Gambling and addiction
People have seen gambling as morally wrong for hundreds of years but it is only recently that it is being seen as a disease of addiction, similar to alcohol or drug misuse.
What is different about gambling is that it is a behavioural addiction – no mood-altering substances are ingested. Gambling addicts are fortunate that their bodies are not ravaged by dangerous chemicals. On the other hand, because they do not use drugs to cope with their moods, they may suffer mentally and emotionally more than most substance misusers. Suicide statistics appear to confirm this.
The “bible” of mental illnesses is the American “Diagnostic and Statistical Manual, generally known in the business as “DSM”. In the last DSM edition (number IV), the diagnostic criteria, pathological gambling was classified under the heading of “impulse control disorders”, a heading which includes other problem behaviours such as kleptomania and pyromania.
This raises the question – is gambling really a disease of addiction – physical, mental and spiritual — in the same way as substance misuse? Interestingly, the American Psychiatric Association have now decided that the answer is ‘yes’ and the new DSM (DSM V), due for publication in May 2013, will re-classify pathological gambling as an “addictive disorder” as opposed to an impulse control disorder.
This is not surprising, considering that the existing 10 criteria for diagnosis of pathological gambling are quite similar to the criteria for the diagnosis of substance misuse.
The criteria are as follows:
1. Preoccupation with gambling.
2. Increased tolerance (increasing amounts of money wagered).
3. Unsuccessful efforts to control.
4. Withdrawal symptoms of restlessness and irritation when unable to gamble.
5. Gambling as a way of escaping from problems or feelings.
6. Returning to continue the compulsive behaviour after losing money.
7. Lying to family, therapists and others.
8. Committing illegal acts in order to continue the addiction.
9. Loss of relationships and jobs.
10. Relying on others to provide money and enable the continuance of the addiction.
Having looked at the diagnosis of pathological gambling, consider the treatment: by bringing the DSM V diagnosis into line with the other addictive disorders, one might expect that the treatment would equate closely as well.
Many of those offering treatment for gambling disorders have anticipated the new DSM V criteria and now offer a recovery programme based on 12 step principles with an emphasis on personal responsibility and change through self-discovery (as used for the treatment of substance misuse based addictions).
However, some important considerations specific to gambling addiction must be taken into account
1. Much gambling behaviour is based on unrealistic thinking, to a greater degree than that found in other addictions.
These include: expecting to win consistently, feeling lucky, chasing losses and being unable to stop. The emphasis in treatment needs to be put on challenging such unrealistic thinking and finding alternative strategies to achieve reasonable life goals. Cognitive Behavioural Therapy (CBT) is recognised as being very suitable for the purpose.
2. Emphasis must be given to relapse prevention, especially the recognition and management of cravings: the substance misuser commonly finds that cravings, which originate from the use of an actual substance, will reduce over a relatively short time.
The gambler’s cravings, however, are purely psychological.
As such, they can recur over a much longer period. Careful thought and planning must be given to the gamblers’ aftercare, their daily activities and how they can be monitored and supported.
3. Consequences of gambling can be swift and devastating in material terms (especially financial). Specialised counselling in areas such as debt management can be vital for a good outcome.
4. The involvement of family and friends prepared to take an active part in the recovery process is also important, especially in areas involving time and money management.
All addicted persons have a basically similar story to tell; a behaviour that at first seemed trivial became an obsession and a dependence that could not be stopped, with devastating consequences. The individual behaviour within each story are very important and must be addressed if treatment is to be successful.
