Pathological Gambling


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Final presentation for the Scaife Advanced Student Medical Seminar by Joshua Altman

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  • -New category would include both substance and behavioral addictions
  • -These characteristics cannot be otherwise explained by a manic episode
  • Many studies have showed that gambling effects the same areas of the brain as those effected by substance abuse
  • Talk about the fMRI study where anticipation of money activates the same regions of the brain as a cocaine user anticipating cocaine
  • -Becomes important with treatment – need to address the co-occuring mental illness with the addiction itself
  • Pathological Gambling

    1. 1. Josh Altman
    2. 2. Gambling Statistics 2009: Legal Gambling market alone generated approximately $335 Billion globally It has been estimated that approximately 85% of Americans have gambled at least one time during their life Between ~65-80% reported having gambled in the past year
    3. 3. When Gambling Becomes aProblem What are some of the beliefs and concepts that lead to a gambling problem? -Gambler’s Fallacy -Idea that continuing to play is the only way to win back money lost -Variable reinforcement schedule
    4. 4. Gambling Addiction Problem Gambling = “an urge to continuously gamble despite harmful negative consequences” The most severe form can be clinically diagnosed as Pathological Gambling
    5. 5. Pathological Gambling Classified as an impulse control disorder by DSM-IV It has been suggested that it be reclassified in a new category “Addiction and Related Disorders” in the new DSM-V
    6. 6. DSM-IV Diagnostic CriteriaFive or more of the following: preoccupied with gambling Needs to gamble with increasing amounts of money in order to achieve the desired excitement Has repeated unsuccessful efforts to control, cut back, or stop gambling Restless or irritable when attempting to cut down or stop gambling Gambles as a way of escaping from problems After losing money gambling, often returns another day to get even Lies about the extent of involvement with gambling Has committed illegal acts such as forgery, fraud, theft, or embezzlement to finance gambling Has jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling Relies on others to provide money to relieve a desperate financial situation caused by gambling
    7. 7. Biology behind PathologicalGambling Brain Regions implicated:  Nucleus Accumbens and Ventral Tegmental Area (Reward and Pleasure areas)  Orbitofronal Cortex (decision making)
    8. 8. Brain regions cont.  Hippocampus and Amygdala (Limbic System – Memory, learning, and emotions)
    9. 9. Neurotransmitters Hypothesis: Chemical Imbalances of  Noradrinergic  Serotonergic  Dopaminergic -Arousal, reward, and mood regulation -Chemical imbalances of these systems may lead to problems with impulsivity, difficulty with control, and mood disorders
    10. 10. Genetic Factors Studies have shown a likely genetic link to pathological gambling Twin study (2012): Differences in number of times gambling could be accounted for both by familial environment (42%) and genetic differences (32%)  Disordered gambling differences resulted primarily from genetic factors
    11. 11. Specific Genes Dopamine Receptor Gene: D2A1 allele  May result in deficits in dopamine reward pathways  Hypothesis: Leads to increased pursuing of pleasure generating activities
    12. 12. Specific Genes: Cont. Serotonin Receptor Polymorphisms  Study found that a certain genotype of the serotonin receptor 2A (“C/C Genotype”) was significantly associated with pathological gambling
    13. 13. Co-Morbid Conditions ~64% of Pathological Gamblers have had some form of co- morbid psychiatric disorder Substance Use Disorders Personality disorders (antisocial, borderline, narcissistic most commonly) Depression Bipolar Disorder Suicide Risk Pathological gamblers with co-occuring mental illness were significantly more severe with their gambling problems
    14. 14. Treatments 12-step based programs – GA CBT and Counseling Online Peer Support Groups Medication Self-Help
    15. 15. Medication Research No drug currently approved specifically for use for pathological gambling SSRI Paroxetine: studies have shown it is efficient in treating people with pathological gambling Nalmefene: Opiate Antagonist – Also shown effective in reducing problematic gambling
    16. 16. Thank You! Questions?