Gambling Addiction Flashcards
Prevalence of gambling in our society
- 56% of uk people gamble (gambling commission 2015)
a. 9000 betting shops - Gambling act 2005
a. allowed fixed odds betting terminals (FOBT)
eg roulette allows relatively high stake betting machines on the high street - Northern cities, boroughs of London and other places with high unemployment bet 4 times as much on gambling machines as rural wealthy southern parts of England where low unemployment (Guardian, 2013)
- twice as many betting shops in poorer areas
- UK online gambling is a multi billion pound business
in 2012 we passed the 2 billion mark
Prevalence in society pt2
Deleuze et al 2015 - online survey (n=770)
- 0,77% state they gamble almost every day
2. 2% state they gamble few times a week - BUT can gamble frequently without addiction
- Sussman et al (2011)
- Gambling addiction prevalence = 2%
Why are psychologists interested?
researching gambling behavior - Impaired Decision Making
Gambling addicts perform worse on decision-making tasks
For example, poorer on the Iowa Gambling Task (Ko et al., 2010
4 virtual deck – sample from cards to win money
Some decks ‘good’, some decks ‘bad’ – addicts persevere longer sampling from the bad decks
This behaviour is linked to orbitofrontal cortex dysfunction
DSM-5 diagnosis of gambling disorder
A) Persistent and recurrent problematic gambling leading to clinically significant impairment or distress, as indicated by the individual exhibiting four (or more) of the following in a 12 month period
(E)Often pre-occupied with gambling (e.g. having persistent thoughts or reliving past gambling experiences, handicapping or planning the next venture, thinking of ways in which to get money with which to gamble)
(F)Often gambles when feeling distressed (e.g. helpless, guilty anxious depressed) (G)After losing money gambling, often returns another day to get even (“chasing” one’s losses)
(H)Lies to conceal the extent of involvement with gambling
(I)Has jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling
(J)Relies on others to provide money to relieve desperate financial situations caused by gambling 13
B. Gambling behavior is not better explained by a manic episode
What does it have a strong comorbidity with?
substance use disorder (Lorains et al., 2011; Oleski et al., 2011)
Disordered gamblers, 3.8 times more likely to have alcohol use disorder (el-Guebaly et al., 2008
What controversial changes to the DSM-IV were made?
clinical description with little empirical support outside of a treatment environment
DSM-IV recognized only the presence or absence of a clinical disorder
gambling problems exist on a continuum, problem gamblers
under the impulse-control disorders
a. important differences between the disorders
Changes from DSM-IV, changes to criteria
Changing the name
DSM-IV required 5 (or more) criteria while DSM-5 requires 4 or more
More liberal diagnosis
a. increased reported prevalence of GD (Denis et al., 2012)
b. More false positives (Batstra et al., 2012)?
Impact on available treatment resources?
DSM-IV includes a criteria where illegal acts have been perpetrated (e.g. theft, fraud etc.) in order to fund gambling while DSM-5 does not.
Qualitatively changing the disorder?
Study to how changes in criteria affected diagnosis
Rennert et al. (2014)
Sampled 1507 people within a substance dependency study who reported gambling at least once per month
Using DSM-IV criteria 563 diagnosed GD
Using DSM-5 criteria 678 diagnosed GD
What did Rennert et al 2014 look at?
Most common criteria linked to DSM-5 diagnosis
Pre-occupation with gambling (90.4%)
Chasing losses (82.6%)
Need to increase amount of money gambled (65.2%)
Reliance on other for money (54.8%)
But found removal of illegal acts had little impact (one of the less common criteria for DSM-IV diagnosis)
DSM-5 diagnosis also associated with
Age of gambling onset
Reports of others objecting to their gambling
Casino gambling
What did Rennert et al 2014 see an increase in?
20.4% increase in prevalence with dsm-5 diagnosis
What did DSM5 reclassify GD as?
impulse-control disorder not elsewhere classified” to “substance-related and addictive disorder”
Reflects similarity with substance addiction (Grant et al., 2010
What are the 5 points of behavioral addiction?
Tolerance, Personality,Progress of addiction, Biological causes and treatment
Explain tolerance
Gamblers have to increase the intensity (stake) in order to get the same mood effects (Blanco et al., 2001)
Similar to building up a tolerance to a drug
Explain personality
Similar to individuals with a substance disorder, high on impulsivity and sensation seeking (Kim & Grant, 2001)
Progression of addiction
Males
Early onset of gambling a predictor of addiction (Grant & Kim, 2001)
Similar to substance abuse
Females
Women show
‘telescoping’ (Potenza et al., 2001)
Later initial engagement but once started to progress faster to addiction
A similar trend is found with substance addiction
Biological causes
Serotonin and dopamine linked to both disorders (e.g. Potenza, 2008)
Diminished activity in the ventral medial prefrontal cortex associated with substance and gambling addiction (Potenza et al., 2003; London et al., 2000
Biolgical causes; what is dopamine, serotonin and he ventral medial prefrontal cortex?
Dopamine
•Neurotransmitter: chemical released by neurons to send signals to other neurons.
•Rewards/pleasure increase dopamine, e.g. addictive drugs increases dopamine activity
Serotonin
•Neurotransmitter involved in regulating mood and learning
Ventral medial prefrontal cortex
•Ventral = underside
Medial = middle
•Linked to processing risk and fear
Treatment
Naltrexone (μ opioid receptor antagonist) used to treat both substance and gambling addiction (Kim et al., 2001; Grant et al., 2008)
How does Naltrexone work?
Antagonist = blocks binding to the receptor: prevents the body responding to opioids (dampens euphoria of drug/gamble)
Is gambling a behavioural addiction? What’s happening to the movement of behavioural addictions?
a growing movement of behavioural addictions, (e.g. hypersexuality, love(?), excessive tanning, social networking, exercise, computer gaming addictions
What did Griffiths (2005) argue addictions have?
6 components - irrespective of whether chemical/behavioural
(1)Salience: most important activity/
pre-occupied/cravings
(2) Mood modification: subjective experience following activity engagement (buzz/escapism)
(3) Tolerance: need increasing amounts of the activity to get same effects (gradual build up of time/resources on the activity)
(4) Withdrawal symptoms: unpleasant feelings/physical effects when unable to engage in the activity
(5) Conflict: spending too much time on the activity causes conflict with persons/things in your life
(6) Relapse: activity quickly restored after a period of control
Various approaches of treatment?
Gamblers anonymous – the process of breaking the hold gambling has over one [in guided groups]
Cognitive behavioural therapy - identify and challenge false beliefs [about potential wins]
μ opioid receptor antagonist – based medication. Dampens euphoria/rewards [changes neurotransmission]
Summary
Psychologist interest: high numbers & individual differences in behaviour
GD has common features with other addiction related disorders, related biological mechanisms
Some key diagnostic criteria recently changed with consequence for numbers
Recent acknowledgement that some behaviour can show addiction is reflected in DSM-4 to DSM-5 changes
There are behavioural/psychological treatments but also medical treatments [similar to substance abuse treatments].
