There is no denying that gambling is a popular activity, with about 2 in 3 adults reporting some type of gambling in 2018, in Canada [
1]. While most of these people only gamble occasionally, 0.12–5.8% of the global population has problem gambling (PBG) [
2], which can be defined as a gambling behavior that causes harmful consequences for the person, his social network and community [
3]. PBG frequently co-occurs with other mental health disorders, including mood and anxiety disorders, as well as substance use and personality disorders [
4]. There is also evidence to suggest that the prevalence of PBG may be up to 4 times higher in people with psychotic disorders compared to the general population [
5‐
7]. This proportion seems to be even greater among young people with first-episode psychosis (FEP), as suggested by the only study to date examining PBG among this population [
8]. In this study, the prevalence of PBG of 6.4% among 219 patients was found to be 16 times higher than the 0.4% found in the general population [
9]. In addition to a possible sharing of genetic influences between psychotic disorders and PBG [
10], this comorbidity may also be due in part to several risk factors for PBG that are common among people with FEP, including an over-representation of males, young age, frequent psychiatric comorbidities, such as substance use disorders and personality disorders, as well as low socioeconomic status and homelessness [
11]. While these risk factors have mostly been documented in general population samples, there is a paucity of data specific to individuals with psychotic disorders. Furthermore, there also appeared to be an association between the occurrence of PBG and aripiprazole, a widely used antipsychotic drug for the treatment of FEP, which had already been reported in previous case reports [
12,
13]. Indeed, among the 14 FEP patients who developed PBG, 12 cases occurred during aripiprazole treatment, resulting in an adjusted odds ratio of 8.6 (
p-value = 0.012). However, the retrospective design of this study, preventing the assessment of a potential causal link, and the limited existing literature do not allow firm conclusions to be drawn about this possible association [
8]. Furthermore, there was no systematic screening for PBG at the study site at that time, which may have led to detection and monitoring bias.
The consequences of PBG are manifold and include financial hardship, broken social relationships and isolation, psychological distress and an increased risk of suicide [
14,
15]. Although data regarding the consequences of PBG among individuals with a psychotic disorder are scarce, these can certainly be hypothesized as being all the more amplified [
16‐
18]. Indeed, psychotic disorders are associated with several repercussions that can be exacerbated by the concomitant presence of PBG, including an increased rate of suicide and violent acts, stigma, low employment rates, and a 15-to-20-year decrease in life expectancy [
19‐
21]. Not surprisingly, treatment of psychiatric comorbidities, which are common in people with a psychotic disorder, is critical to recovery [
22,
23]. Despite this, to our knowledge, there are no tools to screen for PBG specifically tailored to this population, while approaches to treating PBG comorbid to a psychotic disorder are virtually non-existent [
24‐
26]. Findings generated by these unmet needs is a low rate of PBG screening among people with a psychotic disorder by healthcare professionals and suboptimal treatment, hindering their hope for recovery [
27‐
30].
Using an innovative screening and assessment procedure for PBG tailored to young adults with FEP, the main aim of this study is to test the hypothesis that risk factors for PBG in this population include substance use disorders, personality disorders, and the use of aripiprazole or other antipsychotics sharing the same mechanism of action (i.e., partial dopamine agonism). It also aims to demonstrate that current treatments for PBG, which have not been adapted for people with FEP, are currently insufficient to lead to recovery.