Diseases

The first step to obtaining appropriate treatment is accurate diagnosis, which requires a complete physical and psychological evaluation to determine whether the person may have a gambling addiction. Since some medical conditions can cause an individual to develop erratic, impulsive behaviors, including problem gambling, the examining physician should rule out (exclude) these possibilities through an interview, physical examination, and applicable laboratory tests, as well as implementing a full mental-health evaluation. A thorough diagnostic evaluation includes a complete history of the patient's symptoms, during which time the practitioner might ask the following questions:

1. How old were you when you gambled for the first time?
2. How much time (how often and for how long each time) do you spend gambling or thinking about gambling?
3. How much money do you lose/spend gambling?
4. What kinds of things do you do to finance gambling?
5. Do you have irresistible urges to gamble?

The doctor usually asks about alcohol and drug use and whether the patient has had thoughts about death or suicide. Further, the history often includes questions about whether other family members have had a gambling problem or other mental-health problems, and if treated, what treatments they received and which were effective versus ineffective.A diagnostic evaluation also includes a mental-status examination to determine if the patient's speech, thought pattern, mood, or memory has been affected, as often happens in the case of a many forms of mental illness. As of today, there is no laboratory test, blood test, or X-ray that can diagnose this mental disorder.

In addition to alleviating risk factors for compulsive gambling, educating the public about the warning signs for this disorder are key components to prevention. Some warning signs include often talking about gambling, bragging about gambling wins, poor performance and unexplained absences from work or school, mood swings, stealing, or excessive borrowing.

When contemplating why people gamble, it is important to understand that there is usually no one specific cause for pathological gambling. Some potential exceptions include the observation that some individuals who are given medications that treat Parkinson's disease or restless leg syndrome (including pramipexole [Mirapex]) have been observed to develop impulse-control disorders like compulsive gambling, shopping, or compulsive sexual behaviors. The theory about that connection involves the increased activity of the chemical messenger dopamine in the brain. Another example where compulsive gambling may have a single cause is in bipolar disorder since exorbitant spending, including compulsive gambling, may be a symptom of the mania that is part of bipolar disorder.Much more commonly, gambling addiction, like most other emotional conditions, is understood to be the result of a combination of biological vulnerabilities, ways of thinking, and social stressors (biopsychosocial model). There are, however, elements that increase the likelihood that the individual will develop a gambling addiction. Risk factors for developing pathological gambling include schizophrenia, mood problems, antisocial personality disorder, and alcohol or cocaine addiction. Individuals who have a low level of serotonin in the brain are also thought to be at higher risk for developing pathological gambling compared to others.People who suffer from compulsive gambling have a tendency to be novelty seekers, feel disconnected (dissociated), relaxed, or aroused while gambling or playing video games. Research also shows that individuals who have money problems, win a large amount of money early into gambling, suffer a recent loss (like divorce, job loss), or are lonely increases the risk of developing compulsive gambling. Easy access to gambling (for example, living near towns with many gambling resources, such as Las Vegas or Atlantic City), belief that they’ve discovered a system to winning at gambling and failing to keep track of money won and lost gambling are more risk factors for engaging in compulsive gambling.

Although as many as one-third of individuals who suffer from pathological gambling may recover from the disease without receiving any treatment, the potential devastation that compulsive gambling can wreak on the life of the suffer and those around him or her clearly indicate that the potential positive aspects outweigh the possible complications that result from an intervention. As much as $5 billion is spent on gambling in the United States every year, with people who are addicted to gambling accruing tens to hundreds of thousands of dollars in debt. Harmful effects that compulsive gambling can have on the individual include financial problems ranging from high debt, bankruptcy or poverty, to legal problems resulting from theft to prostitution, to wanting, attempting, or completing suicide. Many compulsive gambling sufferers experience stress-associated medical problems like insomnia, stomach ulcers and other gastrointestinal problems, headaches, and muscle aches. Gambling addiction can have a multitude of negative effects on the family. Statistics indicate that families of people with compulsive gambling are more likely to experience domestic violence and child abuse. Children of problem gamblers are at significantly higher risk of suffering from depression, behavior problems, and substance abuse. One of the challenges of treatment of compulsive gambling is that as many as two-thirds of people who begin treatment for this disorder discontinue treatment prematurely, whether treatment involves medication, therapy, or both.

Pathological gambling involves persistent and recurring problem gambling that includes several of the following symptoms that are not the result of another mental-health problem, like during a manic episode:

• A preoccupation with gambling, either by reliving past gambling, planning for future gambling experiences, and/or thinking of ways to secure money to finance gambling
• Needing more and more money for gambling in order to achieve the desired level of gambling enjoyment
• Repeated unsuccessful attempts to stop or reduce betting behaviors
• Becoming uneasy or easily irritated when trying to reduce or stop gambling
• Gambling for the purpose of escaping problems or to relieve depression or anxiety
• Returning to gambling after losing money in an effort to recoup losses
• Lying to family or other loved ones, mental-health professionals, or others in an effort to hide the extent of the gambling behavior
• Committing crimes (for example, stealing, fraud, or forgery) or securing illegal loans to finance gambling
• Risking important relationships, employment, or other opportunities due to gambling
• Depending on others for money to resolve dire financial situations that are the result of gambling

Gambling addiction is a mental-health problem that is understood to be one of many kinds of impulse-control problems and having many similarities to obsessive compulsive disorder. However, it is now understood to be more similar to other addictive disorders. The types of gambling that people with this disorder might engage in are as variable as the games available. Betting on sports, buying lottery tickets, playing poker, slot machines, or roulette are only a few of the activities in which compulsive gamblers engage. The venue of choice for individuals with gambling addiction varies as well. While many prefer gambling in a casino, the rate of online/Internet gambling addiction continues to increase with increased use of the Internet. Alternatively, some compulsive gamblers may also engage in risky stock market investments. Gambling addiction is also called compulsive gambling or pathological gambling.Estimates of the number of people who gamble socially and qualify for being diagnosed with a gambling addiction range from 2%-3%, thereby affecting millions of people in the United States alone. Other important statistics on problem gambling include that it tends to affect at least 1% of people internationally. Teens actually tend to suffer from this disorder at a rate that is twice that of adults.Although more men than women are thought to suffer from pathological gambling, women are developing this disorder at higher rates, now making up as much as 25% of individuals with pathological gambling. Other facts about compulsive gambling are that men tend to develop this disorder during their early teenage years while women tend to develop it later. However, the disorder in women then tends to get worse at a much faster rate than in men. Other apparently gender-based differences in gambling addiction include the tendencies for men to become addicted to more interpersonal forms of gaming, like blackjack, craps, or poker, whereas women tend to engage in less interpersonally based betting, like slot machines or bingo. Men with pathological gambling tend to receive counseling about issues other than gambling less often than their female counterparts.Problem gambling generally means gambling that involves more than one symptom but fewer than the at least five symptoms required to qualify for the diagnosis of compulsive or pathological gambling. Binge gambling is a subtype of compulsive gambling that involves problem gambling but only during discrete periods of time. That is different from a general gambling addiction, which tends to involve excessive gambling behavior on an ongoing basis and to include persistent thoughts (preoccupation) about gambling even during times when the person is not engaged in gambling.

With treatment, the prognosis of compulsive gambling can be quite encouraging. More than two-thirds of people with this disorder tend to abstain from problem gambling a year after receiving six weeks of treatment. After treatment has ended, less than one-fifth of those who receive follow-up for relapse prevention tend to relapse into gambling addiction behavior after one year compared to half of those who do not receive follow-up.

Although there is no standardized treatment for pathological gambling, many people participate in Gamblers' Anonymous (GA) or learn how to stop engaging in gambling behaviors. The approximately 8% one-year abstinence rate that intervention tends to produce is often improved when GA is combined with psychotherapy that is administered by a trained professional. That seems to be particularly true when cognitive behavioral treatment is the psychotherapy approach that is used by the practitioner. Medications that have been found to be helpful in decreasing either the urge to gamble or the thrill involved in doing so include antiseizure medications like carbamazepine (Tegretol) and topiramate (Topamax), mood stabilizers like lithium (Eskalith, Lithobid), medications used to address addictions like naltrexone (ReVia), and antidepressants like clomipramine (Anafranil) and fluvoxamine (Luvox). Psychotherapy appears to be more effective than any of the medications used to treat this disorder so far. Financial/debt counseling and self-help interventions may also be important aspects of the care provided to individuals with gambling addiction.Individuals who engaged in illegal behavior in the year prior to treatment tend to have more severe symptoms of this disorder, have more gambling-related debt compared to people who have not engaged in illegal activity during that time period. It is therefore thought that people who engage in breaking laws in the year before treatment begins need more intensive treatment for a longer period of time, sometimes even requiring inpatient or residential treatment, often referred to as rehab. Another important fact to consider in treatment for a gambling addiction is that up to 70% of people with this disorder also have another psychiatric problem. Therefore, it is not enough to just treat the gambling problem but any coexisting mental-health condition (such as alcoholism or other substance abuse problem, mood disorder, or personality disorder) should be addressed as well in order to give the person with a gambling addiction his or her best chance for recovery from both conditions. There is also a need for research about how a person's culture can play a role in the development and treatment of problem gambling.Some studies have explored the possibility that so-called home remedies may help treat gambling addiction. Some remedies being explored to address this disorder include glutamate, diet, and aromatherapies.

NAADAC - The Association for Addiction Professionals1001 N. Fairfax St., Suite 201Alexandria, VA 22314Phone: 1-800-548-0497Fax: 1-800-377-1136UCLA Gambling Studies Programhttp://www.uclagamblingprogram.orgMassachusetts Council on Compulsive Gambling1-800-426-1234http://www.masscompulsivegambling.org

Compulsive Gamblers Hubhttp://www.cghub.homestead.comCompulsive Gambling Center924 East Baltimore St.Baltimore, MD 212021-800-LOST-BET (1-800-567-8238)http://www.lostbet.comDebtors AnonymousGeneral Service OfficeP.O. Box 920888Needham, MA 02492-0009Phone: 781-453-2743Fax: 781-453-2745http://www.debtorsanonymous.orgGam-Anon International Service Office, Inc.P.O. Box 157Whitestone, NY 11357718-352-1671Gamblers Anonymous (GA) International Service OfficeP.O. Box 17173Los Angeles, CA 90017213-386-8789[email protected]GamBlockhttp://www.gamblock.comProblem Gambling.com24 Hours a Day7 Days a WeekU.S. Gambling Hotline: 1-800-522-4700Canadian Gambling Hotline: 1-888-391-1111United States National Gambling Help Line1-800-522-4700