Gambling and substance use co-occurrence among emerging adults: a systematic review

Objective Gambling and substance use co-occur at high rates among emerging adults (ages 18–29). Therefore, this paper aimed to systematically review the latest empirical evidence on the co-occurrence of these behaviors within this population, with a focus on problematic and disordered engagement.Method Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, a search was conducted across four electronic databases (PsycINFO, PubMed, Scopus, and Web of Science) for peer-reviewed articles published between 1 January 2015 and 15 October 2024. Inclusion criteria were: (1) quantitative studies, (2) samples within an 18 to 29 age range, and (3) measurement of problematic gambling, substance use, and their co-occurrence. Data were synthesized narratively, and study quality was evaluated using the 14-item QualSyst methodological checklist.Results A total of 43 studies met the inclusion criteria. Across studies, problematic gambling was consistently associated with alcohol, cannabis, nicotine, and general drug use. Notably, substance-related problems were more common among emerging adults with gambling problems than gambling problems were among emerging adults who used or misused substances. Stronger co-occurrence associations for problematic gambling and substance use were generally found in samples using college students and non-probability recruitment methods. Additionally, several risk factors—including impulsivity, anxiety, depression, and being male—emerged as shared correlates of these behaviors.Conclusions Problematic gambling and substance use are often positively associated among emerging adults, underscoring the need for integrated screening and prevention strategies in these areas. Males who gamble in this population may be especially susceptible to co-occurring problems.