Gambling Addiction: The Bad, The Ugly and The Treatment

Gambling Addiction is more common than most of us know! To start with, what is gambling?

Gambling is defined as risking something of value, usually, money, on the outcome of an event decided at least partially by chance. A study shows that four in five Americans say they have gambled at least once in their lives. Also, as much as $5 billion is spent on gambling in the United States every year.

Some other terms you may see in place of Gambling Addiction are Gambling Disorder, Pathological Gambling, Compulsive Gambling, and Problem Gambling. However, the correct designation, according to the DSM-5, is Gambling Disorder.

While gambling may be an expensive entertainment for some, it is a distressing disorder for many others. Of course, not everyone who goes to a casino or bets on horses becomes addicted to gambling. Most casual gamblers do not develop compulsive gambling. Some studies have, however, suggested that certain people may be more vulnerable to gambling addiction.

In the past, gambling disorder was regarded as more of a compulsion than an addiction. New studies, however, show a better understanding of the biology of this disorder.

The ability to gamble online makes this problem even worse. Many gambling websites help to fuel this addiction. Also, ready access to the internet makes this addiction even more challenging to manage. This disorder can ruin different aspects of an individual’s life. Some examples are the effects on academic performance, relationships, finances, responsibilities, jobs, and self-esteem.

 

History of Gambling

Where do I begin? There is a lot of history when it comes to gambling.

History shows that humans love to gamble and have done so for, perhaps, thousands of years!

Gambling addictionIt is believed that playing cards first appeared in China in the 9th century. The cards previously had human forms, and later Kings and Queens as the games spread to Europe. In China, there are also indications of simple games of chance discovered on tiles.

The oldest known dice were found in Egypt. Greek and Roman pottery indicate that betting on animal fights was common. “White pigeon ticket” was played in gambling houses in China around 200 BC, with permission of the province governor. It was thought that the governor received a percentage of the profits, which was used to fund state projects.

The first casinos appeared in Italy in the 17th century. Roulette and Vingt-et-un were brought to the United States from France. Wealthy businesspeople and farmers gambled on the Mississippi steamboats. A version of poker was being played in New Orleans in 1829.

Sittman and Pitt in New York made the first gambling machine. The first video slot was developed in 1976.

 

Types of Gambling

There are now several available gambling opportunities. This diversity of gambling means there are also different types of gambling addiction. As a result, it may not always be obvious when someone has pathological gambling.

Some of the common types are:

  • Bingo
  • Raffle and lottery tickets
  • Pitching quarters
  • Dice games
  • Casino-style card games (e.g., blackjack)
  • Other card games (e.g., Spades)
  • Electronic games (e.g., online poker, slots)
  • Games of personal skill (e.g., basketball, pool, video games)
  • Betting on sporting events (e.g., soccer)
  • Native American stick games, Mahjong, and other cultural games
  • Horse and dog racing
  • Office sports pool
  • Animal fights
  • Gambling websites

The above list is by no means exhaustive. There are several different types of gambling.

 

What is Mobile Gambling?

Mobile gambling refers to playing games of chance or skill for money by using a remote device such as a tablet or smartphone with a wireless internet connection. Most of the big casinos now have a mobile platform for their players.

The mobility of gambling has attracted a new crop of players. Handheld devices are now commonly used to gamble. The immediate access, convenience, and interactions with social networks, mean gambling is even more of a problem with this generation. There are now many gambling sites with mobile apps, thus fueling this disorder.

As of 2015, the predicted Jupiter Research report for mobile casino games was over $48 billion US dollars in revenue. It should be interesting to find out exactly what this number is today!

 

What Causes Gambling Addiction?

There are several reasons why people gamble. Some of these factors include the following:

  • To get the emotional high from gambling. Some people enjoy the adrenaline rush from the high stake risks.
  • An attempt to make money. This drive applies to both those with financial problems and those without any issues with their finances.
  • The social status that comes from being a good gambler.
  • As a way to socialize and interact with others.
  • To escape ongoing problems, loneliness, and isolation.
  • The thrills from being in casinos and other popular gambling environments.
  • Easy accessibility to gambling
  • As a challenge and to show off their skill.
  • Just for the fun of it.

Many studies show genes affect gambling. This association is similar to that found with illicit drugs and alcohol. The following show an increased likelihood of gambling:

  • Individuals with lower levels of serotonin.
  • Seekers of activities with an immediate reward.
  • Individuals who do not take into consideration the long-term consequences of their actions.
  • People with an impulsive nature.

 

How Does Compulsive Gambling Start?

For many people, the urge to gamble comes from the supposed financial incentive of winning large sums of money. In some cases, this may start with financial problems. On the contrary, several other individuals who gamble have no monetary difficulties.

CasinoPeople who have issues with money gamble in the hopes that they can use the winnings to offset their deficits. As a result, they take huge risks, usually leading to huge losses. In spite of this, the process continues in an attempt to win back the losses. A vicious cycle often ensues, and this can be very hard to break. Even though gamblers may sometimes win massive amounts, it is rarely enough to cover up previous losses. Most people who are addicted to gambling tend to run in the deficit.

In addition, some people gamble due to the emotional high (euphoria) and excitement they experience. In a way, this is similar to the experience of taking illicit drugs. Unfortunately, this can very quickly lead to problem gambling.

Some people are thrill-seekers. Such a personality trait may make such people more likely to gamble than others.

Of course, there is also the issue of mental disorders. Depression, anxiety, obsessive-compulsive disorder (OCD), and bipolar disorder (especially when manic) are examples of illnesses that can contribute to people gambling.

 

Gambling and Dopamine

Recent studies have shown that gambling and drug addiction are quite similar. The reward system in the brain is responsible for releasing dopamine. This dopamine release is what causes pleasure from things like food and sex.

However, when the reward system is stimulated by cocaine, opioids, methamphetamines, and other drugs, the release of dopamine can be up to ten times the normal amount. As a result of this, using drugs continuously decreases the ability to cause a “high.”

Further use of drugs causes the brain to adapt, hence producing less dopamine and becoming less responsive to its effects. Tolerence thus develops. This means larger amounts of drugs are needed to get high. Also, stopping the drugs causes withdrawals.

The prefrontal cortex is a part of the brain that helps control impulses. Drug use causes a weakening of the connection between the reward system and the prefrontal cortex. This, therefore, makes it even harder to stop using drugs.

This process also applies to gambling addiction!

 

Who Typically has Problems with Gambling?

Gambling can present in a diverse range of people. However, the following groups have been shown to have problem gambling more commonly:

  • Men are more likely than women to have gambling problems
  • It is more common in adolescents and young adults
  • Commoner in ethnic minority groups
  • Unmarried people are more likely to gamble
  • It is seen more in people with low socioeconomic status
  • People with high school education and less are more likely to gamble

 

Do I have a Gambling Addiction?

Gamblers Anonymous (GA) is a fellowship of men and women who share their experience, strength, and hope with each other. They aim to solve their gambling addiction and help others in the process. GA has 20 questions they ask of new members. Most compulsive gamblers answer positively to at least 7 of these questions. The questions asked are:

  1. Did you ever lose time from work or school due to gambling?
  2. Has gambling ever made your home life unhappy?
  3. Did gambling affect your reputation?
  4. Have you ever felt remorse after gambling?
  5. Did you ever gamble to get money with which to pay debts or otherwise solve financial difficulties?
  6. Did gambling cause a decrease in your ambition or efficiency?
  7. After losing, did you feel you must return as soon as possible and win back your losses?
  8. After a win did you have a strong urge to return and win more?
  9. Did you often gamble until all your money was gone?
  10. Did you ever borrow to finance your gambling?
  11. Have you ever sold anything to finance gambling?
  12. Were you reluctant to use “gambling money” for normal expenditures?
  13. Did gambling make you careless of the welfare of yourself or your family?
  14. Did you ever gamble longer than you had planned?
  15. Have you ever gambled to escape worry, trouble, boredom, loneliness, grief, or loss?
  16. Have you ever committed, or considered committing, an illegal act to finance gambling?
  17. Did gambling cause you to have difficulty in sleeping?
  18. Do arguments, disappointments, or frustrations create within you an urge to gamble?
  19. Did you ever have an urge to celebrate any good fortune by a few hours of gambling?
  20. Have you ever considered self-destruction or suicide as a result of your gambling?

 

The Four Phases in Gambling Disorder

According to the Illinois Institute for Addiction Recovery, there are four phases in gambling addiction:

Winning Phase:

In this phase, the perception of a winning streak makes the individual continue to gamble. It often starts with a huge win. This success causes a lot of excitement and leads to a positive view of gambling. Because of the big win, such individuals may begin to see themselves as talented. This feeling also leads to the hope that they will continue to win. As a result, they spend more money and time gambling.

Losing Phase:

This is the phase were problem gamblers “chase” their losses. They continue to gamble after losing money. This is usually an attempt to earn back what they’ve lost. That slight chance of winning back some money keeps them going and fuels this habit. This is when they begin to borrow money, default on debts, lie to family, friends and colleagues, miss work and school, gamble alone, and isolate.

Desperation Phase:

There is a loss of control in this phase. Even though there is a lot of guilt and shame after gambling, they are unable to stop. They begin to hope for a big win to offset their losses. For this reason, they take huge risks while gambling. They also become desperate to raise money for their addiction. Indeed, some people may end up stealing and cheating. Job loss, school dropout, relationship breakups, and legal issues may occur due to this.

Hopeless Phase:

This is the phase where compulsive gamblers “hit rock bottom.” They become so hopeless and helpless and give up on even trying to get help. At this phase, some gamblers use drugs and alcohol to self medicate. Some individuals may consider and even attempt suicide. This is, perhaps, because they feel the burden from their losses is too heavy to bear.

 

Signs of Gambling Addiction

According to the DSM-5, the proper designation is Gambling Disorder. It is classified under Substance-Related and Addictive Disorders. People with gambling disorder may present with:

  1. The need to gamble with increasing amounts of money in order to achieve the desired excitement.
  2. Restlessness or irritability when attempting to cut down or stop gambling.
  3. Repeated unsuccessful efforts to control, cut back, or stop gambling.
  4. Preoccupied with gambling. This can include persistent thoughts of gambling, reliving past gambling experiences, planning the next venture, or thinking of ways to get money to gamble.
  5. Gambles when feeling distressed (e.g., helpless, guilty, anxious, depressed).
  6. After losing money gambling, often returns another day to get even (“chasing” one’s losses).
  7. Lying to hide the extent of gambling.
  8. Destroyed or lost a significant relationship, job, or educational or career opportunity because of gambling.
  9. Relies on others to provide money to relieve desperate financial situations caused by gambling.

 

Gambling Withdrawal

Do people with pathological gambling develop withdrawals when they stop gambling? Many individuals have described several symptoms when they try to cut down on this habit. Some of such withdrawals are:

  • Restlessness
  • Irritability
  • Craving and strong urges to gamble
  • Anxiety
  • Worsening depression
  • Nausea
  • Stomach cramps
  • Sweating
  • Difficulty sleeping
  • Headaches
  • Racing heart (palpitations)
  • Chest tightness
  • Tremors
  • Muscle tension and soreness
  • Difficulty breathing

 

Red Flags of Gambling Addiction

Family members and friends may pick up some concerns with gamblers’ behaviors. Some of such red flags are:

  • Neglecting bills, stealing or frequently asking to borrow money.
  • Skipping school and work.
  • Lying about their whereabouts.
  • Spending lots of time playing online gambling games.
  • Irritability and aggression when confronted.
  • Frequent visits and travels to gambling hotspots.
  • Withdrawn and isolated.
  • Failure to keep up with plans.
  • Increase in use of alcohol and drugs.
  • Mood swings, worsening depression, and anxiety.
  • Legal issues as a result of money related crimes

 

Screening Tools for Gambling Addiction

Healthcare providers need to screen for gambling. This is because very few people seek help for gambling addiction, but instead request for treatment of other mental and medical issues. Besides, there are no visible signs to indicate they have such a habit.

Some screening tools for gambling addiction are:

Brief Screening Tools

  • Brief Bio-Social Gambling Screen (BBGS)
  • Lie-Bet Screening Instrument
  • NODS-PERC – National Opinion Research Center Diagnostic Screen for Gambling Disorders, Preoccupation, Escape, Risked Relationships and Chasing Screen
  • NODS-Clip – National Opinion Research Center Diagnostic Screen for Gambling Disorders, Loss of Control, Lying and Preoccupation screen

Diagnostic Screening Tools

  • The DSM-5 Gambling Disorder Criteria
  • National Opinion Research Center Diagnostic Screen for Gambling Problems (NORC Diagnostic Screen)
  • Problem Gambling Severity Index
  • Gamblers Anonymous 20 Questions
  • South Oaks Gambling Screen (SOGS)
  • South Oaks Gambling Screen – Revised for Adolescents
  • South Oaks Gambling Screen – Spanish

 

Disorders Associated with Gambling Addiction

People with compulsive gambling are more likely to have other mental health issues.  Some of these conditions include:

  • Depression
  • Anxiety
  • Bipolar Disorder
  • Obsessive-Compulsive Disorder (OCD)
  • Schizophrenia
  • Attention Deficit Hyperactivity Disorder (OCD)
  • Post-Traumatic Stress Disorder
  • Personality Disorder
  • Substance Use Disorders (drugs and alcohol)
  • Relational Problems
  • Suicidality

In addition, gamblers are more likely to have the following issues:

  • Financial problems
  • Legal troubles
  • Problems at work or school
  • Marital discord
  • Social issues
  • Medical issues
  • Increased risk of contracting sexually transmitted diseases including HIV/AIDS

 

Gambling, Drug Use, and Mental Illness

People with gambling disorder tend to have more issues with drugs and mental illness. The National Epidemiologic Survey on Alcohol and Related Conditions showed the following:

  • 73.2% had an alcohol use disorder
  • 38.1% had a drug use disorder
  • 60.4% had nicotine dependence
  • 49.6% had a mood disorder
  • 41.3% had an anxiety disorder
  • 60.8% had a personality disorder

 

Gambling and Suicide

Gambling addiction is associated with suicidal thoughts, suicidal attempts, and completed suicide. Many risk factors contribute to this. Depression and other mental illness, financial difficulties, legal problems, and substance abuse (alcohol and drugs) are the commonest.

The pain, stress, and isolation that comes with gambling disorder may cause some people to feel hopeless. Some studies have shown that up to 50% of individuals with compulsive gambling have suicidal thoughts. Also, about 17% have attempted suicide.

 

Treatment of Gambling Disorder

How do you treat gambling addiction?

Only about 10% of people with a gambling problem seek treatment. When gamblers seek help, it is usually due to financial pressures and intervention from family. The treatments for gambling disorder are similar to methods of treating other addictions. These include the use of medications, therapy, residential treatment, and support groups.

Medications

There are no medications specifically approved for compulsive gambling. However, drugs like naltrexone (ReVia) show positive responses. Some other medications show benefits in small studies. These include carbamazepine (Tegretol), topiramate (Topamax), Lithium (Lithobid, Eskalith), fluvoxamine (Luvox) and clomipramine (Anafranil). None of these medications are, however, approved by the FDA for treating gambling addiction.

Gamblers may have other addictions and mental illness. Because of this, it is crucial to diagnose and treat these disorders.

There are approved drugs for treating addiction to alcohol and opioids. Medication-Assisted Treatment involves using medications to treat addiction. Such medications include naltrexone, buprenorphine, methadone, disulfiram, and acamprosate. Antidepressants and anti-anxiety medications help treat ongoing depression and anxiety. Mood stabilizers and antipsychotics are also helpful, depending on the co-occurring mental issues.

Counseling

There are several different types of therapy. One of the commonest forms is Cognitive-Behavioral Therapy (CBT). This form of therapy aids in developing a positive skillset. It helps people understand the relationship between thoughts, emotions, and behaviors. Redirection, visualization, and distraction are some of the methods available for dealing with gambling urges.

CBT techniques help with negative thinking and cognitive distortions. This form of therapy can help people deal with their stressors, as well as identify and change their behaviors. CBT also helps with their way of thinking that may lead to negative consequences. It helps obtain motivation to change and cultivate ideas to avoid gambling.

Family therapy is also quite helpful. Gamblers’ family members may have a lot of anger and distrust. Addressing these feelings is necessary. Also, gambling may offer intermittent financial rewards. Because of this, some family members may even be angry when the patient stops gambling and bringing home these gains. Resolving these issues will go a long way in repairing the family dynamics.

Gambling Rehab

Inpatient or residential treatment facilities are helpful for people who need time away from their regular environment to help with staying sober. Such individuals usually need round-the-clock support and monitoring to prevent gambling.

The first gambling residential treatment center was based on a program for people with alcohol use disorder. It was started in 1972 at the Brecksville, Ohio Veterans Administration Hospital.

Residential treatment helps individuals identify their gambling triggers, learn to avoid high-risk situations, and also develop skills for dealing with urges. Providing consistent individual therapy, group sessions, and other therapies help with this. Medications may also be an option.

In addition to these, such programs also arrange for proper after-care planning to ensure success. This discharge plan may include identifying a sound support system, addressing legal and medical issues, recommending support groups, making suggestions for financial planning, and referring to professional healthcare providers for therapy and, perhaps, medications.

Gambling Anonymous (GA)

Gambling Anonymous is a gambling support group. In this fellowship, men and women share their experiences, strengths, and hopes with each other. The goal is recovery from gambling. Membership is free, and the organization is self-supporting. It has no religious or political affiliations.

In addition to acting as a support network, groups also serve as a sounding board. Talking and listening to others in a group can help put an individual’s problems into perspective. Of course, there is also the advantage of being held accountable by other members of the group.

Another benefit of group therapy is diversity. People have different backgrounds and personalities. This means different ideas can be brought up in group sessions. Such a variety of insights can help others understand and tackle their issues even better.

In some groups, autobiography helps. This involves people writing a history of their gambling lives and reading this to the group. The process of relaying such personal information, in addition to the feedback received is usually quite an emotional experience. This undoubtedly contributes to the recovery process.

Social Support Networks

Coping with gambling addiction is tough. Despite proper treatment, maintaining sobriety can be quite tasking. It is vital to have good social support. Growing and strengthening ties with family and friends go a long way to help with recovery. Interacting more with work colleagues, engaging with sports groups, volunteering, and joining local clubs are other ways of building good social support.

In addition to the above treatments for gambling, individuals need to be proactive. Making a conscious decision not to gamble is essential. Also, better money management is essential. Without money, there will be no gambling. Getting rid of credit cards, closing betting accounts, and only carrying limited cash are helpful ways to help curb this addiction. It is also crucial to fill up free time with healthier habits. Furthermore, avoiding environments likely to cause gambling is important.

 

Preventing Relapse

BettingTreatment for gambling addiction works for many individuals. However, preventing relapse remains a challenge. For some people, staying in recovery may even be harder than quitting. The internet and general easy accessibility to gambling make it tough for people to abstain. Cell phones and computers make access to online gambling super easy.

Just like people who abuse drugs are likely to relapse, this is also the case for gambling. After quitting, a single episode of gambling can quickly spiral out of control. Hence, the need to prevent and avoid the temptation to gamble.

Many factors play a role in preventing relapse. Some of these are related to the environment. On the other hand, some others are due to the individual.

Positive patterns of behavior help with the recovery process. This may, however, require new lifestyle skills. To ensure success with preventing relapse, it is essential for an individual to build these new behaviors into daily life. Substituting old habits with new healthy ones go a long way. Some examples include taking on new hobbies, exercising, changing social circles, and avoiding trigger locations.

 

How to Cope with Gambling Cravings

The intense urge to gamble during recovery is normal. Experiencing such cravings is commonplace in people who have pathological gambling. Some of the ways of coping with these cravings include:

  • Identify and avoid your triggers
  • Mindfulness
  • Distractions
  • Urge surfing
  • Reach out to others
  • Express your feelings
  • Cognitive-Behavioral therapy
  • Get a hobby and job
  • Using self-talk and recalling negative consequences
  • Exercise
  • Medication-Assisted Treatment

I wrote a previous article that gives more details about how to stop cravings. You should check this out.

Note that overcoming gambling disorder is tough! Even though slips may occur, you need to pick up yourself and get back on your recovery process.

 

Resources for Gambling Disorder

There are many resources available to help with gambling disorder.

  • Gamblers Anonymous – http://www.gamblersanonymous.org/ga/
  • Gam-Anon – https://www.gam-anon.org/
  • Debtors Anonymous – https://debtorsanonymous.org/
  • Safe Harbor Compulsive Gambling Hub – http://www.sfcghub.com/
  • Lost Bet – http://www.lostbet.com/
  • GamBlock – http://gamblock.com/
  • National Problem Gambling Hotline – 1-800 522 4700;  https://www.ncpgambling.org

 

Conclusion

Gambling Disorder is variously referred to as Gambling Addiction, Pathological Gambling, Compulsive Gambling, and Problem Gambling. According to the DSM-5, however, the correct term is Gambling Disorder.

Gambling opportunities are diverse and include casino-style card games, slot machines, bingo, raffle and lottery tickets, horse race betting, and online gambling. Just as is the case with addiction to drugs, gambling is also associated with the brain reward system and dopamine. This disorder tends to be commoner in men than women. It is also seen more often in young adults, singles, and low socioeconomic status. The four phases of gambling addiction are: Winning Phase, Losing Phase, Desperation Phase, and Hopeless Phase.

People who have a problem with gambling tend to have a higher incidence of drug abuse and mental illness. Suicides are also more prevalent than in the general population. Many screening tools help to diagnose people with compulsive gambling. Some examples are NORC Diagnostic Screen, SOGS, and BBGS.

Treatment of gambling disorder may include the use of medications, counseling, residential facilities (rehab), support groups (such as Gambling Anonymous), and a good social support network. Ultimately, the first step is accepting to get help. Many individuals have recovered from the hold of this addiction and are back living their normal lives. Recovery is possible!

Have you suffered from compulsive gambling? Do you know a family member or friend who has? Please leave your comments on your experiences and share this article with others who may need help.