Understanding Pathological Gambling

About gambling

Gambling has been around for hundreds of centuries. Its inception can be traced back ancient societies such as the Egyptians, Persians, and Japanese. In Ancient Rome, several emperors were said to be avid gamblers. Augustus Caesar was passionately addicted to gambling. Throughout the world, gambling is especially common, and over the past twenty years gambling enterprises have increased dramatically. In the United States, forty-eight of the fifty states have legalized gambling in some form. In the general population it is estimated that 4 out of 5 people engage in gambling. However, gambling can become pathological when taken to an extreme. It's estimated that about 2% have a problem whereby they can't stop themselves from gambling, also called compulsive or pathological gambling. Along with illegal sports betting and the rise of online gambling, the issue of pathological gambling is becoming increasingly widespread. It poses not only a threat to public health, but also to economic and social aspects of society.

Who is affected by compulsive gambling?

The onset for gambling problems is earlier for men than women, usually beginning during adolescence, whereas for women the problem starts later in life. Co-occurring disorders especially substance abuse, mood disorders, and ADHD, are common with compulsive gambling. Occasionally personality disorders, such as borderline personality disorder, accompany pathological gambling. For women who are diagnosed it is common for depression to be present as well. Alcoholism is particularly common among those with compulsive gambling since casinos often offer free alcoholic beverages to patrons. Cross-cultural differences are also present in compulsive gambling, as the popularity of gambling activities in different countries varies. Also, perceptions of the disorder change from culture to culture. Gambling in the United States is so commonplace that pathological gambling is often unnoticed.

A real mental health problem

Mental health professionals consider pathological gambling as under the heading "Impulse Control Disorders Not Elsewhere Classified." It lists ten maladaptive gambling behaviors that characterize the chronic disorder. At least five must be present and persistent in a person for them to receive a diagnosis. These behaviors cover three main areas: loss of control, progressive increase in gambling practices (such as time and money spent), and inability to stop. It is not uncommon for a person to be restless or irritable when attempting to cut down or stop gambling. Pathological gambling is also characterized by harm to the person's social functioning, and it is also possible for someone to jeopardize or lose a significant relationship, job, or educational career opportunity because of gambling. Compulsive gambling may also be seen when someone had a manic episode in bipolar disorder, but in that case the person is diagnosed with bipolar disorder, not pathological gambling

An accurate description of the disorder would be to say the person has uncontrollable urges to gamble despite obvious consequences. These urges eventually affect the person's life in all aspects, even destroying relationships and careers. The disorder is progressive and is characterized by different stages. For instance, the "chasing" of losses is often considered a pivotal stage in the development of pathological gambling. It is defined as continuing to gamble in order to make up for losses. This is illustrative of how pathological gamblers have difficulty stopping the behavior.

Causes of compulsive gambling

Probable causes of this disorder vary. Earlier psychological perspectives saw pathological gambling as type of neurosis. Freud's psychoanalytic perspective saw gambling as an expression of guilt and self-punishment. Today, one accepted cause of the disorder is based on neurobiology, in particular, neurotransmitter dysfunctions, which is typical of impulse-control disorders. Serotonin, nonepinephrine, and dopamine to all be significant in either the development or manifestation of pathological gambling. In particular, the dopamine function is of particular interest. Genetic defects involving dopamine receptors, which are thought to be associated with many addictive disorders, may result in a dysregulation of the associated reward pathways. Gambling activates these pathways and perhaps alters them with increases in maladaptive gambling behaviors. Another theory is that cognitive biases may be the cause of compulsive gambling. Biases are an individual's irrational beliefs, cognitive distortions, and erroneous perceptions about his or her ability to influence, control, or predict the outcome of a chance event. People who gamble think they can eventually beat the system and come out ahead, even though they know the odds of winning are not in their favor.

Overcoming a gambling addiction

There are multiple treatment options for compulsive gambling. The most common are Gamblers Anonymous (modeled after the successful Alcoholics Anonymous), cognitive behavioral therapy (CBT), and various drug treatments. CBT as a treatment for pathological gambling is a fairly new option that is being tested for success. Cognitive behavioral therapy has been found to correct the cognitive biases that may create the maladaptive gambling patterns. Research studies show that groups given some form of cognitive behavioral therapy improved in gambling behaviors, and subjects with individual therapy sessions did even better. Additionally, psychological and social problems decrease with any type of treatment. Drug-treatment studies are even less common than those on CBT for pathological gambling. Serotonin Reuptake Inhibitors (SRIs), mood stabilizers, and opioid antagonists have all been tried with some success, but since research studies have used fairly small sample sizes the results must be taken with a grain of salt. The prognosis for compulsive gambling is usually good, ending with the patient decreasing and ultimately stopping gambling and associated behaviors.

Profiles in gambling

In the Singapore Medical journal, Dr. K. D. Lim described a case study of a 32-year-old Asian housewife diagnosed with pathological gambling. The woman grew up in a farming village. There was a history of problem gambling in her family, exemplified by her father who was a problem gambler. This was one of the multiple factors that predisposed the patient to developing pathological gambling. Other factors included a lack of social support and boredom, which essentially was the impetus for her to begin gambling. At the age of twenty, when the patient was pregnant with her first child, she began to play cards with her friends as a leisurely way to relieve boredom.

The woman's symptoms included an irresistible urge and preoccupation to gamble; her longest abstinence from gambling only lasted five days, illustrating a strong drive to gamble. Her gambling problem also resulted in physical, psychiatric, and social complications, including lack of sleep and not eating. Furthermore, the patient's increasing losses due to gambling had caused a depressed mood, although she was never diagnosed with major depression.

The patient's treatment included a variety of methods. Dr. Lim describes the most important components as "surveillance of her gambling activity, cognitive restructuring, family work, relapse-prevention, and pharmacotherapy." This included a form of cognitive behavioral therapy, mentioned earlier as one of the newer and effective way at treating people with pathological gambling. In this case, the CBT focused on changing certain unrealistic thoughts the patient had about her activities, such as her perception of her gambling skills. Medicine was also prescribed, and she was directed to take fluvoxamine after a series of relapses. The woman's treatment and outcome was effective; she became motivated to stop gambling, resulting in an improvement of her social functioning, her marriage, and relationship to her children.

Compulsive gambling is a complex problem

Pathological gambling is a disorder that has been in the mental health spotlight in recent decades due to ever increasing gambling activity. For people with problem gambling, help is available and is truly effective. New research continues to focus on creating better treatment methods or improving the already existent ones. 


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