Comorbid pathological gambling, mental health, and substance use disorders: Health-care services provision by clinician specialty

Abstract

Background and aims Pathological gambling (PG) is an impulse control disorder. This study assessed the burden of co-occurring behavioral addictions and mental health disorders in treatment-seeking patients and estimated the likelihood of receiving care for these disorders by clinician specialty. Methods Study data were derived from the Massachusetts All-Payer Claims Database, a representative database, for the period 2009-2013. The sample included commercially insured adult residents of Massachusetts. Univariate and multivariate logistic regressions were used to estimate the likelihood of provision of care by clinician specialty adjusting for patient's demographic characteristics and level of care. Bonferroni correction was applied to adjust for multiple testing. Results The study sample included 869 patients. Treatment-seeking patients who had a diagnosis of PG were mostly males (71%), aged 45-54 years (26.7%) and enrolled in a health maintenance organization (47%). The most prevalent co-occurring disorders among patients with PG as principal diagnosis were anxiety disorders (28%), mood disorders (26%), and substance use disorders (18%). PG was associated with a more than twofold likelihood of receiving care from social workers and psychologists (p < .05). Depressive disorders were associated with a three times greater likelihood of receiving care from primary care physicians (PCPs) (p < .05). Having three and four or more diagnosis was associated with a greater likelihood of receiving care from PCPs. Discussion and conclusions Psychiatric and substance use disorders are prevalent among treatment-seeking pathological gamblers. The likelihood of receiving care from specialty clinicians significantly varies by clinical diagnosis and patient clinical complexity.

Keywords: All-Payer Claims Data; behavioral addictions; clinician specialty; mental health disorders; pathological gambling; treatment provision.

Figure 1.

Most prevalent psychoactive substance diagnosis among treatment-seeking patients, 2009–2012. Note. Non-dependent abuse of drugs includes alcohol abuse, tobacco use disorder, cannabis abuse, opioid abuse, and cocaine abuse. Drug dependence includes opioid-type dependence and anxiolytic-, cocaine-, and cannabis dependence. Chart includes treatment-seeking patients with primary diagnosis (n = 180) out of 447 patients who had pathological gambling as principal diagnosis and patients with a principal diagnosis when pathological gambling was primary diagnosis (n = 373) out of 869 patients in the analytical sample who had a principal diagnosis

Figure 2.

Treatment-seeking patients and health-care providers by Massachusetts County, 2009–2012. Note. Data for Nantucket and Dukes County were suppressed