Compulsive gambling
Compulsive gambling, also referred to as gambling disorder or pathological gambling, is characterized by an uncontrollable urge to gamble despite negative consequences. This behavior can lead to significant hardships, including financial troubles, relationship issues, and professional difficulties. Unlike recreational gamblers who engage in gambling for enjoyment, individuals with compulsive gambling often experience cravings and a sense of euphoria associated with gambling, similar to substance use disorders.
Research indicates that compulsive gambling can have familial ties, as children of parents with gambling addictions may be socialized into this behavior. The disorder can co-occur with other mental health issues, making it complex to treat. Statistics suggest that approximately 0.4 to 2 percent of adults globally are affected by gambling disorders, with rates potentially higher among adolescents.
Diagnosis typically follows criteria outlined in the DSM-5, which emphasizes the adverse impacts of gambling and requires the presence of specific symptoms over a designated period. Treatment may involve cognitive-behavioral therapy, family therapy, and sometimes medication for underlying mental health conditions. Support groups, such as Gamblers Anonymous, are also available to assist those affected by gambling addiction and their families. Effective prevention strategies often emphasize awareness and education, as many individuals may not recognize their susceptibility to gambling addiction until it becomes problematic.
Compulsive gambling
DEFINITION: Gambling is an activity that involves a degree of risk and an expenditure of money or goods with the hope of an increased return but with the possibility of a total loss. Some people gamble for pleasure and in a nonaddictive fashion, and they suffer no ill effects from gaming activities. Others have a problem with gambling, which is manifested by their increasing desire to gamble, regardless of whether their gambling creates hardships in their lives or the lives of their loved ones. These hardships can include money and debt problems, difficulties at work or concentrating on tasks, relationship problems, or other negative consequences.
ALSO KNOWN AS: Compulsive gambling; disordered gambling; pathological gambling; problem 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-occurring 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.
Research suggests that approximately 0.4 to 2 percent of adults worldwide experience gambling disorders, according to the American Psychological Association. 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. The National Council on Problem Gambling offers risk education on their web site to educate athletes about the problems and risks of sports gambling. The organization provides resources on gambling addiction and recovery, responsible gaming, and links to certified gambling counselors. They also offer training and certification in gambling counseling. In 2012 they developed the first US Internet Responsible Gaming Standards to guide stakeholders on internet gambling.
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 effects 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 experiencing the condition. The word "pathological" has negative connotations, and many feel it reinforced the stigma associated with the problem, thus potentially inhibiting those with a 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-TR that 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 their 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 experiencing this disorder as well as for persons in their 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 person experiencing addiction negatively affects others with their addiction, therapists have suggested that family members could benefit from some intervention. Gam-Anon is an organization that provides help to families and friends of compulsive gamblers.
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.
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