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To the Editor: Estimates of the prevalence of gambling problems range between .4 percent and 2.0 percent in the general population of the United States and Canada (1). Problem gambling has substantial costs, both economic and personal (1): the estimated economic cost of problem gambling in the United States is $5 billion, and the personal costs include jeopardized relationships and employment. Effective treatments for gambling dependence have been developed, and there is growing awareness in the general population and the treatment and research communities of the importance of providing these services (2).
Central to the planning of services for people with various addiction problems are estimates of the proportion of those in need who obtain treatment. Such information is often used to emphasize the importance of the development of additional services, because many addicted individuals who might benefit from help never receive it. Prevalence estimates of service use are available for most addictive behaviors, such as for alcohol abuse and dependence (3). However, one notable exception is problem gambling, perhaps because epidemiologic surveys of addictive behaviors rarely ask about both gambling problems and use of treatment services. One recent exception was the 2002 National Epidemiologic Survey on Alcohol and Related Conditions, a face-to-face survey of a large (N=43,093), nationally representative U.S. sample (4). Included in this survey was an assessment of gambling dependence that used DSM-IV criteria. The survey found a prevalence rate of .4 percent. Respondents who met a lifetime definition of gambling dependence were asked whether they had "ever gone to Gamblers Anonymous" and whether they had ever gone to "any kind of counselor, therapist, doctor, psychologist, or any other person like that for help with your gambling?" Use of Gamblers Anonymous or treatment was low—6.7 percent and 5.1 percent, respectively; the combined rate of attendance for either was 9.1 percent. Further subgroup analyses were not possible because of the low prevalence rates of gambling dependence and treatment use.
Thus, even among people with severe gambling problems, only one in ten ever obtain any type of services. What can be concluded from these findings? They might be used as evidence that there is a need for more services for problem gamblers. Alternatively, the low prevalence of treatment use could be used as an argument that treatment is an epiphenomenon—a response provided by society to the existence of problem gambling that serves little or no purpose. Is there a middle ground between these conclusions? Problem gambling will rarely be treated, but it is worthwhile to provide services because they do help those who use them. Finally, are there ways to improve the accessibility of services for problem gamblers? Further research on barriers to obtaining gambling treatment might clarify why so few problem gamblers seek treatment. In addition, it is possible that the provision of a range of treatment services, both inside and outside the walls of traditional treatment services—for example, intensive, brief, and self-help interventions—might allow more people with gambling dependence to seek help for their problems (5).
Dr. Cunningham is affiliated with the social, prevention, and health policy research department at the Centre for Addiction and Mental Health in Toronto, Ontario.
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