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PSYC3018 > Addiction - Gambling Disorder > Flashcards

Addiction - Gambling Disorder Flashcards

1
Q

Gambling & problem gambling defined

A
  • 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
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2
Q

Psychological motivations of gambling

A
  • 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
  • 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)
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3
Q

Comorbidity in Pathological/Problem Gambling (PG)

A
  • 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
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4
Q

Features of PG

A
  • 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.
  • Male gender
    • Impulsivity, substance use, risk-taking behaviours
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5
Q

Pathological gambling in DSM-IV

A
  • Classified as an ‘impulse control disorder (ICD)’
  • Categorised alongside:
    • Kleptomania (compulsive shoplifting)
    • Pyromania (compulsive fire-setting)
    • Trichotillomania (compulsive hair-pulling)
    • Intermittent explosive PD
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6
Q

PG in DSM-5

A

Developed based on the premise of Substance-related disorder

Criterion A: Four or more

  1. Preoccupation (psychological dependence)
  2. Increased amount gambled (tolerance)
  3. Irritability/restlessness on cessation (withdrawal)
  4. Escape from stress (negative reinforcement & motivation)
  5. Chasing losses (erroneous & distorted cognitions)
  6. Lying
  7. Repeated failure to cease (impaired control)
  8. Illegal acts
  9. Risked significant relationships
  10. Bailout
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7
Q

PG stages: Early winning phase

A
  • 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
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8
Q

PG stages: Losing phase

A
  • 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
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9
Q

PG stages: Desperation phase

A
  • Efforts to survive financially & psychologically become increasingly extreme (e.g., illegal activities, relationship manipulation)
  • 60% have committed an offence to finance gambling
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10
Q

Cognitive model of PG

A

Assumption: erroneous beliefs & misunderstanding concepts of probability & mutual independence of chance events contributes to overinflated estimate of winning

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11
Q

Cognitive error: Illusion of control

A

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

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12
Q

Cognitive error: Gambler’s fallacy

A

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%).

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13
Q

Cognitive error: Biased evaluation

A

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

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14
Q

Cognitive error: Selective recall

A

Selectively recalling wins and forgetting losses

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15
Q

Cognitive error: Cognitive regret

A

Having invested considerable time and money in a session, a sense of regret at missing out on the next, potentially winning, gamble.

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16
Q

Cognitive error: superstitious beliefs

A

Use of “lucky” charms, objects, prayers, or rituals to “improve” the chances of winning.

17
Q

Cognitive error: Luck as a personal quality

A

Believing one has a special “lucky” quality. May have cultural associations with reference to ancestors looking after one’s well-being.

18
Q

Cognitive error: Gambling as a source of income

A

The belief that one can win at gambling – that is, that over

the long term, one can come out ahead.

19
Q

Cognitive error: Illusory correlations

A

Misinterpretation of a correlation between mutually independent events.

20
Q

Learning mechanisms in PG: operant conditioning

A
  • Reinforcement schedules:
    • Intermittent (occasional) & variable (unpredictable)
  • Random ratio reinforcement schedule:
    • Highly resistant to extinction
21
Q

Learning mechanisms in PG: Classical conditioning

A
  • 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]
22
Q

Pathway 1: Behaviourally conditioned problem gamblers

A
  • Symptoms are causal outcomes of gambling-related problems
    • Positively reinforced
  • 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
  • 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
23
Q

Pathway 2: Emotionally vulnerable problem gamblers

A
  • 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
  • Motivation: gambling with money, not for money: prolong sessions to allow continued emotional escape
    • Negatively reinforced (because gambling helps alleviate emotional distress)
  • 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
  • Treatments:
    • psychotherapeutic: enhance coping skills, deal with stressors, provide support
    • may require medication to balance neurochemistry
24
Q

Pathway 3: ‘Antisocial impulsivist’ problem gambler

A
  • 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
  • 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
  • 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

PSYC3018 (15 decks)

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