Lecture 17 Gambling

Question 1

definition of non-substance bahavioural addiction

Answer 1

Repetitive persistent behaviours resulting in significant harm or distress that causes functional impairment

Question 2

changes in DSM-5

Answer 2

1. Introduced a new category:
   • Substance-related and addictive behaviours.
   • Non-substance-related disorder
2. Reclassified pathological gambling as gambling disorder
3. Internet Gaming Disorder included in Section III (Conditions for Further Study)
   - Behavioural similarities to substance use disorders
   - Has significant public health implications
   - Internet gaming recognised by Chinese government as a disorder with policies & treatment services provided

Question 3

DSM-5 non substance related disorders

Answer 3

Criterion A: 4+

1. Preoccupation (psychological dependence)
2. Increased amount gambled (tolerance)
3. Irritability/restlessness on cessation (withdrawal)
4. Escape from stress (negative reinforcement & motivation)
5. Chasing losses (erroneous & distorted cognitions)
6. Lying
7. Repeated failure to cease (impaired control)
8. Illegal acts
9. Risked significant relationships
10. Bailout

Question 4

Confirmatory three step approach

Answer 4

1. Anecdotal observations consider behaviour a priori as addictive
2. Screening instrument developed (often derived from criteria defining
   another disorder – substance use/gambling disorder
3. Identify risk factors known to play a role in the development and maintenance of substance use/gambling disorders (impulsivity, attentional biases)

ignores:
1. functional impairment
2. stability of dysfunctional behaviour (evidence that behaviours are transient and context specific)

Question 5

definition of gambling

Answer 5

Risking item of value on outcome of events determined by chance for personal gain
• Electronic gaming machines: Pokies/slots, poker, blackjack, keno, roulette
• Numbers: Lottery, lotto, scratch-cards
• Wagering: Horses, dogs, sports

all gambling involves risk-taking

Question 6

problem gambling vs pathological gambling

Answer 6

problem gambling: personal or social harm resulting from excessive gambling

pathological gambling: meeting DSM criteria

Question 7

prevalence of gambling

Answer 7

60-85% of general population

past year pathological gambling prevalence: 0.2% in norway & UK, 5.3% in HK

in USA: 0.4-1.1% pathological, 1-2% problem gambler

adolescence:
3-14%

among gaming venue patrons:
15-25%

Question 8

internet gaming disorder

Answer 8

– Not just a social phenomenon in countries with extensive Internet access
– A potential psychiatric disorder disorder
– Prevalence rates in adolescents range from 0.8 to 26.7%
– Above 10% in adolescents in South Korea, China, Taiwan, Hong Kong, & Singapore
– Associated with impairment in cognition, psycho-social relationships, & daily life
– Gambling-like features risk factor/gateway to gambling through social media

Question 9

young australians playing gambling-themed games

Answer 9

high school students:
13% played simulated games, 32% at least once

adolescents:
23% played social casino games, 22% played practice games

Question 10

Features of games contributing to problems

Answer 10

– Structure of game: Breaks in play & in-App purchases
– Accessibility on multiple platforms
– Psychological: Depression, social anxiety, ADHD, impulsivity, sensation-seeking
– Anonymity & capacity to play unsupervised
– Poor age verification
– Multiple pay options

Question 11

CBT for gambling

Answer 11

1. cognitive component: erroneous beliefs about gambling are maintained & reinforced through biased interpretation of gambling outcomes

intervention focus on identifying and correcting cognitive distortions
• Illusions of control
• Gambler’s fallacy
• Biased evaluation
• Mutual independence
• Probabilities
• Illusory correlations (superstitions)

2.Behavioural component:
learnt maladaptive behaviour caused by early experiences and prevailing reinforcement schedules

intervention: classical and operant conditioning techniques to reduce arousal associated with gambling
e. g. positive reinforcement of alternative behaviors, stimulus control, behavioural counseling & avoidance of trigger

Question 12

decision to gamble

Answer 12

• Cost/benefit analysis
• Impulsivity (neural substrates/personality) •Personality needs (ego, narcissism)
• Emotional escape

Question 13

pathways model of pathological gambling

Answer 13

premise: pathological gamblers are not a homogenous population

3 subtypes with:

• common phenomenology
• differ in aetiological factors
• differ in treatment requirements

Question 14

3 pathways of gambling

Answer 14

1. Symptoms are causal outcomes of gambling-related
   problems: Amenable to psycho-education, brief interventions & brief CBT
2. Affective disturbances, poor coping skills, & substance use contribute to gambling (dissociation & escape)
3. Deficits in reward pathways (dopaminergic) & impulsive: Psychopharmacology & intensive interventions

Question 15

pathway 1

Answer 15

Demographics:
– Motivation to generate excitement, winning
– Briefer history of excessive gambling
– Childhood & family stability

Psychopathology
– Absence of psychopathology
– Depression/ anxiety: secondary to problem gambling
– Substance abuse minimal: onset after gambling problems

Question 16

pathway 2

Answer 16

– Comorbid conditions: Anxiety, depression, lack of social support, gambling used as means of emotional escape
– Motivation: gambling with money, not for money: prolong sessions to allow continued emotional escape
– Poor stress-coping & problem-solving strategies

Question 17

pathway 3

Answer 17

– Age: early onset problem gambling
– Early history of family instability, abuse/neglect
– Gambling reflects one of many maladaptive behaviours
– High levels of impulsivity, anti-social behaviour
– Poorer performance at school (inattentive, disruptive)
– Involvement in activities with high degree of stimulation
– Substance abuse –drugs & alcohol & broad spectrum of criminal behaviours