Here's an article that raises the questions and makes some connections:

Alcoholism Susceptibility Linked To Compulsive Gambling, Shopping by Joan Arehart-Treichel

Psychiatric News July 19, 2002
Volume 37 Number 14

Although fascinating insights into pathological gambling, compulsive buying, and some other addictive behaviors are emerging, many questions about such behaviors remain. One might say that "Steve," a 50-year-old from Augusta, Ga., has the cards stacked against him as far as alcoholism is concerned. Both his parents were alcoholics. Thus, Steve may well have inherited a double dose of alcoholism susceptibility. Yet Steve isn’t an alcoholic; he has a gambling problem. Nonetheless, his gambling compulsion may also have derived from a double whammy of alcoholism susceptibility. This possibility was suggested at a symposium on behavioral addictions at APA’s 2002 annual meeting in May in Philadelphia. There is ample scientific evidence that alcoholism susceptibility and pathological gambling susceptibility are related, David Gorelick, M.D., a psychiatrist at the National Institute on Drug Abuse in Baltimore, Md., reported. For instance, persons with an alcohol problem often have a gambling one as well. The evidence comes from studies conducted not just in the United States, but also in Canada and Switzerland. A dose-response relationship has been found between how much people drink and their risk of pathological gambling. There are also striking similarities between alcohol abuse and gambling abuse: a preoccupation with the behavior, an increase in the behavior during times of stress, the need for more of the behavior to achieve the desired effect, and withdrawal symptoms from the behavior. It could be that alcoholism and pathological gambling have the same cause, Gorelick conjectured. Compulsive Buying What’s more, alcohol excess and gambling excess might possibly be related to a third addictive behavior—compulsive buying, said another symposium speaker, Michel Lejoyeux, M.D., a psychiatrist at the University of Paris in Colombes, France. Lejoyeux studied 158 university students and found that 20 percent were compulsive buyers. He then compared the compulsive buyers with the noncompulsive students. He found that the former drank greater amounts of alcohol, smoked more often, and spent significantly more money on gambling than the noncompulsive students. However, whether compulsive buying shares any biological origins with alcohol and gambling addictions is far from clear. In fact, compulsive buying may be related to depression since all of the compulsive buyers in Lejoyeux’s study met DSM-IV criteria for a major depressive disorder, and a number came from a family with a history of depression or bipolar disorder. In contrast, a genetic propensity for depression is probably not sufficient to trigger compulsive buying; certain personality traits—say, sensation seeking—may be necessary as well. The reason? Lejoyeux found that sensation seeking was considerably more prevalent in the depressed compulsive buyers than in the depressed subjects who were not compulsive buyers. Pedophilia, exhibitionism, fetishism, and other addictive sexual behaviors are probably not related to alcohol, gambling, and buying addictions, suggested Florence Thibaut, M.D., a professor of psychiatry at the University of Rouen in France and France’s premiere authority on addictive sexual behaviors. The basis for this statement is that addictive sexual behaviors usually do not coexist with other types of addictive behaviors. In fact, questions about the origins of addictive behaviors are currently a lot more numerous than are answers, symposium speakers said. For instance, the personality trait of impulsivity seems to be a hallmark of addictive behaviors. After all, youngsters who are impulsive often end up gambling and/or abusing substances by age 17 years, Gorelick reported, and compulsive buyers are not only sensation seeking but impulsive, Lejoyeux said. But might certain addictive behaviors—for example, pyromania—be more planned than impulsive? Jean Ades, M.D., a psychiatrist at the University of Paris in Colombes, France, raised this possibility. Marc Potenza, M.D., an assistant professor of psychiatry at Yale University and director of the Yale problem-gambling clinic, reported that he and colleagues had used functional magnetic resonance imaging and videotaped cues of happy, sad, or addiction-related scenarios to see what parts of the human brain might be involved in pathological gambling or cocaine addiction. They found that the anterior cingulate—a part of the cortex lying close to the corpus callosum in the front part of the brain—as well as the thalamus and basal ganglia appear to be involved in both pathological gambling and cocaine dependence. These brain structures have also been implicated in alcohol dependence as well as in nonaddictive behaviors like the obsessions and compulsions of obsessive-compulsive disorder, Potenza said. But are they involved in all addictive behaviors? The jury is still out, symposium speakers indicated. Kleptomania Link? Might there be a link between compulsive buying and kleptomania? Ten percent of Lejoyeux’s compulsive buyers had engaged in kleptomania at some point, he discovered, but he doesn’t think that shoplifting is the same as compulsive buying, he said. Could there be a connection between compulsive buying and addictive sexual behaviors? Some of Lejoyeux’s compulsive buyers admitted to feeling sexual excitement when they made purchases. Finally, might childhood sexual abuse play a role in addictive sexual behaviors? It is a possibility since a number of those who engage in such behaviors were sexually abused as children, Thibault said. However, the relationship between sexual addiction and sexual offending is far from clear, she admitted.

Mood, Substance Abuse Disorders Common Among Sex Offenders

[My letter to the editor:

Re: Mood, Substance Abuse Disorders Common Among Sex Offenders
For over 12 years I have been hypothesizing that sex offenses were caused by sex addiction as part of the Hypoism paradigm, the disease that causes all addictions. For over 12 years this hypothesis has been ignored and censored. This article's data is strong evidence in favor of my hypothesis because hypoics not only have a single addiction but usually many addictions all in conjunction and all caused by the common pathophysiology, addictability. Besides the mood disorders seen in hypoics, the most common "other symptom" seen in these sex addicts, though they were never called sex addicts in the article, a big clinical mistake and bias, was substance addictions, seen in 85%. Thus, these "sex offenders" are hypoics with sex and substance addictions. If other addictions were looked for my guess is that 100% would have other addictions, drugs and behaviors, the primary symptoms of Hypoism. Why is this significant? Because Hypoism has a defined pathophysiology, the genetic alteration of a particular brain mechanism, the decision-making apparatus or instinct regulating mechanism, and out of this understanding come ways for preventing addictions and recovery from addictions, actually from the underlying disease Hypoism, including sex addiction, something that truly doesn't exist today because sex addiction is viewed as caused by the "psychobabble" mechanism which has no valid theory behind it or treatment no less any way to prevent it. This is all delineated in my book, Hypoic's Handbook. The continued censorship and ignoring of Hypoism has only one effect on our country - to perpetuate all those addictions and their consequences that we all want to stop. This is a big price to pay for the continued belief and use of a wrong theory of behavior.]

Psychiatric News May 21, 2004 Volume 39 Number 10

Joan Arehart-Treichel

It’s likely that deviant sexual attractions or antisocial personalities are at the root of sexual crimes, but many sexual offenders also have a mental illness.

Most sexual offenders have paraphilias or antisocial personalities and in many cases also have depression, bipolar disorder, or an impulse control disorder.

These findings come from a study conducted by Neal Dunsieth, M.D., an assistant clinical professor of psychiatry at Wright State University in Dayton, Ohio, and colleagues and are reported in the March Journal of Clinical Psychiatry.

"To our knowledge," they noted, "ours is now the largest group of sexual offenders evaluated using structured clinical interviews for psychiatric disorders, personality disorders, and paraphilias."

Their study included 113 convicted sexual offenders voluntarily participating in an 18-month, residential, sexual-offender treatment program in Columbus, Ohio, between 1996 and 2001. All were male, aged 18 years or older, and 35 years old on average. About two-thirds of the subjects were white, and one-third were African American. All were convicted of at least one sexual offense. None, however, admitted to a sexually sadistic murder.

Upon admission to the treatment program, all participants were evaluated with a number of structured clinical tools including the Structured Clinical Interview for DSM-IV Axis I Disorders, augmented with modules for DSM-IV impulse control disorders not elsewhere classified and sexual disorders; the Structured Clinical Interview for DSM-IV Axis II Disorders; a history of sexual and physical abuse; a history of psychotic, mood, anxiety, eating, substance use, impulse control, and paraphilic disorders in first-degree relatives; a review of medical and legal records and polygraph examinations.

Not surprisingly, 74 percent of sexual offenders were found to have a paraphilia, 56 percent met criteria for antisocial personality disorder, 28 percent met criteria for borderline personality disorder, and 25 percent met criteria for narcissistic personality disorder. More unexpectedly, however, many had other diagnoses. Fifty-eight percent had a mood disorder, 35 percent had bipolar disorder, 38 percent had an impulse control disorder, and 23 percent had an anxiety disorder. Moreover, 85 percent qualified, according to DSM-IV criteria, for a lifetime diagnosis of substance abuse disorder.

In addition, offenders with paraphilias were much more likely than other offenders to have mood, anxiety, and impulse control disorders. More than half of the subjects had been victims of sexual abuse themselves, while more than a quarter had been victims of incest.

The study did have some limitations, Dunsieth and his team noted. For example, no non-sexual-offender control group was used in the study, and investigators who diagnosed subjects for psychiatric disorders were not blinded to their sexual offenses. Nonetheless, Dunsieth told Psychiatric News, the results imply that clinical psychiatrists should "assess mental illness in sexual offenders and note a strong correlation between deviant sexual attraction [paraphilias] and an increased incident of mental illness."

"Overall this is a very positive study," Richard Krueger, M.D., medical director of the Sexual Behavior Clinic at New York State Psychiatric Institute, said in an interview. For one thing, he said, "it is very difficult to do this kind of study. Often departments of correction or parole are resistant to involvement in academic studies." For another, he added, "they did a family history of sexual offenders, which is not often reported, and I think that is an important contribution."

He agreed with Dunsieth that the study results "highlight the importance of a full psychiatric assessment of individuals involved with sexual crimes. Often they get plugged into sexual-offender programs without a psychiatric evaluation."

"This is a welcomed study reminding us that the sexual-offender population is a heterogeneous group composed of multiple overlapping diagnostic subgroups," Charles Smith, M.D., clinical director of the Whiting Forensic Division of the Connecticut Valley Hospital in Middletown, Conn., told Psychiatric News. "This diagnostic heterogeneity has serious implications for the design of social policy to ensure public safety by containing the behavior of known sexual offenders. Dunsieth and colleagues demonstrate very convincingly that subgroups of sexual offenders can be identified with divergent therapeutic problems and differential treatment concerns. It is a reasonable extrapolation of this work to envision treatment interventions and risk-reduction strategies tailored to, and optimized for, different sexual offender subgroups."

"The study does offer hope," Smith added, "that treatment of comorbid mental health conditions among some sexual offenders may be an effective approach to decreasing offender recidivism."

The sexual offender treatment program on which this study was based and data collection for the study were financed by the Ohio Adult Parole Authority.

The study, "Psychiatric and Legal Features of 113 Men Convicted of Sexual Offenses," is posted online for paid subscribers at www.psychiatrist.com/privatepdf/2004/v65n03/v65n0302.pdf.

^{The abstract of this paper:}

Psychiatric and legal features of 113 men convicted of sexual offenses.

Dunsieth NW Jr, Nelson EB, Brusman-Lovins LA, Holcomb JL, Beckman D, Welge JA, Roby D, Taylor P Jr, Soutullo CA, McElroy SL.

Center for the Study of Criminal Behavior, Department of Psychiatry, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH 45267-0559, USA.

BACKGROUND: To increase understanding of the relationships among sexual violence, paraphilias, and mental illness, the authors assessed the legal and psychiatric features of 113 men convicted of sexual offenses. METHOD: 113 consecutive male sex offenders referred from prison, jail, or probation to a residential treatment facility received structured clinical interviews for DSM-IV Axis I and II disorders, including sexual disorders. Participants' legal, sexual and physical abuse, and family psychiatric histories were also evaluated. We compared offenders with and without paraphilias. RESULTS: Participants displayed high rates of lifetime Axis I and Axis II disorders: 96 (85%) had a substance use disorder; 84 (74%), a paraphilia; 66 (58%), a mood disorder (40 [35%], a bipolar disorder and 27 [24%], a depressive disorder); 43 (38%), an impulse control disorder; 26 (23%), an anxiety disorder; 10 (9%), an eating disorder; and 63 (56%), antisocial personality disorder. Presence of a paraphilia correlated positively with the presence of any mood disorder (p <.001), major depression (p =.007), bipolar I disorder (p =.034), any anxiety disorder (p=.034), any impulse control disorder (p =.006), and avoidant personality disorder (p =.013). Although offenders without paraphilias spent more time in prison than those with paraphilias (p =.019), paraphilic offenders reported more victims (p =.014), started offending at a younger age (p =.015), and were more likely to perpetrate incest (p =.005). Paraphilic offenders were also more likely to be convicted of (p =.001) or admit to (p <.001) gross sexual imposition of a minor. Nonparaphilic offenders were more likely to have adult victims exclusively (p =.002), a prior conviction for theft (p <.001), and a history of juvenile offenses (p =.058). CONCLUSIONS: Sex offenders in the study population displayed high rates of mental illness, substance abuse, paraphilias, personality disorders, and comorbidity among these conditions. Sex offenders with paraphilias had significantly higher rates of certain types of mental illness and avoidant personality disorder. Moreover, paraphilic offenders spent less time in prison but started offending at a younger age and reported more victims and more non-rape sexual offenses against minors than offenders without paraphilias. On the basis of our findings, we assert that sex offenders should be carefully evaluated for the presence of mental illness and that sex offender management programs should have a capacity for psychiatric treatment.

Nicotine Dependence and Psychiatric Disorders in the United States

Results From the National Epidemiologic Survey on Alcohol and Related Conditions

Bridget F. Grant, PhD, PhD; Deborah S. Hasin, PhD; S. Patricia Chou, PhD; Frederick S. Stinson, PhD; Deborah A. Dawson, PhD

Arch Gen Psychiatry. 2004;61:1107-1115.

Background  No information is available on the co-occurrence of DSM-IV nicotine dependence and Axis I and II psychiatric disorders in the US population.

Objectives  To present national data on the co-occurrence of current DSM-IV nicotine dependence and other psychiatric disorders by sex and to estimate the burden of all US tobacco consumption carried by nicotine-dependent and psychiatrically ill individuals.

Design  Face-to-face interviews.

Setting  The United States.

Participants  Household and group-quarters adults (N = 43 093).

Main Outcome Measures  Prevalence and comorbidity of current nicotine dependence and Axis I and II disorders and the percentage of cigarettes consumed in the United States among psychiatrically vulnerable subgroups.

Results  Among US adults, 12.8% (95% confidence interval, 12.0-13.6) were nicotine dependent. Associations between nicotine dependence and specific Axis I and II disorders were all strong and statistically significant (P<.05) in the total population and among men and women. Nicotine-dependent individuals made up only 12.8% (95% confidence interval, 12.0-13.6) of the population yet consumed 57.5% of all cigarettes smoked in the United States. Nicotine-dependent individuals with a comorbid psychiatric disorder made up 7.1% (95% confidence interval, 6.6-7.6) of the population yet consumed 34.2% of all cigarettes smoked in the United States.

Conclusions  Nicotine-dependent and psychiatrically ill individuals consume about 70% of all cigarettes smoked in the United States. The results of this study highlight the importance of focusing smoking cessation efforts on individuals who are nicotine dependent, individuals who have psychiatric disorders, and individuals who have comorbid nicotine dependence and other psychiatric disorders. Further, awareness of industry segmentation strategies can improve smoking cessation efforts of clinicians and other health professionals among all smokers and especially among the most vulnerable.

Psychiatric Correlates of Gambling in Adolescents and Young Adults Grouped by Age at Gambling Onset

Wendy J. Lynch, PhD; Paul K. Maciejewski, PhD; Marc N. Potenza, MD, PhD

Arch Gen Psychiatry. 2004;61:1116-1122.

Background  Gambling is a prevalent behavior, yet few studies have investigated its mental health correlates. Although early-onset engagement in behaviors with addictive potential has generally been associated with more severe problems, direct investigation of a nationally representative sample of gamblers grouped by age at onset of gambling has not been performed.

Objective  To identify differences in psychiatric correlates of gambling and gambling-related attitudes and behaviors in adolescents (aged 16-17 years) and in young adults (aged 18-29 years) with early-onset (before age 18 years) and adult-onset gambling.

Design  Logistic regression analysis.

Setting  Public access data set derived from random-digit-dialing telephone surveys.

Patients  The study analyzed data from adolescent (n = 235), early-onset adult (n = 151), and adult-onset (n = 204) past-year gamblers and adolescent (n = 299) and adult (n = 187) nongamblers in the Gambling Impact and Behavior Study.

Main Outcome Measures  Gamblers and nongamblers were compared within each group on measures of sociodemographics and psychiatric health. Adolescent, early-onset adult, and adult-onset past-year gamblers were compared on measures of gambling attitudes and behaviors.

Results  Adolescent gamblers were more likely than adolescent nongamblers to report alcohol and drug use and abuse/dependence and depression. Elevated rates of alcohol and drug use and abuse/dependence were observed in early-onset adult gamblers vs adult nongamblers, and only elevated rates of alcohol use were observed in adult-onset gamblers vs adult nongamblers. Substantial differences in reasons for and patterns of gambling were observed among the 3 groups of gamblers.

Conclusions  Adolescent-onset gambling is associated with more severe psychiatric problems, particularly substance use disorders, in adolescents and young adults. More research is needed to investigate the relationships and inform prevention and treatment strategies.

Harv Rev Psychiatry 2004;12:367–374, Toward a Syndrome Model of Addiction: Multiple Expressions, Common Etiology, Howard J. Shaffer, PhD, CAS, Debi A. LaPlante, PhD, Richard A. LaBrie, EdD, Rachel C. Kidman, BA, Anthony N. Donato, MPP, and Michael V. Stanton, BA
"In this article, we suggest that evidence of multiple and interacting biopsychosocial antecedents, manifestations, and consequents—within and among behavioral and substance-related patterns of excess—reflects an underlying addiction syndrome. We propose, in particular, that addiction should be understood as a syndrome with multiple opportunistic expressions (e.g., substance use disorders and pathological gambling). Our goals in this column are to (1) describe a new, syndromal model of addiction, (2) review the most recent literature that supports viewing addiction as a syndrome, and (3) indicate how this perspective can advance clinical practice and identify areas in which more research is needed. To accomplish these goals, we review the empirical evidence for this addiction syndrome and organize it into three primary areas: (1) shared neurobiological antecedents, (2) shared psychosocial antecedents, and (3) shared experiences (e.g., manifestations and sequelae)."