©2008 the gppc initiative1 pathological gambling an “invisible” addiction

©2008 The GPPC Initiative 1

Pathological Gambling

An “Invisible” Addiction


Treatment Issues

Generally the same, particularly with other co-occurring disorders:– Assess– Diagnose– Plan/Initiate Treatment– Evaluate the effectiveness of

method


Pathological Gambling

• Largely “Invisible”• Largely ignored / overlooked / tolerated

until some precipitating crisis• Personal calamity with collateral damage• High Incidence of Co-Occurring Disorders• High vulnerability at outer edges of the

age spectrum (i.e., Teens and Elders)


Behavioral Addiction

• Deflection / Displacement• Sub-optimal Stimulation• The gambler becomes

emotionally unavailable to family, friends, and associates


Diagnostic Spectrum

• Spectrum– Low Risk– At Risk– Problem Gambling– Pathological Gambling


Types of Gamblers

• Casual Social• Serious Social• Relief & Escape• Compulsive (Problem, Pathological)• Professional• Anti-social Personality

adapted from SAMHSA, 2005


Risk Factors

• Age at onset of gambling• Gender• Ethnicity• Access• Co-occurring disorders• Family history• Biochemical imbalance


Direct Risk Factors

• Risk Practices• Risk Cognitions• Risk level can increase based on:

– Number of risk practices and cognitions– The extent of involvement in each


Thinking Errors (adapted from Ciarrocchi, 2001)

• Negative Winning Expectancy• Independence of Turns• Illusion of Control• Superstition• Recuperating Losses• The “Near-Miss”


Indirect Risks

• Social Predisposition• Emotional Predisposition• Biological Predisposition• Environmental Conditions


Health Problems

• Hypertension / Angina• Heart Attack / Stroke• Obesity• Alcoholism / Cirrhosis• Tobacco use


Co-Morbidity

• Mood Disorders• Substance Abuse

(e.g.,“MethGamblers”)• Anxiety Disorders• Personality Disorders• ADHD• High Risk of Suicidality


Prevalence / Incidence• 85% of Americans report having

gambled at least once• 60% report having gambled

within the last year• More men than women• More young people than seniors• More African-Americans than

other ethnic groups


Gambling Population

3% 7%

90%

Problem

At Risk

Ever

Compulsive Gambling affects up to

6 Million Americans


Nevada vs. The World

• 6.5% General U.S. Population “At Risk”– NV = 9.9%

• 2.5% General U.S. Population “Problem”– NV = 6.4%


So What’s the Problem?

Gambling Population (% )

2.5

6.56.4

9.9

0

2

4

6

8

10

12

Problem At Risk

U.S.NV


Addiction as a Maladaptive Behavior

• Addiction is a learned behavior• Most appropriate treatment

approach is to teach skills to prevent relapse

• Cognitive-Behavioral approach can work


Gambling (Gaming)

Any betting or wagering, for self or others, whether for money or

not, no matter how slight or

insignificant, where the outcome is uncertain or depends upon

chance or “skill”

Gamblers Anonymous


Substance Abuse

Antisocial Behavior

School/Work Problems

Problem Gambling

Psychological Problems

Poor Health Practices

Interpersonal Problems

Gambling is part of an inter-related set of high risk/problem behaviors

(adapted from Williams & Connolly, 2003)


Self-Controlled Impulsive

Risk aversive Risk seeking

Stress resilient Stress vulnerable

Strong intellect/skills Weak intellect/skills

Caused by a common set of factors (adapted from Williams & Connolly, 2003)

Abusive/neglectful Nurturing/disciplined

upbringing upbringing

Antisocial parental Prosocial parental

modelling modelling

Deviant peer group Prosocial peer group

Poor schools/ Good schools/teachers teachers

Biological Environmental


Decisional Balancefor Addictions

If one’s use / behavior creates more

problems than it relieves, seek

assistance

©2008 the gppc initiative1 pathological gambling an “invisible” addiction

Documents

gppc initiative9

gppc initiative16

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gppc initiative17 addiction

gppc initiative15 nevada

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risk nv

skill gamblers anonymous