To put the pathological and problem gambling prevalence rates in perspective, it is instructive to compare them with the rates for other addictive behaviors. The prevalence of alcohol dependence provides one relevant comparison. Like gambling, many people have access to alcohol and engage in drinking, but most of them do not abuse alcohol or become dependent. Drug dependence provides a different sort of comparison. Illicit drugs, being illegal, are not as widely available as alcohol and gambling, but many are highly addictive.
The National Comorbidity Survey (Kessler et al., 1994) provides data collected in 1990-1992 from a national probability sample of noninstitutionalized persons ages 15 to 54 for DSM-III-R psychiatric disorders. Table 3-5 shows the prevalence rates for alcohol and drug dependence compared with those for pathological gambling. In addition, the prevalence rates for alcohol dependence and abuse combined and for drug dependence and abuse combined are compared with the rates for pathological and problem gambling (Levels 2 and 3) combined. As Table 3-5 shows, the estimated prevalence rates for gambling problems are lower in all categories than those for alcohol and drug problems.
Over the past 20 years, there has been a steady expansion in the availability of legal gambling. Currently, legal forms of gambling are available in all the U.S. states except Hawaii, Tennessee, and Utah; 37 states have lotteries; the great majority permit gambling on charitable games, including bingo and pari-mutuel betting; and in 1998 casinos or casino-style gambling was permitted in 21 states (National Opinion Research Center, 1999). Such rapid expansion in the availability of gambling provides an opportunity to examine the extent to which increased availability is associated with increased prevalence rates for pathological and problem gambling. When comparing the 1975 survey lifetime prevalence estimate of 0.77 percent for probable compulsive gambling (Commission on the Review of the National Policy on Gambling, 1976) with the preliminary lifetime prevalence estimate of