Impact of a Casino Opening on Gambling Behaviors of People Engaged in Methadone Maintenance.

This study examined gambling behavior in the context of a newly opening casino, comparing disordered gamblers to non-disordered gamblers, in a population of individuals involved in methadone maintenance treatment. Disordered gamblers (N = 50) and non-disordered gamblers (N = 50) were surveyed before and after the opening of a new casino on gambling behaviors, substance use, and psychological symptoms. No statistically significant changes in gambling behaviors were observed for disordered gamblers or non-disordered gamblers across time points; however, non-disordered gamblers demonstrated non-significant increases in horse and dog race betting, electronic games, and casino table games. As expected, disordered gamblers were found to spend significantly more money on electronic games and casino table games (p < 0.05) and demonstrated higher rates of drug use and impulsivity than non-disordered gamblers. The introduction of a new casino did not appear to have a major impact on gambling behaviors of individuals attending methadone maintenance treatment, though the non-significant increases in gambling among non-disordered gamblers may indicate that this population is preferentially impacted by the opening of a new casino. Future investigation into the longer term effects of opening a new casino on this population may be warranted.

Twelve-Month Prevalence of DSM-5 Gambling Disorder and Associated Gambling Behaviors Among Those Receiving Methadone Maintenance.

This study sought to: (1) determine the prevalence of gambling disorder using the Diagnostic and Statistical Manual of Mental Disorders Version 5 (DSM-5; American Psychiatric Association in Diagnostic and statistical manual of mental disorders, American Psychiatric Publishing, Arlington, 2013) criteria; (2) identify the frequency and amount of money spent on gambling behaviors; and (3) determine demographic and treatment related predictors associated with gambling disorder in a substance using population. People receiving methadone maintenance treatment (N = 185) in an urban medical center consented to participate in the study. We used DSM-5 criteria to assess the 12-month prevalence of gambling disorder. Questions adapted from a previously developed measure were used to identify, describe and quantify the frequency of use and amount of money spent on gambling behaviors. Most participants were African-American (71.4 %), male (54.1 %), unmarried (76.8 %), unemployed (88.1 %) and had an income of <$20,000 (88.5 %). On average, participants were receiving 81.0 mg of methadone (SD: 22.8) daily. Nearly half (46.2 %) of participants met DSM-5 criteria for gambling disorder. Compared to those without gambling disorder, those with gambling disorder did not differ significantly with respect to demographic characteristics nor methadone dose. However, those with gambling disorder had been in methadone maintenance treatment for significantly less time. Those with gambling disorder were significantly more likely to report engaging in a variety of gambling behaviors. Given that the 12-month prevalence of DSM-5 defined gambling disorder was nearly 50 % future efforts to screen and treat gambling disorder in the context of methadone maintenance treatment are clearly warranted.

Evaluation of brief screens for gambling disorder in the substance use treatment setting.

BACKGROUND AND OBJECTIVES: The goal of this study was to determine the diagnostic accuracy of brief screens for Gambling Disorder within a sample of people receiving outpatient treatment for substance use disorders. METHODS: Individuals (n = 300) recruited from intensive outpatient substance use treatment (23.67%) or methadone maintenance programs (76.34%) participated in the study. Four brief screens for Gambling Disorder were administered and compared to DSM-5 criteria. Receiver operator curves were created and an Area Under the Curve (AUC) analysis (an overall summary of the utility of the scale to correctly identify Gambling Disorder) was assessed for each. RESULTS: On average participants were aged 46.4 years (SD = 10.2), African American/Black (70.7%), with an income less than $20,000/year (89.5%). Half the participants were female. Approximately 40% of participants (40.5%; n = 121) met DSM-5 criteria for Gambling Disorder. Accuracy of the brief screens as measured by hit rate were .88 for the BBGS, .77 for the Lie/Bet, .75 for NODS-PERC, and .73 for the NODS-CLiP. AUC analysis revealed that the NODS-PERC (AUC: .93 (95% CI: .91-.96)) and NODS-CLiP (AUC: .90 (95% CI: .86-.93)) had excellent accuracy. DISCUSSION AND CONCLUSIONS: The NODS-PERC and NODS-CLiP had excellent accuracy at all cut-off points. However, the BBGS appeared to have the best accuracy at its specified cut-off point. SCIENTIFIC SIGNIFICANCE: Commonly used brief screens for Gambling Disorder appear to be associated with good diagnostic accuracy when used in substance use treatment settings. The choice of which brief screen to use may best be decided by the needs of the clinical setting.

Gambling behaviors and attitudes in adolescent high-school students: Relationships with problem-gambling severity and smoking status.

BACKGROUND AND AIMS: Smoking is associated with more severe/extensive gambling in adults. The purpose of this study was to examine relationships between smoking and gambling in adolescents. METHODS: Analyses utilized survey data from 1591 Connecticut high-school students. Adolescents were classified by gambling (Low-Risk Gambling [LRG], At Risk/Problem Gambling [ARPG]) and smoking (current smoker, non-smoker). The main effects of smoking and the smoking-by-gambling interactions were examined for gambling behaviors (e.g., type, location), and gambling attitudes. Data were analyzed using chi-square and logistic regression; the latter controlled for gender, race/ethnicity, grade, and family structure. RESULTS: For APRG adolescents, smoking was associated with greater online, school, and casino gambling; gambling due to anxiety and pressure; greater time spent gambling; early gambling onset; perceived parental approval of gambling; and decreased importance of measures to prevent teen gambling. For LRG adolescents, smoking was associated with non-strategic gambling (e.g., lottery gambling); school gambling; gambling in response to anxiety; gambling for financial reasons; greater time spent gambling; and decreased importance of measures to prevent teen gambling. Stronger relationships were found between smoking and casino gambling, gambling due to pressure, earlier onset of gambling, and parental perceptions of gambling for ARPG versus LRG adolescents. DISCUSSION: Smoking is associated with more extensive gambling for both low- and high-risk adolescent gamblers. CONCLUSION: Smoking may be a marker of more severe gambling behaviors in adolescents and important to consider in gambling prevention and intervention efforts with youth.

Cigarette smoking, problem-gambling severity, and health behaviors in high-school students.

INTRODUCTION: Smoking and gambling are two significant public health concerns. Little is known about the association of smoking and gambling in adolescents. The current study of high-school adolescents examined: (1) smoking behavior by problem-gambling severity and (2) health-related variables by problem-gambling severity and smoking status. METHODS: Analyses utilized survey data from 1591 Connecticut high-school students. Adolescents were classified by problem-gambling severity (Low-Risk Gambling [LRG], At-Risk/Problem Gambling [ARPG]) and smoking status (current smoker, non-smoker). Analyses examined the smoking behavior of ARPG versus LRG adolescents as well as the smoking-by-problem-gambling-severity interactions for health and well-being measures (e.g., grades, substance use). Chi-square and logistic regression analyses were used; the latter controlled for gender, race/ethnicity, school grade, and family structure. RESULTS: More adolescents with ARPG than LRG reported regular smoking, heavy smoking, early smoking onset, no smoking quit attempts, and parental approval of smoking. ARPG and LRG adolescents who smoked were more likely to report poor grades, lifetime use of marijuana and other drugs, current heavy alcohol use, current caffeine use, depression, and aggressive behaviors and less likely to report participation in extracurricular activities. The association between not participating in extracurricular activities and smoking was statistically stronger in the LRG compared to the ARPG groups. Post-hoc analyses implicated a range of extracurricular activities including team sports, school clubs, and church activities. CONCLUSIONS: Smoking was associated with poorer health-related behaviors in both ARPG and LRG groups. Interventions with adolescents may benefit from targeting both smoking and gambling.

At-Risk/Problematic Shopping and Gambling in Adolescence.

Elevated levels of both pathological gambling (PG) and problem shopping (PS) have been reported among adolescents, and each is associated with a range of other negative health/functioning measures. However, relationships between PS and PG, particularly during adolescence, are not well understood. In this study, we explored the relationship between different levels of problem-gambling severity and health/functioning characteristics, gambling-related social experiences, gambling behaviors and motivations among adolescents with and without at-risk/problematic shopping (ARPS). Survey data from Connecticut high school students (n = 2,100) were analyzed using bivariate analyses and logistic regression modeling. Although at-risk/problematic gambling (ARPG) was not increased among adolescents with ARPS, adolescents with ARPG (vs non-gamblers) were more likely to report having experienced a growing tension or anxiety that could only be relieved by shopping and missing other obligations due to shopping. In comparison to the non-ARPS group, a smaller proportion of respondents in the ARPS group reported paid part-time employment, whereas a greater proportion of respondents reported excessive gambling by peers and feeling concerned over the gambling of a close family member. In general, similar associations between problem-gambling severity and measures of health/functioning and gambling-related behaviors and motivations were observed across ARPS and non-ARPS adolescents. However, associations were weaker among ARPS adolescents for several variables: engagement in extracurricular activities, alcohol and caffeine use and gambling for financial reasons. These findings suggest a complex relationship between problem-gambling severity and ARPS. They highlight the importance of considering co-occurring risk behaviors such as ARPS when treating adolescents with at-risk/problem gambling.

A latent class analysis of pathological-gambling criteria among high school students: associations with gambling, risk and health/functioning characteristics.

OBJECTIVES: To identify subtypes of adolescent gamblers based on the 10 Diagnostic and Statistical Manual of Mental Disorders, fourth edition criteria for pathological gambling and the 9 Diagnostic and Statistical Manual of Mental Disorders, fifth edition criteria for gambling disorder and to examine associations between identified subtypes with gambling, other risk behaviors, and health/functioning characteristics. METHODS: Using cross-sectional survey data from 10 high schools in Connecticut (N = 3901), we conducted latent class analysis to classify adolescents who reported past-year gambling into gambling groups on the basis of items from the Massachusetts Gambling Screen. Adolescents also completed questions assessing demographic information, substance use (cigarette, marijuana, alcohol, and other drugs), gambling behaviors (relating to gambling formats, locations, motivations, and urges), and health/functioning characteristics (eg, extracurricular activities, mood, aggression, and body mass index). RESULTS: The optimal solution consisted of 4 classes that we termed low-risk gambling (86.4%), at-risk chasing gambling (7.6%), at-risk negative consequences gambling (3.7%), and problem gambling (PrG) (2.3%). At-risk and PrG classes were associated with greater negative functioning and more gambling behaviors. Different patterns of associations between at-risk and PrG classes were also identified. CONCLUSIONS: Adolescent gambling classifies into 4 classes, which are differentially associated with demographic, gambling patterns, risk behaviors, and health/functioning characteristics. Early identification and interventions for adolescent gamblers should be sensitive to the heterogeneity of gambling subtypes.

An exploratory examination of marijuana use, problem-gambling severity, and health correlates among adolescents.

BACKGROUND AND AIMS: Gambling is common in adolescents and at-risk and problem/pathological gambling (ARPG) is associated with adverse measures of health and functioning in this population. Although ARPG commonly co-occurs with marijuana use, little is known how marijuana use influences the relationship between problem-gambling severity and health- and gambling-related measures. METHODS: Survey data from 2,252 Connecticut high school students were analyzed using chi-square and logistic regression analyses. RESULTS: ARPG was found more frequently in adolescents with lifetime marijuana use than in adolescents denying marijuana use. Marijuana use was associated with more severe and a higher frequency of gambling-related behaviors and different motivations for gambling. Multiple health/functioning impairments were differentially associated with problem-gambling severity amongst adolescents with and without marijuana use. Significant marijuana-use-by-problem-gambling-severity-group interactions were observed for low-average grades (OR = 0.39, 95% CI = [0.20, 0.77]), cigarette smoking (OR = 0.38, 95% CI = [0.17, 0.83]), current alcohol use (OR = 0.36, 95% CI = [0.14, 0.91]), and gambling with friends (OR = 0.47, 95% CI = [0.28, 0.77]). In all cases, weaker associations between problem-gambling severity and health/functioning correlates were observed in the marijuana-use group as compared to the marijuana-non-use group. CONCLUSIONS: Some academic, substance use, and social factors related to problem-gambling severity may be partially accounted for by a relationship with marijuana use. Identifying specific factors that underlie the relationships between specific attitudes and behaviors with gambling problems and marijuana use may help improve intervention strategies.

Perceived parental permissiveness toward gambling and risky behaviors in adolescents.

BACKGROUND AND AIMS: Perceived parental permissiveness toward gambling may relate to adolescents' engagement in various risky behaviors. To examine this possibility, we analyzed data from a high-school based risk-behavior survey to assess relationships between perceived parental permissiveness toward gambling and adolescent gambling behavior, substance use and related problems. We also evaluated predictions that relationships between perceived parental permissiveness toward gambling and risky behaviors would be particularly strong amongst adolescents reporting high sensation-seeking or impulsivity. METHODS: High-school students (n = 2,805) provided data on risky behaviors, perceived parental permissiveness toward gambling, impulsivity and sensation-seeking. Bivariate and logistic regression analyses were conducted to examine relationships with gambling and alcohol, cigarette and marijuana use. RESULTS: Perceived parental permissiveness toward gambling related significantly to adolescent gambling, all substance-use behaviors as well as alcohol and drug problems. There were significant parental-permissiveness-by-sensation-seeking interactions in multiple models. Relationships between perceived parental permissiveness toward gambling and alcohol-use frequency were particularly strong among those with high sensation-seeking. This relationship also applied to gambling and heavy cigarette smoking, albeit to a lesser extent. Impulsivity related strongly to drug problems among those who perceived their parents to be more and less permissive toward gambling. DISCUSSION AND CONCLUSIONS: These findings support the relevance of perceived parental permissiveness toward gambling to adolescent risky behaviors. Parenting perceived as less permissive toward gambling appeared to have protective effects on gambling, alcohol and cigarette use, even among those with high sensation-seeking. Reducing parental permissiveness toward gambling may be a valuable intervention goal, particularly for parents of sensation-seeking adolescents.

Adolescent alcohol-drinking frequency and problem-gambling severity: adolescent perceptions regarding problem-gambling prevention and parental/adult behaviors and attitudes.

BACKGROUND: The study examined in adolescents how alcohol-drinking frequency relates to gambling-related attitudes and behaviors and perceptions of both problem-gambling prevention strategies and adult (including parental) behaviors/attitudes. METHODS: A survey assessing alcohol, gambling, and health and functioning measures in 1609 high school students. Students were stratified into low-frequency/nondrinking and high-frequency-drinking groups, and into low-risk and at-risk/problematic gambling groups. RESULTS: High-frequency drinking was associated with at-risk/problematic gambling (χ(2)(1,N = 1842) = 49.22, P < .0001). High-frequency-drinking versus low-frequency/nondrinking adolescents exhibited more permissive attitudes towards gambling (e.g., less likely to report multiple problem-gambling prevention efforts to be important). At-risk problematic gamblers exhibited more severe drinking patterns and greater likelihood of acknowledging parental approval of drinking (χ(2)(1, N = 1842) = 31.58, P < .0001). Problem-gambling severity was more strongly related to gambling with adults among high-frequency-drinking adolescents (odds ratio [OR] = 3.17, 95% confidence interval [95% CI] = [1.97, 5.09]) versus low-frequency/nondrinking (OR = 1.86, 95% CI = [0.61, 2.68]) adolescents (interaction OR = 1.78, 95% CI = [1.05, 3.02]). CONCLUSIONS: Interrelationships between problematic drinking and gambling in youth may relate to more permissive attitudes across these domains. Stronger links between at-risk/problem gambling and gambling with adults in the high-frequency-drinking group raises the possibility that interventions targeting adults may help mitigate youth gambling and drinking.

Relationships between problematic internet use and problem-gambling severity: findings from a high-school survey.

With the popularity of Internet use among adolescents, there is concern that some youth may display problematic or addictive patterns of Internet use. Although excessive patterns of Internet use was considered for inclusion in the DSM-5 with pathological gambling and substance-use disorders in a category of addictive disorders, it was determined that more research was needed on Internet-use behaviors before such actions be further considered and possibly undertaken. The present study is the first to investigate whether at-risk/problematic Internet use (ARPIU) may moderate the strength of association between problem-gambling severity and gambling-related characteristics and health and well-being measures in adolescents. Survey data from 1884 Connecticut high-school student stratified by Internet use (ARPIU vs. non-ARPIU) were examined in bivariate analyses and logistic regression models. Gambling-related characteristics and health and well-being measures were mostly positively associated with problem-gambling severity in both Internet use groups. Interaction odds ratio revealed that the strength of the associations between problem-gambling severity and marijuana, alcohol and caffeine use were stronger amongst the non-ARPIU compared to the ARPIU group, suggesting that the relationships between these substance use behaviors and problem gambling may be partially accounted for by ARPIU. Future studies should examine the extent to which preventative interventions targeting both problematic Internet use and problem gambling may synergistically benefit measures of health and reduce risk-taking behaviors in adolescence.

Serious Physical Fighting and Gambling-Related Attitudes and Behaviors in Adolescents.

BACKGROUND AND AIMS: Physical fighting and gambling are common risk behaviors among adolescents. Prior studies have found associations among these behaviors in adolescents but have not examined systematically the health and gambling correlates of problem-gambling severity amongst youth stratified by fight involvement. METHODS: Survey data were used from 2,276 Connecticut high-school adolescents regarding their physical fight involvement, gambling behaviors and perceptions, and health and functioning. Gambling perceptions and correlates of problem-gambling severity were examined in fighting and non-fighting adolescents. RESULTS: Gambling perceptions were more permissive and at-risk/problem gambling was more frequent amongst adolescents reporting serious fights versus those denying serious fights. A stronger relationship between problem-gambling severity and regular smoking was observed for adolescents involved in fights. DISCUSSION AND CONCLUSIONS: The more permissive gambling attitudes and heavier gambling associated with serious fights in high-school students suggest that youth who engage in physical fights warrant enhanced prevention efforts related to gambling. The stronger relationship between tobacco smoking and problem-gambling severity amongst youth engaging in serious fights suggest that fighting youth who smoke might warrant particular screening for gambling problems and subsequent interventions.

Differences in gambling problem severity and gambling and health/functioning characteristics among Asian-American and Caucasian high-school students.

Studies of Asian-American adults have found high estimates of problematic gambling. However, little is known about gambling behaviors and associated measures among Asian-American adolescents. This study examined gambling perceptions and behaviors and health/functioning characteristics stratified by problem-gambling severity and Asian-American and Caucasian race using cross-sectional survey data of 121 Asian-American and 1659 Caucasian high-school students. Asian-American and Caucasian adolescents significantly differed on problem-gambling severity, with Asian-American adolescents more often reporting not gambling (24.8% vs. 16.4%), but when they did report gambling, they showed higher levels of at-risk/problem gambling (30.6% vs. 26.4%). Parental approval or disapproval of adolescent gambling also significantly differed between races, with Asian-American adolescents more likely to perceive both parental disapproval (50.0% vs. 38.2%) and approval (19.3% vs. 9.6%) of gambling. Asian-American adolescents were also more likely to express concern about gambling among close family members (25.2% vs. 11.6%). Among Asian-American adolescents, stronger associations were observed between at-risk/problem gambling and smoking cigarettes (interaction odds ratio=12.6). In summary, differences in problem-gambling severity and gambling perceptions indicate possible cultural differences in familial attitudes towards gambling. Stronger links between cigarette smoking and risky/problematic gambling amongst Asian-American adolescents suggest that prevention and treatment efforts targeting youth addictions consider cultural differences.

Gambling-related attitudes and behaviors in adolescents having received instant (scratch) lottery tickets as gifts.

OBJECTIVE: Instant (scratch) lottery ticket gambling is popular among adolescents. Prior research has not determined whether adolescents' gambling behavior and attitudes toward gambling are influenced by the receipt of scratch lottery tickets as gifts. METHOD: Cross-sectional survey data from 2,002 Connecticut high school students with past-year gambling were analyzed using bivariate approaches and logistic regression analyses. Interactions between gambling-problem severity and lottery-gift status were examined in relation to multiple outcomes. RESULTS: Adolescents who received a scratch lottery ticket as a gift compared with those who did not were more likely to report features of problem gambling, buy scratch lottery tickets for themselves, and buy and receive other types of lottery tickets; they were also less likely to report parental disapproval of gambling and to see gambling prevention efforts as important. Later (≥15 years) age-at-gambling-onset was inversely linked to gambling-problem severity in the lottery gift group (odds ratio [OR] = .38) but not in the nongift group (OR = .91), yielding a significant severity by gift status interaction. Other academic, health, and gambling-related correlates of gambling-problem severity were similar in the gift and nongift groups. CONCLUSIONS: For adolescents, the receipt of scratch lottery tickets as gifts during childhood or adolescence was associated with risky/problematic gambling and with gambling-related attitudes, behaviors, and views suggesting greater gambling acceptability. The extent to which the receipt of scratch lottery tickets may promote gambling behaviors and the development of gambling problems warrants consideration. Education, prevention, and treatment strategies should incorporate findings relating to receipt of gambling products by underage individuals.

The relationship between age of gambling onset and adolescent problematic gambling severity.

The aim of this study was to characterize the association between problem gambling severity and multiple health, functioning and gambling variables in adolescents aged 13-18 stratified by age of gambling onset. Survey data in 1624 Connecticut high school students stratified by age of gambling onset (≤ 11 years vs. ≥ 12 years) were analyzed in descriptive analyses and in logistic regression models. Earlier age of onset was associated with problem gambling severity as indexed by a higher frequency of at-risk/problem gambling (ARPG). Most health, functioning and gambling measures were similarly associated with problem gambling severity in the earlier- and later-age-of-gambling-onset groups with the exception of participation in non-strategic forms of gambling, which was more strongly associated with ARPG in the earlier-onset (OR = 1.74, 95%CI = [1.26, 2.39]) as compared to later-onset (OR = 0.94, 95%CI = [0.60, 1.48]) group (Interaction OR = 1.91, 95%CI = [1.18, 3.26]). Post-hoc analysis revealed that earlier-onset ARPG was more strongly associated with multiple forms of non-strategic gambling including lottery (instant, traditional) and slot-machine gambling. The finding that problem gambling severity is more closely associated with multiple non-strategic forms of gambling amongst youth with earlier-onset gambling highlights the relevance of these types of youth gambling. The extent to which non-strategic forms of gambling may serve as a gateway to other forms of gambling or risk behaviors warrants additional study, and efforts targeting youth gambling should consider how best to address non-strategic gambling through education, prevention, treatment and policy efforts.

Health/functioning characteristics, gambling behaviors, and gambling-related motivations in adolescents stratified by gambling problem severity: findings from a high school survey.

In adults, different levels of gambling problem severity are differentially associated with measures of health and general functioning, gambling behaviors, and gambling-related motivations. Here we present data from a survey of 2,484 Connecticut high school students, and investigate the data stratifying by gambling problem severity based on DSM-IV criteria for pathological gambling. Problem/pathological gambling was associated with a range of negative functions; for example, poor academic performance, substance use, dysphoria/depression, and aggression. These findings suggest a need for improved interventions related to adolescent gambling and a need for additional research into the relationship (eg, mediating factors) between gambling and risk and protective behaviors.

Correlates of at-risk/problem internet gambling in adolescents.

OBJECTIVE: The Internet represents a new and widely available forum for gambling. However, relatively few studies have examined Internet gambling in adolescents. This study sought to investigate the correlates of at-risk or problem gambling in adolescents acknowledging or denying gambling on the Internet. METHOD: Survey data from 2,006 Connecticut high school student gamblers were analyzed using χ(2) and logistic regression analyses. RESULTS: At-risk/problem gambling was found more frequently in adolescent Internet gamblers than in non-Internet gamblers. Compared with at-risk/problem gambling in the non-Internet gambling group, at-risk/problem gambling in the Internet gambling group was more strongly associated with poor academic performance and substance use (particularly current heavy alcohol use; odds ratio 2.99; p = .03) and less strongly associated with gambling with friends (odds ratio 0.32; p = .0003). At-risk/problem gambling in the Internet and non-Internet gambling groups, respectively, was associated at p < .05, each with multiple adverse measurements including dysphoria/depression (odds ratios 1.76 and 1.96), getting into serious fights (odds ratios 2.50 and 1.93), carrying weapons (odds ratios 2.11 and 1.90), and use of tobacco (odds ratios 2.05 and 1.88 for regular use), marijuana (odds ratios 2.02 and 1.39), and other drugs (odds ratios 3.24 and 1.67). CONCLUSIONS: Clinically, it is important to assess for teenagers' involvement in Internet gambling, particularly because adolescent at-risk/problem Internet gambling appears specifically associated with non-peer involvement, heavy alcohol use, and poor academic functioning.

Lifetime histories of trauma among pathological gamblers.

This study extends the work completed with pathological gamblers and substance abusers, looking at associations between a history of trauma and comorbid substance dependence, impulsivity, measures of problem severity, and personality variables. We studied 111 patients admitted to the gambling treatment program at the Brecksville VA Medical Center and found that 64% of gamblers reported a history of emotional trauma; 40.5%, physical trauma; and 24.3%, sexual trauma. Most of this trauma occurred in childhood. A history of trauma was associated with a greater relative frequency of suicide attempts and drug and alcohol dependence, more severe scores in measures of psychiatric distress, and limited effects on personality functioning.