Information
Editors
Gambling Addiction
Essentials
- Resembles other addictions; a strong urge to gamble even though it causes problems.
- Gambling addiction is a complex disorder, the onset of which may be influenced not only by neurobiological and genetic predisposition, but also by social causes, certain personality traits and several environmental factors.
- 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
- The dopamine agonists pramipexole and ropinirole and the dopamine modulator aripiprazole are probably associated with an increased risk of developing a gambling problem.
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.
Risk factors
- At-risk groups include, for example, young people, the elderly, prisoners and people with low socio-economic status.
- Being at risk means that there are specific causes that expose these groups to gambling problems and may contribute to the development of gambling into a harmful activity.
Identification
- Questions about gambling should be asked in a low threshold manner, e.g. at pupil and student health services and occupational health and age group examinations.
- Systematic screening for gambling problems is warranted when a patient presents to health care with other mental health or substance abuse problems.
- The BBGS (Brief Biosocial Gambling Screen http://www.divisiononaddiction.org/outreach-resources/gdsd/toolkit/bbgs/), which assesses gambling history over the previous 12 months using three questions, is an appropriate screening tool.
- 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 with living expenses from family, friends or welfare?
- The patient should be examined for any other psychiatric disorders.
- Diagnostic criteria (ICD-10), pathological gambling (F63) used as the term
- 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.
- Criteria according to the ICD-11 will come into effect in the coming years.
- 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.
- Routine pharmacotherapy with naltrexone is not recommended as first line therapy.
- If pharmacotherapy is used as supportive therapy to prevent relapses, potential adverse effects should be monitored. When initiating pharmacotherapy, the patient's overall situation and any associated symptoms should be assessed.
- Services for substance abusers
- Peer support groups, such as Gamblers Anonymous http://www.gamblersanonymous.org/ga/
- Self-help groups and services
- Check locally available services, websites and other resources.
References
- Alho H, Aalto M, Castren S, Pajula M (eds.). [Gambling and gaming addiction]. Duodecim Publishing Company Ltd 2022. ISBN: 978-952-360-061-4.
- Potenza MN, Balodis IM, Derevensky J, et al. Gambling disorder. Nat Rev Dis Primers 2019;5(1):51.[PubMed]