L14 - Addiction - Gambling

Question 1

Define gambling:

Answer 1

Risking an item of value on and outcome determined (predominately) by chance.

Problem gambling occurs when personal or social harm results from gambling behaviour.

Pathological/Gambling Disorder: when DSM criteria are met.

Question 2

Why do individuals engage in gambling behaviours despite adverse consequences?

Answer 2

• Hope to recoup losses (chasing).
• Emotional escape.
• Satisfy emotional needs (narcissism, ego).
• Manage dysfunctional affective states.

Question 3

What is the prevalence of gambling?

Answer 3

• In Australia and Europe:
  Pathological: 0.4-1.1%
  Problem: 1-2%
• 90% of individuals begin gambling before age 20.
• Average age seeking treatment is 35-39.

Question 4

What are some comorbid conditions in individuals with gambling addiction?

Answer 4

• 30-40% alcohol abuse/dependance in pathological gamblers.

- 75% with depression, 40% with anxiety.

Question 5

What are the differences between DSM-IV and DSM-5 in the classification of gambling?

Answer 5

DSM-IV:
- Impulse control disorder, like kleptomania and trichotillomania.
DSM-5:
- Non-substance behavioural addiction.

Question 6

What are Custer’s (1984) three stages of gambling disorder?

Answer 6

1. Early winning phase:
   - Large win prior to development in 2/3 pathological gamblers setting up facilitative cognitions (“this is easy”).
   - Gambling becomes strong influence on mood, increase in frequency and intensity.
2. Losing phase:
   - Heightened preoccupation with gambling.
   - Chasing losses.
   - Increased stress irritability.
3. Desperation phase:
   - Efforts to survive financially and psychologically become extreme (illegal activity, relationship manipulation).
   - 60% have committed an offence to finance gambling.

Question 7

What is the Cognitive Model of gambling?

Answer 7

• Erroneous beliefs and misunderstanding concepts of probability and mutual independence of chance events contributes to over inflated estimates of winning.
• Illusions or control, luck, skill.
• Biased memories.
• Gambler’s Fallacy.

Question 8

What is the Integrated Bio-Psycho-Social Model of gambling?

Answer 8

• Multiple interactive vulnerability factors.
• Neurobiological/genetic (reward pathway dysregulation).
• Family history (modelling, exposure, trauma).
• Personality traits and coping strategies.

Question 9

What is the Learning Model of gambling?

Answer 9

Operant Conditioning:
- random ratio reinforcement schedule is highly resistant to extinction.
Classical Conditioning:
- Neutral stimuli (time of day, lights, sounds) become associated with arousal.
- Stimuli trigger reward memories -> increased urge to gamble.

Question 10

What is the Pathways Model of gambling?

Answer 10

• The Pathways Model of gambling is based on the premise that gamblers are not a homogenous population.
• 3 Subtypes exist with differing aetiological factors and treatments.

Question 11

What is Pathway 1?

Answer 11

• Symptoms are causal outcomes of gambling-related problems.
• Briefer history, childhood/family stability.
• Any depression/anxiety are secondary.
• Treated with psycho-education, brief interventions, and brief CBT.

Question 12

What is Pathway 2?

Answer 12

• Affective disturbances, poor coping skills, and substance use contribute to gambling.
• Gambling used as an emotional escape.

Question 13

What is Pathway 3?

Answer 13

• Deficits in reward pathways, and impulsive.
• Early onset, family history of abuse/neglect.
• Gambling pursued for stimulation.
• Treated with psychopharmacology and intensive interventions.