Pathological Gambling Environmental

Pathological gambling disorder is seen as gambling which is uncontrollable and can alter and adversely affect the individual’s recreational and social activities. This disorder has an extremely disruptive and adverse affect on the life of the individual that suffers from it. As a result of this pathological gambling, individuals may end up losing all of their life savings, and may also be forced to commit various crimes including forging checks, stealing or embezzling in order to acquire more money to fulfill their compulsive habit. This disorder can also lead to the development of major problems in relationships as well as jobs.

1. The etiology of pathological gambling has not been yet elucidated, but there is evidence that it is a multifaceted illness, attributable to the interaction of individual and environmental factors.
2. Gambling disorder tends to run in families, but environmental factors may also contribute. Symptoms of the disorder can begin as early as adolescence or as late as older adulthood. Men are more likely to begin at a younger age and women are more likely to begin later in life.
3. Social and environmental factors: Living in an environment where gambling is widely practiced and accepted can increase one’s chances of becoming a compulsive gambler. Other social factors, such as isolation from others, peer pressure to gamble, or the frequent abuse of drugs or alcohol may contribute to problem gambling.

What used to be called problem gambling or pathological gambling is now generally referred to as disordered gambling, according to several sources, including the New York Council on Problem Gambling.

Pathological gambling can also be described as an Impulse Control Disorder1 or process addiction which is different from addictions to elements such as alcohol, food, tobacco and drugs. These types of addictions include a ‘high’ or a ‘rush’ which is gained when certain actions are performed as part of the addictive behavior. In case of gambling, the individuals may gain the ‘high’ from the overall setting and atmosphere of the place, for example a bingo hall, casino, race track and other places. The feeling that the individual gets from taking risks in this environment can evoke the addiction further. In many cases it is seen that compulsive gamblers own a piece of clothing or accessory which they claim is lucky for their gambling, and hence wear it every time they participate in a gambling activity. Some of these individuals use the piece of clothing or accessory to acquire the ‘high’ or ‘rush’ before gambling.

Causes:

The definite causes of pathological gambling disorder are unknown, although there are a number of studies and surveys that indicate that there is a significant difference on biological levels, between the general population and the compulsive gamblers. These surveys however cannot form the basis of the causes of pathological gambling. Many people tend to use their habit of gambling in order to gain an escape from signs of depressions which is more commonly seen in women than in men. Some of the gamblers seek to gamble in order to alter their moods because of the intense amount of energy and excitement that is commonly seen in gambling rooms. Thus, it is common to find that some people may be interested in other aspects of gambling than simply the money that is involved. It can be said that they ‘rush’ or ‘high’ that is seen in individuals suffering from pathological gambling disorders may not be associated with the money.

Symptoms:

Some of the most common symptoms that are seen in individuals suffering from pathological gambling disorder include immense amount of preoccupation with activities associated with gambling which tend to interfere with the individual’s social, occupational and personal life. The individual fells that he/she cannot control these gambling instincts and thus continues to visit casinos to place bets, failing to stop or cut down on the habit. One of the most commonly seen behaviors among compulsive gamblers is known as chasing. Chasing refers to placing bets of large amounts of money and thus taking more risks. This is done in order to make up for money that has been lost in gambling previously by the individual. The individual is also prone to immoral activities such as lying, forgery, stealing, fraud involved with credit cards, embezzling, and various other behaviors that are associated with acquiring money for gambling.

Demographics:

Gambling disorder affects more males than females in the United States with a sex ratio of 2:1. Over all as many as 4% of the population of the United States might meet the criteria for the disorder. In some countries this percentage is as high as 7%.

Diagnosis:

The disorder is usually diagnosed when an affected persons family or spouse become concerned and is seldom self reported. The most common symptom that most patients suffer from is Denial.

The Diagnostic and Statistical Manual of Mental Disorders(4th edition), specifies that a person affected with pathological gambling disorder must have at least 5 of the following symptoms to meet the diagnostic criteria for the disorder:

• The person thinks about gambling almost all the time
• The person keeps using larger and larger amounts of money every time when gambling
• The person has tried to stop gambling but has been unable to do so
• Whenever the gambling is stopped, the person becomes moody or cranky
• The person uses gambling as a method to escape problems
• The person continues to gamble in order to win back the money that has been lost (“chasing”)
• The person lies about the severity and extent of gambling
• The person has engaged in illegal or immoral behavior in order to make money for gambling
• The person has problems at home or work because of the gambling
• The person tends to rely on other people to get out of financial problems that have been caused by gambling

Treatments:

There are many treatments available for pathological gambling disorder:

• Psychodynamic Psychotherapy
• Cognitive Behavioral Therapy
• Substance Abuse Treatment
• Relaxation Techniques
• Aversion Therapy
• Gamblers Anonymous

References:

Impulse Control Disorders: A Clinician’s Guide to Understanding and Treating Behavioral Addictions Jon E. Grant

APA: Diagnostic and Statistical Manual of Mental Disorders. 4th ed. text revision

Pathological gambling (PG) involves being unable to resist the impulse to gamble. The transition from recreational gambling to pathological gambling may occur gradually, or it may transition suddenly in response to a stressful event such as job loss (Bayer, 2000).

Some features associated with pathological gamblers include denial, overconfidence, delusions of grandeur, development of superstitions, highly competitive, and overly concerned with approval from others (Bayer, 2000). In order to be diagnosed as a pathological gambler, the individuals symptoms must be persistent and recurrent, and the individual must be preoccupied with reliving past gambling experiences or planning future gambling excursions (Bayer, 2000). After some time, the individual may feel compelled to take higher risks to produce the desired level of excitement. This disorder can result in a host of occupational, social, and legal problems. Compulsive gamblers often find themselves lying to their family members and friends to hide the severity of their problem. They may even resort to illegal, but typically nonviolent, means of acquiring money to gamble (Bayer, 2000).

Compulsive gamblers are more prone to medical conditions that are brought about by stress such as hypertension, peptic ulcers, and migraine headaches (Bayer, 2000). They may also have comorbid mood disorders, substance-related disorders, antisocial behavior, attention-deficit disorder, or hyperactivity (Bayer, 2000). Compulsive gambling can be confused with bipolar disorder, which sometimes accompanies compulsive gambling (Bayer, 2000).

This impulse-control disorder is more common among men than women. Women who do have this disorder are often hesitant to seek treatment; this may be because society tends to view gambling as less acceptable for women than men.

Pathological gambling typically begins in adolescence for boys and later in life for girls (Bayer, 2000). It may be regular or episodic, but it is often chronic (Bayer, 2000). Environmental stressors or depression may increase the frequency of gambling (Bayer, 2000).

Treatment for compulsive gambling includes inpatient & outpatient programs, residential care, halfway houses, behavior modification, individual and group therapy, and traditional psychoanalysis (Bayer, 2000). Relapses are common.

DSM-IV-TR criteria

A. Persistent and recurrent maladaptive gambling behavior as indicated by five (or more) of the following:

1. is preoccupied with gambling (e.g., preoccupied with reliving past gambling experiences, handicapping or planning the next venture, or thinking of ways to get money with which to gamble)
2. needs to gamble with increasing amounts of money in order to achieve the desired excitement
3. has repeated unsuccessful efforts to control, cut back, or stop gambling
4. is restless or irritable when attempting to cut down or stop gambling
5. gambles as a way of escaping from problems or of relieving a dysphoric mood (e.g., feelings of helplessness, guilt, anxiety, depression)
6. after losing money gambling, often returns another day to get even (“chasing” one’s losses)
7. lies to family members, therapist, or others to conceal the extent of involvement with gambling
8. has committed illegal acts such as forgery, fraud, theft, or embezzlement to finance gambling
9. has jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling
10. relies on others to provide money to relieve a desperate financial situation caused by gambling

B. The gambling behavior is not better accounted for by a manic episode.

Associated features

Pathological gambling (PG) is characterized as a chronic, progressively maladaptive, impulse-control disorder, that is distinguished by continued acts of gambling despite compounding severe negative consequences. Individuals with PG may present distortions in thinking and may believe that money is both the cause and solution to all of their problems. Individuals with PG tend to be highly competitive, energetic, and easily bored. They may be overly concerned with others’ approval and may be extravagantly generous. When they are not gambling, they may considered to be workaholics or “binge” workers. They may be at risk for medical conditions associated with stress, and those seeking treatment have high rates of suicidal ideation and attempts. Individuals who suffer from PG often have problematic interpersonal relationships. These relationships become increasingly strained during the progression of the disorder. Some individuals with PG may try to legally finance gambling and living expenses through loans. Others may also commit illegal acts such as forgery, fraud, theft, or embezzlement in order to gain financing. There is evidence to support comorbidity of PG with alcohol abuse and depression. A 1992 study showed that 12.9% of heavy drinkers had a gambling problem, compared to 5% of nondrinkers. Comorbidity rates of PG and major depressive disorder can reach as high as 76%. Other associated features of PG include unemployment, substance abuse, and suicide attempts. Most pathological gamblers tend to deny their problem and therefore do not get help. Associated features also include repetitive behaviors which shares features with obsessive-compulsive disorder.

Child vs. adult presentation

Historically, PG has been stereotyped as an adult disorder, but with the vast growth of casino expansion and the creation of internet gambling, adolescent rates of PG have superseded adult prevalence rates by two to four times. According to a 2006 Adolescent Psychiatry article by Timothy W. Fong, gambling is a media-driven, socially acceptable form of behavior. Fong also noted that 86% to 93% of all adolescents have gambled for money at least once (2006). Seventy-five percent of those did it within the confines of their home, while 85% of parents did not care (Fong, 2006). Fong stated that adolescent gambling is the most popular risk-taking behavior seen in adolescents, trumping cigarettes, alcohol, drugs, and sex (2006). The reasons why adolescents start gambling in comparison to the reasons why adults start gambling are very different. Adolescents use gambling as a form of excitement, a relief of boredom, and a coping mechanism or relief from daily stress. Adolescents have a need to keep playing for spectator success, and gambling is a social acceptable form of competition.

Pathological Gambling Environmental Issues

Gender and cultural differences in presentation

More men than women are diagnosed with pathological gambling, with a 2:1 ratio, and men have a higher tendency to start at a younger age. Gambling usually begins in early adolescence in men and from ages 20-40 in women. Culturally, pathological gambling is more prevalent in minority groups. Socioeconomic status also strongly correlates; it is more common in poor individuals who cannot afford to gamble and who inevitably feel as though they cannot afford not to gamble.

Epidemiology

• As gambling facilities become more prevalent, so do PG rates. In fact, 2 million Americans are considered to be pathological gamblers, with another 3 million considered being “problematic gamblers,” and 15 million more considered to be at risk. There is a 4% prevalence rate in America. Prevalence rates in other countries vary. Worldwide rates range from 2% to 6%.
• Pathological gambling usually begins in early adolescence in males and later in life in females. A few individuals are “hooked” with their first bet, but for most the course is more insidious. Years of social gambling may be followed by an abrupt onset that may be precipitated by greater exposure to gambling or to some stressor. The pattern may be regular or episodic, and the course of the disorder is often chronic.

Etiology

The causes do not seem to be biological as there is no evidence to support it. A psychological cause is more likely. A pathological gambler typically has symptoms of depression or alcoholic tendencies. They usually turn to gambling to get the “high” of winning to escape from everyday problems or more serious life problems.

Empirically supported treatments

Pathological Gambling Environmental Act

• Treatment for PG includes therapy and possibly medication. Before treatment can begin, the individual must first realize that they do indeed have a problem and that they need help. Announcing this to friends and family is usually best. Treatment is based on behavior changes. The counselor will usually start by uncovering the underlying cause of the gambling addiction. If the patient is depressed then the depression is treated accordingly. For several of the people who stay in treatment, it is successful. On average, however, 50% drop out of the therapy.
• Aversion therapy is one option available to pathological gamblers. During aversion therapy, the patient is exposed to the stimulus while also being exposed to something that would cause them discomfort. Treatments usually try to help the patient overcome their impulses and learn to control urges. Also, the gambler must learn to overcome the illusion that they will “win the next time.”
• There are also self-help groups like Gamblers Anonymous that the patient can join. Groups for the family are also available.
• It is often recommended that the individual never return to gambling. It is also recommended that the individual never return to the places that he or she gambled, because returning causes the patient to be at high risk for a relapse.
• Medications such as antidepressants and opioid antagonists (naltrexone) may help, also.

Pathological Gambling Environmental Definition

• Follow this link to see more stats on gambling and to see what some of the signs are to help spot someone with a gambling problem: http://www.overcominggambling.com/facts.html