Substance addiction (or drug addiction) is a neuropsychiatric disorder characterized by a recurring desire to continue taking the drug despite harmful consequences. Non-substance addiction (or behavioral addiction) covers pathological gambling, food addiction, internet addiction, and mobile phone addiction. Their definition is similar to drug addiction but they differ from each other in specific domains. A non-substance addiction includes things such as gambling, risky sex, food, the internet, mobile devices, and shopping. These are sometimes called behavioral addictions.
Gambling disorder involves repeated, problem gambling behavior. The behavior leads to problems for the individual, families, and society. Adults and adolescents with gambling disorder have trouble controlling their gambling[1]. The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) replaced the DSM-IV diagnosis of Pathological Gambling (PG) with Gambling Disorder (GD). GD requires four rather than five criteria for the diagnosis and excludes the “Illegal Acts” criterion.
Symptoms
To meet the criteria for gambling disorder, a person has to have at least four of the problems identified below, within a 12-month period, in conjunction with persistent and recurrent problematic gambling behavior[2]:
- Needing to gamble with more money to get the same excitement from gambling as before
- Feels restless or irritable when trying to reduce or stop gambling
- Keeps trying to reduce or stop gambling without success
- Gambling is frequently on the person’s mind—both reliving past gambling experiences and planning future gambling events
- Gambles when feeling depressed, guilty, or anxious
- Tries to win back gambling losses
- Lies to cover up how much they are gambling
- Loses not only money, but also relationships, their job, or a significant career opportunity as a result of gambling
- Becomes dependent on other people to give them money to deal with financial problems that have been caused by gambling
According to the current DSM-5, diagnosis of GD is made when an individual meets four or more of the following criteria within a 12-month period:
a) Needs to gamble with increasing amounts of money in order to achieve desired excitement;
b) Exhibits restlessness or irritability when trying to decrease gambling activity.
A diagnosis of gambling disorder requires at least four of the following during the past year: Need to gamble with increasing amounts to achieve the desired excitement. Restless or irritable when trying to cut down or stop gambling. Repeated unsuccessful efforts to control, cut back on or stop gambling. Problems with gambling may be common in those with antisocial personality disorder and other personality disorders. If the criteria are met for both disorders, both can be diagnosed.
DSM-5 provides nine diagnostic criteria for gambling disorder[3].
A. Persistent and recurrent problematic gambling behavior leading to clinically significant impairment or distress, as indicated by the individual exhibiting four (or more) of the following in a 12 month period:
a. Needs to gamble with increasing amounts of money in order to achieve the desired excitement;
b. Is restless or irritable when attempting to cut down or stop gambling;
c. Has made repeated unsuccessful efforts to control, cut back, or stop gambling;
d. Is often preoccupied with gambling (e.g., having persistent thoughts of reliving past gambling experiences, handicapping or planning the next venture, thinking of ways to get money with which to gamble);
e. Often gambles when feeling distressed (e.g., helpless, guilty, anxious, depressed);
f. After losing money gambling, often returns another day to get even (“chasing” one’s losses);
g. Lies to conceal the extent of involvement with gambling;
h. Has jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling;
i. Relies on others to provide money to relieve desperate financial situations caused by gambling.
B. The gambling behavior is not better explained by a manic episode.
Specify if:
Episodic:
Meeting diagnostic criteria at more than one time point, with symptoms subsiding between periods of gambling disorder for at least several months.
Persistent:
Experiencing continuous symptoms, to meet diagnostic criteria for multiple years.
Specify if:
In early remission:
After full criteria for gambling disorder were previously met, none of the criteria for gambling disorder have been met for at least 3 months but for less than 12 months.
In sustained remission: After full criteria for gambling disorder were previously met, none of the criteria for gambling disorder have been met during a period of 12 months or longer.
Specify current severity:
Mild: 4–5 criteria met.
Moderate: 6–7 criteria met.
Severe: 8–9 criteria met.
Factors that lead to gambling disorder
Mayo Clinic specialists state that compulsive gambling may be a reason for biological, genetic, and environmental factors, such as[4]:
- mental health disorders (the presence of substance abuse problems, personality disorders, emotional states)
- age and sex (usually found in the youth and middle-aged people, and more common to men than women). Two to 7% of youths develop a gambling disorder, compared with about 1% of adults, and many gambling disorders begin in adolescence. College students also gamble at higher rates than the general population. Men are more likely to have gambling problems than women, but the disparity seems to have narrowed in recent years. Men appear more drawn to such strategic forms of gambling as card games or sports betting, while women tend to prefer such non-strategic forms as bingo or slot machines.
- family or friends impact. People who have a parent with a gambling problem are more likely to have problems too. Yale research is working to understand the connection between genetics and gambling disorders. It’s estimated that a gambling disorder’s development is 50 percent due to genetic factors and 50 percent due to environmental factors.
- personality traits. People who tend to be restless, easily bored, extremely hard-working, or very competitive may be at greater risk of developing gambling disorder.
- drugs with rare side-effects (for example, antipsychotic medications or dopamine agonists).
- Other behavior or mood disorders. People with gambling disorder often abuse alcohol, tobacco, or other drugs, have mood or personality disorders such as schizophrenia or antisocial personality disorder, or have attention deficit hyperactivity disorder (ADHD). A 2008 study showed that people with psychiatric disorders are 17 times more likely to develop gambling problems.
Other studies add the following triggers to the mentioned above:
- traumatic conditions
- job-related stress
- solitude
- other addictions
If not interfered, the gambling disorder may cause very serious and lasting effects for individuals’ life:
- relationship related issues
- problems with money, bankruptcy as well
- legal problems, imprisonment
- health problems
- suicide, including suicidal thoughts and attempts
Treatment
Some people can stop gambling on their own. But many people need help to address their gambling problems. Only one in ten people with gambling disorder seek treatment.
Gambling affects people in different ways. Different approaches may work better for different people. Several types of therapy are used to treat gambling disorders, including cognitive behavioral therapy (CBT), psychodynamic therapy, group therapy, and family therapy.
Counseling can help people understand gambling and think about how gambling affects them and their family. It can also help people consider options and solve problems.
There is no Food and Drug Administration (FDA) approved medications to treat gambling disorders. Some medications may help treat co-occurring conditions like depression or anxiety.
Support from family and friends can be critical to a person’s recovery from gambling. However, only the individual can decide to stop the behaviors.
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 (FDA).
Gamblers Anonymous (GA) is a commonly used treatment for gambling problems. Modeled after Alcoholics Anonymous, GA is a twelve-step program that emphasizes a mutual-support approach. There are three in-patient treatment centers in North America. One form of counseling, cognitive behavioral therapy (CBT) 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.
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.
Counseling can help:
- Gain control over your gambling.
- Heal family relationships.
- Deal with your urge to gamble.
- Handle stress and other problems.
- Find other things to do with your time.
- Put your finances in order.
- Maintain recovery and avoid triggers.
Motivational interviewing
Motivational interviewing is one of the treatments of compulsive gambling. The motivational interviewer’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.
Management of Gambling Disorder
The most frequently studied treatment type for gambling disorder is Cognitive Behavioral Therapy (CBT). This type of treatment attempts to change the thoughts and behaviors that are fundamental to maintaining a pattern of behavior (e.g., gambling disorder). Through counseling, they learn that their gambling is a problem. The counsellor will give information, advice and support. This will help the person see that gambling causes harm, and decide what to do about it.
“Dos” and “Don’ts” for Partners, Friends, or Family Members
Do
- Seek the support of others with similar problems; attend a self-help group for families such as Gam-Anon.
- Recognize your partner’s good qualities.
- Remain calm when speaking to the person with a gambling disorder.
- Let them know that you are seeking help for yourself; the gambling is affecting you (and possibly children).
- Explain problem gambling to children.
- Understand the need for treatment of problem gambling and that it may take time.
- Set boundaries in managing money; take control of family finances; review bank and credit card statements.
Don’t
- Preach, lecture, or allow yourself to lose control of your anger
- Exclude the gambler from family life and activities
- Expect immediate recovery, or that all problems will be resolved when the gambling stops
- Bailout the gambler
People with gambling disorder can have periods where symptoms subside. The gambling may not seem a problem in between periods of more severe symptoms. Gambling disorder tends to run in families. Factors such as trauma and social inequality, particularly in women, can be risk factors. Symptoms can begin as early as adolescence or as late as older adulthood. Men are more likely to start at a younger age. Women are more likely to start later in life. Excessive gambling can drain finances, ruin personal and professional relationships, and harm the gambler’s mental health. Problem gamblers are at increased risk of suicide. It’s very important to take any thoughts or talk of suicide seriously.
Bibliography
- 1. Rennert L, Denis C, Peer K, Lynch KG, Gelernter J, Kranzler HR. DSM-5 gambling disorder: prevalence and characteristics in a substance use disorder sample. Exp Clin Psychopharmacol. 2014;22(1):50–56. doi:10.1037/a0034518
- Stinchfield R, McCready J, Turner NE, et al. Reliability, validity, and classification accuracy of the DSM-5 diagnostic criteria for gambling disorder and comparison to DSM-IV. J Gambl Stud. 2016;32(3):905–922. doi:10.1007/s10899-015-9573-7
- American Psychiatric Association. What is gambling disorder?
- Rash CJ, Weinstock J, Van Patten R. A review of gambling disorder and substance use disorders. Subst Abuse Rehabil. 2016;7:3–13. doi:10.2147/SAR.S83460
- Jones L, Metcalf A, Gordon-Smith K, et al. Gambling problems in bipolar disorder in the UK: prevalence and distribution. Br J Psychiatry. 2015;207(4):328–333. doi:10.1192/bjp.bp.114.154286
- Menchon JM, Mestre-Bach G, Steward T, Fernández-Aranda F, Jiménez-Murcia S. An overview of gambling disorder: from treatment approaches to risk factors. F1000Res. 2018;7:434. doi:10.12688/f1000research.12784.1
- Hahnmann TE. Moderate-risk and problem slot machine gamblers: a typology of gambling-related cognitions. J Gambl Issues. 2016;34. doi:10.4309/jgi.2016.34.8
- Mallorquí-Bagué N, Mena-Moreno T, Granero R, et al. Suicidal ideation and history of suicide attempts in treatment-seeking patients with gambling disorder: the role of emotion dysregulation and high trait impulsivity. J Behav Addict. 2018;7(4):1112–1121. doi:10.1556/2006.7.2018.132
- Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. (DSM-5) American Psychiatric Association. American Psychiatric Association Publishing. 2013.
- Gabbard’s Treatment of Psychiatric Disorders, Fifth Edition Edited by Glen O. Gabbard, M.D. American Psychiatric Publishing. 2014.
[1] https://www.google.com/search?q=what+does+gambling+disorder+mean, accessed on 17.2.2022 at 10.00 AM
[2] American Psychiatric Association. What is gambling disorder?
[3] From the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (section 312.31)
[4] https://courses.lumenlearning.com/hvcc-abnormalpsychology/chapter/non-substance-related-disorders/, Accessed on 17.2.2022 at 10.10 AM
