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Unformatted text preview: Bio-Psycho-Social Dynamics of Gambling Addiction Addiction Dr Dessa Bergen­Cico Gambling Spectrum from Recreational to Pathological Gambling Recreational interesting enjoyable activity, with no or minimal adverse effects on finances, work, or relationships major financial losses, interferes with work, and disrupts relationships The term ‘addiction’ was previously applied exclusively to chemicals such as alcohol and other drugs. Through research on the brain and its processes, we now understand that many behaviors can become as addictive as a substances. Gambling can be such an addiction. Mental Health professionals debate whether it is an addiction or impulse control problem Begins in early adolescence in males Begins in early adolescence in males Begins between 20 ­ 40 yrs in females. Exacerbation peak during periods of high stress Barriers to getting help shame and secrecy while attempting to recoup financial losses 4 Phases of Pathological Gambling Phases Winning (Feelings of Elation) beginning, bets are small, feelings from the game satisfy the gambler Losing (Chasing losses, $ loss) try to re­coop their losses begin chasing their money, bets become larger Desperation (Impulsivity, Depression, Relationships strained,) lose jobs, max out credit cards, borrow from friends and family, and can even turn to illegal activities • Giving up: stop thinking that they will win it all back and just want to stay “in action” so they don’t have to think about their problem(s). “There were no feelings. That’s why I There played it. There were no feelings. Blocked all the feelings. Blocked all the stress. Blocked all the anxiety. There were no feelings.” There -- 42 year-old recovering escape-seeking compulsive slot machine player (pg 296) (pg Neurochemistry of Gambling Addiction Addiction Gambling is a neurobiological Gambling addiction as well as a behavior addiction – Activates areas in the brain to Activates produce dopamine produce – MRIs gambling leads to high MRIs amounts of Dopamine even during “Anticipatory period" gambling “Anticipatory – This stimulation leads to addiction This similar to drug addiction process similar – Brain activation related to Brain expected reward immediate, while the activation related to risk was delayed delayed States associated with brain dopamine activation dopamine Pleasure Reward Reinforcement Drive, wanting Drive, Expectancy Expectancy Brain dopamine activation as the neural response to a Brain "reward prediction error" (Schultz, 2001) "reward Video Poker Slot Machines Video Video Poker slot machines have been referred to as the "crack cocaine of gambling." Immediate and effective reinforcement rate Problem gamblers who regularly play these machines appear to progress into pathological gambling much faster than problem gamblers who only gamble at horse races, or other games that do not have such an immediate rate of gratification Prevalence of pathologic gambling Prevalence of pathologic gambling disorder in US adults is now estimated at 2% to 5% Prevalence is twice that in areas in which a casino is within a 50­mile radius Blume SB. Pathological gambling. In: Lowinson JH, Ruiz P, Millman RB, et al, eds. Substance abuse: a comprehensive textbook. 3rd ed. Baltimore: Williams & Wilkins, 1997:330­7 Shaffer HJ, Hall MN, Vanderbilt J. Estimating the prevalence of disordered gambling behavior in the United States and Canada: a meta­analysis. Harvard Medical School Division on Addictions, 1997 Action Gambler Action Risk taker Male dominated Sports Poker Hallway Bookie Fantasy leagues Grandiose, narcissistic College gambling problems grow w/ gateways such as March Madness Michael Jordan Michael Started gambling on friendly golf matches 1992­94: frequently visited Vegas and Atlantic City – Lost $1.25 million in ten days Jordan blamed gambling addiction on “competitiveness” – He played to win, “not for money” Charles Barkley Charles Since 1999 retirement Barkley has admitted to “heavy gambling” Has lost over $10 million – 2006­ Lost $2.5 Mil in 6 hours Openly jokes about his losses John Daly John PGA Tour Golfer since 1991 Daly lost $50­$60 million – During a 12­year period He only made $8.8 million from Golf – Made much more from endorsement deals (his reputation costs him some deals) Wilson, Hooters,Dunlop, etc. Actors Actors Actors often have expendable cash Leads to gambling – The rush of gambling leads to addiction James Woods, and Ben Affleck Escape Gambler Escape Female Depression Trauma Equated w/“freedom” right of passage Slots, VLT’s and Lottery http://www.cbsnews.com/stories/2006/03/09/e Suicide, Crime & Gambling • After casinos opened in Atlantic City, the total number of crimes within a thirty­mile radius increased 100 percent. • The suicide rate for pathological gamblers is twenty times higher than for non­gamblers (one in five attempts suicide). • 65%of pathological gamblers commit crimes to support their gambling habit. • The average debt incurred by a male pathological gambler in the U.S. is between $55,000 and $90,000 (it is $15,000 for female gamblers). • Internet gambling and video slots are as addictive as alcohol/drugs Signs and Symptoms of a Gambling Addiction The American Psychological Association (APA) reports 10 diagnostic criteria for determining the extent of ones gambling addiction. 1)Preoccupation 2)Tolerance 3) Withdrawal 4) Escape 5)Chasing 6)Lying 7)Performing Illegal Acts 8)Risked a significant relationship 9)Bailout 10)Loss of control 5 or more = Pathological Gambler 3 or 4 = Problem Gambler 1 or 2 = An “at risk” Gambler Symptoms of Gambling Addiction Preoccupation – Preoccupied with gambling (e.g., preoccupied with reliving past gambling experiences, handicapping or planning the next venture, or thinking of ways to get money to gamble) Tolerance – Needs to gamble with increasing amounts of money in order to achieve the desired excitement Withdrawal – Is restless or irritable when attempting to cut down or stop gambling Escape – Gambles as a way of escaping from problems or relieving dysphoric mood (e.g., feelings of helplessness, guilt, anxiety or depression) Chasing – After losing money gambling, often returns another day in order to get even ("chasing one's losses"). Chasing is a classical behavior pattern characterizing pathological gambling. Source: The American Psychological Association Lying – Symptoms of Gambling Addiction to Lies to family members, therapists or others conceal the extent of involvement with gambling Illegal acts – Has committed illegal acts (e.g., forgery, fraud, theft or embezzlement) in order to finance gambling Risked significant relationship – Has jeopardized or lost a significant relationship, job or educational or career opportunity because of gambling Bailout – Has relied on others to provide money to relieve a desperate financial situation caused by gambling Loss of control – Has made repeated unsuccessful efforts to control, cut back or stop gambling Source: The American Psychological Association Treatment for Gambling Addiction Treatment Psychotherapy Psychotherapy Group therapy (Gambler’s anonymous) Residential treatment programs Inpatient treatment programs Counseling by a Certified Gambling Counselor Part 3 Against All Odds Crisis stabilization is very important at the beginning of treatment, because pathological gamblers have a much higher suicide rate than persons addicted to other substances or activities. Recovery/Treatment Recovery/Treatment Medication – opioid antagonists inhibit good feelings from gambling numbing player Counseling and Support – 12­Step Program Gamblers Anonymous Combination of both is more effective than just medication Part 4 Against All Odds Treatment continued Treatment • Psychotherapy – solve underlying problems to reduce compulsion to gamble • Self­help groups ­ Gamblers Anonymous • Relocation away from temptation and access to gambling • Friends and Family support • Turn over financial responsibilities to trusted family or friend Local Resources Local Jim Klein 315­381­3101 – jklein@centralny.twcbc.com – www.ibwwell.com Gamblers Anonymous ...
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