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Gambling

A Psychiatric Disorder

Problem gambling is an urge to gamble despite harmful negative consequences or a desire to stop. The term ‘problem gambling’ is preferred to ‘compulsive gambling‘ among many professionals, as few people experience true compulsions in the clinical sense of the word. Problem gambling is often defined by whether harm is experienced by the gambler or others, rather than by the gambler’s behavior. Severe problem gambling may be diagnosed as clinical pathological gambling if the gambler meets certain criteria.

Pathological gambling

Gambling is a psychological disorderExtreme cases of problem gambling may cross over into the realm of mental disorders. Pathological gambling was recognized as a psychiatric disorder in the DSM-III, but the criteria were significantly reworked based on large-scale studies and statistical methods for the DSM-IV. As defined by the American Psychiatric Association, pathological gambling is an impulse control disorder that is a chronic and progressive mental illness.

Pathological gambling is now defined as persistent and recurrent maladaptive gambling behavior meeting at least five of the following criteria, as long as these behaviors are not better explained by a manic episode:

  1. Preoccupation. The subject has frequent thoughts about gambling experiences, whether past, future, or fantasy.
  2. Tolerance. As with drug tolerance, the subject requires larger or more frequent wagers to experience the same “rush”.
  3. Withdrawal. Restlessness or irritability associated with attempts to cease or reduce gambling.
  4. Escape. The subject gambles to improve mood or escape problems.
  5. Chasing. The subject tries to win back gambling losses with more gambling.
  6. Lying. The subject tries to hide the extent of his or her gambling by lying to family, friends, or therapists.
  7. Loss of control. The subject has unsuccessfully attempted to reduce gambling.
  8. Illegal acts. The subject has broken the law in order to obtain gambling money or recover gambling losses.
  9. Risked significant relationship. The subject gambles despite risking or losing a relationship, job, or other significant opportunity.
  10. Bailout. The subject turns to family, friends, or another third party for financial assistance as a result of gambling.
  11. Biological Bases. The subject has a lack of norepinephrine.

As with many disorders, the DSM-IV definition of pathological gambling is widely accepted and used as a basis for research and clinical practice internationally.

Effects of different types of gambling

Some forms of gambling are allegedly less harmful. According to an article entitled “What happens to the best laid plans: global lessons on legalisation and liberation of gaming laws” by William R. Eadington of the University of Nevada, these forms from least to most dangerous are:

  1. Lotteries (traditional), bingo – soft gambling
  2. Destination resort casinos
  3. Urban or suburban casinos
  4. Convenient Gambling: gaming devices in bars, slot machines
  5. Ultra-Convenient Gambling: interactive television, mobile phone, or internet gambling

Relation to other problems

As debts build up, people turn to theft or the sale of drugs. A lot of pressure comes from bookies or loan sharks that people rely on for capital to use for gambling. Also, a teenager that does not receive treatment for pathological gambling when in their desperation phase is likely to contemplate suicide. 20% of teenagers that are pathological gamblers do consider suicide. This according to the article, “High Stakes: Teens Gambling With Their Futures”, by Laura Paul.

Abuse is also common in homes where pathological gambling is present. Growing up in such a situation leads to improper emotional development and increased risk of falling prey to problem gambling behaviour.

Pathological gambling is similar to many other impulse control disorders such as kleptomania, pyromania, and trichotillomania. Other mental diseases that also exhibit impulse control disorder include such mental disorders as antisocial personality disorder, or schizophrenia.

Prevalence

According to a variety of sources, the prevalence (ie. extent of existing cases) of problem gambling is 2-3% and pathological gambling is 1% in the United States, though this may vary by country. By contrast, about 86% of Americans have gambled during their lives and 60% gamble in a given year. Interestingly, despite the widespread growth in gambling availability and the increase in lifetime gambling during that past 25 years, past year problem gambling has remained steady. Currently, there is little evidence on the incidence of problem gambling (ie. new cases).

Available research seems to indicate that problem gambling is an internal tendency, and that problem gamblers will tend to risk money on whatever game is available, rather than a particular game being available inducing problem gambling in otherwise “normal” individuals. However, research also indicates that problem gamblers tend to risk money on fast-paced games. Thus a problem gambler is much more likely to lose a lot of money on poker or slot machines, where rounds end quickly and there is a constant temptation to play again or increase bets, as opposed to a state lottery where the gambler must wait until the next drawing to see results.

Assessment

The most common instrument used to screen for “probable pathological gambling” behavior is the South Oaks Gambling Screen (SOGS) developed by Lesieur and Blume (1987) at the South Oaks Hospital in New York. This screen is undoubtedly the most cited instrument in psychological research literature.

Treatment

Treatment includes therapy, support groups, education, and problem management. AIRR of MAUI supports abstinence from gaming for individuals assessed as having a true gambling addiction. For gamblers experiencing problems – problem gamblers – harm reduction strategies may also be employed. Call us today for a free and confidential assessment! .