Pathological Gambling: The Problem

Pathological Gambling: The Problem

            Gambling has been around for thousands of years, from the ancient Greeks to colonial settlers in America to today’s online poker tournament participants.  Since the 1930’s, when Nevada was allowed to reintroduce legal gambling in the form of a casino, gambling addictions have grown increasingly prevalent.  There are two types of addicted gamblers; problem gamblers and pathological gamblers.  NHI.gov defines pathological gambling as being unable to resist impulses to gamble, which can lead to severe personal and/or social consequences.(“Pathological gambling”, 2013) Pathological gamblers suffer the most out of all addicted gamblers and have the most impaired lives.  Problem gamblers can include both pathological gamblers and those who have less severe forms of the addiction.  NCPgambling.org defines problem gambling as gambling that can cause disruptions in any area of life whether it is psychological, physical, social, or vocational.  (“National council on,” 2013) Now that it is clear what the broad definition for problem gambling is, we can take a closer look at what specific factors are examined in order to diagnose the disorder.

The DSM outlines the symptoms that must be present in order for a person to be diagnosed as a pathological gambler.  DSM–IV–TR (2000) 4th ed., text rev. states the following:

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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 adysphoric 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.­­­­­­­­­­­­­­­­­

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It is important to note how many of the symptoms cover biological, psychological, and social factors that are consequences of gambling.  Many of the symptoms outlined deal with preoccupied thoughts of gambling all the time.  Social consequences such as lying to family and friends are also present.  The need to wager more money in order to feel excitement shows how gambling addictions are similar to substance addictions where a tolerance is built up and more is needed to achieve the desired effect.  Along with the DSM, there are tests used by counselors to diagnosis a gambling addiction.  The most widely used test is the South Oaks Gambling Screen.  The test starts with a series of questions about how often one has exhibited certain gambling behaviors.  It then asks a series of mostly yes or no questions that help determine whether or not you are addicted.  For example, “Have you ever felt like you would like to stop betting money on gambling, but did not think that you could?” or “Have you ever hidden betting slips, lottery tickets, gambling money, IOUs, or other signs of betting or gambling from your spouse, children or other important people in your life?” are questions that are used to help determine if the person has a problem or not.   (“South oaks gambling,” 2013) One can receive a maximum score of twenty on the screening.  A few questions are not counted towards the scoring and are only used to determine diagnosis if the total score shows a person is at risk.  If one scores a zero then they have no gambling problems.  If someone scores a one through four they may have some problems with gambling.  If a person scores a five or higher than it is likely that they are a pathological gambler.  Screenings such as the South Oaks along with the DSM are the main tools use to diagnosis a person as a pathological gambler.

Pathological gambling diagnoses have become increasingly prevalent in United States.  According to rehab-international.org, 2.5 million adults suffer from compulsive gambling and three million could be considered problem gamblers. (“Statistics,” 2013) The number of people who are at risk for becoming problem gamblers is estimated at fifteen million.  2.9 percent of the United States population are considered problem gamblers, with .6 percent of them being pathological gamblers.  Many statistics show that Whites have more gambling problems than other ethnicities, however more recent studies have shown that Blacks and Hispanics have had increased gambling addiction prevalence in recent years.  Overall, men are much more likely to be pathological gamblers than women.  Of those who are problem gamblers, men generally first experience problems in early adolescence while females experience problems later in adulthood.  It is estimated that fifteen to thirty-three percent of compulsive gamblers also have drug and/or alcohol addictions.  In the United States, Nevada has the highest prevalence rate of pathological gamblers at 2.5-3.5 percent of the population.  These numbers are likely as high as they are due to the high volume of casinos in Las Vegas.  Other countries have also shown it has problems with compulsive gambling.  Australia and the territory of Puerto Rico have among the highest prevalence rates of compulsive gambling at seven percent.  Approximately .5-3 percent of Europeans are compulsive or problem gamblers.  Although many of these statistics are fairly consistent across the research, it is important to keep in mind that many websites, even those with “.org” or “National Center for”, are run by politics and these political agendas may display the statistics in a way that helps their cause. Young (2013) suggested that an increasing prevalence in diagnostics for pathological gambling has allowed casinos and gambling companies to shift responsibility from themselves to the customer.  Political lobbyists for the casinos have allowed this to happen and as a result some of the prevalence statistics could not only be fudged, but used to the advantage of casinos and lotteries.  In another article, Young (2013) describes how many national surveys on the prevalence of pathological gambling are flawed, yet they continue to go unchallenged by many researchers and the public.  Because of the political and commercial factions present, it is important to research and know where the prevalence statistics are coming from and who conducted the research.

There are several biological, social, and psychological risk factors that can lead one to become a pathological gambler. Balon (2005), reviewed a book called the Biology of Gambling, and concluded that it is still not completely known what the exact biological risk factors for becoming a gambling addict are, however there is a large amount of research that can give us a better idea about what some of the biological causes could be.  Fong (2005) extensively researched some of the biopsychosocial that serve as the basis and consequences of addiction.  Some of the biological risk factors include alterations in dopamine and serotonin function, genetic loading, and neurophysiological responses to gambling.  People who are compulsive gamblers are more genetically prone to acting in compulsive ways in general in life.  Some of the neurochemical differences in those prone to gambling problems may cause impairment in responses to reward, impulsivity, learning, and self-control.  Some of the neuroimaging that has been done shows that the parts of the brain affected are the anterior cingulate, orbitofrontal cortex, and the midbrain reward circuitry. The research suggests people are born with these neurochemical imbalances and highly reactive parts of the brain are at higher risk for gambling and substance addictions.  In terms of biological consequences of addiction, researchers have not been able to prove that compulsive gambling directly causes biological changes in a person, however some of the experiences that come with gambling addictions can cause changes.  For example, many pathological gamblers experience a high amount of stress when they are not gambling or when they try to stop but cannot.  This stress and anxiety can cause neurotransmitter changes in the same way a mood disorder can.

In addition to biological factors there are several psychological factors that can lead to pathological gambling.  Some of these factors include personality features, such as dysfunctional impulsivity, impaired reward processing, poor coping mechanisms to stress, and defense mechanisms such as guilt and shame that can continue make addiction become worse. The addiction is listed as an impulse control disorder in the DSM so many of the psychological factors fall under the same category as those who have impulsive personalities. Many pathological gamblers are also depressed or bipolar.  Comorbidity rates are nearly seventy-five percent for depression and thirty percent for bipolar disorder. (Fong, 2005)  Many of these mood disorders increase in severity when a pathological gambler tries to stop gambling.  This helps to show how mood disorders can be both a cause and a consequence of the behavior.  Those who are biologically prone to impulsivity and are depressed may start gambling as a way to avoid their problems.  As a result, when they become addicted to gambling they become even more depressed when they try to stop.  Another psychological factor associated with pathological gambling is a distorted cognitive framework.  Many addicted gamblers cannot stop because they have unrealistic dreams of success and winning big amounts.  They continue to gamble after huge losses in attempt to prove their own self-worth.

In addition to biological and psychological factors, social factors drive the basis and consequences of pathological gambling.  Some of the social risk factors include access to gambling, influence from family and friends, and the age of onset for gambling.  These factors all work together and create vulnerability in particular demographic groups and increase the group’s risk overall.  Other factors and consequences include problems at work, strained interpersonal relationships, and trouble with the law.  Overall, close to five billion dollars a year and forty billion dollars in lifetime costs are lost due to gambling in addition to the legal consequences that sometimes result in pathological gambling. (Fong, 2005)  One study showed that the average debt of a compulsive gambler is as high as forty thousand dollars.  Peer and family influences are very important social factor that lead to compulsive gambling.  If a person spends a great deal of time with others who gamble they are much more likely to develop a gambling addiction.  Those who have family members, parents in particular, who have gambling problems are much more likely to become addicted to gambling themselves.  Other factors such as proximity to casinos and to others who gamble frequently have shown to be social risk factors.  Other than the tremendous financial problems associated with the addiction, legal and family problems are likely to occur as well.  Pathological gamblers are more likely than average to become divorced from their spouse.  They experience strained relationship with their family members due to being emotionally absent and attempting to constantly borrow money without repayment.  In a Gamblers Anonymous survey, nearly fifty-seven percent of participants admitted to stealing money to finance gambling.  Other research has shown that nearly thirty to forty percent of white-collar crimes are related to pathological gambling.  A newer risk factor that is currently under further research is the effect of gambling on homelessness.  Pathological gambling has led to homelessness in many places and those who become homeless as a result of gambling continue to gamble.

As a result of the problems of pathological gambling, several organizations and foundations have been developed to help prevent and treat pathological gambling.  One of the largest groups that helps pathological gamblers is Gambler Anonymous.  They describe the organization as a program for people who struggle with gambling addiction which is free and provides counseling along with storytelling which helps people overcome addiction. (Gamblers anonymous, 2013)  They use a twelve step program to help addicts overcome their addiction.  Another major organization devoted to help gambling addicts is the National Council on Problem Gambling.  The mission of the council is to increase public awareness of problem gambling and to provide access to treatment programs. (National council on, 2013)  The website provides information and statistics on problem gambling in addition to an extensive list of counseling programs available in each state.  A third major organization for problem gamblers is the National Center for Responsible Gaming.  They are an organization devoted to funding research that increases understanding of pathological and youth gambling and find effective ways to treat the addiction. (National center for, 2013)

Each year, the National Council on Problem Gambling holds a national conference where all are invited to hear several talks and participate in activities that increase awareness for problem gambling.  The 2012 conference was held in Milwaukee, Wisconsin.  There were several guest speakers who presented research on problem gambling and talked about ways to reduce its prevalence in the United States.  There were also several workshops and breakout sessions that kept participants actively involved in awareness and prevention.

In 2012, Tim McGowan wrote an article for CNN.com entitled, The gambling game: Soccer’s battle with betting.  The article discussed the problems with the prevalence of betting in English Premier League soccer.  Not only do many of the fans bet on the games but several of the players have been found to bet under the table.  Some of the famous soccer players such as Wayne Rooney have been known to own race horses and gamble through that channel.  The players have been taken to court for taking large bribes to perform one way or another in major soccer games.  A former FIFA president was taken to court for taking 1.5 million dollars in bribes. (McGowan, 2012)  Some of the soccer players have become immersed in the gambling culture and have been known to have alcohol and gambling problems.  There are several strict laws in place that determine what soccer players can bet on and what they cannot bet on, but some people feel that these laws are not being taken seriously enough.  It is important for politicians to continue to pass legislation that prohibits gambling by athletes on their own respective sports.  These laws must not only be passed, but strictly enforced.

In a study by Rosenberg et. al. (2013), pathological gamblers were assigned four types of medicine that were supposed to help treat their gambling addictions.  The study had seventy-eight participants who were allocated to take naltrexone, topiramate, bupropion, or escitalopram for a two year period.  After the two year period of taking the drug there was a two year follow up with each of the participants.  The amount of success of the drug usage was measured by the 21-item Hamilton Depression Rating Scale, the Hamilton Anxiety Rating Scale, the Global Assessment of Functioning, and the Visual Analog Scale.  These measures were taken before treatment and one month, six months, twenty-four months, and forty-eight months after treatment started.  During the first two years of treatment thirty-four participants dropped out of the program.  Significant improvement on all rating scales was seen in each group after two years of using the drug with the exception of the Hamilton Anxiety Scale in the group that took topiramate.  The results of this study show that medication can potentially be an effective treatment in aiding the recovery of pathological gamblers.  The researchers highlighted that biopsychosocial treatments are necessary and medication should not be the only form of treatment in a person who is addicted to gambling.

With an increased prevalence and several biological, social, and psychological consequences it is clear that pathological and problem gambling is an issue for not only millions of people with the problem, but the millions more who are affected by problem gambling.  Research and organizations that increase awareness of problem gambling can help prevent the spread of this addiction.

 

 

Work Cited

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC

This is a great source of information when looking over disorders.  The DSM is the authority in psychology in terms of diagnosing disorders in people.  I used the most up to date version of the DSM so all diagnostic criteria should be both accurate and relevant.

 

Balon, R. (2005). Review of the biology of gambling. The American Journal of Psychiatry,         162(1), 201. doi: 10.1176/appi.ajp.162.1.201

I used this review article to introduce the idea that biology behind pathological gambling is still being heavily researched.  Balon does a good job describing where some of the research is lacking.  This article is from 2005 so it may not completely cover everything we know now and we may have had some scientific advances in research since the article was written, however it still provides a good explanation of some of the lacking research.  Because this is from an established, peer-reviewed psychiatry journal, it should have been appropriately reviewed.

 

Fong, T. (2005, March). The biopsychosocial consequences of pathological gambling.   Psychiatry, 2(3): 22-30 Retrieved from:    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3004711/

This was an extremely helpful research article about the biological, social, and psychological consequences of pathological gambling.  It is from 2005 so it is fairly recent although it may be lacking some information from more recent years.  It is from the peer reviewed journal, Psychiatry so its authority is adequate.

 

Gamblers anonymous. (2013). Retrieved from http://www.gamblersanonymous.org/ga/node/1

This was taken from the Gamblers Anonymous website.  It was adequate in giving the appropriate information I needed to give a basic explanation of what the foundation was all about.  All information is current and up to date.  In terms of organizations for pathological gambling, this site provides appropriate detailed information compared to the others.

 

McGowan, T. (2012, July 12). The gambling game: Soccer’s battle with betting. CNN.com.      Retrieved from http://www.cnn.com/2012/07/12/sport/football/fifa-spot-fixing   football/index.html?iref=allsearch

This was a news article from CNN.com.  CNN.com has a wide variety of news article and is a great source of information.  I go to this site for my news every day.  News sites can potentially be biased however I feel CNN is one of the better forms of media that remains unbiased, which is why I searched the website for an article about gambling.  The article is from last year so it is in line with current news about gambling.

 

National center for responsible gaming. (2013). Retrieved from http://www.ncrg.org/

This was one of the websites I found for organizations that deal with gambling addictions.  It was up to date and provided good information about gambling addiction and what the organization does for people.

 

National council on problem gambling. (2013, May 18). Retrieved from            http://www.ncpgambling.org/i4a/pages/index.cfm?pageid=1

I used this website to describe an organization and for statistics.  It is a good source of information on the basics of the addiction.  Information is updated frequently so everything on the website is current information.  It was especially effective in discussing the national conference on problem gambling.

 

Rosenberg, O., Dinur, L., & Dannon, P. (2013). Four-year follow-up study of pharmacological treatment in pathological gamblers. Clin Neuropharmacol, 36(2), 42-45. doi:       10.1097/WNF.0b013e31828740ea.

This was the research article I reviewed.  It was a study from a journal that was peer reviewed.  It was published only a few months ago so all the information is very current.  I chose this study because I wanted to look at a current research article that dealt with the use of medication in treatment of gambling addiction

 

Shaffer, H. J., & LaPlante, D. A. (2013). Considering a critique of pathological gambling           prevalence research. Addiction Research & Theory, 21(1), 12-14. doi:         10.3109/16066359.2012.715223

I used this source because it comes from a peer reviewed journal that was published very recently.  It helped me explain how political and commercial agendas have affected some of the prevalence statistics for pathological gambling.

 

South oaks gambling screen. (2013). Retrieved from:    http://www.stopgamblingnow.com/sogs_print.htmI

This source was used so I could give an example of a widely used screening for compulsive gambling.  It is used all the time by counselors and is fairly valid.  It is the best source to use in terms of screens used to determine gambling problems.

 

Statistics. (2013). Retrieved from http://rehab-international.org/gambling-addiction/gambling       addiction-statistics/

I used this website to find statistics on prevalence statistics for problem gambling.  It was recently updated, however it is unclear whether or not there was some political motive behind the website.  It may not be the best source, which is why I used others along with research showing how commercial and political ventures may have influenced some of the statistics.

 

Vorvick, L., & Rogge, T. (2012, Febuary 13). Pathological gambling. Retrieved from            http://www.nlm.nih.gov/medlineplus/ency/article/001520.htm

I used this website to find statistics and basic information about pathological gambling.  It had fairly recent information but I am unsure whether it was peer reviewed.  It appeared to be from an appropriate website because it was from a National Health Institute labled “.gov”.

Young, M. (2013). ‘following the money’: The political economy of gambling research.  Addiction Research & Theory, 21(1), 17-18. doi: 10.3109/16066359.2012.719053

I used this source because it comes from a peer reviewed journal that was published very recently.  It helped me explain how political and commercial agendas have affected some of the prevalence statistics for pathological gambling.

Young, M. (2013). Statistics, scapegoats and social control: A critique of pathological gambling prevalence research. Addiction Research & Theory, 21(1), 1-11. doi:           10.3109/16066359.2012.680079

I used this source because it comes from a peer reviewed journal that was published very recently.  It helped me explain how political and commercial agendas have affected some of the prevalence statistics for pathological gambling. It is from the same author as the previous citation and is written about the same subject.