Gambling

GAMBLING ADDICTION

Problem gambling is an urge to gamble despite harmful negative consequences or a desire to stop. The term is preferred to compulsive gambling among many professionals, as few people described by the term experience true compulsions in the clinical sense of the word. Problem gambling often is defined by whether harm is experienced by the gambler or others, rather than by the gambler's behavior. Severe problem gambling may be diagnosed as clinical pathological gambling if the gambler meets certain criteria.

Pathological gambling

Extreme cases of problem gambling may cross over into the realm of mental disorders. Pathological gambling was recognized as a psychiatric disorder in the DSM-III, but the criteria were significantly reworked based on large-scale studies and statistical methods for the DSM-IV (312.31). As defined by American Psychiatric Association, pathological gambling is an impulse control disorder that is a chronic and progressive mental illness.

Pathological gambling is now defined as persistent and recurrent maladaptive gambling behavior meeting at least five of the following criteria, as long as these behaviors are not better explained by a manic episode:

  • Preoccupation. The subject has frequent thoughts about gambling experiences, whether past, future, or fantasy.
  • Tolerance. As with drug tolerance, the subject requires larger or more frequent wagers to experience the same "rush".
  • Withdrawal. Restlessness or irritability associated with attempts to cease or reduce gambling.
  • Escape. The subject gambles to improve mood or escape problems.
  • Chasing. The subject tries to win back gambling losses with more gambling.
  • Lying. The subject tries to hide the extent of his or her gambling by lying to family, friends, or therapists.
  • Loss of control. The subject has unsuccessfully attempted to reduce gambling.
  • Illegal acts. The subject has broken the law in order to obtain gambling money or recover gambling losses.
  • Risked significant relationship. The subject gambles despite risking or losing a relationship, job, or other significant opportunity.
  • Bailout. The subject turns to family, friends, or another third party for financial assistance as a result of gambling.
  • Biological Bases. The subject has a lack of norepinephrine.
  • As with many disorders, the DSM-IV definition of pathological gambling is widely accepted and used as a basis for research and clinical practice internationally.

(Source : http://www.medic8.com/healthguide/articles/gambling.html)

How Does Gambling Addiction Start?

Gambling addiction can start just like any other addiction to drugs or alcohol. It all begins with one high, just one win. The progression of gambling addiction can vary greatly depending on several factors, the more obvious being personality type. One variation of gambling addiction seems to be linked to the kinds of games played. Many people who play more strategic and "skill" games like poker tend to progress much more slowly than those who play quick, immediate gratification games like slot machines and video poker tend to progress at a much faster pace. No matter what the speed of the progression, gambling addiction has three main stages which a gambling addict will experience during the progression to a pathological gambler.

The Winning Stage of Gambling Addiction

The winning stage of gambling addiction is often considered to still be fun and innocuous, but the behaviors of someone in this first stage of gambling addiction are subtle signs of a decent into a compulsive gambling addiction.

In the winning stage of gambling addiction, the addict begins to gamble more often. ALthough gambling may still be occasional, the time in between gambling begins to shorten. Gambling also begins to be a part of life as the gambler starts to enjoy the high or escape that gambling provides to him or her. The gambler also begins to talk about his or her gambling experiences more often, as winning streaks, or a big win become justification for more gambling. During this stage of gambling addiction, family and friends rarely see any problems as the gambling addict is still having fun and has not suffered any real consequences as a result of his or her gambling. The duration of this winning stage of gambling addiction varies, but is generally much shorter for the video poker gambler than for the race track gambler.

The Losing Stage of Gambling Addiction

The losing stage of gambling addiction is the stage at which problems begin to become more obvious and the fun and euphoria of the winning stage has begun to fade.

In the losing stage of gambling addiction, the addict begins to gamble much more often, often making gambling a ritual. Bets become larger as the addict needs to put more on the line to feel the same level of euphoria from the winning stage of gambling addiction. The gambler also bets more often, trying to win back losses as soon as possible. More free time is spent gambling, home and work life often begin to suffer as a result of excess time spent gambling. The addict begins to be preoccupied with gambling, often taking out loans to finance continued gambling. Often, because of losses and deteriorating financial situations, the addict will feel depression and/or anxiety and try to hid his or her gambling from family and loved ones. The losing stage of gambling is easily recognizable by an astute observer, but it still often overlooked by friends and family who have no reason to suspect that anything has gone wrong.

The Depression Stage of Gambling Addiction

The depression stage of gambling addiction is the stage when the gambling addict experiences more extreme depression and anxiety over mounting financial pressures and continued gambling loses. The gambler will become increasingly isolated from friends and loves ones, feeling desperate to have a change of luck with their gambling. It is in this final stage that gambling addicts often try to steal or commit crimes to finance continued gambling after they have already sold all of their belongings. Once the depression stage of gambling addiction has taken effect, most all gambling addicts consider suicide, and about 1/3 of them attempt it. Many additional addictions can take root as a result of gambling addiction. While gambling may have been the escape to begin with, once it has become the very source of depression and anxiety, many addicts begin to drink or abuse drugs as an escape from their initial escape, which has turned into a nightmare. Many gambling addicts who turn to crime and robbery to finance their gambling addiction are arrested and charged with crimes to be permanently on their criminal records.

The best time to address gambling addiction is in the winning stage, when things still seem to be fine and there aren't are glaring signs of a problem, but it is difficult to recognize the signs if one does not know what to look for. Generally, by the time a gambling addict gets to the depression stage of gambling addiction, there are additional problems to address, and the overall addiction and compulsive behavioral problems have become so complex, that it takes longer and more intense treatment for success. While relapse is a risk no matter what stage gambling addiction is treated, like with any addiction, it is always best to address it as early as possible for the best chances at success without relapse.

(Source : http://www.treatment-centers.net/gambling-addiction.html)

Prevalence

According to a variety of sources, the prevalence (ie. extent of existing cases) of problem gambling is 2-3% and pathological gambling is 1% in the United States, though this may vary by country. By contrast, about 86% of Americans have gambled during their lives and 60% gamble in a given year. Interestingly, despite the widespread growth in gambling availability and the increase in lifetime gambling during that past 25 years, past year problem gambling has remained steady.

Available research seems to indicate that problem gambling is an internal tendency, and that problem gamblers will tend to risk money on whatever game is available, rather than a particular game being available inducing problem gambling in otherwise "normal" individuals. However, research also indicates that problem gamblers tend to risk money on fast-paced games. Thus a problem gambler is much more likely to lose a lot of money on poker or slot machines, where rounds end quickly and there is a constant temptation to play again or increase bets, as opposed to a state lottery where the gambler must wait until the next drawing to see results.

Dopamine agonists, in particular pramipexole (Mirapex), have been implicated in the development of compulsive gambling and other excessive behavior patterns (e.g., PMID 16009751).

(Source : http://www.medic8.com/healthguide/articles/gambling.html)

Assessment

The most common tool used to screen for "probable pathological gambling" behavior is the South Oaks Gambling Screen (SOGS) developed by Lesieur and Blume (1987).

The South Oaks Gambling Screen is a 20-item questionnaire based on DSM criteria for pathological gambling. It may be self-administered or administered by nonprofessional or professional interviewers. A total of 1,616 subjects were involved in its development: 867 patients with diagnoses of substance abuse and pathological gambling, 213 members of Gamblers Anonymous, 384 university students, and 152 hospital employees. Independent validation by family members and counselors was obtained for the calibration sample, and internal consistency and test-retest reliability were established. The instrument correlates well with the criteria of the revised version of DSM. It offers a convenient means to screen clinical populations of alcoholics and drug abusers, as well as general populations, for pathological gambling.

(Example : http://www.addictionrecov.org/southoak.aspx)

Treatment

Problem gambling can be helped with the proper treatment which includes psychological therapy and support groups for compulsive gamblers.

When it comes to treating a gambling addiction, there is no magical bullet cure. Gambling addiction, like alcoholism, is an illness, and should be treated as such.

Treatment of a gambling addiction includes psychological, cognitive, behavioral and relaxation therapy either singly or in combination. It is essential that the person concerned acknowledges the progressive illness and shows a strong desire to stop his activity.

Like smoking, the gambling addict should never gamble again. A major change in lifestyle is required and constant therapy is required to prevent the destructive behavior to re-occur. Therapy is long and may take years of professional counseling. Many times, as part of treatment, the compulsive gambler will be urged to join Gamblers Anonymous – a self-help support group program for compulsive gamblers.

Triggers such as alcohol and drugs should be strictly avoided. Those with associated depression, anxiety, mania and obsessive compulsive disorders, may need to be treated with drug therapy along with psychotherapy.

There is evidence that the SSRI paroxetine is efficient in the treatment of pathological gambling. Additionally, for patients suffering from both pathological gambling and a comorbid bipolar spectrum condition, sustained release lithium has shown efficacy in a preliminary trial. The opiate antagonist drug nalmefene has also been trialled quite successfully for the treatment of compulsive gambling.

 

Related Links:

http://www.addictionsearch.com/treat_app.php

http://www.nida.nih.gov/NIDAHome.html

http://www.nlm.nih.gov/medlineplus/compulsivegambling.html

http://www.ncpgambling.org/i4a/pages/index.cfm?pageid=1

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