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Pathological gambling

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Problem gambling is an urge to gamble despite harmful negative consequences or a desire to stop. The term is preferred to compulsive gambling among many professionals, as few people described by the term experience true compulsions in the clinical sense of the word. Problem gambling often is 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 gamblingEdit

Extreme cases of problem gambling may cross over into the realm of mental disorders. Pathological gambling was recognized as a psychiatric disorder in the DSM-III, but the criteria were significantly reworked based on large-scale studies and statistical methods for the DSM-IV. As defined by American Psychiatric Association, pathological gambling is an impulse control disorder that is a chronic and progressive mental illness.

Pathological gambling is now defined as persistent and recurrent maladaptive gambling behavior meeting at least five of the following criteria, as long as these behaviors are not better explained by a manic episode:

  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 subject has unsuccessfully attempted to reduce gambling.
  8. Illegal acts. The subject has broken the law in order to obtain gambling money or recover gambling losses.
  9. Risked significant relationship. The subject gambles despite risking or losing a relationship, job, or other significant opportunity.
  10. Bailout. The subject turns to family, friends, or another third party for financial assistance as a result of gambling.
  11. Biological Bases. The subject has a lack of norepinephrine.

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.

Effects of different types of gamblingEdit

Some forms of gambling are allegedly less harmful. According to William R. Eadington, University of Nevada, in an article entitled "What happens to the best laid plans: global lessons on legalization and liberation of gaming laws", ranked from least dangerous to most dangerous are:

  1. Lotteries (traditional), bingo - soft gambling
  2. Destination resort casinos
  3. Urban or suburban casinos
  4. Convenient Gambling: gaming devices in bars, slot machines
  5. Ultra-Convenient Gambling: interactive television, mobile phone, or internet gambling

Biological basesEdit

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 underdosage.

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 siuations where they could win, lose or break even in a casino-like environment. Subjects' reactions were measured using a fMRI, a neuro-imaging device very similar to a 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 complusive behavior, including a gambling addiction.

Relation to other problemsEdit

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. Also, a teenager that does not receive treatment for pathological gambling when in their desperation phase is likely to contemplate suicide. 20% of teenagers that are pathological gamblers do consider suicide. This according to the article High Stakes: Teens Gambling With Their Futures by Laura Paul.

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.

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.

PrevalenceEdit

According to a variety of sources, the prevalence (i.e., extent of existing cases) of problem gambling is 2-3% and pathological gambling is 1% in the United States, though this may vary by country. By contrast, about 86% of Americans have gambled during their lives and 60% gamble in a given year. Interestingly, despite the widespread growth in gambling availability and the increase in lifetime gambling during that past 25 years, past year problem gambling has remained steady. Currently, there is little evidence on the incidence of problem gambling (i.e., new cases).

Available research seems to indicate that problem gambling is an internal tendency, and that problem gamblers will tend to risk money on whatever game is available, rather than a particular game being available inducing problem gambling in otherwise "normal" individuals. However, research also indicates that problem gamblers tend to risk money on fast-paced games. Thus a problem gambler is much more likely to lose a lot of money on poker or slot machines, where rounds end quickly and there is a constant temptation to play again or increase bets, as opposed to a state lottery where the gambler must wait until the next drawing to see results.

Dopamine agonists, in particular pramipexole (Mirapex), have been implicated in the development of compulsive gambling and other excessive behavior patterns (e.g., PMID 16009751).

AssessmentEdit

The most common instrument used to screen for "probable pathological gambling" behavior is the South Oaks Gambling Screen (SOGS) developed by Lesieur and Blume (1987) at the South Oaks Hospital in New York. This screen is undoubtedly the most cited instrument in psychological research literature (printable PDF version).

TreatmentEdit

There is evidence that the SSRI paroxetine is efficient in the treatment of pathological gambling [1]. Additionally, for patients suffering from both pathological gambling and a comorbid bipolar spectrum condition, sustained release lithium has shown efficacy in a preliminary trial. [2]. The opiate antagonist drug nalmefene has also been trialled quite successfully for the treatment of compulsive gambling.


Pathological gambling: History of the disorder

  • historical sources
  • famous clinicans


Pathological gambling: Theoretical approaches

Pathological gambling: Epidemiology

According to the National Council on Problem Gambling, incidence of problem gambling is 2-3% and pathological gambling is 1% in the United States, though this may vary by country. By contrast, 86% of Americans have gambled in their lives and 60% gamble in a given year.


Pathological gambling: Risk factors


Dopamine agonists, in particular pramipexole (Mirapex), have been shown to cause compulsive gambling (PMID 16009751).

Pathological gambling: Etiology

Pathological gambling: Diagnosis & evaluation


Pathological gambling: Treatment


Pathological gambling: For people with this difficulty

Pathological gambling: For their carers

Instructions_for_archiving_academic_and_professional_materials Pathological gambling: Academic support materials

Pathological gambling: For the practitioner

Pathological gambling: Anonymous fictional case studies for training


See also}Edit

References & BibliographyEdit

  1. Kim SW, Grant JE, Adson DE, Shin YC, Zaninelli R (2002). A double-blind placebo-controlled study of the efficacy and safety of paroxetine in the treatment of pathological gambling. Journal of Clinical Psychiatry 63 (6): 501-507. PMID 12088161.
  2. Hollander E, Pallanti S, Allen A, Sood E, Baldini Rossi N (2005). Does sustained release lithium reduce impulsive gambling and affective instability versus placebo in pathological gamblers with bipolar spectrum disorders?. American Journal of Psychiatry 162 (1): 137-145. PMID 15625212.

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Additional materialEdit

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