Gambling Problems in US Military Veterans

This systemic review examined the published literature on the rates, correlates, comorbidities, treatment, and genetic contributions to US veterans’ gambling behaviors in 39 studies.

Quantitative Data Highlights

• 2% is the estimated rate of clinically diagnosed Gambling Disorder in US military Veterans.

Treatment

• Of Veterans seeking treatment for Gambling Disorder:
  • 66% to 79% of veterans indicated that they experienced cravings/urges to gamble,
  • 33% met criteria for comorbid substance abuse and Gambling Disorder,
  • 29.5% presented a lifetime diagnosis of PTSD, and
  • 27% of veterans report problems due to gambling.

Suicide

• 39.5% of veteran compulsive gamblers had previously attempted suicide.
• Veterans with Gambling Disorder and chronic pain are 1.9x more likely to attempt suicide than veterans with a pain disorder alone.

Risk Factors

• Being a veteran.
• Co-occurring disorders. (Link to “Treatment” and “Comorbidities” category, content below)
• Genetic factors. (link to “Family Systems” category, content below)
• Diagnosis of PTSD.
• Social Pressure

Protective Factors

•  Strong social support.

Qualitative Data Highlights

PTSD

• Baseline PTSD symptoms were associated with a higher risk of developing problem gambling 10 years later.
• Symptoms of PTSD were related to more general cognitive distortions around gambling, including positive gambling expectancies.
• Both veterans with Gambling Disorder and non-veterans, symptoms of post-traumatic stress were uniquely related to gambling in response to negative affect, gambling in response to social pressure, and gambling due to a need for excitement.

Comorbidities

• Psychiatric disorders such as PTSD can co-occur at high rates among US veterans receiving residential problem gambling treatment.
• Gambling Disorder is frequently comorbid with other psychiatric disorders.

Suicide

• Gamblers with trauma backgrounds that included experienced physical and emotional abuse were more likely to attempt suicide.

Poverty

• Gambling Disorder is the second strongest predictor of homelessness among veterans, second to illicit drug use.

Challenges

• In 2019, Congressional legislation required standard screening among U.S. active-duty personnel, however screening has not been widely implemented by the DOD.
  • The report also notes that neither the Department of Defense (DOD) nor the Coast Guard systematically screen for problem gambling.

Suicide

• Considerable concern about the increased risk for suicide among veterans with problem gambling behavior is warranted.

Treatment

• Little research exists to provide a clear clinical and practical understanding of the disorder within this population.
• Standardized screening for PG has not been widely implemented across U.S. VA hospitals or by the Department of Defense.
• Greater attention is needed to routinely assess for suicidality and problem gambling severity among all active duty or veterans seeking healthcare.
• VA mental health services were found to underdiagnose problem gambling (PG) among the veteran population.
• Studies outside of the DOD and VA healthcare systems have found much higher rates of Gambling Disorder among U.S. Service Members and Veterans.

Prevention

• Limited research has been centered on developing prevention and treatment interventions for affected individuals and their families.

Conclusions

Treatment

• Current strategies for treating Gambling Disorder in military members may be inadequate and should include plans to address likely psychiatric comorbidities and privacy concerns.
• Standardized screening for problem gambling could serve to detect those earlier in the course of the illness, thus reducing full onset of the Gambling Disorder, which in turn would prevent much of the irrevocable psychological, medical, social, and financial problems associated with problem gambling.

Family Systems

• There appears to be a substantive genetic link to the development of the disorder and other psychiatric comorbidities.

Recommendations

Screening

• Standardized screening for Gambling Disorder among organizations (DOD military bases, Veterans Affairs Medical Centers, universities with veteran student programming) that serve US veterans is strongly needed, and across healthcare settings that interact with military populations.

Future Research

• More research is needed to better understand how gambling severity evolves over the life course as well as differences across US military populations, particularly as a function of gender, ethnicity, and other cultural factors.
• Identified, demonstrated effective treatments need to be studied, developed, and tailored to this population to ensure it adequately addresses their specific needs and leads to recovery.
• Further investigation is needed to determine the role of gambling in social and financial issues (e.g., homelessness).
• A better understanding of gambling characteristics and co-occurring problems among this population will inevitably lead to improved interventions and treatment that appropriately target their unique needs.