What is gambling in psychopathology?

Introduction

A gambler is a person who risks something of value based on an uncertain outcome for the possibility of reward: Typically, money is bet in the hope of making more money. Gamblers are classified as recreational, professional, or pathological. Recreational gambling is an enjoyable activity that has no evident adverse effects and may have possible mental-health benefits among certain groups, such as the elderly. A few individuals are professional gamblers, making their living by playing games of chance that involve some level of skill. Pathological gambling has a long history in the psychiatric literature, but it was not defined as a medical problem until 1980, when it was added to the diagnostic nomenclature. It is an impulse-control disorder and tends to lead to increasingly adverse consequences for individuals, their families, and others.

A diagnosis of pathological gambling requires the presence of five out of ten criteria: (1) becoming preoccupied with gambling, (2) exhibiting tolerance and withdrawal, (3) escaping from moods and life’s problems, (4) chasing losses with more gambling, (5) lying about gambling, (6) losing control over the reduction of betting, (7) becoming irritable when trying to stop gambling, (8) committing illegal acts to obtain funds, (9) risking interpersonal relationships and vocation to gamble, and (10) seeking bailouts, such as turning to others for financial assistance. Mania must be ruled out when diagnosing pathological gambling.

Prevalence, Risk Factors, and Theories

Most people who gamble in a given year are recreational gamblers. In the United States, only about 1 percent of adults (2.4 million people in 2012) become pathological gamblers—about the same percentage as are diagnosed with schizophrenia. Another 2 to 3 percent are considered problem gamblers, who experience detrimental consequences as a result of their betting but meet fewer than five of the diagnostic criteria. Slightly higher rates of pathological and problem gambling are found among adolescents.

Risk factors for developing pathological gambling include a parental history of gambling problems, alcohol and tobacco use, and membership in a minority. Males are more likely to be pathological gamblers than females. The most common comorbid conditions with pathological gambling are a personality disorder, which occurs in about half of those diagnosed (antisocial personality disorder is the most frequently found), and substance abuse, which is found in about one-third of pathological gamblers. Whether as a cause or a consequence, anxiety and depressive disorders are often diagnosed as well. When pathological gambling becomes chronic, a major depressive disorder may be present. Pathological gambling invariably affects the spouse and family of the gambler, making marital and family counseling necessary.

Theories explaining the development of pathological gambling are multivariate and address a range of factors, including biological, environmental, and parental. Studies during the first decade of the twenty-first century suggest a biological foundation for pathological gambling. The

neurotransmitters serotonin and dopamine are implicated, as are endorphins. For example, some patients treated for Parkinson’s disease with a dopamine agonist spontaneously developed urges to gamble and, in some instances, progressed to problem and pathological gambling. The urges remitted with cessation of medication.

Pathological gamblers show impulsivity, an inability to delay gratification, and higher levels of physiological arousal, such as increased heart rate, during gambling activity. There may be fundamental physiological differences in the neurological makeup of people who gamble to excess compared with those who can gamble in moderation.

Also associated with gambling are elaborate contingencies of
reinforcement to create and sustain the behavior. The modern casino is a technological wonder designed to produce only one outcome: sustained gambling. In the 1970s, when the American gaming industry discovered that marketing to the middle class could significantly increase the pool of gamblers, industry members sought to increase the number of states in which gambling was legal. Eventually, gambling was legalized in some form in every state except Hawaii and Utah. The availability of gaming opportunities has led to an increase in pathological gamblers, which the industry has addressed with programs promoting responsible gambling. States that introduced lotteries have established programs to educate citizens about the dangers of gambling in excess.

Treatment and Prevention

A treatment program for pathological gambling begins with a comprehensive assessment that examines the individual’s gambling frequency and duration, the extent of negative consequences, personality type, and psychological context. Common assessment tools include theSouth Oaks Gambling Screen (SOGS), a general psychiatric symptoms checklist, and careful questioning about substance abuse.

Treatment for pathological gambling can take a variety of forms. One effective method is cognitive behavior therapy, which focuses on changing patterns of thought and cognition related to gambling impulses. Another is
Gamblers Anonymous, founded in 1957 and patterned after Alcoholics Anonymous, which provides a free twelve-step program with strong peer support. Daily meetings are held in many cities in the United States, and Gamblers Anonymous offers support and education for spouses, family, and friends of gamblers. Psychopharmacological treatments for gambling—including selective serotonin reuptake inhibitors (SSRIs), opioid antagonists, and mood stabilizers—also have shown some promise.

Many states have websites that guide those who might have a problem with gambling to treatment locations. These sites also provide educational information and self-assessments. The National Council on Problem Gambling also provides educational information. Programs to prevent pathological gambling include state-mandated informational cards and plaques placed in casinos, state-supported television and billboard advertisements warning of the consequences of excessive gambling, and educational curricula designed to enlighten adolescents about the dangers of gambling.

Bibliography

Ariyabuddhiphongs, Vanchai. "Problem Gambling Prevention: Before, During, and After Measures." International Journal of Mental Health and Addiction 11.5 (2013): 568–82. Print.

Brewerton, Timothy D., and Amy Baker Dennis, eds. Eating Disorders, Addictions and Substance Use Disorders. Heidelberg: Springer, 2014. Print.

Castellani, Brian. Pathological Gambling: The Making of a Medical Problem. Albany: State U of New York P, 2000. Print.

Grant, Jon E., and Mark N. Potenza. Pathological Gambling: A Clinical Guide to Treatment. Arlington: Amer. Psychiatric, 2004. Print.

Knapp, Terry J., and Edward W. Crossman. “Pathways to Betting: Childhood, Adolescent, and Underage Gambling.” Gambling: Behavior Theory, Research, and Application. Ed. Patrick M. Ghezzi et al. Reno: Context, 2006. 207–30. Print.

Koot, S., et al. "Compromised Decision-Making and Increased Gambling Proneness following Dietary Serotonin Depletion in Rats." Neuropharmacology 62.4 (2012): 1640–50. Print.

Lesieur, Henry R., and Sheila B. Blume. “The South Oaks Gambling Screen (SOGS): A New Instrument for the Identification of Pathological Gamblers.” American Journal of Psychiatry 144.9 (1987): 1184–89. Print.

Perkinson, Robert R., Arthur E. Jongsma Jr., and Timothy J. Bruce. The Addiction Treatment Planner. 5th ed. Hoboken: Wiley, 2014. Print.

Petry, Nancy M. Pathological Gambling: Etiology, Comorbidity, and Treatment. Washington: APA, 2004. Print.

Whelan, James P., Timothy A. Steenbergh, and Andrew W. Meyers. Problem and Pathological Gambling. Cambridge: Hogrefe, 2007. Print.