Pathological gambling

• What is Pathological gambling
• Statistics on Pathological gambling
• Risk Factors for Pathological gambling
• Progression of Pathological gambling
• Symptoms of Pathological gambling
• Clinical Examination of Pathological gambling
• How is Pathological gambling Diagnosed?
• Prognosis of Pathological gambling
• How is Pathological gambling Treated?
• Pathological gambling References

What is Pathological gambling

Pathological gambling is a inpulse-control disorder. This means that a person acts on certain impulse that is potentially harmful but they cannot resist the action. This is not the same as problem gambling.
In pathological gambling (disorder), there is a chronic inability to resist the impulse of gambling in a person. This is to the extent when gambling is so serious that it damages a person’s financial, functional, social and vocational life.

Statistics on Pathological gambling

Although comprehensive studies worldwide have not been compiled, there are local studies that all point to a 3-5% rate of problem gamblers in the general population, and approximately 1% rate of pathological gamblers.
Australia has a long history of gambling, and the highest per capita expenditure on gambling of all Western nation. Hence it is no surprise that pathological gambling is on the rise in Australia.

Risk Factors for Pathological gambling

There are several predisposing factors that are seen in pathological gamblers. Aside from early exposure to peer pressure, the following are the risk factors:
 

• Risk-taking behaviour: those who have morbid risk-taking behaviour are more likely to be pathological gambler, since gambling is a type of risk-taking. These people can have high attempted suicide rates as well.

 
 

• Mental disorder: pathological gambling may occur in any mental disorder, however it is most commonly associated with depression. Alcohol misuse/dependence and substance misuse/dependence are also common.

 
 

• Genetics/Hereditary: Studies have shown that childhood experiences and influences in early life can increase the risk of pathological gambling.

 

Progression of Pathological gambling

The typical pathological gambler is in the age group of 30-40s. The disorder often starts off like described below. In the settings of a big win or life stresses (as detailed below), the gambler starts to spend more time and money to engage in multiple gaming opportunities. Over the time frame from months to years, he or she begins to fall behind and hence repeating the spiral down again, instead of cutting and stopping loses. When all the options of obtaining money failed, men tend to resort to scams and credit card fraud; while women may go into prostitution.
Generally, the pathological gamblers have a fluctuating course of disease. Depending on social situations and life events (e.g. stresses in life, relationship problems, financial crises, pregnancy, etc), pathological gambling can recur after some time of remission. Remission means that the person have the features of pathological gambling (as described below in clinical history).
Some pathological gamlers will seek help and quit, yet many will run the vicious cycle as described above until serious complications occur.

How is Pathological gambling Diagnosed?

Because this is a psychiatric disorder, no routine laboratory investigations are useful for the diagnosis of pathological gambling. Yet, as in clinical examination, some basic tests may show features of other disorders, such as alcoholism. Urine screen might show recreational drugs in the urine.

Prognosis of Pathological gambling

The prognosis of pathological gambling can be varied, depending on the underlying disorders or personality. Also it depends on the severity of life stresses or any triggering factors that initiated the cycle of pathological gambling.

How is Pathological gambling Treated?

Management of pathological gambling involves changing the lifestyle of the patient. For optimal outcome, it is important to involve a whole team of mental health workers, including psychiatrist, psychologist, social worker, counsellor, general practitioner and others.
The following treatment options are most likely to be used in combination:
 

• counselling: this need to assess the financial situation, marriage, relationship with spouse/partner, and other social issues that are affected by pathological gambling.

 
 

• self-help group: e.g Gamblers Anonymous Australia to provide social support for the individual and the family.

 
 

• psychological treatment: good outcome has been reported using cognitive-behavioural therapy. This is a psychological therapy first requiring the patient to recognise the disorder, then using step-by-step methods to treat pathological gambling. If complete stoppage cannot be achieved, sometimes controlled gambling can have good outcomes as well.

 
 

• psychiatric treatment: if there are any other mental disorders undelying pathological gambling, the patient need to have psychiatric assessment for further treatment.

 

Pathological gambling References

[1] Dickerson M, Baxter P, Boreham P, Harley W, Williams J. Report of the First Year of the Study into the Social Impact of the Introduction of Gaming Machines to Queensland Clubs and Hotels, The State of Queensland (Department of Families, Youth and Community Care), 1995.
[2] Gelder M, Lopez-Ibor JJ, Andreasen N. New Oxford Textbook of Psychiatry. Oxford University Press. 2003.
[3] JAMA Patient Page: WHen Gambling Becomes a Bad Bet [online]. 2001. [Cited 2005 September 22nd]. Available from: URL:
http://www.hmc.psu.edu/healthinfo/articles/gambling.pdf
[4] Sadock BJ, Sadock VA. Kaplan and Sadock’s Comprehensive Textbook of Psychiatry. 8th ed. Lippincott Williams & Wilkins. 2005.