Gambling

Question 1

how is gambling defined?

Answer 1

• any activity that involves a risk of losing something important when the outcome is not essential and the likelihood of attaining the outcome involves some level of uncertainty (not always referring to $)

Question 2

how far back does gambling date back to?

Answer 2

• around 3000 BC

Question 3

what different forms of gambling have existed throughout history?

Answer 3

• betting on dice
• human and animal fights and competitions
• cards
• table games
• machines
• Gambling houses that are similar to casinos have been dated as far back as the 1600s in Europe

Question 4

what % of Canadians and Americans have gambled at some point in time in their lives and how much $ does this Canadian industry bring in? and how many people experience a gambling problem?

Answer 4

• 85%
• $13B a year industry in Canada
• most people who participate in gambling experience few to no negative consequences but about 3% of Canadians do experience a gambling problem

Question 5

what correlation is there between developing a gambling problem and the availability of these facilities?

Answer 5

• a strong correlation between the prevalence of gambling opportunities and the rate of the gambling problem
• even stronger correlation when there is a short delay between the gambling activity and the outcome (ie. slot machines vs. lottery tickets)
• *more rapid, continuous and repetitive are more likely to lead to problems than those that are delayed, discontinuous and sporadic

Question 6

DSM 5

Answer 6

• until the DSM 5 gambling was considered to be part of ‘impulse control behaviour’ rather than ‘use disorders’ but it’s now placed in use disorders bc there are many similarities

Question 7

what are the similarities between gambling disorder and other use disorders?

Answer 7

• gambling has been shown to release dopamine via the VTA-NA pathway with a concomitant euphoric rush
• • dopamine reward level is related to the degree of uncertainty in the gambling rather than the monetary reward
• self-reported “craving” - increases when a problem gambler is shown gambling-related cues
• evidence of tolerance - gamblers need to increase the amount or dose of gambling in order to continue to experience the excitement they initially felt
• experience withdrawal-like symptoms that would be mostly psychological or emotional rather than physical

Question 8

DSM 5: Diagnostic Criteria: Gambling Disorder

Answer 8

• persistent and reoccurring problematic gambling behaviour leading to clinically significant impairment or distress as indicated by the individual exhibiting 4 + of the symptoms in a 12month period
• • the gambling behaviour is not better explained by a manic episode (manic episodes involve risky behaviour so they want to make sure that it’s NOT a manic episode)
• Mild: 4-5
• Moderate: 6-7
• Severe: 8-9

Question 9

Episodic

Answer 9

• meeting diagnostic criteria at more than one point in time, with symptoms subsidising between periods of gambling disorder for at least several months

Question 10

Persistent

Answer 10

• experiencing continuous symptoms, to meet diagnostic criteria for multiple years

Question 11

early remission

Answer 11

• after the full criteria for gambling, disorder has been met, none of the criteria for gambling disorder has been met for at least 3 months but less than 12 months

Question 12

sustained remission

Answer 12

• after the full criteria for gambling, disorder has been met, none of the criteria for gambling disorder has been met of a period of 12 months or longer

Question 13

Characteristics that GUD shares with SUD

Answer 13

• increased likelihood for comorbid psychiatric conditions with SUD which is also common in GUD
• 90% of people with life long GUD also have at least 1 other life long psychiatric disorder
• life long rates of mood disorder, anxiety disorder and alcohol use disorder are elevated among those with GUD
• • the comorbid condition is present prior to the development of GUD so it should be considered a risk factor for the development of GUD rather than a consequence of GUD

Question 14

personality traits that are similar between those with GUD and SUD

Answer 14

• impulsiveness: tendency to act with little or no regard for the consequences
• negative urgency: tendency to act rashly in response to negative affect usually reflecting low conscientiousness, disagreeableness and neuroticism
  a. high degree in disagreeableness reflects selfishness and lack of empathy
  b. low conscientiousness reflects the propensity to be self-controlled etc.
  c. high in neuroticism means likley to experience negative emotions such as anxiety, fear, worry and anger

Question 15

what personality disorder does GUD share with?

Answer 15

• borderline perosnality disorder

- anti-social personality disorder

Question 16

what is the heritability of GUD?

Answer 16

• ranges from 0.50-0.60 which is similar to alcohol and other drugs
• genetic factors are the most influential in the chronic involvement phase as compared to initiation

Question 17

Modified Stroop Test

Answer 17

• individuals who have a higher level of involvement with gambling activities show greater Stroop Interference to gambling-related words than to matched, control words

Question 18

Eye-gaze task

Answer 18

• 2 pictures either relevant to the condition under study or neutral are presented simultaneously and the participant’s eyes fixation is measured
• if the participant fixates on the target picture more than the neutral picture this is taken as evidence of attentional bias
• attentional Bias is shown by gamblers to personally relevant pictures

Question 19

Treatment of GUD and SUD’s

Answer 19

• only about 10% of people actually sought treatment, and this proportion is actually lower than for most SUDs
• the primary forms for treatment involve the same psychotherapeutic approaches used in the treatment of SUD (most often combined with a treatment program)

Question 20

Treatment of GUD and SUD’s: Motivational interviewing or enhancement

Answer 20

• developed by William Miller
• based on: expressing empathy through reflective listening, develop discrepancy between the client’s goals and values and their current behaviour, support self-efficacy and optimism etc.
• client-centred approach
• therapist help facilitate the client expressing in their own words their need for change and their reasons for wanting to change (increasing the commitment to change)
• recognizing self-efficacy

Question 21

Treatment of GUD and SUD’s: Cognitive-behavioural therapy

Answer 21

• based on the premise that our actions reflect the interplay between emotional reactions that we have to life events and the behaviours that we use to exhibit
• it engages the client in examining how they interpret and evaluate what’s happening around them and how it influences their own behaviour
• involves:
  1. identifying distortions in the client’s thinking
  2. assisting the client in recognizing that their thoughts are interpretations rather than facts
  3. having the client to consider situations from different perspectives

Question 22

what are some examples of problem gambling?

Answer 22

• “due for a win” is a common cognitive distortion which can keep a person playing longer than what they intended
• The illusion of control: many players think they have a specialized attribute that allows them to predict the outcomes of games that are actually not predictable (they selectively recall)
• cognitive distortion doesn’t have to be about the behaviour - it can be about how someone interprets the behaviour or conceptualize the world
• • this faulty thinking can lead to someone misinterpreting something and leading to filtering, polarized thinking, overgeneralization, jumping to conclusions, catastrophizing and personalization

Question 23

what is one main aspect of CBT?

Answer 23

• functional analysis of behaviour: how does the behaviour unfold (automatic thoughts, cravings, triggers etc.)
• CBT tries to challenge the client’s cognitive distortions by sometimes presenting a client with a scenario and then having the client interpret that scenario

Question 24

Treatment of GUD and SUD’s: Relapse Prevention

Answer 24

• most predictable outcome of treatment
• this therapy is incorporated into a larger CBT program of treatment
• part of this is the functional analysis of relapse situations and coming to understand the triggers that might cause a lapse
• also important to reframe a lapse and moving away from them being failures and more about a learning curve
• Abstinence violation effect (AVE) the client is educated that a lapse is not a relapse

Question 25

Treatment of GUD and SUD’s: mindfulness training

Answer 25

• designed to restructure how clients react to life events but this takes time and occurs over many sessions
• involves having clients acknowledge the thought or emotion and be aware of the present conditions supporting the thought or emotion - they should accept that these thoughts will occur but that they should focus more on the reaction to them and through meditative-like activities

Question 26

Treatment of GUD and SUD’s: pharmacotherapies

Answer 26

• no currently approved medication fro GUD
  (SSRIs and opiate antagonists have been investigated)
• results have not shown reliable effects often being any better than a placebo
• in situations where there is a comorbid psychological condition pharmacotherapy is effective in reducing it