Addictive Disorders: Gambling Flashcards
Gambling and Problem Gambling definition
Gambling: risking an item of value on outcomes of events based on chance
Problem Gambling: when there is social or personal harm resulting from the gambling behaviour
Gambling and Problem Gambling definition
Gambling: risking an item of value on outcomes of events based on chance
Problem Gambling: when there is social or personal harm resulting from the gambling behaviour
Psychosocial motivation for gambling?
Why? > Excitement > Hope of winning large amounts > Social environment Why persist? > Hope to recoup losses > Emotional escape > Satisfy emotional needs eg narcissism (being the poker master etc) > Manage dysfunctional affective states (much like uppers and downers drugs) eg anxiety etc
What is the prevalence of gambling and problem gambling?
60-85% of general population gamble.
USA, Aus & Europe
- 0.4 - 1.1% pathological
- 1 - 2% problem gamblers
More prevalent in adolecents (3 - 14%) as more risk taking, but then grow out of it
People attending gaming venues 15-35%
Features of pathological gambling (age and sex)?
Age:
> much earlier is exposed at a young age
> Onset is 12 - 15 years (90% before 20)
> Average seeking treatment is 35 - 39 years
Sex:
> Females bimodal (youth and >45)
> Males - impulsivity, substance-use and risk taking are features of problem gamblers
Comorbidity of pathological gambling?
> 30-40% alcohol abuse/dependence - need to find cause and effect (alcohol at licensed gambling premises)
75% mood disorder eg depression
40% anxiety
What percentage of problem gamblers seek formal treatment?
What was gambling classified as in DSM IV
Impulse control disorder
What is problem gambling classified as now in the DSM V?
Substance related disorders -> addiction and related disorders
What are the 10 criteria for pathological gambling?
- Preoccupation
- Increased amount gambled
- Irritability/restlessness on cessation
- Escape from stress
- Chasing losses
- Lying
- Repeated failure to cease
- Illegal acts
- Risked significant relationships
- Bailout
How many out of the 10 Criterion (A) must be fulfilled?
Four
What is the significance of an early win?
2/3 pathological gamblers experience large wins prior to developing their problems
Sets up facilitative cognition - ‘I can win, this is easy.’
Increases affective salience - gambling becomes stronger impact on mood than other activites
Increases frequency and intensity
What are the assumptions of the cognitive model?
> Illusion of control: personal skill
Luck: personal attribute & superstitious beliefs
Biased memories: recall of just wins over losses
Myths regarding capacity to beat the statistics
Cognitive regret: persist to avoid the pain of missing a win (e.g. waiting for a bus and not wanting to leave)
Gamblers fallacy: assuming that after a loss or losing streak, that a win is inevitable
Neurobiology and Genetics
Suggestion of a deprivation in dopaminergic activity
Dopamine: reward, compulsion, motivation
Hippocampus: reward memories
Serotonin: impulsivity
The gambling behaviour balances out the deprivation of dopaminergic activity
Integrated Bio-Psycho-Social Model
Neurobiological/Genetic:
> meso-limbic/orbito-frontal rewards systems (same as substance abuse)
Family History:
> Modeling (Bandura)
> Exposure/attitude
> trauma/rejection
Belief Schemas:
> the normalisation of gambling builds schemas that it is
Peer Group Interactions:
> having a game of pool with mates, betting and increasing the motivation/reward etc
Coping strategies:
Personality traits:
What aspect of the ‘Integrated Bio-Psycho-Social Model’ does Cognitive Therapy deal with?
The Belief Schemas
What aspect of the ‘Integrated Bio-Psycho-Social Model’ does Psychpharmacological intervention deal with?
The Neurobiological/Genetic
What aspect of the ‘Integrated Bio-Psycho-Social Model’ does Behavioral therapy deal with?
Coping strategies, personality traits and neurobiological/genetic factors
What type of reinforcement schedule is gambling?
Random ratio
Why is gambling highly resistant to extinction?
Because it is a random ratio reinforcement schedule; can’t predict when the next positive outcome will occur
Are pathological gamblers homogenous or heterogenous?
Heterogenous in term of their pathways to pathological gambling, but similar characteristics and outcomes.
What are the three psychopathological pathways to problem gambling?
- Behaviourally Conditioned:
- Emotionally Vulnerable:
- Impulsive/Anti-social:
Describe the behaviourally conditioned problem gambler (how? motivation? treatment?)
How:
> reinforcement (positive) and conditioning - usually with a BIG win.
> bad decisions, rather than impulsivity
> problems, such as substance abuse, depression and anxiety are the outcome of gambling related problems - not the source of it
Motivation:
> cognitive distortions of success - I can actually beat the system
Treatment:
> CBT: behavioural modification plan, change cognitive biases and environment
Describe the emotionally vulnerable problem gambler (how? motivation? what type of gambling? treatment?)
How:
> Uses reinforcement (negative) and conditioning to REMOVE or MODERATE affective mood states
> Depression, anxiety ALREADY present
> Usually have poor coping skills
Motivation:
> It is an emotional escape
What type: Low-skill and isolating modalities eg old lady playing the pokies etc.
Treatment:
> Treat the cause, which is the comorbid affective mood states (anxiety, depression etc)
> Can be responsive to medication
Describe the antisocial, impulsivist problem gambler (how? motivation? what type of gambling? treatment?)
How:
> Deficits in reward pathways (dopaminergic)
> Impulsive and low tolerance for boredom
> less likely to seek help
> high ADHD correlation
Motivation:
> Gives them a buzz - risky behaviour
What type:
> high-risk and high-thrill; huge win AND huge loss gives them arousal, which they neurologically lack
Treatment:
> Most unresponsive to treatment
> Management of impulsivity, poor attention, etc through intensive CBT focused on impulse control
> Can be responsive to medication
Psychosocial motivation for gambling?
Why? > Excitement > Hope of winning large amounts > Social environment Why persist? > Hope to recoup losses > Emotional escape > Satisfy emotional needs eg narcissism (being the poker master etc) > Manage dysfunctional affective states (much like uppers and downers drugs) eg anxiety etc
What is the prevalence of gambling and problem gambling?
60-85% of general population gamble.
USA, Aus & Europe
- 0.4 - 1.1% pathological
- 1 - 2% problem gamblers
More prevalent in adolecents (3 - 14%) as more risk taking, but then grow out of it
People attending gaming venues 15-35%
Features of pathological gambling (age and sex)?
Age:
> much earlier is exposed at a young age
> Onset is 12 - 15 years (90% before 20)
> Average seeking treatment is 35 - 39 years
Sex:
> Females bimodal (youth and >45)
> Males - impulsivity, substance-use and risk taking are features of problem gamblers
Comorbidity of pathological gambling?
> 30-40% alcohol abuse/dependence - need to find cause and effect (alcohol at licensed gambling premises)
75% mood disorder eg depression
40% anxiety
What percentage of problem gamblers seek formal treatment?
less that 10%
What was gambling classified as in DSM IV
Impulse control disorder
What is problem gambling classified as now in the DSM V?
Substance related disorders -> addiction and related disorders
What are the 10 criteria for pathological gambling?
- Preoccupation
- Increased amount gambled
- Irritability/restlessness on cessation
- Escape from stress
- Chasing losses
- Lying
- Repeated failure to cease
- Illegal acts
- Risked significant relationships
- Bailout
How many out of the 10 Criterion (A) must be fulfilled?
Four
What is the significance of an early win?
2/3 pathological gamblers experience large wins prior to developing their problems
Sets up facilitative cognition - ‘I can win, this is easy.’
Increases affective salience - gambling becomes stronger impact on mood than other activites
Increases frequency and intensity
What are the assumptions of the cognitive model?
> Illusion of control: personal skill
Luck: personal attribute & superstitious beliefs
Biased memories: recall of just wins over losses
Myths regarding capacity to beat the statistics
Cognitive regret: persist to avoid the pain of missing a win (e.g. waiting for a bus and not wanting to leave)
Gamblers fallacy: assuming that after a loss or losing streak, that a win is inevitable
Neurobiology and Genetics
Suggestion of a deprivation in dopaminergic activity
Dopamine: reward, compulsion, motivation
Hippocampus: reward memories
Serotonin: impulsivity
The gambling behaviour balances out the deprivation of dopaminergic activity
Integrated Bio-Psycho-Social Model
Neurobiological/Genetic:
> meso-limbic/orbito-frontal rewards systems (same as substance abuse)
Family History:
> Modeling (Bandura)
> Exposure/attitude
> trauma/rejection
Belief Schemas:
> the normalisation of gambling builds schemas that it is
Peer Group Interactions:
> having a game of pool with mates, betting and increasing the motivation/reward etc
Coping strategies:
Personality traits:
What aspect of the ‘Integrated Bio-Psycho-Social Model’ does Cognitive Therapy deal with?
The Belief Schemas
What aspect of the ‘Integrated Bio-Psycho-Social Model’ does Psychpharmacological intervention deal with?
The Neurobiological/Genetic
What aspect of the ‘Integrated Bio-Psycho-Social Model’ does Behavioral therapy deal with?
Coping strategies, personality traits and neurobiological/genetic factors
What type of reinforcement schedule is gambling?
Random ratio
Why is gambling highly resistant to extinction?
Because it is a random ratio reinforcement schedule; can’t predict when the next positive outcome will occur
Are pathological gamblers homogenous or heterogenous?
Heterogenous in term of their pathways to pathological gambling, but similar characteristics and outcomes.
What are the three psychopathological pathways to problem gambling?
- Behaviourally Conditioned:
- Emotionally Vulnerable:
- Impulsive/Anti-social:
Describe the behaviourally conditioned problem gambler (how? motivation? treatment?)
How:
> reinforcement (positive) and conditioning - usually with a BIG win.
> bad decisions, rather than impulsivity
> problems, such as substance abuse, depression and anxiety are the outcome of gambling related problems - not the source of it
Motivation:
> cognitive distortions of success - I can actually beat the system
Treatment:
> CBT: behavioural modification plan, change cognitive biases and environment
Describe the emotionally vulnerable problem gambler (how? motivation? what type of gambling? treatment?)
How:
> Uses reinforcement (negative) and conditioning to REMOVE or MODERATE affective mood states
> Depression, anxiety ALREADY present
> Usually have poor coping skills
Motivation:
> It is an emotional escape
What type: Low-skill and isolating modalities eg old lady playing the pokies etc.
Treatment:
> Treat the cause, which is the comorbid affective mood states (anxiety, depression etc)
> Can be responsive to medication
Describe the antisocial, impulsivist problem gambler (how? motivation? what type of gambling? treatment?)
How:
> Deficits in reward pathways (dopaminergic)
> Impulsive and low tolerance for boredom
> less likely to seek help
> high ADHD correlation
Motivation:
> Gives them a buzz - risky behaviour
What type:
> high-risk and high-thrill; huge win AND huge loss gives them arousal, which they neurologically lack
Treatment:
> Most unresponsive to treatment
> Management of impulsivity, poor attention, etc through intensive CBT focused on impulse control
> Can be responsive to medication
