While pathological gambling is amenable to treatment, its diagnosis often proves elusive: Gamblers often deny or minimize their problems, guidelines for screening and treating pathological gambling are not universally applied, and the availability of internet gambling opportunities allows gamblers to more easily conceal their activities.
Young people – including children – may be at increased risk for developing pathological gambling behavior due to exposure to online and video gambling opportunities. (1,2)
Data show that most pathological gamblers began gambling in their youth; one study revealed that up to 7% of 11- to 18-year-olds exhibited problem gambling behaviors. (3)
Pathological Gambling Is a Widespread Problem
Despite uncertainties in pathological gambling’s true prevalence, it is clear that gambling “addiction” affects persons in every social class, and the problem may be growing. In the 1960s, approximately 61% of Americans gambled in some manner; in 1991, 80% of surveyed individuals in the United States admitted to participating in gambling, and up to 2% of these individuals may demonstrate problem gambling behaviors. (4)
People who are heavy drinkers or who suffer from depression are more likely to be problem gamblers. Although social difficulties caused by compulsive gambling can contribute to depression, research shows that the severity of one’s depression does not necessarily correlate with the amount of money lost in gambling. Thus, depression might be an independent risk factor for problem gambling behavior. (5)
Interestingly, Las Vegas, NV, and Atlantic City, NJ, have some of the highest suicide rates in the U.S.
With liberalized gaming regulations and an increasing number of casinos, lotteries, and other gambling venues, the incidence and prevalence of pathological gambling will no doubt rise.
Diagnostic Criteria for Pathological Gambling
“Gambling addict,” “problem gambler,” and “probable pathological gambler” are all terms used to describe individuals whose gambling behaviors cause social dysfunction but do not meet diagnostic criteria for pathological gambling. The distinction is more than one of clinical interest, as suicide attempts, felony convictions, domestic violence, and unemployment are all more common among true pathological gamblers than in other groups.
In general, a diagnosis of pathological gambling requires that a person gamble in a persistent and maladaptive manner that impairs social function and is not associated with manic episodes. Specific DSM-IV criteria for a diagnosis of pathological gambling are outlined as follows:
A. Persistent and recurrent maladaptive gambling behavior as indicated by at least five of the following:
- Preoccupation with gambling (e.g., reliving past gambling experiences, planning the next venture, or planning ways to get money for gambling)
- Needs to gamble with increasing amounts of money in order to achieve desired level of excitement
- Has repeated unsuccessful efforts to control, cut back or stop gambling
- Is restless or irritable when attempting to cut down or stop gambling
- Gambles as a way of escaping from problems or of relieving dysphoric mood (i.e., guilt, anxiety, depression, helplessness, etc.)
- After losing money from gambling, often returns another day to get even (“chasing losses”)
- Lies to family members, therapist, or others to conceal extent of involvement with gambling
- Has committed illegal acts such as forgery, fraud, theft, or embezzlement to finance gambling
- Has jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling
- Relies on others to provide money to relieve desperate financial situations caused by gambling
B. Gambling behavior is not better accounted for by a manic episode
(Adapted from American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th edition. American Psychiatric Association, 1994:615-18)
Treating the Pathological Gambler
A critical part of helping pathological gamblers is the restoration of normal thinking and living patterns.
Behavioral, cognitive, and combination cognitive-behavioral therapies are probably the most effective means of treating pathological gambling.
Cognitive approaches challenge and correct gamblers’ beliefs that they have control over chance events. Irrational thoughts (e.g., relying on superstitious beliefs or “systems” to achieve gambling success) must be abolished.
Behavioral therapy addresses pathological gambling as a learned behavior that can be systematically replaced with more appropriate behaviors.
Coexisting depression often responds to pharmacologic therapy.
Gamblers Anonymous and Gam-Anon, modeled after similar organizations for alcoholics, are the primary self-help, abstinence-based groups available for pathological gamblers and their families, respectively.
Pathological gambling is a relatively common problem among Americans. Many experts believe that, while it is treatable, pathological gambling (like alcoholism or drug addiction) is not curable.
Sources:
- Haninger K, Thompson KM. Content and ratings of teen-rated video games. JAMA 2004;291:856-65
- Thompson KM, Haninger K. Violence in E-rated video games. JAMA 2001;286:591-8
- Proimos J, DuRant RH, Pierce JD, Goodman E. Gambling and other risk behaviors among 8th- to 12th-grade students. Pediatrics 1998;102:e23)
- Lopez Viets VC, Miller WR. Treatment approaches for pathological gamblers. Clin Psychol Rev 1997;17:689-702
- Becona E, Del Carmen Lorenzo M, Fuentes MJ. Pathological gambling and depression. Psychol Rep 1996;78:635-40
Stephen Allen Christensen - Dr. Steve Christensen's writing has appeared in magazines, professional journals, poetry anthologies, and children's books since 1976.
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