https://orcid.org/0000-0002-4655-1858
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Anna Segura, Richard E Heyman, Jennie Ochshorn, Amy M Smith Slep, A Response to Smith et al., Military Medicine, Volume 190, Issue 3-4, March/April 2025, Page 103, https://doi.org/10.1093/milmed/usae467
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Dear Editors,
We appreciate the opportunity to respond to Smith et al.’s letter regarding our gambling meta-review.1 We concur wholeheartedly with their amplification of the importance of addressing gambling problems among service members (SMs), a critical issue highlighted in our meta-review.
As noted in our paper, from 2005 to 2018, the DoD dropped gambling screening items from the Health-Related Behaviors surveys because of consistent and low prevalences. Our meta-review concluded that using low sensitivity and specificity screening measures in populations with low prevalences leads to identifying giant haystacks with few needles (i.e., an overwhelming number of false positives and few actual cases). As we noted, when applying the best screening tools to the general SM population, “positive results would be incorrect 64-99% of the time,” which may potentially burden resources without commensurate benefits.
We remain committed to our conclusion that until more accurate screening tools with high sensitivity and specificity become available, it remains prudent to limit screening efforts to specific settings with higher prevalences, such as those in the Air Force Alcohol and Drug Abuse Prevention and Treatment program or SMs seeking mental health services. Our study points out that for SMs with alcohol-related problems, positive results using the best screening tools (e.g., Problem Gambling Severity Index-Short Form and Massachusetts Gambling Screen-DSM-IV subscale) would be correct 68 to 76% of the time. We suggested a dual-phase screening process in these subpopulations: Initial screening to identify subclinical gambling or gambling disorder followed by a structured clinical interview to assess Diagnostic and Statistical Manual of Mental Disorders -5th Edition gambling disorder criteria.
