Problem gambling, or ludomania, is an urge to continuously gamble despite harmful negative consequences or a desire to stop. Problem gambling often is 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 is a common disorder that is associated with both social and family costs. The condition is classified as an impulse control disorder, with sufferers exhibiting many similarities to those who have substance addictions (alcohol and drugs).
“Problem gambling is characterized by many difficulties in limiting money and/or time spent on gambling which leads to adverse consequences for the gambler, others, or for the community.”
“Being unable to resist impulses to gamble which can lead to severe personal or social consequences”
According to DSM-IV, pathological gambling is now defined as separate from a manic episode. Only when the gambling is occurring independent of other impulsive, mood, or thought disorders is it considered its own diagnosis. In order to be diagnosed, an individual must have at least five of the following symptoms:
Preoccupation -The subject has frequent thoughts about gambling experiences, whether past, future, or fantasy.
Tolerance – As with drug tolerance, the subject requires larger or more frequent wagers to experience the same “rush”.
Withdrawal – Restlessness or irritability associated with attempts to cease or reduce gambling.
Escape – The subject gambles to improve mood or escape problems.
Chasing – The subject tries to win back gambling losses with more gambling.
Lying – The subject tries to hide the extent of his or her gambling by lying to family, friends, or therapists.
Loss of control – The person has unsuccessfully attempted to reduce gambling.
llegal acts – The person has broken the law in order to obtain gambling money or recover gambling losses. This may include acts of theft, embezzlement,fraud, or forgery.
Risked significant relationship – The person gambles despite risking or losing a relationship, job, or other significant opportunity.
Bailout – The person turns to family, friends, or another third party for financial assistance as a result of gambling
The gambler’s fallacy is the erroneous belief that a win in a game of pure chance is “due” after a string of losses. While it is logically correct to say that more trials of a probabilistic event increase the likelihood of the event occurring at least once, earlier games are independent of and have no influence over subsequent games.
Relation to other problems
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.
According to evidence from both community- and clinic-based studies, individuals who have pathological gambling are highly likely to exhibit other psychiatric problems at the same time, including substance use disorders, mood and anxiety disorders, or personality disorders.
Pathological gambling shows several similarities with substance abuse. There is a partial overlap in diagnostic criteria; pathological gamblers are also likely to abuse alcohol and other drugs. The telescoping phenomenon reflects the rapid development from initial to problematic behavior in women compared with men. This phenomenon was initially described for alcoholism, but it has also been applied to pathological gambling. Also biological data provide a support for a relationship between pathological gambling and substance abuse.
As debts build up people turn to other sources of money such as theft, or the sale of drugs. Much of this pressure comes from bookies or loan sharks on whom people rely for gambling capital.
Compulsive gambling can affect personal relationships.
Child abuse is also common in homes where pathological gambling is present. Growing up in such a situation can lead to improper emotional development and increased risk of falling prey to problem gambling behavior.
A gambler who does not receive treatment for pathological gambling when in his or her desperation phase may contemplate suicide. Problem gambling is often associated with increased suicidal ideation and attempts compared to the general population.
Early onset of problem gambling increases the lifetime risk of suicide. However, gambling-related suicide attempts are usually made by older people with problem gambling. Both comorbid substance use and comorbid mental disorders increase the risk of suicide in people with problem gambling.
Most treatment for problem gambling involves counseling, step-based programs, self-help, peer-support, medication, or a combination of these. However, no one treatment is considered to be most efficacious, and Hope Trust devises individual treatment strategies.
Gamblers Anonymous (GA) is a commonly used treatment for gambling problems. Modeled after Alcoholics Anonymous, GA uses a 12-step model that emphasizes a mutual-support approach. Hope Trust bases its treatment broadly on the 12 Steps.
One form of counseling, cognitive behavioral therapy (CBT) has been shown to reduce symptoms and gambling-related urges. This type of therapy focuses on the identification of gambling-related thought processes, mood and cognitive distortions that increase one’s vulnerability to out-of-control gambling. Additionally, CBT approaches frequently utilize skill-building techniques geared toward relapse prevention, assertiveness and gambling refusal, problem solving and reinforcement of gambling-inconsistent activities and interests. Hope Trust employs CBT to reinforce the gamblers’ recovery.
As to behavioral treatment, some recent research supports the use of both activity scheduling and desensitization in the treatment of gambling problems. At Hope Trust, the person is urged to follow a structured lifestyle with little or no triggers.
One step-based program for gambling issues is Gamblers Anonymous. Gamblers Anonymous uses a 12-step program adapted from Alcoholics Anonymous and also places an emphasis on peer support.
Other step-based programs are specific to gambling and generic to healing addiction, creating financial health, and improving mental wellness.
Hope Trust’s experience with gambling treatment
Hope Trust has significant experience with treatment of gambling. The evidence- based recovery program is structured within the broad peer group (other addictions included) and is based on the 12 Step model which is proven to be effective. The other elements include Hope Trust’s well known model – effective protocols for breaking denial, family support, relapse prevention, family communication, CBT, medical and psychiatric inputs, follow-up, and holistic approach including Yoga, meditation and mindfulness.