Compulsive GamblingRef: http://www.gjpsy.uni-goettingen.de/gjp-article-moreyra.htmThis behavior usually progresses from occasional to habitual gambling. The urge to gamblebecomes so great that the tension can only be relieved by more gambling. Higher stakes andpersonal risks become involved, as well as neglect of other interests, family, and work. Severefamily problems, financial ruin, and criminal behavior to support the habit may result. The causefor this behavior is unknown.DSM IV TRPersistent, maladaptive gambling is expressed by 5 or more of the following. The patient• Needs to put increasing amounts of money into play to get the desiredexcitement.• Has repeatedly tried (and failed) to control or stop gambling.• Feels restless or irritable when trying to control gambling.• Uses gambling to escape from problems.• Often tries to recoup loses.• Lies to cover up the extent of gambling.• Has stolen to finance gambling.• Has jeopardized a job or important relationship.• Has had to rely on others for money to relieve the consequences ofgambling.• Is preoccupied with gambling.• A manic episode doesn’t better explain the behaviourAssociated Disorders:• General Medical Conditions that are associated with stress• Mood Disorders• Attention-Deficit/Hyperactivity Disorder• Substance Abuse or Dependence• Borderline Personality DisordersIncidence♦ 1-3% of adults,♦ Men more often than women.o Men have on average 20yrs of gambling before they go for treatment, women 3yearso Women tend to show signs of depression which may be causal to their gamblingo Onset is adolescence in men and later in women.♦ Relapse rate is very high♦ Volberg, 1994: As opportunity to gamble increase so does rates of CG.
ExplanationsBiological: This is an AddictionSome individuals have vulnerable dopamine systems so that they get a ‘rush’ of dopamine on awin which overly rewards their behavior. Thus certain individuals are predisposed to be risk-takers and have overly developed ‘reward’ response to successful risk which is why they becomeaddicted.Evidence for♦ When a person gets an unexpected reward more dopamine reaches the anterior cingulate(reward center) and if they are expecting a win and do not get it less dopamine reachesthis area.♦ Dr. Hans C. Breiter: Used FMRI’s of 12 men while they participated in a game of chanceinvolving winning or losing money. The tests were divided into two stages - expectancyand outcome. During the expectancy phase, the subjects were shown how much moneythey could potentially win, depending on where the arrow stopped on a spinning disk.During the outcome phase, the arrow stopped on a designated monetary value on thedisk, and the subjects found out whether they had won or lost money on that spin. Thisexperiment showed that blood flow to the brain changed in ways similar to that seen inother experiments where an infusion of cocaine is given to cocaine addicts. Similarchanges in blood flow to the brain occur when low doses of morphine are given to drug-free individuals. The changes varied in accordance with the amount of money involved.♦ Bergh et al. (1997) found that in a study with 10 pathological gamblers and 7 controlsmatched for height and weight, pathological gamblers had a decrease in dopamine in theCerebral Spinal Fluid (CSF) and an increase in dopamine metabolites compared tovolunteersEvaluationWhat this does explain…♦ Connection with ADHD in that they tend to also be hyperactive and often exhibitinappropriate behaviors.♦ Explains all the ‘addict’ type behaviors (e.g. tolerance (having to increase the level ofgambling), withdrawal (feelings of restlessness and irritability)♦ Co-morbidity with other addictionsWhat this does not explain♦ Depression rates (75%) (which should be linked to Serotonin and Norepinephrine notDopamine).♦ Why more women than men (women are just as capable of being addicts)Treatment: Naltraxone inhibits the transmission of dopamine.Turón et al. (1990) used naltraxone in a study with 30 pathological gamblers. 56% remained in abstinence after 10mths oftreatment.Kim (1998), looked at a 55 year-old male pathological gambler. When they gave 100mg a daythe patient’s interest towards gambling and his gambling behavior completely disappeared.
Behavioral ExplanationSkinner showed that giving rats variable and unpredictable rewards strongly reinforced theirbehavior. The behavioral explanation states that gambling is a reinforced behavior where peoplewill ‘work’ for a potentially large reward. It also suggests that the reward is not just external (i.e.money) but the levels of arousal (either autonomic or cortical) that occur when winning thereward.Evidence for…♦ Skinner’s rats♦ Morán, 1970: Occasional economic gains in a pathological gambler are a strongreinforcement, at least in the initial stages of the disorder♦ Custer & Milt, 1985: Half of the gamblers report a significant monetary gain in the initialphase of their disorder that could act as a trigger for it.EvaluationThis does explain♦ It would explain the depression rates (75%) as resulting from the damage done to socialand financial well being.♦ ADHD co-morbiity could be explained by the idea that ADHD’s are more responsive toreward than ‘normal’ people (which would explain their attention seeking behaviour).This does not explain♦ why women are less likely to gamble than men♦ why the average onset age is in adolescence for men, but later life for women♦ why some people can gamble and NOT get addicted even if they have a big win at thebeginning.TreatmentKoller: Averse Conditioning where gambling is conditioned to be associated with shocks. Studiesshowed a significant decrease in the impulse to gamble and the corresponding behavior in thepatients, achieving complete abstinence in some cases. However, these studies used smallsample sizes and lacked valid and reliable tools to assess the outcomes.Form of Mood Disorder♦ McCormick, 1984: 75% depression rate in gamblers♦ McCormick, 1984: higher rate of suicide attempts than in normal population.♦ Higher incidence of mood disorders in 1stdegree relativesProblems♦ Taber, 1987: Affective disorders are not primary but appear to be a reaction to the losesfrom gambling.♦ Thorson: some studies have not found significantly high rates of depression in 1stdegreerelatives.Cognitive Explanation.The cognitive explanation focuses on irrational thinking as explaining the development andmaintenance of CG. Gambling creates the illusion of control and the perception that one iscapable of controlling the results. They believe in ‘luck’ where they can have a ‘feeling’ which willdictate whether they will win or not.
Evidence:♦ Gaboury & Ladouceur, 1989: Regular gamblers have more irrational thoughts thanoccasional gamblers and therefore, they engage in more risky behaviors.♦ Leopard, 1978: Losses are interpreted as a sign of an imminent gain because the badluck has to end at some point. Supporting this idea, a study found that 60% of gamblersrisk more money after having lost instead of after having won.♦ Ladouceur et al., 1987: Gamblers tend to remember and overestimate their gains, andthey tend to forget, underestimate or rationalize their losses. It is possible that these kindsof distortions explain the histories of initial gains, prior to the onset of the disorder,described by many patients.EvaluationThis does explain♦ why some people gamble and others don’t. For example, maybe women are under lesspressure to ‘perform’ or ‘demonstrate that they can make money for the family and besuccessful’ thus are less likely to gamble.♦ Also, the onset at adolescence is when people feel least in control of their lives andperhaps want to prove to themselves they can control and be ‘good’ at something.This does not explain♦ why drugs can help cure the problem♦ why people can want to stop but feel unable♦ the physiological effects of gambling (e.g. being restless and irritable when trying to stop).Gamblers AnonymousGamblers Anonymous, a self-help group modeled after Alcoholics Anonymous, is the most widelyused treatment option for pathological gambling. It emphasizes confession to a group of peers inorder to attain total abstinence, and it offers financial, legal and vocational assistance.♦ Only 10-30% of patients that attend a meeting ever return.♦ Stewart & Brown, 1988 found that from those who continue the treatment, only 8%remain abstinent after one year and 7% do so for longer than two years.♦ Russo et al.1984: studied the outcome of patients who received individual and grouppsychotherapy, and attended Gamblers Anonymous at the same time in an inpatientprogram. 55% of the patients were abstinent.