Gambling Problems in US Military Veterans (Systemic Review)

Gambling disorder (GD) is a debilitating mental illness characterized by persistent patterns of dysregulated gambling behaviors. Recent evidence suggests that US military veterans are a high-risk population vulnerable to the development of problem gambling. This systemic review examined the published literature on the rates, correlates, comorbidities, treatment, and genetic contributions to US veterans’ gambling behaviors in 39 studies.

Findings

Gambling Behaviors Among Veterans: Rates and Frequency

• The US Government Accountability Office (GAO) reviewed the Military Health System records of the DOD and Coast Guard (CG) from fiscal year 2011 to 2015, reported that less than 0.03% of active-duty service members each year were diagnosed with gambling disorder or seen for problem gambling within the healthcare system.
• The report also notes that neither the Department of Defense (DOD) nor the Coast Guard systematically screen for problem gambling.
• In 2019, Congressional legislation required standard screening among U.S. active-duty personnel, however screening has not been widely implemented by the DOD.
• VA mental health services were also found to underdiagnose problem gambling (PG) among the veteran population.
• Standardized screening for PG has not been widely implemented across U.S. VA hospitals.
• Studies outside of the DOD and VA healthcare systems have found much higher rates of Gambling Disorder (GD) among U.S. Service Members and Veterans.

Psychiatric Comorbidities with Gambling Disorder (GD)

• GD is frequently comorbid with other psychiatric disorders; veterans are at a higher risk compared with non-veterans for many psychiatric conditions.
• 33% of hospitalized veterans seeking treatment met criteria for comorbid substance abuse and GD.
• 66.4% of veterans seeking treatment for GD reported a lifetime history of substance abuse or dependence.
• 41% of veterans seeking treatment for GD showed a lifetime history of a mood disorder, 29.5% presented a lifetime diagnosis of PTSD, 77% reported lifetime substance use.

PTSD and Trauma-Related Conditions

• Gamblers are more likely to have a diagnosis of PTSD, but no association found between combat exposure and likelihood of gambling.
• Researchers examined stressful life experience pre-, peri-, and post-deployment and found that veterans with PTSD were significantly more likely to engage in at-risk gambling behavior.
• The experience of post-deployment stressful life events and less social support increased the probability of at-risk gambling behavior.
• Symptoms of PTSD were related to more general cognitive distortions around gambling, including positive gambling expectancies.
• Veteran 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.

Suicide Risk

• 39.5% of veteran compulsive gamblers had previously attempted suicide.
• A clinical sample of veterans with GD and chronic pain, comorbid veterans were 1.9x more likely to attempt suicide than veterans with a pain disorder alone.
• Considerable concern about the increased risk for suicide among veterans with problem gambling behavior is warranted.

Homelessness

• GD is associated with veteran homelessness. GD is the second strongest predictor of homelessness among veterans, second to illicit drug use.