Gambling in psychopathology
Gambling is a multifaceted activity that can range from a leisurely pastime to a serious psychological disorder known as pathological gambling, which is classified as an impulse-control disorder. Individuals may gamble recreationally without adverse effects, while a smaller subset develops compulsive gambling behaviors that can lead to significant distress, including anxiety and depression, as well as disrupted familial and social relationships. The diagnosis of pathological gambling requires specific criteria, including preoccupation with gambling and loss of control over betting behaviors.
Research indicates that around 1% of adults in the U.S. meet the criteria for a gambling addiction, with higher prevalence rates among adolescents. Risk factors for developing this disorder often include a family history of gambling issues and substance use. Treatment approaches vary and can include cognitive behavioral therapy, support groups like Gamblers Anonymous, and pharmacological interventions. Additionally, prevention efforts are underway, such as educational programs and awareness campaigns aimed at reducing the risks associated with gambling. Understanding the psychological complexities and societal impacts of gambling can provide valuable insights for those affected and their families.
Gambling in psychopathology
- DATE: 2000 forward
- TYPE OF PSYCHOLOGY: Psychopathology
- Gambling can be a recreational activity, a profession, or a psychopathology. Pathological gambling is an impulse-control disorder that often produces depression and anxiety as secondary conditions and also disrupts marital and family relationships. Psychopharmacological, behavioral, and twelve-step treatments are helpful.
Introduction
An individual who gambles 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. Individuals who gamble may be classified as recreational, professional, or pathological. Recreational gambling is an enjoyable activity that has no evident adverse effects for most people and may have possible mental health benefits among certain groups, such as older adults. A few individuals gamble professionally, making their living by playing games of chance that involve some level of skill. Problem gambling, or ludomania, 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 compulsive 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. must be ruled out when diagnosing compulsive gambling.
Prevalence, Risk Factors, and Theories
Most people who gamble in a given year gamble recreationally. In the United States, only about 1 percent of adults develop an addiction to gambling—about the same percentage as are diagnosed with . Another 2 to 3 percent of individuals have a gambling disorder, who experience detrimental consequences due to their betting but meet fewer than five of the diagnostic criteria. Slightly higher rates of compulsive and problem gambling are found among adolescents.
Risk factors for developing compulsive gambling include a parental history of gambling problems, alcohol and tobacco use, and membership in a minority. Males are more likely to develop an addiction to gambling than females. The most common comorbid conditions with compulsive gambling are a personality disorder, which occurs in about half of those diagnosed (antisocial personality disorder is the most frequently found), and substance use disorder, which occurs in about one-third of individuals who compulsively gamble. Whether as a cause or a consequence, anxiety and depressive disorders are often diagnosed as well. When compulsive gambling becomes chronic, a major depressive disorder may be present. Compulsive gambling invariably affects the spouse and family of the individual with an addiction to gambling, making marital and family counseling necessary.
Theories explaining the development of compulsive 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 compulsive 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 compulsive gambling. The urges remitted with cessation of medication.
Individuals who compulsively gamble show impulsivity, an inability to delay gratification, and higher levels of physiological arousal, such as increased heart rate while gambling. 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 people who gamble, 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 people who gamble compulsively, 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 compulsive 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 the South Oaks Gambling Screen (SOGS), a general psychiatric symptoms checklist, and careful questioning about substance abuse. The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, 5th edition, Text Revision (DSM-5-TR) outlines criteria for diagnosing pathological gambling (PG) or gambling disorder (GD).
Treatment for compulsive 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 individuals who gamble. Because many individuals who experience a gambling addiction engage in behaviors that impact their family and friends, group or family therapy may be appropriate in some instances. Psychopharmacological treatments for gambling—including selective serotonin reuptake inhibitors (SSRIs), opioid antagonists, and mood stabilizers—also have shown some promise.
Most 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 compulsive 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.
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