Pathological Gambling Environmental

Pathological gambling frequently co-occurs with anxiety disorders; however, the extent to which this co-occurrence is related to genetic or environmental factors is unknown. Because people with co-occurring disorders typically have more severe illness, do. Pathological gambling does not have a direct relationship with any specific cause, but rather it is a set of factors that can lead to the development of a pathological gambling disorder. Although it is a disease that develops differently depending on the predisposition and environment of the individual, different risk factors are established.

Pathological gambling (PG) involves being unable to resist the impulse to gamble. The transition from recreational gambling to pathological gambling may occur gradually, or it may transition suddenly in response to a stressful event such as job loss (Bayer, 2000).

Some features associated with pathological gamblers include denial, overconfidence, delusions of grandeur, development of superstitions, highly competitive, and overly concerned with approval from others (Bayer, 2000). In order to be diagnosed as a pathological gambler, the individuals symptoms must be persistent and recurrent, and the individual must be preoccupied with reliving past gambling experiences or planning future gambling excursions (Bayer, 2000). After some time, the individual may feel compelled to take higher risks to produce the desired level of excitement. This disorder can result in a host of occupational, social, and legal problems. Compulsive gamblers often find themselves lying to their family members and friends to hide the severity of their problem. They may even resort to illegal, but typically nonviolent, means of acquiring money to gamble (Bayer, 2000).

Compulsive gamblers are more prone to medical conditions that are brought about by stress such as hypertension, peptic ulcers, and migraine headaches (Bayer, 2000). They may also have comorbid mood disorders, substance-related disorders, antisocial behavior, attention-deficit disorder, or hyperactivity (Bayer, 2000). Compulsive gambling can be confused with bipolar disorder, which sometimes accompanies compulsive gambling (Bayer, 2000).

This impulse-control disorder is more common among men than women. Women who do have this disorder are often hesitant to seek treatment; this may be because society tends to view gambling as less acceptable for women than men.

Pathological gambling typically begins in adolescence for boys and later in life for girls (Bayer, 2000). It may be regular or episodic, but it is often chronic (Bayer, 2000). Environmental stressors or depression may increase the frequency of gambling (Bayer, 2000).

Treatment for compulsive gambling includes inpatient & outpatient programs, residential care, halfway houses, behavior modification, individual and group therapy, and traditional psychoanalysis (Bayer, 2000). Relapses are common.

DSM-IV-TR criteria

A. Persistent and recurrent maladaptive gambling behavior as indicated by five (or more) of the following:

1. is preoccupied with gambling (e.g., preoccupied with reliving past gambling experiences, handicapping or planning the next venture, or thinking of ways to get money with which to gamble)
2. needs to gamble with increasing amounts of money in order to achieve the desired excitement
3. has repeated unsuccessful efforts to control, cut back, or stop gambling
4. is restless or irritable when attempting to cut down or stop gambling
5. gambles as a way of escaping from problems or of relieving a dysphoric mood (e.g., feelings of helplessness, guilt, anxiety, depression)
6. after losing money gambling, often returns another day to get even (“chasing” one’s losses)
7. lies to family members, therapist, or others to conceal the extent of involvement with gambling
8. has committed illegal acts such as forgery, fraud, theft, or embezzlement to finance gambling
9. has jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling
10. relies on others to provide money to relieve a desperate financial situation caused by gambling

B. The gambling behavior is not better accounted for by a manic episode.

Associated features

Pathological gambling (PG) is characterized as a chronic, progressively maladaptive, impulse-control disorder, that is distinguished by continued acts of gambling despite compounding severe negative consequences. Individuals with PG may present distortions in thinking and may believe that money is both the cause and solution to all of their problems. Individuals with PG tend to be highly competitive, energetic, and easily bored. They may be overly concerned with others’ approval and may be extravagantly generous. When they are not gambling, they may considered to be workaholics or “binge” workers. They may be at risk for medical conditions associated with stress, and those seeking treatment have high rates of suicidal ideation and attempts. Individuals who suffer from PG often have problematic interpersonal relationships. These relationships become increasingly strained during the progression of the disorder. Some individuals with PG may try to legally finance gambling and living expenses through loans. Others may also commit illegal acts such as forgery, fraud, theft, or embezzlement in order to gain financing. There is evidence to support comorbidity of PG with alcohol abuse and depression. A 1992 study showed that 12.9% of heavy drinkers had a gambling problem, compared to 5% of nondrinkers. Comorbidity rates of PG and major depressive disorder can reach as high as 76%. Other associated features of PG include unemployment, substance abuse, and suicide attempts. Most pathological gamblers tend to deny their problem and therefore do not get help. Associated features also include repetitive behaviors which shares features with obsessive-compulsive disorder.

Child vs. adult presentation

Historically, PG has been stereotyped as an adult disorder, but with the vast growth of casino expansion and the creation of internet gambling, adolescent rates of PG have superseded adult prevalence rates by two to four times. According to a 2006 Adolescent Psychiatry article by Timothy W. Fong, gambling is a media-driven, socially acceptable form of behavior. Fong also noted that 86% to 93% of all adolescents have gambled for money at least once (2006). Seventy-five percent of those did it within the confines of their home, while 85% of parents did not care (Fong, 2006). Fong stated that adolescent gambling is the most popular risk-taking behavior seen in adolescents, trumping cigarettes, alcohol, drugs, and sex (2006). The reasons why adolescents start gambling in comparison to the reasons why adults start gambling are very different. Adolescents use gambling as a form of excitement, a relief of boredom, and a coping mechanism or relief from daily stress. Adolescents have a need to keep playing for spectator success, and gambling is a social acceptable form of competition.

Gender and cultural differences in presentation

More men than women are diagnosed with pathological gambling, with a 2:1 ratio, and men have a higher tendency to start at a younger age. Gambling usually begins in early adolescence in men and from ages 20-40 in women. Culturally, pathological gambling is more prevalent in minority groups. Socioeconomic status also strongly correlates; it is more common in poor individuals who cannot afford to gamble and who inevitably feel as though they cannot afford not to gamble.

Epidemiology

• As gambling facilities become more prevalent, so do PG rates. In fact, 2 million Americans are considered to be pathological gamblers, with another 3 million considered being “problematic gamblers,” and 15 million more considered to be at risk. There is a 4% prevalence rate in America. Prevalence rates in other countries vary. Worldwide rates range from 2% to 6%.
• Pathological gambling usually begins in early adolescence in males and later in life in females. A few individuals are “hooked” with their first bet, but for most the course is more insidious. Years of social gambling may be followed by an abrupt onset that may be precipitated by greater exposure to gambling or to some stressor. The pattern may be regular or episodic, and the course of the disorder is often chronic.

Etiology

The causes do not seem to be biological as there is no evidence to support it. A psychological cause is more likely. A pathological gambler typically has symptoms of depression or alcoholic tendencies. They usually turn to gambling to get the “high” of winning to escape from everyday problems or more serious life problems.

Empirically supported treatments

• Treatment for PG includes therapy and possibly medication. Before treatment can begin, the individual must first realize that they do indeed have a problem and that they need help. Announcing this to friends and family is usually best. Treatment is based on behavior changes. The counselor will usually start by uncovering the underlying cause of the gambling addiction. If the patient is depressed then the depression is treated accordingly. For several of the people who stay in treatment, it is successful. On average, however, 50% drop out of the therapy.
• Aversion therapy is one option available to pathological gamblers. During aversion therapy, the patient is exposed to the stimulus while also being exposed to something that would cause them discomfort. Treatments usually try to help the patient overcome their impulses and learn to control urges. Also, the gambler must learn to overcome the illusion that they will “win the next time.”
• There are also self-help groups like Gamblers Anonymous that the patient can join. Groups for the family are also available.
• It is often recommended that the individual never return to gambling. It is also recommended that the individual never return to the places that he or she gambled, because returning causes the patient to be at high risk for a relapse.
• Medications such as antidepressants and opioid antagonists (naltrexone) may help, also.

• Follow this link to see more stats on gambling and to see what some of the signs are to help spot someone with a gambling problem: http://www.overcominggambling.com/facts.html

What is

Pathology is a pathology that consists of the progressive alteration of behaviour by which the individual experiences an uncontrollable need to play, over and above any negative consequences. It is recognized as a disease by the World Health Organization and by the American Psychiatric Association (APA).

Pathological gambling occurs in games with an addictive capacity, which are those in which little time passes between the bet and the prize achieved. Jerónimo Saiz, member of the Executive Committee of the Spanish Society of Psychiatry and patron of the Spanish Foundation of Psychiatry and Mental Health, explains that “the game associated with gambling is the one that takes place in bingos casinos and online games”.

According to the specialist, “the gambling addict is like a drug addict who needs to gamble and does whatever it takes to play, in other words, he turns gambling into an urgent first need”.

The Spanish Federation of Rehabilitated Gamblers (Fejar) adds that gambling is pathological when the person thinks, lives and acts according to it, leaving aside or on a second level other objectives and needs. Although gambling is an addiction that does not have a substance as a material reference, the gambler presents the same features as an addict:

• Repetition of a behavior or action that is pleasurable and increasing its frequency to obtain the desired effects. Different chemicals, such as dopamine and endorphins, act as stimulants and reinforce the pathological behaviors.
• Loss of control of the person derived from the failure of cerebral mechanisms of behavior inhibition.
• Appearance of withdrawal if the habit is interrupted.

Causes

Pathological gambling does not have a direct relationship with any specific cause, but rather it is a set of factors that can lead to the development of a pathological gambling disorder. Although it is a disease that develops differently depending on the predisposition and environment of the individual, different risk factors are established:

Genetics

Genetic endowment seems to influence pathological gambling, as it has been found that children of gambling parents have a higher risk of becoming gamblers than children of non-playing parents. However, gambling is not a physical or psychological trait that is passed on from parent to child, but rather what the child inherits is a certain propensity to become addicted if exposed to gambling.

Family and social environment

The most direct environment (parents and educators) represents the model of learning and imitation for many young people. If unrestricted play is encouraged or practised as a normal habit within the environment, there is a risk that the young person will later become a pathological player. On the other hand, the social environment (friendships and social groups in general), together with a problem or lack of assertiveness, can also be a risk factor.

Psychological and social problems

People who are experiencing psychological instability or who have personal and social problems represent a significant risk group for developing pathological gambling. Gambling can be used as an escape from reality and can become a necessary pathological habit.

Game structure and advertising

Most forms of gambling that can cause pathological gambling; slot machines, bingo, casino games, etc., have an addictive component that is based on the repetition of rewarding behavior that creates expectations of being rewarded.

In some cases, there is advertising that is constantly launched and that reinforces the idea that playing can be a means of solving economic problems and other types of conflictive situations derived from economic scarcity.

Symptoms

Pathological gambling is a form of gambling that has consequences. According to Saiz, it becomes visible as a result of the changes that the game produces in the habits and behaviour of the players, who begin a period of self-destruction. The signs that may indicate a case of pathological gambling are.

• Abandonment of work and social life: As Saiz explains, gambling is beginning to occupy a prominent place in the lives of individuals, who are beginning to disregard their work life and social relationships. Sudden passivity and overly secretive behaviour, associated with factors such as frequent visits to the casino or constant gambling on the Internet, may indicate a case of pathological gambling.
• Economic problems: unexpected expenses, loans, lack of money, etc. All this makes that the individual can resort to the lie to avoid responsibilities and to hide the consequences derived from his gambling.
• Anxiety and depression disorders: The gambler needs to keep on gambling, despite the damage it does to him/her. His mind is preoccupied with gambling, with obtaining formulas to win and with getting money to gamble. All this, together with the fact that in many occasions the gambler does not have access to the game, can cause anxiety disorders. On the other hand, the set of economic problems, accumulated lies, deterioration of social and family relationships and the rest of the conflictive situations that pathological gambling entails can lead to depression.
• Personality changes: The problems derived from pathological gambling and the constant need to play can produce changes in behaviour, such as irritability, lack of communication or even aggressiveness.

Prevention

In many societies gambling is considered a socially accepted act and is part of everyday life. One of the keys to preventing pathological gambling is to find the limit between healthy gambling as a leisure activity and pathological or harmful gambling; information and communication are necessary for this.

Finding leisure alternatives and keeping a busy life can also be a form of prevention.

Types

The types of pathological gambling are determined by the way the individual plays. Each game has its own structure and addictive component:

• Slot machines: Its addictive component is based on reinforcing behavior through prizes. The individual introduces a coin and the machine rewards that behavior; although in most occasions no reward is obtained, whenever the machine awards some prize it will reinforce the behavior of throwing the coin. He also follows other visual and auditory strategies, such as claiming music.
• Games of chance: Although in this type of games (lottery, bingo, betting, etc.) there is an intermittent reinforcement of the behavior (depending on the type of game, it is difficult to get a prize), they are based on chance and the creation of expectations, which sometimes are fulfilled and reward the behavior.
• Role-playing: Responds to a type of pathological gambling that is far from the profile of the traditional gambler. The main addictive component of role-playing games is the escape from reality they offer. Although the economic problems caused by other types of gambling may not be present, it causes the same deterioration and personal and social problems as the rest.

Diagnosis

The diagnosis of pathological gambling is possible because of the consequences and symptoms of the pathological game. Nieves Andrés explains that it is most common to diagnose pathological gambling when the degree of illness is such that there are already important consequences derived from bad habits (debts that accumulate, lies, frequent visits to casinos and places where one can gamble, etc.).

Pathological Gambling Environmental Act

The evolution and diagnosis of the illness, says Jerónimo Saiz, “is like entering a spiral where you gamble more than you should”. The spiral begins with having problems with gambling, which leads to economic and social problems, which in turn trigger a series of psychological problems, such as anxiety disorders and depression.