The Gerontologist
Vol. 42, No. 1, 92–99
A Comparison of Young, Middle-Aged,
and Older Adult Treatment-Seeking
Pathological Gamblers
Purpose: Pathological gambling is an increasing public
health concern, but very little is known about this disorder
in older adults. This study evaluated gambling and psycho-
social problems across age groups in treatment-seeking
gamblers. Design and Methods: At intake to gambling
treatment programs, 343 pathological gamblers completed
the Addiction Severity Index (ASI) and gambling question-
naires. Participants were categorized by age into young
adults (ages 18–35 years; n  97), middle-aged adults
(ages 36–55 years, n  197), and older adults (aged
older than 55 years, n  49). Differences in demograph-
ics, gambling variables, and ASI composite scores were
compared across the groups. Results: The middle- and
older age gamblers were more likely to be female (45%–
55%) than were the younger gamblers (23%), but the
groups were similar with respect to most other demo-
graphic variables. When controlled for gender, older
age was associated with increased employment prob-
lems, but fewer social, legal, and substance-abuse diffi-
culties. Compared with middle-aged gamblers, older
gamblers wagered on fewer days. Age  Gender effects
emerged in onset of gambling problems and amount
spent gambling. Older women did not begin gambling
regularly until an average age of 55 years, whereas
older male gamblers generally reported a lifelong his-
tory of gambling. The older female gamblers also wa-
gered the greatest amounts in the month prior to treat-
ment entry. Implications: These data suggest that older
adults compose a minority of treatment-seeking gam-
This research was supported in part by the Patrick and Catherine Wel-
don Donaghue Medical Research Foundation Investigator Program and
NIH Grants R01-MH60417, R01-MH60417-Supp, R01-DA13444, R29-
DA12056, P50-AA03510, P50-DA09241, and the Claude Pepper Older
Americans Independence Center at University of Connecticut Health Cen-
ter (Grant P60-AG13631).
JoAnne Boccuzzi, Jaime Kelley, and Cheryl Molina assisted in data col-
lection and management, and the staff at the Compulsive Gambling
Treatment Program, Bettor Choice Programs, and the Connecticut Council
on Problem Gambling are thanked for their participation in this project.
Dr. Richard Fortinsky provided helpful suggestions on the manuscript.
Address correspondence to Nancy M. Petry, PhD, Department of Psy-
chiatry, University of Connecticut Health Center, 263 Farmington
Avenue, Farmington, CT 06030-3944. E-mail: petry@psychiatry.uchc.edu
1
Department of Psychiatry, University of Connecticut Health Center,
Farmington.
92
Copyright 2002 by The Gerontological Society of America
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Nancy M. Petry, PhD1
blers, but differences in psychosocial problems across the
age groups may suggest the need for interventions tai-
lored to particular issues encountered by older pathologi-
cal gamblers. Specifically, treatments focusing on later
life development of problems may be indicated for older
female gamblers.
Key Words: Pathological gambling, Older adults,
Gender, Treatment
Pathological gambling affects about 1.6% of the
adult population (Shaffer, Hall, & Vander Bilt, 1999).
The personal and social effects of this disorder in-
clude significant financial losses, family problems, le-
gal and employment difficulties, and psychological
distress, including suicide (Petry & Armentano, 1999).
However, relatively little is known about the ante-
cedents or correlates of pathological gambling in
older adults.
Older age is often associated with lower rates of
pathological gambling (National Research Council,
1999; Shaffer et al., 1999). In general population
surveys, prevalence rates of pathological gambling in
older adults are quite low. For example, in the Na-
tional Opinion Research Center’s (NORC; 1999)
telephone survey, only 0.4% of individuals aged
older than 65 years met diagnostic criteria for patho-
logical gambling.
Although these data may suggest that gambling is
not a significant public health concern among older
adults, this conclusion must be drawn with caution.
Many studies do not break out prevalence rates by
age groups, and usually less than 20% of individuals
in telephone surveys are in the oldest cohorts. In the
NORC (1999) study, for example, less than 400 re-
spondents were 65 years or older. This sample size
may not be large enough to derive accurate estimates
of prevalence rates for a disorder that occurs at a rel-
atively low frequency.
Only one known published report focused exclu-
sively on gambling in older adults. McNeilly and
Burke (2000) surveyed a nonrandom sample of 315
older adults in Nebraska. Ninety-one participants
were recruited from gaming facilities (commercial
The Gerontologist
and charitable bingo facilities or in a shuttle bus day-
trip to a casino), and 224 were recruited from senior
and retirement centers of American Association of
Retired Persons chapter members. Among the partic-
ipants surveyed at gaming venues, 11% were classi-
fied as pathological gamblers. About 3% of those
surveyed from other community events were patho-
logical gamblers. This study, albeit of a sample of
convenience, suggests a clinically significant rate of
disordered gambling in older adults, especially among
those with recent participation in gambling activities.
The expansion of legalized gambling opportunities
in the past 15 years may be associated with a rise in
gambling participation, and this increase is particu-
larly pronounced in older adults (NORC, 1999). In a
national telephone survey of gambling conducted in
1975, only 35% of individuals older than 65 years
reported gambling in their lifetimes (Kallick, Suits,
Dielman, & Hybels, 1976). In contrast, 80% of indi-
viduals older than 65 years who were interviewed in
1998 reported lifetime participation in gambling ac-
tivities (NORC, 1999). Past-year gambling participa-
tion also increased dramatically in this oldest age
group, with only 23% of older adults reporting past-
year gambling in 1975 versus 50% in 1998.
A rise in disordered gambling behaviors seems to
parallel the spread of legalized gambling opportuni-
ties. In a meta-analysis of all prevalence studies con-
ducted in North America, Shaffer and colleagues
(1999) found a statistically significant increase in the
percentages of adults classified with pathological
gambling in studies conducted since 1993 compared
with those conducted earlier. Therefore, older adults
may begin to experience gambling problems at
higher rates as gambling participation expands in
this age group.
Because of the paucity of clinical and research at-
tention to gambling in older adults, the National
Gambling Impact Study Commission (1999) recom-
mended further investigation of this issue. This study
is one step in this direction. Using data collected
from treatment-seeking pathological gamblers, I com-
pared gambling and related psychosocial problems
across age groups, specifically focusing on gamblers
in the oldest age cohort.
Methods
Participants
Participants were drawn from a retrospective
analysis of 343 consecutive admissions of individuals
initiating treatment for pathological gambling through-
out the state of Connecticut between August 1998
and July 2000. Approximately half of the sample
was initiating treatment at a state-funded gambling
treatment center; this treatment combined 12-step
programs, cognitive–behavioral treatment, and edu-
cational group and individual sessions. The other
half of the sample was beginning treatment in a Na-
tional Institutes of Health–funded study evaluating
cognitive–behavioral therapy for pathological gam-
bling. Only 5 individuals refused to participate, and
Vol. 42, No. 1, 2002
all withdrawals were related to dissatisfaction with
random assignment procedures in the treatment
study. Most participants learned about the treatment
programs through one or more of the following
sources: media advertisements, professional social
service referrals, the Connecticut Compulsive Gam-
bling Helpline, or word-of-mouth referrals. No dif-
ferences in demographic characteristics were noted
among participants receiving treatment at the differ-
ent programs, so data were pooled for analyses. The
study was approved by the University of Connecticut
Health Center Institutional Review Board.
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Procedure
The Addiction Severity Index (ASI; McLellan, Lu-
borsky, Cacciola, & Griffith, 1985) was administered
to all participants at intake to treatment. The ASI as-
sesses severity of medical, psychiatric, employment,
family/social, legal, alcohol, and drug problems ex-
perienced in the past month. Composite scores are
derived from responses to items within each of these
problem areas. Responses are standardized and
summed to produce a mathematical estimate of sta-
tus in each area and range from 0.00 to 1.00, with
higher scores indicative of more severe problems. A
number of studies have demonstrated the reliability
and validity of this instrument in a variety of sub-
stance-abusing populations (Kosten, Rounsaville, &
Kleber, 1983; McLellan, Alterman, Cacciola, Metzger,
& O’Brien, 1992; McLellan et al., 1985), and the
ASI is one of the most commonly used instruments
for both clinical and research purposes in addiction
populations.
A gambling section of the ASI has also been created
(Lesieur & Blume, 1991a). It has adequate-to-excel-
lent reliability and validity in assessing gambling
problems in substance abusers who also present with
gambling problems, as well as among individuals with
a primary diagnosis of pathological gambling (Lesieur
& Blume, 1991a, 1992; Petry, 2001).
All participants also completed the South Oaks
Gambling Screen (SOGS; Lesieur & Blume, 1987).
Scores of greater than or equal to 5 are indicative of
a diagnosis of pathological gambling, and all partici-
pants included in this report scored over 5. SOGS
scores were not a criterion for treatment entry, but
these scores suggest that all individuals seeking gam-
bling treatment were likely to meet diagnostic crite-
ria for pathological gambling.
Data Analysis
Participants were divided into age groups that,
broadly defined, covered young adulthood (18 to 35
years), middle age (36 to 55 years), and older adult-
hood (56 years and older). Basic demographics were
compared across the groups using chi-square tests
for categorical data and analyses of variance for con-
tinuous data. Variables that were nonnormally dis-
tributed were transformed when possible. For vari-
ables that could not be normally distributed even
93
after transformation, nonparametric tests were used Table 1. Demographic Characteristics of the Three Age Groups
to evaluate differences among the groups.
Because more women were in the middle and Middle-
older age groups compared with the younger group, Young Aged Older
subsequent age-related comparisons controlled for Variable Adults Adults Adults
gender. First, multivariate analysis of covariance
n 97 197 49
(MANCOVA) was used to evaluate differences among Age range 19–35 36–55 56–75
the groups, with gender and age categories as fixed Gender (% men)*** 77.3 55.8 44.9
factors and ASI composite index scores as the depen- Race (%)
dent variables. Age emerged as a significant predictor Caucasian 85.3 87.2 93.9
in the overall analysis, as well as in six of the eight African American 9.5 8.2 4.1
domains. For domains in which overall F tests were Hispanic 2.1 2.1 0.0
Native American 0.0 0.5 0.0
significant, Dunnett’s post-hoc tests compared each

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Asian 3.2 1.0 2.0
age group to the others. Further, when an overall test Education (years) 12.7 (1.8) 12.8 (2.2) 12.2 (2.1)
for a domain was significant, subsequent analyses Marital status (%)***
evaluating differences with respect to specific vari- Single 42.7 14.3 0.0
ables making up these domains were protected against Married/remarried 32.3 46.4 61.2
multiple comparisons (Tabachnick & Fidell, 1996). Divorced/separated 16.7 32.1 26.5
Widowed 0.0 2.0 12.2
Analyses of covariance then evaluated differences Other 8.3 5.1 0.0
among the groups on specific items associated with Primary type of gambling (%)
each problem area. Gender was included as a fixed Slots 10.3 40.6 57.1
covariate in these analyses. For dichotomous vari- Cards (mainly blackjack) 35.1 18.8 14.3
ables associated with domains that differed among Scratch/instant tickets 12.4 10.1 2.0
Animals (includes OTB) 6.2 8.1 8.2
the age groups, chi-square analyses were used. Sports 16.4 4.6 2.0
Data analyses were conducted on SPSS (SPSS Inc., Dice 2.0 3.5 4.0
Chicago, IL, 1997). The alpha value was .05, and all Video poker 2.1 2.0 6.1
tests were two-tailed. Missing data, composing less Lottery 4.1 2.0 0.0
than 5% of the total data, were not interpolated, so Internet 2.1 0.5 0.0
degrees of freedom vary slightly depending on how Other or unspecified 9.2 9.8 6.3
many participants responded to each item. Notes: Values represent means (SDs) unless otherwise noted.
Because age is a continuous variable, these analy- OTB  off-track betting.
ses were repeated using age as a continuous, rather ***p  .001.
than a categorical, variable. The overall MANCOVA
produced similar results to those reported herein, popular form of gambling among the middle and
and therefore, for ease of presentation, this article older age groups. These age groups also contained
presents data with age groups trichotomized. Indi- higher proportions of women. Preferences for slot ma-
viduals in the middle age range demonstrated very chine gambling differed significantly between genders,
similar patterns in ASI scores, regardless of whether with only 18% of men compared with 61% of
ages were broken down by decades (e.g., 30–39, 40– women preferring slot machine gambling, 2(1, N 
49, 50–59), or according to the simpler three-group 343)  62.51, p  .001. Preferences for slot machine
classification presented within this article. Finally, gambling also differed significantly across the age
these same analyses were conducted classifying only groups, 2(2, N  343)  37.94, p  .001.
adults older than age 60 years in the oldest age co- The overall MANCOVA revealed that ASI com-
hort. Again, similar results were obtained, but only posite scores differed significantly among the three
8% of the sample was aged older than 60 years, so age groups, F(16,606)  3.17, p  .001. Gender did
data are presented with the larger group of older not emerge as a significant predictor in this analysis,
gamblers including those aged older than 55 years. and the Gender  Age Category interaction effect
was also not significant. Except for the medical and
psychiatric scores, differences in composite scores
Results
were statistically significant across age groups for all
Table 1 shows demographic characteristics of the the other ASI indexes. The means, standard devia-
three groups of participants. Although only 23% of tions, and F values for each problem area are pre-
participants in the youngest age group were female, sented below.
about half of those in the middle and older age groups Table 2 shows gambling-related variables. Because
were female, 2 (2, N  343)  18.24, p  .001. The of the gender difference across the age groups, val-
three age groups also differed in terms of marital sta- ues are presented separately for men and women
tus, 2(8, N  343)  71.6, p  .001, with the oldest within each age category. ASI gambling composite
age group most likely to be married and the youngest scores differed significantly across the age categories,
age group most likely to be single. No other demo- F(2,337)  3.07, p  .05, with the middle age group
graphic differences were noted among the groups. The showing the most severe gambling difficulties on this
preferred forms of gambling are also shown across the index of recent (past month) gambling problems.
three age groups. Slot machine gambling was the most Gambling ASI scores did not differ by gender.

94 The Gerontologist
 Table 2. Gambling Variables Across Age Groups and Genders

Variable Young Adults Middle-Aged Adults Older Adults

ASI-gambling*
Men 0.64 (0.23) 0.67 (0.25) 0.56 (0.34)
Women 0.59 (0.26) 0.71 (0.21) 0.68 (0.20)
SOGS score†
Men 12.5 (3.5) 12.6 (4.0) 13.7 (4.7)
Women 11.7 (4.3) 12.2 (3.3) 10.0 (3.9)
Age first gambled***,‡
Men 17.0 (5.1) 17.5 (8.5) 21.2 (12.9)
Women 21.3 (6.5) 30.4 (10.8) 41.7 (18.7)
Age started gambling regularly*** ,‡

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Men 21.0 (4.8) 27.5 (11.7) 33.2 (18.7)
Women 25.5 (5.3) 39.1 (7.5) 54.8 (13.0)
Years of gambling problems**,†
Men 5.8 (4.4) 12.4 (10.7) 16.0 (17.9)
Women 4.6 (4.1) 5.1 (4.7) 5.6 (7.2)
Days gambled in past month*
Men 11.5 (10.1) 13.9 (10.7) 9.3 (10.3)
Women 8.9 (9.1) 12.4 (10.4) 9.2 (7.9)
Amount gambled in past month† (median and IQ range)
Men $1,000 (2,500) $1,000 (3,313) $1,500 (4,125)
Women $800 (2,110) $1,000 (1,500) $1,800 (3,800)
Amount gambled as % of monthly income (median and
IQ range)*
Men 94 (408) 67 (474) 187 (677)
Women 125 (809) 77 (374) 249 (850)
Current gambling debt (median and IQ range)
Men $4,000 (13,900) $6,000 (25,000) $25,000 (35,000)
Women $3,250 (11,862) $5,000 (28,868) $12,000 (29,500)
Ever sought treatment for gambling before, including at
Gamblers Anonymous (%)
Men 40.0 50.5 50.0
Women 22.7 34.5 44.4
Notes: Values listed under the three age categories represent means (SDs) unless otherwise noted. ASI  Addiction Severity Index;
IQ  interquartile range; SOGS  South Oakes Gambling Screen. The asterisks indicate significant effects across age groups. The dag-
gers indicate significant Age  Gender interaction effects.
*p  .05; **p  .01; ***p  .001; †p  .05; ‡p  .01.

In terms of lifetime gambling problems, a signifi-
cant effect of age group did not emerge on SOGS
scores, but gender, F(1,330)  10.02, p  .001, and
Age  Gender effects, F(2,330)  3.65, p  .05,
were significant. Women had lower scores than men
did, and this effect was most pronounced in the old-
est women, who had the lowest SOGS scores, indica-
tive of fewer lifetime gambling problems.
Older gamblers were likely to begin gambling later
in life, F(2,329)  21.29, p  .001, as were women,
F(1,329)  86.63, p  .001. An Age  Gender effect
was noted, F(2,329)  9.63, p  .001, with older
women not initiating gambling until an average age
of 42 years. This pattern was similar with respect to
the age at which participants began gambling regu-
larly, and the effects of age, gender, and Age  Gen-
der were all significant, with F(2,333)  58.85,
F(1,333)  84.15, and F(2,333)  9.78, ps  .001.
The total number of years of gambling problems also
differed among the three age groups, F(2,333) 
6.95, p  .01, as well as between genders, F(1,333) 
29.90, p  .01. The Age  Gender interaction was
significant as well, F(2,333)  4.59, p  .01. Before
entering treatment, men (especially older men) expe-
rienced a longer duration of gambling problems than
women did.
Days of gambling in the past month differed
among the three age groups, F(2,336)  4.07, p 
.05, with the middle age group gambling most fre-
quently. Gender and the interaction between gender
and age were not related to days of gambling.
Amount wagered in the past month did not differ be-
tween genders. However, the Age  Gender interac-
tion effect was significant, F(2,336)  4.60, p  .05,
with older women wagering the largest amounts.
Amount gambled as a percentage of monthly income
also varied across the age groups, F(2,323)  3.00,
p  .05, as well as between genders, F(1,323) 
4.57, p  .05. Women gambled large proportions of
their monthly incomes prior to entering treatment,
and this effect was especially pronounced in older
women, who gambled in excess of 200% of their in-
comes. No significant differences in gambling debt or
previous gambling treatment were noted across
groups.
Employment, social, and legal variables are shown
in Table 3. ASI employment composite scores dif-
fered among the three age groups, F(2,322)  8.70,
p  .05, with the middle age group having the least
severe problems. Average responses to some of the
items that are included in the employment section are
shown in Table 3, and, as a reference point, employ-

Vol. 42, No. 1, 2002 95

 Table 3. Employment, Social, and Legal Variables Across Age Groups and Genders

Variable Young Adults Middle-Aged Adults Older Adults

ASI employment*
Men 0.24 (0.23) 0.19 (0.22) 0.30 (0.18)
Women 0.33 (0.24) 0.19 (0.18) 0.31 (0.18)
Employed full time (%)***
Men 78.7 81.8 40.9
Women 45.5 71.3 33.3
Monthly income (median and IQ range)*
Men $1,425 (1,796) $2,100 (2,560) $720 (2,200)
Women $450 (1,200) $1,482 (1,200) $960 (1,900)
ASI social**

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Men 0.36 (0.22) 0.33 (0.24) 0.30 (0.22)
Women 0.44 (0.23) 0.33 (0.24) 0.30 (0.25)
Satisfied with current marital/living situation (%)*
Men 41.9 50.9 63.6
Women 40.0 57.5 59.3
ASI legal*
Men 0.16 (0.22) 0.09 (0.19) 0.09 (0.18)
Women 0.12 (0.21) 0.06 (0.16) 0.07 (0.16)
Ever served time in jail (%)
Men 16.0 25.5 31.8
Women 4.5 5.7 11.1
Currently on probation or parole (%)**
Men 16.0 6.4 4.5
Women 9.5 2.3 0.0
Currently awaiting trial (%)
Men 14.9 11.0 4.5
Women 14.3 3.5 7.4
Any illicit activity in past month (%)***
Men 25.3 8.4 9.1
Women 0.0 3.4 0.0
Notes: Values listed under the three age categories represent means (SDs) unless otherwise noted. ASI  Addiction Severity Index;
IQ  interquartile range. The asterisks indicate significant effects across age groups.
*p  .05; **p  .01; ***p  .001.

ment composite scores in drug-abusing patients usu-
ally range from 0.6 to 0.8, substantially higher than
scores in these pathological gamblers. Not surpris-
ingly, fewer older participants were employed full
time compared with younger participants, 2(2, N 
343)  30.48, p  .001, but only 9.1% of the men
and 18.5% of the women in the oldest cohort were
retired (data not shown). Past-month income differed
across the age groups, F(2,322)  5.18, p  .01,
with the middle age group having the highest monthly
income.
Scores on the ASI social problem index differed
across the age groups, with the oldest age group
showing the fewest problems, F(2,299)  3.89, p 
.05. Older adults were more likely to be satisfied
with their marital and living situation than were
younger adults, 2(2, N  343)  6.05, p  .05.
Controlling for gender, ASI legal scores also dif-
fered across the age groups, F(2,328)  3.62, p 
.05, with most severe legal problems in the youngest
age group. No age effects emerged with respect to
the percentages ever incarcerated in their lifetimes.
However, the youngest age group was more likely to
be on probation or parole, 2(2, N  343)  12.02,
p  .01. About 10% of the sample was awaiting le-
gal charges, trial, or sentencing, and these percent-
ages did not differ among the age groups. In the past
month, significantly more of the younger participants
reported engaging in illicit activities than did the
older participants, 2(2, N  343)  15.91, p  .001.
Drug and alcohol variables are shown in Table 4.
Controlling for gender, ASI composite scores were
significantly different across the three age groups,
F(2,332)  5.18 and 3.89, ps  .05, for alcohol and
drugs, respectively. The youngest age group had the
highest ASI scores, whereas the two older age groups
did not differ from one another. Younger gamblers
were more likely to smoke cigarettes than older gam-
blers were, 2(2, N  343)  10.25, p  .01. The
majority of participants in the younger and middle age
groups had smoked marijuana in their lifetimes, al-
though marijuana use was less prevalent in the older
age group, 2(2, N  343)  37.35, p  .001. A sim-
ilar age effect was noted with respect to cocaine use,
2(2, N  343)  10.87, p  .01. No age-related dif-
ferences emerged in terms of percentages of the par-
ticipants who had ever been treated for a substance-
use disorder. Relative to the youngest age group, the
older participants were also less likely to have used
illicit drugs in the month prior to entering treatment
for gambling, 2(2, N  343)  24.45, p  .001.
Discussion
These data suggest that older treatment-seeking
pathological gamblers differ from younger and mid-

96 The Gerontologist
 Table 4. Drug and Alcohol Variables Across Age Groups bling until casinos became legalized on Native Amer-
and Genders ican reservations in Connecticut in 1992. Most of the
women reported casino gambling, and slot machines
Middle- in particular, to be their preferred form of gambling.
Young Aged Older In contrast, the older men generally reported a
Variable Adults Adults Adults
lifelong history of gambling. Over 75% began gam-
bling in their teenage years, and 77% began regular
ASI alcohol*
Men 0.13 (0.16) 0.08 (0.13) 0.04 (0.08) gambling prior to the age of 30 years. Because most
Women 0.09 (0.19) 0.05 (0.12) 0.04 (0.09) states had no forms of legalized gambling in the
ASI drug* 1950s to 1960s when they began gambling, these
Men 0.03 (0.08) 0.00 (0.01) 0.00 (0.02) men probably were participating in illicit forms of
Women 0.02 (0.08) 0.01 (0.03) 0.00 (0.01) gambling during their youth. The high rate of incar-
Current cigarette
ceration (32%) in these older male pathological gam-

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smokers (%)**
Men 44.6 30.3 23.8 blers suggests that they engaged in a variety of illegal
Women 66.7 36.8 26.9 behaviors when they were younger.
Ever smoked Prior to the widespread growth in legalized gam-
marijuana (%)*** ing, pathological gambling was almost exclusively a
Men 82.4 76.9 40.9 male disorder, and virtually no reports of female
Women 85.7 66.7 29.6
Ever used cocaine (%)**
treatment-seeking pathological gamblers exist prior
Men 41.9 50.5 18.2 to the early 1990s (see Lesieur, 1988, 1993; Lesieur
Women 33.3 29.9 14.8 & Blume, 1991b; Marks & Lesieur, 1992). Although
Ever treated for drug or male gender is still considered a risk factor for devel-
alcohol abuse (%) opment of gambling problems, rates of pathological
Men 31.0 35.5 29.6 gambling currently are estimated to be only 1.5 to 2
Women 21.1 15.1 8.3
Any illegal drug use in
times that found in women (NORC, 1999).
past month (%)*** This gender gap may be narrowing with the wide-
Men 24.0 3.7 0.0 spread legalization of gambling. As the current gen-
Women 18.2 10.3 0.0 eration grows up accustomed to legalized gambling,
Notes: Values listed under the three age categories represent
development of gambling problems in the later stages
means (SDs) unless otherwise noted. ASI  Addiction Severity In- of life, as shown in this sample of women, may be-
dex. The asterisks indicate significant effects across age groups. come a less common phenomenon. Now that women
*p  .05; **p  .01; ***p  .001. are exposed to gambling throughout life, those who
may be more prone to develop gambling problems
may do so at younger ages. As noted with substance-
dle-aged gamblers on a number of dimensions. Older use initiation, opportunity to sample may be the
gamblers were more likely to be female than were greatest predictor of involvement and subsequent de-
younger gamblers, and they demonstrated different velopment of problems (Van Etten, Neumark, & An-
onsets and intensities of gambling problems. In terms thony, 1999). The gender differences noted with re-
of other psychosocial difficulties that may be related spect to prevalence of substance-use disorders seem
to gambling, older gamblers had more serious em- to be related to girls having fewer opportunities than
ployment problems but fewer social, legal, alcohol, boys do to sample illicit drugs. Girls who have had
and drug problems. These differences are discussed the opportunity to sample drugs use them at the
along with limitations of the study design that may same rates as boys do (Van Etten et al., 1999). Like-
bear on their interpretation. wise, more and more women are gaining exposure to
The older gamblers demonstrated different gam- gambling opportunities, and therefore the gender dif-
bling histories and patterns than the younger gam- ferences in gambling participation seem to be de-
blers did. The oldest group of gamblers had ASI creasing (NORC, 1999). More research is necessary
gambling composite scores that were lower than the to examine the prevalence and correlates of disor-
middle age group. Compared with middle-aged gam- dered gambling among women, especially as access
blers, the older gamblers wagered on fewer days. to legalized gambling spreads.
Age  Gender effects emerged in terms of amount In the present sample of treatment-seeking patho-
wagered per month, with older female gamblers logical gamblers, close to 50% were female. In-
spending the most money, and the highest percentage creases in treatment seeking among women may be
of their income, gambling. reflective of a well-known phenomenon that women
Age  Gender effects were noted with respect to seek mental health treatment services more often
development of gambling problems as well. Among than men do, and they do so after experiencing
the older female gamblers, age of gambling initiation symptoms for a shorter duration (e.g., Garfield,
and regular gambling did not occur until much later 1994). Women entered treatment an average of 4 to
in life. An individual analysis of the female patholog- 5 years after development of gambling problems,
ical gamblers older than 55 years of age revealed that compared with an average of 11 years for men.
52% of these women had never gambled and 89% These data are consistent with gender-specific treat-
did not begin regular (weekly or more frequent) gam- ment-seeking patterns in other mental health disor-

Vol. 42, No. 1, 2002 97

ders (Horwitz, 1977; Kessler, Brown, & Broman,
1981).
Other differences in psychosocial problems were
noted across the age groups as well. Family and so-
cial problems were less severe in the older treatment-
seeking pathological gamblers. The older gamblers
were more satisfied with their living situations than
were the younger gamblers. However, older patho-
logical gamblers scored higher on the ASI employ-
ment composite index. As expected, older adults
were less likely to be employed full time, although
few were retired. Their monthly incomes were lower
than the middle age group’s, yet they showed trends
toward wagering larger amounts of money and in-
creased debt. Older adults may have a more difficult
time paying off gambling debts, because many re-
ceive limited incomes that are unlikely to increase
over time. Therefore, financial counseling may be an
important component of treatment for older gam-
blers.
Although few of these individuals seeking treat-
ment for pathological gambling were actively abus-
ing drugs or alcohol in the month prior to entering
treatment, the older gamblers had less serious cur-
rent substance-abuse problems than the younger
gamblers did. The older gamblers were less likely to
have used illicit drugs in the month prior to entering
treatment. About a third of the participants, regard-
less of age group, had a history of substance-abuse
treatment, and these rates of substance-abuse prob-
lems are consistent with other studies of treatment-
seeking pathological gamblers (Lesieur, Blume, &
Zoppa, 1986; Ramirez, McCormick, Russo, &
Taber, 1983). Illegal activities showed a similar trend,
with the youngest age group showing more serious
current problems, although lifetime problems were
consistent across the age groups. This pattern may be
reflective of a “maturing-out” phenomenon of illegal
behaviors as individuals age (Winick, 1962).
Several limitations to this study affect the generali-
zation of these findings. First, only 13% of the sam-
ple was over age 55 years. Although very similar ef-
fects were noted when analyses were limited to even
older adults (older than age 60 years), the sample
size became quite small (8%, n  28), especially
when broken down by gender. These low percent-
ages of older adults seeking gambling treatment may
emerge because older age may be a protective factor
against development of gambling problems (NORC,
1999), or it may reflect a general reduction in treat-
ment seeking for mental health problems in older age
groups (Shapiro, Skinner, Kessler, et al., 1984).
Second, because this sample was drawn from a
group of treatment-seeking pathological gamblers,
these results cannot be generalized to the larger
group of pathological gamblers who do not enter
treatment programs. The results are further limited
by fact that all the gamblers were from Connecticut.
Whether these results can be generalized to treat-
ment-seeking pathological gamblers in other areas of
the country remains to be determined. Large preva-
lence studies of pathological gamblers in the general
98
population will be necessary to better understand the
association between gambling and psychosocial prob-
lems and how these variables may differ with age.
Despite these limitations, this is the first known
study evaluating gambling and psychosocial prob-
lems of older adult pathological gamblers. A number
of differences emerged across the age groups, and
these differences may suggest that specific issues
should be addressed to attract and retain older
pathological gamblers in treatment programs. Inte-
grated treatment programs for substance-abuse and
pathological gambling, for example, may not be ap-
propriate for older pathological gamblers, because so
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few have current substance-use problems. Treat-
ments that address financial problems, especially as
related to an older age group with fixed incomes,
may be particularly useful for this population given
their high monthly gambling expenditures and rela-
tively low incomes. Finally, gender-specific treat-
ments may be useful in older gamblers, as the onset
of disordered gambling later in life for female gam-
blers is a very striking finding in this study. Further
understanding of pathological gambling and its treat-
ment in older adults is needed.
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Received May 11, 2001
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Accepted August 31, 2001
Decision Editor: Laurence G. Branch, PhD
99