Another limitation is the use of single items to

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Another limitation is the use of single items to assess marijuana and amphetamine use, and the fact that the amphetamine measure cannot distinguish which specific substance was used. Although the ASSIST is a widely-used screening measure for substance use and related harm (Humeniuk 2006 ; WHO 2002 ), the measure uses the term amphetamine to describe the entire class of stimulant drugs, including both legal and illegal substances and those with purely stimulating as well as hallucinogenic effects. The ability to further refine the type of stimulant used, and distinguish between legal, illegal, medical, and non-medical J Gambl Stud 123
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use of stimulants is an important issue for future research. Despite this limitation, the study did use psychometrically validated measures that have been widely used to assess sub- stance use worldwide. All data were collected on a single west-coast campus, thus results may not be fully generalizable to the broader population of college students, although the campus is large, demographically diverse, and generally representative of other large west-coast universi- ties. An additional limitation with respect to generalizability is that all participants in the longitudinal sample met criteria for at-risk or probable pathological gambling at baseline and had a concurrent substance use disorder (abuse or dependence). While this is a lim- itation, the ability to find prospective relationships between baseline stimulant use and gambling behavior 12 months later in this restricted sample suggests the relationship may be even more robust in a general college sample. Furthermore, these prospective analyses (i.e. baseline levels of stimulant use are being used to predict future gambling, controlling for initial levels of gambling) predict whether elevated levels of stimulant use at a snapshot in time predicts change in gambling. While this is not strictly a causal model, since there could be unobserved factors causing that change, with longitudinal data, we can establish temporal precedence of one thing (elevated stimulant use) occurring before the other thing (changes in gambling). Only experimental manipulations can rule out third variable explanations (i.e. ‘‘unobserved factors’’), thus we suggest a causal pathway, rather than strictly a causal model. Further research needs to establish such experimental models. Future Directions Future studies need to utilize a more detailed assessment of what students are reporting related to their substance use. By understanding type of drug use, amount used, and motives associated with use (including motives for comorbid or co-occurring gambling and stimulant use), additional risk factors can be identified, and implications for prevention and intervention can be more thoroughly established. Given the association with numerous other risky behaviors, college counseling centers (who already thoroughly screen for a range of behaviors during intake sessions) could routinely screen for non-medical use of
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