Problem gambling is an urge to gamble continuously despite harmful negative
consequences or a desire to stop. Problem gambling is often 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 is a common disorder that is associated with both social and family
costs. The DSM-5 has re-classified the
condition as an addictive disorder, with sufferers exhibiting many similarities
to those who have substance addictions. The term gambling addiction has long
been used in the recovery movement. Pathological gambling was long
considered by the American Psychiatric Association to be an impulse control
disorder rather than an addiction. However, data suggest a closer
relationship between pathological gambling and substance use disorders
than exists between PG and obsessive-compulsive disorder.
Definition Research by governments in Australia 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 characterized 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." The University of Maryland Medical Center defines
pathological gambling as "being unable to resist impulses to gamble, which can
lead to severe personal or social consequences".
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. The DSM-V has since reclassified
pathological gambling as "gambling disorder" and has listed the disorder
under substance-related and addictive disorders rather than impulse-control
disorders. This is due to the symptomatology of the disorder
resembling an addiction not dissimilar to that of substance-abuse. In order to
be diagnosed, an individual must have at least four of the following symptoms in
a 12-month period: Needs to gamble with increasing amounts
of money in order to achieve the desired excitement
Is restless or irritable when attempting to cut down or stop gambling
Has made repeated unsuccessful efforts to control, cut back, or stop gambling
Is often preoccupied with gambling Often gambles when feeling distressed
After losing money gambling, often returns another day to get even
Lies to conceal the extent of involvement with gambling
Has jeopardized or lost a significant relationship, job, education or career
opportunity because of gambling Relies on others to provide money to
relieve desperate financial situations caused by gambling
History and biology According to the Illinois Institute for
Addiction Recovery, evidence indicates that pathological gambling is an
addiction similar to chemical addiction. It has been observbed that some
pathological gamblers have lower levels of norepinephrine than normal gamblers.
According to a study conducted by Alec Roy, formerly at the National Institute
on Alcohol Abuse and Alcoholism, norepinephrine is secreted under stress,
arousal, or thrill, so pathological gamblers gamble to make up for their
under-dosage. According to a report from Harvard
Medical School's 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-like environment. Subjects' reactions were
measured using fMRI, a neuroimaging technique. And according to Hans
Breiter, co-director of the Motivation and Emotion Neuroscience Center at
Massachusetts General Hospital, "monetary reward in a gambling-like
experiment produces brain activation very similar to that observed in a
cocaine addict receiving an infusion of cocaine." Studies have compared
pathological gamblers to substance addicts, concluding that addicted
gamblers display more physical symptoms during withdrawal. Deficiencies in
serotonin might also contribute to compulsive behavior, including a
gambling addiction. A limited study was presented at a
conference in Berlin, suggesting opioid release differs in problem gamblers form
the general population, but in a very different way from alcoholics or other
substance abusers. = Controversy over biomedical model =
Some medical authors suggest that the biomedical model of problem gambling may
be unhelpful because it focuses only on individuals. These authors point out
that social factors may be a far more important determinant of gambling
behaviour than brain chemicals and they suggest that a social model may be more
useful in understanding the issue. For example, an apparent increase in problem
gambling in the UK may be better understood as a consequence of changes
in legislation which came into force in 2007 and enabled casinos, bookmakers,
and online betting sites to advertise on TV and radio for the first time and
which eased restrictions on the opening of betting shops and online gambling
sites. = Relation to other problems =
Pathological gambling is similar to many other impulse control disorders such as
kleptomania. According to evidence from both community- and clinic-based
studies, individuals who are pathological gamblers are highly likely
to exhibit other psychiatric problems concurrently, including substance use
disorders, mood and anxiety disorders, or personality disorders.
Pathological gambling shows several similarities with substance abuse. There
is a partial overlap in diagnostic criteria; pathological gamblers are also
likely to abuse alcohol and other drugs. The "telescoping phenomenon" reflects
the rapid development from initial to problematic behavior in women compared
with men. This phenomenon was initially described for alcoholism, but it has
also been applied to pathological gambling. Also biological data provide a
support for a relationship between pathological gambling and substance
abuse. In a 1995 survey of 184 Gamblers
Anonymous members in Illinois, Illinois State professor Henry Lesieur found that
56 percent admitted to some illegal act to obtain money to gamble. Fifty-eight
percent admitted they wrote bad checks, while 44 percent said they stole or
embezzled money from their employer. Compulsive gambling can affect personal
relationships. In a 1991 study of relationships of American men, it was
found that 10% of compulsive gamblers had been married more than twice. Only
2% of men who did not gamble were married more than twice. According to
statistics by the BGM, families of problem gamblers are more likely to
experience child abuse or other forms of domestic violence.
Suicide rates A gambler who does not receive treatment
for pathological gambling when in his or her desperation phase may contemplate
suicide. Problem gambling is often associated with increased suicidal
ideation and attempts compared to the general population.
Early onset of problem gambling increases the lifetime risk of suicide.
However, gambling-related suicide attempts are usually made by older
people with problem gambling. Both comorbid substance use and comorbid
mental disorders increase the risk of suicide in people with problem gambling.
A 2010 Australian hospital study found that 17% of suicidal patients admitted
to the Alfred Hospital's emergency department were problem gamblers. In the
United States, a report by the National Council on Problem Gambling showed
approximately one in five pathological gamblers attempt suicide. The council
also said that suicide rates among pathological gamblers were higher than
any other addictive disorder. David Phillips, a sociologist from the
University of California-San Diego, found "visitors to and residents of
gaming communities experience significantly elevated suicide levels".
According to him, Las Vegas, the largest gaming market in the United States,
"displays the highest levels of suicide in the nation, both for residents of Las
Vegas and for visitors to that setting". In Atlantic City, the second-largest
gaming market, he found "abnormally high suicide levels for visitors and
residents appeared only after gambling casinos were opened".
Mechanism The findings in one review indicated the
sensitization theory is responsible. Dopamine dysregulation syndrome has been
observed in the aforementioned theory in people with regards to such activities
as gambling. Diagnosis
The most common instrument used to screen for "probable pathological
gambling" behavior is the South Oaks Gambling Screen developed by Lesieur and
Blume at the South Oaks Hospital in New York City. In recent years the use of
SOGS has declined due to a number of criticisms, including that it
overestimates false positives. 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
frequently used screening measure based upon the DSM-IV criteria is the National
Opinion Research Center DSM Screen for Gambling Problems. The Canadian Problem
Gambling Inventory is another newer assessment measure. The Problem Gambling
Severity Index, which focuses on the harms associated with problem gambling,
is composed of nine items from the longer CPGI.
Treatment Most treatment for problem gambling
involves counseling, step-based programs, self-help, peer-support,
medication, or a combination of these. However, no one treatment is considered
to be most efficacious and no medications have been approved for the
treatment of pathological gambling by the U.S. Food and Drug Administration.
Only one treatment facility has been given a license to officially treat
gambling as an addiction, and that was by the State of Virginia.
Gamblers Anonymous is a commonly used treatment for gambling problems. Modeled
after Alcoholics Anonymous, GA uses a 12-step model that emphasizes a
mutual-support approach. There are three in-patient treatment centers in North
America. One form of counseling, cognitive behavioral therapy 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. As to behavioral treatment, some recent
research supports the use of both activity scheduling and desensitization
in the treatment of gambling problems. In general, behavior analytic research
in this area is growing 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 opioid antagonist drug nalmefene has also been trialled
quite successfully for the treatment of compulsive gambling.
= Step-based programs = Other step-based programs are specific
to gambling and generic to healing addiction, creating financial health,
and improving mental wellness. Commercial alternatives that are
designed for clinical intervention, using the best of health science and
applied education practices, have been used as patient-centered tools for
intervention since 2007. They include measured efficacy and resulting recovery
metrics. = Motivational interviewing =
Motivational interviewing is one of the treatments of compulsive gambling. The
motivational interviewing's basic goal is promoting readiness to change through
thinking and resolving mixed feelings. Avoiding aggressive confrontation,
argument, labeling, blaming, and direct persuasion, the interviewer supplies
empathy and advice to compulsive gamblers who define their own goal. The
focus is on promoting freedom of choice and encouraging confidence in the
ability to change. = 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 while allowing
them to attempt recovery on their own, often without having to disclose their
issues to loved ones. = Self-help =
Research into self-help for problem gamblers has shown benefits. A study by
Wendy Slutske of the University of Missouri concluded one-third of
pathological gamblers overcome it by natural recovery.
= Impact = According to the Productivity
Commission's 2010 final report into gambling, the social cost of problem
gambling is close to 4.7 billion dollars a year. Some of the harms resulting from
problem gambling include depression, suicide, lower work productivity, job
loss, relationship breakdown, crime and bankruptcy. A survey conducted in 2008
found that the most common motivation for fraud was problem gambling, with
each incident averaging a loss of $1.1 million.
Prevalence = Europe =
In Europe, the rate of problem gambling is typically 0.5 to 3 percent. The
"British Gambling Prevalence Survey 2007", conducted by the United Kingdom
Gambling Commission, found approximately 0.6 percent 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, fixed odds betting terminals and betting exchanges. In Norway, a
December 2007 study showed the amount of present problem gamblers was 0.7
percent. = North America =
In the United States, the percentage of pathological gamblers was 0.6 percent,
and the percentage of problem gamblers was 2.3 percent in 2008. Studies
commissioned by the National Gambling Impact Study Commission Act has shown
the prevalence rate ranges from 0.1 percent to 0.6 percent. Nevada has the
highest percentage of pathological gambling; a 2002 report estimated 2.2 to
3.6 percent of Nevada residents over the age of 18 could be called problem
gamblers. Also, 2.7 to 4.3 percent could be called probable pathological
gamblers. According to a 1997 meta-analysis by
Harvard Medical School's division on addictions, 1.1 percent of the adult
population of the United States and Canada could be called pathological
gamblers. A 1996 study estimated 1.2 to 1.9 percent of adults in Canada were
pathological. In Ontario, a 2006 report showed 2.6 percent of residents
experienced "moderate gambling problems" and 0.8 percent had "severe gambling
problems". In Quebec, an estimated 0.8 percent of the adult population were
pathological gamblers in 2002. Although most who gamble do so without harm,
approximately 6 million American adults are addicted to gambling.
Signs of a gambling problem include: Using income or savings to gamble while
letting bills go unpaid Repeated, unsuccessful attempts to stop
gambling Chasing losses
Losing sleep over thoughts of gambling Arguing with friends or family about
gambling behavior Feeling depressed or suicidal because of
gambling losses = Oceania =
Both casinos and poker machines in pubs and clubs facilitate problem gambling in
Australia. The building of new hotels and casinos has been described as "one
of the most active construction markets in Australia"; for example, AUD$860
million was allocated to rebuild and expand the Star Complex in Sydney.
A 2010 study, conducted in the Northern Territory by researchers from the
Australian National University and Southern Cross University, found that
the proximity of a person's residence to a gambling venue is significant in terms
of prevalence. Harmful gambling in the study was prevalent among those living
within 100 metres of any gambling venue, and was over 50% higher than among those
living ten kilometres from a venue. The study's data stated:
"Specifically, people who lived 100 metres from their favourite venue
visited an estimated average of 3.4 times per month. This compared to an
average of 2.8 times per month for people living one kilometre away, and
2.2 times per month for people living ten kilometres away".
According to the Productivity Commission's 2010 report into gambling,
0.5% to 1% of the Australian adult population suffered with significant
problems resulting from gambling. A further 1.4% to 2.1% of the Australian
adult population experienced moderate risks making them likely to be
vulnerable to problem gambling. Estimates show that problem gamblers
account for an average of 41% of the total gaming machine spending.
See also Gambler's Lament, an ancient poem about
gambling Gambling Commission
GamCare Gaming law
National Council on Problem Gambling National Council on Problem Gambling
Problem Gambling Foundation of New Zealand
References External links
Gamblers Anonymous National Council on Problem Gambling
Gambler's Help Southern - Australia National Center for Responsible Gaming
Know the Odds Gambling Resources Contributions of Mathematics in Problem
Gambling