Problem gambling (ludomania) is an urge to gamble Gambling is the wagering of money or something of material value on an event with an uncertain outcome with the primary intent of winning additional money and/or material goods. Typically, the outcome of the wager is evident within a short period despite harmful negative consequences or a desire to stop. The term is preferred to compulsive gambling among many professionals[citation needed], as few people described by the term experience true compulsions Obsessive–compulsive disorder is an anxiety disorder characterized by involuntary intrusive thoughts. When a sufferer begins to acknowledge these intrusive thoughts, the sufferer then develops anxiety based on the dread that something bad will happen. The sufferer feels compelled to voluntarily perform irrational, time-consuming physical in the clinical sense of the word.[citation needed] 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. Although the term gambling addiction is common in the recovery movement[1] pathological gambling is considered to be an impulse control disorder Impulse control disorder is a set of psychiatric disorders including intermittent explosive disorder , kleptomania (stealing), pathological gambling, pyromania (fire-starting), trichotillomania (pulling one's hair out) and dermatillomania (skin picking). The onset of these disorders usually occurs between the ages of 7 and 15. Impulsivity, the key and is therefore not considered by the American Psychological Association The American Psychological Association is a professional organization representing psychologists in the U.S., with around 150,000 members and an annual budget of around $70m. The American Psychological Association is occasionally confused with the American Psychiatric Association, which also uses the acronym APA to be an addiction.[2]

Contents

Definition

Debate exists over how problem gambling should be defined.[3] Research by governments in Australia Australia , officially the Commonwealth of Australia, is a country in the southern hemisphere comprising the mainland which is the world's smallest continent (also largest island), the major island of Tasmania, and numerous other islands in the Indian and Pacific Oceans.N4 Neighbouring countries include Indonesia, East Timor and Papua New Guinea led to a universal definition for that country which appears to be the only research based definition not to use diagnostic criteria.

Problem gambling is characterised by many difficulties in limiting money and/or time spent on gambling which leads to adverse consequences for the gambler, others, or for the community.[4]

Most other definitions of problem gambling can usually be simplified to any gambling that causes harm to the gambler or someone else in any way. However, these definitions are usually coupled with descriptions of the type of harm or the use of diagnostic criteria such as the South Oaks Gambling Screen, [5] Canadian Problem Gambling Index [6] or the Victorian Gambling Screen [7].

Pathological gambling

Extreme cases of problem gambling may cross over into the realm of mental disorders A mental disorder or mental illness is a psychological or behavioral pattern that occurs in an individual and is thought to cause distress or disability that is not expected as part of normal development or culture. The recognition and understanding of mental disorders has changed over time and across cultures. Definitions, assessments, and. Pathological gambling was recognized as a psychiatric disorder in the DSM-III The Diagnostic and Statistical Manual of Mental Disorders is published by the American Psychiatric Association and provides diagnostic criteria for mental disorders. It is used in the United States and in varying degrees around the world, by clinicians, researchers, psychiatric drug regulation agencies, health insurance companies, pharmaceutical, but the criteria were significantly reworked based on large-scale studies and statistical methods for the DSM-IV The Diagnostic and Statistical Manual of Mental Disorders is published by the American Psychiatric Association and provides diagnostic criteria for mental disorders. It is used in the United States and in varying degrees around the world, by clinicians, researchers, psychiatric drug regulation agencies, health insurance companies, pharmaceutical. As defined by American Psychiatric Association The American Psychiatric Association is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the most influential world-wide. Its some 38,000 members are mainly American but some are international. The association publishes various journals and pamphlets, as well as the Diagnostic and Statistical, pathological gambling is an impulse control disorder Impulse control disorder is a set of psychiatric disorders including intermittent explosive disorder , kleptomania (stealing), pathological gambling, pyromania (fire-starting), trichotillomania (pulling one's hair out) and dermatillomania (skin picking). The onset of these disorders usually occurs between the ages of 7 and 15. Impulsivity, the key that is a chronic and progressive mental illness A mental disorder or mental illness is a psychological or behavioral pattern that occurs in an individual and is thought to cause distress or disability that is not expected as part of normal development or culture. The recognition and understanding of mental disorders has changed over time and across cultures. Definitions, assessments, and.

According to DSM-IV, Pathological gambling is now defined as separate from a manic episode Mania is a severe medical condition characterized by extremely elevated mood, energy, unusual thought patterns and sometimes psychosis. There are several possible causes for mania including drug abuse and brain tumors, but it is most often associated with bipolar disorder, where episodes of mania alternate with episodes of major depression. These. Only when the gambling occurs independent of other impulsive, mood, or thought disorders is it considered its own diagnosis. In order to be diagnosed, and indiviudal must have at least 3 of the following symptoms:

  1. Preoccupation. The subject has frequent thoughts about gambling experiences, whether past, future, or fantasy.
  2. Tolerance. As with drug tolerance In physiology, physiological tolerance or drug tolerance is commonly encountered in pharmacology, when a subject's reaction to a drug decreases so that larger doses are required to achieve the same effect. Drug tolerance can involve both psychological drug tolerance and physiological factors. Characteristics of drug tolerance: it is reversible,, the subject requires larger or more frequent wagers to experience the same "rush".
  3. Withdrawal. Restlessness or irritability associated with attempts to cease or reduce gambling.
  4. Escape. The subject gambles to improve mood or escape problems.
  5. Chasing. The subject tries to win back gambling losses with more gambling.
  6. Lying. The subject tries to hide the extent of his or her gambling by lying to family, friends, or therapists.
  7. Loss of control. The person has unsuccessfully attempted to reduce gambling.
  8. Illegal acts. The person has broken the law in order to obtain gambling money or recover gambling losses. This may include acts of theft In criminal law, theft is the illegal taking of another person's property without that person's freely-given consent. As a term, it is used as shorthand for all major crimes against property, encompassing offences such as burglary, embezzlement, larceny, looting, robbery, mugging, trespassing, shoplifting, intrusion, fraud (theft by deception) and, embezzlement Embezzlement is the act of dishonestly appropriating or secreting assets, usually financial in nature, by one or more individuals to whom such assets have been entrusted. It is a kind of financial fraud. For instance, a clerk or cashier handling large sums of money can embezzle cash from his or her employer, a lawyer can embezzle funds from, fraud In the broadest sense, a fraud is an intentional deception made for personal gain or to damage another individual. The specific legal definition varies by legal jurisdiction. Fraud is a crime, and is also a civil law violation. Many hoaxes are fraudulent, although those not made for personal gain are not technically frauds. Defrauding people of, or forgery Forgery is the process of making, adapting, or imitating objects, statistics, or documents , with the intent to deceive. The similar crime of fraud is the crime of deceiving another, including through the use of objects obtained through forgery. Copies, studio replicas, and reproductions are not considered forgeries, though they may later become.
  9. Risked significant relationship. The person gambles despite risking or losing a relationship An interpersonal relationship is a relatively long-term association between two or more people. This association may be based on emotions like love and liking, regular business interactions, or some other type of social commitment. Interpersonal relationships take place in a great variety of contexts, such as family, friends, marriage,, job, or other significant opportunity.
  10. Bailout. The person turns to family, friends, or another third party for financial assistance as a result of gambling.

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.

Biological basis

According to the Illinois Institute for Addiction Recovery, recent evidence indicates that pathological gambling is an addiction similar to chemical addiction. It has been seen that some pathological gamblers have lower levels of norepinephrine As a stress hormone, norepinephrine affects parts of the brain where attention and responding actions are controlled. Along with epinephrine, norepinephrine also underlies the fight-or-flight response, directly increasing heart rate, triggering the release of glucose from energy stores, and increasing blood flow to skeletal muscle than normal gamblers.

According to a study conducted by Alec Roy, M.D. formerly at the National Institute on Alcohol Abuse and Alcoholism The National Institute on Alcohol Abuse and Alcoholism , as part of the U.S. National Institutes of Health, supports and conducts biomedical and behavioral research on the causes, consequences, treatment, and prevention of alcoholism and alcohol-related problems. It funds approximately 90 percent of all such research in the United States and, norepinephrine is secreted under stress, arousal, or thrill, so pathological gamblers gamble to make up for their under-dosage.

Further to this, according to a report from the Harvard Medical School Division on Addictions there was an experiment constructed where test subjects were presented with situations where they could win, lose or break even in a casino A casino is, in the modern sense of the word, a facility that houses and accommodates certain types of gambling activities. Casinos are most commonly built near or combined with hotels, restaurants, retail shopping, cruise ships and other tourist attractions. Some casinos are known for hosting live entertainment events, such as stand-up comedy,-like environment. Subjects' reactions were measured using fMRI Functional MRI or functional Magnetic Resonance Imaging is a type of specialized MRI scan. It measures the haemodynamic response related to neural activity in the brain or spinal cord of humans or other animals. It is one of the most recently developed forms of neuroimaging. Since the early 1990s, fMRI has come to dominate the brain mapping field, a neuro-imaging technique very similar to MRI Magnetic Resonance Imaging , or nuclear magnetic resonance imaging (NMRI), is primarily a medical imaging technique most commonly used in radiology to visualize the internal structure and function of the body. MRI provides much greater contrast between the different soft tissues of the body than computed tomography (CT) does, making it especially. And according to Hans Breiter, MD, co-director of the motivation and Emotion Neuroscience Centre at the Massachusetts General Hospital Massachusetts General Hospital is a teaching hospital of Harvard Medical School and a biomedical research facility in Boston, Massachusetts, "Monetary reward in a gambling-like experiment produces brain activation very similar to that observed in a cocaine Cocaine is a crystalline tropane alkaloid that is obtained from the leaves of the coca plant. The name comes from "coca" in addition to the alkaloid suffix -ine, forming cocaine. It is both a stimulant of the central nervous system and an appetite suppressant. Specifically, it is a dopamine reuptake inhibitor, a norepinephrine reuptake addict receiving an infusion of cocaine."

Deficiencies in serotonin Serotonin (5-hydroxytryptamine, or 5-HT) is a monoamine neurotransmitter. It is found extensively in the gastrointestinal tract of animals, and about 80 to 90 percent of the human body's total serotonin is found in the enterochromaffin cells in the gut where it is used to regulate intestinal movements. The rest is synthesized in serotonergic might also contribute to compulsive behavior, including a gambling addiction.

Relation to other problems

As debts build up people turn to other sources of money such as theft In criminal law, theft is the illegal taking of another person's property without that person's freely-given consent. As a term, it is used as shorthand for all major crimes against property, encompassing offences such as burglary, embezzlement, larceny, looting, robbery, mugging, trespassing, shoplifting, intrusion, fraud (theft by deception) and, or the sale of drugs Many natural substances such as beers, wines, and some mushrooms, blur the line between food and drugs, as when ingested they affect the functioning of both mind and body. A lot of this pressure comes from bookies A bookmaker, or bookie, is an organization or a person that takes bets and pays winnings depending upon results and, depending on the nature of the bet, the odds or loan sharks A loan shark is a person or body that offers unsecured loans at high interest rates to individuals, often backed by blackmail or threats of violence that people rely on for capital to gamble with. Also, a gambler who does not receive treatment for pathological gambling when in his or her desperation phase may contemplate suicide Suicide is the intentional taking of a human's own life. Many dictionaries also note the metaphorical sense of "willful destruction of one's self-interest" (e.g., "political suicide"). Suicide may occur for a number of reasons, including depression, shame, guilt, desperation, physical pain, emotional pressure, anxiety,.[8]

Abuse is also common in homes where pathological gambling is present. Growing up in such a situation leads to improper emotional An emotion is a mental and physiological state associated with a wide variety of feelings, thoughts, and behavior. Emotions are subjective experiences, or experienced from an individual point of view. Emotion is often associated with mood, temperament, personality, and disposition. The English word 'emotion' is derived from the French word é development Child development refers to the biological and psychological changes that occur in human beings between birth and the end of adolescence, as the individual progresses from dependency to increasing autonomy. Because these developmental changes may be strongly influenced by genetic factors and events during prenatal life, genetics and prenatal and increased risk of falling prey to problem gambling behavior.

Pathological gambling is similar to many other impulse control disorders such as kleptomania Kleptomania (Greek: κλέπτειν, kleptein, "to steal", μανία, "mania") is the condition of not being able to resist the urge to collect or hoard things. People with this disorder are compelled to steal things, generally things of little or no value, such as pens, paper clips, tape, small toys. Some may not be aware, pyromania A type of mania, pyromania is an impulse to deliberately start fires to relieve tension and typically includes feelings of gratification or relief afterward. Pyromania is distinct from arson, and pyromaniacs are also distinct from those who start fires because of psychosis, for personal, monetary or political gain, or for acts of revenge, and trichotillomania Trichotillomania (also known as "Trichotillosis"), or "trich" as it is commonly known, is an impulse control disorder or form of self-injury characterized by the repeated urge to pull out scalp hair, eyelashes, facial hair, nose hair, pubic hair, eyebrows or other body hair, sometimes resulting in noticeable bald patches.:645. Other mental diseases that also exhibit impulse control disorder Impulse control disorder is a set of psychiatric disorders including intermittent explosive disorder , kleptomania (stealing), pathological gambling, pyromania (fire-starting), trichotillomania (pulling one's hair out) and dermatillomania (skin picking). The onset of these disorders usually occurs between the ages of 7 and 15. Impulsivity, the key include such mental disorders as antisocial personality disorder Antisocial personality disorder is defined by the American Psychiatric Association's Diagnostic and Statistical Manual as "...a pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood or early adolescence and continues into adulthood." Deceit and manipulation are considered essential features, or schizophrenia Schizophrenia , from the Greek roots skhizein (σχίζειν, "to split") and phrēn, phren- (φρήν, φρεν-; "mind") is a psychiatric diagnosis that describes a mental disorder characterized by abnormalities in the perception or expression of reality. Distortions in perception may affect all five senses, including sight,.

Other problems associated with compulsive gambling can be personal relationships. In a 1991 study of relationships of American men, it was found that 10% of compulsive gamblers had been married three or more times. Only 2% of men who did not gamble were married more than twice. [9]

Prevalence

A study by the United Kingdom Gambling Commission, the "British Gambling Prevalence Survey 2007", found that approximately 0.6% of the adult population had problem gambling issues, the same percentage as in 1999. The highest prevalence of problem gambling was found among those who participated in spread betting Spread betting is any of various types of wagering on the outcome of an event, where the pay-off is based on the accuracy of the wager, rather than a simple "win or lose" outcome, which is known as fixed-odds or money-line betting. A spread is a range of outcomes, and the bet is whether the outcome will be above or below the spread (14.7%), fixed odds betting terminals Fixed Odds Betting Terminals are computerised machines normally found in betting shops which allow players to bet on the outcome of various games and events with Fixed Odds. They were introduced to UK shops in 2002 by a company called 'the global draw' , shortly after the abolition of the Betting Tax in October 2001 (11.2%) and betting exchanges The term betting exchange is used to describe a form of bookmaking in which the operator offsets its risk perfectly through technology, such that the effect to the customer is that customers are seen to bet between themselves. Coined because of its apparent similarities to a stock exchange - it is often defined as "a stock exchange for bets& (9.8%).[10]

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 roulette Roulette is a casino and gambling game named after a French diminutive for "wheel". In the game, players may choose to place bets on either a number, a range of numbers, the color red or black, or whether the number is odd or even. To determine the winning number and color, a croupier spins a wheel in one direction, then spins a ball in or slot machines A slot machine , fruit machine (British), or poker machine (Australian) is a casino gambling machine with three or more reels which spin when a button is pushed. Slots are also known as one-armed bandits because slot machines were originally operated by a lever on the side of the machine (the one arm) instead of a button on the front panel, and, where rounds end quickly and there is a constant temptation A temptation is an act that looks appealing to an individual. It is usually used to describe acts with negative connotations and as such, tends to lead a person to regret such actions, for various reasons: legal, social, psychological , health, economic, etc. Temptation also describes the coaxing or inducing a person into committing such an act, to play again or increase bets, as opposed to a state lottery A lottery is a form of gambling which involves the drawing of lots for a prize. Some governments outlaw it, while others endorse it to the extent of organizing a national lottery. It is common to find some degree of regulation of lottery by governments where the gambler must wait until the next drawing to see results.

Henry Lesieur, a psychologist at the Rhode Island Hospital Rhode Island Hospital is a private, not-for-profit hospital located in Providence, Rhode Island. It is a teaching hospital affiliated with the Warren Alpert Medical School of Brown University. A major trauma center for southeastern New England, the hospital is dedicated to being on the cutting edge of medicine and research. Rhode Island Hospital's gambling treatment program, say thirty percent of the profits from gambling machines come from problem gamblers.[11]

Dopamine agonists A dopamine agonist is a compound that activates dopamine receptors in the absence of the dopamine ligand. Dopamine agonists activate signaling pathways through the dopamine receptor and trimeric G-proteins ultimately leading to changes in gene transcription, in particular pramipexole EU EMEA:link, US FDA:link (Mirapex), have been implicated in the development of compulsive gambling and other excessive behavior patterns (e.g., PMID 16009751).

Assessment

The most common instrument used to screen for "probable pathological gambling" behavior is the South Oaks Gambling Screen (SOGS) developed by Lesieur and Blume (1987) at the South Oaks Hospital in New York City. This screen is undoubtedly the most cited instrument in psychological research literature.[12] In recent years the use of SOGS has declined due to a number of criticisms including that it over-estimates false positives In statistics, the terms Type I error and type II error (β error, or a false negative) are used to describe possible errors made in a statistical decision process. In 1928, Jerzy Neyman (1894-1981) and Egon Pearson (1895-1980), both eminent statisticians, discussed the problems associated with "deciding whether or not a particular sample may.

The DSM-IV diagnostic criteria presented as a checklist is an alternative to SOGS, it focuses on the psychological motivations underpinning problem gambling and was developed by the American Psychiatric Association. It consists of ten diagnostic criteria. One screening measure based upon the DSM-IV criteria is the National Opinion Research Center DSM Screen for Gambling Problems (NODS). This measure is currently used frequently. The Canadian Problem Gambling Severity Index (PGSI) is another newer assessment measure. The PGSI focuses on the harms and consequences associated with problem gambling.

Treatment for Pathological Gambling

A variety of treatments exist for pathological gambling including counseling, self-help groups, and psychiatric medications. However, no one treatment is considered to be most efficacious and no medications have been approved for the treatment of pathological gambling by the US Food and Drug Administration (FDA).

Gamblers Anonymous (GA) is a commonly used treatment for gambling problems. Modeled after Alcoholics Anonymous, GA uses a 12-step model that emphasizes a mutual-support approach.

One form of counseling, cognitive behavioral therapy (CBT) has been shown to reduce symptoms and gambling-related urges. This type of therapy focuses on the identification of gambling-related thought processes, mood and cognitive distortions that increase one’s vulnerability to out-of-control gambling. Additionally, CBT approaches frequently utilize skill-building techniques geared toward relapse prevention, assertiveness and gambling refusal, problem solving and reinforcement of gambling-inconsistent activities and interests.

There is evidence that the SSRI paroxetine is efficient in the treatment of pathological gambling.[13] Additionally, for patients suffering from both pathological gambling and a comorbid bipolar spectrum condition, sustained release lithium has shown efficacy in a preliminary trial.[14] The opiate antagonist drug nalmefene has also been trialled quite successfully for the treatment of compulsive gambling.

Treatment for problem gambling

Most treatment for problem gambling involves counselling, step-based programs, self-help, peer-support, or a combination of these.

Counseling

Gambling counselling is usually delivered by professional counsellors who are often either qualified psychologists or social workers. In many jurisdictions services are free or subsidised by government agencies. Telephone counselling services are also available in many countries. Examples of services include GamCare (UK) and Gambler's Help (Australia).

Step-based programs

One step-based program for gambling issues is Gamblers Anonymous. Gambler's Anonymous uses a 12 step program adapted from Alcoholics Anonymous and also places an emphasis on peer support. Other step-based programs (some commercially operated) that are both specific to gambling and generic to addiction have also be used to treat problem gamblers.

Peer-support

A growing method of treatment is peer support. With the advancement of online gambling, many gamblers experiencing issues use various online peer-support groups to aid their recovery. This protects their anonymity whilst allowing to attempt to self-recover often without having to disclose their issues to loved ones.

Self-help

Research into self-help for problem gamblers is showing promising results. David Hodgins research into the use of workbooks followed up with telephone support has shown benefits.[15]

See also

References

  1. ^ Gambling Addiction: The Problem, the Pain, and the Path to Recovery
  2. ^ Should the scope of addictive behaviors be broadened to include pathological gambling?
  3. ^ UK Gambling Commission 2006. http://www.gamblingcommission.gov.uk/UploadDocs/Contents/Documents/Gambling%20Commission%20problem%20gambling%20issues%20paper.pdf
  4. ^ Gambling Research Australia (2005) Problem Gambling and Harm: Towards a National Definition http://www.gamblingresearch.org.au/CA256902000FE154/Lookup/GRA_Reports_Files1/$file/NatDefs_ExecSum.pdf
  5. ^ Lesieur, H. R., & Blume, S. B. (1987). The South Oaks Gambling Screen (SOGS): A new instrument for the identification of pathological gamblers. The American Journal of Psychiatry, 144(9), 1184-1181.
  6. ^ Ferris, J., & Wynne, H. (2001). The Canadian problem gambling index: Final report. Canadian Centre on Substance Abuse (CCSA).
  7. ^ Ben-Tovim. D., Esterman. A., Tolchard. B., & Battersby, M. (2001). The Victorian Gambling Screen: Project report. Melbourne: Victorian Research Panel.
  8. ^ High Stakes: Teens Gambling With Their Futures by Laura Paul
  9. ^ "Legalized Gambling; America's Bad Bet by John Eidsmoe
  10. ^ The British Gambling Prevalence Survey 2007
  11. ^ Strickland, Eliza (2008-06-16). "Gambling with science: Determined to defeat lawsuits over addiction, the casino industry is funding research at a Harvard-affiliated lab". Salon. http://www.salon.com/news/feature/2008/06/16/gambling_science/.
  12. ^ (printable PDF version)
  13. ^ Kim SW, Grant JE, Adson DE, Shin YC, Zaninelli R (2002). "A double-blind placebo-controlled study of the efficacy and safety of paroxetine in the treatment of pathological gambling". Journal of Clinical Psychiatry 63 (6): 501–507. PMID 12088161.
  14. ^ Hollander E, Pallanti S, Allen A, Sood E, Baldini Rossi N (2005). "Does sustained release lithium reduce impulsive gambling and affective instability versus placebo in pathological gamblers with bipolar spectrum disorders?". American Journal of Psychiatry 162 (1): 137–145. doi:10.1176/appi.ajp.162.1.137. PMID 15625212.
  15. ^ http://modelprograms.samhsa.gov/pdfs/promising/minimal-intervention-approach-to-problem-gambling.pdf

External links

Categories: Gambling and society | Addiction | Mental illness diagnosis by DSM and ICD

 

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