Addiction - Gambling Disorder Flashcards
Gambling & problem gambling defined
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Gambling: Risking item of value on outcome of events determined by chance
- Electronic gaming machines: Pokies/slots, poker, blackjack, keno, roulette
- Numbers: Lottery, lotto, scratch-cards
- Wagering: Horses, dogs, sports
- Problem Gambling: Personal or social harm resulting from excessive gambling behaviour
- Pathological Gambling/Gambling Disorder: Meeting DSM criteria
Psychological motivations of gambling
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Why do people gamble?
- Excitement generated by the uncertainty but hope of winning
- Hope of winning large amounts to enhance lifestyle choices
- Fun in a social context & environment
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Why do people persist in gambling despite adverse consequences?
- Hope to recoup losses (chasing)
- Emotional escape
- Satisfy emotional needs (narcissism, ego)
- Manage dysfunctional affective states (depression, anxiety)
Comorbidity in Pathological/Problem Gambling (PG)
- 30-40% alcohol abuse/dependence in PG
- Of those with PG, their risk of comorbid:
- Substance use disorder increased by 5.5 times (30-40% alcohol abuse/dependence)
- Mood disorder increased by 3.7 times (75% dep.)
- Anxiety disorder increased 3.1 times (40% anx.)
- Cause – effect relationship
- Pathological gambling preceded comorbid condition in 23% of cases
- < 10% of problem gamblers seek formal treatment
Features of PG
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Age:
- Adolescence & young adults
- Age at onset predictive of gambling disorder
- Average age of onset = 12 – 15 yrs. (90% begin before age 20)
- Females bimodal distribution: youth & > 45 yrs.
- Average age seeking treatment = 35-39 yrs.
- Adolescence & young adults
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Male gender
- Impulsivity, substance use, risk-taking behaviours
Pathological gambling in DSM-IV
- Classified as an ‘impulse control disorder (ICD)’
- Categorised alongside:
- Kleptomania (compulsive shoplifting)
- Pyromania (compulsive fire-setting)
- Trichotillomania (compulsive hair-pulling)
- Intermittent explosive PD
PG in DSM-5
Developed based on the premise of Substance-related disorder
Criterion A: Four or more
- Preoccupation (psychological dependence)
- Increased amount gambled (tolerance)
- Irritability/restlessness on cessation (withdrawal)
- Escape from stress (negative reinforcement & motivation)
- Chasing losses (erroneous & distorted cognitions)
- Lying
- Repeated failure to cease (impaired control)
- Illegal acts
- Risked significant relationships
- Bailout
PG stages: Early winning phase
- 2/3 of pathological gamblers experience large wins prior to developing problems
- Facilitative cognitions (e.g., “I can win the casino” “This is easy”)
- Gambling becomes a stronger influence on mood than other activities (i.e., increased affective salience)
- Increased frequency & intensity
PG stages: Losing phase
- Heightened preoccupation with gambling
- Growing losses & attempts to recoup (‘chasing losses’, “rational choice” of increasing the bet since the debt is too large and couldn’t be offset by a small win)
- Increased stress, irritability, withdrawal
PG stages: Desperation phase
- Efforts to survive financially & psychologically become increasingly extreme (e.g., illegal activities, relationship manipulation)
- 60% have committed an offence to finance gambling
Cognitive model of PG
Assumption: erroneous beliefs & misunderstanding concepts of probability & mutual independence of chance events contributes to overinflated estimate of winning
Cognitive error: Illusion of control
Belief and over magnification of one’s skills and ability to influence or predict the outcome of an event.
Cognitive error: Gambler’s fallacy
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%).
Cognitive error: Biased evaluation
Successful outcomes are attributed to one’s skill, losses are discounted as due to unforeseen external reasons.
Cognitive error: Selective recall
Selectively recalling wins and forgetting losses
Cognitive error: Cognitive regret
Having invested considerable time and money in a session, a sense of regret at missing out on the next, potentially winning, gamble.
Cognitive error: superstitious beliefs
Use of “lucky” charms, objects, prayers, or rituals to “improve” the chances of winning.
Cognitive error: Luck as a personal quality
Believing one has a special “lucky” quality. May have cultural associations with reference to ancestors looking after one’s well-being.
Cognitive error: Gambling as a source of income
The belief that one can win at gambling – that is, that over
the long term, one can come out ahead.
Cognitive error: Illusory correlations
Misinterpretation of a correlation between mutually independent events.
Learning mechanisms in PG: operant conditioning
- Reinforcement schedules:
- Intermittent (occasional) & variable (unpredictable)
- Random ratio reinforcement schedule:
- Highly resistant to extinction
Learning mechanisms in PG: Classical conditioning
- Neutral stimuli (e.g., sights, sounds, time of the day, people) become associated with physiological arousal & subjective excitement
- Subsequent exposure to such cues (including advertising) [CS] >>> Elicits arousal/excitement, and in turn anticipation fo winning experienced as gambling cravings) [CR]
Pathway 1: Behaviourally conditioned problem gamblers
- Symptoms are causal outcomes of gambling-related problems
- Positively reinforced
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Demographics:
- Entry at any age
- Entry precipitated by exposure through chance, family members or peer groups
- Motivation to generate excitement, winning
- Less dissociation & more absorption
- Briefer history of excessive gambling
- Childhood & family stability
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Psychopathology
- Absence of psychopathology
- Depression/ anxiety: secondary to problem gambling
- Substance abuse minimal: onset after gambling problems
- Amenable to psycho-education, brief interventions & brief CBT
Pathway 2: Emotionally vulnerable problem gamblers
- Psychosocial and biological vulnerabilities:
- Pre-morbid anxiety, depression
- History of poor coping and problem-solving skills
- Lack of social support, negative family background experiences, developmental variables and life events
- gambling used as means of emotional escape
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Motivation: gambling with money, not for money: prolong sessions to allow continued emotional escape
- Negatively reinforced (because gambling helps alleviate emotional distress)
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Psychopathology:
- Higher than Pathway 1 group
- Comorbid conditions (addictions & mental health)
- Precipitated by depression, anxiety and alcohol dependence
- Psychological dysfunction makes this group more resistant to change
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Treatments:
- psychotherapeutic: enhance coping skills, deal with stressors, provide support
- may require medication to balance neurochemistry
Pathway 3: ‘Antisocial impulsivist’ problem gambler
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Demographics:
- Age: early onset problem gambling
- Early history of family instability, abuse/neglect
- Gambling reflects one of many maladaptive behaviours
- Engage in wide array of behavioural problems independent of their gambling
- Substance abuse, suicidality, irritability, low boredom tolerance, & criminal behaviours
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Psychopathology
- Exhibit highest level of psychopathology out of 3 groups
- High levels of impulsivity, anti-social behaviour
- Poorer performance at school (inattentive, disruptive)
- Characterised by extroverted & dramatising profile
- Involvement in activities with high degree of stimulation
- Gambling pursued for its stimulation & capacity to generate excitement/arousal: Supports escape vs. action seeking typologies
- Dysfunctional neurological structures and functions
- Dysregulation of neurotransmitter systems
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Treatments:
- less motivated to seek treatment, poor compliance rates, respond poorly to treatments
- intensive cognitive-behavioural interventions aimed at impulse control administered over longer terms
- medication to balance neurochemistry
