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Wendy S. Slutske, PhD; Seth Eisen, MD, MSc; William R. True, PhD, MPH; Michael J. Lyons, PhD; Jack Goldberg, PhD; Ming Tsuang, MD, PhD, DSc, FRCPsych

Arch Gen Psychiatry. 2000;57:666-673.

Background  In comparison with alcohol dependence (AD), relatively little is known about the causes of pathological gambling (PG). Given the high rate of comorbidity between PG and AD, knowledge about the causes of AD may be applied to understanding those of PG.

Methods  Subjects were adult male twin pairs from the Vietnam Era Twin Registry. Lifetime histories of PG and AD were assessed by structured psychiatric telephone interview. The validity of a continuum of PG liability was tested to determine whether the causes of subclinical PG, or problem gambling, are quantitatively or qualitatively distinct from those of DSM-III-R PG disorder. Genetic model-fitting methods were used to quantify the extent to which the genetic and environmental risk for PG could be explained by the risk for AD.

Results  Tests of the continuity model of PG were all consistent with the hypothesis that subclinical PG and DSM-III-R PG disorder have many, perhaps all, of the same risk factors and thus differ quantitatively rather than qualitatively. Depending on the PG definition, between 12% and 20% of the genetic variation and between 3% and 8% of the nonshared environmental variation in the risk for PG were accounted for by the risk for AD.

Conclusions  Subclinical PG, or problem gambling, may be a milder form of PG, rather than an etiologically distinct syndrome. Risk for AD accounts for a significant but modest proportion of the genetic and environmental risk for subclinical PG and DSM-III-R PG disorder.

From the Department of Psychology, University of Missouri–Columbia (Dr Slutske); the Medical Service (Dr Eisen) and Research Service (Drs Eisen and True), St Louis Department of Veterans Affairs Medical Center, the Department of Internal Medicine, Division of General Medical Sciences, Washington University School of Medicine (Dr Eisen), and the School of Public Health, St Louis University Health Sciences Center (Dr True), St Louis, Mo; the Department of Psychology, Boston University (Dr Lyons), the Massachusetts Mental Health Center, Department of Psychiatry, Harvard Medical School (Drs Lyons and Tsuang), and the Harvard Institute of Psychiatric Epidemiology and Genetics (Dr Tsuang), Boston, Mass; the Department of Veterans Affairs, Health Services Research and Development, Cooperative Studies in Health Services, Hines, Ill (Dr Goldberg); and the Epidemiology Program, School of Public Health, University of Illinois, Chicago (Dr Goldberg).

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