Problem gambling, substance use disorders, and their cooccurrence are serious public health concerns. We conducted a comprehensive review of the literature to understand the present state of the evidence on these coaddictions. Our main focus was illicit drug use rather than misuse of legal substances. The review covers issues related to gambling as a hidden problem in the illicit drug use community; prevalence, problem gambling, and substance use disorders as kindred afflictions; problem gambling as an addiction similar to illicit drug use; risk factors and problems associated with comorbidity, and gender issues. We end with some suggestions for future research. 1. Introduction The relation between illicit drug abuse and problem gambling remains understudied, with a preponderance of information generated from treatment samples. Research on problem gambling itself suggests stark differences between gamblers seeking treatment and those identified in the general population: treatment populations are generally white, middle-aged men while those in the general population are more likely than treatment populations to be women, minorities, and of lower education [1–3]. Moreover, a sizable number of problem gamblers and substance abusers have mental health problems, particularly antisocial personality disorder, which may inhibit treatment participation [4]. Conversely, the so-called “Berkson bias” would suggest that, with most conditions, cooccurrence of disorders increases the likelihood that someone will seek treatment [5, 6]. While informative in its own right, information gathered from treatment samples remains limited. A meta-analysis of available prevalence studies of gambling was conducted by the Division on Addictions at Harvard Medical School [7]. This was a landmark meta-analysis of 152 studies conducted between 1977 and 1997, including 35 Canadian studies. Findings showed that over the previous 25 years, the estimated prevalence of gambling problems in the general adult population had been low but rising. The estimated lifetime prevalence in the general adult population for problem and pathological gambling combined was reported at 6.72% for more recent studies (conducted between 1994 and 1997) in comparison to a mean prevalence of 4.38% among older studies (conducted between 1977 and 1993). There were no significant differences in prevalence rates between the United States of America and Canada. A more recent review [8] showed that the prevalence of past year excessive gambling varied with a low of 0.6% to a high of 6.4%. Canadian statistics on drug
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