Information
Editors
Gambling Addiction
Essentials
- Resembles other addictions; a strong urge to gamble even though it causes problems.
- Gambling disorder is a functional addiction with background factors and symptomatology similar to substance addictions.
- Causes shame, anxiety and depression making it more difficult to admit that there is a problem and to seek treatment.
- Often associated with other mental or substance-related disorder
- Treatment by psychotherapeutic methods
- Dopaminergic antiparkinsonian drugs evidently predispose to pathological gambling and increase the possibility of developing gambling addiction.
Characteristics
- Strong, compulsive urge to gamble in order to win, to get the associated excitement (feeling good or "high") or to get rid of worries
- Increased tolerance leads to gambling increasingly often or for higher stakes.
- Continuous or periodically repeated gambling
- Gambling is central to life, and images associated with gambling are predominant in the person's mind.
- Tolerance increases, i.e. the invested stakes/sums increase. After losing, the person must play again to compensate for the loss.
- Gambling continues even if it causes problems. Despite attempts, it is not possible to control, reduce or stop gambling.
- Withdrawal symptoms: restlessness, irritability, anxiety, guilt, low mood
- Covering up the gambling problem and lying to relatives (about the time or money spent, about running into debt)
- Financial or social problems follow: money acquired for gambling by theft, for example; work or relationships become secondary to gambling, etc.
- Often associated with the use of intoxicants, and concomitant depression or personality disorder may predispose to compulsive gambling.
- Depression, anxiety, guilt, shame, despair, self-destructiveness
- Grades of severity as for other addictions: risk gambler, problem gambler, gambling addict
- Gambling that is under control is often social and limited in time, and the stakes are moderate.
- Symptoms may vary with time.
Identification
- Even one Yes response in the Brief Biosocial Gambling Screen (BBGS) suggests a gambling problem.
- During the past 12 months, have you become restless, irritable or anxious when trying to stop/cut down on gambling?
- During the past 12 months, have you tried to keep your family or friends from knowing how much you gambled?
- During the past 12 months did you have such financial trouble as a result of your gambling that you had to get help from family or friends?
- The patient should be examined for any other psychiatric disorders.
- Diagnostic criteria (ICD-10)
- Two or more episodes of gambling per year
- These episodes do not have a profitable outcome for the person, but are continued despite personal distress and interference with personal functioning in daily living.
- The intense urge to gamble is difficult to control so that the patient is unable to stop gambling by an effort of will.
- The person is preoccupied with thoughts or mental images of the act of gambling or the circumstances surrounding the act.
- For DSM-5 criteria of gambling disorder, see e.g. http://www.problemgambling.ca/EN/ResourcesForProfessionals/Pages/DSM5CriteriaGamblingDisorder.aspx.
- Self-assessment tests like SOGS (South Oaks Gambling Screen) and PGSI (Problem Gambling Severity Index) are available.
Treatment
- Psychotherapeutic methods, such as cognitive behavioural therapy Psychological Therapies for Problem Gambling Cognitive Psychotherapy and motivational interviewing The Role of Motivational Interviewing in Changing Lifestyles and in Treatment
- To succeed, patients must admit the problem to themselves and their families.
- Distorted thoughts associated with gambling must be put right (distorted ideas about gambling events and the chances of winning, lucky days, rituals, etc.).
- Keeping things secret and lying usually make anxiety and loneliness worse and predispose to a continued spiral.
- Services for substance abusers
- Peer support groups, such as Gamblers Anonymous http://www.gamblersanonymous.org/ga/
- Information and support services (telephone- or web-based)
- Pharmacotherapy can be tried in addition to psychotherapy and other treatments, particularly at an early stage.
- Opioid antagonists (off-label): naltrexone 50 mg once daily or nalmefene 18 mg once daily
- Mood-stabilizing drugs (lithium), second-generation antipsychotics (such as olanzapine) or antidepressants (such as citalopram) in usual doses may help some patients.
- Being able to reduce or control one's gambling is a good plan to motivate the patient and start the treatment. However, the eventual target should always be complete abstinence from gambling.
- Check relevant websites and other locally available resources.