A powerpoint on Treatment Considerations for Gambling Use Disorder is available on Slide Share at:
http://www.slideshare.net/drleighholman/gambling-use-disorder-treatmen-considerations
http://www.slideshare.net/drleighholman/gambling-use-disorder-treatmen-considerations
Intervention
Diagnostic Features:Distorted Thinking:
- Denial
- Superstitions
- Sense of power & control over the outcome of chance events
- Overconfidence
- §Some are impulsive, competitive, energetic, restless, and easily bored” (p. 587).
- “May be overly concerned with the approval of others and may be generous to the point of extravagance when winning.”
- “Others may be depressed and lonely, and they gamble when feeling helpless, guilty, or depressed.”
- About 50% in treatment have suicidal ideation & about 17% have attempted suicide.
Prevalence
Last 12 months .2%-.3% of the general population
Lifetime prevalence rate gender & ethnicity
Risk & Prognostic Factors:
Last 12 months .2%-.3% of the general population
Lifetime prevalence rate gender & ethnicity
- Males: .6%
- Females: .2%
- African Am .9%
- Whites .4%
- Hispanics .3%
Risk & Prognostic Factors:
- Temperament
- Genetic
- Course Modifiers
Course and Development Earlier onset:
More common with males
Often begin with family & friends
Associated with impulsivity & substance abuse
HS & college students who have the disorder may grow out of it
Younger prefer sports betting
Older: Machine/bingo gambling more likely
Females: mid-late adult onset is typical
more rapid development in females
more likely than males to have depression, bipolar, & anxiety
Low rate of treatment seeking in general <10%, but more older onset females present for treatment than other populations
Frequency gambling can be more associated with the type of gambling than the severity of gambling. (scratch ticket vs. casino)
Amount of money not necessarily an indicator of a gambling problem
More common with males
Often begin with family & friends
Associated with impulsivity & substance abuse
HS & college students who have the disorder may grow out of it
Younger prefer sports betting
Older: Machine/bingo gambling more likely
Females: mid-late adult onset is typical
more rapid development in females
more likely than males to have depression, bipolar, & anxiety
Low rate of treatment seeking in general <10%, but more older onset females present for treatment than other populations
Frequency gambling can be more associated with the type of gambling than the severity of gambling. (scratch ticket vs. casino)
Amount of money not necessarily an indicator of a gambling problem
Functional Consequences:
Poor general health & utilize medical services at a high rates
Tachycardia & angina more common in GD population even when other substance use disorders are controlled for.
Jeopardize or loss of important relationships
Repeated lying to cover up the extent of gambling
May request money used for gambling or to pay off gambling debts
Employment/educational activities may be adversely impacted
Poor general health & utilize medical services at a high rates
Tachycardia & angina more common in GD population even when other substance use disorders are controlled for.
Jeopardize or loss of important relationships
Repeated lying to cover up the extent of gambling
May request money used for gambling or to pay off gambling debts
Employment/educational activities may be adversely impacted
- Absenteeism
- Poor work/school performance
Differential Diagnosis:Non-disordered gambling
Manic Episode
Personality Disorders
Other Medical Conditions (e.g. Parkinson’s meds)
Co-morbidity:
Substance us disorders
Depressive disorders
Anxiety disorders
Personality disorders
Manic Episode
Personality Disorders
Other Medical Conditions (e.g. Parkinson’s meds)
Co-morbidity:
Substance us disorders
Depressive disorders
Anxiety disorders
Personality disorders
Compulsive Activity
Loss of Control
- Stein, Hollander, & Liebowitz (1993) define compulsive gambling as “a conflict between a gambler’s stated intention, such as to not gamble, or to not gamble more than X amount, and the actual behavior, which violates the intention.”
- May experience ‘fugue-like’ states where they “find themselves engaging in unplanned, spontaneous gambling activity” (Chamberlain, 2004, p. 135).
- Triggers: internal & external
Loss of Control
- The Chase (1984) – the more they lose the more they gamble – chasing losses
- Double Down: double each bet they make following a loss with the intention of winning the bet that will eliminate the loss.
- Downward spiral of loss of more than intended and continuing to gamble to try to win back the losses.
- Gambling binges frequently end in exhaustion, disoriented, & an overwhelming sense of despair and depression that is unavoidable.
- Reports of being overpowered by the impulse to gamble
- Increasing pervasiveness of gambling in a person’s life to the point that all activities center around gambling
Continued Use Despite Adverse Consequences
- Mental health consequences include anxiety, depression, substance abuse, loss of a sense of self, loss of hope, feelings of shame & embarrassment, fear of consequences, suicidal ideation & attempts.
- Financial consequences, job loss
- Relationship issues: abandonment of family members; wives of compulsive gamblers are 4 times more likely to commit suicide than the general population (Lesieur, 1993); miss family commitments; iritability, defensiveness, verbal and physical violence.
- “The risk for self-destructive behavior is higher [in gambling] than with any other addiction” (Chamberlain, 2004).
- The longer they are able to hide the gambling, the more problematic it becomes. There are no obvious signs of intoxication, like substance dependence.
- Gambling is non-linear in it’s consequences (may have a win as they are going through a downward spiral, where substance addiction consequences generally progressively get worse.)
Patterns of Compulsive GamblingGamblers seek different emotional experiences through their gambling activity:
Escape Gamblers: Gambling becomes a trance-like escapePredisposing Factors:
Action Gamblers: Gambling becomes a powerful stimulant.
Escape Gamblers: Gambling becomes a trance-like escapePredisposing Factors:
- Physical, emotional, or sexual abuse
- Poor relationships
- Losses
- Denial of gambling as a problem
- Maintain family trust is important
- Onset later in life
- Faster progression of compulsive behavior
- Seeking to escape from loneliness or boredom
- Begins as a social activity and entertainment
- Participates mainly in games of chance
- Fewer big-win experiences
- Becomes emotionally dependent on gambling
- Preoccupied with gambling
- Depression
- Secretive about excess gambling
- Guilt about both financial losses and failure to meet standards of behavior
- Guild over lost time with family
- Shame related to dishonesty
- Fears of being revealed and disgraced
- Loss of household money
- Credit card problems
- Use of money from family savings or accounts
- Sale of valued family possessions
- Denial that gambling is a problem
- Frequently doesn’t want to stop gambling
- Partner may not intervene
- Family less supportive in getting help
- Child care
- Male dominated treatment and recovery services
Action Gamblers: Gambling becomes a powerful stimulant.
- Predisposing factors:
- Family of origin
- Personality characteristics
- Introduced by friends or family
- Begins betting at an early age
- Occasional gambling
- Experimenting with new types of gambling
- Developing a relationship with gambling
- Deviant behavior
- Precipitating or traumatic event
- Experiences a big win
- Frequent winning
- Fantasizing about winning
- Increases amount of money bet & time spent gambling
- Lies about gambling
- Brags about winning
- Chases losses
- Loses time from work or school
- Cannot stop gambling
- Begins to accumulate debts
- Relationship with family & friends impacted
- Frequently borrows money
- Drops non-gambling activities
- Becomes irritable, restless, depressed
- Unable to pay debts
- Sells possessions or family valuables
- Increases drug/alcohol use
- Thoughts of committing crimes to finance gambling
- Loss of job or drops out of school
- Withdraws from family & friends
- Blames others
- Shame, guilt, despair
- Thoughts of or attempts at suicide
- Emotional, physical, financial breakdown.
- Often begins when a recreational gambler wins big.
- Predominantly male, view gambling as a skill to be learned & as a desirable way to make a living without the drudgery of employment
- Experience an unequaled rush of sensation; feel powerful & special, adrenaline rush; enjoy recognition & status
- Tend to play games requiring skill like black jack, craps, or poker;
- Often describe a system they have
- Generally much more competitive personalities
- Like to be perceived as a high-roller, respected & admired, viewed as talented and skilled
- Stimulated by overcoming the odds – even purposely take irrational risks to provide more stimulation that comes from digging out of a hole