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The authors examined heart rate responses to video lottery terminal (VLT) play and alcohol intake. Forty-four VLT players were randomized to an alcohol (mean blood alcohol concentration = 0.06%) or a control beverage condition. Heart rate was recorded at pre- and postdrinking baseline and during VLT play. Alcohol participants displayed elevated heart rates relative to controls at postdrinking and VLT play. Controls displayed elevated heart rates during VLT play relative to both pre- and postdrinking baselines, whereas alcohol participants displayed elevations at post- relative to predrinking and at VLT play relative to postdrinking. Heart rate increases from predrinking to VLT play were greater among alcohol participants relative to controls. Results provide novel information that the combination of VLT play and alcohol further intensifies heart rate increase relative to either alone. Implications for pathological gambling and alcohol use disorder comorbidity are discussed.