Gambling behaviors and psychopathology related to Attention-Deficit/Hyperactivity Disorder (ADHD) in problem and non-problem adult gamblers

Highlights

• ADHD is associated with higher risk of problem gambling among gamblers.

• ADHD is associated with more psychopathology among gamblers.

• ADHD is associated with higher addiction severity profile among problem gamblers.

Abstract

Previous studies showed that Pathological Gambling and Attention Deficit/Hyperactivity Disorder (ADHD) often co-occur. The aim of this study was to examine whether ADHD is associated with specific severity patterns in terms of gambling behavior, psychopathology and personality traits. 599 problem and non-problem-gamblers were recruited in addiction clinics and gambling places in France. Subjects were assessed with the Wender-Utah Rating Scale-Child, the Adult ADHD Self-Report Scale, the Mini International Neuropsychiatric Interview, the Temperament and Character Inventory, the South Oaks Gambling Screen and questionnaires assessing gambling related cognitive distortions and gambling habits. 20.7% (n=124) of gamblers were screened positive for lifetime or current ADHD. Results from the multivariate analysis showed that ADHD was associated with a higher severity of gambling-related problems and with more psychiatric comorbidity. Among problem gamblers, subjects with history of ADHD were also at higher risk for unemployment, psychiatric comorbidity and specific dysfunctional personality traits. This study supports the link between gambling related problems and ADHD in a large sample of problem and non-problem gamblers, including problem-gamblers not seeking treatment. This points out the necessity to consider this disorder in the prevention and in the treatment of pathological gambling.

Introduction

Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurobiological syndrome affecting between 3.5% and 5.6% of children age 6–12 in France (Lecendreux et al., 2011). ADHD is characterized by impulsivity, hyperactivity, disorganization and inattention, and is associated with a high level of impairment in different areas of life, including poor academic performance, behavioral and social problems, or poor self-esteem. While ADHD symptoms tend to subside over time, data suggest that a majority of adults continue to struggle with a substantial number of ADHD symptoms (Biederman et al., 2000). Research into a neurobiological substrate has shown dopamine, a neurotransmitter with a central role in psychomotor activity, reward-seeking behavior (Brassett-Harknett and Butler, 2007), and norepinephrine (Del Campo et al., 2011) to be involved.

There is much evidence in literature of a positive association between ADHD and addictive disorders. In particular, the link between ADHD and substance-related disorders has been the subject of a large number of studies, suggesting that ADHD symptoms during childhood may constitute a major risk factor for substance addiction and more severe addictive behavior (Biederman et al., 1998; Wilens et al., 1998). Among non-substance addictions, Pathological Gambling (PG) has been recently added to the spectrum of addictive disorders in the fifth revision of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2013, Hasin et al., 2013). Studies assessing the relationship between PG and ADHD have shown that about 20–30% of pathological gamblers have a history of ADHD, and that individuals with lifetime ADHD have higher rates of PG and more severe gambling habits than individuals without ADHD (Rodriguez-Jimenez et al., 2006; Breyer et al., 2009; Grall-Bronnec et al., 2011; Romo et al., 2015). As impulsivity is a factor common to both PG and ADHD, it has been suggested that ADHD-related strong impulsivity increases the risk of experiencing gambling problems (Davtian et al., 2012, Walther et al., 2012). Additionally, beyond impulsivity, specific personality traits have been described among pathological gamblers with ADHD (Davtian et al., 2012, Aymami et al., 2015). However, despite evidence as to the occurrence of PG and ADHD, investigations into this comorbidity are limited in number and have methodological limitations. Most of the clinical studies covered small samples and included only problem gamblers recruited in treatment settings, which limits generalization to non-treatment-seeking problem gamblers. For example, in a study among treatment-seeking problem gamblers, past or current ADHD was associated with more severe gambling problems, higher level of gambling-related cognitions, more psychiatric disorders and higher level of impulsivity (Grall-Bronnec et al., 2011). However, the sample size was not sufficient to check for important covariates and to permit a comprehensive assessment of the relationships between ADHD diagnosis and patterns of gambling characteristics. Finally, personality functioning has been little studied although recent data (Davtian et al., 2012, Chamberlain et al., 2015) suggests that dysfunctional personality traits may be related to the presence of ADHD symptoms in problem gamblers.

The aim of this multicenter French study was to assess clinical characteristics of gamblers with ADHD in a large sample of French gamblers recruited both in treatment settings and in different gambling places. In particular, we wanted to examine whether ADHD symptoms were related to specific severity patterns in terms of gambling behavior, psychopathology and personality traits.