17 Addiction – gambling

Question 1

What’s the definition of gambling?

Answer 1

Risking an item of value on outcome of events determined by chance.

Question 2

What’s the difference between problem gambling and pathological gambling?

Answer 2

• Problem Gambling: Personal or social harm resulting from excessive gambling behaviour
• Pathological Gambling: Meeting DSM criteria

Question 3

What are four reasons why people persist in gambling despite adverse consequences?

Answer 3

1. Hope to recoup losses (chasing)
2. Emotional escape
3. Satisfy emotional needs (narcissism, ego –they think it’s cool)
4. Manage dysfunctional affective states (depression, anxiety)

Question 4

How prevalent is gambling in the general population?

Answer 4

60-85%

Question 5

What’s the prevalence of problem/pathological gambling in Australia?

And among gaming venue patrons?

Answer 5

-0.4 - 1.1% –pathological gamblers
1 - 2% –problem gamblers

Among gaming venue patrons – 15 - 25%

Question 6

How was pathological gambling classified in DSM-IV?

Answer 6

As an impulse control disorder.

Question 7

What are the 9 criteria for Gambling Disorder in the DSM-5?

Answer 7

Four or more of following

1. Needs to gamble with increasing amounts of money in order to achieve the desired excitement.
2. Is restless or irritable when attempting to cut down or stop gambling.
3. Has made repeated unsuccessful efforts to control, cut back, or stop gambling.
4. Is often preoccupied with gambling (e.g., having persistent thoughts of reliving past gambling experiences, handicapping or planning the next venture, thinking of ways to get money with which to gamble).
5. Often gambles when feeling distressed (e.g., helpless, guilty, anxious, depressed).
6. After losing money gambling, often returns another day to get even (“chasing” one’s losses).
7. Lies to conceal the extent of involvement with gambling.
8. Has jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling.
9. Relies on others to provide money to relieve desperate financial situations caused by gambling.

Question 8

For what amount of time must symptoms continue to classify them as gambling disorder?

Answer 8

12 months

Question 9

How may gambling disorder be triggered, going on the experience of 2/3 pathological gamblers?

Answer 9

2/3 pathological gamblers experience early large wins before developing problems.

Question 10

What are the 3 stages in Custer’s (1984) model of gambling addiction?

Answer 10

1. Early winning phase
   - Big wins early
   - Facilitative cognitions –’this is easy’
   - Gambling has increased affective salience
2. Losing phase
   - Heightened preoccupation
   - Growing losses; chasing losses
   - Increased stress
3. Desperation phase
   - Efforts to survive psychologically and financially become more extreme
   - 60% commit an offence to finance gambling

Question 11

What’s the average age of onset for Gambling Disorder?

Answer 11

12-15 years. 90% begin before age 20.

Question 12

What percentage of pathological gamblers have alcohol abuse/dependence?

Answer 12

30-40%

Question 13

How is gambling associated with mood/anxiety disorders? 3 ways

Answer 13

1. Increased prevalence of mood/anxiety disorders among pathological gamblers.
2. Gambling both causes and is caused by comorbid conditions.
3. Pathological gambling preceded the comorbid condition in 23% of cases.

Question 14

What percentage of gamblers seek formal treatment?

Answer 14

Less than 10%

Question 15

What are the 2 main neurobiological difference between gamblers and non-gamblers?

Answer 15

1. Difference in dopamine pathways associated with reward, pleasure and compulsion.
2. Differences in serotonin pathway associated with mood, memory, sleep and cognition.

Question 16

Give 2 pieces of evidence that serotonin might be involved in gambling behaviour.

Answer 16

1. Problem gamblers show reduced concentrations of serotonin metabolite (5-hydroxyindoleacetic acid) in cerebrospinal fluid.
2. Selective serotonin reuptake inhibitors show therapeutic effects.

Question 17

Give 3 pieces of evidence that dopamine might be involved in gambling behaviour.

Answer 17

1. The D2 receptor antagonist, haloperidol, can enhance the rewarding properties of gambling behaviour. The compulsive seeking of addictive reinforcement may represent a compensatory response to deficits in specific dopamine receptor (i.e., D2) function in the brain.
2. Administration of the psychostimulant, amphetamine, to pathological gamblers can prime cognitions about gambling.
3. Dopaminergic treatments can trigger gambling disorder in Parkinson’s patients.

Question 18

What is the reinforcement schedule used in gambling?

Answer 18

Variable ratio reinforcement schedule. Most resistant to extinction.

Question 19

How might classical conditioning be implicated in gambling?

Answer 19

Neutral stimuli –pub, people, time of day –become associated with arousal and subjective excitement.

Question 20

What is the Illusion of Control cognitive error?

Answer 20

Belief and over-magnification of one’s skills and ability to influence or predict the outcome of an event.

Question 21

What is the Gambler’s Fallacy?

Answer 21

The idea that a series of losses must be followed by a win when, in fact, the chances of winning / losing remain the same on each play (e.g., with every toss of a coin, the probability of heads or tails is 50%).

Question 22

What kind of biased attribution might be seen in interpreting game outcomes in gamblers?

Answer 22

Successful outcomes are attributed to one’s skill, losses are discounted as due to unforeseen external reasons.

Question 23

What kind of Selective Recall might be exhibited in gamblers?

Answer 23

Selectively recalling wins and forgetting losses.

Question 24

What is the Gambling as a Source of Income fallacy?

Answer 24

The belief that one can win at gambling – that is, that over the long term, one can come out ahead.

Question 25

What are Illusory Correlations in gambling?

Answer 25

Misinterpretation of a correlation between mutually independent events. E.g. if press button slowly and win, assume it was because of way button was pressed.

Question 26

What is the premise of the pathways model of pathological gambling?

Answer 26

That pathological gamblers are NOT a homogenous population. They have a common phenomenology, but differ in aetiological factors and treatment requirements.

Question 27

What are the three subtypes in the pathways model of pathological gambling?

Answer 27

1. Behaviourally conditioned gamblers
2. Emotionally vulnerable gamblers
3. Antisocial impulsivist gamblers

Question 28

What are the clinical characteristics of behaviourally conditioned gamblers?

Answer 28

Symptoms are causal outcomes of gambling-related problems. No premorbidities. Amenable to psycho-education, brief interventions & brief CBT

Question 29

What are the clinical characteristics of emotionally vulnerable gamblers?

Answer 29

Affective disturbances, poor coping skills and substance use contribute to gambling, which offers dissociation & escape. Gambling WITH money, not FOR money.

Question 30

What two arousal types are present in emotionally vulnerable gamblers, and what game types are they associated with?

Answer 30

Hyper-arousal/anxious –go for low-skilled games like slots, which allow them to dissociate

Hypo-arousal/depressed –go for skilled games such as poker to boost levels of excitement

Question 31

What are the clinical characteristics of antisocial impulsivist gamblers?

Answer 31

Family history of abuse/neglect. High levels of impulsivity and anti-social behaviour. High comorbidity –especially ADHD and alcohol. Best treatments are psychopharmacology & intensive interventions.