PROBLEM GAMBLING

Problem gambling is an urge to gamble despite harmful negative consequences or a desire to stop. The term is preferred to compulsive gambling among many professionals, as few people described by the term experience true compulsions in the clinical sense of the word. Problem gambling often is defined by whether harm is experienced by the gambler or others, rather than by the gambler's behavior. Severe problem gambling may be diagnosed as clinical pathological gambling if the gambler meets certain criteria.
Contents
1 Definition
2 Pathological gambling
2.1 Biological bases
2.2 Relation to other problems
3 Prevalence
4 Assessment
5 Treatment for Compulsive Gambling
6 Treatment for Problem Gambling
6.1 Counselling
6.2 Step-Based Programs
6.3 Peer-support
6.4 Self-Help
7 See also
8 References
9 External links
Definition
There has been much debate over how problem gambling should be defined.[1] Research by governments in Australia led to a universal definition for that country which appears to be the only research based definition not to use diagnostic criteria.
“Problem gambling is characterised by many difficulties in limiting money and/or time spent on gambling which leads to adverse consequences for the gambler, others, or for the community.”[2]
Most other definitions of problem gambling can usually be simplified to any gambling that cause harm to the gambler or someone else in any way, however these definitions are usually coupled with descriptions of the type of harm or the use of diagnostic criteria such as the South Oaks Gambling Screen [3] or Canadian Problem Gambling Index.[4]
Pathological gambling
Extreme cases of problem gambling may cross over into the realm of mental disorders. Pathological gambling was recognized as a psychiatric disorder in the DSM-III, but the criteria were significantly reworked based on large-scale studies and statistical methods for the DSM-IV. As defined by American Psychiatric Association, pathological gambling is an impulse control disorder that is a chronic and progressive mental illness.
Pathological gambling is now defined as persistent and recurrent maladaptive gambling behavior meeting at least five of the following criteria, as long as these behaviors are not better explained by a manic episode:
1. Preoccupation. The subject has frequent thoughts about gambling experiences, whether past, future, or fantasy.
2. Tolerance. As with drug tolerance, the subject requires larger or more frequent wagers to experience the same "rush".
3. Withdrawal. Restlessness or irritability associated with attempts to cease or reduce gambling.
4. Escape. The subject gambles to improve mood or escape problems.
5. Chasing. The subject tries to win back gambling losses with more gambling.
6. Lying. The subject tries to hide the extent of his or her gambling by lying to family, friends, or therapists.
7. Loss of control. The person has unsuccessfully attempted to reduce gambling.
8. Illegal acts. The person has broken the law in order to obtain gambling money or recover gambling losses. This may include acts of theft, embezzlement, fraud, forgery, or bad checks.
9. Risked significant relationship. The person gambles despite risking or losing a relationship, job, or other significant opportunity.
10. Bailout. The person turns to family, friends, or another third party for financial assistance as a result of gambling.
11. Biological Bases. The person has a lack of norepinephrine.
As with many disorders, the DSM-IV definition of pathological gambling is widely accepted and used as a basis for research and clinical practice internationally.

Biological bases
According to the Illinois Institute for Addiction Recovery Recent evidence indicates that pathological gambling is an addiction similar to chemical addiction. It has been seen that some pathological gamblers have lower levels of norepinephrine than normal gamblers.
According to a study conducted by Alec Roy, M.D. formerly at the National Institute on Alcohol Abuse and Alcoholism, norepinephrine is secreted under stress, arousal, or thrill, so pathological gamblers gamble to make up for their underdosage.
Further to this, according to a report from the Harvard Medical School Division on Addictions there was an experiment constructed where test subjects were presented with situations where they could win, lose or break even in a casino-like environment. Subjects' reactions were measured using a fMRI, a neuro-imaging device very similar to a MRI. And according to Hans Breiter, MD, co-director of the motivation and Emotion Neuroscience Centre at the Massachusetts General Hospital, "Monetary reward in a gambling-like experiment produces brain activation very similar to that observed in a cocaine addict receiving an infusion of cocaine."
Deficiencies in serotonin might also contribute to complusive behavior, including a gambling addiction.
Relation to other problems
As debts build up people turn to other sources of money such as theft, or the sale of drugs. A lot of this pressure comes from bookies or loan sharks that people rely on for capital to gamble with. Also, a teenager that does not receive treatment for pathological gambling when in their desperation phase is likely to contemplate suicide. 20% of teenagers that are pathological gamblers do consider suicide. This according to the article High Stakes: Teens Gambling With Their Futures by Laura Paul.
Abuse is also common in homes where pathological gambling is present. Growing up in such a situation leads to improper emotional development and increased risk of falling prey to problem gambling behavior.
Pathological gambling is similar to many other impulse control disorders such as kleptomania, pyromania, and trichotillomania. Other mental diseases that also exhibit impulse control disorder include such mental disorders as antisocial personality disorder, or schizophrenia.
Prevalence
According to a variety of sources, the prevalence (i.e., extent of existing cases) of problem gambling is 2-3% and pathological gambling is 1% in the United States, though this may vary by country. By contrast, about 86% of Americans have gambled during their lives and 60% gamble in a given year. Interestingly, despite the widespread growth in gambling availability and the increase in lifetime gambling during that past 25 years, past year problem gambling has remained steady. Currently, there is little evidence on the incidence of problem gambling (i.e., new cases).
Available research seems to indicate that problem gambling is an internal tendency, and that problem gamblers will tend to risk money on whatever game is available, rather than a particular game being available inducing problem gambling in otherwise "normal" individuals. However, research also indicates that problem gamblers tend to risk money on fast-paced games. Thus a problem gambler is much more likely to lose a lot of money on poker or slot machines, where rounds end quickly and there is a constant temptation to play again or increase bets, as opposed to a state lottery where the gambler must wait until the next drawing to see results.
Dopamine agonists, in particular pramipexole (Mirapex), have been implicated in the development of compulsive gambling and other excessive behavior patterns (e.g., PMID 16009751).
Assessment
The most common instrument used to screen for "probable pathological gambling" behavior is the South Oaks Gambling Screen (SOGS) developed by Lesieur and Blume (1987) at the South Oaks Hospital in New York. This screen is undoubtedly the most cited instrument in psychological research literature (printable PDF version).
Treatment for Compulsive Gambling
There is evidence that the SSRI paroxetine is efficient in the treatment of pathological gambling [5]. Additionally, for patients suffering from both pathological gambling and a comorbid bipolar spectrum condition, sustained release lithium has shown efficacy in a preliminary trial. [6]. The opiate antagonist drug nalmefene has also been trialled quite successfully for the treatment of compulsive gambling.
reatment for Problem Gambling
Most treatment for problem gambling involves counselling, step-based programs, self-help, peer-support, or a combination of these.
Counselling
Gambling counselling is usually delivered by professional counsellors who are often either qualified psychologists or social workers. In many jurisdictions services are free or subsidised by government agencies. Telephone counselling services are also available in many countries. Examples of services include Gamcare (UK) and Gambler's Help (Australia).
Step-Based Programs
The most common step-based program for gambling issues is Gamblers Anonymous. Gambler's Anonymous uses a 12 step program adapted from Alcoholics Anonymous and also places an emphasis on peer suppport. Other step-based programs (some commercially operated) that are both specific to gambling and generic to addiction have also be used to treat problem gamblers.
Peer-support
A growing method of treatment is peer support. With the advancement of online gambling, many gamblers experiencing issues use various online peer-support groups to aid their recovery. This protects their anonymity whilst allowing to attempt to self-recover often without having to disclose their issues to loved ones.
Self-Help
Research into self-help for problem gamblers is showing promising results. David Hodgins research into the use of workbooks followed up with telephone support has shown benefits.[7] Online self-help sites have been funded which aim to provide gamblers with support whilst protecting their anonymity. Sites include: First Step and WebGAM.
See also
· Compulsive hoarding

Gambling Addiction Questions and Answers

Is pathological gambling similar to chemical dependency?
Yes and no. Similarities between pathological gambling and chemical dependency include an inability to stop/control the addiction, denial, severe depression, and mood swings. Pathological gambling and chemical dependency are both progressive diseases with similar phases. These include "chasing" the first win/high, experiencing blackouts and using the object of addiction to escape pain. Both pathological gamblers and persons addicted to alcohol or drugs are preoccupied with their addiction, experience low self-esteem, use rituals, and seek immediate gratification.
Unlike chemical addiction, pathological gambling is a hidden disease ­ gamblers do not stumble, have needles in their arm, or smell of cards and dice. Pathological gamblers cannot overdose in the conventional sense, but they experience tremendous financial problems that require immediate attention. More resources are available to chemical dependency than gambling addiction, in part because most people do not perceive gambling as potentially addicting. It is very important that pathological gamblers receive crisis stabilization at the beginning of their treatment, because pathological gamblers have a much higher suicide rate than persons addicted to alcohol or drugs.

How are children affected by pathological gambling?
Children may be affected in several ways. They may be physically and/or emotionally abandoned by their parents, who are unable to provide their children with needed attention and nurturing because of the time spent gambling. "Casino kids" have been left by themselves at the outer rim of casinos while their parents gamble, according to some casino security officers. In some extreme cases, children are left in the family car in the casino parking lot for hours at a time while their parents gamble inside. Less obviously, children may also spend several hours each week with babysitters while their parents gamble in casinos, bingo halls or card rooms. All of these scenarios may lead a child to feel physically and emotionally abandoned.
In addition, the dysfunction that pathological gambling creates in a home often includes spouse and child abuse. Children are abused verbally, mentally and physically by the gambler, and often even more so by the co-dependent spouse. This devastating abuse frequently goes unnoticed or is denied by others as the child suffers in silence.
Another way children are affected by pathological gambling is when they become pathological gamblers themselves. Today, teens are approximately three times more likely than adults to become problem and pathological gamblers. It is imperative that we educate young people about the dangers of pathological gambling and the importance of seeking help if gambling becomes a problem.

Are gamblers addicted to money?
Pathological gamblers are addicted to action, not money. Many pathological gamblers will gamble to lose in the desperation phase of their addiction, because it is the action they seek, not the money. For a gambler, being in action is similar to being high on cocaine for the person addicted to cocaine. Both describe their "drug of choice" as seductive and ultimately destructive.

What is the physician's role in treating pathological gambling at the Illinois Institute for Addiction Recovery?
Pathological gambling has been recognized as a major addiction illness, similar in many ways to the chemical dependency of cocaine. It is characterized by the sudden euphoria of winning and the marked dysphoria, depression and frustration of repeated losing.
The physician is needed to assess these patients for the frequent incidence of cross addiction to drugs and alcohol, for potential drug withdrawal, and for potential suicidal tendencies associated with the depression that most patients experience. Underlying medical problems are often neglected while patients are in a gambling frenzy, leading to symptoms of illness and health deterioration. Laboratory tests and physical examinations can often uncover unexpected medical problems.
The most important medical contribution the physician makes is to assist patients who are experiencing withdrawal by supporting their need for group therapy, assessing for possible antidepressant medication, and making referrals for appropriate psychological help. The use of sedative medication is avoided, as these drugs may lead to a deepening of the depression and may actually exacerbate suicidal behavior.

What is the financial counselor's role in treating pathological gambling at the Illinois Institute for Addiction Recovery?
Pathological gamblers often find themselves in a devastating financial position by the time they reach treatment. Helping them become financially stable goes a long way in supporting their recovery and the well-being of their families.
It is the responsibility of the financial counselor first to determine the extent of the gambler's debt, and then to help guide them out of their financial problems through debt management, budgeting and restitution.
Gamblers in treatment at Proctor Hospital work extensively with the financial counselor, through every level of care, to achieve financial stability.
Is there one type of gambling that is more addictive than others?
Video poker and slot machines have been referred to as the "crack cocaine of gambling." Because of their immediate and effective reinforcement schedules, problem gamblers who regularly play these machines appear to progress into pathological gambling much faster than problem gamblers who only gamble at horse races, or other games that do not have such an immediate rate of gratification.
Just as crack cocaine ­ referred to as the "great precipitator" ­ shortened the length of time between first use of cocaine and chronic addiction, so too have video poker and slot machines apparently reduced the length of time between first wager and pathological gambling. In the past, a gambler would experience 15 to 25 years of "sick" gambling at the horse track before he or she reached the desperation phase. Today, it is not uncommon for a gambler addicted to slot or video-poker machines to progress into the desperation phase in two or three years.

Is there a biological basis for pathological gambling?
Biological findings from a recent study indicate that pathological gambling is an addiction similar to chemical addiction.
A study conducted by Alec Roy, M.D., a psychiatrist formerly at the National Institute on Alcohol Abuse and Alcoholism, showed that some pathological gamblers have lower levels of norepinephrine than normal gamblers. This brain chemical is secreted under stress, arousal, thrill and excitement, so pathological gamblers may engage in activities such as gambling to increase their levels of norepinephrine.
This evidence supports the assertion made by Dr. Henry Lesieur, among others, that some pathological gamblers are "action seekers" who gamble, not for money, but for the excitement associated with being in action.
Many popular cine stars-"action seekers"- from India have lost astronomical amounts in American casinos!Remember day trading,option trading,speculations in share market are very well comes under this topic.