L03 Flashcards
Gambling
Wagering of a valuable on an event with an uncertain outcome with the intent of winning goods.
Outcome unknown, could win could lose.
An early win and some life problem increases the likelihood of pathological gambling.
Many myths/superstitions- hot/cold machines, chasing belief, personification of gambling device or systems.
Gambling Criteria
Over a 12 month period
4-5 is mild
6-7 is moderate
8-9 is severe
Sub groups of gamblers
Group 1- no problem gambling
Absence of psychopathology
Poor decision making
Anxiety
More motivated to seek tx and comply
Controlled gambling possible
Sub Groups of Gamblers
Group 2- problem gambling
Some psychopathology
History of family gambling
Excessive use of avoidance
Passive aggressive behaviour
Gamble to escape
Abstinence recommended
Sub Groups of Gamblers
Group 3- gambling disorder
Biological predisposition
Impulsivity preceded gambling problems
Childhood behaviours such as ADHD, inability to delay gratification
Sensation seeking
Often chaotic lifestyle
Recommend inpatient tx
Gamblers
All gambling addicts are problem gamblers, although not all problem gamblers have a gambling addiction.
Biochemistry
During gambling there is an association with higher levels of endorphins
Decreased serotonin associated with adult risk taking behaviours-alcoholism and gambling
Dysregulation implicated in severe gambling
High rate of co-occurring disorders with severe gambling, 16% had problems with alcohol and drugs, and/or mental health problems 22%.
Gambling screen
South Oaks Gambling Screen- most widely used in gambling counselling, 20 item question.
Score of 5 or more indicative of probable severe gambling.
Not specifically based on DSM V.
Effective in co occurring disorders populations.
Gambling screen
In clinical practice
Lie/bet questionnaire found to be effective
1) have you ever felt the need to bet more and more money?
2) have you ever had to lie to people who are important to you about how much money you gamble?
A yes to either indicative of probable harmful gambling.
Assessment/Diagnosis
SOGS
The South Oaks Gambling Screen is a 20-item questionnaire based on DSM criteria for pathological gambling. Score of 0- no problem with gambling; 1-4 some problems with gambling; 5 or more probable severe gambler
Lie Bet
1) have you ever felt the need to bet more and more money?
2) have you ever had to lie to people important to you about how much money you gambled? Yes to one or both further investigation needed.
Rehabilitation and Recovery
Short term: self-exclusion, dealing with money/crisis interventions
Bibliotherapy
Self help groups: gambling addiction based on the 12 step model
CBT/SMART recovery/RT
Motivational interviewing- incorporating the stages of change
Psychopharmacology- some small studies have found that antidepressants, mood stabilizers, opioid antagonists have positive effects- the studies included fluvoxamine, escitalopram, lithium, and naltrexone.
Treatment
1) screening for gambling using a standardized instrument or the DSM-V criteria.
2) immediate intervention if the client is suicidal.
3) referral to gambling counsel or for ongoing assistance.
4) enlisting the help of supports to strengthen tx adherence and effectiveness
5) actively participating in the tx plan with subsequent assessment for relapses, may include gambling anonymous.
Gambling and learning theory
Winning at gambling is positively rewarding.
Intermittent reinforcement is the most difficult thing to extinguish.
Gambling is a good example of intermittent reinforcement.
Gaming
Proposed condition for the DSM
“Causes significant impairment or distress”
Does not include general use of internet, online gambling, social media, or smart phones.
Has proposed symptoms- 5 or more within one year.
