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Pathological gambling

Definition

Pathological gambling is being unable to resist impulses to gamble, which can lead to severe personal or social consequences.

Alternative Names

Gambling - compulsive; Compulsive gambling; Addictive gambling

Causes, incidence, and risk factors

Pathological gambling usually begins in early adolescence in men, and between ages 20 and 40 in women.

Pathological gambling often involves repetitive behaviors. People with this problem have a hard time resisting or controlling the impulse to gamble. Although it shares features of obsessive compulsive disorder, pathological gambling is likely a different condition.

In people who develop pathological gambling, occasional gambling leads to a gambling habit. Stressful situations can worsen gambling problems.

Symptoms

People with pathological gambling often feel ashamed and try to avoid letting others know of their problem. The American Psychiatric Association defines pathological gambling as having five or more of the following symptoms:

• Committing crimes to get money to gamble
• Feeling restless or irritable when trying to cut back or quit gambling
• Gambling to escape problems or feelings of sadness or anxiety
• Gambling larger amounts of money to try to make back previous losses
• Having had many unsuccessful attempts to cut back or quit gambling
• Losing a job, relationship, or educational or career opportunity due to gambling
• Lying about the amount of time or money spent gambling
• Needing to borrow money due to gambling losses
• Needing to gamble larger amounts of money in order to feel excitement
• Spending a lot of time thinking about gambling, such as remembering past experiences or ways to get more money with which to gamble

Signs and tests

A psychiatric evaluation and history can be used to diagnose pathological gambling. Screening tools such as the Gamblers Anonymous 20 Questions can help with the diagnosis.

Treatment

Treatment for people with pathological gambling begins with recognizing the problem. Pathological gambling is often associated with denial. People with the illness often refuse to accept that they have a problem or need treatment.

Most people with pathological gambling enter treatment under pressure from others, rather than voluntarily accepting the need for treatment.

Treatment options include:

• Cognitive behavioral therapy (CBT) has been found to be effective.
• Self-help support groups, such as Gamblers Anonymous. Gamblers Anonymous is a 12-step program similar to Alcoholics Anonymous. Principles related to stopping the habit (abstinence) for other types of addiction, such as substance abuse and alcohol dependence, can also be helpful in the treatment of pathological gambling.
• A few studies have been done on medications for the treatment of pathological gambling. Early results suggest that antidepressants and opioid antagonists (naltrexone) may help treat the symptoms of pathological gambling. However, it is not yet clear which people will respond to medications.

Support Groups

Expectations (prognosis)

Like alcohol or drug addiction, pathological gambling is a chronic disorder that tends to get worse without treatment. Even with treatment, it's common to start gambling again (relapse). However, people with pathological gambling can do very well with the right treatment.

Complications

Complications may include:

• Alcohol and drug abuse problems
• Anxiety
• Depression
• Financial, social, and legal problems (including bankruptcy, divorce, job loss, time in prison)
• Heart attacks (from the stress and excitement of gambling)
• Suicide attempts

Getting the right treatment can help prevent many of these problems.

Calling your health care provider

Call your health care provider or mental health professional if you believe you have symptoms of pathological gambling.

Prevention

Exposure to gambling may increase the risk of developing pathological gambling. Limiting exposure may be helpful for people who are at risk.

Public exposure to gambling, however, continues to increase in the form of lotteries, electronic and Internet gambling, and casinos. Intervention at the earliest signs of pathological gambling may prevent the disorder from getting worse.

References

Gould CM, Sanders KM. Impulse-control disorders. In: Stern TA, Rosenbaum JF, Fava M, Biederman J, Rauch SL, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 1st ed. Philadelphia, Pa: Mosby Elsevier;2008:chap 23.

Gamblers anonymous. Twenty questions. Accessed January 31, 2010.