Understanding the Addiction to Gambling
Gambling is increasingly recognized as a public health issue, contributing to ongoing health inequalities, the experience of physical and mental health problems, and overall poor wellbeing.[1] The impacts of gambling can be long lasting, affecting the health and wellbeing of individuals, families, and communities.[2] Patients with depression and those who drink at risky levels are twice as likely to report gambling problems.[3] Harmful gambling for some can become pathological with features of dependent behavior.[4] Problem gambling is associated with anxiety disorders as well as suicidal thoughts and behavior.
Studies of youth gambling have shown inequalities in youth gambling behavior, with those from more socially deprived backgrounds being more likely to experience problems.[5] Children are vulnerable, subject to their environment, irresponsible, and susceptible to peer pressure, which is why public health initiative worry about the negative implications of gambling on children. Most adults and adolescents gamble with society viewing gambling as a normative behavior.[6] Although most people gamble without experiencing problems, a minority develop gambling problems, with lifetime estimates among adults typically cited in the range 0.2-5.3%; precise estimates depend on the threshold used for considering gambling problematic.[7]
Those individuals with addictive personalities are more likely to develop gambling problems. “Several external perturbagens (e.g. drugs, food, gambling, sex, video games, high calorie foods, and stress) can tip this balance in vulnerable individuals and trigger an addictive behavior.[8]” “At the same time, specific neural nodes and their associated networks, when dysfunctional can destabilized the interaction between brain circuits increasing the vulnerability for psychiatric disorders, including addiction.[9]” “The ability to form habits has been a powerful and positive force in evolution.[10]” “Compulsive behaviors, like addiction, can take hold when the neural circuity that instantiates adaptive habits is thrown off balance by exposure to drugs or other positive (food, sex, and gambling) or negative reinforces (stress) in vulnerable individuals.[11]”
From the 137 research articles (between 1985-2010) focusing on gambling among youth aged between 9 and 21 years,[12] the conclusion was that the study of adolescent gambling could be summarized as follows: (1) it was conducted by a relatively small group of researchers in Britain, Canada, and the United States; (2) it was primarily prevalence focused quantitative, descriptive, school based, and theoretical; (3) it most often been published in the Journal of Gambling Studies; (4) it was most often examined in relation to comorbidity with alcohol use; (5) it had relatively few valid and reliable screening instruments that were developmentally appropriate of adolescents; and (6) it lacked diverse samples.[13] The four recommendations for both research and prevention of intervention included: (1) provide greater attention to the development and validation of survey instruments or diagnostic criteria to assess adolescent problem gambling; (2) begin to develop and test more gambling prevention or intervention strategies; (3) examine the comorbidity of gambling and substances other that alcohol; and (4) pay greater attention to racial and ethnic differences in the study of adolescent gambling.[14] To broaden knowledge about sports gambling public health impacts, it is crucial to facilitate exchange of experience in gambling research, prevention, treatment, and policy advocacy across international jurisdictions.[15]
“Based on similarities between gambling and substance-use disorders in neurocognitive and other domains, gambling disorder has recently been classified in the “Diagnostic and Statistical Manual of Mental Disorders (5th edn) (DSM-5)” as behavioral addiction.[16]” “There exist multiple unanswered questions about the patho-physiology underlying gambling disorder and the promise for translating the neurobiological understanding into treatment advances remains largely unrealized.[17]” Gambling may take many forms, including lotteries, electronic gambling machines, dice, cards, and sports, and may occur in multiple venues (e.g. casinos, convenience stores, bars, internet websites), either legally or illegally.[18]
For a diagnosis of pathological gambling, four of nine criteria are needed for a DSM-5 diagnosis of gambling disorder.[19] “Gambling Disorder is 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.[20]” “These criteria and indications include: (1) needs to gamble with increasing amounts of money in order to achieve the desired excitement; (2) is restless or irritable when attempting to cut down or stop gambling; (3) has made repeated unsuccessful efforts to control, cutback, or stop gambling; (4) is often preoccupied with gambling (e.g. having persistent thoughts of reliving past gambling experiences, handicapping or planning the next adventure, thinking of ways to get money with which to gamble); (5) often gambles when feeling distressed (e.g. helpless, guilty, anxious, depressed); (6) after losing money gambling, often returns another day to get even (‘chasing’ ones losses); (7) lies to conceal the extent of involvement with gambling; (8) has jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling; (9) relies on others to provide money to relieve desperate financial situations caused by gambling.[21]” The level of problematic gambling behavior is based on meeting the criteria above, Mild (4-5), Moderate (6-7), Severe (8-9).[22]
“Unlike many other psychiatric disorders, there are no medications with direct indications for treating gambling disorder (i.e. no drug has an indication approval from the FDA for treating the disorder).[23]” “Thus, there is a significant need for medication development efforts to help advance the treatment of gambling disorder.[24]”
Other common gambling related cognitions of irrational cognitions associated to gambling behaviors which have been recognized in people who gamble include those with and without gambling problems.[25] These irrational cognitions include: superstitions, gambler’s fallacy, illusion of control, inaccurate processing of wins, losses or near wins (so-called ‘near-miss’ effect), persistence of gambling despite often recurrent losses (so-called ‘chasing’), or other gambling related domains.[26] “The structured assessment of irrational gambling-related cognitions are now permitting more nuanced and systematic investigations into the relationships between irrational gambling-related cognitions, gambling behaviors, and gambling problems.[27]”
An irrational cognitions scale that is commonly used to assess those beliefs related to gambling is the Gambling Related Cognition Scale (“GRCS”),[28] with 23-item measurements.[29] “The GRCS has been found to identify and assess five factors relating to interpretative control/bias (e.g. ‘relating my winnings to my skill and ability makes me continue gambling’), illusion of control (e.g. ‘I have specific rituals and behaviors that increase my chances of winning’), predictive control (e.g. ‘losses when gambling are bound to be followed by a series of wins’), gambling-related expectancies (e.g. ‘gambling makes things seem better’), and a perceived inability to stop (e.g. ‘it is difficult to stop gambling as I am out of control’).[30]” Furthermore, there are differences that relate to gender with men scoring higher on all subscales except for the illusion-of-control subscale.[31]
“Although multiple behavioral therapies has shown promise and are used in clinical settings, little is known about the biological mechanisms of action underlying these therapies or the extent to which specific therapies might best help specific groups of people with gambling problems.[32]” Unlike many other psychiatric conditions, there is no medication with an approved indication from the FDA for gambling disorder;[33] however, since compulsive gambling disorder falls under the umbrella of obsessive compulsive disorders, doctors treat patients with gambling disorder with obsessive compulsive disorder (OCD) medications such as Selective Serotonin Reuptake Inhibitors (SSRI’s).
Despite the advancements throughout history, there exists gaps in the understanding of the biological foundations of gambling disorder, how gambling disorder is similar to and distinct from other psychiatric conditions, how gambling disorder relates to specific cognitive functions, and how gambling disorder may be targeted therapeutically.[34]
References:
[1] Addictive Behaviors, Perceptions, People, and Place: Findings from a rapid review of qualitice research on youth gambling, Heather Wardle
[2] Addictive Behaviors, Perceptions, People, and Place: Findings from a rapid review of qualitice research on youth gambling, Heather Wardle
[3] The Practitioner, June 2017, Clinical Reviews, Gambling linked to mental health problems, Dr. Jez Thompson
[4] The Practitioner, June 2017, Clinical Reviews, Gambling linked to mental health problems, Dr. Jez Thompson
[5] Addictive Behaviors, Perceptions, People, and Place: Findings from a rapid review of qualitice research on youth gambling, Heather Wardle
[6] The Neural Bases Of Cognitive Processes In Gambling Disorder, Marc N. Potenza, Trends in Cognitive Sciences, August 2014, Vol. 18, No. 8
[7] The Neural Bases Of Cognitive Processes In Gambling Disorder, Marc N. Potenza, Trends in Cognitive Sciences, August 2014, Vol. 18, No. 8
[8] Neurobiology, Unbalanced neuronal circuits in addiction, Nora D Volkow, Gen-Jack Wang, Dardo Tomasi, and Ruben D Baler.
[9] Neurobiology, Unbalanced neuronal circuits in addiction, Nora D Volkow, Gen-Jack Wang, Dardo Tomasi, and Ruben D Baler.
[10] Neurobiology, Unbalanced neuronal circuits in addiction, Nora D Volkow, Gen-Jack Wang, Dardo Tomasi, and Ruben D Baler.
[11] Neurobiology, Unbalanced neuronal circuits in addiction, Nora D Volkow, Gen-Jack Wang, Dardo Tomasi, and Ruben D Baler.
[12] Journal of Adolescent Health 2017, Adolescent Gambling: An Update on Research Since 2010.
[13] Journal of Adolescent Health 2017, Adolescent Gambling: An Update on Research Since 2010.
[14] Journal of Adolescent Health 2017, Adolescent Gambling: An Update on Research Since 2010.
[15] Journal of Adolescent Health 2017, Adolescent Gambling: An Update on Research Since 2010.
[16] The Neural Bases Of Cognitive Processes In Gambling Disorder, Marc N. Potenza, Trends in Cognitive Sciences, August 2014, Vol. 18, No. 8
[17] The Neural Bases Of Cognitive Processes In Gambling Disorder, Marc N. Potenza, Trends in Cognitive Sciences, August 2014, Vol. 18, No. 8
[18] The Neural Bases Of Cognitive Processes In Gambling Disorder, Marc N. Potenza, Trends in Cognitive Sciences, August 2014, Vol. 18, No. 8
[19] The Neural Bases Of Cognitive Processes In Gambling Disorder, Marc N. Potenza, Trends in Cognitive Sciences, August 2014, Vol. 18, No. 8
[20] The Neural Bases Of Cognitive Processes In Gambling Disorder, Marc N. Potenza, Trends in Cognitive Sciences, August 2014, Vol. 18, No. 8
[21] The Neural Bases Of Cognitive Processes In Gambling Disorder, Marc N. Potenza, Trends in Cognitive Sciences, August 2014, Vol. 18, No. 8
[22] The Neural Bases Of Cognitive Processes In Gambling Disorder, Marc N. Potenza, Trends in Cognitive Sciences, August 2014, Vol. 18, No. 8
[23] The Neural Bases Of Cognitive Processes In Gambling Disorder, Marc N. Potenza, Trends in Cognitive Sciences, August 2014, Vol. 18, No. 8
[24] The Neural Bases Of Cognitive Processes In Gambling Disorder, Marc N. Potenza, Trends in Cognitive Sciences, August 2014, Vol. 18, No. 8
[25] The Neural Bases Of Cognitive Processes In Gambling Disorder, Marc N. Potenza, Trends in Cognitive Sciences, August 2014, Vol. 18, No. 8
[26] The Neural Bases Of Cognitive Processes In Gambling Disorder, Marc N. Potenza, Trends in Cognitive Sciences, August 2014, Vol. 18, No. 8
[27] The Neural Bases Of Cognitive Processes In Gambling Disorder, Marc N. Potenza, Trends in Cognitive Sciences, August 2014, Vol. 18, No. 8
[28] The Neural Bases Of Cognitive Processes In Gambling Disorder, Marc N. Potenza, Trends in Cognitive Sciences, August 2014, Vol. 18, No. 8
[29] The Neural Bases Of Cognitive Processes In Gambling Disorder, Marc N. Potenza, Trends in Cognitive Sciences, August 2014, Vol. 18, No. 8
[30] The Neural Bases Of Cognitive Processes In Gambling Disorder, Marc N. Potenza, Trends in Cognitive Sciences, August 2014, Vol. 18, No. 8
[31] The Neural Bases Of Cognitive Processes In Gambling Disorder, Marc N. Potenza, Trends in Cognitive Sciences, August 2014, Vol. 18, No. 8
[32] The Neural Bases Of Cognitive Processes In Gambling Disorder, Marc N. Potenza, Trends in Cognitive Sciences, August 2014, Vol. 18, No. 8
[33] The Neural Bases Of Cognitive Processes In Gambling Disorder, Marc N. Potenza, Trends in Cognitive Sciences, August 2014, Vol. 18, No. 8
[34] The Neural Bases Of Cognitive Processes In Gambling Disorder, Marc N. Potenza, Trends in Cognitive Sciences, August 2014, Vol. 18, No. 8
