The developmental path to gambling disorder among U.S. veterans: a life-course perspective

Gambling disorder (GD) is characterized by persistent gambling behavior associated with significant distress and functional impairment. Pathways to GD reflect a complex interplay of individual, environmental, and experiential factors. United States (U.S.) veterans are considered particularly vulnerable due to heightened exposure to trauma and cumulative life stressors. In a qualitative study examining barriers to treatment among veterans, participants described various risk factors contributing to GD, prompting a secondary analysis to better identify the unique risk factors shaping the pathways leading U.S. military veterans and service members to develop and persist in GD.

Participants included 28 U.S. service members and veterans (8 women; aged 27-73, M _age = 46.5) recruited in the primary study. Semi-structured interviews were conducted via Zoom and included an assessment of GD diagnostic criteria (past year and 10-year history). A combination of secondary analysis and a theory-informed approach was employed, using the Pathways Model of Problem and Pathological Gambling as the overarching theoretical framework. In practice, the analysis combined deductive and inductive approaches to content analysis.

Three main themes were revealed, each representing a specific life period: childhood, military service, and civilian life. The themes included: a) life history of vulnerability and yearning for change; b) the broken promise: the military as a multidimensional risk for developing gambling problems; and c) sinking deeper into gambling in the post-military period. While these themes corresponded with the second subtype of the Pathways Model-emotional vulnerability-they primarily illustrate the dynamic interplay between individual vulnerability and the changing socio-cultural and environmental contexts across the participants' life stages and turning points.

Integrating the Pathways Model with a life-course perspective, findings underscore the dynamic interplay between individual vulnerability and environmental context in shaping GD trajectories across veterans' life stages. Rather than disrupting risk, key transitions may reinforce maladaptive patterns over time. Future studies should incorporate a life-course perspective into the theoretical framework of the Pathways Model of problem gambling.