Gambling – definition, diagnosis and treatment

There are many types of addictions. Some involve a certain substance abuse, while others do not.

Addictions are defined as “a persistent behavioural pattern, characterized by: a desire or need to continue the activity which places it outside voluntary control, a tendency to increase frequency or amount of the activity over time, psychological dependence on the pleasurable effects of the activity and a detrimental effect on the individual and society” (Walker, Schellink & Anjoul, 2008). Ever since 1980, pathological gambling has been considered by the American Psychiatric Association to be a genuine form of addiction (Blume, 1994) exhibiting the diagnostic criteria included in the DSM-III of 1987.

However, the history of gambling goes far back enough to the beginning of mankind's recorded history – from kings losing their crown and kingdom to simple folk sometimes resorting to desperate measures such as murder in order to assure their odds in a bet, the fictional always descends down from the authentic (Blume, 1994). According to Blume (1994), the gambling business in the United States alone has reached gigantic proportions (2,4 billion dollars in the United states in the last century).

Gambling – definition and mechanics

Gambling is defined as a “momentary transaction between two parties based on the outcome of an uncertain event” (Walker, Schellink & Anjoul, 2008, p.11).

The mechanism that supports the addiction process is extremely complex, and many theories having been elaborated on the subject. The term “gambling” is often discussed in conjunction with concepts of the “near miss” and “reward and reinforcement”. There can be several types of reward: financial (money), psychological (a burst of self esteem, arousal, excitement) and social (peer praise). On the other hand, the “near miss” symptom can act as a trigger: the sensation that he / she was just about to lose but he / she didn’t, is a confirmation of the strategy of the gambler, encouraging him / her to place another bet, motivated by the enticement of a future success.

It seems that a passion for gambling is often developed since adolescence, as a recreational activity. After a first big win, an interest for repeating the experience quickly builds up. Gambling becomes an easy way of dealing with life's financial challenges (earning easy money) and a remedy for dysphoric states. Gradually, the gambler alienates his friends, family and day to day activities, focusing more and more on his gambling activities, which inevitably become more compulsive.

In the losing phase, when paradoxically the gambler feels more and more compelled to insist upon the activity (hoping for a big win that would cover the accumulated losses), the individual becomes so involved and goes as far as putting his and his family's savings in jeopardy and even his/her physical integrity at risk (borrowing money from loan sharks, resorting to illicit activities etc).

Often-times, gambling addiction goes hand in hand with other addictions, such alcohol and drugs.

Currently, the hypothesis of gambling as a compulsion is being researched, with it not all the time being treated as an addiction (Blanco, Moreyra, Nunes, Sáiz-Ruiz & Ibáñez, 2001). On the other hand, gambling is oftentimes associated with other psychiatric disorders. Depression is one of them. Becona, Lorenzo & Fuentes (1996) show that the number of people suffering from depression is two times greater with gamblers than with people who don't have gambling problems. Another pathology that is often associated with gambling is anxiety (Blume, 1994).

Diagnosis and treatment

A diagnosis is made by a psychiatrist with the aid of the South Oaks Gambling Screen instrument (SOGS) and a diagnostic is usually established when the gambler in question is already in a desperate phase. The treatment prescribed is both pharmaceutical and psychotherapeutic. Gamblers Anonymous is an organization that operates since 1957, with meetings being constantly held in most cities. 

Most often, therapy or family counselling are recommended. The support of friends and family is vital for the gambler, both for re-establishing self esteem as well as for covering the debts that are usually piled up in these situations. It is recommended, in order for the gambler to realize the consequences of his / her actions, for him / her to settle his / her debts, otherwise the chances for a fall back into that same pattern increase.

On the other hand, an education regarding addictions and a knowledge base of methods for preventing them is very important. Maintaining an abstinence towards the issue is another step to follow, with support groups such as Gamblers Anonymous representing a source for models of abstinence where the gambler can create bonds and even find a life purpose (whether it be helping other, developing one's own spirituality, etc.)

References

Becona, E., Lorenzo, M.C.  & Fuentes, M.J. (1996). Pathological gambling and depression, Psychological reports, 78, 635-640

Blanco, C., Moreyra, P, Nunes, E.V., Saiz-Ruiz, J., Ibanez, A. (2001). Pathological gambling: addiction or compulsion? Semin Clin Neuropsychiatry, 6, 167-176.

Blume, S. B. (1994). Compulsive gambling and the medical model. Journal of Gambling Behaviour, 3, 237-247.

Griffiths, M. (1995). Adolescent gambling. London: Routledge.

Walker, M., Schellink, T., & Anjoul, F. (2008). Explaing why people gamble. In Zangeneh, M.,

Blaszczynski, A. & Turner, N. (Eds.). In the pursuit of winning: Problem gambling theory,

research and treatment, (pp. 11-31). New York: Springer