people and poor people, have disproportionately high rates of pathological gambling.

To understand changes in gambling and pathological gambling over time, as well as the nature and origins of pathological gambling, both cross-sectional and longitudinal studies of gambling will be necessary. The committee recommends that the Centers for Disease Control and Prevention and the National Institutes of Health should routinely include measures of pathological gambling in their annual surveys, and that measures of gambling and related leisure activities and outcomes (e.g., debts) should be added to other prospective, longitudinal studies on health or mental health. Doing so not only would add valuable information about gambling over time, but would also provide important information about baseline measures and other disorders that tend to cooccur with pathological gambling.

Research is beginning to elucidate the onset and course of pathological gambling. For example:

  • Pathological gambling often occurs with other behavioral problems, including substance abuse, mood disorders, and personality disorders.
  • Recent research suggests that the earlier one starts to gamble, the more likely one is to become a pathological gambler.
  • Pathological gamblers are more likely than nonpathological gamblers to report that their parents were pathological gamblers. These findings, in conjunction with twin studies and recent neuroscience studies, suggest that pathological gambling may be influenced by familial factors and the social environment.

An accurate examination of the costs of pathological gambling requires an assessment of the costs and benefits of gambling generally. Gambling appears to have net economic benefits for economically depressed communities, but the available data are insufficient to determine with accuracy the overall costs and benefits of gambling. Pervasive methodological problems prevent firm conclusions about the social and economic effects of gambling or pathological gambling on communities, nor can the committee say whether pathological gamblers contribute disproportionately to overall gambling revenues. Similarly, the committee



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