Co-Occurrence

Co-occurring conditions refer to when a person experiences two or more mental health or behavioral health conditions at the same time, and they can be common for people who struggle with problem gambling. These conditions may interact, shaping someone’s symptoms and influencing treatment outcomes. Understanding how gambling disorder overlaps with substance use and other health conditions is essential to addressing the full scope of risk.  

Research consistently shows a strong link between substance misuse and problem gambling. Studies have found that more than half (57.5%) of individuals with problem gambling also engage in substance misuse behaviors. Additionally, adults receiving mental health and substance use treatment experience problem or pathological gambling at rates 4- to 10-fold higher than the general adult population. 

Tobacco and alcohol use also play a significant role. In fact, tobacco use is the most frequent comorbidity with gambling disorder. Of the people seeking treatment for gambling disorder, nearly half (46.4%) reported daily tobacco use. A recent meta-analysis of population-based studies shows the scope of overlap among people with gambling disorder: 

  • Roughly 1/3 (34.2%) also have a substance use disorder 

  • 30.9% have a mood disorder 

  • 29.9% have an anxiety disorder 

  • 14.3% have a personality disorder 

  • 5.9% have a psychotic disorder  

People at the highest risk for gambling problems often already face substance use or mental health challenges and vice versa. These connections reveal the importance of addressing problem gambling within a broader behavioral health context. Integrated screening, diagnosis, and care can improve outcomes by treating the whole person. The Substance Abuse and Mental Health Services Administration (SAMHSA) provides evidence-based tools and resources to help providers deliver coordinated care for people living with co-occurring disorders. 

Holistic prevention approaches matter too. Evidence-informed interventions that address alcohol and tobacco use can also reduce risk for problem gambling.