Motivation for gambling as revealed in the marketing methods of the legitimate gambling industry.
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The gambling addict versus the gambling professional. A difference in character?.
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Female↗
Access to gambling opportunities and compulsive gambling.
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Compulsive Behavior↗
[Efficiency of a gambling prevention program for youths: results from the pilot study].
UNLABELLED: A meta-analysis of North American studies indicates that the prevalence rate of pathological gambling varies between 4.4% and 7.4% among adolescents. Pathological gambling is thus not a phenomenon that suddenly appears once youths reach an adult age. On the contrary, significant contact with gambling occurs in childhood adolescence. For this reason, it is important to develop an effective gambling prevention program that will reduce the risk that youths will develop gambling problems. The information promoted in the prevention program our research team created and evaluated here teaches youths to recognize the traps of gambling activities, while enabling them to make an informed decision as to their eventual participation in those activities. The program is based on knowledge and recognition of key indices that can be easily identified as warning signs of a loss of control. It is predicted that youths who participate in this prevention program will improve their knowledge of gambling activities and will develop a more realistic attitude towards those activities than youths from a control group. The experimental group's problem-solving skills are also expected to improve. An experimental design (pre-test, post-test and follow-ups with control group) was used to evaluate the program's effectiveness. Overall, 1193 youths participated in this study. The prevention program involves three 60-minute meetings. The objectives of these meetings are the following: (meeting #1) improve youths' knowledge of gambling activities and help them acquire a more realistic attitude towards these activities; (meeting #2) teach a structured problem-solving approach to resist to peer-pressure; (meeting #3) inform youths of the consequences that may be associated with abusive participation in gambling and teach them to recognize warning signs of a loss of control over gambling habits. DEPENDENT VARIABLES: (a) knowledge of and attitudes towards gambling and gambling activities; (b) problem-solving skills; (c) frequency of participation in gambling activities; (d) discussion with relatives, friends and teachers regarding gambling activities and attention paid towards gambling habits among close friends and family. Participation in the gambling prevention program significantly improves youths' knowledge of the real probabilities of winning and the pitfalls included in gambling activities and favours the development of a more realistic attitude towards these activities. However, the participation in the prevention program does not help to improve their problem-solving skills. Nonetheless, it leads more youths to talk about gambling with their parents and teachers, and enables them to be more aware of the gambling habits of their friends and family. Finally, note that it was impossible to verify any decrease in gambling habits as the majority of participants (62%) were non or very occasional gamblers. However, no iatrogenic effect was observed on the frequency of participation in gambling activities. Aside the positive impact of the program on the attitudes and knowledge of students, participation in the preventive sessions contributed to create a dialogue with adults and increased youths' interest in the gambling habits of their friends and family. These discussions enabled the youths to validate the information they received during class, to consolidate what they learned during the prevention sessions, and favour the dissemination of this knowledge beyond the scope of the academic environment. The results obtained regarding youths' attitudes and knowledge demonstrate that attitude modification takes place progressively. However, once well assimilated, these new attitudes seem to take hold in a fairly durable way. On the other hand, acquisition of knowledge seems to take place immediately after the theoretical concepts are taught. Yet, they slightly decreased before stabilising a few months later. This suggests that assimilation of new knowledge may be optimized by the addition of an intervention session a couple of months after the end of the intervention. Even if it was impossible to verify any decrease in participants' gambling habits, it is possible to think that the impact of participation in the gambling prevention program could be observable and measurable within a few years. However, only a long-term follow-up study would make it possible to assess whether participation in the program does indeed contribute to decreasing gambling habits and the number of youths who regularly participate in gambling activities. Despite the non-significant results observed for problem-solving skills, it seems nonetheless important to include this component, which benefits from great theoretical support, especially within the framework of prevention programs targeting youths. However, the teaching method must be changed in order to maximize the intervention's effectiveness. Despite some methodological limitations observed during the evaluation of this program, the results obtained clearly demonstrate that participation in the prevention program significantly improves youths' attitudes and knowledge regarding gambling activities. The teaching of accurate knowledge and realistic attitudes towards gambling should help youths to recognize the cognitive traps inherent to gambling activities and thus contribute, over the long run, to decrease the number of youths with gambling problems.
Adolescent↗
Gambling and other risk behaviors among 8th- to 12th-grade students.
OBJECTIVE: To examine the associations between a self-reported history of gambling or problems related to gambling and health risk behaviors in adolescence. DESIGN: An anonymous risk behavior survey was administered to 21 297 8th- through 12th-grade students in 79 public and private schools in Vermont. Gambling or problems related to gambling were the outcome variables of interest. Demographic variables and 13 target risk behaviors related to substance use, sexual activity, and violence were tested for association with gambling and problems related to gambling. RESULTS: Of the students, 53% reported gambling in the past 12 months, and 7% reported problems attributable to gambling. Male gender, any use of alcohol, infrequent use of cigarette smoking, any marijuana use, any inhalant use, infrequent steroid use, frequent illegal drug use, seatbelt nonuse, driving after drinking alcohol, being threatened, carrying a weapon, being involved in a fight, and years of sexual activity were all significantly associated with reported gambling in the past 12 months. Among the students who gambled, younger age, male gender, daily marijuana use, frequent use of cocaine, frequent use of inhalants, any steroid use, never wearing seatbelts, carrying a weapon for up to 3 days a month, fighting, and years of sexual activity were all significantly associated with reported problems with family and friends as a consequence of gambling. There was an increase in the absolute number of risk behaviors reported between those who had not gambled, those who had gambled, and those for whom gambling had created problems. CONCLUSIONS: Risk behaviors are associated with gambling in adolescence. The typology of risk behaviors was different for adolescents who reported gambling compared with those for whom gambling had created problems. Both gambling and problems related to gambling were significantly associated with the absolute number of risk behaviors reported by adolescents in a graded manner. Involvement in gambling should be assessed as part of the health encounter. Assessment may provide a nonthreatening entry into the evaluation of other risk behaviors. Furthermore, it may identify youth who are at risk of developing additional risk behaviors or pathological gambling. Interventions then could be targeted toward prevention of these undesirable outcomes.
Adolescent↗
Familial and social influences on juvenile gambling behavior.
Social learning theory maintains that individuals model, learn and maintain behaviors that are observed, appealing and reinforcing. As such, parents and family members can often serve as significant models for gambling. Four hundred and seventy seven children between the ages of 9 and 14 completed a questionnaire inquiring about their gambling activities, including where and with whom gambling occurs, as well as information concerning their perceptions of their own gambling behavior. Results indicate that 86% of children who gamble regularly reported gambling with family members. Fifty-three percent of students who gambled within the previous 12 months reported gambling with their siblings, 40% gambled with their parents, 46% gambled with other relatives, and 75% gambled in their own homes. Students' responses also indicated gambling with their friends (75%), gambling alone (18%), and with strangers (8%). As children's age increases they tend to gamble more at friend's homes and at school. Prevalence rates indicated that 81% of the total sample had gambled at one point in their lives and 52% of those children reported gambling once a week or more. Eleven percent reported that gambling makes them feel important, 27% feel they gamble more than they desire to do so, and only 10% of the grade 8 students fear being caught gambling, suggesting gambling activities to be a socially acceptable behavior. Several clinical and research questions are addressed.
Journal Article↗
Disordered gambling in adolescents : epidemiology, diagnosis, and treatment.
Rapid expansion of legalized gambling has been associated with increased rates of gambling disorders among adults and adolescents worldwide. Epidemiologic studies suggest that, in North America, up to 6% of adults and 20% of adolescents have a gambling problem. Despite increasing prevalence rates of gambling disorders, little research is available on how to treat such disorders in adolescents. Much of what is known about how to treat adolescent problem and pathological gambling comes from research on psychosocial and psychopharmacologic treatments for adult pathological gambling. Risk factors for adolescent gambling disorders include male gender, alcohol and drug use, deviant peers, family history of gambling, and impulsive behavior. While several risk factors characterize disordered gambling among adolescents, the extent to which these characteristics are related remains to be determined. In terms of screening for adolescent problem and pathological gambling, several instruments designed to reflect the Diagnostic and Statistical Manual of Mental Disorders diagnostic criteria for pathological gambling are available. Psychosocial approaches used to treat adult pathological gambling include Gamblers Anonymous, cognitive-behavioral therapy (CBT), and motivational enhancement therapy (MET). Among adolescents, CBT as well as an eclectic therapy have been helpful in reducing problematic gambling behavior. In terms of pharmacotherapy, three classes of psychotropic drugs have been used to treat adult pathological gambling - serotonin reuptake inhibitors, opioid antagonists, and mood stabilizers. While some of these pharmacotherapies have been efficacious in treating adult pathological gambling, additional double-blind, placebo-controlled studies are needed to determine the long-term effectiveness of these treatments. No known study has evaluated the use of psychopharmacologic agents in treating adolescent pathological gambling. Possible reasons for the lack of research on treatment for adolescent gambling disorders include lack of motivation to pursue treatment, feelings of self-control, and negative perception of therapy. Referrals from parents, teachers, and peers of adolescents, as well as community outreach programs, may be useful in successfully deriving a treatment population. Clinicians are advised to be sensitive to behavioral risk factors and to screen for disordered gambling in high risk adolescents. A combination of CBT and MET, as well as medication for any comorbid psychiatric condition, is recommended.
Adolescent↗
Gambling participation in the U.S.--results from a national survey.
Demographic patterns of gambling participation in the U.S. were examined. A national telephone survey was conducted with 2,630 representative U.S. residents aged 18 or older. The sample as weighted for analysis was 48% male, 12% black, and 11% Hispanic. Respondents were questioned on 15 types of gambling: how often they played and how much they won or lost. Eighty-two percent gambled in the past year. Lottery was the most commonly played game, while casino gambling accounted for the largest extent of gambling involvement. Men and women were equally likely to gamble in the past year, but men gambled more frequently and had larger wins and losses, particularly on sports betting and games of skill. Blacks were less likely to have gambled in the past year, but blacks who gambled did so more heavily than other racial groups. Blacks and Hispanics were more likely than average to be pathological gamblers. The rate of past year gambling declined with age, but extent of gambling involvement among gamblers did not vary with age. Rates of participation in most forms of gambling increased with socioeconomic status, but higher socioeconomic status gamblers had lower rates of pathological gambling, and lower extent of gambling involvement, particularly for lottery. New Englanders gambled more heavily than other Americans. Comparison with past studies showed an increase in overall gambling participation in the U.S., and large increases in rates of participation in lottery and casino gambling.
Adolescent↗
Prevalence of gambling among Minnesota public school students in 1992 and 1995.
The purposes of this study were to examine the prevalence of gambling among youth, compare rates of gambling between 1992 and 1995, and determine what levels of gambling frequency may be considered common and uncommon. The two samples included 122,700 Minnesota public school students in the 6th, 9th, and 12th grades in 1992; and 75,900 9th and 12th grade students in 1995. Students were administered the Minnesota Student Survey, a 126-item, anonymous, self-administered, paper-and-pencil questionnaire that inquires about multiple content domains, including gambling behaviors. The same questionnaire, with minor revisions to the gambling items, was administered in both 1992 and 1995 to students in their classrooms by the Minnesota Department of Education. There were slight decreases in overall gambling rates from 1992 to 1995. The majority of students gambled at least once during the past year. However, most did not play any game on a weekly/daily rate and did not report any problems associated with their gambling. Gender, grade, and race effects were found for gambling frequency. Boys gambled more often than girls, and 9th and 12th grade students gambled more often than 6th grade students. Asian American and White students reported lower rates of gambling frequency than Mexican/Latin American, African American, and American Indian students. From a statistical standpoint (i.e., beyond the 97.7 percentile), it may be considered in the uncommon range for girls to play two or more games at a weekly/daily rate, and for boys to play four or more games at a weekly/daily rate. Variables associated with gambling frequency included antisocial behavior, gender, and alcohol use frequency. Although the finding that gambling did not increase from 1992 to 1995 is encouraging, this is the first generation of youth to be exposed to widespread accessibility to gambling venues and gambling advertising and it will be important to continue monitoring the prevalence of youth gambling.
Journal Article↗
Characteristics of older adult problem gamblers calling a gambling helpline.
BACKGROUND: Few investigations have characterized groups of older adults with gambling problems, and published reports are currently limited by small samples of older adult problem gamblers. Gambling helplines represent a widespread mechanism for assisting problem gamblers to move into treatment settings. Given data from older adult problem gamblers in treatment, we hypothesized that older as compared with younger adult problem gamblers calling a gambling helpline would be less likely to report gambling-related problems. DESIGN AND METHODS: Logistic regression analyses were performed on data obtained from January 1, 2000 to December 31, 2001, inclusive, from callers with gambling problems (N = 1,084) contacting the Connecticut Council on Problem Gambling Helpline. RESULTS: Of the 1,018 phone calls used in the logistic regression analyses, 168 (16.5%) were from older adults and 850 (83.5%) from younger adults. Age-related differences were observed in demographic features, types and patterns of gambling reported as problematic, gambling-related problems and psychiatric symptoms, substance use problems, patterns of indebtedness, and family histories of addictive disorders. Older as compared with younger adult problem gamblers were more likely to report having lower incomes, longer durations of gambling, fewer types of problematic gambling, and problems with casino slot machine gambling and less likely to report gambling-related anxiety, family problems, illegal behaviors and arrests, drug problems, indebtedness to bookies or acquaintances, family histories of drug abuse, and problems with casino table gambling. CONCLUSIONS: Older as compared with younger adult problem gamblers calling a gambling helpline differ on many clinically relevant features. The findings suggest the need for improved and unique prevention and treatment strategies for older adults with gambling problems.
Adult↗
Risk factors for pathological gambling.
To better understand pathological gambling, potential risk factors were assessed within three domains--gambling behaviors, substance abuse and other problem behaviors, and sociodemographic factors. A random-digit-dial telephone survey was conducted in 1999-2000 with a representative sample of the U.S. population aged 18 or older. The current analyses uses data from the 2168 respondents who gambled in the year before the interview. Gambling measures included the Diagnostic Interview Schedule (DIS)-IV for pathological gambling, frequency of 15 types of gambling, and size of win or loss on the last occasion. Other measures included the quantity and frequency of alcohol consumption, frequency of illicit drug use and criminal offending, and the DIS-IV for alcohol and drug abuse and dependence. Results showed that casino gambling is associated with a high risk of gambling pathology. Lottery, cards, and bingo are associated with a moderately high risk of gambling pathology. Participation in a greater number of types of gambling is strongly predictive of gambling pathology, even after frequency of gambling and size of win or loss are taken into account. Alcohol abuse is strongly predictive of gambling pathology, even with gambling behaviors held constant. Minority and low socioeconomic status (SES) group members have higher levels of gambling pathology than other groups after all other factors are considered.
Adolescent↗
Problem and pathological gambling among college athletes.
BACKGROUND: Problematic gambling is common in college students, and in particular, athletes. METHODS: The frequency of problem and pathological gambling was determined among 636 college athletes at three Midwest universities using the South Oaks Gambling Screen (SOGS). The Gambling Attitude Scale (GAS) was used to assess college athletes' attitudes toward gambling in general and toward four modes of gambling (casinos, betting on horse races, lottery and the Internet). A profile of college athletes' gambling attitudes and behavior was developed through the data obtained from each of these instruments. RESULTS: Nearly 15% of respondents had a SOGS score >or=3, indicating problem or pathological gambling. Those at risk for a gambling problem gambled frequently, had family and/or friends with perceived gambling problems, were nonwhite, older, started gambling at a younger age, preferred games of skill, and held positive attitudes toward gambling in general and Internet gambling, in particular. CONCLUSIONS: Gambling problems are widespread among college athletes who constitute a vulnerable group. Specific interventions are needed to target this group.
Adolescent↗
Internet gambling: an emerging concern in family practice medicine?
BACKGROUND: Gambling problems are rarely brought to the attention of family practice physicians, but pathological gambling can be associated with poor emotional and physical health. Recent availability and easy accessibility of Internet gambling may be associated with pathological gambling status, and Internet gambling may confer health risks. OBJECTIVE: This study evaluated the prevalence of Internet gambling, its association with pathological gambling, and the relationship between Internet gambling and health status among patients attending medical and dental clinics. METHODS: The South Oaks Gambling Screen and Short Form 12 were administered to 1414 adults in waiting areas of clinics. RESULTS: Only 6.9% of respondents reported ever gambling on the Internet, with 2.8% indicating frequent Internet wagering. Almost two-thirds (65.9%) of regular Internet gamblers were classified as probable pathological gamblers, compared with 29.8% of ever-Internet gamblers and 7.6% of non-Internet gamblers. Internet gambling was associated with poor mental and physical health, and this association remained significant even after controlling for age, gender, site and pathological gambling status. CONCLUSIONS: These data suggest that Internet gambling is linked to pathological gambling and is independently associated with poor health. Family practice physicians should consider referring patients who gamble on the Internet for further treatment.
Adult↗
Risk of harm among gamblers in the general population as a function of level of participation in gambling activities.
AIMS: To examine the relationship between gambling behaviours and risk of gambling-related harm in a nationally representative population sample. DESIGN: Risk curves of gambling frequency and expenditure (total amount and percentage of income) were plotted against harm from gambling. SETTING: Data derived from 19, 012 individuals participating in the Canadian Community Health Survey-Mental Health and Well-being cycle, a comprehensive interview-based survey conducted by Statistics Canada in 2002. MEASUREMENT: Gambling behaviours and related harms were assessed with the Canadian Problem Gambling Index. FINDINGS: Risk curves indicated the chances of experiencing gambling-related harm increased steadily the more often one gambles and the more money one invests in gambling. Receiver operating characteristic analysis identified the optimal limits for low-risk participation as gambling no more than two to three times per month, spending no more than 501-1,000 CAN dollars per year on gambling and investing no more than 1% of gross family income on gambling activities. Logistic regression modelling confirmed a significant increase in the risk of gambling-related harm (odds ratios ranging from 2.0 to 7.7) when these limits were exceeded. CONCLUSIONS: Risk curves are a promising methodology for examining the relationship between gambling participation and risk of harm. The development of low-risk gambling limits based on risk curve analysis appears to be feasible.
Adolescent↗
Prevalence of gambling disorders in a primary care setting.
BACKGROUND: Pathologic gambling prevalence seems to be increasing as opportunities for gambling increase. Prevalence may be different in a primary care setting compared with population-based studies. OBJECTIVES: To determine the gambling disorder prevalence in a primary care setting and to investigate associations between gambling disorders and proximity to a casino, substance abuse, health ratings, age, sex, and socioeconomic status. DESIGN: Cross-sectional survey of 1394 patients presenting to their primary care physicians between November 1, 1997, and April 1, 1998. SETTING: Three primary care clinics in Wisconsin. PATIENTS: Adults aged 18 years and older. MAIN OUTCOME MEASURES: Gambling disorders, defined by scores of 3 or greater on the South Oaks Gambling Screen (SOGS), and information about drug use (alcohol, tobacco, and marijuana), overall health, specific health symptoms, age, sex, race, and socioeconomic status. RESULTS: A total of 1051 patients completed the survey. More than 80.0% of the patients had gambled, and 6.2% met the criteria for gambling disorders. Gambling disorders were more prevalent in men, nonwhites, and patients from lower socioeconomic groups. Patients with gambling disorders were more likely to use tobacco and abuse alcohol compared with nonproblem gamblers. No relation was seen between marijuana use and gambling disorders. Patients with gambling disorders rated their health more poorly and reported more severe symptoms of heartburn and backache. CONCLUSIONS: A considerable percentage of patients presenting to primary care clinics are affected by their need to gamble. There is significant comorbidity with tobacco use and alcohol abuse. Primary care physicians should consider asking about gambling habits in high-risk patients.
Adult↗
Interventions for pathological gambling.
BACKGROUND: With the legalization of new forms of gambling there are increasing numbers of individuals who appear to have gambling related problems and who are seeking help. The individual and societal consequences are significant. Pathological gambling can result in the gambler jeopardizing or losing a significant relationship or job and committing criminal offences. Pathological gamblers may develop general medical conditions associated with stress. Increased rates have been reported for mood disorders, attention-deficit/hyperactivity disorder, substance abuse or dependence. There is a high risk of suicide and a high correlation with antisocial, narcissistic and borderline personality disorders and alcohol addiction. With increasing public awareness of gambling related problems health funders and practitioners are asking questions about the efficacy of treatments. Consequently quality research into gambling treatment is crucial. OBJECTIVES: The objective of this review was to complete a systematic review and meta-analysis of all randomised controlled trials (RCTs) of psychological and pharmacological treatments for pathological gambling, from both published and unpublished scientific reports. SEARCH STRATEGY: Published and unpublished RCTs of treatments of pathological gambling were identified by searches of electronic databases and hand searching journals likely to contain RCTs of gambling treatments. Researchers and gambling treatment centres were contacted by letter. Bibliographies of all identified research studies were scanned to identify other relevant references. SELECTION CRITERIA: All RCTs of treatments for pathological gambling were eligible for inclusion. DATA COLLECTION AND ANALYSIS: The data was entered into the Cochrane Review Manager software (REVMAN). The component RCTs were quality rated, with special emphasis on the concealment of treatment allocation and blinding. Relative risk analyses were conducted for the dichotomous outcome of controlled vs. uncontrolled gambling. The relative risks were aggregated using both fixed and random effects models. Tests for heterogeneity were undertaken. Both short-term (1 month or less) and long-term (6 months or longer) outcomes were considered. MAIN RESULTS: Only four RCTs of psychological treatments were identified. These RCTs were heterogeneous in terms of design, interventions, outcome measurement and follow-up periods. All had small numbers of participants. The studies had poor methodological quality features. The experimental interventions, behavioural or cognitive-behavioural therapy (BT/CBT), were more efficacious than the control interventions in the short-term (relative risk 0.44, 95% confidence interval (CI) 0.24-0. 81). There was a trend for long-term treatment with BT/CBT to be more efficacious than the control treatments, but the statistical significance of this was sensitive to the statistical model used for meta-analysis. With a fixed effect model the relative risk was 0.56 (95% CI 0.33-0.95); the relative risk with a random effects model was 0.61 (95% CI 0.25-1.47). REVIEWER'S CONCLUSIONS: This systematic review revealed a paucity of evidence for effective treatment of pathological gambling. As gambling is becoming more accessible in many countries and there is epidemiological evidence of increasing rates of pathological gambling, more rigorous RCTs are required.
Behavior Therapy↗
A comparison of treatment-seeking pathological gamblers based on preferred gambling activity.
AIMS: To compare and contrast gamblers with different forms of problematic gambling activities. DESIGN, SETTING AND MEASUREMENTS: Pathological gamblers completed the Addiction Severity Index (ASI) and gambling questionnaires when initiating out-patient treatment. PARTICIPANTS: Participants (n = 347) were categorized by their most problematic form of gambling activity: sports, horse/dog-races, cards, slots and scratch/lottery tickets. Differences in demographics, gambling variables, and ASI composite scores were compared across groups. FINDINGS: After controlling for demographic variables, the types of gamblers differed in severity of gambling, alcohol and psychiatric problems. Horse/dog-race gamblers were generally older, male and less educated; they began gambling regularly at a young age and spent relatively high amounts of money gambling. Sports gamblers were young males and had intermediary gambling problems; they had relatively high rates of current substance use but few psychiatric problems. Card players spent low to moderate amounts of time and money gambling, and they generally reported few alcohol problems and little psychiatric distress. Slot machine players were older and more likely to be female. Slot gamblers began gambling later in life, had high rates of bankruptcy and reported psychiatric difficulties. Scratch/lottery gamblers spent the least amount of money gambling, but they gambled the most frequently and had relatively severe alcohol and psychiatric symptoms. CONCLUSIONS: Gambling patterns and severity of psychosocial problems vary by form of problematic gambling, and these differences may influence treatment recommendations and outcomes.
Adult↗
Gambling behavior of Louisiana students in grades 6 through 12.
OBJECTIVES: The prevalence of problem and gambling behavior, the average age of onset of gambling behavior, and the co-occurrence of gambling disorder with substance use were determined in the Louisiana student population grades 6 through 12. METHODS: A stratified randomized sample of 12,066 students in Louisiana schools during the 1996-1997 school year was surveyed about gambling behavior using the South Oaks Gambling Screen--Revised for Adolescents (SOGS-RA). RESULTS: Fourteen percent of the students never gambled, 70.1 percent gambled without problems, 10.1 percent indicated problem gambling in the past year (level 2 according to the SOGS-RA), and 5.8 percent indicated pathological gambling behavior in the past year (level 3). Weekly or more frequent lottery play was reported by 16.5 percent. The average age of onset of gambling behavior was 11.2 years. Fifty-nine percent of the students with problem and pathological gambling behavior reported frequent alcohol and illicit drug use. CONCLUSIONS: A significant minority of Louisiana students in grades 6 through 12-15.9 percent--acknowledged gambling-related symptoms and life problems. The association of problem and pathological gambling with use of alcohol, tobacco, and marijuana provides preliminary support for the inclusion of gambling among other adolescent risk behaviors.
Adolescent↗