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Addictions

Gambling Disorder (Addiction)

A. Tom Horvath, Ph.D., ABPP, Kaushik Misra, Ph.D., Amy K. Epner, Ph.D., and Galen Morgan Cooper, Ph.D.

Gambling addiction occurs when an individual continues to gamble despite negative consequences. Gambling disorder is the only behavioral addiction included in DSM-5. The reason gambling was included, but not other activity addictions, is because gambling addiction has been well researched. This research identified the neurological similarities between gambling addiction and drug addiction. There appears to be a genetic basis as well (APA, 2013). Oddly enough, the "near-misses" lead to increased levels of dopamine (Chase & Clark, 2010).

man gambling and drinkingLike most addictions, gambling disorder develops over time and may increase in severity over time. Likewise, gambling disorder patterns can be either regular or episodic. There may be periods of heavy gambling during emotional and psychological distress. This may be followed by a period of abstinence. Gambling disorder is not related to the amount of money that is spent on gambling. A gambling disorder indicates gambling continues despite the impairment and harm it causes.

The diagnostic criteria for gambling disorder are very similar to the criteria for substance use disorders. These are: 1) impaired control, 2) social impairment, and 3) risky use

Impaired control criteria:

1. Has made repeated, but unsuccessful effort to control or stop gambling
2. Becomes preoccupied with gambling
3. Needs to gamble with increasing amounts of money to achieve the same desired excitement
4. Becomes restless or irritable when attempting to cut down or stop gambling

Social impairment criteria:

The essential feature of this disorder is that someone continues to gamble despite the harm caused to personal and family relationships, and harmful consequences at work or school.

5. Lies to conceal extent of gambling
6. Has lost or jeopardized important relationships with others, and/or lost educational or occupational opportunities due to gambling
7. Relies on other people to make up for the resulting financial problems

Risky use criteria:

8. Often gambles when under stress
9. After losing money, returns again to get even (called "chasing one's losses)

The diagnosis of gambling disorder is made when someone meets four or more of these nine criteria.

The American College of Neuropsychopharmacology, suggests people with gambling problems may be successfully treated using certain medications intended for substance addiction (ACNP, 2009). Cognitive-behavioral therapy or self-help groups (e.g., SMART Recovery or Gamblers Anonymous) are also helpful. Treatments are discussed here.

SEVERITY:

The DSM-5 uses a dimensional scale to estimate the severity of addiction. This scale is based upon the total number of symptoms matching the diagnostic criteria. The scale ranges from mild-to moderate-to-severe. Clinicians include this severity code as part of the diagnosis. Four or five symptoms matching the diagnostic criteria would be considered a mild gambling disorder. Six or seven symptoms would be labeled a moderate gambling addiction. Eight or nine symptoms represent a severe gambling disorder.

 

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