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Substance Abuse and Rehabilitation 2016:7 submit your manuscript | Dove press Dove press 5 Gambling and SUD Prevalence AUD exhibits high prevalence rates relative to many other psychiatric conditions. For example, lifetime and past-year prevalence rates of AUD were 30.3% and 8.5%, respectively, in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). 13 These rates are substantially higher than prevalence rates of any nontobacco DUD (lifetime: 10.3%, past-year: 2.0%) and major depressive disorder (life- time: 13.2%, past-year: 5.3%). 13 Results from nationally repre- sentative samples estimate a substantially lower prevalence for GD with 1%–2% meeting lifetime criteria and half of that meeting past-year criteria. 14–17 Young age, male sex, low socio- economic status, and unpaired marital status (ie, never married, divorced, separated, widowed) are common demographics shared by individuals with GD and AUD/DUD. 13,15–17 Diagnostic threshold In the DSM-5 , the diagnostic threshold for GD was lowered from five of ten criteria to the current threshold of four of nine criteria. 1 The changes done by the DSM-5 SUD Work Group to the GD criteria were designed to minimize impact on prevalence rates while improving diagnostic accuracy. 18 Nonetheless, modest increases in GD prevalence rates are likely as DSM-5 criteria are adopted. For example, in a sample of randomly selected US household residents (N = 2,417), prevalence rates of GD increased from 0.1% to 0.2% using the DSM-5 criteria. 19 Samples from clinical settings that serve high-risk gamblers will also be affected. Prevalence of GD increased from 81.2% under DSM-IV to 90.3% using DSM-5 criteria among West Virginian gamblers (N = 2,750) calling a state gambling help line. 8 Despite a lower threshold, stark differences remain between SUD and GD in terms of diagnostic thresholds and recognition of milder forms of the disorder. 8,20 For the DSM-5 SUD criteria, which combine DSM-IV substance abuse and dependence items in a single diagnostic set, only two or more of eleven symptoms are required for diagnosis. Severity is indicated with mild (2–3 symptoms), moderate (4–5 symptoms), and severe (six or more symptoms) specifiers, which is incongruent with GD severity specifiers: mild (4–5 symptoms), moderate (6–7 symptoms), and severe (8–9 symptoms). If GD criteria were to be more directly modeled after SUD criteria with its lower threshold, the prevalence rate of GD would rise significantly, as an additional 2% of indi- viduals endorse subclinical lifetime gambling problems. 14,15 Consideration of such a change, despite the potential impact on prevalence rates, may be warranted if individuals with subthreshold GD symptoms experience clinically significant levels of impairment or harm on par with mild AUD/SUD and if they benefit from identification and treatment. Several studies document substantial negative impacts associated
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