Behavioral Addictions: Compulsive Gambling

Compulsive gambling (also known as pathological gambling) can be defined by the uncontrollable urge to keep gambling despite the toll it takes on your life. If you're prone to compulsive gambling, you may continually chase bets, lie or hide your behavior, and resort to theft or fraud to support your addiction (PubMed, 2012). 

Symptoms of Compulsive gambling include: Concealing gambling, making higher and higher bets to earn back losses, lying to family and friends about whereabouts when out gambling, making unsuccessful attempts to cut back or quit, and many, many more (Mayo Clinic, 2011; PubMed, 2012).

It has been hard to determine at what point gambling becomes an addiction rather than a "bad habit." A deciding factor in this is when people who compulsively gamble make it become a way of life. For example, a person who takes time out of their day to gamble instead of going to spend time with their family (Mayo, 2011). Furthermore, people that are willing to commit crimes in order to feed their gambling addictions (PubMed, 2012). While these are concrete examples of when a habit becomes an addiction, there are subtle examples too as to when this happens. Making unsuccessful attempts to stop or cut back on gambling is a prime example. Many people don't see it as a problem and when they are unable to cut back, they just keep gambling in order to make up the money they have lost. They do not see it as a problem, but as a second job (Mayo, 2011; PubMed, 2012).   
Recently there has been a psychiatric test and history evaluation to diagnose compulsive gambling. Other tools like the Gambler's Anonymous 20 questions can help with the diagnosis (PubMed, 2012). 

The prevalence of compulsive gambling has been hard to estimate due to the erratic nature of the behavior and the fine line between habit and addiction. The best estimates seem to put about one-half of 1% (0.42-0.6%) as compulsive gamblers at sometime during their lifetime (Massachusetts Council of Compulsive Gambling, 2008). As a measure to how significant of a problem this is, here are some prevalence rates of other addictions/behavioral disorders in the United States (couresty of Massachusetts Council of Compulsive Gambling, 2008).

• Opioid use disorder (e.g., oxycontin, morphine): 1.4%⁷

• Cocaine use disorder: 2.8%⁷

• Amphetamine use disorder (e.g., methamphetamine): 2.0%⁸

• Anti-social personality disorder: 3.6%⁸ 
• Obsessive-compulsive disorder: 1.6%⁹ 
• Schizophrenic disorders: 0.6%¹⁰

• Anorexia nervosa: 0.6%¹¹

• Bulimia nervosa: 1.0%¹¹

As you can see compulsive gambling holds a close tie to other disorders/addictions. It has almost the same prevalence rate as Schizophrenia, Anorexia, and Bulimia. This should put into context how big of a problem this is in the United States specifically, but also the effects it has worldwide. Since this seems to be a growing issue in society, treatment options have been made to help people who have this addiction.

Most people with Compulsive Gambling problems refuse to admit that they have a problem. In order to treat a patient, they most times need to be pressured into seeing that they have a problem. Treatment plans include the use of Cognitive Behavioral Therapy (CBT), Gamblers Anonymous (GA) which is a 12-step treatment plan just like Alcoholics/Narcotics Anonymous (PubMed, 2012). These have been shown to yield surprisingly good results with compulsive gamblers and their relapse rate is much lower than a lot of other addictions. A new form of treatment, however, has been shown to have some positive biological effects on the body. Antidepressants and Opiod antagonists (like naltrexone) have shown to help the body rid itself of compulsive gambling tendencies (PubMed, 2012). However, these have not been through extensive trials so they are rarely used, except in extreme cases of compulsive gambling. Above to the right you can see a flow chart of compulsive gambling and recovery. 


While these treatments are often effective, there seems to be many complications with compulsive gambling. Anxiety, depression, dependence of alcohol (an extremely high co-morbid rate with compulsive gamblers), financial, social, and legal problems, etc. (PubMed, 2012). These complications can often end up leading the compulsive gamblers into other form of rehabilitation which many people do not know. 

Overall, I found researching this to be very fascinating. I didn't realize how in-depth it was and just how low people will go to be able to gamble. I think the most shocking piece of information I read was the high co-morbid rate with compulsive gambling and alcohol abuse. I suppose this is exasperated by the fact that depression rates are also high in compulsive gamblers. In saying this, many depressives end up with alcohol problems. Compulsive gambling seems as if it is a perfect storm in which other problems surface and require separate treatments. Finally, I think the medication route that is beginning to be used is fairly fascinating. By using medication, it almost is saying that there is a biological component to gambling and is not strictly environmental. I tried to research and find some neurological components to gambling but I was unable to find anything concrete enough to put into the blog. 

Until next time....  

-Derek



References:

Massachusetts Council of Compulsive Gambling. (2008).Prevalence of problem gambling. Retrieved from http://www.masscompulsivegambling.org/paths/what_prevalence.php

Mayo Clinic. (2011, January 19). Compulsive gambling. Retrieved from http://www.mayoclinic.com/health/compulsive-gambling/DS00443/DSECTION=symptoms
(For this website, they had a "next" tab which you paged through the causes, treatment, etc. Only thing in citation that would change is the subject at end of the URL).

PubMed. (2012, February 13). Pathological gambling. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH000248.