Epidemiological surveys of pathological gambling: Critique and suggestions for modification.

Epidemiological studies of problem and pathological gambling were examined for their accuracy. Fundamental flaws and biases were found in these surveys. These include problems with survey instruments; nonresponses and refusal bias; the exclusion of institutionalized populations; exclusion of other groups; and failure to protect against denial on the part of the respondent when others are present near the telephone. Based on the issues discussed, one can reasonably be expected to assume that most epidemiological surveys seriously underestimate the extent of problem and pathological gambling. Alternative strategies for addressing these issues are discussed. These strategies include the use of field interviews, surveys of institutionalized populations, frequent player surveys and significant other surveys. The value and potential problems of these approaches are also discussed.