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Reviewing Pathological Gambling

gambling addictionUniversity of Malaya Centre of Addiction Sciences Department of Psychological Medicine faculty members Seyed Amir Jazaeri and Mohammad Hussain Bin Habil define problem gambling as “an urge to gamble despite harmful negative consequences or a desire to stop.”[1] They state that problem gambling has been defined as an addiction or a medical problem in the past, citing Rosenthal’s definition as one of the most widely accepted, as it was also the foundation for the DSM-IV criteria: “a progressive disorder characterized by a continuous or periodic loss of control over gambling; a preoccupation with gambling and with obtaining money with which to gamble; irrational thinking; and a continuation of the behavior despite adverse consequences.”[2] Originally recognized as a psychiatric disorder in the DSM-III, the American Psychiatric Association now sees pathological gambling as an impulse control disorder that is also a mental illness. In order for a diagnosis of pathological gambling to be made, the individual must meet five of the following 11 criteria:

  1. Pre-occupation: The individual must have frequent thoughts about gambling that are either from the past, in the future, or a fantasy.
  2. Tolerance: The individual must continue to gamble larger and more frequent wages in order to experience a “rush.”
  3. Withdrawal: The individual will feel restless or irritable when gambling is reduced or ceased.
  4. Escape: The individual gambles in order to improve their mood or escape from their problems.
  5. Chasing: The individual will try to win back their losses by gambling even more.
  6. Lying: The individual will go to great lengths to hide their gambling problem from friends, family, and others.
  7. Loss of Control: The individual will be unable to successfully reduce their gambling without professional help.
  8. Illegal Acts: The individual will have broken the law to obtain money for gambling or to recover their losses due to gambling.
  9. Risk of Significant Relationship: The individual will gamble despite the risk of losing a relationship, job, or other opportunity.
  10. Bailout: The individual will ask family, friends, or other third parties for financial help due to gambling.
  11. Biological Bases: The individual lacks a normal level of norepinephrine.1

The Illinois Institute for Addiction Recovery has released findings of pathological gambling being similar to chemical addictions, as many pathological gamblers have been found to have lower levels of norepinephrine than normal gamblers.1 In fact, National Institute on Alcohol Abuse and Alcoholism former member Alec Roy, M.D. states that norepinephrine is secreted when a person is under stress, arousal, or thrill; therefore, pathological gamblers seek to gamble in order to make up for their lower levels.1 Research has shown that problem gamblers will risk money on whatever game is available, not sticking to one game in particular.1 Also, they will more likely risk more money on faster-paced games.1 The Massachusetts General Hospital Motivation and Emotion Neuroscience Center Co-Director Hans Breiter, M.D. stated that gambling that leads to monetary winnings produces brain activation similar to when someone with an addiction to cocaine receives a dosage.1 Unfortunately, as individuals with problem gambling build up large amounts of debt, they often turn to other sources to obtain money, such as theft or drug sales, due to the pressure from bookies and loan sharks.1 Many contemplate suicide, feeling completely overwhelmed by their situation.1

According to Jazaeri and Bin Habil, the prevalence of problem gambling is between two and three percent of the United States’ population, and pathological gambling has a prevalence of one percent.1 Although there has been an increase in gambling availability in the past 25 years, problem gambling has remained steady.1

The first step in the treatment of gambling is realizing there is a problem; however, after that, recovery programs are typically unique to the individual and their situation.1 There are several treatment options, though. There is Gamblers Anonymous (GA) which is a 12 step program, modeled after Alcoholics Anonymous (AA). With GA, the individual will choose a sponsor who is a former gambler that has the time and experience remaining free from gambling addiction.1 The sponsor will provide the individual with guidance and support.1 There is also cognitive-behavioral therapy (CBT), which will often focus on changing the unhealthy gambling behaviors and thoughts.1 CBT will teach problem gamblers how to successfully fight urges to gamble, deal with their emotions in a healthy way rather than through gambling escape, and solve problems caused by their addiction.1 A CBT variation, called the four steps program, looks to change the individual’s thoughts and beliefs through four steps: re-label, re-attribute, refocus, and revalue.1 There is also the option of debt restructuring, and if severe enough, admission to an inpatient program.1 During inpatient stays, individuals will focus on stopping gambling and other underlying personal and relationship issues, as well as making a list of their debts and developing a plan to repay them.1

Jazaeri and Bin Habil state that compulsive gamblers need the support of their family and friends during treatment; however, the decision to seek treatment has to be wholly theirs.1 Family members often have conflicting emotions regarding a loved one’s problem gambling. Some will cover up for them and others will spend time keeping them away from gambling.1 Others will be angry with their loved one for gambling again and again.1 The gambler may have borrowed or stolen money from family members in order to gamble, with no way of repaying the debt, and others may have run up joint credit cards.1 However, in all cases, professional treatment should be sought, as the consequences of a gambler’s actions may cause a severe drop in self-esteem, putting them at risk of suicide.1



[1] Jazaeri, S. A. and Bin Habil, M.H. (2012). Reviewing Two Types of Addiction–Pathological Gambling and Substance Use. Indian J Psychol Med 34(1): 5–11.

[1] Rosenthal RJ. Pathological gambling. Psychiatric Analyses. 1992;22:72–8.

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