Abstract

Backgrounds and aims: Problem gambling occurs at higher levels in the homeless than the general population. Past
work has not established the extent to which problem gambling is a cause or consequence of homelessness. This study
sought to replicate recent observations of elevated rates of problem gambling in a British homeless sample, and
extend that finding by characterizing (a) the temporal sequencing of the effect, (b) relationships with drug and alcohol
misuse, and (c) awareness and access of treatment services for gambling by the homeless. Methods: We recruited
72 participants from homeless centers in Westminster, London, and used the Problem Gambling Severity Index to
assess gambling involvement, as well as DSM-IV criteria for substance and alcohol use disorders. A life-events scale
was administered to establish the temporal ordering of problem gambling and homelessness. Results: Problem
gambling was evident in 23.6% of the sample. In participants who endorsed any gambling symptomatology, the
majority were categorized as problem gamblers. Within those problem gamblers, 82.4% indicated that gambling
preceded their homelessness. Participants displayed high rates of substance (31.9%) and alcohol dependence (23.6%);
these were not correlated with PGSI scores. Awareness of treatment for gambling was significantly lower than for
substance and alcohol use disorders, and actual access of gambling support was minimal. Discussion and conclusions:
Problem gambling is an under-recognized health issue in the homeless. Our observation that gambling typically
precedes homelessness strengthens its role as a causal factor. Despite the elevated prevalence rates, awareness and
utilization of gambling support opportunities were low compared with services for substance use disorders.