Problem gambling is an urge to gamble
continuously despite harmful negative consequences or a desire to stop.
Problem gambling is 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. Pathological gambling is a common disorder that is
associated with both social and family costs.
The DSM-5 has re-classified the condition as an addictive disorder, with
sufferers exhibiting many similarities to those who have substance addictions.
The term gambling addiction has long been used in the recovery movement.
Pathological gambling was long considered by the American Psychiatric
Association to be an impulse control disorder rather than an addiction.
However, data suggest a closer relationship between pathological
gambling and substance use disorders than exists between PG and
obsessive-compulsive disorder. 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.” The University of
Maryland Medical Center defines pathological gambling as “being unable
to resist impulses to gamble, which can lead to severe personal or social
consequences”. 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.
The DSM-V has since reclassified pathological gambling as “gambling
disorder” and has listed the disorder under substance-related and addictive
disorders rather than impulse-control disorders. This is due to the
symptomatology of the disorder resembling an addiction not dissimilar
to that of substance-abuse. In order to be diagnosed, an individual must have at
least four of the following symptoms in a 12-month period:
Needs to gamble with increasing amounts of money in order to achieve the desired
excitement Is restless or irritable when attempting
to cut down or stop gambling Has made repeated unsuccessful efforts
to control, cut back, or stop gambling Is often preoccupied with gambling
Often gambles when feeling distressed After losing money gambling, often
returns another day to get even Lies to conceal the extent of
involvement with gambling Has jeopardized or lost a significant
relationship, job, education or career opportunity because of gambling
Relies on others to provide money to relieve desperate financial situations
caused by gambling History and biology
According to the Illinois Institute for Addiction Recovery, evidence indicates
that pathological gambling is an addiction similar to chemical addiction.
It has been observbed that some pathological gamblers have lower levels
of norepinephrine than normal gamblers. According to a study conducted by Alec
Roy, 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.
According to a report from Harvard Medical School’s 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 neuroimaging
technique. And according to Hans Breiter, co-director of the Motivation
and Emotion Neuroscience Center at 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.” Studies have compared pathological gamblers to substance
addicts, concluding that addicted gamblers display more physical symptoms
during withdrawal. Deficiencies in serotonin might also contribute to
compulsive behavior, including a gambling addiction.
A limited study was presented at a conference in Berlin, suggesting opioid
release differs in problem gamblers form the general population, but in a very
different way from alcoholics or other substance abusers.
=Controversy over biomedical model=Some medical authors suggest that the
biomedical model of problem gambling may be unhelpful because it focuses only on
individuals. These authors point out that social factors may be a far more
important determinant of gambling behaviour than brain chemicals and they
suggest that a social model may be more useful in understanding the issue. For
example, an apparent increase in problem gambling in the UK may be better
understood as a consequence of changes in legislation which came into force in
2007 and enabled casinos, bookmakers, and online betting sites to advertise on
TV and radio for the first time and which eased restrictions on the opening
of betting shops and online gambling sites.
=Relation to other problems=Pathological gambling is similar to many
other impulse control disorders such as kleptomania. According to evidence from
both community- and clinic-based studies, individuals who are
pathological gamblers are highly likely to exhibit other psychiatric problems
concurrently, including substance use disorders, mood and anxiety disorders,
or personality disorders. Pathological gambling shows several
similarities with substance abuse. There is a partial overlap in diagnostic
criteria; pathological gamblers are also likely to abuse alcohol and other drugs.
The “telescoping phenomenon” reflects the rapid development from initial to
problematic behavior in women compared with men. This phenomenon was initially
described for alcoholism, but it has also been applied to pathological
gambling. Also biological data provide a support for a relationship between
pathological gambling and substance abuse.
In a 1995 survey of 184 Gamblers Anonymous members in Illinois, Illinois
State professor Henry Lesieur found that 56 percent admitted to some illegal act
to obtain money to gamble. Fifty-eight percent admitted they wrote bad checks,
while 44 percent said they stole or embezzled money from their employer.
Compulsive gambling can affect personal relationships. In a 1991 study of
relationships of American men, it was found that 10% of compulsive gamblers
had been married more than twice. Only 2% of men who did not gamble were
married more than twice. According to statistics by the BGM, families of
problem gamblers are more likely to experience child abuse or other forms of
domestic violence. Suicide rates
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 were problem gamblers. In the United States, a report by the National
Council on Problem Gambling showed approximately one in five pathological
gamblers attempt suicide. The council also said that suicide rates among
pathological gamblers were higher than any other addictive disorder.
David Phillips, a sociologist from the University of California-San Diego,
found “visitors to and residents of gaming communities experience
significantly elevated suicide levels”. According to him, Las Vegas, the largest
gaming market in the United States, “displays the highest levels of suicide
in the nation, both for residents of Las Vegas and for visitors to that setting”.
In Atlantic City, the second-largest gaming market, he found “abnormally high
suicide levels for visitors and residents appeared only after gambling
casinos were opened”. Mechanism
The findings in one review indicated the sensitization theory is responsible.
Dopamine dysregulation syndrome has been observed in the aforementioned theory in
people with regards to such activities as gambling.
Diagnosis The most common instrument used to
screen for “probable pathological gambling” behavior is the South Oaks
Gambling Screen developed by Lesieur and Blume at the South Oaks Hospital in New
York City. In recent years the use of SOGS has declined due to a number of
criticisms, including that it overestimates false positives.
The DSM-IV diagnostic criteria presented as a checklist is an alternative to
SOGS, it focuses on the psychological motivations underpinning problem
gambling and was developed by the American Psychiatric Association. It
consists of ten diagnostic criteria. One frequently used screening measure based
upon the DSM-IV criteria is the National Opinion Research Center DSM Screen for
Gambling Problems. The Canadian Problem Gambling Inventory is another newer
assessment measure. The Problem Gambling Severity Index, which focuses on the
harms associated with problem gambling, is composed of nine items from the
longer CPGI. Treatment
Most treatment for problem gambling involves counseling, step-based
programs, self-help, peer-support, medication, or a combination of these.
However, no one treatment is considered to be most efficacious and no
medications have been approved for the treatment of pathological gambling by
the U.S. Food and Drug Administration. Only one treatment facility has been
given a license to officially treat gambling as an addiction, and that was
by the State of Virginia. Gamblers Anonymous is a commonly used
treatment for gambling problems. Modeled after Alcoholics Anonymous, GA uses a
12-step model that emphasizes a mutual-support approach. There are three
in-patient treatment centers in North America. One form of counseling,
cognitive behavioral therapy has been shown to reduce symptoms and
gambling-related urges. This type of therapy focuses on the identification of
gambling-related thought processes, mood and cognitive distortions that increase
one’s vulnerability to out-of-control gambling. Additionally, CBT approaches
frequently utilize skill-building techniques geared toward relapse
prevention, assertiveness and gambling refusal, problem solving and
reinforcement of gambling-inconsistent activities and interests.
As to behavioral treatment, some recent research supports the use of both
activity scheduling and desensitization in the treatment of gambling problems.
In general, behavior analytic research in this area is growing There is
evidence that the SSRI paroxetine is efficient in the treatment of
pathological gambling. Additionally, for patients suffering from both
pathological gambling and a comorbid bipolar spectrum condition, sustained
release lithium has shown efficacy in a preliminary trial. The opioid antagonist
drug nalmefene has also been trialled quite successfully for the treatment of
compulsive gambling.=Step-based programs=
Other step-based programs are specific to gambling and generic to healing
addiction, creating financial health, and improving mental wellness.
Commercial alternatives that are 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.
=Motivational interviewing=Motivational interviewing is one of the
treatments of compulsive gambling. The motivational interviewing’s basic goal
is promoting readiness to change through thinking and resolving mixed feelings.
Avoiding aggressive confrontation, argument, labeling, blaming, and direct
persuasion, the interviewer supplies empathy and advice to compulsive
gamblers who define their own goal. The focus is on promoting freedom of choice
and encouraging confidence in the ability to change.
=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 while allowing them to attempt recovery on their own,
often without having to disclose their issues to loved ones.
=Self-help=Research into self-help for problem
gamblers has shown benefits. A study by Wendy Slutske of the University of
Missouri concluded one-third of pathological gamblers overcome it by
According to the Productivity Commission’s 2010 final report into
gambling, the social cost of problem gambling is close to 4.7 billion dollars
a year. Some of the harms resulting from problem gambling include depression,
suicide, lower work productivity, job loss, relationship breakdown, crime and
bankruptcy. A survey conducted in 2008 found that the most common motivation
for fraud was problem gambling, with each incident averaging a loss of $1.1
=Europe=In Europe, the rate of problem gambling
is typically 0.5 to 3 percent. The “British Gambling Prevalence Survey
2007”, conducted by the United Kingdom Gambling Commission, found approximately
0.6 percent of the adult population had problem gambling issues—the same
percentage as in 1999. The highest prevalence of problem gambling was found
among those who participated in spread betting, fixed odds betting terminals
and betting exchanges. In Norway, a December 2007 study showed the amount of
present problem gamblers was 0.7 percent.
=North America=In the United States, the percentage of
pathological gamblers was 0.6 percent, and the percentage of problem gamblers
was 2.3 percent in 2008. Studies commissioned by the National Gambling
Impact Study Commission Act has shown the prevalence rate ranges from 0.1
percent to 0.6 percent. Nevada has the highest percentage of pathological
gambling; a 2002 report estimated 2.2 to 3.6 percent of Nevada residents over the
age of 18 could be called problem gamblers. Also, 2.7 to 4.3 percent could
be called probable pathological gamblers.
According to a 1997 meta-analysis by Harvard Medical School’s division on
addictions, 1.1 percent of the adult population of the United States and
Canada could be called pathological gamblers. A 1996 study estimated 1.2 to
1.9 percent of adults in Canada were pathological. In Ontario, a 2006 report
showed 2.6 percent of residents experienced “moderate gambling problems”
and 0.8 percent had “severe gambling problems”. In Quebec, an estimated 0.8
percent of the adult population were pathological gamblers in 2002. Although
most who gamble do so without harm, approximately 6 million American adults
are addicted to gambling. Signs of a gambling problem include:
Using income or savings to gamble while letting bills go unpaid
Repeated, unsuccessful attempts to stop gambling
Chasing losses Losing sleep over thoughts of gambling
Arguing with friends or family about gambling behavior
Feeling depressed or suicidal because of gambling losses
=Oceania=Both casinos and poker machines in pubs
and clubs facilitate problem gambling in Australia. The building of new hotels
and casinos has been described as “one of the most active construction markets
in Australia”; for example, AUD$860 million was allocated to rebuild and
expand the Star Complex in Sydney. A 2010 study, conducted in the Northern
Territory by researchers from the Australian National University and
Southern Cross University, found that the proximity of a person’s residence to
a gambling venue is significant in terms of prevalence. Harmful gambling in the
study was prevalent among those living within 100 metres of any gambling venue,
and was over 50% higher than among those living ten kilometres from a venue. The
study’s data stated: “Specifically, people who lived 100
metres from their favourite venue visited an estimated average of 3.4
times per month. This compared to an average of 2.8 times per month for
people living one kilometre away, and 2.2 times per month for people living
ten kilometres away”. According to the Productivity
Commission’s 2010 report into gambling, 0.5% to 1% of the Australian adult
population suffered with significant problems resulting from gambling. A
further 1.4% to 2.1% of the Australian adult population experienced moderate
risks making them likely to be vulnerable to problem gambling.
Estimates show that problem gamblers account for an average of 41% of the
total gaming machine spending. See also
Gambler’s Lament, an ancient poem about gambling
Gambling Commission GamCare
Gaming law National Council on Problem Gambling
National Council on Problem Gambling Problem Gambling Foundation of New
External links Gamblers Anonymous
National Council on Problem Gambling Gambler’s Help Southern – Australia
National Center for Responsible Gaming Know the Odds Gambling Resources
Contributions of Mathematics in Problem Gambling