ABSTRACT
OBJECTIVES: To describe and evaluate tests of the performance of the NODS-CLiP, an efficient standardized diagnostic interview instrument for adult pathological and problem gambling. SETTING AND SAMPLES: Identical batteries of diagnostic questions about gambling behavior, motives, and thoughts were administered to participants in eight general adult population field studies conducted in the United States between 1999 and 2003, including six state-level random-digit-dial (RDD) telephone surveys, one national RDD survey, and one in-person systematic random sample survey of commercial gambling patrons in eight states. Total survey N = 17,180. Response rates ranged from 24 to 71%. MEASURES: Data from all experienced gamblers (N = 8,867) were re-analyzed to compare diagnostic status derived from the 17-item NORC Diagnostic Screen for Gambling Disorders (NODS), a validated DSM-IV-based instrument, with results from all 2- to 4-item subsets of NODS items. RESULTS: Three NODS questions pertaining to loss of Control, Lying, and Preoccupation (the "CLiP"), requiring one minute to administer, identified virtually all pathological gamblers and most problem gamblers diagnosed by the complete NODS. The CLiP has excellent sensitivity and specificity for NODS constructs. CONCLUSIONS: A two-stage NODS-CLiP procedure appears quite promising as an efficient epidemiological instrument for general population research and clinical triage for gambling disorders.
Subject(s)
Behavior, Addictive/diagnosis , Gambling/diagnosis , Risk-Taking , Surveys and Questionnaires/standards , Adult , Behavior, Addictive/psychology , Deception , Diagnostic and Statistical Manual of Mental Disorders , Fantasy , Female , Gambling/psychology , Humans , Male , Middle Aged , Psychometrics , Reproducibility of Results , United States/epidemiology , Young AdultABSTRACT
AIMS: To help refine the definition and diagnosis of gambling disorders, we investigated the distribution among US gamblers of the 10 DSM-IV criteria for Pathological Gambling. DESIGN: We drew data from two stratified random surveys (n = 2417, n= 530) of gambling behavior and consequences among community-based samples of US adults. A fully structured questionnaire, administered by trained lay interviewers, screened for the life-time prevalence of problem and Pathological Gambling. Per DSM-IV definitions, anyone meeting five or more of 10 itemized criteria was considered a pathological gambler. We analyzed these criteria among all gamblers who met one or more criteria (n = 399). FINDINGS: Most gamblers who met only one or two criteria reported 'chasing their losses'. At subclinical levels (three to four criteria), gamblers also reported elevated rates of gambling-related fantasy: lying, gambling to escape and preoccupation. Pathological gamblers with five to seven criteria reported marked elevations of loss of control, withdrawal symptoms and tolerance (internalizing dimensions of dependence); risking their social relationships and needing to be bailed out financially (externalizing dimensions). Most of the highest-level pathological gamblers (eight to 10 criteria) reported committing illegal acts to support gambling. CONCLUSION: Dependence in a biobehavioral sense appears to be a hallmark of Pathological Gambling, but it marks only one threshold in a qualitative hierarchy of disorders beginning with a common subclinical behavior, 'chasing'. Epidemiological assessments and future DSM revisions might consider explicit recognition of a problem gambling disorder, identifying people presenting some cognitive symptoms of Pathological Gambling but not clear signs of dependence. Pathological gamblers in turn appear to have two distinct levels of severity.
