Gambling, Discrimination, and Stressful Life Events among Substance Use Disorder Treatment Patients.

Abstract

People with addictive disorders are vulnerable to stigma and discrimination, which can impact addiction treatment outcomes through increased psychological distress and reduced self-efficacy. We investigated relationships between problem gambling, psychological distress, self-efficacy, and stressful life experiences related to identity among patients in SUD treatment. Patients (N = 590) from 19 residential treatment facilities across California completed a survey on substance use, problem gambling, psychological distress (Kessler Psychological Distress Scale - K6), self-efficacy, and intersectional discrimination [Intersectional Discrimination Index - Major (InDI-M)]. Multivariable regression analyses compared three groups on these measures: problem gambling (PG, n = 70), non-problem gambling (NPG, n = 154), and no gambling (NG, n = 366). About 38% of the sample reported past-year gambling. Compared to NG, PG had higher lifetime (mean difference [MD] = 2.61, 95% CI = 0.80, 4.42) and past-year (MD = 1.82, 95% CI = 1.37, 2.27) InDI-M scores; and higher K6 scores (MD = 2.09, 95% CI = 1.14, 3.04). PG also had increased risk of lifetime eviction (adjusted odds ratio [AOR] = 2.49, 95% CI = 1.66, 3.75) and property damage/theft (AOR = 2.99, 95% CI = 1.43, 6.26); and past-year relationship loss (AOR = 4.95, 95% CI = 1.77, 13.83) and physical attack (AOR = 2.57, 95% CI = 1.40, 4.72) compared to NG. In this sample, PG reported more psychological distress and identity-based stressful experiences. Clinical interventions for SUD patients with comorbid PG should prioritize trauma-informed approaches, self-stigma reduction, and case navigation for social determinants of health such as housing insecurity.