What is compulsive gambling?

Causes

Problem gambling has a familial component because parents with a gambling addiction tend to socialize their children into the gambling world. Many of these young people, in turn, develop disordered gambling behavior. Neuroscientific and genetic research, which includes research with twins, has also determined that compulsive gambling runs in families and is often a co-occuring disorder with other addictions and/or mental health issues. Cultural components have also been associated with problem gambling.

Risk Factors

Greater numbers of men typically experience gambling addiction, although women are also at risk. People with gambling addictions often have other mental health issues (including personality, mood, and/or anxiety disorders) and other addictive disorders, which increase the challenge in determining what effects were caused by gambling and what were caused by other comorbidities. Problem gamblers often consume alcohol, nonprescription drugs, and tobacco in unhealthy ways, which also contributes to dysfunctional behavior.

Prevailing research suggests that approximately 1 percent of the world’s population experience gambling problems. The disordered gambling figures for adolescents in locations where such research has been completed are much higher, with the implication that gambling-addiction numbers will rise as adolescents age and as increasing means to gamble become available. The growth of online gaming, which includes online gambling, is particularly challenging for local authorities to license, control, or measure. Particular concerns with these web-based services are that young players are difficult to identify and thus cannot be prevented from accessing these sites, even when local laws do not permit children to gamble.

Symptoms

According to the fifth edition of the
Diagnostic and Statistical Manual of Mental Disorders
(DSM-5), published in 2013 by the American Psychiatric Association (APA), gambling disorder is considered to be an addictive disorder similar to substance use disorder (SUD). As with SUD, gambling disorder affects the brain's reward system in ways similar to the affects of abusing drugs or alcohol. Additionally, problem gamblers report cravings for gambling and getting a "high" as a result of the stimulus of gambling. The previous edition of this manual, the DSM-IV-TR published in 2000, categorized gambling disorder as an impulse control disorder, not an addiction disorder, and labeled the condition "pathological gambling." The DSM-5 not only reclassified problem gambling as an addictive disorder but also renamed it "gambling disorder, which was welcomed by clinicians, researchers, and those suffering from the condition. The word "pathological" has negative connotations, and many feel it reinforced the stigma associated with the problem, thus potentially inhibiting sufferers of gambling disorder from seeking help.

Gambling disorder is defined operationally by the DSM-5 as the presence of at least four of nine criteria that the individual experiences within a twelve-month period. The measures focus on the negative effects of gambling (such as a preoccupation with gambling, using gambling as a way to escape problems, and difficulty cutting back on or stopping gambling despite repeated attempts) and the negative consequences or problems that result from gambling (such as lying to hide the degree of gambling, deteriorating personal and/or professional relationships, loss of educational or employment opportunities as a result of gambling, and financial hardship and increasing debt to cover gambling losses). The DSM-5 also removed the criterion from the DSM-IV-TRthat states that problem gamblers commit illegal acts such as fraud, theft, or forgery. Research has shown that there is a low prevalence of this behavior among problem gamblers, and this stand-alone symptom did not help to distinguish those with gambling disorder from those without.

A person may manifest a gambling addiction for a period of time and then gain some control over his or her behavior, only to relapse and begin the cycle yet again. This is common among other addictive disorders, and this cyclical progression is challenging for the person suffering from this disorder as well as for persons in his or her family and social circles.

Screening and Diagnosis

There are many screening and diagnostic tools to measure or assess problem gambling. Many of these are based on the DSM-5 criteria for measuring gambling disorder. Two common tools are the Brief Biosocial Gambling Screen (BBGS) and the modified NORC diagnostic screen, which also has a self-administered version titled "NODS-SA.." Although often criticized for producing too many false positives, the South Oaks Gambling Screen is often used to assess problem gambling and has also been adapted to assess problem gambling in youth.

Diagnosis typically occurs using the DSM-5 criteria for gambling disorder. The criteria are used by mental health professionals and by insurance companies to reimburse for treatment. Diagnosis typically places the person along a continuum of increasingly disordered behavior. At the lowest levels are people who have never gambled, who do not gamble excessively, or who do not cause harm to themselves or others because of gambling behavior. Gamblers who display symptoms of gambling disorder are diagnosed according to the level of severity. Those with mild severity have displayed four to five of the nine DSM-5 criteria for gambling disorder during the previous twelve months. Those with moderate severity display six to seven criteria, and those with severe symptoms display eight to nine criteria. Individuals with gambling disorder are also referred to as compulsive gamblers, disordered gamblers, excessive gamblers, intemperate gamblers, or problematic gamblers.

Treatment and Therapy

Treatment traditionally involves cognitive and cognitive behavioral therapy (CBT) as well as family therapy, although more recent approaches have focused on pharmacological interventions, especially antidepressants or other drugs that treat the often co-occurring mental health issues such as anxiety and bipolar disorder. The change in classification of problem gambling to now be included as an addiction-based disorder forces insurance companies to cover treatment and medication. Free Gamblers Anonymous groups are found in most urban centers, which is helpful for this client group.

In addition to methodological problems with studies that make it difficult to identify the most promising treatment options, there are conceptual issues. Generally, people with gambling addictions have been considered to be a fairly uniform subject group by researchers; however, there are many differences within the group in terms of comorbidity and other factors, which might influence treatment outcomes. Also, there are many problem gamblers who manage to recover without treatment.

Treatment efforts also have focused on spouses and other family members of problem gamblers. Because the gambling addict negatively affects others with his or her addiction, therapists have suggested that family members could benefit from some intervention.

Prevention

It can be argued that the best prevention for gambling addiction is to avoid gambling, since most people do not realize their propensity for unhealthy and problematic gambling until they have a problem. Generally, government dollars have been spent on treatment rather than on prevention, but there are strong public health arguments that support greater efforts in prevention. Many groups lobby against legalizing gambling in the United States.

Bibliography

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. Washington: American Psychiatric Assoc., 2013. Print.

Denis C., M. Fatséas, and M. Auriacombe. "Analyses Related to the Development of DSM-5 Criteria for Substance Use Related Disorders: An Assessment of Pathological Gambling Criteria." Drug and Alcohol Dependence 122.1–2 (2012): 22–27. PRint

Kaminer, Yifrah, and Oscar G. Bukstein, eds. Adolescent Substance Abuse: Psychiatric Comorbidity and High-Risk Behaviors. New York: Routledge, 2008. Print.

Ladouceur, Robert, and Stella Lachance. Overcoming Pathological Gambling: Therapist Guide. New York: Oxford UP, 2006. Print.

Leeman, Robert F., and Marc N. Potenza. "Similarities and Differences Between Pathological Gambling and Substance Use Disorders: A Focus on Impulsivity and Compulsivity." Psychopharmacology 219.2 (2012): 469–90. Print.

Nathan, Peter E., and Jack M. Gorman, eds. A Guide to Treatments That Work. 3rd ed. New York: Oxford UP, 2007.

Newman, Stephen C., and Angus H. Thompson. “The Association between Pathological Gambling and Attempted Suicide: Findings from a National Survey in Canada.” Canadian Journal of Psychiatry 52.9 (2007): 605–12. Print.

Petry, Nancy M. Pathological Gambling: Etiology, Comorbidity, and Treatment. Washington: American Psychological Association, 2005. Print.

Williams, Robert J., and Rachel A. Volberg. "The Classification Accuracy of Four Problem Gambling Assessment Instruments in Population Research." International Gambling Studies 14.1 (2014): 15–28. Print.

Wong, Irene Lai Kuen. “Internet Gambling: A School-Based Survey among Macau Students.” Social Behavior and Personality 38.3 (2010): 365–72. Print.