Pathological gambling among cocaine-dependent outpatients

Objective: The authors investigated the occurrence of pathological gambling among cocaine-dependent outpatients, its influence on short-term outcome o f treatment, and comparative characteristics of patients with and without p athological gambling. Method: The subjects were 313 cocaine-dependent (200 also opiate-dependent) outpatients in clinical trials of medication for cocaine dependence. Patho logical gambling (DSM-III-R criteria) was assessed with the Diagnostic Inte rview Schedule, and sociodemographic and socioeconomic characteristics were determined with the Addiction Severity Index. Outcome was defined as time in treatment (proportion of maximum scheduled time) and proportion of cocai ne-positive urine samples during treatment. Results: Pathological gambling had a lifetime occurrence rate of 8.0% and a current (past month) occurrence of 3.8%. Onset preceded the onset of cocai ne dependence in 72.0% of the patients (and preceded onset of opiate depend ence in 44.4%). Patients with pathological gambling (lifetime or current) d id not differ significantly from other patients in length of treatment or p roportion of cocaine-positive urine samples. Those with lifetime pathologic al gambling were significantly more likely to have tobacco dependence (84.0 % versus 61.1%) and antisocial personality disorder (56.0% versus 19.8%), t o be unemployed (84.0% versus 49.3%), to have recently engaged in illegal a ctivity for profit (64.0% versus 38.5%), and to have been incarcerated (62. 5% versus 33.9%). Conclusions: Pathological gambling is substantially more prevalent among co caine-dependent outpatients than in the general population. Patients with p athological gambling differ from other cocaine-dependent outpatients in som e sociodemographic characteristics but not in short-term outcome of treatme nt for cocaine dependence.