the onset of the disorder, at least for pathological gamblers. Furthermore, remission is less likely among the young and those with the more severe forms for the disorder. Given the high personal and societal costs associated with problem and PG [1] and the long latency to remission, there is a need to improve interventions for the prevention and treatment of gambling disorders.

Disclaimer: The views and opinions expressed in this report are those of the authors and should not be construed to represent the views of any of the sponsoring organizations, agencies, or the U.S. government.
Funding/Support: The National Epidemiologic Survey on Alcohol and Related Conditions was sponsored by the National Institute on Alcohol Abuse and Alcoholism with supplemental support from the National Institute on Drug Abuse. Work on this manuscript was supported by NIH grants DA019606, DA020783, DA023200, DA023973, and MH082773 (Dr. Blanco), AA014223, DA018652, and AA018111 (Dr. Hasin), HD060772 and DA020667 (Martins), DA021567 (Petry), and the New York State Psychiatric Institute (Drs. Blanco and Hasin).

 

Doi

https://doi.org/10.30435/ABA.01.2019.04

Cite this article as

Bernardi, S.  Petry, N.M. Martins, S.S. Hasin, D.S. Liu, S. Grant, B.F. Blanco, C. (2019). Predictors of remission from problem and pathological gambling: Results from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Archives of Behavioral Addictions, 1(1). doi: 10.30435/ABA.01.2019.04

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