Problem Gambler

Problem gambling (ludomania) is an urge to gamble despite harmful negative consequences or a desire to stop. Problem gamblers are 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. Although the term gambling addiction is common in the recovery movement pathological gambling is considered to be an impulse control disorder and is therefore not considered by the American Psychological Association to be an addiction.

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.

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 According to DSM-IV, Pathological gambling is now defined as separate from a manic episode. Only when the gambling occurs independent of other impulsive, mood, or thought disorders is it considered its own diagnosis. In order to be diagnosed, an indiviudal must have at least 5 (or more) of the following symptoms:

  1. Preoccupation. The subject has frequent thoughts about gambling experiences, whether past, future, or fantasy.
  2. Tolerance. As with drug tolerance, the subject requires larger or more frequent wagers to experience the same “rush”.
  3. Withdrawal. Restlessness or irritability associated with attempts to cease or reduce gambling.
  4. Escape. The subject gambles to improve mood or escape problems.
  5. Chasing. The subject tries to win back gambling losses with more gambling.
  6. Lying. The subject tries to hide the extent of his or her gambling by lying to family, friends, or therapists.
  7. Loss of control. The person has unsuccessfully attempted to reduce gambling.
  8. Illegal acts. The person has broken the law in order to obtain gambling money or recover gambling losses. This may include acts of theft, embezzlement, fraud, or forgery.
  9. Risked significant relationship. The person gambles despite risking or losing a relationship, job, or other significant opportunity.
  10. Bailout. The person turns to family, friends, or another third party for financial assistance as a result of gambling.

As with many disorders, the DSM-IV definition of pathological gambling is widely accepted and used as a basis for research and clinical practice internationally.

Biological basis

According to the Illinois Institute for Addiction Recovery, recent evidence indicates that pathological gambling is an addiction similar to chemical addiction. It has been seen that some pathological gamblers have lower levels of norepinephrine than normal gamblers.

According to a study conducted by Alec Roy, M.D. 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.

Further to this, according to a report from the Harvard Medical School 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 neuro-imaging technique very similar to MRI. And according to Hans Breiter, MD, co-director of the motivation and Emotion Neuroscience Centre at the 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.”

Deficiencies in serotonin might also contribute to compulsive behavior, including a gambling addiction.

Relation to other problems

Pathological gambling is similar to many other impulse control disorders such as kleptomania, pyromania, and trichotillomania. Other mental diseases that also exhibit impulse control disorder include such mental disorders as antisocial personality disorder, or schizophrenia.

According to evidence from both community- and clinic-based studies, individuals who have pathological gambling are highly likely to exhibit other psychiatric problems at the same time, including substance use disorders, mood and anxiety disorders, or personality disorders.

As debts build up people turn to other sources of money such as theft, or the sale of drugs. A lot of this pressure comes from bookies or loan sharks that people rely on for capital to gamble with.

Compulsive gambling is often very detrimental to personal relationships. In a 1991 study of relationships of American men, it was found that 10% of compulsive gamblers had been married three or more times. Only 2% of men who did not gamble were married more than twice.

Abuse is also common in homes where pathological gambling is present. Growing up in such a situation leads to improper emotional development and increased risk of falling prey to problem gambling behavior.

Suicide rate

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 was a problem gambler.

Step-based programs

One step-based program for gambling issues is Gamblers Anonymous. Gamblers Anonymous uses a 12-step program adapted from Alcoholics Anonymous and also places an emphasis on peer support.

Other step-based programs are specific to gambling and generic to healing addiction, creating financial health, and improving mental wellness. Commercial alternatives, 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.

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 whilst allowing to attempt to self-recover often without having to disclose their issues to loved ones.

For the complete article and citations: http://en.wikipedia.org/wiki/Problem_gambling