New research shows that when people recovering from gambling addiction slip back into old habits, those with attention-deficit/hyperactivity disorder (ADHD) are likely to suffer a more severe relapse.
Interestingly, the study found no significant differences in treatment response between the participants with ADHD and those without. Those with the disorder showed similar improvement, dropout and relapse rates to the control group.
However, when relapses occurred, participants with ADHD symptoms experienced more severe relapses, meaning they wagered and lost more money than participants without. Additionally, gambling disorder patients who relapsed scored higher on ADHD measures, particularly those related to inattention.
The findings, said researchers, suggest a “need for more vigilant follow-up and interventions” for patients dealing with both problem gambling and ADHD.
Exploring Associations Between Gambling Disorder and ADHD
The study will be published in the open-access, peer-reviewed journal Comprehensive Psychiatry in January 2024. It has been freely available online since late October.
The collaborative effort involved a team of researchers and academics from Spain and the US, including Yale’s School of Medicine.
In addition to Yale, several universities and organizations contributed to the findings:
- Instituto de Investigación Biomédica de Bellvitge (IDIBELL)
- Bellvitge University Hospital—IDIBELL
- Instituto de Salud Carlos III
- Universidad Internacional de La Rioja
- Universitat Autonoma de Barcelona
- University of Barcelona
- Connecticut Mental Health Center
While several previous studies have pointed to the connection between gambling disorder and ADHD, scholars have yet to explore how ADHD may influence gambling disorder treatment outcomes.
Therefore, the purpose of the study, said researchers, was to explore associations between demographics, ADHD symptoms, and clinical features in those with a gambling disorder. They were also looking for links between ADHD symptoms and treatment outcomes, specifically relapse and dropout statistics.
For the longitudinal study, researchers followed 170 gambling disorder outpatients at a university as they underwent 16 weeks of cognitive behavioral therapy (CBT). Additionally, the research assessed the first three months of follow-up data.
Before conducting the study, the researchers hypothesized that those with ADHD would exhibit greater severity of gambling disorder and poorer treatment outcomes overall. However, that theory would prove only partially true.
Gambling Disorder Relapse More Severe With ADHD
As researchers expected, the presence of ADHD symptoms in patients was statistically associated with greater severity of gambling disorder. The researchers rated participants’ symptoms using the Adult ADHD Self-Report Scale (ASRS).
They also found those with ADHD had worse psychopathology, higher impulsivity, and more “disadvantageous” personality traits. Specifically, those patients scored higher for novelty-seeking, harm-avoidance, and self-transcendence and lower scores for persistence, self-directedness, and cooperativeness.
Notably, findings also showed that higher scores on the ADHD hyperactivity dimension were associated with younger patients and earlier onset of gambling disorder. The result suggests ADHD should be a consideration when treating gambling disorder among youth.
However, despite the initial hypothesis, researchers found no difference in treatment outcomes for gambling disorder patients, whether with or without ADHD.
From the report:
Contrary to our hypotheses, this study failed to find significant differences between individuals with GD with and without self-reported ADHD symptoms in terms of relapses and dropouts.
Despite the lack of difference in treatment outcomes, researchers found that when a relapse did occur, those with ADHD gambled larger sums.
The study also found that those who relapsed during treatment displayed statistically higher ASRS scores, particularly on measures of inattention.
Given that both gambling disorder and ADHD present common symptoms, researchers suggest treatment for gambling disorder may positively influence the regulation of ADHD characteristics.
The results, they explained, require more study:
In other words, certain psychological techniques that are applied in CBT for GD, such as cognitive restructuring, stimulus control, or emotion-regulation strategies, may also be useful for addressing ADHD symptoms, and this currently speculative possibility warrants further direct examination.
More Research Needed to Create Better Safeguards
In its conclusion, researchers noted that these study results add support and knowledge to the understanding of the co-occurrence between gambling disorder and ADHD.
They also reaffirmed the need for subsequent research.
A significant finding to emerge was that there were no significant differences in dropout and relapse rates between gambling disorder patients with ADHD symptomatology and those without.
We observed differences in the severity of relapses and ADHD features in gambling disorder patients who relapsed. Thus, there is a need for additional research into how best to safeguard individuals with co-occurring gambling addiction and ADHD symptoms, particularly with respect to reducing frequencies and impacts of gambling relapses.