Gambling is an ancient and common pastime in most parts of the world, including India. However some gamblers tend to lose control over their gambling, so much so that this behavior takes over their entire life. They seek opportunities to gamble and engage in gambling at the cost of other important life activities. They continue to gamble despite losing large amounts of money and against mounting odds. They are unable to resist and despite multiple attempts to stop, they quickly relapse. This is much like how drug users get addicted to seeking and using drugs. Pathological gambling was initially thought to be an impulse control disorder. However the similarity to substance use disorders has now been recognized, and the major classifications of mental disorders like the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) and ICD-10 (International Classification of Diseases) now classify gambling disorders as addiction.
Around 2-3% of people who gamble for fun, are at risk of becoming pathological gamblers.
There are three patterns of excessive gambling. ‘At risk gambling’ is when the gambler is at increased risk of developing a gambling problem but has not faced any major adverse effects yet. ‘Problem gambling’ is when the gambling begins to disrupt the gambler’s personal, family and recreational pursuits. ‘Pathological gambling’, on the other hand, is when the person cannot resist the urge to gamble, whether it is to chase losses or simply to seek arousal. When they do it excessively, it becomes a destructive pattern.
Pathological gambling is persistent and recurrent. Some of the signs that a person has a gambling addiction (or pathological gambling) are:
Research suggests that pathological gambling, like other addictive disorders, is caused by a combination of genetic, environmental and biological factors. It is also attributed to the functioning of the reward pathway in our brains. The reward pathway is activated whenever we are involved in activity that makes us feel good and this results in the release of the neurotransmitter dopamine, which gives us a feeling of satisfaction. In cases of addiction, either to a drug or a habit such as gambling, the prefrontal cortex, which is the region that tames impulses, is weakened. Researchers claim that in individuals with a gambling problem, the reward circuit is under-activated and therefore they look for activities such as gambling to stimulate the reward pathways.
The risk factors for pathological gambling include family history, developmental stress, drug addiction and age. Young people, especially those who have what is called an ‘externalizing temperament’, marked by difficulty in sustaining interest, greater impulsivity of thoughts, moods, excessive motor activity, appear to be at much greater risk for developing early problems with addictive substances and addictive behaviours. It is also important to note that like with all addiction disorders, a majority of gambling addicts are men.
For pathological gambling to be diagnosed, the symptoms need to be present in the long term (and occur within a year of meeting a medical expert). Mental health professionals use screening tools, psychological assessments and the person’s history to make a diagnosis.
Pathological gambling is a long-term disorder and if left untreated it can lead to further complications such as:
The most important thing to remember is treatments are most effective when the person is engaged in the treatment process. Pathological gambling is usually treated through a combination of psychotherapy such as Cognitive Behavioral Therapy (CBT), medication similar to the ones used in the long term treatment of substance use disorders, and participation in self help groups. It must be noted that over 70% of people that receive treatment for a gambling addiction also have a history of a psychiatric condition.
If you are concerned about a loved one’s gambling, it is important to understand the problem first before approaching them and encouraging them to seek help. When you do raise your concern, make sure the timing is right and do no talk about the past – only address the current problem and explain how the gambling is affecting the people around them. Avoid using language such as ‘you must’ or ‘you should’. Once they agree to meet an expert and receive treatment following a diagnosis, ensure you give them plenty of time for their effort to be successful. Learn to recognize the triggers associated with your loved one’s compulsive gambling. A trigger is something that urges them to gamble and triggers differ from one person to another. For example, it could be spotting a casino ad, or having plenty of cash in hand and having no stimulating activity to spend it on. Recognize the triggers and ensure your loved one is not exposed to them often.