Gambling disorder and its treatment

 

What is it?

 

Gambling is a pathology that consists of the progressive alteration of behavior in which the individual experiences an uncontrollable need to play, over and above any negative consequence. It is recognized as a disease by the World Health Organization and by the American Psychiatric Association (APA).

 

Gambling occurs in games that have addictive capacity, which are those in which little time elapses between the bet and the prize won. Jerónimo Saiz, member of the Executive Committee of the Spanish Society of Psychiatry and patron of the Spanish Foundation of Psychiatry and Mental Health, explains that "the game associated with gambling is the one that takes place in bingo casinos and online games." According to the specialist, “the gambler is like a drug addict who needs gambling and does whatever it takes to play, that is to say, he makes gambling an urgent first necessity ”.

 

The Spanish Federation of Rehabilitated Gamblers (Fejar) adds that gambling is pathological when the person thinks, lives and acts according to it, leaving aside or in a second step other objectives and needs. Although gambling is an addiction that does not have a substance as a material reference, the gambler has the same traits as an addict :

 

• Repeating a behavior or action that is pleasant and increasing its frequency to obtain the desired effects. Different chemicals, such as dopamine and endorphins, act as stimulants and reinforce pathological behaviors.
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• Loss of control of the person derived from the failure of the brain's behavioral inhibition mechanisms.
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• Appearance of withdrawal syndrome if the habit is interrupted.

 

 

Causes

 

Pathological gambling is not directly related to any specific cause, but rather a set of factors that can lead to the development of a pathological gambling disorder. Although it is a disease that develops differently depending on the predisposition and environment of the individual, different risk factors are established:

 

Genetics

 

It seems that genetic endowment influences gambling, since it has been found that the children of gambling parents have a higher risk of becoming gambling than the children of non-gamblers. However, gambling is not a physical or psychic trait that is transmitted from parents to children, but what the child inherits is a certain propensity to become addicted if exposed to gambling.

 

Family and social environment

 

The most direct environment (parents and educators) represents the model of learning and imitation of many young people. If unrestricted play is encouraged or practiced as a normal habit within the environment, there is a risk that the youngster will later become a pathological gambler. On the other hand, the social environment (friends and social groups in general), together with a problem or lack of assertiveness, can also be a risk factor.

 

Psychological and social problems

 

People who are going through moments of psychological instability or who have personal and social problems represent an important risk group when it comes to developing gambling. The game can serve as an escape to flee from reality and end up becoming a necessary pathological habit.

 

Structure of the game and advertising

 

Most forms of gambling that can cause problem gambling; Slot machines, bingo, casino games, etc., have an addictive component that is based on the repetition of a behavior that is rewarded and that creates expectations of being rewarded.

 

According to Nieves Andrés, psychologist, behavior therapist and member of the Official College of Psychologists of Castilla y León, “in addition to the fact that many games are designed to engage, if the players associate this habit with specific moments, such as a coffee break or any type of leisure and enjoyment, the action of playing is reinforced and can become a necessity ”.

 

In some cases, there is advertising that is constantly launched and that reinforces the idea that gambling can be a means to solve economic problems and other types of conflictive situations derived from economic scarcity. 

 

Symptoms

 

Pathological gambling manifests itself through the consequences derived from pathological gambling. According to Saiz, it becomes visible as a result of the changes that the game produces in the habits and behavior of the players, which begin a period of self-destruction. The signs that may indicate a case of compulsive gambling are:

 

• Abandonment of work and social life : According to Saiz, the game begins to occupy a preponderant place in the lives of individuals, who begin to be unconcerned about their work life and their social relationships. Sudden passivity and excessively reserved behavior, associated with factors such as the person visiting the casino frequently or constantly gambling online, can indicate a case of pathological gambling.
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• Financial problems : Unforeseen expenses, loans, lack of money, etc. All this means that the individual can resort to lying to avoid responsibilities and hide the consequences derived from their gambling.
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• Anxiety and depression disorders : The gambler needs to continue gambling, despite the damage it does. Your mind is preoccupied with gambling, getting formulas to win, and getting money to gamble. All this, coupled with the fact that in many cases the gambler does not have access to the game, can cause anxiety disorders. On the other hand, the set of economic problems, accumulated lies, deterioration of social and family relationships and the rest of the conflictive situations that pathological gambling entails can lead to depression.
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• Changes in personality : Problems derived from gambling and the constant need to play can produce changes in behavior, such as irritability, lack of communication or even aggressiveness. 

 

Prevention

 

In many societies, gambling is considered a socially accepted act and is part of everyday life. One of the keys to preventing gambling is finding the limit between healthy play as a leisure activity and pathological or harmful gambling; information and communication are necessary for this. Finding leisure alternatives and maintaining a busy life can also be a form of prevention.

 

Types

 

Pathological gambling rates are determined depending on the form of gambling to which hook the individual. Each game has its own structure and addictive component:

 

• Slot machines : Its addictive component is based on reinforcing behavior through prizes. The individual inserts a coin and the machine rewards that behavior; although in most cases no reward is obtained, whenever the machine awards a prize it will reinforce the behavior of tossing the coin. He also follows other visual and auditory strategies, such as claim music.
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• Games of chance : Although in this type of game (lottery, bingo, betting, etc.) there is an intermittent reinforcement of behavior (depending on the type of game, it is difficult to get a prize), they are based on chance and the creation of expectations, which are sometimes met and reward behavior.
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• Role-playing games : It responds to a type of pathological game that moves away, to a certain degree, from the profile of the traditional gambler. The main addictive component of role-playing games is the escape from reality they offer. Although the financial problems that other types of gambling may not have, it causes the same deterioration and personal and social problems as the rest.

 

Diagnosis

 

The diagnosis of compulsive gambling is possible as a result of the consequences and symptoms of pathological gambling. Nieves Andrés explains that the most common is to diagnose gambling when the degree of illness is such that there are already significant consequences derived from bad habits (accumulating debts, lies, frequent visits to casinos and places where you can gamble, etc.).

 

The evolution and diagnosis of the disease, says Jerónimo Saiz, "is like entering a spiral where you play more than you should." The spiral begins with having problems with gambling, which leads to economic and social problems, which in turn trigger a series of psychological problems, such as anxiety disorders and depression. 

 

Treatments

 

To improve the chances of successful treatment, different types of therapies have to be combined. The drug therapy is very useful, because the drugs help curb impulses and manage systems regulating behavior. Selective serotonin reuptake inhibitor drugs, also used in the treatment of depression, can be administered. The is also used naltrexone, a drug that slows impulsivity.

 

The drugs need to be accompanied by individual psychotherapy, the objective of which is to reinforce positive behaviors and suppress negative ones. Saiz points out that, to solve an addiction problem, you have to recognize the problem and want to solve it. The specialist explains that, from recognizing the situation and wanting to change it, there are different types of therapy where family and environment involvement play a crucial role.

 

One of the keys to treating gambling is to establish external control, since there is no internal control, when it comes to restricting money: preventing the gambling patient from going to the bank alone, preventing him from going to casinos, and so on. In addition, many times the game replaces deficiencies, so you have to tryreinforce certain factors, such as social skills or self-esteem, to give the individual that pillar that is missing and that, in some way, he / she finds in the game.

 

Other data

 

There are  differences in terms of sex  in gambling. Jerónimo Saiz, member of the Executive Committee of the Spanish Society of Psychiatry and patron of the Spanish Foundation of Psychiatry and Mental Health, affirms in this sense that it has been proven that in female gambling problems diagnosis is late, but it is treated and evolves better That men. This can be explained by the traditional idea of ​​society where women had a lower contribution to the domestic economy.

 

 

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