Problem gambling (ludomania) is an urge to gamble despite harmful negative consequences or a desire to stop. The term is preferred to compulsive gambling among many professionals, as few people described by the term experience true compulsions in the clinical sense of the word. 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. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... // F00-F99 - Mental and behavioural disorders (F00-F09) Organic, including symptomatic, mental disorders (F00) Dementia in Alzheimers disease (F01) Vascular dementia (F011) Multi-infarct dementia (F02) Dementia in other diseases classified elsewhere (F020) Dementia in Picks disease (F021) Dementia in Creutzfeldt-Jakob disease (F022) Dementia in Huntingtons... Gamble redirects here. ... OCD redirects here. ...

Definition

Debate over how problem gambling should be defined.^[1] Research by governments in Australia led to a universal definition for that country which appears to be the only research based definition not to use diagnostic criteria.

Problem gambling is characterised 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.^[2]

Most other definitions of problem gambling can usually be simplified to any gambling that causes harm to the gambler or someone else in any way. However, these definitions are usually coupled with descriptions of the type of harm or the use of diagnostic criteria such as the South Oaks Gambling Screen, ^[3] Canadian Problem Gambling Index ^[4] or the Victorian Gambling Screen ^[5].

Pathological gambling

Extreme 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 American Psychiatric Association, pathological gambling is an impulse control disorder that is a chronic and progressive mental illness. Mental disorder or mental illness are terms used to refer psychological pattern that occurs in an individual and is usually associated with distress or disability that is not expected as part of normal development or culture. ... The Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association, is the handbook used most often in diagnosing mental disorders in the United States and other countries. ... The Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association, is the handbook used most often in diagnosing mental disorders in the United States and other countries. ... Due to the epidemic of medical errors, readers are cautioned to be aware that the American Psychiatric Association isnt immune to this. ... Impulse control disorder is a set of psychiatric disorders including intermittent explosive disorder (hot-headedness), kleptomania (stealing), pathological gambling, pyromania (fire-starting) and trichotillomania (pulling ones hair out). ... A mental illness or mental disorder refers to one of many mental health conditions characterized by distress, impaired cognitive functioning, atypical behavior, emotional dysregulation, and/or maladaptive behavior. ...

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: A manic episode is a period of unusually high energy, sometimes including uncontrollable excitement. ...

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. Stealing in order to feed their gambling addiction.
8. Loss of control. The person has unsuccessfully attempted to reduce gambling.
9. Illegal 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, forgery, or bad checks.
10. Risked significant relationship. The person gambles despite risking or losing a relationship, job, or other significant opportunity.
11. Bailout. The person turns to family, friends, or another third party for financial assistance as a result of gambling.

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. Drug tolerance occurs when a subjects reaction to a drug (such as a painkiller or intoxicant) decreases so that larger doses are required to achieve the same effect. ... A young waif steals a pair of boots Stealing redirects here. ... Forgery is the process of making or adapting objects or documents (see false document), with the intention to deceive. ... In the contexts of sociology and of popular culture, the concept of interpersonal relationships involves social associations, connections, or affiliations between two or more people. ...

Biological basis

According to the Illinois Institute for Addiction Recovery, recent evidence indicates that pathological gambling is an addiction similar to chemical addiction. It has been seen that some pathological gamblers have lower levels of norepinephrine than normal gamblers. Norepinephrine (INN)(abbr. ...

According to a study conducted by Alec Roy, M.D. formerly at the National Institute on Alcohol Abuse and Alcoholism, norepinephrine is secreted under stress, arousal, or thrill, so pathological gamblers gamble to make up for their under-dosage. The National Institute on Alcohol Abuse and Alcoholism (NIAAA), as part of the U.S. National Institutes of Health, supports and conducts biomedical and behavioral research on the causes, consequences, treatment, and prevention of alcoholism and alcohol-related problems. ...

Further to this, according to a report from the Harvard Medical School Division on Addictions there was an experiment constructed where test subjects were presented with situations where they could win, lose or break even in a casino-like environment. Subjects' reactions were measured using fMRI, a neuro-imaging technique very similar to MRI. And according to Hans Breiter, MD, co-director of the motivation and Emotion Neuroscience Centre at the Massachusetts General Hospital, "Monetary reward in a gambling-like experiment produces brain activation very similar to that observed in a cocaine addict receiving an infusion of cocaine." This article is about casinos for gaming. ... Functional Magnetic Resonance Imaging (or fMRI) describes the use of MRI to measure hemodynamic signals related to neural activity in the brain or spinal cord of humans or other animals. ... The mri are a fictional alien species in the Faded Sun Trilogy of C.J. Cherryh. ... Massachusetts General Hospital (often abbreviated to Mass General or just MGH) is a teaching hospital of Harvard Medical School and biomedical research facility in Boston, Massachusetts. ... For other uses, see Cocaine (disambiguation). ...

Deficiencies in serotonin might also contribute to compulsive behavior, including a gambling addiction. For the professional wrestling stable, see Ravens Nest#Serotonin. ...

Relation to other problems

As debts build up people turn to other sources of money such as theft, or the sale of drugs. A lot of this pressure comes from bookies or loan sharks that people rely on for capital to gamble with. 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.^[6] A young waif steals a pair of boots Stealing redirects here. ... Many drugs are provided in tablet form. ... A bookmaker, or a bookie, is an organisation or a person that takes bets and may pay winnings depending upon results and, depending on the nature of the bet, the odds. ... A loan shark is a person or body that offers illegal unsecured loans at high interest rates to individuals, often backed by blackmail or threats of violence. ... For other uses, see Suicide (disambiguation). ...

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 behavior. Abuser redirects here. ... For other uses, see Emotion (disambiguation). ... This article or section does not cite its references or sources. ...

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. Kleptomania (Greek: κλέπτειν, kleptein, to steal, μανία, mania) is an inability or great difficulty in resisting impulses of stealing. ... Property damage caused by fire Pyromania is an obsession with fire and starting fires in an intentional fashion. ... Trichotillomania (TTM), or trich as it is commonly known, is an impulse control disorder characterized by the repeated urge to pull out scalp hair, eyelashes, facial hair, nose hair, pubic hair, eyebrows or other body hair. ... Impulse control disorder is a set of psychiatric disorders including intermittent explosive disorder (hot-headedness), kleptomania (stealing), pathological gambling, pyromania (fire-starting) and trichotillomania (pulling ones hair out). ... Antisocial personality disorder (APD) is a mental disorder defined by the American Psychiatric Associations Diagnostic and Statistical Manual: The essential feature for the diagnosis is a pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood or early adolescence and continues into adulthood. ...

Other problems associated with compulsive gambling can be personal relationships. In a 1991 study of relationships of American men, it was found that 10% of compulsive gamblers had been married three or more times. Only 2% of men who did not gamble were married more than twice. ^[7]

Prevalence

A study by the United Kingdom Gambling Commission, the "British Gambling Prevalence Survey 2007", found that approximately 0.6% of the adult population had problem gambling issues, the same percentage as in 1999. The highest prevalence of problem gambling was found among those who participated in spread betting (14.7%), fixed odds betting terminals (11.2%) and betting exchanges (9.8%).^[8] Spread betting is a term used to describe various types of wagering on the outcome of an event, where the pay-off is based on the precision of the wager, rather than a simple binary outcome (win or loss). ... Fixed Odds Betting Terminals (FOBTs) are computerised machines normally found in betting shops which allow players to bet on the outcome of various games and events with Fixed Odds. ... A bet exchange or p2p gambling web site is a fairly recent Internet phenomenon, and is used to describe a web site acting as a broker between parties for the placement of bets (gambling, in other words). ...

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 roulette 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. Roulette is a casino and gambling game named after the French word meaning small wheel. In the game a croupier spins a wheel in one direction, then spins a ball in the opposite direction around a tilted circular surface running around the circumference of the wheel. ... Slot machines in the Trump Taj Mahal A slot machine (American English), fruit machine (British English), or poker machine (Australian English) is a certain type of casino game. ... For other uses, see Temptation (disambiguation). ... A lottery is a popular form of gambling which involves the drawing of lots for a prize. ...

Dopamine agonists, in particular pramipexole (Mirapex), have been implicated in the development of compulsive gambling and other excessive behavior patterns (e.g., PMID 16009751). Dopamine agonist is a synthetic drug that mimics the effect of the neurotransmitter dopamine. ... Pramipexole (INN, trade names Mirapex® and Sifrol®) is a medication indicated for treating Parkinsons disease and restless legs syndrome (RLS). ...

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 City. This screen is undoubtedly the most cited instrument in psychological research literature.^[9] In recent years the use of SOGS has declined due to a number of criticisms including that it over-estimates false positives. A false positive, also called false alarm, exists when a test reports, incorrectly, that it has found a signal where none exists in reality. ...

The DSM-IV diagnostic criteria presented as a checklist is an alternative to SOGS, it focuses on the psychological motivations underpinning problem gambling and was developed by the American Psychiatric Association. It consists of ten diagnostic criteria. One screening measure based upon the DSM-IV criteria is the National Opinion Research Center DSM Screen for Gambling Problems (NODS). This measure is currently used frequently. The Canadian Problem Gambling Severity Index (PGSI) is another newer assessment measure. The PGSI focuses on the harms and consequences associated with problem gambling.

Treatment for Pathological Gambling

A variety of treatments exist for pathological gambling including counseling, self-help groups, and psychiatric medications. However, no one treatment is considered to be most efficacious and no medications have been approved for the treatment of pathological gambling by the US Food and Drug Administration (FDA).

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. Meetings are free and are held most nights of the week. See the GA website for meeting times and locations.

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.

There is evidence that the SSRI paroxetine is efficient in the treatment of pathological gambling.^[10] Additionally, for patients suffering from both pathological gambling and a comorbid bipolar spectrum condition, sustained release lithium has shown efficacy in a preliminary trial.^[11] The opiate antagonist drug nalmefene has also been trialled quite successfully for the treatment of compulsive gambling. SSRI is an acronym that stands for several things: It is a class of antidepressants called selective serotonin reuptake inhibitor SSRI also is used as the stock symbol for Silver Standard Resources Inc. ... Paroxetine (Paxil, Seroxat, Pexeva) is a selective serotonin reuptake inhibitor (SSRI) antidepressant. ... Nalmefene (Revex) is an opioid receptor antagonist used primarily in the management of alcohol dependence, and also has been investigated for the treatment of other addictions such as pathological gambling and addiction to shopping. ...

Treatment for problem gambling

Most treatment for problem gambling involves counselling, step-based programs, self-help, peer-support, or a combination of these.

Counseling

Gambling counselling is usually delivered by professional counsellors who are often either qualified psychologists or social workers. In many jurisdictions services are free or subsidised by government agencies. Telephone counselling services are also available in many countries. Examples of services include Gamcare (UK) and Gambler's Help (Australia). Gamblers Help is a network of agencies funded by the State Government in Victoria, Australia to provide a range of community services for gambling related issues. ...

Step-based programs

One step-based program for gambling issues is Gamblers Anonymous. Gambler's Anonymous uses a 12 step program adapted from Alcoholics Anonymous and also places an emphasis on peer support. Other step-based programs (some commercially operated) that are both specific to gambling and generic to addiction have also be used to treat problem gamblers. // Gamblers Anonymous (GA) is twelve-step program for problem gamblers. ...

Peer-support

A growing method of treatment is peer support. With the advancement of online gambling, many gamblers experiencing issues use various online peer-support groups to aid their recovery. This protects their anonymity whilst allowing to attempt to self-recover often without having to disclose their issues to loved ones.

Self-help

Research into self-help for problem gamblers is showing promising results. David Hodgins research into the use of workbooks followed up with telephone support has shown benefits.^[12]

References

See also

• Compulsive hoarding
• Gaming law
• National Council on Problem Gambling - Singapore
• wikisource:The Rig Veda/Mandala 10/Hymn 34 for a very early description of gambling addiction and its harmful effects.

Compulsive hoarding (or pathological hoarding) is a term which is used to describe extreme hoarding behaviour in humans. ... Gaming law can be described as the set of rules and regulations that apply to the gaming or gambling industry. ... The National Council on Problem Gambling (NCPG) was set up in Singapore on 31 August 2005 to address problem gambling, following the governments decision to legalise casino gambling and build two integrated resorts. ...

External links

• Gamblers Anonymous
• National Council on Problem Gambling (US)
• Gambler's Help Southern - Australia
• National Center for Responsible Gaming
• An Introduction to Gambling Addiction
• Compulsive Gamblers Self-Assessment
• Final Report of Task Force on Gambling Addiction in Maryland
• The Institute for Gambling Education and Research at the University of Memphis